The focus of this study is the vicious circle of poverty and ill-health. The case is injuries but it could have been any lasting and severe disease. Poverty and health have very close links to economic development and to how health care is financed. Out-of-pocket payment seems to increase the risk of poverty while prepaid health care reduces it. The overall objective is to investigate the “injury poverty trap” and suggest possible solutions for it. A cohort of 23,807 people living in 5,801 households in Bavi district of Vietnam was followed from 1999 to 2003 to investigate income losses caused by non-fatal unintentional injuries in 2000 as well as the relationships between social position in 1999 and those injuries. For the possible solutions, a survey in 2064 household was performed to elicit people’s preferences and willingness to pay for different health care financing options. The results showed that unintentional injuries imposed a large economic burden on society, especially on the victims. By two pathways – treatment costs and income losses – unintentional injury increased the risk of being poor. The losses for non-poor and poor injured households were about 15 and 11 months of income of an average person in the non-poor and poor group, respectively. Furthermore, poverty was shown to be a probable cause of non-fatal unintentional injuries. Specifically, poverty led to home injuries among children and the elderly, and adults 15 – 49 years of age were particularly at risk in the workplace. The middle-income group was at greatest risk for traffic injuries, probably due to the unsafe use of bicycles or motorbikes. About half of the population preferred to keep an out-of-pocket system and the other half preferred health insurance. People’s willingness to pay suggested that a community-based health insurance scheme would be feasible. However, improvements in the existing health insurance systems are imperative to attract people to participate in these or any alternative health insurance schemes, since the limitations of the existing systems were generalized to health insurance as a whole. A successful solution should follow two tracks: prepayment of health care and some insurance based compensation of income losses during the illness period. If the risk of catastrophic illness is more evenly spread across the society, it would increase the general welfare even if no more resources are provided.

The main objective of this epidemiological study was to assess the incidence of unintentional non-fatal injuries, together with their determinants and consequences, in a defined Vietnamese population, thus providing a basis for future prevention. A one-year follow-up survey involved four quarterly cross-sectional household injury interviews during 2000. This cohort study was based within a demographic surveillance site in Bavi district, northern Vietnam, which provides detailed, longitudinal information in a continuous and systematic way. Findings relate to three phases of the injury process: before, during and after injury. The study showed that unintentional non-fatal injuries were an important health problem in rural Vietnam. The high incidence rate of 89/1000 pyar reflected almost one tenth of the population being injured every year. Home injuries were found to be most common, often due to a lack of proper kitchens and dangerous surroundings in the home. Road traffic injuries were less common but tended to be more severe, with longer periods of disability and higher unit costs compared with other types of injury. The leading mechanisms of injury were impacts with other objects, falls, cuts and crushing. Males had higher injury incidence rates than females except among the elderly. Elderly females were often injured due to falls in the home. Being male or elderly were significant risk factors for injury. Poverty was a risk factor for injuries in general and specifically for home and work related injuries, but not for road traffic injuries. The middle income group was at higher risk of traffic injuries, possibly due to their greater mobility. Injuries not only affected people’s health, but were also a great financial burden. The cost of an injury, on average, corresponded to approximately 1.3 months of earned income, increasing to 7 months for a severe injury. Ninety percent of the economic burden of injury fell on households, only 8% on government and 2% on health insurance agencies. Self-treatment was the most common way of treating injuries (51.7%), even in some cases of severe injury. There was a low rate of use of public health services (23.2%) among injury patients, similar to private healthcare (22.4%). High cost, long distances, residence in mountains, being female and coming from ethnic minorities were barriers for seeking health services. People with health insurance sought care more, but the coverage of health insurance was very low. Some prevention strategies might include education and raising awareness about the possible dangers of injury and the importance of seeking appropriate care following injury. To avoid household hazards, several strategies could be used: better light in the evening, making gravel paths around the house, clearing moss to avoid slipping, wearing protective clothing when using electrical equipment and improving kitchens. Similarly, improving road surfaces, having separate paths for pedestrians and cyclists and better driver training could reduce road accidents. In Vietnam, and especially in a rural district without any injury register system, a community-based survey of unintentional injuries has been shown to be a feasible approach to injury assessment. It gave more complete results than could have been obtained from facility-based studies and led to the definition of possible prevention strategies.

Adolescent participants (N=170) completed questionnaires assessing individual characteristics (gender, age, Sensation Seeking, Aggression/Oppositionality, Impulsivity) and characteristics of the neighbourhoods in which they live (Neighbourhood social cohesion/informal social control of youth). Postal codes as reported by the youth were linked to 2006 Canadian census data in order to determine area-level Socioeconomic Status (SES) for each adolescent. Data regarding adolescents’ individual traits and characteristics of the neighbourhoods in which they live were examined both as main effects and in individual by neighbourhood interactions as predictors of adolescents’ risk of injury. Individual traits predicted injury risk, however, neighbourhood social processes and SES did not predict adolescent injury risk when examined as main effects, whether included alone or together with individual characteristics. Neighbourhood social processes and Neighbourhood SES each moderated the relation between certain individual traits and injury risk. The value of examining individual-context interactions in injury risk research is discussed.

Unintentional injuries are the leading cause of death and disability for youth under 20, and motor vehicle collisions are the leading cause of death in youth aged 15-19 (World Health Organization, 2010). Research has consistently shown that driver education programs do not result in safer youth driving. Indeed, the biggest predictor of collisions involving youth is parental history of collisions. This dissertation comprised two studies – one to develop a measure of risky driving and one that examined the influence of parents on youth risky driving. Participants (N = 432) for both studies were undergraduate students aged 17 to 22 who had obtained their G2 driver’s licence in the past year. In Study 1, exploratory and confirmatory factor analyses of the new Youth Domains of Risky Driving Scale revealed a four-factor solution consisting of aggressive, substance use, distracted, and moving violation subscales. In Study 2, this new measure was used to evaluate relations between parental modeling of risky driving behaviours, parental teaching about safe driving behaviours, and youth risky driving. Results revealed that parental modeling was generally more predictive of youth risk than parental teaching, for all four subtypes of driving behaviours examined. Youth whose parents modeled risky driving behaviour were more likely be willing to drive in a risky manner, to expect that they would do so in the future, and to report a history of risky driving in the past. Findings from this study highlight the role parents play in the development of youth risky driving. Implications for future interventions targeting parent driving behaviour in the early months of youth licensure are discussed. / Canadian Institutes of Health Research

The main purpose of this study is to investigate the unintentional learning that happens during the use of computer games. With the use of interviews with students in the ages 13-15 who all have played the game series Assassin’s Creed, and then compared them with students who does not play the game, we have been able to identify that some learning is taking place, but that the student’s attitude towards the subject, and their maturity, also is vital for the learning. Even tough, the students who didn’t really enjoy history as a subject showed better knowledge after playing the game, than the students who hadn’t played at all, which indicates that computer games can be a good source for learning. Another purpose was to investigate the students’ attitude towards using computer games in their education. Interestingly all the students we interviewed, even those who are not interested in computer games were positive to the use of computer games in some form in their education, either themselves playing, or the teacher using it as a form of interactive media to show a certain event or person. Our conclusion shows that computer games are a good source of learning, and the use of computer games as a pedagogic tool in the education definitely should be a subject for further research.

This mixed methods study examines how teachers and administrators react when the school is under the stress of an accountability system. In this study, teacher job satisfaction and school climate are measured as these often overlooked variables have a great impact on student academic achievement (Goddard, Sweetland, & Hoy, 2000). Accountability systems such as No Child Left Behind need to be explored for negative unintended consequences such as the lowering of teacher job satisfaction and school climate. Questionnaires, interviews, and observations are used to measure teachers’ job satisfaction and school climate of two high schools that have been on Tennessee’s High Priority List but have not yet experienced restructuring with alternative governance. This study uses sequential intermethod mixing with the qualitative component being the dominant portion. The quantitative data came from Lester’s (1987) TJSQ assessment of teacher job satisfaction and Hoy et al.’s (1991) OCDQ-RS assessment of school climate. In the two high schools, 148 teachers responded to both questionnaires. Qualitative data, in the form of interviews and observations, were obtained to further explore the results of the quantitative portion of the study. The researcher performed interviews with a purposive sampling of 30 teachers who had worked at the schools since placement onto the HPL. Although the two schools were demographically and academically very similar, they had very different levels of job satisfaction and school climate. The teachers at both schools had high confidence in their coworkers and took great pride in the cohesiveness of the faculty. Teachers in School A explained the levels of job satisfaction and school climate have lowered in result of the new principal’s controlling management style and the high pressure environment created through frequent teacher reprimands. The job satisfaction and school climate levels were significantly higher at School B, but teachers complained about non-instructional duties and blamed the school district’s supervisors for extra workload that distracted from their instructional duties.

abstract: In this study, I used critical, qualitative methods to explore how the material and symbolic dynamics of milk banking complicate expectations of organizing and (in)effective lactation. Guided by theories of alternative organizing, in/voluntary membership, the structuration of d/Discourse, and corporeal commodification, I conducted document analysis, fieldwork, and interviews with hospital and milk bank staff and maternal donors and recipients. Results trace the (her)story and protocols of the milk banking industry and examine the circumstances of donation and receipt; the d/Discourses of filth, suspicion, and inadequacy that circulate the lactating, maternal body; and the presence or resistance of commodification within each organization. Milk banking occurs when mothers provide excess breastmilk to parents with low supply or compromising medical conditions. “Milk banking” is used as an umbrella term for different ways of organizing donor milk; organizing evolved from wet-nursing to a continuum of in/formal markets. Formal markets include for-profit and non-profit milk banks that pasteurize and/or sterilize breastmilk for Neonatal Intensive Care Units. Informal markets involve self-organized exchanges online that are driven by monetary ads or donation. Both formal and informal markets elicit questions regarding flows of capital, labor, reproductive choice, and exploitation. However, current research resides in medicine, law, and popular press, so we know little about how milk banking happens in real time or how participation affects maternal identity. My analysis makes four contributions to organizational communication theory: (1) alternative organizing punctuates the construction of and conflicts between in/formal markets and shows why such theories should be represented as cyclical, rather than linear; (2) membership in milk banking is unintentional and distinct from in/voluntary membership; (3) the obscured organization is a necessary alternative to Scott’s (2013) hidden organizations; and (4) d/Discourses of “safety” are used to discipline and indict, not just represent operational differences. Social-rhetorical implications reveal how milk banking operates as an affective economy (Ahmed, 2004) and mark where privileges and inequalities are present in the absence of data; practical implications suggest consideration of policy changes. Methodologically, this study also offers insight into crystallization (Ellingson, 2009) and participant witnessing (Tracy, forthcoming) and challenges the hegemonic underpinnings of fieldwork. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2019

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