This study investigated the effects of Get Into Fitness Today (GIFT), a health program for adults that promotes balanced nutrition, physical activity, and weight loss through weekly meetings that provide education and social support. In addition to investigating the effects of GIFT, this evaluation sought to better understand explanatory models used by participants and program staff, and the roles of education and empowerment in weight loss and health education. This mixed methods, case study evaluation consisted of quantitative analysis of existing program records for 664 participants, 40 hours of participant observation of class sessions with ten GIFT groups, and follow-up interviews with 17 participants of three case study groups. Supplementary sources of information included a community health focus group and nearly 1000 goal forms completed by participants. Through analysis and triangulation of the multiple data sources, it was found that participants who complete the program are highly satisfied and have positive outcomes, but only about one-third of participants finish the program. The data suggests that at least some participants stop attending because they do not find the educational material to be novel or the classes to be especially engaging. While both staff and participants share the dominant, individualistic explanatory model of obesity, a new model that is strengths-based, focused on health rather than weight, and aims to empower individuals within structural constraints may be more appropriate.

Children born with HIV in the 1980s and 1990s are surviving into adolescence and adulthood, due to the availability of highly active antiretroviral therapy (HAART). Growing up with a chronic and stigmatized disease presents considerable challenges as young people explore their sexuality, develop relationships, and take steps to become independent and productive adults. Adherence to HAART is an essential and life-long practice for the maintenance of health and longevity. For adolescents born with HIV, a daily medication schedule is one aspect of disease management that also includes medical visits, HIV status acceptance, bouts of illness, and disclosure of HIV status to others. This research uses a framework of medical ecology to explore the personal, socio-familial, and medical contexts in which perinatally HIV-infected adolescents, as competent social actors, navigate the complexities of HIV disease management. It examines personal behaviors and attitudes, family dynamics, peer relationships, and health care structures and relationships that affect their adherence to HAART. A key finding of this study was increased agency and adaptation to HIV among adolescents who learned their diagnosis earlier in life and whose caregivers demonstrated acceptance of HIV and support for the adolescents. They were able to adhere to their medication regimens, despite busy schedules, non-disclosure to friends, and treatment fatigue, and also had a somewhat better understanding of the medical aspects of HIV and HAART. Yet all of the adolescents had gaps in their understanding of clinical indicators and viral resistance, and the relationship between adherence and HIV transmission. This deficit in a medical conceptualization and understanding of HIV and its ramifications is another important finding of this study. The adolescents' notions and actions regarding HIV disease, based on social, cultural, and medical norms and interactions within their environment, have a significant impact on the natural history of HIV. The level and consequent infectiousness of HIV as it responds to medications, mutates in their absence, and multiplies or is suppressed, depends on the individual's strict adherence to medications and attention to medical details, and affects HIV transmission to the individual's sexual partners. From both an individual medical and a public health perspective, an understanding of the ramifications of adherence and non-adherence to HAART is crucial. Early acceptance and understanding of HIV increase the possibility of successful medication adherence and overall disease management. In order to facilitate perinatally-infected adolescents' disease management and adherence to medications, it is recommended that the process of disclosure of HIV diagnosis to the child begin early so that the child is fully aware by the age of ten. The acceptance of HIV in the family and clear-cut roles and responsibilities for disease management should be facilitated by ongoing instruction and counseling. Adolescents should be given thorough, if basic, instruction on the medical aspects of HIV, and should be encouraged to have friends, and especially sexual partners, accompany them to their clinic visits. This will encourage greater understanding of HIV and perhaps lead to less stigmatization of HIV and those living with HIV. Finally, providers and adolescent patients should construct a partnership in which their individual models of disease management are integrated and power and responsibility are appropriately shared.

Recent studies on the Argentine public health system have demonstrated that the lack of medical resources in different parts of the country force pediatric oncology patients and their family members to travel to Buenos Aires in order to access care. This internal migration poses difficulties for these families as travel and resettlement are expensive, lead to the separation of family members, and interrupt the child's schooling. This dissertation was designed to document the everyday life experiences of traveling families in order to understand the barriers they faced while attempting to access medical treatment and the strategies they used to surmount these obstacles. Narrative research and Critical Medical Anthropology were combined in order to analyze individual treatment and migration experiences within the political and economic context of the Argentine public health system. The interviews, visual timelines, drawings, and participant-observation carried out with 35 families shed light on differences in the conceptualization of medical treatment and migration between children and their parents, the ways in which the process of parenting was affected by relocation, and the changes that need to be made in the current Argentine public health system to provide timely and high quality pediatric oncology treatment and avoid delays in diagnosis and treatment.

This dissertation research explores how values regarding sexuality, morality, responsibility, protection, trust, and risk — expressed through parent, daughter, and healthcare provider relationships and interactions — inform parental decisions regarding the Gardasil® vaccine. In particular, the research examines the competing and conflicting meanings that parents and providers ascribe to vaccination and how actors position the vaccine within a wider set of negotiated, value–laden discourses. Because these narratives are situated within a larger structural field that shapes the landscape in which providers and parents interact, relevant historical and structural factors, including vaccine policy, cost, and compensation are discussed.

Over the past 15 years Monteverde, Costa Rica has undergone rapid economic, social, political, and environmental change due to a flourishing ecotourism economy. While the effects of ecotourism development in Monteverde are many, two important consequences have been: 1) the immigration of Nicaraguan nationals to the area seeking low-skilled wage labor; and 2) compromised water resources management due to pollution and rapid population growth. The objective of this research is to investigate and identify the inter-relationships between ecotourism development in Monteverde and its affect on infectious diseases outcomes within the context of immigration and water resources management. Specifically, this dissertation uses both anthropological and public health methods within a political ecology of health framework to compare prevalence rates of intestinal parasites between Nicaraguan immigrants and Costa Rican residents living in Monteverde. Results indicate that Nicaraguan immigrants suffer disproportionately from infections with intestinal parasites compared to Costa Rican residents. The results further indicate that community based water resources are not a significant source of infection. Instead, the prevalence of intestinal parasites is most likely the result of fecal-oral transmission at the household level and is related to indicators such as access to health care, underemployment, home ownership, and household sanitation infrastructure.

Immigrant women often lack the social support and help from extended family and other social relationships, which is very significant during the pregnancy, delivery, and postnatal period. This research was conducted among Bangladeshi immigrant women living in the United States, in order to understand their experiences during pregnancy and childbirth: how they coped with the settings of a different country during that period, and how they felt about this situation. While there are several studies on immigrant women and maternal health issues in anthropology, to my knowledge, there have been none that focused specifically on the childbirth experiences of Bangladeshi immigrant women in the US. These women have very specific culturally-based perceptions about the US health care system around issues such as communication with service providers, dealing with the hospital system, the role of health insurance, and so on. This research was conducted among Bangladeshi women in Tampa, Florida, and sought to understand their experiences during pregnancy and childbirth and perceptions of access and quality in the health care system. Fifteen women were selected through purposive and snowball sampling. Data was collected using in-depth interviews. This study examines the experiences of these Bangladeshi immigrant women within their socioeconomic context and immigration status.

This dissertation research utilizes anthropological methods to determine the degree to which the signs and symptoms female caregivers identify as causes of acute respiratory infections (ARIs) in under-fives in rural Ecuador correspond with Western biomedical categories. By employing both a semi-structured medical history questionnaire and more open-ended ethnographic methods such as in-depth informant interviews and focus group research, the researcher identifies the factors which determine timely health care-seeking behaviors of female caregivers in this case study. Economic factors such as the cost of medications and lost work hours were determined to be the primary financial obstacles for timely health care-seeking. Other barriers included limited and inconsistent hours at the health centers and transportation issues. Families of lower socioeconomic status were also more likely to have children suffering particular respiratory ailments. Childhood respiratory illness was identified as an outcome of poverty, which had the potential to reproduce itself through the negative effect of illness on household income. However, the research determined that there was an overall lack of recognition of the biomedical signs and symptoms of serious lower respiratory infections regardless of socioeconomic status. The model of ethnomedicine supports the finding that compliance with timely health care-seeking is limited without collaboration between healthcare professionals and communities to work towards beneficial and achievable goals that are joined by a common purpose. By understanding local cultural beliefs towards ARIs, healthcare professionals are in a better position to: (1) assess the accuracy or inaccuracy of ethnomedical beliefs and determine if there is a conflict in symptom recognition and care-seeking behavior with the biomedical model; (2) determine culturally-appropriate interventions or recommendations to address the health problems of the commu nity and identify barriers; and (3) work with existing community resources in order to foster effective health communication. This research finds that public health messages regarding ARIs be informed by ethnomedical knowledge of home treatments and beliefs. Moreover, health centers need to adhere to regular hours of operation and increase staff capacity to better meet the needs of their clients.

Music-based healing is utilized as a healing tool in many cultural contexts around the world. This thesis examines the cultural practice of music therapy in the context of the larger discipline of medicine in the United States through an ethnographic study of music therapists in the Greater Atlanta area. It contextualizes this data with research in medical ethnomusicology that explores cross-cultural traditions of music in healing rituals. It also connects music therapy to the observation that forces of globalization are strongly correlated with an increase in rates of inequality, poverty, stress, and disease. This thesis discusses how Atlanta-area music therapists use music healing with patients suffering from physical and mental disease and how economic stratification impacts access to music therapy. It is concerned with deeper and not immediately evident processes taking place in music therapy, such as the role of music as a medium and facilitator in healing.

In August 2008, a biomedical intervention providing free drugs to school aged children to treat two endemic diseases –schistosomiasis haematobium and soil-transmitted helminths - in Morogoro region, Tanzania, was suspended after violent riots erupted. Parents and guardians rushed to schools to prevent their children taking the drugs when they heard reports of children dying in Morogoro town after receiving treatment. When pupils heard these reports, many of those who had swallowed the pills began to complain of dizziness and fainted. In Morogoro town hundreds of pupils were rushed to the Regional Hospital by their parents and other onlookers. News of these apparent fatalities spread throughout the region, including to Doma village where I was conducting fieldwork. Here, protesting villagers accused me of bringing the medicine into the village with which to “poison” the children and it was necessary for me to leave the village immediately under the protection of the Tanzanian police. This thesis, based on eleven months fieldwork between 2007 and 2010 in Doma village and parts of Morogoro town, asks why was this biomedical intervention so vehemently rejected? By analysing local understandings and responses to the mass distribution of drugs in relation to the specific historical, social, political, and economic context in which it occurred, it shows that there was a considerable disjuncture between biomedical understandings of these diseases, including the epidemiological rationale for the provision of preventive chemotherapy, and local perspectives. Such a disjuncture, fuelled by the reports of fatalities and the pupil’s fainting episodes brought about considerable conjecture both locally and nationally, that the drugs had been faulty, counterfeit, or hitherto untested on humans. Among many of the poorer inhabitants of Morogoro town, there was suspicion that this had been a covert sterilization campaign. From an official perspective, such conjecture was dismissed as mere rumour, proliferated by “ignorant” people. However, from an anthropological perspective, these ‘rumours’ reveal profound local anxieties including a pervasive fear that poor Africans are being targeted for covert eugenics projects by governments in the industrialized world. The thesis also shows that many of the assumptions embedded in global policies seeking to control neglected tropical diseases are mistaken. Indeed, it is suggested that it is unlikely that schistosomiasis haematobium and soil-transmitted helminths will be controlled so long as policy makers persist with the idea that one policy, designed by staff working for the World Health Organisation – with minor modifications added in Dar es Salaam - can be rolled out uniformly, irrespective of the political, social and economic context in which the programme occurs.

Dental caries, popularly known as tooth decay or cavities, is among the world's most common health problems. When caught early, it is also one of the most easily resolvable. Yet, advanced decay is a trenchant marker of social inequality and a major contributor to the maldistribution of physical pain and psychosocial suffering. Why? Access to dental care within the U.S. model of fee-for-service dental private practice follows existing lines of social stratification. Dental disparities, a term that calls attention to the relationships between maldistributed disease and maldistributed care, reflect deep ontological, moral, and political differences about responsibility for the prevention and treatment of dental disease, the quality and distribution of dental care, and even what constitutes health and well-being. What kinds of sociopolitical and moral negotiations constitute and transpire around dental disparities? How do these negotiations shape the experiences of patients and providers, and how do their experiences shape these negotiations? What can an ethnography of the dental safety net–a complex, fragile, and unpredictable network of treatment opportunities for low-income families–tell us about health governance more broadly? These are some of the questions that drive my research. In this dissertation, I explore how the sociopolitical relations of dental disparities are enacted through the dental safety net. Drawing on fifteen months of ethnographic research in clinical and community settings in central Appalachia, a region that has come to symbolize the dental crisis in the popular imagination, I show how the dental safety net exemplifies health governance in a neoliberal milieu. A fragmented system characterized by a discontinuity that starkly contrasts the model of health care generally advocated in both private and public medical systems, I argue that the dental safety net in far southwest Virginia does not merely fail to relieve the suffering of marginalized people but also can produce it. For example, the constitution of publicly-funded and charitable dental care can serve to routinize and even incentivize excess extractions among low-income adults while exempting preventive or restorative care. In addition to its effects on underserved patients, the dental safety net is a site through the fraught and contradictory relationships of dental providers and the sociopolitical stakes of the pursuit of oral health equity can be understood. For example, the flexible teamwork arrangements prized in private practice, when posited for the dental safety net, are often interpreted by dentists as risks of pluralization and threats to professional hierarchy that must be contained through legislative means. Borrowing from the crude classificatory scheme used to screen teeth quickly, I show how the dental safety net is decayed, as it bears the wear of overuse beyond maintenance; missing, or better described as an absence than a presence; and filled, like a cavitated tooth or a canaled dental root, with manufactured solutions of variable standards and longevity.