[Show abstract][Hide abstract] ABSTRACT: A multimedia version of Piers-Harris Children's Self-Concept Scale 2 (Piers-Harris 2) was created with audio and cartoon animation to facilitate the measurement of self-concept among younger children. This study aimed to assess the psychometric qualities of the computer version of Piers-Harris 2 scores, examine its score equivalence with the paper-and-pencil version, and survey the respondent preference of the two versions. Two hundred and forty eight Taiwanese students from the first to fourth grade were recruited. In regard to the psychometric properties, high internal consistency (α = .91) was found for the total score of multimedia Piers-Harris 2. High interscale correlations (.77 to .83) of the multimedia Piers-Harris 2 scores and the results of confirmatory factor analysis suggested the multimedia Piers-Harris 2 contained good structural characteristics. The scores of the multimedia Piers-Harris 2 also had significant correlations with the scores of the Elementary School Children's Self Concept Scale. The equality of convergence and criterion-related validities of Piers-Harris 2 scores for the multimedia and paper-and-pencil versions and the results of ICCs between the scores of the multimedia and paper-and-pencil Piers-Harris 2 suggested their high level of equivalence. Participants showed more positive attitudes towards the multimedia version.
PLoS ONE 08/2015; 10(8):e0135386. DOI:10.1371/journal.pone.0135386 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Family planning has improved the well-being of families by preventing high-risk pregnancies and abortions and reducing unplanned pregnancies. However, the effectiveness of family planning efforts has not been consistent across countries. This study examined factors associated with contraceptive use among married women in Ethiopia. Data were from the 2011 Ethiopian Demographic and Health Survey. The sample comprised 10,204 married women (aged 15-49 years). Logistic regression models were used to analyze the data. Among married women in Ethiopia 29.2% used contraceptive methods. About 44.1% of women who were not current users of contraceptives reported that they intended to use contraceptives in the future. Age at first marriage, being educated, number of living children, exposure to mass media, being employed, having educated partners, and having been informed about contraceptive use at health facilities were positively associated with current contraceptive use. By contrast, older age, a rural resident, or Muslim; belonging to the Afar or Somali ethnic groups; desiring numerous children; having husbands who desired additional children; and abortion experience were negatively associated with current contraceptive use. Our findings indicated that improving education, providing employment opportunities for women and providing training to family planning providers are essential to increasing contraceptive use.
Women & Health 07/2015; DOI:10.1080/03630242.2015.1074640 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The theory of ecological unequal exchange explains how trade and various forms of economic activity create the problem of environmental degradation, and lead to the deterioration of population health. Based on this theory, our study examined the inter-relationship among economic characteristics, ecological footprints, CO2 emissions, infant mortality rates and under-5 mortality rates in low-income countries.
A longitudinal ecological study design.
Sixty-six low-income countries from 1980 to 2010 were included in the analyses. Data for each country represented an average of 23 years (N=1497).
Data were from the World Development Indicators, UN Commodity Trade Statistics Database, Global Footprint Network and Polity IV Project.
Linear mixed models with a spatial power covariance structure and a correlation that decreased over time were constructed to accommodate the repeated measures. Statistical analyses were conducted separately by sub-Saharan Africa, Latin America and other regions.
After controlling for country-level sociodemographic characteristics, debt and manufacturing, economic activities were positively associated with infant mortality rates and under-5 mortality rates in sub-Saharan Africa. By contrast, export intensity and foreign investment were beneficial for reducing infant and under-5 mortality rates in Latin America and other regions. Although the ecological footprints and CO2 emissions did not mediate the relationship between economic characteristics and health outcomes, export intensity increased CO2 emissions, but reduced the ecological footprints in sub-Saharan Africa. By contrast, in Asia, the Middle East and North Africa, although export intensity was positively associated with the ecological footprints and also CO2 emissions, the percentage of exports to high-income countries was negatively associated with the ecological footprints.
This study suggested that environmental protection and economic development are important for reducing infant and under-5 mortality rates in low-income countries.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BMJ Open 07/2015; 5(7):e006183. DOI:10.1136/bmjopen-2014-006183 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Health-protective behaviors, such as receiving a vaccine, wearing a face mask, and washing hands frequently, can reduce the risk of contracting influenza. However, little is known about how social capital may influence health-protective behavior in the general population. This study examined whether each of the social capital dimensions (bonding, bridging, and linking) contributed to the intention to adopt any of the health-protective behaviors in an influenza pandemic. The data of this study were from the 2014 Taiwan Social Change Survey. A stratified, three-stage probability proportional-to-size sampling from across the nation, was conducted to select adults aged 20 years and older (N = 1,745). Bonding social capital was measured by the frequency of neighborly contact and support. Bridging social capital was measured based on association membership. Linking social capital was measured according to general government trust and trust in the government's capacity to counter an influenza pandemic. Binary logistic regressions were used to assess the multivariate associations between social capital and behavioral intention. The study results indicate that social capital may influence the response to influenza pandemic. Specifically, the intention to receive a vaccine and to wash hands more frequently were associated with the linking dimension and the bonding dimension of social capital, while the intention to wear a face mask was associated with all forms of social capital. The findings of this study suggest that government credibility and interpersonal networks may play a crucial role in health-protective behavior. This study provides new insights into how to improve the effectiveness of influenza prevention campaigns.
PLoS ONE 04/2015; 10(4):e0122970. DOI:10.1371/journal.pone.0122970 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
Despite the large reduction in infant mortality rates in the last two decades, the burden of infant mortality is still high in Malawi. Because few studies have specifically addressed the determinants of infant mortality in Malawi, this exploratory study identified a series of distal, intermediate, and proximal factors related to infant mortality using a conceptual framework that explains the risk in developing countries. The objective of this study was to examine the effects of family and socioeconomic factors on the risk of an infant dying before the age of 12 months.
In this study, we analyzed the 2004 and 2010 data of the Malawi Demographic and Health Surveys. This study adopted a cross-sectional study design involving 4,698 and 12,174 singleton births in the years 2004 and 2010, respectively. Multiple logistic regression models were used to estimate the effects of selected variables on infant mortality.
In the multivariate logistic regression analyses, women who resided in wealthy urban areas were 58% less likely to report infant deaths than those in rural areas [odds ratio (OR) = 0.48]. Infants who were second or third in birth order were less likely to die before 12 months. However, cesarean section delivery was found to be a risk factor associated with infant mortality in the year 2004 (OR = 1.95). By contrast, women who were in the highest 20% of household wealth, who resided in the northern region, and were in the 20–29 age group were less likely to report infant deaths. However, cesarean section delivery (OR = 1.42), male infants (OR = 1.26), and small size at birth (OR = 1.63) were the significant predictors of infant mortality in the year 2010. Furthermore, the mother's education and household wealth were not significant predictors of infant mortality in Malawi.
The present study shows that improving the quality of life in rural areas, evenly distributing health care delivery services and other social economic factors across the nation, and improving maternal health care, neonatal care, and nutrient intake could decrease infant mortality in Malawi.
Journal of Experimental and Clinical Medicine 08/2014; 6(4). DOI:10.1016/j.jecm.2014.06.005
[Show abstract][Hide abstract] ABSTRACT: The concept of social cohesion has invoked debate due to the vagueness of its definition and the limitations of current measurements. This paper attempts to examine the concept of social cohesion, develop measurements, and investigate the relationship between social cohesion and individual health.
This study used a multilevel study design. The individual-level samples from 29 high-income countries were obtained from the 2000 World Value Survey (WVS) and the 2002 European Value Survey. National-level social cohesion statistics were obtained from Organization of Economic Cooperation and Development datasets, World Development Indicators, and Asian Development Bank key indicators for the year 2000, and from aggregating responses from the WVS. In total 47,923 individuals were included in this study. The factor analysis was applied to identify dimensions of social cohesion, which were used as entities in the cluster analysis to generate a regime typology of social cohesion. Then, multilevel regression models were applied to assess the influences of social cohesion on an individual's self-rated health.
Factor analysis identified five dimensions of social cohesion: social equality, social inclusion, social development, social capital, and social diversity. Then, the cluster analysis revealed five regimes of social cohesion. A multi-level analysis showed that respondents in countries with higher social inclusion, social capital, and social diversity were more likely to report good health above and beyond individual-level characteristics.
This study is an innovative effort to incorporate different aspects of social cohesion. This study suggests that social cohesion was associated with individual self-rated after controlling individual characteristics. To achieve further advancement in population health, developed countries should consider policies that would foster a society with a high level of social inclusion, social capital, and social diversity. Future research could focus on identifying possible pathways by which social cohesion influences various health outcomes.
International Journal for Equity in Health 10/2013; 12(1):87. DOI:10.1186/1475-9276-12-87 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Few studies have addressed how political and economic contexts shape the effects of health services and environment, such that a politically and economically unstable society, despite having sufficient health professionals and facilities, finds it difficult to transfer health resources into actual population health performance. We examined whether political and economic characteristics moderate the effects of health services on infant mortality rates (IMR) in less-developed countries.
This study used a longitudinal ecological study design and focused on 46 less-developed countries during the 30-year period from 1980 to 2009. Data were derived from World Development Indicators, the United Nations Commodity Trade Statistics Database and the Polity IV project. Lagged dependent variable panel regression models were used to increase the causal inferences. Random intercept models were used to accommodate the possible problem of a serial correlation of errors because of the repeated measurements.
After controlling for baseline IMR and other socioeconomic variables, our study showed that democracy had a direct effect on IMR, and a moderating effect on the relationship between health services and IMR. The effects of health services on IMR were stronger for countries with a lower level of democracy than for countries with a higher level of democracy in the 10-year models. Compared with other trade-rated characteristics, democracy is a more robust predictor of long-term IMR in less-developed countries.
Our study provides additional evidence that democracy has direct effects on IMR and further showed that democracy can modify the effects of health services on IMR.
Journal of epidemiology and community health 06/2013; 67(12). DOI:10.1136/jech-2013-202685 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study used a longitudinal dataset and lagged dependent-variable panel regression models to examine whether political and economic characteristics directly predict under-5-year mortality rates (U5MR), and moderate the effects of health services and environment on U5MR. We used a sample of 46 less-developed countries from 1980 to 2009. Our results showed that the effects of political and economic characteristics on U5MR varied by non-sub-Saharan and sub-Saharan countries. After controlling for baseline U5MR and other socioeconomic variables, while foreign investment and health services were negatively associated U5MR, democracy was positively associated with U5MR in nonsub-Saharan countries. In contrast, debt was positively associated with and democracy and foreign investment were negatively associated with U5MR in sub-Saharan countries. The interaction analyses indicated that for sub-Saharan countries, the effects of health services on U5MR only existed for countries with low foreign investment.
Health & Place 06/2013; 23C:111-121. DOI:10.1016/j.healthplace.2013.05.007 · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This longitudinal study builds on the cross-sectional work of Karim et al and examines the influence of welfare state regime on population health with a particular focus on East Asian welfare states (eg, Hong Kong, Japan, Korea, Singapore and Taiwan).
Data were extracted from the Organisation of Economic Co-operation and Development Data Set, World Development Indicators and Asian Development Bank's key indicators from 1980 to 2006. Infant mortalities and life expectancy were used as health-outcome varables. Thirty-one countries were categorised into six types of welfare regimes: Scandinavian, Anglo-Saxon, Bismarckian, Southern, Eastern European and East Asian. Mixed models were applied to analyse the data with repeated measurements.
In keeping with Karim et al, Scandinavian and Eastern European welfare states have lower and higher infant mortalities respectively compared with East Asian welfare states. Eastern European welfare states had a lower life expectancy than East Asian welfare states. Most welfare states had a higher social, health and education expenditure, and higher densities of physicians than East Asian welfare states.
East Asian welfare states did not have worse health than most welfare states. Future studies should continue to incorporate East Asian countries in the typology of welfare regimes that include more social, economic, political and healthcare system characteristic variables to provide insight on the mechanism by which welfare-state regimes influence population health.
Journal of epidemiology and community health 08/2011; 66(7):e23. DOI:10.1136/jech.2010.126961 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many diseases in Africa can be prevented with appropriate public health interventions. This study aimed to assess the bibliometric characteristics of public health related research articles published by researchers in African institutions from 1991 to 2005. Data used in this study were obtained from the online version of the ISI Web of Science: Science Citation Index Expanded (SCI-Expanded). Articles published between 1991 and 2005 that had the phrase 'public health' in the title, author keywords or abstract, and had at least one author whose contact address was in an African country, were selected for analysis. The annual number of public health related articles published by African researchers significantly increased from 28 articles in 1991 to 135 articles in 2005, a 382% increase. International collaboration also increased: from 45% of articles having international collaborators during 1991-1995, to 52% during1996-2000, and to 67% during 2001-2005. Collaborations were mostly with European and North American countries. Keywords, subject categories and collaboration patterns of articles varied across regions, reflecting differences in needs and collaboration networks. Public health related research output, as well as international collaborations, have been increasing in Africa. Regional variation observed in this study may assist policymakers to facilitate the advancement of public health research in different regions of Africa, and could be useful for international organisations in identifying needs and to allocate research funding. Future bibliometric analyses of articles published by African researchers, can consider conducting regional comparisons using standardised methods, as well as describing the overall patterns, in order to provide a more comprehensive view of their bibliometric characteristics.
South African Journal of Science 06/2011; 107(5-6):54-59. DOI:10.4102/sajs.v107i5/6.309 · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was conducted to evaluate the effects of transported Asian dust and other environmental parameters on the levels and compositions of ambient fungi in the atmosphere of northern Taiwan. We monitored Asian dust events in Taipei County, Taiwan from January 2003 to June 2004. We used duplicate Burkard portable air samplers to collect ambient fungi before, during, and after dust events. Six transported Asian dust events were monitored during the study period. Elevated concentrations of Aspergillus (A. niger, specifically), Coelomycetes, Rhinocladiella, Sporothrix and Verticillium were noted (p < 0.05) during Asian dust periods. Botryosporium and Trichothecium were only recovered during dust event days. Multiple regression analysis showed that fungal levels were positively associated with temperature, wind speed, rainfall, non-methane hydrocarbons and particulates with aerodynamic diameters ≤10 μm (PM(10)), and negatively correlated with relative humidity and ozone. Our results demonstrated that Asian dust events affected ambient fungal concentrations and compositions in northern Taiwan. Ambient fungi also had complex dynamics with air pollutants and meteorological factors. Future studies should explore the health impacts of ambient fungi during Asian dust events, adjusting for the synergistic/antagonistic effects of weather and air pollutants.
International Journal of Biometeorology 02/2011; 56(2):211-9. DOI:10.1007/s00484-011-0413-x · 3.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the relationships of adolescents' perceptions of parental and peer behaviors with cigarette and alcohol use in different neighborhood contexts. The sample included 924 adolescents (49% boys, 51% girls) 12-14 years of age whose addresses were matched with 1990 census block groups. Six neighborhood types were identified through a cluster analysis. The findings suggest that parental smoking was associated with increased adolescent smoking in suburban white middle socioeconomic status (SES) neighborhoods. Peer smoking was associated with increased adolescent smoking in rural neighborhoods. Parental monitoring was associated with decreased adolescent drinking in urban white high-SES neighborhoods and parental drinking was associated with increased adolescent drinking in urban white middle-SES neighborhoods, respectively. Peer drinking was associated with increased adolescent drinking in urban neighborhoods. This study demonstrates the importance of examining parental and peer influences on adolescent smoking and drinking in different neighborhood contexts.
Journal of Youth and Adolescence 11/2009; 38(10):1388-98. DOI:10.1007/s10964-009-9424-x · 2.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study suggests a multivariate-structural approach combining factor analysis and cluster analysis that could be used to examine neighborhood effects on an individual's health. Data were from the Taiwan Social Change Survey conducted in 1990, 1995, and 2000. In total, 5,784 women and men aged over 20 years living in 428 neighborhoods were interviewed. Participants' addresses were geocoded with census data for measuring neighborhood-level characteristics. The factor analysis was applied to identify neighborhood dimensions, which were used as entities in the cluster analysis to generate a neighborhood typology. The factor analysis generated three neighborhood dimensions: neighborhood education, age structure, and neighborhood family structure and employment. The cluster analysis generated six types of neighborhoods with combinations of the three neighborhood dimensions. Multilevel binomial regression models were used to assess the effects of neighborhoods on an individual's health. The results showed that the biggest health differences were between two neighborhood types: (1) the highest concentration of inhabitants younger than 15 years, a moderate education level, and a moderate level of single-parent families and (2) the highest educational level, a median level of single-parent families, and a median level of elderly concentrations. Individuals living in the first type had significantly higher chances of having functional limitations and poor self-rated health than the individuals in the second neighborhood type. Our study suggests that the multivariate-structural approach improves neighborhood measurements by addressing neighborhood diversity and examining how an individual's health varies in different neighborhood contexts.
Journal of Urban Health 01/2009; 86(1):5-18. DOI:10.1007/s11524-008-9306-7 · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite the concept of social capital receiving great attention in the area of health research, few studies have analyzed the differential effects of social capital between genders. This article assesses gender differences in the relationships between social capital and smoking and drinking behavior in Taiwan. Data on individual sociodemographic characteristics, smoking, drinking, and social capital were obtained from the Taiwan Social Change Survey conducted in 1995 and in 2000. The overall response rate was 67%. In total, 3713 women and men aged over 20 years living in 204 neighborhoods were interviewed. Social capital indicators were aggregated at the neighborhood level, and included neighborhood closeness, political influence, social contact, social trust, and social participation. The data were analyzed with multilevel binomial regression models. Gender differences were found in some aspects of social capital. Stronger effects of social trust on smoking were found for women than for men, whereas stronger effects of neighborhood closeness on drinking were found for women than for men. Social participation was positively associated with drinking in both genders. The findings of this study provide new evidence for the differential effects of social capital by gender in Taiwan, suggesting that more studies are needed to understand social capital's effects in Asian societies and the mechanisms by which the effects may vary with gender.
Social Science & Medicine 11/2008; 67(8):1321-30. DOI:10.1016/j.socscimed.2008.06.033 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Inequality in health has long been a topic of discussion. The purpose of this research was to provide estimates of the proportions of elderly who had difficulties in activities of daily living in each of the 23 administrative areas of Taiwan, and to assess if there was geographical disparity in disability across areas. A nationally representative sample of 303,545 subjects was selected for interview. Among the subjects selected for interview, 239,861 completed the survey, a completion rate of about 80%. For the purpose of this research, only those aged 65 years or older were included (N = 114,873) in the analyses. Non-standardized and standardized prevalences of disability were presented for each of the 23 administrative areas in Taiwan, and geographical distribution of elderly disability was plotted. Results show that significant difference in disability prevalence exists among administrative districts, even after adjusting for age and sex structure of the population. Moreover, the extent of gender disparity also varied from one area to another. The western region, in general, had lower disability prevalence than the eastern region. Findings imply that since disability prevalence varied significantly across administrative areas, funding for long-term care should not be allocated based on the number of elderly population in an administrative area. Areas with high prevalence should identify reasons for their high prevalence rates and implement proper interventions.
The journal of nursing research: JNR 04/2008; 16(1):47-54. DOI:10.1097/01.JNR.0000387289.53559.6d · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We assessed direct effects of neighborhood-level characteristics and interactive effects of neighborhood-level characteristics and individual socioeconomic position on adult smoking and drinking, after consideration of individual-level characteristics in Taiwan.
Data on individual sociodemographic characteristics, smoking, and drinking were obtained from Taiwan Social Change Survey conducted in 1990, 1995, and 2000. The overall response rate was 67%. A total of 5883 women and men aged over 20 living in 434 neighborhoods were interviewed. Participants' addresses were geocoded and linked with Taiwan census data for measuring neighborhood-level characteristics including neighborhood education, neighborhood concentration of elderly people, and neighborhood social disorganization. The data were analyzed with multilevel binomial regression models.
Several interaction effects between neighborhood characteristics and individual socioeconomic status (SES) were found in multilevel analyses. Our results indicated that different neighborhood characteristics led to different interaction patterns. For example, neighborhood education had a positive effect on smoking for low SES women, in contrast to a negative effect on smoking for high SES women. This result supports the hypothesis of "relative deprivation," suggesting that poor people living in affluent neighborhoods suffer from relative deprivation and relative standing. On the other hand, neighborhood social disorganization has positive effects on drinking for low SES individuals, but not for high SES individuals. These interactive effects support the hypothesis of the double jeopardy theory, suggesting that living in neighborhoods with high social disorganization will intensify the effects of individual low SES.
The findings of this study show new evidence for the effects of neighborhood characteristics on individual smoking and drinking in Taiwan, suggesting that more studies are needed to understand neighborhood effects in Asian societies.
BMC Public Health 02/2007; 7(1):151. DOI:10.1186/1471-2458-7-151 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the effects of neighbourhood level socioeconomic status (SES) and convenience store concentration on individual level smoking, after consideration of individual level characteristics.
Individual sociodemographic characteristics and smoking were obtained from five cross sectional surveys (1979-1990). Participants' addresses were geocoded and linked with census data for measuring neighbourhood SES and with telephone yellow page listings for measuring convenience store concentration (density in a neighbourhood, distance between a participant's home and the nearest convenience store, and number of convenience stores within a one mile radius of a participant's home). The data were analysed with multilevel Poisson regression models.
82 neighbourhoods in four northern California cities.
8121 women and men aged 25-74 from the Stanford heart disease prevention programme.
Lower neighbourhood SES and higher convenience store concentration, measured by density and distance, were both significantly associated with higher level of individual smoking after taking individual characteristics into account. The association between convenience store density and individual smoking was modified by individual SES and neighbourhood SES.
These findings are consistent with a growing body of literature suggesting that the socioeconomic and physical environments of neighbourhoods are associated with individual level smoking.
Journal of Epidemiology & Community Health 08/2005; 59(7):568-73. DOI:10.1136/jech.2004.029041 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The influence of neighborhoods on adolescent behaviors has received increasing research attention. In the present study, we use structural equation models to specify pathways from neighborhoods to adolescent cigarette and alcohol use through parental closeness, parental monitoring, parent substance use, and peer substance use. We use a national sample with 959 adolescents 12 to 14 years of age whose residential addresses were matched with 1990 Census tracts to provide neighborhood characteristics. We found that for adolescent cigarette use low socioeconomic status (SES) neighborhoods were associated with increased parental monitoring, which was further associated with decreased adolescent cigarette use. For adolescent alcohol use, high SES neighborhoods were associated with increased parent drinking, which was further associated with increased adolescent alcohol use. Low SES neighborhoods were associated with increased parental monitoring and increased peer drinking, which were in turn associated with decreased and increased adolescent alcohol use, respectively.
Journal of Health and Social Behavior 07/2005; 46(2):187-204. DOI:10.1177/002214650504600205 · 2.72 Impact Factor