BACKGROUND: Although prior studies have established the association of asthma with smoking and obesity, literature on difference-in-differences analyses involving sexual identity is sparse. Therefore, this study aimed to examine the between and within sexual identity-group differences in asthma prevalence among individuals who smoke and are obese. METHODS: We aggregated the 2017-2019 National Survey on Drug Use and Health data on adults ( = 128,319) to perform weighted multivariable logistic regression analysis and marginal estimates and marginsplot to determine asthma prevalence by sexual identity and the status of smoking and obesity. RESULTS: About 66% of the study population reported having asthma. Among the individuals with asthma, 42% were obese, 10% were daily cigarette smokers, and 6% identified as bisexual persons. Lesbian/gay daily smokers (86%) or former smokers (75%) had a higher probability of having asthma than bisexual (daily smokers = 78% vs former smokers = 72%) and heterosexual (daily smokers = 68% vs former smokers = 65%) persons. Within each sexual identity subgroup, daily smokers (68-86%) had the highest probability of asthma. Obese bisexual (73%) or lesbian/gay (72%) persons had higher probabilities of having asthma than heterosexual persons (69%). Obese (73%) or overweight (72%) bisexual (compared to normal weight = 70% or underweight = 51%) and obese (69%) or overweight (65%) heterosexual (compared to normal weight = 62% or underweight = 57%) persons had the highest probabilities of having asthma within their groups, whereas overweight persons (overweight = 81% vs underweight = 79%, normal weight = 78%, and obese = 72%) had the highest probabilities within lesbian/gay persons. CONCLUSIONS: Smoking and obesity show heightened odds for asthma, with significant odds for sexual minorities in asthma diagnosis relative to heterosexuals. These findings provide formative information for future longitudinal and experimental studies to explore these mechanisms of asthma risks among sexual and gender minorities.

Background: Environmental exposures acting through different mechanisms have been linked with a number of cancers. Perfluoroalkyl chemicals (PFCs) are endocrine disrupting chemicals affecting estrogen homeostasis. Objectives: We examined the association between PFCs and a group of estrogen related cancers and explored if increased non-occupational exposure was associated with increased odds of developing these cancers. We also explored which of these chemical exposures was more correlated with each cancer. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), we selected participants ≥ 20 years of age. Our outcome variable was presence or absence of breast, prostate, ovarian and uterine cancer (yes/no); our exposure variables were serum PFCs. Logistic regression models were used in investigating the association between PFCs and cancer types and between quartiles of PFCs exposure concentrations and presence or absence of cancer while adjusting for covariates. Discriminant analysis was used to assess the correlation between individual PFCs compounds and individual cancer types. Results: PFCs were associated with increased odds of ovarian cancer; PFOA: 1.02(1.01, 1.02), PFOS: 1.01 (1.012, 1.013), PFHS 1.031 (1.030, 1.033), PFDE: 1.29(1.27, 1.30) and increased odds of breast cancer; PFOA: 1.089(1.089, 1.09), PFOS: 1.011(1.011, 1.011), PFNA: 1.031(1.030, 1.033), PFHS: 1.02 (1.02, 1.02), PFDE: 1.19(1.18, 1.19). PFCs were not associated with increased odds of prostate or uterine cancers. Comparing the odds in quartile 4 to quartile 1 for ovarian cancer, PFOA: 1.77(1.75,1.79), PFOS: 2.25(2.22, 2.28), PFHS: 1.86(1.84, 1.88), PFDE: 2.11(2.09, 2.14). For breast cancer, PFOA: 2.30(2.28, 2.31), PFOS: 1.47(1.46, 1.48), PFNA: 1.04(1.03, 1.05), PFHS:7.07(6.97,7.17), PFDE: 1.38(1.37, 1.39). PFOA was more correlated with breast cancer (0.7) and PFHS was more correlated with ovarian cancer (0.9). Discussion: PFCs were associated with increased odds of ovarian and breast cancers with a positive dose-response relationship. PFOA was more correlated with breast cancer and PFHS more with ovarian cancer.

Objectives: As social determinants of health, mortgage possessions (primarily foreclosures in the US context) and housing instability have been associated with certain mental and physical health outcomes at the individual level. However, individual risks of foreclosure and of poor health are spatially patterned. The objective of this study is to examine the extent to which area-specific social and economic characteristics help explain the relationship between mortgage possessions and obesity prevalence in 75 of the 100 most populous US metropolitan areas. Study design: This is a cross-sectional study. Methods: The study relies on three sources of data: the Selected Metropolitan/Micropolitan Area Risk Trends (SMART) project, RealtyTrac foreclosure data, and the American Community Survey. Focal social and economic characteristics include foreclosure rates, levels of racial residential segregation, and poverty. Obesity prevalence and several control measures for each metropolitan area are also used. Ordinary least squares regression, weighted using the SMART project data, is used, and statistical significance is set at 0.05. Results: The results suggest that mortgage possessions are independently associated with higher obesity prevalence and that foreclosures operate through the specific channel of racial residential segregation and its tie to the racial composition of a metropolitan area. Socio-economic status of an area, and not poverty, is related to foreclosures and obesity prevalence. Conclusion: Mortgage possessions not only are socio-economic but also have negative health consequences, such as obesity. The findings provide an empirical base for other researchers to uncover the relationships between segregation, mortgage possessions, and obesity at the individual level of analysis. The public health community should be engaged in addressing the issue of foreclosures in the US because the failure to engage may have broad financial and health consequences across large cities.

This study investigated the risk factors for workplace sexual harassment in South Korea using cross-sectional data of the 2014 and 2017 Korean Working Conditions Survey (KWCS). A generalized linear model specified with a Poisson distribution and log link function was performed. Females, younger adults, jobs in services or sales, tasks that involve visiting places where clients reside, and significant work time contribution to customers were associated with increased gender harassment and unwanted sexual attention. Evidence suggests that third parties and male-oriented culture may pose a serious threat to healthy working conditions.

Objectives: Understanding the impact of poverty on health can inform efforts to target social programs and regional economic development. This study examined the effects of poverty on health among the 95 counties of Tennessee. Methods: All of the counties of Tennessee were ranked by 5-year median household income, from the wealthiest to the poorest. The counties were divided into quintiles, from wealthiest to poorest, to reflect the general impact of wealth on health. Next, the five wealthiest counties and the five poorest counties were identified, allowing for examination of the extremes of poverty and wealth within Tennessee. Comparisons of quintiles and five wealthiest and poorest counties on key measures were performed using the independent t test. Results: People living in the wealthiest quintile lived on average 2.5 to 4 years longer and had lower rates of all health behaviors and health outcomes investigated compared with those in the poorest quintile. This disparity was even more pronounced when comparing the wealthiest five counties to the poorest five. The five poorest counties, for example, had twice the years of potential life lost and were overwhelmingly rural in character, with similar accompanying disparities such as median income, high unemployment, and a more aged population. Conclusions: This study highlights the fact that lower income is associated with significantly worse health outcomes in Tennessee and reinforces the importance of economic development, specifically, and addresses the social determinants, more generally, in helping to improve Tennessee's overall health statistics.

Background: The Healthy People 2020 goal for the public health system is “to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services.” To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri. Methods: Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health & Senior Services (2012), binary logistic regression analysis was performed to predict accreditation status of LHDs. Likelihood ratio tests were used to examine whether the addition of each predictor added significantly to the model compared with a model including total revenues alone. Adjusted odds ratios (aORs), 95% confidence intervals, the significance level of the likelihood ratio test, and the overall Nagelkerke pseudo-R2 for each model are reported. Results: Having a community health improvement plan (aOR = 6.2), a strategic plan (aOR = 7.9), evaluating programs (aOR = 3.6), being in a region with a high proportion of accredited LHDs (aOR = 5.5), and participating in multijurisdictional collaborations (aOR = 6.4) all increased the likelihood of accreditation. Barriers of time (aOR = 0.1) and cost (aOR = 0.3) were negatively associated with accreditation. Conclusions: Accredited LHDs were more likely to have completed the prerequisites for accreditation and collaborate with other LHDs. These activities help LHDs meet the accreditation standards. In addition, with shrinking budgets, LHDs will need additional financial and technical support to achieve accreditation. Assisting LHDs to find ways to increase the staff is important. Through collaborations with other LHDs, regional or multicounty positions can be created. Also collaborations with universities, specifically colleges or schools of public health, can provide opportunities for internships at LHDs giving practical experience while providing important assistance to LHDs.

Needs assessment--Cost analysis--Modeling--Pilot studies--Sample programs--Training programs--Communication.

Needs assessment--Cost analysis--Modeling--Pilot studies--Sample programs--Training programs--Communication.

Diploma thesis "Inspection of the quality of social services" deals with low quality of social services with measurement of the quality control of social services. Its main objective is to assess the position of the actors (inspectors and providers of social services), social services inspection process and make recommendations for its improvement. The work is characterized by a history of social services, whereon relates social services inspection. The work is based on the principle of subsidiarity, the theory of trust, the theory of government and market failures, as well as information asymmetry theory and the theory of bureaucracy. The diploma thesis also includes quality standards of social services, mark quality and management in social services. Work also includes the very process of inspection of social services. The following chapter is a quality framework for social services. Another part is devoted to the research methods used. At the end of thesis are the recommended areas to alteration which leading to increase efficiency and effectiveness of the process of inspection of social services.

Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Policy makers and development practitioners particularly in developing countries face daunting challenges in formulating strategies to achieve sustained growth and improved standards of living through productive engagement of the population in the economy rather than through welfare transfers. Business activities are self-sustaining and therefore have the potential to contribute greatly through the economic system to the creation of sustainable employment and prosperity. Yet many developing countries are faced with inadequate levels of business activity and business growth. Historical approaches to stimulating and supporting business development have proved largely cost ineffective and unequal to the challenge. The hypothesis that fundamental paradigm shifts in the approach to business support are taking place internationally is tested in this thesis. Key features of an evolving entrepreneurial approach to business support are identified and described representing the defining elements of the new business development support paradigm. Institutional implications of the approach in the context of institutional development theory and current approaches to the stimulation of local economic development at local community level are also discussed, as are key implications of the new paradigm for local government. / AFRIKAANSE OPSOMMING: Beleidmakers en praktisyns in ontwikkelende lande staar uitdagings in die gesig wat betref die handhawing van volgehoue ontwikkeling en die verbetering van lewensstandaarde by wyse van werkgeleentheidskepping en produktiewe betrokkenheid van die bevolking by die ekonomie eerder as deur sosiale welvaarts oordragte. Sake bedrywe en 'n dinamiese sakesektor het die potensiaal om aansienlik by te dra tot volhoubare ontwikkeling. Maar die meeste ontwikkelende lande ondervind ontoereikende vlakke van sake aktiwiteit en van groei in die omvang van die sakesektor. Benaderings tot die stimulering van uitbreiding van die sakesektor as grondslag vir volgehoue werkskepping is in die verlede grootliks koste ondoeltreffend en die resultate was ontoereikend. Die hipotese dat daar 'n fundamentele aanpassing van die paradigma onderliggend aan benaderings tot stimulering van die sakesektor as deel van algehele ontwikkelingsstrategie plaasvind word in die tesis getoets. Kern eienskappe van 'n nuwe benadering word geidentifiseer en omskryf. Institusionele implikasies van die benadering in die samehang van ontwikkelingsteorie en huidige benaderings tot plaaslike ekonomiese ontwikkeling op plaaslike gemeenskapsvlak word ook bespreek, asook kern implikasies van die nuwe paradigma vir plaaslike regering.