Obesity and occupation in Thailand: using a Bayesian hierarchical model to obtain prevalence estimates from the National Health Examination Survey.

BACKGROUND: Like many developing countries, Thailand has experienced a rapid rise in obesity, accompanied by a rapid change in occupational structure. It is plausible that these two trends are related, with movement into sedentary occupations leading to increases in obesity. National health examination survey data contains information on obesity and socioeconomic conditions that can help untangle the relationship, but analysis is challenging because of small sample sizes. METHODS: This paper explores the relationship between occupation and obesity using data on 10,127 respondents aged 20-59 from the 2009 National Health Examination Survey. Obesity is measured using waist circumference. Modelling is carried out using an approach known as Multiple Regression with Post-Stratification (MRP). We use Bayesian hierarchical models to construct prevalence estimates disaggregated by age, sex, education, urban-rural residence, region, and occupation, and use census population weights to aggregate up. The Bayesian hierarchical model is designed to protect against overfitting and false discovery, which is particularly important in an exploratory study such as this one. RESULTS: There is no clear relationship between the overall sedentary nature of occupations and obesity. Instead, obesity appears to vary occupation by occupation. For instance, women in professional occupations, and men who are agricultural or fishery workers, have relatively low rates of obesity. CONCLUSION: Bayesian hierarchical models plus post-stratification offers new possibilities for using surveys to learn about complex health issues.

Prevalence, motivations, and adverse effects of vaginal practices in Africa and Asia: findings from a multicountry household survey.

BACKGROUND: Women worldwide use various vaginal practices to clean or modify their vulva and vagina. Additional population-level information is needed on prevalence and motivations for these practices, characteristics of users, and their adverse effects. METHODS: This was a household survey using multistage cluster sampling in Tete, Mozambique; KwaZulu-Natal, South Africa; Yogyakarta, Indonesia; and Chonburi, Thailand. In 2006-2007, vaginal practices and their motivations were examined using structured interviews with women 18-60 years of age (n=3610). RESULTS: Prevalence, frequency, and motivations varied markedly. Two thirds of women in Yogyakarta and Chonburi reported one or more practices. In Yogyakarta, nearly half ingest substances with vaginal effects, and in Chonburi, external washing and application predominate. In Tete, half reported three or four current practices, and a quarter reported five or more practices. Labial elongation was near universal, and 92% of those surveyed cleanse internally. Two third's in KwaZulu-Natal practiced internal cleansing. Insertion of traditional solid products was rare in Chonburi and Yogyakarta, but one tenth of women in KwaZulu-Natal and nearly two thirds of women in Tete do so. Multivariate analysis of the most common practice in each site showed these were more common among less educated women in Africa and young urban women in Asia. Explicit sexual motivations were frequent in KwaZulu-Natal and Tete, intended for pleasure and maintaining partner commitment. Practices in Chonburi and Yogyakarta were largely motivated by femininity and health. Genital irritation was common at African sites. CONCLUSIONS: Vaginal practices are not as rare, exotic, or benign as sometimes assumed. Limited evidence of their biomedical consequences remains a concern; further investigation of their safety and sexual health implications is warranted.

Patterns of smoking among adolescents in Malaysia and Thailand: findings from the International Tobacco Control Southeast Asia survey.

At present, 70% of the world's 1.1 billion smokers are in developing countries, with over 50% in Asia alone. The current study examined patterns of youth smoking in Thailand and Malaysia. Respondents were 2002 youths between the ages of 13 and 17 from Thailand (n = 1000) and Malaysia (n = 1002). Respondents were selected using a multistage cluster sampling design and surveyed between January 2005 and March 2005. Approximately 3% of youth between the ages of 13 and 17 were current smokers, with an additional 10% to 12% reporting experimental smoking. Males were between 7 and 15 times more likely to report smoking behavior than females. Less than 1% of females respondents in either country met the criteria for current smoking, and less than 5% met the criteria for experimental smoking. In contrast, more than 50% Thai males and approximately one-third of Malaysian males aged 17 met the criteria for either experimental or current smoking.

Payment mechanisms and prescriptions in four Thai hospitals.

This paper examines the effect of payment mechanisms on prescription patterns in four district hospitals in provincial Thailand. Outpatients aged 60 or over at the four hospitals belong either to an insurance scheme that funds hospitals on a fee-for-service basis, or to a scheme using capitation. Hospitals have a financial incentive to differentiate between patients belonging to different schemes; however, doctors, who are paid salaries, face different pressures. The paper has two objectives: (i) to describe financial and non-financial influences on doctors' prescribing decisions; (ii) to test for differences between the cost of prescriptions received by fee-for-service and those received by capitated patients. The analysis uses data from treatment records, surveys, and interviews. We find that prescription costs for fee-for-service patients are significantly higher than those for capitated patients, controlling for age, sex, diagnosis and (to a limited extent) socio-economic status. The cost differences are attributable entirely to differences in the probability of receiving expensive drugs, and owe nothing to differences in quantities prescribed.