Search Results (853)

This study estimates the prevalence of co-use of alcohol and cannabis, assesses the sociodemographic risk factors of co-use, and examines the associations between mental health and heavy episodic drinking (HED) and alcohol–cannabis co-use in Canada during the early years of the COVID-19 pandemic. Nine successive cross-sectional surveys, held from May 2020 to January 2022, of adults (aged ≥18 years) living in Canada were pooled for 9011 participants. The prevalence of co-use was calculated across sociodemographic groups. Logistic regressions were used to assess associations. Alcohol–cannabis co-use was associated with a greater likelihood of engaging in HED and experiencing symptoms of anxiety, depression, and loneliness. The prevalence of co-use of alcohol was different across sociodemographic groups. The highest prevalence was among TGD people (35.5%), followed by individuals aged 18–39 years (14.5%). Additionally, being TGD (aOR = 3.61, 95% CI 2.09–6.25), separated/divorced/widowed (aOR = 1.60, 95% CI 1.23–2.07), living in an urban area (aOR = 1.26, 95% CI 1.07–1.56), and having a high household income (aOR = 1.41, 95% CI 1.09–1.82) increased the likelihood of reporting alcohol–cannabis co-use. These findings underscore the fact that developing public health and clinical interventions for preventing and treating excessive alcohol or cannabis use must consider both alcohol and cannabis use patterns and should be tailored to the highest-risk TGD and young adults. Full article

This study assesses the effects of the COVID-19 pandemic on catastrophic health expenditures and income inequality in Benin. A microsimulation was calibrated to estimate the impact of the pandemic under three different shock scenarios: low, moderate, and severe. The analysis relies on secondary data from household living condition surveys. The results indicate that the COVID-19 crisis would lead to a significant average income loss of up to 20% and income inequality, while the number of households with catastrophic health expenditures would increase by 4%. More importantly, the findings reveal heterogeneous impacts across households, with urban residents, younger individuals, more educated households, and male-headed households experiencing the greatest income decline. These findings underscore the need for targeted health coverage and employment policies to better protect vulnerable populations in Benin in the face of future shocks. Full article

The COVID-19 pandemic’s rapid shift to working from home has fundamentally challenged residential acoustic design, which traditionally prioritises rest and relaxation rather than sustained concentration. However, a clear gap exists in understanding how acoustic needs and the subjective evaluation of soundscape appropriateness (SA) differ between these conflicting activities within the same domestic space. Addressing this gap, this study reveals critical differences in how people experience and evaluate home soundscapes during work versus relaxation activities in the same residential spaces. Through an online survey of 247 Chinese participants during lockdown, we assessed soundscape perception attributes, the perceived saliencies of various sound types, and soundscape appropriateness (SA) ratings while working and relaxing at home. Our findings demonstrate that working at home creates a more demanding acoustic context: participants perceived indoor soundscapes as significantly less comfortable and less full of content when working compared to relaxing (p < 0.001), with natural sounds becoming less noticeable (−13.3%) and distracting household sounds more prominent (+7.5%). Structural equation modelling revealed distinct influence mechanisms: while comfort significantly mediates SA enhancement in both activities, the effect is stronger during relaxation (R² = 0.18). Critically, outdoor man-made noise, building-service noise, and neighbour sounds all negatively impact SA during work, with neighbour sounds showing the largest detrimental effect (total effect size = −0.17), whereas only neighbour sounds and outdoor man-made noise significantly disrupt relaxation activities. Additionally, natural sounds act as a positive factor during relaxation. These results expose a fundamental mismatch: existing residential acoustic environments, designed primarily for rest, fail to support the cognitive demands of work activities. This study provides evidence-based insights for acoustic design interventions, emphasising the need for activity-specific soundscape considerations in residential spaces. As hybrid work arrangements become the norm post-pandemic, our findings highlight the urgency of reimagining residential acoustic design to accommodate both focused work and restorative relaxation within the same home. Full article

Food security is defined as a state in which all people at all times have both physical and economic access to sufficient food to meet their dietary needs for a productive and healthy life. The general objective of this work was to assess the situation of food insecurity and its impact on the quantity and quality of food consumption during lockdown in the first wave of the COVID-19 pandemic and to identify the determinants associated with the different food insecurity (FI) categories on a sample of 2227 people (1168 people from Spain and 1059 people from Morocco). Food insecurity (FI) assessed by the Household Food Insecurity Access Scale (HFIAS) were compared in both countries, controlling for the effect of sociodemographic variables, age, gender, marital status, and education level. The mean HFIAS was 0.53 in the Spanish and 3.55 in the Moroccan samples (p < 0.001). Only 2.1% of the Spanish sample were in a situation of severe insecurity against 15.5% in Morocco (p < 0.001). Moroccans with moderate and severe food insecurity decreased their consumption of meat, fish, eggs, nuts, legumes, and fruits. The risk of food insecurity was higher in men than in women, in separated or divorced people, in people with secondary and middle education, and in younger people. Full article

COVID-19 vaccine hesitancy in Pakistan is a barrier to optimal vaccine uptake and has been situated within a context of hesitancy towards other vaccines. A mixed-methods study was conducted during the initial COVID-19 vaccine roll-out in 2021 in four union councils in Peshawar, consisting of a cross-sectional survey, eight focus group discussions (FGDs) with community members and eight in-depth interviews with healthcare workers (HCWs) to assess perceptions toward vaccines. Multivariable logistic regression was used to assess factors associated with COVID-19 vaccine hesitancy. Of 400 survey participants, 57.3% were vaccine acceptant and 42.8% vaccine hesitant. Just over half (56.8%) perceived COVID-19 vaccines to be safe. Most (88%) reported trust in HCWs to provide accurate vaccine information. FGDs revealed that women received less information about the vaccine compared to men and cultural restrictions were barriers even for those willing to be vaccinated. Correlates of vaccine acceptance included male sex (aOR 2.25; 95% CI 1.29–3.91), age 50 years or greater (aOR 1.74; 95% CI 1.19–6.31), social network support (e.g., vaccine acceptance among an individual’s social network) in receiving COVID-19 vaccines (aOR 2.38; 95% CI 1.45–3.89), community concern about COVID-19 spread (aOR 2.84; 95% CI 1.73–4.66), and trust in HCWs to provide vaccine information (aOR 3.47; 95% CI 1.62–7.42). Future vaccine promotion should prioritize engaging community leaders, sharing transparent information, combatting misinformation and rumors, and implementing household-based interventions especially targeting the importance of vaccination among women and young people to increase uptake. Full article

COVID-19 has caused global problems with complex ramifications. Vulnerable households worry about disruptions to food security. Mobility restrictions, decreased salaries, and supply chain disruptions have increased food insecurity. This study examined the best food security model and its determinants. The primary research data were collected from 257 respondents via cluster random sampling. Binary logistic regression, using R-Studio, was employed to analyze the data. The study showed that the Minimal Model (MM) was optimal in explaining food security status, with three predictors: the available food stock (AFS), education of the household head (EHH), and household income (HIc). This aligned with studies showing that food purchase ability depends on income and education. Male household heads demonstrated better food security than females, while women’s education influenced consumption through improved nutritional knowledge. Higher income provides more alternatives for meeting needs, while decreased income limits options. Food reserve storage influenced household food security during the pandemic. The Minimal Model effectively influenced food security through the AFS, EHH, and HIc. The findings underline the importance of available food stock, household head education, and household income in developing approaches to assist food-insecure households. The research makes a significant contribution to ensuring food availability and promoting sustainable development post-pandemic. Full article

The study examines changes in household food security and identifies their key determinants in Zambia by comparing the pre-pandemic period to the COVID-19 pandemic period. Using nationally representative surveys from 2015 and 2021 and the coarsened exact matching (CEM) approach, 8650 households were matched for comparison. Two complementary food security measures are analysed using multinomial logit regression models: household expenditure share, representing economic vulnerability, and household dietary diversity score (HDDS), representing diet quality. The results show that household food expenditure share significantly increased from 53.8% to 61.4%, indicating increased economic vulnerability. Notably, household dietary diversity improved from 7.1 to 8.2 out of 12, indicating better dietary quality. Consistent determinants of food security—such as household size, education level, marital status, region, and employment—remained significant, but their protective effects weakened during the pandemic. Specifically, the protective effect of education declined, urban households became relatively more vulnerable, and wealthier households experienced minimal changes. The study recommends targeted interventions, including expanding social protection programmes for economically vulnerable households, supporting informal food markets, enhancing rural–urban food supply linkages, and promoting nutrition education to ensure diverse, affordable food access during crises. Full article

As COVID-19 transitions from pandemic to endemic, our prevention and control policies have shifted from broad, strict community interventions to focusing on the prevention of cluster outbreaks. Currently, information on the characteristics of cluster outbreaks remains limited. This study describes the features of COVID-19 clusters in Shanghai. It aims to provide valuable insights for managing localized outbreaks. We conducted a retrospective analysis of clusters of confirmed COVID-19 cases. Epidemiological descriptions, the transmission characteristics of clusters, and individual risk factors for contagiousness were analyzed. A total of 381 cases of COVID-19 were confirmed and 67 clusters were identified. Most clusters (58.21%, 39/67) only had two cases, with a declining proportion held by clusters of more cases. Familial transmission was predominant, accounting for 79.10% (53/67) of clusters. Although other types of cluster outbreaks, such as those in workplaces (1.49%, 1/67), occur less frequently compared to household clusters, they tend to involve larger scales and more cases. Workplaces and similar venues are more likely to experience large-scale cluster outbreaks. Contagiousness was higher among cases with runny nose (risk ratio [RR]: 4.8, 95% CI: 1.40–16.44, p-value = 0.01) and those with diabetes (RR: 3.8, 95% CI: 1.01–14.60, p-value = 0.05). In conclusion, household cluster outbreaks, in particular, are both a key priority and a foundational issue. Establishing an indicator system based on the transmissibility of cases holds significant practical value for infectious disease prevention and control. By enhancing household hygiene and developing a case classification and management system based on transmissibility, it is possible to better prevent and control regional COVID-19 outbreaks. Full article

This study seeks to identify the factors driving household food insecurity in Cameroon during the COVID-19 pandemic, examine the effects of coping strategies on household resilience, and explore complementarities among these strategies. We used data from the COVID-19 panel surveys conducted by the National Institute of Statistics of Cameroon. Three models are estimated: an ordered logit model for food insecurity factors, a logit model for the impact of coping strategies, and a multivariate probit model for complementarities. The findings reveal that food insecurity is exacerbated by conflict, socio economic shocks (e.g., loss of employment, crop theft), and price hikes. About 28.59% of households are resilient, mainly due to past savings, cash transfers, free food, and in-kind transfers. The study emphasizes the importance of social and governmental support to mitigate food insecurity during crises, and underscores the need for monitoring socio-economic conditions during pandemics and other crises. Full article

Purpose: Socio-demographic inequities in mental health were magnified by COVID-19, with women experiencing greater household burden with less support in Canada and globally. While some health patterns during COVID-19 have been observed globally, there is a research gap in rural mental health during COVID-19 in Canada. We hypothesize there is a disparity in mental health decline during COVID-19 between men and women. Methods: In rural Ontario, mental health was measured through a survey of approximately 18,000 individuals living in seven counties. In 2021, survey respondents were asked to rate their mental health prior to and during COVID-19. Women reported poorer mental health during COVID-19 in comparison to men when tested via chi-squared tests, odds ratios, and percentage change. Responses to survey questions regarding social, financial, and mental health support were then evaluated. Findings: We found significant disparities in mental health ratings before and during COVID-19 between men and women. Women reported poorer mental health, increased substance use, and increased worry about social, financial, and community stressors. Respondents who self-identified as a woman were associated with poorer mental health outcomes. Conclusions: Interventions should be specific to geographic communities as well as individual needs (e.g., additional financial and childcare support). Rural communities need to be considered as independent geographies rather than as one geography (i.e., urban vs. rural). Full article

The concept ‘mobility of care’ captures all the daily travel necessary for the upkeep of a household, including trips to grocery stores, health-related appointments, errands, and caring activities for dependents. Since it was originally coined in 2009, a handful of studies have shown how poorly mobility of care trips are captured in transportation surveys. These preliminary analyses also find that care trips comprise a substantial proportion of daily mobility. As women disproportionately engage in ‘mobility of care’ travel, the under-consideration of care trips is argued to result in a gender bias in transport planning. Despite this, transport policy related to mobility of care has received less attention. Given that transport policy shapes how transport systems operate, this paper explores the extent to which recent transport policies consider mobility of care. A critical policy review framework is used to systematically examine seven policy documents (435 pages) from the Toronto Transit Commission (TTC), the largest transit agency in Canada. Results indicate that mobility of care is rarely directly considered or significantly discussed. Instead, transport policy often uses the commute to work as the default trip. Mentions of care destinations and trip characteristics associated with mobility of care are more common in recent years and most frequently discussed in relation to the COVID-19 pandemic or specialized services for seniors and people with disabilities. Policies that likely facilitate mobility of care indirectly are also identified, including fare discounts, transfer windows, and accessibility policies. The review concludes with preliminary recommendations on how transit agencies can more directly plan for mobility of care. Full article

This paper investigates the dynamics of energy poverty across EU Member States from 2015 to 2023, a period characterized by economic recovery, the COVID-19 pandemic, and a significant energy crisis. Utilizing Eurostat EU-SILC data, the study analyzes trends in four key indicators: the inability to keep homes adequately warm, arrears on utility bills, housing cost overburden rate, and the at-risk-of-poverty rate. Data processing and trend analysis were performed using R and RStudio, while a k-means cluster analysis, executed in Python via Visual Studio Code, identified and compared distinct country groupings based on their energy poverty profiles in 2015 and 2023. The findings reveal a general improvement in energy poverty indicators across the EU until 2019, followed by a marked deterioration, particularly in energy affordability metrics post-2021 due to the energy crisis. This impact was observed to be distinct from general income poverty trends. While significant geographical disparities persist, with Southern and Eastern European countries often more vulnerable, the analysis also points to notable improvements in several Central and Eastern European nations. The cluster analysis, which identified eight clusters in 2015 and seven in 2023, suggests a degree of partial convergence. Key shifts include Poland’s transition to a lower-risk cluster and Spain’s move to a higher-risk group, while Southern Europe generally remains highly susceptible. This research underscores the dynamic and multifaceted nature of energy poverty, highlighting the necessity for targeted, context-specific policies. Addressing energy poverty is crucial for enhancing household resilience and achieving truly comprehensive energy security throughout the EU, especially amid the ongoing energy transition and potential future socio-economic shocks. Full article

The recent COVID-19 and energy crises have intensified energy poverty (EP) in Europe, driven by skyrocketing energy prices and worsening financial pressures. This paper measures the different EP dimensions in three different EU Member States, namely Spain, Italy, and France, and carries out a comparative analysis of the EP situation in these countries between 2017 and 2022. This study reveals that, despite some disparities, the Member States share similar EP trends, with an alarming increase in the population living in dwellings with the presence of leaks, dampness, and rot. Also, the EP situation seemed to improve in all three countries until 2019, but it has since worsened. This reinforces that harmonized metrics and policies to address EP at the EU level could be relevant, especially in neighboring countries. This article also proposes an econometric analysis applied to the French case study to unpack the characteristics of households vulnerable to EP. Although the results are not univocal, some energy vulnerability drivers have been identified, such as a low level of education, being inactive or unemployed, or having a large family to support. These factors might help EU decision-makers in designing policies to tackle EP adequately. Full article

This paper investigates the implication of the COVID-19 pandemic on household food insecurity in Burkina Faso. We used data from the High-Frequency Phone Survey collected from the period June 2020 to June 2021 by the World Bank in collaboration with the National Institute of Statistics. To assess the persistence of food inadequacy, we estimated a dynamic linear probability model. Our results revealed that female and elderly household members were more likely to skip meals during the pandemic than their respective counterparts. For households that skipped a meal due to the pandemic, the likelihood of facing food insecurity in the subsequent month increased by 37 percent. Similarly, individuals who ran out of food in consecutive months were 0.28 times more likely to experience the same situation in the following month. While other shocks can cause food insecurity, the global health-related, economic, social, and information dimensions of COVID-19 created a distinctive and multifaceted form of food shortage that sets it apart from many other types of shock. These findings suggest the implementation of effective programs to respond to shocks and the mitigation effects experienced by most disadvantaged groups. Full article

In this paper, we utilize the 2019/20 Uganda National Household Survey data to answer three related questions: (i) To what extent did out-of-pocket payments (OOPs) for health care services exceed the threshold for household financial catastrophe amidst COVID-19? (ii) What is the impoverishing effect of OOPs for health care services on household welfare? (iii) What are the socioeconomic and demographic determinants of OOPs for health care services in Uganda? Leveraging three health expenditure thresholds (10%, 25%, and 40%), we run a Tobit model for “left-censored” health expenditures and quantile regressions, and we find that among households which incur any form of health care expense, 37.7%, 33.6%, and 28.7% spend more than 10%, 25%, and 40% of their non-food expenditures on health care, respectively. Their average OOP budget share exceeds the respective thresholds by 82.9, 78.0, and 75.8 percentage points. While, on average, household expenditures on medicine increased amidst the COVID-19 pandemic, expenditures on consultations, transport, traditional doctors’ medicines, and other unbroken hospital charges were reduced during the same period. We find that the comparatively low incidence and intensity of catastrophic health expenditures (CHEs) in the pandemic period was not necessarily due to low household health spending, but due to foregone and substituted care. Precisely, considering the entire weighted sample, about 22% of Ugandans did not seek medical care during the pandemic due to a lack of funds, compared to 18.6% in the pre-pandemic period. More Ugandans substituted medical care from health facilities with herbs and home remedies. We further find that a 10% increase in OOPs reduces household food consumption expenditures by 2.6%. This modality of health care financing, where households incur CHEs, keeps people in chronic poverty. Full article