Kentucky interdisciplinary community screenings: Socioeconomic determinants as predictors of disparities in health outcomes in Kentucky

The purpose of this dissertation was to examine the relationship between community level socioeconomic indicators in Medically Underserved Areas of Kentucky and individual level socioeconomic indicators as predictors of individual health outcomes. The guiding premise of this dissertation was that community level socioeconomic indicators (neighborhood efficacy) are better predictors of health than individual socioeconomic indicators. The purpose was not to establish causality between independent and dependent variables, but rather to learn whether there are statistically significant differences in socioeconomic factors (at both individual and community levels) among Area Health Education Centers (AHEC) regions or counties in Kentucky and their respective geographic areas, and the extent to which any such differences could be seen as predictors of health outcomes of the KICS clients screened in such areas. This dissertation has examined for neighborhood effect among five of Kentucky AHEC regions and provides support for the question posed by Sampson, et al. (2002, p.447) "Why does neighborhood matter, for what, and to what degree?";The findings in this dissertation demonstrate that where one lives in Kentucky matters for health outcomes of individuals screened in the KICS project. Overall, the clients with the poorest of health outcomes resided in the higher poverty and lower education counties of Kentucky. The results support the premise that community level socioeconomic indicators (neighborhood efficacy) are better predictors of health than individual socioeconomic indicators.;This descriptive dissertation has used secondary KICS client data (11 of the 13 year project) collected in a longitudinal trend study from 1993 to 2005. Participants of the KICS project were recruited by regional AHEC personnel and volunteered for the free health screenings. Measurement instruments included the physical, dental, and social history forms used in the screenings. Data included aggregated data from 1993 to 2003 of the individuals participating in the summer screenings. Kentucky county level census data from 1990 and 2000 were averaged and included in the analysis. Stepwise logistical regression analyses were conducted to determine socioeconomic factors at the community level and individual level as predictors of health outcomes. Zip codes of the of individual participants were geocoded using the Geographic Information System (GIS) a database management system designed to organize spatial data.