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Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries.

ABSTRACT: BACKGROUND:Scant evidence exists on the relation between the availability of health professionals and adolescent health, and whether the size of the health workforce equally benefits adolescents across socioeconomic strata. METHODS:We conducted a cross-sectional analysis of adolescent health in 38 countries. Data from 218 790 adolescents were drawn from the 2013/2014 Health Behavior in School-aged Children survey. We used multilevel regression analyses to examine the association between the density of the health workforce and psychosomatic and mental health symptoms with differences in country wealth and income inequality controlled. RESULTS:A higher density of psychologists was associated with better self-reported mental health in adolescents (P = 0.047); however, this finding was not robust to sensitivity analyses. The densities of physicians and psychiatrists were not significantly associated with better adolescent psychosomatic or mental health. Cross-level interactions between the health workforce and socioeconomic status did not relate to health, indicating that larger health workforces did not reduce socioeconomic differences in adolescent health. CONCLUSIONS:This study found that adolescents in countries with a higher density of health providers do not report better psychosomatic or mental health. Other social or structural factors may play larger roles in adolescent health.

SUBMITTER: Riehm KE

PROVIDER: S-EPMC6459357 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries.

Riehm Kira E KE Latimer Eric E Quesnel-Vallée Amélie A Stevens Gonneke W J M GWJM Gariépy Geneviève G Elgar Frank J FJ

Journal of public health (Oxford, England) 20190301 1

<h4>Background</h4>Scant evidence exists on the relation between the availability of health professionals and adolescent health, and whether the size of the health workforce equally benefits adolescents across socioeconomic strata.<h4>Methods</h4>We conducted a cross-sectional analysis of adolescent health in 38 countries. Data from 218 790 adolescents were drawn from the 2013/2014 Health Behavior in School-aged Children survey. We used multilevel regression analyses to examine the association b ...[more]

PMID: 29893874

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Project description:AimsTo assess the associations between types of cannabis control policies at country level and prevalence of adolescent cannabis use.Setting, participants and designMultilevel logistic regressions were performed on 172,894 adolescents 15 year of age who participated in the 2001/2002, 2005/2006, or 2009/2010 cross-sectional Health Behaviour in School-Aged Children (HBSC) survey in 38 European and North American countries.MeasuresSelf-reported cannabis use status was classified into ever use in life time, use in past year, and regular use. Country-level cannabis control policies were categorized into a dichotomous measure (whether or not liberalized) as well as 4 detailed types (full prohibition, depenalization, decriminalization, and partial prohibition). Control variables included individual-level sociodemographic characteristics and country-level economic characteristics.FindingsConsiderable intra-class correlations (.15-.19) were found at country level. With respect to the dichotomized cannabis control policy, adolescents were more likely to ever use cannabis (odds ratio (OR) = 1.10, p = .001), use in past year (OR = 1.09, p = .007), and use regularly (OR = 1.26, p = .004). Although boys were substantially more likely to use cannabis, the correlation between cannabis liberalization and cannabis use was smaller in boys than in girls. With respect to detailed types of policies, depenalization was associated with higher odds of past-year use (OR = 1.14, p = .013) and regular use (OR = 1.23, p = .038), and partial prohibition was associated with higher odds of regular use (OR = 2.39, p = .016). The correlation between cannabis liberalization and regular use was only significant after the policy had been introduced for more than 5 years.ConclusionsCannabis liberalization with depenalization and partial prohibition policies was associated with higher levels of regular cannabis use among adolescents. The correlations were heterogeneous between genders and between short- and long-terms.

Project description:BackgroundIncreases in body mass index (BMI) and the prevalence of overweight in low- and middle income countries (LMICs) are often ascribed to changes in global trade patterns or increases in national income. These changes are likely to affect populations within LMICs differently based on their place of residence or socioeconomic status (SES).ObjectiveUsing nationally representative survey data from 38 countries and national economic indicators from the World Bank and other international organizations, we estimated ecological and multilevel models to assess the association between national levels of gross domestic product (GDP), foreign direct investment (FDI), and mean tariffs and BMI.DesignWe used linear regression to estimate the ecological association between average annual change in economic indicators and BMI, and multilevel linear or ordered multinomial models to estimate associations between national economic indicators and individual BMI or over- and underweight. We also included cross-level interaction terms to highlight differences in the association of BMI with national economic indicators by type of residence or socioeconomic status (SES).ResultsThere was a positive but non-significant association of GDP and mean BMI. This positive association of GDP and BMI was greater among rural residents and the poor. There were no significant ecological associations between measures of trade openness and mean BMI, but FDI was positively associated with BMI among the poorest respondents and in rural areas and tariff levels were negatively associated with BMI among poor and rural respondents.ConclusionMeasures of national income and trade openness have different associations with the BMI across populations within developing countries. These divergent findings underscore the complexity of the effects of development on health and the importance of considering how the health effects of "globalizing" economic and cultural trends are modified by individual-level wealth and residence.

Project description:BackgroundHealth workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system. In 2010, Ethiopia established a national authority aiming to ensure competence and ethics of health professionals. Subsequently, subnational regulators were established and regulatory frameworks were developed. Although there were anecdotal reports of implementation gaps, there was lack of empirical evidence to corroborate the reports. We conducted a national study to explore health professional regulation practices and gaps focusing on registration, licensing, ethics, scope of practice, and continuing professional development.MethodsWe conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers. We used two stage stratified cluster sampling to select health professionals. The quantitative data were subjected to descriptive and multivariable logistic regression analysis. We conducted thematic analysis of the qualitative data.ResultsWe interviewed 554 health professionals in the quantitative survey. And 31 key informants participated in the qualitative part. Nearly one third of the respondents (32.5%) were not registered. Many of them (72.8%) did not renew their licenses. About one fifth of them (19.7%) did nothing against ethical breaches encountered during their clinical practices. Significant of them ever practiced beyond their scope limits (22.0%); and didn't engage in CPD in the past 1 year (40.8%). Majority of them (97.8%) never identified their own CPD needs. Health regulators and managers stressed that regulatory bodies had shortage of skilled staff, budget and infrastructure to enforce regulation. Regulatory frameworks were not fully implemented.ConclusionsHealth professionals were not regulated well due to limited capacity of regulators. This might have affected quality of patient care. To ensure effective implementation of health professional regulation, legislations should be translated into actions. Draft guidelines, directives and tools should be finalized and endorsed. Capacity of the regulators and health facilities needs to be built. Reinstituting health professionals' council and regulation enforcement strategies require attention. Future studies are recommended for assessing effects and costs of weak regulation.

Project description:This study examined associations of watching television, electronic games, computer uses with school stress, and satisfaction among adolescents. Nationally representative data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey were analysed. School stress and school satisfaction were each assessed using a 4-point self-reported item and then dichotomised. Participants reported discretional time spent on different screen-based activities. Of the 191,786 participants (age 13.6 [1.6] years; 51% girls), 35% reported high levels of school stress, while 30% reported high satisfaction with their school. Multilevel multivariable logistic regression modelling showed that adolescents reporting watching television > 4 h/day (≤ 1 h/day as reference) had 31% higher odds of school stress (OR 1.31; 95% CI: 1.27-1.35) and 36% less odds of school satisfaction (OR 0.64; 95% CI: 0.62-0.67). Prolonged electronic gaming (> 4 h/day) increased the odds of school stress by 26% (OR 1.26; 95% CI: 1.22-1.30) and decreased the odds of school satisfaction by 37% (OR 0.63; 95% CI: 0.61-0.65). Adolescents with prolonged computer use had 46% higher odds of school stress (OR 1.46; 95% CI: 1.42-1.50) and 39% lower odds of school satisfaction (OR 0.61; 95% CI: 0.59-0.63). Association estimates were more evident among younger adolescents than their older counterparts with no apparent gender differences.ConclusionProlonged screen use, irrespective of type, was positively associated with school stress and inversely associated with school satisfaction with high computer use showing the highest adverse associations. Prospective research is needed to understand directionality and mechanisms of these relationships.What is known• Screen-based activities are adversely associated with various health and wellbeing indicators in adolescents.. • The relation between screen time and school-related outcomes is yet to understand fully.What is new• Prolonged screen time is associated with increased school stress and decreased school satisfaction in adolescents. • Computer use showed higher adverse associations than watching television or playing electronic games.

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Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries.

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Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries.

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