Background: This study analyzes local wellness policies of 176 Georgia public school systems. The purpose of the study was to analyze potential relationships between demographic characteristics of Georgia school systems and compliance with the Child Nutrition and WIC Reauthorization Act of 2004, as well as the strength of wellness policy goals in the areas of nutrition, physical activity, and other school-based activities. Methods: Demographic data from the Georgia Department of Education were used as independent variables. Compliance ratings and the strength of wellness policy goals were derived from an evaluation tool developed by a research team at Georgia State University’s Institute of Public Health as part of a project contracted by the Georgia Department of Education. Analysis was conducted using Pearson’s correlation (two-tailed), crosstabulation, and linear regression. Results: Statistically significant positive associations were found between academic performance and strength of overall wellness policy goals (p < .05), as well as goals in the areas of nutrition education and other school-based activities (p < .01). Economic status of the student population was found to be positively associated with the strength of nutrition education goals (p < .05). No statistically significant associations were identified between demographic characteristics of school systems and physical activity goals. No associations were identified between involving community stakeholders in wellness policy development and having more comprehensive wellness policy goals. Conclusions: This study found statistically significant evidence of districts with stronger academic performance having more comprehensive overall wellness policy goals and stronger goals specifically in the areas of nutrition education and other school-based activities goals. Findings should assist the Georgia Department of Education in allocating its limited resources to help school systems improve wellness in public schools throughout Georgia. Recommendations are made to strengthen federal and state policy regarding school wellness, to conduct more research regarding the influence of community involvement on school wellness, and to provide guidance to local school systems having less resources and lower student academic performance in order to ensure health disparities are not further exacerbated.

The purpose of this capstone is to develop a program to address health literacy among African American adults. The social cognitive theory and the health belief model was used to create a model of an age appropriate, culturally sensitive program with a pre and post test to improve the health literacy in this population. The Community Health Literacy Improvement Program (CHIP) is a pilot program that will consist of a four week didactic intervention focused on combating prose, document, and quantitative health illiteracy. This program will be implemented through a community based nonprofit organization. Participants who complete the CHIP program will be able to identify risk factors for chronic diseases, assess their ability to avoid chronic diseases, and be able to locate community health resources. This proposed intervention will show that community based nonprofit organizations have an important role to play in building community buy in and establishing the agency necessary for community based, culturally sensitive programs such as CHIP to succeed.

<p>In 2010, approximately 84% of the American population lives in a metropolitan area. Different metropolitan areas are characterized by distinct labor markets and economies, housing markets and residential patterns, socioeconomic and demographic factors, and according to some, even distinct 'spirits.' The nature and influence of such structural factors lie at the heart of urban sociology, and have particularly profound effects on patterns of racial and ethnic stratification. This dissertation examines new urban structural changes arising within recent decades, and their implications for racial/ethnic stratification. Specifically, I study the transition to the 'new economy' and racial/ethnic wage inequality; increases in the level and inequality of housing prices and racial/ethnic stratification in homeownership; and increased income inequality, combined with population aging, and racial/ethnic disparities in disability and poor health. I measure metropolitan-level structural factors and racial/ethnic inequalities with data from 5% samples of the 1980, 1990, and 2000 Censuses; the 2010 American Community Survey (ACS); and the 1999-2001 and 2009-2011 Current Population Surveys (CPS). Cross-sectional multilevel regression models examine the spatial distributions of structural factors and racial/ethnic inequality, and the fixed-effects regression models identify the impact of changes in structural factors over time on observed trends in racial stratification. Additionally, I distinguish between effects on minority-white gaps in resource access, and minorities' levels of resource access. This dissertation also makes novel contributions to the field by empirically documenting complex patterns of inequalities among the country's four largest racial and ethnic groups. Perhaps most relevant to theories of racial stratification, this dissertation demonstrates seemingly race-neutral structural changes can have racially stratified effects. </p><p>Chapter 1 describes the foundational literature in urban sociology and racial/ethnic stratification, and provides an overview of the subsequent chapters. Chapter 2 measures the transition to the `new economy' with six structural factors of labor markets: skill-biased technological change, financialization, the rise of the creative class, employment casualization, immigration, and deunionization. Overall, the results indicate the observed Latino-white wage gap may be up to 40% larger in 2010 than in the theoretical absence of the new economy, and the black-white wage gap may be up to 31% larger. Chapter 3 focuses on the long-term trend toward higher and more unequally distributed home prices within local housing markets, epitomized by the housing crisis of the late 2000s. Increases in housing market inequality worsen the Asian-white homeownership gap, but narrow the black-white and Latino-white gaps. However, the level of homeownership is reduced for all groups. Chapter 4 empirically tests the frequently-debated Income Inequality Hypothesis, that macro-level income inequality undermines population health, and hypothesizes any negative effect on health is stronger in areas with greater population aging. The results provide no support for the Income Inequality Hypothesis or any of its proposed extensions, but the chapter's analytic approach may be fruitfully applied to future examinations of structural determinants of health. The theoretical and substantive conclusion of the dissertation is that metropolitan areas represent salient, and changing structural contexts that significantly shape patterns racial/ethnic stratification in America.</p> / Dissertation

Individuals diagnosed with schizophrenia commonly experience problems with accurately assessing their health status due to cognitive deficits including impaired working memory, amotivation, and communication difficulties. Little is known about whether these deficiencies influence health behavior decision-making among individuals with schizophrenia. Individuals with schizophrenia die an average of 25 years earlier than those without a mental illness. Approximately 60% of premature deaths in this population are from medical comorbidities; mortality rates due to cardiovascular and pulmonary diseases are two to three times higher than the general population. In order to reduce morbidity and mortality, it is important to find effective ways to assist these individuals in modification of risky behaviors (e.g., smoking, poor dietary habits, and sedentary lifestyles) and to incorporate daily health promoting behaviors (e.g., balanced diet and regular exercise). This qualitative descriptive study was conducted to describe the decision-making processes used by adults with schizophrenia when making health behavior decisions, identify what it means to be healthy from the perspectives of adults with schizophrenia, and identify the perceived barriers and facilitators that affect health behavior decisions. Ten adults diagnosed with schizophrenia were interviewed for this study. Fifty-percent of participants were female, ages 28 to 59 years, and received treatment in a community mental health centers. Data were analyzed using content analysis. Methods included the use of field notes, open and axial coding, and development of a visual model. Trustworthiness of the findings was established through the qualifications and experience of the investigator, peer scrutiny, and member checks. Three phases of health behavior decision making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. The main category that described health behavior decision making was “Tracking Health Behaviors,” which resulted in the ability to maintain physical and mental health. Within each phase, specific actions associated with achieving and maintaining physical and mental health were identified and were displayed in a visual model. These findings provide a guide to clinicians in identifying health behavior decision making processes and may lead to the design of clinical interventions that improve the health status of adults with schizophrenia.

Regional economic disparities are a widely noted characteristic of the Canadian economy. This thesis examines regional disparities in terms of wages and labour productivity in the manufacturing sector. Regional disparities are analysed along three dimensions: provinces, rural/urban areas and industrial structure. Various competing theories are discussed and compared to the findings. Shift-share based decomposition analyses the magnitude and pattern of disparity and controls for industrial structure. Weighted regression is used to combine provincial and rural/urban effects. The findings support theories that emphasize provinces as units of analysis. The rural/urban results gave qualified support to urban theory. Accounting for industrial structure impacted both the rural/urban and provincial results. The regression analysis found the rural/urban dimension was significant; however, industrial structure and provincial effects were more significant. These results suggest industrial location and provincial economic policies can influence regional economic disparities in Canada.

The aim of this thesis is to analyze the growth performances of regions in Turkey and the role of human capital in this process within the framework of new growth theory. For this aim, it firstly attempts to investigate the evolution of regional income growth differences in Turkey in the period 1980-2000 and the tendency of provinces in Turkey towards income growth convergence. Secondly, by taking a detailed account of human capital, it aims to explore the contribution of human capital differences towards explaining income growth disparities among Turkey&rsquo / s provinces. In this framework, human capital is defined in terms of education, entrepreneurship and innovation.

The aim of this study is to analyze regional disparities and to test the convergence hypothesis across the provinces of Turkey. The study also attempts to analyze the spatial spillovers in the growth process of the provinces. The analyses cover the 1987-2001 period. Two alternative methodologies are used in the analyses. First, the methodology of &amp / #946 / -convergence based on cross-sectional regressions is used and effects of spatial dependence are analyzed using spatial econometric techniques. Second, Markov chain analysis is used and spatial dependence is integrated using spatial Markov chains. Results of both methodologies signal nonexistence of convergence and existence of spatial spillovers in the growth process of provinces.

The purpose of this study was to determine the role of acculturation in the food consumption patterns of low income Hispanic women living in Texas and enrolled in the Women, Infants, and Children (WIC) Program by testing the following hypotheses: a) There are significant differences in consumption of fruit and vegetables by selected socio-demographic variables; and, b) less healthy food consumption patterns are associated with higher levels of acculturation in health-related research involving low-income Hispanic women living in Texas. A secondary-data analysis of the responses to the Texas Food & Nutrition (TEXFAN) questionnaire was performed. TEXFAN is a 122-item survey designed to measure WIC participants' consumption behaviors and to assess the impact of new food packages in Texas' WIC program. A total of 3,336 adult, non-pregnant women self-identified as having Hispanic ethnic background of all races were considered for this study. Analysis of Variance and Kruskal-Wallis tests showed significant differences in nutritional practices among Hispanic women for age, educational attainment, employment status, race, area of residence, and acculturation. Logistic Regression analysis confirmed the hypothesis that lower levels of acculturation are associated with healthier food consumption patterns. The majority of respondents (70.7%, N=2,358) did not consume the recommended five servings of fruits and vegetables a day; therefore, do not have healthy patterns of food consumption. Consequently, the majority of respondents (70.0%, N= 1,709) has a weight statuses above normal and at a higher proportion than women in the State of Texas and the nation. Acculturation continues to interest social and behavioral researchers but variations on conceptualization, definition, operationalization, and measurement negatively impact generalizability and applicability of results. Interventions not considering acculturation are not likely to be successful. Research has to include community, ecological, cultural and contextual factors (e.g., machismo, accessibility to sidewalks, availability of fresh healthy foods, etc.). Development of effective intervention programs should be aimed to increase consumption of healthy food and an adherence to the recommendations of the "Healthy Plate" and the "Dietary Guidelines for Americans 2010" among Hispanics. Also, interventions should generate necessary skills among Hispanics for empowering them to sustain proper nutritional behaviors and overcome barriers.

Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke. / Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship

Aims: The aims of this thesis were to investigate trends and ethnic disparities in the incidence and outcome of stroke in Auckland, New Zealand between 1981 and 2003. Methods: Trends were assessed using information from the three Auckland Regional Community Stroke (ARCOS) studies, conducted in people (aged ≥15 years) in Auckland, during 12-month calendar periods in 1981-1982, 1991-1992, and 2001-2002. These studies used comparable definitions and case finding methods and have been shown to meet the stringent criteria for a population-based “ideal” stroke incidence study. Rates were calculated using Poisson distribution and are presented with 95% confidence intervals. Trends in survival were assessed using Cox Proportional hazards regression modelling. Results: Overall trends in the incidence and event rates of stroke declined across the study period. These declines were significant in males and for the ages 65 to 74 years only. However, growing disparities in the rates of stroke between the major ethnic groups in New Zealand were found, with significant declines in New Zealand Europeans and increases in Māori and Pacific populations. Dramatic improvements in survival over the study period were also found, with the greatest improvement in the acute period, within the first 28-days after stroke. Adjustments for patient or disease severity factors strengthened the survival model. However, adjustments for care/service factors nullified the survival model, thus explaining most of the improving trend. Conclusions: The small declines in the incidence of stroke, improvements in survival and the ageing of the New Zealand population will lead to data dramatic increases in the number of people living with the effects of stroke. To maintain stable numbers of strokes occurring, more intensive prevention strategies need to target high-risk populations and population-wide health education strategies are needed to improve the health of the general population, hence reducing the risk of stroke. / Health Research Council (HRC) of New Zealand Pacific Health PhD scholarship