There is a tremendous discrepancy between the number of people likely meeting criteria for a mental disorder or substance dependence in Canada and the number of people actually receiving mental health or substance dependence treatment. Thus, it is important to examine what facilitates entrance into the mental health care system and what prevents people from receiving the treatment they need. Mixed findings exist as to whether socioeconomic status (SES) and other social determinants of health play a role in receiving treatment in Canada. However, due to several methodological issues with previous studies that have examined this issue, three studies were designed to re-examine and add to the literature in this area by investigating: (1) whether SES (i.e., income and education) and other social determinants as well as psychological distress predict the number of services received by any professional for any mental disorder or substance dependence, as well as predict overall satisfaction with the services received (2) the psychometric validity and reliability of the 3-factor model proposed by Statistics Canada to measure barriers due to accessibility, acceptability and availability, and (3) whether SES, other social determinants and psychological distress predict specific barriers to receiving mental health treatment for an unmet need. All data were obtained from the Canadian Community Health Survey, cycle 1.2, Mental Health and Wellbeing. In Study 1, the SES/social determinants model predicted the number of services received for both medication and psychotherapy. Out-of-pocket spending, was the strongest predictor of the number of consultations from any provider, however it was also inversely related to overall satisfaction with services. Higher levels of distress predicted greater dissatisfaction with services received. Study 2 revealed that the three factor model of accessibility, acceptability and availability was invalid and unreliable as a measure of barriers to mental health services. It is, therefore, recommended that each specific barrier be treated as an independent causal indicator of an index measuring overall accessibility to mental health services. Finally, in Study 3, when examining each barrier independently, both education and income played important roles in recognizing there was a problem, seeking services, and actually accessing the services needed. Other social determinants also played important roles which differed depending on the type of barrier being examined. The results of the three dissertation studies indicate a clear relation between SES, other social determinants and psychological distress, and accessibility and barriers to mental health services in Canada for those suffering any mental disorder or issue related to substance dependence. The findings have significant implications in terms of potential policy implications, recommendations for the design of future national level surveys, and recommendations for future research on this topic.

With the increasing advocacy for maintaining a healthy lifestyle in regards to exercise and the average age of the population in the U.S. growing older, there has been an increased incidence of arthritic knee damage as a result of osteoarthritis. Once non-procedural methods of treatment have been exhausted, such as NSAIDs and physical therapy, the most effective therapy to regain previous range of motion and quality of life is total knee arthroplasty (TKA). Additionally, TKA is useful to treat patients with rheumatoid disease once their knees have reached end-stage cartilage damage, although it does not restore function as well in these patients as it does in patients with osteoarthritis. Current technological developments have produced prostheses that mimic physiological movement and allow attachment of components positioned similarly to ligaments in the human knee, providing better longevity and functional recovery from the damaged state. The TKA procedure has become fast-tracked to limit the length of stay for patients and the cost to both the individual and the hospital. Though this change to fast-track procedures has helped limit post-operative complications, such as venous thromboembolism, multiple comorbidities and componentry failure continue to increase the risk of failure or revision of the procedure. With the projected increase in the need for TKAs in the future, it is important to review factors that may influence access and success of this procedure, for example, the effect socioeconomic status has on the ability of different patients to receive quality replacements and experience sustained quality of life. Multiple studies have shown that utilization of TKA differs between low income and high income populations, with racial minority populations undergoing the procedure less often as they represent a greater percentage of low income populations. Interestingly, low income patients report greater improvement in function when compared to high income patients, most likely due to low income patients being admitted with more severe knee damage when compared to the other population. Their satisfaction, along with financial constraints and insurance, are factors that lower the rate of revision for low income populations even though their measured range of motion post-operatively is not as good as that in high income populations on average. Social support has been determined to be a significant factor in determining whether patients will undergo TKA and follow the rehabilitation prescribed to them appropriately. Studies have shown less social support reported from minority groups, but not low income cohorts specifically. Using the current knowledge of the impact these differences in socioeconomic status can have on the outcomes of TKA, can help create healthcare environments which will optimize the success rate of TKA for all patients, regardless of socioeconomic status, and prevent unnecessary strain on the healthcare system due to avoidable post-operative issues. Future studies should determine what policies and procedures can be implemented to help aid patients, such as greater social support, and to support hospitals with limited resources in an effort to improve surgical outcomes.

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The purpose of this study was to estimate the direct and indirect effects of certain school learning variables on the academic achievement of Black 10th graders. Simultaneously looking at variables associated with student background characteristics (i.e., gender and socioeconomic status); the school (i.e., students' perceptions of the school environment, teachers, and teaching); family (i.e., parental expectations and involvement>; and students (i.e., educational aspirations and motivation) a model of academic achievement was constructed. Responses to questions from a large, nationally representative dataset (i.e., the National Educational Longitudinal Study of 1988 or NELS:88) were employed to test the model. The 1,766 Black students participating in the study in both 1988 and 1990 formed the sample. Following a test of the overall model using a program of linear structural relations (LISREL), developed by Joreskog & Sorbom (1989), the magnitude of path coefficients were examined for significance. Prior achievement produced an overwhelmingly large effect on later achievement. Socioeconomic status (SES) produced a large effect and students' perceptions of teachers produced a small although statistically significant effect on achievement. In addition, prior achievement, SES, and parental aspirations also influenced student aspirations. Student motivation was affected by prior levels of achievement, gender, and SESe Findings indicate that despite high educational aspirations of both Black children and their parents, these aspirations often affect neither student achievement as measured by scores on standardized tests nor student motivation. / Ph. D.

Public school finance and school accountability are highly contentious subjects. This correlational study illustrates campus level instructional spending efficiency by examining various input and output variables. The study utilizes data envelopment analysis of selected variables to compare elementary campuses and create instructional spending efficiency measures within purposively selected metropolitan educational service regions in Texas. The study analyzes elementary school instructional spending and student classification as economically disadvantaged compared to student achievement in English language arts. The study finds a direct relationship between instructional spending efficiency and student achievement. The relationship between the socioeconomic variable of economically disadvantaged status is inverse. This finding suggests that in depth examinations of highly inefficient, but relatively high academic performing cases, may uncover effective instructional or operational practices tailored to the needs of the sub-populations.

UA Open Access Publishing Fund / Background: Current understanding of tuberculosis (TB) genotype clustering in the US is based on individual risk factors. This study sought to identify whether area-based socioeconomic status (SES) was associated with genotypic clustering among culture-confirmed TB cases. Methods: A retrospective cohort analysis was performed on data collected on persons with incident TB in King County, Washington, 2004–2008. Multilevel models were used to identify the relationship between area-level SES at the block group level and clustering utilizing a socioeconomic position index (SEP). Results: Of 519 patients with a known genotyping result and block group, 212 (41%) of isolates clustered genotypically. Analyses suggested an association between lower area-based SES and increased recent TB transmission, particularly among US-born populations. Models in which community characteristics were measured at the block group level demonstrated that lower area-based SEP was positively associated with genotypic clustering after controlling for individual covariates. However, the trend in higher clustering odds with lower SEP index quartile diminished when additional block-group covariates. Conclusions: Results stress the need for TB control interventions that take area-based measures into account, with particular focus on poor neighborhoods. Interventions based on area-based characteristics, such as improving case finding strategies, utilizing location-based screening and addressing social inequalities, could reduce recent rates of transmission.

Past research has been divergent about perceived income inequality among diversely positioned members of the Chinese population. Several scholars have suggested that persistent earnings disparity results in societal unrest while others claim that most Chinese citizens view existing disparities as relatively reasonable. In this dissertation I argue that individuals with different socioeconomic status possess different perceptions of income inequality which reflect differences in legitimating income inequality and wealth rearrangement preferences. Implementing the survey data from the China General Social Survey (CGSS), I developed a new measurement of perceived earnings disparity and a Structural Equation Model (SEM) to analyze perceived earnings disparity among the Chinese population. This analysis is integrated with psychological and cultural approaches in order to understand why it is that Chinese people seem relatively unresponsive to persistent income inequality. Results show that: (1) People with high socioeconomic status believe that income inequality is the normal result of competition in the market economy and those with low socioeconomic status tolerate income inequality for government’s good economic performance; (2) socioeconomic status differentials in perceived income inequality diverge as higher earnings disparity becomes evident in contemporary China; and (3) the people within the lowest economic strata are sensitive to the intensified income inequality, and have stronger demands for redistributive policies while those in the highest strata express attitudes that suggest indifference to this issue. The divergence in perceptions of income inequality and redistributive preferences between people from the elite and the bottom can be seen as a sign of social as well as economic polarization in Chinese society. The research partly supports the existing statement that the members in privileged group turn into oligarch while those in disadvantaged group are amenable to populist expressions. The policy implication is that the government should implement an institutional approach to solve the persistent income inequality.