Who tests, who doesn't, and why? Uptake of mobile HIV counseling and testing in the Kilimanjaro Region of Tanzania.

BACKGROUND: Optimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania. METHODS: Between December 2007 and April 2008, 878 MVCT participants and 506 randomly selected community residents who did not access MVCT were surveyed. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing between MVCT participants and community residents who did not access MVCT. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing, between the two groups. RESULTS: MVCT clients reported greater HIV exposure risk (OR 1.20 [1.04 to 1.38] for males; OR 1.11 [1.03 to 1.19] for females). Female MVCT clients were more likely to report low household expenditures (OR 1.47 [1.04 to 2.05]), male clients reported higher rates of unstable income sources (OR 1.99 [1.22 to 3.24]). First-time testers were more likely than non-testers to cite distance to testing sites as a reason for not having previously tested (OR 2.17 [1.05 to 4.48] for males; OR 5.95 [2.85 to 12.45] for females). HIV-related stigma, fears of testing or test disclosure, and not being able to leave work were strongly associated with non-participation in MVCT (ORs from 0.11 to 0.84). CONCLUSIONS: MVCT attracted clients with increased exposure risk and fewer economic resources; HIV related stigma and testing-related fears remained barriers to testing. MVCT did not disproportionately attract either first-time or frequent repeat testers. Educational campaigns to reduce stigma and fears of testing could improve the effectiveness of MVCT in attracting new and high-risk populations.

The Environmental Costs of Automobile-Centric Transportation Planning

Since the passage of the Federal-Aid Highway Act of 1956, the automobile has become the primary form of transportation on the Mississippi Gulf Coast. As the rate of motor vehicle use continues to rise faster than population growth, the benefits of the current transportation system are coming at a price that rivals annual household expenditures for housing. Furthermore, the automobile-centric transportation system incurs environmental costs. Carbon dioxide emissions, motor fuel use, health care costs for chronic illness, and the loss and impairment of natural resources due to sprawling development, continue to escalate. This project analyzes the environmental costs associated with automobile-centric planning for the urbanized area of the Mississippi Gulf Coast and compares these costs to those of alternative transportation modes.

Efectos distributivos de las políticas públicas para la mitigación del cambio climático en América Latina: una aproximación con un meta-análisis

El principal objetivo de este estudio es analizar los efectos potenciales de diversas políticas climáticas sobre la distribución del ingreso en América Latina. Este análisis se realizó con base en un meta-análisis y su meta-regresión y el análisis de las encuestas de ingreso gasto de diversos países de América Latina. Los principales resultados obtenidos de este análisis muestran que en general existe una tendencia a identificar efectos regresivos derivados de la instrumentación de políticas públicas orientadas a la mitigación. Sin embargo, la revisión de la literatura y de las encuestas de ingreso gasto muestran que los resultados son heterogéneos por países y que dependen de factores tales como el instrumento aplicado, la inclusión de estrategias de reciclaje fiscal y del nivel de desarrollo.

Congestión vehicular en Medellín: una posible solución desde la Economía

Según la teoría económica el mecanismo de precios es una herramienta adecuada para solucionar el problema de congestión vehicular. El objetivo de este artículo es diagnosticar el grado de congestión vehicular de la ciudad de Medellín (Colombia) y proponer alternativas que den solución a dicho problema desde la óptica de la teoría económica. A diferencia de otros estudios, esta investigación analizó la relación entre el gasto de las familias en transporte y la elección de transporte (público o privado) a través la metodología de elasticidades. Se encontró evidencia a favor de la hipótesis de los precios como mecanismos para desincentivar el uso del automóvil privado, pues a medida que aumenta el nivel de gasto en transporte (asociado a un supuesto peaje urbano), la probabilidad de usar transporte privado disminuye, mientras que la probabilidad de utilizar transporte público aumenta.

The Bangladesh gender gap in education : biased intra-household educational expenditures

By investigating the educational expenditure of children over the ten years (2000 to 2010), we evaluate whether there exists any gender specific discrepancy at the household level and the trend of such discrepancy over the years. Using three rounds of nationally representative Household Income & Expenditure Surveys this study reveals that households spend less on education for their school-going girls compared to boys. By disaggregating the total expenditure into fixed and variable components, we find persistent gender imbalance in educational expenditure where households provide better quality of education for boys. Moreover, we find that gender based discrepancy has a very persistent trend and does not show any significant sign of narrowing the gap over the years. Cohort wise difference-in-difference estimation also reveals that the gap has initially widened and later converged but has not diminished beyond the initial level of discrepancy, which may warrant targeted policy intervention.

Family expenditures for housing and household operation : five regions /

Cover title.

Family expenditures for housing and household operation : five regions /

Contribution from Bureau of Home Economics in cooperation with the Works Projects Administration.

Out-of-pocket expenditures for hospital care in Iran : who is at risk of incurring catastrophic payments?

Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian—regardless of their employment status—can better protect households from catastrophic health spending.

British working-class household composition, labour supply, and commercial leisure participation during the 1930s

The early twentieth century constituted the heyday of the ‘breadwinner–homemaker’ household, characterized by a high degree of intra-household functional specialization between paid and domestic work according to age, gender, and marital status. This article examines the links between formal workforce participation and access to resources for individualized discretionary spending in British working-class households during the late 1930s, via an analysis of household leisure expenditures. Leisure spending is particularly salient to intra-household resource allocation, as it constitutes one of the most highly prioritized areas of individualized expenditure, especially for young, single people. Using a database compiled from surviving returns to the Ministry of Labour's national 1937/8 working-class expenditure survey, we examine leisure participation rates for over 600 households, using a detailed set of commercial leisure activities together with other relevant variables. We find that the employment status of family members other than the male breadwinner was a key factor influencing their access to commercial leisure. Our analysis thus supports the view that the breadwinner–homemaker household was characterized by strong power imbalances that concentrated resources—especially for individualized expenditures—in the hands of those family members who engaged in paid labour.

Malaria prevention in north-eastern Tanzania: patterns of expenditure and determinants of demand at the household level.

Objective. This study aims to provide a better understanding of the amounts spent on different malaria prevention products and the determinants of these expenditures. Methods. 1,601 households were interviewed about their expenditure on malaria mosquito nets in the past five years, net re-treatments in the past six months and other expenditures prevention in the past two weeks. Simple random sampling was used to select villages and streets while convenience sampling was used to select households. Expenditure was compared across bed nets, aerosols, coils, indoor spraying, using smoke, drinking herbs and cleaning outside environment. Findings. 68% of households owned at least one bed net and 27% had treated their nets in the past six months. 29% were unable to afford a net. Every fortnight, households spent an average of US $0.18 on nets and their treatment, constituting about 47% of total prevention expenditure. Sprays, repellents and coils made up 50% of total fortnightly expenditure (US$0.21). Factors positively related to expenditure were household wealth, years of education of household head, household head being married and rainy season. Poor quality roads and living in a rural area had a negative impact on expenditure. Conclusion. Expenditure on bed nets and on alternative malaria prevention products was comparable. Poor households living in rural areas spend significantly less on all forms of malaria prevention compared to their richer counterparts. Breaking the cycle between malaria and poverty is one of the biggest challenges facing malaria control programmes in Africa.

Use of electronic travel diaries and vehicle instrumentation packages in the year 2000 : Atlanta Regional Household Travel Survey

The Georgia Institute of Technology is currently performing research that will result in the development and deployment of three instrumentation packages that allow for automated capture of personal travel-related data for a given time period (up to 10 days). These three packages include: A handheld electronic travel diary (ETD) with Global Positioning System (GPS) capabilities to capture trip information for all modes of travel; A comprehensive electronic travel monitoring system (CETMS), which includes an ETD, a rugged laptop computer, a GPS receiver and antenna, and an onboard engine monitoring system, to capture all trip and vehicle information; and a passive GPS receiver, antenna, and data logger to capture vehicle trips only.

Examination of relationships between urban form, household activities, and time allocation in the Atlanta Metropolitan Region

A substantial body of research is focused on understanding the relationships between socio-demographics, land-use characteristics, and mode specific attributes on travel mode choice and time-use patterns. Residential and commercial densities, inter-mixing of land uses, and route directness in conjunction with transportation performance characteristics interact to influence accessibility to destinations as well as time spent traveling and engaging in activities. This study uniquely examines the activity durations undertaken for out-of-home subsistence; maintenance, and discretionary activities. Also examined are total tour durations (summing all activity categories within a tour). Cross-sectional activities are obtained from household activity travel survey data from the Atlanta Metropolitan Region. Time durations allocated to weekdays and weekends are compared. The censoring and endogeneity between activity categories and within individuals are captured using multiple equations Tobit models. The analysis and modeling reveal that land-use characteristics such as net residential density and the number of commercial parcels within a kilometer of a residence are associated with differences in weekday and weekend time-use allocations. Household type and structure are significant predictors across the three activity categories, but not for overall travel times. Tour characteristics such as time-of-day and primary travel mode of the tours also affect traveler's out-of-home activity-tour time-use patterns.

Household type and structure, time-use pattern, and trip-chaining behavior

In order to examine time allocation patterns within household-level trip-chaining, simultaneous doubly-censored Tobit models are applied to model time-use behavior within the context of household activity participation. Using the entire sample and a sub-sample of worker households from Tucson's Household Travel Survey, two sets of models are developed to better understand the phenomena of trip-chaining behavior among five types of households: single non-worker households, single worker households, couple non-worker households, couple one-worker households, and couple two-worker households. Durations of out-of-home subsistence, maintenance, and discretionary activities within trip chains are examined. Factors found to be associated with trip-chaining behavior include intra-household interactions with the household types and their structure and household head attributes.