Thesis (M.S.P.H.)--University of Michigan, 1937.

Thesis (M.S.P.H.)--University of Michigan, 1937.

In recent decades, the Aboriginal population in Canada has become increasingly urbanized. Urbanization has been accompanied by high rates of mobility between reserve/rural and urban areas, as well as within cities. While research has documented Aboriginal peoples’ mobility rates, little attention has been given to mobility experiences, and an understanding of the socio-political and historic context in which mobility is set remains underdeveloped. Furthermore, little is known about the impact of mobility on movers’ holistic health (i.e., physical, mental, emotional, spiritual), and while research has suggested that mobility may impact access to urban social and health services, little is known in this area. The objectives of this dissertation are therefore to examine: the broader motivations that shape mobility, the link between mobility and health as well as service use, and to produce a more comprehensive understanding of the relationship between service providers and movers. These objectives are addressed using multiple methods. Quantitative analyses of the 2006 Aboriginal Peoples Survey identified mobility as a significant correlate of conventional (physician/nurse) and traditional (traditional healer) health care use. In order to explore nuanced links between mobility, health, and urban service delivery, a collaborative, community-based research relationship was established with an urban Aboriginal-led organization and 46 in-depth, semi-structured interviews were conducted with Aboriginal service providers, non-Aboriginal service providers, and urban Aboriginal movers in the city of Winnipeg, Manitoba, Canada. These research findings reveal the importance of service delivery that actively supports urban Aboriginal movers, and demonstrates the relationship between mobility and holistic health as well as service access in urban areas. Furthermore, current scales of service delivery are found to be insufficient for meeting the needs of mobile urban Aboriginal populations. Despite these findings, urban Aboriginal movers are maintaining important networks of support between their points of origin and destination, and are creating new spaces of engagement within cities.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 73-82).

Thesis (M. Sc.)--University of Canterbury, 2009. / Typescript (photocopy). Includes bibliographical references (p. 154-174). Also available via the World Wide Web.

Background: Since 2008, more than half of the world's population now live an urban area. The consequences of this are strains on existing resources such as access to healthcare, housing and infrastructure. Therefore, access to data at the urban level is important for those involved in policy making in order to assess and address these issues. This is especially important for developing countries where resources are already limited without the added strain of urbanisation. This PhD study is nested within the EURO-URHIS 2 project, a DG Research, FP7 Programme project which is collecting data on a series of indicators deemed to be important to urban health. The first part of this PhD study investigates whether the EURO-URHIS 2 data collection tools designed for use in Europe can be replicated in Vietnam. During a preliminary fieldwork trip to Vietnam it was found that it would not be possible to obtain permission to interview policy makers or the urban population of Ho Chi Minh City within the study time frame. Therefore, the second part of this PhD study is to explore the use of existing data sources, functions and activities of Non-Governmental Organisations (NGOs) in Vietnam. Methods: The EURO-URHIS 2 existing data survey was used to collect country and urban area level data from Vietnam. The data for the NGO study was collected using an online questionnaire hosted on a server by the University of Manchester. Results: The study found that it was possible to use the EURO-URHIS 2 existing data tool to collect a range of health indicator data at the country and urban level in Vietnam. The online study determined the role of international NGOs working in Vietnam and barriers to using existing sources of information. The study also found low levels of NGO engagement with other NGOs, policy makers, local authorities and Vietnamese government organisations. Conclusions: The successful implementation of EURO-URHIS 2 existing data survey allowed the examination of the potential health implications of urbanisation in Vietnam. The NGO study identified key areas where international NGOs in Vietnam were active, barriers to using existing sources of data and NGO relationships with other actors. The study also suggested opportunities for further NGO engagement.

This dissertation sought to characterize the association between urbanicity and incidence of first-episode psychosis (FEP) in Chile by using data from national registries, including a national FEP registry, as well as other health and social databases. Numerous large, well-controlled studies from Northern European countries (e.g., Denmark) have found that being born or brought up in urban environments increases the odds of developing psychosis. Given the strength and consistency of these findings over decades, the urbanicity-psychosis association is considered one of the fundamental epidemiologic findings on environment and psychosis, and full-fledged research programs have been examining potential mechanisms. Yet it now appears that the association may not be universal. Studies from some European countries, Latin America, and China have reported null results. These findings have started to change our understanding of the urbanicity-psychosis association and have raised important questions regarding how the association works in understudied, lesser-resourced settings. Chile, with its unique juxtaposition of substantial infrastructure (national registries) and shared challenges with other Latin American countries, offers an unprecedented context for developing such research. Accordingly, the specific aims of this dissertation were to 1) conduct a qualitative systematic literature review on the definitions of urbanicity and community-level social factors in the context of psychosis research, 2) examine whether urbanicity at birth and at admission is associated with increased risk of FEP, and 3) examine the moderation effects of social deprivation in the association between urbanicity and incidence of FEP.

This dissertation contains three chapters that examine urban policies. The first chapter considers the impacts of a new card fee for prepaid transit cards in New York City. Since 1998, the New York City Metropolitan Transportation Authority (MTA) system has used prepaid cards (MetroCards) to collect subway and bus fares. In 2013, the MTA imposed a $1 card fee (surcharge) on new MetroCard purchases. Using a novel dataset with transaction-level deposit and card use information, I show that the fee caused riders to put more money on new MetroCard purchases, particularly those in low-income neighborhoods and those who used cash or debit (rather than credit) cards. As a result, the net monthly outstanding balance from transit card deposits increased dramatically, with riders lending an extra $150 million, on an annual basis, to the MTA. Moreover, over $20 million of the increased balances in the first year were never redeemed and escheated to the MTA when these cards expired. The leading explanation highlights the importance of the cost of effort to remember to carry the same card. I pose a structural model to calibrate the effect of a new card fee. Counterfactual simulation predicts that a new card fee of $4.35 will maximize the MTA's profit. These findings have implications for fiscal policy designs and fee structures of prepaid card industry. The second chapter examines the causal effects of local access to alcohol on birth outcomes. After the repeal of National Prohibition in 1933, 30 states gave counties and municipalities the local option to continue alcohol restrictions. Citizens set alcohol control policies in their communities through jurisdiction-wide elections (i.e., local option elections). Currently, 10% of U.S. communities maintain a ban on some or all alcohol sales. Assessing the impact of local access to alcohol on alcohol-related outcomes such as birth weight, drinking under the influence, alcohol-related crimes, and so on is complicated by the potential non-random selection of liquor laws. I examine the causal effects of local access to alcohol on birth outcomes by comparing municipalities where referenda on legalizing liquor sales passed and failed by narrow margins. My results indicate that municipalities which were studied experienced higher incidence of low birth weight after legalizing the local sale of alcohol to the general public. The incidence of low birth weight rose by 4.5% for babies born within two years after the elections. The third chapter measures the deleterious effect of institutional discrimination on health. Interest in the impact of institutional discrimination on health outcomes has increased dramatically. Since research has mostly been done in the western context where social segregation has already been established, it is difficult to isolate the effect of initial social segregation on health outcomes. In this chapter, I examine the causal effect of institutional discrimination on health by exploiting a 1964 change in household registration system (hukou) in China, which caused a nationwide discrimination against rural dwellers. The 1964 change in the hukou system started to put tight control on domestic migration. Thereafter, movement from rural to urban areas became virtually impossible. Following the 1964 change in hukou policy, the fraction of urban hukou residents suddenly fell from over 50% to about 40%. I use this discontinuity in the proportion of urban hukou residents to identify the causal effect of institutional discrimination anchored in the hukou system on health. The regression-discontinuity (RD) design estimates suggest that urban hukou citizens have much better chances of being in good health. The deleterious effect of rural hukou on health possibly works through mechanisms of labor disparity, limited access to healthcare, and deprivation of quality education.

Measuring disparities in Quality of Life (QOL) can be challenging due to the vast amount of factors to be included. This study attempts to measure disparities in QOL using a newly developed Urban Health Index (UHI). Using 128 census tracts in City of Atlanta in Georgia as an example, this study selects six variables that are related to QOL. Their geometric mean is then used to construct a single numeric value for each census tract. The QOL disparity ratio is then determined by the upper and lower 10% of the data. The slope of disparity is calculated using the remaining 80% of the data. The results show that urban health index may be an affective indicator of QOL in a city.

The dissertation investigates how individual behaviors and health outcomes interplay with surrounding built environments, in three essays. We conceptually focus on travel behaviors and accessibility. In the first essay, we hypothesize that urban sprawl increases requisite travel time which limits leisure time available as inputs to health production. We utilize the American Time Use Survey to quantify decreases in health-related activity participation due to commuting time. We identify significant evidence of trade-offs between commuting time and exercise, food preparation, and sleep behaviors, which exceed labor time trade-offs on a per-minute basis. Longer commutes are additionally associated with an increased likelihood of non-grocery food purchases and substitution into less strenuous exercise activities. We also utilize daily metropolitan traffic accidents as instruments which exogenously lengthen a particular day’s commute. The second essay tests whether the likelihood of food insecurity and “paradoxical” joint insecurity-obesity occurrences vary over the degree of urban sprawl. We utilize data from the Behavioral Risk Factor Surveillance System’s Social Context Module merged with urban sprawl measures developed by Smart Growth America. We find significantly negative associations between urban sprawl and the likelihood of food insecurity, and that insecurity is more likely in areas of less developed street connectivity. We find that joint outcomes are more likely in less sprawled areas and that likelihood is greater in areas of greater street connectivity, which fails to support theories proposing that healthy food inaccessibility is a determinant of joint outcomes. The third essay evaluates research claims that walking and cycling to school increases students’ physical activity levels in a predominantly urban sample. We utilize the third wave of the Survey of Adults and Youth–a geocoded dataset–to identify determinants of walking or cycling to school, and in turn to explore to what extent active travel impacts adolescents' weekly exercise levels. Consistent with the literature, we find that the distance between home and school is the largest influence on the travel mode decision. We also find no evidence that active travel increases the number of students’ weekly exercise sessions. These results suggest that previous findings may not extend to all environments or populations.