Multinomial Logit Regression Model Research Articles

Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis.

Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early- to mid-2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non-incentivized ACSCs (angina and asthma). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two-stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended-fee-for-service (FFS), 1388 blended-capitation models, and 1164 interprofessional team-based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation-based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended-FFS-based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team-based practices.

Understanding residents’ choice of urban farming systems in the Kumasi metropolis of Ghana: Land use policy implications

The heightened food insecurity in urban settings has rekindled the debate over the promotion of urban agriculture (UA) as a sustainable alternative food supply source across the globe. This study, therefore, examines the determinants of urban residents’ decisions to engage in UA and their choice of agriculture practices. Cross-sectional data was solicited from 430 urban dwellers through a multi-stage sampling technique. The data was analysed using descriptive as well as binary and multinomial logit regression models. The descriptive analysis shows that the cultivation of crops (34.7 %) predominates urban agricultural practices before crop-livestock integration (32.6 %) and livestock farming (32.6 %). The study identifies gender, age, religious affiliation, years of formal education, location of residence, household size, food insecurity status, availability of vacant land, extension access, and household income as significant determinants of urban households’ decision to participate in UA. The multinomial logit regression analysis revealed that urban farmers’ decision to practice only crop production is invariant between livestock-only production and integrated crop-livestock systems. When compared to the base category of the integrated crop-livestock system, the findings indicate that farmers’ educational background, food insecurity, engagement in salaried jobs, location, extension, and credit access are the main drivers of the decision to practice either crop-only or sole livestock production systems. The findings of this study have useful implications for the formulation of UA programs based on the different farming systems practiced in the study location.

Safety evaluation via conflict classification during automated shuttle bus service operations

The widespread adoption of Connected and Automated Vehicles (CAVs) is being propelled, not only in the realm of private vehicles but also within transit systems. This development serves to enhance urban transport activities, rendering transportation more appealing to passengers. The present study aims to identify and examine the safety effects of testing different operational speed shuttle bus services in various future mobility conditions. To investigate impacts of autonomous shuttle bus services and to further examine their operational speed, the microscopic simulation method was performed. Specifically, four sets of simulation scenarios were comprised: a baseline scenario representing the current conditions and three operational speed scenarios (15 km/h, 30 km/h and 45 km/h) for an autonomous shuttle service. Each one of these sets included eleven CAV market penetration rates (MPRs) of CAVs of the general traffic (ranging from 0 to 100% in 10% increments). By analyzing the trajectory data extracted from microsimulation, traffic conflicts were identified and further analyzed by developing Mixed-Effects Multinomial Logit Regression models (ME-MLMs) in order to associate conflict type taking into account network characteristics as well as traffic conditions. Several aspects were determined as statistical significant parameters influencing type of conflict. The analysis yielded several significant findings that provide quantitative measurements and assessments of the effects observed, enabling a better understanding of the safety implications associated with the widespread adoption of automated services.

Determining factors and barriers to the uptake of climate change adaptation strategies of agriculture and aquaculture farm households in Myanmar

PurposeClimate change is an undeniable reality that threatens people’s livelihoods. Flooding and saltwater intrusion, along with the rising sea levels, are affecting agricultural and aquaculture livelihoods in Myanmar’s coastal areas. Although climate change adaptation is gaining popularity as a resilience strategy to cope with the negative effects of climate change, both agriculture- and aquaculture-farmers are more often deterred from implementing climate change adaptation strategies due to practical availability and socioeconomic barriers to adaptation. This study aims to evaluate the barriers and factors that influence farm household’ choice of climate change adaptation measures.Design/methodology/approachThis study was conducted with 599 farm households (484 rice-farmers and 115 fish farmers) based in the coastal areas of Myanmar during 2021–2022 to explore the farmer’s choice of climate change adaptation measures and the determining factors. The multinomial logit regression (MLR) model was used to examine the factors influencing the farmers’ choice of climate change adaptation strategies.FindingsThe study found out that farm households use a variety of adaptation methods at the farm level, with building embankment strategy (23.4%) in agriculture and net-fencing measure (33.9%) in fish farming being the most popular adaptation strategies. Farmers’ decisions to adopt climate change adaptation strategies are influenced by factors such as distance to market, education level of the household head, remittance income and the availability of early warning information, among others. The study also discovered that COVID-19 has had an impact on the employment opportunities of household members and the income from farming as well had a consequential effect on the adoption of climate change adaptation measures. Furthermore, lack of credit (42.4%), labor shortage (52.8%), pest and disease infestation (58.9%), high input costs (81%) and lower agricultural product prices (73%) were identified as major barriers to the adoption of climate change adaptation measures by both agriculture and aquaculture farm households.Originality/valueThis study demonstrates that the COVID-19 pandemic and farm-level barriers are the major factors influencing farm households’ choice of climate change adaptation measures, and that removing practical farm-level barriers and encouraging the adoption of adaptation techniques as potential COVID-19 recovery actions are required. This study also highlighted that the adaptive capacity of agriculture and aquaculture farm households should be strengthened through formal and informal training programs, awareness raising, the exchange of early warning information and the development of proper credit scheme programs.

Unveiling determinants of household lighting preferences in rural Tanzania: insights for sustainable energy access

This paper investigates the determinants and prospects of household lighting choices in rural Tanzania using a Multinomial Logit Regression Model. The analysis is based on data from 4671 households, focusing on three lighting options: electricity, solar energy, and candle lighting. The results reveal significant factors influencing these choices, including household head characteristics, household size, marital status, education, employment status, number of rooms, and income. Key findings indicate that the age of the household head negatively influences the likelihood of choosing grid-electricity, while having a male head of household significantly reduces the probability of opting for any lighting option. Larger household size is negatively associated with choosing electricity and candle lighting. Marital status shows that married households are more likely to use candle lighting. Employment status positively impacts the likelihood of adopting all three lighting options, with employed household heads being more likely to choose modern lighting solutions. Income levels are crucial, as higher income significantly increases the probability of selecting electricity and candle lighting, but not solar energy. These findings provide valuable insights for policymakers and stakeholders aiming to enhance sustainable energy access in rural Tanzania. It highlights the importance of addressing socio-economic factors to promote the adoption of modern and sustainable lighting technologies.

Effect of social capital on enrolment of informal sector occupational groups in the national health insurance scheme in Ghana: a cross-sectional survey

BackgroundEnrolment of informal sector workers in Ghana’s National Health Insurance Scheme (NHIS) is critical to achieving increased risk-pooling and attainment of Universal Health Coverage. However, the NHIS has struggled over the years to improve enrolment of this subpopulation. This study analysed effect of social capital on enrolment of informal sector workers in the NHIS.MethodsA cross-sectional survey was conducted among 528 members of hairdressers and beauticians, farmers, and commercial road transport drivers’ groups. Descriptive statistics, principal component analysis, and multinomial logit regression model were used to analyse the data.ResultsSocial capital including membership in occupational group, trust, and collective action were significantly associated with enrolment in the NHIS, overall. Other factors such as household size, education, ethnicity, and usual source of health care were, however, correlated with both enrolment and dropout. Notwithstanding these factors, the chance of enrolling in the NHIS and staying active was 44.6% higher for the hairdressers and beauticians; the probability of dropping out of the scheme was 62.9% higher for the farmers; and the chance of never enrolling in the scheme was 22.3% higher for the commercial road transport drivers.ConclusionsSocial capital particularly collective action and predominantly female occupational groups are key determinants of informal sector workers’ participation in the NHIS. Policy interventions to improve enrolment of this subpopulation should consider group enrolment, targeting female dominated informal sector occupational groups. Further studies should consider inclusion of mediating and moderating variables to provide a clearer picture of the relationship between occupational group social capital and enrolment in health insurance schemes.

Gender differences in child sexual abuse in China: Examining the mediation and moderation effects

Mixed findings exist regarding gender differences in child sexual abuse (CSA) in China. A large representative sample of 14,564 children, aged 14–18, from five major Chinese cities, was used to investigate gender differences in CSA by examining the mediating effects of risky lifestyle activities and the moderating role of repeated victimization. Multinomial logit regression models were employed, with direct and indirect CSA as dependent variables, and gender and risky lifestyle activities as independent variables. Of the respondents, 7.5 percent reported at least one incidence of one-time or repeated CSA in the past year. Boys showed a higher risk of experiencing both direct and indirect repeated CSA compared to girls. Risky lifestyle activities had a statistically significant mediating effect on the gender–CSA relationship. Additionally, statistically significant moderating effects of repeated victimization were observed. Effective strategies to address CSA could include screening the forms and frequency of one-time incidence CSAs. Furthermore, gender-specific prevention and intervention programs targeting adolescents' risky lifestyle activities should be implemented.

Families on the space–time continuum: Conceptualizing and measuring temporal and spatial dimensions

AbstractObjectiveIn this article, I propose a new approach to study the opportunities and challenges for low‐income families through a focus on two key dimensions of family life: time and space. I show how the interaction of these two dimensions produces a range of scenarios for different types of social support to emerge.BackgroundThe space–time continuum (STC) is a theoretical framework in physics that removes the distinction between time and space and, instead, treats them as part of a seamless continuum. Similar to its adaptation in psychology, I use it to develop a model of family dynamics to better understand the correlates of kinship support.MethodDrawing on data drawn from a longitudinal project in Nairobi, Kenya, the spatial dimension is operationalized as the proportion of kin who live in close proximity and the temporal pertains to the duration of time in which family members maintain particular arrangements. Multinomial logit regression models are used to analyze the relationship between STC exposure and the odds of having each type of support composition.ResultsThe receipt of specific types of support from kin does vary across the STC quadrants though not entirely consistent with expectations. Moreover, the role of non‐kin was found to be surprisingly low across all waves of data collection, underscoring the continued importance of kin‐based relationships.ConclusionThe space–time continuum approach offers a way to connect macro level factors such as labor market constraints to micro level adaptation, agency, change and continuity in family structure and function. In doing so, I also make a case for the critical role that research in the African context can play in the development of theory and methodological innovation in family sociology.

Understanding the determinants of household cooking-fuel choice in sub-Saharan Africa: evidence from Nigeria

Abstract Overreliance on traditional cooking fuels by agricultural households poses a significant obstacle to achieving the United Nations Sustainable Development Goal 7 by 2030 in Nigeria. Despite the emerging recognition of remittances as a crucial factor influencing cooking-fuel choices in the energy-transition literature, there is a paucity of studies examining this influence in Nigeria. Using data from 4400 agricultural households sourced from the fourth wave of the Nigerian Living Standard Measurement Survey data sets, this study examined the influence of remittances on cooking-fuel choices, among other factors in Nigeria. Employing descriptive statistics and the multinomial logit regression model, the analysis reveals that traditional cooking fuels, including wood, crop residue and animal dung, continue to dominate the cooking-fuel landscape. The empirical result of the multinomial logit model showed that households that receive remittances are more likely to use modern cooking fuels. Furthermore, wealthier, more educated households with access to electricity are more likely to use modern and transitional cooking fuels than traditional cooking fuels. Based on the findings, the study suggests the incentivization of remittances into the country through the reduction in associated transaction costs and accelerated public infrastructural investment in affordable electricity and good road networks to connect rural areas to gas-supply networks to drive the transition to modern cooking energy. Additionally, educational and awareness campaigns about the health risks associated with traditional cooking energy, particularly indoor air pollution, should be encouraged, especially in rural areas.

Measuring the Effect of Built Environment on Students’ School Trip Method Using Neighborhood Environment Walkability Scale

School trips affect different aspects, such as air pollution and urban traffic, and of personal wellbeing, such as students’ physical and mental health. The increasing concern about environmental sustainability has prompted a reevaluation of daily activities, including school transportation. While different factors that affect students’ school trips have been investigated in the literature, the effect of the built environment has been evaluated only sporadically in previous studies. To fulfil this knowledge gap, this study aims to investigate the effect of the built environment on students’ school trips by adapting and extending the well-known Neighborhood Environment Walkability Scale (NEWS) questionnaire. The questionnaire survey was conducted with parents from 36 schools in Yazd, Iran, providing a sample of 1688 students aged 7–18 years. The items from the NEWS questionnaire were placed in nine factors by performing factor analysis. The Multinomial Logit Regression model was applied to check the predictive power of these nine factors. It was found that the variables of land use mix-diversity, land use mix-access, crime, age, gender, household income and car ownership had a significant effect on students’ school trips. The more easily students have access to different places, the less they use public services and cars compared with the active travel mode. The use of public services and cars increases with the increase in crime rate along the route to school. The findings indicate that built environment features may impact students’ shift from traditional transportation modes to active alternatives, such as walking and cycling, contributing to the attainment of broader sustainability objectives.

Analysis of practices and factors of solid waste management among urban households of Addis Ababa city, Ethiopia

The management of solid waste is crucial for urban areas to prevent the spread of diseases, reduce pollution, enhance cleanliness, promote resource recovery, and create employment opportunities. This study aims to examine the practices and factors related to the management of solid waste among urban households in Addis Ababa City, Ethiopia. A survey was conducted with 200 participants from four districts in two sub-cities. The survey utilized an interview questionnaire. The data collected were analyzed using descriptive statistics and the multinomial logit regression model. The results indicate that various factors such as gender, age, education, employment status, income, family size, and attitude significantly influence the selection of solid waste disposal methods by households. Gender significantly influences the preference for nearby containers over open spaces when it comes to waste disposal. Females are 7.55 times more inclined than males to choose nearby containers instead of open spaces. Age also plays a substantial role, with respondents aged 46-64 being 604 times more likely to utilize nearby containers. Respondents aged 65 and above are 69 times more likely, while respondents aged 31-45 are three times more likely to use nearby containers. Education level is also a significant factor, as individuals holding college diploma or higher degree are more likely to opt for nearby containers and door-to-door pickers rather than open spaces. Retired individuals are less likely to utilize door-to-door pickers compared to government employees. The decision between nearby containers and open spaces for waste disposal is influenced also by family size. The likelihood of choosing nearby containers decreases by 45% with each unit increase in family size. Attitude also plays a role in the preference for door-to-door pickers over open spaces. The likelihood of using door-to-door pickers increases by 64% for each unit increase in attitude. Individuals with higher incomes are unexpectedly inclined towards using open spaces as a method of waste disposal, possibly due to their increased consumption levels, resulting in higher generation of solid waste in their households. To promote a clean, healthy, and sustainable urban environment, the government needs to formulate and implement solid waste management strategies that effectively consider the specific demographic and socio-economic characteristics of households.

Disparities in resilience and recovery of ridesourcing usage during COVID-19

The COVID-19 pandemic has impacted ridesourcing services dramatically, but empirical research on disparities in the resilience and recovery of ridesourcing has been scarce. To address this literature gap, we used ridesourcing trip data in Chicago to create two time series: one for Census tract-level ridesourcing usage (including pickups and dropoffs) and the other for linkages between origin and destination (OD) pairs. We performed time-series clustering analyses that integrated manifold learning and Gaussian Mixture Modeling to optimize the number of clusters for high-dimensional time-series data. The tract-level usage can be grouped into three clusters, and the OD-pair linkages can be grouped into six clusters. We examined the spatial patterns of the tract-level usage clusters and the OD-pair linkage clusters. Furthermore, we estimated a multinomial logit regression model to examine the relationships between clusters and land use, built environment, and sociodemographic factors. Our results suggested that the share of residential land use had a positive association with high resilience and fast recovery of ridesourcing usage. Limited transportation accessibility and a lack of alternative transportation modes were also associated with high resilience and fast recovery of ridesourcing usage. Trips that linked dense employment centers were less likely to be made during the pandemic. Census tracts with a greater share of minorities or a higher poverty rate tended to generate more ridesourcing trips during the pandemic.

Preferences of Patients with Congenital Thrombotic Thrombocytopenic Purpura and Other Chronic Conditions for in-Home Prophylactic Infusions

Background Congenital thrombotic thrombocytopenic purpura (cTTP) is an ultra-rare, life-threatening, thrombotic microangiopathy caused by an inherited deficiency of the von Willebrand factor (VWF)-cleaving enzyme ADAMTS13. Current treatment approaches include replacement therapy with intravenous (IV) infusions of either fresh frozen plasma, solvent/detergent-treated plasma, or factor VIII/VWF concentrates administered in a hospital/clinical setting. There is recent interest in novel treatments for cTTP and other chronic conditions where patients may be able to receive treatment at home with limited risk and a manageable safety profile compared to outpatient treatment. Understanding patient preferences regarding treatment at home vs an outpatient setting could help to inform approaches to patient care for both cTTP and other chronic conditions. Aims The primary objective was to assess stated preferences of patients with either cTTP or another chronic condition requiring treatment with regular IV infusions (listed in Table 1) toward prophylactic infusions administered at home vs in an outpatient setting. Secondary objectives were to estimate the utility and disutility of 7 attributes (listed in Table 2) associated with patient preferences and to assess whether clinical, sociodemographic, or other factors influence patient preferences. Methods This cross-sectional cohort study utilized an online discrete choice experiment survey, in which patients were presented with pairwise choice sets consisting of 7 attributes and their associated levels (listed in Table 2). In the survey, each patient was asked to choose their preferred alternative in a choice set (repeated 16 times) using different combinations of varying attribute levels for all 7 attributes, using an orthogonal experimental design. The survey also included a time trade-off exercise to enable the attribute levels to be adjusted for quality adjusted life years. The survey was conducted in France, Germany, Spain, the UK, and the US. Patients ≥18 years old with either cTTP or another chronic condition (listed in Table 1) who were receiving prophylactic IV infusions for ≥3 months, in either an outpatient setting or a hybrid outpatient and at-home setting, were eligible for inclusion. Treatment frequency ranged from once a week to once every 3 weeks. Data were analyzed using multinomial logit regression models. Results In total, 307 complete patient responses (France, n=18; Germany, n=95; Spain, n=96; UK, n=7; US, n=91) were included in the analyses. Median (range) age was 44.0 (20.0-78.0) years and 25 patients (8.1%) had cTTP ( Table 1). Overall, 137 patients (44.6%) reported an overall preference for receiving infusions at home, 85 patients (27.7%) reported a preference for receiving treatment in a hospital/clinic, and 85 patients (27.7%) reported a preference for receiving treatment via a hybrid outpatient and at-home setting. The majority of patients would prefer either a doctor or a nurse to administer their treatment at home (n=125, 40.7%). Patients placed significantly greater value on certain treatment-setting attributes ( Table 2); being comfortable with the treatment environment was considered the most important attribute. For the ‘convenience and impact on daily life’ attribute, selection of ‘flexibility in scheduling infusions’ was influenced by age (estimate: 0.019, 95% CI: 0.007; 0.032), and whether the patient had been diagnosed >5 years ago vs <1 year ago (estimate: 0.744, 95% CI: 0.255; 1.269). A high proportion of patients (60.9%) were willing to trade 12 months of their lives to receive treatment at home. Also, 59.0% and 56.4% of patients, respectively, were willing to trade 12 months to ensure that complications did not necessitate treatment in a hospital setting and that travelling to a hospital/clinic was not required to receive prophylaxis. Conclusions The majority of patients with cTTP or another chronic condition requiring treatment with regular IV infusions stated that they would prefer to receive treatment at home with support from healthcare providers. A high proportion of patients were also willing to trade 12 months of their lives to receive treatment at home; a limitation of the time trade-off exercise was that the maximum time that could be traded was 12 months. These findings provide insights into the importance of the treatment setting preferences of patients receiving prophylactic infusions.

Impact of land use on bike-sharing travel patterns: Evidence from large scale data analysis in China

With bike sharing flourishing around the world, researches focus on the optimisation of station layouts, but seldom explore the dynamical features of residents’ bike-sharing travel habits. Land use factors probably indicate the activities and reflect the reasons behind residents’ travel habits; however, few studies provide empirical evidences, especially with big data analysis technology. Thus, we conduct a big data-driven empirical research to clarify residents’ travel patterns and the effects of land use thereon, which is based on the full system records of one typical bike-sharing city in China. K-modes clustering method is used to identify residents’ single and daily bike-sharing travel patterns. Three multinomial logit regression models are applied to exploring the selection mechanisms of the travel patterns. Eventually, we find that with the reference of ST pattern, the TPT-ENW pattern selection is most affected by the number of accommodation service places around travel destinations and one standard deviation increase will increase relative risk of this pattern by 1.57467. The MNT-SC pattern is most affected by the number of corporations and the other five single travel patterns are all significantly affected by the number of catering service places, which indicates commuting and dining are the travel purposes of these patterns. In addition, we find a multinomial logit model with individual fixed effects can explain residents’ daily travel pattern selection better than a pooled multinomial logit model. The analysis of residents’ travel routines explains the distribution of bike-sharing mobility and provides basis for bike-sharing system policy formulation.

Determinants of farmers’ adaptation strategies to climate change impacts in northwestern Ethiopia

Climate change and related extreme events have become global challenges in ensuring sustainable development. This affects water availability and agricultural production, particularly in developing countries. This study explored the factors affecting farmers' adaptation mechanisms to climate change in different agro-ecological zones of the Bure Zuria district of northwestern Ethiopia. A household survey, focus group discussion, key informant interviews, and observations were used to acquire primary data on farmers' socioeconomic and demographic characteristics, adaptation strategies and potential barriers. About 190 randomly selected households from different agro-ecologies were included in this study. Moreover, reports and published sources were used to acquire secondary data. Data were analyzed using a multinomial logit regression model and descriptive statistics. The results indicated that soil and water conservation practices (26.7%) were the main adaptation responses in highland agro-ecology. In contrast, supplementary feeding for livestock (56%) was the main adaptation response to the adverse effects of climate extremes in lowland agro-ecology. Farmers identified land scarcity (25.84%) and shortage of water for irrigation (28.57%) as major barriers to adaptation in the highland and lowland agro-ecologies, respectively. In addition, agro-ecology, education level, age, active labor, number of livestock (TLU), off-farm income, frequency of extension contacts, credit access, and market access were decisive factors affecting farmers’ adaptation mechanisms to withstand extreme climatic events. In conclusion, soil and water conservation practices are more practiced in highland areas than in lowland areas. Because the steepness of farmlands and erodible soils increase farmers' vulnerability to flood hazards in highland areas than in lowland areas. It is suggested that investigations on the climate change-induced gender-differentiated impacts shall be conducted to design all-inclusive and effective responses.

Factors determining cassava farmers’ accessibility to loan sources: Evidence from Lampung, Indonesia

Abstract Credit accessibility is crucial for sustainable agricultural development. However, the difficulty in accessing credit has caused farmers to take many considerations when taking a loan. This research aims to determine the factors determining access and credit sources for cassava farmers in Lampung Province, Indonesia. Central Lampung was chosen as the research location because it had a total cassava production share of 36%. This study used Isaac’s and Michael’s formulae to determine the total samples. The data were collected by interviewing 263 respondents. Of 263 farmers, only 109 (41.4%) had access to loans. Data were analysed using the Multinomial Logit Regression Model to examine the factors determining access and credit sources for cassava farmers. Marginal effect analysis was also used to determine the probability of changes in independent variables. Regression results showed that the type of credit sources chosen by the farmers was determined by age, income, agribusiness experience, land size, education, organisation membership, and credit experience (R 2 = 89.1%). Partially, age, income, land size, education, credit experience, and business experience significantly influence the funding source. The results indicate that age, agribusiness experience, and land size are the main factors in choosing the types of credit. Land size has the biggest positive influence on farmers’ access to formal banks (11.49%).

PERCEPTIONS, PROFITABILITY AND DETERMINANTS OF GRANULATED CASSAVA PACKAGING IN KUMASI METROPOLIS, GHANA

Packaging does not only protect a product but also provides directions for using the product, as well as relevant information about its content and nutritional value. This study was undertaken to assess Granulated Cassava (Gari) sellers’ perception, profitability and determinants of packaging in Ashanti Region. The study area was purposively selected because of the active participation and contribution of marketing activities. A structured questionnaire was administered in the form of interview to obtain primary data from the respondents. Data was generated using binary and multinomial logit regression model and Garret ranking technique. The results showed that there is 0.11% difference in the gross margin of both ventures which is also statistically significant at 1%. Years of education, legal requirement, and durability of the packaging material and cost of packaging material were the significant factors that influence sellers’ choice of packaging. Lack of technical know-how, cost of capital equipment and lack of knowledge on packaging equipment and/or material were the most limiting constraints affecting Gari packaging. The study recommends that investors should invest in the Gari packaging business since it has a relatively higher rate of returns as compared to the unpackaged one.

Association of smoking status and nicotine dependence with multi-morbidity in China: A nationally representative crosssectional study.

Multi-morbidity is a public health priority as it is associated with an increased risk of mortality and a substantial healthcare burden. Smoking is considered a predisposing factor for multi-morbidity, but evidence for an association between multi-morbidity and nicotine dependence is insufficient. This study aimed to explore the association between smoking status, nicotine dependence, and multi-morbidity in China. We recruited 11031 Chinese citizens from 31 provinces in 2021 using a multistage stratified cluster sampling strategy to ensure the study population represented national population characteristics. The association between smoking status and multi-morbidity was analyzed using binary logistic regression and multinomial logit regression models. We then analyzed the associations between four kinds of smoking status (age at smoking initiation, cigarette consumption per day, smoking when ill in bed, and inability to control smoking in public places), nicotine dependence, and multi-morbidity among participants who were current smokers. Compared with non-smokers, the odds of multi-morbidity were higher among ex-smokers (adjusted odd ratio, AOR=1.40, 95% CI: 1.07-1.85). The risk of multi-morbidity was greater in participants who were underweight/overweight/obese (AOR=1.90; 95% CI: 1.60-2.26) compared with those who were normal weight. and also greater for drinkers (AOR=1.34; 95% CI: 1.09-1.63) than non-drinkers. Compared with children who began smoking at the age of <15 years, participants aged >18 years had a lower likelihood of multi-morbidity (AOR=0.52; 95% CI: 0.32-0.83). People who consumed ≥31 cigarettes per day (AOR=3.77; 95% CI: 1.47-9.68) and those who smoked when ill in bed (AOR=1.70; 95% CI: 1.10-2.64) were more likely to have multi-morbidity. Our findings show that smoking behavior, including initiation age, frequency of daily smoking, and still smoking during illness or in public, is a critical risk factor for multi-morbidity, especially when combined with alcohol consumption, physical inactivity, and abnormal weight (underweight, overweight, or obese). This highlights the crucial effect of smoking cessation in the prevention and control of multi-morbidity, especially in patients with three or more diseases. Implementing smoking and lifestyle interventions to promote health would both benefit adults and prevent the next generation from initiating habits that increase the risk of multi-morbidity.

Does prescribing apixaban or rivaroxaban versus warfarin for patients diagnosed with atrial fibrillation save health system costs? A multivalued treatment effects analysis.

Non-valvular atrial fibrillation (AF) is a common heart arrhythmia in the elderly population. AF patients are at high-risk of ischemic strokes, but oral anticoagulant (OAC) therapy reduces such risks. Warfarin had been the standard OAC for AF patients, however its effectiveness is highly variable and dependent on close monitoring of the anticoagulant response. Newer OACs such as rivaroxaban and apixaban address these drawbacks but are more costly. It is uncertain which OAC therapy for AF is cost-saving from the healthcare system perspective. We followed a cohort of patients in Ontario, Canada, aged ≥ 66 who were newly diagnosed with AF and prescribed OACs between 2012 and 2017. We used a two-stage estimation procedure. First, we account for the patient selection into OACs using a multinomial logit regression model and estimated propensity scores. Second, we used an inverse probability weighted regression adjustment approach to determine cost-saving OAC options. We also examined component-specific costs (i.e., drug, hospitalization, emergency department and physician) to understand the drivers of cost-saving OACs. We found that compared to warfarin, rivaroxaban and apixaban treatments were cost-saving options, with per-patient 1-year healthcare cost savings at $2436 and $1764, respectively. These savings were driven by cost-savings in hospitalization, emergency department visits, and physician visits, outweighing higher drug costs. These results were robust to alternative model specifications and estimation procedures. Treating AF patients with rivaroxaban and apixaban than warfarin reduces healthcare costs. OAC reimbursement policies for AF patients should consider rivaroxaban or apixaban over warfarin as the first-line treatment.

Nutritional Vulnerability Transitions among Rural Households in Nigeria

Aims: It has long been considered that specific age/gender groups, such as women and children, are predisposed to nutritional vulnerability. Thus, nutritional vulnerability among agricultural households is neglected and understudied. This study aims at an empirical assessment of nutritional vulnerability dynamics among rural households in Nigeria.&#x0D; Study Design: Secondary data used for this study was waves 2 and 3 of the general household survey panel data. The sampling design consisted of two stages of sampling: the selection of enumeration areas based on probability proportionate to the size of the enumeration areas and the systematic random selection of ten households from each enumeration area. There were 3370 households selected in rural areas and 1630 households selected in urban areas. 2090 rural households with the required information for this study were included in the analysis.&#x0D; Methodology: Descriptive statistics, nutritional vulnerability score, logit regression model, Markov model, and multinomial logit regression models were used to analyse nutritional vulnerability transitions among rural households in Nigeria.&#x0D; Results: Nutritionally vulnerable households in rural Nigeria include those with aged heads, little or no formal education, limited assets, and no access to land or credit. Nutritional vulnerability in rural Nigeria is primarily transient, with around two-fifths of households experiencing transient nutritional vulnerability and nearly one-third experiencing chronic nutritional vulnerability. While the age of the household head, tertiary education, and access to credit all had a substantial impact on transient nutritional vulnerability, gender, tertiary education, asset value, and access to credit all had an impact on chronic nutritional vulnerability.&#x0D; Conclusion: Support mechanisms such as initiatives to promote access to healthy food, credit, land, and education are critical. To successfully address the issues affecting the nutrition and health of persons facing vulnerabilities, social welfare programs with interventions based on the characteristics of each vulnerable group and the predisposing factors should be adopted.