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Browsing by Subject "Socioeconomic Status"

Now showing 1 - 6 of 6
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    Chronic Kidney Disease: Evaluating Area Level Socioeconomic Characteristics, Individual Characteristics, and Patterns of Care by Census Tract in the Twin Cities Metro Area
    (2020-04) Ghazi, Lama
    Chronic kidney disease (CKD) is a major public health problem that affects 15% of the United States adult population. CKD is asymptomatic until advanced stages; therefore, diagnosis and treatment are usually delayed. CKD has been shown to be associated with low socioeconomic status (SES). Disadvantaged socioeconomic populations have a disproportionate burden of CKD and have contributed to the growing CKD epidemic. This dissertation characterizes the interplay between neighborhood characteristics and CKD using the Fairview Health Services electronic health record (EHR) database, a large health system in Minnesota that services the Twin Cities metro area and surrounding communities. For all manuscripts, we used census tracts as our geographical unit of analysis. Data for census tract was obtained from the American Community Survey 5-year data [2008-2012]. We linked each patients’ residence, obtained from their EHR data, to the appropriate census tract and tract characteristics. We defined a low and high SES tract as belonging to the first and fourth quartile, respectively of the distribution of each census tract SES measure in the metropolitan area. In the first manuscript, we evaluated whether adding neighborhood SES to current screening recommendations – patients with hypertension and/or diabetes - improves the sensitivity and/or specificity for detecting CKD. Overall, CKD was prevalent in 13% of our cohort (2008-2019). Additional screening of patients who live in low neighborhood SES improved our sensitivity but decreased our specificity to detect CKD compared to current screening recommendations. In the second manuscript, we examine: 1) if there is an independent association of neighborhood SES and individual insurance type with CKD prevalence and 2) association of neighborhood racial composition, a measure of racial segregation, with CKD prevalence. We observed that patients living in low vs. high SES neighborhood had higher CKD prevalence. Moreover, for patients <65 years being on Medicaid compared to other insurance was associated with higher CKD prevalence. We found no association between neighborhood racial composition (percent blacks in tracts) and CKD prevalence. The third manuscript explores whether neighborhood SES is associated with quality of care received by patients with CKD. Interestingly, we found that quality of care measures (prescribing appropriate medications, testing for proteinuria, or documenting CKD in patients’ charts) are not associated with neighborhood SES. However, overall adherence to CKD guidelines is low (for example, only 27% of patients with CKD had their proteinuria level evaluated). Overall, area SES contributes to CKD burden among patients seen at Fairview Health Services. In the future, health systems may want to consider a multifactorial approach, including neighborhood characteristics and a patient’s individual level SES, to improve detection and management of CKD.
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    Essays in Inequality and Gender in Developing Countries
    (2015-10) Lovaton Davila, Rodrigo
    This dissertation is comprised of three essays: two of which focus on the impacts of changes in maternity leave legislation on women's employment status and fertility, and the third concentrates on aggregation methods for the construction of asset-based proxy measures for household socioeconomic status in developing countries. In the first essay, I explore the effects of maternity leave on labor market outcomes in six countries in Latin America (Bolivia, Chile, Colombia, Ecuador, Peru, and Venezuela). The evidence shows that maternity leave has a positive effect on the labor force participation and unemployment-to-population ratio of women of childbearing age. In the second essay, I investigate the impact of maternity leave on fertility for the same set of six countries. Results suggest that maternity leave has small negative effects on higher order births for young adult women (18 and 30 years old), while it has small positive effects on fertility for older adult women (31 and 45 years old). If we consider these two effects, the evidence indicates that increases in maternity leave duration are associated to postponing some additional births. Finally, the third essay analyzes the performance of alternative methods to aggregate data for an asset-based wealth index using ordinal variables. Despite recommendations given by previous research, results suggest a relatively similar performance of principal components analysis on dichotomized data with respect to other methods that work with ordinal variables.
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    Examining Moderators of Response to Executive Function Reflection Training: Initial Skill and Socioeconomic Status
    (2016-06) Schubert, Erin
    The achievement gap between children of different socioeconomic status (SES) is a grand challenge for developmental psychologists. Fortunately, not all low SES children develop adverse outcomes. Research has identified executive function (EF) as an import-ant characteristic of resilient functioning. EF can be improved through a diverse array of training programs. Yet, these programs do not improve the EF of all participants. An understanding of which individuals benefit from EF training is essential to wide scale dissemination of empirically validated interventions. The objective of this research was to determine the characteristics of children who are most likely to benefit from EF training. Participating families (N = 134) were recruited from group childcare centers, representing a broad range of SES. Children were randomly assigned to a control or intervention group. Parents provided information on children’s demographic and socioeconomic characteristics. All children participated in individual pre- and post- sessions during which their EF and IQ were assessed with direct behavioral measures. Experimenters completed a report on child EF after each session. Between assessment sessions, children in the intervention group received two 10-15 minute sessions of EF reflection training. Children in the control group participated in two 10-15 minute sessions in which they practiced EF tasks but were not given training or feedback. Children in the intervention group as a whole demonstrated marginally significantly better EF performance at post-test than children in the control group. Further, children from lower SES families showed more improvement following the intervention than children from families with higher SES. Children’s initial EF was not a significant moderator of response to intervention while controlling for SES.
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    Socioeconomic Status and Social Capital Levels of Microcredit Program Participants in India
    (Hubert H Humphrey Institute of Public Affairs, 2009-05-29) Langer, Anna
    Poor households lack access to traditional financial services in many developing countries, even though they demand and could efficiently utilize such services. Without access to services such as credit or savings, poor households may not be able to take advantage of business opportunities or deal with large expenses (Littlefield and Rosenberg, 2004). Microcredit has received attention for being an innovative and effective development tool that may be able to solve this problem, compensating for low-income households’ lack of access to traditional financial services. Observers theorize that traditional financial institutions fail to serve low-income households more often than they fail to serve higher-income households because of poor households’ lack of collateral, country interest rate limits, and transaction costs facing banks associated with lending to low-income households (Armendariz and Morduch, 2007). While microcredit programs can do little to change institutional factors such as interest rate limits, they can affect a household’s access to collateral and the transaction costs associated with lending money. The main way in which they do this is through group-based lending. In group lending, collateral is gathered on a group basis, and groups are formed among individuals who know each other, lowering the transaction costs associated with gathering information about potential borrowers (Armendariz and Morduch, 2007: 89). Given microcredit’s aim to compensate for poor households’ lack of access to credit, what types of households utilize microcredit services in relation to others in their community? Are these the households that are likely to be failed by the traditional system? Scholars in the field have pondered these questions. As Khandker (1998: 7) writes, an important issue for research is “determining which poor and small borrowers actually participate in these programs.”
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    Socioeconomic status moderates the etiology of alcohol use
    (2013-05) Hamdi, Nayla Rashad
    This study examined whether socioeconomic status (SES), measured by household income and educational attainment, moderates genetic and environmental influences on alcohol use. We found that genetic effects were greater in low-SES conditions, while shared environmental effects (i.e., environmental effects that enhanced the similarity of twins from the same families) gained importance in high-SES conditions. This basic pattern of results was found for both income and education and replicated at a second wave of assessment spaced nine years after the first. Our findings indicate that the etiology of alcohol use varies as a function of the broader social context. Thus, efforts to find the causes underlying alcohol consumption are likely to be more successful if such contextual information is taken into account.
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    Student Experiences and Educational Outcomes of Southeast Asian Female Secondary School Students in the United States: A Critical Quantitative Intersectionality Analysis
    (2018-04) Jang, Sung Tae
    The purpose of this study is to examine the relationship between Southeast Asian female students’ multiple identities (race or ethnicity, gender, and socioeconomic class [SES]) and their schooling experiences and educational outcomes. It also seeks to identify school organizational characteristics that mediate the effects of the convergence of multiple marginalized identities on Southeast Asian female students’ experiences and educational outcomes. This study used restricted-use data from High School Longitudinal Studies 2009 provided by the National Center for Education Statistics, and employed multiple regression, logistic regression, and linear mixed effect modeling. Math achievement scores of Southeast Asian students were significantly higher than those of other race or ethnicity groups, except Other Asian/Pacific Islanders, regardless of gender. However, Southeast Asian females’ intention to pursue higher education was significantly lower than that of Southeast Asian males as well as being the lowest among all female students. Furthermore, the influence of SES on Southeast Asian female students’ math achievement scores was not statistically different from the average impact of SES on math achievement scores for all students. In terms of students’ schooling experiences, Southeast Asian female students are less likely to hold gender stereotypes regarding males’ superior math abilities than are other race or ethnic groups. In addition, Southeast Asian female students perceived a higher degree of positive interactions with math teachers (i.e., teacher’s expectation, teacher’s treatment in terms of respect, and teacher’s fairness). Focusing on math teachers’ teacher quality measures (i.e., years of teaching experience, a graduate degree), Southeast Asian students’ math teachers did not have significantly different teacher quality compared to that of their white counterparts. Finally, the effect of SES on the quality of interactions with math teachers was positive for Southeast Asian female students. This pattern was not unique to Southeast Asian high school girls; that is, higher SES had a similarly positive association on the quality of interactions with teachers for other race or ethnicity groups, except Hispanic students. This study also found that the school organizational characteristics used in this study did not mediate or differentiate the intersectionalities related to Southeast Asian female students. In other words, the patterns described above held regardless of schooling context. Although the model minority stereotype toward Asian students suggests that they are the most likely to pursue higher education, this study reveals the limits of the myth. It demonstrated that Southeast Asian females have the lowest intention (among females) to pursue higher education even though they had good schooling experiences, earned among the highest grades in high school, and did not consider boys to be better at math. The findings reveal a larger systemic failure to consider the specificities within the Asian population, which limits the provision of adequate support for Southeast Asian females to realize their full potential through their future academic careers. Implications for policy and leadership are discussed.