Cigarette smoking is the leading cause of preventable morbidity and mortality in the United States. While smoking rates have steadily declined among the general population, smoking is becoming increasingly concentrated among socioeconomically disadvantaged groups due to higher initiation and lower cessation rates. This dissertation examines determinants and mechanisms of smoking cessation in the context of the Kick it for Good study (KIG), a community smoking intervention for Boston public housing residents. In the first study, we explored mediators and moderators of the KIG intervention effect on smoking cessation. We did not find any significant mediators for 3-mo cessation outcomes, although there was modest evidence for mediation by self-efficacy to quit at 12-months. We found living with other smokers and perceived stress were moderators of the KIG intervention effect on smoking cessation. In the second study, we examined predictors of attitudes and knowledge of nicotine replacement therapy (aNRT). We found discussing smoking cessation with a healthcare provider and use of nicotine replacement therapy (NRT) were associated with more positive attitudes and greater knowledge of NRT. The KIG intervention did not impact aNRT outcomes throughout the study period. In the third study, we examined the effect of depression on smoking cessation and whether this effect was moderated by social support. We found smokers with depression classified by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) were more likely to report smoking abstinence than those without depression. Social support did not moderate the effect of depression on cessation. We also conducted a sensitivity analysis to determine if the cutoff of 10 for the CES-D was valid in this population of low-income and racially/ethnically diverse smokers. We did not find evidence of depression misclassification by the CES-D-10, although there remains the need to validate the scale in socioeconomically disadvantaged populations. These findings provide valuable information on how smokers living in Boston public housing were able to achieve smoking abstinence in the context of a cessation intervention. The insights gained from these results may be applied to future intervention studies to help address the disparity in smoking rates among socioeconomically disadvantaged smokers.

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Health disparities are a recognized public health concern and the need to address these disparities remains worthy of bringing new methods that assist in closing the gap. This research examined the effectiveness of data science to highlight health disparities, and to convey the value of data science applications in related health care applications. The goal of this research was accomplished by undertaking a multi-phased and multi-method approach, best represented in three individual essays. In essay one, a systematic literature review assessed the state in current academic literature of data science applications used to explore health disparities and to determine its applicability. The systematic review was guided by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Essay two assessed the capacity of data science software to address the effectiveness of these data science technologies in examining health disparities data. This was conducted using KDnuggets data pertaining to analytics, data science, and machine-learning software. The research in this essay demonstrated the potential utility of leading software to perform the kinds of data science operations that can achieve improved care in healthcare networks by addressing health disparities. Essay three provided an appropriate case study to showcase the value data science brings to the healthcare space. This study used a geographic information system to create and analyze choropleth maps to determine the distribution of prostate cancer in Texas. SPSS software was used to assess the social determinants of health that may explain prostate cancer mortality.

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In recent decades, neurologists have been directing more of their research efforts to exploring the sources of health disparities in medical and surgical treatment of epilepsy. Many studies reveal that racial and ethnic minority patients continue to receive suboptimal care, which has some dire repercussions on their physical and mental health, as well as their social well-being because epilepsy is a chronic disease that tends to affect multiple aspects of the patient’s life. Although the earliest landmark studies emphasized the importance of mixed methodology research, the studies that followed tended to rely heavily on quantitative methods to unravel patterns of disparities with sparse use of qualitative methods to give voice to the patients concerned. In this work, I present a mixed methodology framework that is particularly suitable to investigating health disparities in epilepsy care, which affirms the complementary nature of quantitative and qualitative methods. I explore some of the challenges that clinicians face to utilizing qualitative methods, and introduce some of the validity criteria and techniques of qualitative research that make it a valuable methodology to understand disparities. I highlight some of the ethical concerns with recent studies in health disparities in epilepsy care which adopt only quantitative or qualitative methodology, and contribute very little to eliminating disparities compared to the potential contribution of mixed methodology research. This will be supported by various examples from research led by clinicians, public health professionals, and social scientists. / Urban Bioethics

Established in 1965 as a part of President Johnson’s War on Poverty effort, the federal community health center (CHC) program is a primary source of federally-subsidized quality health care services for medically-vulnerable populations in the United States. Despite its current role as a medical safety-net for the nation’s health care system, the CHC program did not begin as a public health program, but rather as a social justice program. Since its formalization, the CHC program has enjoyed relatively consistent Congressional support as a cost-effective means of providing primary healthcare to indigent populations; however, the narrative of the program has shifted overtime from a focus of empowerment and lifting communities out of poverty, to the fortification of the national health care system as a cost-effective provider of quality healthcare care for all. In this manuscript, I argue that this transition from community empowerment and the mitigation of fundamental causes of disease to a more risk-based emphasis on the issue of access, has diminished the urgency around the engagement of the structural effects of poverty on health in favor of a “one size fits all” approach to the provision of basic health care. In an effort to objectively quantify the effects of geographic access on health as a means for evaluating the success of the contemporary program, this research project explores the extent to which proximal access to a CHC is significantly associated with various self-reported indicators of positive health outcomes. My primary research method is multivariable regression utilizing secondary data from the 2012 Southeastern Pennsylvania Household Health Survey, the 2008-2012 5-year American Community Survey Estimate, and the Health Resources and Services Administration Data Warehouse. Using statistical modeling, I test the effect of CHC access on three distinct measures of individual health: (1) self-reported health status, (2) the likelihood of having pain lasting 6 months or more, and (3) the likelihood of having a usual source of health care. Within each model, I also test a series of interaction terms through nested sub-models to uncover any conditional effects of access for selected social groups. This statistical design offers the opportunity to explore whether the main association between access to a CHC and health varies based on the social characteristics and/or social environment of the individual. The findings of my analysis suggest that the effect of CHC access varies for different social groups, with less disadvantaged groups, such as poor non-Hispanic whites with high social capital, and poor individuals living in areas of low disadvantage, receiving the greatest benefit from proximal CHC access. However, individuals at the extremes of social disadvantage benefit least from CHC access alone. I argue that while the provision of CHC access is a noble and necessary tactic for fighting the persistence of health disparities in our medically-vulnerable communities, focusing on access alone is insufficient to solve the problem. The pendulum must switch back to community empowerment and the eradication of structural threats to health to initiate real change for medically-vulnerable populations. / Sociology

Racial, ethnic and gender disparities have been found among a variety of health variables, but to date no study has comprehensively examined whether similar differences exist between sleep variables such as duration, efficiency and quality, in early adolescence. There is a general consensus among previous literature that adolescence is a time when a decrease in total sleep time and an increase in sleep problems are observed. Previous literature, however, mainly focused on the influence of puberty to explain these changes. the current study examined if differences exist between 1462 Caucasian, Hispanic/Latino, and African American early adolescents (ages 10-14 years) on sleep duration, efficiency and quality. Results showed that adolescent boys reported significantly longer sleep durations, better sleep quality, shorter sleep onset latencies, and later rise times than girls. Results also showed that sixth graders slept longer than seventh and eighth graders, and that seventh graders woke up much earlier than the other two grades. Lastly, results showed that Caucasian students reported longer sleep onset latencies and lower sleep efficiencies than African American students. Trends were observed for boys having greater sleep efficiencies than girls and for Caucasian students sleeping longer than Hispanic students. Based on the differences observed in our sample, introducing sleep education in middle school is discussed.

Kwan Wing Kai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 85-93). / Abstract / Acknowledgment / Chapter Chapter 1. --- Introduction --- p.1 / Chapter 1.1 --- A Review of Recent Studies on the Productivity of Chines Economy --- p.3 / Chapter 1.2 --- Aims of Study --- p.10 / Chapter Chapter 2. --- The Sources of Productivity Growth --- p.16 / Chapter 2.1 --- Degree of Government Intervention --- p.16 / Chapter 2.2 --- Ownership Structure --- p.18 / Chapter 2.3 --- Output Structure --- p.24 / Chapter 2.4 --- Changes in Regional Development Strategy --- p.25 / Chapter 2.4.1 --- Regional Development Strategy before1979 --- p.27 / Chapter 2.4.2 --- Regional Development Strategy since1979 --- p.29 / Chapter 2.4.3 --- The Impacts of Different Regional Strategies on Productivity Change --- p.31 / Chapter Chapter 3. --- Theoretical Framework and Estimation Methods --- p.33 / Chapter 3.1 --- Methed I: The Conventional Approach --- p.35 / Chapter 3.2 --- Method II: Replacing the Variable of the Growth of Capital Stock by Investment-Output Ratio --- p.40 / Chapter 3.3 --- Method III: Approximation of the Production Function by Taylor Expansion --- p.45 / Chapter Chapter 4. --- Empirical Results of the Three Different Methods --- p.51 / Chapter 4.1 --- Estimation Results of the Three Different Methods --- p.51 / Chapter 4.2 --- Comparison of the Estimation Results of the Three Methods --- p.63 / Chapter 4.3 --- An Assessment of Provincial Productivity Growth --- p.66 / Chapter 4.4 --- Regional Productivity Difference since1979 --- p.75 / Chapter Chapter 5. --- Conclusion --- p.82 / References --- p.85 / Appendix 1. List of the Abbreviations for Provinces --- p.94 / Appendix 2. A Summary of Notations --- p.95 / Appendix 3. Estimates of Provincial Capital Stock (1979-1992) --- p.97 / Chapter A3.1 --- Initial value of Capital Stock --- p.98 / Chapter A3.2 --- Net Increase of Capital Stock --- p.101 / Chapter A3.3 --- Estimating the Annual Series of Capital Stock --- p.102 / Appendix 4. The Process of Fiscal Decentralization and Deterioration of Regional Redistribution --- p.106 / Chapter A4.1 --- The Process of Fiscal Decentralization --- p.106 / Chapter A4.2 --- The deterioration of Regional Redistribution --- p.110 / Appendix 5. Estimation Results of the Three Different Methods --- p.114

The study of regional inequality has attracted numerous attentions of geographers and economists. The interdisciplinary research has been reflected in a spatial-temporal hierarchical structure, that is, the multi-scalar nature of economic convergence and the temporal dynamics of geographical inequality. With the support of big databases, the integration of these two growing fields provides opportunities for a spatially integrated social science. Therefore, this dissertation aims to explore this long-debated issue from two novel perspectives. On the one hand, the newly available county-level dataset will be employed to reexamine the three major issues of economic inequality and then a comparative analysis at the county level, city level and provincial level will be conducted to study the scale nature of economic inequality. On the other hand, the spatial data exploratory analysis as well as the geospatial analysis provides a new methodological framework to study the spatial effects of economic development. / With the support of the Barameter on China’s Development database, this dissertation covers 2254 county-level units, 338 prefecture-level units and 27 provincial units during the period of 1997 to 2010. Three major research issues have been reexamined at three different spatial scales using the geospatial analysis. Firstly, besides the temporal trend of economic inequality at multiple scales, the decomposable Theil index is applied to measure the intra/inter provincial/prefectural inequality as well as the urban-rural disparity. It is found that economic inequality is more prominent within provinces and between prefectures. Moreover, different from previous studies, the inequality within urban or rural areas is much more intense than the urban-rural disparity. Secondly, global and local spatial patterns of economic inequality are explored with the exploratory spatial data analysis technique. With the recent advances in geovisualization, a spatially explicit view of development mobility provides new insights on the role of spatial spillover effects. It is found that spatial clustering of economic development is investigated differently at these three spatial scales during the whole time period. Spatial integrated moves where the county-level unit’s development improves or worsens more than its neighbors are more frequently encountered than the reversed situation. Thirdly, spatial filtering method as well as multilevel modelling is employed to examine the causal mechanisms underlying economic inequality, which are nested among different spatial scales in China. The spatio-temporal and hierarchical analysis reveals that the county-level development is influenced significantly by its decentralization, fixed investment as well as urbanization rate. Simultaneously, the multi-mechanisms underlying regional development are spatially heterogeneous shaped largely by geography and policy. / The above findings thus contribute to the recent literature on economic inequality and suggest meaningful theoretical and policy implications. The county-level scale provides a novel perspective for understanding the trajectory of economic development in China. As suggested by the new economic geography literature, the prominent significance of space is reaffirmed at different spatial scales and reiterates pervasive existence of spillover effects operating at local scales. Furthermore, institutional reforms, such as empowering counties, should be enlarged to strengthen cooperative relationships among local governments thus realizing cross-border economic cooperation. Meanwhile, with the advances of geocomputing and geovisualization, new interdisciplinary approaches are needed to study this longstanding issue, so as to visualize the spatially integrated dynamics of regional development. / 自从改革开放以来，中国经济保持着每年约10%的增长速度。在快速增长的同时，愈来愈显著的区域差异问题也成为困扰中央和地方政府的一大难题。许多学者已对区域差异问题展开了广泛且深入的研究，主要围绕区域差异的时间趋势、空间格局以及驱动因素等三大主要问题，但至今由于研究方法、研究尺度或者研究区域的不同，学者们很难达成对区域差异问题的统一见解，从而影响有效区域政策的制定。 / 区域差异研究发展到至今，大致经历了从宏观尺度向微观尺度的转变，研究的视角也开始更注重时间空间的动态结合，但仍存在以下不足：首先，以往研究主要围绕省级单元进行，或者仅以个别经济发展较快的省份作为研究对象，宏观尺度的研究掩盖了微观尺度上的区域发展过程，而个别省份的研究又影响了区域研究的整体性；其次，以往研究主要依赖于传统的统计方法，虽然一些最新的研究开始应用多层次模型等，但根据克鲁格曼提出的新经济地理，空间的作用不可忽略。空间模型的应用仍是以后更深入了解区域差异的重要方法。 / 本文针对现今区域差异研究的不足，在具有可比性时空动态分析的理论框架和多尺度多机制的分析框架下，从研究尺度和研究方法上进行创新，旨在为更深入理解区域差异问题提供一种新的视角。基于从1997年到2010年的全国县级发展数据库，本文首先探讨并比较县级、地级市及省级层面上区域差异的时间趋势，其次采用地理可视化技术和空间马尔科夫链，探讨了区域差异的空间格局及其动态特征，最后运用空间过滤方法及多层次多变量模型，探讨了不同尺度上驱动因素的相互作用。完成的主要研究工作如下： / 首先，在分析了几种不同衡量区域差异的指标后，本文采用了泰尔系数衡量并比较全国省、市、县等不同尺度上的区域差异趋势，并利用泰尔系数的分解性特征，进一步研究区域差异在不同地理尺度上、城乡单元之间的关联性和特征，并着重研究了区域差异趋势的空间异质性。本文发现了区域差异在较小的空间尺度上更为显著，省级、地级市之间的区域差异大体呈现倒U型，但县域空间差异却呈现逐渐增强的趋势。通过多尺度泰尔系数的分解，区域经济差异在省内部和地级市之间更为明显。不同于以往的研究，城市或者乡村内部的差异远超过城乡差距，并成为导致县域差异的主因。另外，由于空间异质性，区域差异在东部、西部、中部、东北呈现不同的时间趋势及特征。 / 其次，在采用地理信息系统和探索性空间数据分析方法鉴定区域发展的全局和局部空间集聚特征后，为了进一步理解这种空间特征的动态性，本文采用空间马尔科夫链探讨区域发展的空间溢出特征，并结合地理可视化技术，更直观显示区域发展的空间关系及其变化。本文发现了区域发展主要呈现出空间集聚的特征，且空间集聚的强度在细尺度上更为明显。2004年开始，空间集聚开始呈现出逐渐北移的新特征。从时空角度看，一个区域的经济发展受它地理邻居单元的影响，呈现出共同进退的特征；一般而言，一个区域的发展速度均快过邻居的发展。 / 再次，采用空间过滤方法，并结合多层次模型，设计出符合理论框架的定量模型。并采用多尺度多变量模型分析财政分权、全球化、固定投资、人力资本以及政策对区域发展的影响，以及驱动因素在不同空间尺度间的相互影响。研究发现空间溢出对于县域发展作用不显著，但受到财政分权、外商投资以及固定资产的重要影响。地理和政策对于区域发展的影响呈现出空间异质性。 / 总之，本文从县级尺度出发，采用最新的一些地理空间方法重新探讨了区域差异的三大经典问题。本文证实了新经济地理学的观点，空间尺度和空间溢出对于重新理解区域发展问题至关重要。同时，本文提出了一些实用性较强的区域发展政策，旨在实现更为均衡的区域发展模式。 / He, Sanwei. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 150-166). / Abstracts also in Chinese. / Title from PDF title page (viewed on 05, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.