Social Pathogenic Sources of Poor Community Health

University of Central Florida STARS Electronic Theses and Dissertations, 2004-2019 2007 Social Pathogenic Sources Of Poor Community Health Hayden Smith University of Central Florida Part of the Public Affairs, Public Policy and Public Administration Commons Find similar works at: https://stars.library.ucf.edu/etd University of Central Florida Libraries http://library.ucf.edu This Masters Thesis (Open Access) is brought to you for free and open access by STARS. It has been accepted for inclusion in Electronic Theses and Dissertations, 2004-2019 by an authorized administrator of STARS. For more information, please contact STARS@ucf.edu. STARS Citation Smith, Hayden, "Social Pathogenic Sources Of Poor Community Health" (2007). Electronic Theses and Dissertations, 2004-2019. 3355. https://stars.library.ucf.edu/etd/3355 SOCIAL PATHOGENIC SOURCES OF POOR COMMUNITY HEALTH by HAYDEN P. SMITH B.Ed. University of Wollongong, Australia, 1992 M.S. University of Central Florida, 2003 A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Public Affairs in the College of Health and Public Affairs at the University of Central Florida Orlando, Florida Spring Term 2007 Major Professor: Thomas T.H. Wan © 2007 Hayden P. Smith ii ABSTRACT The United States currently provides a health care system that is neither efficient nor equitable. Despite outspending the world on health care, over three-fourths of developed countries produce better health outcomes (Auerbach et al., 2000). Simultaneously, the “Ecological School of Thought” has documented the large impact that social, economic, and environmental circumstances play in health outcomes. Unfortunately, these ‘ecological” studies are frequently conducted without theoretical justification, and rely solely on a cross-sectional research design and a myriad of unrelated variables. This study represents an important step towards the development of a true theory of “ecology”. More specifically, we argue that the adversity associated with socio-economic disadvantage, social disorganization, and a lack of health care resources, leads to adverse health outcomes, represented by sentinel health events. This research employs both a cross-sectional (2000) and longitudinal designs (1990 – 2000) to assess the antecedents of sentinel health events in 309 United States counties. Structural Equation Modeling was the statistical technique employed in the study. Findings revealed that socioeconomic disadvantage remains a primary contributor to sentinel health. Indeed the economic growth between 1990 and 2000 was associated with increased rates of sentinel health events. Social disorganization was identified as a primary contributor to sentinel health events at a specific time point (2000), but was not significant over time (1990 -2000). Conversely, the inadequacy of health care resources was non-significant in the cross-sectional model (2000), but significant in the longitudinal model (1990 -2000). In both models, racial characteristics were fundamentally linked to ecological predictors of health iii We found support for the notion that sentinel health events would be reduced through economic equity and the development of healthy environments where community ties are reinforced. Less support is found for saturating given geographical areas with health care resources in order to reduce sentinel health events. Future research should be directed by the theoretical advancements made by this study. More specifically, future studies should examine independent cross-level effects, that is, through the inclusion of behavior variables as mediating factors for ecological constructs. iv I wish to express gratitude for the tremendous love and support extended by my parents, Neil and Patricia Smith. The enduring love of such great parents provides the key support to undertake such a project. Despite living in two separate continents, I know you are both with me everyday. This body of work is dedicated to my incredible wife, Rachel Vandergeest. It was your continued support, love, and compassion that facilitated this achievement. I am truly blessed to have you by my side and look forward to many more good years. I could not have done this without you. v ACKNOWLEDGMENTS A deep sense of gratitude and respect is extended to my mentor and friend, Dr. Thomas Wan. I first met Dr. Wan over four years ago when I assisted in setting up his computer; at the time I had no idea that with his direction words like “structural equation modeling” would enter my vernacular. Much has occurred in these four years. I have watched Dr. Wan develop an innovative and challenging program while still giving valuable time and guidance to give each student. Perhaps the greatest accolade I can offer Dr. Wan is my commitment to follow in his innovative footsteps. I would also like to take this opportunity to thank my entire committee: Dr. Myron Fottler, Dr. Brandon Applegate, and Dr. Jackie Zhang. Throughout the dissertation process, Dr. Fottler has offered the unique gift of deciphering pages of confused notes and turning them into logical thoughts. A great deal of professional and personal thanks is also extended to Dr. Applegate. Dr. Applegate devoted an incredible amount of time and energy into the multiple drafts of this document. You sir, have a bottle of Jameson’s and a game of cribbage coming your way. Although not on my committee I would also like to extend a note of gratitude to Dr. Lawrence Martin. Dr. Martin was a model of optimism and his sense of humor a breath of fresh air that usually arrived just when I needed it most. I also wish to express my deep appreciation to my friend and colleague, Alicia Sitren. Alicia’s wisdom and kindness acted as a safety net to me on multiple occasions. I look forward to future work with this exemplary scholar and friend. One final and very important acknowledgement goes to Ms. Margaret Mlachak, who was instrumental in so many aspects of my personal life. Knowing that someone like Margaret was in my corner was a tremendous benefit during the times of hard work. vi TABLE OF CONTENTS LIST OF FIGURES ........................................................................................................................ x LIST OF TABLES......................................................................................................................... xi LIST OF ACRONYMS/ABBREVIATIONS..............................................................................xiii CHAPTER ONE: INTRODUCTION............................................................................................. 1 Statement of the Problem............................................................................................................ 2 The Ecological School of Thought ............................................................................................. 3 Social Causation Theory............................................................................................................. 5 Research Questions..................................................................................................................... 6 New Contributions...................................................................................................................... 7 Structure of the Research............................................................................................................ 8 Definition of Terms................................................................................................................... 10 CHAPTER TWO: LITERATURE REVIEW............................................................................... 11 Historical Background .............................................................................................................. 11 The Endogenous Variable......................................................................................................... 14 Sentinel Health Events (SHE)............................................................................................... 15 The Exogenous Variables ......................................................................................................... 18 Socio-Economic Disadvantage ............................................................................................. 19 Social Disorganization.......................................................................................................... 41 Inadequacy of Health Care Resources .................................................................................. 56 Testable Hypotheses ................................................................................................................. 71 Summary................................................................................................................................... 71 Equity and Public Health .......................................................................................................... 72 vii CHAPTER THREE: RESEARCH DESIGN................................................................................ 74 Study Design............................................................................................................................. 74 Research Population.................................................................................................................. 74 Data Sources ............................................................................................................................. 77 Measurement

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