In 1997, the Virginia Refugee Health Program coordinated a protocol and reimbursement structure to encourage health departments to perform initial health screenings on refugees settling in the Commonwealth by establishing four recommended levels of assessment. This thesis is concerned with these initial health-related services provided to refugees by Virginia's health departments, the quality of these services, and how they vary from one district to another. For this study, I interviewed health department staff representing 13 of Virginia's 19 districts that rendered health screenings in 2000. Information such as the level of assessment provided, and the types of procedures and services offered were the main foci of the interviews. I found that of the 13 districts, three (the cities of Alexandria and Virginia Beach, and Prince William County) offer only the required minimum to refugees. The variations I discovered in the services that health districts provide suggest, conceptually, the workings of both "structure" and "agency." Each health department is formally and informally structured in terms of staffing, services, and resources in accordance with its individual needs and initiatives. The structure of current funding at both the state and local level acts to inhibit some health districts from providing all four levels of assessment. In addition, human agency in the form of personal interest in meeting refugee's health needs as well as district collaboration with local resettlement agencies, also plays an important role in the extent of refugee services rendered. / Master of Science

Since its initial identification in 1975, Lyme disease has become a public health concern in the U.S.  Increased concern is sparked by the rapid rate at which the disease is emerging into new areas.  One area of disease emergence is the state of Virginia which has been experiencing exponentially increasing rates of the disease.  This research studies Virginia's landscape-level habitats to explore demographic and environmental variables related to the spread of Lyme disease. The land cover data came from the National Land Cover Database (2006), demographic data came from the U.S. census (2010), and Lyme disease case data came from the Virginia Department of Health (2006-2010).  Key variables examined in this statewide study include the percentages of landscape types measured inside each census tract, measures of forest fragmentation, and measures of land cover interspersion inside state census tracts. Analysis was carried out using a spatial Poisson regression model.  Of the original 15 variables, 10 were significantly correlated to Lyme disease.  The six that were positively correlated with disease incidence include percent herbaceous land, percent water, two edge contrast measurements of herbaceous-forest land, median age, and average income.  The four that were negatively correlated were percent developed, population density, and two edge contrast measurements of developed-herbaceous land. Overall results indicate that specific environmental and demographic variables are associated with increased disease incidence as Lyme disease emerges in Virginia.  Results from this study could help create a predictive statewide map for Lyme disease incidence and aid in disease awareness and resource allocation. / Master of Science

Birth defects are the leading cause of infant death in the United States. Research has linked poor maternal micronutrient intake to birth defects including neural tube defects, heart defects, and oral clefts. After investigating spatial patterns of these birth defects in the City of Dallas and the neighborhood characteristics within clusters, geospatial access to supermarkets and convenience stores measured by proximity and concentrations are examined as environmental risk factors for nutrition-related birth defects. Spatial clusters of all three nutrition-related birth defects exist in the City of Dallas. Cluster for NTD occurs in vulnerable places with lower income and high minority population specifically Hispanics with no supermarkets. Cluster for heart defects mostly occurs in high income and predominantly white neighborhoods with many supermarkets. Clusters of oral clefts mostly occurs in middle-class income with relatively high minority populations with many convenience stores. For the entire study area, geographical access to supermarkets that include healthy foods are shown to be spatially reachable from most of mothers of infants with nutrition-related birth defects as well as convenience stores that typically include the majority of unhealthy processed foods with very few nutrients. Thus, not only easy geographical access to healthy food vendors but to convenience stores with low quality produces is observed at the same time.

This dissertation explores the spatial patterns and place-based characteristics of colorectal cancer (CRC) late stage incidence and CRC-specific mortality in Miami-Dade County. Because CRC is the second leading cause of death among all cancers and is almost 90 percent preventable through medical screenings, investigations of CRC disparities across groups and communities are extremely relevant in the fight against cancer. This paper analyzes the geographic distribution of CRC cases in Miami-Dade County between two periods, 1988-1992 and 1998-2002 to: a) identify significant "hot spots" or clusters of disease; b) investigate associations of CRC patterns with neighborhood level characteristics such as socio-economic status, race/ethnicity, and poverty; and c) explore the policy implications of the spatial trends identified for the disease, with particular reference to the Welfare Reform Act of 1996. This dissertation analyzes data from the Florida Cancer Data Registry and tract level U.S. Census data, to identify the spatial distribution of CRC and study its relation to place-based variables using Geographic Information Systems (GIS) and spatial statistical modeling. Identifying spatial clusters of disease can assist in targeting public health interventions and improving social service delivery, particularly for uninsured populations. Identifying communities facing greater obstacles to screenings and quality medical care through the use of spatial analysis is an effort to mitigate these barriers while simultaneously providing empirically based evidence linking neighborhood-level social and economic conditions to health disparities.

This research examines public health mapping over two time periods, 1944-1954 and 2000-2004 and explores how mapping disease shaped scientific knowledge about disease. During World War II, the Atlas of Diseases was produced by cartographers and geographers well versed in the subjectivity of maps. Today professionals in a variety of disciplines use digital mapping software to produce maps of disease. This research takes a look at how public health maps and mapping of disease have changed over time and discusses the political implications of public health mapping as an aspect of geographic governance.

No description available.

Because tobacco smoking causes 430,000 U.S. deaths annually, wide-reaching smoking bans are needed. Bans reduce cigarette consumption, encourage cessation, protect nonsmokers from second-hand smoke, and promote an attitude that smoking is undesirable. Therefore, bans may prevent future generations from suffering many smoking-related health problems. The federal government has not implemented widereaching smoking bans so it falls on individual states, counties, or communities to devise appropriate smoking policy. To date, smoking policy has been determined by legislators, who may have conflicts that prevent them from acting in the publics best interest. However, this method of implementing smoking policy may be changing. In 2005, Washington residents voted by ballot initiative to strengthen existing state smoking regulations. In 2006, Arizona, Nevada, and Ohio residents voted by ballot initiatives to implement strict statewide smoking bans. This research presents a way to predict how residents of other states might vote if given the opportunity. Two research hypotheses are tested and accepted: a positive relationship between favorable votes and urbanness, and a preference favoring smoking bans where smoking regulations already exist. Finally, a projection is made that a smoking ban vote in Kentucky would yield favorable results, and a map showing projected county votes is provided.

Thesis (Ph.D.) - Carleton University, 2002. / Includes bibliographical references (p. 398-414). Also available in electronic format on the Internet.

No description available.

Orientador: Sandra Eliza Contri Pitton / Banca: Ana Tereza Caceres Cortez / Banca: Lucy Marion Calderini Philadelpho Machado / Banca: Francisco Mazetto / Banca: José Conti / Resumo: A condição de vida urbana de uma população está relacionada à quantidade e qualidade de serviços oferecidos, dentre eles, encontram-se a educação, a habitação, o saneamento básico, o emprego, o lazer e a saúde. No caso do Brasil, está em vigência o Programa Saúde da Família (PSF), como uma estratégia de trabalho e prestação de serviços no setor saúde. Para tal os antigos postos de saúde passaram a ser denominados Unidades de Saúde da Família (USF), seus funcionários fazem parte da Equipe de Saúde da Família (ESF), e dentre eles criou-se à função de Agente Comunitário da Saúde (ACS). O Ministério da Saúde, através do PSF enfatiza que os serviços oferecidos devem ser articulados especialmente no atendimento de três grupos de pessoas: a criança, a gestante e o idoso, salientando que cada USF deve programar ações específicas para estes setores, no intuito de minimizar os agravos a vida urbana. Dentre os grupos anteriormente citados, as estimativas populacionais apontam para o crescimento da população idosa mundial, e mostram que em 2050 existirão no mundo 23 bilhões de idosos sendo que dois terços desses estarão em países em desenvolvimento como o Brasil, segundo UNITED NATIONS, 2001. No sentido de contribuir com a temática até o momento apresentada, esta investigação objetivou observar como se realizam no espaço geográfico as ações das ESF's para a promoção da manutenção da capacidade funcional do idoso. Partindo-se da idéia inicial de que as equipes de saúde de família possuem inúmeras deficiências no entendimento do espaço vivido de sua clientela, e também o desconhecimento da amplitude de suas obrigações, o que resultam na desigualdade, inafetividade e desqualificação dos serviços oferecidos. / Abstract: The condition of urban life of a population is related to the quantity and quality of services offered, among them, are the education, housing, sanitation, employment, leisure and health. In the case of Brazil, is in effect the Family Health Program (PSF) as a strategy to work and provide services in the health sector. To this end the old posts of health began to be called Units of Family Health (USF), its officials are part of the Family Health Team (ESF), and among them set up to the function of Agent Community Health (ACS) . The Ministry of Health, through the FHP emphasizes that the services provided should be articulated especially in the care of three groups of people: the children, the elderly and pregnant women, noting that each USF must implement specific actions for these sectors in order to minimize the disorders urban life. Among the groups cited above, the population estimates point to growth in the elderly population worldwide, and show that in 2050 there in the world 23 billion of elderly where two thirds of these are in developing countries like Brazil, according UNITED NATIONS, 2001. In order to contribute to the themes presented so far, the research aimed to see how take place in the geographical area of the ESF's actions for the promotion of maintaining the functional capacity of the elderly. Based on the initial idea that the teams of health of families have many shortcomings in understanding the living space of their clients, and also ignorance of the extent of its obligations, which result in inequality, inafetividade and disqualification of services offered. / Doutor