Paulyn Jean Acacio-Claro

Introduction: Like many countries globally, childhood immunisation coverage is below government targets in the Philippines and has worsened during the COVID-19 pandemic, leading to outbreaks of vaccine-preventable diseases. This study aimed to identify the social and behavioural drivers of routine childhood immunisation and preferred caregiver information sources to improve uptake in the Philippines. Methods: A quantitative, cross-sectional study, as part of a larger mixed-methods study, was undertaken in three regions in the Philippines with low immunisation coverage in 2023. Data on Behavioural and Social Drivers (BeSD) of immunisation, preferred information sources and vaccination status of children under 5 years were collected, analysed and reported according to the WHO BeSD framework. Results: The study included 653 caregivers and 950 children, with 65% of children fully immunised, 31.8% partially immunised and 2.5% being zero-dose or having received no vaccines. Key reasons for complete vaccination included the protection vaccines offer, healthcare worker recommendations and vaccines being free of charge. For partial vaccination, top reasons were intercurrent illness, inaccessible vaccination sites and parental belief that the child was too young to receive vaccines. The most common reason for non-vaccination was also intercurrent illness. The predictors of complete vaccination were older age of caregivers (46–59 years) (prevalence ratio (PR)=1.29; 95% CI 1.12 to 1.48) and low concerns about vaccine safety (PR=1.13; 95% CI 1.03 to 1.25). Other Christian denominations, compared with Catholics, were less likely to have fully immunised children (PR 0.82; 95% CI 0.69 to 0.97). Preferred vaccine information sources included the Department of Health, healthcare workers and mass media. Conclusions: We found that only 65% of children were fully immunised in 2023, with both access and acceptance factors impacting uptake of routine childhood vaccines. Improving service accessibility and education of healthcare workers on vaccine safety and effectiveness and more targeted messaging from health authorities and mass media about the benefits of vaccination could increase uptake in the Philippines, with learnings from this study applicable globally.

The 2019 Philippine Universal Health Care Act (Republic Act 11223) was set for implementation in January 2020 when disruptions brought on by the pandemic occurred. Will the provisions of the new UHC Act for an improved health system enable agile responses to forthcoming shocks, such as this COVID-19 pandemic? A content analysis of the 2019 Philippine UHC Act can identify neglected and leverage areas for systems’ improvement in a post-pandemic world. While content or document analysis is commonly undertaken as part of scoping or systematic reviews of a qualitative nature, quantitative analyses using a two-way mixed effects, consistency, multiple raters type of intraclass correlation coefficient (ICC) were applied to check for reliability and consistency of agreement among the study participants in the manual tagging of UHC components in the legislation. The intraclass correlation reflected the individuals’ consistency of agreement with significant reliability (0.939, p < 0.001). The assessment highlighted a centralized approach to implementation, which can set aside the crucial collaborations and partnerships demonstrated and developed during the pandemic. The financing for local governments was strengthened with a new ruling that could alter UHC integration tendencies. A smarter allocation of tax-based financing sources, along with strengthened information and communications systems, can confront issues of trust and accountability, amidst the varying capacities of agents and systems.

Finnish students start academic or vocational track in upper secondary education at age 16 years. Track placement is based on grades, but family background and psychosocial resources may have influences. Using 2014 survey data of Grade 9 students in Helsinki Metropolitan area linked to the Joint Application Registry data as of 2017, we fitted two-level, sex-stratified, generalized structural equation models to determine how reserve capacity (academic self-efficacy and social support), family background, and the comprehensive schools predict track placement. Adjusting for the effect of grades, low reserve capacity and disadvantaged family background increased probabilities of vocational track and non-placement of students. Schools also affected track placement, suggesting differences among comprehensive schools in the area. Findings imply that building reserve capacities of adolescents, through enhancing academic self-efficacy and social support, particularly in those with disadvantaged backgrounds, could increase chances of academic track placement in upper secondary school.

Aim: We studied how multigenerational socioeconomic circumstances influence adolescents’ smoking. Previous studies have shown that low academic achievement as well as parents’ low socioeconomic circumstances are associated with adolescents’ smoking, but there are few studies on grandparents’ influence on their grandchildren’s smoking. For the chain of three generations, we hypothesised that high socioeconomic circumstances of both parents and grandparents decrease the probability of smoking and adolescents’ own education and circumstances contribute to this association. We further investigated the role of intergenerational social mobility. Method: Survey data from 1979 to 1997 on 12- to 18-year-old Finns (n=54,487) were linked with 1970–2009 registry-based data of their grandparents, parents and themselves. Socioeconomic circumstances among parents and grandparents were measured by socioeconomic status, education and material resources and among adolescents by academic achievement, educational orientation, family structure and parental smoking. Logistic regression analysis was used to study the associations. Results: Associations of adolescent smoking with grandparental socioeconomic circumstances were weak and mediated through parental circumstances. Parental smoking and divorce and living in a non-intact family increased smoking. Adolescents’ low academic achievement and orientation to low education level were the most important predictors of smoking. Upward intergenerational social mobility between fathers and children decreased the risk of smoking, whereas downward mobility increased it. Conclusions: The influence of grandparents’ low socioeconomic circumstances on grandchildren’s smoking is mediated through parents’ socioeconomic circumstances. Low academic achievement in adolescence is a strong predictor of smoking and adolescents orient towards the group of their future education level, not that of their parents.

Background. Family socioeconomic status (SES) is related to a child´s educational success. Intermediate pathways for this relationship, such as through pubertal timing and reserve capacity, occur in adolescence. Aim. To study whether family SES affects a child’s adult education through a psychosocial and behavioural pathway (reserve capacity) and/or a biological pathway (pubertal timing) or only through school achievement in adolescence. Subjects and methods. Finnish adolescents sampled in five cross-sectional surveys from 1985-1995 (N = 37,876) were followed through the Registry of Completed Education and Degrees until 2009, when they were 29-43 years old. Family SES data also came from this registry. Structural equation modelling adjusted for ages at baseline and follow-up was used. Results. Low family SES increased the probability of low adult education, delayed pubertal timing (in boys), weak reserve capacity and low school achievement. Reserve capacity and school achievement directly affected adult education and mediated the relationship of family SES with the outcome. Delayed pubertal timing predicted low adult education except when school achievement was added to the model. Conclusions. Our results show that family SES affects the child’s adult education level through psychosocial and biobehavioural pathways, but the biological pathway is mediated by school achievement.

Despite robust evidence on the inverse relationship between socioeconomic status (SES) and mortality, deviations from expected results have been observed likely due to school achievement and psychosocial resources, termed as “reserve capacity.” Since adolescence is a critical period in developing sound psychological and behavioural patterns and adolescent markers of SES were seldom used, we determine if family SES in adolescence predicts later mortality. We also study how reserve capacity (perceived health, health-promoting behaviour and social support) and school achievement modify this relationship and reduce the negative effects of low SES. A longitudinal study was designed by linking baseline data on 12 to 18 year-old Finns in 1985–95 (N = 41,833) from the Adolescent Health and Lifestyle Surveys with register data on mortality and SES from Statistics Finland. Average follow-up time was 18.4 years with a total of 770,161 person-years. Cox regression models, stratified by sex, were fitted to determine the effects of variables measured during adolescence: family SES, reserve capacity and school achievement on mortality risk. All reserve capacity dimensions significantly predicted mortality in boys. Perceived health and social support predicted that in girls. Adolescents with the lowest school achievement were more than twice at risk of dying compared to those with better school performance. Low SES increased the risk of death in boys (Hazard ratios: 1.6, 95% CI 1.1–2.4) but not in girls. Reserve capacity and school achievement weakened the effects of low SES on boys’ risk of death. High reserve capacity and good school achievement in adolescence significantly reduce the risk of mortality. In boys, these also mitigate the negative effect of low SES on mortality. These findings underscore the roles of reserve capacity and school achievement during adolescence as likely causal or modifying factors in SES-health inequalities.

Family socioeconomic circumstances directly influence adult education level. Adolescent psychosocial resources and health-promoting behaviour collectively termed as ‘reserve capacity’ and school achievement may likely mediate the effect of family socioeconomic circumstances on adult education level. We tested these relationships using 1985–1995 survey data on 12–18-year-old Finns (N = 41,822) linked with three-generation registry data of Statistics Finland until 2009. Results of the multinomial logistic regression models, adjusted for sex and age at end of follow-up, showed that socioeconomic circumstances of parents and grandparents predicted adult education level. School achievement and reserve capacity dimensions of perceived health, health-promoting behaviour and social support in adolescence also positively predicted adult education. Moreover, these tended to decrease the effect of family socioeconomic circumstances on educational level. Our findings suggest that formulating interventions which build reserve capacity and improve school performance, especially among adolescents from disadvantaged socioeconomic backgrounds, could likely reduce educational inequalities.

Sample surveys carried out during the last four decades have proven the existence of “unmet need”, a term coined to describe a significant gap between a woman’s sexual and contraceptive behaviour and her stated fertility preference. According to the Demographic and Health Surveys (DHS) definition, a woman has an unmet need for contraception if she is fecund, sexually active and not using any contraceptive method, and yet does not want a child for at least two years. If a woman is pregnant or amenorrhoeic after giving birth, she is also considered to have had an unmet need if she had not wanted the pregnancy or birth either when it occurred or ever (Ross and Winfrey, 2002).

Some types of occupations involve high levels of exposure to potentially genotoxic gaseous and particulate substances from internal combustion engines used in motor vehicles. These occupational exposures may contribute to the development of many illnesses, usually through chromosomal change mechanisms that include strand breakage, deletions, sister chromatid exchange and non-disjunction. To determine the effect of occupational exposure in gasoline station attendants and traffic enforcers, the micronucleus test was used. Exfoliated oral mucosa cells from 18 gasoline station attendants, 18 traffic enforcers and 18 control subjects in the City of Manila were examined for micronucleated cell (MNC) frequency. Analysis of buccal cells showed that MNC frequencies in exposed individuals were significantly greater than in control subjects (p ≤ 0.05). However, between gasoline station attendants and traffic enforcers, MNC frequencies of the two exposed groups exhibited no significant difference. No relation was also found between MNC frequency and any of the factors such as age, smoking habits, alcohol habits and working period. This was further confirmed in the multiple regression analysis which showed that only occupational exposure was a good predictor of MNC frequency. The results of this study suggest that gasoline station attendants and traffic enforcers, compared to the control individuals, are at a greater risk of chromosomal damage. For the assessment of chromosomal damage, the study, development, and standardization of tests are recommended for public institutions concerned with matters regarding environmental quality and community health.