Objectives We first sought to assess if bicyclist typology was associated with health. Second, we investigated whether bicyclist typology was related to health through physical activity and commute bicycling. Finally, we sought to develop profiles of disposition toward commute bicycling following proposed changes to a specific destination and the significance of pertinent covariates. Methods Data from the 2014 Georgia State University-Bicycling Survey were used. We first estimated the adjusted odds of worse health-related quality of life by bicyclist typology. A mediation model was then used to estimate the relative total and direct effects of bicyclist typology on health-related quality of life and relative indirect effects through physical activity and commute bicycling. A finite mixture modeling approach was used to identify latent classes of disposition toward whether proposed changes to a specific destination would increase likelihood of commute bicycling. The manual 3-Step protocol was used to assess the effect of covariates on the probability of latent class membership. Results Respondents who had never bicycled, were not motivated to commute bicycle, and who required greater bicycle facilities to feel comfortable commute bicycling had higher odds of worse health-related quality of life. Physical activity and, to a lesser extent, commute bicycling status mediated the effect of bicyclist typology on health-related quality of life. The seven-class solution was decided on as the “best” model for disposition toward whether proposed destination improvements would increase the likelihood of commute bicycling. Several covariates were identified that impact the probability of latent class assignment. Conclusions Initial evidence of a health disparity by bicyclist typology was revealed. Physical activity appears to serve as the primary means through which bicyclist typology has an effect on health. Urban environments that make physical activity, including commute bicycling, more comfortable for a larger proportion of the population may be a potential important health intervention. Understanding the patterns of disposition toward whether proposed destination improvements would increase the likelihood of commute bicycling may assist in targeting and prioritizing commute bicycling-related interventions toward subpopulations of interest.

Background: The sexually transmitted infections (STIs), chlamydia and gonorrhea, disproportionately affect racial and ethnic minorities. Community attributes like poverty and prevalence of STIs, along with residential segregation and its impact on composition of sexual networks contribute to these disparate rates. The Southeast had the highest rates of chlamydial and gonorrheal infection among the four regions of the United States. Because relationships between race and place can confound national statistics, it is important to examine whether racial disparities within the region are associated with higher rates of infection. Purpose: The study aims to evaluate local geospatial clustering of gonorrhea and chlamydia rates in the Southeast, and their persistence during 2000-2005 and any associations with residential segregation, income inequality, unemployment and uninsured rates, and race. Methods: Using the Local Indicators of Spatial Association tests of spatial clustering, cluster maps were created for each STI outcome and year. Independent sample t-tests were then used to examine the difference in means of each community level variable across counties composing the high-rate clusters and all other counties in the region. Results: Over 60% of counties composing high-rate clusters persisted as high rate clusters over time, and were significantly associated with higher levels of community disadvantage than all other counties (p < 0.01). Overall gonorrhea rates decreased from 2000 to 2005 and chlamydia rates increased, while their associations with community disadvantage remained persistently strong over time. Conclusions: Counties with higher rates of chlamydia and gonorrhea persist over time and experience persistently higher levels of residential segregation and income inequality, as well as higher unemployment and uninsured rates, and higher proportions of blacks in the population. The social environment and segregated sexual networks may play important roles in the persistently high rates of chlamydia and gonorrhea observed for certain regions within the Southeast. Continued surveillance of reportable STIs and their probable predictors is needed in order to better understand the persistent disparities in STI rates across counties in the Southeast.

The purpose of the present study was to examine how low-income, racial and ethnic minority, urban families experience and manage their child’s asthma. The rationale for this study stems from existing literature on asthma disparities and documented predictors of increased asthma morbidity and mortality. In particular, this study considered how specific types of stress may disproportionately impact low-income, racial and ethnic minority, urban families that have a child with asthma. This study aimed to determine associations between urban stressors (stressful life events, perceived discrimination, subjective socioeconomic status) and child asthma outcomes (emergency department visits, school days missed, asthma control), and considered depressive symptoms and asthma self-efficacy as mediators in these associations. Analyses were conducted in a sample of 97 urban caregivers and their children in Richmond, Virginia. Findings revealed that neighborhood stress was significantly associated with asthma control. Stressful life events were significantly associated with school days missed. Perceived discrimination and subjective SES were not significantly related to any child asthma outcomes. Bootstrapping procedures demonstrated that child depressive symptoms mediated the relation between neighborhood stress and asthma control. Child asthma self-efficacy did not significantly mediate associations between neighborhood stress and any child outcomes. Caregiver depressive symptoms and caregiver asthma self-efficacy did not significantly mediate any associations between caregiver-reported urban stressors and child asthma outcomes. Results from the present study suggest that urban stressors, especially neighborhood stress and stressful life events, are important to consider in the context of child asthma management and subsequent health outcomes. Exposure to urban stressors may further contribute to pediatric asthma disparities because they are disproportionately experienced by low-income, racial and ethnic minority, urban families. Each urban stressor that was related to a child outcome was associated with a particular asthma outcome. Specifically, child-reported neighborhood stress was related to asthma control. Caregiver-reported stressful life events were associated with school days missed. These findings suggest that exposure to specific types of stress may impact asthma management differently. Future research should, therefore, explore the impact and contribution of specific stressors in greater depth. Further, child depressive symptoms significantly mediated the relation between neighborhood stress and asthma control, although caregiver depressive symptoms did not significantly mediate any associations between urban stressors and child asthma outcomes. Additionally, both child and caregiver depressive symptoms were significantly associated with multiple urban stressors and child asthma outcomes. Depressive symptoms may, therefore, be important to target in future research as possible explanatory variables or variables that contribute to stress appraisals and child asthma outcomes.

Master of Science / Department of Journalism and Mass Communications / Nancy Muturi / Health disparities are prevalent among ethnic minorities, including immigrants in the United States. These disparities come in the form of low health insurance, low social economic status, ethnic discrimination, language and cultural barriers. As ethnic minorities, international students also suffer from numerous health problems that are associated with their lower social, economic and immigration status when they come to the United States. Health communication is an effective tool for increasing health literacy and for reducing health disparities. Applying the uses and gratification theory and the staged model of trust, the study was conducted among 120 American students and 135 international students to examine the extent to which access to health information, the type of information accessed, how they use it, and how they determine what trustworthy information is differed between the two groups. Key findings indicate that nutrition is the most common health topic accessed online by college students regardless of place of origin. Though both groups access online health information with the same motivation of information, they use online health information in different situations. Source credibility is the most important factor for college students in determining trustworthy health websites, and government websites and other health organization websites were found to be more trustworthy. The study also provides both theoretical and practical implications, which include consideration of ethnic backgrounds in disseminating health information through online channels and understanding the needs and motivation for people’s access to health information and how they use it to be able to meet those needs. In designing health communication campaigns that target college students, the study proposes that the differences between native-born and international students need to be taken into consideration.

Thesis advisor: Stephanie Berzin / A growing body of evidence shows that sexual minority youth disproportionately suffer from poor mental health and substance abuse outcomes in comparison to their heterosexual peers. Parental support has been found to be a strong protective factor for these youth. There is a lack of research, however, that examines the role of non-parental adult support, such as natural mentors (e.g., teachers, grandparents, and coaches). Guided by minority stress and resiliency theories, the current study aims to deepen our understanding of whether natural mentors act as a resilience resource for sexual minority youth. The current study uses the National Longitudinal Study of Adolescent to Adult Health (Add Health) restricted-use dataset. This is a large, nationally representative sample of both heterosexual (n=12,667) and sexual minority youth (n=1,413), ages 18 to 26. Variable-centered (i.e., multiple regression analysis with moderation) and person-centered (latent class analysis) statistical techniques were utilized to explore the effect of the presence and characteristics of natural mentoring relationships on a range of mental health and substance abuse outcomes. Results show that natural mentors have a similar relationship with health outcomes, regardless of sexual orientation. Perceived closeness is a critical characteristic of the mentoring relationship, exhibiting significant associations with depression, suicide ideation, self-esteem, life satisfaction, and binge drinking. Furthermore, those who have lifelong, close relationships with non-parental adult family members receive the most benefit. It is noteworthy that sexual minority youth are significantly less likely to have a permanent family mentor. Rather, they are more likely to have mentors from high school with whom they lack closeness as they transition into adulthood. Several suggestions for individual and school-based interventions to assist sexual minority youth in developing and maintaining long-term relationships with non-parental adult family members are discussed. The current study emphasizes the importance of supporting and advocating for greater policy change that will directly address minority stressors that sexual minority youth face. Findings from the current study make a significant contribution to the social work field by extending our knowledge regarding resiliency among sexual minority youth and offering concrete avenues for intervention. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

The aim of this study was to explore the Health Service Utilization (HSU) of homeless people in Dublin. In particular, it sought to identify a critical realist explanatory model for why the HSU of homeless people differs from that of the general population. Critical realist (CR) ethnography was used as the research methodology and was supplemented with forty-seven semi-structured interviews and two focus groups. The HSU of homeless participants in Dublin is described. When compared to the domiciled population, homeless people were found to have a tendency to present late on in their illness, to have higher utilization of primary care services and lower utilization of secondary care services and to avoid psychiatric services. The factors that influenced participants HSU tendency are identified as external or internal influences on HSU. External factors are described as physical, administrative or attitudinal barriers or deterrents; or external promoters of health service usage. Internalised inhibitors and promoters are illustrated as either cognitions or emotions that are developed in reaction to external circumstances and which either negatively or positively impact on health service usage. Interactions between health professionals and participants that resulted in exclusion (by the health professional or self-exclusion) are described as Conversations of Exclusion. A critical realist model was outlined that offers an explanation for why homeless people’s HSU differs from that of the general population in Dublin. This model included a description of the generative mechanisms identified as producing the HSU tendencies in the study population. The implications of this new model are discussed in the light of the literature and previous models that seek to explain the HSU of homeless people.

The purpose of this thesis is to ethnographically explore the social life of health reform policy. This thesis focuses on the Ponce Center, a safety net HIV clinic in Atlanta. The thesis engages with a fragmented healthcare world, and the inhabitants of these worlds who are charged with rectifying the fragmentation and make care possible. They are, in technical language, service providers, whether they are policy-makers, patients, or political activists. In order to make the healthcare and policy worlds functional, the AIDS community in Atlanta perceive their first task as attempting to connect aspects of the fragmented healthcare assemblage that are otherwise disparate. The core theme of this thesis is articulations, translations, and piecing together aspects of everyday life particularly with regard to various ways of contending with fragmentation. This thesis explores the relationship between the affective, ideological, physical and structural dynamics of inequality, poverty, vulnerability, identity, and a sense of community and belonging. This thesis is about the policy processes. It does not focus on policy-making, but policy interpretation, implementation, and enactment in Atlanta, Georgia. The thesis tracks the appropriation and contestation of the Affordable Care Act (ACA) as a site of interaction between the experience of HIV as a pre-existing condition, inequitable access to treatment through health insurance, and larger social policy and poverty discourses. Finally, it considers the processes by which major policy reforms draw in disparate actors, who are embedded in complex networks of power and resource relations - assemblages - and inevitably play a role in reshaping society.

No description available.

The UpliftU® program is a long-term residential program for women and families who are homeless or at risk for homelessness. This program is one part of a larger, community-based non-profit organization serving low-income and homeless families in Hillsborough County, Florida for over 35 years. This program is not an emergency shelter program, but rather offers up to 18 months of participation in a self-sufficiency program to single women and families. The goal of the program is to prevent future homelessness for residents by helping them to reach their highest level of self-sufficiency. After volunteering at this organization for nine months, I completed an internship as the Health Specialist Case Manager for the UpliftU® program during the summer of 2008. The internship was conducted using ethnographic research methods to understand counseling team members' and resident mothers' perceptions of access to health care resources and their experiences in utilizing area health care services. This thesis compares the perspectives of the counseling team members with the resident mothers' perspectives, and examines barriers to and gaps in service provision, as reported by both groups. Findings from qualitative data analysis suggest that counseling team members conceptualize the barriers to health care as originating at the individual level with resident mothers' behaviors and actions, while resident mothers' expressed that they experience barriers to health care services at interpersonal and institutional levels. Resident mothers described how health professionals and staff treating them poorly leads to barriers to health care at an interpersonal level, and that at an institutional level the bureaucratic hassles associated with public insurance and public clinics also acted as barriers to care. Such differences in perception of causality of barriers to health care services between counseling team members and resident mothers have significant ramifications for resident mothers' health and ability to access health care services.

This dissertation seeks to extend quantitative research on environmental justice and address methodological limitations of previous studies by: (a) using new indicators of exposure to air pollution and contemporary risk modeling techniques; (b) assessing disparities in human health risks, instead of focusing only on potential exposure or proximity to pollution sources; and (c) using multivariate regression models that consider the effects of spatial dependence. The case study examines racial/ethnic and socioeconomic disparities in the geographic distribution of exposure to airborne toxic emissions from industrial point sources in the Houston-Galveston-Brazoria metropolitan statistical area. Industrial pollution sources for this study comprise facilities listed in the US EPA's Toxic Release Inventory (TRI). The Risk-Screening Environmental Indicator (RSEI) model is used to estimate potential human health risks from air pollutants based on data on toxicity and dispersion of chemical releases from TRI facilities. The analyses utilize four indicators of potential exposure to industrial pollution: (a) presence or absence of air emissions, (b) total quantities (pounds) of air emissions, (c) toxicity-weighted quantities of emissions and (d) modeled risk scores based on the cumulative health risk posed by air emissions. Traditional linear regression and spatial autoregressive techniques based on several neighborhood configurations are used to model the occurrence and magnitude of these four indicators, using relevant explanatory variables from the 2000 census, at the census tract and block groups levels of aggregation. Results indicate a disproportionate pattern of health risks from TRI facilities in the HGB-MSA, with the Hispanic population facing the highest exposure. The locations and magnitude of toxic pollution are significantly statistical effected by the presence of minority residents and population density. Additionally, key differences in the significance of explanatory variables between the spatial and conventional regression models demonstrate the importance of correcting for spatial dependence in environmental justice analysis. The analytical results for several variables are also sensitive to the choice of data resolution (tract or block group). Overall, this study indicates that more flexible spatial analytic techniques are required to improve the identification of environmental injustice and past studies utilizing conventional statistical methods should be revisited to explicitly account for spatial effects.