Do Vaccine Mandates on Childcare Services Work?

Here is the latest paper I have published with Ang Li that provides an evaluation of No Jab No Play policies that have been enacted in a series of Australian states.  Here is the title and abstract: 

 Title:  

Vaccine mandates on childcare entry without conscientious objection exemptions: A quasi-experimental panel study

 Abstract: 

Objectives

Examine the effect of No Jab No Play policies, which linked vaccine status to childcare service entry without allowing for personal belief exemptions, on immunisation coverage.

Study design

Immunisation coverage rates from the Australian Immunisation Register were linked to regional level covariates from the Australian Bureau of Statistics between January 2016 and December 2019. Differential timings of policy rollouts across states were used to assess changes in coverage with the implementation of policies with generalised linear models. Quantile regression and subgroup analysis were also conducted to explore the variation in policy responses.

Results

Baseline mean vaccination rates in 2016 were 93.4% for one-year-olds, 91.2% for two-year-olds and 93.2% for five-year-olds. Increases in coverage post-policy were significant but small, at around 1% across age groups, with larger increases in two and five-year-olds. Accounting for aggregate time trends and regional characteristics, implementation of the policies was associated with improved full immunisation coverage rates for age one (post-year 1: 0.15% [95 %CI–0.23; 0.52]; post-year 2: 0.56% [95 %CI 0.05; 1.07]), age two (post-year 1: 0.49 [95 %CI: 0.00; 0.97]; post-year 2: 1.15% [95 %CI: 0.53; 1.77], and age five (post-year 1: 0.38% [95 %CI 0.08; 0.67]; post-year 2: 0.71% [95 %CI 0.25; 1.16]. The policy effect was dispersed and insignificant at the lowest quantiles of the distribution of immunisation coverage, and smaller and insignificant in the highest socioeconomic areas.

Conclusion

Findings suggest that No Jab No Play policies had a small positive impact on immunisation coverage. This policy effect varied according to prior distribution of coverage and socio-economic status. Childcare access equity and unresponsiveness in high socioeconomic areas remain concerns.

 

What are the mental health benefits of stable housing for private renters?

New paper by Ang Li, Emma Baker, and Rebecca Bentley has been published in Social Science and Medicine, looking at how stable and secure tenancy affects the mental health and level of psychological distress of private renters compared to home owners. The results suggest that stability helps to close the mental health gap between those two groups by increasing renters well being at a faster rate overtime. This is interesting to me for two reasons: 1) it suggests that ontological security is more important than tenure type. It isn't necessarily homeownership that is protective of mental health. 2) it underscores the relationship between housing and mental health, and that the rights of tenants should be considered a public health issue. 

Here is the abstract for 'Understanding the mental health effects of instability in the private rental sector: A longitudinal analysis of a national cohort': 

Using a population-based longitudinal dataset in Australia over nearly 20 years, this study examines the impact of tenure instability on mental health and psychological distress among a low-income working-age population. The analysis compares private renters (who are notable for their relative tenure insecurity in the Australian context) and homeowners with similar sociodemographic characteristics. To enhance group comparability and address the presence of time-varying covariates that confound and mediate the relationship between tenure exposure and mental health, marginal structural models were used applying weights estimated cumulatively over time. The results show that while private rental tenants report worse mental health than homeowners initially (mental health difference: Beta = −5.29, 95%CI −7.61 to −2.97; psychological distress difference: Beta = 1.77, 95%CI 0.55 to 2.99), this difference diminishes to become statistically indistinguishable by 5–6 years of occupancy (mental health difference at year 6: Beta = −2.09, 95%CI −4.31 to 0.13, predicted mental health increases: from 65.06 to 69.83 for private renters and from 70.46 to 72.02 for homeowners; psychological distress difference at year 5: Beta = 0.81, 95%CI −0.09 to 1.71, predicted psychological distress decreases: from 19.85 to 18.04 for private renters and from 17.95 to 17.10 for homeowners). Residential stability is particularly beneficial for private renters in early middle adulthood (35–44 years), with each additional year of stable occupancy for private renters correlated with a 0.99 (95%CI 0.46 to 1.53) increase in mental health and a −0.47 (95%CI −0.69 to −0.24) decrease in psychological distress. The findings provide evidence that stable and secure rental tenure is protective of mental health, and the mental health of stable renters becomes comparable to that of homeowners over time. This adds support for housing policies that promote and improve the stability and security of rental tenure.

This demonstrates another dimension to how the housing system effects our life chances and health outcomes.