BACKGROUND. Frailty is a syndrome characterized by a decreased resistance to stressors, leading to increased vulnerability to adverse outcomes, including mortality. Multi-morbidity refers to the presence of two or more chronic diseases, and is associated with increased risk of adverse health outcomes. Most of the literature in frailty is based on older people (65+ years) living in high income countries. OBJECTIVE. To compare the predictive ability of three frailty indices for all-cause and one-year mortality among high- (HIC), middle- (MIC), and low- income country (LIC) participants; and to assess the mortality risk associated with multi-morbidity. METHODS. Using data from the Prospective Urban and Rural Epidemiological (PURE) study, we developed three indices using different definitions of frailty (one phenotypic frailty index; two cumulative deficit indices). All indices were tested for predictive ability for mortality both individually and with multi-morbidity. RESULTS. Prevalence of phenotypic frailty was greatest in LIC (8%), intermediate in MIC (7%), and lowest in HIC (4%). Multi-morbidity was most prevalent in HIC (20%), intermediate in MIC (15%), and lowest in LIC (13%). Increased frailty was associated with greater mortality risk using all frailty indices (e.g. HR (95% CI) of 2.63 (2.35-2.95) for the phenotypically frail relative to the robust). At each frailty level, mortality risk was higher within one year of baseline measurement than afterwards, and increased if it was accompanied by concurrent multi-morbidity (e.g. HR of phenotypic frailty increases from 2.27 (1.96-2.62) to 5.08 (4.34-5.95) if accompanied by multi-morbidity). CONCLUSION. All frailty indices predicted mortality. This study is unique in evaluating the prognostic ability of frailty indices in middle-aged adults across HIC, MIC, and LICs. / Thesis / Master of Science (MSc)

Background: Compared with typically developing children, children with special needs often struggle with academic and social aspects of school, though certain factors can improve their academic and social developmental trajectory. The objective of this investigation was to explore the association between the developmental health of children with special needs at school-entry, as measured by the Early Development Instrument (EDI), and neighborhood-level SES. To date, the EDI has only been validated for use in typically developing children. Hence, a secondary objective of this investigation was to explore the psychometric properties of the EDI for children with special needs. Methods: The data for this investigation were from the Pan-Canadian database of children’s developmental health at school entry. The psychometric properties of the EDI, including item and domain characteristics, factor structure, and construct validity, were tested for children with special needs. Hierarchical generalized linear models was used to model the association between EDI domain scores and a custom neighborhood SES index. Results: A total of 29,841 (69.8% male) and 29,520 (69.7% male) children with special needs were available for the investigation on the psychometric properties of the EDI and the relationship between EDI outcomes and SES, respectively. The psychometric performance of the EDI in children with special needs was similar to its performance in typically developing children. The EDI was subsequently used to explore the association between developmental outcomes and neighborhood socioeconomic status (SES). All EDI domains were positively correlated with SES, indicating that children in high SES neighborhoods have better developmental outcomes at school entry than those in lower SES neighborhoods. Conclusions: The results of this investigation draw attention to the potential impact of contextual factors on children’s health and have implications for policy development and service planning. These results also indicate that the EDI performs similarly in children with special needs and typically developing children, thus enabling its more extensive use for this population. / Thesis / Master of Science (MSc) / Background: Compared with typically developing children, children with special needs often struggle with academic and social aspects of school, though certain factors can improve their academic and social developmental trajectory. The objective of this investigation was to explore the association between the developmental health of children with special needs at school-entry, as measured by the Early Development Instrument (EDI), and neighborhood-level SES. To date, the EDI has only been validated for use in typically developing children. Hence, a secondary objective of this investigation was to explore the psychometric properties of the EDI for children with special needs. Methods: The data for this investigation were from the Pan-Canadian database of children’s developmental health at school entry. The psychometric properties of the EDI, including item and domain characteristics, factor structure, and construct validity, were tested for children with special needs. Hierarchical generalized linear models was used to model the association between EDI domain scores and a custom neighborhood SES index. Results: A total of 29,841 (69.8% male) and 29,520 (69.7% male) children with special needs were available for the investigation on the psychometric properties of the EDI and the relationship between EDI outcomes and SES, respectively. The psychometric performance of the EDI in children with special needs was similar to its performance in typically developing children. The EDI was subsequently used to explore the association between developmental outcomes and neighborhood socioeconomic status (SES). All EDI domains were positively correlated with SES, indicating that children in high SES neighborhoods have better developmental outcomes at school entry than those in lower SES neighborhoods. Conclusions: The results of this investigation draw attention to the potential impact of contextual factors on children’s health and have implications for policy development and service planning. These results also indicate that the EDI performs similarly in children with special needs and typically developing children, thus enabling its more extensive use for this population.

No / Class theorists ask for research on the 'paradox of class' - the fact that while class appears to be materially just as important as ever, it hardly features as part of a self-conscious social identity. At the same time mothering is usually seen as a classless activity. This paper describes class based differences in how mothers combine employment and caring for their children, how they divide labour with their partners, and how they choose childcare. These are not simple structural divisions between working class and middle class, but instead refer to more nuanced social identities. These class based differences in mothering present different mixes of choice and constraint, or of 'rationality' and 'preference' in choosing alternative courses of action. However, theories focusing on classless individualised preference (Hakim) and class-based rationality (Goldthorpe) do not go far beyond a tautological description of these alternatives. Rather, the paper shows how preference and rationality are socially and culturally created through the development of career as an identity, through biographical experience, through relations with partners, and through the development of normative views in social networks.

Researchers and reformers have suggested that school climate is an important aspect of effective schools (Hoy & Hannum, 1997, p. 290). Literature also suggests that effective schools have a positive school climate (Chrispeels, 1990). The purpose of this study is to determine if the climate of schools affects the student achievement in school divisions in the Commonwealth of Virginia. The construct study conducted herein relies exclusively upon data collected by the Virginia Department of Education (VDOE) and reported in the Discipline, Crime and Violence Incidents annual report (DCVI), the Free and Reduced Lunch report, and the Truancy report to form a climate index (CI). A Hierarchical Cluster analysis was used to determine relationships between school division climate, as measured by the CI, and student achievement, as measured by the Virginia Standards of Learning (SOL) Tests, in school divisions in the Commonwealth of Virginia. Based on the CI, there is a relationship between school division climate and student achievement in English/reading, mathematics, history/social science, and science in the Commonwealth of Virginia. Moreover, incidents of disorderly conduct combined with the number of students who receive free and reduced lunch are the best predictors of student achievement. / Ed. D.

The purpose of this study was to identify which school divisions in the Commonwealth of Virginia have equitable representation of Culturally Linguistically Economically Diverse (CLED) students in gifted programs within their schools. Existing literature on CLED students was reviewed. Three years of data (school years 2016-2017, 2017-2018, and 2018-2019) obtained from the Virginia Department of Education (VDOE) were analyzed to determine whether equitable representation exists within gifted education programs in each of the 132 Virginia school divisions. Furthermore, the researcher used the Freedom of Information Act (FOIA) to acquire longitudinal gifted data from each school division 2016-2019. The Relative Difference Composition Index (RDCI), Equity Allowance Formula (EAF), and Representation Index (RI) formulas were used to determine, which schools have equitable representation within their gifted programs. This study sought to answer the following questions: 1. What school divisions have proportional representation of economically disadvantaged students? 2. What school divisions have proportional representation of Black or African American students? 3. What school divisions have a proportional representation of Hispanic or Latinx students? At the conclusion of the data collection process, the researcher examined (1) which school divisions have equitable representation of gifted students in their gifted programs in schools using the EAF, and (2) What schools have equitable representation utilizing the RI. The analysis revealed the majority of the school divisions in the Commonwealth of Virginia had equitable representation when the EAF was applied to the economically disadvantaged students. When the EAF was applied to the 2016-2019 school years data for the Black or African American students and Hispanic or Latinx students the range of 33%- 42% were proportionately represented. The English Language Learner students were not proportionately represented when the EAF was applied. When the RI formula was applied to the data, none of the school divisions had perfect proportion in the Commonwealth of Virginia. In 2016-2017, Halifax school division had a score of .86 which translates to proportionate representation when the EAF and RI formula were applied to the data. The findings of this study provide educational leaders with relevant research toward equitable representation for CLED students in the Commonwealth of Virginia. The VDOE and school leaders could offer professional development regarding equitable representation for teachers and staff that work with CLED students to resolve disproportionality. School divisions could benefit from the implementation of equity allowance goals to help reduce inequitable representation of CLED gifted students. / Doctor of Education / The underrepresentation of students with low incomes in gifted education is a persistent problem (Ford, 2013a; Hamilton, McCoach, Tutwiler, Siegle, Gubbins, Callahan, Brodersen, and Mun, 2018). In recent times, researchers have started to discuss educational access and outcomes for low socioeconomic students (Goings and Ford, 2018). According to VanTassel-Baska and Stambaugh (2018), there is a need to address economically disadvantaged for students who attend public schools in the United States. In particular, there are problems formally identifying economically disadvantaged students for gifted services (VanTassel-Baska and Stambaugh, 2018). Researchers seldom focus on gifted students that live in low-income households. The purpose of this study was to identify which school divisions in the Commonwealth of Virginia have equitable representation of Culturally Linguistically Economically Diverse (CLED) students in gifted programs within their schools. Existing literature on CLED students was reviewed. Three years of data (school years 2016-2017, 2017-2018, and 2018-2019) obtained from the Virginia Department of Education (VDOE) were analyzed to determine whether equitable representation exists within gifted education programs in each of the 132 Virginia school divisions. Furthermore, the researcher used the Freedom of Information Act (FOIA) to acquire longitudinal gifted data from each school division 2016-2019. The RDCI, Ford Equity (EAF), and RI formulas were used to determine, which schools have equitable representation within their gifted programs. At the conclusion of the data collection process, the researcher examined (1) which school divisions have equitable representation of gifted students in their gifted programs in schools using the EAF, and (2) What schools have equitable representation utilizing the RI. The analysis will reveal which school divisions have equitable representation within the Commonwealth of Virginia.

Adolescence is a period of heightened risk for substance use and heightened vulnerability to substance exposure. Yet, little is known about how socioeconomic status (SES) influences adolescent decision making and behavior across development to add to these risks. This prospective longitudinal study used latent growth curve modeling (GCM) to examine the contributions of SES on adolescent delay discounting and substance use in a sample of 167 adolescents (52% male). Confirmatory factor analysis (CFA) was used to compute SES factor scores across three waves using a composite of parent and spouse education years and combined annual household income. Adolescent delay discounting and substance use were measured annually across three waves. The main goal of this study is to examine how SES may explain individual differences in growth trajectories of delay discounting and substance use. We used parallel process growth curve modeling with SES as a time-varying and time-invariant covariate to examine the associations between adolescent SES, delay discounting, and substance use onset as well as frequency. These results reveal that delay discounting exhibits a declining linear trend across adolescent development whereas cigarette, alcohol, marijuana, and polysubstance use exhibit increasing linear trends across adolescent development. Furthermore, low SES (as a time-invariant covariate) may lead to earlier onset adolescent alcohol and polysubstance use by way of heightened levels of delay discounting. These findings suggest that delay discounting interventions may be a promising avenue for reducing socioeconomic disparities in early onset alcohol and polysubstance use, while delay discounting development is still underway. / Master of Science / Adolescence is a period of heightened risk for substance use and heightened vulnerability to the effects of substances. Yet, little is known about how socioeconomic status (SES) influences adolescent decision making and behavior to add to these risks. This study used latent growth curve modeling (GCM) to examine the role of SES on adolescent decision making and substance use in a sample of 167 adolescents (52% male). Confirmatory factor analysis (CFA) was used to compute SES factor scores across three time points using an average of parent and spouse education years and income. Adolescent delay discounting and substance use were measured annually across three time points. The main goal of this study is to examine how SES may explain individual differences in delay discounting and substance use across adolescence. We used parallel process growth curve modeling with SES as a time-varying and time-invariant covariate to examine the links between adolescent SES, delay discounting, and substance use age of onset and frequency. These results reveal that delay discounting shows linear decreases in growth across adolescence whereas cigarette, alcohol, marijuana, and polysubstance use show increasing linear growth across adolescence. Additionally, low SES may lead to earlier onset adolescent alcohol and polysubstance use by way of heightened levels of delay discounting. These findings suggest that delay discounting interventions may help reduce socioeconomic differences in early onset alcohol and polysubstance use, while delay discounting development is still in progress.

Over the past 20 years, counseling professionals have become more committed to addressing multicultural competence and issues of diversity in order to respect and acknowledge the spectrum of worldviews clients represent. Race, ethnicity, gender, sexual orientation, and spirituality/religion are well-researched areas commonly included in counselor education courses. These courses allow counselors-in-training to examine their biases, beliefs, values, and worldviews about diverse populations, and develop applicable skills. However, far too often, social class and socioeconomic status are excluded from counselors' multicultural training, and similarly, often overlooked as an integral aspect of clients' culture (Liu, 2011; Smith, 2008). The current literature reveals that scholars have taken more interest in social class in the past decade, but none has explored counselors' social class awareness and understanding, two foundational aspects of multicultural competence. The purpose of this study was to describe counselors' social class understanding and awareness through qualitative methodology. Via semi-structured interviews, licensed counselors in the Commonwealth of Virginia described how they understood social class and socioeconomic status, their awareness about social class and socioeconomic status, and issues related to classism. Four themes emerged related to social class understanding and awareness: income/money, social class designations, social status, and the places people live. Three themes surfaced linked to socioeconomic status understanding and awareness: Income, education and financial stability. Two categories emerged with regard to classism: participants' classism experiences and participant demonstrations of classism during the interview process. Three themes arose related to participant demonstrations of classism during the interview process: class microaggressions, class misconceptions, and class privilege. Implications for counseling, counselor education, and supervision are discussed, study limitations are provided, and avenues for future research are considered. / Ph. D.

Although prior research suggests that ER development typically exhibits a positive growth trajectory across adolescence as prefrontal brain regions continue to mature, individual differences in the rate of development have yet to be fully elucidated. The present study illustrates developmental processes in which family context (i.e., socioeconomic status, parent perceived stress, and family emotional climate) influences developmental trajectories of emotion regulation using both growth curve and latent change score analyses. The sample included 167 adolescents (53% males) who were first recruited at age 13 or 14 years and assessed annually four times. Our results support the mediating role of family emotional climate in the association between socioeconomic status and changes in emotion regulation, but not parent perceived stress. Our findings emphasize the constraints placed on ER development as a result of low SES and highlight the need for intervention efforts at proximal levels, such as the family emotional climate, for adolescents who face such distal risk factors. / M.S. / Given continued brain development across the period of adolescence and maturation in specific brain regions related to emotion regulation (the ability to change the experience or expression of an emotion), we expected that emotion regulation abilities would also continue to develop during this period. We were also interested in understanding what family contextual factors may be influencing how emotion regulation develops. For example, we expected that family economic and social position (including education level, income, aid, and satisfaction with finances), parent stress, and the family emotional climate (the degree of both positive and negative emotionality expressed within the family unit through parenting practices and the quality of the parent child relationship) would affect how emotion regulation unfolds in adolescents. That is, we predicted that families demonstrating a higher socioeconomic status, less parental stress, and better parenting practices would create safe and supportive contexts to learn and practice emotion regulation skills, resulting in adolescents with more adaptive emotion regulation abilities. We tested our hypotheses using longitudinal analyses from 167 adolescent participants and their parents. Our results demonstrate that parent stress is not directly related to emotion regulation development, but that socioeconomic status is related to emotion regulation development through family emotional climate. Such results suggest that for adolescents who may be at risk for developing poor emotion regulation abilities, their family can be taught skills related to improving parenting and the quality of the relationship between parent and adolescent in order to lessen the possibility of that outcome.

In the everyday environment, we receive information from various sensory inputs, and yet, we perceive and integrate the incoming information in a way that is meaningful. Remarkably, infants and toddlers are capable of sensory integration early in life. By integrating information, particularly speech, infants ultimately learn to reproduce language by late toddlerhood. These language skills form a foundation for learning and achievement later in life, and there is documented evidence that language skills vary by experiences related to socioeconomic status (SES). Language disparities can be measured early in development, and continue to divide throughout childhood. Although there is clear evidence that language learning trajectories are influenced by SES, less is known about multisensory integration (MSI) as they are measured here and how these skills may differ as a function of SES. Here, MSI was investigated to gain insight into the potential changes that occur in MSI and expressive vocabulary for 68 toddlers between 18 months and 24-months. Finally, this relationship was investigated in the context of SES. At 18-months, toddlers demonstrated significant matching for nonsocial conditions, and at 24-months toddlers also matched for low competition social trials, thus demonstrating an improvement in matching from 18 to 24-months. There were no significant relationships between MSI and expressive vocabulary, and only one unexpected relationship between MSI and SES. These findings extend the research from Bahrick and colleagues (2018) by supplementing the previously studied 12-month-olds and 2-5-year-olds with an earlier age (e.g., 18-months), and open new doors for studying toddlers’ emerging social MSI. / M.S. / In the everyday environment, we experience various sights and sounds from multiple sources, and yet, we perceive the incoming information in a way that is meaningful. Infants and toddlers are also capable of combining multiple sources of information together in a way that is beneficial for language learning. Merging sensory information (e.g., correctly matching their mother’s voice to their mother) creates a foundation for language learning. There is evidence that suggests language abilities differ as a result of socioeconomic status (SES), and can be found early in development and continue to progress into childhood. Although research indicates differences in language arise as a result of SES, it is unclear whether the ability to merge multiple sources of information (also known as multisensory integration), particularly while experiencing competing information (e.g., noise, multiple speakers) also differs as a result of SES. Here, the ability to integrate multiple sources of information and vocabulary in young toddlers ages 18-months and 24-months was studied to understand whether these skills progress with age and also whether they differ as a result of SES. 18-month-olds demonstrated better integration of sensory information when blocks were falling (e.g., nonsocial event) than when women were shown on the screen speaking in child-directed speech (e.g., social event). At 24- months, toddlers also correctly matched the information of the social event when there was no competing information on the screen, thus improving social integration from 18-months. There were no significant relationships between MSI and vocabulary, and only one relationship between MSI and SES. More research will need to be conducted to understand the improvement of social integration from 18 to 24-months, and more questions will need to be addressed on how SES may play a role in integrating information.

It is imperative to identify the structural characteristics that influence academic performance so that we are aware of the impact that policy change has on the educational outcomes of our youth. This study used district-level regression analysis to identify the influence of socioeconomic status, per-pupil funding, and student-to-teacher ratio on the academic performance of students in Virginia's public schools. The data set was created by linking data from the U.S. Census and the Virginia Superintendent's Report. Four assumptions were tested: as median income increases (socioeconomic status), academic performance improves; as per-pupil funding increases, academic performance improves; increases in student-to-teacher ratios lead to poorer academic performance; and when socioeconomic status is controlled, the influence of race upon academic performance is greatly diminished. Previous literature suggests: that a positive correlation exists between socioeconomic status and academic performance; that a negative correlation exists between student-to-teacher ratio and academic performance; that results are mixed regarding the correlation between per-pupil funding and academic performance; and that residual racial effects persist despite the control of socioeconomic status. The regression analysis yielded significant results concerning the socioeconomic status and race variables, results that are presented and discussed in this paper. / Master of Science