Representative Survey Research Articles

Peer effects of health behaviors and the moderating role of Internet use among middle-aged and older adults: a nationally representative cross-sectional survey in China

ObjectiveThis study investigates peer effects on the health behaviors of middle-aged and older adult people in China and examines the moderating role of Internet use.MethodsA total of 16,188 respondents were selected from the China Health and Retirement Longitudinal Study (CHARLS) 2020 data set. Ordinary Least Squares and Quantile Regression were used to validate the peer effect of health behaviors on middle-aged and older adults, and a moderating effects model was used to test the moderating roles of Internet use and Internet proficiency. Finally, the peer effect was analyzed for heterogeneity according to Internet use preferences.ResultsThe peer effect had a positive influence on the individual health behaviors of middle-aged and older adult people in China (β = 0.5341, p < 0.001). Middle-aged and older adult people were more sensitive to the average health behavior level of the community when they lived in rural communities and/or had a low level of education. Internet use positively moderated the health behavior peer effect in the older adult population (β = 0.0094, p < 0.1), and Internet proficiency negatively moderated the peer effect of the health behaviors of the middle-aged population (β = 0.1589, p < 0.1). According to the magnitude of the influence of peer effect, the Internet preference type can be ranked from social and entertainment (β = 0.6250, p < 0.01), to cultural and entertainment (β = 0.5835, p < 0.01), to comprehensive (β = 0.4622, p < 0.01).ConclusionThere is a peer effect on the health behaviors of middle-aged and old-aged individuals, in which Internet use plays a moderating role. The construction of healthy communities should be promoted, giving full play to the community’s active role in health promotion. Attention should be paid to the health-enabling function of the Internet, encouraging middle-aged and older adult people to use the Internet actively, moderately, and diversely, and making full use of the advantages of short videos for online health education.

Sanitation ladder in rural and urban India: can subsidy from the Swachh Bharat Mission ensure transition to safely managed toilets?

ABSTRACT The Swachh Bharat Mission, globally the biggest public programme to support sanitation, has focused on subsidised construction of household toilets in rural areas, while aiming for solid waste disposal and behavioural changes in urban areas. In spite of that, India witnesses a huge gap from the Sustainable Development Goals (SDGs) related to usage of safely managed sanitation associated with more environment-responsive technology and hygiene management. The Joint Monitoring Programme (2017) created a hierarchical sanitation ladder identifying categories of toilets, namely, safely managed, basic, limited, unimproved, and open defecation. This study attempts to contribute to the existing literature by locating the empirical estimation of the sanitation ladder in India across both rural and urban settings, using nationally representative unit-level National Sample Survey Office data (2018). Results find that only 38% of urban and 6% of rural households in India use safely managed toilets. Also, using logistic regression, the study posits that receiving subsidy for toilet construction can significantly improve usage of safely managed toilets along the ladder only among the poorest class of urban India and the factor is generally more potent in rural areas. The findings identify that there is hardly any benefit in subsidizing the middle-income class and hence highlight a need to redesign the subsidy-driven sanitation policy.

Bottled or Tap Water? Factors Explaining Consumption and Measures to Promote Tap Water

The production and consumption of plastic bottled water have several negative environmental impacts worldwide. To identify the barriers and motivations for drinking tap and bottled water, we conducted a nationally representative questionnaire survey among 3411 respondents in the Czech Republic in 2022. People aged 18–34 are moderate consumers of bottled water and very frequent consumers of tap water. Bottled water consumption tends to be less frequent among people with a higher education, while tap water consumption is less frequent among people with lower incomes. The most important factors that explain the frequency of drinking bottled and tap water are taste perception, health concerns and habit. Health concerns about tap water and the unpleasant taste of tap water increase the consumption of bottled water. People with a strong habit of drinking tap water are less likely to consume bottled water. The constructs from the theory of planned behaviour were statistically significant. The results can guide decision-makers in promoting tap water to consumers. To encourage tap water drinking, we suggest measures to increase the availability of tap water in public places in conjunction with campaigns targeting the taste and health perception, as well as the habit, of drinking tap water.

Use of Preferred Source of Contraception Among Users of the Pill, Patch, and Ring in the US

Individuals who use contraceptive pills, patches, and rings must frequently interact with the health care system for continued and consistent use. As options for obtaining these methods expand, better understanding contraceptive users' preferences for source of contraception can help facilitate access. To describe use of preferred source of contraception and to understand associations between prior reproductive health care experiences and preference for traditional in-person sources vs alternative sources. This was a cross-sectional nationally representative survey study fielded in the US in 2022 through NORC's population-based AmeriSpeak panel. Eligible panelists were assigned female sex at birth, aged 15 to 44 years, not infecund, and not personally using permanent contraception. Of the screened panelists, 3150 were eligible; 3059 completed the survey (97%). The analysis sample included 595 individuals who currently used a pill, patch, or ring contraceptive. Data were analyzed from January 25, 2023, to August 15, 2024. Primary outcomes were use of any preferred source and use of most preferred source when most recently obtaining contraception. Sources included in-person care, telehealth, pharmacist-prescribed, online service, and over the counter. A binary variable captured whether respondents most preferred traditional, in-person contraceptive care vs an alternative approach. Prior reproductive health care experiences included missing a pill, patch, or ring because they couldn't obtain it on-time and receipt of person-centered contraceptive counseling at most recent contraceptive visit. Sociodemographic characteristics and responses are presented as unweighted numbers with weighted prevalences. In this study, 581 of 595 unweighted respondents (weighted prevalence, 95.9%) of the analytic sample identified as female, 256 unweighted respondents (weighted prevalence, 64.4%) were ages 15 to 29 years, and 448 unweighted respondents (weighted prevalence, 73.8%) had most recently obtained their contraception in-person. Only 197 unweighted respondents (weighted prevalence, 35.6%) selected in-person care as their most preferred source. Additionally, 296 unweighted respondents (weighted prevalence, 49.7%) had most recently obtained their method through any preferred source, and 227 unweighted respondents (weighted prevalence, 39.8%) had obtained it through their most preferred source. In adjusted regression analyses, respondents who previously reported being unable to get their method on time (adjusted odds ratio [aOR], 2.57; 95% CI, 1.36-4.87) had higher odds of preferring an alternative source vs traditional in-person care. Those who recently received person-centered contraceptive counseling (aOR, 0.59; 95% CI, 0.35-0.98) had lower odds of preferring an alternative source. In this national study of individuals who used the pill, patch, and ring, most preferred alternative sources to obtain their contraception, and only half had most recently used a preferred source. These findings suggest that expansion of alternative contraceptive sources can better meet the needs of contraceptive users and support reproductive autonomy.

Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study.

In the United States, maternal mortality is high and patterned by race and socioeconomic status (SES). Patient-provider relationships and societal discrimination have been separately associated with poor maternal outcomes, but it is not clear how such mechanisms may be interrelated. Thus, the present study investigates how societal experiences of discrimination are associated with and manifest in patient-provider relationship quality among perinatal women. The study uses a mixed methods design with an explanatory-sequential approach. First, a path analysis using structural equation modeling of a cross-sectional representative survey of 244 perinatal women in Kalamazoo County, Michigan, was conducted. Second, a thematic qualitative analysis was conducted of focus groups composed of survey participants (n = 34). In the quantitative analyses, race and SES were associated with experiences of societal discrimination in the expected directions (race: b, 1.87; SE, 0.58; P =.001; SES: b, 2.18; SE, 0.60; P <.001), discrimination positively predicted vigilant behaviors (b, 0.81; SE, 0.15; P <.001), and more vigilant behaviors predicted worse patient-provider relationship quality (b, 0.18; SE, 0.07; P <.001). In the qualitative findings, we found detailed accounts linking provider discrimination, vigilance, and patient-provider relationships among focus groups composed of only women of color (n = 9). Overall, the quantitative analyses find support for the conceptual model showing race and SES are associated with societal discrimination, which is associated with vigilant behaviors and, in turn, quality of patient-provider relationships. The qualitative analyses provide preliminary evidence for how these pathways manifest in care settings and demonstrate the importance of establishing trust in patient-provider relationships, especially among women of color.

Unveiling her perspective: Exploring women's multi-local living arrangements in German cities

Multi-local lifestyles are increasingly shaping current living realities. Earlier German studies identified (work-related) multi-locality as a “male phenomenon” influenced by traditional gender relations. Women, especially during the family phase, are less likely to choose multi-local arrangements, while multi-local women are often childless. As tendencies towards individualization and pluralization have increased in the last years, coupled with the effects of the Covid-19 pandemic, the question is whether (and to what extent) differences between men and woman in multi-local lifestyles persist. Using a representative survey and qualitative interviews with multi-local residents in Frankfurt am Main and Leipzig, the study investigates the quantitative dimension of multi-locality, as well as differences in how this lifestyle is perceived. In this paper, we contribute to a better understanding of the specific multi-local living realities of women and men, as well as the differences in how they are realized and perceived.

Gender differentials in cognitive frailty among older adults in India: a multivariate decomposition approach.

There has been an increasing focus on the interplay between physical frailty and cognitive impairment, as both conditions pose significant risks for life-threatening health complications and are receiving considerable attention in global geriatric health initiatives. A recent consensus introduces "cognitive frailty," denoting the co-existence of physical frailty and cognitive impairment without dementia. This study aims to ascertain the prevalence of cognitive frailty and investigate the factors contributing to gender differentials of cognitive frailty among older adults in India. This study has used the data from the nationally representative survey Longitudinal Ageing Study in India 2017-18. This study included a sample of 13,946 males and 14,989 females aged 60 and above. Descriptive and bivariate analyses were conducted. A proportion test was employed to assess gender disparities and determine the statistical significance of risk factors. Furthermore, multivariate decomposition analysis was performed to identify the extent to which various covariates contribute to explaining the gender differences observed in cognitive frailty. The overall prevalence of cognitive frailty was 4.4%. There was a significant gender difference in cognitive frailty among older adults in India (Difference: 4.3%; p-value < 0.001] with 2.1% (95% CI: 1.8-2.3) older males and 6.4% (95% CI: 6.0-6.8) older females suffering from cognitive frailty. The considerable gender gap in cognitive frailty would be reduced if women had similar levels of education (37% reduction) than men. Results highlight that increasing age, being a woman (AOR: 1.61; 95% CI: 1.33-1.95), out-of-wedlock, less education and non-working status (AOR:2.19; 95% CI: 1.71-2.80) were significantly associated with cognitive frailty. Poor nutritional status, and depression are also prone among the cognitively frail participants. Gender sensitive interventions improving education access for women are crucial. Developing countries like India urgently require a multidimensional approach to ensure appropriate and comprehensive healthcare for the elderly population.

CDC finds link between frequent social media use and bullying

Observing that social media has become a pervasive presence in everyday life, including among youths, the Centers for Disease Control and Prevention's (CDC's) nationally representative Youth Risk Behavior Survey (YRBS) in 2023 included for the first time an item assessing U.S. high school students' frequency of social media use.

Defining, Measuring, and Increasing “Rootedness” in the High Migration Context of Honduras

Executive Summary The notion of “rootedness” in the sociology and migration literature is not well defined despite its increasing use by academics and, especially, practitioners. Defining and measuring rootedness has been problematic given that it is often operationalized as, but is not fully captured by, a concept related to social capital, community attachment, and participation. Rootedness is also often thought of as solely the absence of the desire to migrate. However, we argue that an individual’s desire to stay can be just as important as the well-documented “root causes” of migration; that is, economic poverty, insecurity, and strong migration networks. We propose a working definition of the concept of rootedness based on an empirical analysis of data from a nationally representative survey in the high migration context of Honduras. We find that rootedness can both be defined as and measured by an individual’s agreement with the idea that where they live is their “true home” and that they “see a good future” in that location. We further find that rootedness can be increased via a strong sense of security (not only the absence of victimization) and active community support for youth. Programs and policies should therefore promote security that goes beyond just preventing crime and fosters a general sense of wellbeing. In particular, programs should promote efforts to ensure that youth are supported by incorporating them in community decision-making, listening to what youth propose, promoting youth participation, and supporting youth leadership. Importantly, income is not strongly associated with this definition of rootedness. This finding highlights the important role of non-economic factors in migration decisions. Even when income increases, it does not necessarily increase the aspiration to stay. To be rooted, as we conceive of it, means more than having sufficient income. In summary, the paper examines and offers a new understanding of the concept of “rootedness,” which speaks to why some members of a community want to migrate and others desire to remain in their home communities. Fleshing out our understanding of rootedness as a way to talk about and measure the desire to remain is therefore crucial to realizing the “right” or “freedom” to stay at home.

Social network size and endorsement of political violence in the US

BackgroundIn recent years, the United States (US) has witnessed a rise in political violence. Prior research has found that an individual’s social network is associated with their likelihood of engaging in various forms of violence, but research on social networks and political violence in the US context is limited. This study examined associations between social network size and endorsement of political violence in a recent nationally representative survey and explored how the relationship varied by use of social media as a major news source, perceptions of the government as an enemy, and membership in a marginalized or privileged racial or ethnic group.MethodsThis was a nationally representative cross-sectional survey study of adults aged 18 and older in the US, administered from May 13-June 2, 2022. The exposure was social network size, defined by the number of strong social connections. We examined three violence-related outcomes: support for non-political violence, support for political violence, and personal willingness to engage in political violence. We estimated prevalence ratios for associations using survey-weighted Poisson regression with robust standard errors, adjusting for hypothesized confounders and including interaction terms to examine effect measure modification.ResultsThe sample included 8,620 respondents. Median age was 48.4 years (95% CI = 47.9–48.8), 51.5% were female (95% CI = 50.4–52.7%), and 62.7% self-identified as non-Hispanic White (95% CI = 61.4–65.9%). In adjusted models, those with zero strong connections were more likely than those with 1–4 strong social connections to consider political violence usually/always justified in general (PR = 2.43, 95% CI = 1.47–4.01). Those with 50 + strong connections were more likely than those with 1–4 strong social connections to consider political violence usually/always justified in at least one situation (PR = 1.19, 95% CI = 1.03–1.37) and were more likely to report being willing to personally use political violence (PR = 1.52, 95% CI = 1.13–2.04). Associations varied somewhat by social media use, perceptions of the government as an enemy, and racialized identity.ConclusionsIndividuals who reported very few and very many strong social connections were more likely than others to support political violence or be personally willing to engage in it in one form or another. Findings point toward potential intervention and prevention opportunities.

Mobile Phone Syndromic Surveillance for Respiratory Conditions in an Emergency (COVID-19) Context in Colombia: Representative Survey Design.

Syndromic surveillance for respiratory infections such as COVID-19 is a crucial part of the public health surveillance toolkit as it allows decision makers to detect and prepare for new waves of the disease in advance. However, it is labor-intensive, costly, and increases exposure to survey personnel. This study assesses the feasibility of conducting a mobile phone-based respiratory syndromic surveillance program in a middle-income country during a public health emergency, providing data to support the inclusion of this method in the standard infection control protocols at the population level. This study aims to assess the feasibility of a national active syndromic surveillance system for COVID-19 disease in Colombia. In total, 2 pilots of syndromic mobile phone surveys (MPSs) were deployed using interactive voice response technology in Colombia (367 complete surveys in March 2022 and 451 complete surveys in April and May 2022). Respondents aged 18 years and older were sampled using random digit dialing, and after obtaining consent, they were sent a 10-minute survey with modules on sociodemographic status, respiratory symptoms, past exposure to COVID-19 infection and vaccination status, preferences about COVID-19 vaccination, and information source for COVID-19. Pilot 1 used a nationally representative sample while pilot 2 used quota sampling to yield representative results at the regional level. In this work, we assessed the performance characteristics of the survey pilots and compared the demographic information collected with a nationally representative household survey. For both pilots, contact rates were between 1% and 2%, while participation rates were above 80%. The results revealed that younger, female, and higher educated participants were more likely to participate in the syndromic survey. Survey rates as well as demographics, COVID-19 vaccination status, and prevalence of respiratory symptoms are reported for both pilots. We found that respondents of the MPSs are more likely to be younger and female. In a COVID-19 pandemic setting, using an interactive voice response MPS to conduct syndromic surveillance may be a transformational, low-risk, and feasible method to detect outbreaks. This evaluation expects to provide a path forward to the inclusion of MPSs as a traditional surveillance method.

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.

Modelling the spatial variability and uncertainty for under-vaccination and zero-dose children in fragile settings

Universal access to childhood vaccination is important to child health and sustainable development. Here we identify, at a fine spatial scale, under-immunized children and zero-dose children. Using Chad, as an example, the most recent nationally representative household survey that included recommended vaccine antigens was assembled. Age-disaggregated population (12–23 months) and vaccination coverage were modelled at a fine spatial resolution scale (1km × 1 km) using a Bayesian geostatistical framework adjusting for a set of parsimonious covariates. There was a variation at fine spatial scale in the population 12–23 months a national mean of 18.6% (CrI 15.8%–22.6%) with the highest proportion in the South-East district of Laremanaye 20.0% (14.8–25.0). Modelled coverage at birth was 49.0% (31.2%–75.3%) for BCG, 44.8% (27.1–74.3) for DTP1, 24.7% (12.5–46.3) for DTP3 and 47.0% (30.6–71.0) for measles (MCV1). Combining coverage estimates with the modelled population at a fine spatial scale yielded 312,723 (Lower estimate 156055–409266) zero-dose children based on DTP1. Improving routine immunization will require investment in the health system as part of enhancing primary health care. The uncertainties in our estimates highlight areas that require further investigation and higher quality data to gain a better understanding of vaccination coverage.

Post-legalization shifts in cannabis use among young adults in Georgia-A nationally representative study.

In 2018, the country of Georgia legalized cannabis for recreational use and decriminalized limited possession. This study aimed to assess whether cannabis use increased among young adults (ages 18-29 years) in Georgia after national policy changes and to evaluate whether perceived access became easier after legalization and current risk factors of young adult cannabis use. We used data from the Georgian nationally representative survey administered in 2015 (n = 1308) and 2022 (n = 758), before and after decriminalization. We performed appropriate bivariate analyses and multivariable linear and logistic regressions to assess the following: legalization's impact on cannabis use; perceived difficulty to obtain cannabis; age of first use; differences in use between females and males; and factors associated with current use. Among young adults lifetime prevalence of cannabis use was similar in 2015 (17.3%) and 2022 (18.1%) [Odds Ratio (95% confidence interval) = 1.1 [0.7, 1.6], P = 0.726). Annual prevalence (7% in 2015 vs 7.7% in 2022) was also similar (1.1 [0.7, 2.0], P = 0.650). In 2022 it was less difficult to obtain cannabis than in 2015 (0.5 [0.4, 0.8], P = 0.021). The age of first use increased statistically significantly (18.1years in 2015 vs 19.1 in 2022, P = 0.003). In 2022, annual prevalence of use was lower among females (1.9% vs 13.1%; OR = 0.1 [0.0, 0.3], P < 0.0001) and higher among those who gambled (11.7% vs 4.4%; OR = 3.2 [1.5, 6.8], P < 0.003). Males initiated cannabis use at an earlier age (19.1years vs 20.6 for females, P = 0.03), and could obtain cannabis easier than females (P < 0.0001). There was a minimal shift of cannabis use in young adults following implementation of recreational cannabis use legalization in Georgia. Males and people who gambled were at higher risk of cannabis use.

Use of Complementary and Integrative Health Approaches in Adults with Long COVID in the US, a Nationally Representative Survey.

Background: Long COVID is a serious, complex condition that has affected the lives of millions of people globally. Complementary and integrative health (CIH) approaches offer a wide range of potential therapies for the management of long COVID symptoms. However, there is limited information available about the utilization of CIH among long COVID patients. Methods: Nationally representative cross-sectional data from the United States 2022 National Health Interview Survey (NHIS, response rate 47.7%, n = 27,651) were used to investigate prevalence and predictors of CIH use in the past 12 months among individuals who experienced long COVID. The 12-month prevalence of CIH use was descriptively analyzed for those with long COVID versus those without using chi-squared tests or unpaired t-tests. Independent predictors of CIH use among individuals with long COVID were analyzed using a stepwise multiple logistic regression analysis. Results: A weighted total of 17,610,801 US adults (19.7%) who had a confirmed case of coronavirus disease 2019 (COVID-19) developed long COVID symptoms. A slightly greater proportion of individuals with long COVID (44.4%) than those without (40.9%) used CIH approaches in the past 12 months. The most used approaches were meditation, yoga, and massage therapy. CIH use by those with long COVID was significantly associated with younger age, female sex, higher education level, having health insurance coverage, higher household income level, receiving three or more COVID-19 vaccination doses, ever having asthma, and ever having an anxiety or depression diagnosis. Conclusions: Long COVID represents a major challenge for patients, health care providers, health care systems, economies, and global public health. CIH approaches may play an important role in symptom management for some patients, and additional research is needed to identify which modalities are most effective. Patients and health care providers may benefit from better information about the available options for treatment.

Cross‐domain policy feedback effects on mass publics

AbstractScholars have extensively explored policy feedback effects on mass publics. However, research exploring how one policy's implementation affects public preferences for another remains limited. This study proposes a novel cross‐domain policy feedback framework, emphasizing functional and normative interdependence as two mechanisms yielding cross‐domain resource and interpretive effects. We use multiple sets of nationally representative survey data and archival records from China, a context deeply rooted in filial piety culture. We employ a fuzzy regression discontinuity design and multilevel regressions to explore the effects of the one‐child policy on public preferences for old‐age support. The findings indicate that individuals subjected to more stringent enforcement exhibit increased support for the government assuming the responsibility for old‐age support. These changes largely stem from the reduction in their actual and desired number of children. The findings have significant implications for mass feedback research and reform efforts regarding population planning and public pension systems.

Beyond Permanent Residences: Measuring Place Attachment in Tempo-Local Housing Arrangements

Current societal shifts, including increased mobility, advances in information technologies, and diverse lifestyles, are driving postmodern housing arrangements that prioritize mobility and flexibility. The traditional view of housing as fixed and stable is evolving to encompass temporary forms, including multi-locality, which are often underestimated due to measurement challenges. Recognizing and integrating the potential of transient populations into urban societies is crucial to enhancing community cohesion and reducing social fragmentation. Therefore, the development of rootedness, emotional connection, and spatial identity should be analyzed in the context of temporary housing practices. Data collected through a representative survey in two major German urban regions in 2023 enable the validation of a four-dimensional place attachment scale, which includes the dimensions of place identity, place dependence, ambient bonding, and social bonding. Each dimension includes distinct elements of place-making constructions. The classification of four tempo-local housing types serves as the foundation for measuring how the temporal and spatial structure of housing arrangements influences emotional attachment to one’s place of residence. Interestingly, spatial mobility, when paired with temporal stability in each location, can cultivate deep connections, revealing an often-overlooked potential within this group. The results emphasize the significance of incorporating spatio-temporal dimensions of housing to foster inclusive, comprehensive, and diverse urban development.

Readiness of the health system to provide non-communicable disease services in Nepal: a comparison between the 2015 and 2021 comprehensive health facility surveys

BackgroundIn Nepal, despite the escalating burden of non-communicable diseases (NCDs), there is a gap in the continuum of care for prevention, diagnosis, treatment, and care services for NCDs. The study aimed at assessing the changes in availability and readiness scores of health facilities between two consecutive health facility surveys.MethodsWe compared NCD readiness scores between 2015 and 2021, using data from two nationally representative cross-sectional Nepal Health Facility Surveys (NHFS). Both consecutive surveys used globally validated standard tools of Demographic and Health Surveys (DHS)’s service provision assessment. Both surveys were undertaken using World Health Organization’s (WHO) service availability and readiness assessment (SARA) tools. Data were collected using the Census and Survey Processing System on tablets, with validation performed through field check tables. Trained enumerators with a medical background collected data for the surveys, and we analyzed the information from a de-identified dataset downloaded from the DHS website upon request. Both the NHFS protocols were reviewed and approved by the Nepal Health Research Council and the institutional review board of ICF. We calculated the readiness scores based on WHO SARA indicators for diabetes, cardiovascular disease (CVD), and chronic respiratory disease (CRD) using a additive procedure. Multivariate linear regression analysis was undertaken to assess associated factors, with complex sampling design accounting for both surveys.ResultsThe overall availability of all three services has improved between 2015 and 2021 NHFS. Although the availability of diabetes-related services increased significantly between 2015 and 2021, this does not correspond to the increase in the readiness score. The readiness score increased by 10% points for CVDs related services and 9% points for CRDs. Compared to public hospitals, primary healthcare facilities experienced greater increase in readiness scores (11.5% versus 20.9%). Interestingly, those health facilities without quality assurance systems experienced a lower increase or even decrease in readiness scores than those with quality assurance systems. For the factors associated with readiness scores, health facilities charging additional or separate fees to the patients had a higher readiness score than those not charging any user fee for all three services. Compared to 2015, the readiness scores in 2021 improved for diabetes [β = 11.01 (95% CI 9.02 to 12.96)], CVD [β = 10.70 (95% CI 9.61 to 11.80)], and CRD [β = 8.41 (95% CI 7.20 to 9.62)].ConclusionThe improvement in NCD service availability does not correspond to the proportional increase in readiness scores, which is crucial for delivering quality care. Regular staff meetings and feedback systems are crucial for improving all services including NCD-related service readiness and should be prioritized by local and provincial governments.

How Do People Perceive Immigrants? Relating Perceptions to Numbers

Abstract How does the general public perceive immigrants, whom do they think of when thinking about “immigrants,” and to what extent are these perceptions related to the actual composition of immigrant populations? We use three representative online surveys in the United States, South Africa, and Switzerland (total N = 2,778) to extend existing work on the perception of immigrants in terms of geographic coverage and individual characteristics. We also relate these responses to official statistics on immigration and integration patterns. In all three countries, there are significant discrepancies between perceptions of immigrants and their real proportion in the population and characteristics. Although we observe clear country differences, there is a striking pattern of people associating “immigrants” with “asylum seekers” in all three countries. We consider two possible explanations for the differences between perceptions and facts: the representativeness heuristic and the affect heuristic. In contrast to previous research, we find only partial support for the representativeness heuristic, whereas the results are consistent with the affect heuristic. We conclude that images of “immigrants” are largely shaped by pre-existing attitudes.

Disparities in Tobacco Smoking by Sex and Employment Status: Results from South Africa’s First Global Adult Tobacco Survey

Background/Objectives: Tobacco smoking is a cause of premature death and illness globally. This study examined the prevalence and factors associated with tobacco smoking among South African adults according to sex, education, and employment status among socio-demographic subgroups. Methods: Data were obtained from the 2021 South African Global Adult Tobacco Survey (a nationally representative household survey using a multi-stage stratified cluster random sampling design). The 6,311 participants were aged 15+ years. Descriptive statistics, chi-square tests, and multiple logistic regression analysis were used to investigate relationships between current smoking and socio-demographic variables. Results: Smoking prevalence was 25.8% (n = 1573) (41.2% among men, 11.5% among women; 29.9% among working individuals, 23.1% among non-working individuals). The multiple logistic regression results showed that males aged 45–64 were twice as likely to be currently smoking than males aged 15–24. Coloured (of mixed race) males were twice as likely to smoke as Black African males. Males with secondary/post-secondary education were less likely to smoke compared to males with no education. Coloured females were seven times and White females were almost five times more likely to smoke than Black African females. Females with post-secondary education were less likely to smoke than those with no formal education. Females earning an income were more likely to smoke compared to those with no income. Non-working participants aged 25–44 and 45–64 were more likely to smoke compared to those aged 15–24 years. Working and non-working Coloured and working White individuals were three times more likely to smoke than working or non-working Black Africans. Conclusion: Groups with higher identified smoking prevalence may indicate where smoking cessation interventions should be targeted to reduce national smoking prevalence.