Social and Behavioral Sciences Commons^™

"The Land That Feminism Forgot": Birthzillas, Madwives, And The Politics Of Chilbirth, Amber Vayo

Doctoral Dissertations

“The Land that Feminism Forgot” is an in-depth exploration of the politics of childbirth that draws together qualitative and quantitative evidence to theorize the connections between treatment in childbirth and maternal mortality. Situating the qualitative research in the larger national context, the second chapter offers a State Reproductive Autonomy Index that provides an overview of the reproductive policy landscape at the national level. The dissertation then explores the role of institutionalized childbirth, medical mistrust, and obstetric violence in the U.S.’s longstanding maternal mortality crisis and offers policy suggestions in key public health areas. Through 120 qualitative interviews with people who …

Quality Of Life For Women With Chronic Lyme Disease: A Socioeconomic Investigation, Dale M. Jones

Doctoral Dissertations

This is a mixed methods investigation of how chronic Lyme disease, including Lyme-like diseases and co-infections, affects the quality of life of women who have chronic Lyme. Both quantitative and qualitative methods were used during three phases of research: a 91-question survey instrument followed by focus group discussions and written narratives. The research considered the socioeconomic impact on quality of life in five areas: obtaining a diagnosis, relationships and personal support systems, struggles with the medical system, the ability to work, and access to treatment. There were 500 responses to the survey, of which 373 were analyzed; 11 participants in …

Accelerometer-Determined Physical Behavior Metrics And Their Associations With Sarcopenia Among Oldest-Old Adults, Eric M. Eberl

Masters Theses

INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were assessed based …

Policing And Health: Police Encounters As A Fundamental Cause Of Racial Health Disparities, Richard S. Carbonaro

Doctoral Dissertations

Structural racism has taken many forms throughout American history and to this day continues to drive social, economic, and health inequalities. Mass incarceration is a modern tool of social marginalization with well documented and deep-rooted racial inequalities. Research has continually shown that mass incarceration negatively impacts the health of disadvantaged communities. Even police stops, the most common and mundane form of criminal justice contact has been linked with deleterious health outcomes at the individual and community level. In this dissertation, I identify specific social and biological mechanisms connecting encounters with the police and health outcomes. In the first chapter, I …

Evaluating Public Masking Mandates On Covid-19 Growth Rates In U.S. States, Angus K. Wong

Masters Theses

U.S. state governments have implemented numerous policies to help mitigate the spread of COVID-19. While there is strong biological evidence supporting the wearing of face masks or coverings in public spaces, the impact of public masking policies remains unclear. We aimed to evaluate how early versus delayed implementation of state-level public masking orders impacted subsequent COVID-19 growth rates. We defined “early” implementation as having a state-level mandate in place before September 1, 2020, the approximate start of the school-year. We defined COVID-19 growth rates as the relative increase in confirmed cases 7, 14, 21, 30, 45, 60-days after September 1. …

Hospital Assessment And Response To Environmental Pollution As A Population Health Need: Identifying Prevalence And Predictors In Community Benefit Practices, Sarah Valentine

Doctoral Dissertations

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community …

Cross-Cutting Narratives Of Opioid Use Disorder Among Pregnant Women And Mothers: Implications For Humanistic Care, Alice Fiddian-Green

Doctoral Dissertations

Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro-level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, …

Improving Chinese Mothers’ Health Literacy: A Wechat Intervention, Qiong Chen

Doctoral Dissertations

The health literacy and eHealth literacy of women during the reproductive age is crucial, as it can affect their health and the health of their children. Promoting health literacy is essential to achieve mothers’ empowerment by improving access to and capacity of using health information effectively. However, functional, interactive, and critical health literacy and eHealth literacy have never been assessed among Chinese women. The first study during this dissertation assessed functional, interactive, and critical health literacy and eHealth literacy among 421 of Chinese mothers with children under 3 years old. The results revealed overall less than optimal level of health …

Young Adult Early Childhood Home Visitors’ Perceptions Of Fan (Facilitating Attuned Interactions) And Its Potential Protection To Burnout, Lee Mackinnon

Doctoral Dissertations

ABSTRACT YOUNG ADULT EARLY CHILDHOOD HOME VISITORS’ PERCEPTIONS OF FAN (FACILITATING ATTUNED INTERACTIONS) AND ITS POTENTIAL PROTECTION TO BURNOUT FEBRUARY 2019 LEE MACKINNON, B.A., WILLIAMS COLLEGE Ed.M., HARVARD UNIVERSITY Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Claire E. Hamilton This qualitative study investigated the experience of young adult early childhood home visitors in the training and implementation of a family engagement tool, Facilitating Attuned Interactions (FAN) (Gilkerson, 2015). Using Interpretative Phenomenological Analysis, the case study explored how 5 home visitors, who were under 30 years of age, viewed their training and use of FAN in three components of their …

The Impact Of Ptsd And History Of Involvement In The Criminal Justice System On Medication Treatment Success In Opioid Use Disorder, Kirk Sanger

Doctoral Dissertations

This analysis examined the impact of post-traumatic stress disorder (PTSD), history of trauma, and a history of involvement in the criminal justice system (CJS) on treatment outcomes related to medication treatment for opioid use disorder. This study employed a secondary analysis of data derived from a multi-state, multi-site treatment center focused on substance abuse and more specifically opioid use disorder treatment. The total sample size was 19,970 patients. The majority of the sample received treatment in Massachusetts, was white, and non-Hispanic. Those with PTSD accounted for 9.5% of the sample, while 12% had a history of trauma. Just under 1/4 …

Organizational Factors Influencing Quality And Equity In Pediatric Primary Care: A Mixed Methods Study, Sarah L. Goff

Doctoral Dissertations

The research conducted for this dissertation broadly explored the relationship between characteristics of healthcare organizations and quality and equity in pediatric healthcare. The first of the three studies identified characteristics of pediatric practices with high scores on measures of quality and patient experience using qualitative methods. The second study assessed whether the candidate characteristics identified in the first study were quantitatively associated with performance on quality measures using a statewide survey and publicly available quality data. This study found several potentially modifiable factors associated with performance, including an organizational culture characterized by good communication and interpersonal relationships amongst providers and …

Maternal Postpartum Depression And Father Involvement Across The Transition To Parenthood, Katie Newkirk

Doctoral Dissertations

Maternal postpartum depression is a common complication of childbirth that affects the whole family. Fathers’ greater involvement in childcare can buffer children from the negative effects of mothers’ depression, and aid in mothers’ recovery, so it is important to understand under what conditions fathers become more or less involved when mothers are depressed. Prior research has supported both a compensation hypothesis, whereby fathers compensate for the effects of mothers’ depression on mothers’ parenting by being more involved in parenting, and a spillover hypothesis, whereby mothers’ negative emotionality causes fathers to pull back from family life and be less involved in …

Searching For The Fulcrum: Can Accountable Care Organizations Lower Spending By Balancing Specialists-To-Primary Care Providers?, Vishal Shetty

Masters Theses

Background:

While value-based payment models emphasizing care coordination have been widely implemented to improve quality and lower expenditures, supporting empirical evidence is sparse. Our objective was to quantify the impact of specialist-to-primary care physician involvement within accountable care organization (ACO) and its association with lower spending.

Methods:

We conducted a retrospective cohort study of Medicare Shared Savings Program ACOs from 2012-2016 using publicly available data provided by the Centers for Medicare and Medicaid Services at the ACO level. We examined the association between the proportion of primary care services delivered by specialists versus other types of care providers and ACO …

Labor Force Participation, Disability, And Implications For Healthcare Utilization And Employment, Lawrence C. Pellegrini

Doctoral Dissertations

The study period (i.e., 1999-2014) is characterized by declining labor force participation rates, rising disability enrollment, varying healthcare utilization, and increasing and changing composition of healthcare provider employment. However, little is known about the effect labor force participation and disability enrollment both have on the US healthcare system (i.e., healthcare utilization and employment). This dissertation is comprised of three manuscripts answering questions related to these relationships. Results show that labor force participation is a more robust indicator than the unemployment rate for exploring the effect of the labor market on healthcare spending and health outcomes, with healthcare spending itself exhibiting …

Distributing Condoms And "Hope": Race, Sex, And Science In Youth Sexual Health Promotion, Chris A. Barcelos

Doctoral Dissertations

This project uses discursive, visual, and ethnographic approaches situated in a critical feminist methodology to understand how ways of knowing about youth sexuality and reproduction influence community health work. I understand the “problem” in this inquiry as the discursive contexts that limit critical ways of knowing about young people’s sexual subjectivities and practices and about the design of policies and programs. Although race, class, gender, and sexuality are understood in the public health literature as important social determinants of health, there is a lack of research that applies a critical, feminist lens to these constructs. I draw on three years …

Transformative Learning Facilitated Dialogue: As A Tool For Social Change An Autoethnography, Leslie A. Saulsberry

Doctoral Dissertations

It is my goal, through this autoethnography, to take you through a reflective journey and present to you my personal theory of how facilitated dialogue in the context of transformative learning, critical reflection, systems thinking, shared vision, and holarchy can create a paradigm shift in our personal consciousness, decisions, behaviors, practice, and social policies—social change. My objective is to show how each theory is like a stepping-stone in the path towards social change. The purpose of this living work is to offer an alternative way of creating a healthy and whole society by exploring how facilitated dialogue can lead to …

A Comparative Sustainability Study For Treatment Of Domestic Wastewater: Conventional Concrete And Steel Technology Vs. Vegetated Sand Beds (Vsb’S) And Their Relative Differences In Co2 Production, Alicia M. Milch

Masters Theses

Conventional wastewater treatment in the U.S. is an energy dependent and carbon dioxide emitting process. Typical mechanical systems consume copious amounts of energy, which is most commonly produced from fossil fuel combustion that results in the production of CO₂. The associated organic load is also metabolized by microorganisms into CO₂ and H₂O. As the desire to reduce CO₂ output becomes more prominent, it is logical to assess the costs of conventional treatment methods and to compare them to alternative, more sustainable technology. Vegetated Sand Bed (VSB) and Reed Bed (RB) systems are green technologies …

Essays On Household Health Expenditures, National Health Insurance And Universal Access To Health Care In Ghana, Evelyn Kwakye

Doctoral Dissertations

Access to quality health services is essential for maintaining a healthy population and economic development hence the growing global consensus that universal health coverage is necessary. Ghana attempts to expand access by making basic health services free at the point of delivery through its National Health Insurance Scheme (NHIS). Prior studies indicate NHIS increases demand for health services, but questions remain about its impact on out of pocket payments, quality of services, and the financial viability of the program. Hence, this dissertation analyzes the financial risk in health care seeking, the effect of NHIS on out of pocket payments and …

Economics Of Fixed-Dose Combination Drugs Approved In The United States, Jing Hao

Doctoral Dissertations

Patent is the most important form of intellectual property protection for new drugs. Patent extension and market exclusivity currently serve as major regulatory incentives to promote new drugs. Combination drug, or fixed-dose combination (FDC) are formulations that contain two or more active ingredients in a single pill. FDCs, especially combinations of singe drugs that are already in the market, are common strategy for brand-name drug companies to extent the patent and exclusivity life. The substitution of single drug products that soon have generic alternatives with newer, brand-name combinations lead to potential increases in pharmaceutical expenditures and raises concerns on economic …

Examining Implementation Of The Massachusetts Act Relative To Safety Regulations For School Athletic Programs (Sessions Laws: Chapter 166 Of The Acts Of 2010): A Multiple-Case Study, Mitchell L. Doucette

Masters Theses

Background/Purpose: Reducing the incidence and negative consequences of concussion among youth athletes is a public health priority. Fifty states have adopted legislation addressing the problem of sports-related concussions among youth-athletes. In 2010, Massachusetts adopted legislation based on Washington State’s Lystedt Law, enacting state-wide requirements for high school athletic programs. This study explored how the legislation has been implemented within Massachusetts schools and school-districts and identified factors influential to local implementation.

Methods: A qualitative multiple-case study approach was utilized. US Census data concerning the household median income and population size of the school-district’s representative town(s) were used to purposively recruit cases. …

Parents' Gender Ideology And Gendered Behavior As Predictors Of Children's Gender-Role Attitudes: A Longitudinal Exploration, Hillary Paul Halpern

Masters Theses

This longitudinal study examined the association between parents’ early and concurrent gender ideology and gendered behaviors and their children’s gender-role attitudes at age six. Specifically, parents' global beliefs about women's and men's "rightful" roles in society, as well as their work preferences for mothers, were considered in relation to the gender-role attitudes held by their first-graders. In addition, parents’ gendered behaviors, including their division of household and childcare tasks, division of paid work hours, and job traditionality were examined as predictors of children’s gender-role attitudes. Based on previous research, it was hypothesized parents’ early and concurrent behavior and ideology would …

Conversations With The Community: An Ethnography Of Two Case Studies Highlighting Community-Research Partnerships In Springfield, Ma, Vanessa Martinez

Doctoral Dissertations

This dissertation is both qualitative and collaborative. It emphasizes the participant observation and ethnographic documentation of two community-researcher partnerships on community-level health interventions in Springfield, MA. Drawing upon critical theories and reflexive methods, I explore and analyze the process of building and sustaining researcher-community partnerships in an era of limited funding. Two Springfield, MA-based projects – one on healthy cooking/eating, and the other on contingency management – serve as case studies to provide a concrete picture of the complex relationships of researcher-community collaborations. I use ethnographic storytelling to provide a multi-dimensional look at two different community-research partnerships on health disparities …

Interpreting, Stephanie Jo Kent

Doctoral Dissertations

What do community interpreting for the Deaf in western societies, conference interpreting for the European Parliament, and language brokering in international management have in common? Academic research and professional training have historically emphasized the linguistic and cognitive challenges of interpreting, neglecting or ignoring the social aspects that structure communication. All forms of interpreting are inherently social; they involve relationships among at least three people and two languages. The contexts explored here, American Sign Language/English interpreting and spoken language interpreting within the European Parliament, show that simultaneous interpreting involves attitudes, norms and values about intercultural communication that overemphasize information and discount …

Understanding Health Issues Among Adolescent Females In A Northeast Province Of Afghanistan, Amina Davlatshoeva

Doctoral Dissertations

The purpose of this study is to develop a deeper understanding of the health issues facing adolescent females (ages 18-21) in rural, northeastern Afghanistan. Incorporating participant observations, in-depth interviews, and narrative inquiries, this study seeks to illustrate adolescent females’ perspectives on health issues. To achieve this goal, ten adolescent females were interviewed in rural, northeastern Afghanistan during 2010. The participants were between 18- and 21-years old. The one-on-one interviews were conducted in a multiple-response format and were structured around three research questions:

• How does a young female’s understanding of health issues shape her identity in northeastern Afghanistan?
• In what ways …