The impact of cash transfer participation on unhealthy consumption in Brazil.
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ABSTRACT:
SUBMITTER: Maciel FA
PROVIDER: S-EPMC10297731 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
Publications
The impact of cash transfer participation on unhealthy consumption in Brazil.
Maciel Fernanda Araujo FA Duarte Diogo D
Health policy OPEN 20221206
We assess the impact of the Brazilian government's conditional cash transfer program Bolsa Família on unhealthy consumption by households, proxied by expenses with ultra-processed food, alcohol, and tobacco products. Using machine learning techniques to improve the propensity score estimation, we analyze the intensive and extensive margin effects of participating in the program on the household purchase of unhealthy products. Our results reveal that program participants spend more on food in gen ...[more]
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Project description:BackgroundHomicide kills more people than war globally and is associated with income inequality. In Brazil, one of the most unequal countries of the world, the homicide rate is four times higher than the world average. Establishing if the Brazilian conditional cash transfer programme [Bolsa Familia Programme (BFP)], the largest in the world, is associated with a reduction in the rate of homicide is relevant for violence prevention programs. We aimed to assess the effect of BFP coverage on homicide and hospitalization rates from violence.MethodsBFP coverage and rates of homicide (overall and disaggregated by sex and age) and hospitalizations from violence from all 5,507 Brazilian municipalities between 2004 and 2012 were explored using multivariable negative binomial regression models with fixed effect for panel data. Robustness of results was explored using sensitivity analyses such as difference-in-difference models.FindingsHomicide rates and hospitalization from violence decreased as BFP coverage in the target population increased. For each percent increase in the uptake of the BFP, the homicide rate decreased by 0.3% (Rate Ratio:0.997; 95%CI:0.996-0.997) and hospitalizations from violence by 0.4% (RR: 0.996;95%CI:0.995-0.996). Rates of homicide and hospitalizations from violence were also negatively associated with the duration of BFP coverage. When, coverage of the target population was at least 70% for one-year, hospitalizations from violence decreased by 8%; two-years 14%, three-years 20%, and four years 25%.InterpretationOur results support the hypothesis that conditional cash transfer programs might have as an additional benefit the prevention of homicides and hospitalizations from violence. Social protection interventions could contribute to decrease levels of violence in low-and-middle-income-countries through reducing poverty and/or socioeconomic inequalities.
| S-EPMC6312285 | biostudies-literature
Project description:IntroductionTuberculosis incidence is disproportionately high among people in poverty. Cash transfer programs have become an important strategy in Brazil fight inequalities as part of comprehensive poverty alleviation policies. This study was aimed at assessing the effect of being a beneficiary of a governmental cash transfer program on tuberculosis (TB) treatment cure rates.MethodsWe conducted a longitudinal database study including people ≥18 years old with confirmed incident TB in Brazil in 2015. We treated missing data with multiple imputation. Poisson regression models with robust variance were carried out to assess the effect of TB determinants on cure rates. The average effect of being beneficiary of cash transfer was estimated by propensity-score matching.ResultsIn 2015, 25,084 women and men diagnosed as new tuberculosis case, of whom 1,714 (6.8%) were beneficiaries of a national cash transfer. Among the total population with pulmonary tuberculosis several determinants were associated with cure rates. However, among the cash transfer group, this association was vanished in males, blacks, region of residence, and people not deprived of their freedom and who smoke tobacco. The average treatment effect of cash transfers on TB cure rates, based on propensity score matching, found that being beneficiary of cash transfer improved TB cure rates by 8% [Coefficient 0.08 (95% confidence interval 0.06-0.11) in subjects with pulmonary TB].ConclusionOur study suggests that, in Brazil, the effect of cash transfer on the outcome of TB treatment may be achieved by the indirect effect of other determinants. Also, these results suggest the direct effect of being beneficiary of cash transfer on improving TB cure rates.
| S-EPMC6386534 | biostudies-literature
Project description:ImportanceThere is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes.ObjectiveTo investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators.Design, setting, and participantsThis cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023.ExposureLive births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery.Main outcomes and measuresLow birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as "brown" and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins.ResultsA total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88).Conclusions and relevanceThis study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight-related outcomes.
| S-EPMC10685879 | biostudies-literature
Project description:BackgroundDespite the efforts of the National Tuberculosis Programme, TB cure rates in Brazil are sub-optimal. The End TB Strategy for post-2015 identifies conditional cash transfer interventions as powerful tools to improve TB control indicators, including TB cure rate. This study aims to inform the new policy by evaluating the role of the Bolsa Familia Programme (BFP), one of the largest conditional cash transfer programmes in the world, on TB cure rates in Brazil.MethodsWe undertook a retrospective cohort study, based on an unprecedented record linkage of socioeconomic and health data, to compare cases of patients newly diagnosed with TB in 2010 receiving BFP cash benefits (n=5788) with those who did not (n=1467) during TB treatment. We used Poisson regression with robust variance to estimate the relative risks for TB cure adjusted for known confounders.ResultsThe cure rate among patients exposed to BFP during TB treatment was 82.1% (4752/5788), 5.2% higher than among those not exposed. This was confirmed after controlling for TB type, diabetes mellitus, HIV status and other relevant clinical and socioeconomic covariates (RR=1.07, 95% CI 1.04 to 1.11 for cure rates among BFP beneficiaries). This association seemed higher for patients not under directly observed treatment (RR=1.11; 95% CI 1.05 to 1.16).ConclusionsAlthough further research is needed, this study suggests that conditional cash transfer programmes can contribute to improve TB cure rate in Brazil.
| S-EPMC6078175 | biostudies-literature
Project description:BackgroundSocioeconomic factors have been consistently associated with suicide, and economic recessions are linked to rising suicide rates. However, evidence on the impact of socioeconomic interventions to reduce suicide rates is limited. This study investigates the association of the world's largest conditional cash transfer programme with suicide rates in a cohort of half of the Brazilian population.Methods and findingsWe used data from the 100 Million Brazilian Cohort, covering a 12-year period (2004 to 2015). It comprises socioeconomic and demographic information on 114,008,317 individuals, linked to the "Bolsa Família" programme (BFP) payroll database, and nationwide death registration data. BFP was implemented by the Brazilian government in 2004. We estimated the association of BFP using inverse probability of treatment weighting, estimating the weights for BFP beneficiaries (weight = 1) and nonbeneficiaries by the inverse probability of receiving treatment (weight = E(ps)/(1-E(ps))). We used an average treatment effect on the treated (ATT) estimator and fitted Poisson models to estimate the incidence rate ratios (IRRs) for suicide associated with BFP experience. At the cohort baseline, BFP beneficiaries were younger (median age 27.4 versus 35.4), had higher unemployment rates (56% versus 32%), a lower level of education, resided in rural areas, and experienced worse household conditions. There were 36,742 suicide cases among the 76,532,158 individuals aged 10 years, or older, followed for 489,500,000 person-years at risk. Suicide rates among beneficiaries and nonbeneficiaries were 5.4 (95% CI = 5.32, 5.47, p < 0.001) and 10.7 (95% CI = 10.51, 10.87, p < 0.001) per 100,000 individuals, respectively. BFP beneficiaries had a lower suicide rate than nonbeneficiaries (IRR = 0.44, 95% CI = 0.42, 0.45, p < 0.001). This association was stronger among women (IRR = 0.36, 95% CI = 0.33, 0.38, p < 0.001), and individuals aged between 25 and 59 (IRR = 0.41, 95% CI = 0.40, 0.43, p < 0.001). Study limitations include a lack of control for previous mental disorders and access to means of suicide, and the possible under-registration of suicide cases due to stigma.ConclusionsWe observed that BFP was associated with lower suicide rates, with similar results in all sensitivity analyses. These findings should help to inform policymakers and health authorities to better design suicide prevention strategies. Targeting social determinants using cash transfer programmes could be important in limiting suicide, which is predicted to rise with the economic recession, consequent to the Coronavirus Disease 2019 (COVID-19) pandemic.
| S-EPMC9162363 | biostudies-literature
Project description:BackgroundOne of the biggest challenges of the response to the AIDS epidemic is to reach the poorest people. In 2004, Brazil implemented one of the world's largest conditional cash transfer programmes, the Bolsa Família Programme (BFP). We aimed to evaluate the effect of BFP coverage on AIDS incidence, hospitalisations, and mortality in Brazil.MethodsIn this longitudinal ecological study, we developed a conceptual framework linking key mechanisms of BFP effects on AIDS indicators and used ecological panel data from 5507 Brazilian municipalities over the period of 2004-18. We used government sources to calculate municipal-level AIDS incidence, hospitalisation, and mortality rates, and used multivariable regressions analyses of panel data with fixed-effects negative binomial models to estimate the effect of BFP coverage, which was classified as low (0-29%), intermediate (30-69%), and high (≥70%), on AIDS indicators, while adjusting for all relevant demographic, socioeconomic, and health-care covariates at the municipal level.FindingsBetween 2004 and 2018, in the municipalities under study, 601 977 new cases of AIDS were notified, of which 376 772 (62·6%) were in males older than 14 years, 212 465 (35·3%) were in females older than 14 years, and 12 740 (2·1%) were in children aged 14 years or younger. 533 624 HIV/AIDS-related hospitalisations, and 176 868 AIDS-related deaths had been notified. High BFP coverage was associated with reductions in incidence rate ratios of 5·1% (95% CI 0·9-9·1) for AIDS incidence, 14·3% (7·7-20·5) for HIV/AIDS hospitalisations, and 12·0% (5·2-18·4) for AIDS mortality. The effect of the BFP on AIDS indicators was more pronounced in municipalities with higher AIDS endemicity levels, with reductions in incidence rate ratios of 12·7% (95% CI 5·4-19·4) for AIDS incidence, 21·1% (10·7-30·2) for HIV/AIDS hospitalisations, and 14·7% (3·2-24·9) for AIDS-related mortality, and reductions in AIDS incidence of 14·6% (5·9-22·5) in females older than 14 years, 9·7% (1·4-17·3) in males older than 14 years, and 24·5% (0·5-42·7) in children aged 14 years or younger.InterpretationThe effect of BFP coverage on AIDS indicators in Brazil could be explained by the reduction of households' poverty and by BFP health-related conditionalities. The protection of the most vulnerable populations through conditional cash transfers could contribute to the reduction of AIDS burden in low-income and middle-income countries.FundingUS National Institute of Allergy and Infectious Diseases, National Institutes of Health.TranslationFor the Portugese translation of the abstract see Supplementary Materials section.
| S-EPMC9577474 | biostudies-literature
Project description: Not available
| S-EPMC10618750 | biostudies-literature
Project description:BackgroundAlthough tubers play a significant role in Brazilian agriculture, very little is known about the intake of tubers among the Brazilian population. The objective of this study was to characterize the intake of tubers across Brazil. The types of tubers consumed were quantified, and the impact of geographic and sociodemographic factors was assessed.MethodsThis cross-sectional study is based on dietary intake data of 33,504 subjects obtained from the Brazilian National Dietary Survey. All tuber containing foods were identified, and the contribution of different tubers to overall tuber consumption in Brazil was quantified. Descriptive analyses assessed the impact of macroregion and sociodemographic characteristics on tuber consumption, and differences in intake were assessed using statistical tests. Lastly, the dietary intakes of tuber consumers and non-consumers were compared after adjusting for energy and covariates to determine if there were any major differences in dietary intakes between the two groups.ResultsFifty-five percent of the Brazilian population consumed tubers, which differed by macroregion. The intake of tubers among consumers also differed between macroregions. Overall, rural areas reported significantly higher mean daily intakes of tubers (122 g/day) among tuber consumers than urban areas (95 g/day). Mandioca and potato were the most commonly consumed tubers (59 and 43% prevalence, respectively, on any of the 2 days), while the highest daily intakes amongst tuber consumers across Brazil were noted for sweet potato (156 g/day) and potato (95 g/day). On a macroregion level, among tuber consumers, mandioca had the highest prevalence of consumption in the North (94%), Northeast (83%), and Central-West (68%), while consumption of potatoes was most prevalent in the Southeast (63%) and South (62%). Compared to women, small but significantly higher tuber intakes were noted for males (108 vs. 85 g/day). There were no significant differences in intakes among income quintiles. After adjusting for energy and other covariates, nutrient intakes between tuber and non-tuber consumers were not meaningfully different, with the exception of sodium (+ 6.0% comparing non-tuber to tuber consumers), iron (+ 6.1%), zinc (+ 5.7%), vitamin C (+ 8.3%), riboflavin (+ 9.0%), and folate (+ 7.9%).ConclusionsTuber consumption is influenced by regional and sociodemographic characteristics of the Brazilian population. When looking at energy-adjusted nutrient intakes, diets of tuber consumers have resulted in somewhat lower intakes of some micronutrients, namely riboflavin, folate, vitamin C, iron, sodium, and zinc.
| S-EPMC8191048 | biostudies-literature
Project description:ContextThe impact of unhealthy foods and beverages, namely those high in sugar, salt, and saturated or trans fats, has been studied extensively in relation to weight, body composition, and noncommunicable diseases, but less so in relation to the risk of dental caries. Few previous reviews have examined the evidence from all countries globally.ObjectiveA systematic review was conducted to assess the impact of unhealthy food and beverage consumption on the risk of dental caries in children aged ≤10 years, commissioned by the World Health Organization to inform updated complementary feeding recommendations.Data sourcesSystematic searches were conducted in the PubMed, Cochrane, and Embase databases for articles meeting the inclusion criteria dating from January 1971 to March 2022; supplementary searches were undertaken for articles from that period to June 2022.Data extractionUnhealthy foods and beverages were identified using nutrient- and food-based approaches. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I).Data analysisA total of 30 023 unique citations were screened, yielding 37 studies for inclusion. Studies were conducted in high-income (n = 23 [62.2%]) or middle-income countries (n = 14 [37.8%]). Evidence synthesis was performed narratively, stratified by age (0 years to <2 years, 2 years to <5 years, and 5 years to ≤10 years) and exposure (unhealthy foods and unhealthy beverages). The heterogeneity of the exposures and comparators across studies was high. Almost all studies (n = 34) reported positive associations between the consumption of sugar-sweetened beverages or foods high in free sugars and dental caries. However, 67.6% of studies were assessed as having serious risk of bias.ConclusionThe evidence indicates that the consumption of unhealthy food and beverages in children ≤10 years appears to increase the risk of dental caries. Further longitudinal studies with high-quality dietary assessments, including studies in low-income countries and children aged >5 years at baseline, are recommended in order to build a more robust evidence base for use in the development of policy recommendations.Systematic review registrationPROSPERO registration no. CRD42020218109.
| S-EPMC11465133 | biostudies-literature
Project description:ObjectiveConditional cash transfer (CCT) programmes provide income to low-income families in return for fulfilling specific behavioural conditions. CCT have been shown to improve child health, but there are few systematic studies of their impact on multiple determinants of child health. We examined the impact of a CCT programme in Colombia on: (i) use of preventive health services; (ii) food consumption and dietary diversity; (iii) mother's knowledge, attitudes and practices about caregiving practices; (iv) maternal employment; and (v) women's empowerment.DesignSecondary analysis of the quasi-experimental evaluation of the Familias en Accion programme. Children and families were assessed in 2002, 2003 and 2005-06. We applied a difference-in-differences approach using logistic or linear regression, separately examining effects for urban and rural areas.SettingColombia.SubjectsChildren (n 1450) and their families in thirty-one treatment municipalities were compared with children (n 1851) from sixty-five matched control municipalities.ResultsFamilias en Accion was associated with a significant increase in the probability of using preventive care services (OR=1·85, 95 % CI 1·03, 3·30) and growth and development check-ups (β=1·36, 95 % CI 0·76, 1·95). It had also a positive impact on dietary diversity and food consumption. No effect was observed on maternal employment, women's empowerment, and knowledge, attitudes and practices about caregiving practices. Overall, Familias en Accion's impact was more marked in rural areas.ConclusionCCT in Colombia increase contact with preventive care services and improve dietary diversity, but they are less effective in influencing mother's employment decisions, empowerment and knowledge of caregiving practices.
| S-EPMC10271116 | biostudies-literature