Public school finance and school accountability are highly contentious subjects. This correlational study illustrates campus level instructional spending efficiency by examining various input and output variables. The study utilizes data envelopment analysis of selected variables to compare elementary campuses and create instructional spending efficiency measures within purposively selected metropolitan educational service regions in Texas. The study analyzes elementary school instructional spending and student classification as economically disadvantaged compared to student achievement in English language arts. The study finds a direct relationship between instructional spending efficiency and student achievement. The relationship between the socioeconomic variable of economically disadvantaged status is inverse. This finding suggests that in depth examinations of highly inefficient, but relatively high academic performing cases, may uncover effective instructional or operational practices tailored to the needs of the sub-populations.

Attention deficit/hyperactivity disorder (ADHD) is commonly reported to be more prevalent in children from socioeconomically disadvantaged backgrounds. In this thesis I will explore in more detail the association between socioeconomic disadvantage and ADHD. This thesis comprises six studies, starting with a systematic review in order to evaluate existing published evidence, which is followed by a qualitative study that explores educational practitioners’ conceptualisation of the causes of ADHD. A series of three analyses utilising existing data from the Avon Longitudinal Study of Parents and Children (ALSPAC) then explore which measures of socioeconomic status (SES) are associated with a research diagnosis of ADHD and potential mediators of this association, and whether timing, duration or changes in exposure to financial difficulty impact on the SES-ADHD association. In the final study in this thesis, I explore whether SES-health associations in general are likely to be due to epigenetic differences in children exposed to low SES. Existing literature provides evidence that an association between SES and ADHD is commonly detected. The facet of SES most predictive of ADHD was mother-reported experience of difficulty affording basic necessities (financial difficulty), associated with an increased risk of a research diagnosis of ADHD of 2.23 (95%CI 1.57, 3.16). Exposure to financial difficulty between birth and age seven was associated with higher levels of ADHD symptoms across childhood of 0.78 points on the Strengths and Difficulties Questionnaire Hyperactivity subscale (95% CI 0.54, 1.00, p < 0.001), whereas later exposure to financial difficulty was not associated with ADHD symptoms. In addition, I found tentative evidence that different patterns of SES exposure are associated with different levels of ADHD symptoms, with those consistently low SES having symptom scores 0.41 points higher than those in difficulty (95% CI 3.46, 3.57, p<0.001). I did not find strong evidence that low SES impacts on epigenetic profiles across childhood. These findings add to emerging evidence of an association between SES and ADHD that has implications for theory and policy.

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Background: This study examines the socioeconomic factors associated with infant and postneonatal mortality in Kenya and tries to quantify these associations in order to put those factors in ranked order so as to prioritize them in health policy plans aiming to decrease infant and postneonatal mortality. The study has used wealth index, mother’s highest educational level, mother’s occupation and place of residence as exposures of interest. Methods: The study uses analytical cross-sectional design through secondary data analysis of the 2003 Kenyan Demographic and Health Survey (KDHS) dataset for children. Series of logistic regression models were fitted to select the significant factors both in urban and rural areas and for infant and postneonatal mortality, separately, through the use of backward stepwise technique. Then the magnitude of the significance for each variable was tested using the Wald’s test, and hence the factors were ranked ordered according to their overall P-value. Results: After excluding non-singleton births and children born less than one year before the survey, a sample size of 4 495 live births was analyzed with 458 infants died before the first year of life giving IMR of 79.6 deaths per 1000 live births. After adjusting for all biodemographic and other health outcome determining factors, the analyses show no significant association between socioeconomic factors and infant mortality in both urban and rural Kenya. The exclusion of deaths that occurred in the first month of ages shows that risk of postneonatal (OR 3.09; CI: 1.29 – 7.42) mortality, in urban Kenya, were significantly higher for women working in agricultural sector than nonworking women. While in rural Kenya, the risk of postneonatal (OR 0.42; CI: 0.20 – 0.90) mortality were significantly lower for mothers with secondary school level of education than mothers with no education. Conclusions: There is lack of socioeconomic differentials in infant mortality in both urban and rural Kenya. However, breastfeeding, ethnicity and gender of the child in urban areas on one hand and breastfeeding, ethnicity and fertility factors on the other hand are the main predictors of mortality in this age group. Furthermore, results for postneonatal mortality show that level of maternal education is the single most important socioeconomic determinant of postneonatal mortality in urban Kenya while mother’s occupation is the single most important socioeconomic determinant of postneonatal mortality in rural areas. Other determinants of postneonatal mortality are ethnicity and gender of the child in urban areas, while in rural areas; the other main predictors are ethnicity, breast feeding and fertility factors.

The research report is submitted to the School of Public Health, Faculty of Health Sciences, University of Witwatersrand, in partial fulfilment of the requirements for the Master of Public Health degree. Johannesburg March, 2014 / Introduction: This is the descriptive study of the socio demographic profile and other characteristics such as the burn injury details and socio economic characteristics of adult burn injury patients treated at Johannesburg Tertiary Hospitals (JTH) during the study period. Relevant stakeholders can use this information in the efforts to reduce preventable burn injuries. Method: Prospective study where all adult burn patients in the burns unit, trauma/surgical wards during the study period were eligible to participate in the study. The information was extracted from the medical files (such as hospital classification, date of birth (DOB), type of burn, type of management done to date etc), this was followed by an interview done by principal investigator only, using a questionnaire to gather the information on patients’ demographic details, socio economic information, income details and burn injury details. Descriptive statistics were used to define the profile of burn patients and other characteristics. Results: The results revealed the description and the profile of adult burn patients: a male (71%), African (94%), unmarried (70%), mean age of 35.6 years. He was most likely to have a secondary school qualification (62%), full time employed possible (51%) in the industrial sector, stays with 2-5 people in his household. He was likely to be originally from outside the Gauteng Province (58%). He sustained burns injuries of 10-29% TBSA, while at home (94%), from flames (68%). He remembered (92%), his activity prior to the burn incident and thought that the burn could have been prevented (82%). Conclusion: Burns injuries were reported to be preventable. The burn injury-prevention program should be targeted to males, in the working age groups, residing in one roomed dwelling or informal settlements. Patients with poor judgement, predisposing medical conditions such as epileptics, those that have modified their electricity supply and heat sources should be prioritised for burn injury-prevention programs.

Research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science (MSc) in Epidemiology in the field of Epidemiology and Biostatistics / Obesity is an emerging problem in South Africa, particularly in women for whom prevalence rates well above 40% have been reported. Parallel to this health problem, South Africa continues to experience relatively high poverty levels of 10.5% to 48.0%. The aim of this study was to estimate the prevalence of obesity and low social economic status (SES) levels at Agincourt Health and Socio-Demographic Surveillance System site (AHDSS). The study also sought to investigate the association between low SES and obesity at AHDSS. Materials and methods This was a secondary data analysis of the original Na Nakekela HIV/Non communicable disease (NCD) study conducted at AHDSS from August 2010 to May 2011. Included in the study presented in this report were residents of AHDSS aged 15 years or older during this time period. Data from 4 502 individuals (2 683 females and 1 819 males) were analysed. Age-specific prevalences of obesity (body mass index ≥ 30kg/m2), and central obesity (waist hip ratio ≥1.0 and ≥0.85 in men and women, respectively), stratified by sex and SES, were calculated. SES was assessed by ascertaining the household assets of AHDSS residents and assigning a weighted score to the household assets, using multiple correspondence analysis (MCA). The household score was then computed and used to classify the population into SES categories. The relative ranks of households, using this score, were then used as a measure of SES. The association between SES and obesity (BMI ≥ 30) was assessed by means of chi-square tests and logistic regression. Results The overall prevalence of obesity at the AHDSS in the study period was 20.4%. Overall, sex -specific prevalences of obesity were 29.3% and 7.4% in females and males, respectively. Females aged 50-59 years and males aged 45-49 years had the highest age-specific prevalence of obesity, at 40.1% and 18.3%, respectively. The overall prevalence of central obesity was 31.1%. Sex-specific prevalence of central obesity in females was 51.1%, while in males it was 4.9%. The highest age-specific prevalence of central obesity in both sexes was for those 70 years and older: 74.3% in females and 11.1% in males. Around 50% of individuals at the AHDSS were classified as belonging to lower SES categories, with females constituting 56.6% of these individuals. The highest prevalence of individuals in the high SES category was females aged 60-69 (14.5%) and males aged 70 (16.4%) years and older. After adjusting for other variables, being in a lower SES category was inversely associated with obesity as measured by BMI, as was being male and being HIV positive. The only positive predictor of high BMI was older age. No association between central obesity and lower SES was found after adjusting for confounders and other explanatory variables. However, older age was a predictor of central obesity. Being male, HIV positive and the male head of the household were factors that were inversely associated with central obesity. Discussion The high prevalence of individuals in the lower SES group (50.5%) reported in this study is similar to the Mpumalanga provincial poverty estimate of 51%.The ratio of obese females to males was at least 2.2 in every age group. The prevalence of central obesity in females of 51.1% in the AHDSS was higher than the national estimate of 47.1% for females, while the male estimate of 4.9% was lower than the 6.8% national estimate for males. In contrast to other studies, no associations between lower SES and obesity as measured by central obesity were observed. Conclusion and Recommendations Specific interventions to reduce obesity in females should be undertaken, including the provision of educational talks. This would empower them to make better informed decisions about food and lifestyle choices. These recommendations should be integrated into already existing HIV prevention programmes because HIV prevention is currently the main focus of policy makers in South Africa. Measures to reduce the number of individuals in the lower SES group, which this study reported to be very high (especially among women), e.g. through job creation, should be considered.

This thesis concerns the modelling of individuals’ health over the life course, within the framework set by the now substantial international literature on the relationship between socioeconomic status and health. The focus is on people with long term illnesses and related disabilities, on inequalities in health by socioeconomic status (SES) and on the impact of health on employment.¶ The main tool of analysis is a dynamic microsimulation model of the Australian population which tracks the demographic, socioeconomic and financial characteristics of individuals and their families over the life course. Its original form, developed at the National Centre for Socioeconomic Modelling, University of Canberra, is based on a one per cent representative sample of the Australian population (around 150,000 individuals), with a series of life course events simulated for individuals and their families up to 2050 - such as births, deaths, migration, taxes, education, labour force participation, earned income, wealth accumulation and government transfers. The model is written in the C programming language and was initially used on a UNIX system. The dramatic increases in the speed and memory size of PCs over the past five years has led to a PC version now being available.¶ Despite their relatively short existence and long development phases, dynamic microsimulation models are now used in many developed countries – for example, the USA, UK, Canada, France, Sweden, Norway and Italy. In recognition of their ability to analyse distributional and financial issues in considerably greater depth than what is possible with traditional methods, their use by government for policy analysis is rapidly increasing.¶ In this thesis two new modules were added to the original Australian dynamic microsimulation model – namely: a Health_SES module and a Health State Transitions module. The former makes the study of health inequalities across socioeconomic groups possible. The latter provides a link between health status and the ability of individuals to carry out every day activities as the severity of their ill-health increases with age. A major advantage of adding these new modules to an existing main model is that it allows much more comprehensive studies over the life courses of individuals than the alternative would allow – that is the building of two stand-alone models developed exclusively for ‘health-SES’ and ‘health state transition’ types of applications.¶ The main data sources used to construct the two new modules were an extract from the Australian Institute of Health and Welfare’s Mortality database covering the 1995-97 period, and the Australian Bureau of Statistic’s 1998 survey of Disability, Ageing and Carers. The analysis of the mortality data was handled using EXCEL, and that of the much larger Disability survey unit record dataset - over 40,000 individuals and 100s of variables – using the SAS programming language.¶ While most of the methodologies used in constructing the new modules are in line with what became the norm for dynamic microsimulation model development, the thesis contains several innovations. The main ones are: a quantitative assessment of the suitability of different types of SES indicators for studies of health inequalities; the modelling of the progression of people’s health from illness-free status to mild and severe disability; the development of a methodology for estimating health state transition probabilities from cross-sectional data (in the absence of longitudinal data); and the linking of health status to individual’s ability to stay in the labour force.¶ As with most models, there are a number of limitations. These are discussed in the thesis, together with areas of possible future improvements.¶ The thesis also presents two novel and topical – though at this stage illustrative – applications of the enhanced dynamic microsimulation model. The first simulates the impact of a narrowing in health inequalities in Australia as health is lifted nationally to the level currently enjoyed by the most affluent 20% of the population. The findings are that, if such a policy change were implemented, close to half a million fewer Australians would be disabled, around 180,000 life years would be saved, health care costs would be around A$1 billion lower per year and the government could save close to A$700 million on the Disability Support Pension.¶ The second application quantifies the likely impacts of longer working lives in future, which may arise from changes such as: more favourable labour market conditions; government incentives to remain in the labour force longer (eg the lifting of the pension age); and general improvements in health. This application estimates the probability that Australians aged 65-70 would work more than 15 hours per week, had such changes eventuated. The decision to retire is modelled as a function of each individual’s own health, socioeconomic status, age, sex and family composition. The impacts are simulated in a world in which current patterns of health by age, sex and SES remain unchanged over time – the Base case; and a world replicating the narrower health inequalities scenario of the first application. Under the Base case an additional 450,000 persons aged 65-70 years were estimated to remain in the workforce - with the related earnings totalling up to $20 billion in 1998 ($35 billion in 2018) and savings by government on the age pension of around $2 billion ($4 billion in 2018). Under the narrower health inequalities scenario the numbers working, their earnings and the related savings on the age pension were estimated to be around 7% higher. Much of the original research carried out for this thesis has appeared, or is yet to appear, in refereed publications.¶