Socioeconomic inequalities in child and adolescent mental health in Australia: the role of parenting style and parents' relationships.

BACKGROUND: Socioeconomic inequalities in health and their determinants have been studied extensively over the past few decades. However, the role of parenting style and parents' couple relationships in explaining mental health inequalities is limited. Therefore, this study aims to investigate the distributional impact of parenting style (angry parenting, consistent parenting, and inductive parenting) and parents' couple relationships (e.g., argumentative, happy relationships) on socioeconomic inequalities and by extension on mental health status of Australian children and adolescents. METHODS: This study utilized data from the Longitudinal Study of Australian Children (Waves 1-7), specifically focusing on intact biological parent families, while excluding single-parent and blended-family households. We applied the decomposition index and the Blinder Oaxaca method to investigate the extent of the contribution and temporal impact of parenting style and parents' couple relationships on the mental health status of Australian children and adolescents. RESULTS: This study revealed that poor parenting style is the single most important factor that leads to developing mental health difficulties in children and adolescents, especially from low socioeconomic status, and it contributes almost 52% to socioeconomic inequalities in mental health status. Conversely, household income, maternal education, employment status, and parents' couple relationships contributed 28.04%, 10.67%, 9.28%, and 3.34%, respectively, to mental health inequalities in children and adolescents. CONCLUSION: Overall, this study underscores the importance of parenting style and parents' couple relationships as significant predictors of mental health outcomes in children and adolescents. These results highlight the need for targeted interventions to support families from low socioeconomic backgrounds to address the significant mental health inequalities observed in the study population.

Multimorbidity and health-related quality of life amongst Indigenous Australians: A longitudinal analysis.

BACKGROUND: The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design. METHODS: Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL. RESULTS: Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (ß = - 6.527; Standard Error [SE] = 1.579), mental-component scale (ß = - 3.765; SE = 1.590) and short-form six-dimension utility index (ß = - 0.075; SE = 0.017). CONCLUSION: This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.

Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries.

Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.

Cognitive impairment and health-related quality of life amongst older Australians: evidence from a longitudinal investigation.

INTRODUCTION: Australia's population is steadily growing older, with older persons expected to make up over 20% of the population by 2066. Ageing is strongly associated with a significant drop in cognitive ability, ranging from mild cognitive impairment to severe cognitive impairment (dementia). This study examined the association between cognitive impairment and health-related quality of life (HRQoL) in older Australians. METHODS: Two waves of longitudinal data from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey were utilised, with the age cut-off for older Australians defined as above 50. The final analysis included 10,737 person-year observations from 6892 unique individuals between 2012 and 2016. This study utilised the Backwards Digit Span (BDS) test and Symbol Digit Modalities test (SDMT) to assess cognitive function. HRQoL was measured using the physical and mental component summary scores of the SF-36 Health Survey (PCS and MCS). Additionally, HRQoL was measured using health state utility values (SF-6D score). A longitudinal random-effects GLS regression model was used to analyse the association between cognitive impairment and HRQoL. RESULTS: This study found that approximately 89% of Australian adults aged 50 or older had no cognitive impairment, 10.16% had moderate cognitive impairment, and 0.72% had severe cognitive impairment. This study also found that moderate and severe cognitive impairment were both negatively associated with HRQoL. Older Australians with moderate cognitive impairment scored worse on the PCS (ß = - 1.765, SE = 0.317), MCS (ß = - 1.612, SE = 0.326), and SF-6D (ß = - 0.024, SE = 0.004) than peers without cognitive impairment given other covariates reference categories remain constant. Older adults experiencing severe cognitive had lower PCS (ß = - 3.560, SE = 1.103), and SF-6D (ß = - 0.034, SE = 0.012) scores compared to their counterparts with no cognitive impairment given other covariates reference categories remain constant. CONCLUSION: We found evidence that HRQoL is negatively associated with cognitive impairment. Our findings will be beneficial for the future cost-effectiveness intervention targeted at reducing cognitive impairment since it provides information on the disutility associated with moderate and severe cognitive impairment.

Informal Caregiving Provision for Disabled or Elderly in the Families and Work Productivity: Evidence from 11 Waves of an Australian Population-Based Cohort.

BACKGROUND: Informal carers are family members, friends or neighbours who care for persons in need. In 2018, around one in ten Australians offered some informal care, most of which was unpaid. It is essential to comprehend how informal caregivers' productivity at work is affected by their caregiving responsibilities. We examine the association between informal caregiving and productivity loss in Australia. METHODS: We utilised 11 waves of data drawn from the Household, Income and Labour Dynamics in Australia (HILDA) survey. Longitudinal random-effects logistic regression and random-effects Poisson regression techniques were used to assess the between-person differences in the association between informal caregiving and productivity loss (absenteeism, presenteeism and working hour tension). RESULTS: The results suggest informal caregiving is associated with a higher rate of absenteeism, presenteeism and working hour tension. We reveal that absence/leave rates at work are greater for those with lighter, moderate and intensive care responsibilities than those without caregiving responsibilities, given other covariates reference categories remain constant. Our findings also indicate that workers with intensive, moderate, and light caregiving responsibilities have considerably higher rates of working hour tension than their peers without caregiving commitments if other covariate reference categories are held constant. The result further shows that, on average, an individual with lighter, moderate and intensive caregiving roles had incurred AUD 276.13, AUD 246.81, and AUD 1927.16, respectively, in absenteeism costs annually compared with their counterparts without caregiving duties. CONCLUSION: Our study reveals that working-age caregivers experience greater absenteeism, presenteeism and working hour tension. Adverse effects of informal caregiving are required to perform the cost effectiveness of an intervention given to caregivers to improve carer and patient health. Our findings will assist health technology assessment (HTA) practitioners in performing an economic evaluation of interventions given to caregivers by providing the indirect cost (productivity loss) of caregiving.

A multilevel analysis of individual and community-level factors associated with childhood immunisation in Bangladesh: Evidence from a pooled cross-sectional survey.

Introduction: Previous studies on childhood vaccinations in Bangladesh relied on single-level analyses and ignored the clustering and hierarchical structure of data collected from people living in different geographical units. This study, therefore, aimed to investigate the association between individual and community-level factors of full childhood immunisation with an improved analytical approach. Methods: Participants were 13,752 children aged 12-59 months. Data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted in 2007, 2011, 2014, and 2017-18. A two-level multilevel logistic regression method was used to analyse the data. Results: Approximately 87% of the children were fully immunised. In the fully adjusted model, at the individual level, mothers who had primary and above education (Adjusted odds ratio [AOR] = 1.78; 95% Confidence Interval [CI]: 1.57, 2.01), mass media exposure (AOR = 1.14; 95% CI: 1.00, 1.30), having vaccination cards (AOR = 3.65; 95% CI: 3.23, 4.14), and having at least 4 antenatal care (ANC) visits (AOR = 1.24; 95% CI: 1.06, 1.44) were strongly associated with full childhood immunisation. At community-level, rural residency (AOR = 1.25; 95% CI: 1.08, 1.44), community women's education (AOR = 1.24; 95% CI: 1.07, 1.43), and community ANC utilisation (AOR = 1.38; 95% CI: 1.19, 1.61) were significantly associated with full childhood immunisation. Conclusion: Along with individual-level factors, community-level factors have a significant effect on childhood immunisation. Policymakers should target improving community-level characteristics, such as community poverty, education levels, and the number of community-level ANC visits, to increase the national level of childhood immunisation. Public health intervention programs aiming at increasing awareness of childhood immunisation should include elements at both individual and community levels.

The impact of gender and age on bullying role, self-harm and suicide: Evidence from a cohort study of Australian children.

There has been limited longitudinal investigation to date into the association between bullying, self-harm, and suicidality in Australia and the impact of specific demographic differences on this relationship. This is despite the continued rise in the incidence of bullying, self-harm, and suicide. As such, the current study draws on data from the Longitudinal Survey of Australian children (LSAC) to examine the association between bullying, self-harm, and suicidality and explore the impact of demographic differences across three bullying related behaviors (being bullied, bullying others and being both bullied and bullying others). The evidence indicates that bully-victims exhibit the highest risk of self-harm and suicidality in Australia. When considering demographic differences, it was identified that females and adolescents aged 16-17-years-of-age had the highest risk of self-harm and suicidality. Further, a direct curvilinear relationship between age and the categories of self-harm was identified with an inflection point around 16-17 years. The study supports the need for further investigation into the association between bullying, self-harm, and suicidality longitudinally with a particular focus on other moderators.

Inequity in psychiatric healthcare use in Australia.

BACKGROUND: Despite recent substantial mental healthcare reforms to increase the supply of healthcare, mental health inequality in Australia is rising. Understanding of the level of inequity (unmet need gap) in psychiatric service use in Australia's mixed public-private health care system is lacking. OBJECTIVE: To present a novel method to measure inequity in the delivery of psychiatric care. METHODS: Data came from wave 9 (year 2009, n = 11,563) and wave 17 (year 2017, n = 16,194) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. Multiple logistic regression was employed to estimate the psychiatric care utilisation compared to its need and the Gini index was used to estimate the standardised distribution of utilisation to measure the extent of inequity. RESULTS: The results show the inequity indices (need-standardised Gini) in psychiatric care utilisation were significant and found to be 0.066 and 0.096 in 2009 and 2017, respectively, for all individuals. In 2009, the inequity indices were found to be 0.051 and 0.078 for males and females, respectively, and 0.045 and 0.068 for rural and urban residents, respectively. In 2017, the indices were calculated to be 0.081 and 0.109 for males and females, respectively, and 0.086 and 0.097 for rural and urban residents, respectively. CONCLUSIONS: This study showed a marked increase in unmet needs in psychiatric care utilisation since 2009. There is a greater need to develop policies to improve equity in psychiatric care utilisation in Australia.

Job satisfaction dynamics: how do they impact employment mode choice for people with a disability?

Background: To enhance economic participation for people with a disability in the labor market, a better understanding of how job satisfaction influences employment mode decisions is needed. Methods: This study uses data collected from 8,345 People with Disability(PWD) workers from waves 3 to 19 of the Household, Income and Labour Dynamics in Australia (HILDA) survey to investigate the relationship between six domains of job satisfaction and employment mode (employee, solo self-employed, and employer) and covariates related to personal, health, socio-economic and employment-related attributes. Results: Analysis of 25,169 individual-level observations show important differences in the level of job satisfaction across the different employment modes and for different covariates. PWD entrepreneurs reported higher levels of satisfaction with their work, flexibility, and overall satisfaction, whereas employees report higher levels of contentment with salary, job security, and work hours. The findings also highlight interesting differences due to personal, health, socio-economic and employment related attributes. Conclusions: Collectively, these insights can guide policymakers to enhance entrepreneurial pathways for people with a disability.

Socioeconomic inequalities in low birth weight in South Asia: A comparative analysis using Demographic and Health Surveys.

Background: Low Birth Weight (LBW) continues to be a prominent universal cause of various short- and long-term health hazards throughout infancy and adulthood. However, no study has revealed the socioeconomic inequalities in LBW among South Asian countries. This study assesses the socioeconomic inequalities among under-five South Asian children with LBW. Methods: Secondary data were derived from six (Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan) nationally representative South Asian Demographic and Health Surveys conducted between 2015 and 2021, and included 170,547 under-five years of age children. The study employed the concentration curve and concentration index to assess the socioeconomic inequalities of those with LBW. Additionally, mixed-effect logistic regression was applied to determine the factors associated with LBW. Results: A significant negative concentration index indicates the wealth-related and education-related inequalities of LBW among under-five South Asian children. LBW is highly concentrated in the socio-economically poor section of the society. Our study found statistically significant negative concentration index in all South Asian countries: Afghanistan (Education: -0.108), Bangladesh (wealth: -0.070 & education: -0.083), India (wealth: -0.059 & education: -0.052), Nepal (by wealth: -0.064 & by education: -0.080), and Pakistan (by wealth: -0.080 & by education: -0.095). Findings from the mixed-effects logistic regression model also show that children from the poorest quintiles (AOR: 1.53, 95% CI: 1.41-1.67) and illiterate mothers (AOR: 1.39, 95% CI: 1.29-1.51) had higher odds of being afflicted with LBW compared to the wealthiest quintiles and educated mothers respectively. Women's pregnancy assessments, such as antenatal care utilisation, iron supplementation intake, and normal delivery mode, are significantly correlated with decreased odds of children's LBW. Conclusion: There exists a strong association between LBW cases and socioeconomic inequalities among South-Asian children below five years of age. This indicates the urgent need for health education and prenatal care services for women from Afghanistan, Bangladesh, India, Nepal, and Pakistan, especially those with lower socioeconomic status.

Disability, physical activity, and health-related quality of life in Australian adults: An investigation using 19 waves of a longitudinal cohort.

BACKGROUND: Any form of long-term physical or mental impairment might negatively influence health-related quality of life (HRQoL). HRQoL, as an independent concept, covers a wide range of characteristics that includes physical, mental, social, and spiritual functions. People with disabilities are continuously exposed to multiple barriers that deteriorate their HRQoL. It also creates impairment in performing physical activities. However, experts opine regular physical exercise as an intervention to help disabled people. This research aims to investigate the association between disability and physical activity with HRQoL among the adult population in Australia. DESIGN: A retrospective cohort study. METHODS: This study utilized the most recent 19 waves of data (2002-2020) from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. Component summary scores such as physical component summary (PCS) and mental component summary (MCS), and SF-6D utility scores were utilized to measure HRQoL. Random-effects GLS regression technique was fitted to estimate the association between disability and physical activity with HRQoL, after adjusting for a range of socio-demographic and health-related characteristics. RESULTS: Disability was negatively associated with the PCS (-5.95), MCS (-2.70) and SF-6D (-0.060) compared with non-disabled counterparts. However, respondents engaged in the recommended level of physical activity had substantial gain in PCS (b = 0.96), MCS (1.57), and SF-6D (0.021) scores. Besides, the results showed that performing the recommended level of physical activity in the presence of disability has lessen the negative effect of disability/ positive moderating effect of physical activity on PCS, MCS, and SF-6D scores by 1.84 points, 0.82 points, and 0.013 percentage points, respectively. CONCLUSION: This study found an inverse association between disability and HRQoL among Australian adults. However, physical activity was associated with improved HRQoL. Therefore, public health interventions, such as the orientation of physical activities, have a higher potential to dwindle the burden regarding HRQoL.

Nexus between maternal underweight and child anthropometric status in South and South-East Asian countries.

OBJECTIVES: Maternal underweight and childhood malnutrition are life-threatening public health concerns in several South and South-East Asian nations. The aim of this study was to better design interventions and prevent malnutrition of children in the region by exploring the association of maternal underweight with children's anthropometric status. METHODS: The Demographic and Health Survey's (DHS) most recent nationally representative data from eight South and South-East Asian states, collected between 2014 and 2018, were pooled for the present study. A multivariable logistic regression model was designed to explore the association between maternal underweight and child anthropometric status. Owing to the hierarchical structure of the DHS data, the study also employed the multilevel logistic regression technique. RESULTS: Among the total participants (N = 213 730), 22.66% of women were found to be underweight, whereas 39.03%, 35.88%, and 22.11% of their children had stunting, underweight, and wasting, respectively. The logistic regression model showed that the children from underweight mothers were 1.27 (95% confidence interval [CI]. 1.24-1.30), 1.69 (95% CI, 1.65-1.73), and 1.48 (95% CI, 1.45-1.52) times more likely to experience stunting, underweight, and wasting, respectively, than those with healthy-weight mothers. The significant association between maternal underweight and stunting, underweight, as well as wasting was additionally established by the multilevel logistic regression analysis. CONCLUSIONS: Findings indicate that maternal underweight is positively associated with children's anthropometric status, such as stunting, underweight, and wasting. The information from this research will guide actors and policymakers to scale up interventions with all-inclusive nutritional issues and promote healthier weight status among mothers to ensure higher odds of healthier anthropometric status in their children in the South and South-East Asian countries.

Do family and maternal background matter? A multilevel approach to modelling mental health status of Australian youth using longitudinal data.

PURPOSE: Most previous research place great importance on the influence of family and maternal background on child and adolescents' mental health. However, age of onset studies indicates that the majority of the mental health disease prevalence occurs during the youth years. This study investigates the relationship of family and maternal background, as well as individual circumstance on youth mental health status. METHOD: Data from 975 participants and 4632 observations of aged cohort 15 to 19 years in the Household, Income and Labour Dynamics in Australia (HILDA) longitudinal study were followed for 10 years (2007-2017). Multilevel logistic regression models were used to analyse the impact of youth circumstances on mental health status. RESULTS: The findings suggests that not all dimensions of family and maternal background (especially maternal education) have impacts on youth mental health. We found low household income (AOR: 1.572, 95% CI: 1.017-2.43) and adverse living arrangement (AOR: 1.586, 95% CI: 1.097-2.294) significantly increases mental disorder odds whereas maternal education or occupation fixed effects were not significant. Individual level circumstances have much stronger impact on youth mental health. We found financial shock (AOR: 1.412, 95% CI: 1.277-1.561), life event shock (AOR: 1.157, 95% CI: 1.01-1.326), long term health conditions (AOR: 2.855, 95% CI: 2.042-3.99), smoking (AOR: 1.676, 95% CI: 1.162-2.416), drinking (AOR: 1.649, 95% CI: 1.286-2.114) and being female (AOR: 2.021, 95% CI: 1.431-2.851) have significant deteriorating effects on youth mental health. CONCLUSIONS: Our finding is in contrast to the majority of studies in the literature which give a preeminent role to maternal characteristics in child and youth mental health status. Mental health interventions should consider heterogeneity of adverse youth circumstances and health-related behaviours.

Price and Income Elasticities of Cigarette Smoking Demand in Bangladesh: Evidence from Urban Adolescents and Young Adults.

INTRODUCTION: Understanding the elasticities of cigarette smoking demand among the youth could help improve the effectiveness of tobacco control interventions. The objective of this study is to measure the price and income elasticities of cigarette smoking demand among urban Bangladeshi male adolescents and young adults aged 10-24 years. METHOD: Using data from a cross-sectional survey conducted in seven urban districts of Bangladesh, we applied probit and ordinary least square (OLS) models to examine the effect of price and income on smoking participation (decision to smoke) and intensity (number of cigarettes smoked). RESULTS: Our results showed that price was not significantly associated with the decision to smoke, while income was a significant determinant of smoking participation. Both price and income determined the smoking intensity. The positive income elasticity (0.39) indicated that participants with greater access to money were more likely to participate in cigarette smoking and smoked more cigarettes. Negative price elasticity (-0.62) implied that increasing prices could lead to a reduction in smoking intensity among adolescents and young adults in urban Bangladesh. CONCLUSION: The inelastic price demand for cigarette smoking suggests that there is scope for increasing tax on cigarettes without compromising the tax revenue. IMPLICATIONS: This is the first study to investigate price and income elasticities among urban adolescents and young adults in Bangladesh. The study found no evidence that increasing the price of cigarettes discourages smoking participation but did show that increasing the price reduces the intensity of smoking among existing smokers. The results also suggest that economic measures such as taxation that increase the price of cigarettes could be a useful policy tool to limit smoking intensity without compromising government tax revenue.

Obesity and the risk of developing chronic diseases in middle-aged and older adults: Findings from an Australian longitudinal population survey, 2009-2017.

BACKGROUND: Overweight and obesity impose a significant health burden in Australia, predominantly the middle-aged and older adults. Studies of the association between obesity and chronic diseases are primarily based on cross-sectional data, which is insufficient to deduce a temporal relationship. Using nationally representative panel data, this study aims to investigate whether obesity is a significant risk factor for type 2 diabetes, heart diseases, asthma, arthritis, and depression in Australian middle-aged and older adults. METHODS: Longitudinal data comprising three waves (waves 9, 13 and 17) of the Household, Income and Labour Dynamics in Australia (HILDA) survey were used in this study. This study fitted longitudinal random-effect logistic regression models to estimate the between-person differences in the association between obesity and chronic diseases. RESULTS: The findings indicated that obesity was associated with a higher prevalence of chronic diseases among Australian middle-aged and older adults. Obese adults (Body Mass Index [BMI] ≥ 30) were at 12.76, 2.05, 1.97, 2.25, and 1.96, times of higher risks of having type 2 diabetes (OR: 12.76, CI 95%: 8.88-18.36), heart disease (OR: 2.05, CI 95%: 1.54-2.74), asthma (OR: 1.97, CI 95%: 1.49-2.62), arthritis (OR: 2.25, 95% CI: 1.90-2.68) and depression (OR: 1.96, CI 95%: 1.56-2.48), respectively, compared with healthy weight counterparts. However, the study did not find any evidence of a statistically significant association between obesity and cancer. Besides, gender stratified regression results showed that obesity is associated with a higher likelihood of asthma (OR: 2.64, 95% CI: 1.84-3.80) among female adults, but not in the case of male adults. CONCLUSION: Excessive weight is strongly associated with a higher incidence of chronic disease in Australian middle-aged and older adults. This finding has clear public health implications. Health promotion programs and strategies would be helpful to meet the challenge of excessive weight gain and thus contribute to the prevention of chronic diseases.

Trends in the prevalence of adult overweight and obesity in Australia, and its association with geographic remoteness.

The prevalence of overweight and obesity has been increasing globally and has become a significant public health concern in Australia in the two past decades. This study explores the most recent national prevalence and trends of adult overweight and obesity in Australia. It will also investigate geographic remoteness as a potential risk factor for an individual being overweight or obese in adulthood. A retrospective longitudinal study that utilised 14 successive waves (wave 6 through 19) of a nationally representative linked individual-level survey. Data was obtained from the Household, Income and Labour Dynamics in Australia survey. The data on 199,675 observations from 26,713 individuals aged ≥ 15 years over the period 2006 to 2019 was analysed. Random-effects logit model was employed to estimate the association between geographic remoteness and the risk of excessive weight gain. The results reveal that the prevalence of overweight, obesity and combined overweight and obesity among Australian adults in 2019 were 34%, 26% and 60%, respectively. The analysis shows that the prevalence of overweight and obesity varies by geographic remoteness. Adults from regional city urban (OR 1.53, 95% CI 1.16-2.03) and rural areas (OR 1.32, 95% CI 1.18-1.47) were more likely to be obese compared with their counterparts from major city urban areas. The results also show that adults living in major city urban areas, regional city urban areas, and regional city rural areas in Australia were 1.53 (OR 1.53, 95% CI 1.16-2.03), 1.32 (OR 1.32, 95% CI 1.18-1.47), and 1.18 (OR 1.18, 95% CI 1.08-1.29) times more likely to be overweight compared with their counterparts from major city urban areas in Australia. Substantial geographic variation in the prevalence of overweight and obesity exists among Australian adults and appears to be increasing. Public health measures should focus on contextual obesogenic factors and behavioural characteristics to curb the rising prevalence of adult obesity.

Husbands' Knowledge of Breast Cancer and Their Wives' Attitudes and Practices Related to Breast Cancer Screening in Saudi Arabia: Cross-sectional Online Survey.

BACKGROUND: Despite Saudi Arabia's free and well-established cancer care program, breast cancer incidence and mortality are rising. Husbands' knowledge, and wives' attitudes and practices related to breast cancer screening are not well understood in Saudi Arabia. OBJECTIVE: The aim of this study was to investigate husbands' knowledge, and wives' attitudes and practices related to breast cancer screening in Saudi Arabia. METHODS: This cross-sectional study collected data from 403 husbands in the holy city of Makkah through an online self-reported questionnaire over a period of 2 months, from May 6 to July 7, 2020. Tabulation, bivariate, and multiple regression analyses were the major tools used for data analysis. Multivariate logistic regressions were used to examine the association between husbands' knowledge and wives' behavior regarding breast cancer screening methods. RESULTS: Husbands' knowledge score (a 1-point increase) was significantly associated with the wives' utilization of mammograms (adjusted odds ratio [AOR] 1.089, 95% CI 1.024-1.159) and breast self-examination (AOR 1.177, 95% CI 1.105-1.255). Husbands' knowledge also influenced the wives' attitudes toward learning about breast self-examination (AOR 1.138, 95% CI 1.084-1.195). There was no significant association between husbands' knowledge and wives' utilization of clinical breast examination. However, richer husbands showed a socioeconomic gradient concerning their wives' utilization of clinical breast examinations (AOR 2.603, 95% CI 1.269-5.341). CONCLUSIONS: Overall, husbands' knowledge of breast cancer influences wives' attitudes and practices related to breast cancer screening methods in Saudi Arabia. Thus, interventions delivered to husbands might increase breast cancer awareness and survival.

Prevalence of Mental Disorders by Socioeconomic Status in Australia: A Cross-Sectional Epidemiological Study.

PURPOSE: To present the prevalence of 3 broad categories of mental disorder (anxiety-related, affective and other disorders) by socioeconomic status and examine the associated socioeconomic risk factors of mental disorders in Australia. DESIGN: A population-based, cross-sectional national health survey on mental health and its risk factors across Australia. SETTING: National Health Survey (NHS), 2017-2018 conducted by the Australian Bureau of Statistics (ABS). PARTICIPANTS: Under aged: 4,945 persons, Adult: 16,370 persons and total: 21,315 persons. MEASURES: Patient-reported mental disorder outcomes. ANALYSIS: Weighted prevalence rates by socioeconomic status (equivalised household income, education qualifications, Socio-Economic Index for Areas (SEIFA) scores, labor force status and industry sector where the adult respondent had their main job) were estimated using cross-tabulation. Logistic regression utilizing subsamples of underage and adult age groups were analyzed to test the association between socioeconomic status and mental disorders. RESULTS: Anxiety-related disorders were the most common type of disorders with a weighted prevalence rate of 20.04% (95% CI: 18.49-21.69) for the poorest, 13.85% (95% CI: 12.48-15.35) for the richest and 16.34% (95% CI: 15.7-17) overall. The weighted prevalence rate for mood/affective disorders were 20.19% (95% CI: 18.63-21.84) for the poorest, 9.96% (95% CI: 8.79-11.27) for the richest, and 13.57% (95% CI: 12.99-14.17) overall. Other mental disorders prevalence were for the poorest: 9.07% (95% CI: 7.91-10.39), the richest: 3.83% (95% CI: 3.14-4.66), and overall: 5.93% (95% CI: 5.53-6.36). These patterns are also reflected if all mental disorders were aggregated with the poorest: 30.97% (95% CI: 29.15-32.86), the richest: 19.59% (95% CI: 18.02-21.26), and overall: 23.93% (95% CI: 23.19-24.69). The underage logistic regression model showed significant lower odds for the middle (AOR: 0.75, 95% CI: 0.53 -1.04, p < 0.1), rich (AOR: 0.71, 95% CI: 0.5-0.99, p < 0.05) and richest (AOR: 0.6, 95% CI: 0.41-0.89, p < 0.01) income groups. Similarly, in the adult logistic model, there were significant lower odds for middle (AOR: 0.84, 95% CI: 0.72-0.98, p < 0.05), rich (AOR: 0.73, 95% CI: 0.62-0.86, p < 0.01) and richest (AOR: 0.76, 95% CI: 0.63-0.91, p < 0.01) income groups. CONCLUSION: The prevalence of mental disorders in Australia varied significantly across socioeconomic groups. Knowledge of different mental health needs in different socioeconomic groups can assist in framing evidence-based health promotion and improve the targeting of health resource allocation strategies.

Public policies and tax evasion: evidence from SAARC countries.

In compliance with the socioeconomic theory, the study has strived to investigate the impact of economic and non-economic public policies on tax evasion using panel data of 7 SAARC countries covering the period from 1998 to 2015. The study has applied the ordinary least square with fixed effect and random effect models to analyze the data assembled. The result of the study implies that the higher the degree of economic freedoms, the lower the tax evasion. More specifically, the government policies about property rights, monetary freedom, fiscal freedom and investment freedom have a negative influence on taxpayers' choices of tax evasion while financial freedom result shows a positive effect on tax evasion. Additionally, there is a negative impact of public sector governance and religiosity on tax evasion, which implies the higher the public sector governance and the higher the religious faith amid the people, the lower the degree of tax evasion. The findings of the study are supposed to offer the governments, tax authorities, and research scholars the valuable insights into public policies for reducing the tax evasion to a significant extent.

Socioeconomic Inequalities in Uptake of Breast Cancer Screening among Saudi Women: A Cross-Sectional Analysis of a National Survey.

Timely and adequate screening for breast cancer could improve health outcomes and reduce health costs. However, the utilization of free breast cancer screening services among Saudi women is very low. This study aims to investigate socioeconomic inequalities in breast cancer screening among Saudi women. The data of this study were extracted from the nationally representative Saudi Health Interview Survey, conducted in 2013; the study included 2786 Saudi women. Multivariate logistic regression, the concentration curve, and the concentration index were used to examine, illustrate, and quantify income- and education-related inequalities in three outcomes: Knowledge about self-breast examination (SBE), clinical breast examination (CBE) received in the last year, and mammography, that has ever been previously carried out. Results showed a marked socioeconomic gradient in breast cancer screening services. The concentration index by income was 0.229 (SBE), 0.171 (CBE), and 0.163 (mammography). The concentration index by education was 0.292 (SBE), 0.149 (CBE), and 0.138 (mammography). Therefore, knowledge about breast cancer screening, and the utilization of screening services, were more concentrated among richer and better-educated women. Poorer and less educated women had less knowledge about self-breast examination, and had considerably less adherence to clinical breast examination and mammography. The findings are helpful for policy makers to devise and implement strategies to promote equity in breast cancer screening among Saudi women.