Data from 7285 individual participants in the USDA Spring Nationwide Food Consumption Survey were analyzed using the nutrient density concept and multiple regression procedures to evaluate the impact of socioeconomic status on the nutritional quality of foods consumed. For each socioeconomic group the average daily amount of nutrients consumed per 1000 kcal of food consumed were computed and compared with the Recommended Dietary Allowances which had been converted to single-value nutrient allowances per 1000 kcal. This nutrient density approach identified qualitative patterns of food consumption for selected income, region, urbanization, household size, race, employment and education groups as well as indicating the degree to which these groups met the RDA. Results demonstrated that socioeconomic status had relatively little impact upon the average nutrient density of diets consumed by the population. Income level had no statistically significant effect upon the nutritional quality of diets for any of the fourteen nutrients studied. Household size affected nutrient density consumption of fat, carbohydrate, vitamin s6 and vitamin C. Race affected calcium, magnesium, vitamin A and thiamin density of diets. Other socioeconomic factors were significantly related to only one or two nutrients. The differences in average nutrient density of diets resulted from differences in the quality of foods consumed from the Basic Four (nutrient-dense) Plus One (calorie-dense) food groups and not from differences in the percent contribution of these two food groups to nutrient intake per 1000 kcal. Average diets for all socioeconomic groups were below nutrient density standards for calcium, iron, magnesium, vitamin B6 and carbohydrate. There was also a high frequency of individuals with vitamins A and vitamin C intakes below nutrient density standards despite adequate group mean intakes per 1000 kcal for these nutrients. Results supported the hypothesis that, regardless of socioeconomic status, Americans consume diets that average very similar nutrient content per energy unit. This type of information contributes to a better understanding of dietary habits of Americans and provides a meaningful framework from which to establish guidelines for government agencies, nutrition educators and the food industry.

This qualitative research study explores the correlation between socioeconomic status and factors of psychotherapy dropout among college students who have prematurely terminated therapy while attending college. Twelve female-identifying college students were interviewed in a semi-structured design. It was predicted that socioeconomic status moderates the impact of financial and logistical barriers to access, mental health stigma, and perceived lack of socioeconomic status competency among practitioners on the decision to leave therapy prematurely, such that these factors have an amplified effect for students coming from lower socioeconomic status backgrounds. Findings indicate that logistical barriers to access are experienced across the socioeconomic spectrum, but with low socioeconomic students having fewer treatment options and an additional step of securing external funding. Results pertaining to identity competency did not indicate a socioeconomic status moderation or the specific need for socioeconomic status competence. Stigma was not found to be related to dropout. Other results are discussed. Further research should apply the present findings and recommendations to intervention-based pilot programs to investigate ways in which dropout can be reduced.

Quantity surcharges have been widespread in the marketplace for decades. However, little is known about what kinds of consumers and under what conditions they are more likely to be impacted by this pricing practice. The current research contributes to the existing literature by investigating how a person’s childhood socioeconomic status affects their reaction toward quantity surcharges during adulthood. Across four studies, we find that childhood socioeconomic status has a positive impact on the purchase of a large and surcharged package size. However, when the economic conditions are threatening, the positive effect of childhood socioeconomic status disappears. The current research also provides a theoretical explanation for the interaction effect of childhood socioeconomic status and economic conditions. The focus on acquiring sufficient resources accounts for the interaction effect.

An achievement gap exists between students of low socioeconomic status (SES) and their peers, particularly in language arts despite intervention and legislation aimed at closing the gap. As a result, annual yearly progress is affected for schools that have a large population of students from low socioeconomic backgrounds. The purpose of this study was to determine what secondary language arts teachers in a school district know about supporting students from low socioeconomic backgrounds in instruction. Research questions were designed to explore teachers' knowledge about supporting the socio-emotional and academic needs of students from low SES backgrounds and to identify the effective school practices in the secondary language arts classroom to address these needs. The conceptual framework was based on the work of Coley and Baker regarding understanding the connection between poverty and education. This qualitative bounded case study was conducted in the secondary language arts department of a suburban southern school district. The 5 participants were selected using purposeful sampling based on teaching experience and participated in interviews and classroom observations. Data were coded and thematic analysis was used to reveal teachers' knowledge about students' socio-emotional needs and how to incorporate the needs to address students' skill deficits in reading, writing, speaking, and listening. Findings suggested a professional development project for teachers including working with parents to support students' education at home and developing professional learning communities and networks to support secondary language arts teachers. This study has implications for positive social change for educators, parents, and community member stakeholders as they work toward supporting learning and cultural needs of students of low SES.

Veteran suicide is a public health issue that requires more research to understand the multidimensional factors, such as resilience, that lead someone to suicide. Adverse childhood events (ACEs), such as poverty and abuse, have affected how resilience is developed. This study examined the association between childhood factors of socioeconomic status, parental discipline, and being a military child, and adult resiliency level. Dienstbier's theory of mental toughness framed the study, which posits that a child who experiences mild ACEs and has time to recover between events, will be more resilient than children who experience serious ACEs, and children who experience little to no ACEs. Army veterans recruited through social media and veterans' organizations, answered an online survey consisting of demographic questions, the Harsh Discipline Scale and 9 item Resiliency Scale. No significant associations were found between these ACEs and resilience level. However, when the harsh discipline scale was analyzed by individual questions, associations were shown between spanking and high resilience with reported answers of "almost always" having higher level of resilience (OR = 12.001, p = .032), and those who reported they were hit with an object scored much lower on resilience than any other category measured. Examining resilience questions individually showed that low and middle socio-economic status had statistically significant higher resilience in responding to extreme pressure in a positive way. More research is needed on these specific ACEs using Dienstbier's theory. Understanding how specific ACEs affect resilience could lead to developing better prevention strategies that focus on helping children process these ACEs and develop higher resilience as adults, thus reducing suicide in the civilian and veteran population.

Worldwide, diarrhea is the second leading cause of death in children aged under 5, yet it is both preventable and treatable. Several studies have established the effects of exposure to inadequate water, sanitation, and hygiene (WASH) on diarrhea prevalence, but little was known on how the interactions of socioeconomic status and WASH influence the economic cost of treatment of diarrhea. This retrospective cross-sectional survey study was focused on assessing the correlation between socioeconomic status, WASH, and household cost of treatment of diarrhea among children aged under 5 in Uganda using the multiple exposure-multiple effect model. Secondary data from the 2015/16 Uganda National Panel Survey were used. At bivariate level of analysis, 5 of 6 independent variables (education level of mother, household expenditure, residence type, source of drinking water, and type of toilet facility) had statistically significant associations with household cost of treatment of diarrhea (p value < .05). The multivariate-hierarchical multiple linear regression indicated that only 3 of the 6 variables significantly predicated household cost of treatment of diarrhea. These were highest education level of mother (p = 0.001), source of drinking water (p = 0.022), and type of toilet facility (p = 0.012). At p value < .05, about 67% of the variation in the cost of treatment was explained by the independent variables. Households with a higher socioeconomic status incurred higher costs of treatment, although those with a lower status experienced the highest prevalence rates. Therefore, policy makers and practitioners could use these findings to employ multiple interventions to address the disease burden and cause behavior change.

Malaria is a challenging infection with increasing and wide-spread treatment failure risk due to resistance. With a estimated death toll of 1-3 Million per year, most cases of Malaria affect children under the age of five years in Sub-Saharan Africa. In this thesis, I analyse the current status of malaria control (focussing on diagnosis and therapy) in Burkina Faso to show how this disease burdens public health in endemic countries and to identify possible approaches to improvement. MB is discussed as a therapeutic option under these circumstances. Burkina Faso is used as a representative example for a country in Sub-Saharan Africa with high endemicity for malaria and is here portrayed, its health system characterised and discussed under socioeconomic aspects. More than half of this country’s population live in absolute poverty. The burden that malaria, especially treatment cost, poses on these people cannot be under-estimated. A retrospective study of case files from the university pediatric hospital in Burkina Faso’s capital, Ouagadougou, shows that the case load is huge, and especially the specific diagnosis of severe malaria is difficult to apply in the hospital’s daily routine. Treatment policy as proposed by WHO is not satisfactorily implemented neither in home treatment nor in health services, as data for pretreatment clearly show. In the face of growing resistance in malaria parasites, pharmacological combination therapies are important. Artemisinins currently are the last resort of malaria therapy. As I show with homology models, even this golden bullet is not beyond resistance development. Inconsidered mass use has rendered other drugs virtually useless before. Artemisinins should thus be protected similar to reserve antibiotics against multi-resistant bacteria. There is accumulating evidence that MB is an effective drug against malaria. Here the biological effects of both MB alone and in combination therapy is explored via modeling and experimental data. Several different lines of MB attack on Plasmodium redox defense were identified by analysis of the network effects. Next, CQ resistance based on Pfmdr1 and PfCRT transporters as well as SP resistance were modeled in silico. Further modeling shows that MB has a favorable synergism on antimalarial network effects with these commonly used antimalarial drugs, given their correct application. Also from the economic point of view MB shows great potential: in terms of production price, it can be compared to CQ, which could help to diminuish the costs of malaria treatment to affordable ranges for those most affected and struk by poverty. Malaria control is feasible, but suboptimal diagnosis and treatment are often hindering the achievment of this goal. In order to achieve malaria control, more effort has to be made to implement better adjusted and available primary treatment strategies for uncomplicated malaria that are highly standardised. Unfortunately, campaigns against malaria are chronically underfinanced. In order to maximize the effect of available funds, a cheap treatment option is most important, especially as pharmaceuticals represent the biggest single matter of expense in the fight against malaria. / Malaria ist eine Krankheit, die uns vor große Herausforderungen stellt. Insbesondere die weltweit verbreiteten Resistenzen, die viele Therapieoptionen nutzlos werden lassen, haben den Kampf gegen die Malaria in den letzten Jahrzehnten deutlich verkompliziert. Schätzungen gehen davon aus, dass Malaria jährlich 1 bis 3 Millionen Todesopfer fordert. Mortalität und Morbidität der Erkrankung konzentrieren sich dabei in besonderer Weise auf Kinder unter fünf Jahren in Afrika südlich der Sahara. In der hier vorgestellten Doktorarbeit analysiere ich den aktuellen Stand der Malaria-Kontrolle in Burkina Faso und zeige beispielhaft auf, warum diese Krankheit eine derart große Bürde für die Volksgesundheit darstellt und wo Ansatzpunkte zur Verbesserung der Kontrollmaßnahmen zu sehen sind, mit einem besonderen Fokus auf Diagnostik und Therapieoptionen. Dabei wird MB als Therapieoption genauer beleuchtet. Um die besonderen Gegebenheiten eines Landes wie Burkina Faso - welches hier als repräsentatives Beispiel für einen Staat mit hoher Endemizität für Malaria herangezogen wird - aufzuzeigen, wird ein Porträt des Landes und seines Gesundheitssystems insbesondere unter Sozio- Ökonomischen Gesichtspunkten gezeichnet. Burkina Faso ist ein sehr armes Land, über die Hälfte seiner Bevölkerung lebt unterhalb der Armutsgrenze. Die Kosten von Malaria sind für diese Menschen gigantisch, und insbesondere die Kosten von Medikamenten wiegen schwer. Eine retrospektive Studie aus Fallakten des Universitäts-Kinderkrankenhauses in Burkina Fasos Hauptstadt Ouagadougou zeigt vor allem, dass allein die Fallzahlen überwältigend sind, und vor allem die spezifische Diagnose der schweren Verlaufsform der Malaria ist unter den vorherrschenden Bedingungen eine Mammutaufgabe. Die Behandlungsvorschriften wie von der WHO vorgegeben werden weder vom Gesundheitssystem noch von der Therapie zu Hause erfüllt, wie in den präsentierten Daten für die Vorbehandlung zeigen. Die zur Verfügung stehenden Malaria-wirksamen Therapeutika sind leider dank Resistenzentwicklung - oft durch unbedachten Masseneinsatz verursacht - sehr begrenzt. Artemisinine sind momentan das einzige Mittel gegen welches noch keine Resistenzen im Feld nachgewiesen wurden. Mittels Homologie-Modellierung zeige ich auf wie einfach eine solche Resistenzentwicklung jedoch denkbar wäre. Artemisinine sollten daher durch sehr gezielten Einsatz als ”letzter Trumpf” möglichst lange vor Resistenzentwicklung geschützt werden, ähnlich wie Reserveantibiotika gegen Multi-resistente Keime. MB ist ein hervorragender Kandidat für eine Kombinationsbehandlung gegen Malaria und eventuell eine Option, Artemisinine länger zu ”schonen”. Hier wird dieses Medikament mit bioinformatischen Mitteln genauer in seinen Wirkmechanismen beleuchtet und in Kombination mit anderen Medikamenten getestet mittels einer experimentell gestützten bioinformatischen Pathway-Modellierung. Durch diese Netzwerk-Analyse wurden verschiedene Angriffspunkte von MB auf das Redox-Netzwerk der Malariaerreger identifiziert. Daraufhin wurden CQ und SP-Resistenzen in silico simuliert. Weitere Analysen zeigten dabei, dass MB synergisitische Wirkungen mit anderen Therapeutika gegen Malaria aufzeigt, wenn sie zielgerichtet eingesetzt werden. Finanziell gesehen hat MB Potenzial, ein zweites CQ zu werden, und somit endlich wieder die Kosten der Behandlung für Menschen die in Armut leben erschwinglich zu machen. Malaria Kontrolle ist erreichbar, aber suboptimale Diagnosestellung und Behandlung behindern das Erreichen dieses Zieles. Hierfür muss eine angepasste, dezentrale und hochgradig standardisierte Primärbehandlung unkomplizierter Malaria implementiert werden und für eine bessere Verfügbarkeit dieser gesorgt werden. Leider leidet die Finanzierung der Kampagnen gegen Malaria an chronischer Unterversorgung. Um den maximalen Nutzen aus den vorhandenen Mitteln ziehen zu können ist eine günstigere medikamentöse Therapie ein entscheidender Beitrag, zumal Medikamente den größten Einzelbetrag im Kampf gegen Malaria verbrauchen.

<p>This thesis described socioeconomic inequalities in fruit and vegetable consumption in Stockholm County.<strong> </strong>A comparative descriptive analysis was carried out with the use of secondary data from the 2006 Stockholm County Public Health Survey. The data was analyzed through cross tabulations that were conducted in SPSS.<strong> </strong>The findings showed that people with high socioeconomic position consumed fruit and vegetables more frequently than those of low socioeconomic position. Differences in fruit and vegetable consumption were found for the three measures of socioeconomic position; education, occupation and income. These differences were pronounced to a larger extent across different education levels compared to levels of occupation and income. Further research is needed to investigate which factors may explain the observed differences.</p>

<p>This thesis study women’s possibility to take reproductive decisions in Babati, Tanzania. Tanzania has one of the highest total fertility rates in Sub-Saharan Africa and hence a high child- and maternal mortality rate. Family planning service can help individuals to reach their reproductive goals but it is not always available or accessible. The purpose is to see what socioeconomic factors affect women’s ability to influence family planning, make a comparison between urban and rural settings, and see if women perceive themselves to have the freedom to choose. A field work in Babati was conducted during three weeks in the spring of 2009. The research questions were answered through a qualitative study with semi structured group interviews, mainly done with women but also with health personnel. The result was analysed through the concepts of gender, power and education. The respondents expressed that the husband is the main obstacle for their possibility to decide over their own fertility. Urban women generally felt free to take reproductive decisions, but rural women did not. The difference between the two settings is explained by women’s negotiating skills that depend on their status within the family and the society. Urban women are more often educated and therefore have more status and more power to influence decision-making, including reproductive decisions. Other problems in rural areas are that family planning services are less accessible and facilities sometimes lack resources. Rural health workers do not always keep statistics which makes it difficult for health planners to know what needs to be improved. The Ministry of Health and other actors need to promote women’s access to the facilities. Further recommendations suggest programs that empower women and educate men in family planning issues.</p>

Previous studies in the area of parental involvement in the education system were based on inconsistent parameters or definitions of the construct (Baker and Soden, 1997). The present study seeks to more clearly define and quantify parental involvement and examine the reduction of academic risk factors for economically disadvantaged students through a program of parental involvement in the educational setting. This study compares the academic achievement (ITBS scores) of 70 students enrolled in 1st thru 5th grades at an elementary public charter school in relation to the level of documented parental involvement (PI). Data indicate that in comparison to students enrolled at two neighborhood traditional public elementary schools, students at the charter school are 1.2 to 1.7 times more likely to pass the state mandated TAKS test in grades three through five. However, statistical analyses did not support the hypothesis that level of parental involvement was associated with academic achievement.