There is a substantial literature that graphic tobacco warnings are effective; however, there is limited evidence based on actual smoking behavior. The objective of this paper is to assess the effect of graphic cigarette warning labels on smoking prevalence and quit attempts. A nationally representative sample of individuals aged 15 years and older from the Canadian National Population Health Survey 1998–2008 is used. The sample consists of 4,853 individuals for the smoking prevalence regression and 1,549 smokers for quit attempts. The generalized estimating equation (GEE) model was used to examine the population-averaged (marginal) effects of tobacco graphic warnings on smoking prevalence and quit attempts. To assess the effect of graphic tobacco health warnings on smoking behavior, we used a scaled variable that takes the value of 0 for the first 6 months in 2001, then increases gradually to 1 from December 2001. We found that graphic warnings had a statistically significant effect on smoking prevalence and quit attempts. In particular, the warnings decreased the odds of being a smoker (odds ratio [OR] = 0.875; 95% CI = 0.821–0.932) and increased the odds of making a quit attempt (OR = 1.330, CI = 1.187–1.490). Similar results were obtained when we allowed for more time for the warnings to appear in retail outlets. This study adds to the growing body of evidence on the effectiveness of graphic warnings. Our findings suggest that warnings had a significant effect on smoking prevalence and quit attempts in Canada.
This paper examines the effect of job stress on two key health risk-behaviors: smoking and alcohol consumption, using data from the Canadian National Population Health Survey. Findings in the extant literature are inconclusive and are mainly based on standard models which can model differential responses to job stress only by observed characteristics. However, the effect of job stress on smoking and drinking may largely depend on unobserved characteristics such as: self control, stress-coping ability, personality traits and health preferences. Accordingly, we use a latent class model to capture heterogeneous responses to job stress. Our results suggest that the effects of job stress on smoking and alcohol consumption differ substantially for at least two "types" of individuals, light and heavy users. In particular, we find that job stress has a positive and statistically significant impact on smoking intensity, but only for light smokers, while it has a positive and significant impact on alcohol consumption mainly for heavy drinkers. These results provide suggestive evidence that the mixed findings in previous studies may partly be due to unobserved individual heterogeneity which is not captured by standard models.
The health benefits of adequate fruit and vegetable (F&V) consumption are significant and widely documented. However, many individuals self-report low F&V consumption frequency per day. This paper examines the disparities in the frequency of F&V consumption by socio-demographic and lifestyle characteristics.
Even though maternal employment can increase family income, several studies suggest that it could have adverse consequences on children’s health. In this study, we use a nationally representative sample of 12,888 children, aged 0–5 years from Egypt to examine the impact of maternal employment on child nutritional indicators, namely: stunting, wasting, and being underweight and overweight. We adopted various estimation methods to control for observable and unobservable household characteristics in order to identify the causal effect of maternal employment. These different techniques include, propensity score matching (PSM), OLS regression with controlling for a wide range of individual characteristics, and an instrumental variable two-stage least squares (IV 2SLS) approach. Results of the PSM and OLS suggest that maternal employment is weakly associated with having a malnourished child. On the other hand, the IV 2SLS suggests a stronger and significant association between maternal employment and poor nutritional status among children.
There is substantial evidence that on average, urban children have better health outcomes than rural children. This paper investigates the underlying factors that account for the regional disparities in child malnutrition in three Arab countries, namely; Egypt, Jordan, and Yemen. We use data on a nationally representative sample from the most recent rounds of the Demographic and Health Survey. A Blinder-Oaxaca decomposition analysis is conducted to decompose the rural-urban differences in child nutrition outcomes into two components; one that is explained by regional differences in the level of the determinants (covariate effects), and another component that is explained by differences in the effect of the determinants on the child nutritional status (coefficient effects). Results show that the under-five stunting rates are 20 % in Egypt, 46.5 % in Yemen, and 7.7 % in Jordan. The rural- urban gap in child malnutrition was minor in the case of Egypt (2.3 %) and Jordan (1.5 %), while the regional gap was significant in the case of Yemen (17.7 %). Results of the Blinder-Oaxaca decomposition show that the covariate effect is dominant in the case of Yemen while the coefficients effect dominates in the case of Jordan. Income inequality between urban and rural households explains most of the malnutrition gap. Results were robust to the different decomposition weighting schemes. By identifying the underlying factors behind the rural- urban health disparities, the findings of this paper help in designing effective intervention measures aimed at reducing regional inequalities and improving population health outcomes.
Summary: This study examined the underlying demographic and socioeconomic determinants of child nutritional status in Egypt using data from the most recent round of the Demographic and Health Survey. The height-for-age Z-score (HAZ) was used as a measure of child growth. A quantile regression approach was used to allow for a heterogeneous effect of each determinant along different percentiles of the conditional distribution of the HAZ. A nationally representative sample of 13,682 children aged 0–4 years was drawn from the 2014 Egypt DHS. The multivariate analyses included a set of HAZ determinants commonly used in the literature. The conditional and unconditional analyses revealed a socioeconomic gradient in child nutritional status, in which children of low income/education households have a worse HAZ than those from high income/education households. The results also showed significant disparities in child nutritional status by demographic and social characteristics. The quantile regression results showed that the association between the demographic and socioeconomic factors and HAZ differed along the conditional HAZ distribution. Intervention measures need to consider the heterogeneous effect of the determinants of child nutritional status along the different percentiles of the HAZ distribution. There is no one-size-fits-all policy to combat child malnutrition; a multifaceted approach and targeted policy interventions are required to address this problem effectively.