Household income is associated with attack frequency, but not with the prevalence of headache: an analysis of self-reported headache in the general population in Germany.

BACKGROUND: Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample. METHODS: Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0-3 days per month), moderate frequency episodic headache (MFEH: 4-14 days per month) and chronic headache (CH: ≥ 15 days per month). RESULTS: Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms. CONCLUSIONS: To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate.

Assessing Post-traumatic Stress Disorder and Social Determinants Among COVID-19 Case-Contact Dyads in Household Settings.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 outbreak raised several public and mental health concerns including tremendous psychological distress. AIM: To assess post-traumatic stress disorder (PTSD) among COVID-19-positive patients and household contacts and to determine the socio-demographic factors associated with PTSD in the study population. METHODS: A cross-sectional study was conducted among COVID-19-positive patients and their family members in Ernakulam district. A daily list of COVID-19-positive patients was obtained from the district officials. Confirmed cases and their close contacts in households were contacted over telephone and were interviewed after obtaining consent. Post-traumatic stress was assessed by the PTSD Symptom Scale - Interview Version (PSS-I-5) questionnaire. RESULTS: There were 279 study participants, of whom 93 were COVID-19 positive and the remaining 186 were their contacts. More than a third (34, 36.6%) of cases suffered from PTSD while about a fifth (40, 21.5%) of contacts suffered from PTSD. Among cases, persons belonging to the below poverty line (BPL) had 2.9l (1.19, 7.24) times higher risk compared to those above poverty line (APL). Women also had a 2.8 (1.14, 7.01) higher odds compared to males. Among contacts, graduates had a 9.54 (95% CI: 1.84, 49.36) increased odds whereas homemakers were found to be protected (0.195 (0.06, 0.66)) against PTSD compared to the employed group. CONCLUSIONS: Psychological counselling and support are essential for addressing PTSD among women and those living with BPL, as these groups are disproportionately affected.

Factors affecting Kaposi's sarcoma-associated herpesvirus transmission in rural Ugandan households, a longitudinal study.

BACKGROUND: We report the impact of HIV infection within a household on oral Kaposi's sarcoma-associated herpesvirus (KSHV) shedding. METHODS: We enrolled 469 individuals from 90 households. Mouthwash rinse samples collected at three monthly visits were analyzed for KSHV DNA using quantitative polymerase chain reaction (qPCR). Generalized linear mixed effects logistic models were applied to analyze factors associated with KSHV ever shedding, and among shedders, always versus intermittent shedding. Linear mixed effects models were applied to models of KSHV viral loads. Intraclass correlation coefficients (ICCs) were calculated to assess the contribution of household-level factors to variations in shedding probabilities. Hotspot analyses of geospatial feature clusters were calculated using Getis-Ord Gi* statistic and visualized using inverse distance weighted interpolation. RESULTS: Analyses included 340 KSHV seropositive individuals, aged 3 + years, with qPCR results from 89 households. Forty households had 1 + persons living with HIV (PLWH), while 49 had none. Among participants, 149(44%) were KSHV ever shedders. Of 140 who shed KSHV at two or more visits, 34(24%) were always shedders. Increasing number of KSHV seropositive household members was significantly associated with ever shedding [Odds ratio(OR) (95% Confidence Interval(95%CI)):1.14(1.03,1.26);p = 0.013]. Among KSHV shedders, a statistically significant age-related trend was identified with 10-19 years being more likely to be always shedders (type III test p = 0.039) and to have higher viral loads (type III test p = 0.027). In addition, higher viral loads were significantly associated with increasing number of household members [coefficient(95%CI):0.06(0.01,0.12);p = 0.042], increasing number of KSHV seropositive members [coefficient(95%CI):0.08(0.01,0.15);p = 0.021], and living in households with 1 + PLWH [coefficient(95%CI):0.51(0.04,0.98);p = 0.033]. Always shedders exhibited higher viral loads than intermittent shedders [coefficient(95%CI):1.62(1.19,2.05);p < 0.001], and viral loads increased with the number of visits where KSHV DNA was detected in saliva (type III test p < 0.001). Household-level factors attributed for 19% of the variability in KSHV shedding (ICC:0.191;p = 0.010). Geospatial analysis indicated overlapping hotspots of households with more KSHV seropositive individuals and KSHV shedders, distinct from areas where PLWH were clustered. DISCUSSION: KSHV oral shedding is influenced by multiple factors at the individual, household, and regional levels. To mitigate ongoing KSHV transmission a comprehensive understanding of factors contributing to oral KSHV reactivation and transmission within households is needed.

Household electricity consumption prediction using database combinations, ensemble and hybrid modeling techniques.

Household electricity consumption (HEC) is changing over time, depends on multiple factors, and leads to effects on the prediction accuracy of the model. The objective of this work is to propose a novel methodology for improving HEC prediction accuracy. This study uses two original datasets, namely questionnaire survey (QS) and monthly consumption (MC), which contain data from 225 consumers from Maharashtra, India. The original datasets are combined to create three additional datasets, namely QS + MC, QS equation (QsEq) + next month's consumptions, and QsEq + MC. Furthermore, the HEC prediction accuracy is boosted by applying different approaches, like correlation methods, feature engineering techniques, data quality assessment, heterogeneous ensemble prediction (HEP), and the hybrid model. Five HEP models are created using dataset combinations and machine learning algorithms. Based on the MC dataset, the random forest provides the best prediction of RMSE (36.18 kWh), MAE (25.73 kWh), and R2 (0.76). Similarly, QsEq + MC dataset adaptive boosting provides a better prediction of RMSE (36.77 kWh), MAE (26.18 kWh), and R2 (0.76). This prediction accuracy is further increased using the proposed hybrid model to RMSE (22.02 kWh), MAE (13.04 kWh), and R2 (0.92). This research work benefits researchers, policymakers, and utility companies in obtaining accurate prediction models and understanding HEC.

Changes in household use of disinfectant and cleaning products during the first lockdown period in France.

BACKGROUND: Few studies evaluated the use of Household Disinfectant and Cleaning Products (HDCPs) during the COVID-19 pandemic, but no population-based cohorts used longitudinal data. We studied changes in HDCPs during the first lockdown, based on longitudinal data from the French population-based NutriNet-Santé and CONSTANCES cohorts. METHODS: Based on standardized questionnaires on household cleaning tasks in 2018-2019 and around the first lockdown in France (March17-May3 2020), we compared the duration of weekly use of HDCPs (< 1 day/week, < 10 min/week; 10-30 min/week; > 30 min/week) and the household cleaning help (yes/no) before and during the lockdown period by Bhapkar and McNemar's tests. Moreover, we assessed self-reported changes in the frequency of HDCPs during the lockdown from before (unchanged/increased). RESULTS: Analyses were carried on 31,105 participants of NutriNet-Santé (48 years, 75% women, 81% ≥ high school diploma) and 49,491 of CONSTANCES (47 years, 51% women, 87% ≥ high school diploma). During the lockdown, compared with 2018-2019, duration of HDCPs use increased (> 30 min; NutriNet-Santé: 44% versus 18%; CONSTANCES: 63% versus 16%) and household help decreased (NutriNet-Santé: 5% versus 40%; CONSTANCES: 3% versus 56%). Regarding the frequency of HDCPs use, 55% of participants of NutriNet-Santé (57% women/49% men) and 83% of CONSTANCES (86% women/81% men) reported an increased use since the beginning of the lockdown, significantly higher among women (p < 0.0001). CONCLUSIONS: The frequency and duration of weekly use of HDCPs has significantly increased since the pandemic. As the use of HDCPs is associated with health issues, further studies are now needed to evaluate the potential health impacts of these changes.

Exploring the relationship between personal exposure to multiple water-soluble components and ROS in size-resolved PMs in solid fuel combustion households.

Water-soluble species are the main components of particulate matters (PMs), which have important impacts on visibility, climate change and human health. Here, personal exposure (PE) to size-resolved PMs from housewives using different solid fuels (biomass and coal) was collected during winter in rural Yuncheng city, Fenwei Plain, China. The concentrations of water-soluble organic carbon (WSOC) and reactive oxygen species (ROS) were higher in the biomass group than coal group, whereas the concentrations of water-soluble inorganic ions and water-soluble nitrogen were higher in the coal group than biomass group. Almost all measured water-soluble components in both groups showed a pattern of increasing concentration with decreasing particle size, with more than 50% of WSOC and water-soluble total nitrogen (WSTN) enriched in PM0.25. The Pearson correlation result was in general agreement with the relationship between water-soluble components and ROS found by random forest model. There was a strong positive correlation between ROS and WSOC in PMs in the coal group, especially in PMs <0.25 µm, which may be due to the emission of a large number of transition metals chelated with WSOC from coal combustion. The contribution of Cl- and F- to ROS was greater in the biomass group. NO2- in both coal and biomass groups had a decent positive effect on ROS generation. The strongest positive linear correlation (R = 0.95) between ROS and K+ in total suspended particulates in the biomass group, whereas there was almost no contribution of K+ to ROS when particle size was distinguished or in random forest model, which reflects the specificity of K+ in inducing ROS. The present study provides new insights for a deeper exploration of the relationship between water-soluble components and oxidative potential in PE PMs from domestic combustion sources.

Exploring the Potential for Tuition-Free Higher Education in South Africa: A Scoping Review.

The debate on tuition-free higher education has raged in South Africa since the #FeesMustFall protests at South African universities in 2015 and 2016. The government responded with a tuition-free education policy targeting students from households earning less than R350 000. However, the question remains can South Africa sustain a tuition-free education policy given its developing nation status and the levels of its GDP? This article sought to assess the feasibility of tuition-free higher education for all in South Africa. A scoping review was used, and fifteen articles about tuition-free higher education feasibility in South Africa were reviewed. The choice of the scoping review was due to the need for an understanding of the current state of play in research on the feasibility of tuition-free higher education in South Africa. The results suggest that tuition-free higher education for all is not feasible in South Africa. There seems to be a consensus that South Africa lacks the resources to finance tuition-free higher education for all. Tuition-free higher education is also viewed as a regressive tax on the poor given that the majority of students in higher education institutions come from middle and upper-income households. However, it is important to note that a distinction is drawn between tuition-free higher education for all and tuition-free higher education for the poor and academically deserving. The latter seems to receive support with some viewing it as a moral imperative in an unequal society such as South Africa's. It is recommended that future studies approach the issue from an empirical standpoint whereby the GDP levels are assessed against higher education funding.

Household fuel use and the regression from prehypertension to normotension among Chinese middle-aged and older adults: a cohort study.

To examine the association of household fuel use with prehypertension regression among middle-aged and older people based on the China Health and Retirement Longitudinal Study (CHARLS), we included a total of 3501 participants with prehypertension at baseline, and they were followed up from 2011-2012 to 2015-2016 with information on blood pressure and household solid fuel use (heating and cooking fuels). Cox proportional hazards regression models were used to explore the hazard ratio (HR) and 95% confidence interval (CI) between fuel use and prehypertension regression. Additionally, we investigated the impact of switching fuels (2011-2013) on the regression to normotension during the 4-year follow-up. Linear regression was used to examine the effect of household fuel use on changes in blood pressure. Compared to solid fuel users, those who used clean fuel for heating at baseline had a positive effect on the regression of prehypertension (HR: 1.28, 95% CI: 1.08-1.53). Participants who used clean fuels for both heating and cooking had increased odds for the regression of prehypertension (HR: 1.32, 95% CI: 1.09-1.60). Compared to consistent solid fuel users, those who consistently used clean fuel for heating had a higher likelihood of transitioning from prehypertension to normotension (HR: 1.36, 95% CI: 1.06-1.73) and exhibited 2.45 mmHg lower systolic blood pressure. In conclusion, household clean fuel use for heating was positively associated with the regression of prehypertension to normotension. Furthermore, switching from solid fuel to clean fuel for heating could reduce the risk of prehypertension in Chinese middle-aged and older adults.

The mediating role of subjective social status in the association between objective socioeconomic status and mental health status: evidence from Iranian national data.

Introduction: Low socioeconomic status (SES) is identified as a pivotal risk factor for mental health. Objective socioeconomic status (OSS) is measured by tangible resources, whereas subjective social status (SSS) reflects an individual's perception of their OSS. A paucity of literature exists that elucidates the specific psychosocial mechanisms or pathways linking OSS with mental illness via SSS. This research aimed to explore the mediating role of SSS in the OSS-mental health association, utilizing data from the Iranian Mental Health Survey (IranMHS). Methods: This study is a secondary analysis of data from IranMHS, a national survey conducted in 2011 through face-to-face interviews with 7,886 Iranian adults aged 15-64. As part of the original survey, the General Health Questionnaire-28 (GHQ-28) was randomly administered to half of these participants. We focused our analysis on data from 3,759 participants who completed all items of the GHQ-28. OSS was evaluated using education, occupation, wealth, and a combined OSS index, while SSS was measured using the MacArthur Scale. We examined how SSS mediates the associations between OSS factors and GHQ scores, including its four dimensions-somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression- while adjusting for demographic variables and conducting gender-stratified analyses. Results: Among the 3759 respondents, 2157 (57.4%) were women, 2110 (56.1%) lived in urban areas, with an average age of 33.1 years (SD=12.1). SSS mediated the associations between wealth and the overall GHQ score (mediation percentage: 92.3%), education (75.4%), OSS index (66.7%), and occupation (34.0%) on the GHQ score. The most significant mediation effects were observed for wealth on the somatic symptoms, social dysfunction, and depression dimensions, with SSS accounting for more than 80% of these associations. Conclusion: The findings indicate a significant mediating role of SSS in the relationship between OSS and mental health. Enhancing our comprehension of the social determinants that moderate the relationship between objective and subjective socioeconomic status may contribute to a more nuanced understanding of the impact of SES on mental health outcomes.

Probabilistic bias analysis for exposure misclassification of household income by neighbourhood in a cohort of individuals with colorectal cancer.

INTRODUCTION: Despite poor agreement, neighbourhood income is used as a proxy for household income, due to a lack of data availability. We quantified misclassification between household and neighbourhood income and demonstrate quantitative bias analysis (QBA) in scenarios where only neighbourhood income is available in assessing income inequalities on colorectal cancer mortality. METHODS: This was a retrospective study of adults with colorectal cancer diagnosed 2006-14 from Statistics Canada's Canadian Census Health and Environment Cohort. Neighbourhood income quintiles from Statistics Canada were used. Census household income quintiles were used to determine bias parameters and confirm results of the QBA. We calculated positive and negative predictive values using multinomial models, adjusting for age, sex and rural residence. Probabilistic QBA was conducted to explore the implication of exposure misclassification when estimating the effect of income on 5-year mortality. RESULTS: We found poor agreement between neighbourhood and household income: positive predictive values ranged from 21% to 37%. The bias-adjusted risk of neighbourhood income on 5-year mortality was similar to the risk of mortality by household income. The bias-adjusted relative risk of the lowest income quintile compared with the highest was 1.42 [95% simulation interval (SI) 1.32-1.53] compared with 1.46 [95% confidence interval (CI) 1.39-1.54] for household income and 1.18 (95% CI 1.12-1.24) for neighbourhood income. CONCLUSION: QBA can be used to estimate adjusted effects of neighbourhood income on mortality which represent household income. The predictive values from our study can be applied to similar cohorts with only neighbourhood income to estimate the effects of household income on cancer mortality.

The roles of employment status and income in the mental health of informal caregivers in Germany.

BACKGROUND: Informal caregivers often experience multiple negative consequences as a result of the informal care they provide. Among other factors, employment status, financial resources, and mental health are related to informal caregiving. This analysis examined the association between informal caregivers' employment status and their mental health, as well as the moderating effect of net household income on this relationship. METHODS: The research question was addressed with data from the German Socio-Economic Panel (SOEP) survey, comprising 3,053 informal caregivers (1,007 male; 2,046 female). Data were obtained through self-reports, and mental health was measured with the Summary Scale Mental Score. Stepwise adjusted multiple linear regression models were used to examine the association between employment status and mental health. The moderating effects were tested with interaction terms. All analyses were also stratified for gender. RESULTS: Informal caregivers with full-time jobs reported better mental health than unemployed or marginally employed caregivers (ß = 0.077, p < 0.001). The significant interaction term for full-time (ß=-0.066, p = 0.001) and part-time workers (ß=-0.066, p = 0.003) indicated a moderating effect of net household income on the association between employment status and mental health. This finding was especially evident in women. CONCLUSIONS: Employment appears to be a relevant protective factor for informal caregivers' mental health. However, if informal caregivers are not employed, a low net household income might additionally restrict their mental health. Therefore, welfare policy structures must be created to reduce the negative financial consequences for informal caregivers and enable them to achieve work-life-care balance.

Association of household chemicals use with cognitive function among Chinese older adults.

Background: The paucity of empirical evidence supporting a correlation between the utilization of household chemicals and cognitive decline in Chinese older adults. Methods: The data utilized for this study originated from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2018). Using regression models to investigate the relationship between exposure to household chemicals and cognitive decline, and evaluate the impact of different fields on cognitive function. Results: The use of household chemicals was associated with a decline in cognitive function (anti-caries agent, OR = 1.68, P = 0.040; air freshener, OR = 2.48, P = 0.002; disinfectant, OR = 1.40, P = 0.033). The more frequent the use of household chemicals, the worse the cognitive function (Model1: OR = 2.54, P = 0.024; Model2: OR = 3.23, P = 0.006; Model3: OR = 3.59, P = 0.003). Conclusion: The study has uncovered a correlation between the utilization of household chemicals and cognitive decline in individuals aged 65 years and over in China.

Who counts in poverty research?

Mainstream poverty analysis currently renders certain people and degrees of privation more socially legible than others across high-income countries. This article examines how these hierarchies carry through to and corrupt wider social scientific analysis, inscribing differential value to actors and phenomena in ways that undermine social understanding and explanation. First, conventional approaches to poverty analysis and measurement obscure the de facto prevalence of deep poverty, as well as those most subject to its violence. Second, a growing number of hyper-marginalised groups are missing from population income surveys, undermining the accuracy of (deep) poverty estimates and public understanding of both its determinants and dynamics. Third, the inferential and external validity of income surveys is significantly diminished by problems surrounding data quality and coverage. Attempts to address this have principally focused on improving data quality, but as demonstrated in this article, these strategies exacerbate poor representation of the lowest-income groups in distributional analysis. Much more than merely technical or pragmatic, these are theoretical and normative judgements about who counts in welfare policy and politics. Overall, I demonstrate how current data practices occlude some the most violent forms of denigration and exploitation that structure advanced marginality, particularly the gendered, racialised, bordering and ableist practices underpinning state-citizen dynamics. Focusing principally on the UK context, I argue that the epistemic erasure committed features in and systematises a policy blindness to deep poverty for some of the most marginalised social groups making it harder to evidence its effects and address its causes across high-income countries.

Avoiding unintentional injuries from household chemicals: Comparing the appeal to children from the perspectives of children, caregivers, and experts.

This study investigated whether caregivers and regulatory experts can predict the appeal of household chemicals for children and explored determinants of differences between adults' and children's child-appeal rating. We invited N = 95 4-year-old children and their caregivers to a laboratory study. Both independently ranked 16 household chemicals from the least to the most child-appealing product. In addition to the laboratory study, we sent an online adaptation of this ranking task to N = 46 experts involved in the monitoring and authorizing of household chemicals. Our findings show that the aggregated child-appeal rating of household chemicals was highly similar among caregivers, experts, and children. When comparing child-appeal ratings of household chemicals with and without child-appealing images, caregivers and experts did well in predicting which products might appeal to children. Finally, our findings show that the similarity between individual caregivers' and their own children's child-appeal ratings of household chemicals varied substantially. To conclude, although adults can assess the general child-appeal of household chemicals, they need to consider that the actual appeal of a household chemical can vary considerably among individual children. Instead of regulating specific product attributes, policymakers should prioritize educating caregivers about pitfalls and misconceptions that hinder effective injury prevention.

Development of integrated assessment tool for water, sanitation and hygiene (WASH) services in non-household settings under climate change context.

Access to improved water, sanitation, and hygiene (WASH) services is crucial in recognizing human rights to water and sanitation and due to their impacts on education, livelihoods, and human health. However, these services are often inadequate in non-household settings such as prisons, refugee camps, schools, and healthcare facilities. Progress in monitoring to ensure sustainable services in these settings has been limited. Although several tools are available to assess WASH services in both household and non-household settings, they have limitations, and none has taken a holistic approach to evaluate WASH performance in all non-household settings. Furthermore, the impacts of climate change on WASH services are rarely considered in these evaluations, making the inadequacies of WASH services worse. To address these gaps, an integrated tool was developed to assess WASH performance in non-household settings, incorporating financial, institutional, environmental impact, technical, social, and climate change factors. The tool provides scores for indicators to solve the problem of a lack of final aggregated data to enable decision-makers to determine the level of WASH performance in a setting. Moreover, it provides qualitative explanations for each score, allowing decision-makers to identify areas for improvement. This tool offers valuable and insightful data for improving WASH facilities and ensuring sustainable services in non-household settings, particularly for WASH service providers and local governments.

The Impact of Household Dysfunction on Dating Violence Perpetration Among Adolescents in the United States: A Scoping Review.

Adverse childhood experiences, such as household dysfunction (HD), play a central role in how adolescents establish, experience, and navigate the challenges of relationship formation, maintenance, and dissolution. HD exposures have been independently associated with dating violence (DV) perpetration in both adolescents and adults. However, research examining the association between the concurrent effect of HD on DV perpetration, especially among adolescents remains scarce. Thus, we conducted a scoping review to accumulate and summarize existing research regarding the impact of HD on DV perpetration among adolescents aged 10 to 17 years in the United States. We used three electronic databases, Medline (Ovid), PsycINFO, and EMBASE, to search for studies published in English between 2013 and August 2023. A total of 14 studies were retained for this review after full-text screening. Most of the included studies (64%) were longitudinal. Concerning HD measurement, 71% of studies evaluated witnessing intimate partner violence (IPV), and the remaining 29% assessed family conflict, both using different instruments. Regarding DV measurement, 43% of studies utilized the Safe Dates Abuse measures to assess various forms of DV perpetration. Findings from 3/4 (75%) studies that evaluated family conflict found it to be a significant predictor of DV perpetration. Additionally, 8/10 (80%) studies that assessed exposure to IPV reported significant associations with various forms of DV perpetration among adolescents. None of the included studies measured HD comprehensively; thus, measurement development is imperative. Findings from this review may help initiate the development of a more comprehensive HD measure, promote early intervention, and foster resilience among adolescents.

Adversities Mediate Social Determinants of Youth Tobacco Use Initiation.

Background: Social determinants of health (SDOH) significantly influence health behaviors, including tobacco use among youth. Adversities such as perceived discrimination, perceived neighborhood stress, life trauma, and financial strain are stressors that may mediate the relationship between various SDOH and youth tobacco use. This study aims to investigate whether multidimensional adversities mediate the effects of SDOH on tobacco use among youth. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study were used to test our hypotheses. The sample included a diverse cohort of youth aged 9-10 years old followed until they were 15-16 years old. We examined the effects of baseline parental education, household income, neighborhood income, and family structure on subsequent youth tobacco use. Structural equation models were used to test if adversities (perceived discrimination, life trauma, financial strain) operate as potential mediators. Results: All ABCD participants were eligible for our analysis, regardless of race, ethnicity, or SDOHs (n = 11,878). The findings indicated that the effects of parental education, household income, neighborhood income, and family structure on youth tobacco use were partially mediated by adversities. Higher levels of parental education and household income were associated with lower tobacco use, and this relationship was weakened when accounting for adversities. Similarly, stable family structures and higher neighborhood income were linked to reduced tobacco use, with adversities playing a mediating role. Conclusions: Multidimensional adversities partially mediate the relationship between SDOH at baseline and subsequent youth tobacco use. Interventions aimed at reducing youth tobacco use should address both the social determinants and multiple adversities experienced by adolescents. Policies to improve the educational and economic situations of families, enhance neighborhood environments, and support stable family structures all reduce youth tobacco use, with lower exposure to adversities explaining this effect.

Pharmacist-led interventions in addressing improper disposal practices of unused and expired household medication: A systematic review.

Background: Improper household medication disposal practices are a source of significant threat to environmental safety and public health. Pharmacists play a crucial role in mitigating these risks by educating the public about proper medication disposal. Evidence regarding the effectiveness of efforts conducted by health professionals to reduce the risks associated with improper disposal practices is still lacking. Therefore, this study aimed to systematically review pharmacist-led interventions in addressing unused and expired household medication disposal. Method: A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar databases to identify studies evaluating pharmacist-led interventions and the effectiveness in improving household medication disposal practices until January 2024 with no constraints on publication year. Two reviewers independently performed the study selection process, data extraction, and outcomes assessment. Subsequently, the entire collected data were extracted and synthesized using qualitative and quantitative methods. Results: The results showed that two among the total 83 studies retrieved during the search process met the inclusion criteria. The identified pharmacist-led interventions included the provision of an at-home medication disposal kit and an informational handout on proper disposal. However, these interventions showed no significant effects in improving household medication disposal practices, and all studies reported a low engagement rate with interventions. Conclusion: The systematic review identified limited literature on pharmacist-led interventions for unused and expired household medication disposal practices, with no observed significant effects. Active patient and pharmacist engagement were required to enhance the effectiveness of interventions. Furthermore, the included limited studies suggested the need for the development of more pharmacist-led interventions to facilitate the role of pharmacist in educating the public on proper household medication disposal.

Prevalence and socio-demographic factors associated with double and triple burden of malnutrition among mother-child pairs in India: Findings from a nationally representative survey (NFHS-5).

Introduction: Improper consumption of food leads to various forms of malnutrition such as undernutrition, overnutrition and micronutrient deficiency. The coexistence of various malnutrition forms in the same household is a public health concern in developing countries. Very little research has been done on exploring the burden and risk factors associated with double (DBM) and triple burden of malnutrition (TBM). Methods: Secondary analysis was done using data from India's National Family Health Survey-5 (NFHS-5), 2019-21. Mothers and under-five children were paired at the household level as a unit of analysis. DBM and TBM were interpreted from children's height-for-age, weight-for-height, weight-for-age and anaemia status and mothers' body-mass-index. Stratification and clustering in the sample design were accounted for during the analysis in STATA v14.2. DBM and TBM were summarized as weighted proportions with 95 % confidence interval (CI) and the risk factors associated were reported as adjusted odds ratio (aOR) with 95%CI using mixed effects logistic regression. Results: We included 167,380 mother-child pairs for analysis. In India, the prevalence of DBM was 7.7 % (95 % CI: 7.5-7.9 %) and TBM was 5.1 % (5.0-5.3 %) at the household level among mother-child dyads. Mothers' age, age at first birth, educational levels, current breastfeeding habits, mode of delivery, child's age, gender, twin birth, birth weight, geographical region, residence, caste and religion, and wealth index were associated with both DBM and TBM. Conclusion: Both DBM and TBM are public health concerns in India. Thus, scaling-up of health intervention, effective implementation of nutritional programmes and life-course approach are needed to control malnutrition.

All-cause and cause-specific mortality risks in individuals with diabetes living alone: A large-scale population-based cohort study.

AIMS: The rise in one-person households is a global trend. We aimed to investigate mortality risk in individuals with diabetes living alone (IDLA) using a large-scale population-based database. METHODS: A total of 2,447,557 adults with type 2 diabetes were identified from the Korean National Health Information Database. One-person households were defined based on the number of registered family members. The risks of all-cause and cause-specific mortalities were estimated using a multivariable Cox proportional hazards regression model. RESULTS: During a median follow-up period of 6.0 years, 191,084 deaths (7.8 %) occurred. IDLA had a higher risk of mortality compared to those not living alone after adjusting for potential confounders (HR 1.20, 95 % CI: 1.18-1.22). This association was more prominent in younger individuals, men, and those with low income, and it was dependent on the duration of living alone. The risks of cause-specific mortality were all significantly higher in the IDLA group compared with the non-IDLA group. Adherence to favorable lifestyle behaviors was associated with a significant reduction in all-cause mortality, particularly in IDLA. CONCLUSIONS: The elevated risk of mortality in IDLA highlights the need for tailored medical interventions and social assistance, particularly for those with unhealthy lifestyles or low income.