1
|
Bidzha ML, Ngepah N, Greyling T. The impact of antiretroviral treatment and child-focused unconditional cash transfers on child mortality. SSM Popul Health 2024; 26:101671. [PMID: 38645667 PMCID: PMC11031782 DOI: 10.1016/j.ssmph.2024.101671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/16/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024] Open
Abstract
Although there is sufficient evidence in the epidemiological literature that antiretroviral treatment (ART) reduces child mortality, there is limited evidence of its effect in the socio-economic determinants of child mortality literature. Furthermore, evidence on the effect of child focused unconditional cash transfers (UCTs) on child mortality is limited, especially in the African context. Using South Africa's provincial level data over the period 2001 to 2019, we evaluate the effect of ART and child focused UCTs on child mortality. We use the two-stage instrumental variable mean group estimator. We find that ART reduces child mortality. Moreover, we find an inverted U-shaped non-linear relationship between UCTs and child mortality that is contingent to the level of cash transfer coverage. Our analyses also reveal that UCTs improve the effect of ART on child mortality by enhancing access and adherence to treatment. While the focus of our analyses was on the child mortality effects of ART and UCTs, our findings reaffirm the well-documented impacts of factors such as public health expenditure, HIV/AIDS, female education, and health worker density on child mortality. Collectively, the combination of high ART and UCTs coverage, increased public health expenditure, enhanced female education, and improved health worker density, represents value for money for policymakers and funders. These areas should be prioritised to improve child well-being.
Collapse
Affiliation(s)
- Mashudu Lucas Bidzha
- School of Economics, University of Johannesburg, Corner Kingsway and University Road, Auckland Park, 2006, South Africa
| | - Nicholas Ngepah
- School of Economics, University of Johannesburg, Corner Kingsway and University Road, Auckland Park, 2006, South Africa
| | - Talita Greyling
- School of Economics, University of Johannesburg, Corner Kingsway and University Road, Auckland Park, 2006, South Africa
| |
Collapse
|
2
|
Sun S. Building Financial Capability and Assets to Reduce Poverty and Health Disparities: Race/Ethnicity Matters. J Racial Ethn Health Disparities 2024; 11:1754-1773. [PMID: 37273162 DOI: 10.1007/s40615-023-01648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Evidence has documented racial wealth inequity as one of the key pathways linking structural racism and racial health inequity. Most prior studies on the wealth-health relationship use net worth as the measure of wealth. This approach provides little evidence on the most effective interventions as various types of assets and debt affect health differently. This paper examines how U.S. young adults' wealth components (e.g., financial assets, nonfinancial assets, secured debt, and unsecured debt) are associated with physical and mental health, and if the associations differ by race/ethnicity. METHODS Data were drawn from the National Longitudinal Survey of Youth 1997. Health outcomes were measured by mental health inventory and self-rated health. Logistic regressions and ordinary least square regressions were used to assess the association between wealth components and physical and mental health. RESULTS I found that financial assets and secured debt were positively associated with self-rated health and mental health. Unsecured debt was negatively associated with mental health only. The positive associations between financial assets and health outcomes were significantly weaker for non-Hispanic Black respondents. Unsecured debt was protective of self-rated health for non-Hispanic Whites only. For Black young adults, unsecured debt had more severe negative health consequences compared to other racial/ethnic groups. CONCLUSION This study provides a nuanced understanding of the complex relationship among race/ethnicity, wealth components, and health. Findings could inform asset building and financial capability policies and programs to effectively reduce racialized poverty and health disparities.
Collapse
Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA.
| |
Collapse
|
3
|
Reinhart E. Money as Medicine - Clinicism, Cash Transfers, and the Political-Economic Determinants of Health. N Engl J Med 2024; 390:1333-1338. [PMID: 38598803 DOI: 10.1056/nejmms2311216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Eric Reinhart
- From the Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago
| |
Collapse
|
4
|
Kelly NK, Bhushan NL, Gottfredson O'Shea N, Gómez-Olivé FX, Aiello AE, Wagner LD, Mall S, Kahn K, Pettifor AE, Stoner MC. Trajectories of intimate partner violence and their relationship to stress among young women in South Africa: An HPTN 068 study. Int J Soc Psychiatry 2024:207640241239535. [PMID: 38563376 DOI: 10.1177/00207640241239535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND One in four South African women will experience intimate partner violence (IPV) in their lifetime, potentially increasing their biological stress. In South Africa, limited IPV and stress research has utilized multiple timepoints or examined modifying factors. Cash transfers (CTs) are associated with reduced IPV and stress and may be an intervention target. AIMS We used data-driven methods to identify longitudinal IPV trajectory groups among South African adolescent girls and young women (AGYW), estimate each group's association with stress, and assess modification by a CT. METHODS A total of 2,183 South African AGYW ages 13 to 24 years from the HIV Prevention Trials Network 068 study were randomized to a CT or control group. Physical IPV was measured five times (2011-2017), and stress was captured once (2018-2019). Stress measures included the Cohen Stress Scale and stress biomarkers (C-reactive protein (CRP), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1)). Group-based trajectory modeling identified IPV trajectories; ordinal logistic regression estimated the association between trajectory group and stress. RESULTS A two-group quadratic trajectory model was identified (higher trajectory group = 26.7% of AGYW; lower trajectory group = 73.3%). In both groups, the probability of IPV increased from ages 13 to 17 years before declining in early adulthood. However, the higher group's probability peaked later and declined gradually. The higher trajectory group was associated with an increased odds of elevated CRP (OR: 1.41, 95% CI [1.11, 1.80]), but not with other stress measures. The CT modified the relationship with CMV: a positive association was observed among the usual care arm (OR: 1.59, 95% CI [1.11, 2.28]) but not the CT arm (OR: 0.85, 95% CI [0.61, 1.19]). CONCLUSIONS Sustained IPV risk during adolescence was associated with elevated CRP in young adulthood. The relationship between IPV and elevated CMV was attenuated among those receiving a CT, suggesting that CTs could possibly reduce biological stress due to IPV.
Collapse
Affiliation(s)
- Nicole K Kelly
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
| | - Nivedita L Bhushan
- Center for Communication and Engagement Research, RTI International, Research Triangle Park, NC, USA
| | - Nisha Gottfredson O'Shea
- Substance Use Prevention, Evaluation, and Research Program, RTI International, Research Triangle Park, NC, USA
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Allison E Aiello
- Department of Epidemiology, Robert N Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Sumaya Mall
- Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina, Chapel Hill, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marie Cd Stoner
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| |
Collapse
|
5
|
Bustos B, Lopez M, Dodge KA, Lansford JE, Copeland WE, Odgers CL, Bruckner TA. Family cash transfers in childhood and birthing persons and birth outcomes later in life. SSM Popul Health 2024; 25:101623. [PMID: 38420110 PMCID: PMC10899058 DOI: 10.1016/j.ssmph.2024.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
Much literature in the US documents an intergenerational transmission of birthing person and perinatal morbidity in socioeconomically disadvantaged groups. A separate line of work indicates that family cash transfers may improve life chances of low-income families well into adulthood. By exploiting a quasi-random natural experiment of a large family cash transfer among a southeastern American Indian (AI) tribe in rural North Carolina, we examine whether a "perturbation" in socioeconomic status during childhood improves birthing person/perinatal outcomes when they become parents themselves. We acquired birth records on 6805 AI and non-AI infants born from 1995 to 2018. Regression methods to examine effect modification tested whether the birthing person's American Indian (AI) status and exposure to the family cash transfer during their childhood years corresponds with improvements in birthing person and perinatal outcomes. Findings show an increase in age at childbearing (coef: 0.15 years, 95% confidence interval [CI]: 0.05, 0.25) and a decrease in pre-pregnancy body mass index (BMI; coef: -0.42, 95% CI: -0.76, -0.09) with increased duration of cash transfer exposure during childhood. The odds of large-for-gestational age at delivery, as well as mean infant birthweight, is also reduced among AI births whose birthing person had relatively longer duration of exposure to the cash transfer. We, however, observe no relation with other birthing person/perinatal outcomes (e.g., tobacco use during pregnancy, preterm birth). In this rural AI population, cash transfers in one generation correspond with improved birthing person and infant health in the next generation.
Collapse
Affiliation(s)
- Brenda Bustos
- Program in Public Health, University of California, Irvine, 856 Health Sciences Quad Irvine, CA, 92697, USA
| | - Marcela Lopez
- Department of Epidemiology and Biostatistics, University of California, Irvine, 856 Health Sciences Quad Irvine, CA, 92697, USA
| | - Kenneth A Dodge
- Sanford School of Public Policy, Duke University, 201 Science Drive, Durham, NC, 27708, USA
| | - Jennifer E Lansford
- Sanford School of Public Policy, Duke University, 201 Science Drive, Durham, NC, 27708, USA
| | - William E Copeland
- Department of Psychiatry, University of Vermont, 1 South Prospect, Burlington, VT, 05405, USA
| | - Candice L Odgers
- School of Social Ecology, University of California, Irvine, 4326 Social & Behavioral Sciences Gateway, Irvine, CA, 92697, USA
| | - Tim A Bruckner
- Program in Public Health, University of California, Irvine, 856 Health Sciences Quad Irvine, CA, 92697, USA
- Center for Population, Inequality, and Policy, University of California, Irvine, School of Social Sciences, Irvine, CA, 92697, USA
| |
Collapse
|
6
|
Sun S. Racial/Ethnic Heterogeneity in Parental Wealth and Substance Use from Adolescence to Young Adulthood. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01893-y. [PMID: 38114858 DOI: 10.1007/s40615-023-01893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Substance use has a negative impact on health outcomes, at the individual and population levels. Little consensus exists regarding the relationship between socioeconomic position and substance use across race/ethnicity. This study examines how race/ethnicity and socioeconomic factors, especially parental wealth, are associated with substance use across an 18-year span from adolescence to young adulthood. METHOD Data were drawn from the National Longitudinal Survey of Youth 1997. Substance use behaviors were measured by self-reported heavy episodic drinking, daily cigarette smoking, and use of cannabis. Parental wealth and parental education were measured at baseline. Other socioeconomic factors included education, employment status, and household income. Two-level logistic regression was performed. RESULTS White respondents were more likely to drink, smoke cigarettes, and use cannabis compared to other racial/ethnic groups. More parental wealth was associated with greater odds of heavy episodic drinking, but lower odds of cigarette and cannabis usage. Race/ethnicity modifies the relationships between parental wealth and substance use. Whereas Black respondents from wealthier families had lower odds of heavy episodic drinking, the direction was opposite among white respondents. Wealth functioned as a protective factor against smoking for all groups, although to a lesser extent among respondents of color than for white respondents. Finally, wealthier Hispanics were more likely to smoke daily and use cannabis compared to other racial/ethnic groups. CONCLUSION These findings highlight a nuanced patterning of racial/ethnic heterogeneity in the relationship between parental wealth and substance use behaviors. Implications for policy and programming are discussed.
Collapse
Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA.
| |
Collapse
|
7
|
Choi SL, Choi JM, McDonough IM, Jiang Z, Black SR. Aging alone and financial insecurity predict depression: a path analysis of objective and subjective indices. Aging Ment Health 2023; 27:2238-2247. [PMID: 37561077 DOI: 10.1080/13607863.2023.2243446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES This study draws on conservation of resources theory and transactional stress theory to guide our understanding of how social isolation, financial insecurity, and social support serve as a balance of both risk and protection for late-life depression. METHODS Data were from the Leave-Behind Questionnaire in the 2016 (N = 4293) and 2018 (N = 4714) waves of the Health and Retirement Study. We conducted a cross-sectional path analysis via structural equation modeling, including objective and subjective perspectives. The same model was tested in both samples. RESULTS Both social isolation and financial insecurity were associated with depression. We found several mediating risks and protective factors of these relationships. Objective financial status affected depression through both perceived financial insecurity and perceived social isolation, whereas objective isolation affected depression through perceived social support. This mediation model was -significant after adjusting for confounders. CONCLUSION This study underscores the importance of investigating the balance between risk and protection for depression, in the rising number of older adults aging alone in society. Findings suggest that objective and perceived measures offer unique windows into psychological constructs. Considering both objective and subjective perspectives may provide alternative targets for subsequent interventions to improve mental health in later life.
Collapse
Affiliation(s)
- Shinae L Choi
- Department of Consumer Sciences, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Jaimie M Choi
- Carruth Center for Counseling and Psychological Services, West Virginia University, Morgantown, WV, USA
| | - Ian M McDonough
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Zhehan Jiang
- Institute of Medical Education, Peking University, Beijing, China
| | - Sheila R Black
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| |
Collapse
|
8
|
Austin RR, Rajamani S, Jantraporn R, Pirsch A, Martin KS. Examining standardized consumer-generated social determinants of health and resilience data supported by Omaha System terminology. J Am Med Inform Assoc 2023; 30:1852-1857. [PMID: 37494963 PMCID: PMC10586028 DOI: 10.1093/jamia/ocad143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023] Open
Abstract
Nursing terminologies like the Omaha System are foundational in realizing the vision of formal representation of social determinants of health (SDOH) data and whole-person health across biological, behavioral, social, and environmental domains. This study objective was to examine standardized consumer-generated SDOH data and resilience (strengths) using the MyStrengths+MyHealth (MSMH) app built using Omaha System. Overall, 19 SDOH concepts were analyzed including 19 Strengths, 175 Challenges, and 76 Needs with additional analysis around Income Challenges. Data from 919 participants presented an average of 11(SD = 6.1) Strengths, 21(SD = 15.8) Challenges, and 15(SD = 14.9) Needs. Participants with at least one Income Challenge (n = 573) had significantly (P < .001) less Strengths [9.4(6.4)], more Challenges [27.4(15.5)], and more Needs [15.1(14.9)] compared to without an Income Challenge (n = 337) Strengths [13.4(4.5)], Challenges [10.5(8.9)], and Needs [5.1(10.0)]. This standards-based approach to examining consumer-generated SDOH and resilience data presents a great opportunity in understanding 360-degree whole-person health as a step towards addressing health inequities.
Collapse
Affiliation(s)
- Robin R Austin
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sripriya Rajamani
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Anna Pirsch
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | | |
Collapse
|
9
|
Lisboa CS, Guimarães NS, Ferreira AJF, Silva KBBD, Alves FJO, Rocha ADS, Ortelan N, Texeira CSS, Falcão IR, Silva NDJ, Ribeiro-Silva RDC, Barbosa D, Barreto ML. Impact of cash transfer programs on birth and child growth outcomes: systematic review. CIENCIA & SAUDE COLETIVA 2023; 28:2417-2432. [PMID: 37531548 DOI: 10.1590/1413-81232023288.14082022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/25/2023] [Indexed: 08/04/2023] Open
Abstract
To investigate the impact of cash transfer (CTs) on birth outcomes, including birth weight, low birth weight and prematurity, as well as child physical growth were included, as assessed by anthropometric indices in children under five years of age. Searching was performed using the PubMed/Medline, Embase, LILACS, Cochrane Library, Scopus and Web of Science databases. Quantitative observational, experimental and quasi-experimental. Eleven studies were included in the review. The majority (81.8%) were carried out in low-and middle-income countries and most involved conditional CTs (63.6%). Four were clinical trials and seven were observational studies. Conditional CTs were found to be associated with a reduction in height-for-age (-0.14; 95%CI -0.27, -0.02); (OR 0.85; 95%CI 0.77-0.94); (OR = 0.44; 95%CI 0.19-0.98), a significantly reduced chance of low weight-for-age (OR = 0.16; 95%CI -0.11-0.43), low weight-for-height (OR = -0.68; 95%CI -1.14, -0.21), and low weight-for-age (OR = 0.27; 95%CI 0.10; 0.71). Unconditional CTs were associated with reduced birth weight (RR = 0.71; 95%CI 0.63-0.81; p < 0.0001) and preterm births (RR = 0.76; 95%CI 0.69-0.84; p < 0.0001). Conditional CTs can positively influence birth outcomes and child growth.
Collapse
Affiliation(s)
- Cinthia Soares Lisboa
- Universidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva. Av. Transnordestina s/n, Novo Horizonte. 44036-900 Feira de Santana BA Brasil.
| | | | | | - Karine Brito Beck da Silva
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Flávia Jôse Oliveira Alves
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Aline Dos Santos Rocha
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Naiá Ortelan
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Camila Silveira Silva Texeira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Ila Rocha Falcão
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | | | - Rita de Cássia Ribeiro-Silva
- Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas de Minas Gerais. Belo Horizonte MG Brasil
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| | - Djanilson Barbosa
- Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia. Santo Antônio de Jesus BA Brasil
| | - Mauricio Lima Barreto
- Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas de Minas Gerais. Belo Horizonte MG Brasil
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Instituto Gonçalo Moniz - Fiocruz Bahia. Salvador BA Brasil
| |
Collapse
|
10
|
Mweemba C, Mutale W, Masiye F, Hangoma P. Why is there a gap in self-rated health among people with hypertension? A decomposition of determinants and rural-urban differences. RESEARCH SQUARE 2023:rs.3.rs-3111338. [PMID: 37461663 PMCID: PMC10350196 DOI: 10.21203/rs.3.rs-3111338/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background Hypertension affects over one billion people globally and is one of the leading causes of premature death. The low- and middle-income countries, especially the sub-Saharan Africa region, bear a disproportionately higher share of hypertension globally. Recent evidence shows a steady shift in the burden of hypertension from the more affluent and urban population towards the poorer and rural communities. Our study examined inequalities in self-rated health among people with hypertension and whether there is a rural-urban gap in the health of these patients. We then quantified factors driving the health gap. We also examined how much HIV accounts for differences in self-rated health among hypertension patients due to the relationship between HIV, hypertension and health in sub-Saharan Africa. Methods We utilized the Zambia Household Health Expenditure and Utilization Survey for the data on SRH and other demographic and socioeconomic controls. District HIV prevalence information was from a previous study. The linear probability model provided a preliminary assessment of the association between self-rated health and independent variables. We then used the Blinder-Oaxaca decomposition to identify self-rated health inequality between urban and rural patients and determine determinants of the health gap between the two groups. Results Advanced age, lower education and low district HIV prevalence were significantly associated with poor health rating among hypertension patients. The decomposition analysis indicated that 45.5% of urban patients and 36.9% of rural patients reported good self-rated health, representing a statistically significant health gap of 8.6%. Most of the identified health gap can be attributed to endowment effects, with education (62%), district HIV prevalence (26%) and household expenditure (12%) being the most important determinants that explain the health gap. Conclusions Urban hypertension patients have better SRH than rural patients in Zambia. Educational interventions, financial protection schemes and strengthening hypertension health services in rural areas can significantly reduce the health gap between the two regions.
Collapse
Affiliation(s)
- Chris Mweemba
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Wilbroad Mutale
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Felix Masiye
- Department of Economics, School of Humanities and Social Science, P.O Box 32379, Great East Road Campus, University of Zambia, Lusaka, Zambia
| | - Peter Hangoma
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
- Chr. Michelson Institute (CMI), Bergen, Norway
- Bergen Center for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
| |
Collapse
|
11
|
Guimarães NS, Magno L, de Paula AA, Silliman M, Anderle RVR, Rasella D, Macinko J, de Souza LE, Dourado I. The effects of cash transfer programmes on HIV/AIDS prevention and care outcomes: a systematic review and meta-analysis of intervention studies. Lancet HIV 2023; 10:e394-403. [PMID: 37270225 PMCID: PMC10329870 DOI: 10.1016/s2352-3018(22)00290-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/02/2022] [Accepted: 09/21/2022] [Indexed: 06/05/2023]
Abstract
BACKGROUND Poverty and social inequality are risk factors for poor health outcomes in patients with HIV/AIDS. In addition to eligibility, cash transfer programmes can be divided into two categories: those with specific requirements (conditional cash transfers [CCTs]) and those without specific requirements (unconditional cash transfers). Common CCT requirements include health care (eg, undergoing an HIV test) and education (eg, children attending school). Trials assessing the effect of cash transfer programmes on HIV/AIDS outcomes have yielded divergent findings. This review aimed to summarise evidence to evaluate the effects of cash transfer programmes on HIV/AIDS prevention and care outcomes. METHODS For this systematic review and meta-analysis, we searched PubMed, EMBASE, Cochrane Library, LILACS, WHO IRIS, PAHO-IRIS, BDENF, Secretaria Estadual de Saúde SP, Localizador de Informação em Saúde, Coleciona SUS, BINACIS, IBECS, CUMED, SciELO, and Web of Science up to Nov 28, 2022. We included randomised controlled trials (RCTs) that evaluated the effects of cash transfer programmes on HIV incidence, HIV testing, retention in HIV care, and antiretroviral therapy adherence, and conducted risk of bias and quality of evidence assessments using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations approach. A random-effects meta-analysis model was used to combine studies and calculate risk ratios (RRs). Subgroup analyses were performed using conditionality types (ie, school attendance or health care). The protocol was registered with PROSPERO, CRD42021274452. FINDINGS 16 RCTs, which included 5241 individuals, fulfilled the inclusion criteria. Of these, 13 studies included conditionalities for receiving cash transfer programmes. The results showed that receiving a cash transfer was associated with lowered HIV incidence among individuals who had to meet health-care conditionalities (RR 0·74, 95% CI 0·56-0·98) and with increased retention in HIV care for pregnant women (1·14, 95% CI 1·03-1·27). No significant effect was observed for HIV testing (RR 0·45, 95% CI 0·18-1·12) or antiretroviral therapy adherence (1·13, 0·73-1·75). Lower risk of bias was observed for HIV incidence and having an HIV test. The strength of available evidence can be classified as moderate. INTERPRETATION Cash transfer programmes have a positive effect on mitigating HIV incidence for individuals who have to meet health-care conditionalities and on increasing retention in HIV care for pregnant women. These results show the potential of cash transfer programmes for HIV prevention and care, especially among people in extreme poverty, and highlight that cash transfer programmes must be considered when developing policies for HIV/AIDS control, as indicated by the UNAIDS 95-95-95 target of the HIV care continuum. FUNDING National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA.
Collapse
Affiliation(s)
- Nathalia Sernizon Guimarães
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Postgraduate Health Science, Medical Sciences College of Minas Gerais, Belo Horizonte, Brazil.
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Department of Life Sciences, State University of Bahia, Salvador, Brazil
| | | | - Miriam Silliman
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Barcelona Institute for Global Health, Barcelona, Spain
| | - James Macinko
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
12
|
Rosenberg M, Beidelman E, Chen X, Canning D, Kobayashi L, Kahn K, Pettifor A, Kabudula CW. The impact of a randomized cash transfer intervention on mortality of adult household members in rural South Africa, 2011-2022. Soc Sci Med 2023; 324:115883. [PMID: 37023659 PMCID: PMC10124166 DOI: 10.1016/j.socscimed.2023.115883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/20/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Increasing socioeconomic resources through cash transfer payments could help promote healthy longevity. However, research in this area is limited due to endogeneity in cash transfer exposures and limited geographic representation. METHODS We leveraged the HPTN 068 randomized cash transfer trial, conducted from 2011 to 2015 in a rural setting in South Africa. We assessed long-term mortality follow-up (until March 2022) on older adult members (n = 3568) of households enrolled in the trial from the complete Agincourt Health and socio-Demographic Surveillance System census of the underlying source population. The trial intervention was a monthly cash payment of 300 Rand conditional on school enrollment of index young women. The payments were split between the young woman (1/3) and their caregiver (2/3). Young women and their households were randomized 1:1 to intervention vs. control. We used Cox PH models to compare mortality rates in older adults living in intervention vs. control households. FINDINGS The cash transfer intervention did not significantly impact mortality in the full sample [HR (95% CI): 0.94 (0.80, 1.10)]. However, we observed strong protective effects of the cash transfer intervention among those with above-median household assets [HR (95% CI): 0.66 (0.50, 0.86)] and higher educational attainment [HR (95% CI): 0.37 (0.15, 0.93)]. INTERPRETATION Our findings indicate that short-term cash transfers can lead to reduced mortality in certain subgroups of older adults with higher baseline socioeconomic status. Future work should focus on understanding the optimal timing, structure, and targets to maximize the benefits of cash transfer programs in promoting healthy aging and longevity.
Collapse
Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Erika Beidelman
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Xiwei Chen
- Biostatistics Consulting Center, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - David Canning
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lindsay Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, MI, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Audrey Pettifor
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology, University of North Carolina-Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
13
|
West S, Castro A. Impact of Guaranteed Income on Health, Finances, and Agency: Findings from the Stockton Randomized Controlled Trial. J Urban Health 2023; 100:227-244. [PMID: 37037977 PMCID: PMC10160253 DOI: 10.1007/s11524-023-00723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 04/12/2023]
Abstract
The purpose of this experiment was to test the effects of a $500 per month guaranteed income for 2 years on health and financial outcomes. A mixed-methods randomized controlled trial in Stockton, CA, USA enrolled 131 individuals to the treatment condition and 200 to control to receive a guaranteed income from February 2019 to January 2021. Quantitative data collection began 3 months prior to allocation at 6-month intervals concluding 6 months after withdrawal of the intervention. Qualitative data collection included 105 interviews across 3 stages. The primary outcomes were income volatility, physical and mental health, agency, and financial wellbeing. The treatment condition reported lower rates of income volatility than control, lower mental distress, better energy and physical functioning, greater agency to explore new opportunities related to employment and caregiving, and better ability to weather pandemic-related financial volatility. Thus, this study provides causal evidence of positive health and financial outcomes for recipients of guaranteed income. As income volatility is related to poor health outcomes, provision of a guaranteed income is a potentially powerful public health intervention.
Collapse
Affiliation(s)
- Stacia West
- The University of Tennessee College of Social Work, Co-Founding Director, The Center for Guaranteed Income Research at the University of Pennsylvania, Philadelphia, USA.
| | - Amy Castro
- The University of Pennsylvania, School of Social Policy and Practice, Co-Founding Director, The Center for Guaranteed Income Research, Philadelphia, USA
| |
Collapse
|
14
|
Sun S, Lee H, Hudson DL. Racial/ethnic differences in the relationship between wealth and health across young adulthood. SSM Popul Health 2023; 21:101313. [PMID: 36589274 PMCID: PMC9798167 DOI: 10.1016/j.ssmph.2022.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
•Wealth attenuated racial differences in self-rated health during young adulthood.•Wealth had consistent incremental effect on health among White & Hispanic Americans.•For Black Americans, wealth was protective of health in the highest wealth quartile.•Individual wealth, not parental wealth was associated with health among Hispanics.
Collapse
Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA
| | - Hedwig Lee
- Department of Sociology, Trinity College of Arts & Sciences, 417 Chapel Dr, Durham, NC, 27708, USA
| | - Darrell L. Hudson
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| |
Collapse
|
15
|
Evaluation of conditional cash transfers and mHealth audio messaging in reduction of risk factors for childhood malnutrition in internally displaced persons camps in Somalia: A 2 × 2 factorial cluster-randomised controlled trial. PLoS Med 2023; 20:e1004180. [PMID: 36848361 PMCID: PMC9970051 DOI: 10.1371/journal.pmed.1004180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/20/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Cash transfer programmes are increasingly used in humanitarian contexts to help address people's needs across multiple sectors. However, their impact on the key objectives of reducing malnutrition and excess mortality remains unclear. mHealth interventions show great promise in many areas of public health, but evidence for their impact on reducing the risk factors for malnutrition is uncertain. We therefore implemented a trial to determine the impacts of 2 interventions in a protracted humanitarian context, a cash transfer conditionality and mHealth audio messages. METHODS AND FINDINGS A 2 × 2 factorial cluster-randomised trial was implemented in camps for internally displaced people (IDP) near Mogadishu, Somalia, starting in January 2019. The main study outcomes were assessed at midline and endline and included coverage of measles vaccination and the pentavalent immunisation series, timely vaccination, caregiver's health knowledge, and child diet diversity. Twenty-three clusters (camps) were randomised to receive or not receive conditional cash transfers (CCTs) and an mHealth intervention, and 1,430 households were followed up over 9 months. All camps received cash transfers made at emergency humanitarian level (US$70/household/month) for 3 months followed by a further 6 months at a safety net level (US$35). To be eligible to receive cash, households in camps receiving CCT were required to take their children <5 years age to attend a single health screening at a local clinic and were issued with a home-based child health record card. Participants in camps receiving the mHealth intervention were asked (but not required) to listen to a series of audio messages about health and nutrition that were broadcast to their mobile phone twice a week for 9 months. Participants and investigators were not blinded. Adherence to both interventions was monitored monthly and found to be high (>85%). We conducted intention-to-treat analysis. During the humanitarian intervention phase, the CCT improved coverage of measles vaccination (MCV1) from 39.2% to 77.5% (aOR 11.7, 95% CI [5.2, 26.1]; p < 0.001) and completion of the pentavalent series from 44.2% to 77.5% (aOR 8.9, 95% CI [2.6, 29.8]; p = < 0.001). By the end of the safety net phase, coverage remained elevated from baseline at 82.2% and 86.8%, respectively (aOR 28.2, 95% CI [13.9, 57.0]; p < 0.001 and aOR 33.8, 95% CI [11.0, 103.4]; p < 0.001). However, adherence to timely vaccination did not improve. There was no change in the incidence of mortality, acute malnutrition, diarrhoea, or measles infection over the 9 months of follow-up. Although there was no evidence that mHealth increased Mother's knowledge score (aOR 1.32, 95% CI [0.25, 7.11]; p = 0.746) household dietary diversity increased from a mean of 7.0 to 9.4 (aOR 3.75, 95% CI [2.04, 6.88]; p < 0.001). However, this was not reflected by a significant increase in child diet diversity score, which changed from 3.19 to 3.63 (aOR 2.1, 95% CI [1.0, 4.6]; p = 0.05). The intervention did not improve measles vaccination, pentavalent series completion, or timely vaccination, and there was no change in the incidence of acute malnutrition, diarrhoea, measles infection, exclusive breastfeeding, or child mortality. No significant interactions between the interventions were found. Study limitations included the limited time available to develop and test the mHealth audio messages and the necessity to conduct multiple statistical tests due to the complexity of the study design. CONCLUSIONS A carefully designed conditionality can help achieve important public health benefits in humanitarian cash transfer programmes by substantially increasing the uptake of child vaccination services and, potentially, other life-saving interventions. While mHealth audio messages increased household diet diversity, they failed to achieve any reductions in child morbidity, malnutrition, or mortality. TRIAL REGISTRATION ISRCTN ISRCTN24757827. Registered November 5, 2018.
Collapse
|
16
|
Abstract
Early in the pandemic, New York City's public hospital system partnered with multiple philanthropic foundations to offer an unconditional cash transfer program for low-income New Yorkers affected by COVID-19. The $1000 cash transfers were designed to help people meet their most immediate health and social needs and were incorporated into healthcare delivery and contact tracing workflows as a response to the public health emergency. To better understand program recipients' experiences, researchers conducted 150 telephone surveys with randomly sampled cash transfer recipients and 20 in-depth qualitative interviews with purposefully sampled survey participants. Survey participants were predominantly Latinx (87%) and women (65%). The most common reported uses of the $1000 were food and rent. Most participants (79%) reported that without the $1000 cash transfer they would have had difficulty paying for basic expenses or making ends meet, with specific positive effects reported related to food, housing, and ability to work. The majority of survey participants reported that receiving the cash assistance somewhat or greatly improved their physical health (83%) and mental health (89%). Qualitative interview results generally supported the survey findings.
Collapse
|
17
|
Sun S, Chen YC. Is Financial Capability a Determinant of Health? Theory and Evidence. JOURNAL OF FAMILY AND ECONOMIC ISSUES 2022; 43:744-755. [PMID: 36338921 PMCID: PMC9628498 DOI: 10.1007/s10834-022-09869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Financial capability, the combination of financial literacy (ability to act) and financial access (opportunity to act), improves people's access to resources, and thus has the potential to improve health and well-being. This paper positions financial capability under the framework of social determinants of health and discusses theory and presents empirical evidence on the link between financial capability and health. Using data from the RAND American Life Panel and the structural equation modeling approach, we distinguish financial capability from the common socioeconomic position indicators such as income and education. We find that financial capability has a positive and longitudinal effect on health, independent of race/ethnicity, gender, income, education, and employment. This study demonstrates that financial capability is an independent social determinant of health. It can be theoretically and conceptually defined, empirically measured, and can inform clinical interventions that may improve population health and well-being. Implications for future research, practice, and policy are discussed.
Collapse
Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, 66045 Lawrence, KS USA
| | - Yu-Chih Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
18
|
Zungu P, Louw KA, Slabbert P, Bantjes J. 'They Sent Me Out to School, and I Came Back with a Baby': Perinatal Women's Experiences of Biographical Disruption and Nonfatal Suicidal Behaviour. QUALITATIVE HEALTH RESEARCH 2022; 32:1767-1779. [PMID: 35938716 DOI: 10.1177/10497323221119314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Exploring perinatal women's experience of nonfatal suicidal behaviour (NFSB) could help illuminate the contexts in which perinatal suicide occurs and new ways to conceptualise maternal suicide prevention. Our aim was to explore perinatal women's subjective experience of NFSB in South Africa. Data were collected via in-depth interviews with seven perinatal women hospitalised following NFSB. Thematic analysis showed how poverty and gender norms shape experiences of pregnancy and highlighted the need for eco-systemic interventions for perinatal women in resource scarce environments to increase social support, assist with childcare, improve educational retention, challenge gender norms and increase paternal involvement. Pregnancy can precipitate biographical disruption by disturbing women's view of themselves and their futures. An inability to reconstruct a coherent narrative and re-imagine the future impedes the transition to motherhood and provides a context for suicide. Using the concept of biographical disruption to frame perinatal suicide, could identify novel approaches to suicide prevention.
Collapse
Affiliation(s)
- Pamela Zungu
- Department of Psychiatry, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, South Africa
| | - Kerry-Ann Louw
- Department of Psychiatry, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, South Africa
| | - Philip Slabbert
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
- Alcohol, Tobacco and Other Drug Research Unit, 59097South African Medical Research Council, South Africa
| |
Collapse
|
19
|
Berkowitz J, Khetpal V, Echouffo-Tcheugui JB, Bambs CE, Aiyer A, Kip KE, Reis SE, Erqou S. Associations between cumulative social risk, psychosocial risk, and ideal cardiovascular health: Insights from the HeartSCORE study. Am J Prev Cardiol 2022; 11:100367. [PMID: 35923764 PMCID: PMC9340530 DOI: 10.1016/j.ajpc.2022.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/16/2022] [Accepted: 07/16/2022] [Indexed: 11/21/2022] Open
Abstract
Higher social risk is associated with achievement of fewer ideal cardiovascular health factors. The association was modestly attenuated after adjusting for depression, stress, and perceived discrimination. Psychosocial factors may mediate part of the association between social risk and achievement of ideal cardiovascular health.
Background Limited studies have assessed the effects of psychosocial risk factors on achievement of ideal cardiovascular health (CVH). Methods Using the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) cohort, we examined the cross-sectional associations of cumulative social risk (CSR) and three psychosocial factors (depression, stress, perceived discrimination) with ideal CVH. CSR was calculated by assigning one point for each of: low family income, low education level, minority race (Black), and single-living status. Ideal CVH was calculated by assigning one point for ideal levels of each factor in American Heart Association's Life's Simple 7. Ideal CVH was dichotomized into fewer versus higher by combining participants achieving <3 versus ≥3 factors. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of having fewer ideal CVH factors. Psychosocial factors were assessed as mediators of the association between CSR and ideal CVH. Results We included 2000 participants (mean age 59.1 [7.5] years, 34.6% male, 42.7% Black, and 29.1% with low income), among whom 60.6% had <3 ideal CVH factors. The odds of having fewer ideal CVH factors increased significantly with increasing CSR scores from 1 to 2, to ≥3 compared to individuals with CSR score of zero, after adjusting for age and sex (OR [95% CIs]: 1.77 [1.41 - 2.22]; 2.09 [1.62 - 2.69] 2.67 [1.97 - 3.62], respectively). Taking the components of ideal CVH separately, higher CSR was directly associated with odds of being in ‘non-ideal’ category for six of the seven factors, but was inversely associated with probability of being in ‘non-ideal’ category for cholesterol. The association was modestly attenuated after adjusting for depression, stress, and perceived discrimination (corresponding OR [95% CI]: 1.69 [1.34 - 2.12], 1.96 [1.51 - 2.55], 2.34 [1.71 - 3.20]). The psychosocial factors appeared to mediate between 10% and 20% of relationship between CSR and ideal CVH. Conclusions Increased CSR was associated with lower probability of achieving ideal CVH factors. A modest amount of the effect of CSR on ideal CVH appeared to be mediated by depression, stress and perceived discrimination. Public health strategies aimed at improving ideal cardiovascular health may benefit from including interventions targeting social and psychosocial risk factors.
Collapse
Affiliation(s)
- Julia Berkowitz
- Department of Medicine, the Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Vishal Khetpal
- Department of Medicine, the Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Claudia E Bambs
- Department of Public Health, and Advanced Center for Chronic Diseases-ACCDiS, School of Medicine, Pontificia Universidad Católica de Chile, United States
| | - Aryan Aiyer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kevin E. Kip
- UPMC Health Services Division, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Steven E. Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sebhat Erqou
- Department of Medicine, the Warren Alpert Medical School of Brown University, Providence, RI, United States
- Division of Cardiology, Department of Medicine, Providence VA Medical Center, Providence, RI, United States
- Corresponding author at: Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, United States.
| |
Collapse
|
20
|
Han X, Shi SK, Zhao J, Nogueira LM, Bandi P, Fedewa SA, Jemal A, Yabroff KR. The first year of the COVID-19 pandemic and health among cancer survivors in the United States. Cancer 2022; 128:3727-3733. [PMID: 35989581 PMCID: PMC9537961 DOI: 10.1002/cncr.34386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/24/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022]
Abstract
Background Cancer survivors represent a population with high health care needs. If and how cancer survivors were affected by the first year of the coronavirus disease 2019 (COVID‐19) pandemic are largely unknown. Methods Using data from the nationwide, population‐based Behavioral Risk Factor Surveillance System (2017–2020), the authors investigated changes in health‐related measures during the COVID‐19 pandemic among cancer survivors and compared them with changes among adults without a cancer history in the United States. Sociodemographic and health‐related measures such as insurance coverage, employment status, health behaviors, and health status were self‐reported. Adjusted prevalence ratios of health‐related measures in 2020 versus 2017–2019 were calculated with multivariable logistic regressions and stratified by age group (18–64 vs. ≥65 years). Results Among adults aged 18–64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self‐rated health improved, regardless of cancer history. Notably, declines in smoking were larger among cancer survivors than nonelderly adults without a cancer history. Few changes were observed for adults aged ≥65 years. Conclusions Further research is needed to confirm the observed positive health behavior and health changes and to investigate the role of potential mechanisms, such as the national and regional policy responses to the pandemic regarding insurance coverage, unemployment benefits, and financial assistance. As polices related to the public health emergency expire, ongoing monitoring of longer term effects of the pandemic on cancer survivorship is warranted. Among cancer survivors aged 18–64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self‐rated health improved, regardless of cancer history.
Collapse
Affiliation(s)
- Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Sylvia Kewei Shi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Stacey A Fedewa
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| |
Collapse
|
21
|
Guo S, Yu X, Davis E, Armstrong R, Naccarella L. Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children. CHILDREN 2022; 9:children9081128. [PMID: 36010019 PMCID: PMC9406777 DOI: 10.3390/children9081128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022]
Abstract
Health literacy is a broad and multidimensional construct, making its measurement and conclusions inconsistent. This study aims to compare the patterning of health literacy using different assessment tools and examine their impact on children’s developmental outcomes. A cross-sectional study was conducted with 650 students in Years 7–9 from four secondary schools in Beijing. Health literacy was measured by the eight-item health literacy assessment tool (HLAT, score range 0–37), the six-item Newest Vital Sign (NVS, score range 0–6), and the 16-item Health Literacy Survey (HLS, score range 0–16). Based on Manganello’s health literacy framework, information on upstream factors (e.g., gender, ethnicity, socioeconomic status) and developmental outcomes (e.g., health-promoting behaviours, health service use, global health status) was collected. Overall, the average scores for health literacy were 26.34 ± 5.89, 3.64 ± 1.64, and 13.72 ± 2.94, respectively, for HLAT, NVS, and HLS. The distribution of health literacy varied by socio-demographics and individual characteristics except for gender, no matter which health literacy assessment tool was used. The magnitude of associations between health literacy, its upstream factors and developmental outcomes was greater when using three-domain instruments (HLAT and HLS) than using single-domain instruments (NVS). The approach to health literacy measurement will influence the conclusion. Using multidimensional assessment tools may better capture a child’s health literacy and contribute to the maximum efficiency and effectiveness of school-based health literacy interventions.
Collapse
Affiliation(s)
- Shuaijun Guo
- Centre for Community Child Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3053, Australia; (E.D.); (R.A.); (L.N.)
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Correspondence: (S.G.); (X.Y.); Tel.: +61-452-110-331 (S.G.); +86-010-8280-2631 (X.Y.)
| | - Xiaoming Yu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
- Correspondence: (S.G.); (X.Y.); Tel.: +61-452-110-331 (S.G.); +86-010-8280-2631 (X.Y.)
| | - Elise Davis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3053, Australia; (E.D.); (R.A.); (L.N.)
| | - Rebecca Armstrong
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3053, Australia; (E.D.); (R.A.); (L.N.)
| | - Lucio Naccarella
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3053, Australia; (E.D.); (R.A.); (L.N.)
| |
Collapse
|
22
|
Novignon J, Prencipe L, Molotsky A, Valli E, de Groot R, Adamba C, Palermo T. The impact of unconditional cash transfers on morbidity and health-seeking behaviour in Africa: evidence from Ghana, Malawi, Zambia and Zimbabwe. Health Policy Plan 2022; 37:607-623. [PMID: 35157775 PMCID: PMC9113146 DOI: 10.1093/heapol/czac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/21/2021] [Accepted: 02/11/2022] [Indexed: 11/12/2022] Open
Abstract
Unconditional cash transfers have demonstrated widespread, positive impacts on consumption, food security, productive activities and schooling. However, the evidence to date on cash transfers and health-seeking behaviours and morbidity is not only mixed, but the evidence base is biased towards conditional programmes from Latin America and is more limited in the context of Africa. Given contextual and programmatic design differences between the regions, more evidence from Africa is warranted. We investigate the impact of unconditional cash transfers on morbidity and health-seeking behaviour using data from experimental and quasi-experimental study designs of five government cash transfer programs in Ghana, Malawi, Zambia and Zimbabwe. Programme impacts were estimated using difference-in-differences models with longitudinal data. The results indicate positive programme impacts on health seeking when ill and on health expenditures. Our findings suggest that while unconditional cash transfers can improve health seeking when ill, morbidity impacts were mixed. More research is needed on longer-term impacts, mechanisms of impact and moderating factors. Additionally, taken together with existing evidence, our findings suggest that when summarizing the impacts of cash transfers on health, findings from conditional and unconditional programmes should be disaggregated.
Collapse
Affiliation(s)
- Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Leah Prencipe
- Department of Public Health, Erasmus Medical Center, Rotterdam 3000 CA, The Netherlands
| | - Adria Molotsky
- American Institutes for Research, International Development Division, 1400 Crystal Drive, 10th Floor Arlington, VA 22202, USA
| | - Elsa Valli
- UNICEF Office of Research – Innocenti, Via degli Alfani 58, 50121 Florence, Italy
| | - Richard de Groot
- Independent Consultant, Josef Israelshof 23, Oosterhout 4907 PT, The Netherlands
| | - Clement Adamba
- Institute of Statistical, Social and Economic Research, University of Ghana-Legon, P.O. Box LG 74, Legon-Accra, Ghana
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, 270 Farber Hall, Buffalo, NY 14214-800, USA
| |
Collapse
|
23
|
Engels D, Elphick-Pooley T. The potential of conditional cash transfers for the control of neglected tropical diseases. THE LANCET GLOBAL HEALTH 2022; 10:e588-e589. [DOI: 10.1016/s2214-109x(22)00115-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022] Open
|
24
|
The effect of conditional cash transfers on the control of neglected tropical disease: a systematic review. Lancet Glob Health 2022; 10:e640-e648. [PMID: 35427521 DOI: 10.1016/s2214-109x(22)00065-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are diseases of poverty and affect 1·5 billion people globally. Conditional cash transfer (CCTs) programmes alleviate poverty in many countries, potentially contributing to improved NTD outcomes. This systematic review examines the relationship between CCTs and screening, incidence, or treatment outcomes of NTDs. METHODS In this systematic review we searched MEDLINE, Embase, Lilacs, EconLit, Global Health, and grey literature websites on Sept 17, 2020, with no date or language restrictions. Controlled quantitative studies including randomised controlled trials (RCTs) and observational studies evaluating CCT interventions in low-income and middle-income countries were included. Any outcome measures related to WHO's 20 diseases classified as NTDs were included. Studies from high-income countries were excluded. Two authors (AA and TH) extracted data from published studies and appraised risk of biases using the Risk of Bias in Non-Randomised Studies of Interventions and Risk of Bias 2 tools. Results were analysed narratively. This study is registered with PROSPERO, CRD42020202480. FINDINGS From the search, 5165 records were identified; of these, 11 studies were eligible for inclusion covering four CCTs in Brazil, the Philippines, Mexico, and Zambia. Most studies were either RCTs or quasi-experimental studies and ten were assessed to be of moderate quality. Seven studies reported improved NTD outcomes associated with CCTs, in particular, reduced incidence of leprosy and increased uptake of deworming treatments. There was some evidence of greater benefit of CCTS in lower socioeconomic groups but subgroup analysis was scarce. Methodological weaknesses include self-reported outcomes, missing data, improper randomisation, and differences between CCT and comparator populations in observational studies. The available evidence is currently limited, covering a small proportion of CCTs and NTDs. INTERPRETATION CCTs can be associated with improved NTD outcomes, and could be driven by both improvements in living standards from cash benefits and direct health effects from conditionalities related to health-care use. This evidence adds to the knowledge of health-improving effects from CCTs in poor and vulnerable populations. FUNDING None.
Collapse
|
25
|
Kim C, Azra K, Teo C, Nielsen A, Bellows Z, Young T, Chum A. Do social protection programmes have a causal effect on suicide mortality? A protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e054677. [PMID: 35459667 PMCID: PMC9036465 DOI: 10.1136/bmjopen-2021-054677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Recent international and national strategies to reduce suicide mortality have suggested that social protection programmes may be an effective multisectoral response given the link between material deprivation and suicides in observational studies. However, there is a lack of evidence on the causal relationship between social protection programmes and suicide, which may hinder substantial national budget reallocations necessary to implement these policies. Social protection programmes are government interventions that ensure adequate income now and in the future, through changes to earned income (eg, minimum wage increase) or social security (via cash transfers or cash equivalents). Our review aims to evaluate the existing evidence on a causal relationship between social protection programmes and suicide mortality by examining all relevant experimental and quasi-experimental studies between January 1980 and November 2021. METHODS AND ANALYSIS The review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We will search references published between 1 January 1980 and 30 November 2021 in 10 electronic databases, including MEDLINE (PubMed), PsycINFO, EMBASE and Applied Social Sciences Index Abstracts. Seven reviewers will independently participate in screening studies from titles, abstracts and full texts across all the stages. Experimental (ie, randomised controlled trials) and quasi-experimental studies (ie, non-randomised interventional studies) written in English, French, Spanish, German, Chinese, Korean and Japanese examining the impact of income security programmes on suicide mortality were included. Meta-analyses will be conducted if there are at least three studies with similar income security programmes. ETHICS AND DISSEMINATION Our proposed review does not require ethical approval. In collaboration with our community partners, we will develop a policy brief for stakeholders to support efforts to implement social protection programmes to help prevent suicides. Our findings will be presented at conferences, published in a peer-reviewer journal and promoted on social media platforms. PROSPERO REGISTRATION NUMBER CRD42021252235.
Collapse
Affiliation(s)
- Chungah Kim
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Karanpreet Azra
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Celine Teo
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Zachary Bellows
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Thomas Young
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Antony Chum
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Epidemiology Divison, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Chipanta D, Estill J, Stöckl H, Hertzog L, Toska E, Chanda P, Mwanza J, Kaila K, Matome C, Tembo G, Keiser O, Cluver L. Associations of Sustainable Development Goals Accelerators With Adolescents’ Well-Being According to Head-of-Household’s Disability Status–A Cross-Sectional Study From Zambia. Int J Public Health 2022; 67:1604341. [PMID: 35283719 PMCID: PMC8916123 DOI: 10.3389/ijph.2022.1604341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/07/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: We examined associations between accelerators (interventions impacting ≥2 SDG targets) and SDG-aligned well-being indicators among adolescents 16–24 years old in Zambia. Methods: We surveyed adults from 1,800 randomly sampled households receiving social cash transfers. We examined associations between accelerators (social cash transfers, life-long learning, mobile phone access) and seven well-being indicators among adolescents using multivariate logistic regressions. Results: The sample comprised 1,725 adolescents, 881 (51.1%) girls. Mobile phone access was associated with no poverty (adjusted Odds Ratio [aOR] 2.08, p < 0.001), informal cash transfers (aOR 1.82, p = 0.004), and seeking mental health support (aOR 1.61, p = 0.020). Social cash transfers were associated with no disability-related health restrictions (aOR 2.56, p = 0.004) and lesser odds of seeking mental health support (aOR 0.53, p = 0.029). Life-long learning was associated with informal cash transfers (aOR 3.49, p < 0.001) and lower school enrollment (aOR 0.70, p = 0.004). Adolescents with disabled head-of-household reported worse poverty, good health but less suicidal ideation. Conclusions: Social cash transfers, life-long learning, and mobile phone access were positively associated with well-being indicators. Adolescents living with disabled head-of-household benefited less. Governments should implement policies to correct disability-related inequalities.
Collapse
Affiliation(s)
- David Chipanta
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
- *Correspondence: David Chipanta,
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lucas Hertzog
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Patrick Chanda
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Jason Mwanza
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Kelly Kaila
- Disability Inclusion Project Luapula, International Labour Organisation, Lusaka, Zambia
| | | | - Gelson Tembo
- Palm Associates Limited, Lusaka, Zambia
- Economics and Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Lucie Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
27
|
Fang S, Huang J. Financial incentives for health should be standard practice. BMJ 2022; 376:o179. [PMID: 35074862 DOI: 10.1136/bmj.o179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Shu Fang
- School of Sociology and Psychology, Central University of Finance and Economics, Beijing, China
| | - Jin Huang
- Saint Louis University and Washington University in St Louis, St Louis, MO, USA
| |
Collapse
|