The purpose of this study is to investigate the program focus and contributing factors to program composition of five health promotion programs for seniors. The programs are selected using opportunistic sampling from five different local areas in metropolitan Vancouver. The five areas together constitute metropolitan Vancouver. A theoretical framework based on health promotion as a process which enables people to take control of their health promotion programming and recognizes that social, political, and organizational interventions are as important as individual actions, is used to support the purpose of this study. An ethnographic approach is used to collect observational, interview and documentary data on program focus, process and organization. The data are analyzed qualitatively to further the understanding of health promotion as a process central to individual and group empowerment in program focus and organization. The findings confirm that these programs focus predominantly on individual behaviour change efforts and only minimally on underlying environmental and community change factors. In the process of examining these health promotion programs for seniors, themes emerged which shed light on which factors most influence program composition. Program organization and process which involves multiple historical, theoretical and organizational factors are seen to most heavily influence program composition. / Graduate and Postdoctoral Studies / Graduate

Masters in Public Administration - MPA / The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level. / South Africa

No description available.

In two empirical articles, this dissertation investigates how a college organization of black men used the concept of brotherhood to foster personal social mobility among members. Both chapters take advantage of two years of fieldwork and interviews with group members. The first article (chapter 2) explores the process whereby a group of black men on a college campus used the concept of brotherhood to create their own emotion culture. In order to support their emotional and social needs without jeopardizing their manhood status, group leaders promoted brotherhood among their new recruits to encourage emotional expressiveness, vulnerability, and trust. By providing one another with support under the ideology of brotherhood, group members were able to construct an emotion culture to help group members cope with the discrimination they faced as socially mobile black men in predominantly white institutions. In the second article (chapter 3) I analyze how a group of collegiate black men came together as a brotherhood to adopt and present professional behaviors and styles in order to navigate professional settings. These behaviors were designed to evoke in potential employers, campus administrators, faculty, and other students images of positive black men that have been celebrated culturally. As a group of young black men with professional aspirations, group members sought to develop professional self-presentation strategies, and present these presentations to the broader community. Overall, this research shows how group members fostered personal social mobility by providing one another with support and teaching professional behaviors that benefited them during their time in college. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2013. / June 11, 2013. / Black Men, College, Emotions, Gender, Race, Social Mobility / Includes bibliographical references. / Douglas Schrock, Professor Directing Dissertation; Patrick L. Mason, University Representative; Irene Padavic, Committee Member; John Reynolds, Committee Member.

This study used social engagement theory to examine the relationship between attending worship services and the trajectories of physical decline among Mexican American elders. Data for this study came from eight waves of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE), a representative panel study of Hispanic elders across five states conducted from 1992-2006. First, linear growth curve models were used to examine the cross-sectional and longitudinal association between attending worship services and physical limitations. Findings from this study highlighted the independent affect of attending worship services at baseline for reducing the onset and development of physical disability among Mexican American elders. Second, this dissertation explored if gender moderated the association between attending worship services and physical disability at baseline and over time. Findings from this dissertation suggest that the health benefit of attending worship services varies across gender. At baseline, attending worship services protected against health limitations among women but not for men. Over time, baseline attendance at worship services tended to benefit men more than women. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2013. / May 31, 2013. / Heatlh, Race, Religion / Includes bibliographical references. / Jill Quadagno, Professor Directing Dissertation; Patrick Mason, University Representative; Amy Burdette, Committee Member; Koji Ueno, Committee Member.

Objectives and Theoretical Framework This study addresses the social dynamics of associations between chronic inflammation and quality of life in older adults, as well the ability of social factors to cause inflammatory disease. It builds on growing evidence in sociological and clinical literatures that chronic inflammation has negative net effects on quality of life across the life course, as well as negative indirect effects via social mechanisms (Hamer and Chida 2011; Lal 2006; Marnell et al. 2005; Testa and Simonson 1996; Sprangers et al. 2000; Epel et al. 2004; Finch and Crimmins 2004; Willson et al. 2007). Biomarkers are used to capture inflammatory pathology, ensuring that people with rare inflammatory conditions are included and thus avoiding many of the challenges presented by the diagnosis data used in previous research (Mirowsky and Ross 1989; Mirowsky and Ross 2003; Crimmins and Seeman 2001). Using this more inclusive method for studying people with chronic inflammation, elaboration models are created to explore how social factors influence the consequences and causation of chronic inflammation. Methods and Data Sources Data from Wave I of the National Social Life, Health, and Aging Project (NSHAP) are used to examine relationships between levels of the inflammatory biomarker C-reactive protein and two different sets of quality of life outcomes. Because many inflammatory diseases are present at birth, studying older adults can reveal long-term effects from living with chronic inflammation (Geronimus 1992). Quality of life is measured in two ways: self-ratings of satisfaction with life in general (happiness, enjoyment of life, and sadness), and self-ratings of satisfaction with intimate relationships (overall happiness, physical satisfaction, and emotional satisfaction). Three types of social factors are examined: structure variables (age, race, sex, income, education), sociomedical sequelae (disability, pain, diagnosis), and process factors (communication and social support, relationship participation). The unique role of each of these elements of social life is explored via mediation, moderation, and fundamental causation analyses. All analyses use ordinal logistic and ordinary least-squares regression techniques as theoretically and mathematically indicated. Findings reveal how chronic inflammation may entrench and even foster social inequality. Key Findings Bivariate models suggest that total effects of chronic inflammatory biomarker levels on quality of life are significant and negative, indicating that chronic inflammation can decrease satisfaction with life and relationships. However, effect significance varies somewhat depending on the measure used; the effects of chronic inflammation on quality of life may thus be sensitive to slight differences between domains of psychosocial experience. Each additional milligram per liter of C-reactive protein appears to reduce the odds of reporting high levels of quality of life between 7 and 10 percent for the following outcomes: overall happiness, happiness with intimate relationships, physical satisfaction with relationships, and emotional satisfaction with relationships. Including sociomedical, interactional, and sociodemographic variables reveals inconsistency in the effects of different social attributes and processes. Associations between emotional quality of life and chronic inflammation may be partially mediated by sociomedical sequelae and social relationship factors. Associations between relational quality of life and chronic inflammation appear to be partially mediated by social relationships, but not by sociomedical sequelae. In both cases, dynamics related to partner intimacy may play an important mediating role. Social structure factors do not appear to moderate overall associations between chronic inflammation and quality of life. However, these constructs do demonstrate consistent ability to predict both emotional and relational outcomes when incorporated into models containing C-reactive protein as the main predictor. Likewise, both social structure and relationship factors may play a role in causing chronic inflammation. Extant research and theory from both sociological and clinical disciplines support these findings, and recommend multiple strategies for further study. Significance and Future Directions Using biomarker data to measure inflammation status reveals important information about how chronic inflammation may impact psychosocial quality of life. Looking at a variety of quality of life outcomes in tandem suggests that several individual domains of emotional and relational quality of life may be especially vulnerable to detrimental effects from chronic inflammation, and that these negative effects occur through different social pathways. Emphasizing social structure and relationship factors that shape relationships between inflammation and different quality of life outcomes can illuminate specific ways that chronic inflammation may predispose people to psychosocial disadvantage and/or exacerbate existing social inequalities. Relational processes, especially those related to participation in and dynamics of intimate partnerships, may be more important than social structures in shaping the effects of chronic inflammation on quality of life. Likewise, further research is needed to explore how different social factors may fundamentally cause chronic inflammation. Future scholarship on these topics can contribute immensely to understanding of both social inequality and medical risk. Finally, effects of chronic inflammation are likely underestimated due to very small samples of people with extremely high C-reactive protein levels; more data on these individuals are thus needed. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2013. / September 3, 2013. / Biosocial Research, Chronic Conditions, Inflammation, NSHAP, Quality of Life, Social Relationships / Includes bibliographical references. / Jill S. Quadango, Professor Directing Dissertation; Neil H. Charness, University Representative; Miles G. Taylor, Committee Member; John R. Taylor, Committee Member.

The concept of sustainability is theoretically comprised of three distinct dimensions: environmental, economic, and social. Most public and academic discourse, however, focuses on environmental and economic sustainability to the neglect of social sustainability, which refers to a condition where an extended set of basic needs are met for all residents regardless of their race/ethnicity, age, religion, gender, socioeconomic status and/or level of ability and the highest possible level of social inclusion and participation in community life is promoted. While some scholars and policymakers have recently turned their attention to social sustainability, conceptualizing and assessing social sustainability is fraught with problems. In this dissertation, I develop a comprehensive social sustainability assessment framework that focuses on six key policy areas: housing, transportation, food, leisure and recreation, social cohesion, and identity and sense of place. I then incorporate data on Vancouver, Seattle, and Portland into the social sustainability framework in order to conduct a comparative analysis of the cities' relative degree of social sustainability. My analysis--which brings both qualitative and quantitative data to bear on 30 social sustainability criteria--indicates that Vancouver is ranked higher than Seattle and Portland in terms of social sustainability. I then adapt and use two sociological theories of policy development--institutional politics theory and power constellations theory, which tend to focus on the national or state level--to test which one better explains the differential level of social sustainability in the aforementioned cities. In short, I find that power constellations theory best explains why Vancouver has the most socially sustainable policies and programs, primarily due to the strength of organized labor and center-left political parties in the city. Overall, this dissertation contributes to research on social policy development and social sustainability and provides scholars and policymakers with a deeper understanding of the institutional and political determinants of social sustainability. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2014. / May 30, 2014. / Comparative-Historical Analysis, Institutional Politics Theory, Power Constellations Theory, Social Sustainability, Urban Policy / Includes bibliographical references. / Douglas Schrock, Professor Directing Dissertation; Andy Opel, University Representative; Jill Quadagno, Committee Member; Daniel Tope, Committee Member.

Marital status significantly shapes individuals' psychological well-being, though more is known about its effect on negative than positive dimensions. This study examines the association between marital status and psychological well-being across negative and positive dimensions, using data from two waves of the Midlife in the United States Survey (MIDUS 1995-1996 and 2004-2006). Compared with prior studies, my research examines a more comprehensive set of indicators of psychological well-being: depression, autonomy, environmental mastery, personal growth, positive relations with others, self-acceptance, and purpose in life. I further examine how the associations between marital status and these dimensions of psychological well-being vary by age. I use three analytic samples to examine the cross-sectional associations and effects over time: Wave 1 sample (n=2,801), Wave 2 sample (n=1,737), and panel data containing respondents in both waves (n=1,657). Although the results vary across the two waves and between cross-sectional and panel analyses, results of Ordinary Least Regression (OLS) models indicate that, compared with those in other marital statuses, married adults tend to have better psychological well-being, including less depression and greater self-acceptance and positive relations with others. Differences among the married also are found, with remarried adults reporting more autonomy than continuously married adults. Using the multiple-group structural equation modeling (SEM), the results showed that the association between marital status and psychological well-being only holds for middle-aged adults (45≤age≤60). These findings of variation in the association between marital status and psychological well-being across not only dimensions of well-being but also age groups highlights the importance of further research examining sources of variation and explanations for them. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2014. / July 2, 2014. / Age variation, Marital Status, Mental health, Multiple-group, Psychological well-being, Structural Equation Modeling / Includes bibliographical references. / Anne E. Barrett, Professor Directing Dissertation; Ming Cui, University Representative; Isaac W. Eberstein, Committee Member; Koji Ueno, Committee Member.

Summary in English. / Bibliography: pages 122-126. / This dissertation studies the delivery of health care to street children. ft investigates the existing street children's facilities and the health system in Ang of a in order to determine an appropriate type of health facilities for the special health needs of these children. The study was based on a review of bibliographic material on street children and related subjects. The findings from this review were tested through a series of interviews with professionals working with street children in Angola and with ~treet children randomly selected from shelters and on the streets in Luanda. The questionnaires were designed for evaluation of the street children's facilities, the health system and to determine street children's preferences and attitudes towards formal institutions in a context where th'e main cause of family disintegration was war. The study concluded that street children's health needs in Angola would be better catered for through independent primary health centres provided with partial in-patient services (temporary sf eeping and eating facilities for children under medical care). These centres would serve mainly children with no access to shelters and those living in shelters without health centres. The study formulates guidelines and presents a design example of the type offacifity proposed.

In 2011 the National Academy of Medicine identified research gaps related to transgender populations and suggested a research agenda that included, among other goals, investigating health outcomes related to transition related care. The overarching goal of this dissertation therefore is to add to the body of knowledge about the state of health of transgender individuals, including utilization of gender-affirming care, preventive care and screening practices for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This dissertation includes three manuscripts. The first is a retrospective chart review including 1670 transgender patients, aged 18 and up (mean age 35.57 years), at a community health center to examine utilization of gender-affirming procedures as well as investigate the prevalence of smoking and uptake of colon cancer screening compared to New York City benchmarks using data from the New York City Community Health Survey (NYC CHS). The results revealed transgender individuals had high uptake of gender affirming hormones (81.9%) but fewer had undergone gender-affirming surgeries (31.5%). Transgender individuals had almost double the rate of current cigarette smoking compared to adults aged 18 and up in the New York City Community Health Survey (OR=1.92, 95% CI=1.61, 2.28) and also had suboptimal colon cancer screening rates compared to New Yorkers aged 50 and older (OR=0.16, 95% CI=0.11, 0.23). The second paper is a scoping review of the literature to investigate postoperative outcomes related to vaginoplasty procedures in transgender women. One hundred and three articles met inclusion criteria and provided information on immediate as well as long term health outcomes. The review demonstrated many inconsistencies in the timing of follow-up as well as how outcomes were measured, but provided invaluable information on the many types of postoperative issues that may be seen after vaginoplasty surgery. Lastly, the third paper examined the prevalence of HIV and STI testing behavior and prevalence of HIV infection among transgender people in a community health center setting. This analysis demonstrated that HIV screening rates were lower than expected (55.7%) given the elevated HIV prevalence in the population. In the multivariate analysis the odds of HIV screening among transmasculine individuals was higher in those who had undergone gender affirming surgeries (OR=1.67, 95% CI= 1.08, 2.58), had a substance use history (OR=5.18, 95% CI=1.41, 18.99) and a history of genital warts (OR=4.64, 95%CI=1.24, 17.34). Among transfeminine individuals the odds of HIV screening were higher in those with only cisgender male partners (OR=2.18, 95% CI=1.52, 3.11), gender affirming surgery (OR=2.56, 95% CI=1.53, 4.31), substance use history (OR=2.76, 95% CI=1.23, 5.78) and genital warts (OR=2.69, 95% CI=1.20, 6.02). HIV prevalence was higher among transfeminine compared to transmasculine individuals (28.1% vs. 2.8%, p<.001). In the multivariable analysis having only cisgender male sex partners increased the odds of HIV infection among transmasculine individuals (OR=10.58, 95% CI=1.33, 84.17), while having at least a high school diploma reduced the odds of infection (OR=0.08, 95% CI=0.01, 0.72). Among transfeminine individuals increased odds of HIV-infection were seen in those who were unemployed (OR=1.7, 95% CI=1.1, 2.64) and those who had a history of genital warts (OR=2.54, 95% CI=1.37, 4.70). White individuals had a lower likelihood of HIV infection (OR=0.40, 95%CI=0.21, 0.73). Overall these three studies provide important information about transition-related, primary and preventive healthcare for transgender populations. The findings of elevated cigarette smoking, underutilization of colorectal cancer screening and low HIV and STI screening rates occurred in this study despite the fact that transgender people were engaged in medical care. Clinics and other health settings that provide transgender health services should include robust metrics for monitoring uptake of preventive health care services and work to improve uptake of services when disparities are evident.