Thesis advisor: Stephanie Berzin / A growing body of evidence shows that sexual minority youth disproportionately suffer from poor mental health and substance abuse outcomes in comparison to their heterosexual peers. Parental support has been found to be a strong protective factor for these youth. There is a lack of research, however, that examines the role of non-parental adult support, such as natural mentors (e.g., teachers, grandparents, and coaches). Guided by minority stress and resiliency theories, the current study aims to deepen our understanding of whether natural mentors act as a resilience resource for sexual minority youth. The current study uses the National Longitudinal Study of Adolescent to Adult Health (Add Health) restricted-use dataset. This is a large, nationally representative sample of both heterosexual (n=12,667) and sexual minority youth (n=1,413), ages 18 to 26. Variable-centered (i.e., multiple regression analysis with moderation) and person-centered (latent class analysis) statistical techniques were utilized to explore the effect of the presence and characteristics of natural mentoring relationships on a range of mental health and substance abuse outcomes. Results show that natural mentors have a similar relationship with health outcomes, regardless of sexual orientation. Perceived closeness is a critical characteristic of the mentoring relationship, exhibiting significant associations with depression, suicide ideation, self-esteem, life satisfaction, and binge drinking. Furthermore, those who have lifelong, close relationships with non-parental adult family members receive the most benefit. It is noteworthy that sexual minority youth are significantly less likely to have a permanent family mentor. Rather, they are more likely to have mentors from high school with whom they lack closeness as they transition into adulthood. Several suggestions for individual and school-based interventions to assist sexual minority youth in developing and maintaining long-term relationships with non-parental adult family members are discussed. The current study emphasizes the importance of supporting and advocating for greater policy change that will directly address minority stressors that sexual minority youth face. Findings from the current study make a significant contribution to the social work field by extending our knowledge regarding resiliency among sexual minority youth and offering concrete avenues for intervention. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

The aim of this study was to explore the Health Service Utilization (HSU) of homeless people in Dublin. In particular, it sought to identify a critical realist explanatory model for why the HSU of homeless people differs from that of the general population. Critical realist (CR) ethnography was used as the research methodology and was supplemented with forty-seven semi-structured interviews and two focus groups. The HSU of homeless participants in Dublin is described. When compared to the domiciled population, homeless people were found to have a tendency to present late on in their illness, to have higher utilization of primary care services and lower utilization of secondary care services and to avoid psychiatric services. The factors that influenced participants HSU tendency are identified as external or internal influences on HSU. External factors are described as physical, administrative or attitudinal barriers or deterrents; or external promoters of health service usage. Internalised inhibitors and promoters are illustrated as either cognitions or emotions that are developed in reaction to external circumstances and which either negatively or positively impact on health service usage. Interactions between health professionals and participants that resulted in exclusion (by the health professional or self-exclusion) are described as Conversations of Exclusion. A critical realist model was outlined that offers an explanation for why homeless people’s HSU differs from that of the general population in Dublin. This model included a description of the generative mechanisms identified as producing the HSU tendencies in the study population. The implications of this new model are discussed in the light of the literature and previous models that seek to explain the HSU of homeless people.

The purpose of this thesis is to ethnographically explore the social life of health reform policy. This thesis focuses on the Ponce Center, a safety net HIV clinic in Atlanta. The thesis engages with a fragmented healthcare world, and the inhabitants of these worlds who are charged with rectifying the fragmentation and make care possible. They are, in technical language, service providers, whether they are policy-makers, patients, or political activists. In order to make the healthcare and policy worlds functional, the AIDS community in Atlanta perceive their first task as attempting to connect aspects of the fragmented healthcare assemblage that are otherwise disparate. The core theme of this thesis is articulations, translations, and piecing together aspects of everyday life particularly with regard to various ways of contending with fragmentation. This thesis explores the relationship between the affective, ideological, physical and structural dynamics of inequality, poverty, vulnerability, identity, and a sense of community and belonging. This thesis is about the policy processes. It does not focus on policy-making, but policy interpretation, implementation, and enactment in Atlanta, Georgia. The thesis tracks the appropriation and contestation of the Affordable Care Act (ACA) as a site of interaction between the experience of HIV as a pre-existing condition, inequitable access to treatment through health insurance, and larger social policy and poverty discourses. Finally, it considers the processes by which major policy reforms draw in disparate actors, who are embedded in complex networks of power and resource relations - assemblages - and inevitably play a role in reshaping society.

No description available.

The UpliftU® program is a long-term residential program for women and families who are homeless or at risk for homelessness. This program is one part of a larger, community-based non-profit organization serving low-income and homeless families in Hillsborough County, Florida for over 35 years. This program is not an emergency shelter program, but rather offers up to 18 months of participation in a self-sufficiency program to single women and families. The goal of the program is to prevent future homelessness for residents by helping them to reach their highest level of self-sufficiency. After volunteering at this organization for nine months, I completed an internship as the Health Specialist Case Manager for the UpliftU® program during the summer of 2008. The internship was conducted using ethnographic research methods to understand counseling team members' and resident mothers' perceptions of access to health care resources and their experiences in utilizing area health care services. This thesis compares the perspectives of the counseling team members with the resident mothers' perspectives, and examines barriers to and gaps in service provision, as reported by both groups. Findings from qualitative data analysis suggest that counseling team members conceptualize the barriers to health care as originating at the individual level with resident mothers' behaviors and actions, while resident mothers' expressed that they experience barriers to health care services at interpersonal and institutional levels. Resident mothers described how health professionals and staff treating them poorly leads to barriers to health care at an interpersonal level, and that at an institutional level the bureaucratic hassles associated with public insurance and public clinics also acted as barriers to care. Such differences in perception of causality of barriers to health care services between counseling team members and resident mothers have significant ramifications for resident mothers' health and ability to access health care services.

This dissertation seeks to extend quantitative research on environmental justice and address methodological limitations of previous studies by: (a) using new indicators of exposure to air pollution and contemporary risk modeling techniques; (b) assessing disparities in human health risks, instead of focusing only on potential exposure or proximity to pollution sources; and (c) using multivariate regression models that consider the effects of spatial dependence. The case study examines racial/ethnic and socioeconomic disparities in the geographic distribution of exposure to airborne toxic emissions from industrial point sources in the Houston-Galveston-Brazoria metropolitan statistical area. Industrial pollution sources for this study comprise facilities listed in the US EPA's Toxic Release Inventory (TRI). The Risk-Screening Environmental Indicator (RSEI) model is used to estimate potential human health risks from air pollutants based on data on toxicity and dispersion of chemical releases from TRI facilities. The analyses utilize four indicators of potential exposure to industrial pollution: (a) presence or absence of air emissions, (b) total quantities (pounds) of air emissions, (c) toxicity-weighted quantities of emissions and (d) modeled risk scores based on the cumulative health risk posed by air emissions. Traditional linear regression and spatial autoregressive techniques based on several neighborhood configurations are used to model the occurrence and magnitude of these four indicators, using relevant explanatory variables from the 2000 census, at the census tract and block groups levels of aggregation. Results indicate a disproportionate pattern of health risks from TRI facilities in the HGB-MSA, with the Hispanic population facing the highest exposure. The locations and magnitude of toxic pollution are significantly statistical effected by the presence of minority residents and population density. Additionally, key differences in the significance of explanatory variables between the spatial and conventional regression models demonstrate the importance of correcting for spatial dependence in environmental justice analysis. The analytical results for several variables are also sensitive to the choice of data resolution (tract or block group). Overall, this study indicates that more flexible spatial analytic techniques are required to improve the identification of environmental injustice and past studies utilizing conventional statistical methods should be revisited to explicitly account for spatial effects.

The purpose of this study was to understand the role of Sport for Development (SFD) in addressing health disparities in low-SES communities. This was done using a multiple case study design, in which administrators, staff, and youth participants from five SFD programs were interviewed. A theoretical model, consisting of the theory of fundamental causes (Link & Phelan, 1995), the classification of SFD programs (Coalter, 2007), and the ecological model of health promotion (McLeroy, 1988), was developed to guide this study. Interviews were transcribed and then analyzed using a deductive coding process (Gilgun, 2005). The findings revealed that the SFD programs in this study were driven by goals such as providing access and opportunity to sport, helping youth develop life skills, and promoting health. The programs worked to achieve those goals by providing education, through their use of sport, and by providing resources and services. Finally, the programs in this study promote health at the intrapersonal, interpersonal, organization, environment, and policy levels. These findings hold various practical, scholarly, and policy implications and could shed light on how SFD programs may operate in order to reduce health disparities among low-SES populations.

acase@tulane.edu

Introduction . Non-Hispanic blacks (blacks) are more insulin resistant compared to non-Hispanic whites (whites), increasing their risk for Type 2 diabetes. The role played by ethnic/racial disparities in the response to physical activity in mediating those higher rates of insulin resistance in blacks is unknown. Because the beneficial effects of exercise are transient and require subsequent doses of exercise to maintain the effect; the metabolic and psychosocial responses to single exercise bouts have strong implications for both opposing insulin resistance and raising the probability that an individual will continue to exercise. Purpose . To compare the metabolic and psychosocial responses to individual bouts of exercise, at the intensity and duration corresponding to the current Institute of Medicine guidelines, in blacks and age/gender/BMI-matched whites. Methods . Insulin sensitivity (hyperinsulinemic-euglycemic clamp) and metabolic flexibility (suppression of resting fat oxidation) along with exercise task self-efficacy, mood, and state-anxiety were assessed before and after a bout of exercise in black and white men and women (metabolic n = 21; psychosocial n = 31). Participants walked on a treadmill at 75% of maximum heart rate for 75 minutes. Exercise sessions were repeated on three separate occasions to assess the cumulative change in psychosocial responses to exercise. Results . There were no ethnic/racial differences in baseline measures of whole-body insulin sensitivity (p = 0.95). Black participants demonstrated larger improvements in the insulin sensitivity response to individual bouts of exercise compared to their white counterparts (+18% vs. -1.8%), which was primarily the result of enhanced non-oxidative glucose disposal during the clamp. Additionally, blacks demonstrated a greater capacity to switch from primarily fat oxidation at rest to primarily carbohydrate oxidation during the clamp (p <0.003). There were no ethnic/racial differences in the psychosocial response to individual bouts of exercise; individual bouts of exercise improved exercise task self-efficacy and reduced psychological distress in both black and white participants (p = 0.006). Black participants reported higher positive in-task mood during all three bouts of exercise (p = 0.003) and lower RPE scores (p = 0.04) during the third exercise bout compared to white participants, despite similar heart rates in both groups. Conclusions . These data demonstrate that metabolic and psychosocial responses to individual bouts of exercise do not help to explain the increased insulin resistance and lower adherence rates to exercise programs reported in blacks compared to whites. If these results are confirmed in a larger, more diverse, free-living population, future research should focus on social determinants of insulin resistance and physical inactivity to obtain a better understanding of the root causes of increased risk of Type 2 diabetes in black populations.

Introduction: Domestic research studies focused on the interrelationships between political ideology characteristics inherent in policy decisions and the contributions these political determinants exert over health indicators and outcomes are limited. Given the paucity of research that focuses on political and policy support of health at the county-level, this study sets out to utilize the University of Wisconsin Population Health Institute’s (UWPHI) annual County Health Rankings data and examine them within the context of county-based majority political partisanship and economic measures. Methods: This exploratory ecological study examined differences between independent variables: partisan voting behavior (trichotomized as conservative, moderate, and liberal) and median per capita household income in U.S. dollars (by quartile) on dependent variables related to mortality (years of productive life lost) and morbidity (number of poor mental and physical health days) at the county-level to compare differences in political and ideological underpinnings that may act as influencers on health outcomes. Multiple data sources were combined and matched to all 3,140 counties located in the U.S. Two-way between-subjects ANOVA statistical tests were conducted to determine if there is an effect of partisan voter index category on the three aforementioned dependent variables related to health outcomes, and median per capita income by quartile. Results: There was a statistically significant main interaction between median per capita household income by quartile and partisan voter index category on years of productive life lost, F(6,2789) = 19.3, p < .000, partial η2 = .040. While there were also statistically significant interactions between the independent and dependent variables of poor mental and physical health days, results of those analyses should be interpreted with caution. Pertaining to years of productive life lost, post hoc analyses of significant interactions revealed significant differences at the lower income quartile, but not in the expected direction. The conservative category had statistically significant lower years of productive life lost in comparison to the liberal category (M = -8.21, SE = 1.47, p = .000). Also, there were significant differences detected in the upper quartile suggesting that the liberal category has lower years of productive life lost in comparison to the conservative category (M = 7.06, SE = 1.06, p = .000). Conclusion: Results should be interpreted with caution and suggest more research and methodological refinements are needed, particularly related to categorizing county-level political dynamics.