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Counties of Appalachia have long been linked to significant health disparities, including low birth weight infants. Low birth weight is directly related to cognitive and physical developmental delays and long-term health effects such as respiratory and congenital disabilities. On average, women residing in Appalachia have lower educational achievement and incomes and face barriers to accessing essential healthcare services, often associated with poor birth outcomes. However, Appalachia is not a monolith, and there is considerable variability in underlying levels of vulnerability and resources within Appalachia. This study examines variation in low birth weight (LBW) by sub-region of Appalachia. A cross-sectional study using 2022 County Health Rankings (CHR) data and Appalachian Regional Commission (ARC) sub-region designations were used to examine the extent to which the percentage of LBW infants varies across Appalachian sub-regions. The percentage of LBW infants at the county level was the dependent variable of interest, and the Appalachian sub-regions were the independent variable of interest. Analysis of variance (ANOVA) was used to compare the mean percentage of LBW infants among Appalachian sub-regions. Means and standard deviations of the percent of infants born at LBW were examined by sub-region and across other variables of interest, including the percentage of the population that was uninsured, of non-Hispanic Black race/ethnicity, had a high school diploma or equivalent, current adult smokers, children in poverty, food insecure, and individuals residing in a rural area. Overall, 90% of the population living in the Appalachian counties have received a high school diploma or equivalent, 11% of all individuals, children, and adults are uninsured, 24% of the adult population admits to smoking daily, nearly 21% of counties have children living at or below the federal poverty baseline, 68% of the counties are classified as rural, and 15% identify as having food insecurity. Almost 7% of the population is non-Hispanic Black. The Southern sub-region had the highest mean percentage of LBW infants (9.8%), followed by Central Appalachia (9.4%), while the Northern sub-region had the lowest (7.6%). The national value for LBW infants is 8.52%. This rate is comparatively lower than all Appalachia sub-regions, except for the Northern sub-region. Our study found that the Southern sub-region of Appalachia had the highest percentage of LBW infants among the sub-regions. These results are unsurprising given the well-documented relationship between LBW infants born to non-Hispanic Black women. Southern sub-region counties of Appalachia span parts of South Carolina, Georgia, Alabama, and Mississippi, all of which have higher proportions of non-Hispanic Black women as a percentage of the overall population. Central Appalachia, however, is predominantly white. Higher rates of LBW infants among this sub-region likely reflect significant differences in access to resources and health behaviors that are more common in Central Appalachia than in other sub-regions. Furthermore, the Northern sub-region of Appalachia is significantly less rural and better resourced than the other sub-regions, which may explain lower occurrences of LBW infants. A limitation of this study includes using CHR as a primary data source, which is compiled from state and national data.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (Ph. D.)--University of Missouri--Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 56-72, 152-166). Also available on the Internet.

The changes in the health care system have been remarkable over the past decades, along with the rapid economic development of China. The overall living standard of rural residents has generally improved; however, health expenses still make up a large part of their annual expenditure. During the new reform period, the importance of the village doctor has been emphasized by many scholars, and yet there are few studies conducted from the perspective of interactions between health administration, village doctor and rural resident to discover the invisible factors that influence the delivery of the health care service. Thus, this study aims to explore the street-level bureaucracy within the rural health care sector and its impact on rural residents. Guided by the Street-level Bureaucracy Theory and its application in public agency research, this study explores street-level bureaucracy in the grassroots health care sector in terms of health care regulation and provision before and after the recent series of health care reforms, and evaluates its impact on rural residents by analyzing health equity in terms of health care access, and the actual working and living conditions of the village doctor were identified. Apart from the official statistical data from document analysis and internet resources, the voices and advice of village doctors and rural residents in Jiangsu Province were also obtained from in-depth interviews, which provided the qualitative information for this study. There are four findings. First, as a typical street-level bureaucrat in the grassroots sector, the working condition of the village doctor has become more stable and their discretionary control has been enhanced greatly after the reforms, due to the implementation of specific rules and regulations and the changes in payment methods; Second, despite the fact that many regulations have been put into effect, compared to the supervision of the health administration, the payment method plays a significant role in the promotion of service equity; Third, village doctors regard their social reputation as important as their income, for they live in a small community network. Although the role of village doctor has been emphasized in the new reform, improvements in health equity are still not obvious and have had limited effect; Fourth, the function of the village doctor is not fully utilized, even though the coverage of current health insurance in rural areas has been tremendously expanded in the past decade. Accordingly, policy implications regarding the understanding of the work and social environment of village doctors in rural areas, especially on the future exploration of their function related to further reforms, are identified in the final chapter. Additionally, the theoretical and practical significances of this study have also been presented. / published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

Background: Previous research suggests that children living on farms have a lower prevalence of asthma compared to their more urban counterparts. Four potential explanations may underlie this association: personal factors, health care access, health risk behaviours, and the environmental explanation. Objectives: The objective of this thesis was to first compare the prevalence of asthma between children living on farms and those living in small towns. The second objective was to identify and compare potential risk and protective factors for childhood asthma in rural and farm environments. Finally, we interpreted the findings in light of the above explanations in terms of which is most likely to explain previously observed differences in pediatric asthma prevalence. Methods: We used cross-sectional data (n=834) from a 2003 study conducted in Estevan, Saskatchewan as well as cross-sectional data (n=2,259) collected as part of the Saskatchewan Rural Health Study in 2011. We determined differences in asthma prevalence and examined the distribution of potential risk and protective factors between farm and small town children. Using multiple logistic regression, we identified a number of potential risk and protective factors for both pediatric asthma and wheeze among these populations. Results: No differences in prevalence of asthma or wheeze were identified by farm and small town status in both analyses. Risk factors that were identified included: male sex, parental history of asthma, personal history of allergy, home dampness, being overweight or obese, premature birth, living in a single parent home, difficulty accessing routine healthcare, previous daycare attendance, having a mother that previously smoked, having mice in the home, having an air filter in the home and feeding livestock. Protective factors included: previous daycare attendance, having pets in the home and having a dehumidifier present in the home. Farm-specific protective factors included: filling or emptying grain bins, cleaning or playing in pens, and living on a grain farm. Conclusions: No differences in asthma or wheeze prevalence were identified between small town and farm children in these study populations. Findings primarily supported the environmental explanation for geographic differences in asthma prevalence identified historically, with modest support for the health care access explanation. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-09-20 16:44:44.525

Thesis (MEd(Human Resource Studies))--University of South Australia, 1997

Thesis (Ph. D.)--University of Technology, Sydney, 2005. / Includes bibliographical references (p. 301-316).

Thesis (Ph. D.)--Victoria University (Melbourne, Vic.), 2007. / Includes bibliographical references.