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According to a recent report from the National Center for Educational Statistics, approximately 20% of the United States' high-school aged population is at risk of dropping out of high school, an outcome that strongly limits participation in economic and educational opportunities. The importance of earning a high school diploma has increased many local districts' efforts to close graduation gaps across the student population. Accordingly, this study evaluated a recuperative environmental leadership and service (EL&S) program in a northwestern local district to ascertain its effectiveness in providing at-risk students the personal and academic support required for high school graduation. Following the logic model program theory, this study examined the program's effectiveness in redirecting off-track students by comparing on time (4 year) and extended-time (> 4 years) graduation rates of at-risk students who did participate (n = 96) and did not participate (n = 76) in the EL&S. Through an ANCOVA, the 4 year and extended graduation rates, 68.3% and 89.1%, respectively, were analyzed and found to be higher than the on-time and extended-time graduation rates for the local district, 65.8% and 68.5%. Results indicated that the EL&S does statistically increase the participants' likelihood of graduating from high school. These findings illustrate the utility of EL&S interventions for at-risk students who have experienced multiple indicators of educational failure. Replication or adaptation of this EL&S program could provide social change benefits to educational stakeholders seeking to close the graduation gap; to families seeking educative and personal support for at-risk students; and to struggling students desiring to contribute to the economic, educative, and social growth of their community.

BACKGROUND: Previous studies show a positive association between household wealth and overweight in sub-Saharan African (SSA) countries; however, the manner in which this relationship differs in the presence of educational attainment has not been well-established. This study examined the multiplicative effect modification of educational attainment on the association between middle-income and rich household wealth and overweight status among adult females in 22 SSA countries. We hypothesized that household wealth was associated with a greater likelihood of being overweight among middle income and rich women with lower levels of educational attainment compared to those with higher levels of educational attainment. METHODS: Demographic and Health Survey (DHS) data from 2006 to 2016 for women aged 18-49 years in SSA countries were used for the study. Overweight was defined as a body mass index (BMI) ≥ 25 kg/m2. Household wealth index tertile was the exposure and educational attainment, the effect modifier. Potential confounders included age, ethnicity, place of residence, and parity. Descriptive analysis was conducted, and separate logistic regression models were fitted for each of the 22 SSA countries to compute measures of effect modification and 95% confidence intervals. Analysis of credibility (AnCred) methods were applied to assess the intrinsic credibility of the study findings and guide statistical inference. RESULTS: The prevalence of overweight ranged from 12.6% in Chad to 56.6% in Swaziland. Eighteen of the 22 SSA countries had measures of effect modification below one in at least one wealth tertile. This included eight of the 12 low-income countries and all 10 middle income countries. This implied that the odds of overweight were greater among middle-income and rich women with lower levels of educational attainment than those with higher educational attainment. On the basis of the AnCred analysis, it was found that the majority of the study findings across the region provided some support for the study hypothesis. CONCLUSIONS: Women in higher wealth strata and with lower levels of educational attainment appear to be more vulnerable to overweight compared to those in the same wealth strata but with higher levels of educational attainment in most low- and middle- income SSA countries.

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Objectives: The purpose of this thesis is to explore the associations between childhood cognitive abilities assessed at age 8 and health and socioeconomic outcomes at age 29-36 in extremely low birth weight survivors (ELBW, <1000g). Methods: Using data from the McMaster Extremely Low Birth Weight Cohort Study, Study 1 explores the influence of overall intelligence, fluid intelligence, and language abilities on the prevalence of lifetime major depressive disorder in ELBW survivors and normal birth weight comparison subjects. Study 2 examines the mediating role of overall intelligence, fluid intelligence, language abilities, quantitative reasoning, and academic achievement on the association between being born at ELBW and socioeconomic outcomes at age 29-36. The final study examines the moderating role of childhood cognitive functioning on links between postnatal psychosocial adversity and adult personal earnings in ELBW survivors. Results: Results from Study 1 suggest that childhood cognitive abilities do not influence the onset of major depressive disorder in ELBW survivors, but are protective against depression in normal birth weight individuals. Study 2 suggests that childhood cognitive abilities partially mediate the association between being born at ELBW and income attainment in adulthood, but not full time employment. Further, Study 2 suggests that this association is stronger in ELBW survivors who have neurosensory impairments. Results of Study 3 suggest that enhanced childhood cognitive functioning is not protective against postnatal psychological adversity in influencing income attainment, as those ELBW survivors with higher childhood intelligence and who suffered psychological adversity reported lower annual income at age 30. Conclusions: This thesis suggests that overall and specific cognitive abilities significantly influence adult outcomes in ELBW survivors and normal birth weight individuals. However, while cognitive reserve may not be protective against psychological adversity in ELBW survivors, early cognitive abilities are a critical indicator of socioeconomic attainment in this vulnerable population. / Thesis / Master of Science (MSc) / The following thesis explores the predictive role of childhood cognitive abilities on adult health and socioeconomic outcomes in extremely low birth weight survivors at age 29-36. Study 1 explores the influence of overall intelligence, fluid intelligence, and language abilities assessed at age 8 on the prevalence of lifetime major depressive disorder in extremely low birth weight survivors and normal birth weight comparison participants. Study 2 examines the mediating role of overall intelligence, fluid intelligence, language abilities, quantitative reasoning, and academic achievement on the association between being born at extremely low birth weight and socioeconomic outcomes at age 29-36. The final study examines the moderating role of childhood cognition on the association between postnatal psychosocial adversity and personal income attainment at age 30 in extremely low birth weight survivors. Overall, this body of work suggests that childhood cognitive abilities are an important contributor to adult outcomes in preterm survivors.

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