This study explored associations between adolescents' perceived health, socioeconomic status (SES), and food insecurity, and examined the potential mediating roles of psychological resilience and self-esteem these associations. A cross-sectional study was conducted with 1,000 adolescents aged 14-17 in the Eastern Mediterranean region of Turkey, using multistage stratified sampling. Data were collected through a researcher-developed SES form, the Children's Food Insecurity Experiences Scale, Rosenberg Self-Esteem Scale, and the Child and Youth Resilience Measure. Generalized Linear Models were used for mediation analysis. Lower SES and higher levels of food insecurity were associated with poorer perceived health. The association with perceived health was generally more negative at higher levels of food insecurity severity. Higher psychological resilience was associated with better perceived health, while lower self-esteem was linked to poorer health perceptions. Significant negative indirect associations through both variables were found between SES/food insecurity and perceived health. Findings highlight the role of psychosocial resources in helping to explain differences in perceived health associated with structural disadvantage during adolescence.
Consanguineous marriage remains a culturally embedded practice in many parts of India. This study examines the spatial distribution and socio-demographic correlates of consanguineous marriage across districts in India. Data were derived from the fifth round of the National Family Health Survey (NFHS-5), conducted in 2019-2021. Moran's Index and Univariate Local Indicator of Spatial Association (LISA) were used for analysis. The prevalence of consanguineous marriage decreased from 14.4% in 1992-93 to 10.8% in 2019-21. Out of 707 districts, 97 districts have high consanguineous marriages above 20 percent; among these, the top five districts are from Karnataka and Tamil Nadu. The regression model revealed that education, caste, religion, place of residence, and wealth index have a significant association with consanguineous marriage in India. Consanguineous marriage exhibits strong spatial clustering across India, driven by underlying socio-demographic characteristics.
In 2020, the total fertility rate in Puerto Rico was estimated at 0.93 children per woman, one of the lowest in the world. While fertility decline preceded the new millennium, little is known about whether the onset of the 2006 economic crisis influenced its pace. Using birth counts from the Puerto Rico Vital Statistics System and population estimates, we calculate fertility measures for 1990-2020. Regression models estimated by ordinary least squares, with Newey-West standard errors, were fit to estimate the overall annual percent change (APC), and to compare the periods before and after the onset of the economic crisis (1990-2005 and 2006-2020). The pace of decline changed for eight of the nine indicators: accelerating for seven, while the ASFR for women aged 40-44 years declined at a slower pace. Stratified models show that all fertility measures and the share of women aged 15-44 declined significantly in both periods, with a faster decline observed in the post-crisis period for six of the nine. A significant acceleration in fertility decline was observed in the age-specific fertility rates for women under 35 years. In Puerto Rico, findings suggest that fertility decline accelerated after the onset of the economic crisis.
While many studies find that received social capital matters for childbearing on the individual level, few studies have investigated how regional social factors relate to fertility rates. In the current study, we used data from 299 municipalities in Finland to examine how different measures of social capital are associated with total fertility rates at the regional level. Data for social indicators were derived from a large national survey (n = 100 750), and data on fertility and covariates were derived from population registries. We applied spatial autoregressive error models to account for spatial autocorrelation between neighboring municipalities. Regions with higher social support and more frequent social contacts had higher total fertility rates, whereas trust, community participation, cultural activities or loneliness were not associated with fertility. These associations were particularly pronounced for fertility rates among individuals aged 20-39 than in other age groups. Moreover, no association was found for regional socio-economic composite score. The results suggest that community-level social capital may be relevant for fertility trends.
Women have a higher risk of Long COVID, defined as symptoms persisting for three or more months after SARS-CoV-2 infection. This study examines whether the elevated risk of Long COVID among women varies across income subgroups in a nationally representative sample of the U.S. population. Using data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS), we estimated adjusted odds ratios for Long COVID associated with female sex, stratified by four age categories and 11 income groups. We conducted random-effects meta-analyses of income subgroup estimates within each age category and assessed heterogeneity using Cochran's Q, I2 statistics, prediction intervals, and Galbraith plots. Among younger age groups (18-34, 35-49, and 50-64 years), Cochran's Q ranged from 7.70 to 10.98 (p > 0.10), and I2 was 0.00%, indicating no significant heterogeneity across income groups. In the ≥65 age group, Cochran's Q was 18.35 (p = 0.0494), and I2 was 21.96%, suggesting modest heterogeneity. The 95% prediction interval for the ≥65 group (1.121-1.978) was wider than those for younger groups: 1.437-1.975 (18-34 years), 1.551-2.019 (35-49 years), and 1.355-1.766 (50-64 years).
Parenthood fundamentally reshapes economic trajectories yet establishing causality remains methodologically challenging due to selection and timing endogeneity. This study introduces a novel identification strategy exploiting contraceptive failures as an exogenous source of variation in parenthood status. Using nationally representative survey data, I compare individuals who experienced contraceptive failures resulting in births against those using contraception who did not conceive. The findings reveal a striking gender paradox: while motherhood substantially reduces women's unconditional employment probability by approximately 20 per cent and higher education attainment by 5 per cent, fatherhood increases men's employment likelihood by 7 per cent and educational achievement by 11 per cent. These effects are most pronounced during children's first decade, with maternal employment penalties disappearing after age 10, though educational gaps persist. If the identifying assumptions are satisfied, this suggests that first unintended parenthood may not fully explain persistent long-term gender disparities, though cumulative fertility and anticipatory effects remain important candidates. This research introduces contraceptive failure as a credible new identification strategy, documenting bidirectional gender effects that amplify inequality. The results challenge conventional policy approaches by revealing that gender gaps arise not only from maternal penalties but also from paternal premiums.
Social isolation and loneliness are recognized risk factors for adverse aging outcomes, but their effects on sarcopenia remain understudied. This study investigated the independent and combined effects of social isolation and loneliness on the risk of incident sarcopenia in two large prospective cohorts: CHARLS (n = 8,856) and ELSA (n = 5,561), including participants aged 50 years and older free of sarcopenia at baseline. Sarcopenia was defined using AWGS2019 and the Revised European Consensus criteria. During mean follow-ups of 3.7 years (CHARLS) and 3.9 years (ELSA), 1,431 and 331 incident sarcopenia cases were identified, respectively. Social isolation and loneliness were significantly associated with increased risk of sarcopenia in each cohort, and participants exposed to both had the highest risk. Population attributable fractions ranged from 5.6% to 14.4%. Mediation analysis revealed that the physical activity accounted for 6-9% of these associations. Mendelian randomization analyses further supported potential causal links, showing that predicted loneliness and isolation were associated with reduced grip strength and lower appendicular lean mass. These findings suggest that social isolation and loneliness are modifiable psychosocial risk factors for sarcopenia, partly mediated by physical inactivity. Public health efforts to prevent sarcopenia in older adults should include strategies to strengthen social connections and emotional well-being.
Declining birth rates and rising childlessness are commonly attributed to structural and life-course drivers, including economic insecurity, the direct and opportunity costs of childrearing, labor market conditions, partnership dynamics, and work-family incompatibility. While these variables are the traditional elements used to describe the reasons behind decreasing birth rates, they do not fully capture an increasingly visible motivational domain: morally grounded evaluations of whether procreation is permissible under perceived social deterioration, climate change, or moral judgments over life, existence as harm, and suffering. Antinatalism refers here to the normative views that procreation is morally impermissible, either always or under a significant set of conditions. This could be understood as a measurable range of evaluative judgments both from conditional reasons and on stronger moral unconditional reasons. The article identifies a gap between traditional explanatory frameworks, and the moral content already present in stated reasons for deciding against procreation. The goal is not to elevate antinatalism as the dominant driver of fertility decline but to incorporate it into a more complete account of the current demographic phenomenon that deserves empirical investigation. Then, the incomplete picture that demographic research has calls upon the need to take the antinatalist variable seriously.
This study examines changes in fruit and vegetable consumption (FVC) across socioeconomic groups in Pakistan over two decades, using data from the Household Integrated Income and Consumption Surveys (HIICS) conducted in 1998-99 and 2018-19. Using a copula-based decomposition approach, the study disaggregates FVC inequality into structure and composition effects. The findings show an average per capita increase of 120.88 grams in FVC, with gains of 23.41, 20.86, and 153.31 grams at the 10th, 50th, and 90th percentiles, respectively. This favorable change was mainly driven by compositional effects, particularly shifts in household income, size, and education. While higher income and larger households are positively associated with FVC, the education of the household head shows a negative association, warranting further investigation. To improve dietary quality and reduce the risk of chronic disease, the findings underscore that policy efforts should focus on income enhancement, targeted nutrition education - especially for larger households - and correcting misperceptions about the health benefits of fruits and vegetables. The findings suggest that policymakers should raise household income, promote nutrition education, and introduce fair food subsidies.
Stunting and wasting are major public health challenges in India, contributing to high child morbidity and mortality. Beyond inadequate nutrition, poor access to water, sanitation, and hygiene (WASH) is increasingly recognized as a key risk factor. This study assessed the association between household WASH access and undernutrition among children under five years. We analyzed data on 143,467 under-5 children from the National Family Health Survey (2019-21). Undernutrition was defined using WHO growth standards for stunting, wasting, and underweight. Household WASH access was defined as improved drinking water, improved sanitation, and a handwashing facility. Kernel-based propensity score matching (PSM) estimated the average treatment effect on the treated (ATT). Undernutrition was consistently higher among children without WASH access (stunting 37% vs. 31%; wasting 19% vs. 17%; underweight 30% vs. 24%). After PSM, WASH access was significantly associated with reduced prevalence of stunting (ATT = -0.009, p < 0.05) and underweight (ATT = -0.008, p < 0.05), but not wasting. The protective effects were stronger among urban, wealthier households and female children, with no significant associations in rural or poorest households. Improved WASH access is modestly associated with lower stunting and underweight, highlighting the importance of equity-focused interventions.
This study aims to investigate the age and sex-related variations in somatotype among older adults in Türkiye using the Heath-Carter method. Anthropometric measurements were taken from 2128 participants (1,009 males and 1119 females) aged 65 and over, selected through stratified sampling from the seven regions of Türkiye. The findings indicated that the most prevalent somatotype in both sexes was Endo-Mesomorph, accounting for 50% of males and 58.1% of females. With advancing age, a decrease was observed in body weight, height, Body Mass Index (BMI), and body fat percentage in both sexes. Age-related remodeling of body composition was further reflected in somatotype patterns: while endomorphy declined in males, both endomorphy and mesomorphy decreased progressively in females. Across all age groups, mesomorphy remained more dominant than endomorphy, suggesting relative preservation of muscularity. In conclusion, this study demonstrates that the Endo-Mesomorph somatotype is predominant among older adults in Türkiye, with notable age- and sex-related differences: age-related changes include a decline in endomorphy in males, while both endomorphy and mesomorphy decrease in females. These results offer new evidence from a large Turkish cohort and align with international findings on age-related body composition remodeling, supporting the development of tailored, culturally relevant interventions for healthy aging.
Individuals urbanize when the net benefits of urban living exceed those of rural conditions. Body mass index (BMI), height, and weight are measures of welfare that reflect the balance between caloric intake and the physiological demands of labor and environmental conditions. Using 19th- and early 20th-century US prison records, this study illustrates that urban residents had lower BMIs, shorter stature, and lower body weight than rural residents. Urban nutritional outcomes varied by race: both white and black urban residents had lower BMIs, shorter stature, and lower weight relative to their rural counterparts. Net nutrition variation was greater among urban males compared to females, indicating that urbanization affected male net nutrition more than female nutritional status.
Bangladesh experiences frequent extreme weather events (EWEs) that are associated with various dimensions of human life, including fertility preferences. This study examines associations among EWEs, family structure (nuclear vs. joint families), and fertility preferences in two climatically distinct regions of Bangladesh. The research was conducted in Chattogram district (cyclone-exposed) and Sunamganj district (flood-exposed), with two villages selected from each district based on high vulnerability to their respective EWEs. Data were collected through structured questionnaires administered to 414 married women of reproductive age (15-49 years) with at least one child, supplemented by 17 in-depth interviews exploring underlying motivations and experiences. Results show significant differences in fertility preferences between nuclear and joint family structures across both climate-vulnerable areas. Women in nuclear families expressed higher fertility preferences compared to those in joint families, with this pattern more pronounced in flood-exposed area (Sunamganj) than cyclone-exposed area (Chattogram). Qualitative findings indicate that family structure shows relationships with adaptive strategies for EWEs. Multiple factors appeared linked to fertility preferences across different family types, including perceived advantages of larger families for disaster coping, intergenerational support systems, spatial constraints, availability of adult male members, contraceptive use, and access to government/NGO assistance. These findings suggest that family structure represents an important but underexplored variable in understanding climate-fertility associations in vulnerable regions.
This article examines birth seasonality in Puerto Rico and explores whether patterns shift during periods of economic transformation. We compiled monthly birth counts for approximately 5.64 million births occurring from 1935 to 2024. Data sources include reports to U.S. agencies (1935-1966), a prior publication (1967-1971), and the Puerto Rico Vital Statistics System (1972-2024). To assess the temporal concentration, we calculated a seasonal index of births and modeled 5-year patterns with LOESS curves. We identified four distinct seasonal patterns. From 1943 to 1949, births peaked in April - May. Between 1950 and 1954, this peak declined as a new one emerged from August to October. Beginning in 1955, a third pattern appeared, with fewer births early in the year and a peak in the second half. This pattern remained stable until about 2010. After 2010, we observe (1) a narrowing of early-year minimums, (2) increased within-period variability, and (3) a decline in December, though (4) the August to November peak persists. These changes align with economic transitions that occurred under US occupation, bringing forth the need to reexamine the hypothesis of cultural or media influence in future studies. Given observed patterns, future research should explore the role that economic shifts may have in shaping birth seasonality in Puerto Rico.
Despite preventing cardiovascular events, adherence to the Mediterranean Diet (MedDiet) is declining globally. This study assessed adherence to the MedDiet and its association with material, social, and health-related deprivation among patients with cardiovascular conditions. Data from 328 patients in a southern Turkish city between December 2022 and August 2023 were collected using a Personal Information Form, the Mediterranean Diet Adherence Scale, and the Deprivation Questionnaire, and analyzed using logistic regression and decision tree analysis. Participants' mean age was 64.0 ± 10.2 years, and 50.6% were women. The mean MedDiet adherence score was 6.37 ± 2.54 (range: 1-12). Longer disease duration was associated with higher adherence in stroke, heart failure, and coronary artery disease, but not hypertension. Male gender (OR = 3.556, 95% CI 2.107-6.000) increased the odds of low MedDiet adherence, whereas older age (OR = 0.957, 95% CI 0.933-0.982) and active effort to follow the diet (OR = 0.538, 95% CI 0.405-0.714) decreased the odds. Decision tree analysis highlighted deprivation as a key factor, with gender and rural residence contributing to disparities. Overall, adherence remains suboptimal, particularly for fish, nuts, and olive oil. Deprived individuals, especially men and rural women, need targeted interventions and policies support for dietary access and secondary prevention.
The variation in age-specific death probability is closely linked to demographic, socioeconomic, and geographical factors. The present study employs a functional neural network regression model to examine the influence of these factors on regional death patterns in China, with a specific focus on individuals aged 40 and above, from a nonlinear perspective. In comparison with conventional linear models, this approach is shown to more effectively capture the intricate relationships present in death patterns, thereby enhancing both the predictive performance and the interpretability of the results. Key findings include: (1) Fifteen key factors influencing regional death patterns are identified, with gender and urban-rural status emerging as the most significant. (2) Educational level has a significant impact on death probability in the 40-44 age group. After the age of 45, probabilities are increasingly affected by climate and economic conditions, while healthcare becomes crucial for those aged 60 and above. (3) Some factors exert different levels of influence on death probability across age groups. (4) Interactions between factors, particularly between urban-rural status and other factors, affect model outputs.
Biological age acceleration predicts multiple "diseases of aging." Objective and subjective social statuses have both been prospectively linked to this outcome. An established chain-of-risk framework suggests that "effects" of each may be mediated by one's subsequent structural position. A separate deaths-of-despair literature identifies a person's sense of futility as another potential link. Such chains remain underexplored. The current study used data from three waves (2008-2016) of the Health and Retirement Study (HRS) to fill these gaps. The analysis was done through a counterfactual regression-with-residuals (RWR) approach. Asimulated decline in a person's objective but not subjective status predicted their age acceleration 8 years later. Contrary to chain-of-risk conceptions, intermediate social standing did not channel effects. Neither did despair. Findings were more consistent with a direct "material shocks" explanation for status-aging linkages than an indirect or psychosocial one. Implications for aging theory and for interventions are discussed.
OBJECTIVES:To analyze the inequalities of population aging in Brazil by a new measure - relative age combined with characteristics approach. METHODS:Data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil) were analyzed. Population subgroups over 50 years old had their relative ages calculated, considering schooling level and self-reported skin color/race. Handgrip strength was employed as a physical health indicator. RESULTS:Results show that Brazilians of the same birth cohort can have more than 10 years of difference between their relative ages. Depending on the schooling level, Brazilians can present characteristics of people 10 years younger (or older) compared with those in the same chronological age. Males who declared themselves Brown have their relative ages up to 4.9 years higher compared with those in the same chronological age and White.
Work disability has become a global public health problem and places a considerable burden on individuals and families. This paper uses data from the China Labor-force Dynamic Survey to investigate the impact of husband's work disability on wife's employment decisions in rural areas of China. Estimation results do not indicate a disability-related added worker effect but show a significant caregiver effect; wives of disabled husbands experience a reduction in the likelihood of employment participation. Results also show that a husband's work disability leads to a lower likelihood that the wife will engage in self-employment rather than wage employment. This may be because the flexibility of self-employment helps women to adjust their labor patterns to care for disabled husbands. The mechanism analysis demonstrates that the disability of husbands does lead to a greater likelihood that the wife will provide more care to the family while at the same time, increasing the household health expenditure.
