THE HEALTH OF YOUNG ADULTS WITH DISABILITIES IN THE UNITED STATES: THE COLLECTIVE ROLES OF RISK FACTORS IN SOCIAL ECOLOGIC FRAMEWORK

Background: Over the last few decades, the prevalence of young adults with disabilities (YAD) has steadily risen as a result of advances in medicine, clinical treatment, and biomedical technologythat enhanced their survival into adulthood. Despite investments in services, family supports, and insurance, they experience poor health status and barriers to successful transition into adulthood. Objectives: We investigated the collective roles of multi-faceted factors at intrapersonal, interpersonal and community levels within the social ecological framework on health related outcome including self-rated health (SRH) of YAD. The three specific aims are: 1) to examine sociodemographic differences and health insurance coverage in adolescence; 2) to investigate the role of social skills in relationships with family and peers developed in adolescence; and 3) to collectively explore the association of sociodemographic characteristics, social skills, and community participation in adolescence on SRH. Methods: Using longitudinal data (N=5,020) from the National Longitudinal Transition Study (NLTS2), we conducted multivariate logistic regression analyses to understand the association between insurance status as well as social skills in adolescence and YAD’s health related outcomes. Structural equation modeling (SEM) assessed the confluence of multi-faceted factors from the social ecological model that link to health in early adulthood. Results: Compared with YAD who had private insurance, YAD who had public health insurance in adolescence are at higher odds of experiencing poorer health related outcomes in self-rated health [adjusted odds ratio (aOR=2.89, 95% confidence interval (CI): 1.16, 7.23), problems with health (aOR=2.60, 95%CI: 1.26, 5.35), and missing social activities due to health problems (aOR=2.86, 95%CI: 1.39, 5.85). At the interpersonal level, overall social skills developed through relationship with family and peers in adolescence do not appear to have association with health related outcomes in early adulthood. Finally, at the community level, community participation in adolescence does not have an association with SRH in early adulthood. Conclusions: Having public health insurance coverage does not equate to good health. YAD need additional supports to achieve positive health outcomes. The findings in social skills and community participation suggest other potential factors may be at play for health related outcomes for YAD and the need for further investigation.

ENGINEERING DIGITAL SHARING PLATFORM TO CREATE SOCIAL CONTAGION: EVIDENCE FROM LARGE SCALE RANDOMIZED FIELD EXPERIMENTS

Peer-to-peer information sharing has fundamentally changed customer decision-making process. Recent developments in information technologies have enabled digital sharing platforms to influence various granular aspects of the information sharing process. Despite the growing importance of digital information sharing, little research has examined the optimal design choices for a platform seeking to maximize returns from information sharing. My dissertation seeks to fill this gap. Specifically, I study novel interventions that can be implemented by the platform at different stages of the information sharing. In collaboration with a leading for-profit platform and a non-profit platform, I conduct three large-scale field experiments to causally identify the impact of these interventions on customers’ sharing behaviors as well as the sharing outcomes. The first essay examines whether and how a firm can enhance social contagion by simply varying the message shared by customers with their friends. Using a large randomized field experiment, I find that i) adding only information about the sender’s purchase status increases the likelihood of recipients’ purchase; ii) adding only information about referral reward increases recipients’ follow-up referrals; and iii) adding information about both the sender’s purchase as well as the referral rewards increases neither the likelihood of purchase nor follow-up referrals. I then discuss the underlying mechanisms. The second essay studies whether and how a firm can design unconditional incentive to engage customers who already reveal willingness to share. I conduct a field experiment to examine the impact of incentive design on sender’s purchase as well as further referral behavior. I find evidence that incentive structure has a significant, but interestingly opposing, impact on both outcomes. The results also provide insights about senders’ motives in sharing. The third essay examines whether and how a non-profit platform can use mobile messaging to leverage recipients’ social ties to encourage blood donation. I design a large field experiment to causally identify the impact of different types of information and incentives on donor’s self-donation and group donation behavior. My results show that non-profits can stimulate group effect and increase blood donation, but only with group reward. Such group reward works by motivating a different donor population. In summary, the findings from the three studies will offer valuable insights for platforms and social enterprises on how to engineer digital platforms to create social contagion. The rich data from randomized experiments and complementary sources (archive and survey) also allows me to test the underlying mechanism at work. In this way, my dissertation provides both managerial implication and theoretical contribution to the phenomenon of peer-to-peer information sharing.

DIFFERENCES IN PSYCHOPATHOLOGY AMONG SUBSTANCE USERS IN RESIDENTIAL TREATMENT RELATED TO HIV STATUS

HIV-positive individuals engage in substance use at higher rates than the general population and are more likely to also suffer from concurrent psychiatric disorders and substance use disorders. Despite this, little is known about the unique clinical concerns of HIV-positive individuals entering substance use treatment. This study examined the clinical characteristics of clients (N=1712) entering residential substance use treatment as a function of self-reported HIV status (8.65% HIV-positive). Results showed higher levels of concurrent substance use and psychiatric disorders for HIV-positive individuals, who were also significantly more likely to meet criteria for bipolar disorder and borderline personality disorder. Past diagnoses of depression, posttraumatic stress disorder, and social phobia were also significantly more common. Study findings indicate a need to provide more intensive care for HIV-positive individuals, including resources targeted at concurrent psychiatric problems, to ensure positive treatment outcomes following residential substance use treatment discharge.

Self-Presentation Styles, Status, and Influence

This research examined effects of individual self-presentation styles on influence in groups. Perceived competence and social acceptance both play a role in determining how much influence group members enjoy. Aggrandizing and deprecating self-presentation styles may affect perceived competence, social acceptance, and ultimately influence. I predicted that aggrandizing self-presentation would lead to perceptions of competence and that self-deprecation would lead to social acceptance. The anticipated strength of those trends, however, was unclear, and I proposed that they would vary depending on status. I conducted two studies designed to assess whether aggrandizing or deprecating self-presentation styles lead to differences in influence outcomes for high and low-status individuals. In Study 1, participants gave feedback and a promotion recommendation for a fictitious (male or female) job candidate based on employee evaluation information presenting the candidate as either deprecating or aggrandizing. The main findings from Study 1 were that aggrandizers were rated as less likable than deprecators. No other predictions were supported. Study 2 was an online experiment in which participants made hiring recommendations in reference to résumés from fictitious applicants that varied by race, gender, and presentation style (aggrandizing, deprecating, or neutral). Results provided some evidence that low-status candidates were punished for using aggrandizing self-presentation strategies. The results of the studies suggest no one- best technique for self-presentation and that there may be costs for aggrandizing or deprecating depending on race and gender.