Asthma is a leading cause of hospitalizations among children in the United States. It accounts for millions of dollars in hospital charges at the national, state, and county levels. The prevention of these hospitalizations is an important public health issue given the financial costs of hospitalizations in an already overburdened healthcare system. This study addresses sociodemographic factors associated with hospitalizations for childhood asthma among children who reside in DeKalb County, Georgia. Results highlight the unequal burden of asthma in the southern portion of the county. Additional analysis suggests that changes to existing institution-level surveillance systems can be made to improve upon the quality of data available to researchers. This research calls for a state-wide asthma surveillance system that routinely collects information on the most common indicators of disease burden, thereby improving the ability of public health professionals to accurately determine and manage the needs of children with asthma.

CONTEXT: Although a large body of epidemiologic evidence suggests that socioeconomic status (SES) is one of the associated risk factors for poor health outcome, its impact on the prevalence of asthma in minority populations is not well understood. AIM: The purpose of this study is to examine the association of SES with asthma in American minority children. Specifically, this study is designed to determine the role of poverty status, insurance coverage, parental education, living conditions, and employment on the risks of asthma in non-Hispanic Black and Hispanic Americans. METHOD: The data (n=77,601) used in this study were retrieved from the National Survey of Children’s Health (NSCH) and the National Center for Health Statistics of 2003. Data on children aged 3-17 years were included in the analysis. Odds ratio from the multivariate logistic regression analysis was used to determine the association between SES variables and the risk of asthma. RESULTS: Non-Hispanic black children were 4 times more likely to develop asthma if their parents had a less than college education, 18 times more likely to develop asthma if they lived in a poverty-stricken environment, 11 times more likely to develop asthma if someone in the household smoked, and 25 times more likely to develop asthma if they were uninsured. Hispanic children are 35 times more likely to develop asthma if someone within the home smoked, and 145 times more likely to develop asthma if they were uninsured. Both African American and Hispanic children were over two times more likely to be hospitalized because of asthma than their non-Hispanic white counterparts. After adjusting for SES, there were no statistically significant differences in odds of asthma in non-Hispanic Black and Hispanic American children. CONCLUSION: Racial/ethnic differences in asthma are not fully explained by their differences in SES. Thus, a reduction and elimination of asthma among minority and Caucasian children requires a comprehensive understanding of the role of other factors. More research is needed to examine genetic and other social and environmental contributors to racial/ethnic differences in asthma.

Purpose: I examined two labour force disparities – unemployment and underemployment, among working-aged individuals (20-64 years) with self-reported disabilities using the 2006 Participation and Activity Limitation Survey (PALS). As disability type was the predictor of interest, two groups were compared: individuals with one or more physical disabilities (e.g. mobility, agility, pain) exclusively vs. those with one or more physical disabilities and a co-morbid mental disability (including depression, phobias or substance use). Methods: This study was a secondary analysis of the 2006 PALS, a cross-sectional survey conducted by Statistics Canada to gather information about individuals whose everyday activities are limited due to a physical or mental condition that used the 2006 census as a sampling frame. I estimated the prevalence of unemployment (last week) and underemployment (last five years) and used multiple logistic regression to measure the association between disability type and each outcome, while considering other relevant covariates. Results: Disability type was significantly associated with both unemployment and underemployment. Other significant effects were age, education level and family income quintile (in addition to current labour force status and frequency of health services access in underemployment), in both the bivariate and multivariate analyses. Those with a mental co-morbidity had approximately double the odds of being unemployed, relative to those with exclusively physical disabilities and the effect continued to be significant when disability severity was included in the model. Individuals with a mental co-morbidity also experienced greater odds (OR: 2.92) of reporting underemployment, compared to those with exclusively physical disabilities, though when disability severity was accounted for, the effect was reduced (OR: 1.52) and no longer significant. Conclusion: To my knowledge, this is the first large-scale investigation using Canadian data to explore the association of disability type and two labour force disparities. In support of my hypothesis, individuals with a mental co-morbidity were found to be more disadvantaged in terms of both accessing employment and probability of encountering stigmatizing experiences in the workplace. More research is needed to gain a better understanding of the nature of these outcomes in order to progress toward the removal of significant barriers that persist in this population. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2011-01-30 20:02:56.55

Chronic disease is a major health burden in the United States, affecting about half of adults, and leading to poor health, disability, and death. However, the burden of chronic disease is not shared equally among Americans, with some groups (created by determinants such as race/ethnicity and socioeconomic resources) experiencing higher rates of morbidity and mortality. When measures of health and socioeconomic resources are examined together, a stepwise gradient pattern emerges. This social gradient has been established for individual measures, such as household income and social class, and several measures of morbidity and mortality. However, nationally, little research has been conducted using area-level measures, such as county economics, to examine its relationship with chronic disease. Three studies were completed using data from the Behavioral Risk Factor Surveillance System (BRFSS). County economic status was determined using unemployment, per capita market income, and poverty. The first study examined the relationship between county economic status and chronic disease and risk factors, both nationally and by metropolitan classification, using data from BRFSS 2013. Further, the social gradient was explored. The second study also used data from BRFSS 2013 to examine county economic status and prevalence of hypertension, arthritis, and poor health, after controlling for known risk factors. This study also examined results by US region. Finally, the third study assessed changes in disparities between persistently poor and persistently affluent counties for heart disease, hypertension, arthritis, and diabetes using data from BRFSS 2001-2010.

ABSTRACT Background: The launch of the Millennium Development Goal4, in 2000 and the national and international mobilization it spurs results to a decline of child under age five mortality rate from 90 per 1000 living birth in 1990 to 40 per thousands in 2012. That decline however is not evenly distributed across the globe and the majority of countries in the Sub-Saharan African region continue to experience a higher rate of under age five mortality than expected in 2013. Within country disparities in child mortality and it determinants was suggested to account for the lagging of those countries to reduce their under age five mortality rate. Objective: the study examined the variation in child mortality across statistical regions in Cote d’Ivoire and the community level factors that can explain those variations after controlling child, the mothers and the household characteristics. Method: The study used data obtained from the 2011-2012 Cote d’Ivoire’ Demography Health Survey. The study population consisted of 7511 children born within the 5 years preceding the survey. Frequency tables were created to show the distribution of the selected child mortality determinants across regions in Cote d’ivoire and three Logistic models were run to measure the association between the under age five mortality and the selected determinants. Results: The proportion of under age five mortality in the study population was 8.52%. There was a statistically significant variation in child mortality across regions. At the community level, the proportion of mothers with a least a secondary education was associated with under-age five mortality risk (OR=0.99, CI=0.98-0.99). There was no significant association between child mortality and the other selected community factors included in the study. Conclusion: This study reveals a significant variation of under age five mortality rate across region in Cote d’Ivoire, even after controlling or child, mother and household level factors. The findings of this study suggest a need for further exploration of the factors that can explain those differences.

The current study employed quantitative and qualitative methods to examine predictors of adherence and diabetes health outcomes in Latino youth, and to gain understanding of mechanisms that underlie health behaviors and outcomes. Forty-nine Latino youth and their caregivers were recruited at a hospital-based outpatient diabetes clinic, 76% of the youth were either first or second-generation Latino youth (i.e., immigrant youth or youth whose parents are immigrants). A primary aim of this study was to quantitatively examine the impact of parent immigrant-related stress on child health behaviors and outcomes. This study complements these quantitative analyses by qualitatively exploring how (e.g., under what conditions) pathways to health are created. Specifically, qualitative analyses examined the unique experiences of Latino immigrant families in managing adherence to treatment and metabolic control, and gain insight into specific health promoters and barriers. Further, the author intended to qualitatively explain the effects of recently enacted immigration laws on Latino youths’ health behaviors and outcomes. Results revealed that higher levels of fear of deportation predict lower child-reported adherence, β = -41, p < .05. Higher levels of caregiver immigrant stress predict higher BMI rates in children, β = .30, p < .05. Immigrant related stressors, including fear of deportation, did not predict A1c or diabetes ketoacidosis (DKA) hospitalizations in the last year. Qualitative results highlight themes related to direct and indirect barriers to health behaviors and outcomes for youth, as well as ethnocultural promoters of coping and resilience.

In March 2012, President Obama issued a Presidential Memorandum creating an interagency Federal Working Group to explore the intersection of HIV/AIDS, violence against women and girls, and gender-related health disparities. Intimate partner violence (IPV) and HIV constitute major public health issues for women, particularly African American women who are disproportionately affected by HIV/AIDS. In 2012, the rate of HIV for African American women was four to 20 times higher than rates for females of other races. This study explores the complex relationship between IPV and STI/HIV risk in African American females. In an attempt to examine the intersection of IPV and STI/HIV risk this study used cross-sectional survey data to quantitatively examine the differences between women who had experienced IPV in the previous 12 months (cases) and women who had not experienced IPV in the previous 12 months (controls) in: 1) previous STI diagnosis, 2) accessing HIV testing and 3) mean scores of fear of condom negotiation due to physical violence. Chi-square analyses were completed to determine if the populations were statistically significant in terms of previous STI diagnosis and accessing HIV testing. An independent-samples t-test was conducted to compare the fear of condom negotiation scores for cases and controls. In addition, qualitative analysis was conducted to further elucidate the mechanisms from experiencing IPV to an increased risk of HIV infection. The quantitative analysis suggests a significant difference between fear of condom negotiation due to fear of physical violence. The qualitative analysis suggests that women who experience IPV are often forced to have sex with their partners, experience physical violence in response to condom negotiation and use drugs and/or alcohol to cope with the abuse. HIV prevention interventions need to address IPV as a possible risk factor. In addition, an enhancement of IPV screening in healthcare settings is needed. Future prospective studies are critical to address the issues of temporality and causality.

Chronic disease is a major health burden in the United States, affecting about half of adults, and leading to poor health, disability, and death. However, the burden of chronic disease is not shared equally among Americans, with some groups (created by determinants such as race/ethnicity and socioeconomic resources) experiencing higher rates of morbidity and mortality. When measures of health and socioeconomic resources are examined together, a stepwise gradient pattern emerges. This social gradient has been established for individual measures, such as household income and social class, and several measures of morbidity and mortality. However, nationally, little research has been conducted using area-level measures, such as county economics, to examine its relationship with chronic disease. Three studies were completed using data from the Behavioral Risk Factor Surveillance System (BRFSS). County economic status was determined using unemployment, per capita market income, and poverty. The first study examined the relationship between county economic status and chronic disease and risk factors, both nationally and by metropolitan classification, using data from BRFSS 2013. Further, the social gradient was explored. The second study also used data from BRFSS 2013 to examine county economic status and prevalence of hypertension, arthritis, and poor health, after controlling for known risk factors. This study also examined results by US region. Finally, the third study assessed changes in disparities between persistently poor and persistently affluent counties for heart disease, hypertension, arthritis, and diabetes using data from BRFSS 2001-2010.

Colorectal cancer (CRC) is the second leading cause of death in the United States and has the highest death rate among Blacks. Whereas studies have targeted patients to increase CRC adherence in the general population few studies have focused on improving providers’ adherence to screening guidelines. Also, CRC screening studies among HIV-positive patients consistently show lower screening rates compared to screening rates among HIV negative persons. Results of screening colonoscopy studies among HIV positive patients show higher prevalence of neoplastic lesions and colon cancer is diagnosed at advanced cancer stages; these patients have shorter disease-free survival compared to HIV-negative patients. The aim of this transdisciplinary retrospective–prospective and randomized control study is to examine providers’ adherence to screening colonoscopy guidelines before and after screening reminders, evaluate the impact of an educational screening video and review of colonoscopy decisions tree plus usual care on patient adherence compared to usual care only. Results showed that providers’ adherence to screening colonoscopy guidelines significantly increased after reminders to refer patients were placed in medical records. The randomized trial showed that patients in the intervention group were more adherent to screening colonoscopy appointments compared to patients in the usual care arm. Also, patients with little or no social support in the intervention arm were more likely to keep appointments. This is the first reported study of a Transdisciplinary prevention model integrating evidence-based medicine, behavioral medicine and human factors decision support through a multi-faceted intervention to increase screening colonoscopy adherence in the HIV population. We integrated a provider reminder system, patient informed decision support of colonoscopy educational video and decision tree review in addition to patient provider communication to promote increased provider and patient screening behavior. Further studies are needed to elucidate the impact of patient centered intervention strategies and social support on screening colonoscopy behavior.

Thesis (Ph. D.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 302-347).