Socioeconomic disparities in health are well documented in the United States in that the higher socioeconomic status (SES) a person is the lower level of incidence and the prevalence of health problem, disease and death will be. Researchers have argued that SES disparities in health are found in different races, across countries, and throughout life. Furthermore, some researchers have argued that high SES persons enjoy their active life expectancy until quite late in life, while low SES persons start to suffer morbidity and functional limitation through middle and early old age. As a result, socioeconomic disparity in health becomes increasingly differential at middle age, while it diminishes until later old age due to physical fragility of human being and declining effect of SES. This study extends previous research by applying the Multi Level Model for Change (MLMFC) and Multi Cohorts Accelerate Longitudinal Design (MCALD) to explore SES disparities in health over the life course. Functional limitation and chronic diseases are used as measurements of health status over time. This study introduces a new way to measure health status over time by combining number and duration of chronic diseases. The results suggest that using a combination of number and duration of chronic diseases as measurement of health over time is more optimal than only using the number of chronic diseases. Both time variant and invariant independent variables are used to explore health trajectory. Findings from this study indicate that people from different SES groups have different health trajectories over the life course. Low SES people tend to age faster than their high SES counterparts. The process of aging in the United States is largely segregated according to individuals’ SES. Financial stress and health risk behaviors are two major mediators of SES disparities in functional limitation. However, SES (measured by income) is consistently a significant predictor of chronic diseases after controlling financial stress and health risk behaviors. Findings of this study suggest that the mechanisms through which SES impacts functional limitation may be different from its impact on chronic diseases. / text

<p> This study tested the effects of hypnosis for injection anxiety, medication side-effects from injectable medications, and general pain with patients who have MS. This seven- to nine-week hypnotic protocol was implemented based on the Palsson hypnosis protocol for Irritable Bowel Syndrome (2006). </p><p> The subjects were randomly assigned to receive in-person hypnosis in addition to listening to a self-hypnosis CD at home five days per week (N=13), or to a standard care group where they received no additional intervention for seven to nine weeks (N=14). The standard care group could listen to a self-hypnosis CD at home five days per week with no in-person treatment. </p><p> An additional goal of this randomized control trial was to teach patients to practice self-hypnosis to improve disease self-management and self-efficacy. </p><p> Paired t-tests were conducted from baseline to Time 3 in both groups to assess the significance of changes in the mean scores over time. The experimental group did not yield statistically significant results over time from baseline to Time 3 in medication side-effects or pain. However, the results did indicate a marginally significant (p=.09) decrease in injection anxiety. In addition, the experimental group showed statistically significant improvement in self-efficacy over time (p=.025), compared with the control group. The latter did not demonstrate any changes in self-efficacy. As expected, the control group did not show any statistically significant changes in their scores from baseline to Time 3 in injection anxiety, medication side-effects, or pain.</p>

<p> The purpose of this project was to write a grant to implement a free swimming program for foster children 17 years and under in the City of Petaluma. The Petaluma Healthy Youth Swimming Program (PHYSH) will provide a series of six 2-week sessions over the summer to teach swimming skills and swimming safety. The program is expected to increase self-esteem and resiliency among foster children and to decrease the disproportional rates of non-intentional drowning found among impoverished children of color. A part-time Master of Social Work Program Manager will be hired to oversee the program. The City of Petaluma's Parks and Recreation Department will provide in-kind donations of two swimming pools, swimming instructors, and lifeguards. Target stores will donate swimsuits to all registered participants. It was not required that this grant be submitted or receive actual funding to meet thesis requirements. </p>

<p> As people's life-expectancy prolongs with advanced medical treatments, numbers of individuals who experience widowhood in later life are expected to increase. As a result, grief work will be one of the common challenges that social workers and older adults will face. The purpose of this project was to develop a grant proposal for the Pathways Volunteer Hospice in Lakewood, California, and to identify funding sources for designing a mindfulness focused bereavement support group program for older widows who are age 60 years and over. With funding resources provided by the Weingart Foundation, the proposed program aims to educate participants on the principles of mindfulness and how they can integrate mindfulness principles and philosophy into their grieving process to better facilitate their coping with their loss. The proposed program will be based on empirically supported methods, such as, Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. The actual submission, and/or funding, of this grant was not required for successful completion of this thesis.</p>

<p> Quality citizen participation in processes of policy development is crucial to a democracy interested in equity of voice for all its citizens. Citizens with less political power, however, are often absent from policy development for a variety of reasons, despite legislative and advocacy efforts for inclusion. In policy development processes, community representatives are a mechanism for traditionally marginalized or disadvantaged citizens to have a voice; yet the question remains how to effectively utilize that voice. This question stems from research demonstrating an increase in quantity citizen participation but not in quality citizen participation, which is more interested in the process of policy development as opposed to a final product. To understand quality citizen participation, a critical ethnography guided by a socio-ecological perspective allowing for the investigation of contextual as well as individual factors impacting policy development processes was conducted to assist in advancing knowledge about the best practices necessary to facilitate quality citizen participation in policy development. The policy development process explored in this qualitative study was the context provided by three CHCs in a Midwestern state. Information was gathered about these three CHC boards from multiple sources to best represent the context surrounding participation on the boards and that participation experience from the perspective of board members. The data analyzed included: descriptive statistics of seven counties which comprised the patient community of the three CHCs participating in the study, descriptive statistics of the patient communities of those three CHCs, interviews with national and state policy experts, the clinic directors and board chairs of the three CHCs and interviews with 16 board members of the three CHCs. Analysis of these data identified individual, relational, organizational, community and public policy level factors which impacted the participation of board members of three CHCs. For example, the education and background experiences of board members (individual) as well as relationships between board members and the management teams of the clinics (relational) facilitated the quality of their participation on the boards. Contextual knowledge of economic, political, and cultural factors were discovered for each of the three clinics, and proved important to understanding the quality of participation of board members. </p><p> Social work educators and practitioners will benefit from the advancement of knowledge about what factors facilitate the quality of citizen participation in policy development processes. The results of this study suggest that practitioners interested in empowering consumers to have a role in the provision of services need to understand what facilitates the quality of citizen participation to ensure that consumers have a legitimate voice in policy development and implementation processes. The results of this study also inform our understanding of citizen participation in multiple policy development processes. For example, because legislators will benefit when barriers to the quality of citizen participation are identified, educators teaching social work students about macro practice will have concrete lessons to draw from; practitioners who work with non-elected members of boards will benefit from barrier identification allowing them to assist in the empowerment of future board members engaged in policy development on a wide variety of boards; and finally actual board members, especially those representing traditionally disadvantaged or marginalized communities, will benefit from knowledge gleaned from similar experiences, and educators teaching social work students about the benefits of advocacy and empowerment could assist to make their participation more effective.</p>

<p> Spirituality has been recognized as a positive factor in the lives of older adults, especially as it influences their emotional, mental, and physical well-being. This convenience sample study included 17 older adults residing at a faith based continuing care retirement community in Florida. The sample was represented by Caucasian older adults with an average age of 84 years, highly educated, majority Protestant and mostly female. Spiritual life reviews were conducted using spiritual life maps (Hodge, 2005) and semi-structured interview questions. Erikson's epigenetic stage of ego-integrity was used along with Butler's life review process and Tornstam's gerotranscendence as a conceptual framework for understanding late life development and spirituality in older adults. This mostly qualitative study used a hermeneutic phenomenological approach to analyze the responses to the open-ended interview questions about spirituality across the life-time. Ego-integrity was measured at the beginning and end of the spiritual life review study. </p><p> Paired t-tests found that participation in the spiritual life review did not influence the ego integrity scores of participants. Specifically, there were no statistically significant difference between the pre ego integrity score (M=82.94, SD= 8.235) and the post ego integrity score (M=84.47, SD= 7.551); t (16) = -.769 p= .453. However, in comparison, the qualitative analysis revealed that the spiritual life review does influence ego-integrity in some participants. Additionally, the spiritual life review confirms gerotranscendence and contributes to information about spiritual development in the lives of older adults. The conclusion offers a discussion about the study's limitations, strengths, implications for future research, and suggestions for clinical practice.</p>

<p> There are basic federal and state rights that are legally provided to residents within skilled nursing facilities. While these rights aim to protect vulnerable nursing home residents from mistreatment, these civil rights granted to residents by law are continuously violated. The purpose of this project was to promote the rights of nursing home residents, specifically their rights to autonomy, dignity, and respect. A grant proposal for a training program was developed on behalf of Wise &amp; Healthy Aging, targeted towards direct care staff within skilled nursing facilities located within Los Angeles County. Components of the training program include teaching the staff about resident rights, the benefits of upholding resident rights, and how to handle or prevent common situations that they are likely to encounter related to these rights. The training program has the potential to increase the quality of life for residents, while decreasing the violations of resident rights within skilled nursing facilities.</p>

<p> The purpose of this project was to write a grant for an obesity prevention program for foster care youth. An extensive literature review was performed to investigate the best ways to reduce the increasing rate of obesity and promote awareness of its physical and psychological effects. The program consists of three components: 1. Education 2. Nutrition and physical fitness, and 3. A week-long camping retreat. As many as 140 foster care youth would be served. </p><p> The Foundation for California Community Colleges was selected as the best potential funder because it funds similar programs throughout the state providing life-skills training to youth transitioning from foster care. If funded, the program would take place at community colleges in Los Angeles. The program is expected to enable foster care adolescents to live a healthy lifestyle leading into adulthood. The actual submission of the proposal was not a requirement for the thesis project.</p>

<p> More than half of spouses of U. S. Army active duty soldiers are overweight or obese. In the U.S. almost a half million people die annually because of health related problems to being overweight or obese (Robbins, Chao, Baumgartner, Runyan, Oordt, &amp; Foneseca, 2006). The military spends $1.1 billion a year on problems related to being overweight or obese for active duty military personnel, retirees, and their families (Dall et al., 2007). </p><p> <i>Method:</i> Permission was granted from the Department of Defense (DoD) and the University of Maryland Institutional Review Board (IRB) to use the 2008 Active Duty Spouses Survey (ADSS) for the secondary data analyses used in this dissertation. Multiple and logistic regression analyses of U.S. Army spouses (<i>n</i> = 1863) examine the association of deployment status within the last year (not deployed, deployed but not to a combat zone, and deployed to a combat zone) with weight status, as measured with body mass index (BMI) scores (healthy weight versus overweight or obese). The independent variables examined were gender, age, race, rank of soldier, education, psychological distress, and perceived social support scores. </p><p> <i>Results:</i> Deployment status and weight status were not related (<i>p</i> = .097). Three-quarters of the male spouses and almost half of the female spouses were overweight or obese. Spouses of soldiers in the enlisted ranks (E5-E9), minority spouses, and those without at least a four-year college degree are more likely to be overweight or obese. As spouses' age and psychological distress increases and perceived social support decreases their BMI increases. </p><p> <i>Conclusions:</i> Findings suggest the risk factors associated with being overweight or obese are minorities; male spouses; the ranks of E5 - E9; less than a four-year degree; as age and psychological distress scores increase so does BMI; and as perceived social support scores increase the BMI decreases. The risk factors may contribute to the Army Surgeon General's Performance Triad of sleep, activity, and nutrition and be used to assist Army personnel and Department of the Army (DA) civilians to teach spouses awareness and methods of changing behaviors that result in choosing healthy options.</p>

Background. Self-categorisation theory and the identity-based motivation perspective suggest that people’s motivation to engage in a particular behaviour is stronger when that behaviour is congruent with their salient social identity. In situations where a certain social identity is made salient, or where people identify strongly with a particular group, the social norm associated with that group may have a strong effect on individual behaviour. This perspective can be used to enhance the understanding of health-related intentions and behaviour. The aim of this thesis is to investigate the usefulness of adding concepts related to social identity to existing social cognitive models of healthy eating. The prediction being made is that members of groups that value healthy eating might be more likely to engage in healthy eating when their membership in that particular group is made salient. Five experimental studies tested the effect of social identity salience and group identification on healthy eating intentions and behaviour. Both intentions and behaviour were measured in each of the five studies, to allow for investigating the existence and potential causes of the intention-behaviour gap for healthy eating. Methods and Results. All five studies included random assignment of participants to conditions, and an experimental manipulation of social identity salience or social image healthiness. In Study 1 (n = 149), conducted among female university students, participants’ female, family, or personal identity was made salient. The results showed that increasing the salience of female or family identity led to stronger healthy eating intentions, but did not increase the likelihood of picking a healthy snack over an unhealthy one. Study 2 (n = 115) did not include a successful manipulation of salient social identity, but it showed a positive association between female identification, measured as a trait, and healthy eating intentions, even after controlling for attitude, subjective norm and perceived behavioural control. Study 3 (n = 156) included a manipulation of social identity salience (female or student) and a manipulation of social image healthiness (images presenting in-group members engaging in either healthy or unhealthy behaviour). The results corroborated the earlier finding that female identification is positively correlated with healthy eating intentions. Also, the results indicated that when participants were shown social images of their in-group members engaging in healthy or unhealthy behaviour, they expressed intentions in line with the social images only if they did not express strong identification with the in-group. Study 4 (n = 87) was conducted in the context of Australian identity and included a manipulation of social images healthiness. The findings provided evidence for the existence of a vicarious licensing effect for healthy eating. Namely, for participants who highly identified with their social group, exposure to pictures of other in-group members engaging in healthy behaviour resulted in choosing less healthy food items from a restaurant menu. Study 5 (n = 117) demonstrated the existence of a vicarious licensing effect in the context of female identity, where participants’ food intake during a taste test was predicted by the interaction of the social image healthiness and their group identification. Conclusions. By examining the predictors of both healthy eating intention and behaviour, the research presented in this thesis sheds light on some of the phenomena potentially underlying the intention-behaviour gap for healthy eating, particularly among women. It appears that the healthy eating norm is internalised by women and translated into healthy eating intentions, to the extent that women who identify more highly with their gender group, and those whose female identity is made temporarily salient, also express stronger healthy eating intentions. The association between female identification and healthy eating behaviour, however, appears to be much less consistent, and in most studies the correlation between healthy eating intentions and eating behaviour was poor, even though a variety of measures of behaviour was used. These findings suggest that actual eating is often not predicted by intentions, but depends on contextual factors, such as being given an opportunity to reinforce the healthy eating goal, or the availability of information about in-group members’ eating behaviour. The results also have implications for health-psychological interventions, in suggesting that people’s response to health-related content (such as social images that may be used in health promotion interventions) may be different depending on their level of group identification. In line with the vicarious licensing effect, individuals who report high levels of group identification might be less likely to respond to interventions aimed at their specific social groups.