Background: High blood pressure is the leading risk factor for disease burden worldwide, contributing to more than 9 million deaths each year. Some research suggests that the prevalence of hypertension increases as individual/household socioeconomic position (SEP) decreases. The results of multilevel studies also suggest an association between poorer neighborhood socioeconomic circumstances and hypertension. Further, at both the individual/household- and area-level, high blood pressure may be more strongly related to SEP among women than men. Most research, however, has been restricted to urban populations. There has not been much research which examines risk factors for hypertension in rural Canada and, in particular, socioeconomic risk factors. Objectives: To examine the relationship between individual/household- and area- level socioeconomic circumstances, gender, and high blood pressure in a rural Saskatchewan population. Methods: There were two data sources for this study. Individual/household-level data were from the Saskatchewan Rural Health Study (SRHS). Analyses focused on adults (n=8,261) who completed the cross-sectional baseline questionnaire. Census subdivisions were used to link SRHS data with area-level data from the 2006 Canadian census. The dependent variable was self-reported diagnosed high blood pressure. The primary independent variables were gender and four measures of socioeconomic circumstances: household income, educational attainment, arealevel material deprivation, and area-level social deprivation. Principal components analysis was used to derive the area-level measures of deprivation. Multilevel logistic regression was the primary method of analysis. Results: Four main findings emerged: 1) low educational attainment was associated with a greater odds of high blood pressure; 2) the relationship between low household income and high blood pressure was more pronounced among women than men; 3) the relationship between higher area-level social deprivation and high blood pressure was more pronounced among men than women; and 4) area-level material deprivation was not associated with high blood pressure. iii Conclusion: Study results revealed complex relationships between SEP, gender, and high blood pressure in this rural Saskatchewan population. Future research applying a longitudinal design is needed to advance understanding of the relationship between SEP and incident hypertension in rural Canada, including the identification of vulnerable subgroups. Also needed is research examining the factors which explain (i.e. mediate) associations between SEP and hypertension in rural settings, particularly at the area-level.

Two score tests for heteroskedasticity in the errors of a bivariate Probit model are developed, and numerous simulations are performed. These tests are based on an outer product of the gradient estimate of the information matrix, and are constructed using an artificial regression. The empirical sizes of both tests are found to be well-behaved, settling down to the nominal size under the asymptotic distribution as the sample size approaches 1000 observations. Similarly, the empirical powers of both tests increase quickly with sample size. The largest improvement in power occurs as the sample size increases from 250 to 500. An application with health care data from the German Socioeconomic Panel is performed, and strong evidence of heteroskedasticity is detected. This suggests that the maximum likelihood estimator for the standard bivariate Probit model will be inconsistent in this particular case. / Graduate / 0501

No description available.

In Tanzania, the enrolment in school is high but the students’ performance is in general low. Parents are seen as important agents to provide students with opportunities to succeed in school. It is therefore of interest to investigate what is being said about parental involvement (PI) in the Tanzanian school. The aim with this study is to identify and analyse common assumptions about PI in the context of the Tanzanian primary school. We had the opportunity to travel to Tanzania for eight weeks to investigate this. Qualitative semi-structured interviews with eight parents and two teachers about PI were carried out in two rural villages. Questions to the parents about their perception of education were furthermore asked in order to achieve a background for their statements about PI. The study is based on a discourse analytical approach, meaning that the result was obtained through identifying discourses by analysing the respondents’ statements. The analysis resulted in five discourses: Education for the future, PI as a resource, PI as pressures from teachers, PI as a lack of education and PI as paying attention to children’s education. The contents which fill the discourses are discussed in relation to the context of the study as well as perception of the relationship between home and school. The parents in this study value education highly and their involvement is mostly about contributing with financial support. Yet, the teachers are demanding a higher involvement from parents. The low socioeconomic background is a barrier for many parents to become involved. A conscious effort, aimed at getting parents more involved, is needed in order to increase the children’s academic performance.

Drawing from Pierre Bourdieu’s socio-cultural approach, this qualitative research project aimed to: (a) understand the responses to current body norms and expectations tied to health and physical appearances amongst underprivileged young women; and; (b) understand to what extent the dominant obesity discourse is inscribed in these women’s bodily habits. Results highlight that participants were aware of the dominant obesity discourse through their perceptions, sentiments, and dispositions towards bodily norms and expectations. Despite their awareness, underprivileged living conditions generated other sets of priorities, such as motherhood, achieving economic stability, completing education, and gaining physical independence which were far greater preoccupations. Underprivileged young women’s ‘choice of the necessary’ is based on optimizing resources and prioritizing needs and responsibilities. Findings support the use of Pierre Bourdieu’s concepts which consider the effects of various aspects of underprivileged living conditions on lifestyles.

There is a growing evidence-base in the epidemiological literature that demonstrates significant associations between people’s living circumstances – including their place of residence – and their health-related practices and outcomes (Leslie, 2005; Karpati, Bassett, & McCord, 2006; Monden, Van Lenthe, & Mackenbach, 2006; Parkes & Kearns, 2006; Cummins, Curtis, Diez-Roux, & Macintyre, 2007; Turrell, Kavanagh, Draper, & Subramanian, 2007). However, these findings raise questions about the ways in which living places, such as households and neighbourhoods, figure in the pathways connecting people and health (Frolich, Potvin, Chabot, & Corin, 2002; Giles-Corti, 2006; Brown et al, 2006; Diez Roux, 2007). This thesis addressed these questions via a mixed methods investigation of the patterns and processes connecting people, place, and their propensity to be physically active. Specifically, the research in this thesis examines a group of lower-socioeconomic residents who had recently relocated from poorer suburbs to a new urban village with a range of health-related resources. Importantly, the study contrasts their historical relationship with physical activity with their reactions to, and everyday practices in, a new urban setting designed to encourage pedestrian mobility and autonomy. The study applies a phenomenological approach to understanding living contexts based on Berger and Luckman’s (1966) conceptual framework in The Social Construction of Reality. This framework enables a questioning of the concept of context itself, and a treatment of it beyond environmental factors to the processes via which experiences and interactions are made meaningful. This approach makes reference to people’s histories, habituations, and dispositions in an exploration between social contexts and human behaviour. This framework for thinking about context is used to generate an empirical focus on the ways in which this residential group interacts with various living contexts over time to create a particular construction of physical activity in their lives. A methodological approach suited to this thinking was found in Charmaz’s (1996; 2001; 2006) adoption of a social constructionist approach to grounded theory. This approach enabled a focus on people’s own constructions and versions of their experiences through a rigorous inductive method, which provided a systematic strategy for identifying patterns in the data. The findings of the study point to factors such as ‘childhood abuse and neglect’, ‘early homelessness’, ‘fear and mistrust’, ‘staying indoors and keeping to yourself’, ‘conflict and violence’, and ‘feeling fat and ugly’ as contributors to an ongoing core category of ‘identity management’, which mediates the relationship between participants’ living contexts and their physical activity levels. It identifies barriers at the individual, neighbourhood, and broader ecological levels that prevent this residential group from being more physically active, and which contribute to the ways in which they think about, or conceptualise, this health-related behaviour in relationship to their identity and sense of place – both geographic and societal. The challenges of living well and staying active in poorer neighbourhoods and in places where poverty is concentrated were highlighted in detail by participants. Participants’ reactions to the new urban neighbourhood, and the depth of their engagement with the resources present, are revealed in the context of their previous life-experiences with both living places and physical activity. Moreover, an understanding of context as participants’ psychological constructions of various social and living situations based on prior experience, attitudes, and beliefs was formulated with implications for how the relationship between socioeconomic contextual effects on health are studied in the future. More detailed findings are presented in three published papers with implications for health promotion, urban design, and health inequalities research. This thesis makes a substantive, conceptual, and methodological contribution to future research efforts interested in how physical activity is conceptualised and constructed within lower socioeconomic living contexts, and why this is. The data that was collected and analysed for this PhD generates knowledge about the psychosocial processes and mechanisms behind the patterns observed in epidemiological research regarding socioeconomic health inequalities. Further, it highlights the ways in which lower socioeconomic living contexts tend to shape dispositions, attitudes, and lifestyles, ultimately resulting in worse health and life chances for those who occupy them.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Examensarbete. / I publ. felaktigt ISSN: 1641-114X.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.