<p>Background: Childrens health, particularly in the early years, forms the basis of future health and development and plays a significant role in predicting individual life and opportunities. Thus, studies which enhance the understanding of the determinants of childrens health status are needed. Previous research on childrens health had focused on the familys and infants characteristics and ignored the potential impact of macro-level influences. The objectives of this thesis were (i) to examine the independent effects of neighbourhood factors on childhood health outcomes, (ii) to explore neighbourhood moderating effects on the associations between some individual risk factors and childhood health outcomes, and (iii) to quantify the contribution of neighbourhood factors to childhood health outcomes.</p><p>Method: The study population included 9,888 children born to women residing in Saskatoon during three years, 1992-1994. The data used in this study were extracted from three sources. The information related to birth outcomes and the mothers characteristics was extracted from the birth registration files maintained by Saskatchewans Vital Statistics Branch. The health services utilization information was generated from Saskatchewan Healths computerized administrative databases. The information related to the neighbourhood characteristics was obtained from Statistics Canadas 1991 Census, from local sources such as the Planning Department of the City, and two specialized neighbourhood surveys. Six domains of neighbourhood were examined in this study: socio-economic disadvantage, social interaction, physical condition, population density, local programs and services, and unhealthy lifestyle norm. This study was divided into two focused topics corresponding to two childrens health outcomes: low birth weight (LBW) and childrens hospitalizations (both incidence and length of stay). Multilevel modelling was employed to examine the independent/moderating impacts of neighbourhood characteristics on these childrens health outcomes. GIS mapping was used to visualize the associations between neighbourhood characteristics and childrens health outcomes.</p><p>Findings of focused topic 1: There was a significant variation across Saskatoon neighbourhoods in the distribution of LBW rate. This significant variation was attributed to both the characteristics of individuals living within the neighbourhoods as well as the characteristics of the neighbourhood of residence. Neighbourhood variables were both independent risk factors for LBW and moderators for the association between maternal characteristics and LBW. Specifically, a greater level of socio-economic disadvantage, a lower level of program availability and accessibility within the neighbourhoods were associated with a higher risk of LBW. A significant interaction between neighbourhood social interaction and single parent status was found. The risk of single parent status on LBW was mitigated by a greater level of social interaction within neighbourhoods. With individual level variables held constant, three neighbourhood variables predicted LBW, together contributing to a change in LBW rate of 7.0%.</p><p>Findings of focused topic 2: This focused topic employed a longitudinal/multilevel design to examine the effects of socio-economic status at multiple levels on childrens hospitalization. The key findings of this focused topic are the following: (i) There was a gradient association between the number of adverse birth outcomes and childhood hospitalization; (ii) There was a significant interaction between family income and adverse birth outcomes (i.e., the effect of adverse birth outcomes on childhood hospitalization was heightened among those children living in low income families); (iii) Neighbourhood characteristics, specifically neighbourhood socio-economic disadvantage, neighbourhood physical condition, and neighbourhood population density had independent effects on childhood hospitalization over and above the effect of family income; (iv) With individual level variables held constant, three neighbourhood variables (i.e., neighbourhood socio-economic disadvantage, physical condition and population density) together accounted for a variation of 40% in the incidence rate of hospitalization, and two neighbourhood variables (i.e., neighbourhood socio-economic disadvantage and physical condition) together accounted for a change in the length of stay per hospitalization from 2.88 days to 5.18 days across neighbourhoods.</p><p>Conclusion: Both individual and neighbourhood characteristics determined childhood health outcomes examined. Neighbourhood factors acted as independent risk factors as well as moderators on the association between individual risk factors and health outcomes. The contribution of neighbourhood factors to childrens health outcomes was quite substantial. The findings suggest that future interventions aimed at improving childrens health status in Saskatoon may be enhanced by targeting both high risk individuals and high risk neighbourhoods. The geographical variations in childrens health outcomes reported in this study are modifiable; they can be altered through public policy and urban planning, and through the efforts of families and children.

No description available.

The No Child Left Behind Act recognizes the importance of quality teachers in improving student achievement in that it mandates that all students have to be taught by “a highly qualified teacher”. The increasing demand for highly qualified teachers has led to a shortage of qualified teachers. In the United States, however, an uneven distribution of high quality teachers exists. A closer look at urban areas reveals that the problem is more severe in those localities than the national average. In order to address the teacher shortage problem in urban areas, more than 40 states initiated an alternative certification route for candidates who hold a bachelor’s degree (Darling-Hammond, 2000; Heilig, Cole, & Springel, 2011), although teachers’ certification or licensing status play an important role in differentiating teacher quality. The purpose of this study was to examine how high quality teachers are distributed across a large, urban district in Texas according to student’s characteristics, school characteristics and student achievement. In addition, more importantly, this study explored how teacher’s quality influences student achievement and, more specifically, on achievement of students with limited English proficiency (LEP). Due to the differences of characteristics in student characteristics and a school system, elementary schools and middle schools were separated in the analyses. In order to examine which students were allocated to high quality teachers and to determine the effect of teacher quality on students’ achievement in an urban district, Southeast Independent School District (SISD), which is a major urban district in Texas with more than 200,000 students, was chosen. As the largest public school system in Texas, SISD has large shares of minority and low-income students. Student data utilized in this analysis came from the Public Education Information Management System (PEIMS), which is data collection and reporting system produced by the Texas Education Agency (TEA) for the public schools of Texas. SISD provided individual level teacher’s data, students’ data, and a matching file so that teacher’s and their students’ data could be linked. All data that SISD provided are protected by using masked identification. To address the research questions, the study involved three statistical approaches – descriptive analysis, Analysis of variance (ANOVA) and three-level hierarchical linear models (HLM). Results from ANOVA indicated unequal distribution of high quality teachers across an urban school district. Economically disadvantaged students, minority students, and students with limited English proficiency were more likely to be allocated to alternatively certified teachers. It implies that students with economically and socially disadvantaged backgrounds lose a chance to have fully-certified or highly qualified teachers. The test scores of students who had fully-certified teachers were higher than the test scores of under-certified teachers’ or alternatively-certified teachers’ students. Campus accountability ratings were also significantly lower for schools that had more Teach for America (TFA) teachers than schools that had more fully-certified teachers. There were also clear distinctions among teacher’s qualifications, student characteristics, and school conditions between elementary schools and middle schools. There were more alternative certified teachers and less fully-certified teachers in middle schools. Middle schools served a higher percentage of students that are economically disadvantaged, at-risk of dropping out, were LEP, and Hispanic. The average campus accountability rating was also lower in middle schools than elementary schools. Overall, school conditions in middle schools were more inferior than in elementary schools among urban schools in Texas. In order to explain the effect of teacher quality and school condition besides student’s characteristics on student performance, a multilevel analysis was necessary to explain each variance of students, teachers, and schools. Through multilevel analyses (or three-level hierarchical linear modeling (HLM)), I confirmed that student background or ability was the strongest predictor of student achievement as many previous studies have found. The results showed that student achievement significantly differed by students’ background or ability even when they have the same reading teachers. However, HLM results also showed that teacher’s and school’s effects on student achievement were not negligible based on their proportions of variances. It implied that student achievement could be differentiated by teacher’s quality or school’s conditions. Among variables regarding teacher qualifications, the fully-certified teacher variable was a solely significant and positive factor of student achievement in middle schools. That is, students who had fully-certified teachers were more likely to achieve higher test scores than those who had under-certified and alternatively certified teachers after controlling all variables. However, in elementary schools that had 95 percent of fully-certified teachers did not show the significant differences of student achievement by teacher’s qualifications. The years of teaching experience and teacher educational attainment was not significant factors to explain student performance. Among school-level predictors, campus accountability ranking was a positively significant factor to predict student achievement in both elementary schools and middle schools. The percentage of economically disadvantaged students in campus was negatively associated with student achievement in middle schools. Since the study focused on reading achievement, the effect of teacher’s quality on the achievement of LEP students was particularly concerning. To address research questions, an interaction effect between teacher certification status and the achievement of LEP students was added on the three-level model. Results from the analysis showed that after accounting all variables LEP students who had fully-certified teachers achieved 0.1 scores higher on the TAKS reading test in the middle schools. Considering that LEP students typically achieved lower than their peers, the results implied that fully-certified teachers mitigate the effect of LEP on TAKS reading. The finding showed a positive effect of fully-certified teachers for students in need and corresponded with previous studies that high quality teachers played a more important role for socially and economically disadvantaged students. To sum up, this study found that teacher quality is a significant factor to predict student achievement, yet highly qualified teachers are unequally distributed across an urban school district. Socially and economically disadvantaged students were less likely to be taught by fully-certified teachers and were more likely to be taught by alternatively certified teachers. Furthermore, their achievement was significantly lower than their peers who were taught by highly qualified teachers. These aspects were more noticeable in middle schools. / text

Background: Symptomatic heart failure is a chronic and disabling condition that affects over 350 000 Canadians and is characterized by inevitable progression. Historically, research on the ways to increase survival has focused on biomedical factors. However, the continued poor prognosis of heart failure has prompted the search for other ways to improve the lives of these patients. Research in other chronic conditions demonstrates that social circumstances, described collectively as individual social interactions (e.g. social support, social participation) and community social factors (e.g. social capital, social norms), can influence health outcomes. Purpose: The purpose of this research was to describe and assess the impact of selected social circumstances potentially related to heart failure outcomes. Methods: Two literature reviews and one empirical study were performed. Conceptual models were proposed to describe the hypothesized pathways between selected social circumstances and heart failure outcomes. The first review was a systematic review of quantitative studies evaluating the relationship between social support and both rehospitalization and death. The review included a critical analysis of the methods employed by previous studies. The second review integrated the qualitative and quantitative literature describing the relationship between individual social interactions (including support, roles and participation) and the quality of life of patients or experience of living with heart failure. A narrative summary was provided and an integration of findings from both qualitative and quantitative study designs was performed. In the empirical study, patients‘ demographic and clinical information was examined simultaneously with selected community factors in a multilevel analysis. Outcomes of interest included rehospitalization or death of heart failure patients. Results: The systematic review shows that previous quantitative research has linked social support to reduced rehospitalization, but there is little evidence to link it with prolonged survival. The critique of the methods describes an inadequate conceptualization and inconsistent measurement of social support. A conceptual model showing how social support can influence rehospitalization is proposed. The integrative review presents qualitative research that identified the following social interactions as important components of the heart failure experience: social support, social participation and role fulfillment. However, no quantitative relationship between social support and quality of life was found. The potential reasons for the discrepant findings between the qualitative and quantitative studies include: the focus on social support as the only component of social interactions assessed in the quantitative literature; and the inconsistent measurement of social support. A conceptual model is presented to describe the multiple components of social interactions and the theoretical basis for their effects. The multilevel analysis demonstrates that individual factors exerted the strongest effect on heart failure outcomes in most models. Community characteristics had little influence on rehospitalization or death. Study design and analysis issues are proposed to explain these findings. Conclusion: The literature reviews and the empirical study provide a contribution to the population health literature, offering a broad approach to assessing the determinants of disease progression in heart failure patients. This thesis research advances the discussion about which social circumstances may influence heart failure outcomes and their pathways. The use of the proposed conceptual models in future research will help clarify the role of social circumstances in the prognosis of heart failure.

The main goal of this study is to investigate the spatial patterns of police-reported crime rates across select Canadian urban neighbourhoods and to explore their relationships with both neighbourhood- and city-level characteristics, as well as neighbourhood spatial dependence. Analyses were based on aggregated data from the 2001 Incident-Based Uniform Crime Reporting Survey (UCR2) and the Census of Population for six Canadian cities: Edmonton, Halifax, Montreal, Saskatoon, Thunder Bay and Toronto. Exploratory spatial data analysis (ESDA) was used to examine the spatial distribution of crime as well as to test for spatial dependence in the crime data. By using multilevel modelling and spatial regression techniques, neighbourhood violent and property crime rates were modeled respectively as a function of both city- and neighbourhood-level contextual variables while controlling for spatial dependence. The results show that crime is not distributed randomly, but tends to be concentrated in particular neighbourhoods, notably around the city centers of these cities. Neighbourhood variance in crime rates is not only dependent on local neighbourhood characteristics, but also on the characteristics of surrounding neighbourhoods, as well as the broader city environment where neighbourhoods are embedded. These findings suggest that strategies aimed at preventing or reducing crime should be developed in light of specific local neighbourhood contexts, while taking into account social forces external to the immediate neighbourhood in the wider social environment.

Background: Symptomatic heart failure is a chronic and disabling condition that affects over 350 000 Canadians and is characterized by inevitable progression. Historically, research on the ways to increase survival has focused on biomedical factors. However, the continued poor prognosis of heart failure has prompted the search for other ways to improve the lives of these patients. Research in other chronic conditions demonstrates that social circumstances, described collectively as individual social interactions (e.g. social support, social participation) and community social factors (e.g. social capital, social norms), can influence health outcomes. Purpose: The purpose of this research was to describe and assess the impact of selected social circumstances potentially related to heart failure outcomes. Methods: Two literature reviews and one empirical study were performed. Conceptual models were proposed to describe the hypothesized pathways between selected social circumstances and heart failure outcomes. The first review was a systematic review of quantitative studies evaluating the relationship between social support and both rehospitalization and death. The review included a critical analysis of the methods employed by previous studies. The second review integrated the qualitative and quantitative literature describing the relationship between individual social interactions (including support, roles and participation) and the quality of life of patients or experience of living with heart failure. A narrative summary was provided and an integration of findings from both qualitative and quantitative study designs was performed. In the empirical study, patients‘ demographic and clinical information was examined simultaneously with selected community factors in a multilevel analysis. Outcomes of interest included rehospitalization or death of heart failure patients. Results: The systematic review shows that previous quantitative research has linked social support to reduced rehospitalization, but there is little evidence to link it with prolonged survival. The critique of the methods describes an inadequate conceptualization and inconsistent measurement of social support. A conceptual model showing how social support can influence rehospitalization is proposed. The integrative review presents qualitative research that identified the following social interactions as important components of the heart failure experience: social support, social participation and role fulfillment. However, no quantitative relationship between social support and quality of life was found. The potential reasons for the discrepant findings between the qualitative and quantitative studies include: the focus on social support as the only component of social interactions assessed in the quantitative literature; and the inconsistent measurement of social support. A conceptual model is presented to describe the multiple components of social interactions and the theoretical basis for their effects. The multilevel analysis demonstrates that individual factors exerted the strongest effect on heart failure outcomes in most models. Community characteristics had little influence on rehospitalization or death. Study design and analysis issues are proposed to explain these findings. Conclusion: The literature reviews and the empirical study provide a contribution to the population health literature, offering a broad approach to assessing the determinants of disease progression in heart failure patients. This thesis research advances the discussion about which social circumstances may influence heart failure outcomes and their pathways. The use of the proposed conceptual models in future research will help clarify the role of social circumstances in the prognosis of heart failure.

This study examined the relationships between math engagement, teacher quality, school factors, and math achievement in middle school students. This study used the Trends in International Mathematics and Science Study (TIMSS) data from the 2007 wave. The data were analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and hierarchical linear modeling (HLM). The results EFA and CFA showed that students’ engagement in math classrooms consists of three dimensions: behavior, cognition, and emotion. The results provided evidence in supporting the multidimensional theory of student engagement, and provided a well-developed instrument that could measure students’ math engagement. The findings of HLM analysis indicated that students’ emotional engagement had a positive association with math achievement. In addition, teacher content knowledge displayed a positive effect on achievement, and teacher subject knowledge preparation and students’ emotional engagement showed an interactional effect on achievement. What’s more, school SES was a significant factor that influences math achievement. The findings suggested that students’ math achievement was not only related to students’ engagement, but also varied across class and school level factors. The study had both theoretical and practical significance, providing valuable insights for math education and math learning. / Ph. D.

This dissertation project researched sudent mobility-- school changes not due to customary promotion-- and its educational correlates, for students and schools in Vermont. Student mobility research in other states has found that the majority of these students are disadvantaged youth from low-income families, and they lag behind their peers academically. Academic consequences of student mobility affect not only students, but also their schools since NCLBA implementation sanctions influence school enrollments by increasing student transfers. The need for information about rural student mobility during early NCLBA implementation is significant in predominantly rural Vermont. This was the first statewide study of outcomes of mobility for students and schools in a rural state. Three basic research questions were: (a) What is the incidence of mobility among Vermont students and schools? (b) What is the impact of mobility, i.e., how does the incidence of mobility vary according to educational correlates for students and schools? (c) What do multilevel analytical models reveal about variation in mobility from student and school perspectives that may be useful for educational policy and practice? To address these questions, the study analyzed data for Vermont public school students, grades 1 through 12, during school years 1999-2004. Data sources included: (a) the Vermont Department of Education Student Census and Demographic Update; (b) student New Standards Reference Examination English Language Arts and Mathematics tests, grades 4, 8, and 10; (c) Vermont School Report indicators, and (d) NCES-US Census public school location information. In-depth cross-sectional and longitudinal analyses of mobility, performance, sociodemographic, and educational correlates revealed significant and disturbing relationships that merit policy and prevention follow-up programming. School-level mobility incidence indicated that while in-migration was 20% on average, over 30% of the schools experienced much higher rates, mirroring urban-based mobility incidence. Academically, mobile students performed 3-10 percentile ranks lower than their stable counterparts did across grade levels and content areas on standardized tests, for longitudinal cohorts as well as cross-sectional grade groups. Risk factor analyses revealed that mobile students, relative to their stable peers, were (a) more likely to participate in free or reduced lunch programs at school, (b) less likely to have a 504 plan in place, (c) more likely to have kept a writing portfolio for 0-1 years (versus 2-5 years), (d) more likely to have kept a mathematics portfolio 0-1 years (versus 2-5 years), and (e) more likely to not meet the standard on mathematics performance tests. Hierarchical generalized nonlinear modeling analyses indicated that between 8% and 32% of the variation in student mobility was attributable to school-level composition and resources. This project aimed to benefit the Vermont educational community in several ways. Analytical methodology will provide the framework for developing a longitudinal monitoring system with mobility incidence, impact, and relevant educational information. Information from analytical results will inform a case study during spring 2005 to address student mobility by raising public awareness of associated issues that affect not only the students and their families, but also classrooms, schools and communities.

This research explores the linkages between HR practices and business sales performance in a retail bank branch network. Whilst previous research in the last two decades has generally supported the notion that when appropriately designed HR practices can help enhance organizational outcomes, there is still ongoing debate regarding how such practices can actually influence business results. In particular, academics have highlighted the importance of the quality of HR implementation, because this can affect employee day-to-day experiences of and reactions to the HR practices which can impact on variance in the business results. In effect, it is crucial for research to take up the employee lens of the implemented practices and their reactions to these, if the HR-performance relationship is to be clearly understood. This thesis contributes to this research agenda by adopting the social exchange lens to shed light on the nature of the aforementioned relationship. A multidisciplinary and multilevel HR-performance model was employed for conducting empirical tests. Specifically, the empirical model was constructed from the literature in three different fields: strategic human resources management, social exchange theory and psychological contract, with the aim of eliciting the nature of employer-employee exchange relationships in the HR process. Subsequently, the model was tested using the data obtained from 1,286 employees in 149 bank branches and analysed so as to assess the multilevel process through which HR practices can influence business sales performance. The empirical results indicate that an organization can improve branch sales performance by paying careful attention to several processes pertaining to the implementation of HR practices. That is, through the psychological contract process, employees, based on their perceptions of the quality of the received practices (i.e. HR level and breach), reciprocate the organization with their discretionary performance, i.e. commitment attitudes and organizational citizenship behaviours and these outcomes have an impact on business results. Moreover, the findings also point to a boundary condition, whereby the HR-performance relationship can be enhanced by stressing the role of the key constituencies responsible for delivering these practices, namely: senior management and the line manager. That is, respectively, through the affective and relational processes, these agents can have an impact on employee perceptions of HR level and whether there has been a breach of the psychological contract, which in turn influence employee reactions in the causal chain. In summary, having applied the social exchange perspective to elicit the employee interaction with the different quality of HR implementation across bank branches, this study has contributed to the literature by identifying the key processes including psychological contract, relational and affective processes through which HR practices can impact on business sales performance, thereby illustrating how an organization’s human resources can serve as the source of sustained business competitive advantage.

Introdução: O Brasil é um país bastante extenso territorialmente, sendo necessário o mapeamento da situação do aleitamento materno em todo o país. Objetivo: Descrever a situação do aleitamento materno (AM), no Brasil e estudar o efeito de determinantes sociais, econômicos e demográficos sobre o AM de crianças menores de um ano de idade. Método: Constituiu-se amostra de 2958 crianças, divididas em dois grupos de 0 a seis meses, com 1477 crianças e de 7 a 12 meses com 1481 crianças, representativas da população nacional. Os dados fazem parte da Pesquisa de Orçamentos Familiares - POF, realizada em 2002-2003. Para o estudo do AM no Brasil, utilizou-se um modelo multinível com dois níveis de hierarquia. Para a análise do AM nas regiões utilizou-se modelo GLM com link=log, que permite o uso da razão de prevalências e intervalos com 90% de confiança. Resultados: No grupo 0 a 6 meses, a freqüência do AM no Brasil foi de 58% [IC90% 55 - 60]. Segundo as regiões, as freqüências foram de 63%, 59%, 51%, 61% e 56%, respectivamente para Norte, Nordeste, Sudeste, Sul e Centro-Oeste. Nas áreas rurais e urbanas a freqüência foi de 60% e 58%, respectivamente. No grupo de 7 a 12 meses a freqüência no Brasil foi de 35% [IC90% 33 - 38]. Nas regiões, as freqüências foram: 44%, 34%, 37%, 34%, 28%, respectivamente para Norte, Nordeste, Sudeste, Sul e Centro-Oeste. Nas áreas rurais e urbanas a freqüência foi de 39% e 34%, respectivamente. Consideraram-se como fatores desfavoráveis ao aleitamento materno, no conjunto da amostra: mães com idades superiores a trinta anos, quatro ou mais moradores no domicílio e uso de creche. Os fatores favoráveis foram: ter duas ou mais crianças menores de cinco anos no domicílio, mães de cor negra ou parda e maior renda. Conclusão: Nos dois grupos de idade, a freqüência do AM foi maior na região Norte e áreas rurais do país. Os fatores que determinam o AM diferem quanto a faixa etária, sendo importante focar ações de promoção da prática da amamentação também em crianças de seis a vinte e quatro meses. / Introduction: Brazil is a very large country and it is necessaries to mapping the breastfeeding situation around the country. Objective: To describe the situation of breastfeeding (BF), in Brazil, to study the effect of social, economic and demographic determinants on the BF of children under one year of age. Method: This sample is constituted of 2958 children, divided into two age groups: from 0 to 6 months composed by 1477 children and from 7 to 12 months composed by 1481 children, representative of the national population. The data are part of the Search for Family Budgets - POF, held in 2002-2003. For the study of BF in Brazil, it was used a multilevel model, with two levels of hierarchy. For the analysis of BF in the regions it was used the GLM model with link = log, which allows the use of prevalences ratio and intervals with 90% confidence. Results: In the age group 0 to 6 months, the frequency of BF in Brazil was 58% [IC90% from 55 to 60]. According to the regions, the frequencies were 63%, 59%, 51%, 61% and 56% respectively for North, Northeast, Southeast, South and Central West. In urban and rural areas the frequencies were 60% and 58% respectively. In the age group 7 to 12 months the frequency in Brazil was 35% [IC90% from 33 to 38]. In the regions, the frequencies were: 44%, 34%, 37%, 34% and 28% respectively for North, Northeast, Southeast, South and Central West. In urban and rural areas the frequencies were 39% and 34% respectively. The unfavorable factors for breast feeding throughout the sample were: mothers over the age of thirty years, four or more people living at home and use of children daycare center. The favorable factors were: having two or more children under five years at home, black or brown mothers and high income. Conclusion: In both age groups, the frequency of BF was higher in the northern and rural areas of the country. The factors that determine the AM differ by age, and it is important to focus actions to promote the practice of breastfeeding also in children from six to twenty-four months.