The Truth and Reconciliation Commission’s first call to action is to reduce the number of Indigenous children and youth in care, including keeping young people in culturally appropriate environments. While we work towards this goal, culturally appropriate resources are needed to support children and youth as evidence shows that when Indigenous youth have access to cultural teachings, they have improved physical, mental, emotional, and spiritual health outcomes. Our project focused on the protective qualities of Indigenous coming of age teachings. Together with our community partner Surrounded by Cedar Child and Family Services, we worked to develop resources that inform and advocate for a culturally-centered coming of age for urban Indigenous youth living in foster care in Victoria, British Columbia on Lekwungen Territory. This dissertation begins with a literature review to provide the social and historical context surrounding urban Indigenous youth-in-care’s access to coming of age teachings. This is followed by a description of the Indigenous research paradigm that guided our work, what it meant for us to do this project in a good way, and the methods that we used to develop three visual storytelling knowledge sharing tools. Three manuscripts are presented, two published and one submitted, that reflect a strength-based vision of coming of age shared by knowledge holders who participated in our community events. The first manuscript retells the events of the knowledge holder’s dinner, where community members shared their perspectives on four questions related to community engagement and youth support. An analysis of the event’s transcripts revealed key themes including the responsibility of creating safe-spaces for youth, that coming of age is a community effort, and the importance of youth self-determining their journey. A graphic recording and short story are used to illustrate and narrate the relationship between key themes and related signifiers. This manuscript highlights the willingness of the community to collectively support youth in their journeys to adulthood. The second manuscript focuses on our two youth workshops that had the objective of understanding what rites of passage youth in SCCFS’s care engage with and how they learn what cultural teachings were most important to them. The findings suggest that when youth experience environments of belonging, and know they are ‘part of something bigger’, qualities like self-determination, self-awareness, and empowerment are strengthened. The third manuscript focuses on how we translated our project findings into different storytelling modalities using an Indigenist arts-based methodological approach. The project findings provided the inspiration and content for a fictional story called Becoming Wolf, which was adapted into a graphic novel, and a watercolour infographic. These knowledge sharing media present our project findings in accessible and meaningful ways that maintain the context and essences of our learnings. This research illustrates how Indigenous coming of age is an experience of interdependent teachings, events, and milestones, that contribute to the wellness of the body, mind, heart, and spirit of youth and the Indigenous community more broadly. Through our efforts, we hope to create a shared awareness about the cultural supports available to urban Indigenous youth that can contribute to lifelong wellness. / Graduate

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide recommendations. Aims 1 and 2 were informed by an adapted SDOH framework, which comprised of upstream structural determinants, and downstream intermediary determinants. Aim 1 was achieved via a scoping review of studies across three databases following the PRISMA-SCR checklist. Aim 2 was achieved via a cross-sectional analysis of data from adult respondents to the 2019 Behavioral Risk Factor Surveillance System, with self-reported hypertension. Bivariate and Multiple Logistic regression analyses were conducted. Aim 3 involved a literature scan on policy concerning SMBP, highlighting the policy implications of findings from the empirical study, and providing recommendations for policy/practice. For aim 1, findings suggest that research studies examined the relationship of relatively more structural determinants, than the few, but highly significant intermediary determinants, with SMBP. For aim 2, looking at the structural determinants, males and those who identify as Black and other minority racial groups were more likely to report SMBP. For intermediary determinants, respondents who consumed fruits, vegetables, and exercised were likely to report SMBP, while those who smoke, who drink, and those with poor mental health days were less likely to report SMBP. Respondents with health coverage and whose provider recommended SMBP were likely to report SMBP use. Those ≥65 years were more likely to report SMBP. For aim 3, I recommend that the Centers for Medicare and Medicaid Services lead policy efforts on SMBP reimbursements. Also, healthcare practices should strengthen their technological infrastructure e.g., telehealth to promote access, and Electronic Health Records to promote efficient data collection and tracking.

Introducción: El no uso de los servicios formales de la salud es un punto prioritario para la sociedad, dado que pone en evidencia las debilidades de la capacidad de atención del sistema de salud e insta su mejora, más aún en la población gineco-obstétrica y pediátrica. No se conoce con exactitud la influencia de los determinantes sociales de la salud en esta conducta en las poblaciones estudiadas. Objetivos: Evaluar la asociación y distribución del no uso de servicios formales de salud en la población gineco-obstétrica y pediátrica y los determinantes sociales de la salud. Materiales y métodos: El presente estudio es un transversal analítico, a partir de los datos del estudio poblacional ENDES 2019. Las variables de resultado fue el NUSFS para atención prenatal y atención de parto en mujeres en edad fértil. Asimismo, se evaluó este comportamiento en la búsqueda de atención para menores de 5 años que presentaron diarrea y fiebre y/o tos en los 14 días. Las variables de exposición fueron los determinantes sociales de la salud, tanto estructurales como intermedios. Se reportaron razones de prevalencia crudas y ajustadas, se tomó en cuenta la estructura compleja de la muestra. Resultados: Se encontró asociación del NUSFS para atención prenatal con estado civil conviviente (RPa=5.23 IC95%=1.34-20.39), estar afiliada al SIS (RPa=4.09 IC95%=1.08-15.41) y que perciba ingresos (RPa=3.33 IC95%=1.16-9.56). El NUSFS para atención de parto, se vieron asociados la edad de la madre comprendida entre los 35 a 49 años (RPa=0.62 IC95%=0.44-0.87), que la mujer se autorreconozca como “Mestiza” (RPa=0.53 IC95%=0.35-0.80), residir en zonas rurales (RPa=1.92 IC95%=1.48-2.48) y tener 4 o más niños nacidos (“4 hijos” RPa=1.53 IC95%=1.08-2.16). El NUSFS para diarrea en menores de 5 años se asocia la edad del jefe del hogar entre 30 y 39 años (RPa=0.71 IC95%=0.54-0.93), que la madre hable una lengua amazónica (RPa=1.97 IC95%=1.01-4.30) y que resida en la selva (RPa=1.55 IC95%=1.02-2.35). Por último, el NUSFS para la atención de fiebre/tos se asoció a la edad de la madre (“25 a 34 años” RPa=0.79 IC95%=0.68-0.93, “35 a 49 años” RPa=0.63 IC95%=0.51-0.77), pertenecer al quintil “Pobre” (RPa=1.27 IC95%= 1.07-1.50) y residir en una zona rural (RPa=0.73 IC95%=0.62-0.86). Conclusiones: Existe asociación entre el no uso de los servicios formales de la salud en las poblaciones gineco-obstétricas y pediátricas y los determinantes sociales de la salud. / Introduction: The non-use of formal health services (NUFHS) is a priority for society, since it highlights the weaknesses in the capacity of the health system and urges its improvement, even more so in the gynecological-obstetric and pediatric populations. The influence of the social determinants of health on this behavior in the populations studied is not exactly known. Objectives: To evaluate the association and distribution of the non-use of formal health services in the gynecological-obstetric and pediatric population and the social determinants of health. Materials and methods: This study is a cross-sectional analysis, based on data from the ENDES (NHS) 2019 population study. The outcome variables were the NUFHS for prenatal care and delivery in women of childbearing age. Likewise, this behavior was evaluated in seeking care for children under 5 years of age who had diarrhea and fever and/or cough within 14 days. The exposure variables were the social determinants of health, both structural and intermediate. Crude and adjusted prevalence ratios were reported, taking into account the complex structure of the sample. Results: Association of the NUFHS was found for prenatal care with cohabiting marital status (aPR=5.23 CI95%=1.34-20.39), being affiliated with SIS (aPR=4.09 CI95%=1.08-15.41) and receiving income (aPR=3.33 CI95 %=1.16-9.56). The NUFHS for delivery care was associated with the age of the mother between 35 and 49 years (aPR=0.62 CI95%=0.44-0.87), that the woman is self-recognized as "Mestiza" (aPR=0.53 CI95%= 0.35 -0.80), resides in rural areas (aPR=1.92 CI95%=1.48-2.48) and has 4 or more children born (“4 children” aPR=1.53 CI95%=1.08-2.16). The NUFHS for diarrhea in children under 5 years of age is associated with the age of the head of the household between 30 and 39 years (aPR=0.71 CI95%=0.54-0.93), that the mother speaks an Amazonian language (aPR=1.97 CI95%=1.01- 4.30) and lives in the jungle (aPR=1.55 CI95%=1.02-2.35). Finally, the NUFHS for fever/cough care was associated with the mothers age (“25 to 34 years old” aPR=0.79 CI95%=0.68-0.93, “35 to 49 years” aPR=0.63 CI95%=0.51 -0.77), belonging to the “Poor” quintile (aPR=1.27 95% CI= 1.07-1.50) and residing in a rural area (aPR=0.73 95% CI=0.62-0.86). Conclusions: There is an association between the non-use of formal health services in the gynecological-obstetric and pediatric populations and the social determinants of health. / Tesis

Background: Patients with newly diagnosed lung cancer have one of the highest rates of psychosocial distress which may be reduced by identifying factors associated with psychosocial distress. This dissertation examined the association of neighborhood-level Social Determinants of Health (SDOH) and delay in treatment initiation with psychosocial distress. It also qualitatively explored perceptions and practices of the lung cancer care team regarding psychosocial distress screening. Methods: Sociodemographic, clinical, and SDOH data of patients newly diagnosed with lung cancer between 2017 and 2021 was analyzed via logistic regression. Thematic analysis was done for interviews conducted with the lung cancer care team. Results: SDOH and delay in treatment were not significantly associated with psychosocial distress. However, a high deprivation level of SDOH was associated with delay in treatment initiation. Qualitatively, four principal themes emerged: (1) Timing and frequency of screening: Multiple screenings at different time points may be more effective; (2) Training needs: All staff would benefit from training; (3) Staffing needs: More psychologists and social workers are needed to address identified patient psychosocial distress and; (4) Opportunity for holistic patient care: Consistent communication of distress screening information to physicians and surgeons may enhance a holistic care model for patients. Conclusions: The lung cancer care team valued psychosocial distress screening and identified opportunities for improving screening processes. The finding of association of high deprivation level of SDOH with greater delay in treatment initiation suggests that targeted interventions to reduce delay in treatment initiation, focusing on economically marginalized groups may be warranted.

No description available.

This dissertation presents in the form of two distinct chapters conceptually related in nature. The first chapter integrates literature from various fields such as indigenous, womanist, and feminist lenses to propose nine principles when working with Muslim women. The purpose of the second chapter is to examine Muslim women’s experiences in therapy at university counseling centers. The study explores women’s experiences from a social determinants of health perspective and a narrative inquiry method—namely, how intrapersonal, interpersonal, institutional, community, and policy factors inform women’s experiences. Qualitative analysis from interviews with six women suggests Muslim women navigate multiple systems which inform their beliefs about health and their experiences in therapy.

The maternal mortality rate in the USA is the highest in the industrialized world. Black women in the USA are three times more likely to die due to pregnancy and childbirth-related health issues than their white counterparts. According to 2017–2019 data from the CDC, 80% of these deaths are preventable.The purpose of this thesis is to understand how women’s bodily autonomy is both racialized and politicized. Key questions here are: What is the relationship between access to healthcare and reproductive rights? How are reproductive rights racialized? How is bodily autonomy racialized and politicized?This research is based on a literature review and a case study of the documentary Aftershock, released in July 2022. Aftershock charts the deaths of two young Black American women after they gave birth and shows how their partners and families stood together and became effective activists determined to fight the Black maternal mortality epidemic in the US, and thereby increase awareness and bring about change in society.

No description available.

<p dir="ltr">This study aims to investigate the potential for improvement of psychotherapeutic outcomes in marginalized individuals who are experiencing discriminatory trauma using critical consciousness. Rooted in systemic inequalities and subjugation, discriminatory trauma, has a significant psychological impact on marginalized populations. According to existing research, critical consciousness has the potential to act as a protective factor, increasing levels of psychological well-being and resilience by encouraging awareness and action in resistance to social and systemic injustice. This study also aims to explore how the unique challenges experienced by marginalized communities can be addressed by the integration of critical consciousness into Couple and Family Therapy (CFT) practices. This study will use a quantitative approach to examine the correlation between critical consciousness, psychological wellbeing, and mental health in individuals experiencing discrimination. Additionally, it will examine ways to integrate critical consciousness into Couple and Family Therapy practices pushing the field into a more equitable and just approach to mental health care. These findings could potentially point the promotion of healing and resilience through the empowerment of marginalized individuals, couples, and families and leading to increased ability to resist the impacts of systemic oppression.</p>

This thesis addresses three interrelated challenges of disease mapping and contributes a new approach for improving visualization of disease burdens to enhance disease surveillance systems. First, it determines an appropriate threshold choice (smoothing parameter) for the adaptive kernel density estimation (KDE) in disease mapping. The results show that the appropriate threshold value depends on the characteristics of data, and bandwidth selector algorithms can be used to guide such decisions about mapping parameters. Similar approaches are recommended for map-makers who are faced with decisions about choosing threshold values for their own data. This can facilitate threshold selection. Second, the study evaluates the relative performance of the adaptive KDE and spatial empirical Bayes for disease mapping. The results reveal that while the estimated rates at the state level computed from both methods are identical, those at the zip code level are slightly different. These findings indicate that using either the adaptive KDE or spatial empirical Bayes method to map disease in urban areas may provide identical rate estimates, but caution is necessary when mapping diseases in non-urban (sparsely populated) areas. This study contributes insights on the relative performance in terms of accuracy of visual representation and associated limitations. Lastly, the study contributes a new approach for delimiting spatial units of disease risk using straightforward statistical and spatial methods and social determinants of health. The results show that the neighborhood risk map not only helps in geographically targeting where but also in tailoring interventions in those areas to those high risk populations. Moreover, when health data is limited, the neighborhood risk map alone is adequate for identifying where and which populations are at risk. These findings will benefit public health tasks of planning and targeting appropriate intervention even in areas with limited and poor-quality health data. This study not only fills the identified gaps of knowledge in disease mapping but also has a wide range of broader impacts. The findings of this study improve and enhance the use of the adaptive KDE method in health research, provide better awareness and understanding of disease mapping methods, and offer an alternative method to identify populations at risk in areas with limited health data. Overall, these findings will benefit public health practitioners and health researchers as well as enhance disease surveillance systems.