Introduction: Adolescents in the United States use alcohol more than any other substance, including tobacco and marijuana. Continuing alcohol misuse has numerous adverse health effects and is linked to liver disease, cancer, cardiovascular disease and neurological damage. Furthermore, alcohol consumption is a significant risk factor for unsafe sexual behaviors, unintentional injuries, physical and sexual assaults, various types of illegal activities, and suicide (USDHHS, 2007). Aim: The purpose of this study is to compare the individual social indicators from 4 categories that have been identified within the literature as being particularly associated with alcohol consumption in general, and underage alcohol consumption in particular. The categories used were: drinking consequences, urbanicity, poverty, and alcohol outlet density. The social indicators in these categories will be compared in the 10 most-at-risk counties (MAR) and the 10 least-at-risk counties (LAR), and the 20 MAR counties and the 20 LAR counties, as they relate to underage alcohol consumption. Methods: The counties were identified in and data was obtained from Governor’s Cooperative Agreement State Incentive Planning and Development Grant: Social Indicator Study to Assess Substance Use Prevention Needs at the State and County Levels in Georgia. An independent 2-tailed t-test was conducted to compare the means of groups in both the 10 MAR/LAR counties and the 20 MAR/LAR counties. Results: Significant differences were observed in all of the individual indicators in the poverty and alcohol outlet density categories for both the 10 MAR/LAR counties and the 20 MAR/LAR counties. Discussion: There needs to be a more accurate, specific and efficient methods of data surveillance concerning underage drinking behavior. Further research should focus on urbanicity, poverty, and alcohol outlet density as they relate to underage alcohol consumption. There were differences observed between the MAR and LAR counties in all of the poverty alcohol outlet density indicators, and researchers and policy makers should pay special attention to these two areas when designing further research and prevention policies.

Bed bugs are making a large international comeback. While people from all economic and social backgrounds can experience a bed bug infestation, the social impacts on the lives of low-income people are potentially far greater given the condition of their living accommodations as well as the financial costs associated with dealing with an infestation. Utilizing the Community Economic Development and Social Determinants of Health approaches, this thesis argues that the experience of a bed bug infestation poses a significant threat to inner-city residents—economically, socially, and in terms of human health. Interviews with 16 inner-city residents, 2 landlords, 1 property manager, 2 By-Law Enforcement Officers, and 5 representatives of inner-city agencies in Winnipeg are drawn upon in developing this argument. In addition, relevant policy documents and other secondary sources are utilized to assess the effectiveness of policies and practices in place to respond to this issue and to offer a more comprehensive approach for responding to the social impacts of bed bugs in the city of Winnipeg.

It is well documented in the literature that Aboriginal peoples have a lower health status compared to the non-Aboriginal population in Canada. The underlining causes for this health disparity are found in the historical and contemporary practices of colonization and social, economic, and political deprivation. This thesis focuses on another of the complex factors which affect Aboriginal health status: the education and training provided to undergraduate medical students on Aboriginal health issues and the social determinants of health in British Columbia. I conducted a critical discourse analysis of the readings materials of three selected courses. I conclude from the analysis that although some of the themes covered by the courses critically present the historical, social and economic contexts for this health disparity, Aboriginal peoples are still characterized as a needy and sick population. Indigenous issues are far from being centrally positioned in the medical curriculum in British Columbia. / Graduate / 0326 / gabipere@hotmail.com

Official-language minorities in Canada may face specific issues in accessing health care services that can lead to negative consequences on their health, utilization of health care services and satisfaction with the health care system. A secondary data analysis of the 2006 Survey on the Vitality of Official-Language Minorities revealed significant differences between the Anglophone minority (n=5,161) and the Francophone minority (n=12,029) with regards to general health, and access to and use of health care services. Important predictors of these outcomes included age, education level, household income, marital status and place of residence (urban/rural). Access to health care services in the minority language was associated with self-perceived health in the Anglophone minority only. Health policy recommendations elaborated in light of the findings include working on both the supply and the demand of health care services offered in the two official languages, while taking into consideration important contextual differences between regions.

The goal of this thesis was to reposition individual preparedness within a social environmental context. First, a theoretical model was developed to more accurately represent the social environmental considerations neglected in current preparedness research and policy. A series of three studies tested this model using a mixed-methods approach: First, subjective conceptualizations of preparedness were explored in a qualitative analysis (N = 12). Findings revealed that participants evaluated their readiness not in terms of prescribed activities, but perceptions about their current resourcefulness as well as past local hazards. Participants’ had positive social environments which also reinforced their perceived coping ability in future emergency events. Subsequent thesis studies investigated the role social environment further, using quantitative data. The second study explicitly tested whether perceptions of risk and coping could explain differences in preparedness based on demographic attributes linked to variations in social environment. Data from a survey examining Canadians perceptions regarding terrorism threats (N = 1503) revealed that greater anticipated response was significantly associated with increased age, as well as female gender, higher education levels, and higher income levels. Statistically significant differences in threat appraisals were also reported based on these demographic groupings. However, mediation analyses demonstrated that with the exception of gender, differences in anticipated response could not be explained via risk perceptions or perceived coping efficacy, suggesting that social environment’s role in preparedness is not related to the internal processes often targeted in current campaigns. The third study used a multilevel design to investigate the contextual role of neighbourhood social environment in anticipated emergency response. Results demonstrated that a more deprived social neighbourhood context was related to lowered anticipated emergency response. This relationship was maintained after controlling for significant individual-level factors such as previous experience and sociodemographics, highlighting the importance of neighbourhood social context in facilitating emergency preparedness. Taken together, these findings provide novel evidence that focusing preparedness strategies to primarily target internal processes is misguided, and that future research and policy must position preparedness efforts in the context of existing social environmental resources and barriers in order to build capacity for effective emergency response.

Bed bugs are making a large international comeback. While people from all economic and social backgrounds can experience a bed bug infestation, the social impacts on the lives of low-income people are potentially far greater given the condition of their living accommodations as well as the financial costs associated with dealing with an infestation. Utilizing the Community Economic Development and Social Determinants of Health approaches, this thesis argues that the experience of a bed bug infestation poses a significant threat to inner-city residents—economically, socially, and in terms of human health. Interviews with 16 inner-city residents, 2 landlords, 1 property manager, 2 By-Law Enforcement Officers, and 5 representatives of inner-city agencies in Winnipeg are drawn upon in developing this argument. In addition, relevant policy documents and other secondary sources are utilized to assess the effectiveness of policies and practices in place to respond to this issue and to offer a more comprehensive approach for responding to the social impacts of bed bugs in the city of Winnipeg.

It is well documented in the literature that Aboriginal peoples have a lower health status compared to the non-Aboriginal population in Canada. The underlining causes for this health disparity are found in the historical and contemporary practices of colonization and social, economic, and political deprivation. This thesis focuses on another of the complex factors which affect Aboriginal health status: the education and training provided to undergraduate medical students on Aboriginal health issues and the social determinants of health in British Columbia. I conducted a critical discourse analysis of the readings materials of three selected courses. I conclude from the analysis that although some of the themes covered by the courses critically present the historical, social and economic contexts for this health disparity, Aboriginal peoples are still characterized as a needy and sick population. Indigenous issues are far from being centrally positioned in the medical curriculum in British Columbia. / Graduate / 0326 / gabipere@hotmail.com

The life expectancy (LE) gap experienced by Aboriginal and Torres Strait Islander peoples in one of Australians most enduring health divides. Whilst there are many likely reasons, cardiovascular diseases (CVD) stand as the primary contributor. In particular, it is the almost ten-fold higher mortality from CVD at young ages that distinguishes this epidemic. The reasons for this disparity remain incompletely understood. Current research has focused on the likely contribution of traditional risk factor burdens in Aboriginal people, who demonstrate higher levels of smoking, obesity, hypertension and dyslipidaemia. Less attention has focused on the potential contribution of disadvantage and its interplay with psychosocial factors. Research on the psychosocial determinants of health, particularly in relation to CVD, has a long pedigree. Social context, particularly inequality between individuals, has assumed its rightful place at the forefront of our understandings of population levels of disease. Among them, socioeconomic position [SEP] and depression are the most robust, and most widely researched. They have not been adequately explored in the context of Aboriginal Australians, nor has the manner in which culture shapes, sustains or transforms disadvantage and psychosocial stress been outlined. The objective of the Men Hearts and Minds (MHM) Study was to identify the possible ways in which social disadvantage may lead to CVD in Aboriginal men in Central Australia and consider the role of psychosocial factors in modifying or mediating this relationship. This required a detailed and multi-disciplinary plan of research, covering the epidemiology of mental illness and chronic diseases, biomedical science, ethnographic field work and qualitative methodologies. Stage I required the development of measurement tools for exploring depression, stress, resilience, mastery and socioeconomic indicators that were valid and robust for use with Aboriginal men within Central Australia. This involved multi-stage qualitative techniques, engaging Aboriginal men, traditional healers (Ngangkari Tjuta) and mental health experts, to define the expressions and construction of mental illness in Aboriginal men. Depression existed, was recognizable, common, and had profound impacts on the social, emotional and physical well-being of Aboriginal men. ‘Worry’ was the most recognisable element, and the principle contributor to depression in Aboriginal men. Much of this was focused on the increasingly heavy and cumulative social and cultural burdens experienced throughout Aboriginal men’s lives, and manifest as a sense of inner turmoil and questioning of self, and of feelings of disconnectedness from all the things of critical importance within their lives. Kurunpa [spirit] was seen as the foundation of vitality and was critical to the physical, emotional and spiritual well-being of Aboriginal people. These findings were then used to interrogate existing psychological testing tools and develop novel measures to explore the interplay of SEP, stress and depression. These tools were then used in a community dwelling sample of Aboriginal men in Central Australia to explore the interaction of SEP, stress and depression and their potential contribution to CVD risk. In total 186 Aboriginal men across urban and remote community settings were assessed. Almost 40% of the sample had elevated depressive symptoms. Depression was highly correlated with standard measures of distress and inversely with mastery. Newly created measures, assessing Chronic Stress, the ‘Sense of Injury’ and deprivation, were highly correlated, reliable and fulfilled many validity criteria. There was a high level of cardiovascular risk, which was related to a number of psychosocial factors, particularly depression. Major depression was over 9 times as common in individuals with prevalent CVD. Cardiovascular risk was patterned across social strata, but not evident with the use of routine measures of SEP. Psychosocial factors modified the observed social gradient. In those with high chronic stress, the social gradient in CVD risk gradient was amplified. This pattern was mirrored in those who had been removed or had family forcible removed. Depression was correlated with a number of atherogenic pathways. Smokers were more likely to be depressed, and depression was strongly related to obesity. Individual with high depression scores were more than 20 times more likely to have a Body Mass Index >30. The interplay between the Autonomic Nervous System (ANS) (estimated with measures of Heart Rate Variability) and the Hypothalamic Pituitary Adrenal (HPA) axis (as measured according to obesity) highlights the interconnections across atherogenic pathways and may frame the cardiometabolic risk and psychosocial pathways to cardiovascular disease in this sample. The phenomenology of cumulative stress, distress and depression within the narratives of Aboriginal men constructed illness as a consequence of the ongoing fight to maintain balance - physically, emotionally and spiritually. From both a social and biological perspective, the construction of depression and heart disease as a consequence of cumulative chronic stress among Aboriginal men was supported in the findings of this work.

I chose the topic of this thesis because of but also because of bad opinions of the people around me about migration as a problem. The main target of this work is to find out what areas within health determinants among immigrants haven´t been investigated for past 5 years in the Czech Republic and Europe. This target is important for possibilities of further researches of health determinants among immigrants. It may help to researchers with the topic which hasn´t been investigated in past years and there is the opportunity to do so. In the research part of this diploma thesis was selected quantitative method where the technique was comparative metaanalysis. Analysis will be done from available databased journals (Scopus, Pub-med) and available Czech journals (non-databased). The time limit was set on 5 years. In the databases Scopus and Pub-med was searched according to following criterions social determinants of health, immigrants, Europe, Czech Republic with the time limit 5 years of those articles. Contribution of this work is finding out which social determinants of health weren´t investigated at all, which is transport and stress in Europe. In the Czech Republic weren´t any researches executed on stress, childhood, unemployment, nutrition and transport. My diploma thesis contributes further possibilities of investigating for future researchers in investigations which haven´t been done yet.

Using United States Behavioral Risk Factor Surveillance Survey (BRFSS) and Census data, this study replicated and extended previous research conducted using the Canadian Community Health Survey (CCHS) by Statistics Canada. It examines the associations among both lifestyle and social determinants predictors and a criterion of perceived health. Results were also compared cross-culturally (United States and Canada). The study used secondary data analysis of 2000 and 2001 United States and Census data. In particular, multiple linear regression (MLR) and hierarchical linear modeling (HLM) were used to analyze state and individual-level data. Unlike data at the aggregate level (Canadian health regions and states of the United States), results at the individual-level were consistent across the United States and Canada. Social determinants of health (socioeconomics) were better predictors of health than lifestyle (behaviors). Individual-level socioeconomic characteristics and lifestyle were better predictors than higher level contexts (i.e., characteristics of a state or health regions). The findings of this study suggest that health educators should further research, and increase the focus in teaching and service on, social determinants of health in addition to efforts emphasizing lifestyles (health behaviors). This recommendation aligns with the soon to be released Healthy People 2020 that will add social determinants of health as a priority area for public health.