Two overall national health goals are to increase the quality and years of healthy life and to eliminate health disparities. Physical inactivity is a leading cause of disability and death due to its relationship with overweight and chronic disease. Hispanic women are less physically active than Hispanic men and Anglo women in leisure time physical activity and recommended levels of physical activity (PA). From a developmental perspective, understanding prevalence and correlates of PA in emerging adulthood may make a significant contribution to increasing PA as women move into full adulthood. The Health Promotion Model (HPM) advanced by Pender provided the framework for examining beliefs about PA and other correlates of PA. This study also developed and tested a scale measuring beliefs about PA (BPA) that tried to access cultural differences between non-Hispanic and Hispanic women. The study was carried out by electronic solicitation to randomly selected non-Hispanic and Hispanic students from 3 southwestern universities and yielded 237 complete online surveys. Instruments comprising the survey included the Short-version of the International PA Questionnaire (IPAQ), Exercise Benefits and Barriers Scale (EBBS), Self-Efficacy for Exercise (SEE), Social Support for Exercise Survey for Family and Friends (SSFA, SSFR), BPA, the Acculturation Rating Scale for Mexican Americans (ARSMA II), and questions about SES. Statistical procedures included factor analysis, t-tests, and multi-sample path analysis. Respondents included 80 non-Hispanic and 157 Hispanic women, aged 18-27. Factor analysis of the BPA produced 7 subscales accounting for 68% of the explained variance (spirituality, role enhancement, socialization preferences, personal benefits, cultural beliefs, exercise difficulty, and women’s roles). Independent sample t-tests indicated group means for spirituality and cultural beliefs significantly differed, as did total BPA, acculturation, & SES. Path analysis provided evidence for a model with good fit for both groups. Significant path coefficients to vigorous PA included benefits, SE, and SSFA. Total indirect effects for SES to vigorous PA through SE and SSFA were significant. Acculturation, SES, SSFR, and BPA were not significant predictors of vigorous PA. / text

Thesis (PhD--Anthropology)--University of Auckland, 2007. / Includes bibliographical references (leaves 177-185).

Source: Masters Abstracts International, Volume: 46-05, page: 2669. Adviser: Jan M. Risser. Includes bibliographical references.

Disparities exist in the U.S. between the health status of African American and Hispanic individuals and the health status of non-Hispanic Caucasian individuals across all age groups. Those minority individuals age 55 and over are more likely to suffer from specific health disparities in areas such as diabetes, heart disease, and cancer than their white majority counterparts. Among the most common chronic disorders experienced within this age group are obesity, type II diabetes and cardiovascular disease, all three of which collectively form what has recently become known as metabolic syndrome. As of 2004, metabolic syndrome is diagnosable once criteria are clinically significant for a variety of different risk factors designated by the World Health Organization. However, like many syndromes these criteria are not stable across individuals, and leaves variability between individuals being diagnosed. It has been seen that each of the above mentioned racial/ethnic groups experience the individual risk factors at disproportionate rates, making it plausible that metabolic syndrome could be experienced in distinctly different ways depending upon racial/ethnic background. Using two nationally representative data sets, it is first largely evident that African American and Hispanic individuals are reaching higher peak rates of diabetes and cardiovascular disease much earlier in age than are non-Hispanic Caucasian individuals. The study goes on to reveals that the metabolic syndrome appears to follow one underlying progressive syndrome that begins with obesity and progresses towards heart disease. Each of the racial/ethnic groups experience significantly different progressions of the syndrome across time. Behavioral analysis found significant differences in health behaviors across the three groups; however a more pervasive lack of initiative in practicing preventive health behaviors is also present. The study achieved a higher understanding of individual differences within metabolic syndrome and insight into how and at what time in the lifespan health services can be most beneficial in providing preventive services to culturally diverse populations.

This dissertation consists of three essays in the field of health economics. The first essay provides the first causal evidence that bargaining power in a relationship shapes pregnancy outcomes and health disparities in the US. A key driver of bargaining power is the availability of potential non incarcerated male partners in the local dating market, which I define at the race by cohort by county level. Because these sex ratios are endogenous, I use a novel instrument that leverages the randomness in sex at birth and the persistence of local demographics to isolate exogenous variation in the relative availability of men. Greater female bargaining power causes better outcomes: fewer out-of-wedlock births, less chlamydia and hypertension among mothers, and fewer infants with APGAR score below the normal level. The marriage market makes a significant contribution to racial disparities in pregnancy health. Specifically, Black women face relatively poor prospects when looking for a partner compared to White women: while there are 102 White men per 100 White women, only 89 Black men are available per 100 Black women. According to my estimates, Black women’s disadvantage accounts for 5-10% of the large racial gap in maternal and neonatal health. The racial difference in male availability is mostly policy-driven, as incarceration accounts for 45% of the gap. A counterfactual policy equalizing county-level incarceration rates for non-violent offenses between Black and White people would prevent 200-700 adverse pregnancy outcomes per year among Black mothers through the bargaining power channel alone. The second essay investigates how reopening hotels and ski facilities in Poland impacted tourism spending, mobility, and COVID-19 outcomes. We used administrative data from a government program that subsidizes travel to show that the policy increased the consumption of tourism services in ski resorts. By leveraging geolocation data from Facebook, we showed that ski resorts experienced a significant influx of tourists, increasing the number of local users by up to 50%. Furthermore, we confirmed an increase in the probability of meetings between pairs of users from distanced locations and users from tourist and non-tourist areas. As the policy impacted travel and gatherings, we then analyzed its effect on the diffusion of COVID-19. We found that counties with ski facilities experienced more infections after the reopening. Moreover, counties strongly connected to the ski resorts during the reopening had more subsequent cases than weakly connected counties. The third essay studies the diffusion of influenza-like illnesses (ILI) through social and economic networks. Using almost two decades of weekly, county-level infection and mortality data from Poland, it studies within and across-counties ILI transmission. Firstly, it evaluates the causal effect of school closures on viral transmission. The results show that closing schools for two weeks decreases the number of within county cases by 30-40%. The decline in infections extends to elderly and pre-school children. In addition, flu-related hospitalizations drop by 7.5%, and mortality related to respiratory diseases among the elderly drops by 3%. Secondly, the paper demonstrates the significant contribution of economic links to diffusion across counties. The disease follows the paths of workers commuting between home and workplace. Together with the structure of the labor mobility networks, these results highlight the central role of regional capitals in sustaining and spreading the virus.

This study examined racial/ethnic differences in pre-clinical disease, social support, and tested whether social support was a moderator of racial/ethnic differences in subclinical atherosclerosis. Participants were NHWs, NHBs, and Latinos (n = 283) from the baseline and cross-sectional sample of the North Texas Heart Study. Results from unadjusted models showed no significant racial/ethnic differences for common or bifurcation intima-media thickness (cIMT). However, unadjusted models for cIMT showed a main effect for race/ethnicity F(2, 229) = 3.12, p = .046, partial η2 = .027, with Latinos demonstrating significantly greater internal cIMT compared to NHB but not NHWs. In minimally adjusted models, there was a main effect for race/ethnicity, F(2, 227) = 3.10, p = .047, partial η2 = .027, with significantly greater internal cIMT in Latinos compared to NHBs but not NHWs. In fully adjusted models, racial/ethnic differences in cIMT were attenuated. Contrary to study hypotheses, no racial/ethnic differences in social support were found and social support was not a moderator of racial/ethnic differences in subclinical disease. In the North Texas Heart Study, few racial/ethnic differences emerged, with fully adjusted risk factor models accounting for these differences.

In the United States there exists a clear and disconcerting racial disparity in the distribution of good health, which can be seen in differential levels of morbidity and mortality affecting blacks and whites. Previous research has examined the role of SES in shaping racial health disparities and recent studies have looked specifically at the effect of education on health to explain the racial disparity in health. Higher levels of education are robustly associated with good overall health for both blacks and whites and this association has been examined over the life-course. This research explores racial differences in the effect of education on health in general as well as over the life-course. Specifically, this paper examines race differences in the effects of education on health over the life-course. Pooled data from the National Health Interview Survey were analyzed using multivariate logistic regression to estimate the effects of race, education and age on health. The results of these analyses indicate that blacks receive lower education returns on their health than whites. The effect of education on health was shown to grow in the beginning of the life-course and diminish at the end of the life course in accordance with the mortality-as-leveler hypothesis. The black white health disparity was shown to grow over the life-course among the highly educated, whereas the disparity was consistent over the life-course for the poorly educated.

Proponents of marriage, both politicians and scholars, emphasize that marriage benefits health and empirical evidence supports the view that the married are healthier than the unmarried. While a significant body of work establishes the link between marital status and health, previous studies do not consider historical trends in this association. The main objective of the present study is to describe whether and how the association between marital status and health has changed over the past three decades in the United States. Given longstanding observations about gender and race differences in family and health processes, the second objective is to consider gender and race variation in marital status/health trends. Third, I consider whether those health trends by marital status can be attributed to change in family income--which is often viewed as an explanatory mechanism between marriage and health. Results based on three decades’ national health survey data show that over the span of the past three decades, the self-rated health of the never-married became more similar to that of the married; in contrast, over this same time span, the self-rated health of the widowed, divorced, and separated worsened over time, relative to the married. Analyses of two additional health measures (i.e. activity limitation and mortality) show that differences in both activity limitation status and general mortality between the married and each of the unmarried groups--including the widowed, divorced, separated and never married--have widened over recent decades. For each measure of health status, I find important gender and race variation in those health trends by marital status and challenge some long-held assumptions about gender, marital status, and health. Moreover, I find little evidence that family income explains those health trends by marital status. Potential explanations and implications of those trends in health and marital status are discussed. / text

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.