Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Leah Ferrucci

Second Advisor

Nicholas A. Christakis

Abstract

I investigated the associations of village structural, behavioral, and social environments with self-rated health and mental health among adults residing in remote rural villages in the mountainous Copán region of Honduras. I estimated nested multilevel logistic models with 17,318 adults in 174 villages. All models controlled for individual characteristics to distill true village-level effects, and nested structure was employed to facilitate direct comparison across models. Both poor self-rated health and mental health were inversely associated with village size and positively associated with coffee cultivation. Poor self-rated health was also positively associated with friend/adversary tie ratio, and poor self-rated mental health was also positively associated with high levels of trash. Comparing across models, the full model including structural, behavioral, and social environment exposures best captured the relationship between village environments and self-rated health. For self-rated mental health, the model comprised of only structural and behavioral environment attributes was the best fit. There is suggestive evidence for some village determinants of health across this context in Honduras. Just as in the developed world, place is important for health and mental health in this rural, developing context. Structural, behavioral, and social characteristics of place should be considered and targeted when considering health betterment, health inequity reductions, and long-term development plans.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/16/2026

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