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It is paramount that an accurate assessment of the impact of a cancer diagnosis is available with which to plan future resource allocation and to highlight the area to direct future policy initiatives. In the second chapter I take a modelling approach to estimate the economic burden of bladder cancer due occupational exposure. Using a multi-stage Markov model, I estimate direct, indirect, and intangible lifetime costs of bladder cancer starting in the year 2011. The results of this analysis indicate that there is a substantial economic burden associated with occupational bladder cancer. Of the three components that make up the total economic costs, intangible costs represent the largest proportion, followed by indirect and direct costs. In the third chapter, I use a data set created via a linkage of several administrative data resources to estimate the relationship between cancer diagnosis and annual labour market earnings. Using the Mahalanobis' distance and propensity score matching combined with a difference-in-difference regression, I isolate the impact of cancer diagnosis on labour market earnings of cancer survivors by comparison to their peers without cancer. There are two conclusions that can be derived from the results. First, I found that cancer survivors recover a fraction of their labour market earnings over time as they are further removed from the time of the cancer diagnosis. Secondly, I found the heterogeneous effects of cancer where most cancer survivors showed a persistent loss of labour market earnings except breast, cervix, and skin cancer survivors in the less-active age group. In the fourth chapter I examine the impact of cancer on health using three commonly used health indicators: life expectancy, Health Utility Index, and health-adjusted life expectancy. Specifically, I decomposed the differences between individuals with and without cancer in above-mentioned indicators by age and cancer type—considering all cancer types, then specifically breast, colorectal and prostate cancers. The results of the study indicate the heterogeneous effects of cancer on health outcomes and provide a repository of health outcome information that other researchers and policymakers can use. / Thesis / Doctor of Philosophy (PhD) / In 2017, there were approximately 206,200 new cancer diagnoses in Canada, and 1 in 2 Canadians are currently expected to develop cancer in their lifetime. The chances are that most Canadians may know someone—likely more than one person—who has been afflicted with cancer. As more Canadians are diagnosed with cancer and survive, researchers are increasingly trying to understand and describe the short- and longer-term impact of cancer on health and social role engagement (particularly paid work) of afflicted individual, with the intent of identifying ways to minimize adverse outcomes. The following chapters investigate the impact of a cancer diagnosis on annual labour market earnings, health, and the aggregation of these and other impacts on the societal economic burden. Chapter 1 sets the context for the entire thesis and draw out the overall objectives and motivations of the work. In Chapter 2 I conduct a comprehensive costing evaluation to estimate the economic burden of occupational cancer, taking a societal perspective, and provide a detailed breakdown of items that contribute to the economic burdens of cancer. In Chapter 3 I estimate the change in labour market earnings due to cancer diagnosis over a period of 5 years to uncover the heterogeneous effects of cancer type on labour market earnings. Finally, in Chapter 4 I estimate the impact of cancer on health using three different health indicators. In Chapter 5 I summarize the findings and contributions of each study.

A woman’s right to choose to have an abortion has been constitutionally protected since 1973 when, in Roe v. Wade, the Supreme Court ruled that the state may not wholly restrict a woman’s choice to terminate a pregnancy. In Roe, the Court invoked the 14th Amendment’s imprecise guarantee of personal liberty as grounds for the right to terminate a pregnancy without excessive interference. In later cases, specifically Planned Parenthood of Southeastern Pennsylvania v. Casey (1992), the Court clarified that mere possession of the right to abortion is insufficient to guarantee personal liberty– abortion seekers must be able to exercise their right, free of “undue burdens.” According to Casey, statutes which pose an undue burden to the right to an abortion violate the Constitution. This thesis considers whether the burdens placed on abortion seekers in Florida are constitutional or a violation of the 14th Amendment guarantee to equal protection under the law. In order to measure the diversity in burdens faced by abortion-seekers, I collect data on all 67 counties across Florida, guided by the Court’s definition of relevant variables for the purpose of abortion access: the number of providers, the availability of a judicial bypass of restrictions, and the physical distance to clinics. This data is combined in a single statistic, which is called the Unde Burden Score. There is tremendous variation in the score across Florida counties, posing a challenge to the promise of equal protection under the law and for those attempting to exercise their reproductive rights. The findings suggest that Florida’s intrastate access to abortion is incredibly contingent on geographic location, suggesting that the equal right to abortion exists in theory, but not in practice.

The diagnosis of Alzheimer's disease (AD) is stressful for both patients and their family caregivers (FCG). As the disease progresses, the patient's memory, functioning status, and behavioral problems get worse, and the needs of the patient that must be addressed by family caregivers increase dramatically. This research examines the impact of the subjective burden with the objective stressors on FCG's depression and to determines which psychosocial resources can be used to either mediate or moderate this relationship. I examine the baseline data that was collected from 670 family caregivers of Alzheimer's patients in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II clinical trial (REACH II), 2001-2004. The measurements used in the current study are caregivers' background and context factors, objective stressors, subjective burden, psychosocial resources, and symptoms of depression. Three research questions will be investigated in this study: (1) How do the caregivers' background and context factors affect FCGs experiences of objective stressors and subjective burden during the caregiving process? (2) What is the relationship between the objective stressors and subjective burdens, and what impact, if any, do they have on FCGs'depressive symptoms? (3) How do psychosocial resources mediate and or moderate the relationship between the primary stressors and FCGs'depression experiences? / Master of Science / The diagnosis of Alzheimer’s disease (AD) is stressful for both patients and their family caregivers (FCG). In 2018, an estimated 5.7 million Americans have been diagnosed with Alzheimer’s disease (Alzheimer’s Association 2018). As the disease progresses, the patient’s memory, functioning status, and behavioral problems get worse, and the needs of the patient that must be addressed by family caregivers increase dramatically. As Aneshensel, Carol S., Leonard I. Pearlin, Joseph T. Mullan, Steven H. Zarit, and Carol J. Whitlatch (1995) noted in their book Profiles in Caregiving: The Unexpected Career, the role of caregiving is generally an ‘unexpected job’ for FCGs (Aneshensel et al. 1995). Based on Pearlin’s stress process model (SPM), the primary goal of my thesis is to compare the impact of the subjective burden of caregiving with that of objective stressors on FCG’s depression, and to determine whether psychosocial resources can either mediate or moderate this relationship. Objective stressors refer to the AD patient’s memory and behavior problems, his or her cognitive impairment, self-care activities, and functional status. Subjective burden is the FCG’s emotional response to objective stressors. Objective stressors and subjective burden are associated with each other, and they are primary stressors in the SPM. Psychosocial resources include FCG’s religious coping, their positive experiences of caregiving, their social networks and whether they were satisfied with social support that they received from others. The present study is important for two reasons. First, rather than focusing on subjective burden alone, the model examined how objective stressors (i.e. burden) influence mental health through their impact on subjective burden. Second, previous influential studies of the stressors of caregiving either did not include the moderating effects of psychosocial resources (Pearlin et al., 1999), or included a limited number of resources and found that they did not play a significant role in how caregiving stress influences caregivers mental health (Aneshensel et al. 1995). In my thesis, I will explore both of the mediating and moderating effects of four types of psychosocial resources. I examine the baseline data that was collected from 670 family caregivers of Alzheimer’s patients from the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) II clinical trial (REACH II), 2001–2004 (Schulz, Burgio, and Stevens 2006). The study participants target on FCGs who are vulnerable to the caregiving stressors. The purpose of the baseline data was to describe the AD patients’ cognitive impairment and behavior problems at the initial stage of the REACH II study, the demands caused by the impairments imposed upon FCGs, the psychosocial resources adopted by FCGs to relieve the caregiving stress, and the consequences of the primary stressors on FCGs’ daily lives. I will explore three research questions in the current study: (1) How do the caregivers’ background and context factors affect FCGs experiences of objective stressors and subjective burden during the caregiving process? (2) What is the relationship between the objective stressors and subjective burdens, and what impact, if any, do they have on FCGs’ depressive symptoms? (3) How do psychosocial resources mediate or moderate the relationship between the primary stressors and FCGs’ depression experiences? The measurements used in the current study are caregivers’ background and context factors, objective stressors, subjective burden, psychosocial resources, and symptoms of depression. Data analysis is primarily based on multiple linear regression. I will also use the post-hoc probing methods to specifically test the significance of the moderating test. There are four key findings in the present study. First, caregivers’ background and context factors have some significant associations with objective stressors and subjective burden, but overall, their impact is minimal. Second, subjective burden has a stronger impact on depressive symptoms than all of the objective stressors do. Third, subjective burden undermines all four psychosocial resources tested in the current study. Fourth, the mediating and moderating effects of psychosocial resources have a negligible impact in the caregiving stress process. Surprisingly, the effect of subjective burden on depressive symptoms among FCGs remained largely unchanged after all psychosocial resources were included in the model as mediators and moderators. In the mediational test, the effects of subjective burden on depression decreased by only 14 percent after all psychosocial resources were taken into account. Likewise, each of these psychosocial resources had only a negligible effect on moderating the impacts of stressors. The study suggests that unless there is a full understanding of the effects of these stressors on caregivers’ well-being, any interventions or preventive actions will be of limited utility. Future research should pay more attention to exploring the relationships between the subjective burden and objective stressors, and examining their different impacts on FCGs’ depression experience. Additionally, the fact that none of the psychosocial resources have a buffering effect in the caregiving process suggests that there is little in the lives of caregivers that mitigates the deleterious effects of caregiving stress on Alzheimer’s caregivers. Policymakers and mental health providers should consider the stress of caregiving, as reflected in both its objective and subjective aspects, as a major risk factor in the lives of those who care for family members with Alzheimer’s disease. Those factors may play a causal role in caregivers’ mental disorders and suicidal ideation.