Introduction: Domestic research studies focused on the interrelationships between political ideology characteristics inherent in policy decisions and the contributions these political determinants exert over health indicators and outcomes are limited. Given the paucity of research that focuses on political and policy support of health at the county-level, this study sets out to utilize the University of Wisconsin Population Health Institute’s (UWPHI) annual County Health Rankings data and examine them within the context of county-based majority political partisanship and economic measures. Methods: This exploratory ecological study examined differences between independent variables: partisan voting behavior (trichotomized as conservative, moderate, and liberal) and median per capita household income in U.S. dollars (by quartile) on dependent variables related to mortality (years of productive life lost) and morbidity (number of poor mental and physical health days) at the county-level to compare differences in political and ideological underpinnings that may act as influencers on health outcomes. Multiple data sources were combined and matched to all 3,140 counties located in the U.S. Two-way between-subjects ANOVA statistical tests were conducted to determine if there is an effect of partisan voter index category on the three aforementioned dependent variables related to health outcomes, and median per capita income by quartile. Results: There was a statistically significant main interaction between median per capita household income by quartile and partisan voter index category on years of productive life lost, F(6,2789) = 19.3, p < .000, partial η2 = .040. While there were also statistically significant interactions between the independent and dependent variables of poor mental and physical health days, results of those analyses should be interpreted with caution. Pertaining to years of productive life lost, post hoc analyses of significant interactions revealed significant differences at the lower income quartile, but not in the expected direction. The conservative category had statistically significant lower years of productive life lost in comparison to the liberal category (M = -8.21, SE = 1.47, p = .000). Also, there were significant differences detected in the upper quartile suggesting that the liberal category has lower years of productive life lost in comparison to the conservative category (M = 7.06, SE = 1.06, p = .000). Conclusion: Results should be interpreted with caution and suggest more research and methodological refinements are needed, particularly related to categorizing county-level political dynamics.

Background: This study analyzes local wellness policies of 176 Georgia public school systems. The purpose of the study was to analyze potential relationships between demographic characteristics of Georgia school systems and compliance with the Child Nutrition and WIC Reauthorization Act of 2004, as well as the strength of wellness policy goals in the areas of nutrition, physical activity, and other school-based activities. Methods: Demographic data from the Georgia Department of Education were used as independent variables. Compliance ratings and the strength of wellness policy goals were derived from an evaluation tool developed by a research team at Georgia State University’s Institute of Public Health as part of a project contracted by the Georgia Department of Education. Analysis was conducted using Pearson’s correlation (two-tailed), crosstabulation, and linear regression. Results: Statistically significant positive associations were found between academic performance and strength of overall wellness policy goals (p < .05), as well as goals in the areas of nutrition education and other school-based activities (p < .01). Economic status of the student population was found to be positively associated with the strength of nutrition education goals (p < .05). No statistically significant associations were identified between demographic characteristics of school systems and physical activity goals. No associations were identified between involving community stakeholders in wellness policy development and having more comprehensive wellness policy goals. Conclusions: This study found statistically significant evidence of districts with stronger academic performance having more comprehensive overall wellness policy goals and stronger goals specifically in the areas of nutrition education and other school-based activities goals. Findings should assist the Georgia Department of Education in allocating its limited resources to help school systems improve wellness in public schools throughout Georgia. Recommendations are made to strengthen federal and state policy regarding school wellness, to conduct more research regarding the influence of community involvement on school wellness, and to provide guidance to local school systems having less resources and lower student academic performance in order to ensure health disparities are not further exacerbated.

The purpose of this capstone is to develop a program to address health literacy among African American adults. The social cognitive theory and the health belief model was used to create a model of an age appropriate, culturally sensitive program with a pre and post test to improve the health literacy in this population. The Community Health Literacy Improvement Program (CHIP) is a pilot program that will consist of a four week didactic intervention focused on combating prose, document, and quantitative health illiteracy. This program will be implemented through a community based nonprofit organization. Participants who complete the CHIP program will be able to identify risk factors for chronic diseases, assess their ability to avoid chronic diseases, and be able to locate community health resources. This proposed intervention will show that community based nonprofit organizations have an important role to play in building community buy in and establishing the agency necessary for community based, culturally sensitive programs such as CHIP to succeed.

<p>In 2010, approximately 84% of the American population lives in a metropolitan area. Different metropolitan areas are characterized by distinct labor markets and economies, housing markets and residential patterns, socioeconomic and demographic factors, and according to some, even distinct 'spirits.' The nature and influence of such structural factors lie at the heart of urban sociology, and have particularly profound effects on patterns of racial and ethnic stratification. This dissertation examines new urban structural changes arising within recent decades, and their implications for racial/ethnic stratification. Specifically, I study the transition to the 'new economy' and racial/ethnic wage inequality; increases in the level and inequality of housing prices and racial/ethnic stratification in homeownership; and increased income inequality, combined with population aging, and racial/ethnic disparities in disability and poor health. I measure metropolitan-level structural factors and racial/ethnic inequalities with data from 5% samples of the 1980, 1990, and 2000 Censuses; the 2010 American Community Survey (ACS); and the 1999-2001 and 2009-2011 Current Population Surveys (CPS). Cross-sectional multilevel regression models examine the spatial distributions of structural factors and racial/ethnic inequality, and the fixed-effects regression models identify the impact of changes in structural factors over time on observed trends in racial stratification. Additionally, I distinguish between effects on minority-white gaps in resource access, and minorities' levels of resource access. This dissertation also makes novel contributions to the field by empirically documenting complex patterns of inequalities among the country's four largest racial and ethnic groups. Perhaps most relevant to theories of racial stratification, this dissertation demonstrates seemingly race-neutral structural changes can have racially stratified effects. </p><p>Chapter 1 describes the foundational literature in urban sociology and racial/ethnic stratification, and provides an overview of the subsequent chapters. Chapter 2 measures the transition to the `new economy' with six structural factors of labor markets: skill-biased technological change, financialization, the rise of the creative class, employment casualization, immigration, and deunionization. Overall, the results indicate the observed Latino-white wage gap may be up to 40% larger in 2010 than in the theoretical absence of the new economy, and the black-white wage gap may be up to 31% larger. Chapter 3 focuses on the long-term trend toward higher and more unequally distributed home prices within local housing markets, epitomized by the housing crisis of the late 2000s. Increases in housing market inequality worsen the Asian-white homeownership gap, but narrow the black-white and Latino-white gaps. However, the level of homeownership is reduced for all groups. Chapter 4 empirically tests the frequently-debated Income Inequality Hypothesis, that macro-level income inequality undermines population health, and hypothesizes any negative effect on health is stronger in areas with greater population aging. The results provide no support for the Income Inequality Hypothesis or any of its proposed extensions, but the chapter's analytic approach may be fruitfully applied to future examinations of structural determinants of health. The theoretical and substantive conclusion of the dissertation is that metropolitan areas represent salient, and changing structural contexts that significantly shape patterns racial/ethnic stratification in America.</p> / Dissertation

Individuals diagnosed with schizophrenia commonly experience problems with accurately assessing their health status due to cognitive deficits including impaired working memory, amotivation, and communication difficulties. Little is known about whether these deficiencies influence health behavior decision-making among individuals with schizophrenia. Individuals with schizophrenia die an average of 25 years earlier than those without a mental illness. Approximately 60% of premature deaths in this population are from medical comorbidities; mortality rates due to cardiovascular and pulmonary diseases are two to three times higher than the general population. In order to reduce morbidity and mortality, it is important to find effective ways to assist these individuals in modification of risky behaviors (e.g., smoking, poor dietary habits, and sedentary lifestyles) and to incorporate daily health promoting behaviors (e.g., balanced diet and regular exercise). This qualitative descriptive study was conducted to describe the decision-making processes used by adults with schizophrenia when making health behavior decisions, identify what it means to be healthy from the perspectives of adults with schizophrenia, and identify the perceived barriers and facilitators that affect health behavior decisions. Ten adults diagnosed with schizophrenia were interviewed for this study. Fifty-percent of participants were female, ages 28 to 59 years, and received treatment in a community mental health centers. Data were analyzed using content analysis. Methods included the use of field notes, open and axial coding, and development of a visual model. Trustworthiness of the findings was established through the qualifications and experience of the investigator, peer scrutiny, and member checks. Three phases of health behavior decision making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. The main category that described health behavior decision making was “Tracking Health Behaviors,” which resulted in the ability to maintain physical and mental health. Within each phase, specific actions associated with achieving and maintaining physical and mental health were identified and were displayed in a visual model. These findings provide a guide to clinicians in identifying health behavior decision making processes and may lead to the design of clinical interventions that improve the health status of adults with schizophrenia.

The purpose of this study was to determine the role of acculturation in the food consumption patterns of low income Hispanic women living in Texas and enrolled in the Women, Infants, and Children (WIC) Program by testing the following hypotheses: a) There are significant differences in consumption of fruit and vegetables by selected socio-demographic variables; and, b) less healthy food consumption patterns are associated with higher levels of acculturation in health-related research involving low-income Hispanic women living in Texas. A secondary-data analysis of the responses to the Texas Food & Nutrition (TEXFAN) questionnaire was performed. TEXFAN is a 122-item survey designed to measure WIC participants' consumption behaviors and to assess the impact of new food packages in Texas' WIC program. A total of 3,336 adult, non-pregnant women self-identified as having Hispanic ethnic background of all races were considered for this study. Analysis of Variance and Kruskal-Wallis tests showed significant differences in nutritional practices among Hispanic women for age, educational attainment, employment status, race, area of residence, and acculturation. Logistic Regression analysis confirmed the hypothesis that lower levels of acculturation are associated with healthier food consumption patterns. The majority of respondents (70.7%, N=2,358) did not consume the recommended five servings of fruits and vegetables a day; therefore, do not have healthy patterns of food consumption. Consequently, the majority of respondents (70.0%, N= 1,709) has a weight statuses above normal and at a higher proportion than women in the State of Texas and the nation. Acculturation continues to interest social and behavioral researchers but variations on conceptualization, definition, operationalization, and measurement negatively impact generalizability and applicability of results. Interventions not considering acculturation are not likely to be successful. Research has to include community, ecological, cultural and contextual factors (e.g., machismo, accessibility to sidewalks, availability of fresh healthy foods, etc.). Development of effective intervention programs should be aimed to increase consumption of healthy food and an adherence to the recommendations of the "Healthy Plate" and the "Dietary Guidelines for Americans 2010" among Hispanics. Also, interventions should generate necessary skills among Hispanics for empowering them to sustain proper nutritional behaviors and overcome barriers.

In 2013 Burma, the country of origin for many refugees of whom have resettled in the U.S. was in the top three countries for notification of suspected Latent Tuberculosis Infection (LTBI). Approximately 5%-10% of individuals diagnosed with LTBI are at risk of developing active tuberculosis (TB) disease; the highest risk occurs within two years following the diagnosis. Burmese refugees face a high potential of developing LTBI during resettlement in the U.S. and are at high risk for subsequent TB. Currently, we have limited knowledge of the Burmese Chin refugees' explanatory model (EM) of LTBI. Understanding the EM of these refugees is important because one's EM facilitates the recognition and response to illness, including early diagnosis and treatment. In the context of LTBI, this relates to the potential prevention of active TB disease. The purpose of this ethnographic study was to discover the Burmese Chin refugees' EM of LTBI and to describe the barriers experienced in receiving LTBI treatment. Kleinman's EM provided a conceptual framework to guide this study. A Burmese refugee gatekeeper assisted with community immersion and participant recruitment. Purposive and snowball sampling were used to recruit participants. Data were collected through participant observation and semi-structured interviews. Three data analysis strategies for ethnography that were used included domain, taxonomic, and componential analyses. Domain analysis began after open, inductive coding of the data. Data saturation was reached and the research questions were answered with eight participants. Data from 15 key informant interviews were abstracted into three domains: EM of LTBI, Fear and Stigmatization, and Barriers to Receiving LTBI Treatment. The over-arching theme, LTBI: My Shadowbox was derived from these three domains, 11 categories, and 25 subcategories through iterative and inductive data analysis. The analysis revealed the participants' language, behavior patterns, beliefs, values and health seeking experiences of LTBI in the U.S. The findings from this study will help to inform culturally tailored interventions to reduce LTBI and TB health disparities among Burmese Chin refugees and potentially other Burmese refugee subgroups in the U.S. Knowledge of the Burmese Chin refugees' EM of LTBI can inform health policy for reducing LTBI treatment barriers.

abstract: Native American communities face an ongoing challenge of effectively addressing cancer health disparities, as well as environmental racism issues that may compound these inequities. This dissertation identified the shared cultural knowledge and beliefs about cancer in a southwest American Indian community utilizing a cultural consensus method, an approach that combines qualitative and quantitative data. A community-based participatory research (CBPR) approach was applied at all stages of the study. The three phases of research that were undertaken included: 1) ethnographic interviews - to identifying the themes or the content of the participants' cultural model, 2A) ranking of themes - to provide an understanding of the relative importance of the content of the cultural model, 2B) pile sorts - identify the organization of items within specific domains, and 3) a community survey - access whether the model is shared in the greater community. The cultural consensus method has not been utilized to date in identifying the collective cultural beliefs about cancer prevention, treatment or survivorship in a Native American community. Its use represents a methodological step forward in two areas: 1) the traditional ethnographic inferences used in identifying and defining cultural meaning as it relates to health can be tested more rigorously than in the past, and 2) it addresses the challenge of providing reliable results based on a small number of community informants. This is especially significant when working with smaller tribal/cultural groups where the small sample size has led to questions concerning the reliability and validity of health-related research. Results showed that the key consultants shared strong agreement or consensus on a cultural model regarding the importance of environmental and lifestyle causes of cancer. However, there was no consensus found among the key consultants on the prevention and treatment of cancer. The results of the community survey indicated agreement or consensus in the sub-domains of descriptions of cancer, risk/cause, prevention, treatment, remission/cure and living with cancer. Identifying cultural beliefs and models regarding cancer could contribute to the effective development of culturally responsive cancer prevention education and treatment programs. / Dissertation/Thesis / Ph.D. Anthropology 2011

BACKGROUND: Over recent decades, the nationwide prevalence of chronic disease among children and adolescents has been on the rise. Conditions such as obesity pose a significant risk to the physical and mental health of individuals in youth as well as in adulthood, as these health risks track into later years and increase in severity. Low-income and racial/ethnic minorities are disproportionately affected by chronic conditions. In particular, African American (AA) youth are reported to have a higher prevalence of fair/poor health than their Caucasian peers. Compounding the effects of this racial disparity in health is the disparity AA youth face in SES, as many live in poverty. The individual and environmental influences associated with factors of race and SES contribute to negative health behaviors leading to poor health status among AA youth living in disadvantaged communities. Health disparities have been shown to manifest in the earliest years of life, therefore the monitoring of at-risk populations of children and adolescents is essential to identifying, addressing, and reducing poor health outcomes throughout the course of life. OBJECTIVE: To determine the health status of AA children and adolescents living in a low-income community using multiple health measures, examine the relationships between these health measures in AA youth, as well as to identify barriers to participation in a family-oriented health promotion program. METHODS: A total of 111 AA boys and girls attending a community fine arts program located in a low-income suburb of Chicago participated in the study. Data from anthropometric measurements, the 20-m Shuttle Run Test, and curl-ups were collected and analyzed to assess the health measures of Body Mass Index (BMI) and BMI Percentile, Cardiorespiratory Fitness (CRF), and Muscular Fitness (MF), respectively. Data pertaining to barriers encountered in attending a health promotion program were collected from 13 families who were active members of the community fine arts program and had participated in health promotion program. The cross-sectional survey consisted of questions pertaining to the different components of the intervention program as well as to family demographic information. RESULTS: The prevalence of overweight and obesity in the entire study population was 34.2%, with 31.6% of boys and 34.8% of girls being classified as overweight/obese. 16.2% of youth categorized specifically as obese, with 26.3% of boys and 15.2% of girls being obese. 43.9% of study participants aged 10-18 years needed improvement in CRF, all of whom were girls. All but one boy reached the healthy fitness zone for curl-ups. Significant positive correlations were found between BMI and age as well as curl-ups and age, and significant negative correlation was found between CRF and age as well as BMI and CRF for AA youth. Of reported barriers, scheduling conflicts and time constraints were consistently most listed by survey respondents. CONCLUSION: Within the at-risk population of AA youth studied, despite high levels of MF, a large proportion presented with problematic health as indicated by the high levels of poor CRF and weight status observed, suggesting a need for intervention in order to address these health issues. An intervention program targeting youth within this and similar communities should take into consideration attenuating excessive program-associated expenses as well as offering more scheduling options and information on efficient food preparation and exercise.

This exploratory study examined links between health communication and other constructs affecting health promotion and disease prevention among Haitian mother-daughter dyads living in West Central Florida, and the risk or protective factors for HIV. Risky sexual behaviors can be reduced with accurate and effective information provided through parent-adolescent communication (Coetzee et al, 2014; Ogle, Glasier & Riley, 2008; Hadley et al., 2009). In Haiti, a country that bears a disproportionate burden of HIV/AIDS, women are the most vulnerable (UNAIDS, 2016a); In the United States (U.S.), foreign-born Haitian women in the state of Florida experience health disparities in many areas and bear a disproportionate burden of HIV/AIDS relative to their non-Haitian peers but little is known about (Florida Department of Health [FLDOH], 2017; U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion [ODPHP], 2017). Indeed, the state of Florida recently reported that newly diagnosed cases of HIV increased for foreign-born Haitian women and in 2016, the latter represented 3.64% of all cases (Florida Department of Health, Bureau of Communicable Diseases, HIV/AIDS Section, 2017a). Recognizing that Haitian mothers traditionally bear the primary responsibility for transmitting traditional norms, values, health beliefs and practices, a concept referred to as poto mitan, this qualitative study examined risks and protective factors for HIV that may emerge in health and sexual health communication among Haitian mothers and daughters. This study comprised a two-phase process in which purposive sampling was first used to recruit and interview a focus group of seven health care providers and Haitian-descendant community leaders who engage Haitian-descendant clients in West Central Florida, after which findings from the focus group were used to strengthen a semi-structured interview guide that would be used to interview 10 Haitian mother/daughter dyads in the area. This study addressed a gap in the scientific literature related to health and sexual health promotion and disease prevention communication among Haitian immigrant women in the U.S., particularly surrounding HIV risk. Specifically, it sought to discover what constitutes specific methods that Haitian mothers use to communicate health and sexual health and the contents of such conversations, as well as the intention of daughters to transmit information that they received from their mothers, even here in the U.S. This study applied a constructivist grounded theory approach, in which Symbolic Interactionism (SI) and the Information-Motivation-Behavioral Skills Model (IMB) were triangulated as a framework. ATLAS.ti® 7.0, a software that supports analysis of textual data, was used to analyze transcripts from the focus group and from the interviews. Findings indicate that (a) Haitian mothers intentionally transmit specific and valued traditional knowledge about health and sexual health to their daughters, specifically in the areas of vaginal health, post-partum rituals, and abstinence as the acceptable mode of HIV prevention; (b) Haitian mothers in the study sample lack adequate and accurate knowledge about HIV/AIDS as well as the time to learn more that they can share with daughters; (c) Haitian mothers in the study sample do engage in direct communication about HIV prevention, taking advantage of teachable moments, using popular music and television programs; (d) there is a strong reliance on religious leaders and school systems to address health and sexual health instruction; (e) Haitian mothers in the sample reported and daughters confirmed that there is extremely limited conversation between the mothers and daughters surrounding sex, HIV risk reduction methods outside of abstinence. (f) Symbolic Interactionism is a useful framework for understanding the process of communication between Haitian mothers and daughters in this study; (g) IMB is useful to understand that the information being provided by Haitian mothers in this sample is at times insufficient and inaccurate, thereby limiting the ability of daughters to effectively and intentionally engage in conduct that protects their sexual health and reduces HIV risk. This study has several implications for social work education, research, practice, and policy. First, social work students must be taught to conduct comprehensive assessments of Haitian women in the context of valued Haitian family dynamics, and to engage in life-long learning regarding protective as well as risk factors for Haitian mothers and daughters. Second, Haitian and non-Haitian health providers who serve Haitian clientele could be surveyed regarding knowledge of health beliefs and practices and its potential impact on the health of their constituents. their Haitian patients. Third, researchers may use this study’s findings as a foundation for developing interventions that enhance strategies aimed at establishing rapport with Haitian clients and for assessing potential interactions between hidden health practices and prescribed medications. Fourth, findings suggest the need to develop interventions that empower trusted religious leaders to gain accurate HIV knowledge and to deliver empowering information effectively to their congregants. Fifth, findings suggest a need to develop outreach programs aimed at heightening HIV awareness and increasing HIV testing for Haitian women who are similar to this study’s sample. Sixth, social workers engaging Haitian female clients can make intentional efforts to include Haitian mothers in treatment. Seventh, this study’s findings underscore a need for social workers to advocate on behalf of Haitian immigrants’ efforts to be properly counted in the census, and to be counted as a culturally distinct group in other surveillance data. Social workers can benefit from understanding the strengths of relationships between Haitian mothers and daughters and to enhance their awareness of the heterogeneity among Haitians in general when working with Haitian clients. To work effectively with Haitian immigrant females overall requires cultural humility to mitigate the likelihood of bias towards them based on known or hidden traditional health beliefs and practices and gender roles.