28 research outputs found
Three essays on the economics of nutrition
No full textThis thesis investigates the relationship between the social and the spatial environment and nutrition of children in high and low income countries. Furthermore, this project investigates the implications of nutrition on human capital outcomes. The first empirical chapter is concerned with whether exposure to fast food increases BMI of adolescents. This question is studied at a time when fast food restaurants started to open in the UK. We merge data on the location and timing of the openings of all fast food outlets in the UK from 1968 -1986, with data on objectively measured BMI from the British Cohort Survey. The relationship between adolescent BMI and the distance from the respondents’ homes and time since opening, is studied. We find that fast food exposure had no effect on BMI. Numerous robustness checks do not change our findings. The second empirical chapter is the first to provide evidence of a direct causal impact of iodine fortification in early life on cognitive skills in childhood. I apply a difference-in- differences strategy using exogenous variation from a nationwide iodine fortification policy in India, comparing test scores of school aged children in naturally iodine sufficient and deficient districts over time. I find that the policy increased the probability of attaining basic numeracy and literacy skills by 2.67 - 5.83%. Previous papers find a larger effect on longer term human capital for women. I do not find a gender differential for basic skills but I observe a positive effect on more difficult literacy tasks for girls but not for boys. The third empirical chapter investigates the effect of iodised salt availability on children’s heights using a large household survey from rural India. Medical evidence points to a mechanistic relationship between iodine deficiency and a decline in the production and functioning of biological factors affecting human growth. I use a two-stage-least-squares regression to circumvent concerns regarding the endogeneity of a household’s availability of iodised salt and children’s anthropometric status. I instrument for iodised salt con- sumption with the distance to the major salt producing state. Salt transported for longer distances is likely to be transported by rail rather than by road. Monitoring of iodised salt is only mandatory before and during rail transport. Therefore, distance serves as a proxy for the likelihood that the salt has been inspected for iodine, and thus iodised. I find that the availability of adequately iodised salt improves height-for-age by 0.664 Z-scores for children up to 1 year
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Three essays on the economics of nutrition
No full textThis thesis investigates the relationship between the social and the spatial environment and nutrition of children in high and low income countries. Furthermore, this project investigates the implications of nutrition on human capital outcomes. The first empirical chapter is concerned with whether exposure to fast food increases BMI of adolescents. This question is studied at a time when fast food restaurants started to open in the UK. We merge data on the location and timing of the openings of all fast food outlets in the UK from 1968 -1986, with data on objectively measured BMI from the British Cohort Survey. The relationship between adolescent BMI and the distance from the respondents’ homes and time since opening, is studied. We find that fast food exposure had no effect on BMI. Numerous robustness checks do not change our findings. The second empirical chapter is the first to provide evidence of a direct causal impact of iodine fortification in early life on cognitive skills in childhood. I apply a difference-in- differences strategy using exogenous variation from a nationwide iodine fortification policy in India, comparing test scores of school aged children in naturally iodine sufficient and deficient districts over time. I find that the policy increased the probability of attaining basic numeracy and literacy skills by 2.67 - 5.83%. Previous papers find a larger effect on longer term human capital for women. I do not find a gender differential for basic skills but I observe a positive effect on more difficult literacy tasks for girls but not for boys. The third empirical chapter investigates the effect of iodised salt availability on children’s heights using a large household survey from rural India. Medical evidence points to a mechanistic relationship between iodine deficiency and a decline in the production and functioning of biological factors affecting human growth. I use a two-stage-least-squares regression to circumvent concerns regarding the endogeneity of a household’s availability of iodised salt and children’s anthropometric status. I instrument for iodised salt con- sumption with the distance to the major salt producing state. Salt transported for longer distances is likely to be transported by rail rather than by road. Monitoring of iodised salt is only mandatory before and during rail transport. Therefore, distance serves as a proxy for the likelihood that the salt has been inspected for iodine, and thus iodised. I find that the availability of adequately iodised salt improves height-for-age by 0.664 Z-scores for children up to 1 year
Intent to Vaccinate Children Against COVID-19 by Caregiver Vaccination Status in Northeast Tennessee
No full textTITLE: Intent to Vaccinate Children Against COVID-19 by Caregiver Vaccination Status in Northeast Tennessee
AUTHOR INFO
Yordanos Tafesse MD1 [email protected]
Olivia A. Sullivan, EMT, MPH1 [email protected]
Samuel Pettyjohn, DrPH, MPH1 [email protected]
1 Center for Rural Health Research, East Tennessee State University, Johnson City, TN.
Addressing vaccine hesitancy is crucial in mitigating the spread of the ongoing COVID-19 pandemic. Children are mostly asymptomatic or have milder symptoms of COVID-19 than adults, and thus may remain undiagnosed, allowing the disease to spread to a large number of people; they are also at a high risk of long-term morbidity from as-of-yet undetermined effects of “long COVID.” Therefore, this analysis sought to examine caregivers’ intent to have their children vaccinated against COVID-19 based on the caregivers’ vaccination status and the age of the children. Using a secondary dataset from a survey in Northeast Tennessee, researchers found a significant difference between vaccinated and unvaccinated caregivers in intent to vaccinate their children in all age groups. Among caregivers with vaccine-eligible (12+ years children), unvaccinated caregivers (n=16) were significantly more likely than vaccinated caregivers (n=71) to not have had their child vaccinated (X2=24, df=1, p=7.8x10-7). Among caregivers who had not yet had their children vaccinated, unvaccinated caregivers (n=23) were significantly more likely to indicate they would “definitely not” get their children vaccinated than vaccinated caregivers (n=76) among all age groups of children: 0-4 years (X2=7.8, df=1, p=5.1x10-3), 5-9 years (X2=28, df=1, p=1.4x10-7), 10-13 years (X2=30, df=1, p=3.6x10-8), and 14+ years (X2=16, df=1, p=6.1x10-5) (Figure 2). The percentage of caregivers indicating they would “definitely not” get their child vaccinated differed by age of children among vaccinated caregivers (X2=11, df=3, p=0.011) but not unvaccinated caregivers (X2=5.1, df=3, p=0.16). Limitations include a small number of unvaccinated caregivers in the sample and the inability to account for correlation in the data. These results corroborate other findings nationwide, and demonstrate the need to provide high-quality education to address vaccine hesitancy in Northeast Tennessee
Faith-based provision of sexual and reproductive healthcare in Malawi
No full textFaith-based organisations constitute the second largest healthcare providers in Sub-Saharan Africa but their religious values might be in conflict with providing some sexual and reproductive health services. We undertake regression analysis on data detailing client-provider interactions from a facility census in Malawi and examine whether religious ownership of facilities is associated with the degree of adherence to family planning guidelines. We find that faith-based organisations offer fewer services related to the investigation and prevention of sexually transmitted infections (STIs) and the promotion of condom use. The estimates are robust to several sensitivity checks on the impact of client selection. Given the prevalence of faith-based facilities in Sub-Saharan Africa, our results suggest that populations across the region may be at risk from inadequate sexual and reproductive healthcare provision which could exacerbate the incidence of STIs, such as HIV/AIDS, and unplanned pregnancies
Racial Disparities Associated With Colon Cancer Screening in a Nationally Representative Sample; A Cross-sectional Study
No full textTITLE: Racial disparities associated with colon cancer screening in a nationally representative sample; A cross-sectional study
AUTHOR INFO
Yorandos Tafesse MD1
Manik Ahuja PhD, MA1
Author Affiliations:
1College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
Colon cancer impacts nearly 2 million individuals in the U.S. each year. Early detection of colon cancer using colonoscopy can reduce the risk of mortality. The United States Preventive Services Task Force (USPSTF) recommends routine screening for colon cancer for all adults 50 to 75 years of age. Colon cancer screening behavior is different across a variety of predictor variables. Previous studies have identified older age, male gender, higher education, higher income, marriage, and the presence of chronic diseases to be associated with increased odds of colon cancer screening. However, less is known about the role of racial differences in screening. This study aims to determine if colon cancer screening rates are different between Whites and racial minorities in the United States controlling for potential confounders. This research can help bridge the existing gap on this topic and aid in identifying high-risk racial groups that could be targeted by future intervention strategies. We used cross-sectional data from the 2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 years or older. We extracted data for adults age 50 or older (n=10,972). Logistic regression analyses were conducted to test the association between race and colon cancer screening. We also included chronic disease status, alcohol use, smoking, gender, and age in our model. Chronic disease status was coded as self-report 2 or more, 1 and 0 chronic diseases (referent), which included the summation of heart disease, hypertension, COPD, and diabetes. Overall, colon cancer screening is as follows among Whites (77.2%), Blacks (72.4%), Asian (60.1%), American Indian/Alaska Native (69.7%), and Hispanic (68.6%). Logistic regression results revealed that having 2 or more chronic diseases (OR=1.73; 95% CI 1.53,1.96), 1 chronic disease (OR=1.45; 95% CI 1.31,1.65), and female gender (OR=1.14; 95% CI 1.04,1.23) were associated with higher odds of screening. Race/ethnic minority status (OR=0.72; 95% CI 0.65, 0.81), low income (OR=0.64; 95% CI 0.57,0.70), and less than high school education (OR=0.71; 95% CI 0.59,0.84) were associated with lower odds of screening. Our research showed that racial minorities have lower odds of colon cancer screening after adjusting for gender, age, chronic diseases, income, and education status. Preventive practices should focus on increasing awareness on and availability of colon cancer screening means to racial minorities in the United States. Further research on the association between race and other screening modalities will help maximize the impacts of targeted interventions
Childhood obesity, is fast food exposure a factor?
No full textAccess to fast food has often been blamed for the rise in obesity which in turn has motivated policies to curb the spread of fast food. However, robust evidence in this area is scarce, particularly using data outside of the US. It is difficult to estimate a causal effect of fast food given spatial sorting and ever-present exposure. We investigate whether the residential access to fast food increased BMI of adolescents at a time when fast food restaurants started to open in the UK. The time period presents the study with large spatial and temporal differences in exposure as well as plausibly exogenous variation. We merge data on the location and timing of the first openings of all fast food outlets in the UK from 1968−1986, with data on objectively measured BMI from the 1970 British Cohort Survey. The relationship between adolescent BMI and the distance from the respondents’ homes and time since opening, is studied using OLS and Instrumental Variables regression. We find that fast food exposure had no effect on BMI. Extensive robustness checks do not change our conclusion
The Difference in Clinical Knowledge Between Staff Employed at Faith-based and Public Facilities in Malawi
No full textThe effect of government contracting with faith-based health care providers in Malawi
No full textWe study the impact of contracting-out of maternal health care by the government of Malawi to providers from the Christian Health Association of Malawi (CHAM) in the form of Service Level Agreements (SLAs). Under a SLA, a CHAM facility provides agreed maternal and newborn services free-of-charge to patients, and is reimbursed on a fixed price per service. We merge data on health facilities in Malawi with pregnancy histories from the 2010 Malawi Demographic and Health Survey, and exploit the staggered implementation of SLAs across facilities. Using difference-in-differences, we estimate the differential effects on pregnancy- related health care utilisation to mothers residing near and far from facilities with a SLA over time. Our findings show that SLAs reduced home births and increased skilled deliveries at CHAM hospitals. We observe greater provision of prenatal care services at CHAM health centres but no overall increase in the number of prenatal care visits. We find evidence of a reduction in certain components of prenatal care
Economic evaluation of interventions to address undernutrition:a systematic review
No full textStrategies to address undernutrition in low- and middle-income countries (LMICs) include various interventions implemented through different sectors of the economy. Our aim is to provide an overview of published economic evaluations of such interventions and to compare and contrast evaluations of interventions in different areas. We reviewed economic evaluations of nutrition interventions in LMICs published since 2015 and/or included in the Tufts Global registry or Disease Control Priorities 3rd edition. We categorized the studies by intervention type (preventive; therapeutic; fortification; delivery platforms), nutritional deficiency addressed and characteristics of the economic evaluation (e.g. type of model, costs and outcomes included). Of the 62 economic evaluations identified, 56 (90%) were cost-effectiveness analyses. Twenty-two (36%) evaluations investigated fortification and 23 (37%) preventive interventions. Forty-three percent of the evaluations of preventive interventions did not include a model, whereas most of fortification strategies used the same reference model. We identified different trends in cost categories and inclusion of health and non-health outcomes across evaluations in the four different topic areas. To illustrate the implications of such trends for decision-making, we compared a set of studies evaluating alternative strategies to combat zinc deficiency. We showed that the use of 'off-the-shelf' models and tools can potentially conceal what outcomes and costs and value judgements are used. Comparing interventions across different areas is fundamental to assist decision-makers in developing their nutrition strategy. Systematic differences in the economic evaluations of interventions delivered within and outside the health sector can undermine the ability to prioritize alternative nutrition strategies
