Browsing by Subject "Health"

Although people frequently pursue multiple goals simultaneously, these goals often conflict with each other. For instance, consumers may have both a healthy eating goal and a goal to have an enjoyable eating experience. In this dissertation, I focus on two sources of enjoyment in eating experiences that may conflict with healthy eating: consuming tasty food (Essay 1) and affiliating with indulging dining companions (Essay 2). In both essays, I examine solutions and strategies that decrease the conflict between healthy eating and these aspects of enjoyment in the eating experience, thereby enabling consumers to resolve such goal conflicts.

Essay 1 focuses on the well-established conflict between having healthy food and having tasty food and introduces a novel product offering (“vice-virtue bundles”) that can help consumers simultaneously address both health and taste goals. Through several experiments, I demonstrate that consumers often choose vice-virtue bundles with small proportions (¼) of vice and that they view such bundles as healthier than but equally tasty as bundles with larger vice proportions, indicating that “healthier” does not always have to equal “less tasty.”

Essay 2 focuses on a conflict between healthy eating and affiliation with indulging dining companions. The first set of experiments provides evidence of this conflict and examine why it arises (Studies 1 to 3). Based on this conflict’s origins, the second set of experiments tests strategies that consumers can use to decrease the conflict between healthy eating and affiliation with an indulging dining companion (Studies 4 and 5), such that they can make healthy food choices while still being liked by an indulging dining companion. Thus, Essay 2 broadens the existing picture of goals that conflict with the healthy eating goal and, together with Essay 1, identifies solutions to such goal conflicts.

Between 1890 and 1965, the ideology of government responsibility for maternal and child health represented a continuous and central goal that fueled programs and institutional networks of progressive and liberal social policy advocates. Beginning in the settlement houses of the 1890s, a cadre of female bureaucrats, social reformers, and their political allies developed an array of federally based programs. Conservative stakeholders--among them anti-feminists, representatives of the medical industry, anti-communists, and white supremacists--strenuously opposed this vision of health justice, arguing that health was a personal responsibility in which government should play no part. Despite the achievements of government-based progressive reformers in instituting their vision in urban settlement houses, under the Sheppard-Towner Act of the mid-1920s and during the years of the New Deal and World War II, the Cold War's approach to domestic social policy after 1947 clamped down on their vision. After this conservative turn against social democratic solutions to welfare needs, these progressive advocates shifted their attention to the international health rights movement and to community-based maternal and child health activities.

My dissertation introduces the concept of health justice as an interpretive lens to trace the history of health policy progressives and their institutional networks. On the one hand, health justice reflects the communitarian premise that the health of all members of society is essential for the common good. On the other hand, health justice implies that health and health care are individual rights that government ought to protect. While communitarian arguments were often on the tip of the tongues of social reformers, a passionate belief in citizenship-based rights and redistributive and humanitarian ideas of social justice undergirded their policy ideas and became a more explicitly stated position during the New Deal and World War II. This justice-based approach to maternal and child health policy was consistently undermined by the prevailing counter-ideologies of individual responsibility for health, local control of public services, racial segregation in health services, and the commodification of health care.

My work relies on primary evidence collected from the personal papers of key protagonists, the administrative records of the Children's Bureau housed at the National Archives, oral histories, and the presidential papers of Harry S. Truman. Published primary materials have been culled from memoirs, professional public health and medical journals, as well as the popular press. I also draw from a body of historical and political science scholarship of the past twenty-five years to contextualize the narrative.

Objectives: To compare measures of health and health quality between Orphans and Vulnerable Children (OVC) in different living arrangements-- institutional and community care; and to correlate different measures of OVC health and health quality using clinical, laboratory and quality of life instruments.

Design: Cross-sectional study.

Setting: Two rural districts (sites) in East Africa, Bungoma in Kenya, and Kilimanjaro in Tanzania.

Participants: 77 male and 45 female OVC aged 16-18 years (N=122). Participants, who had attained a minimum age of 16 at the date of interview, were selected from the larger sample of OVC in the Positive Outcomes for Orphans (POFO) study. POFO, a longitudinal study in five less wealthy countries that started in 2006, obtained its sample through cluster randomization.

Methods: To obtain self-ratings of OVC physical health, OVC responded to an interviewer administered SF-36 questionnaire, a multipurpose generic measure of health status. A neutral examiner then measured OVC physical health using 4 clinical variables: a physical health examination, body mass index, hemoglobin level, and the Harvard physical fitness score.

Main Outcome Measures: SF-36 scores presented as a two component score- the physical health and mental health composite sub-scores. For physical health, normal findings for age were considered as meeting the threshold for good physical health.

Results: Of the 122 OVC, 89 (73%) lived in the community while 33 (27%) lived in institutional settings. For the SF-36, the mean physical composite score for the entire study population was 50.6 (SD=6.2). Mean body mass index (BMI) was 19.3 (SD=2.4). Mean hemoglobin was found to be 13.2g/dl (SD=1.8). The average Harvard physical fitness score was found to be 40.7(SD=16.9). Pearson's correlations between SF-36 Physical Functioning and hemoglobin, BMI, and the Harvard Step-Test fitness score were 0.1, 0.1, and -0.1 respectively. There was no evidence that self-rating of OVC health outcomes differed by living arrangement. Using paired t-tests for continuous variables and chi-square tests for categorical variables, no significant p- values were obtained at the 95% level. Using a threshold of vision 20/20 for normal vision, 91.0% of community OVC and 78.8% of OVC in institutions had normal vision (p=0.07).

Conclusion: Although this study did not detect significant differences in self-reported measures of health among OVC in different living arrangements, physical examination revealed a slightly high incidence of poor vision among those living in institutions. In this sample, the correlations between SF-36 physical functioning sub-score and 3 physical health outcomes of BMI, hemoglobin, and the Harvard Step-test fitness score were weak.

In the context of today's global mobility, information, bodies and goods are circulating across the globe, and even further into outer space. However, we face a paradox: the more we move, the more we become sedentary. The modes of transportation that enable our global mobility are working against us, insidiously dwindling our psycho-physical mobility. Globalization is thus not the world becoming bigger (or too big), but the world becoming immobile. Taking the body as the central non-place of political space, Architectures of Aliveness: Building Beyond Gravity interrogates the possibility of inhabiting circulation as a pragmatic form of resistance to the contemporary immobilization of life. In an era in which bodies and goods are ever more constantly in global circulation, architectures of aliveness ask, what would an experience of weightlessness do for us?

Biotechnology serves as the current dominant model for enlivening architecture and the mobility of its inhabitants. Architectures of aliveness invert the inquiry to look instead at outer space's modules of inhabitation. In questioning the possibility of making circulation inhabitable --as opposed to only inhabiting what is stationary--architectures of aliveness problematize architecture as a form of biomedia production in order to examine its capacity to impact psychic and bodily modalities toward an intensification of health. Problematized synchretically within life's mental and physical polarization, health is understood politically as an accretion of our capacity for action instead of essentially as an optimization of the biological body. The inquiry emerges at the intersection of biotechnology, neurosciences, outer space science and technology, and architecture. The analysis oscillates between historical and contemporary case studies toward an articulation that concentrates on contemporary phenomena while maintaining an historical perspective. The methodology combines archival research, interviews, and artistic and literary analysis. The analysis is informed by scientific research. More precisely, the objective is to construct an innovative mode of thinking about the fields of exchangeability between arts and sciences beyond a critique of instrumentality.

The outcomes suggest that architectures of aliveness are architectures that invite modes of inhabitation that deviate from habitualized everyday spatial engagements. It also finds that the feeling of aliveness emerges out of the production of analog or continuous space where the body is in relation with space as opposed to be represented in it. The analysis concludes that the impact of architecture on our sense of wellbeing is conditioned by proprioceptive experiences that are at once between vision and movement and yet at the same time in neither mode, suggesting an aesthetic of inhabitation based on our sense of weightedness and weightlessness.

These outcomes are thus transduced to the field of media studies to enchant biomediatic inquiry. Proposing a renewed definition of biomedia that interprets life as a form of aesthetic relation, architectures of aliveness also formulate a critique of the contemporary imperialism of visualization techniques. Architectures of aliveness conclude by questioning the political implications of its own method to suggest opacity and agonistic spaces as the biomediatic forms of political space.

This paper discusses results from a study of the use of cleaner cooking solutions and general health status of people in rural areas from the Battambang province of Cambodia. Data collection included 372 demographic, health and socio-economic surveys with households living in 6 villages in the Samlout district, general health examinations, and measurements of stove use and household concentrations of PM 2.5. The data reveal that health in this population is a major concern, with a very high prevalence of reported abdominal pain, nausea, chronic cough, chest pains, and fever during examinations.  At the household level, we find that clean stove ownership is significantly correlated with the educational status of household head and socio-economic status of a household. Respondents from households with clean stoves appear less likely (though not statistically significantly so) to report household individuals having health problems such as occasional cough, high blood pressure and tuberculosis. Concentrations of PM2.5 are positively correlated with prevalence of occasional cough, high blood pressure and tuberculosis. Based on these results, we advise field testing and evaluation of targeted health interventions in these villages to address the numerous concerns of the local population, including exploring the potential role of clean stoves.

There is widespread evidence that health disparities between whites and blacks in the U.S. cannot be fully explained by inter-group socioeconomic differences. Further, research shows that racism plays a significant role in explaining racial health disparities. However, there is less research that attends to what psychosocial and socioeconomic resources may be protective of black middle-class health over time. My research starts to fill this gap by examining whether racial identity and childhood socioeconomic status are protective of black health over time.

In Chapter 2, I use data from the American Changing Lives Study (ACL) and examine whether a strong racial identity is a protective mechanism in the relationship between racism and two health outcomes: self-rated health and depressive symptoms. My findings suggest that whether racial identity is protective depends on the health outcome and the frequency of racism respondents experience. My results also indicate that middle-class is not consistently a protective factor for black health.

In Chapter 3, I use data from the National Survey of American Life (NSAL) and the ACL to investigate whether childhood socioeconomic status is associated with adult health for blacks, and particularly black women. I argue that relative childhood socioeconomic advantage is more important for disadvantaged race and race/gender groups. Further, using an intersectional approach, I argue that it is most important for black women. My findings indicate that the association of childhood socioeconomic status and adult health is significant for blacks, but not whites. I also find that childhood socioeconomic status is especially important for black women.

*Designated as an Exemplary Master's Project for 2014-15*

The essays in applied microeconomics contained within this dissertation examine prices in the developing economy contexts of Indonesia and the Philippines. Prices, observed and unobserved, are determined by and incentivize the behavior of all agents in the economy. Prices describe the interaction of individuals within a household and households within a market and reveal traits critical for development. Traits such as the efficiency of household resource allocations and the completeness of markets are analyzed in Central Java, Indonesia using a rich, longitudinal survey containing detailed price data used to estimate household demand systems. Unobserved, implicit prices of environmental goods are analyzed in the context of the Philippines. The valuation of environmental quality's implicit price is illustrated by comparing the health and human capital outcomes of the highly and least exposed. Exposure to environmental toxins can produce short and long-term damages to health and human capital reflecting undervaluation of the implicit price of environmental quality. The combined results of these essays on prices in development economics reveal allocation inefficiencies within the household and the economy and provide direction for development policy around the world.

This dissertation encompasses three essays that examine the extent to which parental loss and social programs affect the health, education and time allocation of children in developing countries.

The first chapter asks the question of whether early life public health interventions have lasting or long term impact on children's human capital development. In order to answer this question, this chapter investigates the long term impact of the safe motherhood program in Indonesia on later cognition and schooling outcomes of children when they are age 11 to 17 years. The paper further investigates this question by examining the impact of the program based on exposure that began during a particular year. The findings suggest that the safe motherhood program had an impact on adolescent cognition and schooling. In particular, the program impact is relatively large and significant for those children who began exposure to the program at age 2 or younger, or not yet conceived. These estimates are robust to a series of robustness and specification checks. The results are also in general consistent with the findings in biological literature that suggest the importance of the first two years of life in shaping outcomes later in life.

The second chapter examines the question of how parental loss or absence affects child well-being. While the strategy of many papers in the literature is to use parental death due to HIV/Aids to examine this question, this chapter uses the 2004 Indian Ocean tsunami as a plausibly exogenous source of variation in parental death. In addition, the paper uses a unique longitudinal dataset that has baseline information on the same sample of individuals interviewed after the tsunami. Also, given rich data, the paper is able to look at various dimensions of child well-being which include school attendance, post-secondary aspirations, time allocation as well as educational attainment and marriage decisions for older children. The paper provides an in-depth analysis by examining the impact of parental death by age and gender of the child as well as looking at the impact in the short term and longer term. The results suggest that death of both parents, which has been little explored in the literature, has a large, negative impact on the human capital accumulation of both males and females. The loss of father alone led older males (aged 15 to 17 at the time of tsunami) to acquire less education compared to same age males whose both parents survived, while no effect is found on younger males aged 9 to 14. Furthermore, the results suggest that maternal death has little impact on schooling outcomes but does affect time allocation of children.

Finally, the third chapter examines the impact of a unique bilateral grant-aid program which provided typhoon-resistant schools and instructional equipment to the Philippines. The results suggest that the presence of both the typhoon-resistant schools and instructional equipment programs had a positive impact on the educational attainment of both men and women. The availability of instructional equipment program alone also increased the educational attainment of men but it does not seem to have had substantive effect on women. On the other hand, the availability of typhoon-resistant schools without the instructional equipment package did not have any impact on schooling outcomes of either the males or females. Except for the falsification exercise which suggests that there could be other underlying trends which may not be fully captured by the specifications, the estimates are in general robust to the inclusion of individual level characteristics, accounting of other concurrent national government's programs, restricting to municipalities in the typhoon belt region and accounting for municipality-specific trends. The findings suggest the importance of not only expanding access to schooling through increased availability of schools or classrooms (particularly, those that are resistant to natural disasters) but also the importance of improving the quality of learning through the availability of school resources that aide in students' learning in developing countries.

Ecological factors and the policy environment are central constraints on population well-being. This dissertation emphasizes the role of shocks to help understand the nature of such constraints, and explores the relationship between population, environment, and development in greater detail than is typically possible.

Chapter 1 opens by contributing to a growing body of evidence around the impacts of old-age pensions on the well-being of pension recipients and their families. I draw from the unique disbursement structure of a popular, widely utilized benefits program in rural Brazil, and data from two nationally representative surveys conducted in 2013 by the Brazilian Institute of Geography and Statistics. I first employ regression discontinuity design to measure the direct effect of the program’s age threshold on pension take-up. Second, I compare differences in reports of health and well-being among age-eligible and age-ineligible adults in rural areas to the same differences among populations that generally do not qualify for the benefit (i.e., urban populations). This difference-in-differences shows robust evidence of a beneficial pension effect, though along somewhat different dimensions by gender. I then show evidence of two credible mechanisms for improved health and well-being: first, improved food security within households that have eligible pension recipients; second, the cohabitation of younger family members, potentially providing support to aging family members. Taken together, this chapter demonstrates that the rural benefits program in Brazil leads to tangible health benefits for its recipients, through channels that are likely to complement rather than crowd out other public services.

Chapter 2 moves on to explore how a massive natural disaster affected smoking behavior, a common coping mechanism. External stressors are commonly hypothesized to play a role in the adoption of certain health behaviors, but understanding the role of exposure is frequently hampered by research designs and data that are inadequate for tracing causality. I use this study to evaluate the relationship between unanticipated exposure to a natural disaster and smoking behaviors using longitudinal data collected from families in Aceh, Indonesia before and after the 2004 Indian Ocean tsunami. Exposure to the tsunami is measured as a community indicator of physical proximity to damage, and as individual indicators of personal experiences at the time of the tsunami. My analysis indicates that the effect of exposure on smoking uptake varies considerably by age, and that most forms of exposure increase smoking volume. These effects appear to be temporary, but even in the context of Indonesia’s extraordinarily high smoking rates an impact is perceptible even ten years after the tsunami.

Chapter 3 delves further into the effects of the tsunami, exploring the distribution of resources after the broad destruction of infrastructure and subsequent, fast-paced reconstruction. I evaluate multiple aspects of water access for roughly 6,000 families through 2014. Logit regression analysis show increasing disparities in access to basic amounts of water, and multinomial logit regression analysis indicates that shifts are driven by a massive increase in the market for privately distributed bottled water. This study disentangles key distributional processes to show how reconstruction influenced a central social determinant of health among an already vulnerable population.

The chapters to follow aim to relate the well-being of individuals to the influences that arise from interconnected policy choices and ecological factors. The first chapter emphasizes a policy shock, the second an ecological shock, and the second seeks to identify a combined effect of the two. This original research is intended to help illuminate the role that institutions might play in improving population well-being.

Adolescence is a period marked by tremendous social, emotional and physical changes; however, adolescents and young adults (AYAs) with intellectual disability (ID), who must navigate this period with limitations in intellectual and adaptive functioning, face additional difficulties. Much remains unknown about their health care transition (HCT) experiences and their health and well-being as they transition into adulthood; therefore, this study examined the HCT, health status, and functional outcomes of AYAs with ID.

This study incorporated both an individual and population approach to understand needs of AYAs with ID. First, within Chapter 1, a qualitative descriptive design study with semi-structured individual interviews with 16 parent participants was used. We utilized purposive sampling of parents with variation on race/ethnicity and AYA age, stage in transition, and condition; and we utilized content analysis. In Chapter 2, we developed a new method for identifying individuals with ID within large, population-level studies not targeted on ID. We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet criteria of ID. The Add Health ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations available within the Add Health database. Through this method, we identified 441 AYAs with ID. Lastly, in Chapter, a descriptive, correlative study utilized the Add Health database and Add Health Indicator to examine the health status and functional outcomes among 254 AYAs with ID.

Our study illuminates the need for (a) improved infrastructure to provide effective HCT and (b) partnerships to help integrate HCT support within other life course systems. Our results support the rationale for a noncategorical HCT-focused approach as well as a parent-peer, coach-facilitated intervention for bridging the gap between systems and meeting family needs. By examining the Add Health ID sample, we identified a decline in health status from adolescence to adulthood among the AYAs with ID, demonstrating that their transition to adulthood is a period during which prevention of obesity and interventions to improve health status should be targeted. The disability-, adolescent-, and family-related factors associated with health status and functional outcomes among AYAs with ID can inform further research, tailoring of interventions, and policies. Researchers can utilize the data-driven method we developed with commonly available data elements in nationally representative datasets to leverage existing rich data sets in order to identify individuals with ID. These data sets, including Add Health, hold significant potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.