This study explores the effects of income, insurance, and source of medical care on access to and utilization of health services. Profiles of dental, physician, and hospital services use are developed for more than 3,500 Oregonians. Low income, lack of health insurance, and/or an inappropriate source of medical care are hypothesized to be barriers to access and utilization. Households which face one or more of these barriers are identified as falling into a "Health Policy Gap." The data for this study were drawn from a 1978 random telephone survey of 1249 Oregon households. The survey was commissioned by the State Health Planning and Development Agency in conjunction with the Northwest Oregon Health Systems Agency, the Western Oregon Health Systems Agency, and the Eastern Oregon Health Systems Agency. The questionnaire was developed by the Oregon State University Research Center. Information was collected on use of health services, insurance coverage, income, household structure, health needs, health behaviors, and health satisfaction. A behavioral model of health services utilization was constructed, dividing the independent variables according to their relative mutability or amenity to policy intervention. Income, insurance, and source of care were selected as policy variables, while other variables less under policymakers' control were labelled household characteristics. The latter were assumed to reflect a household's propensity to consume services. They included household structure, health need, residential mobility, and health behaviors. Dependent variables included measures of dental and physician visits, use of the telephone for physician advice, preventive exams, and hospitalization during the past year. Multiple techniques of analysis were employed. Cross-tabular procedures were applied to investigate the interrelationship of income, insurance, and source of care. Multiple linear regression and partial correlation methods were used to select as control variables household characteristics highly correlated to each measure of health services use. Analysis of variance and multiple classification analysis were used to develop profiles of health services use. These last techniques allowed an examination of the relationship of each policy variable and health measure while applying increasing levels of statistical control. The initial bivariate relationship was studied in isolation; it was then studied while controlling for the other policy variables, and finally while controlling for both the other policy variables as well as selected household characteristic variables. Findings support the hypotheses. Income is found to be related to insurance coverage, and insurance coverage to source of medical care, although income is not found to be directly related to source of care. Low income, lack of insurance, and an inappropriate source of medical care depress use across almost all services. However, their relative barrier effects differ by the measure of service examined. After controlling for the effects of household structure, health need, residential mobility, and health behaviors, the greatest disparity in use of dental services remains due to income, in physician services to insurance and income, and in hospital services to insurance. Clear implications arise for policymakers, whether in the public or private sectors. The low income, the uninsured, and those with an inappropriate source of care face real barriers to access. Since the relative magnitude of these barrier effects vary by the health measure examined, neither income, insurance, nor health system delivery strategies can be assumed to evenly enhance use patterns. Their effects must be separately estimated for differing measures of health services. Furthermore, the relationship between these policy variables needs detailed study before large-scale policy interventions are undertaken. Understanding the complexity of these findings for different measures of health services as well as the interrelationship of income, health insurance, and source of care is crucial in designing and implementing more effective and equitable health policies in the future.

This is a policy implementation case study. The case is the relocation of the Town of North Bonneville, Washington, by the U.S. Army Corps of engineers. Three questions are addressed in this study. One, did the U.S. Army Corps of Engineers, in relocating the Town, accomplish what was intended to be accomplished? Two, how and why were Federal policies applicable to the relocation of this town changed during the implementation process? Three, what can the North Bonneville experience contribute to existent knowledge, understanding, and appreciation of policy implementation? The principal precepts for policy implementation promoted by this study of the relocation of the Town of North Bonneville, Washington, are as follows: (1) Implementing agencies must recognize and consider what they have to do or may have to do to accomplish what they are intended to accomplish,not merely what they want to do or expect to do. Potential impediments to implementation that are unrecognized and unconsidered may fail to develop, but unless addressed problems cannot be solved. (2) Implementing agencies must expeditiously study and understand the policies that they are assigned to implement. Failure of understanding presents the appearance of ambiquity; indeed, even the clearest policy is effectively ambiquous if it is not understood. (3) Implementing agencies must promptly and plainly explain the policies they are charged with implementing to affected and interested persons or groups. Failure to explain leaves affected and interested persons or groups to form their own expectations of what the policy is, which expectations if erroneous may be difficult to dislodge. (4) Implementing agencies must attend that once a policy is stated and explained all subsequent actions are consistent with the policy as stated and that any action that may appear to constitute a deviation is adequately explained. Otherwise the credibility of the agency and of the policy being implemented by the agency is undermined.

Low-density residential development patterns in New England have resulted in the excessive loss of farms, forests and other open spaces and increased automobile dependence. Coupled with increasingly high land costs, sprawl has contributed towards an affordable housing crisis in Massachusetts. The need for sustainable development (such as new urbanism and smart growth) has been increasingly recognized, yet efforts have been hampered, in part, due to apathy and local residents’ resistance towards increasing residential densities, resulting in limited choices for willing homebuyers. This study examines perceptions of residential neighborhoods and sustainable development among residents in Hopkinton and Southborough, Massachusetts; two communities with rural and suburban character located in the rapidly growing metropolitan Boston region. A photo-based survey sent through the mail asked respondents to rate scenes of innovative residential settings and to answer questions about their attitudes towards environmental issues, planning approaches and neighborhood preferences, their current residential setting and demographic characteristics. The results from 253 survey respondents showed three important themes: (1) that residents expressed strong environmental values yet many lacked awareness of the environmental impacts of low density housing, (2) strong preference for views of nature and open spaces was prevalent and (3) visual design variables can dramatically influence perceived density. Key findings indicate two sub-groups. Approximately one-third of the respondents strongly support denser, sustainable development alternatives and value neighborhood planning that reduces auto dependency, meets the needs of households with various incomes and protects open space. While, the other two-thirds of the sample favor calm, scenic, low density neighborhoods and would like to see their community preserve its open spaces and maintain its historic and rural aesthetic. The study concludes with recommendations for regionally appropriate approaches to sustainable development that take into account the multiple scales and stakeholder involvement.

Import substitution presents many economic development opportunities that can help regions achieve greater economic sustainability and self-reliance. Yet import substitution is largely neglected in economic development theory, practice and literature. There are few methods and resources available to planners trying to identify import substitution opportunities. However, impending economic challenges, such as energy market instability, climate change and carbon emissions regulation, mean that planners will be called upon with greater frequency and urgency to help regional economies adapt. This study offers and evaluates two methods for identifying import substitution opportunities within a regional economy. The first method is rooted in economic base theory, the dominant approach to regional economic development since the 1930s. The second method is derived from industrial cluster analysis, a much-used economic planning approach since the 1990s. Analysis of these two methods and their application to the Springfield, Massachusetts Metropolitan Statistical Area suggest that: 1) both methods show promise as screening tools to help planners focus economic development resources on subsequent industry research efforts, such as surveys, which are essential to the development of effective policy initiatives; 2) the industrial cluster analysis method is capable of identifying a wider range of candidate industries; 3) the economic base theory method may be more effective in smaller regions; and 4) the economic base theory method is useful for estimating leakage. The study also demonstrates that import substitution integrates aspects of economic base theory, particularly the capability to identify leakage and opportunities to increase industry multipliers, with the facets of industrial cluster analysis that emphasize local interindustry linkages and value chain networks.

Professions such as landscape architecture have long laid claim to altruistic concepts of working for the betterment of society, as opposed to their own special interests. In recent time within the United States, such altruistic claims have come into question, as a skeptical public has challenged the true motivations of professionals. This dissertation examines commitments to social responsibility in the landscape architecture community, in an effort to understand the range of attitudes and ideas present in a profession that is highly diverse in terms of its work jurisdictions and context. Conclusions were drawn from an analysis of discourse in landscape architecture and related environmental design disciplines, a study of educational standards for accredited professional degree programs, and interviews with landscape architects practicing in the Los Angeles region. Findings suggest that many landscape architects believe in abstract notions such as stewardship, but that the interpretations of these notions vary widely. Respondents in the public sector often demonstrated different conceptions of their role in the planning and design process, and stronger connections to the land and its inhabitants, than was the case for most private sector respondents. Respondents in all work contexts also described conflicts that emerged in their practice as a result of obligations to clients, communities, employers, special interest groups that they may be affiliated with, personal values and well-being. These conflicts often presented challenges in terms of meeting abstract notions of social responsibility, and often appeared to shape their attitudes towards these responsibilities. This study confirms that professionals are presented with many conflicts of interest in daily practice, as a result of being firmly embedded in society. So challenges to cultural authority that question the motivations of professionals may be justified in many cases. The lack of explicit engagement of social responsibility issues in discourse and education makes it difficult to counter such challenges in the case of landscape architecture. The dissertation concludes with a discussion of implications for discourse, education and practice, including the need for a theoretical framework in landscape architecture and potential for discretionary action, drawing upon theories of communicative action.

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