Individual Sociodemographic Characteristics Research Articles

Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study.

Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated associations between individuals' characteristics (including socioeconomic deprivation and long term health conditions (LTC)) and the frequency of emergency department (ED) attendances, in the Norfolk and Waveney subregion of the East of England. The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year from 1 April 2022 to 31 March 2023. Linked primary and secondary care and geographical data included each individual's sociodemographic characteristics, and number of ED attendances during the same year and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendances were estimated using Poisson regression models. 1,027,422 individuals were included of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population ED attendances were more frequent in individuals aged under five years, (adjusted Incidence Rate Ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15-35 years); living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63)) for least deprived compared to most deprived,and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)). In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance.

Neighborhood material versus social deprivation in Canada: different patterns of associations with child and adolescent mental health problems.

In a nationwide study, we aimed to study the association of neighborhood deprivation with child and adolescent mental health problems. We used data from the Canadian Health Survey on Children and Youth (N = 47,871; age range: 1-17years) and linked these to Neighborhood Material and Social Deprivation data calculated using Canada's Census of Population. Using a series of logistic regressions, we studied the association between living in deprived areas and mental health problems among children and youth. We used bootstrap replicate weights for all analyses and adjusted them for individual sociodemographic characteristics. In the adjusted model, the parent-reported developmental disorder was associated with more socially deprived neighborhoods (OR 1.29; 95% CI 1.07, 1.57 for most vs. least deprived quintiles). However, mental health service need or use was associated with living in less materially deprived areas (OR 0.78; 95% CI 0.63, 0.96 for most vs. least deprived quintiles). Among mental health problemsreported by the youth (12-17years old), poor/fair general mental health, alcohol drinking, and cannabis use were associated with neighborhood social deprivation in the adjusted models. In contrast, poor/fair general mental health, suicide ideas, alcohol drinking, and cannabis use were all negatively associated with higher materially deprived quintiles. Our study provides further support for the existing evidence on the association between neighborhood deprivation, particularly social deprivation, and the mental health of children and adolescents. The findings can help public health policymakers and service providers better understand and address children's mental health needs in their neighborhoods.

Greater perceived access to green spaces near homes: Safer and more satisfied residents

Safe and green living environments are highly appreciated by people and, as stated by the United Nations, are a key priority for sustainable urban development. The current study explores whether perceived and objective indicators of access to green spaces in the living environment, as well as individual socio-demographic characteristics, affects perceived safety as well as municipal satisfaction. It also examined whether perceived safety moderates the relationship between perceived access to green spaces and municipal satisfaction. Five indicators of access to green spaces were used: Four were objectively derived using Geographical Information Systems (GIS), while one indicator was based on survey data on inhabitants’ perceived access to green spaces. The same survey also revealed the variables of perceived safety and municipal satisfaction. Correlation, regression, and moderation analyses were applied. The results showed that objective and perceived indicators did not correlate. Furthermore, strong and positive associations were revealed between perceived access to green spaces and municipal satisfaction B=0.45 (95% CI = 0.41, 0.50) and perceived safety (B = 0.39; 95% CI = 0.32, 0.46). The more satisfied people were with their access to green spaces and safety outdoors in the evenings and nights, the more satisfied they were with their living environments. These associations were evident even after controlling for socio-demographic variables. These results provide evidence of the importance of green spaces and support planners’ arguments for preserving current or developing new green spaces. The study also shows the importance of not only relying on objective indicators of access to green spaces and encourages planners and researchers to explore perceived indicators.

Социодемографические детерминанты индивидуальной переоценки склонности к проэкологическому поведению

<p>The overestimating effect of one's tendency and contribution to pro-environmental practices, and underestimating the pro-environmental behavior of others has been noted recently in cross-country studies. The present work is devoted to a detailed post-hoc analysis of the available empirical data on this effect on the Russian sample (N = 109, M<sub>age</sub> = 28.3, SD<sub>age</sub> = 10.4, 39% men) and identification of the role of socio-demographic variables (gender, age, income, employment, size of city) as its predictors. The analysis showed that the nature of the contribution of the variables under consideration to the respondents' self-estimation and estimation of others with respect to pro-environmental behavior is non-consistent, which is in line with recent studies. On average for all models and statistically significant determinants, the standardized coefficient ???? does not exceed ∓0.25, which formally corresponds to a small effect size. However, given the empirical distribution of effect size typical of social psychology, it is more likely to be medium effects. The prediction power of linear models based on individual socio-demographic characteristics also turns out to be low, the coefficient of determination varies from 0.02 to 0.11. Therefore, it is acceptable to speak about the considered variables as predictors except in relation to resource saving and eco-mobility. The conclusion is made that along with socio-demographic determinants it is necessary to include other predictors in the design of experiments and investigate them more deeply.</p>

The Impacts of Visible Green Spaces on the Mental well-being of University Students

AbstractThe benefits of green spaces on individuals’ health have been widely acknowledged due to their inherent natural qualities. Currently, university students are experiencing significantly higher levels of mental health problems than other social groups. There is a scarcity of studies examining the association between built environment factors and mental health issues among university students, particularly in the Chinese context. University campuses in China are physically isolated, secluded communities, and in this respect, they differ markedly from the spatial organisation patterns of Western universities. Therefore, this study focuses on the correlation between the extent of green space exposure within closed university campuses and the occurrence of mental health issues among resident students. A deep-learning methodology incorporating streetscape images, remote sensing data, and multilevel linear modelling is employed in order to facilitate a comprehensive analysis. The results demonstrate a negative correlation between green space exposure on campus and the level of mental health issues among university students. Individual socio-demographic characteristics, such as whether a person has a partner, are also found to influence the level of mental health issues that they experience. In addition, a significant relationship is found between travel patterns and mental health issues, with students who walked regularly having a lower incidence of mental health issues than those who drove. Our research indicates that, in order to foster healthier communities and enhance social inclusion, urban planners should prioritise the development of greener campuses and urban transport services to improve accessibility to green spaces.

Identifying the barriers and facilitators to fruit and vegetable consumption in rural Australian adults

Within rural Australia, only 47% and 9% of adults meet recommendations for fruit and vegetable intake, respectively, which is a leading contributor to the increased risk of non-communicable disease. Previous literature has identified barriers and facilitators to increasing fruit and vegetable intake in rural Australian settings, such as having greater access to fresh produce(1). However, this literature is limited by observing fruit and vegetables as a single food group and small sample sizes. This study aimed to determine the barriers and facilitators to meeting fruit and vegetable recommendations (as separate food groups) in rural Australian adults. It was hypothesised that barriers and facilitators to consumption of fruits and vegetables would be identified at the individual, social-environmental and physical-environmental levels of a socio-ecological framework and these would differ between fruit and vegetables(2). Data from the 2019 Active Living Census were used, completed in the Loddon Campaspe region of north-west Victoria, Australia. Data were available at the level of the individual (socio-demographic characteristics, health behaviours, education level, financial stability), social-environment (household size), and physical-environment (use of community gardens). Information on fruit and vegetable consumption was collected using two open-ended questions asking how many serves were consumed each day. Survey weighting was used to account for the survey design. Descriptive statistics were reported for continuous (mean and standard errors [SE]) and categorical (frequencies) data. Multivariate logistic regression analyses were used to determine odds ratios (OR) and 95% confidence intervals (CI) for meeting fruit and vegetables recommendations according to barriers and facilitators at the individual, social-environmental and physical-environmental level. A total of 13,464 adults with complete data were included in the analysis (51% female; mean age 48 (0.17) years). Mean fruit intake was 2.85 (0.02) serves per day and mean vegetable intake was 1.56 (0.01) serves per day. A total of 48% of participants consumed the recommended two serves of fruit daily, while 19% consumed the recommended five serves for vegetables. Multivariate analyses determined distinct barriers and facilitators to consumption between fruit and vegetables. For example, a larger household size facilitated meeting vegetable recommendations (OR: 1.41; 95% CI: 1.22, 1.63), but not fruit, and greater alcohol consumption was a barrier to meeting fruit recommendations (OR: 1.47; 95% CI: 1.31, 1.64), but not vegetables. Common facilitators across both fruit and vegetables included higher age, lower BMI, being a non-smoker, and engaging in more vigorous activity. The results of this research will help inform future policies to increase both fruit and vegetable intake in rural communities, therefore contributing to efforts to improve the health of rural Australians.

Food insecurity, inflammation, and immune function among older US adults: Findings from the health and Retirement study

BackgroundFood insecurity (FI) is a pressing public health concern among older adults and has been associated with adverse cardiovascular outcomes. Greater systemic inflammation may provide a pathway to explain these associations, but few studies have examined the link between FI and markers of inflammation. Thus, the objective of the present study was to evaluate the associations between FI and multiple inflammatory and immune functioning biomarkers using a nationally representative study of US adults aged > 50 years. MethodParticipants (n = 3,924) were drawn from the longitudinal Health and Retirement Study (HRS). Household FI was assessed using the six-item Short Form Food Security Survey Module from the 2013 HRS Health Care and Nutrition Study. Markers of inflammation (neutrophil–lymphocyte ratio, albumin, hs-CRP, IL6, IL10, IL-1Ra, sTNFR-1, and TGFβ-1) and immune functioning (CMV) were collected during the 2016 HRS Venous Blood Study. Multivariate logistic and linear regression models were used to evaluate associations between household FI and inflammatory and immune functioning biomarkers, adjusting for individual and household sociodemographic characteristics. ResultsThe weighted prevalence of FI was 18.8 %. Age and sex-adjusted mean showed that FI was associated with higher levels of inflammation and impaired immune functioning (Ps-value < 0.05). Older adults with FI had higher mean levels of albumin, hs-CRP, IL6, IL10, IL-1Ra, TGFß-1, and CMV seronegative and borderline (Ps-value < 0.05). Multivariate-adjusted regression model showed that FI was associated with high-risk categories of hs-CRP (OR 1.34, 95 % CI 1.06, 1.68), IL-6 (OR 1.66, 95 % CI 1.28, 2.14), IL-1Ra (OR 0.67, 95 % CI 0.48, 0.93), TGFß-1 (OR 1.87, 95 % CI 1.45, 2.42), seronegativity for CMV (OR 0.48, 95 % CI 0.35, 0.64). ConclusionIn this nationally representative sample of older adults, FI was positively associated with multiple markers of systemic inflammation and impaired immune functioning. Public health efforts that directly work to reduce FI among older adults are warranted and may result in further improvements in their health and well-being.

Exploring the impacts of neighborhood disadvantage on Medicare beneficiaries’ early COVID-19 vaccine uptake

A variety of factors influenced the American public's experiences with the COVID-19 pandemic and initial availability and uptake of COVID-19 vaccines. To examine variation in early COVID-19 vaccine uptake based on neighborhood disadvantage along with individual sociodemographic and health characteristics, we used Spring 2021 data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative, longitudinal survey of the Medicare population conducted by the Centers for Medicare & Medicaid Services. Bivariate analyses showed that beneficiaries in disadvantaged neighborhoods were less likely to have received at least one vaccine dose than those in less disadvantaged neighborhoods (49.7%, SE = 1.6 versus 66.6%, SE = 1.0, p < 0.0001). After accounting for individual characteristics, the relationship between neighborhood disadvantage and vaccine uptake was not statistically significant. However, interaction effects of neighborhood disadvantage by urbanicity showed a more complex picture, where those in disadvantaged urban areas had the lowest odds of vaccine uptake (p < 0.01). The relationship between neighborhood disadvantage and vaccination is multifaceted, requiring further research to inform future vaccination efforts targeting the most vulnerable beneficiaries.

Associated factors to non-medical and medical use of psychoactive medication among Mexican adolescents and adults in a national household survey

BackgroundNon-medical use of psychoactive medication is a public health problem. Studies in other contexts indicate that individual sociodemographic characteristics are associated with non-medical use, but these associations have not been assessed in the Mexican context. ObjectivesTo estimate the prevalence non-medical and medical use of psychoactive medication among Mexican adolescents and adults’ medication users and to estimate the associations between sociodemographic characteristics and non-medical use of psychoactive medication, using data from a nationally representative sample. MethodsSecondary analysis of data collected from the National Survey of Drug, Alcohol, and Tobacco Consumption (ENCODAT) 2016 to 2017. The analytical sample included people aged 12 to 65 years. The sample was stratified into two age categories: adolescents (12-17 years) and adults (18-65 years). Sub-analyses were performed to describe prevalence of use and non-medical use of psychoactive medication at the state-level. Descriptive statistics and multinomial logistic regression models were used to estimate associations between sociodemographic characteristics and medical, non-medical, and non-use of psychoactive medication in adolescents and adults. ResultsAmong Mexican medication users in 2016, the national prevalence of non-medical use of psychoactive drugs was 19.6%; 22.2% among adolescents and 19.4% among adults. States adjacent to the US-Mexico border reported the highest levels of non-medical use of psychoactive medication. Illicit drug consumption was associated with non-medical use. Sociodemographic characteristics associated with non-medical use varied between adolescents and adults. ConclusionsThere is a high proportion of non-medical use of psychoactive drugs among Mexican medication users, especially among young people. Understanding factors associated with the misuse of psychoactive medications in Mexico can inform policy for prevention and treatment.

Prevalence of food insecurity amid COVID-19 lockdowns and sociodemographic indicators of household vulnerability in Harar and Kersa, Ethiopia

BackgroundThe COVID-19 pandemic was associated with widespread social disruptions, as governments implemented lockdowns to quell disease spread. To advance knowledge of consequences for households in resource-limited countries, we examine food insecurity during the pandemic period.MethodsWe conducted a cross-sectional study and used logistic regression to examine factors associated with food insecurity. Data were collected between August and September of 2021 through a Health and Demographic Surveillance System (HDSS) using a survey instrument focused on knowledge regarding the spread of COVID-19; food availability; COVID-19 related shocks/coping; under-five child healthcare services; and healthcare services for pregnant women. The study is set in two communities in Eastern Ethiopia, one rural (Kersa) and one urban (Harar), and included a random sample of 880 households.ResultsRoughly 16% of households reported not having enough food to eat during the pandemic, an increase of 6% since before the pandemic. After adjusting for other variables, households were more likely to report food insecurity if they were living in an urban area, were a larger household, had a family member lose employment, reported an increase in food prices, or were food insecure before the pandemic. Households were less likely to report food insecurity if they were wealthier or had higher household income.ConclusionsAfter taking individual and household level sociodemographic characteristics into consideration, households in urban areas were at higher risk for food insecurity. These findings suggest a need for expanding food assistance programs to more urban areas to help mitigate the impact of lockdowns on more vulnerable households.

Associated factors to established entrepreneurs in Colombia, a view from GEM in 2006 – 2022

The aim of this article was to analyze the key factors related to established entrepreneurs in Colombia using data from the Global Entrepreneurship Monitor (GEM) at the national level from 2006 to 2022, in cross-sectional cuts. To achieve the described objective, an asymmetric logistic model was used for rare sample events due to the low participation of established entrepreneurs in the total sample. Among the most important results, it was found that sociodemographic characteristics of individuals, such as gender, age, and level of education, as well as self-perception regarding fear of failure and the entrepreneurial environment, showed a higher association and level of significance with established entrepreneurs compared to variables associated with company or productive unit characteristics, such as sector, innovation, and use of new technology.

Urban Mobility Mode Shift to Active Transport: Sociodemographic Dependency and Potential Greenhouse Gas Emission Reduction

The aim of this study was to explore the association between travel mode choice and individual sociodemographic characteristics among urban city dwellers, as the selection of daily travel modes is influenced by several factors. The study collected 1,290 short daily trips data from 415 respondents living in Klang Valley using a random sampling technique. Logit regression models were utilized to identify the impact of sociodemographic traits on travel mode choices. Men, low education levels, students, and households without children and do not own private vehicles are more likely to choose active transportation. Besides, the study examines the potential for greenhouse gas (GHG) emission reduction. Based on Life Cycle Assessment (LCA), 142 kgCO2e or 108 kgCO2e/km of GHG were released by automobiles from the collected travel trip data. The result shows that active transport could potentially achieve 14.52% GHG emission reduction by stated preference and nearly 17% GHG emission reduction by criteria fulfillment. These findings could provide valuable information for developing practical planning policies aimed at reducing GHG emissions from the road transport sector.

Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia

ObjectiveTimely access to primary care and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individual’s socioeconomic circumstances or...

Prompt access to outpatient care post-incarceration among adults with a history of substance use: Predisposing, enabling, and need-based factors

IntroductionAs expanded Medicaid coverage reduces financial barriers to receiving health care among formerly incarcerated adults, more information is needed to understand the factors that predict prompt use of health care after release among insured adults with a history of substance use. This study's aim was to estimate the associations between characteristics suggested by the Andersen behavioral model of health service use and measures of health care use during the immediate reentry period and in the presence of Medicaid coverage. MethodsIn this retrospective cohort study, we linked individual-level data from multiple Wisconsin agencies. The sample included individuals aged 18–64 released from a Wisconsin State Correctional Facility between April 2014 and June 2017 to a community in the state who enrolled in Medicaid within one month of release and had a history of substance use. We grouped predictors of outpatient care into variable domains within the Andersen model: predisposing- individual socio-demographic characteristics; enabling characteristics including area-level socio-economic resources, area-level health care supply, and characteristics of the incarceration and release; and need-based- pre-release health conditions. We used a model selection algorithm to select a subset of variable domains and estimated the association between the variables in these domains and two outcomes: any outpatient visit within 30 days of release from a state correctional facility, and receipt of medication for opioid use disorder within 30 days of release. ResultsThe size and sign of many of the estimated associations differed for our two outcomes. Race was associated with both outcomes, Black individuals being 12.1 p.p. (95 % CI, 8.7–15.4, P < .001) less likely than White individuals to have an outpatient visit within 30 days of release and 1.3 p.p. (95 % CI, 0.48–2.1, P = .002) less likely to receive MOUD within 30 days of release. Chronic pre-release health conditions were positively associated with the likelihood of post-release health care use. ConclusionsConditional on health insurance coverage, meaningful differences in post-incarceration outpatient care use still exist across adults leaving prison with a history of substance use. These findings can help guide the development of care transition interventions including the prioritization of subgroups that may warrant particular attention.

Predictors of Motivation to Receive a COVID-19 Vaccination and the Number of COVID-19 Vaccine Doses Received in Patients with Schizophrenia.

Individuals with schizophrenia are more likely to be infected with COVID-19 than are members of the general population. No prospective study has examined the associations of multi-dimensional factors with the motivation to receive vaccination against COVID-19. This follow-up study investigated the effects of individual (sociodemographic and illness characteristics, depression, and self-esteem), environmental (perceived social support), and individual-environmental interaction factors (self-stigma and loneliness) on the motivation to receive vaccination against COVID-19 and the number of COVID-19 vaccine doses received one year later among 300 individuals with schizophrenia. The associations of baseline factors with motivation to receive vaccination against COVID-19 and the number of vaccine doses received 1 year later were examined through linear regression analysis. The results indicated that greater loneliness (p < 0.01) and being married or cohabitating (p < 0.05) at baseline were significantly associated with lower motivation to receive vaccination against COVID-19 at follow-up. Disorganization (p < 0.05) at baseline was significantly associated with fewer COVID-19 vaccine doses at follow-up; greater motivation to receive vaccination was significantly associated with more COVID-19 vaccine doses at follow-up (p < 0.001). Health professionals should consider the identified predictors while developing intervention programs aimed at enhancing vaccination against COVID-19 in individuals with schizophrenia.

Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic

Knowledge about characteristics of US pregnancy-associated decedents is needed to guide responses. To examine individual sociodemographic characteristics and residing county's health care resources and socioeconomic factors among pregnancy-associated overdose decedents in comparison with obstetric decedents and overdose decedents who were not pregnant in the past year. This cross-sectional, exploratory study included 1457 pregnant and postpartum overdose decedents, 4796 obstetric decedents, and 11 205 nonpregnant overdose decedents aged 10 to 44 years from 2018 to 2021. Data were analyzed August 2023. Decedents from the 2018-2021 Multiple Cause of Death Files linked to the 2021 Area Health Resources Files and the 2018-2021 County Health Rankings data at the county level. Pregnancy-associated deaths were defined as deaths during pregnancy or within 1 year of pregnancy termination. This study focused on unintentional drug overdoses or drug overdoses with undetermined intent involving the most common psychotropic drugs of misuse. From 2018 to 2021, across the pregnancy-postpartum continuum, pregnancy-associated overdose mortality ratios consistently increased among women aged 10 to 44 years. Mortality ratio more than tripled among pregnant and postpartum women aged 35 to 44 years from 4.9 (95% CI, 3.0-8.0) per 100 000 mothers aged 35 to 44 years with a live birth in January to June 2018 to 15.8 (95% CI, 12.3-20.4) in July to December 2021 (average semiannual percentage changes, 15.9; 95% CI, 8.7-23.6; P < .001). Compared with pregnant obstetric decedents, pregnant overdose decedents had increased odds of being aged 10 to 34 years (75.4% vs 59.5%; range of odds ratios [ORs], 1.8 [95% CI, 1.3-2.5] for ages 10 to 24 years to 2.2 [95% CI, 1.7-2.8] for ages 25 to 34 years), being non-college graduates (72.1% vs 59.4%; range of ORs, 2.7 [95% CI, 1.7-4.3] for those with some college education to 3.9 [95% CI, 2.4-6.1] for those with less than high school education), being unmarried (88.0% vs 62.1%; OR, 4.5; 95% CI, 3.7-6.0), and dying in nonhome, non-health care settings (25.9% vs 4.5%; OR, 2.5; 95% CI, 1.8-3.6) and were associated with decreased odds of dying in health care settings (34.7% vs 77.6%; range of ORs, 0.1 [95% CI, 0.1-0.1] for those who died in hospital inpatient settings to 0.4 [95% CI, 0.3-0.6] for those who died in hospital outpatient/emergency room settings). From 2018 to 2021, the mortality ratio more than tripled among pregnant and postpartum women aged 35 to 44 years, consistent with increases in overdose mortality across US populations. Most pregnancy-associated overdose deaths occurred outside health care settings, indicating the need for strengthening community outreach and maternal medical support. To reduce pregnancy-associated overdose mortality, evidence-based interventions are urgently needed at individual, health care, local, and national levels, along with nonpunitive approaches incentivizing pregnant and postpartum women to seek substance use disorder treatments.

The Effects of Three Facets of National Identity and Other Socioeconomic Traits on Attitudes Towards Immigrants

AbstractThe academic literature showed an increasing interest in studying the link between national identity and anti-immigrant sentiment. This work is based on ten countries from the International Social Survey Program (ISSP) dataset for two different waves: 2003 and 2013. The paper aims to analyse the influence of the three facets of national identity (nationalism, political patriotism, and cultural patriotism) and other socioeconomic traits on attitudes towards immigrants (ATI). Untried methods in social science based on the fuzzy-hybrid analysis (FHA) and the fuzzy clustering are used first to analyse citizens according to their levels of openness towards immigrants, nationalism, cultural patriotism, and political patriotism. Then, the ordered probit model is applied to thoroughly examine the intricate relationships connecting the three facets of national identity and individual sociodemographic characteristics with ATI. The results show that the national identity and cultural patriotism constructs negatively influence ATI, while political patriotism positively influences ATI. In addition, country, political orientation, age, religion, economic situation, gender, place of birth, principal status, and education are crucial factors that explain ATI.

Association Between State Paid Family and Medical Leave and Breastfeeding, Depression, and Postpartum Visits.

To evaluate the association of state paid family and medical leave policies with the likelihood of breastfeeding, postpartum depression symptoms, and attendance of the postpartum visit. This was a cross-sectional study that used 2016-2019 data from PRAMS (Pregnancy Risk Assessment Monitoring System) for 43 states and Washington, DC. We describe the association of state paid family and medical leave generosity with rates of breastfeeding, postpartum depression symptoms, and attendance of the postpartum visit. Logistic and Poisson regression models tested the significance of state paid family and medical leave coverage generosity after controlling for individual respondent sociodemographic characteristics, with sensitivity analyses for respondents with deliveries covered by Medicaid insurance. Of the 143,131 respondents, representative of an estimated 7,426,725 population, 26.2% lived in eight states and DC with the most generous paid family and medical leave, 20.5% lived in nine states with some paid family and medical leave, and 53.3% lived in 26 states with little or no paid family and medical leave. Overall, 54.8% reported breastfeeding at 6 months or at time of the survey, ranging from 59.5% in the most generous paid family and medical leave states to 51.0% in states with the least paid family and medical leave coverage. Postpartum depression symptoms varied from 11.7% in the most generous states to 13.3% in the least generous states (both P<.001). State differences in postpartum visit attendance rates (90.9% overall) did not differ significantly. After adjusting for respondent characteristics, compared with states with the least paid family and medical leave, breastfeeding was 9% more likely (adjusted incidence rate ratio [aIRR] 1.09, 95% CI, 1.07-1.11) in states with the strongest paid family and medical leave coverage and 32% more likely (aIRR 1.32, 95% CI, 1.25-1.39) in analyses limited to respondents with deliveries covered by Medicaid insurance. A more generous state paid family and medical leave policy was significantly associated with a lower likelihood of postpartum depression symptoms compared with states with the least paid family and medical leave (adjusted odds ratio 0.85, 95% CI, 0.76-0.94) and a modest but significant increase in postpartum visit attendance (aIRR 1.03, 95% CI, 1.01-1.04) among respondents with deliveries covered by Medicaid insurance. Respondents from states with strong paid family and medical leave had a greater likelihood of breastfeeding and had lower odds of postpartum depression symptoms, with stronger associations among respondents with deliveries covered by Medicaid insurance. Despite major potential health benefits of paid family and medical leave, the United States remains one of the few countries without federally mandated paid parental leave.

Ukrainian refugees’ wellbeing and adaptation in Denmark

Abstract In Denmark - 28 765 individuals from Ukraine have been granted residency under the Danish Special Act. While Ukrainians share the war exposure with other groups of refugees in Denmark, they differ in many aspects. For example, the special act has allowed Ukrainians access to the welfare state benefits (including healthcare) relatively fast and they have been accommodated outside of asylum centers. In addition, the political climate in the reception of Ukrainians has been rather favorable compared to the last refugee crisis. Yet, we know very little about their health needs and access to care. The aim of our project is to identify and understand the health needs of Ukrainian refugees and how they access healthcare in Denmark in order to inform the development of strategies that help them cope with postmigration stress and improve their quality of life. We have developed a survey, in collaboration with a group of experts by experience (Ukrainian refugees). The survey combines validated tools and self-developed questions and includes several themes: i) factors influencing adaptation of Ukrainian refugees; ii) individual sociodemographic characteristics; iii) trauma/war exposure; iv) living and housing conditions in Denmark; v) experiences in access to Danish healthcare system; and vi) health needs and well-being including symptoms of trauma. The target population is Ukrainian refugees in Copenhagen aged 18 and above. Currently, there are 2916 refugees living across the city. The aim is to recruit at least half of them, located in three municipalities: Copenhagen Municipality, Frederiksberg Municipality and Gentofte Municipality. The survey has been launched May 2023, and by November 2023, we expect to have collected and analyzed all data, which we are going to present at workshop. Our participatory research methods involving Ukrainian refugees throughout the process include their engagement in intervention and policy suggestions based on the survey.

Quantifying COVID-19 policy impacts on subjective well-being during the early phase of the pandemic: A cross-sectional analysis of United States survey data from March to August 2020.

To stop the spread of COVID-19, a number of public health policies and restrictions were implemented during the pre-vaccination phase of the pandemic. This study provides a quantitative assessment of how these policies impacted subjective well-being (SWB) in the United States over a 6-month period spanning March to August 2020. We study two specific research objectives. First, we aim to quantify the impacts of COVID-19 public health policies at different levels of stringency on SWB. Second, we train and implement a conditional inference tree model for predicting individual SWB based both on socio-demographic characteristics and policies then in place. Our results indicate that policies such as enforcing strict stay-at-home requirements and closing workplaces were negatively associated with SWB, and that an individual's socio-demographic characteristics, including income status, job, and gender, conditionally interact with policies such as workplace closure in a predictive model of SWB. Therefore, although such policies may have positive health implications, they also have secondary environmental and social implications that need to be taken into account in any cost-benefit analysis of such policies for future pandemic preparedness. Our proposed methodology suggests a way to quantify such impacts through the lens of SWB, and to further advance the science of pandemic preparedness from a public health perspective.