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<p>The life course perspective, especially the theme of linked lives, posits that human lives are embedded in social relationships with family across the life course. Inspired by this framework, the purpose of this dissertation is to extend understanding of the impact of intergenerational relationships on psychological and relational well-being by examining a more complex network of family relationships than has been considered in previous research. Guided by stress theories and spillover theory, this dissertation addresses two research questions that emphasize the complexity and interconnectedness of later-life families: 1) Does the tension with other family relationships—specifically those with siblings and spouses—mediate the association between maternal differential treatment and psychological well-being in adulthood? 2) How does the quality of the ties between mothers and their adult children shape the quality of the ties between mothers and their children-in-law? To address these research questions, I use data collected as part of the Within-Family Differences Study. For the first question, I use data collected from adult children as part of the WFDS-II. For the second research question, I use data collected from mothers as part of the WFDS-I & II.</p> <p>Past research used equity theory and social comparison theory to explain the direct effect of maternal differential treatment (MDT) on psychological well-being. However, this focus on psychological pathways ignores possible social pathways, such as indirect effects of MDT on well-being through disrupting other family relationships. Using the life course perspective and stress proliferation theory, the first study found that sibling tension mediates the association between adult children’s perceptions of maternal disfavoritism and their psychological well-being—a process I call the stress proliferation of maternal disfavoritism. In contrast, adult children’s perceptions of maternal favoritism cannot trigger this stress proliferation process of producing marital tension nor sibling tension. </p> <p>In line with the life course perspective, principles of classic theories of social interaction in both sociology and psychology suggest that the mother-child tie would be affected by the introduction of the child’s spouse into the original dyad. However, only a small number of qualitative studies have investigated the association between mother-child-in-law relationships and mother-child relationships. To fill this knowledge gap, the second study used spillover effect theory and found that older mothers’ tension with adult children predicted change in mothers’ tension with children-in-law across 7 years, whereas older mothers’ tension with children-in-law did not predict change in mothers’ tension with children across 7 years. This study suggests that the association between mother-child relations and mother-child-in-law relations may be the result of the unidirectional effect of mother-child relations on mother-child-in-law relations rather than the reciprocal association found in the previous qualitative studies. In other words, mothers’ evaluation of mother-child-in-law relations is dependent on their evaluation of mother-child relations, whereas the reverse is not true. In addition, I did not find gender differences in the association between mother-child tension and mother-child-in-law tension over time.</p> Taken together, this dissertation sheds new light on the ways in which mothers’ intergenerational relationships with their adult children and their children-in-law shape the relational and psychological well-being of members of both generations. A deeper understanding the implications of dynamics among mother-child relationship and other family relationships for health could aid in developing interventions aimed at improving health and family relationships. More broadly, this dissertation contributes to the literature on social relationships as social determinants of health by showing how intergenerational relationships are connected to other family relationships to affect family members’ health.

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The focus of this thesis is on the social history of public health and medicine in British Malaya during the late 19th and early 20th centuries. I argue that the introduction of modern medicine, medical services, and medical knowledge to Malaya, while serving the immediate needs of colonial economic extraction, and providing legitimacy to colonial rule, also functioned as a cultural agent of colonization, and later modernization. As a cultural agent, modern medical knowledge challenged traditional medical practices and beliefs, and set a new cultural standard of truth, morality, and aesthetic that was to become the cultural basis of modern Malaya and later Malaysia. Using Weber and Habermas theory of societal rationalization, I further contend that the disenchantment of the world by modern medical knowledge, and the reign of the instrumental rationality of modern science, resulted in a predicament of modernity that continues to plague modern Malaysia. The tension of modernity is reflected in the struggle by the Malaysian government to maintain a balance between the pursuit of modernity on one hand, and the preservation of Islamic religious beliefs that define the very nature of the Malaysian nation on the other. In other words, there is an effort to make Malaysia both a modern scientific state and a Muslim state; and I contend that the goal is achieved through cultural discourses of Islam and modern science that are in harmony with each other.

The focus of this thesis is on the social history of public health and medicine in British Malaya during the late 19th and early 20th centuries. I argue that the introduction of modern medicine, medical services, and medical knowledge to Malaya, while serving the immediate needs of colonial economic extraction, and providing legitimacy to colonial rule, also functioned as a cultural agent of colonization, and later modernization. As a cultural agent, modern medical knowledge challenged traditional medical practices and beliefs, and set a new cultural standard of truth, morality, and aesthetic that was to become the cultural basis of modern Malaya and later Malaysia. Using Weber and Habermas theory of societal rationalization, I further contend that the disenchantment of the world by modern medical knowledge, and the reign of the instrumental rationality of modern science, resulted in a predicament of modernity that continues to plague modern Malaysia. The tension of modernity is reflected in the struggle by the Malaysian government to maintain a balance between the pursuit of modernity on one hand, and the preservation of Islamic religious beliefs that define the very nature of the Malaysian nation on the other. In other words, there is an effort to make Malaysia both a modern scientific state and a Muslim state; and I contend that the goal is achieved through cultural discourses of Islam and modern science that are in harmony with each other.

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This dissertation investigates race as a determinant of health trajectories for immigrants to the United States. Previous research suggests that integration into U.S. society can be detrimental to the health and mortality outcomes of many minority immigrant groups. Popular explanations for post-migration health changes have focused on individual-level mechanisms, such as behavioral changes associated with acculturation. I use multiple sources of data and a variety of quantitative methods to situate these changes in a context of racial inequality for three migrant groups. In my first case, I draw on historical data collected from the Vital Statistics of the United States and the U.S. Census to analyze the changing health trajectories associated with European immigrants’ transition from marginalized minorities to members of the white majority in the early 20th century. My second case draws on restricted-use data from the National Survey of American Life to test how interpersonal and institutionalized racial discrimination influence health patterns of black immigrants from the Caribbean. In my third case, I use population-level birth data from New York City (2000-2010) to investigate changes in birth outcomes associated with elevated anti-Muslim sentiment after the attacks of September 11, 2001. Taken together, these cases demonstrate how racial formation in the United States shapes patterns of post-migration outcomes. I find that marginalized European immigrants exhibited patterns of worsening mortality trajectories, but the overall gap between European immigrants and native-born whites narrowed as racial categories were redefined in the early 20th century. This pattern of intergenerational health improvement contrasts with the segmented trajectories of contemporary Caribbean black immigrants, whose health is shaped by experiences of both interpersonal and institutionalized racism. Similarly, rates of low birth weight births increased for Middle Eastern and Asian Indian immigrants in the decade after the attacks of September 11, 2001, likely due to increased experiences of discrimination. By tying health trajectories and outcome disparities to the construction and stratification of racial boundaries, I advance theory about the "upstream" social causes of health and illness and develop a framework for analyzing the sociohistorical formation of health disparities.

This dissertation explores the spatial patterns and place-based characteristics of colorectal cancer (CRC) late stage incidence and CRC-specific mortality in Miami-Dade County. Because CRC is the second leading cause of death among all cancers and is almost 90 percent preventable through medical screenings, investigations of CRC disparities across groups and communities are extremely relevant in the fight against cancer. This paper analyzes the geographic distribution of CRC cases in Miami-Dade County between two periods, 1988-1992 and 1998-2002 to: a) identify significant "hot spots" or clusters of disease; b) investigate associations of CRC patterns with neighborhood level characteristics such as socio-economic status, race/ethnicity, and poverty; and c) explore the policy implications of the spatial trends identified for the disease, with particular reference to the Welfare Reform Act of 1996. This dissertation analyzes data from the Florida Cancer Data Registry and tract level U.S. Census data, to identify the spatial distribution of CRC and study its relation to place-based variables using Geographic Information Systems (GIS) and spatial statistical modeling. Identifying spatial clusters of disease can assist in targeting public health interventions and improving social service delivery, particularly for uninsured populations. Identifying communities facing greater obstacles to screenings and quality medical care through the use of spatial analysis is an effort to mitigate these barriers while simultaneously providing empirically based evidence linking neighborhood-level social and economic conditions to health disparities.

As technology advances, health care decisions have become increasingly complex. American hospitals, based on accreditation standards, are required to have a system and process to address ethics, patient rights, and responsibilities. These practices vary widely, and there is very little consistency and few standards across the country. Key court cases have provided minor structure, and the federal government has been silent in the formulation of these structures but not necessarily in this arena. Most often, these accreditation standards related to clinical ethics are managed by Healthcare Ethics Committees (HEC). Bioethics has become a growing field, the level of integration between this discipline and healthcare practice varies widely. Using qualitative methods based on Grounded Theory, this analysis presents six key thematic findings, as well as interpretations to identify current challenges and opportunities to make recommendations for improvement by enhancing clarity and reducing ambiguity.

The dissertation is an ethnographic study of religion as conceived and experienced by organ transplant recipients. It is also a cultural study of North America’s collective expressions of transplant as found in Christian journals, popular media, advocacy literature and public policy statements. The study finds evidence that religious metaphors and directives, cosmological figures and theological arguments, rituals, scriptures and places of worship are actively, vociferously, and consciously engaged with organ transplant discourse and with the experience of giving or receiving organs. While the transplant recipients under study cannot be considered representative (being largely advocates for transplant and almost exclusively of Christian background or affiliation), this group was articulate about the ways their new organ invoked the sacred: they described new metaphysical understandings, they spoke of a closer relationship with God, the universe and other human beings, they divulged inexplicable incidents and mystical states of being, they articulated a complex set of ethical prescripts. “Thinking how many times you should have been dead and you’re still here” was for many an imperative to “start to find out why.” I argue that these spiritual seekers traverse a 21st century terrain shaped by the practices and discourses of what Foucault termed “biopower”. The private and public production of sanctified donors and ‘redeemed’ recipients is inextricably bound to the desires of transplant professionals and government officials, and cannot hope to escape the very real commodification of the body that transplant represents. This seeming paradox of ‘the sacred in the secular’ does not make transplant’s religious constructions inauthentic or irrelevant. Religion remains an active and inventive register for the recording of potent bodily experiences of illness, loss and conditional regeneration. Further, the religious activity around transplant affords a window on emerging rites, on contemporary understandings of death and immortality, and on new conversations about miracles and morality. Circuits of biotechnology are not immune to religious influence and inflection – but, simultaneously, contemporary religious meanings, practices and experiences are indelibly shaped by our newfound ability to transplant organs.