Дисертації з теми "321299 Public Health and Health Services not elsewhere classified"

This thesis is an evaluation of the effectiveness of a community-wide diabetes prevention program conducted in three Divisions of General Practice in Sydney, Australia. The aims were to assess whether translation of diabetes prevention programs was feasible in real-life settings and whether results achieved were comparable with those of randomised trials on which this intervention was based. Its primary goals were to assess whether the lifestyle intervention could increase participation in moderate-to-vigorous physical activity to 210 minutes per week, reduce total fat and saturated fat consumption to 30% and 10% of total daily energy intake, increase fibre consumption to 15 g/1,000 kcal/day, and lead to 5% weight loss over one year. The background section covers the physiopathology of type 2 diabetes, its risk factors, and the available population screening tools to identify people at risk. The growing morbidity and mortality burden, the economic implications of this public health problem, and the importance and feasibility of preventing or delaying the onset by intervening in the precursor stages are then summarised. Evidence for preventability is examined through a literature review of lifestyle interventions in research settings comprising highly structured and closely monitored physical activity and dietary programs under controlled conditions. Examples of the effectiveness of translation of randomised controlled trials (RCTs) into less stringent programs in community settings such as workplaces, churches, indigenous communities and whole-of-country initiatives are presented. A systematic review and meta-analysis of effectiveness of the lifestyle approaches in routine clinical practice supplements the evidence for application of prevention principles in real-life settings. The main chapters of the thesis centre on process and impact evaluation of the semi-structured Sydney-based intervention, which recruited 1,250 participants from the mainstream Australian 29 public using general practitioner services in the study area, who were followed for 12 months. The intervention’s goals aligned with those of the Finnish Diabetes Prevention Program but with less stringent entry criteria and less intensive intervention components delivered by purpose-trained lifestyle officers. The Program included an initial individual assessment and coaching session, three subsequent group sessions in the following three months, then three follow-up coaching calls at three, six and nine months. A final assessment at one year, using the same objective and self-reported measures as in the initial assessment, captured changes in body weight, physical activity and dietary habits. The process evaluation showed that it is feasible and effective to use targeted screening to identify and recruit high-risk individuals into a free-of-charge program in the general practice setting, however a quarter of participants were lost to follow-up by one year. While minor variations in aspects of the Program were required to meet local need, Program fidelity in delivering components, and self-reported adherence to diet and physical activity was high. Using a before-after study design, the impact evaluation measured 1-year changes in key Program parameters in relation to baseline. These comprised: measured weight, waist circumference, BMI, and glycaemia measurements; and self-reported dietary intake and structured physical activity, using a 3-day food record and the Physical Activity Scale for the Elderly (PASE) questionnaire, respectively. The main findings at 12 months for the 586 completers as at December 2010 were: a mean weight loss of 2.1 kg; waist circumference reduction of 2.5 cm; no significant change in glycaemia; 3% reduction of fat and saturated fat intake; 16% increase in fibre intake; and mean increase in moderate-to-vigorous physical activity of 13.7 minutes/week. All these changes were smaller than those achieved by the RCTs in research settings, most likely due to the lower intensity and monitoring of the Sydney intervention. Weight loss and waist circumference reductions were similar for participants in 30 group session and those who received telephone-only coaching. Diabetes incidence was 1% at the end of the first year. An economic appraisal of the Program implementation completes the evaluation. A cost of A$400 per kg lost among people achieving the weight goal was estimated on Program completion, but the cost was double for the overall group that included non weight losers. The cost of achieving the physical activity goal and the dietary goals was not feasible or sustainable with resources available in routine clinical settings. The costs per outcome were similar for participants not attending group sessions, who received only telephone coaching. Hence it is worth exploring this less labour-intensive modality if a general practice based Program were to be delivered as routine preventive care. In sum, the evaluation of this community-wide diabetes prevention program showed that translation of diabetes prevention programs into routine practice, while feasible at less intensive levels than in RCTs, has a somewhat lower effect on diabetes risk reduction and it can still be a financial burden in clinical settings. However, given the potential for population-wide benefit, the effectiveness of alternative delivery modes, number and duration of program components and more targeted patient sub-groups should be investigated.
The Sydney Diabetes Prevention Program was funded by New South Wales Health as part of the Australian Better Health Initiative. Financial contribution and other in-kind support were provided by the Sydney South West Area Health Service and the Australian Diabetes Council -NSW.

Competency to practise has become an essential part of a health professional’s lifelong journey. It is defined in many ways to encompass the intellectual and experiential elements of training along with a person’s efforts to keep up-to-date. Many would describe competency as ‘fit for purpose’ to do the job, ensuring that the public are protected and given the professional service that meets their expectation. One of the conundrums of the regulators of pharmacy practice is how the competency of pharmacists can be measured and monitored to fulfil their statutory obligations to the public. Many agree that the best way of determining competency would be to observe people in their day-to-day practice. However, this would be a prohibitively costly exercise. This thesis originated from the question of how competency could be assessed in a form that would give regulators confidence and that was cost effective. Most assessment methods used are de facto methods of measurement. However, regulators need to have confidence that the assessments are able to accurately measure the standard of a person’s professional practice.

This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators - and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the 'in-between' discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or 'difficult' parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.

Widespread use of prescription opioids has been a major public health concern since 1999. Many consequences are associated with the problem, such as opioid misuse, abuse, and drug overdose deaths. Opioids are not the only medications involved with drug overdose deaths. Due to stricter control of prescription opioids, those who misused opioids are associated with initiation of another illicit drug abuse. This results in increased drug overdose death involving heroin and semisynthetic/synthetic opioids. Another risk factor for increased overdose death is concurrent use of opioids with other central nervous system (CNS) depressants and some anticonvulsants. Concurrent use of opioids and benzodiazepine, z-drugs (zolpidem and zaleplon), gabapentin, and/or pregabalin is associated with increased risk of respiratory depression and drug overdose death. To combat problematic opioid use, many mitigation strategies were introduced. However, opioid-related problems remain.

Increasing numbers of Australian older people are living with chronic disease. Their ability to effectively self-manage their conditions is an important issue, not only for their own health but also for the government, who are concerned with spiralling healthcare costs. CDSM is informed, in part, by an individual’s health literacy which are non-disease-specific skills relating to finding, appraising and using health information, and encompass factors such as communicating with health care providers, navigating complex health systems and having social support to engage in managing health. New technologies provide the opportunity to deliver healthcare in innovative ways. However, there is a paucity of evidence on their use, particularly in community care. The purpose of this study was to: (1) understand what home-based group videoconference (VC) interventions have been developed for the e-health setting; (2) identify the mechanisms of delivering group education and social support by VC for older people; and (3) examine the impact of such a program in delivering patient education on health literacy, chronic disease self-management (CDSM) and social support. E-health, an umbrella term which includes telehealth, provides healthcare from a distance using telecommunications techniques. The Australian Government considers e-health as a key component in the future delivery of healthcare. E-health and telehealth are emerging vehicles to provide health information on CDSM as well as the opportunity to develop innovative patient education methods. Telehealth disrupts usual care, for example, using videoconferencing (VCing) for a consultation can negate the need for health professionals and patients to be physically in the same space. A particularly underexplored area is the use of group videoconferencing (VCing) for CDSM and health literacy patient education that is delivered into the patients’ homes. Group work is an effective method for providing CDSM knowledge and skills. However, there are known barriers for patients in accessing groups; these include timing, mobility, transport, and fear of meeting new people. Group VCing may provide the opportunity to overcome some of these barriers to enable wider access to group settings. iii This study, the Telehealth Literacy Project (THLP) was situated in the real world setting, working in collaboration with an aged care industry partner provider with community-dwelling older people aged between 49 and 90. It was nested within a wider telehealth remote monitoring study and explored the methodology of using group VCing to engage with older people. In order to answer the research questions, an intervention was developed specifically to test the methodology of group VCing. This thesis is focused on answering the research questions on the methodology of using group VCing and not on critiquing the intervention. In addition it reports only data from the THLP. A mixed method research design was employed during the study, including a systematic review, co-creation of the intervention with health professionals and participants and for the program evaluation, pre- and post-intervention quantitative measures (with control and intervention groups) and qualitative interviews. An evaluation framework was developed from the literature comprising overarching concepts of feasibility, acceptability and effectiveness In the THLP there were two groups, an intervention group comprising 52 participants who opted-into the weekly VC group intervention and a control group of 60 participants who chose not to take part in the intervention but who completed a baseline questionnaire. Following baseline data analysis those who opted-in to take part in the intervention were grouped by similar levels of health literacy. Each week intervention participants would meet in a virtual room and take part in discussions with the researcher on different health literacy and generic CDSM issues. Slides and videos were used to facilitate discussion with an emphasis on participants being engaged in conversation with each other to promote social support.

"Research highlights the increasing burden of physical inactivity and chronic disease ... The overall purpose of this research was to explore the utility and effectiveness of internet delivered physical activity behaviour change programs in primary and secondary prevention ... The second step was to examine predictors of website usage within a current publicly accessible physical activity website (10,000 Steps) aimed at primary prevention "--Abstract.

Background: Falls and fall-related injury among older people are a major public health burden. Exercise-based fall prevention programmes are effective in reducing falls in older community-dwelling people. However, this effectiveness is hampered by low participation and adherence. Digital technologies are a novel and potentially effective method for delivering tailored fall prevention exercise programmes to older people. Aims and objectives: This thesis aims to evaluate the effectiveness, acceptability and cost-effectiveness of technology-driven fall prevention programmes in older community-dwelling people. The following research questions were examined: Are eHealth-delivered exercise programmes effective at improving balance in people aged 65 years and older living in the community compared to a control? Is a home-based balance exercise programme delivered through a tablet-based technology acceptable to older people living in the community? Is an e-Health balance exercise programme a cost-effective way to reduce falls and injurious falls in community-living older people compared to usual care? Methods: A series of related studies were conducted to answer these questions, including: a systematic review with meta-analysis, a qualitative study, and a health economic evaluation. The systematic review and meta-analysis evaluated randomised controlled trials of eHealth-delivered exercise programmes for community-dwelling people aged 65 years and over, published in English. The primary outcomes were static and dynamic balance. Secondary outcomes included fall risk and fear of falling. The standardised mean differences (SMDs, Hedges’s g) were calculated with 95% confidence intervals from random effects meta-analyses. The qualitative study recruited 50 participants from StandingTall, a large randomised controlled trial which delivered a home-based fall prevention programme via a tablet-computer. Participants were selected using purposive sampling and to ensure maximum variability. Data was collected via one-on-one interviews by qualified research staff at one of three different time points (1 month, 6 months and 12 months) over 12 months. Interviews were transcribed verbatim, verified for accuracy and then analysed thematically. The economic evaluation was a within-trial evaluation of StandingTall. Five hundred and three people aged 70 years or over participated. Cost-effectiveness was measured as the incremental cost per fall, and per injurious fall, prevented. General linear models were used with a gamma distribution for costs and a Poisson regression for rates of falls and injurious falls. Incremental Cost-Effectiveness Ratios (ICERs) were calculated to assess the additional expenditure required to generate an additional unit of benefit. One-way sensitivity analysis and sub-group analyses were performed. Results: The systematic review and meta-analysis identified nine trials of 498 participants. Eight trials measured static balance, with the pooled effect indicating that eHealth-delivered exercise programmes have a significant effect on static balance (eight trials; SMD = 0.40; 95% CI 0.14 to 0.67). All nine trials measured dynamic balance to find there was no effect on dynamic balance (nine trials; SMD=0.22; 95% CI -0.09 to 0.54). Three trials measured fall risk to find there was no evidence of an effect of eHealth-delivered exercise programmes on fall risk compared to control (SMD=0.28, 95% CI -0.06 to 0.63; I2 = 42.9%, p = 0.173). Three trials measured fear of falling to find there was no evidence of an effect of eHealth-delivered exercise programmes on fear of falling compared to control (SMD = -0.07, 95 % CI -0.34 to 0.20; I2 = 0.0%, p = 0.950). The qualitative study identified eight themes, which fall into two categories: experiences of using StandingTall and the design of StandingTall. Overall, participants appreciated the flexibility of StandingTall’s tablet-based online delivery, and described an improvement in physical awareness and confidence with everyday activities. Participants also reported various challenges with the technology, and determined that computer literacy is essential for successful engagement. Despite this participants found the overall design of StandingTall as user-friendly, clear, and easy-to-understand. The economic evaluation found the total programme delivery and care resource cost was $8,321 (standard deviation, SD 18,958) to intervention participants and $6,829 (SD 15,019) to control participants. The incremental cost per fall prevented was $4,785 and per injurious fall prevented was $6,585. Discussion and conclusion: Falls present a major age-related health challenge for society, and one which is likely to grow in significance as life expectancy increases. This body of research has provided preliminary evidence to demonstrate that balance exercise programmes delivered using technology are an effective, cost-effective and acceptable way of improving balance in older people. This, in combination with the ubiquitous availability of technology, could allow rapid scale-up and implementation of eHealth fall prevention programmes to large populations.

Skin cancer screening clinics were introduced into a number of towns throughout Queensland as part of the Melanoma Screening Trial (MST), a study investigating the efficacy of screening for melanoma. The MST requires 60% of these towns' populations aged over 30 years to be screened for

melanoma within a three year intervention phase. The aim of this case study is to assess the relationship between Rogers' (1995) diffusion of innovations and the health promotion strategies implemented to encourage attendance at skin cancer screening clinics.

Data were obtained from a number of sources, including administrative files, progress reports, interviews and focus groups and were positioned within a comparative theory/practice matrix. Pattern matching logic was used to

assess the relationship between the health promotion strategies and the theoretical construct of diffusion of innovations.

All components of diffusion of innovations (Rogers, 1995) were addressed by the health promotion strategies encouraging attendance at the skin cancer screening clinics. The delivery of the skin cancer screening clinics was in accordance with principles identified by past diffusion research. The skin cancer screening clinics conformed to most predictors of diffusion success and were delivered within a "real" environment, as suggested by past community -based interventions. A number of changes to existing health promotion strategies and the addition of some new strategies have been suggested to improve the rate of diffusion of skin cancer screening clinics in

the future.

The objective of research is to develop a computer simulation modeltoprovide a means to effectively and efficiently reduce medication errors associated with points of distribution sitesby identifying and manipulating screeners with a high probability of generating errors.Points of distribution sites are used to rapidly distribute chemoprophylaxis to a large population in response to a pandemic event or a bioterrorism attack. Because of the nature of therapid response, points of distribution sites require the use of peer-trained helpers who volunteer their services.The implications are that peer-trained helperscould have a variety of experience or education levels. Thesefactors increase the risk of medical errors. Reducing medical errors is accomplished through changing the means in which healthcare providers are trained and focusing on a team approach to healthcare delivery. Computer simulations have been used in the past to identify sources of inefficiency and potential of error. Data for the model werecollected over the course of two semesters. Of the 349 data points collected from the first semester, only 137 data points were usable for the purposes of modelbuilding. When the experiment was conducted again for the second semester, similar results werefound. The control simulation was run 20 times with each screener generating errors with a probability of 0.101 following a Bernoulli distribution. The variable simulation was run 30 times with each screener generating the same probability of errors; however, the researcher identified the screeners generating the errors and immediately stopped them from processing additional agents once they reached five errors. An ANOVA was conducted on the percent errors generated from each simulation run. The results of the ANOVA showedsignificant difference between individuals within the groups. A simulation model wasbuilttoreflect the differences in medical error rates between screeners. By comparing the results of the simulation as the screeners are manipulated in the system, the model can be used to show how medical errors can be reduced in points of distribution sites

This research explored the experience of parents who have a child with newly diagnosed food allergies in regional Queensland. The findings add to the knowledge of strategies that parents can adopt to manage their child's medical, nutritional, and psychosocial needs and how healthcare professionals can support them during this time.

Gamblers are known to engage in an array of cognitive distortions that fuel poor gambling decisions. Dual process theory suggests that people have preferences for either intuitive or analytical thinking; and these preferences can predict or influence the choices they make. This thesis explored the interplay between a gambler’s cognitive style (their preference for intuitive vs. analytical thinking), their gambling beliefs, and their consequent gambling behaviour. In order to demonstrate the protective nature of analytical thinking, a measure of protective gambling beliefs was developed that was then incorporated into three additional studies designed to assess how an intuitive cognitive style contributes to poor gambling decisions, and conversely the potential for increased analytical thinking to generate safer gambling. The main findings showed that 1) preferences for intuitive (and lack of analytical) thinking contributes to beliefs about gambling that fuel problem gambling and greater gambling consumption; 2) Using general analytic primes at point of play is counterproductive in generating safer gambling, and counter to expectations, resulted in an increase in positive expectations regarding gambling outcomes; 3) Ongoing analytical training that is specific to gambling, in contrast, resulted in protective belief changes and a reduction in time spent gambling. These findings have implication for generating effective interventions and clinical tools that help demystify the decision-making process for gamblers who may be experiencing harm because of intuitive thinking that contributes to poor gambling choices.

This research explored the notion of rural health equity and the complexities of formulating innovative and equitable health solutions at the small-scale rural and remote settlement level. Outcomes included improved identification of rural determinants of health and development of new rural health equity data-capture approaches, screening tools and rapid assessments.

As globalization continues to increase, the demand for culturally intelligent employees is central for navigating everyday intercultural business interactions. For college students preparing to enter the workforce, cultural intelligence is trained at universities through cultural training courses and study abroad experiences. Although cultural training courses and study abroad experiences are recognized as important factors in developing cultural intelligence, their effects are often assumed. Additionally, research indicates that international travel alone does not enhance a person’s overall cultural intelligence. This research examined a university program designed using Bandura’s Social Learning Theory to increase undergraduate students’ cultural intelligence through an on-campus cultural training course followed by a study abroad experience. Study 1 compared the effectiveness of a university program consisting of a cultural training course with a study abroad experience against a comparison control group. Multi-level modeling analyses suggest that students who participated in the cultural training course followed by a study abroad experience significantly increase in motivation, cognitive, metacognitive, and behavior CQ. Furthermore, interaction analyses examined the relationship between the two study groups, students’ self-assigned cultural development goals, the quality of their reflective journal entries, and an examination of any potential cultural mentor effects. None of these variables was associated with CQ growth. Study 2 compared two study abroad groups who either spent 3- or 6-weeks abroad after completing a shared cultural training course. Both groups experienced a statistically significant increase in all four CQ domains relative to a comparison group. When comparing the 3- and 6-week study abroad groups, there were no differences in motivation, cognitive, or behavior CQ; however, in metacognitive CQ, the 3-week group experienced a statistically significant increase compared to the 6-week group. No student-level predictors (age, gender identity, ethnicity, year in school, previous overseas experience, and grade point average) or program-level predictors (cultural mentor, number of countries visited) had a significant relationship with CQ development. These results demonstrate that a university intercultural development program that combines a cultural development training course with an instructor-led study abroad experience can help students improve their cultural intelligence, regardless of a student’s background, and that students can experience significant CQ growth in as little as 3-week abroad.

The purpose of this thesis is to analyse the attitude, intention and behaviour of Queensland nurses towards computerisation in their workplace using quantitative and qualitative survey methods. It also identifies possible mediators and moderators of this relationship using the Theory of Reasoned Action in a path model. Other moderating variables such as age group, previous computing experience, computing ability, computer usage, educational levels and gender were used in this study.

The Theory of Reasoned Action is used by Fishbein and Ajzen to predict volitional behaviour and to assist in understanding psychological determinants. One thousand questionnaires were distributed to registered nurses in Queensland and 330 (33%) valid responses were received. A qualitative telephone survey (n = 40) was also employed to validate the quantitative survey. The results of this study found that positive attitudes were found to influence the intention of nurses to use computers in the workplace.

Although normative beliefs and motivation to comply were found to have a direct influence on subjective norm, subjective norm was not found to be significantly associated with one's intention to perform the behaviour. However, a positive outcome evaluation and behavioural beliefs were found to be directly associated with one's behaviour which were mediated through positive attitudes. It was also demonstrated that all positive intentions produced positive behaviour (action of using computers at work).

The study demonstrated the positive effect of prior computing experiences before starting nursing and the effect of high computer usage frequency on one's intention. An inverse effect was demonstrated between nurses who had good experiences with computer and their intention to use computer. In addition, the study found that older, less educated female nurses demonstrated a higher intention to use computers in the workplace. The qualitative study also supported the quantitative study. The qualitative study provided the researcher with reasoning as to why nurses behave a certain way towards computerisation in the workplace. It was used as a reasoning tool to confirm some of the respondents' actions.

This research has its own limitations. It was conducted in late 1999 and computerisation has since then penetrated Australian hospitals to a greater extent than ever before. In addition, the survey tool could also be tested for its construct and criterion related validity. This would improve the sensitivity of the survey tool. Notwithstanding that, the results from this study would significantly benefit management in the identification of groups of nurses who are likely to resist the computerisation process in the workplace.

Victorian Public Hospitals have operated under a burden of several different financial reporting requirements for several years. The research sought to examine the duplication of mandatory financial reporting requirements applicable to an atypical small Non -Metropolitan Victorian Public Hospital.

Previously published research as undertaken by Arthur Anderson, 1995, commissioned by OHS provided a basis of this research. The Anderson research was broad and encompassed the reporting requirements as applicable to both the largest and smallest Victorian public Hospitals. The research sought opinion of a qualitative nature, but did not examine the duplication of requirements from a

quantitative perspective.

The research is based on a case study of a single hospital and the three major financial reporting requirements, as applicable to this hospital. These reporting requirements were compared not only for duplication of mandatory reporting requirements, but also any anomalous reporting requirements were investigated.The initial benefit of the research being that with identified duplication of data, scope may exist for a reduction in either the content or number of reporting requirements.

This study of four domestic abattoirs in South Australia with Quality Assurance programmes in place established the size of bacterial populations that could be expected on pig carcasses on entry to abattoir dressing floors at pre-evisceration, the extent of contamination occurring during carcass dressing, and the effect of chilling on these populations. Analysis was conducted for salmonellae, Escherichia coli, Total Viable Count, and pseudomonads. Exterior swabbing was compared to swabbing of corresponding interior sites which are sterile initially. The interior swabbing sites were found to be a more reliable measure of contamination during the dressing process than the swabbing of already contaminated exterior sites. During the identification of some of the points of carcass contamination, the effectiveness of end-of-work foam cleaning programmes used at abattoir dressing floors and their relationship to the potential for airborne contamination of carcasses was examined and found to be positive. Operators' work tools and hands were identified as sources of interior carcass contamination combined with failure of operators to adhere to Standard Operating Procedures (SOPs) during carcass dressing, especially those related to hand and forearm washing at appropriate times. Foot-operated full-immersion hot water units for operators' knives and steels were designed and installed at two abattoirs to give operators access to physically and biologically clean work tools throughout carcass dressing.
PhD Doctorate

Listening (Janusik, 2002; Miller, 2018; Wolvin & Coakley, 1996) and eating disorders (EDs; National Centre for Eating Disorders (NCFED), 2018) are often not taught within schools, especially among adolescents. To address this, a school-based brief motivational interviewing (MI) intervention on listening when talking about EDs was created, implemented, and evaluated among adolescents (n = 260) from two middle schools within the Midwestern part of the United States. Specifically, School 1 (n = 100), and School 2 (n = 160) and three teachers (i.e., Teacher 1, Teacher 2, Teacher 3) allowed the researcher to present and collect data. In other words, three total teachers between the two schools, and one teacher, Teacher 1 (n = 100), was from School 1, and the other two teachers, Teacher 2 (n = 120) and Teacher 3 (n = 40) were from School 2. Participants were randomly placed into either the 1) the EDs listening intervention (education-plus) with an MI component (n = 6 classes) or 2) an education-plus Q&A intervention (n = 7 classes). All the participants were involved in the guest lecture and the pre-test and post-test survey, but data was only saved and analyzed from participants that had guardians/parents who consented (n = 75). The methodology for this dissertation project was a 2 (pre/post, unmatched) X 2 (condition) subject’s design. This dissertation project had two independent variables: (1) experimental condition (e.g., education plus MI and education plus Q&A), and (2) time (e.g., pre and post). This dissertation project had five dependent variables: (1) knowledge of listening, (2) knowledge of EDs, (3) listening self-efficacy, (4) knowledge of OARS, and (5) knowledge of the righting reflex. This dissertation project also had the random factor of schools (e.g., School 1 (A) and School 2 (B), and the fixed factor of gender identity (e.g., male and female). The results revealed a promise of efficacy and increased knowledge regarding EDs and aspects of listening, specifically through MI (e.g., OARS). Other areas of knowledge improved but not significantly. In other words, there were no significant differences in knowledge gains between MI and Q&A, but MI compared to Q&A showed a more extensive influence on self-efficacy. The main limitation of this study was the limited guardian/parental consent, resulting in a small sample size.

Background: Male contraceptive options are limited to condoms or vasectomy and have lacked significant developments for about a century, suggesting the value of exploring male hormonal contraceptives (MHC). In October 2018, a transdermal gel method entered Phase 2 clinical trials, indicating MHC may soon be available. However, eventual uptake of potentially contentious innovations, like MHC, requires informed marketing and promotional strategy. Consumer behavior research methodologies can aid in determining consumer perspectives, providing a framework for effective marketing to encourage MHC adoption upon market introduction.

Methods: Phases 1 & 2. Focus groups (n=29) and individual, in-depth interviews (n=20) among college-aged men and women aged 18-26 years were conducted using a semi-structured approach. Techniques from expanded grounded theory were used, allowing for a constant comparative approach to data contextualization and theme identification. Ads were created based on focus group results and tested in the interviews. Content analysis served as the data analysis strategy, allowing for a constant comparative approach to data contextualization and theme identification. Phase 3. College-aged men and women (n=1,997) aged 18-26 years participated in a web-based survey. Multiple linear regression was used to examine significant predictors of attitudes toward, interest in, and intention to use or encourage use of MHC. A conjoint analysis procedure was also used to assess the relative importance of attributes on ad effectiveness and preference.

Results: Phase 1. Three primary themes emerged from focus group discussions: 1) openness to MHC; 2) resistance to MHC; and 3) MHC gel innovation characteristics. Men and women were generally interested in the idea of an MHC method. Hesitance about MHC surrounded the social acceptance of a novel contraceptive product, resistance to changing current contraceptive routines, and fear of health consequences. Participants shared insights about promotional strategies which fell within the diffusion of innovations (DOI) characteristics of relative advantage, complexity, compatibility, and observability. Phase 2. In-depth interviews offered insight into perceptions of message development for MHC. Four themes emerged: 1) humor, 2) information, 3) relatability, and 4) credibility. Message testing in interviews yielded an understanding of elements participants responded most strongly to, including: 1) ad sentiment, 2) trustworthiness, and 3) visual appeal. Phase 3. Regression analyses revealed being sexually active (p=0.001) and having prior knowledge of potential MHC methods (p=0.031) aligned with positive MHC attitudes, interest, and intention. Conservative political views (p=0.002) and being satisfied with current male birth control offerings (p=0.000) were associated with negative MHC attitudes. Conjoint analysis identified informational messages as most important (56.62%). Informational (p=0.000) and aspirational messages (p=0.003) paired with relatable characters were the most highly preferred ads.

Conclusions: Findings revealed college-aged men and women express a general interest in the idea of MHC, with hesitance stemming from social acceptance of a novel contraceptive product, resistance to changing current contraceptive routines, and fear of potential side effects and long-term health consequences. Promotional strategy for MHC, or similar novel health products, must focus on stratifying consumers based on their readiness to accept a potential innovation and use tactics like aspirational marketing, social norms marketing, and informational marketing to confirm benefits and address concerns. Qualitative formative research also illuminated salient concepts for MHC advertising. Message testing revealed informational ads with elements of credibility may be most useful for promoting MHC, along with ad concepts audiences feel they can relate to or trust, and practical messaging or imagery meant to increase agency in use. The quantitative survey further supported these findings among a broader, university audience, indicating informational messages or aspirational messages paired with trustworthy, relatable characters are the most effective ad attributes to incorporate into marketing strategy when promoting a novel contraceptive product, like MHC.

Enrollment in post-secondary education for individuals with autism spectrum disorder (ASD) is increasing; however, students with ASD are less likely to complete a degree than students with other disabilities. Classroom performance requires attending to course-related information while filtering distractions. These attentional functions are critical for academic achievement. However, ASD is associated with pervasive impairments in attentional filtering. The present study used visual search, a task in which individuals with ASD excel, to investigate filtering of irrelevant social and non-social auditory information in college students with and without ASD. Results of the present study suggest a filtering deficit for individuals with ASD and indicate that this filtering impairment is present for both social and non-social information. Importantly, these deficits are present on a task in which individuals with ASD excel. Our findings suggest that irrelevant social and non-social sounds may adversely affect performance in college-aged students with high-functioning ASD and highlight the importance of minimizing competing background noise for these students.

Objectives The study will assess patterns of known individual, interpersonal, and community-level circumstances leading to suicide to understand how these factors can co-occur. These patterns will help focus on prevention strategies.

Methods Data was collected from the Iowa Violent Death Reporting System, Census data from the American Community Survey, and 2010 rural-urban commuting area codes from the Economic Research Service. The study consisted of three steps. The first step latent class analysis was conducted on data from suicide deaths from Iowa in 2016-2018 to create classes of patterns of circumstances leading to suicide. The second step maximum probability assignment was used to assign the sample of 1,276 to the created latent classes. Finally, in the third step bivariate regressions were ran to understand the relationship between the created latent classes and the rurality variable (nonmetropolitan vs metropolitan).

Results Five latent classes of distinct patterns of suicide factors emerged. Class 1 is physical health problems living in areas that are average on all community-level variables. This class 1 is seen to happen with higher odds in nonmetropolitan areas. Class 2 is interpersonal problems in areas where living alone is high. This class 2 happened with higher odds in nonmetropolitan areas. Class 3 is mental health problems or depressed mood with no legal problems in areas that had lower educational attainment. This class 3 did not indicate greater odds based on rurality. Class 4 is history of mental health treatment in well-off areas. This class 4 was seen to happen with higher odds in metropolitan areas. Class 5 is substance abuse problems in poorer areas. This class 5 did not indicate greater odds based on rurality. All the classes shared a common theme of experiencing mental health issues or being in a depressed mood.

Conclusions Suicide is a complex concern that could be classified into several classes that have distinct patterns of suicide factors. These classes and patterns help with identifying what services and interventions are needed in certain communities. Overall, providing support in regards to mental health as well as intervening in childhood to support positive development may provide substantial mitigation to the odds of committing suicide. In investigating these patterns, future prevention and intervention effort can take into consideration these patterns to tailor to the individual and the environments where they live.

This dissertation evaluated the complex inter-relatedness between co-occurring childhood maltreatment exposures, physical intimate partner violence (perpetration and victimization), substance use frequency, and molecular genetics for substance use, utilizing appropriate developmental models and theoretical approaches. Three studies were proposed within this dissertation. Data for the three studies come from a national longitudinal panel study: The National Longitudinal Study of Adolescent to Adult Health (Add Health; Harris, 2013). Across studies, latent profile analysis was used to evaluate co-occurring childhood maltreatment exposures based on type and severity of exposures, which resulted in three homogenous sub-groups. The first sub-group was composed of individuals that had high levels of physical abuse exposure and moderate levels of childhood neglect and emotional abuse exposures (high physical abuse sub-group). The second sub-group (high sexual abuse sub-group) included individuals with high severity of sexual abuse exposure and moderate severity of all other childhood maltreatment types (i.e., physical abuse, emotional abuse, and neglect). This second sub-group was, therefore, the most vulnerable in terms of their childhood maltreatment exposure. A final normative sub-group was also found that included a majority of individuals with low severity of childhood maltreatment exposure across types. Additionally, across all three studies, a probabilistic multifaceted genetic risk score (i.e., polygenic risk score) was created to evaluate substance use related genetic risk. The first study evaluated the role of co-occurring childhood maltreatment exposure on substance use development from adolescence to young adulthood while evaluating substance use related genetic moderation. Generalized estimating equations were used to test the proposed model in study 1. Findings suggest that the high physical abuse sub-group was more susceptible to genetic risk and had increases in substance use frequency only at high levels of genetic risk. In contrast, for the high sexual abuse sub-group, childhood maltreatment and environmental exposures were more ubiquitous for substance use development from adolescence to young adulthood. To elaborate, the high sexual abuse sub-group demonstrated increases in substance use from adolescence to young adulthood irrespective of genetic risk. In study 2, substance use frequency in young adulthood was tested as a mechanism between childhood maltreatment sub-groups and subsequent physical intimate partner violence perpetration in adulthood. Once again, genetic moderation for the direct association between childhood maltreatment sub-groups and substance use frequency in young adulthood was tested within the larger mediation model. In study 3, physical partner violence victimization in young adulthood was tested as a mediator of the association between childhood maltreatment sub-groups and substance use frequency in adulthood. In study 3, in addition to the above-mentioned genetic risk score, an additional substance use related dopamine polygenic risk score was also tested. Specifically, in study 3, genetic moderation by both genetic risk scores was tested on 1) the direct pathway from childhood maltreatment sub-groups to substance use frequency in adulthood, and 2) the direct pathway from physical intimate partner violence victimization in young adulthood to substance use frequency in adulthood. In both studies 2 and 3, product of co-efficient method was used to estimate mediation hypothesis, and moderated-mediation models were used to test for genetic moderation within the mediation model. Research aims for studies 2 and 3 were largely not supported. However, supplementary models indicate that substance use frequency may not be a causal mechanism but may be a contextual factor exacerbating the association between childhood maltreatment exposures and physical intimate partner violence perpetration. Implications for findings are discussed in detail.

This quantitative study examined the relationship between parental comprehensive sexual and reproductive health communication (SRH), religiosity and sex positivity in first- and second-generation African immigrants. Comprehensive SRH communication was measured by frequency through the Sexual Communication Scale (SCS), religiosity was measured through the Faith Activities in the Home Scale (FAITHS) and sex positivity was measured through the Sex Positivity Scale (SPS). It was hypothesized that there would be a negative relationship between religiosity and sex positivity and a positive relationship between religiosity and sex positivity in first-and second-generation African immigrants. Results indicated that higher levels of religiosity in the participant’s upbringing was significantly associated with higher sex positivity. Additional findings revealed higher instances of SRH communication correlated with higher sex positivity in men and lower sex positivity in women. This study aimed to set a foundation for future studies on first- and second-generation African immigrants as it relates to sexual health.