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Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.
Socioeconomic resources and adult mental health in Canada (2022)
Associations between socioeconomic factors and mental health have been widely documented. However, more research is needed to determine which socioeconomic resources matter, when they matter, and why they matter for mental health. In this dissertation, I use data from the Longitudinal and International Study of Adults, collected by Statistics Canada and linked to tax records from the Canada Revenue Agency, to investigate how the educational credentials and family incomes of survey respondents and their parents shape psychological distress in adulthood. In the first empirical chapter, using binary logistic regression and the Karlson-Holm-Breen decomposition technique, I find that the education and family incomes of survey respondents are joint and independent predictors of psychological distress. Subsequent analyses using fixed effects regression provide evidence that the association between education and psychological distress is causal in nature. In the second empirical chapter, I use negative binomial regression to find little to no evidence that intergenerational social reproduction impacts adult psychological distress, despite the presence of strong associations between parental and personal socioeconomic resources. In the third empirical chapter, I investigate whether socioeconomic resources in adulthood matter more for the mental health of people who experienced early life disadvantage (theory of resource substitution) or early life privilege (theory of resource multiplication). I find no evidence in support of either theory. In the fourth empirical chapter, I revisit Sorokin’s proposition that social mobility is detrimental to mental health. Using diagonal reference models, I find that downward educational mobility corresponds to greater levels of psychological distress, though the effects are weak and are observed only among men. Overall, the findings from these chapters indicate that temporally proximal rather than distal socioeconomic resources are most impactful for levels of distress of Canadian adults. Intergenerational social reproduction and social mobility do not appear to have a strong impact on distress, and parental resources do not appear to condition the effect of personal resources on distress. These findings suggest that socioeconomic inequalities in psychological distress are not as deeply rooted as they might be and can potentially be mitigated within a relatively short time frame with adequate policies and interventions.
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Rhythms and relations in transactional sex: Relating past, present, and future time dimensions to the practice of purchasing sexual services in Canada (2019)
This dissertation employs a mixed methods strategy consisting of layered multiple correspondence analyses and thematic analyses of open-ended content from 852 completed online surveys to investigate factors that shape the practices of people who pay for sexual services in Canada. It describes 12 substantively unique classifications of clients whose diverse experiences of the past, preferences for more or less intimate connections in the present, and perceptions of future risks associated with purchasing sexual services inform their safety practices and willingness to intervene when witnessing conflict. The discussion revisits three central debates in client research. First, it considers the idea of clients as perpetrators of violence and conflict, showing how lack of foresight catalyzes situational conflict and unsafe action, cognitive connections to the future shape safe practices and desire to support others in need, and future planning assures stability and regularity in transactions. Second, it considers the common position that most clients are sources of violence against service providers, arguing that some clients’ embodiment of past experiences provides a unique insider’s perspective that can mitigate violence and promote safety. Finally, it considers the role of stigma in influencing clients’ willingness to take action against victimization and conflict.
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Political regimes and health: competing explanations (2014)
Many studies find that democratic governance improves population health. However, few offer a rigorous conceptualization of democracy. Many studies may overestimate the contribution of democracy to population health by removing cases with missing data from their analyses. Some highlight the importance of a legacy of democracy for health, but utilize measures of ‘level’ or degree of democracy that may confound the impact of democracy with other qualities of political regimes. Finally, few studies test specific explanations for the putative health effects of democracy. To address these issues, I use annual time-series data spanning from 1960 through 2010 to investigate variations in population health by political regime type. A combination of data supplementation and multiple imputation facilitates production of a working dataset with virtually complete data for 168 nations. My analysis proceeds utilizing a common measure of the ‘level’ of democracy (the Polity IV scale), followed by the application of a more specific operationalization of democracy that assesses whether countries choose their leaders via free and fair elections. I determine whether democracy is associated with population health outcomes after which I test various competing explanations for how and why democracy ostensibly promotes health while ruling out likely confounders. I find that level of democracy correlates positively with life expectancy and negatively with infant mortality rates and crude mortality rates. However, the accumulation of Polity scores over time (‘democratic capital’) is relevant for infant mortality only, while the strength and legacy of regimes is associated with population health irrespective of regime type. Models using the binary measure of electoral democracy indicate that, on average, people living in democratic nations can expect 10.8 more years of life and have 57% less infant mortality and 21% less overall mortality. I identify several mechanisms that may link political democracy to population health, namely, systems of accountability that constrain the decision-making powers of elected leaders, the promotion of strong institutional frameworks through the distribution of freedoms to compete for political influence and the advancement of economic prosperity. Options for further investigating the influence of democracy on population health are discussed.
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Master's Student Supervision
Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.
Minimizing race through colourblind healthcare: examining Black women's experiences of medical racism during prenatal care (2022)
Racial disparities in maternal and infant health have long been understood through the lens of systemic racism, a critical structural determinant of health. Pregnant Black women experience racism within all social institutions, including healthcare, where their experiences have regularly been characterized by overt discrimination and outwardly hostile medical environments. However, contemporary manifestations of racism now also operate more inconspicuously, and little is known about how pregnant Black women experience more elusive forms of racism within the healthcare setting. This paper advances an understanding of medical racism by examining how it subtly manifests in Black women’s prenatal healthcare experiences. Drawing on interviews with Black women in Jamaica and Canada, I introduce the concept of ‘colourblind healthcare’ to explain how medical racism, which is often conceptualized as an overt phenomenon, is also a covert and structural one. Colourblind healthcare is a form of allegedly ‘race-neutral’ healthcare delivery that minimizes the significance of race within the healthcare setting. When healthcare providers refuse to recognize race, whiteness is usually their assumed norm. Accordingly, colourblind healthcare is characterized by 1) healthcare providers privileging biomedical approaches to healthcare delivery over race-conscious ones, and 2) healthcare providers dismissing and overlooking non-white health concerns. My findings show that Black women navigate this elusive form of medical racism by either minimizing or centring discussions around race within the prenatal healthcare context. This paper highlights how seemingly non-racial healthcare practices in fact perpetuate racism by providing Black women with lower-quality care and putting them at risk of harm.
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The intergenerational transmission of socioeconomic resources and adult self-rated health in China (2020)
Informed by Bourdieu and Passeron’s theory of reproduction, I utilize cross-sectional survey data from the 2015 Chinese General Social Survey to investigate whether and how parents utilize their socioeconomic resources to facilitate the acquisition of socioeconomic resources by their children that in turn affect the health of the adult children. I find that parental education, parental type of work unit and self-rated childhood social class but not parental membership in the Chinese Communist Party (CCP) manifest independent associations with the self-rated health of survey respondents and that the intergenerational pathways from parental socioeconomic resources to self-rated health differ for men and women. Specifically, much of the association between parental socioeconomic resources and respondent self-rated health is explained by educational attainment among women and by household income among men. I also uncover a son-preference intergenerational transmission process for men born after 1970, near the beginning of significant market transitions in China. This study illuminates the importance of the intergenerational transmission of multiple forms of capital in fostering the good health of Chinese adults. In particular, these findings suggest that wealthy and well-educated Chinese parents tend to invest their capitals in the educational trajectories of their female children and in fostering the household incomes of their male children, both of which ultimately translate into good self-rated health for their adult children. This research not only documents the effect of parental resource on self-rated health but also reveals that the relationship between the state and individuals, which reflects the social changes that have characterized contemporary China, is an important factor when it comes to an understanding the nature of socioeconomic inequalities in health in this national context.
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The stratification of attendance at cultural activities in Canada (2017)
Scholars have debated the relative applicability of homology and omnivorousness, two theories of cultural stratification, for explaining links between socioeconomic position and cultural repertoires. However, the discussion has mostly focused on musical tastes rather than attendance at cultural activities. Using data from the 2005 and 2010 Canadian General Social Survey on Time Use, I examine how measures of socioeconomic position predict attendance at twelve different kinds of cultural activities. I apply three analytical techniques to these datasets: (1) binary logistic regressions to investigate the socioeconomic bases of attendance at each cultural activity, (2) ordered logistic regressions to assess the nature of the relationship between socioeconomic position and omnivorous attendance, and (3) latent class analyses to inductively identify patterns of attendance and the socioeconomic bases thereof. Controlling for demographic factors, I find that education and income are both positively associated with attendance at each activity and with omnivorous cultural engagement. The latent class models reveal three distinct groups of attendees: highbrow omnivores, selective omnivores, and inactive people. Education and income predict membership in the two omnivorous groups, with stronger effects for highbrow omnivores. I confirm that omnivorousness is associated with cultural and economic elites but also reveal different gradations of omnivorousness, thus suggesting that the two theoretical frameworks are to a degree entangled with one another.
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Investigating the methodological applicability of intersectionality to physical activity and smoking in Canada (2013)
BACKGROUND: In Canada, substantial health inequities have been documented by income, education, gender, race, and sexuality. Researchers examining such inequities have typically employed ‘additive’ analyses where these variables are treated independently of one another. Some scholars have argued that the additive approach cannot fully illuminate health inequities by class, gender, race, and sexuality, calling for ‘multiplicative’ approaches inspired by intersectionality theory to replace additive approaches.PURPOSE: I investigate the applicability of intersectionality theory for explicating two health practices - physical exercise and smoking - using Canadian data. I predict that intersections of classism, patriarchy, racism, and heterosexism at macro levels of Canadian society affect the incidence of exercise and smoking at the individual level, in the case of physical exercise as a desirable pursuit which is facilitated by the privilege that accrues to multiple dominant-group identities and in the case of smoking as a coping mechanism for dealing with the oppressive stressors that accrue to multiple subordinate-group identities.METHODS: Informed by the theoretical underpinnings of current intersectional scholarship, I compare the ability of the additive and intersectional approaches to explicate these two health practices in Canada. Using nationally-representative data from the Canadian Community Health Survey Cycles 2.1 and 3.1 and binary logistic regression modelling, I examine and compare the main effects of class, race, gender, and sexuality (additivity) and then four-, three-, and two-way interaction effects between class, race, gender, and sexuality (multiplicativity) as predictors of physical activity and smoking.RESULTS: I find that results from the additive models are consistent with previous empirical research on physical activity and smoking. The interaction models produce statically significant three- and two-way interactions for physical activity and smoking that are complex in nature and consistent with some but not all of the predictions derived from intersectionality theory.CONCLUSION: This study challenges prevailing understandings of social causes of health behaviours by class, gender, race, and sexuality that have been generated by additive modes of analysis. The study also suggests that, in regard to physical activity and smoking, some but perhaps not all tenets of intersectionality are potentially useful in explaining these health practices.
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The social emergence of health: a theoretical interpretation and empirical application of Pierre Bourdieu's relational theory of social action in a three-dimensional Canadian field (2012)
Pierre Bourdieu's theory of social action has been the inspiration for an array of diversehealth studies seeking to better understand the nature of social stratification and its relation tohealth behaviours and outcomes. While several of his well-known theoretical concepts, suchas social capital, cultural capital and habitus, have garnered a great deal of attention in thehealth research community, the nature of their application has for the most part been limitedto deterministic schemas examining relationships between social position and social action.There are as yet no health-related studies that offer a comprehensive theoretical account ofBourdieu’s ‘constructivist structuralism,’ incorporating all of his theoretical conceptions offield, habitus, capital, doxa and time. In light of these theoretical and empirical oversights, Ioffer a health-relevant re-envisioning of Bourdieu's expansive body of work and examine theimplications of his relational framework for health research. Drawing upon a relationalexploratory analytic method called multiple correspondence analysis and using originalCanadian survey data from Vancouver and Toronto, Canada, I translate my interpretation ofBourdieu’s theoretical principles into a thoroughly Bourdieusian empirical depiction of ahealth-relevant three-dimensional geometric social space. The visual mapping of social spacerevealed seven different groupings of individuals whose common attributes and dispositionsare socially patterned around health-related behaviours and outcomes, illuminating distinctspaces of social differentiation within which healthy and unhealthy individuals are located.
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