Conectar
by Ahmed Usama Fahim, Atika Aboni, Shirajoom Munira, Nishat Tasnim Toosty
IntroductionChild discipline, while intended to instill appropriate behavior, often manifests as violent practices in low- and middle-income countries, including Bangladesh. Maternal exposure to violence, attitude towards intimate partner violence (IPV), and disciplinary beliefs serve as key determinants of physical disciplinary practices. These dynamics illustrate how exposure to violence in adulthood can shape parenting behaviors, highlighting the urgency of addressing cultural attitudes that sustain harsh physical discipline.
Materials and methodsThis study analyzed nationally representative cross-sectional data from the 2019 Bangladesh Multiple Indicator Cluster Survey (MICS) which included 30044 mother-child (children aged between 2 and 14 years) pairs. Physical disciplinary practice is analyzed as an ordered outcome, considering maternal experience of physical violence as the primary exposure along with their attitudes toward IPV and disciplinary beliefs as mediators. This study used ordinal logistic regression within a structural equation modeling framework and bootstrapping technique to analyze indirect associations, providing robust inference that accounts for sampling variability and accommodates binary mediators.
ResultsMothers exposed to violence had significantly higher odds of physically disciplining their children (odds ratio, OR=1.77 and 95% confidence interval, CI=[1.60, 1.95]). Three mediators significantly increased the odds of adopting harsh physical disciplinary practice by 2% through maternal positive attitudes toward IPV, by 51% through their disciplinary beliefs, and by 6% through their overall life satisfaction. The total association indicated that maternal exposure to violence nearly tripled the odds (OR = 2.89 and 95% CI= [2.52, 3.31]) of physical disciplinary practices.
ConclusionThis study suggested that supportive environment for children can be fostered by reducing violence against women, promoting mothers’ life satisfaction, and reshaping women’s perceptions of spousal abuse and disciplinary beliefs.
To examine the association between socioeconomic status (SES), financial subsidies and awareness-related factors such as age, cancer stage and family history, and the uptake of cancer genetic testing, with a focus on equitable access to care.
Retrospective cohort study.
Tertiary care cancer genetics service in Singapore.
The study population included 2687 individuals of all ages, genders and ethnicities who attended pretest counselling between 2014 and 2020 and were eligible for genetic testing for hereditary cancer syndromes.
The primary outcome was the uptake of genetic testing. The main explanatory variables were SES (proxied by Housing Index), subsidy status, age, cancer stage and family history. Analyses examined whether associations varied across SES and age subgroups.
Receipt of financial subsidies was strongly associated with testing uptake (adjusted OR 9.15, 95% CI 2.68 to 31.20). Uptake exceeded 90% among subsidised individuals across all socioeconomic strata, compared with 56–68% among non-subsidised individuals, with the largest gains in the lowest SES group (43 vs 28 percentage points (pp) in the highest). The level of subsidy was not associated with uptake. Younger patients (18–39 years) had higher uptake than those aged 60+ (66% vs 57%); patients with advanced cancer (stage IV) had the highest uptake (82% vs 57–66% in earlier stages); and family history was associated with increased uptake, strongest for having a child with cancer (+28 pp). Interaction analysis suggested that the additive effects of subsidies were greatest in lower SES groups and in older adults.
Financial subsidies were strongly associated with higher genetic testing uptake. Awareness indicators like age, cancer stage and family history were associated with higher uptake. The association between subsidies and uptake varied by SES and age, suggesting that subsidies may help reduce disparities and improve equitable access to genetic testing services.
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