Socio-economic Contextual Factors Research Articles

Socioeconomic inequalities in contraceptive use among Brazilian women: A multilevel analysis stratified by parity

ObjectiveTo investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity. MethodsCross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units. ResultsNulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women. ConclusionsThe high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies. Implications for practiceThe need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.

What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it is telling us.

Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called 'cost of living crisis'. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.

The socioeconomic context of stigma: examining the relationship between economic conditions and attitudes towards people with mental illness across European countries.

Efforts to reduce the stigma associated with mental illness have intensified over the past 30 years with a particular focus on improving public attitudes. Difficult economic circumstances can be harmful to intergroup relations, but little is known about whether there is a relationship between socioeconomic conditions and attitudes towards people with mental illnesses. Random effects logistic regression modelling was employed to explore the relationship between individual financial circumstances, contextual socioeconomic factors and difficulty speaking to a person with a significant mental illness across European countries. Lower GDP per capita and higher income inequality at the country level, alongside individual financial difficulties, were each associated with a greater likelihood of reporting difficulty speaking to a person with a significant mental illness. Micro and macro-economic factors are associated with public attitudes towards people with mental illness across Europe. With prolonged economic instability predicted over the coming years in Europe it is important that these findings are taken into consideration when designing mental health and social policies, in order to safeguard the progress that has been made in reducing mental health stigma to date.

Support for weight-related anti-discrimination laws and policies: Modelling the role of attitudes toward poverty alongside weight stigma, causal attributions about weight, and prejudice

In the present study, we sought to position support for weight-related anti-discrimination laws and policies within a broader political and socioeconomic context. Specifically, we hypothesised that individualistic (rather than structural) anti-poverty attitudes would provide the basis for negative weight-related dispositions. To test this hypothesis, we asked 392 respondents from the United Kingdom to complete measures of support for weight-related anti-discrimination laws and policies, attributions about the causes of being larger-bodied, and weight-related stigma and prejudice. Path analysis with robust maximum likelihood estimation indicated that greater individualistic anti-poverty attitudes were significantly and directly associated with lower support for weight-related anti-discrimination laws and policies. This direct association was also significantly mediated by weight-related stigma and via a serial mediation involving both weight-related stigma and prejudice. Although greater individualistic anti-poverty attitudes were significantly associated with greater personal attributions for being larger-bodied, the latter did not emerge as a significant mediation pathway. The present findings highlight the importance of considering broader political and socioeconomic contextual factors that may provide a basis for the development, maintenance, and manifestation of negative weight-related dispositions.

Digital Explosion and Entrepreneurship Education: Impact on Promoting Entrepreneurial Intention for Business Students

This study aims to examine the effect of entrepreneurship education and artificial intelligence (AI) development on entrepreneurial intentions while investigating the mediating role of perceived behavioral control. The proposed model also accounts for individual and contextual socioeconomic factors. This study tries to fill the gap in the entrepreneurship literature, which is still lacking with respect to the impact of new technologies on entrepreneurship intentions and shows conflicting results regarding the influence of entrepreneurship education. Our study surveyed 223 business students in Lebanon. The context of this study is of high importance, particularly since the country is currently facing a deep, multifaced political, economic, and financial crisis, and entrepreneurship might be considered an important channel for generating basic sources of income, steering the recovery process, and increasing Lebanese resilience against this highly unstable economy. The structural equation modeling technique (SEM) was conducted to validate the hypotheses. The results show that perceived behavioral control fully mediates the relations between performance expectancy of AI solutions, entrepreneurship education, and entrepreneurial intention. Risk aversion and social support exert a direct impact on entrepreneurial intentions. The findings highlight the need to account for entrepreneurship education and AI development when analyzing entrepreneurial intentions.

Individual and Socioeconomic Contextual Factors Associated with Obesity in Brazilian Adolescents: VigiNUTRI Brasil.

This study investigated the association of socioeconomic contextual factors of the municipality of residence of adolescents, their eating behavior and food consumption with the prevalence of obesity. This was a cross-sectional study, based on individual data regarding anthropometry, eating behavior (eating in front of screens and having at least three main meals a day), and markers of healthy and unhealthy eating of 23,509 adolescents aged 10 to 19 years, participating in the Food and Nutrition Surveillance of the Brazilian Population monitored in Primary Health Care (VigiNUTRI Brasil) assessment in 2018. Based on multilevel Poisson regression, a higher prevalence of obesity was observed among adolescents living in municipalities with per capita income above USD209.68 (PR = 1.22; 95% CI 1.05;1.42) and among those who consumed hamburgers and/or processed meats the previous day (PR = 1.09; 95% CI 1.01;1.17). Adolescents who had the habit of having three main meals a day (PR = 0.81; 95% CI 0.73;0.89 p < 0.05) and who consumed fresh fruit the previous day (PR = 0.91; 95% CI 0.84;0.98 p < 0.001) had lower prevalence of obesity. The results reinforce the influence of the social context and food consumption on obesity rates. The persistence of this situation implies a worsening in the current and future health of adolescents.

Responses of grazing households to different levels of payments for ecosystem services

ABSTRACT Introduction Payments for Ecosystem Services (PES) programs have been implemented globally to protect ecosystems while securing the well-being of affected people. Reasonable payment standards are key to successful PES programs. Although some approaches are available for determining payment standards, few studies have applied them for grassland conservation with location indicators and socioeconomic contexts properly considered. Methods Using China’s first pilot Grassland Ecological Compensation Policy (GECP) as an example, we analyzed the effects of payment levels, other natural and socioeconomic factors on herders’ willingness to participate in the GECP in Damao County in Inner Mongolia where grassland degradation is happening at an alarming rate due to overgrazing and cropland expansion. Outcomes Our results show that households with lower herding income, older age, higher education, larger grassland areas, and worse social relationships are more inclined to participate in the GECP. Conservation payment level, as well as natural and socioeconomic contextual factors, significantly affect the response of herdsmen, and a reasonable grassland payment standard with a 95% policy compliance rate should be 8.8 yuan mu−1. Discussion and Conclusion Our findings can inform governments to develop effective PES programs to balance the need of human well-being improvement and grassland conservation in China and beyond.

Predictors of HIV testing among women experiencing intimate partner violence in the Central Region of Ghana.

HIV testing, which is important for the control of the HIV pandemic, has been hampered by several factors including Intimate Partner Violence (IPV), resulting in low uptake. This study sought to determine the predictors of HIV testing among women experiencing IPV. Secondary analysis of data generated from a cross-sectional mixed-method unmatched cluster-randomized controlled trial designed to evaluate a multi-faceted community intervention to reduce the incidence of IPV in Ghana was done (N = 2000). Logistic regressions were performed to determine the predictors of HIV testing among women experiencing IPV, using the trial baseline data. The prevalence of HIV testing among women exposed to IPV in the study setting was 42.4%. Less than a third of the respondents (30.2%) had ever used condom and 96.6% had unemployed partners. Age, educational attainment, employment, residence and condom use were found to be significant predictors of HIV testing among women experiencing IPV. Women aged 25-39 years were more than twice as likely to test for HIV (AOR:2.41; 95%CI:1.45-4.02) than those above 45 years. Women with formal education (Junior-High-AOR:2.10; 95%CI:1.42-3.12; Senior-High-AOR:3.87; 95%CI:2.07-7.26); who had ever used condom (AOR:1.42; 95%CI:1.05-1.93); those reporting life satisfaction (AOR:1.44; 95%CI:1.08-1.92); and coastal residents (AOR:1.97; 95%CI:1.45-2.67) were more likely to test for HIV than those who did not and inland residents. However, employed women (AOR:0.66; 95%CI:0.45-0.96) were less likely to test for HIV than unemployed women. Less than half of the women exposed to IPV had tested for HIV. Socioeconomic disadvantages related to age, education, employment, residence and life satisfaction predicted HIV testing among women exposed to IPV. Considering the vulnerability of women experiencing IPV to HIV infection, strategies to improve uptake of HIV testing must tackle contextual socioeconomic factors that hinder access to services.

Adolescent individual, school, and neighborhood influences on young adult hypertension risk.

Geographic and contextual socioeconomic risk factors in adolescence may be more strongly associated with young adult hypertension than individual-level risk factors. This study examines the association between individual, neighborhood, and school-level influences during adolescence on young adult blood pressure. Data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (1994-1995 aged 11-18 and 2007-2008 aged 24-32). We categorized hypertension as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg. Secondary outcomes included continuous systolic and diastolic blood pressure. We fit a series of cross-classified multilevel models to estimate the associations between young adulthood hypertension with individual-level, school-level, and neighborhood-level factors during adolescence (i.e., fixed effects) and variance attributable to each level (i.e., random effects). Models were fit using Bayesian estimation procedures. For linear models, intra-class correlations (ICC) are reported for random effects. The final sample included 13,911 participants in 128 schools and 1,917 neighborhoods. Approximately 51% (7,111) young adults were hypertensive. Individual-level characteristics-particularly older ages, Non-Hispanic Black race, Asian race, male sex, BMI, and current smoking-were associated with increased hypertension. Non-Hispanic Black (OR = 1.21; 95% CI: 1.03-1.42) and Asian (OR = 1.28; 95% CI: 1.02-1.62) students had higher odds of hypertension compared to non-Hispanic White students. At the school level, hypertension was associated with the percentage of non-Hispanic White students (OR for 10% higher = 1.06; 95% CI: 1.01-1.09). Adjusting for individual, school, and neighborhood predictors attenuated the ICC for both the school (from 1.4 null to 0.9 fully-adjusted) and neighborhood (from 0.4 to 0.3). We find that adolescents' schools and individual-level factors influence young adult hypertension, more than neighborhoods. Unequal conditions in school environments for adolescents may increase the risk of hypertension later in life. Our findings merit further research to better understand the mechanisms through which adolescents' school environments contribute to adult hypertension and disparities in hypertension outcomes later in life.

The Child Opportunity Index 2.0 and Hospitalizations for Ambulatory Care Sensitive Conditions.

Hospitalizations for ambulatory care sensitive conditions (ACSCs) are thought to be avoidable with high-quality outpatient care. Morbidity related to ACSCs has been associated with socioeconomic contextual factors, which do not necessarily capture the complex pathways through which a child's environment impacts health outcomes. Our primary objective was to test the association between a multidimensional measure of neighborhood-level child opportunity and pediatric hospitalization rates for ACSCs across 2 metropolitan areas. This was a retrospective population-based analysis of ACSC hospitalizations within the Kansas City and Cincinnati metropolitan areas from 2013 to 2018. Census tracts were included if located in a county where Children's Mercy Kansas City or Cincinnati Children's Hospital Medical Center had >80% market share of hospitalizations for children <18 years. Our predictor was child opportunity as defined by a composite index, the Child Opportunity Index 2.0. Our outcome was hospitalization rates for 8 ACSCs. We included 604 943 children within 628 census tracts. There were 26 977 total ACSC hospitalizations (46 hospitalizations per 1000 children; 95% confidence interval [CI]: 45.4-46.5). The hospitalization rate for all ACSCs revealed a stepwise reduction from 79.9 per 1000 children (95% CI: 78.1-81.7) in very low opportunity tracts to 31.2 per 1000 children (95% CI: 30.5-32.0) in very high opportunity tracts (P < .001). This trend was observed across cities and diagnoses. Links between ACSC hospitalizations and child opportunity extend across metropolitan areas. Targeting interventions to lower-opportunity neighborhoods and enacting policies that equitably bolster opportunity may improve child health outcomes, reduce inequities, and decrease health care costs.

Evaluating empirical evidence for housing development effects on the management of remaining private-owned forest in the U.S.

Forest ecosystems are notably influenced by: 1) the rate and spatial distribution of forest land development, and 2) how remaining undeveloped forest lands are managed. Regarding this second factor, economics and ecology research conducted in different locations in the U.S. suggests that increasing housing development can reduce the profitability of commercial timber production and thus the intensity with which landowners manage their forest lands. Some studies, however, suggest that in some locations these effects are not evident. We sought to consider what contextual factors might influence where and when development effects on forest management might become evident. We began with a critical review and synthesis of existing research addressing the degree to which housing development influences private forest management. We followed that with an empirical (logit) analysis of the likelihood of “active” (e.g., thinning) and extractive (e.g., harvesting) management on nonindustrial private forest lands in Oregon and Washington (U.S.), as a function of stand, site, and other factors, including nearby housing development. From our review and synthesis of previous research literature, we conclude that the varying results of previous studies likely owe to a combination of biophysical and socioeconomic contextual factors that influence both how prevalent development impacts might be in different locations and how easily they can be observed in empirical analyses. The results of our analysis of active and extractive management in Oregon and Washington are largely consistent with this finding, with some regions showing statistically significant negative effects owing to housing development, and other regions remaining largely unaffected. We conclude that policymakers and managers need to consider the biophysical and socioeconomic context of different study areas when evaluating the implications of individual study results.

Are contextual socioeconomic factors associated with diarrhea in Mozambique children under age 5?

Abstract Background Diarrhea is still highly prevalent in Mozambique children under age 5, which leads to avoidable morbidity and mortality. Specific socio-economic variables may influence diarrhea prevalence. Methods Secondary data analysis with the application of multiple logistic regression models on the data of 10026 living children under age 5 from Mozambique's Demographic Health Survey (DHS) report from 2011. Data were collected from June 2011 to November 2011 and had a household sample size of 13919. RStudio 1.1.442 was chosen as the statistical software to conduct the multiple regression modeling and the graphic representation of the results. Results From the 10026 children under age 5, 10.6% of them (1064) had diarrhea in the last 2 weeks. The prevalence of diarrhea during that period was 1.25 times higher in the urban areas in comparison with the rural areas (adjusted OR [95% CI]: 1.25 [1.03-1.52]). Households with a higher number of children had 12% less risk, per children's group (adjusted OR [95% CI]: 0.88 [0.80-0.96]). No increased risk of diarrhea was found for other variables, including sanitation, source of drinking water and refrigerator presence. Conclusions Urban areas and Households with fewer children are more likely to have a higher diarrhea risk while adjusting for other variables. It is important to notice that WASH variables such as sanitation and source of drinking didn't seem to lower diarrhea risk in Mozambique's context. Further research should take into consideration a greater sample and identify other possible reasons that may explain the high prevalence of diarrhea. Key messages Several factors may influence the prevalence of diarrhea in Mozambique. Beside the existence of sanitation infrastructure, there maybe be the need to improve its quality.

Social inequality and pneumonia hospitalization in children under five years of age in Maranhão, Brazil

Abstract Objectives: to describe the characteristics of pneumonia hospitalizations in children under five years of age across the State of Maranhão, Brazil, and explore patterns of spatial distribution of admissions. Methods: ecological study using data on occurrences (age, gender, skin color/race, month of occurrence, and municipality of residence) between 2012 and 2017 taken from the Unified Health System’s Hospital Information System and municipal level socioeconomic indicators for 2010. Each respiratory disease, including pneumonia, was presented as a percentage of overall admissions for respiratory tract diseases, together with the monthly distribution of admissions as a percentage of total annual cases, and annual rate of admissions by gender. The General G* statistic was calculated to identify significant clustering of municipalities with similar proportions of hospital admissions for pneumonia relative to overall hospital admissions. Results: pneumonia was the leading cause of admissions for respiratory disease, accounting for 57% of all cases and occurring with greater frequency in the rainy season (February to June) and in cities with lower socioeconomic indicator values. The rate of admissions decreased over the study period. Significant clusters (p&lt;0.05) of municipalities with high proportions of hospital admissions for pneumonia relative to overall hospital admissions occurred predominantly in the south of the state, while clusters with low propor-tions were located mainly in and around the metropolitan region of the state capital São Luís. Conclusions: pneumonia was shown to be a key cause of hospitalization in children and its distribution was associated with contextual socioeconomic factors, reflecting the quality of life and health status of children in Maranhão.

Gender differences in disability among older adults in the context of social gender and income inequalities: 2013 Brazilian Health Survey.

To estimate the magnitude of gender differences in disability among adults aged 60 and older and to evaluate whether they can be associated with social gender inequality and socioeconomic contextual factors at the level of Brazilian federative units. This is a multilevel study that used data from 23,575 older adults of 27 federative units who participated in the 2013 Brazilian Health Survey. The activity limitation index was developed from the item response theory, using activities of daily living and instrumental activities of daily living variables. The association of individual and contextual variables with disability was estimated by assessing the magnitude of differences between genders, using cross-level interaction effects in multilevel generalized linear models, including only the variables that were statistically significant in the final model. The prevalence of disability was higher among women (37.6%) than among men (26.5%), totaling 32.7% of the older adults. In the adjusted multilevel analysis, disability was influenced by income inequality (γgini = 0.022, p < 0.001) among federative units. In addition, gender differences in disability were associated with social gender inequalities (γmgiiXsex = 0.020, p = 0.004). Women had higher disability disadvantages compared to men, and those differences were associated with social gender inequalities among the Brazilian federative units influenced by income inequality.

Perceptions vs. Practice: A Longitudinal Analysis of Energy-Efficient and Energy Conservation Practices in Minnesota’s Tourism Industry

The importance of adopting sustainable practices in the tourism industry is well established. This project assessed tourism professionals’ perceptions of constraints and benefits to sustainable practices as well as actual implementation of energy practices across time. Adopting a longitudinal approach, perceptions and practices were tracked through an Internet-based questionnaire administered among tourism professionals in 2007, 2010, and 2013 in a Midwestern U.S. state. Professionals consistently agreed that attracting new clientele, improving consumer perceptions, and organizational image were benefits of sustainable practices, while initial financial costs constrained implementation. The most frequently implemented energy practices were using daylight and compact fluorescent light bulbs (CFLs). Only the use of two energy practices increased across time: using CFLs and Energy Star equipment. Overall, the adoption of sustainable practices was varied, and implementation rates remained minimally changed between 2007 and 2013. Reasons for the varied adoption and lack of changes in practice implementation may be explained by perceived barriers to implementation, lack of perceived benefits, and socio-economic contextual factors. With consideration to institutional theory and organizational capacity, industry and organizational-level implications are presented.

Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis.

Existing quantitative evidence suggests that at a population level, socioeconomic factors affect access to preferred place of death. However, the influence of individual and contextual socioeconomic factors on preferred place of death are less well understood. To systematically synthesise the existing qualitative evidence for socioeconomic factors affecting access to preferred place of death in the United Kingdom. A thematic synthesis of qualitative research. Cochrane Library, MEDLINE, Embase, CINAHL, ASSIA, Scopus and PsycINFO databases were searched from inception to May 2018. A total of 13 articles, reporting on 12 studies, were included in the synthesis. Two overarching themes were identified: 'Human factors' representing support networks, interactions between people and decision-making and 'Environmental factors', which included issues around locations and resources. Few studies directly referenced socioeconomic deprivation. The main factor affecting access to preferred place of death was social support; people with fewer informal carers were less likely to die in their preferred location. Other key findings included fluidity around the concept of home and variability in preferred place of death itself, particularly in response to crises. There is limited UK-based qualitative research on socioeconomic factors affecting preferred place of death. Further qualitative research is needed to explore the barriers and facilitators of access to preferred place of death in socioeconomically deprived UK communities. In practice, there needs to be more widespread discussion and documentation of preferred place of death while also recognising these preferences may change as death nears or in times of crisis.

Do socio-economic contextual factors influence SMEs' service quality A cross-sector and cross-city SERVPERF analysis

There is an increasing body of knowledge on service quality relationship with many contextual factors including culture, firm size and public vs. private settings. However, local socio-economic factors influence towards SMEs service quality is still unknown. We conducted statistical analyses to observe the relationship between contextual socio-economic factors of an SME's city and its service's quality performance using a SERVPERF survey database of more than 3,000 Brazilian SMEs. While service performance did not linearly correlate with the analysed socio-economic factors, a closer look at the data shows significant differences in service performance among groups of SMEs on highly developed and underdeveloped cities from the other cities. The paper discusses theoretical and managerial implications derived from these findings and proposes new research questions to generate data-backed knowledge to support SMEs service quality improvement.

Do socio-economic contextual factors influence SMEs' service quality A cross-sector and cross-city SERVPERF analysis

Do socio-economic contextual factors influence SMEs' service quality A cross-sector and cross-city SERVPERF analysis

The Family–School Linkage in Addressing Bullying in Hong Kong: A Sociocultural Perspective

The phenomenon that around ten percent of schoolchildren are bullied regularly in Hong Kong has attracted much scholarly attention in anti-bullying research. Current literature suggests taking into consideration the contextual features and socioeconomic factors in anti-bullying research, instead of applying identical intervention/prevention measures across cultures. Therefore, this article examines the role of school-family linkage as a mirror of the wide social-culture context, and analyzes the functions of such linkage in anti-bullying practice in Hong Kong. This study was conducted following a film approach in 2015. That is, a group of middle school teachers in Hong Kong were invited to watch small films showing typical bullying and anti-bullying episodes, followed by semi-structured interviews. The article demonstrates a list of good practices representing the functioning of a positive family-school linkage in bullying addressing. However, parental involvement does not always facilitate and can hinder bullying addressing on campuses. This study implies that efficient bullying addressing aligns with parental involvement in the intervention process, suggesting more parental involvement and more collaboration between family and school in anti-bullying. It also raises an urgent question in regards to balancing the various opinions between parents and teachers in child-raising and bullying addressing. This article suggests further and more investigations examining anti-bullying from a socioeconomic perspective.

Parent–child attachment as a mechanism of intergenerational (dis)advantage

A growing literature connects childhood socio-emotional skills to adult socio-economic outcomes. But what explains differing levels of socio-emotional skills? Current theories consider parental investment and socialisation, but neglect the emotional and relational aspects of parenting. Attachment theory offers a model of the micro-level mechanisms that connect parenting processes and socio-emotional development intergenerationally. It has, however, tended to de-emphasise macro, contextual socio-economic factors. Through an extensive, integrative review of the empirical literature on the effects and antecedents of parent–child attachment, we argue that attachment is a mechanism through which socio-emotional – and socio-economic – (dis)advantages persist.