Author ORCID Identifier

0000-0002-0024-3278

Date of Award

1-10-2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Laura Salazar, PhD

Second Advisor

Kevin Maloney, PhD, MPH

Third Advisor

Catlainn Sionean, PhD, MA

Abstract

Government metrics like poverty thresholds may not adequately capture the full extent of need within the United States. This is problematic for women with children, a group that is more vulnerable to adverse health outcomes. Alternative metrics, such as material hardship, have been proposed to assess socioeconomic status. Using epidemiological and advanced research approaches, this dissertation demonstrated that material hardship experiences can be used as an alternative determinant for health for women. Analyses were conducted using the Survey of Income and Program Participation (SIPP) and the National HIV Behavioral Surveillance-Heterosexually active persons at risk for HIV (NHBS-HET).

In Study 1, a scoping review was conducted to describe the characteristics defining material hardship based on 31 eligible manuscripts focusing on women within the United States. Consistent elements of material hardship included challenges related to housing, food, utilities, and health care. In addition, the health outcomes studied primarily focused on mental health, with particular attention to its intersection with maternal health. In Study 2, data from the 2018 SIPP panel was used to estimate the cumulative incidence (per 10,000 women-led households) of housing hardship (499.7), food insecurity (849.1), and utilities hardship (707). Among women who had consistent health insurance coverage, those experiencing food insecurity had an 18.9% increased risk of not seeing a health care provider, while those experiencing utilities hardship had a 5.9% increased risk. For women who had health coverage gaps, those experiencing housing hardship had a 2.8% increased risk of not seeing a health care provider whereas those experiencing utilities hardship had a 13.7% increased risk. In Study 3, data from the 2019 NHBS-HET was used to determine potential relationships of individual- and county-level characteristics with material hardship as well as direct and indirect relationships with HIV risk. Being uninsured was associated with nearly 3 times the odds of experiencing material hardship compared to those with insurance. In contrast, residing in areas with a high concentration of single-parent households was found to be protective against material hardship. The direct relationships between material hardship and HIV risk as well as the indirect relationship through psychological distress were positive and significant.

File Upload Confirmation

1

Download

Available for download on Sunday, December 06, 2026

Share

COinS