Before the widespread adoption of the commercial internet and long before social media platforms, networked computing was considered a niche hobby for technoevangelists. For LGBTQ+ people, however, it proved to be a vital lifeline at the onset of one of the most significant medical events in recent history: the HIV/AIDS epidemic. Working against the compounding influences of homophobic stigma, ableist rhetoric, and misinformation, LGBTQ+ people utilized this emerging technology to forge social connection and networks of critical information exchange from the privacy of their own homes. This dissertation explores the ways in which LGBTQ+ people made use of computer networking during the first decade of the HIV/AIDS epidemic in the United States, and offers considerations for how these important contributions to a burgeoning tech scene have been archived, recorded, or otherwise remembered.

Here, I provide an overview of the bulletin board system (BBS) and Usenet scene in the 1980s, and how it was used by LGBTQ+ people to navigate an evolving cultural landscape affected by HIV/AIDS. I outline the scholarly legacy for this work through current and historical literature, then demonstrate my project’s significance within that landscape. I then provide an extended case study of a particular BBS, SURVIVORS, dedicated to AIDS discussion amongst people with AIDS. Following, I present the implications of three fractured born-digital records that represent queer life online at the onset of the epidemic. Finally, I examine how LGBTQ+ people co-developed content moderation policies online to confront misinformation, discrimination, and abuse; reworking the contemporary and otherwise presumed values of free speech or meritocratic discussion in similar spaces. Together, this study offers a sustained archival analysis of an underresearched, but crucial, component of networking computing history.

We enumerate Hurwitz orbits of shortest reflection factorizations of an arbitrary element in the infinite family \(G(m, p, n)\) of complex reflection groups. As a consequence, we characterize the elements for which the action is transitive and give a simple criterion to tell when two shortest reflection factorizations belong to the same Hurwitz orbit. We also characterize the quasi-Coxeter elements (those with a shortest reflection factorization that generates the whole group) in \(G(m, p, n)\).

Mathematics Subject Classifications: 05A05, 05A15, 05E18, 20F55

In any given community, there are multiple organizations and sectors – including health care, public health, education, and social services – that have a hand in addressing health, as well as the social and economic determinants of health. Often, these sectors are siloed and not coordinating as well as they could be. This dissertation examines organizational changes within different sectors that can support linkage and collaboration across sectors. The first study examines what area characteristics promote the establishment of school-based health centers (SBHCs), which are a key way to increase access to health care for children who are most in need. Findings showed that the availability of nearby community health centers, as well as the existence of a SBHC state advocacy organization, supported the establishment of SBHCs. These results point to the need for extra financial and technical support for school districts in counties that have few or no community health centers. The second study examines multilevel organizational influences of physician practices’ screening for social risks, a care delivery innovation recommended to mitigate disparities, and a key step for preparing health care systems to engage in relationships with relevant community organizations in service of addressing identified needs. Increasingly, physician practices are being acquired by health systems. This study examines how system versus practice characteristics influence whether practices implement screening for social risks, with the goal being to understand what organizational level of intervention may be most effective for increasing screening for social risks. We found that practice-level characteristics explained more of the variance in a practice's screening for social risks, which suggests that efforts to expand social risk screening among system-owned practices should focus on strategies at the practice level, such as increasing technology capacity and patient engagement strategies. The third study tests an approach for identifying US counties with better-than-expected child health outcomes, also known as positive deviants. This study provides the first step – identification of positive deviant counties – that future qualitative research can build on to understand community activities, including multi-sector collaboration and linkages, that contribute to exceptional child health outcomes.

Health systems face increasing pressure to improve population health by addressing health related social needs such as adequate housing, transportation, or food insecurity. Current evidence around these initiatives is still nascent. One common intervention to address health related social needs is case management. There is need to better understand the holistic impacts of case management, the role of specific case management program components, and the effects of social needs interventions implemented as distinct activities. The three papers that comprise this dissertation examine social needs interventions from different angles. The first paper uses a rigorously designed, large-scale health and social needs case management program to identify whether case management services improved vaccination rates in the wake of the Covid-19 pandemic. The second paper builds on the same case management program to understand whether housing deposits, a unique program benefit, impacted health services use. The third paper analyzes whether hospital activities to address social needs are associated with better quality of care. Collectively, these papers suggest that health system efforts to address social needs hold promise yet may require continued tailoring for specific patient populations and local communities.

The use of cigarettes and other substances continues to be a prevalent behavior among adolescents. To assess the general relationships between cigarette/substance use and various personality/attitudinal, parental, and peer influences data was gathered from a sample of 1,194 seventh grade students. The students were predominently white and middle class. Analyses of personality variables found self-esteem and anxiety not to be related significantly to use. Need for peer approval and association with cigarette/substance users showed a small relationship. Of the attitudinal variables health beliefs showed a weak negative relationship, academic orientation a moderate negative, perceived social utility a small positive, and behavioral intention a sizeable positive relationship with cigarette use. Interpersonal influences varied in strength. Parental smoking was moderately related to use (especially for girls), while parental attitudes about smoking were typically even more important (particularly for boys). Peer influences and the students' tendency to use other substances were among the most significant factors accounting for cigarette use. In addition to general findings, three other sets of relationships were considered. The first of these found that students who affiliated with other cigarette smokers were higher in need for peer approval and had a higher perceived social utility for cigarette use. The second question showed self-esteem to not be related significantly to achievement or social variables. The final question indicated that personality variables related to persuasibility do not moderate the influence of peer group smoking. Programmatic suggestions were made.

States are increasingly leveraging waivers and other flexibilities in the Medicaid program to experiment with using Medicaid to fund services to address health-related social needs. This trend has created new financial incentives for cross-sector collaboration and integration of care. Better integrated social and medical care is expected to lead to more effective services, lower costs, and improved outcomes for patient populations that frequently use high-cost medical services, but is challenging to achieve. This dissertation examines care integration efforts for two populations that have been the focus of recent reforms: older people and people experiencing homelessness.

The first study uses qualitative interviews with county aging services leaders in the San Francisco Bay Area to identify the challenges and opportunities counties face in delivering services to older people and people with disabilities. The second study uses qualitative interviews to describe motivations and concerns of healthcare and social services organizations when integrating social and medical care for people experiencing homelessness in Los Angeles County. The third study uses participatory methods to explore street medicine providers’ perspectives on the impact of newly available Medicaid funding on their service model. Taken together, these studies elevate the voices of providers, payors, and county leaders to document early lessons and insights from their experiences delivering integrated services.