Repeated Cross-sectional Data Research Articles

Reaching women at work with health programming in Bangladesh: results of difference-in-differences analysis among female factory workers

The rapid growth of Bangladesh’s ready-made garment sector has transformed the country’s economy while also employing a predominantly female workforce. Companies have begun collaborating with NGOs to provide health messages to and expand health services for workers. This study evaluates the effect of the Health Enables Return (HER) health model’s approach of using peer health educators to deliver health messages and increased availability of health products. Using repeated cross-sectional data from female workers in HERhealth and comparison factories between May 2015 and March 2017, baseline (n = 1704) and endline (n = 1503) samples were matched on eight characteristics and then difference-in-differences estimations were used to determine the effect of the HERhealth model on knowledge and behaviours. The average changes over time in knowledge and behaviours were statistically different between the HERhealth and comparison factories. Knowledge of when a woman is at higher risk for pregnancy during her menstrual cycle increased from baseline to endline in both groups but was 12 percentage points greater in the HERhealth factories than in the comparison. An increase in family planning use among ever-married women was observed in the HERhealth factories but decreased in the comparison factories leading to a 12 percentage point difference-in-differences. The greatest effect of the HERhealth model was observed on women’s use of sanitary products for menstrual management which significantly increased in both groups, but the increase was 35% greater in the HERhealth factories. The HERhealth model is effective in increasing knowledge and in improving health behaviours when health products are available in factory infirmaries.

Foodwork in the United Kingdom from 1983 to 2014: A compositional data analysis of repeat cross-sectional time use surveys

BackgroundWhile foodwork (tasks required to access food, including home food preparation) in the UK declined toward the end of the 20th century, it is not known whether this trend has continued into the 21st century. While evidence suggests many people feel they lack the time to cook, it is not known whether this is attributable to increasing demands on their time. MethodsAnalysis of repeat cross-sectional data from three UK time use surveys: 1983, 2000 and 2014; participants aged 19+ (N = 14,810). We analysed changes in foodwork participation across survey years using linear regression, adding interaction terms to determine whether trends varied between different socio-demographic groups. We categorized time use over 24 h into eight parts, forming a composition: (1) personal care; (2) sleep; (3) eating; (4) physical activity; (5) leisure screen time; (6) work (paid and unpaid); (7) socialising and hobbies; and (8) foodwork. We examined whether the time-use composition varied across survey years, testing for interactions with socio-demographic characteristics. ResultsFoodwork declined significantly between 1983 and 2014. However, a concurrent increase in time spent on work was not observed. Instead, time spent on sleep and screen time increased significantly. The decline in foodwork was significant among women but not among men. ConclusionWhile many people in the UK continue to allocate time to foodwork on a daily basis, foodwork has continued to decline into the 21st century, though there was no concurrent increase in time being allocated to work, suggesting external and non-discretionary demands on time have not increased. Practitioners seeking to address a lack of time as a barrier to foodwork may wish to accommodate a broad definition of what this could mean.

Taxed and untaxed beverage intake by South African young adults after a national sugar-sweetened beverage tax: A before-and-after study.

In an effort to prevent and reduce the prevalence rate of people with obesity and diabetes, South Africa implemented a sugar-content-based tax called the Health Promotion Levy in April 2018, one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100 ml). This before-and-after study estimated changes in taxed and untaxed beverage intake 1 year after the tax, examining separately, to our knowledge for the first time, the role of reformulation distinct from behavioral changes in SSB intake. We collected single-day 24-hour dietary recalls from repeat cross-sectional surveys of adults aged 18-39 years in Langa, South Africa. Participants were recruited in February-March 2018 (pre-tax, n = 2,459) and February-March 2019 (post-tax, n = 2,489) using door-to-door sampling. We developed time-specific food composition tables (FCTs) for South African beverages before and after the tax, linked with the diet recalls. By linking pre-tax FCTs only to dietary intake data collected in the pre-tax and post-tax periods, we calculated changes in beverage intake due to behavioral change, assuming no reformulation. Next, we repeated the analysis using an updated FCT in the post-tax period to capture the marginal effect of reformulation. We estimated beverage intake using a 2-part model that takes into consideration the biases in using ordinary least squares or other continuous variable approaches with many individuals with zero intake. First, a probit model was used to estimate the probability of consuming the specific beverage category. Then, conditional on a positive outcome, a generalized linear model with a log-link was used to estimate the continuous amount of beverage consumed. Among taxed beverages, sugar intake decreased significantly (p < 0.0001) from 28.8 g/capita/day (95% CI 27.3-30.4) pre-tax to 19.8 (95% CI 18.5-21.1) post-tax. Energy intake decreased (p < 0.0001) from 121 kcal/capita/day (95% CI 114-127) pre-tax to 82 (95% CI 76-87) post-tax. Volume intake decreased (p < 0.0001) from 315 ml/capita/day (95% CI 297-332) pre-tax to 198 (95% CI 185-211) post-tax. Among untaxed beverages, sugar intake increased (p < 0.0001) by 5.3 g/capita/day (95% CI 3.7 to 6.9), and energy intake increased (p < 0.0001) by 29 kcal/capita/day (95% CI 19 to 39). Among total beverages, sugar intake decreased significantly (p = 0.004) by 3.7 (95% CI -6.2 to -1.2) g/capita/day. Behavioral change accounted for reductions of 24% in energy, 22% in sugar, and 23% in volume, while reformulation accounted for additional reductions of 8% in energy, 9% in sugar, and 14% in volume from taxed beverages. The key limitations of this study are an inability to make causal claims due to repeat cross-sectional data collection, and that the magnitude of reduction in taxed beverage intake may not be generalizable to higher income populations. Using a large sample of a high-consuming, low-income population, we found large reductions in taxed beverage intake, separating the components of behavioral change from reformulation. This reduction was partially compensated by an increase in sugar and energy from untaxed beverages. Because policies such as taxes can incentivize reformulation, our use of an up-to-date FCT that reflects a rapidly changing food supply is novel and important for evaluating policy effects on intake.

A comparison of repeat cross-sectional and longitudinal results from the COMPASS study: design considerations for analysing surveillance data over time

ABSTRACT Selection of appropriate study design and analytical methods is critical for producing robust research, as the design and analytical approach used can ultimately shape results and their interpretation. The objective of this research was to examine how findings from a large repeat cross-sectional data system compare to those from a sample of longitudinal data nested within the same data system, using milk and milk alternative consumption as a case study. Overall, the repeat cross-sectional and longitudinal findings were consistent, and this article highlights the strengths and limitations of both methodologies under examination. Application to social research and public health and policy are discussed.

Estimating Poverty Transitions in Turkey Using Repeated Cross-Sectional Data

In order to fight poverty more effectively, it is vital to determine the extent to which households are chronic or transient poor. In this context, this paper has two aims. The first is to estimate poverty transition between 2006 and 2016 in Turkey using a newly developed synthetic panel method. With this method, the transition of poverty between two-time points can be estimated without the need for real panel data. The second aim of the study is to test how well this method works. To this end, the analysis has been performed once again by using real panel data for the years 2006-2009 and 2013-2016. The findings show that the percentage of households those who chronically poor is between 3.9% and 10.7%, the percentage of those who escaped from poverty is between 12.1% and 20.8% and the percentage of those who fall into poverty is between 5.4% and 12.2%. The analysis with actual panel data has revealed that the method works quite well.

Evaluating the Impact of the Healthy Kids Community Challenge (HKCC) on Physical Activity of Older Youth.

(1) Background: The Healthy Kids Community Challenge (HKCC) was a community-based obesity prevention intervention funded by the Government of Ontario (Canada). (2) Methods: A quasi-experimental design was used to examine the impact of the HKCC on physical activity (PA) outcomes using both repeat cross-sectional (T1 2014–2015, n = 31,548; T2 2015–2016, n = 31,457; and T3 2016–2017, n = 30,454) and longitudinal data (n = 3906) from the COMPASS study. Grade 9–12 students in HKCC communities were placed into one of three intervention groups [T2 data collection post-HKCC finishing (IG1), T2 data collection during HKCC (IG2), and T2 data collection pre-HKCC starting (IG3)], Ontario students in non-HKCC communities were Control Group 1 (CG1) and Alberta students were Control Group 2 (CG2). (3) Results: Repeat cross-sectional results show over time the HKCC had no significant impact on PA outcomes in any of the intervention groups. Longitudinal results show a significant decrease in time spent in moderate-to-vigorous PA (IG2: −3.15 min/day) between T1 and T3 in IG2. (4) Conclusions: These results suggest the HKCC did not have an impact on improving PA outcomes among older youth in HKCC communities. Moving forward, there is a need to provide effective and sustainable interventions to promote PA among older youth.

Trends in Jewish Young Adult Experiences and Perceptions of Antisemitism in America from 2017 to 2019

Since 2016, a series of horrific acts motivated by antisemitism appear to have caused a fundamental shift in the prevalence of antisemitism in the United States. Little is known, however, about how the events during this time have affected the day-to-day experiences and concerns of American Jews. Using repeated cross-sectional data from surveys of Jewish young adults who applied to Birthright Israel, this paper analyzes recent trends in Jewish young adults’ experiences and perceptions of antisemitism. Despite the high-profile incidents during this period, there is no evidence of a major increase in experiences of antisemitic harassment among Jewish young adults—either on or off campus—between 2017 and 2019. At the same time, data show a substantial increase in concerns among young Jews about antisemitism in the United States and on college campuses, with concerns about antisemitism in the United States (but not on campus) being especially concentrated among liberal Jews. These results suggest that Jewish concerns about antisemitism are linked to broader views about the climate for marginalized populations in the United States. They also point to growing Jewish anxieties over violence, safety, and acceptance in the United States. In an era of widely disseminated antisemitic conspiracy theories, even young Jews who have no first-hand experience of antisemitic harassment have become concerned.

Public health insurance and birth outcomes: evidence from Punjab, Pakistan

Public health insurance targeted towards low-income households has gained traction in many developing countries. However, there is limited evidence as to the effectiveness of these programs in countries where institutional constraints may limit participation by the eligible population. This paper evaluates a recent health insurance initiative introduced in Pakistan and discusses whether eligibility for the programme improves maternal health seeking behaviour. The Prime Minister National Health Program provides free insurance coverage to low-income families. The programme is in the early phases of implementation and has, since 2016, only been rolled out in a few eligible districts within the country. This allows for a comparison of eligible households in districts where the programme has been introduced to those that are eligible to receive insurance at a future date. Using repeated cross-sectional data from multiple rounds of representative household survey, a difference-in-difference model has been estimated. Results show that at least for a specific beneficiary group (i.e. pregnant women), there has been a positive increase in utilization of hospital services. Furthermore, we provide evidence using mother fixed effects that the programme increased the likelihood of a child's birth being documented. Since possession of a birth certificate can secure civic rights for a child, this is an unintended but positive outcome of the programme.

What are the temporal dynamics of taste?

While the social-structural construction of cultural taste has been a sustained subject of inquiry within the sociology of culture, its temporal dynamics have not received the same treatment. Using repeated cross-sectional survey data (1982-2012) and a novel age-period-cohort estimation strategy that treats cohort effects as age-by-period interaction effects, we detail how (a) age-graded trajectories, (b) historic fluctuations, and (c) generational acculturation jointly determine the temporal dynamics of cultural omnivorousness among Americans. First, we find that omnivorousness accumulates over the life-course in age-graded trajectories. Individuals experience their peak levels of omnivorousness in the mid-to-late stages of adulthood. Taste acquisition is most rapid in the early phases of adulthood, and slows down towards the late phases of adulthood. Second, omnivorousness is subject to unpredictable historic fluctuations. Sharp increases in the 1990s recess and stabilize in the two decades to follow. Third, generational acculturation affects omnivorousness in uneven ways. Baby boomers experience higher than expected levels of omnivorousness, while the cohorts preceding and succeeding the Baby Boomers instead experience lower than expected levels of omnivorousness. Generational acculturation may also manifest most strongly in the early and late stages of adulthood. Our results imply that any temporal analysis of culture cannot avoid dealing with the age, period and cohort identification problem, that the period affect associated with the 1992 wave of the SPPA persists even in an age-period-cohort analysis, and that generational differences are endogenous to any time-invariant index of cultural taste.

A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres

BackgroundAs dietary behaviours developed during early childhood are known to track into adulthood, interventions that aim to improve child nutrition at a population level are recommended. Whilst early childhood education and care (ECEC) is a promising setting for interventions targeting children’s nutrition behaviours, previous interventions have largely used high intensity, face-to-face approaches, limiting their reach, implementation and potential impact at a population level. Web-based modalities represent a promising means of supporting the delivery of childcare-based interventions whilst overcoming challenges of previous approaches; however, the feasibility of using such modalities to support implementation is largely unknown. As such, this study sought to collect feasibility and pilot data to inform the design of a web-based intervention together with health promotion officer support within childcare centres. Child dietary intake will also be assessed to provide an estimate of the impact of the implementation intervention.MethodsA superiority cluster randomised controlled trial with repeat cross-sectional data collection employing an effectiveness-implementation type-II hybrid design will be conducted with childcare centres within the Hunter New England region of New South Wales, Australia. Type-II hybrid designs provide the opportunity to assess intervention efficacy whilst piloting the feasibility of the implementation strategies. Centres allocated to the intervention group will receive access to a web-based program together with health promotion officer support to implement targeted healthy eating practices to improve child diet in care. A number of outcomes will be assessed to inform the feasibility to conduct a larger trial, including childcare centre and parent recruitment and consent rates for each component of data collection, uptake of the implementation strategies, acceptability of the intervention and implementation strategies, appropriateness of the implementation strategies and the contextual factors influencing implementation.DiscussionThis study will provide high-quality evidence regarding the potential feasibility of a web-based intervention and the impact of healthy eating practices on child diet in care. Web-based modalities provide a promising approach for population-wide implementation support to childcare centres given their potential reach and consistency with existing infrastructure.Trial registrationProspectively registered with Australian New Zealand Clinical Trial Registry (ACTRN12619001158156).

Trends in youth e-cigarette and cigarette use between 2013 and 2019: insights from repeat cross-sectional data from the COMPASS study

ObjectivesE-cigarettes are an increasingly popular product among youth in Canada. However, there is a lack of long-term data presenting trends in use. As such, the objective of this study was to examine trends in e-cigarette and cigarette use across various demographic characteristics between 2013 and 2019 among a large sample of secondary school youth in Canada.MethodsUsing repeat cross-sectional data from a non-probability sample of students in grades 9 to 12, this study explored trends in the prevalence of ever and current e-cigarette use and cigarette smoking between 2013–2014 and 2018–2019 in British Columbia, Alberta, Ontario, and Quebec. Trends in ever and current e-cigarette use and cigarette smoking were studied across demographic variables among students in Ontario.ResultsThe prevalence of e-cigarette ever and current use was variable across province and increased over time, particularly between 2016–2017 and 2018–2019. In contrast, the prevalence of current cigarette smoking was relatively stable over the study period, decreasing significantly in Alberta and Ontario between 2017–2018 and 2018–2019. In Ontario, the prevalence of ever and current e-cigarette use increased among all grades, both genders, and all ethnicities.ConclusionConsistent with data from the United States, the prevalence of e-cigarette use among our large sample of Canadian youth has increased substantially in a short period of time. Surveillance systems should continue to monitor the prevalence of tobacco use among youth. Additional interventions may be necessary to curb e-cigarette use among Canadian youth.

Association of alcohol control policies with adolescent alcohol consumption and with social inequality in adolescent alcohol consumption: A multilevel study in 33 countries and regions

Background Previous research found inconsistent associations between alcohol control policies and socioeconomic inequality with adolescent drinking outcomes. This study expands the focus beyond individual associations to examine whether a combination of policies is related to socioeconomic inequality in adolescent drinking outcomes and whether this relationship varies across survey years.Methods Multilevel modelling of 4 waves of repeat cross-sectional survey data (2001/02, 2005/06, 2009/10, and 2013/14) from the Health Behaviour in School-aged Children (HBSC) study was carried out. The sample was composed of 671,084 adolescents (51% girls) aged 11, 13, and 15 (mean age=13.58; SD=1.65) from 33 European and North American countries/regions. The dependent variables were lifetime alcohol consumption, weekly alcohol consumption, and lifetime drunkenness. Independent variables were of three types: individual-level variables (age, sex, Family Affluence Scale, and the Perceived Family Wealth), time-level variable (survey year), and context-level variables (minimum legal drinking age, physical availability, advertising restrictions, a total alcohol policy index, and affordability of alcohol).Results The total alcohol policy index showed a negative relationship with both lifetime and weekly consumption. Higher affordability of alcohol was related to higher lifetime and weekly consumption and higher lifetime drunkenness. Family Affluence Scale was positively related to all three alcohol measures and Perceived Family Wealth was negatively related to lifetime drunkenness, with these associations increasing across survey years. The total alcohol policy index buffered the associations of Family Affluence Scale and Perceived Family Wealth with adolescent drinking outcomes.Conclusion A combination of alcohol control policies is more effective in reducing adolescent drinking outcomes than single policy measures. Reducing the affordability of alcohol stood out as the most successful single measure. Socioeconomic inequalities (i.e. higher alcohol consumption and drunkenness in adolescents with higher family affluence and higher drunkenness in adolescents perceiving their families to be poor) have persisted and even increased across survey years. A combined alcohol control policy can help in tackling them.

Could “holistic” area-based regeneration be effective for health improvement?

Regeneration is intended to tackle the negative effects of area disadvantage. Studies of health impacts of regeneration over thirty years have produced mixed and inconsistent results. This study translates the theory of wider determinants of health into a framework of five residential environments that may be impacted by regeneration: physical; services; economic; social; and psychosocial. It uses repeat cross-sectional survey data across a decade to assess differential change in physical and mental health for residents of regeneration areas compared with other areas. Across the deprived areas in the study, all five types of environment are associated with mental health, but associations are fewer and less consistent for physical health. The results indicate a small negative association between living in a regeneration area and physical health and a modest positive association with mental health. Suggestions are made for how regeneration might become more holistic and effective as a public health intervention.

Using repeated cross-sectional data to examine the role of immigrant birth-country networks on unemployment duration: an application of Guell and Hu (2006) approach

Guell and Hu (J Econom 133:307–341, 2006) propose a robust econometric estimator using repeated cross-sectional data in the context of duration/survival analysis where otherwise limited or no results are possible because reliable panel data at an individual level are missing. We present a detailed exposition of the Guell and Hu (GH) strategy and show a Monte Carlo simulation for unemployment duration where the GH method produces better estimates compared to panel data with individual matching errors. We further apply the GH model to examine the immigrant unemployment duration in the USA using the Current Population Survey data from 2001 to 2013 and focus on the role of the birth-country networks on the unemployment duration around the Great Recession. We find that birth-country networks measured at the state level significantly lower unemployment duration for all immigrants, and this effect is stronger during the pre- and post-recession periods than during the recession. We also find that networks are more effective in lowering duration for immigrants unemployed for 1–2 months than for immigrants who are unemployed for longer periods, and this effect is the strongest during the post-recession period. The findings are robust to different specifications and measures of networks including those measured at the local MSA level.

Endogenous Selection Bias and Cumulative Inequality over the Life Course: Evidence from Educational Inequality in Subjective Well-Being

Abstract According to theories of cumulative (dis-)advantage, inequality increases over the life course. Labour market research has seized this argument to explain the increasing economic inequality as people age. However, evidence for cumulative (dis-)advantage in subjective well-being remains ambiguous, and a prominent study from the United States has reported contradictory results. Here, we reconcile research on inequality in subjective well-being with theories of cumulative (dis-)advantage. We argue that the age-specific endogenous selection of the (survey) population results in decreasing inequalities in subjective well-being means whereas individual-level changes show a pattern of cumulative (dis-)advantage. Using repeated cross-sectional data from the European Social Survey (N = 15,252) and employing hierarchical age-period-cohort models, we replicate the finding of decreasing inequality from the United States with the same research design for Germany. Using panel data from the German Socio-Economic Panel Study (persons = 47,683, person-years = 360,306) and employing growth curve models, we show that this pattern of decreasing inequality in subjective well-being means is accompanied by increasing inequality in intra-individual subjective well-being changes. This pattern arises because disadvantaged groups, such as the low educated and individuals with low subjective well-being show lower probabilities of continuing to participate in a survey and because both determinants reinforce each other. In addition to allowing individual changes and attrition processes to be examined, the employed multi-cohort panel data have further key advantages for examining inequality in subjective well-being over the life course: They require weaker assumptions to control for period and cohort effects and make it possible to control for interviewer effects that may influence the results.

Community sentiment following the Deepwater Horizon oil spill disaster: A test of time, systemic community, and corrosive community models

Abstract A fundamental concern in the social science scholarship on disasters is understanding community impacts and recovery as a social process. This study examines community sentiment in the aftermath 2010 BP Deepwater Horizon oil spill (DHOS), including the influence of time and the explanatory utility of two major theoretical perspectives—the systemic community model and the corrosive community model—in predicting community sentiment in the context of this disaster. Specifically, our objectives are to assess how community sentiment in the wake of the DHOS: 1) changes over time; 2) is related to the systemic model; and 3) is related to the corrosive model. To meet these objectives, we analyze four waves of data from a unique repeated cross-sectional household survey data—the Louisiana Community Oil Spill Survey (COSS)—collected between 2010 and 2013. Our results demonstrate that 1) accounting for other factors, community sentiment community sentiment was significantly greater in later time periods compared to 2010, and 2) the simultaneous and complimentary utility of the systemic and corrosive community frameworks for understanding community sentiment in the wake of the DHOS.

Preventing violence against children in schools (PVACS): protocol for a cluster randomised controlled trial of the EmpaTeach behavioural intervention in Nyarugusu refugee camp

BackgroundWe aim to test the effectiveness of the EmpaTeach intervention to prevent physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania. EmpaTeach is a 10-week, 14-session, classroom management and cognitive-behavioural therapy-based intervention for groups of teachers for delivery by lay personnel in resource-constrained settings.MethodsWe will conduct a two-arm cluster randomized controlled trial (RCT) with parallel assignment and an approximately 1:1 allocation ratio. All primary and secondary schools in Nyarugusu will be invited to participate. Whole schools will be stratified according to whether they are Congolese or Burundian, and primary or secondary schools, then randomised to active intervention or wait-list control conditions via a public meeting with headteachers. We will collect survey data from n = 500 teachers and at least n = 1500 students before the intervention, soon after, and at least 6 months after the end of the intervention. The primary outcome measure will be students’ self-reports of experience of physical violence from school staff in the past week, measured using a modified version of the International Society for the Prevention of Child Abuse and Neglect Screening Tool-Child Institutional at the first follow-up after the intervention. Secondary outcomes include emotional violence, depressive symptoms and educational test scores. Analysis will be intention to treat, using repeat cross-sectional data from individuals.DiscussionIf successful, the EmpaTeach intervention would represent one of a handful of proven interventions to reduce violence from teachers to students in any setting. IRC provides an immediate platform for scale up of the intervention via its current work in more than 40 conflict-affected countries.Trial registrationNCT03745573, registered November 19, 2018 at clinicaltrials.gov, https://clinicaltrials.gov/ct2/show/NCT03745573.

Assessing the determinants and drivers of multidimensional energy poverty in Ghana

Improving household access and use of clean energy has been central to global development efforts in recent years. The negative effects of energy poverty on health, climate, livelihoods and economy has led to increased investments towards achieving universal access to clean energy. However, significant deprivations in clean energy remains, especially in developing countries. Energy poverty may involve simultaneous deprivations on availability and affordability of clean energy. Using repeated cross-sectional data, this paper assesses the extent and determinants of multidimensional energy poverty in Ghana between 2008 and 2014. The paper finds that though the level of multidimensional energy poverty reduced in Ghana between 2008 and 2014, the incidence and intensity of multidimensional energy poverty remains high. Further, we find substantial subgroup differences in multidimensional energy poverty. The results reveal significant relationships between household characteristics and the multidimensional energy poverty status of households. The reductions in multidimensional energy poverty were driven by the coefficient effects attributable to structural and policy changes over the period. To facilitate universal access to clean energy and reduce the degree of multidimensional energy poverty, there is the need to intensify the LPG promotion campaign and adopt strategies that target left-behind and underserved groups.

School Feeding Reduces Anemia Prevalence in Adolescent Girls and Other Vulnerable Household Members in a Cluster Randomized Controlled Trial in Uganda

ABSTRACTBackgroundFood for education (FFE) programs that include school meals are widely used to improve school participation and performance, but evidence on nutritional benefits is limited.ObjectiveThis study tested whether food fortified with multiple micronutrients provided in FFE programs reduced anemia prevalence of primary-school-age adolescent girls, adult women, and preschool children.MethodsThrough the use of a cluster randomized controlled trial with individual-level repeated cross-sectional data, we measured impacts on anemia prevalence from 2 FFE programs, a school feeding program (SFP) providing multiple-micronutrient-fortified meals and a nutritionally equivalent take-home ration (THR). Camps for internally displaced people (IDP) (n = 31) in Northern Uganda were randomly assigned to SFP, THR, or a control group with no FFE. Rations were provided for 15 mo at SFP and THR schools. A survey of households (n = 627) with children aged 6–17 y was conducted (baseline and 18 mo later). Analyses used difference-in-differences by intent to treat.ResultsAdolescent girls aged 10–13 y in FFE schools experienced a significant (P < 0.05) 25.7 percentage point reduction (95% CI: −0.43, −0.08) in prevalence of any anemia [hemoglobin (Hb) <11.5 g/dL, age 10–11 y; Hb <12 g/dL, age 12–13 y] and a significant 19.5 percentage point reduction (95% CI: −0.35, −0.04) in moderate-to-severe anemia (Hb <11 g/dL) relative to the control group, with no difference in impact between SFP and THR. The THR reduced moderate-to-severe anemia prevalence (Hb <11g/dL) of adult women aged ≥18 y (12.8 percentage points, 95% CI: −0.24, −0.02). All IDP camps initially received micronutrient-fortified rations through a separate humanitarian program; in one district where most households stopped receiving these rations, SFP reduced moderate-to-severe anemia of children aged 6–59 mo by 22.1 percentage points (95% CI: −0.42, −0.02).ConclusionsFFE programs reduced any anemia and moderate-to-severe anemia in primary-school-age adolescent girls and reduced moderate-to-severe anemia for adult women and preschool children. This study was registered with clinicaltrials.gov as NCT01261182.

The importance of non-farm livelihoods for household food security and dietary diversity in rural Myanmar

Recent processes of socio-economic change in rural Myanmar are etching significant shifts to the social distribution of advantage and disadvantage, with implications for patterns of food security and dietary quality. This paper uses original repeat cross-sectional household survey data to identify emergent relationships between land and livelihoods on the one hand, and food security and dietary quality, on the other. The paper concludes that although land ‘matters’ (landholding households are more likely to be food secure and have higher dietary diversity than landless households), this association is strongly conditioned by livelihood and seasonal circumstances. Households with livelihood arrangements articulated to the non-farm economy, whether they were landholders or landless, exhibited superior food and nutritional outcomes compared to those with livelihoods only in farming. Hence, while access to arable land remains an important factor in shaping food security and dietary diversity, of greater importance is the capacity for households to supplement their land assets with livelihood activities in the non-farm economy. This finding reinforces broader arguments that emphasise the importance of the non-farm economy as a vital shaper of wellbeing for rural households in the global South.