Browsing by Subject "Health"

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Advancing Equity in Accessibility and Travel Experiences: The Role of Gender and Identity
(Minnesota Department of Transportation, 2023-05) Song, Ying; Fan, Yingling; Zhang, Yaxuan; McDonnell, Ania
Gender can have a significant influence on people's behaviors and experiences. Hence, excluding gender diversity in transportation research and practices can result in biased or incomplete understandings of issues and perceptions about transportation and quality of life. This study examined whether and how gender, in a broader sense, can result in distinctly different activity-travel patterns and subjective well-being (SWB) outcomes using survey data. The study reviewed existing literature and found that gender was not binary meaning that some gender identities were not solely female or male. The literature also indicated a person's gender typically intersected with their other social identities such as race and family type and created unique needs and experiences. To address the complex nature of gender, the team collected new data using the Daynamica smartphone application and included specific questions concerning (1) participants' gender identities and attitudes toward gender roles, (2) their share of household-supporting tasks in 14-day travel diaries, and (3) their emotions during trips and activity participation. The team used 2021 Daynamica survey data and 2019 Travel Behavior Inventory data from the Metropolitan Council to extract activity-travel patterns before and after COVID-19. The team associated these patterns with participants' gender and other identities and SWB outcomes through visual explorations and statistical analysis. The findings suggested the importance of capturing the complex, intersectional nature of gender, confirmed the persistent existence of gender differences in transportation needs, experiences, and SWB outcomes in Minnesota, and supported continuous efforts and investments to advance gender equity in transportation.
Assessing the Economic Impact and Health Effects of Bicycling in Minnesota
(Minnesota Department of Transportation, 2016-12) Qian, Xinyi; Linscheid, Neil; Tuck, Brigid; Lindsey, Greg; Jessica, Schoner; Pereira, Mark; Berger, Aaron
This project estimated the economic impact of the bicycling industry and events in Minnesota, estimated bicycling infrastructure use across the state, and assessed the health effects of bicycling in the Twin Cities metropolitan area (TCMA). A survey of bicycling-related manufacturers, wholesalers, retailers, non-profit and advocacy groups found the industry produced a total of $779.9 million of economic activity in 2014. Using data from multiple sources, the number of bicycle trips in Minnesota was estimated to be between 75.2 and 96 million annually. The TCMA accounts for 69%-72% of the total number of trips and miles traveled in Minnesota. Bicycling events, including races, non-race rides, fundraising events, mountain bicycling events, high school races, and bicycle tours, produced a total of $14.3 million of economic activity in 2014. All six types of bicycling events mainly attract white, non-Hispanic male participants. “Riding my bicycle” was the most frequently identified reason to attend an event (except for fundraising event participants), and there is a variety of enjoyable attributes that differed across event types. Overall, respondents were satisfied with the events. Bicycle commuting prevents 12 to 61 deaths per year, saving $100 million to $500 million. Bicycle commuting three times per week is also linked to 46% lower odds of metabolic syndrome, 32% lower odds of obesity, and 28% lower odds of hypertension, all of which lower medical costs. Project findings tell a compelling story for the positive effects of bicycling and provide direct evidence that supports the efforts of promoting bicycling-related industry, infrastructure, events, and activities.
Associations Between Nutrition, Gut Microbial Communities, and Health in Nonhuman Primates
(2015-12) Clayton, Jonathan
The primate gastrointestinal (GI) tract is home to trillions of bacteria that play major roles in digestion and metabolism, immune system development, and pathogen resistance, among other important aspects of host health and behavior. In 2009, the Human Microbiome Project was established with the goal of better understanding the role microbial communities play in health and disease. While the research community has made substantial progress in understanding the role microbial communities play in human health and disease, much less attention has been given to host-associated microbiomes in nonhuman primates (NHPs). My research is focused on developing a better understanding of the link between primate microbial communities and the establishment and maintenance of health. I have begun exploring host-associated microbiomes in NHPs, including red-shanked doucs (Pygathrix nemaeus) and mantled howling monkeys (Alouatta palliata), among other species. Some primate species, such as the red-shanked douc, fail to thrive in captivity due to health issues (e.g., gastrointestinal disease). Maintenance of many primate species in captive settings is hindered by critical gaps in our understanding of their natural diet and the enteric microbial adaptations that facilitate the digestive process. By comparing wild and captive animals within the same species, I hope to determine whether shifts in gut microbiota are linked with health in captivity. Microbes can act as indicators for health of the host, thus broad primate microbiome surveys may allow for the development of predictive biomarkers to improve nonhuman primate health and management.
Beyond The Sum Score: A Multidimensional Examination Of Allostatic Load Using Principal Component Analysis And Latent Profile Analysis In Previously Institutionalized Youth
(2023-09) Zhong, Danruo
Allostatic Load (AL), the stress-related physiological toll on the body, has been significantly associated with long-term health in humans. In this dissertation study, I examined the impact of early institution care on allostatic load in adolescents, using 13 biomarker data collected from 97 previously institutionalized youth who were adopted internationally from orphanage-liked institutions (PI; 61 females and 36 males; age range 12.02 to 21.39 years; Mean age = 16.31, SD age= 2.4 years) and 96 youth born and raised by birth families (Non-adopted, NA; 50 females and 46 males; age range 12.11 to 21.82 years; Mean age = 15.24, SD age= 2.35 years). Three distinct statistical approaches, namely, the Group Allostatic Load Index (GALI), the Principal Component Analysis (PCA), and the Latent Profile Analysis (LPA) were used to characterize the allostatic load. ANCOVA, Structural Equation Modeling (SEM), and multinomial logistic regression were utilized to examine how AL was associated with the experience of early institutional care. Our findings revealed a significant association between early institutional care and elevated allostatic load in adolescents. The sex difference was also found, such that males were more vulnerable to elevated AL levels than females. Moreover, age was positively associated with allostatic load. Furthermore, the construct of AL transcended beyond a single sum score, as evidenced by the detected multi-dimensions of AL and various underlying AL profiles among the studied individuals. Finally, three methods in the present study each offered unique perspectives that collectively enriched our understanding of AL. Taken together, this dissertation study underlined early health risks in youths who experienced early institutional care, highlighting the need for early, targeted, and personalized intervention programs for the ELS-impacted, at-risk population.
Bordered Resistance: Immigrant Health Justice, Biocitizenship, and the Racialized Criminalization of Health Care
(2019-06) Hoekstra, Erin
Bridging critical health and migration studies, this dissertation examines the health effects of racialized processes of immigrant criminalization, focusing on the organizations that provide medical care in an informal, often underground, health system. Governed by a "biopolitics of disposability" (Giroux 2006), immigrant ineligibility for health care contributes to undocumented migrants' experience as distinctly vulnerable, exploitable, and ultimately disposable. Whereas health institutions are usually figured as solutions to the violence embodied in unequal health outcomes, this dissertation argues that spaces of health are also perpetrators of structural violence. Clinics operate as de facto border checkpoints, leaving migrant patients susceptible to deportation for accessing emergency medical services. In the face of the violence of the mainstream health system, a network of humanitarian organizations provide health care to uninsured, undocumented migrants, while resisting the collusion between health and immigration enforcement. In contrast to medical humanitarianism's focus on constructions of migrant "deservingness," this dissertation argues that the concept of biocitizenship, a medicalized belonging based on common humanity, transcends dichotomies of deserving and undeserving, "good" or "bad" migrants. Biocitizenship also critiques the disentitlement and dehumanization of a biopolitics of disposability. Drawing from twelve months of ethnographic fieldwork with free clinics and humanitarian organizations across Arizona, this dissertation examines immigrant health justice (IHJ) organizations' use of humanitarianism as both a discursive strategy and a field of action. In the borderlands, IHJ organizations frame their politically-contentious work as apolitical medical care and fight for the recognition of the patient status of migrants in need of emergency first aid. In the interior, the IHJ turns its critique toward "health" itself. Employing a rights-based humanitarian discourse, activists castigate the for-profit health system as complicit with immigration enforcement, indicting it for mass structural violence. Centrally, this dissertation argues that these related but distinct discourses across the borderlands and interior amount to an insurgent humanitarianism that exposes the fatal consequences of immigrant criminalization. By claiming various biocitizenships on behalf of their patients, IHJ organizations and activists use medicalized language as the basis of a politics of visibility, highlighting the health needs and fatalities of migrants across the country.
Broadening the Perspective on Health and Youth Development
(2000) Sigler Andrews, Nikki; Russell, Stephen
Cervical cancer screening behavior of Hmong women: a social network analysis
(2012-09) Shweta, Shweta
This study examined the relationship between health and cervical cancer networks of Hmong American women and their cervical cancer screening practices. Incidence of cervical cancer and cervical cancer mortality rates are high for Hmong American women (Mills, Yang & Riordan, 2005; Ross, Xie, Kiffmeyer, Bushhouse & Robinson, 2003). Cervical cancer mortality rates for Hmong American women are three times higher than Asian American and Pacific Islander women and four times higher than non-Hispanic White women (Yang, Mills & Riordan, 2005). Despite high cancer related mortality rates, the utilization of cervical cancer screening is low (Yang, Mills & Dodge, 2006). Regular screening is important as it helps to detect cancer early when the treatment is most effective (Tanne, 2012). Barriers to cancer screening in the Hmong community include a lack of education, low income, cultural beliefs, language, traditional health practices, and mistrust of the Western health system (Lee & Vang, 2010). Hmong people value social cohesion and community living and often consult community members for making health related decisions (Barrett et. al., 1998). Using network analysis and logistic regression, this study explored the relationship between specific characteristics of the cervical cancer network and cervical cancer screening practices of Hmong American women. The health networks of study participants included all friends, family, health care providers, or co-workers with whom they had discussed their health in the last one year. Likewise, cervical cancer networks included everyone with whom the study participants had discussed cervical cancer in the last one year. Analysis found that Hmong American women who had a cervical cancer network were more likely to be aware of pap tests, receive pap tests and be aware of human papillomavirus (HPV) vaccines than Hmong American women who did not have a cervical cancer network. Having a cervical cancer network was not significantly associated with receiving HPV vaccines or Hmong American woman's perceived need for cancer screening. When controlled for demographic variables, a cervical cancer network was not found to be a significant predictor of cancer screening practices. With regard to characteristics of members within the cervical cancer network, education was found to be significantly associated with the awareness of HPV vaccines. Analysis also found that income, number of years in the United States and ability to speak English were significant predictors of Hmong American women having a cervical cancer network. Further, income, education, and having a regular health care provider were also significantly associated with cervical cancer screening practices of Hmong American women. It is important that practitioners and policy makers use social networks as a resource to improve the utilization of screening services. Programs for encouraging screening should target clients and their networks. For developing culturally appropriate screening programs, policy makers should consult local leaders. Programs developed in consultation with community may be efficacious in convincing Hmong American women to utilize services regularly (Lee & Vang, 2010).
Child nutritional well-being in Ghana: an analysis of associated individual, household, and contextual health indicators and socioeconomic and biophysical environmental variables.
(2011-08) Nikoi, Ebenezer Goodman Ashie
Depriving children of the nutrients needed for growth sets them up to fail in life. When children are well nourished and cared for, they are more likely to survive, thrive, and to meaningfully contribute to society. This study assesses the association of characteristics of individual children under age five in Ghana, their mothers, and their households—as well as socioeconomic and environmental characteristics of the places where they live—with differential nutritional well-being. What distinguishes this study from most research on young children’s nutritional status in the Global South is its analysis of data for individual children, made possible by use of Demographic and Health Surveys (DHS), and assignation of district variables that capture characteristics of their places of residence to individual children as cases. This enables assessment of the relative explanatory role of variables that describe the socioeconomic and biophysical environments. This study implements a three-level multivariate logistic regression analysis with separate models for each of the nutritional outcome variables—height-for-age, weightfor- age and hemoglobin—at each level. Descriptive statistics summarize the prevalence of stunting, underweight, and hemoglobin and delineate frequencies and proportions for selected independent variables at each level. Further statistical analysis relies on chisquared (χ2) tests to determine significant bivariate associations. All significantly associated variables in the bivariate analysis are subjected to binary logistic regression analysis. The results of fixed effects are reported with odds ratios (ORs) along with confidence intervals for p<.05. The following variables were found to be significantly associated with at least one of the three nutritional outcomes in multivariate analyses at the child and district levels: child’s age, months of breastfeeding, fever, mother’s health status, prenatal care, mother’s occupation, mother’s ethnicity, household water supply, household wealth status, population density, percent literate (vs. illiterate) in district, percent in rural (vs. urban) locations, wealth status of district residents, and ecological zone of residence. As found in much previous research, mother’s education and occupation, father’s education and occupation, household size and structure, and sanitation were significantly associated with children’s nutritional status in bivariate analysis but not in multivariate analysis. After controlling for the characteristics of children, mothers and households, significant associastions with children’s nutritional status were found for population density, percentage of literate (vs. illiterate) residents in a district, wealth status of district residents, and residence in the Guinea Forest-Savanna Mosaic and Central African Mangrove ecological zones. Other significantly associated variables in the final models were the age of the child, months of breastfeeding, whether the child’s mother has health insurance and the wealth status of a child’s household. Notwithstanding the shortcomings of this study, its findings can potentially assist stakeholders by providing a better understanding of the diverse set of factors that influence children’s nutritional status and some explanation for differences in nutritional status among places within Ghana.
Computational Sleep Science: Machine Learning for the Detection, Diagnosis, and Treatment of Sleep Problems from Wearable Device Data
(2017-12) Sathyanarayana, Aarti
This thesis is motivated by the rapid increase in global life expectancy without the respective improvements in quality of life. I propose several novel machine learning and data mining methodologies for approaching a paramount component of quality of life, the translational science field of sleep research. Inadequate sleep negatively affects both mental and physical well-being, and exacerbates many non-communicable health problems such as diabetes, depression, cancer and obesity. Taking advantage of the ubiquitous adoption of wearable devices, I create algorithmic solutions to analyse sensor data. The goal is to improve the quality of life of wearable device users, as well as provide clinical insights and tools for sleep researchers and care-providers. Chapter 1 is the introduction. This section substantiates the timely relevance of sleep research for today's society, and its contribution towards improved global health. It covers the history of sleep science technology and identifies core computing challenges in the field. The scope of the thesis is established and an approach is articulated. Useful definitions, sleep domain terminology, and some pre-processing steps are defined. Lastly, an outline for the remainder of the thesis is included. Chapter 2 dives into my proposed methodology for widespread screening of sleep disorders. It surveys results from the application of several statistical and data mining methods. It also introduces my novel deep learning architecture optimized for the unique dimensionality and nature of wearable device data. Chapter 3 focuses on the diagnosis stage of the sleep science process. I introduce a human activity recognition algorithm called RAHAR, Robust Automated Human Activity Recognition. This algorithm is unique in a number of ways, including its objective of annotating a behavioural time series with exertion levels rather than activity type. Chapter 4 focuses on the last step of the sleep science process, therapy. I define a pipeline to identify \textit{behavioural recipes}. These \textit{recipes} are the target behaviour that a user should complete in order to have good quality sleep. This work provides the foundation for building out a dynamic real-time recommender system for wearable device users, or a clinically administered cognitive behavioural therapy program. Chapter 5 summarizes the impact of this body of work, and takes a look into next steps. This chapter concludes my thesis.
Designing a Self-Determination Theory-Based App for a Wellness Behavior Change
(2020-06) Wicker, Olivia
Chronic diseases and mental health conditions are a costly and rising health concern. According to the Centers for Disease Control and Prevention (CDC), chronic diseases are rapidly growing and are currently the number one cause of death in America (Chronic Diseases in America). In addition, 19.2% of Americans suffer from a mental health illness, according to the National Alliance on Mental Health (“Mental Health By the Numbers | NAMI: National Alliance on Mental Illness”). Many of these diseases are related and can be linked to unhealthy personal behaviors, such as lack of physical activity and poor nutrition (Chronic Diseases in America;“WHO | 2. Background”). Improving these health behaviors could help lower and/or improve many physical and mental conditions. In the last decade, there has been an expansion in health and fitness apps, but that does not translate to improved health behaviors. One concern is there is a lack of regulation and theory implemented in them (Higgins; Herrmann and Kim; Ozdalga et al.). Few apps take the needed step to use behavior change strategies and building self-efficacy and instead only monitor behavior, provide information, and assist with goal setting (Direito et al.; Higgins; Herrmann and Kim; Sullivan and Lachman, Schoeppe et al.). Apps often offer incentive programs that do not show long-term results and are a source of extrinsic motivation (Herrmann and Kim). Rewards and extrinsic motivation can be helpful for starting a program or health change, but intrinsic motivation is needed for behavior maintenance (Pope and Harvey; Sardi et al.). Self-determination theory is a human behavior meta-theory that suggests people become self-determined by three innate needs: autonomy, relatedness, and competence (Ryan and Deci). Building an app around self-determination theory will better promote long-term health changes that the user will be intrinsically motivated to maintain. This thesis proposes a prototype app designed around self-determination theory. Both the user experience and the design of the user interface promote the theory. This is a design-based project intended to explore a way in which the app could be designed. With this approach, the app would have three levels, moving the user towards becoming intrinsically motivated. As the user advances levels, the app assists with and promotes the user’s autonomy, relatedness, and competence. The final level (and goal) of the app should have two effects on the user that work together: assist the user in developing intrinsic motivation to make healthy choices and to discourage reliance on the app to the point of potentially not needing it at all. This will create a long-term change for the user in multiple health and wellness behaviors, which will, in theory, lead to fewer health problems and chronic diseases and a longer, healthier life.
The Detroit Medical Center: Race and Renewal in the Motor City
(2019-05) Nickrand, Jessica
In 1956, the City of Detroit began plans for the Detroit Medical Center [DMC]—the largest urban renewal project in the nation. This hospital campus, motivated by leadership at four inner-city hospitals, sought to use public funding to raze the surrounding “blighted” neighborhood to attract private patients, thus providing a new industry for a city in economic decline. This strategy was ultimately unsuccessful and instead further contributed to both the city’s economic decline and the continued poor health of Detroit’s residents. This dissertation argues that the development of the DMC, which largely used federal funding for its completion, was built for the city planners and officials hoped for rather than for the city that existed. In doing so, planners and officials ignored pleas from activists and demographic trends, pouring money into a project that did not serve the community that utilized this institution. This, in turn, further taxed the city’s municipal hospital, Detroit Receiving, as the city continued to experience economic decline and the population of poor and indigent patients grew. Even as the violence of the Detroit Riots in 1967 highlighted both the extreme unease of Detroit’s black community and the central importance of adequate medical provision for Detroit’s most vulnerable populations, the city was ultimately unable, or unwilling, to prioritize the needs of its residents. This stigma associated with medical provision for Detroit’s indigent population even resulted in the continued failure of the individual hospitals of the DMC to merge into one integrated medical center, which external marketing consultants had deemed essential for the success of the DMC. Ultimately, the development of the DMC contributed to Detroit's economic decline. Rather than investing in its immediate community, DMC planners continued to make choices and spend money in attempts to court suburbanites and private patients. This resulted in continued financial strain on the city when these investments were not recuperated because most of the center’s patients and clientele always remained near the hospitals of the DMC–an area of concentrated poverty. By not investing in its community through the largely publicly-funded DMC, the city of Detroit did not ensure adequate health provision for its neediest residents. This contribution to the creation of a perpetually unhealthy, and poor, populace. A community must be healthy to work, to become educated, to be engaged consumers; the city of Detroit was not interested in making its residents healthier, and this is demonstrated by its actions during the development of the DMC. Because of this, the DMC never fulfilled its potential, and caused the city even further financial stress. In the end, this development is a symbol of what could have been but never was. As a study of the ways in which a struggling city attempted to use medical care as an engine of economic recovery, this dissertation provides a case study for historians interested in health and medicine in American urban cities and encourages planners and contemporary urbanists to consider the consequences of not providing adequate health provision to a city’s most vulnerable residents.
The discursive construction of complementary and Alternative Medicine (CAM) in women's popular health media and medical journals
(2014-01) Branson, Carolina
In this dissertation, I examine how CAM is discursively constructed in four major biomedical journals, The Journal of the American Medical Association, Nature, Science, and The New England Journal of Medicine, and three widely known women's popular health media sites, The Dr. Oz Show, Women's Health magazine, and Prevention magazine, and argue that risk is a major trope in the construction of CAM. In my analysis, I found that medical journals use risk discursively to circumscribe the extent to which CAM is accepted in the mainstream medical community and to reinforce institutional boundaries. In women's popular health media, I found that risk is used discursively to reinforce the importance of conventional beauty standards while also supporting CAM as a valid supplement to conventional medicine by emphasizing how using CAM may enhance or improve health. Finally, I argue that although medical journals use the risk of CAM to validate professional norms, and women's health media conflate health and appearance using CAM, women's popular health media also provide specific examples of resistance against both the construction of the riskiness of CAM by medical journals and the patriarchal discourses that inflect the popular media's coverage of CAM.
The economics of a new health technology: an evaluation of the impact of statins on lifestyle behaviors
(2012-04) Dehmer, Steven Patrick
Background: Heart disease has been the leading cause of death in the United States since 1921, and although death rates have declined since their peak in the 1960s, it remains a significant burden to the population's health. For most of the second half of the 20th century, changes in lifestyle--such as in diet and exercise--have been the most salient intervention to prevent cardiovascular disease. However, pharmaceutical interventions have gained significant traction in recent decades and may now be supplanting lifestyle change therapies. This study presents a theoretical framework for conceptualizing behavioral feedbacks from new medical technologies, and conducts an empirical case study to investigate whether the introduction of cholesterol-lowering statin drugs can be associated with changes in diet and exercise behavior. Although statins are highly effective in reducing cardiovascular disease risk, lifestyle improvements can garner significant health benefits in addition to lowering cholesterol. Methods: Grossman's model for the demand of health is applied to inform theoretical predictions on health behaviors with the introduction of a new medical technology such as statins. An extension incorporating uncertainty in one's own health status is introduced to motivate the demand for prevention. This extension also allows for the possibility that prevention screening services may send signals of varying quality to an individual regarding one's true health status. If a prescription for a statin sends a stronger informational signal than a high cholesterol diagnosis alone, this could lead to an association of statin use with improved health behaviors. An empirical investigation to test the theoretical predictions is conducted through a causal inference analysis of the introduction of statins on therapeutic lifestyle behaviors (i.e., improved diet and exercise). Longitudinal survey data on a panel of 8,000 individuals from 1995-1998 is linked with statin prescription (claims) data for analysis. Key to causal inference, the timing of this survey coincides with a rapid secular trends in statin adoption. This corresponds with considerable intrapersonal heterogeneity in observed treatment (i.e., statin use) and allows for multiple analytical strategies to account for potential endogeneity bias--namely, panel data and physician/clinic-based instrumental variable methods. To test the practical implications of behavioral changes associated with statin use, multiple simulations are conducted to estimate the economic and health impacts on a U.S.-representative birth cohort, as well as the surveyed cohort from which the empirical results are drawn. An evidence-based Markov microsimulation model is presented for the conduct of this simulation analysis. Results: Preliminary results show an effect that is ostensibly counter-intuitive: a new statin prescription tends to improve health behaviors. Physical activity, in particular, is shown to increase by as much as 30 to 50 percent with statin use. The available data limits inference to short-run impacts (i.e., within four years), but simulations are used to test a range of potential short- and long-term consequences. Short-run impact on health and costs is negligible; however, the predicted long-term impact of improved behaviors on health outcomes can reach 5 to 10 percent reductions in events. For most scenarios, predicted changes in costs are negligible, in part due to their general inverse relationship with longevity. Conclusions: When faced with a newly introduced technology, people are anticipated to respond to any altered incentives. However, if a new technology also serves as a conduit for improved health information, people should be expected to respond to that new information as well. With the introduction of statins, this study shows that a new prescription caused people to choose to exercise more. This result suggests that although both potential modes of action may be in effect, the response to new information may dominate--at least in the short-run. Further empirical and theoretical study will be needed to fully understand the long-term response to statins or similar "new" health technologies.
Effect of grouping strategy and stocking density on the behavior of prepartum dairy cows and the association between behavior and periparturient cow health
(2014-10) Luchterhand, Karen Marie
The transition dairy cow is one of the highest risk animals for falling ill or dying on the dairy farm. The objectives of this thesis were: Determine whether providing a stable pen management affected displacements from the feed bunk and feeding behavior of prepartum Jersey dairy cows; Examine the effects of prepartum stocking density on social, lying and feeding behavior of prepartum Jersey cows;Investigate the relationship between prepartum feeding times and periparturient health disorders, first test milk yield and milk composition in Jersey cows; Determine whether social dominance, determined by displacements from the feed bunk prepartum and 3 different methods, was associated with health, reproduction, and milk yield of transition Jersey cows; and Determine whether lying behavior was associated with postpartum health events up to 60 days in milk.
Enabling Neighborhood Health Research and Protecting Patient Privacy
(2021-08) Krzyzanowski, Brittany
Maps and spatial analysis offer a more comprehensive understanding of complex neighborhood health relationships, and yet there is a remarkable lack of maps within the literature on neighborhood health. Review of the literature confirmed that only a small proportion of articles on neighborhood health (28%) contained maps. Despite this, our subsequent survey showed that the majority (63%) of investigators created maps, worked with maps, or used mapping software to explore their data at some point during their study. Neighborhood health investigators are not neglecting to explore the spatial nature of their data, but rather, they are just not publishing the maps that they are using. One of the major barriers identified by our survey was privacy regulations, such as HIPAA law, which stood as a direct barrier for 14% of survey respondents who created maps but did not share them. Many researchers find core elements of the HIPAA privacy provision specific to map data ambiguous or difficult to understand, which is reflected in disagreement and uncertainty in research and policy circles on how to enact this provision. This dissertation provides a thorough examination of the safe harbor provision and elucidates the ambiguity within the law to encourage safe and effective sharing of mapped patient data. Moreover, many scholars and policy makers have challenged this rule, saying that it is possible to share finer-grained mapped health data without jeopardizing patient privacy. One promising strategy is regionalization, or zone design, which offers a way to build finer-grained geographical units in ways that integrate the HIPAA safe harbor requirements. This dissertation explores two existing regionalization methods (Max P Regions and REDCAP) and also introduces two novel variants of these approaches (MSOM and RSOM) which we compare and contrast in terms of fitness for analysis and display of protected health information. Each regionalization procedure has its own strengths and weaknesses, but REDCAP provides the best overall performance. In general, all of the regionalization procedures produced contiguous regions that result in a better resolution map than the current standard for sharing patient data and offer to help investigators work within the bounds of privacy provisions to share maps and spatial data.
Engaging Older Adults with Alzheimer's Disease in Exercise: Impact on Caregivers
(2022-05) Sims, Tai
In 2020, over 11 million informal caregivers cared for 6.5 million older adults with Alzheimer’s disease in America. By 2050 the number of older adults with Alzheimer’s disease is projected to double, which will demand the need for more informal caregivers. Family most often serve as informal caregivers. Informal caregiving is associated with increased burden, and poorer wellbeing and overall health. Interventions that target family caregivers of people with Alzheimer’s disease have shown minimal benefit on caregiver outcomes. Interventions that target people with Alzheimer’s disease, often neglect examining the intervention’s impact on family caregivers. In particular, exercise interventions have shown some promise in improving cognition and physical function of people with Alzheimer’s disease; however, little is known on how such interventions impact family caregivers. The purpose of this mixed methods study was to evaluate the impact of a 6 month, moderate intensity aerobic exercise intervention for community-dwelling older adults with Alzheimer’s disease on caregiver burden, wellbeing and general health. The study results were mixed across quantitative and qualitative data for caregiver burden and wellbeing. However, the findings suggest that improved caregiver burden and wellbeing may have been a consequence of perceived benefits of respite time and social support received by both study groups, rather than changes in care-recipients as a result of the exercise intervention. Both quantitative and qualitative data indicated the exercise intervention did not influence caregivers’ general health. This study provides some insight that integrating a family caregiver component into community-based exercise programs has the potential to benefit both people with Alzheimer’s disease and their family caregivers.
Enhancing Environment and Health in Transportation Project Design
(University of Minnesota Center for Transportation Studies, 2007-12) Carmody, John; Singh, Virajita
Good transportation design that enhances communities results in positive impacts on the natural environment--the air, water, soil, and biodiversity that are the life support systems for human society on earth. Design of outdoor and indoor environments can also positively influence human health. The issues related to environment and health fall under the concept of sustainability. This research includes a review of environmental assessment methods, rating systems and guidelines that are currently being used to transform sustainable building practices in the United States. In addition, there is an examination of case studies of exemplary transportation projects demonstrating the benefits of sustainable design approaches. The research includes case studies at three scales--large-scale development, buildings, and infrastructure--and identifies the lessons learned from these projects. While environmental sustainability issues are not new in transportation projects, there is a new and growing recognition that problems are more extensive and more urgent than previously recognized and that there must be a deeper understanding of the connection between planning, design, and construction decisions, as well as their resulting impacts. Transportation design can and should address regional and community scale ecological issues. Effective practices include applying an integrated design approach, making environmental outcomes explicit in the design process, and measuring performance outcomes during the life of the project. An emerging set of sustainable guidelines and standards can be effective tools for setting goals and organizing the design process for well-designed transportation projects.
Essays in Macroeconomics
(2024-05) Perez Perez, Luis
Over the course of the past five decades, several puzzling macroeconomic trends have caught the eye of economists and policymakers alike. The rise of market power, the decline of the labor share, and the decline of productivity growth are simply some prominent examples. Given their importance, much has been written and discussed about these topics, yet little is still known about their underlying causes. In addition to these phenomena, in recent years economists have turned their attention to the Covid-19 pandemic, grappling with understanding its economic ramifications and with formulating optimal policy interventions. My doctoral dissertation, titled "Essays in Macroeconomics," consists of four distinct yet interconnected chapters. These chapters delve into the topics outlined above, with Economic Growth and Public Finance serving as unifying themes. The first two chapters fall within the scope of Economic Growth, while the last two center on Public Finance. Methodologically, each chapter combines economic theory with empirical or quantitative analysis, if not both, to shed light on important macroeconomic questions.
Essays on child development in developing countries
(2013-08) Humpage, Sarah Davidson
This dissertation presents the results of three field experiments implemented to evaluate the effectiveness of strategies to improve the health or education of children in developing countries. In Guatemala, community health workers at randomly selected clinics were given patient tracking lists to improve their ability to remind parents when their children were due for a vaccine; this is found to significantly increase children's likelihood of having all recommended vaccines. This strategy is particularly effective for older children. In Peru, a teacher training program is found to have no effect on how frequently children use their computers through the One Laptop Per Child program. In Costa Rica, learning English as a foreign language using one software program is found to be significantly more effective than studying with a teacher, or with a different software program, confirming the heterogeneity of effects of educational technology.
Essays on Household Finance and Health Economics
(2024-04) Ascarza Mendoza, Diego
This dissertation consists of three chapters. The first chapter studies why two out of three Americans claim Social Security benefits before reaching their Full Retirement Age and why even sufficiently rich people often claim early. I resolve this puzzling phenomenon by extending a standard incomplete markets life-cycle model to incorporate health dynamics and bequest motives. Relative to the existing literature, health plays a broader role, affecting medical expenses and mortality and directly the marginal utility of consumption. This role of health is disciplined using microdata on consumption, assets, income, and health from the Health and Retirement Study (HRS) and the Consumption and Activities Mail Survey (CAMS). The calibrated model successfully replicates the fraction of early claimers. Counterfactual exercises show that health-dependent preferences and bequest motives are crucial for this result. The model's success is explained by a novel channel that comes from the interaction between the negative effect of worsening health on the marginal utility of consumption, the downward health trend because of aging, and bequest motives. These two elements reduce the gains from delaying by 1) making individuals more impatient and 2) increasing the strength of bequest motives relative to future consumption. The second chapter is joint work with Christian Velasquez and Walter Ruelas-Huanca. This chapter explores the dynamics of mental health over the life cycle and assesses how sensible it is to approximate health by only considering physical health. Using data from the Panel Study of Income Dynamics (PSID) and approximating mental health with the presence of depression symptoms, we document seven facts about the evolution of mental health and contrast them with physical health. The results show two striking differences between mental health and physical health. First, while physical health consistently deteriorates with age, depression incidence follows a U-shape. Second, the likelihood of full recovery from physical health deficits decreases with age and is lower than the one for mental health, which exhibits a flat pattern. Finally, we propose and estimate a parsimonious statistical model for mental health that replicates these facts and can be easily incorporated into life cycle models. The third chapter is joint work with Tomas Rose and James Schmitz. This chapter studies the welfare implications of granting access to a standard mortgage-type credit market for financing affordable, factory-built homes. First, we briefly describe the legal regulations that have allegedly precluded low- and middle-income households in the US from accessing regular mortgage credit lines to finance the purchase of factory-built homes. We further document the current status of the credit market in the manufactured homes segment and highlight the predominance of loans featuring higher interest rates, shorter maturity, and absence of tax deductions (since some of these loans do not qualify legally as mortgages). We build a simple, dynamic, life-cycle model of housing decisions to quantify the welfare gains from changing these regulations. Using data from IPUMS (US Census Bureau), the PSID, and several other available sources, we calibrate our model to match the current home-ownership distribution at the bottom half of the US income distribution. Even at our most conservative exercise, in which we only allow for tax deductions at the factory-built homes credit segment (without modifying either the interest rate or the time to maturity), we find significant welfare gains that are equivalent to, on average, a permanent real income transfer of 6%, or to a present discounted life-time real income transfer of 94%.

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