Prioritization of the essentials in the spending patterns of Canadian households experiencing food insecurity.

OBJECTIVE: Food insecurity is a potent determinant of health and indicator of material deprivation in many affluent countries. Food insecurity is associated with compromises in food and housing expenditures, but how it relates to other expenditures is unknown. The present study described households' resource allocation over a 12-month period by food insecurity status. DESIGN: Expenditure data from the 2010 Survey of Household Spending were aggregated into four categories (basic needs, other necessities, discretionary, investments/assets) and ten sub-categories (food, clothing, housing, transportation, household/personal care, health/education, leisure, miscellaneous, personal insurance/pension, durables/assets). A four-level food insecurity status was created using the adult-specific items of the Household Food Security Survey Module. Mean dollars spent and budget share by food insecurity status were estimated with generalized linear models adjusted first for household size and composition, and subsequently for after-tax income quartiles. SETTING: Canada. SUBJECTS: Population-based sample of households from the ten provinces (n 9050). RESULTS: Food-secure households had higher mean total expenditures than marginally, moderately and severely food-insecure households (P-trend <0·0001). As severity of food insecurity increased, households spent less on all categories and sub-categories, except transportation, but they allocated a larger budget share to basic needs and smaller shares to discretionary spending and investments/assets. The downward trends for dollars spent on basic needs and other necessities became non-significant after accounting for income, but the upward trend in the budget shares for basic needs persisted. CONCLUSIONS: The spending patterns of food-insecure households suggest that they prioritized essential needs above all else.

'It's because I like things it's a status and he buys me airtime': exploring the role of transactional sex in young women's consumption patterns in rural South Africa (secondary findings from HPTN 068).

BACKGROUND: 'Transactional sex', defined as a non-marital, non-commercial sexual relationship in which money or material goods are exchanged for sex, is associated with young women's increased vulnerability to HIV infection. Existing research illustrates that the motivations for transactional sex are complex. The fulfilment of psycho-social needs such as the need to belong to a peer group are important factors underlying young women's desires to obtain certain consumption items and thus engage in transactional sex. METHODS: We use a mixed-methods approach to explore the relationship between transactional sex and consumption patterns among young women in rural Mpumalanga province, South Africa. In the secondary analysis of 693 sexually active young women, we use factor analysis to group the different consumption items and we use multivariable logistic regression to demonstrate the relationship between transactional sex and consumption patterns. The qualitative study uses five focus group discussions and 19 in-depth interviews to explore further young women's motivations for acquiring different consumption items. RESULTS: The quantitative results show that young women that engage in transactional sex have higher odds of consuming items for entertainment (e.g., movie tickets) than on practical items (e.g., food and groceries). The qualitative findings also revealed that young women's perceptions of items that were considered a 'need' were strongly influenced by peer pressure and a desire for improved status. Further, there was a perception that emerged from the qualitative data that relationships with sugar daddies offered a way to acquire consumer goods associated with a 'modern lifestyle', such as items for personal enhancement and entertainment. However, young women seem aware of the risks associated with such relationships. More importantly, they also develop relationship with partners of similar age, albeit with the continued expectation of material exchange, despite engaging in the relationship for love. CONCLUSION: This study shows that young women are willing to take certain risks in order to have a degree of financial independence. Interventions that provide alternative methods of attaining this independence, such as the provision of cash transfers may have potential in preventing them from engaging in transactional relationships. Further, the psycho-social reasons that drive young women's motivations for consumption items resulting in risky sexual behaviours need to be better understood.

US Medicaid program: An analysis of the spending and utilization patterns for antidepressants from 2017 to 2021.

Background: Major depressive disorder (MDD) is a serious mental health condition that contributes to health complications, financial burden and death. In 2020, about one in five US adults had a lifetime diagnosis of MDD. With Major Depressive Disorder (MDD) being a common mental health concern, it is important to understand treatment patterns within public health systems like Medicaid, as they play a crucial role in providing care to diverse populations. Objective: The study investigated antidepressant usage and market distribution in the Medicaid Program. By doing so, the study aimed to provide insights into how these trends reflect broader changes in mental health treatment practices and policy implications within the Medicaid system during the study period. Methods: Public Medicaid data from 2017 to 2021 were analyzed, focusing on 30 FDA-approved antidepressants. Spending and prescription data were aggregated using Excel and Python. Results: The total US Medicaid expenditure on antidepressants increased from about $1 billion dollars in 2017 to $1.12 billion dollars in 2021, an increase of about 10%. Consistently, SSRIs were the class of antidepressants that Medicaid spent the most on. The highest Medicaid spending on a single antidepressant in 2017 and 2018 was bupropion. During the remaining years of the study (2019, 2020, 2021) Medicaid appropriated most funds toward Vortioxetine. The total number of antidepressant prescriptions increased from 52 million scripts to 59 million scripts (an increase of about 14%). Conclusions: The increase in Medicaid spending on antidepressants during the study period can be explained by an increase in utilization (a 14% increase in antidepressant prescriptions from 2017 to 2021), and a shift toward prescribing newer more costly antidepressants (like SSRIs and others) and away from prescribing older, less costly antidepressants like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs)."