Compared to wealthy individuals, individuals with low socioeconomic status (SES) often receive health services of lower intensity or quality and have difficulty accessing care. This is particularly true in the area of inpatient surgery. Individuals with low socioeconomic status are often less likely than individuals associated with high socioeconomic status to receive timely surgical care, and less likely than high SES to receive evidence-based treatments for surgical care. Despite these large gaps, there is a lack of consensus whether disparities in surgical outcomes are primarily due to differences in patient characteristics such as acuity or whether they are attributable to disparities in the quality of surgical care among those with access. The overall goal of this dissertation is to illuminate the relationship between socioeconomic status and surgical outcomes. The project aims are: 1) classify trends in post-surgical quality and analyze data on the relationship between socioeconomic status and surgical outcomes; 2) to evaluate whether changes in access to care can eliminate disparities in outcomes by analyzing the impact of the Massachusetts health reform on socioeconomic disparities in inpatient surgery; and 3) to show the potential effects of SES on surgical outcomes by using the Theory of Fundamental Causes. To meet the study objectives, this study proposes to use data from the Nationwide Inpatient Sample (NIS) and the State Inpatient Database (SID). This approach uses socioeconomic information in the NIS and SID that is a quartile classification of the estimated median household income of residents in the patient’s ZIP Code. The outcomes of interest are widely used quality measures: post-surgery mortality and complications at the national level, post-surgical mortality in Massachusetts for select inpatient surgeries, and difference-in-difference estimates. The approach used to identify trends in post-surgical quality uses two analytical software products to analyze the NIS using a regression-based approach. Study findings will identify progress and gaps in the quality of inpatient surgical care over recent years and further determine whether improving access to care through policy design can eliminate or reduce disparities in surgical care outcomes. In the face of health reform, this research will offer important insight into the study of surgical disparities and potential impact following health policy changes such as the expansion of Medicaid, implementation of health insurance exchanges, and the individual mandate requiring individuals to obtain health coverage.

This paper investigates the relationship between tourism and well being, or quality-of-life, within eighteen counties in Utah. To evaluate the relationship, comparisons of the counties' differing l evel s of tourism versus their levels of welfare are necessary. To make these comparisons, three basic steps were followed. First, a social ordering model was derived. The proposed social ordering model was based upon Maslow's theory of the hierarchy of human needs. By utilizing his theory, both economic and noneconomic indicators were identified, and a basis was provided upon which to judge the differing positions of well-being. Factor analysis was applied to this model in order to aggregate the indicators and derive a single quality-of-life index. Second, measurement of tourism was developed. A direct measurement of the level of tourist activity was not available. An indirect indicator of tourism was estimated by taking the proportion of total gross taxable revenue earned by eating and drinking establishments and taxable room sales. The derived indirect variable was more reflective of comparative tourism dependency levels than of the actual level of tourism. Therefore, the variable was renamed touri sm dependency. Third, the correlation between quality-of-life and tourism dependency was calculated. A Pearson correlation coefficient test was performed from which initial results sugge sted a potentially strong negative relationship between the particular qualifiers of well-being used here and tourism. It was apparent that thE two variables that could be defined by certain available indicators were not perfect measurements of the proposed variables, but aspects or components of the desired variables . Each reflected certain attributes of the proposed variables, but not the total concept. A possible explanation for the strong inverse relationship between the qualifiers of quality of life and tourism in this study may be each county's potential for economic diversification. Other studies have shown that areas that are dependent upon a single resource may experience higher levels of economic, demographic, and social instability as compared to those areas with a more diverse economic base. These factors, which in this model would lead to lower values for the calculated quality -of- life indicator in those counties, were estimated to be more tourist dependent .

Inequality within the family (i.e. differential parenting) is associated with a variety of measures of child adjustment. To date there is no research examining the effects of this phenomenon on children’s physical health, or on the fashion in which this phenomenon may combine and interact with socioeconomic markers. The present study assessed 375 mothers and their children over a period of 18 months. Differential maternal negativity between siblings predicted change in child health, controlling for child gender, age, maternal education, income/assets, and absolute level of negativity in the household. The association between maternal education and change in child health was strongest when children were also exposed to high differential negativity, suggesting that these predictors combined in a cumulative fashion. Findings indicate that multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in combination with one another to predict change in child health.

Inequality within the family (i.e. differential parenting) is associated with a variety of measures of child adjustment. To date there is no research examining the effects of this phenomenon on children’s physical health, or on the fashion in which this phenomenon may combine and interact with socioeconomic markers. The present study assessed 375 mothers and their children over a period of 18 months. Differential maternal negativity between siblings predicted change in child health, controlling for child gender, age, maternal education, income/assets, and absolute level of negativity in the household. The association between maternal education and change in child health was strongest when children were also exposed to high differential negativity, suggesting that these predictors combined in a cumulative fashion. Findings indicate that multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in combination with one another to predict change in child health.

Inequality within the family (i.e. differential parenting) is associated with a variety of measures of child adjustment. To date there is no research examining the effects of this phenomenon on children’s physical health, or on the fashion in which this phenomenon may combine and interact with socioeconomic markers. The present study assessed 375 mothers and their children over a period of 18 months. Differential maternal negativity between siblings predicted change in child health, controlling for child gender, age, maternal education, income/assets, and absolute level of negativity in the household. The association between maternal education and change in child health was strongest when children were also exposed to high differential negativity, suggesting that these predictors combined in a cumulative fashion. Findings indicate that multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in combination with one another to predict change in child health.

Inequality within the family (i.e. differential parenting) is associated with a variety of measures of child adjustment. To date there is no research examining the effects of this phenomenon on children’s physical health, or on the fashion in which this phenomenon may combine and interact with socioeconomic markers. The present study assessed 375 mothers and their children over a period of 18 months. Differential maternal negativity between siblings predicted change in child health, controlling for child gender, age, maternal education, income/assets, and absolute level of negativity in the household. The association between maternal education and change in child health was strongest when children were also exposed to high differential negativity, suggesting that these predictors combined in a cumulative fashion. Findings indicate that multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in combination with one another to predict change in child health.

Considerable socioeconomic disparities have been identified for smoking and cessation: lower socioeconomic status (SES) groups have higher rates of tobacco use, are less likely to successfully quit, and may also be less likely to intend or attempt to quit. However, results are inconsistent for some quitting-related outcomes, and little is known about how socioeconomic disparities may vary across countries and over time. This study examined the extent to which SES was associated with smoking cessation and related constructs among representative samples of smokers in Canada, the US, the UK, and Australia, using data from the first five waves (2002-2006) of the ITC Four Country Survey (35 532 observations from 16 458 respondents). Generalized estimating equations modeling was used to examine whether education and income were related to intentions to quit (any, and within the next six months), incidence of quit attempts, smoking abstinence (for at least one, six and 12 months), and reduction in daily cigarette consumption by at least half. Potential differences in the associations over time and across countries were also considered. In addition, logistic regression modeling examined associations between education and income, reasons for quitting, and use of cessation assistance, using a cross-sectional sample of the most recent survey wave. Respondents with higher education were more likely to intend to quit, have made a quit attempt, and be abstinent for at least one and six months, and those with higher income were more likely to intend to quit and be abstinent for at least one month. Associations were stable throughout the time period under study. Country differences were observed in quit intentions: UK and US respondents were less likely to intend to quit than Australians and Canadians. Also, UK respondents were least likely to attempt to quit overall, but those that did attempt were more likely to be abstinent for at least one and six months. Socioeconomic and between-country differences were also identified in the cross-sectional analyses of use and access to cessation assistance and reasons for quitting. The results suggest that socioeconomic disparities exist at multiple stages in the path to smoking cessation.

Considerable socioeconomic disparities have been identified for smoking and cessation: lower socioeconomic status (SES) groups have higher rates of tobacco use, are less likely to successfully quit, and may also be less likely to intend or attempt to quit. However, results are inconsistent for some quitting-related outcomes, and little is known about how socioeconomic disparities may vary across countries and over time. This study examined the extent to which SES was associated with smoking cessation and related constructs among representative samples of smokers in Canada, the US, the UK, and Australia, using data from the first five waves (2002-2006) of the ITC Four Country Survey (35 532 observations from 16 458 respondents). Generalized estimating equations modeling was used to examine whether education and income were related to intentions to quit (any, and within the next six months), incidence of quit attempts, smoking abstinence (for at least one, six and 12 months), and reduction in daily cigarette consumption by at least half. Potential differences in the associations over time and across countries were also considered. In addition, logistic regression modeling examined associations between education and income, reasons for quitting, and use of cessation assistance, using a cross-sectional sample of the most recent survey wave. Respondents with higher education were more likely to intend to quit, have made a quit attempt, and be abstinent for at least one and six months, and those with higher income were more likely to intend to quit and be abstinent for at least one month. Associations were stable throughout the time period under study. Country differences were observed in quit intentions: UK and US respondents were less likely to intend to quit than Australians and Canadians. Also, UK respondents were least likely to attempt to quit overall, but those that did attempt were more likely to be abstinent for at least one and six months. Socioeconomic and between-country differences were also identified in the cross-sectional analyses of use and access to cessation assistance and reasons for quitting. The results suggest that socioeconomic disparities exist at multiple stages in the path to smoking cessation.

For decades, research has explored how family background shapes access to and success in postsecondary education. However, much less is known about the effect of family background on one’s educational and occupation success within specific fields. Given rapid advances in science and technology and a changing global economy, understanding these processes within science, technology, engineering, and mathematics (STEM) are particularly important to the broader understanding of stratification. Many recent studies in the U.S. stress the importance of increasing our STEM labor force to remain competitive in the global market, and demand for highly skilled workers is at an all-time high and increasing. While the demand for these jobs is high, many researchers argue that the supply of highly skilled workers is lagging behind. In order to meet these demands, many of these researchers point to increasing the talent pool by drawing from underrepresented groups. This study looks at how family socioeconomic background affects entry into STEM majors, persistence in STEM major, and early labor market outcomes among college graduates from STEM fields, and compares these patterns and processes to those in non-STEM fields. Results from this study show stronger SES differences in STEM fields than non-STEM fields at each point from college major choice to the labor market. Together, these results suggest that less socioeconomically advantaged students may be at a particular disadvantage in STEM fields. / text

The purpose of this study is to derive a method for estimation of costs and benefits of implementing Port Collaborative Decision Making (Port CDM), and to apply this method to the Port of Gothenburg. By using the Port of Gothenburg as a case study, conclusions can be drawn regarding the economic viability of Port CDM in one of Scandinavia‟s largest ports. This study considers two major sources of benefits that are hypothesized to result from transitioning to collaborative port operations: improved possibilities for speed optimization prior to arrival in port due to increased predictability in estimated berthing times, and shortened service times due to increased possibility for planning and resource optimization by port service providers.The estimation of impacts is based on one month‟s traffic data in the Port of Gothenburg. Predictability of estimations is analyzed to determine the benefit potential of Port CDM. The estimated cost savings for cargo vessels can be divided into 5 categories: bunker, emission, time, manning and capital cost savings. The costs of implementing and maintaining Port CDM are estimated with values from relevant previous research.The results of this study indicate that the implementation of Port CDM in the Port of Gothenburg is a profitable investment, for the shipping industry and for society as a whole. The estimated annual net benefit is 27.3 million euros. A sensitivity analysis using alternative unit valuations for emissions, as well as low and high estimations of the effectiveness of Port CDM, indicates that the economic viability of the project is robust under all assumptions considered.