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.

<p> Children of Hispanic origin have the highest prevalence of asthma of all ethnic groups in the United States, especially Puerto Rican children, who have a prevalence of 12.9%. Treatment nonadherence has been identified as one contributing factor. The purpose of this qualitative study was to explore the reasons for nonadherence to the asthma treatment regimen among Puerto Rican children. Parents and health care providers of asthmatic children were interviewed regarding their beliefs about asthma as a disease, its effect on the child&rsquo;s life, and their experience with asthma treatment. Two models served as the theoretical framework: the health belief model and the Institute of Medicine model framework for asthma disparities. Interview data were collected from 8 parents using a questionnaire, and a focus group was conducted with 3 health care professionals. Data were manually coded to identify emerging themes. Even though parents reported fear of asthma medications and medication side effects, none of the parents stopped the asthma treatment. Results also indicated that lack of education about asthma, asthma treatment, and asthma action plan was evident in 75% of the parents. None of the parents who migrated to the United States from Puerto Rico received education about asthma while living in Puerto Rico. Health care professionals reported that although parents are familiar with asthma, they do not understand that it is a chronic disease that requires daily treatment. Findings may be used to create an asthma education plan tailored to the needs of the Hispanic population. </p><p>

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University.

<p> Type 2 diabetes is a chronic metabolic disorder and the seventh leading cause of death in the United States. Type 2 diabetes is linked to many chronic diseases, including cardiovascular disease, stroke, and chronic kidney failure. African American adults have a high prevalence of Type 2 diabetes with early onset of diabetes complications. Poor dietary behavior is the primary cause of Type 2 diabetes and its complications, changing dietary behaviors can prevent the onset of diabetes complications or impede existing ones. The purpose of this phenomenological study was to explore patients&rsquo; perceptions of diet-only therapy in the prevention of diabetes complications. Face-to-face interviews were conducted with six African American adults with Type 2 diabetes between 40 to 64 years using purposeful sampling method. Health belief model formed the conceptual framework of the study. I applied inductive coding process and manually analyze data for themes. Participants expressed fear of diabetes complications, acknowledged effectiveness of dietary therapy, physician communication and strong family support in Type 2 diabetes management. Findings can produce positive social change among African American adults with type 2 diabetes. Patients can be motivated to change their dietary behaviors to prevent disability and death from diabetes complications. Adherence to diet can reduce medical costs associated with Type 2 diabetes and its complications at the individual, family, community, and government levels. Health care providers can apply the findings in their interactions with patients to provide a more patient-centered education that integrates patients&rsquo; cultural and dietary preferences to facilitate adoption of dietary interventions and long-term adherence.</p><p>

<p> Climate change has become responsible for substantial mortality and morbidity around the world. These numbers are said to rise, as climate change will continue to have both direct and indirect effects on human health, as well as threaten the determinants of health. Some health effects include asthma, respiratory disease, cancer, cardiovascular disease, stroke, health-related illness, human developmental effects, mental illness, neurological disease, vector-borne disease, waterborne disease, and more. Given the implications it carries on human health, climate change should be of fundamental relevance to doctors and future doctors alike. The aim of this thesis is to explore the importance of preparing doctors and student doctors for a climate-changing world. This includes developing skills and insights necessary in a clinical practice and a public health role. The research methods in this thesis is sought to identify if future doctors are being prepared and are willing to take action against climate change and the health implications it poses. The focus is also to identify the perceptions of doctors on climate change and its health risks, as little is known about this. Through theoretical and quantitative evidence, the goal is to provide insight on the role future doctors, who are both prepared and willing to take actions, can play in influencing patients to participate in climate change mitigation.</p><p>

Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Biology and Public Health, 1930. / Includes bibliographical references (leaves 67-68). / by Lawrence Parker Abare. / B.S.

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Biology and Public Health, 1935. / Includes bibliographical references. / by John Langworthy Fuller. / Ph.D.