Thesis (Trabajador Social Rural)--Universidad de San Carlos de Guatemala. / Includes bibliographical references (p. 57-58).

Thesis (Ph. D.)--Syracuse University, 2009. / "Publication number AAT 3381604."

Thesis (Ph. D.)--Syracuse University, 2005. / "Publication number AAT 3194020."

Thesis (PH.D.) -- Syracuse University, 2006 / "Publication number AAT 3251810."

<p> The Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every three years, formulate implementation strategies, and report yearly to the IRS and the public the progress of their work. The IRS CHNA incentivizes hospitals to provide programs responsive to community health needs. The purpose of this study was to examine the relationship between community benefit programs and prioritized community health needs in the context of a national IRS reporting requirement through analysis of published community benefit reports among North Carolina&rsquo;s (NC) tax-exempt hospitals. </p><p> This study employed quantitative research that analyzed longitudinal and cross-sectional data; qualitative research that reviewed published documents; and mixed-methods research that analyzed the integrated quantitative and qualitative results. The findings indicate that performing IRS-mandated CHNA did not substantially increase the alignment of community benefit programs with prioritized community health needs but did clearly highlight those needs. NC tax-exempt hospitals continue to focus on providing patient care financial assistance than population health, a strategy misaligned with community health needs. Although the hospitals are beginning to address population health and access to care concerns, their dollar expenditures in these areas paled in comparison to patient care financial assistance. If the IRS&rsquo; purpose in mandating CHNA was to spur a shift in community benefit priorities toward population health needs and away from the traditional patient care financial assistance, then, the evidence from 4 years after the requirement&rsquo;s implementation, indicates it is currently failing in North Carolina. As elucidated in the articles, their ingrained patient-level intervention perspective and desire to recover high unreimbursed costs or lost revenues for providing care to Medicare, Medicaid, and poor patients likely influence the hospitals&rsquo; community benefit programming to favor individual welfare over population health. Nevertheless, policymakers should continue to direct community benefit programs toward population health because it is a step in the right direction. Organizational change takes time and the desired results of policy interventions are usually incremental. Thus, conducting CHNA must remain a legal obligation by non-profit hospitals for maintaining their privileged tax status to facilitate organizational paradigm shift in community benefit programming toward population health programs or community building activities and away from individual welfare.</p><p>

<p> This study explored the perceived effects of microaggressions on Peer Support Specialists (PSS). Although some research exists on the perceived effects of microaggression on individuals with lived experience of mental illness, known culturally as a marginalized group (Sue, 2010); none exists on PSS. The mental health movement began in the early 1900&rsquo;s, which later evolved into mental health recovery and psychiatric rehabilitation. This movement brought forth the development of psychopharmacology, supportive services, and mental health programs. During the early phases of mental health recovery and treatment, individuals with lived experience of mental illness were utilized as peers and eventually as peer support specialists, or liaisons. Peer support specialists (PSS) provide an invaluable resource to individuals struggling with mental illness, as the literature supports. Despite strides towards societal acceptance, individuals with mental illness, continue to experience discrimination, stigma and microaggressions. Research on historical trauma, although beyond the scope of this research will be reviewed to provide an understanding of how microaggressions are passed on and additionally a narrative review of Adverse Childhood Experiences (ACEs) and the Connor-Davidson Resilience Scale (CD-RISC-25), aimed to contribute to the understanding of the history of trauma, engagement, and recovery. This research qualitatively explored the experience of sixteen participants who are PSS and in active recovery of mental illness. Semi structured focus group interviews revealed five major themes: Category 1&ndash;Microinvalidation: (1.1) Invalidation; (1.2) Second Class Citizen; Category 2&ndash;Resilience: (2.1) Advocacy; (2.2) Belonginess; (2.3) Perseverance.</p><p>

<p> Caregivers&rsquo; compliance with polio vaccine regimens and timely receipt of the recommended 4 doses of polio vaccine are pivotal to eliminating polio. This cross sectional study, conducted in Lagos State, Nigeria, examined polio vaccine compliance and demographic attributes of caregivers&rsquo; for statistically significant associations. Using an adapted health belief model theoretical framework, 1,200 participants were recruited from well-baby clinics in 8 local government areas in Lagos State. Participants completed a brief demographic survey providing data on caregivers&rsquo; age, gender, residence (rural or urban), and their level of education as well as records from their children&rsquo;s immunization cards. Data obtained were tested for associations between caregiver&rsquo;s demographic information and their children&rsquo;s receipt of polio doses within specified timelines using chi-square and logistic regression analysis. Fisher&rsquo;s exact analysis were conducted for variables with frequencies less than 5. The only significant association recorded was between the receipt of Polio Dose A and location of caregivers&rsquo; residence: Rural dwelling caregivers were less likely to receive the first dose of polio. Results showed Polio Dose D to be the dose most likely received in an untimely manner as well as most likely missed of the 4 doses. Logistic regression analysis did not show any variable to be of greater odds in predicting completion of the 4 doses or compliance with timelines of their receipt. Study&rsquo;s results may inspire polio program planners to develop interventions that broaden the immunization coverage for rural dwellers to include nontraditional maternity locations. Positive social change will ensue by the improvement caregivers&rsquo; compliance with full polio dose receipts with timelines, maximizing immunity. </p><p>

This three-essay dissertation examines racial disparities in infant health outcomes and exposure to air pollution in Texas. It also asks whether the EPA's Risk-Screening Environmental Indicators Geographic Microdata (RSEI-GM) might be used to assess the effects of little-studied toxic air pollutants on infant health outcomes. Chapter 1 contributes to the “weathering” literature, which has shown that disparities in infant health outcomes between non-Hispanic black and non-Hispanic white women tend to widen with age. In this study, we ask whether the same patterns are observed in Texas and among Hispanic women, since other studies have focused on black and white women from other regions. We find that black and Hispanic women in Texas do “weather” earlier than white mothers with respect to rates of low birthweight and preterm birth. This differential weathering appears to be mediated by racial disparities in the distribution and response to socioeconomic risk factors, though a large gap between black and white mothers across all ages remains unexplained. Chapter 2 extends the statistical environmental justice literature by examining the distribution of toxic air pollution across infants in Texas. We find that, within Texas cities, being black or Hispanic is a significant predictor of how much pollution one is exposed to at birth. We further find that, among mothers who move between births, white mothers tend to move to significantly cleaner areas than black or Hispanic mothers. In Chapter 3, we use geocoded birth records matched to square-kilometer pollution concentration estimates from the RSEI-GM to ask whether the pollution-outcome relationships that emerge through regression analysis are similar to the effects found in previous research. If so, the RSEI-GM might be used to study the health effects of nearly 600 chemicals tracked in that dataset. We conclude, based on instability of results across various specifications and lack of correspondence to previous results, that the merged birth record-RSEI data are not appropriate for statistical epidemiology research.

The conversion of publicly owned industries and services into privately owned assets has been one of the most radical and controversial global economic trends of the past three decades. The major underlying rationale for this conversion is that public ownership is inherently economically inefficient. This point of view not only ignores the substantive evidence that disapproves this claim, but it also fails to recognize the merits of public ownership in promoting social welfare and health. Public ownership—in the form of public employment—does the latter in two ways: first, by providing employees with better and more equal benefits and working conditions than does the private sector, and second, by ensuring the smooth delivery of affordable quality social services to the public at large. This study quantitatively evaluates the impact of public employment on health at both the national and the individual level. At the national level, a cross-country sample from the 1980s shows that an increase of public sector employment was associated with a statistically and economically significant increase in life expectancy—a major indicator of population health. The association was even more prominent for middle- and low-income countries and for women. At the individual level, using logistic regression on data from a 2006 Chinese household survey, this study finds that public sector employees were statistically more likely to report good or excellent health than private sector employees. Analysis of the data reveals that much of this health premium is attributable to the fact that the public sector provides more permanent jobs than the private sector. Further, the private sector appears to have steep social class-health gradients, while such health inequality is moderate or even absent within the public sector. As a complement to the quantitative findings, this study also conducts a qualitative survey of China’s institutional and social context. It helps to further explain why the public sector in China remains a better employer after the collapse of the “iron rice bowl” system. Several policy implications emerge from this study. First, public sector employment deserves serious consideration as an instrument to promote health and health equality. Second, job security is essential for health; proposals for a more flexible and less regulated labor market are neither theoretically nor empirically justified. And last but not least, if the public sector continues its recent practice of implementing neoliberal policies, such as privatization and deregulation, its health premium over the private sector may go away.

The theory selected as the potential framework for better explaining teenage pregnancy, among a cohort of health-insured sexually active teens, was Social Bond Theory. With this theoretical framework in mind, eight research questions were generated, with the primary focus of interest in determining the correlation between ten social bond scale scores to outcome status (deliver, abort and contracept). A 50-item survey instrument was developed for purposes of this research utilizing original and existing demographic and social bond questions. The questionnaire was adapted for use with a CATI system of telephone interviewing, pretested and finally administered to a total of 213 teenage respondents. Results from the stepwise multiple regression analysis showed that among the respondents who sustained a pregnancy, significant differences existed between the deliver and abort groups. The deliver group was more highly religious (p =.001) and more likely to have come from a family of lower socioeconomic status (p =.001) than were the respondents from the abort group. When comparing the abort and contracept respondents, the only significant difference was that the abort group was less connected with family than were the contraceptors (p =.02). For all demographic measures and all remaining social bond measures, these two groups of respondents were not significantly different. Lastly, it was determined that the young women most likely to be teenage mothers among the study respondents were those who were less hopeful about the future (p =.005), were less involved in school-related activities (p =.018), were more religious (p =.023) and were more likely to be of non-white racial/ethnic status (p =.015) than those who successfully contracepted.