Middle-income Families Research Articles

Mother's Characteristics and Socioeconomic Status as Possible Risk Factors for Children's Caries in Jordan.

Background Clinical oral health status of children affects their health-related quality of life. A major determinant of oral health is early childhood caries, which possesses a negative effect. Objective The primary objective of the study was to examine the association between socioeconomic status and different mother's characteristics and the risk of dental caries in children using the decay missing filled (DMF) score as an indicator. Methods This was a cross-sectional descriptive study that was in the pediatric dental clinic in Hashem Ibn Al-Hussein medical military hospital in Jordan. Pearson correlation was used to examine associations between two continuous variables. Linear regression was used to detect variables that might predict the decayed missing filled teeth (dmft) score of the child. Results A total of 264 children were enrolled in the study. Average age of children was 4.80 ± 1.99 years, and average mothers' age was 32.74 ± 5.68. Mothers had an average DMFT score of 8.84 ± 5.39, while children had an average dmft score of 6.17 ± 4.82. There was no association between the mother's age and the dmft score of the child (Pearson correlation = 0.08, and P value = 0.215). However, a moderate, statistically significant correlation was found between the mother's and the child's DMFT scores (Pearson correlation = 0.418, and P value = 0.001). Children who belonged to low and middle-income families had a higher dmft score compared to those that belonged to families with high income. Conclusion Socioeconomic status of the family, mother's habits, dental hygiene, and education level are important factors that influence the child's oral health. Strategies that focus on children with these characteristics can help them achieve better oral health.

What makes them last? Predicting time to relationship dissolution in adolescent women’s intimate relationships with male partners

Adolescents acquire important intimacy and communication skills in their relationships that contribute to relationship longevity. Yet we know relatively little about which factors help relationships endure. Objective: This study tracked adolescent women’s ( N = 387; 14–17 years) relationships from onset to dissolution to assess factors that contribute to relationship length. Prior relationship experience, relationship characteristics, and current relationship behaviors were assessed as contributors. Method: A sample of 387 female adolescents (89% African American) were recruited from three primary care adolescent health clinics serving lower- to middle-income families in a large Midwestern city. All were interviewed every 3 months about ongoing relationships. The main outcome measure was time to dissolution. Results: The average relationship lasted 5.87 months ( SD = 11.76). Greater numbers and more time spent in prior relationships were associated with longer duration of the current relationship. Being older, having more status changes during the relationship (promotions and demotions), and reporting greater relationship quality, sexual communication, and sexual autonomy were associated with significantly longer time to breakup. Conclusions: Research to date has not tracked specific relationship timelines. In line with a developmental tasks perspective, this study provides new insights into the value of adolescent women’s past relationship experiences, measures of aging and accrued experience, as well as current relationship characteristics and behaviors to the development of relationship maintenance skills. These findings have educational and clinical implications as they inform programming initiatives designed to help young people establish healthy, consensual intimate relationships.

Opportunities in Housing Property for Young and First-Time Homebuyer in Malaysia

The biggest concern for first-time buyers is affordability, especially in major Malaysian cities such as Klang Valley, Penang and Johor. Low and middle-income families are worried because affordability will not only affect their ability to become homeowners, but also the size and type of houses they can buy. In order to solve the problem of affordability of real estate, the Malaysian government has provided two key programs for the relatively new workforce. However, most young and first-time buyers are not aware of these offers. This article aims to review the opportunities for young and first-time homebuyers to own a home. This article first reviews young and time homebuyers, the definition of housing, housing loans, the support provided by the Malaysian government for first-time homebuyers in terms of affordable housing and financial support.

Anaemia and associated factors among non-pregnant women of reproductive age in Ethiopia

Background/Aims Anaemia is a common health problem that has devastating consequences for women of reproductive age. Studies have indicated that anaemia among women of reproductive age contributes to a higher risk of unfavourable pregnancy outcomes, such as low birth weight and mental impairment. The aetiology of anaemia in Ethiopia is not well established and there is a lack of evidence, particularly in the case of non-pregnant women. Therefore, this study aimed to determine the prevalence of anaemia and associated factors among non-pregnant women of reproductive age in Ethiopia. Methods The dataset from the 2016 Ethiopia Demographic and Health Survey was used with the authorisation and permission of the Ethiopia Central Statistics Authority. A total of 13 436 non-pregnant women were included. Data were processed and analysed using STATA-14 format. Multilevel logistic regressions were used to determine anaemia's association with different predictors. Variables with P<0.25 in bivariate analysis were selected as candidate variables for the final model to control for confounding variables. The odds ratio with a 95% confidence interval was used to declare statistical significance at P<0.05. Results The prevalence of anaemia among non-pregnant women of reproductive age in Ethiopia was 26.3%. Locally, the highest (59.2%) and lowest (15.8%) prevalences of anaemia were recorded in Somali and Addis Ababa respectively and a quarter (25.0%) of rural residents were anaemic. Multivariate analysis showed that anaemia was negatively associated with being a from high- or middle-income family (P=0.001), having a job (P=0.001), using hormonal methods of family planning (P=0.001) and having a normal body mass index (P=0.009). However, being married (P=0.001), having had at least one child (P<0.05) and living in a rural residence (P=0.022) were positively associated with anaemia. Conclusions Anaemia is a common public health problem among women of reproductive age in Ethiopia. Economic status, place of residence, birth frequency and household size were significantly associated with anaemia among the participants. Therefore, to reduce anaemia prevalence among women of reproductive age in a sustainable manner in Ethiopia, different strategies and interventions methods such as iron-folic supplementation before pregnancy and nutrition education on iron-rich food and environmental hygiene should be strengthened.

Human Milk Bank in a Rural Setup - A Success Story.

This article describes the experience of a rural human milk bank, with the problems faced in first 6 months including the coronavirus disease (COVID) crisis and interventions leading to success. The study included individual counselling by dedicated counsellors, focused counselling of primipara mothers seeking the help of obstetricians, counselling of pre-term mothers by neo-natal nurses, periodically delivered information in post-natal wards, and counselling of grandmothers and husbands. The COVID crisis was dealt with donations from reverse transcriptase-polymerase chain reaction-negative mothers with social distancing and mask use. Younger, educated, working mothers with normal delivery and from middle-income families were easy to counsel. Periodic announcements in wards significantly increased awareness about milk banks and donation. Pre-term mothers could be motivated when their baby was nil by mouth or they saw other babies in need of milk. Lactation support to mothers with breast problems, especially in primipara, helps in getting more donors. Counselling of fathers was easier than that of grandmothers. Structured awareness programs and counselling strategies along with education of grandmothers and husbands were very effective in increasing human milk donation.

The early impact of the global lockdown on post-secondary students and staff: A global, descriptive study.

Objectives:The aim of this study was to gain a preliminary, broad-level understanding of how the first lockdown impacted post-secondary students, faculty, and staff worldwide.Methods:The data were obtained via a global online cross-sectional questionnaire survey using a mixed-method design and disseminated to university students, faculty, and staff from April to November 2020. The data were categorized in four themes/categories: (1) social life and relationships, (2) access to services, (3) health experiences, and (4) impact on mental health well-being.Results:The survey included 27,804 participants from 121 countries and 6 continents. The majority of participants were from Europe (73.6%), female (59.2%), under 30 years of age (64.0%), living in large urban areas (61.3%), %), and from middle-income families (66.7%). Approximately 28.4% of respondents reported that the lockdown negatively impacted their social life, while 21.2% reported the lockdown had a positive impact. A total of 39.2% reported having issues accessing products or services, including essentials, such as groceries, or medical services. In addition, respondents reported an increase in stress and anxiety levels and a decrease in quality of life during the first 2 weeks of the lockdown.Conclusions:The COVID-19 pandemic and lockdown measures had an evident impact on the lives of post-secondary students, faculty, and staff. Further research is required to inform and improve policies to support these populations at both institutional and national levels.

Impact of COVID-19 pandemic on learning status of student in Nepal.

This study was designed to evaluate the impact of the COVID-19 pandemic on the learning status of students from different educational boards and universities of Nepal. An online survey was conducted from tenth to twentieth of September 2020 to record the data. A self-designed questionnaire link, using "Google form" was sent to the students via social networks. A total of 589 participants shared their complete information. The simple percentage distribution was employed to evaluate the learning status of the students. During the lockdown period, >70% of the students were engaged in online classes, most commonly by using the Zoom app. The majority of the students were using WIFI as an internet source to attend online classes. Students have been suffering from various problems related to anxiety, stress, economic crises, poor internet connectivity, deprivation of study materials, required e-learning accessories, and an unsuitable study environment. Mainly, students from remote areas and middle income families suffered enormously. Among those participants, who were able to attend the online classes, the majority of students (70%) were dissatisfied with the ongoing online classes. Only 23.3% of the participants suggested the feasibility of online classes in the near future. Our study recommended that training teachers and students about online classes might create effectiveness toward e-learning. The government needs to provide free internet services to the remote areas and the poor students since in the current scenario, huge numbers of the population are struggling with the economic burden.

Pattern of Otitis Externa in ENT Outpatient Department

Introduction: Otitis externa is an acute or chronic reaction of the whole or a part of the skin of the external ear arising from local or general causes or a combination of both [1]. It is a very common medical problem affecting 5-20% of patients attending otolaryngologists in the tropical and subtropical regions of the world. Objective: To assess the Pattern of Otitis Externa in the ENT Outpatient Department. Methods: A prospective study was carried out in the outpatient department of Bangabandhu Shelkh Mujib Medical University among 200 patients (220 affected ears) with the aural symptoms suggestive of otitis externa and 110 healthy control (220 ears), from July 2002 to December 2003, with the aims and objectives to find out the pattern of disease among the patients suffering from otitis externa in Bangladesh. Results: It is found from the study that the maximum number (35%) of patients were within 21-30 years of age group. Most patients were male (56%), with a male-female ratio is 1.3:1. Higher numbers of patients were fallen within lower and middle-income family groups (up to 2,500 and 3,501-4,000 taka per month, respectively). Most of the patients (30%) were laborers, and most patients were literate. The majority lived in a paka (44%) or semi-paka (38%) house and used tap water for bathing (53.5%). Most patients used cotton buds (49%) for cleaning of ears. Otitis externa was mostly found in the summer and rainy season (69%), with maximum occurrence during June (18.2%) and July (16.4%). In most of the patients, symptoms persisted for less than two months (76.3%), of which itching, pain in the ear, and sense of blocking are the commonest triad of symptoms. Itching is the predominant symptom (98.2%) in fungal, and pain is the dominant symptom (92.8%) in bacterial otitis externa. Acute infection is commonly painful, whereas chronic disease is mostly itchy. The regarding involvement right ear was more involved (60%) than the left one and the ear canal was more commonly diffusely involved (84.5%). Among the predisposing factors for the causation of otitis externa, ear cleaning either by self or others ranked the top 42, 7% of the list. It was mainly associated with acute cases. The fungus was isolated from the affected ear in most instances (49.1%), followed by Isolation of bacteria (31.8%), of which bacteria were often associated with the acute cases, and fungus was found more in the chronic cases. Aspergillus was found in 89.7% of the fungal species, and candida was found in 7.5% of cases. Pseudomonas was the predominant organism (40%), and Staphylococcus was the second most common (37.1%) among the bacterial species isolated. The microbiological finding among the healthy control showed that the external ear canal is less commonly harboring pathogenic organisms. Bacteria were isolated from 18.2% of cases, and fungus was isolated from only 6.3%. Conclusion: From this study, it is also evident that although bacteria could be detected from control cases, the Isolation of fungus was negligible. Most of the bacteria were normal commensal. Whereas in diseased ear presence of fungus in the ear canal was highly significant (p<0.001), which signifies the prerequisite of an altered aural flora and fauna for the development of fungal infection.

Evaluation of bile duct stones extracted by ERCP (Endoscopic Retrograde Cholangio-Pancreatography).

Objective: To determine the frequency of different types of gallstones on ERCP stone extraction from bile duct. Study Design: Cross Sectional study. Setting: Department of Gastroenterology of the Nishtar Hospital Multan. Period: September 2019 to October 2020. Material & Methods: Patients with bile duct stones on imaging of either sex aged 18 – 70 years were included in our study while patients with IHD, malignancies, liver cirrhosis, asthma, TB, COPD, ILD and pregnant women were excluded from our study. During ERCP the gross appearance of extracted stones and related findings were noted. Results: Our study included 139 patients meeting inclusion criteria, of these 139 study cases, 49 (35.3%) were male and 90 (64.7%) were female patients with bile duct stone. Mean age was 45.78 ± 12.05 year (range; 27 – 68 years). Of these 139 study cases, 56 (40.3%) were from rural areas, 83 (59.7 %) were from urban areas, 52 (37.4%) had poor socioeconomic status and 87 (62.6%) were from middle income family background. Diabetes was noted in 35 (25.2%), hypertension in 53 (38.1%) and obesity in 32 (23 %) (Mean BMI was 26.53±214kg/m2). Mean stone size in our study was 15.82 ± 6.34 mm while 78 (56.12 %) had single stones. Pure cholesterol gallstones were noted in 47 (33.8%), mixed cholesterol stones in 71 (51.1%) and brown pigmented gall stones in 21 (15.1%). Conclusion: Mixed cholesterol stones were more frequent followed by pure cholesterol and brown pigmented stones in bile duct gallstones patients. Mixed cholesterol stones were significantly associated with rural residential status and hypertension while brown pigmented stones were residential status, hypertension and obesity.

How does Affordable Housing Supply Affect Commercial Housing Prices：Crowd out Supply or Divert Demand？

Since the housing system reform in 1998, China’s commercial housing prices have risen rapidly, and far exceeded the affordability of commonality. In order to solve the housing problems of middle and low income families, China launched the construction of affordable housing, which has greatly improved people’s livelihood and social welfare. The impact of affordable housing supply on the real estate market is also related to the interests of social groups. How to understand the relationship between the two types of housing has become an important reference for building an internally coordinated and efficient housing supply system.Combined with China’s special housing security and land system, this study theoretically analyzes the possible impact of affordable housing supply on the commercial housing market by constructing the equilibrium model of supply and demand. Based on the panel data of 248 prefecture-level cities in China from 2007 to 2016, the FEM and IV models are used to test the theoretical hypothesis, and the mechanism and heterogeneity are further discussed.The results show that: In the statistical sense, we find that affordable housing crowds out commercial housing supply through the competitive allocation of land, but it cannot replace demand in the segmented housing market, which eventually raises housing prices. Furthermore, the crowding-out effect is more obvious in the regions with low land financial dependence. But the economic meaning of empirical results is weak, and the crowding-out effect and the impact of housing prices can be ignored. This means that the supply of affordable housing basically does not harm the welfare of other groups.In general, this study has strong policy implications. On the one hand, China should establish multi-agent supply channels. Collective construction land and idle land owned by enterprises can be used to build affordable housing to ensure the independence of the land supply mechanism. On the other hand, some cities can gradually relax the access restrictions on affordable housing according to the actual situation. They can provide talent housing for college graduates and professional and technical personnel, and provide affordable rental housing for urban “new citizens” and migrant workers, so as to effectively divert the demand for commercial housing and stabilize the price of commercial housing.

The phenotypic associations and gene-environment underpinnings of socioeconomic status and diurnal cortisol secretion in adolescence.

While converging evidence suggests that both environmental and genetic factors underlie variations in diurnal cortisol, the extent to which these sources of influence vary according to socioeconomic status (SES) has seldom been investigated, particularly in adolescence. To investigate whether a distinct genetic and environmental contribution to youth's diurnal cortisol secretion emerges according to family SES and whether the timing of these experiences matters. Participants were 592 twin pairs, who mostly came from middle-income and intact families and for whom SES was measured in childhood and adolescence. Diurnal cortisol was assessed at age 14 at awakening, 30 min later, in the afternoon and evening over four nonconsecutive days. SES-cortisol phenotypic associations were specific to the adolescence period. Specifically, higher awakening cortisol levels were detected in wealthier backgrounds, whereas higher cortisol awakening response (CAR) and diurnal changes were present at both ends of the SES continuum. Moreover, smaller genetic contributions emerged for awakening cortisol in youth from poorer compared to wealthier backgrounds. The results suggest that the relative contribution of inherited factors to awakening cortisol secretion may be enhanced or suppressed depending on the socio-family context, which may help to decipher the mechanisms underlying later adjustment.

Impact of the COVID-19 pandemic on substance use among adults without children, parents, and adolescents

Impact of the COVID-19 pandemic on alcohol and illicit substance use among adults without children, parents, and adolescents was investigated through two studies with five samples from independent ongoing U.S. longitudinal studies. In Study 1, 931 adults without children, parents, and adolescents were surveyed about the pandemic’s impact on personal behavior. 19–25% of adults without children, parents, and adolescents reported an increase in alcohol or illicit substance use. In Study 2, 274 adults without children, parents, and adolescents who had been interviewed prior to the pandemic onset about alcohol and illicit substance use problems were re-interviewed after the pandemic’s onset to test within-person change. The rate of alcohol or illicit substance use problems increased from pre-pandemic to post-pandemic onset from 13% to 36% among the three groups. Increase in alcohol and illicit substance use problems was positively correlated with increased depression/anxiety and household disruption, suggesting possible mechanisms for increases in substance problems. Findings in both studies held across low- and middle-income families. Findings suggest the need for communitywide policies to increase resources for alcohol and illicit substance use screening and intervention, especially for adolescents.

Research on the direct financial burden on families with 2-6 years old children having autism spectrum disorder in China

Objective To investigate and explore the direct expenditures on health care and intervention of the families of 2-6 years old children with autism spectrum disorder (ASD). Methods Using the questionnaire to investigate the financial cost on Chinese families of 2-6 years old ASD children. Chi square analysis and ANOVA analysis were used to compare the mean values of various expenditures. Results Caregivers of 3 880 ASD children were recruited in 33 Provinces of China.The direct expenditure of intervention is average 7 339.48 Yuan per month (88 073.76 Yuan per year), which accounts for 85.56% of the total household income. The total direct expenditure of intervention is average 9 677.87 Yuan per month (116 134.44 Yuan per year), which accounts for 127.38% of the total household income. To the low-income families, their intervention expenditure's percentage can high up to 210%, along with the middle-income families 97% and the high-income families 56%. The statistical difference is obviously significant (all P Conclusion The cost of intervention of ASD children has caused a serious financial burden on their families, especially to the poor and the families with low functioning children.

Identification of Effective Integrated Indicators for Sustainable Affordable Housing Provision

The affordable housing sector is receiving increasing attention in developed and developing countries. That attention increased due to the economic inflation and the increasing population growth, which generated a housing deficit affecting low and middle-income households. Accordingly, the research gap emerged with the need to search for affordable and sustainable housing in the residential built environment that meets low- and middle-income family groups’ economic, social and environmental sustainability criteria. This paper focused on identifying the most important planning and design indicators contributing to affordable housing provision, integrated with sustainability criteria to achieve part of the comprehensive sustainable development vision. This study aims to identify indicators and produce a framework that works as a guideline to provide reasonable housing that is adequate for low and middle-income groups and to reduce householders’ tolerance of its operational costs. A preliminary list of 72 sustainability performance indicators of affordable housing was identified through an extensive literature review. This was followed by a derived two stages framework to define housing affordability. These findings provide useful references for policymakers as well as industry practitioners to develop affordable housing programs sustainably. This helps to achieve the sustainable development at the regional scale.

The Association of Feeding Practices and Sociodemographic Factors on Underweight and Wasting in Children in Ethiopia: A Secondary Analysis of Four Health Surveys from 2000 to 2016.

Feeding practices highly influence the nutritional status of children between 6 and 23 months of age in developing countries, including Ethiopia. Therefore, this study was conducted to investigate the association of feeding practices and sociodemographic factors on underweight and wasting of children aged 6-23 months in Ethiopia. Data on 8003 children 6-23 months of age from four Ethiopia demographic and health surveys (EDHS) from 2000 to 2016 were analyzed using complex sample crosstabs for multivariate analysis. The association of feeding practices and sociodemographic factors on underweight and wasting was assessed via multiple logistic regression analyses adjusting the covariates. The outcomes were reported based on the adjusted odds ratios (ORs) with 95% confidence interval (CI). Male children, very small at birth size children, diarrhea and fever, and short stature mother were risk factors for underweight and wasting (p < 0.05-0.001). Also, minimum dietary diversity, rich and middle-income families, vitamin A in the previous 6 months and antenatal care visits during pregnancy were protective factors for both underweight and wasting (p < 0.05-0.001). Minimum meal frequency was significantly related to lower odds of wasting (p < 0.001). Higher age of the child was significantly associated with underweight (p < 0.05-0.001); however, it was less likely wasted (p < 0.05-0.01). The present study depicted that among infant young children feeding core indicators except breastfed, all the other indicators did not met the required standard; however, sociodemographic factors on four health surveys from 2000 to 2016 were associated with underweight and wasting in children in Ethiopia. • Over the years the prevalence of underweight in children aged 6-23 months in the country has shown a significant improvement from 40.2% in 2000 to 34.7% in 2005, then further reduced to 28.9% and 20.0% in 2011 and 2016 EDHS, respectively.• In the same manner, the prevalence of wasting in children aged 6-23 months in Ethiopia also observed improvement from 18.9% in 2000 to 16.7% in 2005, then further reduced to 15.4% and 13.9% in 2011 and 2016 EDHS, respectively.• Male children, very small at birth size children, diarrhea and fever (for the last 2 weeks), and short stature mother were risk factors for underweight and wasting.• Minimum dietary diversity, rich and middle-income families, vitamin A in the previous 6 months and antenatal care visits during pregnancy were protective factors for both underweight and wasting.• Minimum meal frequency was significantly related to lower odds of wasting.• Higher age of the children was significantly associated with underweight; however, less likely wasted.

Societal Panorama of Power: Emancipation of Women or Threat?

The pandemic has brought the world to a standstill. The dearth to survive in the wake of devastation has made humans adapt to the new normal which was never experienced but now has become a protocol. The phrase which was the tagline for global partnerships ‘united we stand, divided we fall’ has now transformed into ‘divided we stand, united we fall’, as a claim to survive this pandemic. In India where the virus has claimed the maximum toll of human lives, continues to fight various battles to survive. On one side, the health workers, doctors, police are risking their lives so that the common man may not be affected while on the other hand, people within the houses are falling victims to domestic and sexual abuse. In the light of the pandemic that has claimed lives as well as loss of employment; the struggle to survive has hit a different tone especially among the lower and the middle income families. The frustration of losing a job is vented on the family members as there remains no source of income to support the family. This article tries to unearth the existing social problems of abuse among men and women at large especially during the pandemic. The principle of resistance is understood in the sexual division of labour where individuals are now trying to be communicating with the outside world while remaining at home.

Working poor in Taiwan: profile and policy response

ABSTRACT This study, adopting a secondary analysis from the Low-income and Middle-income Family Living Condition Survey 2018, aims to investigate the magnitude, the basic characteristics, the working conditions of the working poor in Taiwan as well as to assess the government’s policy responses.This study found that the working poor are a group of people who are mainly 26 to 45 years old, high school graduates, technical or service workers. Approximately 70% of the working poor work full-time but still have a family income below the poverty line, indicating that the typical situation of the working poor is ”long working hours and low wages”. In recent years, Taiwan has developed policies to respond to it, including expanding the scope of social assistance and doubling the beneficiaries, raising the minimum wage, protecting the employment rights of atypical workers, providing child allowances, promoting the employment of the disadvantaged, and expanding childcare and long term care services. These policies all have resulted in significant progress. However, the main issue remaining to be addressed is the strict criteria employed in the poverty screening process. These criteria urgently need to be modified to allow more working poor to enter into the social assistance system and obtain assistance. Additionally, reforms in the distribution of social assistance resources and in an aspect of the tax system are suggested.

Income Shocks and Out-of-Pocket Health Care Spending: Implications for Single-Mother Families.

We examine how out-of-pocket health care spending by single-mother families responds to income losses. We use eleven two-year panels of the Medical Expenditure Panel Survey for the period 2004–2015 and apply the correlated random effects estimation approach. We categorize income in relation to the federal poverty line (FPL): poor or near-poor (less than 125% of the FPL); low income (125 to 199% of the FPL); middle income (200 to 399% of the FPL); and high income (400% of the FPL or more). Income losses among high-income single-mother families lead a decline in out-of-pocket spending toward office-based care and emergency room care of $119–$138 and $30–$60, respectively. Among middle-income single-mother families, income losses lead to a $30 decline in out-of-pocket spending toward family emergency room care and a $45–$91 decline in mother’s out-of-pocket spending toward prescription medications. Further research should examine whether these declines compromise health status of single-mother family members.

Adhering to a Mediterranean diet in a Mediterranean country: an excess cost for families?

Adherence to the Mediterranean diet (MD) has been decreasing in southern Europe, which could be linked to several cultural or educational factors. Our aim is to evaluate the extent to which economic aspects may also play a role, exploring the relationship between food prices in Portugal and adherence to the MD. We evaluated data from the Portuguese National Food, Nutrition, and Physical Activity Survey (IAN-AF 2015-2016) (n 3591). Diet expenditures were estimated by attributing a retail price to each food group, and the diet was transposed into the Mediterranean Diet Score used in the literature. Prices were gathered from five supermarket chains (65 % of the Portuguese market share). Linear regression models were used to assess the association between different adherence levels to the MD levels and dietary costs. Greater adherence to the MD was associated with a 21·2 % (P < 0·05) rise in total dietary cost, which accounts for more 0·59€ in mean daily costs when compared with low adherence. High adherence individuals (v. low adherence) had higher absolute mean daily costs with fish (0·62€/+285·8 %; P < 0·05), fruits (0·26€/+115·8 %; P < 0·05) and vegetables (0·10€/+100·9 %; P < 0·05). The analysis stratified by education and income level showed significantly higher mean daily diet cost only amongst higher income groups. Our findings suggest that greater adherence to the MD was positively and significantly associated with higher total dietary cost. Policies to improve population's diet should take into consideration the cost of healthy foods, especially for large low- and middle-income families.

Where Self-Interest Trumps Ideology: Liberal Homeowners and Local Opposition to Housing Development

How much does self-interest drive Americans’ policy attitudes? Survey research typically finds that self-interest’s role is minimal. Such conclusions are typically reached by examining attitudes toward federal policies that present diffuse costs and low stakes. We consider a starker test case of self-interest: controversies surrounding development of dense and affordable housing in Americans’ communities. Liberal homeowners, especially, must cope with dissonance between their egalitarian ideology and a desire to protect their home values and quality of life. They often embrace liberal housing goals and redistributive housing policies but join conservatives in opposing dense housing in their own communities. Two survey experiments show that liberal homeowners are cross-pressured and barely more likely than conservative homeowners to support dense housing development. Messages appealing to homeowners’ self-interest reduce support further, while countervailing appeals about housing’s benefits to low- and middle-income families barely offset the negative effect. We discuss implications for the politics of equal opportunity at the state and local level.