Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

The lack of environmental sanitation measures is a worldwide problem, especially in developing countries, and greatly facilitates the spread of disease. This thesis aims to contribute towards a better understanding of the effect on diarrhoea, nutritional status and intestinal nematode infections of drainage and sewerage in an impoverished urban environment. After an extensive literature review of some relevant aspects of the health impact of environmental sanitation, field research was designed and conducted in nine poor urban areas of the city of Salvador (pop. approximately 2.3 million), capital of Bahia State, in northeast Brazil. The study was targeted to a sample of children under 15 years old living in the poor urban areas of the city at the time of the field work (August 1989-November 1990). An extensive questionnaire was applied to collect information on each child and on the conditions of the family and the household, three stool examinations of the children 5-14 years old were performed (to measure nematode infection and reinfection), diarrhoea was monitored fortnightly, in children under 5 years old for one year, and anthropometric measurements taken every two months. The results showed that among children in neighbourhoods with unimproved community sanitation the incidence of diarrhoea was consistently higher and the nutritional status, expressed by the mean height-for-age z-score, was significantly lower throughout the study period as compared to those with improved sanitation. Regarding intestinal nematode infections, as the level of community sanitation improves, the following trends were noted: prevalence and intensity of infection and reinfection declined, risk factors for infection became more numerous and more significant, clustering of cases by house­ hold became more significant, predisposition of individuals to reinfection and to heavy infection became more marked, and infections with different species were increasingly aggregated in the same individuals. These results suggest that sewerage and drainage can have a significant effect on diarrhoea, nutritional status and intestinal nematode infections and that the evidence of the health impact was strongest for intestinal nematode infections. The interpretation of these epidemiological findings in the light of the Brazilian health, urban and social policies contributes to a comprehensive framework for the control of nematode infections, diarrhoea and malnutrition in poor urban areas of Salvador and elsewhere.

<p> The massive migration of rural labor to urban areas in China over the past few decades has created the largest labor flow in world history. The proportion of the residential population in rural areas decreased from 80% in the late 1970s to 44% in 2016. Due to institutional and practical constraints, whole family migration is often not feasible for most migrant families. As a result, 61 million children age 0-17 are estimated to be left behind in rural communities by at least one parent seeking employment elsewhere. These numbers reflect a major change in the family and community environment in which children are cared for. Parental migration brings about changes in family structure and dynamics, entails a trade-off between economic benefits and parenting inputs, such as parental supervision and emotional support. At community-level, large-scale selective migration leads to remarkable changes in community demographic composition, shifting sociocultural norms and aspirations, influencing community institutional resources and collective social capital. </p><p> Over the past few decades, the scientific literature examining the implications of this large-scale migration and split families on the well-being of children left-behind has proliferated. However, empirical evidence on the effect of parental migration on left-behind children&rsquo;s well-being is mixed for China and other countries in the context of international migration. Few studies have attempted to reconcile the inconsistent findings by examining the moderator effect. Although the potential effects of migration on cognitive development of children in origin communities reflect both household- and community-level processes, few studies have examined how community-level migration affects child development. In addition, mostly focused on the well-being of school-aged children, very limited study has been conducted on parental migration and early childhood development in the first few years of children&rsquo;s lives, especially in the domain of cognitive and behavioral outcomes. Moreover, most researches have relied on cross-sectional data, exploring the association between a contemporaneous measure of parental migration and statically measured child outcomes at one point in time, ignoring the potential impact of the timing, transition and cumulative exposure to parental migration/absence, and may also be prone to selection bias. </p><p> To bridge the gap, the first analysis examines the conditions that may influence the effect of parental migration on child self-rated health (SRH). The results suggest a relatively weak main effect, but this is due in part to the influence of moderating factors. Children are more likely to report a good health status when the economic return of migration is substantial, if they are from impoverished communities, or when mothers remained at home to provide care while the father migrated a short distance within the same province. The second analysis focuses on examining community migration effect. Findings suggest lower cognitive achievement in communities experiencing high migration intensity. Children living in very high migration intensity areas are expected to have 3.57- and 1.54-unit lower verbal and math scores, which are equivalent to 1.67 and 0.87 years of formal education respectively. A possible explanation for this effect is the change in demographic composition brought about by the outmigration of better-educated adults. Finally, applying growth curve modeling strategy, the third analysis examines parental migration and early childhood development trajectories and states, taking into account timing, transition and cumulative exposure to parental migration. Our findings indicate that while left-behind children are comparable in the prevalence of childhood illness, positive behaviors and preschool enrollment, two-parent migration has a detrimental effect on children&rsquo;s linear growth, cognitive stimulation, and home environment. Lack of appropriate cognitive stimulation in the critical early years could have important implications for child cognitive development.</p><p>

Efforts to encourage healthy behaviour often fail to bring about sustained changes in people’s lifestyles. New approaches to tackling chronic disease include the use of financial incentives: rewards paid to individuals conditional upon their achieving some pre-specified target, such as losing weight or quitting smoking. Incentives may provide an extra motivation to adopt healthy lifestyles, and structure behaviour change efforts in ways more conducive to success. Health incentives have, however, provoked controversy, attracting accusations of ‘bribing people to be healthy,’ ‘rewarding bad behaviour,’ and ‘wasting taxpayers’ money.’ It remains unclear how viable health incentives could be as a tool for health promotion; but, even if effective, their contentious nature may still give reason for hesitancy. Here, I explore whether such ethical concerns present us with convincing reasons not to use health incentives. I begin by looking at the nature of the criticisms of incentives in the media, and grouping these arguments into more general themes for discussion. I then proceed to consider each of these in turn, beginning first with debates about the requirements for the state to act efficiently without overstepping its legitimate sphere of influence. I then move on to concerns relating to the potential for incentives to undermine liberty and autonomy. Next, I discuss whether health incentives are unjust insofar as they are undeserved, and how this relates to agent freedom and responsibility for adopting healthy lifestyles. Finally, I consider the worry that using money as a healthcare intervention could corrupt certain values that we care about. In concluding, I seek to give an overall idea as to the ethical permissibility of health incentives, and identify some key features that are likely to render incentives more or less acceptable as a means of improving health.

The aim of this thesis was to study a worksite exercise intervention for sedentary workers in China. This involved a 10-minute Qigong exercise session twice a day. Four inter-related studies examined the development, implementation, and evaluation of this intervention. First, a feasibility study demonstrated that short exercise breaks could be integrated into the workday routine for employees with sedentary job roles. Second, a pilot study was conducted to test the intervention under research processes. Third, a waitlist controlled trial study showed increases in employees’ physical activity between baseline and post-intervention for intervention (n=193) and waitlist control (n=83) participants, but no changes in work performance or sickness absence. And finally, a process evaluation using RE-AIM framework, i.e. Reach, Effectiveness, Adoption, Implementation, and Maintenance, was conducted using data from focus groups, document analysis, and exercise log reviews. In terms of reach, the exercise intervention was successfully marketed to all employees. In terms of adoption, it was considered that organisational support to implement the intervention was good. The intervention had been implemented broadly as planned. There was high exercise acceptance, but a gradual decrease in exercise adherence through the intervention period. With regard to maintenance, there was no clear management plan to sustain the programme beyond the period of study. To the author’s knowledge, this research is the first to test the effectiveness of worksite exercise in China. It is recommended in future that such interventions focus further on the study of implementation and include outcomes more proximal to the intervention such as job satisfaction and work engagement.

This thesis provides an investigation into aggressive driving behaviour, from a Forensic Psychological perspective. The methods used include a systematic review, two quantitative research studies, and a psychometric critique. A systematic review and meta-analysis of the relationship between a measure of driving anger, the Driving Anger Scale (DAS; Deffenbacher, Oetting & Lynch, 1994), and various aggressive driving outcomes showed a strong positive correlation. However, the validity of this finding is hampered by the extensive use of self-report questionnaires, as opposed to real-world driving behaviours, to measure aggression on the roads. The first empirical research study investigated the relationship between personality characteristics (including driving anger) and aggressive driving outcomes. The results showed that three variables accounted for more than half of the variance in self-reported aggressive driving behaviour. These were a tendency toward physical aggression, the progress impeded aspect of driving anger, and psychopathic tendencies. The findings provide ideas for future research, and intervention to reduce aggressive driving behaviours. The second research study expanded on this, and considered the impact of inattentive responding on outcomes for online surveys, and how these may relate to the driving aggression literature. This was enabled by the discovery that around a third of respondents to a survey failed instructional manipulation checks; inclusion of these participants in analysis obscured the results found in the first study. The findings are discussed in terms of practical implications for researchers. A psychometric critique of the Propensity for Angry Driving Scale (PADS; DePasquale, Geller, Clarke & Littleton, 2001) is also presented. This raised questions about the reliability and validity of the PADS, which will be of interest to researchers considering driving anger and aggression in the future. The findings from each methodology are finally considered together, with a discussion of the implications for the field of aggressive driving research.

The overall aim of the research described in this thesis is to explore the role of socioeconomic status (SES) (defined in terms of education, salary, and job grade) and demographic and personal factors (including age, weight, number of dependants, and gender) in relation to the eating behaviours of employees, and to explore barriers and facilitators to healthy eating in the workplace. The purpose of examining these issues in the workplace is to better enable practitioners to develop interventions designed to assist workers in the adoption of healthy eating behaviours. The thesis opens, in Chapter 1, with an introduction to these concepts and consideration of their role in providing a focus for targeted workplace interventions to promote healthy food-related behavioural choices. Chapter 2 shows that the vast majority of academic research on relations between SES and eating behaviours is based on community samples. Little is known about such relations in occupational samples. This is an important knowledge gap because with many people spending more than half of their daily waking hours at work, the workplace represents an ideal location for the promotion of healthy eating choices. In response to the knowledge gap identified above, the overall aim of this investigation is to examine relations between three indices of SES (education, salary band, and grade), plus demographic and personal factors (age, gender, number of dependants, and Body Mass Index (BMI)) and eating behaviours in a large public sector employee sample. Five specific eating behaviours are considered: Consumption of a healthy, well-balanced diet, fruit consumption, vegetable consumption, eating past the point of being full, and cost of food influencing purchasing behaviour. Analyses were carried out on data from the Stormont Study, an organisation-wide health-focused employee survey conducted in 2012 (Time 1) and 2014 (Time 2) in the Northern Ireland Civil Service (NICS). The Stormont Study methodology is presented in Chapter 3. A descriptive epidemiology based on cross-sectional analyses of data collected at T1 and T2 is presented in Chapter 4. These analyses identified the importance of demographic factors, in addition to the measures of SES in relation to eating behaviours. To explore relations between SES and eating behaviours, cross-sectional, prospective, and longitudinal analysis was carried out in Chapter 5. Relations between SES and eating behaviours were observed in all three analyses – however only grade and education reached significance in the longitudinal analysis. The demographic variables significantly contributed to the statistical model in all three analyses; age and BMI produced consistently significant relationships with nearly all eating behaviours across all three sets of analysis. Chapter 6 explores the extent to which eating behaviours differed between age groups and BMI categories, to understand if interventions may benefit from demographic tailoring for high risk groups. In light of findings from the quantitative studies, and to better inform interventions to improve eating behaviours in the workplace, a qualitative study, in Chapter 7, was conducted in 2017, within a higher SES management group, in a large organisation that had recently been privatised after many decades in public ownership. The findings of the quantitative studies were explored with participants, in addition to asking them to consider the barriers and facilitators to eating a healthy, well-balanced diet, and their perceptions of the role of the employer in promoting healthy eating. Thematic saturation was reached upon completion of 15 interviews. Five main themes were identified, each containing multiple sub-themes: (1) knowledge, (2) behaviour, (3) access, (4) workplace culture and (5) responsibility (government and organisational responsibilities). Workplace culture was seen as a barrier to healthy eating, and therefore initiatives designed to modify work culture may prove effective as a means by which to promote healthy eating in the organisational setting. Chapter 8 considers the research as a whole and the application of findings to workplace health promotion practice. Strengths and limitations of the investigation are discussed and recommendations made for future study.

Objective: This thesis examined the prevalence of burnout, alcohol consumption, and psychological distress and their association with stress-related working conditions – defined either in terms of the Effort-Reward Imbalance (ERI) model, or the ERI model combined with the Job Demand-Control-Support (job strain) model (DCS) – in two large-scale international samples of humanitarian aid workers. The studies herein were the first in the extant literature to examine organisational stressors using job stress models in this occupational group. Furthermore, given the paucity of previous research on the subjective stress-related experiences of humanitarian aid workers, this thesis also contains an interview-based study that explored how humanitarian aid workers perceived the transactional stress process. One key characteristic of this thesis was that both quantitative and qualitative approaches were utilised to provide a deep and ecologically valid understanding of the stressor-strain relationship. Identifying the links between stressful aspects of work and both psychological and behavioural health outcomes may help inform the design of sector-specific health interventions. Methods: A mixed-methods approach was adopted to allow for a thorough examination of the prevalence of health and health-related behavioural outcomes, their relationship to stress-related working conditions (psychosocial stressors), and the concept of work-related stress in the population under study. Survey designs were used for Study 1 and 2 and involved the administration of a structured questionnaire. For the first study (Parts 1-2, Organisation A), logistic regression analyses were run based on a cross-sectional survey (N = 1,980) conducted separately for men and women to investigate the relations between ERI and both burnout (Part 1) and heavy alcohol consumption (Part 2) while controlling for demographic and occupational characteristics. In Study 2 (Organisation B), logistic regression analyses were based on a cross-sectional survey (N = 283) conducted separately for men and women to investigate the independent and combined relations between the ERI and DCS models and psychological distress while controlling for demographic and occupational characteristics. The final study was interview-based (Study 3, Organisation B) and it explored how humanitarian aid workers (N = 58) employed by a United Nations-aligned organisation perceived the transactional stress process. Results: The prevalence rates for the burnout components were as follows: high emotional exhaustion—36% for women and 27% for men; high depersonalisation—9% and 10%; and low personal achievement—47% and 31% for women and men, respectively. Intermediate and high ERI scores were associated with a significantly increased risk of high emotional exhaustion, with mixed findings for depersonalisation and personal achievement. The prevalence of heavy alcohol consumption among women (18%) was higher than the corresponding rate for men (10%), lending support for the effort-reward perspective only among women. Intermediate and high ERI scores in women was associated with a three-fold risk of heavy alcohol consumption. The results broadly suggest that occupational stressors from the ERI and DCS models, both individually and in combination, are significantly associated with psychological distress. A thematic analysis undertaken within the qualitative study revealed several main themes. An emergency culture was found where most employees felt compelled to offer an immediate response to humanitarian needs. The rewards of humanitarian work were perceived as motivating and meaningful, and employees experienced a strong identification with humanitarian goals and reported high engagement. Constant change and urgent demands were reported by the participants to result in work overload. Finally, managing work-life boundaries, and receiving positive support from colleagues and managers, helped buffer perceived stress, work overload, and negative health outcomes. Conclusions: The results of the present thesis convincingly demonstrate the usefulness of the ERI model as a framework for investigating burnout and heavy alcohol consumption among humanitarian aid workers. Furthermore, the findings demonstrate the independent and combined predictive effects of components of two alternative job stress models (ERI and DCS) on psychological distress. Taken together, the findings underscore the deleterious associations between work-related psychosocial hazards and mental and behavioural health outcomes. Specifically, unique insights were obtained about the work-related stress process in relation to humanitarian aid workers – for example, the emergency culture shaping organisational norms. The results suggest that interventions based on these two influential theories, and supplemented by knowledge on role-specific stressors evident in the sector, hold promise for reducing health outcomes. The practical implications of the results are discussed and suggestions are made in the light of the present research and stress theory.