American Indians suffer disproportionately from mental disorders such as depression and substance abuse. American Indians have lower socioeconomic status than white Americans making them more vulnerable to mental health stressors and disorders, such as depression. Unfortunately, the causal processes and mechanisms producing negative psychological outcomes remain unclear. Despite the disadvantages faced by many American Indians, the Native American community offers cultural norms and values that facilitate treatment of and recovery from mental stressors. The Native American community offers its members an extended social support network as well as healing ceremonies, which could mitigate the effects of depression. In my dissertation, I compare the level of psychological distress between two tribal populations from a study from the Centers for American Indian and Alaska Native Health (CAIANH) at the University of Colorado at Denver. I use logistic regression to examine the relationship between the psychological distress score and tribal identity. The logistic regression analysis also explores the relationship between self-rated health and socioeconomic attainment. Finally, I compare the outcomes between the Northern Plains tribe and the Southwest tribe. The results suggest that individuals with a strong sense of cultural spirituality have lower psychological distress than individuals who do not have strong cultural spirituality. Also, individuals of the Southwest tribe who spent part of their lives off the reservation or near the reservation experience lower psychological distress compared to those who spent their entire lives on the reservation; in contrast, individuals of the Northern Plains tribe are disadvantaged in terms of mental health if they spent part of their lives off or near the reservations than those who stay on the reservation their whole lives. Members of either the Northern Plains tribe or Southwest tribe who feel socially isolated are very likely to experience severe psychological distress or rate their health poorly. The findings of the study indicate that resiliency factors among the tribes such as cultural-spirituality, reservation community and social support are protective, but the findings also encourage further understanding of mechanisms and utilization of the resources available. / text

A high degree of physical functioning is necessary for independently performing the numerous routine and valued tasks of daily life. Poor functioning not only hinders independent living, it can lower the quality of life, impede full social participation, and elevate the risk of death. However, not all adults are at equal risk of poor functioning: women experience worse functioning and live a greater number of years functionally impaired compared with men. Studies of this gap have focused on inequities in adult circumstances, such as socioeconomic status, but have generally fallen short of fully accounting for it. Recasting this research within a life-course, epidemiological framework points to the potential role of early-life circumstances. Early-life circumstances may impart a biological imprint, and they may also launch long-term trajectories of social circumstances, that could differentially shape functioning for men and women. Thus, this dissertation examines the life course origins of the gender gap in functioning and active life expectancy among older U.S. adults using two nationally-representative datasets: the National Survey of Midlife Development in the United States and the Health and Retirement Study. In sum, the findings reveal that: (a) a host of early-life circumstances, such as parents’ education levels, leave an indelible stamp on functional ability and active life expectancy for women and men, irrespective of adult circumstances, (b) while some early-life adversities, such as extreme poverty, were marginally more consequential for women’s than men’s functioning, they appear to be primarily more consequential for precipitating metabolic conditions such as diabetes and obesity rather than directly impacting functioning, (c) explanations of the gap must incorporate endogenous biological differences between men and women; explanations that focus exclusively on socially-structured inequities are insufficient, and (d) exposures to socioeconomic resources accumulate across the life course to shape functioning differently for men than women; particularly between white men, who enjoy better functioning with higher educational attainment irrespective of early-life socioeconomic exposures, and white women whose functioning gains plateau if they experienced early-life socioeconomic adversities. Overall, the results underscore the importance of a life course perspective in explicating gender disparities in functioning, longevity, and active life expectancy. / text

Background: Skin cancer is one of the most preventable forms of cancer yet for certain types of skin cancers, it can be fatal if it goes untreated. While ultraviolet radiation is the main cause of skin cancer, there are several other risk factors, including sunburn history, smoking, environmental pollutants, family history, personal history, and skin color. Practicing sun protection behaviors and receiving regular skin cancer screenings can prevent the cancer from ever developing. This study examines the demographic and socioeconomic status risk factors for skin cancer. Methods: The Health Information National Trends Survey data was used from 2005. Using this secondary dataset, chi-square analysis was performed to determine the prevalence of skin cancer within the demographic categories of age and race/ethnicity as well as socioeconomic status indicators educational attainment, annual household income, employment status, and marital status. Univariate and multivariate analyses were performed to determine the correlations of the variables with skin cancer. A p-value of 0.05 and a 95% confidence interval were maintained throughout the analyses to determine any statistical significance. Results: Of the 3,804 respondents who answered the question related to cancer diagnosis, 226 indicated they had a positive skin cancer diagnosis, which was 5.94% of the total sample. Skin cancer and increased age were consistently associated (χ2 (2) = 171.5, p<.001). The skin cancer peak prevalence was for all those respondents aged 65 and older. Higher educational attainment and higher annual household income were associated with greater likelihood of skin cancer. Conclusions: This study revealed that skin cancer is significantly associated with increased age, higher educational attainment, and higher annual household income. Implementing consistent screening practices and targeted behavioral interventions are important areas for health focus in the future.

Background and aims: The overall aim of this thesis was to increase knowledge regarding the occurrence of childhood onset T1D and T2D in Sweden and in relation to that describe and elucidate important aspects on two grave complications to diabetes; end-stage renal disease (ESRD) and mortality. The two first studies included in this thesis aimed to describe and analyze the cumulative incidence of childhood onset T1D in Sweden and to assess the occurrence of undetected T2D in Swedish children. The aim with the third study was to describe the cumulative incidence of ESRD, and to analyze how ESRD risk differs with age at-onset and sex. The aim of the fourth study was to show how parental socioeconomic status (SES) affects all cause mortality in Swedish patients with childhood onset T1D. Study populations: The foundation for the studies on T1D was data from the Swedish Childhood Diabetes Registry (SCDR). When studying ESRD we also included adult onset T1D cases from the Diabetes Incidence Study in Sweden (DISS). The study on T2D was a population-based screening study where BMI was measured in 5528 school-children and hemoglobin A1c was measured in children with overweight according to international age and sex specific BMI cut-offs. To study ESRD and mortality, we linked the SCDR to various nationwide registers containing individual information on SES, mortality and ESRD. Results: The incidence rates of childhood onset T1D has continued to increase in Sweden 1977–2007. Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7– 47.3) during 2005–2007. Cumulative incidence by birth-cohorts has shifted to a younger age at-onset over the first 22 years of incidence registration. From the year 2000 there was a significant reverse in this trend (p&lt;0.01). In contrast to the increase of T1D, we found no evidence of undetected T2D among Swedish school children. Despite a relatively high incidence in T1D in Sweden there is low cumulative incidence of ESRD, 3.3% at maximum 30 years of duration. We found difference between the sexes regarding long-term risk of developing ESRD that was dependent on the age at onset of T1D. When analyzing how socioeconomic status affects mortality in different age at death groups, we found that having parents that received income support increased mortality up to three times in those who died after 18 years of age. Conclusion: The incidence of childhood onset T1D continued to increase in Sweden 1978-2007. Between the years 1978-1999 there was a shift to a younger age at-onset, but from the year 2000 there is a change in this shift indicating a possible trend break. The prevalence of T2D among Swedish children up to 12 years of age is probably very low. There is still a low cumulative incidence of T1D associated ESRD in Sweden. The risk of developing ESRD depends on age at-onset of T1D, and there is a clear difference in risk between men and woman. Excess mortality among subjects with childhood onset T1D still exists, and low parental socioeconomic status additionally increased mortality in this group.

BACKGROUND This thesis studies the relationship between area-level socioeconomic status and the incidence and 30-day survival of out of hospital cardiac arrest. The effect of socioeconomic status on health has been studied for over 150 years.  Although cardiac arrest is a major public health problem there has been very little focus on socioeconomic status and out of hospital cardiac arrest. DATA AND METHODS The cardiac arrest data are obtained from the Swedish cardiac arrest registry. Data on age structure and percentage of immigrants is from SCBs total population registry and socioeconomic data come from SCBs LISA database. The incidence analysis is made in two steps. The first step calculates the age standardized incidence and the second step is an OLS analysis. For the survival analysis a logistic regression analysis is made to measure the probability of survival in different income areas. RESULTS For the socioeconomic status – incidence analysis the results from the OLS analysis suggest that the incidence is almost twice as high in the lowest income area. Intercept (Highest group) = 26.8 and &lt;140 000 (lowest group) = 24.5. In the survival analysis (using a binary logistic regression analysis) there was a significantly lower OR for the lowest income group for all patients (OR= 0.521, p= 0.049) and for the sub group (patients 18-75 years old) there was a significant negative relationship for the two lowest groups. &lt;140 000 (OR= 0.444, p= 0.032) and 140 000-159 000 (OR= 0.620, p= 0.046). CONCLUSION There is a significant relationship between living in a poor neighborhood and out of hospital cardiac arrest. Those living in poorer areas have both an increased incidence and lower chance of survival of out of hospital cardiac arrest.

Introduction: While the influence of parental behavior and economic status on children’s weight status is well-known, little is known about the impact of specific family-related aspects such as parental and grandparental social support. This study investigates the importance of parental and grandparental social support and economic capital for children’s weight status in a clinical sample of preschoolers with obesity. Methods: Baseline data from an obesity intervention study for preschoolers, 4-6 years of age (n = 39, 56 % girls) was used. Among parents, 73% were overweight/obese, 60% had a 3-year high school education and 50% were of non-Swedish origin. Linear regression analyses, simple and multiple, were performed separately for mothers and fathers on indicators of economic capital and social support with child BMI SDS as the dependent variable. Additionally, combined analyses were conducted in which parental income was stratified by emotional support. Results: Low levels of income for both parents and low emotional support from grandparents for fathers were significantly associated with a higher child BMI. Moreover, the association between parental income and the child’s BMI SDS was stronger among those parents who had low emotional support versus those who had high emotional support. Conclusion: The study indicate that both economic capital and social support of parents may influence the level of obesity in their children and that emotional support of grandparents is especially important when parental income is low.

The aim of this study was to assess the socio-demographic variations in nutritional habits and their trends over the last decade in Lithuanian adult population. Methods: Six health behaviour surveys were carried out within the international FINBALT HEALTH MONITOR project between 1994-2004. For every survey the national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering sociodemographic characteristics and some nutrition habits. Response rates ranged from 61.7% to 74.4%. Education was measured using five educational levels. The respondents were categorized into three groups: persons with incomplete secondary education (primary or incomplete secondary), secondary (secondary or vocational), and university education. The degree of urbanization was based on the administrative classification of the places of residence. The respondents were grouped as living in cities, towns, or villages. The effect of age, level of education, place of residence, and marital status upon nutritional habits was evaluated using multifactor logistic regression analysis that was carried out separately for men and women. Results: Positive trends in nutritional habits were observed between 1994-2004 in Lithuania. The diet of the Lithuanian population tended to become closer to the WHO recommendations for healthy nutrition. The intake of animal fat decreased. Almost a half of population replaced butter on bread by low fat margarine. The proportion of men using vegetable oil for cooking increased from 31.1% in 1994 to 82.6% in 2004, and the proportion of women – from 47.7% to 89.4, respectively. The consumption of fresh vegetables, fruit, and dark bread has increased. Although all social groups of the Lithuanian population have changed their diet, social differences in nutrition habits still remained significant. Women, highly educated persons and urban population have healthier diet than men, people with lower education and rural population. The odds ratio of using vegetable oil among men with university education was higher by 98% and among women – by 67% than that among persons with incomplete secondary education. The respondent with university education were more than twice as likely as low educated people to consume fresh fruits daily. The proportion of persons drinking whole milk was much higher in villages (OR 4.80 (CI 4.0-5.8) for men and 7.33 (CI 6.1-8.8) for women) compared to cities. Conclusions: Existing social differences in nutritional habits should be considered in the programs for the promotion of healthy nutrition and implementation of Lithuanian Food and Nutrition Action Plan development / <p>ISBN 91-7997-157-1</p>

Bakgrund: Alkoholberoende är en psykisk sjukdom med både hög förekomst och stor utbredning. Socioekonomisk status (SES) är ett begrepp som innefattar utbildningsnivå, yrkesstatus och inkomst (Statistikcentralen, i.d). Många olika faktorer såsom arv och miljö kan öka risken för att en person drabbas av ett alkoholberoende. Tidigare forskning är oense gällande sambandet mellan alkohol och SES. Syfte: Att kartlägga hur människor med olika socioekonomiska förutsättningar upplever sitt alkoholberoende och mötet med sjukvården. Metod: En explorativ design med kvalitativ forskningsansats som bygger på personers egna upplevelser och erfarenheter av fenomenet alkoholberoende. Resultat: Känsloliv och tillgänglighet var avgörande orsaker till att ett alkoholberoende utvecklades. Yrkeslivet kunde både bidra till ökad och minskad alkoholkonsumtion. Alkohol kunde användas för att uppnå behag, dämpa ångest och känna samhörighet. Nyktra alkoholister upplevde överlag inte alkohol som något negativt. Personer med högre SES konsumerade mer alkohol i veckorna och fick lättare och snabbare tillgång till vård. Oavsett SES kunde alkoholberoende leda till psykiska besvär och försämrad ekonomi, vilket påverkade de personer med lägst SES hårdast. Rattfylleri var det mest frekvent rapporterade riskbeteendet under alkoholpåverkan, detta hade ingen koppling till SES. Upplevelser av passivitet från omgivningen var vanligt, när omgivningen agerade kunde det väcka förnekelse. Sjuksköterskans bemötande upplevdes som oklanderligt men sjukvården betraktades generellt som icke-fungerande. Terapeutisk effekt uppnåddes lättare om hjälparen också hade ett alkoholberoende, en av orsakerna till att Anonyma Alkoholisters verksamhet upplevdes som positiv. Produktivitet, intressen och motivation var nyckelfaktorer för att motverka återfall. Slutsats: I de socioekonomiska grupperna varierade upplevelserna av alkoholberoendet främst gällande dryckesmönster, tillgång till vård samt bakomliggande orsaker till alkoholdrickandet. Ett alkoholberoende drabbade de personer med lägst SES hårdast. Bemötandet av personer med alkoholberoende inom svensk hälso- och sjukvård upplevdes som oklanderligt, dock var många delar av vården utformade på ett icke-fungerande sätt. / Background: Alcohol addiction is a widespread mental illness with high prevalence. Socioeconomic status (SES) is a term that includes education, occupational status and income (Statistikcentralen, i.d). Many different factors such as heredity and the environment may increase the risk of a person becoming addicted to alcohol. Previous research presents different results about the relationship between alcohol and socioeconomic status. Aim: To chart how people with different socioeconomic conditions experienced their alcohol addicition and the health care. Methods: An explorative design with qualitative research approach based on people’s own experiences of the phenomenon alcohol addiction. Results: Emotions and availability were main reasons of the development of an alcohol addiction. People´s employment could contribute to both increased and reduced alcohol consumption. Alchol could be used to reach amenity and solidarity and to decrease anxiety. Sober alcoholics did not experience alcohol as something negative. People with a high SES consumed a greater quantity of alcohol during the weekdays and had easier and quicker access to health care than people with lower SES. Alcohol addition could contribute to psychological issues and a worsened economy, especially for the people with lowest SES. Drunk driving was the most highly reported risk behaviour under the influence of alcohol but without connection to the SES. The respondents experienced that the surrounding people mostly remained passive but when they did react it could issue in denial. The nurse’s treatment were experienced as impeccable but the health care was generally considered as not effective. Therapeutic effect was achieved more easily if the helpers had their own addictions, one of the reasons to that Anonymous Alcoholics was regarded as a positive activity. Productivity, hobbies and motivation were key factors to prevent relapse. Conclusion: The experience of the alcohol addiction varied between the socioeconomic groups, mainly concerning drinking patterns, access to health care and the underlying causes to alcohol drinking. An alcohol addiction affected those people with the lowest SES mostly. The treatment of people with alcohol addiction in the swedish health care were experienced as faultless, yet there were many aspects of the healthcare that were generally considered to be dysfunctional.

Research Doctorate - Doctor of Philosophy (PhD) / In this dissertation, Van Davy makes a case for a cohesive system of schools which can serve the public — both the national interest and individual interests — while directly addressing the current national schooling system’s failure: * to replace, for the entire student cohort...high levels of student boredom with high interest and engaging curriculum and pedagogy; * to replace, for low SES and indigenous students...low levels of learning outcomes, low enrolment levels in senior schooling, and only brief experience of curriculum choice with a curriculum paradigm providing intrinsic value, understanding of pathways from disempowerment to empowerment, curriculum choice from the earliest years, and schooling outcomes which, over time, equal those of the national cohort of students * to replace a citizenry divided in its support for public, church-based, and exclusionary schools with a community united in its support for a socially agreed set of social purposes for schooling and a new curriculum paradigm, one half of which is generated by this set of social purposes * to address a major political issue: social cohesion The proposed new and cohesive system of schools is envisaged to meet the needs - both Common Good and Individual Good - of the citizenry. It will grow from an earlier and pre-requisite national social agreement around a set of political goals which together sketch a preferred future society - these political goals in the hands of education specialists will generate an "essential" curriculum as one of two elements in a new two-tiered curriculum to be followed from the earliest until the latest years of schooling. The second element, occupying the other half of the curriculum from the earliest to the latest years of schooling, will be an elective curriculum designed to encourage all students to pursue their own interests in as much depth as desired. Studies of sectarian studies will be included in the elective curriculum. Davy’s analysis ranges across a number of disciplines, fusing together a number of viewpoints: historical, political theory, educational performance, and educational theory. It searches Australia’s schooling outcomes, identifies low SES and Aboriginal outcomes as major areas of failure, and challenges a number of widely accepted schooling practices. In the process, Davy discovers OECD and ACER data, but little official interest or analysis, concerning widespread boredom amongst Australia’s students. He argues that, in respect of both low SES students and student boredom, system responsibilities such as the nature of Australia’s curriculum, could be just as implicated as concerns for “teacher quality.” Davy’s interest extends beyond the purely educational. He examines the purposes that public and non-public school authorities articulate, as well as reasons parents give for enrolling their children in schools. From this research Davy identifies several issues and suggests that very considerable “choice” in schooling could be found in a different curriculum paradigm, and that both public and non-public schools are deficient when measured against widely-accepted concerns for religious freedom, social cohesion, and fundamental democratic principles. For Davy, a major political issue confronting Australia is the national imperative of “social cohesion.” He searches Australia’s schooling history for evidence of any social agreement around the social purposes of schooling, including more recent attempts to formulate “essential" and “new basics” and “national” curriculum. He concludes that while many educators, and the OECD, refer to the need for a pre-requisite set of social purposes that outline a preferred future society, the politics of schooling has not permitted this to eventuate and, given the absence of this management fundamental, “it is not surprising that schooling systems are shaped by internal logics (ideologies, religions, personalities, internal politics, quest for advantage and/or privilege) rather than wider concerns for the shape of the globe’s and nation’s future, and the advancement of the twins: Common Good and Individual Good.” With these problems laid bare — low SES and indigenous outcomes, student boredom, and social cohesion — Davy addresses all three simultaneously. He draws confidence from contemporary political theorists proposing political processes which engage the public in a “deliberative democracy.” He constructs a surrogate “foundation of agreed principles” which, he deduces, the processes of deliberative democracy might lead the Australian people to construct, then outlines a step-by-step means by which these principles can generate an essential curriculum for all Australian children, while encouraging a full range of choice within an elective stream. The political processes of open collaboration throughout civil society which produces the social agreement may produce a new political context. This new, less adversarial and more trusting political context is seen to be fertile ground for the replacement of Australia’s fractured schooling system with a cohesive schooling system for the Australian public — an Australian schooling system — to be managed nationally.

Title from first page of PDF document. Includes bibliographical references (p. 21-22).