<p>Compared to people who are White and have high socioeconomic status (SES), those who are Black and have low SES are more likely to receive suboptimal pain care. One potential contributor to these disparities is biased provider decision-making—there is compelling evidence that providers are influenced by patient race and SES when making pain treatment decisions. According to the dual process model, people are more likely to be influenced by demographic stereotypes, including implicit beliefs, when they are under high cognitive load (i.e., mental workload). One stereotype belief relevant to pain care is that Black and low SES people are more pain tolerant. Aligned with the dual process model, providers who are under high cognitive load and have strong implicit beliefs that Black and low SES people are more pain tolerant may be particularly likely to recommend fewer pain treatments to them. To test this hypothesis, I recruited physician residents and fellows (n=120) to make pain treatment decisions for 12 computer-simulated patients with back pain that varied by race (Black/White) and SES (low/high). Half of the providers were randomized to the high cognitive load group in which they were interrupted during the decision task to make conversions involving hypertension medications for another patient. Remaining providers completed the task without being interrupted. Providers’ implicit beliefs about race and SES differences in pain tolerance were measured with two separate Implicit Association Tests (IATs). Multilevel modeling indicated that providers recommended stronger medications to low than high SES patients (OR=.68, p=.03). There was also a significant interaction between patient SES and cognitive load (OR=-.56, p=.05) and a trending interaction between patient race and cognitive load (OR=1.7, p=.07). Under low cognitive load, providers recommended more pain treatments to high SES (vs. low SES) and Black (vs. White) patients, but under high cognitive load, providers recommended more pain treatments to low SES (vs. high SES) patients and equivalent treatment to Black and White patients. There were no three-way interactions between patient demographics (race or SES), cognitive load, and providers’ implicit beliefs (race-pain or SES-pain IAT scores). However, there was a trending interaction between patient race and race-pain IAT scores (OR=2.56, p=.09). Providers with stronger implicit beliefs that White people are pain sensitive and Black people are pain tolerant recommended more pain treatments to White patients and fewer pain treatments to Black patients. Lastly, there was a trending effect that providers with stronger implicit beliefs that high SES people are pain sensitive and low SES people are pain tolerant recommended stronger medications in general (OR=13.03, p=.07). Results support that provider cognitive load is clinically relevant and impacts clinical decision-making for chronic pain for racially and socioeconomically diverse patients. Future studies are needed to further understand the impact of cognitive load on providers’ pain care decisions, which may inform evidence-based interventions to improve pain care and reduce disparities.</p> <p>  </p>

This thesis is a report of a survey of a political attitudes at McMaster University. The results are based on the data obtained in interviews with 193 undergraduates chosen in a random sample of the undergraduate population. This information was used to examine the level of interest in politics among the members of the sample, and the different ideological attitudes and party preferences of the students interviewed. The different levels of interest in politics were related to ecological factors such as family and school background, socio-economic status, sex, group involvement and place of residence. Political preferences were related to such factors as socio-economic status, religion, family preferences and academic interests. The more interesting conclusions might be summarized as follows. The students as a whole are more apathetic towards politics than might have been expected. Those who have an above average interest in politics tend to be found among those studying Arts subjects at Honours level and whose parents also have an above average interest. They also tend to be male. Students also tend to agree with their parents’ politics, except those who have a high level of interest in the subject. Finally, the interested students tend to be more radical (at least by the scale set up for this survey) than the apathetic. / Thesis / Master of Arts (MA)

This research study examines the relationship between academic achievement and at-risk students. Many issues today affect the achievement gap and the ability for at-risk students to succeed. Most data, as revealed in the studies included in this review, conclude the factors identifying at-risk students do have significant impact on the academic achievement of individual students and schools. Most often, these students are not successful and eventually drop out of school or pursue a GED. Data indicate that teacher-student relationships, parent or caregiver-student relationships, motivation, SES (socioeconomic status), and peer influence can affect success for at- risk students. Twelfth grade students from two high schools in an urban school district were given the opportunity to participate in a survey. This study investigates correlations between the dependent variable grade point average (GPA), and the independent variables teacher-student relationships, parent or caregiver-student relationships, motivation, SES, and peer influence. Five regressions were run to determine if any of the independent variables predict GPA. Data from this study indicate that the variance between the dependent variable of GPA and each of the five independent variables is significant; however the practicality of these resultsâ having a significant influence on the GPA of the study participants is minimal. The strongest variance found was between GPA and motivation and between GPA and peer influence. Other findings include a relationship between GPA and participation in sports or activities. As GPA increases, the percentage of students participating in sports and activities increased. The students in this study do have positive relationships with their teachers; have a parent or caregiver encouraging them to do well in school; and plan to attend college. / Ed. D.

The study's purpose was to examine large and small high schools in Virginia to try to understand if the high school student population size influenced the student achievement of eleventh grade students based on identified predictor variables. Several studies were identified and included in the literature review. From the literature review, the predictor variables of socioeconomic status, student attendance, minority status, and teacher quality were identified to aid in the development of the main research question and five guiding questions. The main research question investigated if there was a relationship between a high school student population size and student achievement when statistically controlling for selected predictor variables. From the literature review, the main research question, five guiding questions, and a methodology were developed that would best aid in the analysis of the data. Data were collected from the Virginia Department of Education for the 2012-2013 school year that consisted of eleventh grade Virginia Standards of Learning assessments, socioeconomic status, student attendance, minority population, and teacher quality. Hierarchical multiple regression was the statistical method used to analyze the data for the research questions. The results of the study indicate there is a relationship between socioeconomic status and student achievement. However, when student population size was introduced, the result was not significant. The overall conclusion regarding socioeconomic status and student achievement is that the issue is not rooted in the size of a high school population. When student attendance was accounted for, a relationship existed between high school student population size and student achievement. When student attendance was accounted for, an indication existed that the high schools in the study with both large and small student populations had a higher percentage of student achievement when students attended on a regular basis. When the size of a high school student population, whether it was large or small, was taken into account, student achievement declined if a high school had a large percentage of minority students. Teacher quality was found to have a relationship with student achievement when high school student population size was taken into account. Overall, results of the study indicate that there was a relationship between a high school student population size and student achievement when statistically controlling for isolated variables. / Ed. D.

Background: Adolescence is a crucial point in life where choices, behaviors, and environmental influences can significantly shape future outcomes. This research investigates the increasing concerns surrounding adolescent substance use and examines its long-term effects on socioeconomic status (SES) in adulthood. Substance use during adolescence has been shown to have significant long-term physiological impacts, as the brain is still developing at this age. Additionally, many short- and long-term effects are associated with substance use, such as impacts on academics, physical and emotional well-being, and social life. Several studies have been conducted to explore the relationship between substance use and SES, however, there is little research that investigates how the initiation of substance use during adolescence will affect SES-related factors in adulthood while using a nationally representative sample and a comprehensive range of substances. Methods: Data from Wave I and Wave V of the nationally representative data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset was used to explore the relationship between early initiation of substance use and subsequent socioeconomic-related outcomes during adulthood. Substance use was defined through survey questions addressing the age of initial exposure to alcohol, marijuana, and other illicit drugs reported at Wave I (ages 1-21), while SES in adulthood was assessed through objective indicators (personal income, educational attainment, and poverty indicators such as being unable to pay utility bills) and the subjective MacArthur Scale of Subjective Social Status (SSS) reported at Wave V (ages 33-43). Logistic regression was used to estimate odds ratios and 95% confidence intervals for the association between age at first substance use for each substance [categorized as never used (referent), first use at age 1-11, age 12-17, or 18 or older] and each adulthood SES outcome accounting for the complex survey design. Results: Age of first alcohol use was not significantly associated with adulthood functional poverty indicators, educational attainment, or personal income relative to the federal poverty line. Compared to those who never used, early alcohol use initiation was found to be strongly associated with a decreased SSS (first use at age 1-11, OR = 1.66, 95% CI = 1.08, 2.55). Age of illicit drug use initiation was significantly associated with functional poverty indicators in adulthood (age 12-17, OR = 1.40, 95% CI = 1.02, 1.90) and lower perceived SSS (age 12-17, OR = 1.56, 95% CI = 1.12, 2.27). Lastly, the first age of marijuana use was statistically significant across all measured outcomes, with differences present across age categories. For example, marijuana use was significantly associated with functional poverty indicators in adulthood (first use at age 1-11, OR = 3.40, 95% CI = 1.55, 7.49; first use at age 12-17, OR = 1.56, 95% CI = 1.30, 1.94), a lowered educational attainment (chi-squared = 69.3804, p = 0.0000), reduced personal income relative to the federal poverty line (first use at age 1-11, OR = 2.28, 95% CI = 1.06, 4.93), and a lowered perceived SSS (first use at age 12-17, OR = 1.39, 95% CI = 1.12, 1.74). Conclusions: The insights from this analysis will be beneficial to the local community as they have the potential to benefit adolescents from a reduced socioeconomic status in the long term; it can inform intervention strategies, public health policies, and result in the formation of other initiatives to mitigate potential consequences of the initiation of substance use. Understanding the relationship between the initiation of substance use during adolescence and the resulting repercussions to socioeconomic status during adulthood is essential in crafting targeted and effective measures to support the well-being of adolescents and, by extension, the broader society.

Doctor of Philosophy / Department of Special Education, Counseling, and Student Affairs / Kenneth Hughey / The characteristics and needs of college students across the United States are ever-changing. As Millennial generation students, born between 1982 and 2003 (Howe & Strauss, 2000), attend college, unique characteristics are present. Commonalities within the Millennial generation have been identified; however, socioeconomic status can impact a student’s ability to demonstrate these characteristics of the Millennial generation (Ramsey, 2008). Socioeconomic status still remains the greatest predictor of college aspirations but can prohibit some Millennial students from the opportunity to attend college (Greene, Huerta, & Richards, 2007). This qualitative study investigated the lived experiences of low socioeconomic Millennial generation college students. Bourdieu’s (1977; Bourdieu & Passeron, 1977, 1990) Cultural Capital Theory was used as the framework to address four research questions regarding knowledge of college, academic experiences, types of support, and collegiate involvement. Research questions were developed utilizing a phenomenological methodology consisting of two semi-structured interviews with open-ended interview questions as the primary data source. Through the analysis of the participant interviews, themes of their lived experiences as a low socioeconomic status Millennial generation college student emerged. Participants shared that their families lacked knowledge and information about college although they encouraged and supported them and understood the importance of a college degree. Although the educational experiences of the participants varied, most encountered challenges transitioning from high school to college. The most important educational experience for the participants is obtaining a college degree, greatly impacting their future. Although self-supportive for most of their lives, attending college is possible through the financial support of the 21st Century Scholars Program. This financial support and the support of their collegiate friends going through similar experiences have been important. Involvement in collegiate activities was important for the participants’ future careers, relationships, and learning; however, they sought these opportunities on their own. This research supports and encourages student affairs practitioners to enhance and improve the services and support provided to low socioeconomic status students in the college community. In addition, this study supports the need for more research related to socioeconomic status within higher education as well as reexamining student development theories to take into consideration socioeconomic status.

The incidence of cutaneous malignant melanoma (CMM) is steadily increasing. Most of the patients have thin CMM with a good prognosis and a 5-year survival of about 90%. The prognosis is highly related to tumour thickness and clinical stage at diagnosis. Effective systemic treatment for patients with metastatic disease has only recently been available. This thesis aims to increase knowledge of trends in tumour thickness, prognostic factors, socioeconomic differences and medical costs in patients with CMM. The population-based Swedish melanoma register is the main source of data in all papers in the thesis. Papers I-III include patients from all of Sweden while paper IV is delimited to the County of Östergötland. Cox regression and logistic regression are the main multivariable methods used. Paper IV is focused on stage-specific costs of CMM by comparing direct healthcare costs to a general population. For men, there has been a shift over time towards thinner tumours at diagnosis accompanied by an improved survival. Women are still diagnosed with considerably thinner tumours and they experience a better survival than men. Tumour ulceration, tumour thickness and Clark’s level of invasion all showed significant independent long-term prognostic information in T1 CMMs. By combining these factors, three distinct prognostic subgroups were identified. Lower level of education was associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. The direct healthcare costs for CMM patients were significantly higher than for the general population, independent of clinical stage. CMM patients diagnosed in clinical stage III-IV were associated with particularly high costs. Even though the survival among Swedish patients with CMM is among the highest in the world and still seems to improve, the results of this thesis emphasise the need of improved early detection strategies. This may be of particular concern in men, older women, and groups with a low level of education. The results also imply that the costs for the management of CMM patients may be reduced if early detection efforts are successful and lead to a more favourable stage distribution. The finding of a better risk stratification of thin CMMs may help to improve the management of this large patient group.

Essay 1: Individuals with higher socioeconomic status (SES) also tend to enjoy better health. Evidence from the economics literature suggests that a potential mechanism behind this “social health gradient” is that human capabilities, that form SES, also facilitate health-promoting behaviors. This essay empirically investigates the significance of socioeconomic differences in health behaviors, using dental care consumption as an operationalization of health investments. I focus on adults at an age where lifetime trajectories for SES can be taken as given and use lifetime income to capture SES. I estimate the impact of lifetime income on dental care consumption and find robust evidence that the social gradient in dental care consumption steepens dramatically over the life-cycle. Considering that dental care consumption only reflects a small part of individuals' health investments the results suggest that lifetime effects of SES on health behaviors could be substantial in other dimensions. Essay 2: This essay studies the effect of competition on prices on a health care market where prices are market determined, namely the Swedish market for dental care. The empirical strategy exploits that the effect of competition differs across services, depending on the characteristics of the service. Price competition is theoretically more intense for services such as examinations and diagnostics (first-stage services), compared to more complicated and unusual treatments (follow-on services). By exploiting this difference, I identify a relative effect of competition on prices. The results suggest small but statistically significant negative short-term effects on prices for first-stage services relative to follow-on services. The results provide evidence that price-setting among dental care clinics responds to changes in the market environment and substantial effects of competition on prices over time cannot be ruled out. Essay 3: The Swedish dental care insurance subsidizes dental care costs above a threshold and becomes more generous as dental care consumption increases. On average, higher-income individuals consume more dental care and have better oral health than low-income individuals. Therefore, the redistributional effects of the Swedish dental care insurance are ambiguous a priori. I find that the dental care insurance adds to the progressive redistribution taking place through other parts of the Swedish social insurance (SI) for individuals aged 35-59 years whereas it reduces the progressivity in the SI for those aged 60-89 years. While the result for the oldest individuals is problematic from an equity point of view, the insurance seems to strengthen the progressitivy of the Swedish social insurance for the vast majority of patients.

The objectives of this study are to provide a comprehensive assessment of inequalities in infant and under-five years' child survival, access to and utilisations of child health services among different socio-economic groups in Ethiopia; and identify issues for policies and programmes at national and sub-national levels. This thesis examines the effect of parental socioeconomic status, maternal and delivery care services, mothers' bio-demographic and background characteristics on the level of differences in infant and under-five years' child survival and access to and utilisation of child health services. Descriptive and multivariate analyses were carried out for selected variables in the literature which were consider as the major determinants of infant mortality rate (IMR) and under-five years' child mortality rate (U5MR); access to and utilisations of child health services based on data from Ethiopian demographic and health survey (EDHS), covering the years 2000-2005. In the multivariate analysis a logit regression model was used to estimates inequalities in infant and under-five years' child survival, and inequalities in access to and utilisation of child health services. In Ethiopia, little was known about inequalities in IMR and U5MR, and inequalities in access to and utilisation of child health services. Besides, there is no systematic analysis of health inequalities and into its determinants using logistic regression. According to the available literature, this is the first comprehensive and systematic analysis of inequality of health in Ethiopia. The findings show that compared to under-five years' children of mothers' partners with no work, mothers' partners in professional, technical and managerial occupations had 13 times more chance of under-five years child survival for 2000 weighted observations. In addition, compared to infants of mothers who were gave birth to one child in last 5 years preceding the survey, infants of mothers who were gave birth to 2 children in last 5 years preceding the survey had 70% less chance of infant survival while infants of mothers who were gave birth to 3 or more children had 89% less chance of infant survival for 2000 weighted observations. Moreover, this study finding also indicates that inequalities increased significantly in the five years period between 2000 and 2005 among mothers with different birth interval. Most of the relations between birth interval and receiving childhood immunisation for vaccine-preventable diseases were statistically significant. Moreover compared to non-educated mothers, mothers who completed secondary and higher education were nearly 10 times more likely to receive DPT3 immunisation for their young children. This study concludes that policy measures that tackle health inequalities will have a positive impact in the implementation of health sector strategy of Ethiopia. Health inequalities studies in Ethiopia and Sub-Saharan Africa (SSA) countries should focus on systematic analysis of different socio-economic groups. The finding of this study support investing in the Ethiopia's health extension package (HEP) is a necessary but not sufficient condition for addressing rural poor health problem. HEP is successful in increasing primary health care coverage in rural Ethiopia to 89.6% (FMOH, 2009) but unable to reduce Ethiopia's higher level of IMR and U5MR. HEP is one of the success stories that address the rural poor health problem and can also be adapted to developing countries of SSA. The finding also shows that the success stories such as health insurance programs like Rwanda (World Bank, 2008a) and Ethiopia (FMOH, 2009/10) will play a key role in achieving country's health care financing goal of universal coverage. This can also be replicated in the developing SSA countries.

Contributions of home environment and family socioeconomic status (SES) on the intelligence test performance of 24 exceptional children aged five through seven years were investigated. It was hypothesized that higher SES would enrich the children's environment providing a more stimulating learning experience, and would reflect a positive correlation with measures of the home environment. Additional hypotheses were that both HOME scores and SES scales would show a positive correlation with intelligence test performance. The positive association found between SES and HOME Inventory scores suggests that families with a higher SES have the ability to direct more resources toward their children. However, according to the present study, this does not affect the intelligence test performance of exceptional children.