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Typescript. / Thesis (D.P.H.)--University of Hawaii at Manoa, 1990. / Includes bibliographical references (leaves 205-218). / Microfiche. / xiii, 218 leaves, bound 29 cm

This study addressed the social determinants of health with a specific focus on three factors in the social environment that either individually or collectively have an influence on health status: gender, socioeconomic status (SES), and people's social relationships. The purpose of the study was to examine whether people's social relationships mediate the effects of SES on self-rated health status and to assess whether these effects differ for women and men. The research questions were examined by formulating a theoretical model and evaluating the hypothesized relationships through the use of structural equation modelling. The analyses were conducted using LISREL on data from 1,239 non-First Nations Yukon residents who participated in the Territory's 1993 Health Promotion Survey. The results of this study suggest that household income significantly affected women's and men's health by influencing aspects of their social relationships. A higher overall rating of the quality of one's social relationships was associated with positive health ratings for both women and men while the perception that support would be available if needed significantly affected only women's self-ratings of their health. Received social support was negatively associated with women's health, but not men's, suggesting that the context in which support is received has an important influence on women's health. Relationship strain, as measured by care provided to several sources, was not significantly related to women's or men's health-ratings. The analyses also identify important interrelationships among the dimensions of social relationships studied as well as some gender differences among these relationships. For both women and men, positive evaluations of the importance of social relationships for their health and a greater number of social ties significantly influenced ratings of the overall quality of their social relationships. Having more social ties also positively influenced the perception of availability of social support for both women and men. The quality of their social relationships influenced the perceived availability of social support only for women. Given the focus of provincial and federal governments in seeking reform of their health-care systems, attention to modifiable determinants of health presents an opportunity to contribute to this reform process. The findings of this study contribute to our understanding of the effects of SES on health by providing support for gender interactions in a set of relationships where aspects of people's social relationships mediate the effects of income on health status. These findings provide support for gender-specific mechanisms by which income level influences perceived health status by shaping people's social relationships, the quality of those relationships and the support they offer.

This study addressed the social determinants of health with a specific focus on three factors in the social environment that either individually or collectively have an influence on health status: gender, socioeconomic status (SES), and people's social relationships. The purpose of the study was to examine whether people's social relationships mediate the effects of SES on self-rated health status and to assess whether these effects differ for women and men. The research questions were examined by formulating a theoretical model and evaluating the hypothesized relationships through the use of structural equation modelling. The analyses were conducted using LISREL on data from 1,239 non-First Nations Yukon residents who participated in the Territory's 1993 Health Promotion Survey. The results of this study suggest that household income significantly affected women's and men's health by influencing aspects of their social relationships. A higher overall rating of the quality of one's social relationships was associated with positive health ratings for both women and men while the perception that support would be available if needed significantly affected only women's self-ratings of their health. Received social support was negatively associated with women's health, but not men's, suggesting that the context in which support is received has an important influence on women's health. Relationship strain, as measured by care provided to several sources, was not significantly related to women's or men's health-ratings. The analyses also identify important interrelationships among the dimensions of social relationships studied as well as some gender differences among these relationships. For both women and men, positive evaluations of the importance of social relationships for their health and a greater number of social ties significantly influenced ratings of the overall quality of their social relationships. Having more social ties also positively influenced the perception of availability of social support for both women and men. The quality of their social relationships influenced the perceived availability of social support only for women. Given the focus of provincial and federal governments in seeking reform of their health-care systems, attention to modifiable determinants of health presents an opportunity to contribute to this reform process. The findings of this study contribute to our understanding of the effects of SES on health by providing support for gender interactions in a set of relationships where aspects of people's social relationships mediate the effects of income on health status. These findings provide support for gender-specific mechanisms by which income level influences perceived health status by shaping people's social relationships, the quality of those relationships and the support they offer. / Graduate and Postdoctoral Studies / Graduate

This dissertation focuses on how important factors such as gender inequalities and gender vulnerabilities contribute to fuelling the spread of HIV/AIDS. The study focuses on a community in Phoenix, called Clayfield. The study examines aspects of masculinity, sexual relations, socio-economic vulnerabilities and domestic violence and demonstrates how these elements predispose women and girls to HIV infection. As a result of gender inequalities and imbalances, women are vulnerable to HIV infection. The study also explores how risky behaviour, by both men and women, can escalate women's vulnerability to the disease. The central argument engages discussion on crucial issues around gender imbalances and vulnerabilities. The study concludes with recommendations pertinent to challenging present gender-based initiatives and interventions, and suggests possible gender-sensitive strategies that could assist in curbing the spread of the disease. / Thesis (LL.M.)-University of KwaZulu-Natal, Westville, 2007.

Indiana University-Purdue University Indianapolis (IUPUI) / The pursuit of a healthy lifestyle has become an important activity to large portions of the population. Health information and research has become readily available to the general public via the Internet and other communication vehicles and public health programs. As information becomes accessible, so too does the opportunity for individuals to take added ownership in seeking their own health care. The purpose of this research was to examine the role of gender in the decision that leads to individuals seeking regular health care. It focuses on the motivations that influence men and women when managing their regular preventative care. Despite the disparity in health care utilization between men and women, both positive and negative role models positively influence health and wellness. Constructs of masculinity and femininity continue to impact the utilization of health care procurement. Improving our health and providing a role model for our children offers the greatest potential for improving the health of our nation.

Indiana University-Purdue University Indianapolis (IUPUI) / Gender differences in the basal function of autonomic cardiovascular control are well documented. Consistent baroreflex (BRx) studies suggest that women have higher tonic parasympathetic cardiac activation compared to men. Later in life and concomitant with menopause, a significant reduction in the capacity of the BRx in females increases their risk to develop hypertension, even exceeding that of age-matched males. Loss of sex hormones is but one factor. In female rats, we previously identified a distinct myelinated baroreceptor (BR) neuronal phenotype termed Ah-type, which exhibits functional dynamics and ionic currents that are a mix of those observed in barosensory afferents functionally identified as myelinated A-type or unmyelinated C-type. Interestingly, Ah-type afferents constitute nearly 50% of the total population of myelinated aortic BR in female but less than 2% in male rat. We hypothesized that an afferent basis for sexual dimorphism in BRx function exists. Specifically, we investigated the potential functional impact Ah-type afferents have upon the aortic BRx and what changes, if any, loss of sex hormones through ovariectomy brings upon such functions. We assessed electrophysiological and reflexogenic differences associated with the left aortic depressor nerve (ADN) from adult male, female, and ovariectomized female (OVX) Sprague-Dawley rats. Our results revealed sexually dimorphic conduction velocity (CV) profiles. A distinct, slower myelinated fiber volley was apparent in compound action potential (CAP) recordings from female aortic BR fibers, with an amplitude and CV not observed in males. Subsequent BRx studies demonstrated that females exhibited significantly greater BRx responses compared to males at myelinated-specific intensities. Ovariectomy induced an increased overall temporal dispersion in the CAP of OVX females that may have contributed to their attenuated BRx responses. Interestingly, the most significant changes in depressor dynamics occurred at electrical thresholds and frequencies most closely aligned with Ah-type BR fibers. Collectively, we provide evidence that, in females, two anatomically distinct myelinated afferent pathways contribute to the integrated BRx function, whereas in males only one exists. These functional differences may partly account for the enhanced control of blood pressure in females. Furthermore, Ah-type afferents may provide a neuromodulatory pathway uniquely associated with the hormonal regulation of BRx function.

Indiana University-Purdue University Indianapolis (IUPUI) / While the majority of chronic pain patients report receiving inadequate care, there is evidence that female and Black patients receive less analgesic medications and treatment for their chronic pain compared to male and White patients, respectively. While treatment disparities have been evidenced in the literature, there is little understanding of provider-factors, such as their decision-making awareness and attitudes, which may contribute to the differences in treatment. This investigation employed quantitative and qualitative procedures to examine the relationship between patient demographics and chronic pain treatment variability, providers’ awareness of these non-medical influences on their decisions, and the extent to which providers’ gender and racial attitudes associate with their treatment decisions. Twenty healthcare trainees made pain treatment decisions (opioid, antidepressant, physical therapy, pain specialty referral) for 16 computer-simulated patients presenting with chronic low back pain; patient sex and race were manipulated across vignettes. Participants then selected among 9 factors, including patient demographics, to indicate which factors influenced their treatment decisions for the simulated patients and completed gender and racial attitude measures. After online study completion, follow-up semi-structured interviews were conducted to discuss the medical/non-medical factors that influence trainees’ clinical treatment decisions. Quantitative analysis indicated that 5%-25% of trainees were actually influenced (p<0.10) by patient sex and race in their treatments, and on the whole, trainees gave higher antidepressant ratings to White than Black patients (p<.05). Fifty-five percent demonstrated concordance, or awareness, between their actual and reported use of patient demographics. Follow-up McNemar’s test indicated trainees were generally aware of the influence of demographics on their decisions. Overall, gender and racial attitudes did not associate with trainees’ treatment decisions, except trainees’ complementary stereotypes about Black individuals were positively associated with their opioid decisions for White patients. During qualitative interviews, aware and unaware trainees discussed similar themes related to sex and racial/ethnic differences in pain presentation and tailoring treatments. We found that (1) a subset of trainees were influenced by patient sex and race when making chronic pain treatment decisions, (2) trainees were generally aware of the influence of patient demographics, and (3) trainees discussed differences in pain presentation based on patients’ sex and ethnic origin. These findings suggest trainees’ are influenced by patient demographics and hold stereotypes about patient populations, which may play a role in their decision-making.