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I-Hua Chen,1,* Pei-Ling Wu,2,3,* Cheng-Fang Yen,4– 6,* Irfan Ullah,7 Sheikh Shoib,8 Shafi Ullah Zahid,9 Aadil Bashir,10 Naved Iqbal,11 Frimpong-Manso Addo,12 Emma Sethina Adjaottor,12 Gifty Boakye Amankwaah,12 Daniel Kwasi Ahorsu,13 Mark D Griffiths,14 Chung-Ying Lin,15– 18 Amir H Pakpour19 1Chinese Academy of Education Big Data, Qufu Normal University, Qufu City, Shandong, People’s Republic of China; 2School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 3Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan; 4Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; 5Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan; 6College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, 91201, Taiwan; 7Kabir Medical College, Gandhara University, Peshawar, Pakistan; 8Sheikh Shoib Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, India; 9Department of Neurosurgery, Jamhuriat hospital, Kabul, Afghanistan; 10Department of Social Work, University of Kashmir, Kashmir, India; 11Department of Psychology, Jamia Millia Islamia, New Delhi, India; 12Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 13Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; 14International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 15Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 16Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 17Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 18Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 19Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden*These authors contributed equally to this workCorrespondence: Emma Sethina Adjaottor; Chung-Ying Lin, Tel +233 20 816 85080 ; +886-6-2353535-5106, Fax + 886-6-2367981, Email eadjaottor.chs@knust.edu.gh; cylin36933@gmail.comPurpose: The percentage of individuals who were fully vaccinated against COVID-19 was 53% worldwide, 62% in Asia, and 11% in Africa at the time of writing (February 9, 2022). In addition to administrative issues, vaccine hesitancy is an important factor contributing to the relatively low rate of vaccination. The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S) was developed to assess COVID-19 vaccination acceptance levels. However, it has only been tested among Taiwanese, mainland Chinese, and Ghanaian populations (Chen et al, 2021; Fan et al, 2021; Yeh et al, 2021). Therefore, the present study examined the construct validity and measurement invariance of the MoVac-COVID19S among individuals from five countries (ie, Taiwan, mainland China, India, Ghana, and Afghanistan).Participants and Methods: A cross-sectional survey study recruited 6053 participants across five countries who completed the survey between January and March 2021. Confirmatory factor analysis (CFA) fit indices were used to examine factor structure and measurement invariance across the five countries.Results: The fit indices of the CFA were relatively good across the countries except for the root mean square error of approximation (RMSEA). Moreover, the four-factor structure (either nine or 12 items) had a better fit than the one-factor structure. However, the four-factor model using nine MoVac-COVID19S items was the only model that had measurement invariance support for both factor loadings and item intercepts across the five countries.Conclusion: The present study confirmed that the MoVac-COVID19S has acceptable psychometric properties and can be used to assess an individual’s willingness to get COVID-19 vaccination.Keywords: factor structure, vaccine hesitancy, young adults

Irfan Ullah,1 Assad Ullah,2 Sher Ali,3 Petra Poulova,4 Ahsan Akbar,5 Muhammad Haroon Shah,6 Alam Rehman,7 Muhammad Zeeshan,8 Fakhr E Alam Afridi3 1Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 2School of Economics, Henan University, Kaifeng, People’s Republic of China; 3Department of Economics, Islamia College Peshawar, Peshawar, Pakistan; 4Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, 500 03, Czech Republic; 5International Business School, Guangzhou City University of Technology, Guangzhou, 510080, People’s Republic of China; 6College of International Students, Wuxi University, Wuxi 214105, Jiangsu, People’s Republic of China; 7Faculty of Management Sciences, National University of Modern Languages, Islamabad, Pakistan; 8College of Business Administration, Liaoning Technical University, XingCheng, Liaoning Province, 125105, People’s Republic of ChinaCorrespondence: Ahsan AkbarInternational Business School, Guangzhou City University of Technology, Guangzhou, 510080, People’s Republic of ChinaEmail akbar@gcu.edu.cnObjective: The provision of healthcare facilities remains high on the manifesto of various political parties in Pakistan and healthcare spending has witnessed a significant surge in the last two decades that is expected to positively influence health outcomes in the country. Therefore, this research aims to explore the effects of healthcare expenditures on the actual health status of the masses in Pakistan for the period 1995Q1 to 2017Q1.Methods: We apply the Quantile Autoregressive Distributed Lag (QARDL) approach for estimation purposes. This is the most recent and emerging estimation technique in time series analysis.Results: Our findings confirm that public healthcare spending significantly impacts health outcomes in Pakistan both in the short-run and long-run. Public healthcare spending improves life expectancy and reduces death rate and infant mortality.Conclusion: The study concludes that public healthcare is the main focus of the current regime. It is noticed that spending on healthcare significantly contributes to the health outcomes in Pakistan. These efforts by the government significantly promote life expectancy and drop down the mortality ratio in the country. Based on these notable facts, the government should allocate sufficient resources towards the latest healthcare technologies and equipment to optimize health outcomes in the country.Keywords: healthcare spending, health outcomes, healthcare technologies, Quantile cointegration, QARDL, Pakistan

Muhammad Imran Shah,1 Irfan Ullah,2 Xiao Xingjian,2 Huang Haipeng,2 Alam Rehman,3 Muhammad Zeeshan,4 Fakhr E Alam Afridi5 1School of Mathematics and Statistics, Wuhan University, Wuhan, People’s Republic of China; 2Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 3Faculty of Management Sciences, National University of Modern Languages Islamabad, Islamabad, Pakistan; 4College of Business Administration, Liaoning Technical University, XingCheng, Liaoning Province, 125105, People’s Republic of China; 5Islamia College Peshawar, Peshawar, PakistanCorrespondence: Irfan UllahReading Academy, Nanjing University of Information Science and Technology, People’s Republic of ChinaEmail irfnecon@nuist.edu.cnObjective: This study investigates life expectancy and trade openness in China for the period 1960– 2018.Methods: We purposed a theoretical model that is tested for China by applying regime-switching regression.Results: Our findings suggest that trade openness increases life expectancy in China; trade affects life expectancy from two aspects; firstly, trade expansion and industrialization lead to high economic activities and resulted in raise the income of the people in society leading to improve life expectancy. Secondly, industrial expansion increases the CO2 emissions which leads to imposes a negative implication on human health and thus reduces life expectancy.Conclusion: Thus, the net effect of trade liberalization depends on the value of income effect and volume of CO2 emissions. Therefore, the government needs to support the trade policies which causes a low level of CO2 emissions, the government may provide incentives to exports and industrialists to adopted green energy in the production process. Besides, the government may impose some regulations such as carbon tax to mitigate the CO2 emissions in society.Keywords: trade, life expectancy, CO2 emissions, health quality, regime-switching regression, China

Muhammad Zeeshan,1 Jiabin Han,1 Alam Rehman,2 Irfan Ullah,3 Fakhr E Alam Afridi4 1College of Business Administration, Liaoning Technical University, Xingcheng, Liaoning Province, 125105, People’s Republic of China; 2Faculty of Management Sciences, National University of Modern Languages, Islamabad, Pakistan; 3Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 4Islamia College Peshawar, Peshawar, PakistanCorrespondence: Alam RehmanFaculty of Management Sciences, National University of Modern Languages, PakistanEmail amrehman@numl.edu.pkObjective: This study investigates the nexus between household health expenditure, CO2 emissions and environmental pollution in China. We analyzed the asymmetric dynamic relationship between CO2 emissions, environmental pollution and household health expenditure for the period 1990 to 2019 in China.Methods: This study adopted nonlinear autoregressive distributed lag (NARDL) and Granger causality following the diagnostic test. Furthermore, we applied Dickey–Fuller (ADF), PP unit root tests, Zivot and Andrews test for structural breaks in our analysis. The NARDL is the most suitable econometric technique for estimations, especially if the asymmetric relationship exists among the variables. NARDL technique is capable to explore the dynamic relationship between CO2 emissions, environmental pollution and household health expenditure.Results: The empirical results verify the asymmetric nexus between CO2 emissions, environmental pollution and household health expenditure in the context of China. The outcomes revealed that in the short run and long run positive shocks of CO2 emissions and environmental pollution positively affecting health expenditure, while negative shocks reduce health spendings. The results also demonstrate bi-directional causality among household health spendings, CO2 emissions and environmental pollution.Conclusion: Our results support many previous studies, documenting that CO2 emissions positively contribute to the amount of household health expenditure, confirming the asymmetric relationship between CO2 emissions and household health expenditure. The results also confirm the statistically significant and asymmetrically positive relationship between environmental pollution and household health expenditure. This implies that Chinese residents have to bear more household health expenditure, in the case of more CO2 emissions and a greater amount of environmental pollution.Keywords: CO2 emissions, environmental pollution, household health expenditure, China

Ahsan Akbar,1 Alam Rehman,2 Irfan Ullah,3 Muhammad Zeeshan,4 Fakhr E Alam Afridi5 1International Business School, Guangzhou College of South China University of Technology, Guangzhou 510080, People’s Republic of China; 2Faculty of Management Sciences, National University of Modern Languages, Islamabad, Pakistan; 3Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 4College of Business Administration, Liaoning Technical University, XingCheng, Liaoning Province 125105, People’s Republic of China; 5Islamia College Peshawar, Peshawer, PakistanCorrespondence: Alam RehmanFaculty of Management Sciences, National University of Modern Languages, Islamabad, PakistanEmail amrehman@numl.edu.pkObjective: Most of the Southeast Asian countries witnessed remarkable economic growth in the last few decades. Trade is a primary factor in achieving this exponential economic progress in these countries. Besides, the positive implications of trade, it has associated cost of escalated energy consumption, CO2 emissions, and resulting health complications which leads to higher public health expenditures. This study examines the nexus between trade liberalization, energy consumption, CO2 emissions, and health expenditures in Southeast Asian countries for the period of 1991 to 2018.Methods: The empirical methods used in this study entail diagnostic testing, correlation analysis, and structure equation modeling (SEM) technique. SEM is an advanced multivariate analysis technique that can test complex multivariate causal associations among a set of variables. Therefore, it is the most suitable econometric approach to explore the dynamic association between trade openness, energy consumption, CO2 emissions, and health expenditures.Results: The empirical results reveal a nexus between trade openness, energy consumption, CO2 emissions, and health expenditure in Southeast Asian countries. Nevertheless, pollutant emissions have a direct impact on health expenditures, whereas trade and energy consumption shows an indirect influence on the escalation in public health spending in sample Southeast Asian countries. Moreover, the mediating path of each indirect effect is energy consumption.Conclusion: These results imply that Southeast Asian countries heavily rely on fossil energy to fuel economic growth. Hence, to promote sustainable and eco-friendly economic development, the respective governments need to reform their energy sectors by tapping into renewable energy resources and deploy green technologies to reduce pollutant emissions for the development of a healthy society. In addition, governments should levy taxes on highly polluting industries so as to curtail carbon emissions and resulting health expenditures.Keywords: trade liberalization, energy consumption, CO2 emissions, health expenditures, Southeast Asia

Objective: This study investigates life expectancy and trade openness in China for the period 1960-2018., Methods: We purposed a theoretical model that is tested for China by applying regime-switching regression., Results: Our findings suggest that trade openness increases life expectancy in China; trade affects life expectancy from two aspects; firstly, trade expansion and industrialization lead to high economic activities and resulted in raise the income of the people in society leading to improve life expectancy. Secondly, industrial expansion increases the CO 2 emissions which leads to imposes a negative implication on human health and thus reduces life expectancy., Conclusion: Thus, the net effect of trade liberalization depends on the value of income effect and volume of CO 2 emissions. Therefore, the government needs to support the trade policies which causes a low level of CO 2 emissions, the government may provide incentives to exports and industrialists to adopted green energy in the production process. Besides, the government may impose some regulations such as carbon tax to mitigate the CO 2 emissions in society., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Shah et al.)

Objective: This study investigates the nexus between household health expenditure, CO 2 emissions and environmental pollution in China. We analyzed the asymmetric dynamic relationship between CO 2 emissions, environmental pollution and household health expenditure for the period 1990 to 2019 in China., Methods: This study adopted nonlinear autoregressive distributed lag (NARDL) and Granger causality following the diagnostic test. Furthermore, we applied Dickey-Fuller (ADF), PP unit root tests, Zivot and Andrews test for structural breaks in our analysis. The NARDL is the most suitable econometric technique for estimations, especially if the asymmetric relationship exists among the variables. NARDL technique is capable to explore the dynamic relationship between CO 2 emissions, environmental pollution and household health expenditure., Results: The empirical results verify the asymmetric nexus between CO 2 emissions, environmental pollution and household health expenditure in the context of China. The outcomes revealed that in the short run and long run positive shocks of CO 2 emissions and environmental pollution positively affecting health expenditure, while negative shocks reduce health spendings. The results also demonstrate bi-directional causality among household health spendings, CO 2 emissions and environmental pollution., Conclusion: Our results support many previous studies, documenting that CO 2 emissions positively contribute to the amount of household health expenditure, confirming the asymmetric relationship between CO 2 emissions and household health expenditure. The results also confirm the statistically significant and asymmetrically positive relationship between environmental pollution and household health expenditure. This implies that Chinese residents have to bear more household health expenditure, in the case of more CO 2 emissions and a greater amount of environmental pollution., Competing Interests: The authors report no conflicts of interest for this work., (© 2021 Zeeshan et al.)

Objective: Most of the Southeast Asian countries witnessed remarkable economic growth in the last few decades. Trade is a primary factor in achieving this exponential economic progress in these countries. Besides, the positive implications of trade, it has associated cost of escalated energy consumption, CO 2 emissions, and resulting health complications which leads to higher public health expenditures. This study examines the nexus between trade liberalization, energy consumption, CO 2 emissions, and health expenditures in Southeast Asian countries for the period of 1991 to 2018., Methods: The empirical methods used in this study entail diagnostic testing, correlation analysis, and structure equation modeling (SEM) technique. SEM is an advanced multivariate analysis technique that can test complex multivariate causal associations among a set of variables. Therefore, it is the most suitable econometric approach to explore the dynamic association between trade openness, energy consumption, CO 2 emissions, and health expenditures., Results: The empirical results reveal a nexus between trade openness, energy consumption, CO 2 emissions, and health expenditure in Southeast Asian countries. Nevertheless, pollutant emissions have a direct impact on health expenditures, whereas trade and energy consumption shows an indirect influence on the escalation in public health spending in sample Southeast Asian countries. Moreover, the mediating path of each indirect effect is energy consumption., Conclusion: These results imply that Southeast Asian countries heavily rely on fossil energy to fuel economic growth. Hence, to promote sustainable and eco-friendly economic development, the respective governments need to reform their energy sectors by tapping into renewable energy resources and deploy green technologies to reduce pollutant emissions for the development of a healthy society. In addition, governments should levy taxes on highly polluting industries so as to curtail carbon emissions and resulting health expenditures., Competing Interests: The authors report no conflicts of interest in this work., (© 2020 Akbar et al.)