Evidence continues to demonstrate that racial/ethnic minority groups experience a disproportionate burden of disease and mortality in cardiovascular-related diseases (CVDs). However, emerging evidence suggests a health advantage for Latinos despite a high risk profile. The current study explored the hospital utilization trends of Latino and non-Latino patients and examined the possibility of an advantage for Latinos within the context of CVD-related events with retrospective data collected over a 12-month period from a local safety-net hospital. Contrary to my hypotheses, there was no advantage for in-hospital mortality, length of stay or re-admission in Latinos compared to non-Latinos; rather, Latinos hospitalized for a CVD-related event had a significantly longer length of stay and had greater odds for re-admission when compared to non-Latinos. Despite data suggesting a general health advantage, Latinos may experience a relative disparity within the context of hospital utilization for CVD-related events. Findings have implications for understanding the hospital utilization trends of Latinos following a CVD-related event and suggest a call for action to advance understanding of Latino cardiovascular health.

Master of Public Health / Food, Nutrition, Dietetics and Health / Sandra B. Procter / Purpose: The objective of this study was to compare characteristics of urban and rural counties in Kansas in order to identify and seek explanations for differences in health factors and population health outcomes. Methods: Select data from the County Health Rankings and Roadmaps program were examined within or using the context of the USDA, Economic Research Service 2013 Rural-Urban Continuum Code (RUC) classification scheme. A comparison of all 19 urban counties vs. all 86 rural counties was conducted, followed by a comparison of counties as they were classified on the rural-urban continuum. Findings: More evidence of health disparities was observed when using the rural-urban continuum comparison than by the strict urban vs. rural comparison. Health determinants, behaviors, and outcomes, were generally more unfavorable in rural counties, but this was mostly captured through the RUC comparison. On average, RUC 4 and RUC 5 communities (both rural) were most disadvantaged when compared to counties that fell somewhere else on the continuum. Overall, there were higher rates of injury death, preventable hospital stays, and premature death in rural areas. Conclusions: The favorable and unfavorable health factors and health outcomes did not present only in urban areas nor only in rural areas nor did they present only in one RUC. These findings showed that there is a complexity to health disparities that cannot be easily captured or addressed without careful attention to the nature of the specific communities in which they are found.

Skin tone variation within American black communities has long been associated with intraracial stratification. Data from the National Survey of Black Americans (NSBA) indicate that lighter-skinned blacks – net of such factors as region of residence, age, and sex – consistently have higher levels of nearly every socioeconomic indicator including educational attainment, personal and family income, and perceived physical attractiveness when compared to their darker counterparts. What does this color caste system mean for the personal identities and emotional experiences of dark-skinned blacks in America? Using data from the NSBA and six interviews with dark-skinned blacks, I set forth social psychological implications of a phenotypically stratified subgroup in the United States.

M.A. / Many studies of regional disparity in South Africa have focused on rural and urban developmental inequality. This research essay sets out to create an exploratory understanding based on an in-depth analysis of South African provincial inequality. The analysis was done by examining the theories related to economic development and then by analysing current economic development. The purpose of this research is to determine the cause of the widening developmental gap among different provinces in South Africa. Case studies were used to examine the widening poverty gap in countries such as Indonesia, Canada and China within the context of their experiences of provincial developmental disparities. Budget allocation and programmes such as IDP and IDZ are discussed within the context of examining whether the SA provincial disparity is diverging or converging.

Thesis advisor: Ina V. S. Mullis / Turkey is expected to be a full member of the European Union (EU) by 2013. In the course of its integration into the EU, Turkey has been simultaneously facing access, quality, and equity issues in education. Over the past decade, substantial progress has been made on increasing the access. However, improving the country's low level of education quality and achieving equity in quality education across the regions continue to be a monumental challenge in Turkey. Most recently, results from the Trends in International Mathematics and Science Study (TIMSS) 2007 indicated that Turkey's educational achievement at the eighth grade, the end of compulsory primary education in Turkey, was far below that of other countries in the EU. Considering Turkey's long standing socioeconomic disparities between the western and eastern parts of the country, the challenges of improving overall education quality are coupled with the challenges of achieving equity in learning outcomes for students across the regions. This dissertation used data from TIMSS 2007 to document the extent of Turkey's regional differences in science achievement at the eighth grade and to investigate factors associated with these differences. Findings from a series of analyses using hierarchical linear models suggested that attempts to increase Turkish students' achievement and close the achievement gaps between regions should target the students in the undeveloped regions, particularly in Southeastern Anatolia and Eastern Anatolia. Designing interventions to improve competency in Turkish and to compensate for the shortcomings of insufficient parental education, limited home educational resources, poor school climate for academic achievement, and inadequate instructional equipment and facilities might be expected to close the regional achievement gaps as well as raise the overall achievement level in Turkey. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Research, Measurement, and Evaluation.

Breast cancer is the leading cause of death among Latinas women. Several barriers persist when accessing health care and utilization of healthcare services such as annual mammograms, leading to a late stage diagnosis or death related to breast cancer illness. The purpose of this study was to examine disparities in breast cancer experiences within Latina communities in the United States. The Health Belief Model served as the foundation of this qualitative grounded theory study. The research questions explored; access to breast care services that encourage early breast cancer detection; breast care diagnostics such as exams, mammograms and biopsies; and views of availability to breast care exams, diagnostics and treatment options improving health outcomes. The participants were females who self-identified as Hispanic and 19 years of age or older and resided in north east part of the United States. Participants must have discovered a breast tumor, engaged in the decision-making process to seek biopsy, and had a breast cancer diagnosis. A total of 12 Latina women were recruited for 60 minutes recorded interviews Later, the interviews were transcribed.. Findings of the study showed the participants perceived the disease as serious leading to death; cultural context, insurance status may not have contributed to susceptibility to the disease. This study benefits Latina women, and other vulnerable female populations in the United States diagnosed with breast cancer. The social change implications of the study can influence program initiatives that seek to improve equitable access to care, breast care services and the quality of life. It provides insight to practice approaches regarding access to care, service utilization, and development of program initiatives.

Alcohol abuse is positively associated with incarceration and is the most common substance abuse problem among offenders. However, most prisons and jails do not offer alcohol treatment and only 10% of offenders who need treatment receive it. Among those who do receive treatment, alcohol-related problems following release and recidivism are drastically reduced. Guided by the Socio-Cultural Framework for Health Services Disparities, this dissertation sought to describe past and future trends of treatment utilization in correctional settings, as well as identify predictors of treatment completion among offenders with alcohol as their primary substance of abuse. Racial/ethnic disparities have been identified repeatedly throughout the criminal justice system (CJS) and include the underrepresentation of racial/ethnic minorities in treatment in prisons and jails. Therefore, racial/ethnic disparities were a primary focus of this research. Study 1 used the Treatment Episode Dataset – Admissions (1992-2014) to compare racial/ethnic differences in treatment utilized in a correctional setting (versus non-correctional settings) among treatment-seekers with alcohol as their primary substance of abuse (n=5,565,884). A higher within-group proportion of African Americans (2.4%) received treatment in a prison or jail, versus 1.2% of Whites and 1.1% of Hispanics. Using forecasted estimates from a generalized linear model (2015-2025), African American men had significantly higher odds of utilizing treatment in a correctional setting in 2025, compared to White men (adjusted odds ratio [aOR] = 1.52, 95% confidence interval [95% CI] = 1.45-1.60). No significant difference between Hispanics and Whites was identified. Study 2 used the Treatment Episode Dataset – Discharges (TEDS-D) (2006-2014) to model treatment completion with individual and system-level factors among offenders with alcohol as their primary substance of abuse (n=23,655). African Americans had 29% lower odds of treatment completion compared to Whites (aOR = 0.71, 95% CI = 0.65-0.76). African Americans and Hispanics referred to treatment by the CJS demonstrated lower odds of treatment completion, compared to Whites also referred by the CJS (aOR = 0.63, 95% CI = 0.57-0.70; and aOR = 0.85, 95% CI = 0.74-0.98, respectively). African Americans and Hispanics referred by the CJS demonstrated even lower odds of treatment completion, compared to Whites referred by any non-CJS source (aOR = 0.50, 95% CI = 0.41, 0.61; aOR = 0.74, 95% CI = 0.57-0.97, respectively). Study 3 used a reduced TEDS-D dataset (2013-2014) to investigate state-level characteristics and treatment completion (n=3,798). Whites and Hispanics were largely unaffected by state-level factors. Among African Americans, those in states where the level of alcohol consumption was high (versus low) and in states which spent a higher percent of their budget on corrections (versus lower) were less likely to complete treatment (aOR = 0.11, 95% CI = 0.02-0.55; and aOR = 0.24, 95% CI = 0.08-0.75, respectively). African Americans in states where the incarceration disparity was high between Hispanics and Whites (versus low) and in states with a high percentage of Republican legislators (versus low) were more likely to complete treatment (aOR = 4.39, 95% CI = 1.10, 17.50; and aOR = 3.88, 95% CI = 1.21, 12.44, respectively). African Americans experienced disparities in treatment services utilization and completion on multiple ecological levels. Few differences between Hispanics and Whites were identified throughout all three studies. A comprehensive outlook of future trends in treatment utilization in correctional settings provides needed perspective on the scope and size of the challenge ahead. Better understanding predictors of treatment completion among offenders may inform interventions aimed at reforming the CJS, improving correctional health services, and promoting evidence-based state legislative priorities.

Compared to wealthy individuals, individuals with low socioeconomic status (SES) often receive health services of lower intensity or quality and have difficulty accessing care. This is particularly true in the area of inpatient surgery. Individuals with low socioeconomic status are often less likely than individuals associated with high socioeconomic status to receive timely surgical care, and less likely than high SES to receive evidence-based treatments for surgical care. Despite these large gaps, there is a lack of consensus whether disparities in surgical outcomes are primarily due to differences in patient characteristics such as acuity or whether they are attributable to disparities in the quality of surgical care among those with access. The overall goal of this dissertation is to illuminate the relationship between socioeconomic status and surgical outcomes. The project aims are: 1) classify trends in post-surgical quality and analyze data on the relationship between socioeconomic status and surgical outcomes; 2) to evaluate whether changes in access to care can eliminate disparities in outcomes by analyzing the impact of the Massachusetts health reform on socioeconomic disparities in inpatient surgery; and 3) to show the potential effects of SES on surgical outcomes by using the Theory of Fundamental Causes. To meet the study objectives, this study proposes to use data from the Nationwide Inpatient Sample (NIS) and the State Inpatient Database (SID). This approach uses socioeconomic information in the NIS and SID that is a quartile classification of the estimated median household income of residents in the patient’s ZIP Code. The outcomes of interest are widely used quality measures: post-surgery mortality and complications at the national level, post-surgical mortality in Massachusetts for select inpatient surgeries, and difference-in-difference estimates. The approach used to identify trends in post-surgical quality uses two analytical software products to analyze the NIS using a regression-based approach. Study findings will identify progress and gaps in the quality of inpatient surgical care over recent years and further determine whether improving access to care through policy design can eliminate or reduce disparities in surgical care outcomes. In the face of health reform, this research will offer important insight into the study of surgical disparities and potential impact following health policy changes such as the expansion of Medicaid, implementation of health insurance exchanges, and the individual mandate requiring individuals to obtain health coverage.

Breast cancer is of a primary concern in women, although it can occur in men. It is the second leading cause of cancer related deaths amongst women, and it is estimated that roughly 39,840 women will die of this disease this year. Breast cancer occurs across all populations and ethnicities. When African-Americans (AA) present with breast cancer, they usually have poorly differentiated tumors, and are more likely to be diagnosed with an advanced stage tumor. When compared to Caucasian (Cau) women, African-American women also have higher breast cancer mortality. The causes of these differences are not yet definitively known, but it has been suggested that the disparities that are present between African-American and Caucasian women are due to a number of factors. A few which have been mentioned are differences in Body Mass Index (BMI), socioeconomic status, health care coverage, and the level of obtained education that exists between the two ethnic groups. Although these factors may account for a small percentage of the difference seen between the two ethnic groups, the underlying cause that may explain why African-American women are at a greater risk of developing aggressive breast cancer may be due to differences in gene expression. A focus of my research project is the comparison of genome-wide gene expression differences between African-American and Caucasian women. Preliminary results from the comparison of normal breast tissue (obtained from reduction mammoplasty) from Caucasian and African-American women suggest there are marked differences in gene expression patterns. Pathway analysis of differentially expressed genes shows that they are involved in protein folding and the immune response. I am currently expanding this study to include a comparison of 10 AA to 10 Cau normal breast samples. These samples are being LCM dissected to separately compare gene expression in epithelial and stromal tissue. Cross comparisons between ethnic groups and tissue types will provide an understanding of normally occurring differences between AA and Cau women, which may help to explain the observed cancer disparities. Data from the study of normal tissue will be compared to gene expression data from triple negative breast cancer (TNBC) patients from both ethnicities.

The paper studies the regional integration as the unique process which depends on the degree of cooperation and interchange among regions. The generalisation of existing approaches for regional integration has been classified by the criterions. The data of the main economic indicators have been analysed. The economic analysis proves the differences in production endowments, the asymmetry in fixed capital investment, the disproportional income, and foreign direct investment distribution in 2001 – 2005 in Ukrainian regions. Econometric modelling depicts the existence of the division for the industrial regions with high urbanisation and backward agrarian regions in the Ukraine, the industrial development disparities among regions; the insufficient infrastructure (telecommunications, roads, hotels, services and etc.), the low labour productivity in industrial sector, and insufficient regional trade.