Objectives We first sought to assess if bicyclist typology was associated with health. Second, we investigated whether bicyclist typology was related to health through physical activity and commute bicycling. Finally, we sought to develop profiles of disposition toward commute bicycling following proposed changes to a specific destination and the significance of pertinent covariates. Methods Data from the 2014 Georgia State University-Bicycling Survey were used. We first estimated the adjusted odds of worse health-related quality of life by bicyclist typology. A mediation model was then used to estimate the relative total and direct effects of bicyclist typology on health-related quality of life and relative indirect effects through physical activity and commute bicycling. A finite mixture modeling approach was used to identify latent classes of disposition toward whether proposed changes to a specific destination would increase likelihood of commute bicycling. The manual 3-Step protocol was used to assess the effect of covariates on the probability of latent class membership. Results Respondents who had never bicycled, were not motivated to commute bicycle, and who required greater bicycle facilities to feel comfortable commute bicycling had higher odds of worse health-related quality of life. Physical activity and, to a lesser extent, commute bicycling status mediated the effect of bicyclist typology on health-related quality of life. The seven-class solution was decided on as the “best” model for disposition toward whether proposed destination improvements would increase the likelihood of commute bicycling. Several covariates were identified that impact the probability of latent class assignment. Conclusions Initial evidence of a health disparity by bicyclist typology was revealed. Physical activity appears to serve as the primary means through which bicyclist typology has an effect on health. Urban environments that make physical activity, including commute bicycling, more comfortable for a larger proportion of the population may be a potential important health intervention. Understanding the patterns of disposition toward whether proposed destination improvements would increase the likelihood of commute bicycling may assist in targeting and prioritizing commute bicycling-related interventions toward subpopulations of interest.

Background: The sexually transmitted infections (STIs), chlamydia and gonorrhea, disproportionately affect racial and ethnic minorities. Community attributes like poverty and prevalence of STIs, along with residential segregation and its impact on composition of sexual networks contribute to these disparate rates. The Southeast had the highest rates of chlamydial and gonorrheal infection among the four regions of the United States. Because relationships between race and place can confound national statistics, it is important to examine whether racial disparities within the region are associated with higher rates of infection. Purpose: The study aims to evaluate local geospatial clustering of gonorrhea and chlamydia rates in the Southeast, and their persistence during 2000-2005 and any associations with residential segregation, income inequality, unemployment and uninsured rates, and race. Methods: Using the Local Indicators of Spatial Association tests of spatial clustering, cluster maps were created for each STI outcome and year. Independent sample t-tests were then used to examine the difference in means of each community level variable across counties composing the high-rate clusters and all other counties in the region. Results: Over 60% of counties composing high-rate clusters persisted as high rate clusters over time, and were significantly associated with higher levels of community disadvantage than all other counties (p < 0.01). Overall gonorrhea rates decreased from 2000 to 2005 and chlamydia rates increased, while their associations with community disadvantage remained persistently strong over time. Conclusions: Counties with higher rates of chlamydia and gonorrhea persist over time and experience persistently higher levels of residential segregation and income inequality, as well as higher unemployment and uninsured rates, and higher proportions of blacks in the population. The social environment and segregated sexual networks may play important roles in the persistently high rates of chlamydia and gonorrhea observed for certain regions within the Southeast. Continued surveillance of reportable STIs and their probable predictors is needed in order to better understand the persistent disparities in STI rates across counties in the Southeast.

The purpose of the present study was to examine how low-income, racial and ethnic minority, urban families experience and manage their child’s asthma. The rationale for this study stems from existing literature on asthma disparities and documented predictors of increased asthma morbidity and mortality. In particular, this study considered how specific types of stress may disproportionately impact low-income, racial and ethnic minority, urban families that have a child with asthma. This study aimed to determine associations between urban stressors (stressful life events, perceived discrimination, subjective socioeconomic status) and child asthma outcomes (emergency department visits, school days missed, asthma control), and considered depressive symptoms and asthma self-efficacy as mediators in these associations. Analyses were conducted in a sample of 97 urban caregivers and their children in Richmond, Virginia. Findings revealed that neighborhood stress was significantly associated with asthma control. Stressful life events were significantly associated with school days missed. Perceived discrimination and subjective SES were not significantly related to any child asthma outcomes. Bootstrapping procedures demonstrated that child depressive symptoms mediated the relation between neighborhood stress and asthma control. Child asthma self-efficacy did not significantly mediate associations between neighborhood stress and any child outcomes. Caregiver depressive symptoms and caregiver asthma self-efficacy did not significantly mediate any associations between caregiver-reported urban stressors and child asthma outcomes. Results from the present study suggest that urban stressors, especially neighborhood stress and stressful life events, are important to consider in the context of child asthma management and subsequent health outcomes. Exposure to urban stressors may further contribute to pediatric asthma disparities because they are disproportionately experienced by low-income, racial and ethnic minority, urban families. Each urban stressor that was related to a child outcome was associated with a particular asthma outcome. Specifically, child-reported neighborhood stress was related to asthma control. Caregiver-reported stressful life events were associated with school days missed. These findings suggest that exposure to specific types of stress may impact asthma management differently. Future research should, therefore, explore the impact and contribution of specific stressors in greater depth. Further, child depressive symptoms significantly mediated the relation between neighborhood stress and asthma control, although caregiver depressive symptoms did not significantly mediate any associations between urban stressors and child asthma outcomes. Additionally, both child and caregiver depressive symptoms were significantly associated with multiple urban stressors and child asthma outcomes. Depressive symptoms may, therefore, be important to target in future research as possible explanatory variables or variables that contribute to stress appraisals and child asthma outcomes.

This dissertation comprises three discrete empirical papers, with an introductory essay that evaluates the impact of different federal policies on prescription drug prices, utilization, and spending. Two main databases are used: (a) Medicaid State Drug Utilization Data and (b) the Medical Expenditure Panel Survey (MEPS) data. These two databases are designed to track Medicaid drug utilization and overall medical use and expenditures, respectively. The variables of interest in this dissertation are prescription drug price, prescription drug use and spending, and overall drug expenditures. The objective of the first paper (Chapter 2) is to examine whether oncology drug prices have significantly changed because the Medicaid rebate increased under the Patient Protection and Affordable Care Act (ACA). The analytic sample includes top-selling oncology drugs, both branded and generic, over an 8-year time period. The prices of top-selling oncology drugs in 2006 were followed through 2013 to find the extent to which drug prices have changed while controlling for state fixed-effect, package size, type of manufacturer, brand or generic, and drug strength. Thus, this study examines whether and to what extent oncology drug prices have changed after the increase in the Medicaid rebate under the ACA. The second paper’s objective (Chapter 3) is to study whether Medicare Part D has reduced racial disparities in diabetes drug use, coverage, and spending since its implementation in 2006. The analytic sample includes individuals aged 55 years and older who had diabetes from 2001 to 2010. Although the impact of Medicare Part D has been studied from different perspectives, its impact on racial disparities in drug use, coverage, and expenditures among diabetics has not been studied yet. The third paper (Chapter 4) focuses on the association between closing the Medicare doughnut hole and prescription drug utilization and spending for Medicare Part D beneficiaries with chronic diseases through 2013. The objective of the third paper is to determine whether the provisions of the ACA that close the coverage gap have affected prescription drug utilization and out-of-pocket (OOP) spending among Medicare seniors with Part D coverage.

Research confirms that breastfeeding disparities persist and that lactation consultants play a key role in reducing them. However, there continues to be a limited availability of International Board Certified Lactation Consultants (IBCLCs) in the US with racial minorities in particular facing persistent barriers in the certification process. Through semi-structured interviews with 36 IBCLCs across the US, this study takes a systematic look at breastfeeding disparities through the lens of the IBCLC. Specifically, this study addresses barriers to certification and employment discrimination faced by IBCLCs of color, race-based discrimination against patients, and the ways in which IBCLCs work to both medicalize and demedicalize breastfeeding. Each of these areas can impact breastfeeding equity, and each help to reveal the ways in which race, class, gender and medicine shape views and practices related to lactation and motherhood. Cost and the increasingly university-focused approach of the IBCLC certification process are found to be significant barrier for participants. Race-based discrimination during the certification process and in the workplace is also an ongoing and persistent reality that affects participant’s relationships with patients and coworkers and their ability to secure workplace resources and to advance in their careers. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient’s backs. Finally IBCLCs are found to demedicalize breastfeeding, but they often lack the authority to change breastfeeding policies. They also engage in other work that medicalizes breastfeeding and perpetuate the idea that mothers are anxiety-prone patients in need of professional intervention.

This paper addresses how food systems and transboundary food supply chains are mediated and shaped by (cross-) cultural and geopolitical borders that function as selective filters. We focus on the ways in which the political boundary in a formerly cohesive foodshed generates "edge effects" that affect (1) food safety, and (2) food waste, particularly in desert communities adjacent to the U.S.-Mexico border. We hypothesize that as these various boundary lines get "out of register" with one another, their dissonance creates both unexpected impacts as well as opportunities for positive change. This initial analysis demonstrates how multiple (and often permeable) social, economic, and ecological edges intersect with food supply chain vulnerabilities and economic opportunities at the border. Drawing on examples from food safety and food waste surrounding the "Ambos Nogales" port of entry on the Arizona-Sonora border, we document the ways in which the border produces ecological and social edge effects that are dissonant with the official legal boundary.

Master of Science / Department of Journalism and Mass Communications / Nancy Muturi / Health disparities are prevalent among ethnic minorities, including immigrants in the United States. These disparities come in the form of low health insurance, low social economic status, ethnic discrimination, language and cultural barriers. As ethnic minorities, international students also suffer from numerous health problems that are associated with their lower social, economic and immigration status when they come to the United States. Health communication is an effective tool for increasing health literacy and for reducing health disparities. Applying the uses and gratification theory and the staged model of trust, the study was conducted among 120 American students and 135 international students to examine the extent to which access to health information, the type of information accessed, how they use it, and how they determine what trustworthy information is differed between the two groups. Key findings indicate that nutrition is the most common health topic accessed online by college students regardless of place of origin. Though both groups access online health information with the same motivation of information, they use online health information in different situations. Source credibility is the most important factor for college students in determining trustworthy health websites, and government websites and other health organization websites were found to be more trustworthy. The study also provides both theoretical and practical implications, which include consideration of ethnic backgrounds in disseminating health information through online channels and understanding the needs and motivation for people’s access to health information and how they use it to be able to meet those needs. In designing health communication campaigns that target college students, the study proposes that the differences between native-born and international students need to be taken into consideration.

The thesis describes and analyses the development of foreign direct investments in Czech Republic with emphasis on state and regional level. The goal of my thesis, focusing on the topic "Regional differences of foreign direct investments", is to answer the question if foreign direct investments help to decrease the regional disparities. The first part of the thesis oves more detail sof FDI definition, types, factors of localizations and barriers. Second part of the thesis answers the question if FDI brings positive impact to economic development. The third part defines the regions supported by government. The main part of the thesis analyses the development of FDI in Czech Republic and two levels of districts during 2000-2008. In the last part of the thesis are mentioned two examples of foreign direct investment localizated in Czech Republic, in different districts.

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.

Chu Kwok-chung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1991. / Includes bibliographical references. / Abstract --- p.i / Acknowledgements --- p.ii / List of Illustrations --- p.v / List of Tables --- p.vii / List of Appendix --- p.ix / Chapter / Chapter 1. --- "INTRODUCTION: THE PROBLEMS, OBJECTIVE AND ITS SETTING" --- p.1 / Chapter 1.1 --- Urbanization as a current subject of great concern --- p.1 / Chapter 1.2 --- Urbanization Policies in China --- p.2 / Chapter 1.3 --- Shift of social concern to social well-being (SWB) in national development --- p.5 / Chapter 1.4 --- The problems --- p.6 / Chapter 1.5 --- Objective of this study --- p.8 / Chapter 1.6 --- The scope of the study --- p.9 / Chapter 1.7 --- The organization of the remainder of the thesis --- p.9 / Chapter 2. --- CONCEPTUAL BACKGROUND --- p.11 / Chapter 2.1 --- Definition of Spatial inequality --- p.11 / Chapter 2.2 --- Types of spatial inequalities and different levels and units of analysis in China --- p.12 / Chapter 2.3 --- Definition of Social Well-being --- p.16 / Chapter 2.4 --- Ingredient of Social Well-being --- p.16 / Chapter 2.5 --- The present selection of the ingredient of SWB --- p.18 / Chapter 2.6 --- Characteristics of welfare goods allocation in China --- p.22 / Chapter 2.7 --- Two approaches in measuring spatial inequalities of SWB --- p.25 / Chapter 2.7.1 --- Single component approach --- p.26 / Chapter 2.7.2 --- Integrated approach --- p.27 / Chapter 3. --- RESEARCH DESIGN --- p.32 / Chapter 3.1 --- Procedure of analysis --- p.32 / Chapter 3.2 --- Assumptions and approximation --- p.34 / Chapter 3.3 --- Techniques of analysis and Treatment of Data --- p.35 / Chapter 3.3.1 --- Measuring spatial inequality via single variable --- p.35 / Chapter 3.3.2 --- Establishing the composite index of SWB --- p.37 / Chapter 3.3.3 --- Unit of analysis (UOA) and level of aggregation (LOA) --- p.41 / Chapter 3.3.4 --- Analyzing the association between the composite index and some economic variables --- p.45 / Chapter 4. --- SPATIAL INEQUALITY IN SEVERAL WELFARE INDICATORS OF CHINESE CITIES IN THE 1980s --- p.48 / Chapter 4.1 --- Spatial inequality by single indicators --- p.48 / Chapter 4.1.1 --- Income and Wealth --- p.48 / Chapter 4.1.2 --- Living facilities --- p.63 / Chapter 4.1.3 --- Education --- p.69 / Chapter 4.1.4 --- Medical facilities --- p.72 / Chapter 4.2 --- Summary --- p.76 / Chapter 5. --- SPATIAL PATTERN OF SOCIAL WELL-BEING OF CHINESE CITIES IN THE 1980s --- p.78 / Chapter 5.1 --- Spatial pattern of social well-being of individual citie --- p.78 / Chapter 5.2 --- Results of different levels of aggregation of UOA --- p.105 / Chapter 5.2.1 --- SWB by City-class level --- p.105 / Chapter 5.2.2 --- SWB by provincial level --- p.107 / Chapter 5.2.3 --- SWB by Economic regions level --- p.110 / Chapter 5.3 --- Summary --- p.113 / Chapter 6. --- POSSIBLE FACTORS AFFECTING INEQUALITY OF URBAN SWB AND IMPLICATIONS ON CHINA'S URBANIZATION POLICIES --- p.116 / Chapter 6.1 --- Economic factors -- Influence of economic variables on urban SWB --- p.116 / Chapter 6.2 --- Policy factor - the formation of the urban SWB pattern --- p.123 / Chapter 6.2.1 --- Differentials of urban development due to biased priorities and conceptualization of cities --- p.124 / Chapter 6.2.2 --- Urbanization policies -- population control polic --- p.132 / Chapter 6.2.3 --- The population control policy and the welfare services provision --- p.139 / Chapter 6.3 --- Examples -- the stories of two provincial capitals --- p.141 / Chapter 6.3.1 --- Lanzhou --- p.142 / Chapter 6.3.2 --- Kunming --- p.148 / Chapter 6.4 --- Implication on China's urbanization policies --- p.151 / Chapter 7. --- "SUMMARY, CONCLUSION AND RECOMMENDATIONS FOR FURTHER RESEARCH" --- p.158 / Chapter 7.1 --- Summary of findings --- p.158 / Chapter 7.2 --- Limitations of this study --- p.164 / Chapter 7.3 --- Directions for further research --- p.167 / Appendix / Bibliography