National Representative Survey Research Articles

Trends in hypertension prevalence, awareness, treatment, and control in the Thai population, 2004 to 2020

Abstract Background Under Thailand’s universal health coverage every citizen has access to primary care including free hypertension treatment. This study describes temporal trends in hypertension prevalence, awareness, treatment, and control in Thailand. Methods Data were analyzed from four survey cycles of Thailand’s National Health Examination Survey (NHES), between 2004 and 2019–2020. The NHES is a nationally-representative cross-sectional survey conducted every five years using a multistage probability sample. Hypertension was defined as systolic blood pressure > = 140 or diastolic blood pressure > = 90 mmHg or currently taking antihypertensive medicines; blood pressure control was defined as < 140/90 mmHg for patients without diabetes and < 130/80 mmHg for those with diabetes. Results In 2019–2020, age-standardized hypertension prevalence in Thailand was 25.7% (24.6% females, 26.8% males). Among people with hypertension, 51.5% were aware of their diagnosis, 47.9% were treated, and 22.7% had controlled blood pressure. Age-standardized hypertension prevalence remained relatively unchanged in Thai adults from 2004 to 2019–2020, however trends varied by age group. Hypertension control increased from 8.8% in 2004 to a peak of 30% in 2014 but dropped to 22.7% by 2019–2020. Hypertension awareness increased from 30.7 to 55.8% between 2004 and 2014, but decreased to 51.5% by 2019–2020. Conclusion Hypertension prevalence in Thailand has remained high over the past 15 years. Despite universal health coverage, hypertension awareness has not improved and blood pressure control has decreased in the past five years. An urgent and concerted public health response is needed to improve diagnosis and control of hypertension to prevent avoidable cardiovascular disease.

A Function of Board Diversity? Does Diversity Equip Nonprofit Performance

Nonprofit boards receive plenty of advice about what they “should” do, but many fail to heed the guidance—perhaps due to limited resources, a failure to prioritize, or not realizing the critical linkage between board performance and organizational performance. This research examines diversity in board membership by linking board diversity to organizational performance. We utilize data from a large, representative national survey of nonprofit executives in the United States to examine the diversity of nonprofit boards in terms of visible diversity and inclusive behaviors and practices. Using regression analysis, we find diverse boards have more inclusive governance practices, and board diversity practices are positively related to nonprofit performance. These findings offer fresh evidence about why diversity matters relative to how boards function and their impact on fulfilling their organizational mission. This research contributes to how we think of diversity and inclusion in the nonprofit sector and why it matters beyond representational value.

Estimated human intake of endogenous and exogenous hormones from beef in the United States.

Endogenous and exogenous hormones may be present in beef. Human consumption of hormones has been linked to adverse health effects. To estimate daily intake of hormonal growth promotants (HGP) from beef consumed by the US population. We combined self-reported beef consumption information from a nationally-representative survey with concentrations of 12 HGP measured in 397 samples of retail beef/fat purchased in California. We defined typical, high, and maximum intake scenarios assuming self-reported consumed beef contained the mean, 95th percentile, and maximum concentrations of each HGP, respectively. We estimated distributions of usual (i.e., long-term) daily intake and short-term daily intake (µg/kg/day). We calculated the hazard quotient (HQ), or ratio of estimated intake to the World Health Organization's acceptable daily intake (ADI) for the HGP. The highest estimated HQs were found for melengestrol acetate (MGA). For usual daily intake under the typical intake scenario, no HQ exceeded 0.02 (0.00047 µg MGA/kg/day). Under the maximum intake scenario, the highest HQ was 0.29 (0.0087 µg MGA/kg/day), corresponding to the 99th percentile of intake among young boys (ages 1-5). The highest short-term intake estimates for MGA under the maximum intake scenario were the 99th percentile of intake among young girls and boys, which equaled (HQ = 1.00) or exceeded (HQ = 1.29) the ADI for MGA, respectively. Hormonal growth promotants (HGP) are used to increase beef production and have been linked to adverse reproductive effects. We estimated daily intake of MGA and several other HGP using US nationally-representative beef consumption data collected between 2015-2018 and HGP concentrations in retail beef. Estimated intake was highest for young children, but estimates were generally very low compared to current health-based intake limits. However, these limits are typically based on studies in adult animals, and further study of potential adverse effects during sensitive developmental periods, such as in early life, may be warranted to ensure recommended intake limits are health-protective.

Prevalence of hypercholesterolemia in the elderly and the very elderly members of the Polish population: results of a national cross-sectional representative survey.

Lipid disorders are the most common cardiovascular risk factor among adult population in Poland. However, there is still insufficient epidemiological data for an ever-growing group of older people. The aim was to describe and analyze the epidemiology of lipid disorders among Polish seniors Patients and methods: The random sample of 4101 participants (M = 2136; W = 1965) aged 65-104, equally distributed in age subgroups (65-69, 70-74, 75-79, 80-84, 85-89, and 90(+)-year-old subjects), participated in a cross-sectional, national survey PolSenior. Anthropometric measurements, blood pressure, and blood samples for tests of lipid profile were obtained. 62.4% of Polish seniors (56.1% of men and 66.3% of women) suffered from hypercholesterolemia. TC level was the highest among 65-69-year-olds, both men (206.0 [201.0-210.9] mg/dL) and women (220.6 [215.6-225.6] mg/dL). Women in each age group had a higher TC concentration than men. Also, in terms of LDL-C, the highest level was found in women aged 65-69 years (131.6 [127.2-136.1] mg/dL) and decreased in older age groups to 120.1 [115.2-125.0] mg/dL in women >90 years of age; similar in men: 121.6 [117.3-125.9] mg/dL in 65-69 y. o. and 106.5 [102.5-110.5] mg/dL in the group over 90 years old. In all the respective age groups, LDL-C was higher in women. In the Polish population among the elderly mean serum TC and LDL-C concentrations are higher in women than in men. The results obtained highlight the importance of lipid disorders as a risk factor also among the elderly Poles.

Prevalence and correlates of driving under the influence of alcohol and cannabis among Spanish adolescents.

Driving under the influence (DUI) of substances is the first cause of death among young populations. Unfortunately, there is a paucity of research looking at DUI risk factors in adolescents. This study aimed to estimate the past-year prevalence and correlates of DUI of alcohol (DUI-A), cannabis (DUI-C), and both (DUI-A+C) in adolescents who reported past-year alcohol and cannabis use. The study sample comprised 3,175 [(47.9 % females; Mage (SD) = 16.76 (.70)] Spanish adolescents from a national representative survey (ESTUDES) conducted by the Spanish Ministry of Health. Hierarchical regression models were conducted to identify correlates of DUI-A only, DUI-C only, and both behaviors, including sociodemographic, substance use and parental control variables. Past-year prevalence of DUI was 9.9 % among past-year alcohol and cannabis users. Past-year DUI of substances was more likely among males (15.4 %) relative to females (6 %) [χ2 = 73.39, p = <.001, Φ = .152]. Being male, reporting higher past-month days of cannabis use and cannabis-related problems were common risk factors for DUI-C and DUI-A+C. Risk factors of DUI-A were greater money availability for going out, higher past-month frequency of heavy drinking episodes and lower past-month cannabis use days. Specific correlates of DUI-A+C were being 18, past-year simultaneous alcohol and cannabis use, and earlier age of alcohol use initiation. There is a need to address DUI in substance use prevention in school settings. Screening should be particularly focused on adolescent substance users, while interventions should target attitudes and risk of substance use and driving.

Modelling the potential impact of a tax on fruit juice in South Africa: implications for the primary prevention of type 2 diabetes and health financing

BackgroundSouth Africa is experiencing a persistent growth in non-communicable diseases. Diabetes is among the top ten causes of mortality, especially among women, which is partly driven by high levels of added sugar consumption and obesity. To reduce obesity rates and the incidence of diabetes, South Africa introduced a tax on sugar sweetened beverages (also known as the Health Promotion Levy (HPL)) in 2018. The tax is applicable to sugar-sweetened beverages but excludes 100% fruit juice. The government is currently considering extending the tax to include fruit juices. This study models the potential health and economic impact of taxing fruit juices at 20% of the retail price of one liter.MethodsTo analyze the distributional impact of the tax, this study uses extended cost-effectiveness analysis methodology. Data on price elasticities, healthcare cost, income, fruit juice consumption were sourced from the literature and representative national surveys. The potential impact of the tax on diabetes incidence, prevalence, mortality, and financial benefits were estimated for each income group (lowest, quintile 1 to highest, quintile 5).FindingsWe estimate that a 20% tax on fruit juice would avert 156,640 incident cases of type 2 diabetes mellitus over 20 years, with most disease averted occurring among the first- and fifth-income groups. Averted deaths from diabetes would average 2,000 deaths per quintile (for quintiles 1 to 4) and about 2,800 in quintile 5. The improved health resulting from averted incidence and deaths will reduce overall healthcare expenditure by R7.5 billion over 20 years, of which R2.3 billion will occur in the fifth quintile. The South African government will also save about R300 million in subsidizing diabetes-related healthcare cost as a result of prevention; and would raise R8.6 billion in tax revenues per annum. Out-of-pocket expenditure savings will be R303 million and a financial risk protection (money-metric value of insurance) of R4.6 billion over the 20-year period.ConclusionWe conclude that an HPL that significantly raises the retail price of fruit juices would reduce consumption and diabetes-related morbidity and mortality. The tax will also provide significant financial benefits in the form of reduced healthcare costs for both government and households as well as providing financial risk protection to individuals. Health taxes are win-win policies that improve population health and generate revenue for governments to fund public health services delivery and thus improve overall health financing activities of the government. Therefore, population level disease prevention measures such as health taxes are important for achieving universal health coverage.

Individuals' top values and health behavior engagement: results of a National US Survey.

Although linked with subjective wellbeing, little research has examined relations of values with health behaviors and health. Because values are principles that guide behavior across situations, this exploratory retrospective study examined how individuals' highest value relates to their health behaviors and health. Participants were 3865 (aged 18-89 years) adults who completed the Health Information National Trends Survey (HINTS), a nationally-representative survey administered by the US National Cancer Institute. HINTS 5 Cycle 4 data were collected early in 2020. Participants selected the value most important to them in their day-to-day life from a set of seven values. Five categories of health-related measures were assessed in relation to values: substance use, physical activity, cancer screening, general health, and coping. Top values were safety of family (29.9%), happiness (20.9%), and autonomy (14.1%). Findings indicated that some top values, such as health and religion, were associated favorably with some health behaviors, while other top values, such as happiness or autonomy, were in some instances associated with poorer health behaviors. These results, while exploratory, suggest that individuals' highest value may be meaningfully related to their health behaviors and self-reported health status. Future research into values and health appears warranted.

Who benefits more from the digital economy: (Non-)Cognitive ability and the labor income premium

This study examines how cognitive and non-cognitive abilities affect changes in individual labor income resulting from digitalization in China. Based on data from the China Family Panel Studies, a representative national household survey conducted in 2018 with over 3700 observations, our findings indicate that the digital economy generally increases labor incomes. However, the impact of the digital economy on labor income is related to individuals' ability. The digital economy has a significant positive effect on labor income returns on cognitive ability, while the effect on the non-cognitive premium is insignificant. Our study contributes to understanding the new human capital theory and provides insights for advancing shared prosperity in the digital era.

Pandemic Palliatives and COVID-19 Coping: Toward the Development of a “Coping with Crisis Communications” (COCCO) Scale

ABSTRACT The COVID-19 pandemic underscored the critical role of coping strategies during global crises and demonstrated how official communications shape public responses. This study evaluates the psychometric validity of a novel pentadic “Coping with Crisis Communication” (COCCO) Scale, which categorizes coping behaviors into five behavioral responses: moving-with, moving-against, moving-outward, moving-away, and moving-inward. A national representative survey of 742 Swiss residents, conducted in February 2022, measured these coping responses to official COVID-19 communications from the Swiss Federal Office of Public Health (FOPH) and traditional Swiss news media (TNM). Items were developed to assess how participants engaged with, opposed, reached outward for support, distanced from, or internalized the messages. Confirmatory factor analyses tested multiple models (5-, 6-, 7-, and 8-factor structures) based on both the initial pentadic theory and data-driven refinements. While the original 5-factor model showed insufficient fit, a 7-factor model (moving-with, moving-toward, moving-against, moving-outward, moving-away, negative-moving-inward, positive-moving-inward) provided a satisfactory factor solution. This model exhibited measurement invariance across the three language versions of the scale (French, Italian, German) and across the two communication contexts (FOPH, TNM). The COCCO scale offers an effective, movement-based assessment of coping strategies in response to crisis communications, serving as a valuable tool for understanding public behavior during global crises.

A representative national indoor radon survey in Germany

A representative national indoor radon survey in Germany

Relationship between qualitative and quantitative loneliness and suicidal ideation by occupational classification in the working-age population: a nationally-representative survey

BackgroundRising digitalization and individualism in the workplace after the COVID-19 pandemic have increased loneliness and related problems in the working-age population. The potential effects of various forms of loneliness on suicidal ideation may differ depending on employment status.MethodThis is a cross-sectional study based on a national survey of mental health in the general Korean population. We classified occupations as “employed,” “self-employed,” or “unemployed.” Loneliness was assessed using the UCLA Loneliness Scale, which measures both qualitative and quantitative aspects of loneliness. Suicidal ideation was evaluated using the Patient Health Questionnaire-9.ResultsA total of 1770 participants aged 30–65 years (mean age: 47.7 years) were included. The mean loneliness score was 43.9 (SD = 10.4), and 28% of the participants experienced a high level of loneliness. The prevalence ratio for suicidal ideation in the group with high levels of loneliness was 3.06 (95% CI 2.57, 3.63) compared to the group with low levels of loneliness. In our subgroup analysis, we consistently observed an association between loneliness and suicidal ideation across the employed group; however, the employed was more related with qualitative loneliness, the self-employed and the unemployed were more related with quantitative loneliness.ConclusionsLoneliness was associated with suicidal ideation. According to employment status, the associations were consistent, but there were interactions between type of loneliness and employment status. These findings suggest that interventions to reduce loneliness and prevent suicidal ideation should be tailored to specific employment groups, focusing on qualitative aspects for employed individuals and quantitative aspects for self-employed and unemployed individuals.

Patterns and perceptions of vaping among adults living in social housing: a representative survey in Great Britain, 2023

BackgroundVaping products are effective for helping people to stop smoking and may therefore offer a potential means to reduce high rates of smoking in socioeconomically disadvantaged groups. This study aimed to examine current patterns and perceptions of vaping among people living in social housing in Great Britain compared with those living in other housing types.MethodsData were from the Smoking Toolkit Study; a nationally-representative survey conducted in 2023 (n = 23,245). Logistic regression tested cross-sectional associations between living in social (vs. other) housing and current vaping among adults; vaping frequency, device type, nicotine concentration, and source of purchase among current vapers; use of vaping products as a smoking cessation aid among past-year smokers who tried to quit; and harm perceptions of vaping products relative to cigarettes among current smokers.ResultsCurrent vaping prevalence was twice as high among adults living in social housing (19.4%) compared with those in other housing types (10.4%; OR = 2.07, 95%CI = 1.84–2.33). This was partly explained by differences in sociodemographic characteristics and smoking status; after adjustment, the odds of being a current vaper were 33% higher (ORadj=1.33, 95%CI = 1.14–1.54). Among vapers, there were no notable differences by housing tenure in vaping frequency, main device type used, usual nicotine concentration, usual source of purchase, or use as a smoking cessation aid. However, current smokers living in social housing were more likely to think vaping is more harmful than cigarettes (31.6% vs. 21.8%; ORadj=1.61, 95%CI = 1.30–1.99).ConclusionsIn Great Britain, adults who live in social housing are more likely to vape than those who live in other housing types, even after accounting for their younger age and higher smoking rates. However, misperceptions about the relative harms of vaping products and tobacco are common among smokers living in social housing. Interventions addressing these misperceptions could help encourage more people living in social housing to switch from smoking to vaping and reduce smoking-related health inequalities.Pre-registrationThe study protocol and analysis plan were pre-registered on Open Science Framework (https://osf.io/n3mvs/).

Trends in body mass index for people with and without HIV: Pooled analysis of nationally-representative health surveys from 10 countries and 173,800 adults in Africa.

It remains unclear if and how body mass index (BMI) levels have changed over time in HIV endemic regions. We described trends in mean BMI and prevalence of overweight between 2003-2019 in 10 countries in Africa including people living with (PLWH) and without (PLWoH) HIV. We pooled Demographic and Health Surveys (DHS) from countries where ≥2 surveys >4 years apart were available with height/weight measurements and HIV tests. HIV status was ascertained with a finger-prick dried blood spot (DBS) specimen tested in a laboratory. The DBS is taken as part of the regular DHS procedures. We summarized age and socioeconomic status standardized sex-specific mean BMI (kg/m2) and prevalence of overweight (BMI ≥25 kg/m2) by HIV status. We fitted country-level meta-regressions to ascertain if changes in ART coverage were correlated with changes in BMI. Before 2011, women LWH (22.9 [95% CI: 22.2-23.6]) and LWoH (22.6 [95% CI: 22.3-22.8]) had similar mean BMI. Over time, mean BMI increased more in women LWH (+0.8 [95% CI: 0.7-0.8] BMI units) than LWoH (+0.2 [95% CI: 0.2-0.3]). Before 2013, the mean BMI was similar between men LWH (21.1 (95% CI: 20.3-21.9)) and LWoH (20.8 (95% CI: 20.6-21.1)). Over time, mean BMI increased more in men LWoH (+0.3 [95% CI: 0.3-0.3]) than LWH (+0.1 [95% CI: 0.1-0.1]). The same profile was observed for prevalence of overweight. ART coverage was not strongly associated with BMI changes. Mean BMI and prevalence of overweight were similar in PLWH and PLWoH, yet in some cases the estimates for PWLH were on track to catch up with those for PLWoH. BMI monitoring programs are warranted in PLWH to address the rising BMI trends.

Evaluating Health Canada’s Proposed Front-of-Pack Labelling Policy: Burden of Healthcare Use Attributed to Health Canada’s Proposed Front-of-Pack Labelling Policy

The economic burden of disease due to consumption of poor diet costs billions of dollars annually to the Canadian healthcare system. This project is in response to the growing interest in the use of nutrient profiling systems on front-of-package (FOP) nutrition labels in Canada. There is a high demand for simplified healthy eating messaging. Health Canada announced improving food environments is a priority in the Healthy Eating Strategy and will implement the mandatory FOP label policy in 2026. Two Ontario-based studies examined the impacts of health behaviors (smoking, alcohol consumption, poor diet and physical inactivity) attributed to hospital bed-days and costs. They found 36% of hospital use was attributable to all health behaviours resulting in 900,000 bed-days annually. Between 2004-2013, 22% of healthcare costs totalling $89.4 billion were attributable to the four health behaviours. These are likely underestimates as diet was measured based on fruit/vegetables frequency. The objective is to evaluate Health Canada’s Proposed FOP policy on hospital bed-days. Detailed dietary data from the nationally representative cross-sectional national survey data Canadian Community Heath Survey-Nutrition 2004 linked to Discharge Abstract Database (2004-14) for hospital use will be used for analysis. Data-driven methodology will be employed and development of multivariable risk models using zero-inflated negative binomial regression with multiple exposure groups to test a dose-response. Results are undergoing, will be ready September 2024. This is the first study to analyze Health Canada’s proposed FOP policy related to economic outcomes. These findings will provide evidence-based recommendations to policymakers on nutrition policy.

The Quality of Society and Happiness: Fairness, Trust, and Community in China

Adam Smith argued that ‘moral sentiments’ – the norms, customs and conventions of society - provide a benefit, improving both economic efficiency and well-being. Three important moral sentiments are a perception of fairness, a willingness to trust people, and a sense of community. We analyse representative national socioeconomic surveys of the China Household Income Project (CHIP), containing information that is used to create scores of happiness, fairness, trust, and community for each respondent. Three main hypotheses are tested: that higher reported fairness, higher reported trust, and greater sense of community each raises happiness. Evidence is found for each hypothesis, as well as for related questions, Attempts are made to ascertain whether the associations are causal; some support is found. The evidence is generally consistent with the broader argument that an informal social contract constrains antisocial behaviour and improves wellbeing in ways little studied by economists.

Associations Between Opioid and Kratom Use in the USA: Differences by Race/Ethnicity and Sexual Orientation.

Kratom is federally unregulated and is marketed as an opioid alternative despite limited evidence and known negative effects. Disparities in associations between opioid and kratom use may be partly attributed to race/ethnicity and sexual orientation given differences in marketing, use motives, and prescriber practices. Data: 2021 nationally representative National Survey on Drug Use and Health among individuals aged 18 + . We used weighted logistic regression analyses to assess race/ethnicity and sexual orientation as moderators of associations between past-year opioid (1) use (total sample, n = 44,877) and (2) misuse and use disorder (among those with past-year opioid use, n = 10,398) and the outcome of kratom use (lifetime, past year). 26.76% reported past-year opioid use, and among those, 12.20% and 7.54% reported past-year opioid misuse and use disorder, respectively; 1.72% and 0.67% had lifetime and past-year kratom use, respectively. Opioid use was positively associated with lifetime (aOR = 2.69, 95%CI = 1.98, 3.66) and past-year (aOR = 3.84, 95%CI = 2.50, 5.92) kratom use; associations among non-Hispanic Black and Hispanic (vs. non-Hispanic White) participants were weaker (p < 0.01). Among participants reporting past-year opioid use, misuse and use disorder were positively associated with lifetime (aORmisuse = 2.46, 95%CI = 1.60, 3.78; aORuse disorder = 5.58, 95%CI = 2.82, 11.04) and past-year (aORmisuse = 2.40, 95%CI = 1.26, 4.59; aORuse disorder = 3.08, 95%CI = 1.48, 6.41) kratom use; among bisexual (vs. heterosexual) participants, opioid use disorder was associated with a lower probability of lifetime kratom use (p < 0.01). We observed positive associations between opioid and kratom use, with potential disparities among certain racial/ethnic and sexual orientation groups. Research should examine the mechanisms contributing to these differences to inform prevention and intervention efforts.

Sex differences in tobacco use, attempts to quit smoking, and cessation among dual users of cigarettes and e-cigarettes: Longitudinal findings from the US Population Assessment of Tobacco and Health Study

SignificanceA growing number of adults use more than one tobacco product, with dual use of cigarettes and e-cigarettes being the most common combination. Monitoring sex disparities in tobacco use is a public health priority. However, little is known regarding whether dual users differ by sex. MethodsData came from Waves 4–6 (12/2016–11/2021) of the Population Assessment of Tobacco and Health Study, a US nationally-representative longitudinal survey. This analysis included current adult dual users of cigarettes and e-cigarettes. We used weighted generalized estimating equations to assess the association between sex and (1) making a cigarette quit attempt (n = 1882 observations from n = 1526 individuals) and (2) smoking cessation (n = 2081 observations from n = 1688 individuals) across two wave pairs, adjusting for age, education, ethnicity, time-to-first cigarette after waking, and e-cigarette use frequency. ResultsAmong US dual users, 14.1% (95% Confidence Intervals [Cl] = 11.9–16.4) of females and 23.4% (20.0–26.9) of males were young adults (aged 18–24), 11.7% (9.2–14.2) of females and 14.4% (11.6–17.2) of males had <high school education, and 82.2% (79.4–84.5) of females and 78.7% (75.1–82.4) of males were white. Overall, 44.9% (41.6–48.1) of females compared with 37.4% (33.5–41.3) of males made an attempt to quit smoking between a baseline and follow-up wave (Adjusted Risk Ratio [ARR] = 1.23, 1.05–1.45). In contrast, there were no apparent differences between females (22.1%, 19.0–25.2) and males (24.3%, 21.5–27.1) in smoking cessation (ARR = 1.06, 0.84–1.35). ConclusionUS females who dually use e-cigarettes and cigarettes were more likely to attempt to quit smoking, but not more likely to succeed at quitting, than males.

Social ties and food insecurity in woman‐headed households

AbstractFood insecurity is a global concern, as set in the Sustainable Development Goal 2. Previous research has focused on the demographics and socioeconomic determinants of food insecurity, while little attention has been paid to the role of social ties. Using a national representative survey of Chile, that includes a questionnaire to measure prevalence of food insecurity and 11 social ties, we estimate the prevalence of four groups using a sample of 70,677 households. Then, we focus on the sub‐sample of 29,203 woman‐headed households, who experience the largest food insecurity prevalence. We use a descriptive analysis, followed by a principal component analysis to aggregate 11 social ties in fewer components to assess the associations between social ties and food insecurity and to identify the ties with stronger impact. The results show that woman‐headed households, without a partner, have a prevalence of moderate or severe food insecurity of 32.8%, 30.9%, 24.7%, after none, one and two social ties, respectively. This decreasing trend is also observed in woman‐headed households with partners. We also found that the 11 social ties studied are highly correlated among them; they can be explained by two indexes—economic and education components. In particular, we found that economic and educational social ties are associated to a larger effect on food insecurity prevalence. This study provides evidence for policy‐makers regarding investment on social ties to tackle food insecurity.

Utilization of Dental Care and Oral Health Outcomes in the United States: Results from the National Health and Nutrition Examination Survey (2017-2020).

This analysis aims to evaluate the association between the time since and reason for a patient's last dental appointment across clinical oral health outcomes. We used data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally-representative survey of noninstitutionalized US adults. The predictors were the time since and the reason for the last dental appointment (routine vs. urgent). We examined the presence and number of missing teeth and teeth with untreated coronal and root caries. Multivariable regression models with interaction were used to assess the association between the time since the last dental appointment and clinical oral health outcomes among routine and urgent users separately. Two-thirds of the US population had a dental appointment within a year, while nearly 44 million individuals did not visit a dentist for the last three years. The odds of having teeth with untreated coronal or root caries increased with the length of time since the last appointment, and urgent users had worse dental outcomes compared to routine users. Compared to those who had a dental appointment within a year, individuals who had their last dental appointment more than 3 years ago had 2.94 times the average number of teeth with untreated caries among routine users (95%CI=2.39, 3.62) and 1.60 times the average among urgent users (95%CI=1.05, 2.43). Recent, routine dental appointments are associated with improved oral health outcomes. The outcomes reiterate how social determinants of health impact access to oral health care and oral health outcomes.

Micronutrient deficiencies and the double burden of malnutrition in Vietnamese female adolescents: a national cross-sectional study in 2020

Vietnam is facing a double burden of malnutrition, with increasing prevalence of overweight coexisting with undernutrition (stunting and/or thinness) and micronutrient deficiencies (MNDs). Although malnutrition during female adolescence leads to poor health outcomes with potential intergenerational effects on offspring, no studies have comprehensively investigated MNDs and nutritional status among contemporary Vietnamese female adolescents. Data from 10- to 18-year-old female participants (n=1471) in the nationally-representative Vietnam General Nutrition Survey 2020 were analysed. Blood nutritional biomarkers, anthropometric measurements, and sociodemographic data were collected, and associations between nutrition status and MNDs were analysed; with anaemia, iron deficiency (ID), iron deficiency anaemia, low serum zinc, low serum retinol, and any MNDs as specified outcomes. Prevalence of overweight, stunting, and thinness was 27.2%, 14.3%, and 6.9%, respectively. Low serum zinc was common (39.8%), as was ID (13.4%). Bivariate analyses showed that older age (16-18 years old), ethnic minority status, lower wealth index, and inflammation were associated with MNDs. In adjusted logistic regressions, stunting was associated with increased odds ratio and [95% confidence intervals] of low serum retinol (8.92 [2.26, 35.15], p<0.01), as was thinness (12.25 [3.47, 43.33], p<0.01). Stunting was also associated with increased odds of having any MND (2.06 [1.31, 3.25], p<0.01). More female adolescents were overweight than undernourished in Vietnam in 2020. However, undernutrition, low serum zinc, and ID remain prevalent. Food systems approaches should be considered to stem the stark increase in the double burden of malnutrition in young people living in Vietnam. UK BBSRCBB/T008989/1.