An emerging framework, the Identity Pathology (IP) model, partially addresses persistent uncertainties about the primary causes of disparities in cardiovascular health (CVH) between black and white women and men through outlining how identity beliefs associated with social group membership lead to predictable differences in the health-damaging effects of discrimination exposure. Using data from the CARDIA cohort, this doctoral thesis seeks to: 1) propose a novel psychosocial characteristic, identity pathology, that drives the distribution of reported race and gender discrimination in health-relevant ways, 2) assess whether there are group differences in the effects of multiple versus single forms of discrimination on future CVH, and 3) assess variation between these groups in the relationships of reported racial and gender discrimination in a variety of daily life settings with future CVH. The IP framework suggests that beliefs about identity unique to each gendered race group influence the perception of discrimination and whether reported exposure will be associated with CVH. Simultaneous reports of racial and gender discrimination in multiple settings (compared with no discrimination) were negatively associated with future CVH only among white men. Further, the setting in which discrimination was reported appeared to be a significant indicator of whether experiencing multiple forms of discrimination negatively impacted CVH in each group. Our findings contribute to the literature through introducing a novel framework for assessing the effects of interpersonal discrimination. This work also provides preliminary evidence that compounded experiences of interpersonal racial and gender discrimination may not substantially contribute to poorer CVH among black women.

As the greatest considerations in health-care design have traditionally been functional —hygiene, efficiency, and flexibility for changing technology— hospitals have evolved to become dehumanizing spaces. In this thesis two specific groups of chronically ill children who have among the longest inpatient stays are studied: cancer and organ transplant patients. Being under immunosuppressive drugs, these children are physically vulnerable thus are kept completely isolated. These long stays and isolation can be very depressing for them. This thesis undertakes the challenge of designing a fully isolated space that doesn’t feel like one or in other words “a micro-town within a bubble”. The author intends to achieve this goal through strong visual connections, natural lighting, and creative space planning.

<p>In recent years, paid work has taken on greater meaning for people living with mental illness. Paid work offers the chance to earn a wage, as well as opportunities for improved self- esteem, greater community participation and can reduce the chances of re-hospitalization. Although employment can offer many rewards, access to mainstream employment for people with mental illness remains been difficult as they often face discrimination and a lack of workplace accommodation. One response to these challenges has been the creation of social enterprises as ‘alternative spaces’ of employment for people with mental illness. Social enterprises are organizations with an entrepreneurial orientation whose focus is building social capacity rather than profit maximization. However, relatively little is known about the kinds of organizations that exist for people with mental illness in Ontario. This thesis uses data from key- informant interviews with organizations across Ontario to document the types of social enterprises that exist. The analysis also critically examines the strategies used by organizations to create jobs that are both suitable for people with mental illness, but also conducive to the ongoing success of the social enterprise.</p> / Master of Arts (MA)

Dairy producers play a central role in evaluating and seeking treatment or care for animal pain. The primary aim of this study is to examine dairy producers’ emotional states and professional quality of life and analyze the relationship between these variables and their perception of pain in dairy cattle. Dairy farm owners and managers of 65 southeastern U.S. herds participated in a survey that included demographic information, the Depression, Anxiety, and Stress Scale, a modified Professional Quality of Life Scale, and 23 items requiring participants to evaluate various painful conditions in cattle.

This research on healthcare strategies of home-based, low-wage, immigrant careworkers contributes to the ways medical anthropology, migration studies and social science understand human-economy-family care relationships and health and carework as commodities in today's global economy. It reveals the consequences for workers as they defray the costs of care for the Italian government and contribute to their home economies. This research was conducted in Genoa, Italy, which has the largest percentage of people over the age of 70 in any city of its size in the world and a tradition of sending and receiving immigrant workers. The main question was: Under the circumstances of providing labor-intensive, in-home supportive services, how do immigrant workers respond to their own health needs? The researcher collected data from interviews with 50 careworkers, 25 professionals who provide services to the careworkers, and 23 administrators in the health system, government agencies, labor unions, and the Catholic Church. The careworkers interviewed were women from South America, as they do most of the carework jobs in this city. Long-term participant observation and interview data were analyzed to: 1) produce empirical data on health concerns of and healthcare resource use by migrant careworkers; and 2) investigate the relationships between health concerns, living/working conditions, and healthcare resource use of transnational immigrants in the informal economy. The data showed that the Catholic Church promoted immigrants as able workers, aided their elderly parishioners, and provided necessary mental health support to careworkers who experienced stress. The data also revealed that the health care system of Italy functioned well to address the physical health concerns of immigrant careworkers. The relationship between the client and the worker was important for the general well-being of the worker and her ability to maintain her general health, have time for medical appointments, socialize outside of the workplace, and attend community events. This study examined: strategies for using health resources; responses of the Italian medical system personnel to anti-immigrant legislation; use of non-State resources to meet health needs; the health consequences of caring for an elderly person in the private home; and ways to address these health consequences.

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed that patients’ chronic pain attributions did influence pain-related functioning, however the impact was relatively small. There was insufficient evidence to conclude that chronic pain attributions influence a patient’s readiness to adopt self-management coping strategies and their subsequent treatment engagement. Additionally, results confirmed that different health care disciplines attribute the cause of patients’ chronic pain in distinct ways and these unique perspectives can lead to discrepant pain-related functioning assessments between providers. Discordant ratings between providers were shown to influence referring patterns for interdisciplinary services and the patient’s overall opioid dose. Similarly, discrepancies between patients and their providers influenced subsequent referral for behavioral health services, the patient’s attendance at those visits, and their overall morphine equivalent doses. Together the results indicate the important role pain attributions can play in chronic pain management and highlight the central role of the patient-provider and provider-provider relationship.

Social workers are trained during the course of their education to work with the elderly and to understand the various dynamics of aging. These professionals also receive education on substance abuse and how to assess clients as well as link them to appropriate supportive services. How can social workers be more inclined to effectively treat the elderly substance abuser? What are, if any, special considerations a social worker should be aware of when working with the geriatric population? What treatment modalities seem to be more effective with the elderly client? This study utilized a qualitative analysis consisting of interviews with eight clinicians who specialize in the area of addiction treatment amongst the aging population. The purpose of this study was to gain insight and knowledge that can be used to promote social worker awareness of elderly substance abuse as well as the identification of effective addiction treatment methods in the field of gerontological social work. The findings of this study will impact future social work practice, policy and research in the areas of education, treatment, and advocacy for the aging and substance abuse populations. Keywords: gerontology, substance abuse, aging, polypharmacy, interventions

Social contact is known to be vital for older adults' mental and physical health, but few studies of social interactions have taken place in long-term care settings. The current study investigated whether the psychological well-being of assisted living residents was influenced by factors associated with residents' social interactions involving humor. Specific aims of the present study were to develop and test a measure related to humor-related social exchanges, to examine how humor-related social exchanges affect residents' mental health, and to explore whether humor-related social exchanges mediated the effects of resident and facility characteristics on indices of mental health. One hundred and forty older adults residing in 14 assisted living facilities in the Portland, Oregon metropolitan area were interviewed about the frequency and types of social interactions they experienced with members of their facility-based social networks, as well as depression, mood, loneliness, self-esteem, and self-rated health. A 12-item, two-factor model of humor-related social exchanges was identified through confirmatory factor analysis, including both positive and negative humor-related social exchange factors. The newly developed scale displayed evidence of adequate reliability and validly in the current sample. Results indicated that both positive and negative humor-related exchanges were associated with various aspects of mental health, although negative humor-related exchanges appeared to be a stronger predictor of mental health than positive humor-related exchanges. Both positive and negative humor-related exchanges also served as mediators between resident and facility characteristics and indicators of mental health. Cultivating a better understanding of the relationships between humor-related social exchanges and mental health may be beneficial for researchers interested in the way humor impacts older adults' ability to cope with stress. This research may also be of value to long-term care providers who create interventions designed at improving residents' mental health and overall quality of life.

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these hazards. The educational intervention had a strong positive effect on resilience scores (effect size of r=72%; p < 0.05). Eighty-six percent of the participants believed that the intervention increased their capabilities for self-care, especially in sleep, spending time outside, hydration, nutrition, and physical stretching exercises but not in journaling. Eighty-one percent stated that they would be likely to seek professional help if needed. Although this study must be repeated in other samples before it be implemented with full confidence, the standardized, high intensity, short duration, resilience training session can be recommended to nursing programs just prior to graduation and to hospitals for nurse orientation programs.

<p>Research examining the relationships between religious indicators and the cardiovascular health of individuals and populations has been relatively understudied in the Canadian context. This thesis contains three main studies, developed from a sequential explanatory mixed method research design.</p> <p>The first study examined the association between the frequency of religious service attendance (RSA) and prevalence of coronary heart disease (CHD), diabetes and high blood pressure in Canada. The Saskatchewan sample of the Canadian Community Health Survey (CCHS-4.1) was used to build multivariable logistic regression models. The analysis revealed participants who attended religious services more than once a week had lower prevalent odds of CHD (OR= 0.82, 95% CI 0.61-1.11, p>0.05), diabetes (OR=0.60, 95% CI 0.45-0.80, p</p> <p>The second study was qualitative and undertaken to help interpret and explain the quantitative results from the CCHS. Twelve semi-structured interviews with ordained pastors and three focus groups with parishioners in Catholic, Anglican and United churches were conducted in Canada. The findings suggest that attending religious services: (1) promotes mental health; (2) provides social support and activities; and (3) promotes health and lifestyle behaviours to lower CHD risk.</p> <p>Qualitative data from the second study was used for the third study, which identified relevant factors associated with the implementation of heart health promotion programs in churches. Among the various factors identified, pastor leadership, funding for a parish nurse, community-focused interventions, secured infrastructure and social support were important to facilitate health promotion programs in churches.</p> / Doctor of Philosophy (PhD)