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This study used cross-sectional UK Biobank data to estimate the influence of active and passive commuting modes and commuting distance on cardiovascular disease (CVD) -related biomarkers as measures of health outcomes. The analysis applied logistic regression to assess the risk of exhibiting individual biomarker values outside a predefined reference interval and standard linear regression to estimate the relation between commuting practices and a composite CVD index. The study sample comprised 208,893 UK Biobank baseline survey participants aged 40 to 69 who use various modes of transport to commute to work at least once a week. Participants were recruited and interviewed between 2006 and 2010 at 22 centers geographically dispersed across England, Scotland, and Wales. The data set included these participants' sociodemographic and health-related information, including lifestyle indicators and biological measures. The primary outcome was a shift from low to high-risk blood serum levels in eight cardiovascular biomarkers: total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, apolipoprotein A and B, C-reactive protein, and lipoprotein (a). Our results indicated a small negative association between the composite risk index for CVD biomarkers and weekly commuting distance. Although estimates for active commuting modes (cycling, walking) may admittedly be sensitive to different covariate adjustments, our specifications show them to be positively associated with select CVD biomarkers. Commuting long distances by car is negatively associated with CVD-related biomarkers, while cycling and walking might be positively associated. This biomarker-based evidence, although limited, is less susceptible to residual confounding than that from distant outcomes like CVD mortality.

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Using 2002-2018 German Socio-Economic Panel (GSOEP) data for German adults aged 18 + , this study measures changes in the body mass index (BMI) distribution and obesity inequality to estimate the relation between the latter and subjective well-being. In addition to documenting a significant association between the various measures of obesity inequality and subjective well-being, especially among women, we show a significant increase in obesity inequality, particularly among females and those with low education and/or low income. This rising inequality points to the need to combat obesity through initiatives targeted at specific sociodemographic groups.

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BACKGROUND: Previous literature documents the direct and indirect economic costs of obesity, yet none has attempted to quantify the intangible costs of obesity. This study focuses on quantifying the intangible costs of one unit body mass index (BMI) increase and being overweight and obese in Germany. METHODS: By applying a life satisfaction-based compensation value analysis to 2002-2018 German Socio-Economic Panel Survey data for adults aged 18-65, the intangible costs of overweight and obesity are estimated. We apply individual income as a reference for estimating the value of the loss of subjective well-being due to overweight and obesity. RESULTS: The intangible costs of overweight and obesity in 2018 amount to 42,450 and 13,853 euros, respectively. A one unit increase in BMI induced a 2553 euros annual well-being loss in the overweight and obese relative to those of normal weight. When extrapolated to the entire country, this figure represents approximately 4.3 billion euros, an intangible cost of obesity similar in magnitude to the direct and indirect costs documented in other studies for Germany. These losses, our analysis reveals, have remained remarkably stable since 2002. CONCLUSIONS: Our results underscore how existing research into obesity's economic toll may underestimate its true costs, and they strongly imply that if obesity interventions took the intangible costs of obesity into account, the economic benefits would be considerably larger.

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This study applies a machine learning (ML) approach to around 400,000 observations from the German Socio-Economic Panel to assess the relation between life satisfaction and age. We show that with our ML-based approach it is possible to isolate the effect of age on life satisfaction across the lifecycle without explicitly parameterizing the complex relationship between age and other covariates-this complex relation is taken into account by a feedforward neural network. Our results show a clear U-shape relation between age and life satisfaction across the lifespan, with a minimum at around 50 years of age.

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The health risks of the current COVID-19 pandemic, together with the drastic mitigation measures taken in many affected nations, pose an obvious threat to public mental health. To assess predictors of poor mental health in the context of the COVID-19 pandemic, this study first implements survey-based measures of health perception biases among Chinese adults during the pandemic. Then, it analyzes their relation to three mental health outcomes: life satisfaction, happiness, and depression (as measured by the CES-D). We show that the health overconfidence displayed by approximately 30% of the survey respondents is a clear risk factor for mental health problems; it is a statistically significant predictor of depression and low levels of happiness and life satisfaction. We also document that these effects are stronger in regions that experienced higher numbers of confirmed COVID-19 cases and deaths. Our results offer clear guidelines for the implementation of effective interventions to temper health overconfidence, particularly in uncontrollable situations like the COVID-19 pandemic.

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By applying multivariate regression to 2020 survey data from four Tehran hospitals, we measure eight recognized sources of Coronavirus disease 2019 (COVID-19) pandemic-related anxiety among 723 healthcare workers (HCWs) with diverse sociodemographic characteristics employed across different hospital areas and positions. The most prominent anxiety source identified is the risk of workplace COVID-19 contraction and transmission to family, followed by uncertainty about organizational support for personal and family needs in the event of worker infection. A supplemental qualitative analysis of 68 respondents in the largest hospital identifies four additional anxiety sources, namely, health, finances, workload, and leadership. This evidence of the multifaceted nature of anxiety sources among HCWs highlights the differentiated approaches that hospital policymakers must take to combat anxiety.

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BACKGROUND: Although prior research on the housing-health linkage suggested that those with poor housing conditions are more likely to report poor health, it is dominated by Western studies and offers little evidence on the housing-health relation in China. Scarce is empirical evidence on the potentially detrimental impact of either qualitative or quantitative housing poverty on health outcomes, especially for seniors in China. This paper aims to fill this void by using data from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) to provide a comprehensive analysis of the demographic, socioeconomic, and behavioral factors that contribute to changes in healthy aging among Chinese adults aged 60 and over. METHODS: Data collected from 8839 adults aged 60 and over in the 2011 and 2015 CHARLS (3732 in 2011 and 5107 in 2015) were used. We first used six blood-based biomarkers to construct a composite measure of the Chinese Healthy Aging Index (CHAI, ranging from 0 (healthiest) to 12 (unhealthiest)) and then assessed the psychometric properties of the CHAI score, including acceptability, internal consistency, convergent validity, discriminative validity and precision. In addition, we employed both mean-based Blinder-Oaxaca and unconditional quantile regression decomposition to decompose the change in healthy aging within the 2011-2015 period. RESULTS: We overall identified a decrease in CHAI score from 5.69 in 2011 to 5.20 in 2015, which implies an improvement in healthy aging during this period. Our linear decomposition revealed that dependent on the type of measure used (whether quality, quantity, or combined quality-quantity), housing poverty explained 4-8% of the differences in CHAI score. Our distributional decompositions also highlighted an important role for housing poverty in the change in healthy aging, accounting for approximately 7-23% of the explained portion. Within this latter, the relative contribution of housing quantity and quality poverty was more pronounced at the median and upper end of the CHAI distribution. We also found household expenditure to be significantly associated with healthy aging among older Chinese adults and made the largest contribution to the improvement in healthy aging over time. CONCLUSIONS: The association between housing poverty and CHAI is independent of household expenditure. Regardless of type, housing poverty is positively associated with a decrease in healthy aging. Thus, improved housing conditions boost healthy aging, and housing amelioration initiatives may offer the most effective solution for augmenting healthy aging in China. Improvement of flush toilets and the access to potable water and a separate kitchen require particular attention. Since high-density congested housing has a negative impact on healthy aging, more attention can also be paid to improvements in the available space for older people. Especially at an institutional level, the government may extend the housing policy from a homeownership scheme to a housing upgrading scheme by improving housing conditions.

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BACKGROUND: Although understanding changes in the body weight distribution and trends in obesity inequality plays a key role in assessing the causes and persistence of obesity, limited research on this topic is available for Cuba. This study thus analyzed changes in body mass index (BMI) and waist circumference (WC) distributions and obesity inequality over a 9-year period among urban Cuban adults. METHODS: Kolmogorov-Smirnov tests were first applied to the data from the 2001 and 2010 National Survey on Risk Factors and Chronic Diseases to identify a rightward shift in both the BMI and WC distributions over the 2001-2010 period. A Shapley technique decomposed the increase in obesity prevalence into a mean-growth effect and a (re)distributional component. A univariate assessment of obesity inequality was then derived by calculating both the Gini and generalized entropy (GE) measures. Lastly, a GE-based decomposition partitioned overall obesity inequality into within-group and between-group values. RESULTS: Despite some relatively pronounced left-skewing, both the BMI and WC distributions exhibited a clear rightward shift to which the increases in general and central obesity can be mostly attributed. According to the Gini coefficients, both general and central obesity inequality increased over the 2001-2010 period, from 0.105 [95% confidence interval (CI) = 0.103-0.106] to 0.110 [95% CI = 0.107-0.112] and from 0.083 [95% CI = 0.082-0.084] to 0.085 [95% CI = 0.084-0.087], respectively. The GE-based decomposition further revealed that both types of inequality were accounted for primarily by within-group inequality (93.3%/89.6% and 87.5%/84.8% in 2001/2010 for general/central obesity, respectively). CONCLUSIONS: Obesity inequality in urban Cuba worsened over the 2001-2010 time period, with within-group inequality in overall obesity dominant over between-group inequality. In general, the results also imply that the rise in obesity inequality is immune to health care system characteristics.

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BACKGROUND: To throw light on the under-researched association between socioeconomic position (SEP) and health in Cuba, this study examined SEP gradients in health and their underlying mechanisms among urban Cuban adults aged 18-65. METHODS: By applying linear regressions to data from the 2010 National Survey on Risk Factors and Chronic Diseases, the analysis explored the SEP-health gradient along three SEP dimensions - education, occupation, and skin colour - using ten health measures: self-reported health (SRH), general and abdominal obesity, hypertension, high glucose, high cholesterol, high triglycerides, low high-density lipoprotein cholesterol, metabolic syndrome, and cumulative risk factors. Regressions also included behaviours and health-related risk perceptions (tobacco and alcohol consumption, diet, physical activity, and risk-related behaviours). It thus investigated the SEP-health gradient and its underlying mechanisms via both behaviours and health-related risk perceptions. RESULTS: Once controlling for gender, age, marital status, region and provincial dummies, the analysis detected educational gradients in SRH (estimated coefficient [95% CI]: middle-level education = 3.535 [1.329, 5.741], p < 0.01; high-level education = 5.249 [3.050, 7.448], p < 0.01) that are partially explainable by both health-affecting behaviours (tobacco and alcohol consumption, diet, physical and sedentary activity) and risk perceptions. Using objective measures of health, however, it found no SEP-health gradients other than hypertension among people identified as having Black skin color (adjusted for demographic variables, 0.060 [0.018, 0.101], p < 0.01) and high cholesterol among those identified as having Mulatto or Mestizo skin color (adjusted for demographic variables, - 0.066 [- 0.098, - 0.033], p < 0.01). CONCLUSIONS: In terms of objective health measures, the study provides minimal evidence for an SEP-health gradient in Cuba, results primarily attributable to the country's universal healthcare system - which offers full coverage and access and affordable medications - and its highly developed education system.

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Using data from the 2015 International Social Survey Program (ISSP), this study conducts a multinational comparison of job satisfaction determinants and their drivers in 36 countries and regions, with particular attention to the reasons for relatively low job satisfaction among Chinese workers. Based on our results from a Blinder-Oaxaca decomposition analysis, we attribute a substantial portion of the job satisfaction differences between China and the other countries to different job attributes and expectations; in particular, to unmet job expectations for interesting work, high pay, and opportunities for advancement. We also note that, contrary to common belief, Chinese workers value similar attributes as Western workers but perceive their work conditions as very different from those in the West.

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BACKGROUND: Improvements in child health are a key indicator of progress towards the third goal of the United Nations' Sustainable Development Goals. Poor nutritional outcomes of Indian children are occurring in the context of high economic growth rates. The aim of this paper is to conduct a comprehensive analysis of the demographic and socio-economic factors contributing to changes in the nutritional status of children aged 0-5 years in India using data from the 2004-2005 and 2011-2012 Indian Human Development Survey. METHODS: To identify how much the different socio-economic conditions of households contribute to the changes observed in stunting, underweight and the Composite Index of Anthropometric Failure (CIAF), we employ both linear and non-linear decompositions, as well as the unconditional quantile technique. RESULTS: We find the incidence of stunting and underweight dropping by 7 and 6 percentage points, respectively. Much of this remarkable improvement is encountered in the Central and Western regions. A household's economic situation, as well as maternal body mass index and education, account for much of the change in child nutrition. The same holds for CIAF in the non-linear decomposition. Although higher maternal autonomy is associated with a decrease in stunting and underweight, the contribution of maternal autonomy to improvements is relatively small. CONCLUSIONS: Household wealth consistently makes the largest contribution to improvements in undernutrition. Nevertheless, maternal autonomy and education also play a relatively important role.

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Using data from the China Health and Nutrition Survey, this study analyses two decades (1991-2011) of change in adult obesity in China with a focus on whether rising obesity rates result from all population cohorts becoming more obese across time (intra-cohort change) or recent cohorts being more obese than their earlier counterparts (inter-cohort change or cohort replacement). To do so, we decompose changes in the body mass index (BMI), waist circumference (WC), general obesity and abdominal obesity of adults aged 20+ using both Firebaugh's linear decomposition and Das Gupta's non-linear technique. Our analysis not only reveals significant increases in both general and abdominal obesity (8.1 and 32 percentage points, respectively) in the two decades studied but shows that the rising means in all four measures are mostly attributable to intra-cohort change. In fact, contrary to findings for the U.S., inter-cohort change for the Chinese sample is actually negative, implying that cohort replacement attenuates intra-cohort change over time. Given that intra-cohort change is the central force for the increase in BMI, WC and obesity with individual increases in obesity widely distributed across all cohorts and age groups over time, policy interventions should focus more broadly on all age groups and birth cohorts.

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BACKGROUND: Work hour constraints (WHC), or the mismatch between desired and actual worktime, can negatively affect work productivity, job satisfaction, worker health and job fluctuations. OBJECTIVES: This study analyzes the WHC trends in the German nursing market between 1990 and 2015. METHODS: Using data from 25 waves (1990-1995 and 1997-2015) of the German Socio-Economic Panel, the contractual, actual, and desired worktime among a representative sample of German nurses (N = 6493) were analyzed. The trends in over/underemployment for full and part-time nurses and the modalities/trends in overtime compensation were analyzed. A Blinder-Oaxaca decomposition was used to explain changes in worktime. RESULTS: Although German nurses' actual and contractual work hours decreased substantially between 1990 and 2015, their desired work hours remained stable (31 h/week), precipitating a persistent gap between actual and desired work hours and an ongoing reliance on overtime. For full-time nurses, the actual work hours consistently exceeded the contracted ones by 3-6 hours. For part-time nurses, the actual and desired work hours have remained very similar, indicating ability to control workforce participation. CONCLUSIONS: WHC remained persistently high over the quarter century studied, with overemployment affecting nearly half of the nursing workforce. Overemployment, resulting primarily from overtime, was high among full-time nurses. Study findings could guide the formulation of programs to optimize German nursing workforce participation.

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In this paper, we use data from the German Socio-Economic Panel to investigate the effect of macro-economic conditions (in the form of local unemployment rates) on smoking behavior. The results from our panel data models, several of which control for selection bias, indicate that the propensity to become a smoker increases significantly during an economic downturn, with an approximately 0.7 percentage point increase for each percentage point rise in the unemployment rate. Conversely, conditional on the individual being a smoker, cigarette consumption decreases with rising unemployment rates, with a one percentage point increase in the regional unemployment rate leading to a decrease in consumption up to 0.8 percent.

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This study uses biomarker information from the 2013 National Nutrition Survey Afghanistan and satellite precipitation driven modeling results from the Global Flood Monitoring System to analyze how floods affect the probability of anemia in Afghan women of reproductive age (15-49). In addition to establishing a causal relation between the two by exploiting the quasi-random variation of floods in different districts and periods, the analysis demonstrates that floods have a significant positive effect on the probability of anemia through two possible transmission mechanisms. The first is a significant effect on inflammation, probably related to water borne diseases carried by unsafe drinking water, and the second is a significant negative effect on retinol concentrations. Because the effect of floods on anemia remains significant even after we control for anemia's most common causes, we argue that the condition may also be affected by elevated levels of psychological stress.

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Using two waves of the National Survey on Risk Factors and Chronic Diseases in Cuba, we identify demographic and socioeconomic characteristics associated with obesity among urban adults aged 18+ and decompose the change in obesity within this 9-year period using both the mean-based Blinder-Oaxaca decomposition and a nonlinear approach. Our results reveal significant increases in overweight and obesity (2.3, 3.1, and 7.6 percentage points for BMI-based overweight, BMI-based obesity, and abdominal obesity, respectively). Depending on the decompositional approach and obesity measure, our analysis explains between 13% and 51% of the rise in overweight and obesity, with most part attributable to changes in risky behavior, age, and education. Of particular importance are the large decline in smoking and the population's changing age structure.

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BACKGROUND: Literature reports a direct relation between nurses' job satisfaction and their job retention (stickiness). The proper planning and management of the nursing labor market necessitates the understanding of job satisfaction and retention trends. The objectives of the study are to identify trends in, and the interrelation between, the job satisfaction and job stickiness of German nurses in the 1990-2013 period using a flexible specification for job satisfaction that includes different time periods and to also identify the main determinants of nurse job stickiness in Germany and test whether these determinants have changed over the last two decades. METHODS: The development of job stickiness in Germany is depicted by a subset of data from the German Socio-Economic Panel (1990-2013), with each survey respondent assigned a unique identifier used to calculate the year-to-year transition probability of remaining in the current position. The changing association between job satisfaction and job stickiness is measured using job satisfaction data and multivariate regressions assessing whether certain job stickiness determinants have changed over the study period. RESULTS: Between 1990 and 2013, the job stickiness of German nurses increased from 83 to 91%, while their job satisfaction underwent a steady and gradual decline, dropping by 7.5%. We attribute this paradoxical result to the changing association between job satisfaction and job stickiness; that is, for a given level of job (dis)satisfaction, nurses show a higher stickiness rate in more recent years than in the past, which might be partially explained by the rise in part-time employment during this period. The main determinants of stickiness, whose importance has not changed in the past two decades, are wages, tenure, personal health, and household structure. CONCLUSIONS: The paradoxical relation between job satisfaction and job stickiness in the German nursing context could be explained by historical downsizing trends in hospitals, an East-West German nurse compensation gap, and an increase in the proportion of nurses employed on a part-time basis. A clearer analysis of each of these trends is thus essential for the development of evidence-based policies that enhance the job satisfaction and efficiency of the German nursing workforce.

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This study uses data from the European Social Survey in order to test the Prinstein-Dodge hypothesis that posits that peer effects may be larger in collectivistic than in individualistic societies. When defining individualism and collectivism at the country level, our results show that peer effects on obesity are indeed larger in collectivistic than in individualistic societies. However, when defining individualism and collectivism with individual values based on the Shalom Schwartz universal values theory, we find little support for this hypothesis.

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BACKGROUND: There is evidence that household air pollution is associated with poor health in China, and that this form of air pollution may even be more of a health concern in China than the much-publicized outdoor air pollution. However, there is little empirical evidence on the relationship between household air pollution and health in China based on nationally representative and longitudinal data. This study examines the association between the type of domestic cooking fuel and the health of women aged ≥16 in rural China. METHODS: Using longitudinal and biomarker data from the China Family Panel Studies (n = 12,901) and the China Health and Nutrition Survey (n = 15,539), we investigate the impact of three major domestic cooking fuels (wood/straw, coal, liquefied petroleum gas (LPG)) on health status using both cross-sectional and panel approaches. RESULTS: Compared to women whose households cook with dirty fuels like wood/straw, women whose households cook with cleaner fuels like LPG have a significantly lower probability of chronic or acute diseases and are more likely to report better health. Cooking with domestic coal instead of wood or straw is also associated with elevated levels of having certain risks (such as systolic blood pressure) related to cardiovascular diseases. CONCLUSIONS: Our study provides evidence that using cleaner fuels like LPG is associated with better health among women in rural China, suggesting that the shift from dirty fuels to cleaner choices may be associated with improved health outcomes.

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OBJECTIVE: Improving the job satisfaction of nurses is essential to enhance their productivity and retention and to improve patient care. Our aim was to analyse trends in German nurses' job satisfaction to enhance understanding of the nursing labour market and inform future policies. METHODS: We used 1990-2012 German Socioeconomic Panel data for trends in nurses' job satisfaction. Comparisons were drawn with doctors, other health care workers, and employees in other sectors of employment. Analysis explored associations between job satisfaction trends and other aspects of employment, such as whether full time or part time and pay. To account for fluctuations across the period of analysis, linear trends were generated using ordinary least squares. RESULTS: Over 23 years, job satisfaction of German nurses underwent a steady and gradual decline, dropping by an average 7.5%, whereas that of doctors and other health care workers increased by 14.4% and 1%, respectively. The decline for part-time nurses (13%) was more pronounced than that for full-time nurses (3%). At the same time, nurses' pay rose by only 3.8% compared to a 23.8% increase for doctors. CONCLUSIONS: The steady decline in nurses' job satisfaction over the last two decades may be attributable to the multiple reforms and associated policy changes that generally disadvantaged nurses. Contributing factors to job satisfaction decline include lower pay and the demanding and strenuous work environment. Irrespective of the reason, health services researchers, leaders, and policy makers should investigate the reasons for this decline given the forecast growth in work load and complexity of care. Supportive policies for nurses would help enhance the quality and sustainability of German health care.

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