Population health differences in cross-border regions within the European Union and Schengen area: a protocol for a scoping review.

INTRODUCTION: Along with European integration and the harmonisation of living conditions, improvements in health have been observed over the past decades. However, sociospatial inequalities within and across member states still exist today. While drivers of these health inequalities have been widely researched on a national and regional scale, cross-border regions remain understudied. The removal of border controls within the European Union (EU) member states has facilitated economic convergence and created new opportunities, including cross-border cooperation in the healthcare systems. However, whether and how these developments have influenced the population health in the respective cross-border regions is unclear. Hence, this scoping review aims to examine the empirical literature on the changes in health outcomes over time at the population level in EU cross-border areas. Additionally, we aim to identify the type of evidence and available data sources in those studies. Finally, we will determine the research gaps in the literature. METHODS AND ANALYSIS: We will follow the Joanna Briggs Institute methodology for this scoping review. The 'Population-Concept-Context' framework will be used to identify the eligibility criteria. A three-step search strategy will be conducted to find relevant studies in the databases of PubMed, Web of Science, Scopus and EBSCOhost (SocIndex). Additionally, we will search on websites of international governmental institutions for further reports and articles. The finalisation of the search is planned for August 2023. The extracted data from the scoping review will be presented in a tabular form. A narrative summary of the selected studies will accompany the tabulated results and describe how they answer the research questions. ETHICS AND DISSEMINATION: We will exclusively use secondary data from available studies for our analysis. Therefore, this review does not require ethical approval. We aim to publish our findings at (inter-)national conferences and as an open-access, peer-reviewed journal article.

Is Adolescent Risk Behavior Associated With Cross-Household Family Complexity? An Analysis of Post-separation Families in 42 Countries.

We examine whether complex cross-household structures of post-separation families are associated with higher risk-taking behavior in adolescence (substance use, bullying, early sexual onset) and whether the proportion, and thus statistical normality, of complex family types in a certain country is a potential moderator of this association. Drawing on representative data from 42 countries and regions from the Health Behavior in School-aged Children (HBSC) study in 2001, 2006, and 2010 (N = 506,977), we provide detailed analyses on adolescent risk behavior even for very rare family types, thereby accounting for the complex cross-household structure present in many post-separation families. We combine logistic and count regression models to analyze risk incidence and intensity. Controlling for relevant child and family characteristics, our results reveal a gradient along which adolescent risk-taking increases with family complexity: The incidence and intensity of risk-taking among adolescents is lowest in two-biological-parent and highest in two-household families with stepparents in both households. The association decreases with a higher proportion of the respective family type in a country. However, the differences between family types, other than the two-biological parent family, are not as pronounced as expected.

Socioeconomic status and sex ratios at birth in Sweden: No evidence for a Trivers-Willard effect for a wide range of status indicators.

OBJECTIVES: This study examines if there exists a positive association between socioeconomic status and the proportion of male births in humans, as proposed by Trivers and Willard in 1973, using individual-level data drawn from the complete population of Sweden. METHODS: We examine more than 3,000,000 births between 1960 and 2007 using administrative register data with comprehensive information on various dimensions of socioeconomic status. We use six different operationalizations of socioeconomic status, including earnings, post-transfer income (including government allowances), wealth, parental wealth, educational level, and occupational class. We apply regression models that compare both changes in status for the same woman over time and differences in status across different women. We also measure socioeconomic status both at the year of child birth and the year of conception. RESULTS: Our results show the absence of any relationship between socioeconomic status and sex ratios, using a large number of different operationalizations of status. CONCLUSIONS: We conclude that no substantive relationship between socioeconomic status and sex ratios exists for the population and period of our study.

Economic stress or random variation? Revisiting German reunification as a natural experiment to investigate the effect of economic contraction on sex ratios at birth.

BACKGROUND: The economic stress hypothesis (ESH) predicts decreases in the sex ratio at birth (SRB) following economic decline. However, as many factors influence the SRB, this hypothesis is difficult to test empirically. Thus, researchers make use of quasi-experiments such as German reunification: The economy in East, but not in West Germany, underwent a rapid decline in 1991. A co-occurrence of a decline in the East German SRB in 1991 has been interpreted by some as support for the ESH. However, another explanation might be that the low SRB in 1991 stems from increased random variation in the East German SRB due to a drastically reduced number of births during the crisis. We look into this alternative random variation hypothesis (RVH) by re-examining the German case with more detailed data. METHODS: Our analysis has two parts. First, using aggregate-level birth register data for all births in the period between 1946 and 2011, we plot the quantum and variance of the SRB and the number of births and unemployment rates, separately for East and West Germany, and conduct a time series analysis on the East German SRB over time. Second, we model the odds for a male birth at the individual level in a multiple logistic regression (1991-2010, ~13.9 million births). Explanatory variables are related to the level of the individual birth, the mother of the child born, and the regional economic context. RESULTS: The aggregate-level analysis reveals a higher degree of variation of the SRB in East Germany. Deviations from the time trend occur in several years, seemingly unrelated to economic development, and the deviation in 1991 is not statistically significant. The individual-level analysis confirms that the 1991-drop in the East German SRB cannot directly be attributed to economic development and that there is no statistically significant effect of economic development on sex determination in East or West Germany. CONCLUSION: Outcomes support the RVH but not the ESH. Furthermore, our results speak against a statistically significant effect of the reunification event itself on the East German SRB. We discuss the relative importance of behavioral and physiological responses to macro-level stressors, a distinction that may help integrate previously mixed findings.

Revisiting a sample of U.S. billionaires: how sample selection and timing of maternal condition influence findings on the Trivers-Willard effect.

Based on evolutionary theory, Trivers & Willard (TW) predicted the existence of mechanisms that lead parents with high levels of resources to bias offspring sex composition to favor sons and parents with low levels of resources to favor daughters. This hypothesis has been tested in samples of wealthy individuals but with mixed results. Here, I argue that both sample selection due to a high number of missing cases and a lacking specification of the timing of wealth accumulation contribute to this equivocal pattern. This study improves on both issues: First, analyses are based on a data set of U.S. billionaires with near-complete information on the sex of offspring. Second, subgroups of billionaires are distinguished according to the timing when they acquired their wealth. Informed by recent insights on the timing of a potential TW effect in animal studies, I state two hypotheses. First, billionaires have a higher share of male offspring than the general population. Second, this effect is larger for heirs and heiresses who are wealthy at the time of conception of all of their children than for self-made billionaires who acquired their wealth during their adult lives, that is, after some or all of their children have already been conceived. Results do not support the first hypothesis for all subgroups of billionaires. But for males, results are weakly consistent with the second hypothesis: Heirs but not self-made billionaires have a higher share of male offspring than the U.S. population. Heiresses, on the other hand, have a much lower share of male offspring than the U.S. average. This hints to a possible interplay of at least two mechanisms affecting sex composition. Implications for future research that would allow disentangling the distinct mechanisms are discussed.

Parental status and gender preferences for children: is differential fertility stopping consistent with the trivers-willard hypothesis?

Based on evolutionary reasoning, Trivers & Willard (1973) predicted status-biased sex composition and parental investment with son-preferencing effects in higher, and daughter-preferencing effects in lower status groups. Previous research shows mixed results. This study uses event-history methods and Swedish register data to study one possible mechanism in isolation: do parents in different status groups vary in their proclivities to continue fertility based on the sex composition of previous offspring? The results show no support for the Trivers-Willard hypothesis on a wide range of different status indicators. Future research on the stated hypothesis should focus on physiological rather than behavioural mechanisms.