This dissertation focuses on results of multi-group SEM models estimated using data from the National Longitudinal Study of Adolescent Health (Add Health) in order to determine appropriate measurement and structural models for the relationship between socioeconomic status (SES) and health among six young adult U.S. social groups. Examining the links between SES and health during young adulthood is important because while there is a strong, documented link between lower SES and poorer health (Adler & Snibbe, 2003), young adults can exercise a considerable amount of agency with regard to their own SES and health. Young adults make critical decisions about pursuing post-secondary education, entering the workforce, and practicing healthy behaviors--activities which differ in their immediate and long-term economic and health payoff (Mirowsky & Ross, 2003; Elder, 1985; 1994). Yet, the nature of SES and its links with health for members of various gender and racial/ethnic groups is not entirely clear. Literature suggests that occupation, education, and income are neither defined nor linked among women in the same ways that they are for men (APA, 2007). Self-assessment of health is also thought to differ by gender and ethnicity (Krause & Jay, 1994). Moreover, limited research has addressed the unique mediating pathways by which aspects of SES affect health for specific social groups (Matthews, Gallo, & Taylor, 2010). In this work, I estimate measurement models for several aspects of SES among African American, Latina, and White men and women, then link aspects of SES with each other and with health using structural equation modeling. I also examine the unique mediating pathways by which aspects of SES are linked with health for these groups. / text

Background/Project Description: There is a growing interest in the contribution of late preterm (34 – 36 week gestational age (GA)) birth to neonatal morbidity and mortality. Late preterm infants have an increased incidence of both respiratory and non- respiratory complications over the first year of life. Rates of prematurity as well as morbidity/mortality in infancy are higher in lower socioeconomic status (SES) groups but how GA and SES interact is relatively unexplored. Methods/Participant Population: A retrospective cohort study was undertaken utilizing anonymized data housed at the Manitoba Centre for Health Policy (MCHP). A population-based cohort of infants born at 34 to 41 weeks of GA was assembled; individual and area-level income information was used to develop SES groups. Outcomes studied included diagnoses received during the birth hospitalisation, neonatal and post-neonatal admissions. Regression models were constructed to explore the effects of GA and SES as well as control for multiple perinatal variables. Appropriate approvals and safeguards for data privacy were maintained. Results: GA and SES exerted a gradient effect on morbidity, which persisted after controlling for multiple confounding variables. The effect of GA was strongest during the birth hospitalisation but persisted throughout the first year with increased morbidity evident with each week of decreasing GA. The detrimental association of low SES with morbidity increased in effect size throughout the first year surpassing that of GA for post-neonatal admissions. An interaction effect of maternal diabetes, respiratory morbidity and SES was suggested and merits further investigation. Neonatal stays of 3 days or longer negated the association of GA with readmission within the first 28 days; in addition shorter stay infants had the highest risks of readmission at 37 weeks as compared to the late preterm gestations. Conclusions: The consistent associations between poverty, prematurity and morbidity require both further study and attention. Attention to the neonatal health of both late preterm and term infants is important due to their large numbers and population impact. The added risk of poverty merits urgent and multifaceted interventions to lay the groundwork for healthy childhood and long-term success.

Background/Project Description: There is a growing interest in the contribution of late preterm (34 – 36 week gestational age (GA)) birth to neonatal morbidity and mortality. Late preterm infants have an increased incidence of both respiratory and non- respiratory complications over the first year of life. Rates of prematurity as well as morbidity/mortality in infancy are higher in lower socioeconomic status (SES) groups but how GA and SES interact is relatively unexplored. Methods/Participant Population: A retrospective cohort study was undertaken utilizing anonymized data housed at the Manitoba Centre for Health Policy (MCHP). A population-based cohort of infants born at 34 to 41 weeks of GA was assembled; individual and area-level income information was used to develop SES groups. Outcomes studied included diagnoses received during the birth hospitalisation, neonatal and post-neonatal admissions. Regression models were constructed to explore the effects of GA and SES as well as control for multiple perinatal variables. Appropriate approvals and safeguards for data privacy were maintained. Results: GA and SES exerted a gradient effect on morbidity, which persisted after controlling for multiple confounding variables. The effect of GA was strongest during the birth hospitalisation but persisted throughout the first year with increased morbidity evident with each week of decreasing GA. The detrimental association of low SES with morbidity increased in effect size throughout the first year surpassing that of GA for post-neonatal admissions. An interaction effect of maternal diabetes, respiratory morbidity and SES was suggested and merits further investigation. Neonatal stays of 3 days or longer negated the association of GA with readmission within the first 28 days; in addition shorter stay infants had the highest risks of readmission at 37 weeks as compared to the late preterm gestations. Conclusions: The consistent associations between poverty, prematurity and morbidity require both further study and attention. Attention to the neonatal health of both late preterm and term infants is important due to their large numbers and population impact. The added risk of poverty merits urgent and multifaceted interventions to lay the groundwork for healthy childhood and long-term success.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 106-115).

Thesis (M.A.)--University of Wisconsin--Madison, 1966. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

OBJETIVO Investigar associação entre participação no programa de assistência alimentar e sobrepeso/obesidade, segundo nível de pobreza. MÉTODOS Estudo transversal com dados sobre 46.217 mulheres não gestantes e não lactantes, de Lima, Peru, obtidos de pesquisas, com representatividade nacional, nos anos de 2003, 2004, 2006 e 2008-2010. A variável dependente foi o sobrepeso/obesidade e a independente foi a participação no programa de assistência alimentar. Utilizou-se regressão de Poisson; os modelos foram estratificados por nível socioeconômico familiar para todo o país, por área de residência (Lima versus o resto do país; urbano versus residência rural) e anos de estudo (2003-2006 versus 2008-2010). Os modelos foram ajustados por idade, nível acadêmico, urbanização e ano de estudo. RESULTADOS Participar do programa de assistência alimentar associou-se com risco aumentado de sobrepeso/obesidade para as mulheres que viviam em domicílios sem indicadores de pobreza (PR = 1,29; IC95% 1,06;1,57). Quando estratificados por área de residência, foram observadas associações similares para as mulheres que vivem em Lima e em áreas urbanas; não foram encontradas associações entre a participação no programa de assistência alimentar e sobrepeso/obesidade entre as mulheres que vivem fora de Lima ou em áreas rurais, independentemente de sua condição de pobreza. CONCLUSÕES Participar do programa de assistência alimentar associou-se com sobrepeso/obesidade para mulheres não pobres. Estudos adicionais serão necessários em países que enfrentam ambas as faces da má nutrição. / pia.chaparro@chess.su.se / OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition. / Revisión por pares

Abstract Oral diseases are, to a notable extent, behavioral diseases. The concept of lifestyle makes it possible to study behavior in a broad sense. The aim was to study the association of lifestyle with oral health and dental health behavior. All of the 1,012 55-year-old citizens of Oulu were invited to a clinical examination, and 780 of them participated. A lifestyle variable to measure health orientation was constructed. Smoking, alcohol consumption, dietary habits and physical activity were used as indicators of lifestyle. The association of lifestyle with dental caries, periodontal health, denture stomatitis and dental health behavior was studied with a cross-sectional design. An unhealthy lifestyle was associated with a higher number of dental decay, periodontal pockets and a higher prevalence of denture stomatitis. Lifestyle accounted for a large part of the differences between socioeconomic groups and between men and women in number of dental decay and periodontal pockets. An unhealthy lifestyle was associated with an increased prevalence of denture stomatitis in yeast carriers. A higher toothbrushing frequency and the use of extra cleaning methods were related to healthier lifestyle. Socioeconomic status was more important than lifestyle as a determinant of dental visits. Smoking was associated with higher lactobacillus counts and the presence of yeasts in saliva. Lifestyle explained a great part of the differences between the socioeconomic groups and between men and women in oral health. It seems that part of the association between oral and general health can be explained by lifestyle. It is important to control for general lifestyle when the biological connections between oral and general health are studied.

Rhetoric about the ‘crisis’ state of language learning in predominantly Anglophone countries is nothing new, given the widely-held belief about English having ‘global lingua franca’ status. Similarly long-standing are notions of language learning being a particularly gendered or classed activity, specifically, one that is perceived as being appropriate for female, and middle-class, pupils. This thesis explores the extent of the role played by notions of gender and class in the formation of language-learning attitudes among native speakers of the ‘global’ language, through a mixed qualitative methodology. Providing some context to the issue of language-learning attitudes in Scotland is textual analysis of news articles and political party manifestos, to ascertain the nature of media reporting, and claimed political commitment, to foreign language education. Against this background, case studies of four urban secondary schools are built up, using textual analysis of their publicly available promotional literature, classroom observation, and interviews with pupils, classroom teachers and members of senior management. Schools were chosen specifically to represent a range of socioeconomic backgrounds, as well as both mixed- and single-sex environments, in order to probe the aforementioned stereotyped notions attached to these two variables, as they relate to language-learning attitudes. Influencing the methodological approach is Norton’s (1995; 2000; 2008) ‘investment’ framework, which has pushed conceptualisations of language-learning motivation forward beyond simple dichotomies, such as ‘integrative versus instrumental’. I re-adapt her framework to better suit the specific context of native speakers of the ‘global’ language embarking upon foreign, rather than second, language learning. This study makes a contribution to knowledge in three separate areas of research literature, namely, language-learning attitudes and motivation among speakers of English (which as yet has been little explored, at least in comparison to motivation theories developed specifically for those learning English as an L2); the role of gender in the formation of language-learning attitudes; and the role of socioeconomic status in the same context, and also its influence on attitudes towards education more generally. Among the key findings are the importance of placing an emphasis on enjoyment of language learning for native English speakers, given the general lack of imperative felt by most; gendered notions attached to different areas of the curriculum, including modern foreign languages (for example, language learning is a ‘girlie’ subject), do exist, but are less pervasive than is suggested by much of the previous literature; the role played by socioeconomic status, however, appears much more influential, and teachers’ expectations of pupils in this regard can exercise a significant impact on a child’s language-learning motivation.

Background: The National Health Service (NHS) aims to achieve maximum health gains with its limited resources, while also ensuring that it provides services according to need, irrespective of factors such as socioeconomic position (SEP). Aim: The aim of this thesis is to explore the relationships between SEP and various aspects of the NHS orthodontic service, including need, demand, supply, and outcomes. Methods: Three main data sources were used: two population-based surveys (the 2003 United Kingdom (UK) Children’s Dental Health Survey (CDHS) and the 2008-2009 NHS Dental Epidemiology Programme for England Oral Health Survey (OHS) in the North West) and an administrative data set (containing 2008-2012 North West NHS orthodontic activity data). The data were used to investigate levels of need and willingness to have orthodontic treatment, treatment utilisation, assessment procedures, and treatment outcomes, and the costs associated with the service. Subsequently, regression analyses were carried out to explore the associations between SEP and the various orthodontic variables. Results: Over a third of 12-year-olds had normative need for orthodontic treatment and over half had patient-defined need. Those in the most deprived groups in the North West tended to have lower levels of treatment compared to those in the least deprived group (despite the fact that normative need was not shown to vary by SEP), and they were more likely to discontinue treatment and have residual post-treatment need (RPTN). There was a great deal of variation among practices/orthodontic clinicians in terms of the percentages of patients with repeated assessments, treatment discontinuations, and RPTN. The major sources of potential inefficiency costs in the NHS orthodontic service in the North West are treatments that result in discontinuations (which cost £2.4 million per year), RPTN (which cost £1.8 million per year), and unreported treatment outcomes (which cost £13.0 million per year). Discussion: The NHS is not delivering orthodontic care equitably between SEP groups in the North West, as those from more deprived groups are more likely to fail to receive treatment, and to have poor outcomes if they do receive treatment. In addition, the wide range of process and outcome indicators between practices/orthodontic clinicians raises issues about quality of the overall service. In particular, treatment outcomes are frequently unreported, which highlights the need to improve the outcome monitoring systems in the NHS orthodontic service.

There is a tremendous discrepancy between the number of people likely meeting criteria for a mental disorder or substance dependence in Canada and the number of people actually receiving mental health or substance dependence treatment. Thus, it is important to examine what facilitates entrance into the mental health care system and what prevents people from receiving the treatment they need. Mixed findings exist as to whether socioeconomic status (SES) and other social determinants of health play a role in receiving treatment in Canada. However, due to several methodological issues with previous studies that have examined this issue, three studies were designed to re-examine and add to the literature in this area by investigating: (1) whether SES (i.e., income and education) and other social determinants as well as psychological distress predict the number of services received by any professional for any mental disorder or substance dependence, as well as predict overall satisfaction with the services received (2) the psychometric validity and reliability of the 3-factor model proposed by Statistics Canada to measure barriers due to accessibility, acceptability and availability, and (3) whether SES, other social determinants and psychological distress predict specific barriers to receiving mental health treatment for an unmet need. All data were obtained from the Canadian Community Health Survey, cycle 1.2, Mental Health and Wellbeing. In Study 1, the SES/social determinants model predicted the number of services received for both medication and psychotherapy. Out-of-pocket spending, was the strongest predictor of the number of consultations from any provider, however it was also inversely related to overall satisfaction with services. Higher levels of distress predicted greater dissatisfaction with services received. Study 2 revealed that the three factor model of accessibility, acceptability and availability was invalid and unreliable as a measure of barriers to mental health services. It is, therefore, recommended that each specific barrier be treated as an independent causal indicator of an index measuring overall accessibility to mental health services. Finally, in Study 3, when examining each barrier independently, both education and income played important roles in recognizing there was a problem, seeking services, and actually accessing the services needed. Other social determinants also played important roles which differed depending on the type of barrier being examined. The results of the three dissertation studies indicate a clear relation between SES, other social determinants and psychological distress, and accessibility and barriers to mental health services in Canada for those suffering any mental disorder or issue related to substance dependence. The findings have significant implications in terms of potential policy implications, recommendations for the design of future national level surveys, and recommendations for future research on this topic.