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Thesis (Ph. D.)--University of Virginia, 1988. / Includes bibliographical references (leaves 122-129). Also available online through Digital Dissertations

No description available.

Thesis (D.P.H.)--University of Hawaii at Manoa, 1991. / Includes bibliographical references (leaves 168-178). / Microfiche. / xiv, 178 leaves, bound ill. 29 cm

Many countries have reduced the generosity of disability benefits while making them more activating - yet few studies have examined how employment rates have subsequently changed. We present estimates of how the employment rates of older workers with poor health in 13 high-income countries changed between 2004-7 and 2012-15 using HRS/SHARE/ELSA data. We find that those in poor health in the USA have experienced a unique deterioration: they have not only seen a widening gap to the employment rates of those with good health, but their employment rates fell per se. We find only for Sweden (and possibly England) signs that the health employment gap shrank. We then examine possible explanations for the development in the USA: we find no evidence it links to labour market trends, but possible links to the USA's lack of disability benefit reform - which should be considered alongside the wider challenges of our findings for policymakers. / Series: Department of Economics Working Paper Series

Preterm birth is a key indicator of maternal and child health, affecting 1 in 10 deliveries in the United States (US) and contributing to long-term morbidity and healthcare costs. The COVID-19 pandemic and policies to mitigate the spread of infection may have indirectly impacted preterm birth, but the results of early epidemiological studies were mixed and declines were largely concentrated in high-income countries and populations. Moreover, while most studies focused on stress-related pathways associated with lockdown policies, healthcare disruptions may have also played a role. The goal of this dissertation was to investigate changes in preterm birth and healthcare disruptions related to the COVID-19 lockdown in a low-income population in the US. In the first aim, I conducted a systematic review of the literature on the pandemic and preterm birth, with a focus on studies that examine heterogeneity by income. In the second aim, New York State (NYS) Medicaid claims were used to examine changes in preterm birth rates during the state’s lockdown policy (NYS on PAUSE) using difference-in-difference methods. In the third aim, changes in preterm were further stratified into those that were spontaneous or medically induced, which may reflect a healthcare pathway. Weekly rates of healthcare utilization, antenatal surveillance, and maternal complications were also assessed using interrupted time series models to characterize healthcare disruptions over the course of the lockdown and across the state. Results from the systematic review documented the rapid growth in research on this topic since the beginning of pandemic. Among the 67 articles included, most reported some decline in preterm birth rates; however, there was large variation by country, methods of exposure assessment, and onset of delivery. Only seven studies focused on differences by individual income (or income proxies) and those that did were inconsistent. Results from Aim 2 suggested that NYS on PAUSE was associated with nearly a percentage point decline in preterm birth rates in the Medicaid-insured population, without a concomitant increase in stillbirth. Aim 3 demonstrated that the change in preterm was largely driven by declines in medically induced preterm. Interrupted time series models showed substantial, but time-limited, declines in pregnancy-related healthcare utilization at the beginning of NYS on PAUSE. Overall, the findings in this dissertation suggest there were modest declines in preterm birth during the COVID-19 lockdown among low-income women in NYS, particularly in medically induced preterm. Healthcare disruptions were common for Medicaid-insured women and may partially explain the reduction in preterm birth in this population. Future research is needed to determine whether this change was positive for some and negative for others, and what that might mean for efforts to improve pregnancy outcomes in the future.

Adverse Childhood Experiences (ACEs) such as exposure to abuse, dysfunction, and neglect have been shown to affect adult health outcomes. The Behavioral Risk Factor Surveillance System (BRFSS) captures national data on risk factors and chronic disease and first included ACE items in 2009. The purpose of this study was to determine whether specific ACEs predicted depressive disorders or poor general health in adulthood. ACEs included: living with someone who suffered from a mental illness, and primary exposure (physical abuse) and secondary exposure (interpersonal violence in home) to violence. BRFSS data from 2009- 2012 were included. Analyses were performed using SPSS and SAS. Descriptive statistics were completed for ACEs, race, gender, history of depressive disorder (DD), and general health status (GH). Logistic regression analyses were conducted to predict DD and GH, controlling for race, gender, and age. Odds ratios (OR) and 95% confidence intervals (CI) were reported. A total of 1,148 individuals were including in the analyses, with 31.4% having DD, 26.9% reported poor GH, 27.4% lived with someone who had a mental illness, 31.3% exposed to primary violence, and 30.2% exposed to secondary violence. Individuals who lived with someone who suffered from a mental illness were three times more likely to have DD (OR 3.28, CI 2.40-4.47) compared to those who did not, however, this exposure did not significantly affect GH. Those exposed to primary violence were 40% more likely to have DD (OR 1.40, CI 1.02-1.92) and were two times more likely to report poor GH (OR 2.09, CI 1.51-2.89) compared to those not exposed. Individuals exposed to secondary violence were 70% more likely to have DD (OR 1.70, CI 1.24-2.32) and were 48% more likely to report poor GH (OR 1.48, CO 1.06-2.05). This suggests that exposure to specific ACEs negatively impacts adult health, resulting in a higher likelihood of DD and poor GH.

The Comprehensive Health Investment Project is a community health project operating in Roanoke, Virginia that is designed to address the needs of families and their children who do not have access to continuous health services. This study examined parental characteristics of those parents participating in the Comprehensive Health Investment Project. Five surveys, which assess parental satisfaction, parental skills, parental comfort, sense of community, and safety practices were administered to parents and subsequently collected for analysis. It is the data from these surveys which provide invaluable descriptions of these parents and family dynamics. Results indicate that the participating parents have high levels of parenting satisfaction and a high level of involvement with their children. The parents had a low sense of community. Overall, parents followed good safety practices with their children. Some questions, when cross tabbed with demographic variables, demonstrated an interaction between the response and the selected variable. However, there was no apparent trend for the interaction to be true for all questions. A description of the method of data analysis and the parenting characteristics exhibited by these parents is included. Recommendations and suggestions are also provided to better assist the CHIP staff in service provision. This research will assist providers in measuring parental program effectiveness and will expand existing knowledge regarding parental practices and satisfaction. / Master of Science

The purpose of this dissertation was to identify the components of women's domestic health work in networks surrounding poor Mexican American and Anglo households and compare women's experiences as domestic health workers. Women representing 10 Mexican American households and 10 Anglo households and their surrounding domestic networks were recruited for this study. Criteria for participation included the presence of at least one child in the household $\le$5 years of age and household income at or below the federally-defined weighted poverty threshold. Sources included, first, 66 interviews with women (n = 26) residing in the study households. Second, women kept 3-week daily health diaries on behalf of all household members. And third, women participated in an inventory of household medications. The study employed several analytic methods, including descriptive statistical analyses, phenomenological insight, taxonomic analyses of women's knowledge structures, life history analysis, thematic analysis, and narrative analyses. The results of the study emphasized several points, including the: (a) gendered but hotly contested nature of domestic responsibility for health, with responsibility negotiated between men and women in households, and disputed between households and social service agencies; (b) significant role played by women's informal networks in defining and evaluating the enactment of maternal responsibility; (c) workings of women's coalitions and cooperatives that protect women's threatened interests and redistribute resources among women; (d) influences governing the transmission of child health and illness knowledge and skills across generations of women; (e) double-edged nature of self-medication that appears as both a source of female autonomy and expertise, yet paradoxically and simultaneously can act as an inappropriate, self-palliating balm for the hurt incurred from inadequate accessibility to quality professional health care for poor women and children; and (f) cross-cutting influences of ethnicity and historical situation in each of the above domains. Women pieced together resources from their cultural background, femaleness, and sometimes their poverty; all these factors also entailed contradictory disadvantages in the production of household health. The health and social policy implications of this study were described in detail in the dissertation, as were the women's own visions for an approximation of utopia.

This thesis examines the changing patterns of mortality in Scotland, with particular emphasis on whether there are widening mortality inequalities among small areas in Scotland. The annual number of deaths in Scotland has decreased steadily since the 1950s, yet mortality rates in Scotland are amongst the highest in Europe for many causes. Furthermore, mortality from some causes, such as suicide, has been increasing over time, particularly among young adults. Evidence suggests that inequalities in mortality have widened over time in Scotland, despite substantial investment in policies aimed at reducing inequalities. Therefore, it is important to seek geographical clues that might help explain what causes these high mortality rates. The changing patterns in Scottish mortality between 1980 and 2001 were examined for small areas, created by the author, known as Consistent Areas Through Time (CATTs). These areas have the same boundaries for each census, so that direct comparisons over time are possible. In this study, CATTs have been used to investigate three aspects of the mortality gap in Scotland. First, the widening mortality gaps between 1980-1982 and 1999-2001 are examined for the total population and for premature mortality (<65 years). Second, the influence that geographic scale and deprivation have on the relationship between population change and premature mortality are assessed. Third, suicide inequalities are examined for the younger (15-44 years), older (45+) and total population, using mortality ratios and statistical modelling. The research found that inequalities in premature mortality (< 65) have widened for all causes of death studied, particularly for suicide. The negative association between mortality and population change was affected by geographic scale, but this relationship could not be fully explained by deprivation. Small area analyses found that the Highlands and Islands had higher suicide rates than elsewhere in Scotland for males, but not females, when social variables were controlled for.