Introduction: Obesity is one of the most important medical problems in the U.S. and is considered to be an epidemic with over 30% of the population being obese. Obesity is associated with increased risk of hypertension, diabetes, cardiovascular diseases, certain cancers and a shorter life expectancy. Recent studies have shown that higher BMI levels are also significantly associated with several lifetime mental disorders such as major depressive disorder, anxiety disorders as well as panic attacks and panic disorders. Purpose: The purpose of this study was to quantify the extent to which higher BMI increased the likelihood of Depression, Anxiety Disorder and Panic Disorder and to observe if co-morbid illnesses such as Hypertension and Diabetes affect this association. Methods: A cross-sectional secondary data analysis was conducted using the 2008 National Health Interview Survey. There were 20,593 adult respondents (over 18 years of age) who were included in the study. Logistic regression models were weighted to account for the complex weighting scheme. Main Determinant measures: Based on their BMI, the participants were classified into 5 groups: Underweight (BMI <18.50), Normal Weight (BMI 18.50 – 24.99), Overweight (BMI 25.00 – 29.99), Obese (BMI 30.00-39.99) and Morbidly Obese (BMI > 40.00). Main Outcome Measures: Presence or absence of Depression, Anxiety Disorder or Panic Disorder based on self-report. Results: People who were obese or morbidly obese had higher odds of suffering from depression, anxiety disorder and panic disorder compared to people who were normal weight. Obese individuals were 35% as likely to suffer from depression, 22% as likely to suffer from anxiety disorder and 36% as likely to suffer from panic disorder relative to normal weight persons. Morbidly obese people were 85% as likely to suffer from depression, 27% as likely to suffer from anxiety disorder and 34% as likely to suffer from panic disorder. No interactions were observed based on the presence of hypertension or diabetes. Conclusion: Obesity is associated with an increased prevalence of depression, anxiety disorder and panic disorder. With obesity rates steadily increasing, understanding the impact of obesity on the occurrence of mental disorders is important.

Past studies often find that, upon arrival U.S. immigrants generally have favorable health profiles than native-born persons, but their health deteriorates with prolonged stay. The classical explanations of this phenomenon are healthy immigrant selection and negative acculturation. With the number of foreign-born people living in the United States reaching an all-time high, the health and financial costs of this “negative acculturation” is substantial. Meanwhile, the negative duration effect on health is contradictory to expectations from classic assimilation theory and what has been observed by labor economists. This study aims to empirically study the effect of duration on immigrant health, with particular attention given to how socioeconomic status differentiates the duration-health relationship. Results based on two national datasets confirmed that immigrants, especially recent arrivals, have a considerably lower risk of worse health relative to native-born adults. I also found that socioeconomic status plays an essential role in the varying level of initial health selectivity among immigrants. The analysis of the interaction effect between duration and SES reveals that duration effects on health vary significantly by socioeconomic status. High SES immigrants tend to experience a non-negative duration effect regardless of their length of U.S. residence, while immigrants with lower socioeconomic standing are more likely to experience a negative duration effect on health with longer duration. Moreover, this study also shows that the initial foreign-born advantages in health are typically larger for persons with low SES than for persons with high SES. However, little evidence suggests there is a health convergence between long-term immigrants and their native-born counterparts with similar socioeconomic status. Potential explanations and implications of these findings are also discussed. / text

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.

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Chapter 1: The Impact of Culture on the Second-Generation Immigrants’ Level of Trust in Canada Trust is one of the main elements of social capital; it determines the extent to which an individual cooperates with others. In this chapter, I assess whether cultural factors influence the level of trust in the population of second-generation immigrants in Canada. This paper is related to two strands of empirical literature. The first analyses the determinants of trust and the second studies the cultural transmission of values, attitudes and beliefs. I follow closely the literature on the cultural transmission and use an epidemiological approach to assess whether trust of second-generation immigrants is affected by their cultural heritage. This approach consists of comparing information about the outcomes of second-generation immigrants with that of the country of origin of their ancestry. We apply this approach using the Ethnic Diversity Survey (EDS), the World Value Survey (WVS) and the European Value Survey (EVS). Estimation results show that the average level of trust in the countries of origin of the ancestors of the second-generation immigrants has a strong significant impact on their level of trust. Thus, individual whose country of ancestry displays a high level of trust, tend to have a high level of trust. This provides evidence that individuals’ level of trust is not only explained by their personal experiences, characteristics, and the environment in which they live; but also by the culture in their country of ancestry. This means that culture does matter! I find that the results remain robust even if certain key countries are omitted or a different data set is used. Chapter 2: Decomposing Health Achievement and Socioeconomic Health Inequalities in Presence of Multiple Categorical Information This chapter presents a decomposition of the health achievement and the socioeconomic health inequality indices by multiple categorical variables and by regions. I adopt Makdissi and Yazbeck's (2014) counting approach to deal with the ordinal nature of the data of the United States National Health Interview Survey 2010. The findings suggest that the attributes that contribute the most to the deviation from perfect health in the United States are: anxiety, depression and exhaustion. Also, I find that the attributes that contribute the most to the total socioeconomic health inequality are ambulation, depression and pain. The regional decomposition results suggest that, if the aversion to socioeconomic health inequality is high enough, socioeconomic health inequalities between regions are the main contributors to the total socioeconomic health inequality in the United States. Chapter 3: Accounting for Freedom and Economic Resources in the Assessment of Changes in Women Poverty in Sub-Saharan Africa This chapter assesses the importance of freedom in women’s wellbeing in twelve Sub-Saharan Africa countries by using data from Demographic Health Surveys. This paper presents a poverty comparison by using the stochastic dominance approach and relies on the economic resources and freedom as the two aspects of wellbeing which evokes the multidimensionality of poverty. This study is related to the following three pieces of literature: the sequential stochastic dominance, the multidimensional poverty, the Sen’s capability approach which is based on freedom. This paper is built on Makdissi et al. (2014) but differs from it in a number of respects. First, it focuses on poverty instead of welfare. Secondly, it applies the Shapley decomposition to determine the contributions of the economic resource distribution and the incidence of the threat of domestic violence to poverty changes over time. Consistent with previous work on the importance of freedom, I find that more freedom, i.e. less threat of domestic violence, affects women’s wellbeing positively since it decreases women’s poverty. The results indicate that women’s wellbeing has improved in Burkina Faso, Ghana, Kenya, Lesotho, Madagascar, Malawi, Rwanda, Senegal, and Zimbabwe and deteriorated in Ethiopia, Nigeria and Tanzania.