Historical Redlining and Present-Day Nonsuicide Firearm Fatalities.

BACKGROUND: Redlining began in the 1930s with the Home Owners' Loan Corporation (HOLC); this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. It is important to understand the potential health implications of this federally sanctioned segregation. OBJECTIVE: To examine the relationship between historical redlining policies and present-day nonsuicide firearm fatalities. DESIGN: Maps from the HOLC were overlaid with incidence of nonsuicide firearm fatalities from 2014 to 2022. A multilevel negative binomial regression model tested the association between modern-day firearm fatalities and HOLC historical grading (A ["best"] to D ["hazardous"]), controlling for year, HOLC area-level demographics, and state-level factors as fixed effects and a random intercept for city. Incidence rates (IRs) per 100 000 persons, incidence rate ratios (IRRs), and adjusted IRRs (aIRRs) for each HOLC grade were estimated using A-rated areas as the reference. SETTING: 202 cities with areas graded by the HOLC in the 1930s. PARTICIPANTS: Population of the 8597 areas assessed by the HOLC. MEASUREMENTS: Nonsuicide firearm fatalities. RESULTS: From 2014 to 2022, a total of 41 428 nonsuicide firearm fatalities occurred in HOLC-graded areas. The firearm fatality rate increased as the HOLC grade progressed from A to D. In A-graded areas, the IR was 3.78 (95% CI, 3.52 to 4.05) per 100 000 persons per year. In B-graded areas, the IR, IRR, and aIRR relative to A areas were 7.43 (CI, 7.24 to 7.62) per 100 000 persons per year, 2.12 (CI, 1.94 to 2.32), and 1.42 (CI, 1.30 to 1.54), respectively. In C-graded areas, these values were 11.24 (CI, 11.08 to 11.40) per 100 000 persons per year, 3.78 (CI, 3.47 to 4.12), and 1.90 (CI, 1.75 to 2.07), respectively. In D-graded areas, these values were 16.26 (CI, 16.01 to 16.52) per 100 000 persons per year, 5.51 (CI, 5.05 to 6.02), and 2.07 (CI, 1.90 to 2.25), respectively. LIMITATION: The Gun Violence Archive relies on media coverage and police reports. CONCLUSION: Discriminatory redlining policies from 80 years ago are associated with nonsuicide firearm fatalities today. PRIMARY FUNDING SOURCE: Fred Lovejoy Housestaff Research and Education Fund.

Trends in prevalence of unmet need for family planning in India: patterns of change across 36 States and Union Territories, 1993-2021.

BACKGROUND: Eliminating unmet need for family planning by 2030 is a global priority for ensuring healthy lives and promoting well-being for all at all ages. We estimate the sub-national trends in prevalence of unmet need for family planning over 30 years in India and study differences based on socio-economic and demographic factors. METHODS: We used data from five National Family Health Surveys (NFHS) conducted between 1993 to 2021 for the 36 states/Union Territories (UTs) of India. The study population included women of ages 15-49 years who were married or in a union at the time of the survey. The outcome was unmet need for family planning which captures the prevalence of fecund and sexually active women not using contraception, who want to delay or limit childbearing. We calculated the standardized absolute change to estimate the change in prevalence on an annual basis across all states/UTs. We examined the patterning of prevalence of across demographic and socioeconomic characteristics and estimated the headcount of women with unmet need in 2021. RESULTS: The prevalence of unmet need in India decreased from 20·6% (95% CI: 20·1- 21·2%) in 1993, to 9·4% (95% CI: 9·3-9·6%) in 2021. Median unmet need prevalence across states/UTs decreased from 17·80% in 1993 to 8·95% in 2021. The north-eastern states of Meghalaya (26·9%, 95% CI: 25·3-28·6%) and Mizoram (18·9%, 95% CI: 17·2-20·6%), followed by the northern states of Bihar (13·6%, 95% CI: 13·1-14·1%) and Uttar Pradesh (12·9%, 95% CI: 12·5-13·2%), had the highest unmet need prevalence in 2021. As of 2021, the estimated number of women with an unmet need for family planning was 24,194,428. Uttar Pradesh, Bihar, Maharashtra, and West Bengal accounted for half of this headcount. Women of ages 15-19 and those belonging the poorest wealth quintile had a relatively high prevalence of unmet need in 2021. CONCLUSIONS: The existing initiatives under the National Family Planning Programme should be strengthened, and new policies should be developed with a focus on states/UTs with high prevalence, to ensure unmet need for family planning is eliminated by 2030.

This study looked at the trends in unmet need for family planning in India, which is defined as the percentage of women of reproductive age who want to delay or limit childbearing but are not using any contraceptive method. A public dataset was used to analyze national and sub-national trends from 1993 to 2021. It was determined that although the percentage prevalence of unmet need decreased in the last 30 years, there were still a substantial number of women with unmet need in 2021. More than half of these women were in Uttar Pradesh, Bihar, Maharashtra, and West Bengal. Furthermore, it was found that percentage prevalence of unmet need was relatively higher amongst younger women and those belonging to poorer households in 2021. Initiatives and policies aimed at reducing unmet need for family planning should be implemented while considering geographic, socioeconomic, and demographic differences.

Women's empowerment and child anthropometric failures across 28 sub-Saharan African countries: A cross-level interaction by Gender Inequality Index.

Background: Child undernutrition remains a major global health issue, particularly in sub-Saharan Africa (SSA). Given the important role mothers play in early childhood health and development, we examined how individual-level women's empowerment and country-level Gender Inequality Index (GII) are jointly related with child undernutrition in SSA. Methods: We pooled recent Demographic and Health Surveys from 28 SSA countries. For 137,699 children <5 years old, undernutrition was defined using anthropometric failures (stunting, underweight, wasting). Women's empowerment was assessed using three domains of Survey-based Women's EmPowERment (SWPER) index: attitude to violence, social independence, and decision-making; and country-level gender inequality was measured using GII from United Nations Development Programme. Three-level logistic regression was conducted to examine the joint associations of SWPER and GII as well as their interactions with child anthropometric failures, after adjusting for sociodemographic covariates. Results: Overall, 32.85% of children were stunted, 17.63% were underweight, and 6.68% had wasting. Children of mothers with low-level of empowerment for all domains of SWPER had higher odds of stunting (attitude to violence: OR=1.15; 95% CI, 1.11-1.19; social independence: OR=1.21; 95% CI, 1.17-1.25; decision-making: OR=1.16; 95% CI, 1.12-1.20), and consistent results were found for underweight and wasting. Independent of women's empowerment, country-level GII increased the probability of underweight (ranging ORs=1.46; 95% CI, 1.15-1.85 to 1.50; 95% CI, 1.18-1.90) and wasting (ranging ORs=1.56; 95% CI, 1.24-1.97 to 1.61; 95% CI, 1.27-2.03). Significant interaction was found between women's empowerment and country-level GII for stunting and underweight (p<0.05). Conclusions: In SSA countries with greater gender inequality, improving women's social independence and decision-making power in particular can reduce their children's risk of anthropometric failures. Policies and interventions targeted at strengthening women's empowerment should consider the degree of gender inequality in each country.

Prevalence of Children Aged 6 to 23 Months Who Did Not Consume Animal Milk, Formula, or Solid or Semisolid Food During the Last 24 Hours Across Low- and Middle-Income Countries.

Importance: The introduction of solid or semisolid foods alongside breast milk plays a vital role in meeting nutritional requirements during early childhood, which is crucial for child growth and development. Understanding the prevalence of zero-food children (defined for research purposes as children aged 6 to 23 months who did not consume animal milk, formula, or solid or semisolid food during the last 24 hours) is essential for targeted interventions to improve feeding practices. Objective: To estimate the percentage of zero-food children in 92 low- and middle-income countries. Design, Setting, and Participants: This cross-sectional study analyzed nationally representative cross-sectional household data of children aged 6 to 23 months from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys conducted between May 20, 2010, and January 27, 2022. Data were obtained from 92 low- and middle-income countries. Standardized procedures were followed to ensure data comparability and reliability. Both percentage and number of zero-food children were estimated. Main Outcomes and Measures: The outcome studied was defined as a binary variable indicating children aged 6 to 23 months who had not been fed any animal milk, formula, or solid or semisolid foods during the 24 hours before each survey, as reported by the mother or caretaker. Results: A sample of 276 379 children aged 6 to 23 months (mean age, 14.2 months [95% CI, 14.15-14.26 months]) in 92 low- and middle-income countries was obtained, of whom 51.4% (95% CI, 51.1%-51.8%) were boys. The estimated percentage of zero-food children was 10.4% (95% CI, 10.1%-10.7%) in the pooled sample, ranging from 0.1% (95% CI, 0%-0.6%) in Costa Rica to 21.8% (95% CI, 19.3%-24.4%) in Guinea. The prevalence of zero-food children was particularly high in West and Central Africa, where the overall prevalence was 10.5% (95% CI, 10.1%-11.0%), and in India, where the prevalence was 19.3% (95% CI, 18.9%-19.8%). India accounted for almost half of zero-food children in this study. Conclusions and Relevance: In this cross-sectional study of 276 379 children aged 6 to 23 months, substantial disparities in the estimates of food consumption across 92 low- and middle-income countries were found. The prevalence of zero-food children underscores the need for targeted interventions to improve infant and young child feeding practices and ensure optimal nutrition during this critical period of development. The issue is particularly urgent in West and Central Africa and India.

Prevalence, trend, and inequality of prolonged exclusive breastfeeding among children aged 6-23 months old in India from 1992-2021: A cross-sectional study of nationally representative, individual-level data.

Background: Prolonged exclusive breastfeeding (PEB) for children older than six months old is a threat to appropriate complementary feeding practices. This study aims to examine the trend of PEB among children aged 6-23 months in India. Methods: We adopted five waves of National Family Health Survey (NFHS) data between 1992-93 and 2019-21. PEB was defined as children aged six months and above currently consuming breastmilk as the only source of energy, protein and micronutrients. We generated descriptive statistics and a series of multivariable logistic regressions to estimate the prevalence and trend in the PEB rate. Moreover, we assessed how child age and socioeconomic factors (i.e. child gender and age, place of residence, household wealth, and maternal education) were related with PEB using mutually and single-adjusted model. Results: There were 184 891 Indian children aged 6-23 months old included in this study with 48.0% being female. We found that the proportion of PEB increased from 4.3% in 1992 to 7.7% in 2021, of which the rate for children aged six-eight months rose from 14.0 to 20.1%. Our results showed that children who were from poorer households or with lower-educated mothers were more likely to experience prolonged exclusive breastfed. Take the year of 2019-21 as an example, compared to the households of the richest quintile, children from households of the poorer quintile were significantly more likely to experience PEB, with odds ratio (OR) of 1.33 (95% confidence interval (CI) = 1.09-1.61). Moreover, children with illiterate mothers had 21% higher odds of having prolonged exclusively breastfeeding (OR = 1.21; 95% CI = 1.01-1.44) compared with children with mothers who have college and above education. Conclusions: PEB among children over six months old is prevalent in India, particularly among children from disadvantaged households. Poverty reduction and maternal education are of great potential importance for policymakers to promote appropriate complementary feeding practice.

Corrigendum to-"Food deprivation among adults in India: an analysis of specific food-categories, 2016-2021" [eClinical medicine 66(2023) 102313].

[This corrects the article DOI: 10.1016/j.eclinm.2023.102313.].

Disclosing Recovery: A pilot randomized controlled trial of a patient decision aid to improve disclosure processes for people in treatment for opioid use disorder.

INTRODUCTION: People engaged in treatment for opioid use disorder (OUD) report struggling with whether and how to disclose, or share information about their OUD history and/or treatment with others. Yet, disclosure can act as a gateway to re-establishing social connection and support during recovery. The current study describes a pilot randomized controlled trial of Disclosing Recovery: A Decision Aid and Toolkit, a patient decision aid designed to facilitate disclosure decisions and build disclosure skills. METHODS: Participants (n = 50) were recruited from a community-based behavioral health organization in 2021-2022 and randomized to receive the Disclosing Recovery intervention versus an attention-control comparator. They responded to surveys immediately after receiving the intervention as well as one month following the intervention at a follow-up appointment. Primary outcome analyses examined indicators of implementation of the intervention to inform a future efficacy trial. Secondary outcome analyses explored impacts of the intervention on the decision-making process, disclosure rates, and relationships. RESULTS: Participants were successfully recruited, randomized, and retained, increasing confidence in the feasibility of future efficacy trials to test the Disclosing Recovery intervention. Moreover, participants in the Disclosing Recovery intervention agreed that the intervention is acceptable, feasible, and appropriate. They additionally reported a higher quality of their decision-making process and decisions than participants in the comparator condition. At their follow-up appointment, participants with illicit opioid use who received the Disclosing Recovery intervention were less likely to disclose than those who received the comparator condition. Moreover, significant interactions between illicit opioid use and the intervention condition indicated that participants without illicit opioid use who received the Disclosing Recovery intervention reported greater closeness to and social support from their planned disclosure recipient than those who received the comparator condition. CONCLUSIONS: The Disclosing Recovery intervention appears to be an acceptable, feasible, and appropriate patient decision aid for addressing disclosure processes among people in treatment for OUD. Moreover, preliminary results suggest that it shows promise in improving relationship closeness and social support in patients without illicit opioid use. More testing is merited to determine the intervention's efficacy and effectiveness in improving relationship and treatment outcomes for people in treatment for OUD.

How economic development affects healthcare access for people with disabilities: A multilevel study in China.

Meeting the healthcare needs of people with disabilities is an important challenge in achieving the central promise of "leave no one behind" during the Sustainable Development Goals era. In this study, we describe the accessibility of healthcare for people living with disabilities, as well as the potential influences of individuals' socioeconomic status and regional economic development. Our data covered 324 prefectural cities in China in 2019 and captured the access to healthcare services for people with disabilities. First, we used linear probability regression models to investigate the association between individual socioeconomic status, including residence, poverty status, education, and healthcare access. Second, we conducted an ecological analysis to test the association between prefectural economic indicators, including GDP (gross domestic product) per capita, urbanization ratio, average years of education, Engel's coefficient, and the overall prevalence of access to healthcare for people with disabilities within prefectures. Third, we used multilevel regression models to explore the association between the individual's socio-economic status, prefectural economic indicators, and access to healthcare at the individual level for people with disabilities. The results showed, first, that higher individual socioeconomic status (urban residence or higher educational level) was associated with better access to healthcare for people with disabilities. Second, regional economic indicators were positively associated with access to healthcare at the aggregate and individual levels. This study suggests that local governments, particularly in low- and middle-income countries, should promote economic development and conduct poverty alleviation policies to improve healthcare access for disadvantaged groups.

Traffic Exposure and Breast Cancer Mortality by Area of Residence: Incorporating Clinical and Socioeconomic Data.

Incorporating clinical and environmental data holds promise for monitoring vulnerable populations at the community level. This spatial epidemiology study explores the link between traffic-related air pollution and breast cancer mortality in Seoul, using public socioeconomic and clinical data from Samsung Medical Center's registry (N=6,089). Traffic and socioeconomic status were collected from official sources and integrated for spatial analysis. The findings revealed a significant association between adult breast cancer mortality and districts with high road density, NO2 emissions, and family income (p<0.05). Significant spatial autocorrelation of residuals was observed (Moran's I test p<0.001).

Spousal multimorbidity and depressive symptoms among older Indian couples: Do one's own health status and sex matter?

With the aging population, increases in non-communicable diseases that require chronic management pose a substantial economic and social burden to individuals with multimorbid conditions and their spousal caregivers. However, little is known about the crossover effect of spousal multimorbidity on mental health outcomes in the context of low- and middle-income countries, and whether it depends on one's own health status and sex. We examined the association between spousal multimorbidity and depressive symptoms using data on 6,158 older couples (12,316 individuals aged 60 years or above) from the Longitudinal Aging Study in India (LASI) 2017-18. Overall, 23.4% of the sample were multimorbid and 27.0% reported having depressive symptoms in the past week. Multivariable logistic regression models showed that spousal multimorbidity was associated with depressive symptoms, even after accounting for one's own multimorbidity status (OR: 1.23; 95% CI: 1.06-1.44). However, this association varied by sex. Among males, their own multimorbidity status was associated with 60% higher odds of having depressive symptoms (OR: 1.60; 95% CI: 1.28-2.00), but spousal multimorbidity was not. Furthermore, for males, the association between spousal multimorbidity and depressive symptoms was contingent upon the presence of their own multimorbidity. Among females, spousal multimorbidity was significantly associated with depressive symptoms, regardless of their own multimorbidity status. Our findings indicate that interventions to promote healthy aging should expand the formal caregiving system and consider family-based approaches to minimize the crossover health consequences of chronic morbidity in conjugal relationships, especially for females.

Complementary and Alternative Medicine Use, Cancer Screening, and Medical Checkups in Japan from 2001 to 2013: A Repeated Cross-Sectional Study.

Introduction: The association between complementary and alternative medicine (CAM) use and other health-related behaviors is an important issue. A previous study reported that complementary medicine use is related to greater use of cancer screening, whereas alternative medicine use is related to lower use of cancer screening. Given the sparse evidence from Japan, we aimed to examine the association of CAM use with cancer screening and medical checkups. We used a repeated cross-sectional survey of a nationally representative sample of Japanese people and conducted age-period-cohort analysis. Methods: The study population was 68,217 of 83,827 individuals observed from 2001 to 2013 who received cancer screening. CAM users were defined as individuals who received acupuncture, moxibustion, anma/massage/shiatsu, or judo therapy for their most worrisome symptom. The outcomes of interest were receiving stomach, lung, colorectal, uterine, and breast cancer screenings and medical checkups. Using crossclassified multilevel logistic regression models, we estimated odds ratios (ORs) and 95% credible intervals (CIs) for cancer screening and medical checkups. Results: For CAM users of complementary medicine, the adjusted ORs for stomach, lung, and colorectal cancer screening were 1.40 (95% CI: 1.35-1.44), 1.37 (95% CI: 1.34-1.40), and 1.52 (95% CI: 1.49-1.54), respectively. We found similar results for uterine and breast cancer screening, and medical checkups. Conclusions: Irrespective of whether they use CAM, CAM users in Japan tend to receive a variety of cancer screenings and medical checkups.

Prevalence of girl and boy child marriage across states and Union Territories in India, 1993-2021: a repeated cross-sectional study.

BACKGROUND: India's success in eliminating child marriage is crucial to the achievement of the Sustainable Development Goal target 5.3. We aimed to estimate the prevalence of child marriage in girls and boys in India and describe its change across 36 states and Union Territories between 1993 and 2021. METHODS: For this cross-sectional study, data from five National Family Health Surveys from 1993, 1999, 2006, 2016, and 2021 were used. The study included 310 721 women aged 20-24 years between 1993 and 2021 and 43 436 men aged 20-24 years between 2006 and 2021. Child marriage was defined as marriage in individuals younger than 18 years for men and women. We calculated the annual change in prevalence during the study period for states and Union Territories and estimated the population headcount of child brides and grooms. FINDINGS: Child marriage declined during 1993 to 2021. The all-India prevalence of child marriage in girls declined from 49·4% (95% CI 48·1-50·8) in 1993 to 22·3% (21·9-22·7) in 2021. Child marriage in boys declined from 7·1% (6·9-30·8) in 2006 to 2·2% (1·8-2·7) in 2021. The largest decreases in child marriage occurred between 2006 and 2016. Between 2016 and 2021, a few states and Union Territories saw an increase in prevalence of child marriage in girls (n=6) and boys (n=8) despite declines in the all-India prevalence. In 2021, 13 464 450 women aged 20-24 years and 1 454 894 men aged 20-24 years were estimated to be married as children. INTERPRETATION: One in five girls and nearly one in six boys are still married below the legal age of marriage in India. There remains an urgent need for strengthened national and state-level policy to eliminate child marriage by 2030. FUNDING: Bill & Melinda Gates Foundation.

Prevalence and changes of intimate partner violence against women aged 15 to 49 years in 53 low-income and middle-income countries from 2000 to 2021: a secondary analysis of population-based surveys.

BACKGROUND: In low-income and middle-income countries (LMICs), intimate partner violence poses a substantial barrier to accomplishing target 5.2 of the Sustainable Development Goals: to eliminate all forms of violence against women and girls. Our study aimed to assess the prevalence and changes of intimate partner violence against women in LMICs. We also explored the association between women's empowerment and intimate partner violence. METHODS: In this secondary analysis of population-based surveys, we obtained data from the nationally representative Demographic and Health Surveys conducted in LMICs between 2000 and 2021. We selected countries with available data on the domestic violence module, and women aged 15 to 49 years who currently or formerly had a husband or partner, and who had provided information about intimate partner violence, were included in the analysis. We first estimated the weighted prevalence of intimate partner violence in LMICs with available data, and then we assessed the average annual rate of change using Poisson regression with robust error variance in a subset of countries with at least two surveys. We used multilevel analysis to investigate the association between intimate partner violence and women's empowerment measured at both the country and individual levels. Country-level empowerment was measured by gender inequality index, while individual-level empowerment considered social independence, decision making, and attitude to violence. FINDINGS: A total of 359 479 women aged 15 to 49 years were included from 53 LMICs. 336 811 women from 21 countries with two surveys provided data for assessing the trends of intimate partner violence. The weighted prevalence of any type of intimate partner violence was 37·2% (95% CI 36·6 to 37·8). A significant overall decline in the prevalence of any type of intimate partner violence was observed with an average annual rate of change of -0·2% (95% CI -0·4 to -0·03); however six countries showed significant increasing trends, with average annual rates of change ranging from 1·2% (95% CI 0·7 to 1·7) in Nigeria to 6·6% (5·3 to 7·8) in Sierra Leone. Notably, the prevalence of psychological intimate partner violence has risen (average annual rate of change, 2·3% [95% CI 2·1 to 2·6]), reflected in increased rates across eight countries. Higher levels of country-level women's empowerment were associated with a lower risk of intimate partner violence: women from countries with the highest tertile of gender inequality index had an increased odds of any type of intimate partner violence (odds ratio 1·58 [95% CI 1·12 to 2·23]). Similarly, better individual-level women's empowerment also showed significant associations with a lower risk of intimate partner violence. INTERPRETATION: The prevalence of intimate partner violence remains high, and some countries have shown an increasing trend. The strong relationship between both country-level and individual-level women's empowerment and the prevalence of intimate partner violence suggests that accelerating women's empowerment could be one strategy to further reduce intimate partner violence against women. FUNDING: National Natural Science Foundation; Vanke School of Public Health, Tsinghua University; and Sanming Project of Medicine in Shenzhen.

The association of a disability-targeted cash transfer programme with disability status and health-care access: a quasi-experimental study using a nationwide cohort of 4·3 million Chinese adults living with severe disabilities.

BACKGROUND: Cash transfer is a crucial policy tool to address inequality. The objective of this study was to investigate the association between China's disability-targeted cash transfer programme and disability status, as well as equitable access to rehabilitation and medical services. METHODS: For this quasi-experimental study, we drew data from the nationwide administrative cohort of individuals with disabilities between Jan 1, 2015, and Dec 31, 2019. Individuals were enrolled in the cohort if they were aged 18 years or older, had severe disabilities as defined by the Chinese Government, and had available cash transfer information for at least 4 consecutive years, without having started receiving cash transfer benefits at the time of enrolment. We used a quasi-experimental design with propensity score matching to estimate the effects of cash transfers on disability status, access to rehabilitation services, and access to medical treatment. The primary outcomes were development of new disability and reduction of existing disabilities. Secondary outcomes were use of rehabilitation services, financial barriers as a major obstacle to accessing rehabilitation services, use of medical services by individuals who had an illness in the previous 2 weeks, and financial barriers as a major obstacle to accessing medical services. FINDINGS: From an initial pool of 51 356 125 individuals with disabilities registered in the administrative system, 2 686 024 individuals were eligible for analysis, of whom 2 165 335 (80·6%) were cash transfer beneficiaries and 520 689 (19·4%) non-beneficiaries. After propensity score matching, the cohort included 4 330 122 adults with severe disabilities. Cash transfer beneficiaries had significantly lower odds of developing new disabilities over time than non-beneficiaries (odds ratio [OR] 0·90, 95% CI 0·86-0·94; p<0·0001) and higher odds of having a reduced number of disabilities over time (1·17, 1·10-1·25; p<0·0001). Compared with non-beneficiaries, cash transfer beneficiaries were more likely to use rehabilitation services (2·12, 2·11-2·13; p<0·0001) and medical services (1·74, 1·69-1·78; p<0·0001), and less likely to report financial hardship to access rehabilitation services (0·53, 0·52-0·54; p<0·0001) and medical services (0·88, 0·84-0·93; p<0·0001) at the study endpoint. INTERPRETATION: The receipt of cash transfers was associated with improved disability status and increased access to disability-related services. The findings suggest that cash transfers could be a potential method for promoting universal health coverage among individuals living with disabilities. FUNDING: China National Natural Science Foundation.

Food deprivation among adults in India: an analysis of specific food categories, 2016-2021.

Background: Adult undernourishment remains pervasive throughout India, and often results from food deprivation, which refers to the inadequate consumption of foods with caloric and nutrient significance. Therefore, understanding the extent to which food groups are missing from an individual's diet is essential to understanding the extent to which they are undernourished. Methods: We used data from two National Family Health Surveys conducted in 2016 and 2021 for this cross-sectional analysis. The study population consisted of women and pregnant women between the ages of 15-49, and men between the ages of 15-54. We examined shifts in the percentage of people not consuming dairy, pulses/beans/legumes, dark leafy green vegetables, fruits, eggs, and fish and meat among women, pregnant women, and men between the two time points. We also examined these patterns by household wealth and education, two important markers of socioeconomic status. Findings: Overall, we found that fewer women, pregnant women, and men were not eating each of the six food groups in 2021 than in 2016. Additionally, the gap in food group consumption between women, pregnant women, and men in the lowest and highest socioeconomic groups shrank between 2016 and 2021. Yet, food group deprivation remained most prevalent among those in the lowest socioeconomic groups. The two exceptions for this were for eggs and meat/fish. Nevertheless, the majority of India's poorest and least educated adults are not consuming high-quality protein sources, including dairy, the consumption of which is far more common among wealthier and more educated Indian adults. Interpretation: Our results show that fewer adults were not consuming important food groups in 2021 than in 2016. However, many of India's poorest and least educated adults are still not consuming high-quality sources of protein or fruits, two food groups that are essential for good health. While adults might be getting protein and nutrients from pulses, legumes, beans, and other vegetables, efforts are needed to improve affordability of, and access to, high-quality sources of protein and fruits. Funding: This work was supported by the Bill & Melinda Gates Foundation, INV- 002992.

Associations between parental adherence to healthy lifestyles and cognitive performance in offspring: A prospective cohort study in China.

BACKGROUND: Previous studies have reported associations of specific maternal and paternal lifestyle factors with offspring's cognitive development during early childhood. This study aimed to investigate the prospective associations between overall parental lifestyle and offspring's cognitive performance during adolescence and young adulthood in China. METHODS: We included 2531 adolescents aged 10-15 years at baseline in 2010 from the China Family Panel Studies. A healthy parental lifestyle score (ranged 0-5) was constructed based on the following five modifiable lifestyle factors: Smoking, drinking, exercise, sleep, and diet. Generalized estimating equation models were used to examine the association between baseline parental healthy lifestyle scores and offspring's fluid and crystallized intelligence in subsequent years (2012, 2014, 2016, and 2018). RESULTS: Offspring in the top tertile of parental healthy lifestyle scores performed better in overall fluid intelligence (multivariable-adjusted ß = 0.53, 95% confidence interval [CI]: 0.29-0.77) and overall crystallized intelligence (multivariable-adjusted ß = 0.35, 95% CI: 0.16-0.54) than those in the bottom tertile of parental healthy lifestyle scores. The results were similar after further adjustment for the offspring's healthy lifestyle scores and persisted across the subgroups of parental socioeconomic status. Additionally, maternal and paternal healthy lifestyle scores were independently associated with better offspring's cognitive performance, with significant contribution observed for paternal never-smoking, weekly exercise, and diversified diet. When both parents and offspring adhered to a healthier lifestyle, we observed the highest level of the offspring's overall crystallized intelligence. CONCLUSIONS: Our study indicates that parental adherence to a healthier lifestyle is associated with significantly better offspring's cognitive performance during adolescence and early adulthood, regardless of socioeconomic status. These findings highlight the potential cognitive benefits of promoting healthy lifestyles among parents of adolescents.

AI computing reaches for the edge.

A chip design integrates computation and memory to efficiently process data at low energy cost.