Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

One of the key determinants of health and wellbeing for adolescents is the utilization of preventive health services. While adolescents are generally healthy, public health officials warn that access to health insurance, preventive care, and proper health education are vital to experiencing continued health and wellbeing throughout the life course. Despite the noted importance of preventive care in adolescence, social disparities continue to exist. Given that racial and ethnic minorities and those who are socioeconomically disadvantaged are less likely to have health insurance coverage, use preventive health services, and follow the recommended immunization schedule, this dissertation focuses on an important aspect of adolescent preventive health care services: vaccinations. Specifically, this study examines race and ethnic specific trends in meningococcal and tetanus, diphtheria, & acellular pertussis (Tdap) vaccination coverage among adolescents in the United States. Understanding such trends could help providers determine the most effective strategies for immunizing adolescents from different racial/ethnic backgrounds, especially as they age into adulthood, as well as reduce the overall impact of vaccine preventable diseases on households and communities. Using provider reported vaccination histories from the National Immunization Survey-Teen, 2008-2016, this dissertation estimates a series of binary logistic regressions to model racial and ethnic trends in meningococcal and Tdap vaccination coverage among U.S. adolescents (n = 155,461) over a nine-year period. I find that the distribution of meningococcal and Tdap vaccinations among adolescents varies by race and ethnicity. Black and Hispanic adolescents tend to display higher odds of vaccination relative to White adolescents. These increased rates suggest a racial/ethnic minority advantage that, at least among Hispanics, is reminiscent of the “Hispanic paradox.” These results further suggest that racial and ethnic disparities in adolescent vaccination persist. Moving forward, race and ethnic specific trends highlight the need for targeted interventions to reduce disparities as well as continued efforts to increase the overall rate of adolescent vaccination, as adolescents remain the least vaccinated demographic age group in pre-adulthood. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester 2018. / June 28, 2018. / Adolescent health, Health disparities, Race and ethnicity, Vaccination / Includes bibliographical references. / Amy M. Burdette, Professor Directing Dissertation; Chris J. Coutts, University Representative; Miles G. Taylor, Committee Member; John R. Taylor, Committee Member.

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

The lack of environmental sanitation measures is a worldwide problem, especially in developing countries, and greatly facilitates the spread of disease. This thesis aims to contribute towards a better understanding of the effect on diarrhoea, nutritional status and intestinal nematode infections of drainage and sewerage in an impoverished urban environment. After an extensive literature review of some relevant aspects of the health impact of environmental sanitation, field research was designed and conducted in nine poor urban areas of the city of Salvador (pop. approximately 2.3 million), capital of Bahia State, in northeast Brazil. The study was targeted to a sample of children under 15 years old living in the poor urban areas of the city at the time of the field work (August 1989-November 1990). An extensive questionnaire was applied to collect information on each child and on the conditions of the family and the household, three stool examinations of the children 5-14 years old were performed (to measure nematode infection and reinfection), diarrhoea was monitored fortnightly, in children under 5 years old for one year, and anthropometric measurements taken every two months. The results showed that among children in neighbourhoods with unimproved community sanitation the incidence of diarrhoea was consistently higher and the nutritional status, expressed by the mean height-for-age z-score, was significantly lower throughout the study period as compared to those with improved sanitation. Regarding intestinal nematode infections, as the level of community sanitation improves, the following trends were noted: prevalence and intensity of infection and reinfection declined, risk factors for infection became more numerous and more significant, clustering of cases by house­ hold became more significant, predisposition of individuals to reinfection and to heavy infection became more marked, and infections with different species were increasingly aggregated in the same individuals. These results suggest that sewerage and drainage can have a significant effect on diarrhoea, nutritional status and intestinal nematode infections and that the evidence of the health impact was strongest for intestinal nematode infections. The interpretation of these epidemiological findings in the light of the Brazilian health, urban and social policies contributes to a comprehensive framework for the control of nematode infections, diarrhoea and malnutrition in poor urban areas of Salvador and elsewhere.

<p> The massive migration of rural labor to urban areas in China over the past few decades has created the largest labor flow in world history. The proportion of the residential population in rural areas decreased from 80% in the late 1970s to 44% in 2016. Due to institutional and practical constraints, whole family migration is often not feasible for most migrant families. As a result, 61 million children age 0-17 are estimated to be left behind in rural communities by at least one parent seeking employment elsewhere. These numbers reflect a major change in the family and community environment in which children are cared for. Parental migration brings about changes in family structure and dynamics, entails a trade-off between economic benefits and parenting inputs, such as parental supervision and emotional support. At community-level, large-scale selective migration leads to remarkable changes in community demographic composition, shifting sociocultural norms and aspirations, influencing community institutional resources and collective social capital. </p><p> Over the past few decades, the scientific literature examining the implications of this large-scale migration and split families on the well-being of children left-behind has proliferated. However, empirical evidence on the effect of parental migration on left-behind children&rsquo;s well-being is mixed for China and other countries in the context of international migration. Few studies have attempted to reconcile the inconsistent findings by examining the moderator effect. Although the potential effects of migration on cognitive development of children in origin communities reflect both household- and community-level processes, few studies have examined how community-level migration affects child development. In addition, mostly focused on the well-being of school-aged children, very limited study has been conducted on parental migration and early childhood development in the first few years of children&rsquo;s lives, especially in the domain of cognitive and behavioral outcomes. Moreover, most researches have relied on cross-sectional data, exploring the association between a contemporaneous measure of parental migration and statically measured child outcomes at one point in time, ignoring the potential impact of the timing, transition and cumulative exposure to parental migration/absence, and may also be prone to selection bias. </p><p> To bridge the gap, the first analysis examines the conditions that may influence the effect of parental migration on child self-rated health (SRH). The results suggest a relatively weak main effect, but this is due in part to the influence of moderating factors. Children are more likely to report a good health status when the economic return of migration is substantial, if they are from impoverished communities, or when mothers remained at home to provide care while the father migrated a short distance within the same province. The second analysis focuses on examining community migration effect. Findings suggest lower cognitive achievement in communities experiencing high migration intensity. Children living in very high migration intensity areas are expected to have 3.57- and 1.54-unit lower verbal and math scores, which are equivalent to 1.67 and 0.87 years of formal education respectively. A possible explanation for this effect is the change in demographic composition brought about by the outmigration of better-educated adults. Finally, applying growth curve modeling strategy, the third analysis examines parental migration and early childhood development trajectories and states, taking into account timing, transition and cumulative exposure to parental migration. Our findings indicate that while left-behind children are comparable in the prevalence of childhood illness, positive behaviors and preschool enrollment, two-parent migration has a detrimental effect on children&rsquo;s linear growth, cognitive stimulation, and home environment. Lack of appropriate cognitive stimulation in the critical early years could have important implications for child cognitive development.</p><p>

Efforts to encourage healthy behaviour often fail to bring about sustained changes in people’s lifestyles. New approaches to tackling chronic disease include the use of financial incentives: rewards paid to individuals conditional upon their achieving some pre-specified target, such as losing weight or quitting smoking. Incentives may provide an extra motivation to adopt healthy lifestyles, and structure behaviour change efforts in ways more conducive to success. Health incentives have, however, provoked controversy, attracting accusations of ‘bribing people to be healthy,’ ‘rewarding bad behaviour,’ and ‘wasting taxpayers’ money.’ It remains unclear how viable health incentives could be as a tool for health promotion; but, even if effective, their contentious nature may still give reason for hesitancy. Here, I explore whether such ethical concerns present us with convincing reasons not to use health incentives. I begin by looking at the nature of the criticisms of incentives in the media, and grouping these arguments into more general themes for discussion. I then proceed to consider each of these in turn, beginning first with debates about the requirements for the state to act efficiently without overstepping its legitimate sphere of influence. I then move on to concerns relating to the potential for incentives to undermine liberty and autonomy. Next, I discuss whether health incentives are unjust insofar as they are undeserved, and how this relates to agent freedom and responsibility for adopting healthy lifestyles. Finally, I consider the worry that using money as a healthcare intervention could corrupt certain values that we care about. In concluding, I seek to give an overall idea as to the ethical permissibility of health incentives, and identify some key features that are likely to render incentives more or less acceptable as a means of improving health.

The aim of this thesis was to study a worksite exercise intervention for sedentary workers in China. This involved a 10-minute Qigong exercise session twice a day. Four inter-related studies examined the development, implementation, and evaluation of this intervention. First, a feasibility study demonstrated that short exercise breaks could be integrated into the workday routine for employees with sedentary job roles. Second, a pilot study was conducted to test the intervention under research processes. Third, a waitlist controlled trial study showed increases in employees’ physical activity between baseline and post-intervention for intervention (n=193) and waitlist control (n=83) participants, but no changes in work performance or sickness absence. And finally, a process evaluation using RE-AIM framework, i.e. Reach, Effectiveness, Adoption, Implementation, and Maintenance, was conducted using data from focus groups, document analysis, and exercise log reviews. In terms of reach, the exercise intervention was successfully marketed to all employees. In terms of adoption, it was considered that organisational support to implement the intervention was good. The intervention had been implemented broadly as planned. There was high exercise acceptance, but a gradual decrease in exercise adherence through the intervention period. With regard to maintenance, there was no clear management plan to sustain the programme beyond the period of study. To the author’s knowledge, this research is the first to test the effectiveness of worksite exercise in China. It is recommended in future that such interventions focus further on the study of implementation and include outcomes more proximal to the intervention such as job satisfaction and work engagement.

This thesis provides an investigation into aggressive driving behaviour, from a Forensic Psychological perspective. The methods used include a systematic review, two quantitative research studies, and a psychometric critique. A systematic review and meta-analysis of the relationship between a measure of driving anger, the Driving Anger Scale (DAS; Deffenbacher, Oetting & Lynch, 1994), and various aggressive driving outcomes showed a strong positive correlation. However, the validity of this finding is hampered by the extensive use of self-report questionnaires, as opposed to real-world driving behaviours, to measure aggression on the roads. The first empirical research study investigated the relationship between personality characteristics (including driving anger) and aggressive driving outcomes. The results showed that three variables accounted for more than half of the variance in self-reported aggressive driving behaviour. These were a tendency toward physical aggression, the progress impeded aspect of driving anger, and psychopathic tendencies. The findings provide ideas for future research, and intervention to reduce aggressive driving behaviours. The second research study expanded on this, and considered the impact of inattentive responding on outcomes for online surveys, and how these may relate to the driving aggression literature. This was enabled by the discovery that around a third of respondents to a survey failed instructional manipulation checks; inclusion of these participants in analysis obscured the results found in the first study. The findings are discussed in terms of practical implications for researchers. A psychometric critique of the Propensity for Angry Driving Scale (PADS; DePasquale, Geller, Clarke & Littleton, 2001) is also presented. This raised questions about the reliability and validity of the PADS, which will be of interest to researchers considering driving anger and aggression in the future. The findings from each methodology are finally considered together, with a discussion of the implications for the field of aggressive driving research.