Historical redlining, a discriminatory practice of the 1930s, present-day social vulnerability (SVI), and sports and recreational injury (SRI) hospitalizations are interconnected topics that highlight the intersection of race, class, and health in the United States but the relationships have not been studied to date. Thus, the overall aim of this dissertation is to examine the effects of historical redlining and present-day social vulnerability on SRI hospitalizations in the United States. The first study systematically reviewed studies that examined the relationships between neighborhood characteristics and SRI using multilevel modeling approach. Studies reviewed show that certain neighborhood factors, such as living in urban communities, were associated with increased risk of SRI. The second study examined the association between historical redlining and present-day neighborhood SVI in the United States. Results show that formerly redlined areas have higher SVI presently. The third study examined the association between historical redlining and present-day SRI hospitalization in the United States. Results show that redlining was not associated with increased odds of SRI hospitalizations, but was associated with longer length of hospital stay (LOS) among Black and Hispanic patients, and higher total hospital charges among Hispanic patients. The fourth study examined the association between individual and neighborhood social vulnerability and sports and recreation-related traumatic brain injury (SR-TBI) hospitalizations among pediatric patients in the United States. Results show that Native American children had higher odds of hospitalization for SR-TBI, longer LOS, but lower odds of discharge to post-acute care compared to White children. Older age was associated with higher odds of hospitalization and longer LOS while male sex was associated with shorter LOS for SR-TBI in children. Compared to children with private insurance, children with public insurance had longer LOS while uninsured children had shorter LOS. Also, hospitalization in neighborhood with higher overall SVI was associated with longer LOS. This study advances our knowledge on the impact of structural racism on present-day SRI outcomes and will inform policy makers to prioritize health equity by addressing the underlying social determinants of health and the root causes of disparities in SRI outcomes. / Doctor of Philosophy / Every year, around 9 million people get hurt while playing sports or participating in recreational activities in the United States. Out of these, more than a third go to the emergency department for treatment, and several thousands need to stay in the hospital because their injuries are more serious. Even though only a small number of sports and recreational injuries (SRI) require hospitalization compared to those treated in the emergency department or outpatient clinics, these injuries tend to be more severe. They can cause significant harm to a person's physical, mental, and emotional well-being, and they also put a lot of pressure on the healthcare system and society as a whole. This dissertation assessed how historical discrimination against certain neighborhoods, called redlining, and present-day social vulnerability affect sports and recreational injury hospitalizations in the United States. This research found that the neighborhood where people live or are hospitalized matter for how often they are hospitalized for SRI, their length of stay in hospital, the amount of money they pay while in hospital, and how often they receive follow-up care after leaving hospital. While historical redlining was not directly linked to higher odds of hospitalization, it was associated with longer hospital stays for Black and Hispanic patients and higher costs for Hispanic patients. This research also found that children from socially vulnerable backgrounds were more likely to be hospitalized for sports-related traumatic brain injuries (SR-TBI) and stay in hospital longer, but were less like to receive follow-up care after leaving hospital. For instance, children from Native American backgrounds were three times more likely to be hospitalized for SR-TBI and stayed in the hospital 27% longer, but were 99.9% less likely to receive follow-up care after leaving hospital compared to White children. Also, children with public health insurance tended to have longer stays in hospital for SR-TBI compared to those with private health insurance. This research highlights how structural discrimination can impact health outcomes, and suggests that policymakers should address the root causes of health disparities in order to promote health equity.

Indiana University-Purdue University Indianapolis (IUPUI) / Policy and natural shocks are exogenous factors, which may disrupt patients’ ability to access recommended health care. My dissertation investigates the effect of recent natural and policy shocks in health care provision on different patient outcomes. The first chapter studies the effect of the 2014 Ebola virus epidemic in West Africa on maternal health care utilization and infant health in Sierra Leone. The Epidemic resulted in the diversion of the limited health care resource away from other services to care for Ebola patients. It also led to maternal stress from fear of infection and community breakdown. The results show the outbreak led to significant decline in maternal health care utilization and infant birth weight. The second chapter examines whether physician practices that are vertically integrated with hospitals provide healthcare at higher costs than non-integrated practices in a Medicare patient population. The degree of integration is exogenously assigned to a patient following a geographical move. The study finds that switching to integrated practice increases health care utilization and spending. Although integration may increase quality of care, the increase in spending suggests the need for a continuing attention to policies and incentives that are associated with integration. Finally, the third chapter documents the impact of the recent changes in state medical and recreational cannabis access laws in the United States on health care utilization. The liberalization of access to cannabis may enable patients to substitute cannabis for another prescription and non-prescription health care services. The results show a significant decline in the utilization of emergency and outpatient services among patients with chronic pain for the states that legalized cannabis. The effect is mainly due to medical cannabis laws, whereas the effect of recreational cannabis is ambiguous. The three chapters, taken together, show that exogenous shocks, such as natural shocks and government policy, affect health care utilization and the health of individuals. Health policies should, therefore, target developing a resilient health care system that withstands natural shocks and promote policies that provide better treatment alternatives.

The purpose of this study was to examine the perceived outcomes of participation in a summer camp that included physical work and service as a major component. A qualitative data analysis approach was used. A convenience sample of 10 male adolescents and 10 parents were selected. The data was analyzed using open, axial, and selective coding. Data analysis was used to ascertain perceived outcomes from the program from both boys and their parents. Analysis of the data showed the emergence of a core theme of boys learning to work and enjoying work. Enjoying work was the term chosen to represent this core theme, and a theory of enjoying work was developed with seven salient attributes. These attributes were that the work was productive and taught skills, provided challenge, was intrinsically rewarding, made a difference for someone else, was done with others, was physical and done outdoors, and took place over an extended period of time.

The problem of this study was to investigate Brigham Young's recreational philosophy, views, practices and activities. This historical research was conducted and information gathered from Brigham Young's journals, the Manuscript History of Brigham Young, compilations of Brigham Young's discourses, books and articles written by his daughters, accounts written by those who were present when recreational events occurred, compilations of manuscripts and documents, and interpretations of various historians who interpreted events as they read them.The historical data collected indicated Brigham Young developed over a period of time a definite philosophy of recreation in regards to his personal life. He enjoyed not only large group gatherings where recreational events occurred but he enjoyed cultural refinement recreational pursuits as well.

When arriving to a new city one can have a hard time finding a place to stay or overall feel lost and a lack of belonging; A problem which could be solved through architecture by providing young people in the same situation: a temporary home and friends to keep when moving out, also local events: inviting in established citizens already having a network in which they can take you in.My architectural solution follows three requirements which I’ve set: 1. Even though there is no land shortage, one should utilize existing urbanized spaces. 2. Leaving spaces for action, interaction and dwelling (instead of a maximized footprint for profit). 3. A balanced relation between private, public and community areas.The research leading up to this included advantages and disadvantages of skyscrapers, the basic human needs for fulfillment, recreational areas providing for it and lastly contemporary architectural projects that have accomplished such.To start off the design process of the studio project a central parking lot was selected to be transformed into an intersecting node of the city areas, creating a city network. After exploring possible mass-void and private-public configurations of the plot, the final variant was motivated by sun studies as it has the most sun exposure and least shadow. It was also the most fun, warm and welcoming form, where the curves move you on the plot. Lastly, the program consists of a mixed use of housing, common spaces and recreational areas, with different activities of differing scale.

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Montane forests provide habitat for unique assemblages of flora and fauna that contribute significantly to a region’s biodiversity. Previous work indicates that montane forest ecosystems are exceedingly vulnerable to a host of anthropogenic stressors including climate change, atmospheric deposition, and recreation, to name a few. Montane forests and other high elevation ecosystems are considered to be among the first and most severely impacted by climate change. It is therefore, imperative to evaluate anthropogenic impacts on montane ecosystems and maintain reliable monitoring methods that are capable of tracking potential shifts in the distribution of species dependent on these systems. I surveyed birds at various distances from hiking trails in the White Mountain National Forest from 2006 - 2009 to determine whether existing monitoring programs, all of which are based on trail-centered surveys, are accurately reflecting bird abundance, abundance stability and recruitment. Contrary to previous studies, I found that recreational trails generally did not alter estimates of abundance, recruitment, abundance stability, and detection probability for five species of birds considered to be indicators of montane forest ecosystem integrity in northeastern North America. Therefore, trail-based monitoring programs for montane birds appear to accurately reflect dynamics of bird communities undisturbed by hiking trails. These conclusions were supported by my finding that the daily nest survival of a montane spruce-fir indicator species, blackpoll warbler (Steophaga striata), did not vary as a function of distance from trail. I then used data from the White Mountain National Forest’s montane bird monitoring program from 1994 through 2009 to assess potential shifts in the elevational distribution of montane birds in conjunction with documented habitat shifts in the region. My results provide evidence that low elevation forest birds have expanded their upper elevational boundary while high elevation birds have expanded their lower elevation boundary. These results highlight the complicated relationship between habitat, climate, and other anthropogenic stressors such as atmospheric deposition and that even in the face of climate change other stressors may be playing a significant role in shifts of species distributions. Understanding how climate affects the reproductive ecology of montane organisms is an important step toward unraveling the potential mechanisms by which climate change will alter the distribution of these species. I used blackpoll warbler breeding data from the Green Mountains, VT from 1994 to 2003 to determine if temporal variation in climate influenced blackpoll nesting initiation and found that years with warm Mays and typical precipitation lead to earlier nest initiation. I also examined the effect of spatial variation in climate on blackpoll reproductive ecology and demography. I found a gradient in habitat quality associated with the spatial variation in climate along an elevation gradient. Blackpolls were less abundant, younger, had lower pairing success, lower daily nest survival, higher nest predator occupancy, and lower fecundity at lower elevations. The climatic conditions at these lower elevations represent the climatic conditions predicted to encompass increasingly larger portions of montane areas. Collectively, these findings contribute to filling in a dearth of knowledge regarding management and an understanding of how species dependent on montane ecosystems are responding to climate change.

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