A Multi-Method Analysis of the Role of Spatial Factors in Policy Analysis and Health Disparities Research

The premise of this research rests on the idea that space has a significant influence on diet and health disparities and on the utilization of food assistance policies targeted towards minimizing those disparities. In the specific context of food deserts, this research integrates a multi-disciplinary conceptual approach and a multi-method approach to explore the relationships and interactions between people and spaces. The multi-disciplinary approach links spatial conceptual perspectives from rural sociology and health geography to provide the theoretical framework for the relevance of integrating space in policy analysis and diet and health disparities research. The multi-method approach provides a more comprehensive examination of diet and health disparities by allowing for the statistical testing of outcomes and the simulated exploration of policy interventions. This dissertation consists of a set of three interconnected essays. The first essay presents conceptual perspectives from a health geography and rural sociology lens and relates the perspectives to aggregate level participation rates for the Supplemental Nutrition Assistance Program (SNAP). Incorporating spatial econometric methods to measure county-level SNAP participation, the results from the analysis show variation in SNAP participation based on county characteristics. Understanding this geographic variation provides an opportunity to formulate SNAP policies and procedures which explicitly respond to and incorporate spatial differences across counties. The second essay expands the analysis of geographic variation by examining health outcomes at the individual-level in relationship to individual-level and county characteristics. This essay measures the consequences of lack of access to food by exploring the adverse health outcomes that can be attributed to the food environment. A hierarchical linear model is implemented and the results show that counties with a higher quality food environment predict higher levels of individual health status. The spatial disparity of the food environment on individual-level health outcomes coupled with the spatial disparity of SNAP participation suggested the need to further explore the complexity of the policy problem of diet and health disparities through an additional lens of simulation modeling. The third essay explores this using an agent-based simulation. I simulate a local food environment and observe changes in the environment as policy interventions are introduced. The results show that poor health status can persist in a poor food environment even with people-based interventions that increase low income consumers’ purchasing power. The place-based policy intervention that changed the environment subsequently changed consumption patterns and improved health outcomes. The understanding of spatial theory in policy context and the implementation of a multi-method approach for addressing the complexity of health disparities contributes to a perspective that the analysis of public policy and design of policy interventions requires a conceptual understanding of the spatial associations underlying the policies being investigated. Above all, this dissertation contributes to the body of knowledge of the complementarities of hierarchical linear modeling and agent-based modeling to examine the complexity of individual-level diet and health outcomes, and a recognition that geographic characteristics not only predict diet and health disparities but also predict the usage of assistance offered that seeks to minimize diet and health disparities.

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Public Policy and Management

Grantor dc:publisher

The Ohio State University

Year dc:date

2013

Author dc:creator

• Rice, Ketra Lachell

Contributors dc:contributor

• Desai, Anand

• Public Policy
• Public Administration
• Geography and Public Policy
• Diet and Health Disparities
• Food Deserts
• Food Policy
• Hierarchical Linear Modeling
• Agent-Based Modeling

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=osu1365613669

OAI identifier oai:identifier

oai:etd.ohiolink.edu:osu1365613669