Doctor of Philosophy / Hospitality Management and Dietetics / Junehee Kwon / Food allergies affect nearly 15 million Americans, and accommodating customers with food allergies has become a challenge for the restaurant industry. One third of the fatal food allergy reactions occurred in restaurants, and it is important for the restaurant industry to properly communicate and manage the food allergy risks. This study explored perceived risks and risk communication related behaviors of restaurant staff when serving customers with food allergies by using both qualitative (interviews) and quantitative (online survey) approaches. Telephone interviews with 16 restaurant managers were audio-recorded, transcribed verbatim, and organized to identify themes. Most participants were aware of the severity of food allergy reactions but perceived that it was the customers’ responsibilities communicating their food allergies with restaurant staff before placing their orders. Training for service staff on food allergies and risk communication topics were limited, and some managers perceived such training unnecessary for restaurant business. Findings from interviews were used to develop an online survey instrument. The survey instrument was pilot-tested and distributed to restaurant employee panels by an online survey research firm. Of 1,328 accessed the survey, 316 usable survey responses (23.8%) were collected from full-service restaurant service staff. Data analyses included descriptive statistics, independent samples t-test, ANOVA, and regression analyses. Results indicated that limited information about food allergies was provided on printed (35.1%) or online menus (28.2%), and very few restaurants had separate menus (8.5%) or complete ingredient lists (14.6%) for customers with food allergies. Meanwhile, restaurant servers lacked knowledge about common food allergens (12.7% correct), differences between food allergies and intolerances (34.2% correct), and government regulations related to food allergies (15.5% correct). Most restaurant servers (82.0%) agreed or strongly agreed that initiating communication and preventing food allergy reactions were responsibilities of customers with food allergies. Perceived severity of food allergy reactions, previous communication training, sources of media exposure, and perceived responsibilities of preventing food allergy reactions were found to influence restaurant servers’ risk reduction and communication behaviors (R²=0.367, p<0.001). Restaurateurs, foodservice educators, food allergy advocates, and policy makers may use these findings when developing food allergy training and strategies to prevent food allergy reactions in restaurants.

Master of Science / Department of Hotel, Restaurant, Institutional Management & Dietetics / Elizabeth Barrett / This research created an interactive, multimedia, food safety education program on CD/ROM for fourth through sixth grade school children. The project was divided into three stages: 1) a survey to assess children's needs, 2) program development, and 3) Beta-testing the program with content experts and the targeted audience. A needs assessment survey was administered to children, 9 to 12 years of age, who were members of a 4-H, Boys and Girls Clubs, or after school program. The survey collected demographic data, food handling frequencies/practices, handwashing habits, and computer usage/media preferences. Children were found to be active in food handling/preparation and stated they knew the definition of food safety. Many, however, were unsure of the meaning of cross-contamination, how to use a thermometer, and were inconsistent with safe handwashing practices. Almost 92% of respondents reported using the computer daily, weekly, or monthly and 91% liked using the computer for learning. To facilitate design of the food safety education program, current food safety education programs were reviewed. At the time, there were limited numbers of programs directed at children and even fewer computer-based. A multimedia specialist assisted in the creation of the food safety education program on CD/ROM titled, "Kid Chef and the Clean Kitchen Crew." The program was divided into four chapters: 1) food safety and foodborne illness, 2) handwashing importance and handwashing techniques, 3) foodborne pathogens, and 4) food safety practices from purchase to cooking to serving. Interactive and multimedia components were used throughout the program. Beta-testing with experts from food safety, multimedia, education, extension, and technology ensured that the program was factual and appropriate for fourth through sixth grade students. Additional Beta-testing with ten children in the targeted age group illustrated acceptance, ease of understanding, and navigation. Changes were made prior to each subsequent critique. The reviewers and target audience indicated the CD format was acceptable for presenting food safety education. Recommendations included increasing the amount of animation, video clips, questions, and translation into Spanish. It is further suggested that the program be tested for effectiveness via a pre/post test design.

Doctor of Philosophy / Department of Economics / Dong Li / The dissertation examines empirical issues related to health and labor economics. It has long been debated whether breastfeeding leads to a higher intelligence quotient (IQ) and greater scholastic achievement. The first study empirically examines the issue. Many past studies fail to take into account the possible endogeneity of the breastfeeding decision and thus falsely identify the correlation between breastfeeding and IQ as a causal relationship. We attempt to distinguish the causation and correlation between the two variables. Our results show that, after controlling for possible endogeneity, breastfeeding has no significant impact on IQ or scholastic achievement. The second essay examines the link between breastfeeding and childhood obesity. Heath economics researchers view breastfeeding as a determining factor as to whether a child becomes obese. There are many theories, involving both biological and psychological factors, as to why breastfeeding is negatively linked to childhood obesity. This essay argues that the breastfeeding decision is not an exogenous one, so estimation technique such as ordinary least squares is not the correct way to estimate the relationship between breastfeeding and childhood obesity. Instruments are used to generate exogenous variations in the breastfeeding variable. After correcting for any estimation bias due to the breastfeeding variable being endogenous, this study documents the benefits of breastfeeding. The third essay analyzes 19 semesters of student evaluations at Kansas State University. Faculty fixed effects are sizable and indicate that, as assessed by students, the best principles teachers also tend to be the best non-principles teachers. OLS estimates are biased because principles teachers are drawn from the top of the distribution and because unmeasured faculty characteristics are correlated with such variables as the response rate and student effort. Student ratings are lowest for new faculty but stabilize quickly. Expected GPA of the class is not an important determinant of student ratings, but equitable grading is; and the rewards for equitable grading appear larger for principles classes. The lower ratings in principles classes are fully accounted for by greater class size.

Master of Science / Department of Special Education, Counseling, and Student Affairs / Brandonn S. Harris / The present study examined adolescents’ perceptions of their caregivers’ parenting style as well as their physical activity participation, motivation, and attitudes. High school students completed questionnaires regarding their physical activity participation, motivation, and attitudes, and they assessed both their male and female caregivers’ parenting style. Results indicated that for males, a permissive parenting style was related to more physical activity participation and that males favor physical activity that features long and hard training and as a way to stay healthy and fit. An authoritative parenting style was related to higher rates of physical activity for females, and their attitudes focused on social aspects of physical activity as well as a release of tension. For both genders, identified regulation was associated with higher rates of physical activity, indicating that higher levels of self-determined motivation are important for promoting active behaviors. Cross-gender relationships between caregiver and child emerged and social and gender norms seemed to influence parenting style and attitudes specific to gender. Additional results and implications are discussed.

Master of Science / Department of Human Nutrition / Koushik Adhikari / Obesity in adolescence is associated with a complex web of ecological, psychosocial, and physiological factors, and many of these factors relate to nutrition and physical activity behaviors. Before interventions are developed, researchers need to know what factors specifically influence an adolescent’s food choices and physical activity within the community context. Cultural norms, school environment, and neighborhood attributes are examples of factors that may vary across different communities, and accounting for this variation can be quite challenging, unless community perspectives are acknowledged. The use of qualitative data from focus groups has shown to be an effective way of gathering community perspectives about the diversity of their views and experiences. The current study used focus groups to reveal facilitators and barriers to healthy eating behavior and physical activity engagement in 6th to 8th grade youth in a low-income community in South-Western Kansas. This methodology enabled community members (adolescents, parents, and teachers) to discuss and articulate their perceptions in relation to 6th to 8th grade youth’s eating habits and physical activity, and assessed available resources, needs, and opportunities for developing effective and sustainable intervention approaches in the community. Using the socio-ecological model, individual influences (e.g., taste preferences), social influences (e.g., parent and peer influences), and larger contextual influences (e.g., school) on early adolescent health were assessed. This information will be used to develop interventions addressing factors at these different levels of influence that are needed to improve eating habits and physical activity of youth in the community.

Master of Science / Department of Hospitality Management and Dietetics / Elizabeth B. Barrett / The Centers for Disease Control estimates that each year 48 million Americans become ill, 128,000 are hospitalized, and 3,000 die of foodborne diseases. In 2011, the CDC reported that Norovirus caused the majority of all foodborne diseases and can be eliminated with proper handwashing, which is the number one way to prevent the spread of foodborne disease. The purpose of this study was to use the Health Belief Model to determine differences in university foodservice employees’ beliefs and perceptions about handwashing and foodborne illness. The constructs of perceived susceptiblity, severity, barriers, benefits, and self-efficacy as they relate to handwashing were used to examine the differences in demographics. Instrument development included a review of literature, focus group feedback, a pilot study and a review by industry experts. The final instrument was distributed to all foodservice employees at Kansas State University using Qualtrics and pen-and-paper surveys. Frequencies, means, t-tests, ANOVA, and regression were used for data analysis and to answer research questions. Results indicated respondents who were older (above 23 years of age), full-time employees, had more than three years of experience, and were food safety certified had a higher perception of susceptibility, benefits, and self-efficacy of handwashing and its relationship to reducing foodborne illness. Perceived severity was highest among respondents with food safety certification and more than three years of experience. Supervisor/Manager category did not agree on barriers to handwashing in the workplace with other positions; however, most employees did not rate barriers as a problem. Non-white respondents showed a lower self-efficacy for ability to wash hands correctly. Results of this study highlight the need for self-efficacy focused handwashing training for first year and non-white employees.

Artwork / Streetlives is a community-based, arts-informed, research project which addresses harm reduction amongst street youth in Thunder Bay, Ontario. Nine street-involved participant researchers (supported by a team of researchers and community organizations) used art making and storytelling as ways of understanding the risks specific to street-involved youth in Thunder Bay. Due to the heterogeneous nature of the participant researcher group and a majority of Aboriginal research participants, a novel approach was used to create principles of research collaboration, in pursuit of the principles of ownership, control, access and possession for ethical research with Aboriginal peoples. The participant researchers found that their most common experience was their vulnerability to governmental social services and law enforcement personnel and policies. They further agreed that the risk of losing their children to child protection services is a source of increased vulnerability and a barrier to accessing treatment. They all agreed that the process of art making was fruitful and were surprised by the clarity and evocative nature of their artwork, finding that meeting weekly to do art is gratifying and therapeutic. They were interested to discover that the art they created, just by telling their stories, contained strong prevention messages they would have been influenced by as younger people. As such the participants want to continue making art, and showing their work, particularly to young people, social service providers, and law enforcement officers, who they think are in the best position to learn from it. This project is building capacity in the community (by teaching artmaking, group work, organizing, critical thinking, and presentation skills), is contributing to scholarship, and significantly and positively impacting the lives of the participant researchers. This work is represented in traditional academic prose and as collaborative fiction.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

Artwork / Streetlives is a community-based, arts-informed, research project which addresses harm reduction amongst street youth in Thunder Bay, Ontario. Nine street-involved participant researchers (supported by a team of researchers and community organizations) used art making and storytelling as ways of understanding the risks specific to street-involved youth in Thunder Bay. Due to the heterogeneous nature of the participant researcher group and a majority of Aboriginal research participants, a novel approach was used to create principles of research collaboration, in pursuit of the principles of ownership, control, access and possession for ethical research with Aboriginal peoples. The participant researchers found that their most common experience was their vulnerability to governmental social services and law enforcement personnel and policies. They further agreed that the risk of losing their children to child protection services is a source of increased vulnerability and a barrier to accessing treatment. They all agreed that the process of art making was fruitful and were surprised by the clarity and evocative nature of their artwork, finding that meeting weekly to do art is gratifying and therapeutic. They were interested to discover that the art they created, just by telling their stories, contained strong prevention messages they would have been influenced by as younger people. As such the participants want to continue making art, and showing their work, particularly to young people, social service providers, and law enforcement officers, who they think are in the best position to learn from it. This project is building capacity in the community (by teaching artmaking, group work, organizing, critical thinking, and presentation skills), is contributing to scholarship, and significantly and positively impacting the lives of the participant researchers. This work is represented in traditional academic prose and as collaborative fiction.