Cigarette smoking is the leading cause of preventable morbidity and mortality in the United States. While smoking rates have steadily declined among the general population, smoking is becoming increasingly concentrated among socioeconomically disadvantaged groups due to higher initiation and lower cessation rates. This dissertation examines determinants and mechanisms of smoking cessation in the context of the Kick it for Good study (KIG), a community smoking intervention for Boston public housing residents. In the first study, we explored mediators and moderators of the KIG intervention effect on smoking cessation. We did not find any significant mediators for 3-mo cessation outcomes, although there was modest evidence for mediation by self-efficacy to quit at 12-months. We found living with other smokers and perceived stress were moderators of the KIG intervention effect on smoking cessation. In the second study, we examined predictors of attitudes and knowledge of nicotine replacement therapy (aNRT). We found discussing smoking cessation with a healthcare provider and use of nicotine replacement therapy (NRT) were associated with more positive attitudes and greater knowledge of NRT. The KIG intervention did not impact aNRT outcomes throughout the study period. In the third study, we examined the effect of depression on smoking cessation and whether this effect was moderated by social support. We found smokers with depression classified by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) were more likely to report smoking abstinence than those without depression. Social support did not moderate the effect of depression on cessation. We also conducted a sensitivity analysis to determine if the cutoff of 10 for the CES-D was valid in this population of low-income and racially/ethnically diverse smokers. We did not find evidence of depression misclassification by the CES-D-10, although there remains the need to validate the scale in socioeconomically disadvantaged populations. These findings provide valuable information on how smokers living in Boston public housing were able to achieve smoking abstinence in the context of a cessation intervention. The insights gained from these results may be applied to future intervention studies to help address the disparity in smoking rates among socioeconomically disadvantaged smokers.

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Health disparities are a recognized public health concern and the need to address these disparities remains worthy of bringing new methods that assist in closing the gap. This research examined the effectiveness of data science to highlight health disparities, and to convey the value of data science applications in related health care applications. The goal of this research was accomplished by undertaking a multi-phased and multi-method approach, best represented in three individual essays. In essay one, a systematic literature review assessed the state in current academic literature of data science applications used to explore health disparities and to determine its applicability. The systematic review was guided by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Essay two assessed the capacity of data science software to address the effectiveness of these data science technologies in examining health disparities data. This was conducted using KDnuggets data pertaining to analytics, data science, and machine-learning software. The research in this essay demonstrated the potential utility of leading software to perform the kinds of data science operations that can achieve improved care in healthcare networks by addressing health disparities. Essay three provided an appropriate case study to showcase the value data science brings to the healthcare space. This study used a geographic information system to create and analyze choropleth maps to determine the distribution of prostate cancer in Texas. SPSS software was used to assess the social determinants of health that may explain prostate cancer mortality.

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In recent decades, neurologists have been directing more of their research efforts to exploring the sources of health disparities in medical and surgical treatment of epilepsy. Many studies reveal that racial and ethnic minority patients continue to receive suboptimal care, which has some dire repercussions on their physical and mental health, as well as their social well-being because epilepsy is a chronic disease that tends to affect multiple aspects of the patient’s life. Although the earliest landmark studies emphasized the importance of mixed methodology research, the studies that followed tended to rely heavily on quantitative methods to unravel patterns of disparities with sparse use of qualitative methods to give voice to the patients concerned. In this work, I present a mixed methodology framework that is particularly suitable to investigating health disparities in epilepsy care, which affirms the complementary nature of quantitative and qualitative methods. I explore some of the challenges that clinicians face to utilizing qualitative methods, and introduce some of the validity criteria and techniques of qualitative research that make it a valuable methodology to understand disparities. I highlight some of the ethical concerns with recent studies in health disparities in epilepsy care which adopt only quantitative or qualitative methodology, and contribute very little to eliminating disparities compared to the potential contribution of mixed methodology research. This will be supported by various examples from research led by clinicians, public health professionals, and social scientists. / Urban Bioethics

Established in 1965 as a part of President Johnson’s War on Poverty effort, the federal community health center (CHC) program is a primary source of federally-subsidized quality health care services for medically-vulnerable populations in the United States. Despite its current role as a medical safety-net for the nation’s health care system, the CHC program did not begin as a public health program, but rather as a social justice program. Since its formalization, the CHC program has enjoyed relatively consistent Congressional support as a cost-effective means of providing primary healthcare to indigent populations; however, the narrative of the program has shifted overtime from a focus of empowerment and lifting communities out of poverty, to the fortification of the national health care system as a cost-effective provider of quality healthcare care for all. In this manuscript, I argue that this transition from community empowerment and the mitigation of fundamental causes of disease to a more risk-based emphasis on the issue of access, has diminished the urgency around the engagement of the structural effects of poverty on health in favor of a “one size fits all” approach to the provision of basic health care. In an effort to objectively quantify the effects of geographic access on health as a means for evaluating the success of the contemporary program, this research project explores the extent to which proximal access to a CHC is significantly associated with various self-reported indicators of positive health outcomes. My primary research method is multivariable regression utilizing secondary data from the 2012 Southeastern Pennsylvania Household Health Survey, the 2008-2012 5-year American Community Survey Estimate, and the Health Resources and Services Administration Data Warehouse. Using statistical modeling, I test the effect of CHC access on three distinct measures of individual health: (1) self-reported health status, (2) the likelihood of having pain lasting 6 months or more, and (3) the likelihood of having a usual source of health care. Within each model, I also test a series of interaction terms through nested sub-models to uncover any conditional effects of access for selected social groups. This statistical design offers the opportunity to explore whether the main association between access to a CHC and health varies based on the social characteristics and/or social environment of the individual. The findings of my analysis suggest that the effect of CHC access varies for different social groups, with less disadvantaged groups, such as poor non-Hispanic whites with high social capital, and poor individuals living in areas of low disadvantage, receiving the greatest benefit from proximal CHC access. However, individuals at the extremes of social disadvantage benefit least from CHC access alone. I argue that while the provision of CHC access is a noble and necessary tactic for fighting the persistence of health disparities in our medically-vulnerable communities, focusing on access alone is insufficient to solve the problem. The pendulum must switch back to community empowerment and the eradication of structural threats to health to initiate real change for medically-vulnerable populations. / Sociology

Racial, ethnic and gender disparities have been found among a variety of health variables, but to date no study has comprehensively examined whether similar differences exist between sleep variables such as duration, efficiency and quality, in early adolescence. There is a general consensus among previous literature that adolescence is a time when a decrease in total sleep time and an increase in sleep problems are observed. Previous literature, however, mainly focused on the influence of puberty to explain these changes. the current study examined if differences exist between 1462 Caucasian, Hispanic/Latino, and African American early adolescents (ages 10-14 years) on sleep duration, efficiency and quality. Results showed that adolescent boys reported significantly longer sleep durations, better sleep quality, shorter sleep onset latencies, and later rise times than girls. Results also showed that sixth graders slept longer than seventh and eighth graders, and that seventh graders woke up much earlier than the other two grades. Lastly, results showed that Caucasian students reported longer sleep onset latencies and lower sleep efficiencies than African American students. Trends were observed for boys having greater sleep efficiencies than girls and for Caucasian students sleeping longer than Hispanic students. Based on the differences observed in our sample, introducing sleep education in middle school is discussed.

Research on health in old age finds gender and racial differences in physical and mental health and points to several social factors that can influence health in later life, including marriage. However, it remains unclear whether the health impacts of marriage differ between men and women or across racial groups in later life. Using the Health and Retirement Study, this project aims to explore the impact of both marital status and marital history on health outcomes, and how gender and race impact these effects. To capture a comprehensive view of health, this study incorporates a wide range of measures, addressing both physical and mental health. Using the gender relations framework, Chapter 2 examines the impact of marital status and history on gender differences in physical health outcomes, including self-rated health, functional limitations, and chronic conditions, of older Americans; Chapter 3 explores the influence of marital status and history on gender differences in mental health outcomes, including life satisfaction, positive affect, depression, and alcohol consumption, of older Americans. Along with the intersectionality framework, Chapter 4 investigates the effect of gender and race intersections on the relationship between marital status, marital history, and self-rated health of older Americans. The results highlight the critical need to consider both gender and race when evaluating the impact of marriage on health outcomes in later life. / Doctor of Philosophy / As the population ages, understanding how different factors affect health in later life becomes increasingly important. While past research has examined health differences across genders and marital status, this study takes a broader approach by exploring the combined impact of gender, marital status, marital history, and race on health outcomes in older adults. Using data from a large national survey, this study finds that marital status and marital history significantly influence both physical and mental health, and that these effects differ by gender. Moreover, gender and race together shape how marital experiences affect health. This research highlights the need to consider both gender and race when studying the effects of marriage on health in later life. These insights are essential for informing policies aimed at promoting healthier aging for all the people.

Kwan Wing Kai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 85-93). / Abstract / Acknowledgment / Chapter Chapter 1. --- Introduction --- p.1 / Chapter 1.1 --- A Review of Recent Studies on the Productivity of Chines Economy --- p.3 / Chapter 1.2 --- Aims of Study --- p.10 / Chapter Chapter 2. --- The Sources of Productivity Growth --- p.16 / Chapter 2.1 --- Degree of Government Intervention --- p.16 / Chapter 2.2 --- Ownership Structure --- p.18 / Chapter 2.3 --- Output Structure --- p.24 / Chapter 2.4 --- Changes in Regional Development Strategy --- p.25 / Chapter 2.4.1 --- Regional Development Strategy before1979 --- p.27 / Chapter 2.4.2 --- Regional Development Strategy since1979 --- p.29 / Chapter 2.4.3 --- The Impacts of Different Regional Strategies on Productivity Change --- p.31 / Chapter Chapter 3. --- Theoretical Framework and Estimation Methods --- p.33 / Chapter 3.1 --- Methed I: The Conventional Approach --- p.35 / Chapter 3.2 --- Method II: Replacing the Variable of the Growth of Capital Stock by Investment-Output Ratio --- p.40 / Chapter 3.3 --- Method III: Approximation of the Production Function by Taylor Expansion --- p.45 / Chapter Chapter 4. --- Empirical Results of the Three Different Methods --- p.51 / Chapter 4.1 --- Estimation Results of the Three Different Methods --- p.51 / Chapter 4.2 --- Comparison of the Estimation Results of the Three Methods --- p.63 / Chapter 4.3 --- An Assessment of Provincial Productivity Growth --- p.66 / Chapter 4.4 --- Regional Productivity Difference since1979 --- p.75 / Chapter Chapter 5. --- Conclusion --- p.82 / References --- p.85 / Appendix 1. List of the Abbreviations for Provinces --- p.94 / Appendix 2. A Summary of Notations --- p.95 / Appendix 3. Estimates of Provincial Capital Stock (1979-1992) --- p.97 / Chapter A3.1 --- Initial value of Capital Stock --- p.98 / Chapter A3.2 --- Net Increase of Capital Stock --- p.101 / Chapter A3.3 --- Estimating the Annual Series of Capital Stock --- p.102 / Appendix 4. The Process of Fiscal Decentralization and Deterioration of Regional Redistribution --- p.106 / Chapter A4.1 --- The Process of Fiscal Decentralization --- p.106 / Chapter A4.2 --- The deterioration of Regional Redistribution --- p.110 / Appendix 5. Estimation Results of the Three Different Methods --- p.114