Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study.

OBJECTIVE: To assess the impact of tobacco control regulations and policy implementation on smoking cessation tendencies in cigarette users born between 1982 and 1991 in Chile. DESIGN: Longitudinal cross-sectional study. SETTING: National level. PARTICIPANTS: Data from the National Survey of Drug Consumption (Service of Prevention and Rehabilitation for Drug and Alcohol Consumption). A pseudo-cohort of smokers born between 1982 and 1991 (N=17 905) was tracked from 2002 to 2016. PRIMARY AND SECONDARY OUTCOMES MEASURES: Primary outcome was the tendency to cease smoking conceptualised as the report of using cigarettes 1 month or more ago relative to using cigarettes in the last 30 days. The main exposure variable was the Tobacco Policy Index-tracking tobacco policy changes over time. Logistic regression, controlling for various factors, was applied. RESULTS: Models suggested a 14% increase in the smoking cessation tendency of individuals using cigarettes 1 month or more ago relative to those using cigarettes in the last 30 days (OR 1.14, CI 95% CI 1.10 to 1.19) for each point increment in the Tobacco Policy index. CONCLUSIONS: Our study contributes to documenting a positive impact of the implementation of interventions considered in the MPOWER strategy in the progression of smoking cessation tendencies in smokers born between 1982 and 1991 in Chile.

Dataset: Repeated and longitudinal measures database from 1994 to 2018 to assess Chile's substance use control policies for the 2000-2010 decade.

We developed a database to assess Chile's substance use control policies implemented in the 2000-10 decade. The database includes the measurement of consumption of substances such as alcohol, tobacco, and drugs (cannabis, cocaine, and "pasta base" (crack)), individual, relationships, and environmental factors related to substance use, and variables that measure the implementation of laws regulating its use. For the construction of the database, we used information from three sources: i) the biannual National Survey of Drug Consumption for the general population of the National Service of Prevention and Rehabilitation for Drug and alcohol consumption (SENDA) from the Chilean government, ii) the cases filed in local police courts by group of offenses from Chile's Ministry of Justice reports, and iii) the regional imprisoned population from Chile's Correctional Services reports. In the case of the first data source, a data curation process was established to construct this unique database from 1994 to 2018, identifying variables measured systematically over time, standardizing variables' operationalization, and adjusting responses to prespecified flows in each year. On the other hand, substance use control laws enacted in 2004 (alcohol), 2005 (drugs), and 2006 (tobacco) were operationalized as categorical and continuous variables as indicators of its implementation.

The Increasing Prevalence of Children Home Alone in Ghana: The Importance of Considering Regional Inequalities.

Research from industrialized settings has linked inadequate child supervision with various negative consequences. Nevertheless, empirical research in lower- and middle-income countries about correlates of inadequate child supervision has been scarce. The few studies that exist tended to focus on individual- and household-level factors, and reported associations that are not significant or in mixed directions depending on the context. Structural factors are left underexplored, but taking a more macro-level lens in settings with high regional disparities can hold the key to explaining increases in prevalence of inadequate child supervision. Exploring the evolution over time of child supervision practices can also enrich this explanation. We use data from two rounds of Ghana Multiple Indicator Cluster Surveys to examine factors associated with children left home alone, and employ regional analysis using strata-level mixed effects. We found that in Ghana, the prevalence of children left home alone without adult supervision increased by 8.5% between 2011 and 2018 - an increase of more than 500,000 children over seven years. Statistical analyses suggest that variation between regions likely are associated with the growth of inadequate child supervision in this country. Future research should pay closer attention to how structural conditions, proxied by regions, can serve as either barriers or facilitators to adequate child supervision practices, helping shed light on residual variance unexplained by individual- and household-level factors. Supplementary Information: The online version contains supplementary material available at 10.1007/s12187-023-10038-w.

Structural gender inequalities and symptoms of postpartum depression in 40 countries.

BACKGROUND: The role of structural gender inequality in macro-level differences in women's perinatal mental health remains largely unexplored. This short communication explores structural gender inequalities and their potential as a macro-level, upstream social determinant of postpartum depression (PPD). METHODS: We compiled meta-analytically derived national-level prevalence estimates of PPD symptoms - based on the Edinburgh Postnatal Depression Scale - with economic (e.g., income inequality), health (e.g., infant mortality rate), sociodemographic (e.g., urban population), and structural gender inequality variables (e.g., abortion policies) for 40 countries. Meta-regression techniques and traditional p-value based stepwise procedures, complemented with a Bayesian model averaging approach, were used for a robust selection of variables associated with national-level PPD symptom prevalence. RESULTS: Income inequality (ß = 0.04, 95% CI = 0.02 to 0.07) and abortion policies (ß = 0.02, 95% CI = 0.00 to 0.03) were the only variables selected in the final, adjusted model, accounting for 60.7% of cross-national variations in PPD symptoms. LIMITATIONS: Study quality of primary studies was not assessed and some national-level meta-analytical estimates were based on few primary studies. A fifth of world countries and territories could be included, with high-income regions overrepresented. High rate of missing national-level data for potential predictors of PPD. Cross-sectional analyses precludes causal inferences. CONCLUSIONS: Abortion policies are a significant macro-level social determinant of PPD, and its liberalization might be associated with women's mental health at a population level. Our findings should be a relevant argument for clinicians to advocate for changing discriminatory social norms against women.

Differential impacts of ridesharing on alcohol-related crashes by socioeconomic municipalities: rate of technology adoption matters.

BACKGROUND: An emergent group of studies have examined the extent under which ridesharing may decrease alcohol-related crashes in countries such as United States, United Kingdom, Brazil, and Chile. Virtually all existent studies have assumed that ridesharing is equally distributed across socioeconomic groups, potentially masking differences across them. We contribute to this literature by studying how socioeconomic status at the municipal level impacts Uber's effect on alcohol-related crashes. METHODS: We use data provided by Chile's Road Safety Commission considering all alcohol-related crashes, and fatal and severe alcohol-related injuries that occurred between January 2013 and September 2013 (before Uber) and January and September 2014 (with Uber) in Santiago. We first apply spatial autocorrelation techniques to examine the level of spatial dependence between the location of alcohol-related crashes with and without Uber. We then apply random-effects meta-analysis to obtain risk ratios of alcohol-related crashes by considering socioeconomic municipality differences before and after the introduction of Uber. RESULTS: In both analyses, we find that the first 9 months of Uber in Santiago is associated with significant rate ratio decreases (RR = 0.71 [95% Confidence Interval (C.I.) 0.56, 0.89]) in high socioeconomic municipalities in all alcohol-related crashes and null (RR = 1.10 [95% C.I. 0.97, 1.23]) increases in low socioeconomic municipalities. No concomitant associations were observed in fatal alcohol-related crashes regardless of the socioeconomic municipality group. CONCLUSIONS: One interpretation for the decline in alcohol-related crashes in high socioeconomic municipalities is that Uber may be a substitute form of transport for those individuals who have access to credit cards, and thus, could afford to pay for this service at the time they have consumed alcohol. Slight increases of alcohol-related crashes in low socioeconomic municipalities should be studied further since this could be related to different phenomena such as increases in alcohol sales and consumption, less access to the provision of public transport services in these jurisdictions, or biases in police reports.

The global viralization of policies to contain the spreading of the COVID-19 pandemic: Analyses of school closures and first reported cases.

BACKGROUND: On January 30th 2020, the World Health Organization (WHO) declared a international health emergency due to the unprecedented phenomenon of COVID-19. After this declaration countries swiftly implemented a variety of health policies. In this work we examine how rapid countries responded to this pandemic using two events: the day in which the first case of COVID-19 was reported, and first day in which countries used school closure as one of the measures to avoid outbreaks. We also assessed how countries' health systems, globalization, economic development, political systems, and economic integration to China, Republic of Korea and Italy increased the speed of adoption. METHODS: We compiled information from multiple sources, from December 31st 2019 to June 1st 2020, to trace when 172 countries reported their first COVID-19 case and implemented school closure to contain outbreaks. We applied cross-national Weibull survival analysis to evaluate the global speed of detection of first COVID-19 reported cases and school closure. RESULTS: Ten days after WHO declared COVID-19 to be an international emergency, relative to seven days from this declaration, countries were 28 (95% CI: 12-77) times more likely to report first COVID-19 cases and 42 (95% CI: 22-90) times more likely to close schools. One standard deviation increase in the epidemic security index rises the rate of report first cases by 37% (Hazard Ratio (HR) 1.37 (95% CI: 1.09-1.72) and delays the adoption for school closures by 36% (HR 0.64 (95% CI:0.50-0.82). One standard deviation increase in the globalization index augments the adoption for school closures by 74% (HR 1.74 (95% CI:1.34-2.24). CONCLUSION: After the WHO declared a global emergency, countries were unprecedently acting very rapidly. While countries more globally integrated were swifter in closing schools, countries with better designed health systems to tackle epidemics were slower in adopting it. More studies are needed to assess how the speed of school closures and other policies will affect the development of the pandemic.

Solid fuel use and early child development disparities in Ghana: analyses by gender and urbanicity.

In Ghana, more than 77% of the population depends on biomass fuels for cooking. Previous studies show that solid fuel use (SFU) has adverse effects on pregnancy and child health outcomes. Yet, no previous study considered potential effects on early child development indicators (ECDI), nor how SFU effects may vary by gender, and rural and urban areas. We investigated the associations of SFU with ECDI measures, and whether these associations exhibited sex and urban/rural differences. We used the 2011-2012 Ghana's Multiple Indicator Cluster Surveys-UNICEF (N = 3326 children; 3-4 years). We derived a binary ECDI measure reflecting whether the child is developmentally on track or not from a caregiver-report of ten yes/no/do not know questions designed specifically to assess four domains of early child development: learning-cognition, literacy-numeracy, socio-emotional, and physical. We used multilevel Poisson regressions adjusting for neighborhood, household, mother, and child's characteristics to estimate covariate-adjusted prevalence ratios (PRs) of the associations between SFU and ECDI and its four dimensions. We run stratified analyses and used z-score tests of differences to evaluate effect modification by sex and urbanicity. Overall, 85% of children were exposed to SFU and 28% of children were not developmentally on track. After adjustment for confounders, children exposed to SFU were more likely to be not developmentally on track in comparison with nonexposed children (PR = 1.16; 95% confidence interval, [95% CI]: 1.10,1.22). These associations were stronger in girls (PR = 1.36; 95% CI: 1.03,1.79) in comparison with boys (PR = 0.87; 95% CI: 0.73,1.04). No difference in associations was observed between urban and rural children. Overall, these associations were mainly driven by the literacy-numeracy dimension. In this study, we show that SFU was associated with developmental delays in Ghanaian girls. Policy efforts which tackle SFU should be mindful of gender disparities in susceptibility to indoor pollution.

Passengers at risk: a multi-level analysis of the decision to travel with a drunk driver.

AIMS: To assess the impact of demographic, intrapersonal and environmental factors on the likelihood in Chile of becoming a passenger of an alcohol-impaired driver (PAID). DESIGN: Multi-level cross-sectional study. SETTING: Data were acquired from two large-scale household surveys of representative samples of Chile's Metropolitan Region. PARTICIPANTS: The study included 1341 individuals ≥ 16 years; 696 of them reported engaging in PAID. MEASUREMENT: The primary outcome was self-reported frequencies of having accepted a ride with an alcohol-impaired driver. FINDINGS: PAID was associated significantly with 'age' [odds ratio (OR) = 0.99, 95% confidence interval (CI) = 0.98-0.99, P = 0.03], 'traffic safety beliefs' (OR = 0.17, 95% CI = 0.078-0.44, P = 0.00), 'time exposure as passenger' (OR = 1.00, 95% CI = 1.00-1.01, P = 0.00) and 'sex' (OR = 0.67, 95% CI = 0.53-0.87, P = 0.00). In women, PAID was associated with 'age' (OR = 0.98, 95% CI = 0.97-0.99, P = 0.02), 'traffic safety beliefs' (OR = 0.17, 95% CI = 0.05-0.59, P = 0.00) and 'low quality of public bus stops' (OR = 0.97, 95% CI = 0.98-0.99, P = 0.01). Younger women with high education levels were more likely to engage in PAID than younger women with low education levels. In men, PAID was associated with 'traffic safety beliefs' (OR = 0.13, 95% CI = 0.02-0.63, P = 0.01) and 'time exposure as passenger' (OR = 1.00, 95% CI = 1.00-1.01, P = 0.02). CONCLUSIONS: In Chile, men are at higher risk of becoming a passenger of an alcohol-impaired driver (PAID) than women. In women, PAID appears to be associated with lower traffic safety beliefs, lower quality of public bus stations and an interaction between education and age. In men, PAID is associated with lower traffic safety beliefs and higher time exposure as passenger.

Explaining Chile's traffic fatality and injury reduction for 2000-2012.

OBJECTIVES: The objective of the current study is to determine the contribution of Chile's 2005 traffic law reform, police enforcement, and road investment infrastructure to the reduction of traffic fatalities and severe injuries from 2000 to 2012. METHODS: Analyses based on structural equation models were carried out using a unique database merging aggregate administrative data from several Chilean public institutions. The sample was balanced (13 regions, over 13 years; N=169). Dependent variables were rates of traffic fatality (total, drivers, passengers, and pedestrians), severe injuries, and total number of crashes per vehicle fleet. Independent variables were (1) traffic law reform, (2) police enforcement, and (3) road infrastructure investment. Oil prices, alcohol consumption, proportion of male population 15-24 years old, unemployment, years' effects and regions' effects, and lagged dependent variables were entered as control variables. RESULTS: Empirical estimates from the structural equation models suggest that the enactment of the traffic law reform is significantly associated with a 7% reduction of pedestrian fatalities. This association is entirely mediated by the positive association the law had with increasing police enforcement and reducing alcohol consumption. In turn, police enforcement is significantly associated with a direct decrease in total fatalities, driver fatalities, passenger fatalities, and pedestrian fatalities by 17%, 18%, 8%, and 60%, respectively. Finally, road infrastructure investment is significantly associated with a direct reduction of 11% in pedestrian fatalities, and the number of total crashes significantly mediates the effect of road infrastructure investment on the reduction of severe injuries. Tests of sensitivity indicate these effects and their statistical significance did not vary substantively with alternative model specifications. CONCLUSIONS: Results suggest that traffic law reform, police enforcement, and road infrastructure investment have complex interwoven effects that can reduce both traffic fatalities and severe injuries. Though traffic reforms are ultimately designed to change road user behaviors at large, it is also important to acknowledge that legislative changes may require institutional changes--that is, intensification of police enforcement--and be supported by road infrastructure investment, in order to effectively decrease traffic fatalities and injuries. Furthermore, depending on how road safety measures are designed, coordinated, and implemented, their effects on different types of road users vary. The case of Chile illustrates how the diffusion of road safety practices globally promoted by the World Health Organization and World Bank, particularly in 2004, can be an important influence to enhance national road safety practices.