Rockli Kim’s research while affiliated with Korea University and other places

Background India witnessed a rise in alcohol and tobacco consumption in the last few decades. However, the burden varies because of the huge population, diverse socioeconomic, cultural, and geographical characteristics, and different liquor policies across states. To understand the burden and progress, it is crucial to examine the consumption patterns at smaller geographical units. This study examines the trends and patterns in alcohol and tobacco consumption across 720 districts nested within 36 states (Union Territories) between 2016 and 2021. Methods We used the fourth (2015–16) and fifth (2019–21) rounds of the National Family Health Survey of India. Both rounds provide the district-representative sample for the estimation. We used a 4-level (level 1-individuals; level 2-clusters; level 3-districts; level 4-states) random effects model to compute the predicted probabilities of alcohol and tobacco consumption (among males and females) for 720 districts in India. We used decile positions to map the consumption prevalence across districts. Results Between 2016 and 2021, alcohol and tobacco consumption among men in India declined significantly, with national alcohol usage dropping from 29.2% to 17.5% and tobacco from 44.5% to 32.6%. The variation attributable to states for both alcohol (40.5% in 2016 and 56.6% in 2021) and tobacco (58% in 2016 and 68.3% in 2021) consumption among men was higher in 2021 as compared to 2016. The consumption of both tobacco and alcohol was notably high in the north-eastern states among both men and women. More than 80% of the districts reported a moderate to high reduction in alcohol consumption for men between the two rounds. Conclusions The national decline in tobacco and alcohol consumption indicates progress. However, there remains a need for continuous and targeted interventions to target high-consumption pockets and address geographic disparities. The results of the present study indicate that interventions focusing on changing tobacco and alcohol consumption should consider the geographical variation at smaller administrative units. By implementing evidence-based policies and interventions suited to the needs of the local areas, public health authorities can continue to make significant strides in improving the health and well-being of the population and reducing the burden of alcohol and tobacco-related diseases.

Introduction In India, most child deaths now occur within the first 28 days of birth. Trends in socioeconomic disparities in death during these early and late neonatal stages over the past few decades have been understudied. This paper elucidates these trends in early neonatal and late neonatal mortality by household wealth and maternal education. We also examined these trends for post neonatal and child mortality, thereby examining the risk of death by socioeconomic status from birth until 59 months. Methods Using data from five rounds of India’s National Family Health Survey, we examined how the early neonatal, late neonatal, post neonatal and child mortality rates changed between 1993 and 2021 by household wealth and maternal education. We also examined how the absolute (difference in rates) and relative (ratio of rates) inequality between the highest and lowest socioeconomic groups changed for each outcome, and which children are on track to meet the Sustainable Development Goal targets. Results Despite large absolute reductions in early neonatal, late neonatal, post neonatal and child mortality, India’s most vulnerable children remain at the highest risk of death as of 2021. Between 1993 and 2021, the absolute and relative socioeconomic inequality for early neonatal deaths increased. Now, most child deaths are among India’s most vulnerable children in terms of household wealth and maternal education, and these children are not on track to meet the Sustainable Development Goal targets for early neonatal and post neonatal mortality. Conclusions Our study highlights persistent socioeconomic inequalities in child death, and that these inequalities exist regardless of mortality stage. More pro poor policies and interventions are required to close these gaps. Doing so is essential for India to meet global targets.

The Geographic Insights Lab at Harvard University developed India Policy Insights (IPI), a spatio-temporal visualization platform for policymakers. IPI provides insights from 122 indicators across population, health, and socioeconomic metrics spanning 720 districts, 543 parliamentary constituencies, and 600,000 villages in India. Its applications include breastfeeding campaigns,policy development, and government reporting. It is fully deployed on Microsoft Azure using Docker, which ensures scalability and reproducibility. Built on an open-source stack with React,.NET, and PostGIS, it processes, stores, visualizes, and queries geospatial big data. This paper highlights IPI's architecture and methodologies for tackling public policy challenges.

Purpose Evidence on the relationship between women’s working status and intimate partner violence (IPV) remains mixed, especially in low- and middle-income countries. Moreover, limited research has examined whether this association varies by husbands’ attitudes toward violence. This study aimed to examine the association between women’s working status and IPV victimization, focusing on the moderating role of husbands’ attitudes toward wife-beating among married women in India. Methods Using nationally representative data from the National Family Health Survey 2019–2021, we analyzed a sample of 42,407 married women aged 18–49. Multilevel linear probability models were used to estimate associations. Results Overall, 26.5% of women reported IPV victimization in the past year. Women’s working status was associated with a higher likelihood of IPV victimization, though the magnitude varied by occupation (b = 0.024, 95% CI [0.009, 0.038] for white-collar jobs; b = 0.053, 95% CI [0.043, 0.063] for blue-collar jobs). Importantly, husbands’ attitudes toward violence moderated these associations: among women whose husbands justified wife-beating, the risk of IPV was higher for both working occupational groups (b = 0.036, 95% CI [0.007, 0.065] for white-collar jobs; b = 0.032, 95% CI [0.014, 0.051] for blue-collar jobs). When husbands perceived wife-beating as unjustifiable, the risk difference between non-working and white-collar women was negligible. Conclusions Women’s working status alone may not protect them against IPV victimization in patriarchal contexts. Efforts to enhance women’s economic empowerment should be coupled with strategies to shift gender norms and reduce the social acceptance of IPV.

Background This study examines the incidence, prevalence, deaths, and disability-adjusted life years (DALYs) related to non-communicable diseases (NCDs) in South Asia, exploring the environmental, metabolic, and behavioural risk factors, and exploring changes in deaths and DALYs driven by population growth, aging, and mortality rates. Methods Using data from the Global Burden of Disease (GBD) study 2021, we estimated age-standardized incidence, prevalence, deaths, and DALYs for four major NCDs: cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases from 2010 to 2021. Gender and age-specific estimations were conducted across all NCDs, with 95% uncertainty intervals and a decomposition analysis was employed to estimate change in death and DALYs attributable to NCDs. Findings The burden of NCDs in South Asia increased by 3.00% in incidence from 2010 to 2021, while overall prevalence decreased by 1.00%, yet the age-standardized prevalence rate remains above the global rate (91,570 per 100,000 population). Incidences of cardiovascular and respiratory diseases declined by 3.00% and 13.00%, respectively, whereas diabetes and cancer rose by 21.00% and 13.00% in South Asia. Nepal faced the highest environmental impact (23.4% of DALYs), Bangladesh the greatest metabolic impact (25.62%), and India the highest from behavioural factors (23.95%). Population growth and aging were primary drivers of changes in deaths and DALYs across the region. Conclusion This finding emphasizes the need for targeted public health interventions addressing environmental, metabolic, and behavioral risks for NCDs in South Asia, alongside strategies to support healthy aging and effective disease management across diverse demographic groups.

Background Engagement in stimulation activities by both parents can have synergistic effects on early childhood development (ECD). While the role of maternal stimulation is well known, the association with paternal stimulation remains underexplored and inconsistent. The current study aimed to assess the distribution of different combinations of maternal and paternal stimulation and explore their associations with ECD in the context of sub-Saharan Africa (SSA). Methods Using the Multiple Indicator Cluster Surveys and Demographic and Health Surveys from 26 SSA countries, we included 69 637 children aged 3–4 years in the analysis. The standardised ECD z-score was constructed using the ECD index. We estimated three-level linear regressions to assess its association with parental engagement in stimulation activities which was classified into four categories: mother low, father low (fewer than four activities); mother high, father low; father high, mother low; mother high, father high. Stratification analyses were conducted to examine whether the association differs by socioeconomic, geographic and learning-related variables. Results Only 4% of parents provided high stimulation jointly (both high), which was associated with higher ECD z-score compared with both parents providing low stimulation (both low), after adjusting for covariates (b=0.04, 95% CI=0.01, 0.08). The association between joint parental stimulation and ECD was greater for children from wealthier households compared with their poorer counterparts (interaction p=0.012). Conclusions Children showed better developmental status when both parents jointly provided high stimulation. Policies and interventions should target both mothers and fathers, and transform traditional norms about parenting to achieve the most optimal development outcomes of children.

Background The relationship between education and cardiovascular health (CVH) metrics in low- and middle-income countries (LMICs) remains unclear. This study explores the associations between education and ideal cardiovascular health score (CVHS), as well as seven CVH metrics. Methods This cross-sectional study extracted data from the STEPwise approach to surveillance surveys in 36 LMICs between 2010 and 2020. We assessed CVHS using the sum score in seven metrics defined by American Heart Association: (1) ≥ 150 min/week of moderate, or 75 min/week of vigorous activity, or an equivalent combination; (2) BMI < 25 kg/m² for non-Asians (< 23 kg/m² for Asians); (3) fruit and vegetable intake ≥ 4.5 servings per day; (4) nonsmoking; (5) blood pressure < 120/80 mmHg (untreated); (6) total cholesterol < 200 mg/dL (untreated); and (7) fasting blood glucose < 100 mg/dL (untreated). The ideal CVHS score ranged from 5 to 7. We disaggregated prevalence of ideal CVHS and seven metrics by education, and constructed Poisson regression models to adjust for other socioeconomic factors. Results Among 81,327 adult participants, the overall ideal CVHS prevalence for the studied countries was highest among individuals with primary education (52.9%, 95% CI: 51.0–54.9), surpassing those of other education levels − 48.0% (95% CI: 44.6–51.3, P = 0.003) for those with no education and 39.1% (95% CI: 36.5–41.8, P < 0.001) for those with tertiary education. Five (ideal physical activity, BMI, blood pressure, total cholesterol, and blood glucose) in seven CVH metrics peaked among participants with primary or secondary education. For instance, the prevalence of ideal blood pressure among individuals with primary education was 34.4% (95% CI: 32.7–36.1), higher than the prevalence in other education levels, ranging from 28.6% to 32.3%. These patterns were concentrated in low-income countries and lower-middle-income countries, while in upper-middle-income countries, the prevalence of ideal CVHS increased with higher education levels, ranging from 15.4% for individuals with no education to 33.1% for those with tertiary education. Conclusions In LMICs, the association between education and ideal CVHS, along with several CVH metrics, exhibited un inverted U-shape, which may be closely related to the different stages of epidemiologic transition.