This study evaluated the efficacy of the Stages of Behavior Change (SBC) Model for use with Hong Kong Chinese. The SBC Model has demonstrated empirical support in a variety of health behaviors and across diverse populations. Further, the SBC has implications for the development of behavior change interventions. The SBC is composed of three components: stages of change, self-efficacy, and decisional balance. The stages of change are used to determine intention and time frames for behavior change. The SBC model applies Bandura's (1977) definition of self-efficacy and Janis and Manns’ (1968, 1977) conflict theory of decision making. The surveys used to measure these components have been validated and are predictive for condom acquisition. Survey data related to HIV/AIDS prevention (condom use) were collected from university students in Hong Kong and the United States. Comparisons were made across cultures (Hong Kong and the United States) and within the two cultural groups. Exploratory factor analyses using Principal Components Analysis revealed a single-factor model for self-efficacy and a 4-factor model for decisional balance (2 factors for advantages and 2 factors for disadvantages) concerning self (1) and others (we). Main effects for culture and staging were found for self-efficacy and the disadvantage component of decisional balance. Main effects for stage were found for advantages with a significant interaction. These data described an increase in self-efficacy across the stages of change for condom use and greater self-efficacy in HK then the US. The hypotheses for this study were supported with the exception of the advantages component of decisional balance within Hong Kong. Post hoc tests found no difference in self-efficacy in sexually active versus sexually non-active subjects in HK and the US and demonstrated differences in sexually active versus sexually non-active subjects in HK for advantages and disadvantages. Results offer support for using this model with Hong Kong Chinese as the data suggest more similarities than differences across two diverse cultures. These results have important implications for understanding behavior change mechanisms in diverse cultural groups and have significance for intervention planning in Hong Kong for AIDS risk reduction. / Ph. D.

Waterborne diseases continue to plague the poorest people in low-income countries and are estimated to cause 4,600,000 acute incidents of diarrhea resulting in over 2,000 deaths daily. A major challenge is performing microbiology tests to monitor drinking water quality. Friends of the Old (FOTO) implemented a novel strategy using evidence-based microbiology to educate communities about the relationship between contaminated water and disease. Two commercially available tests for E.coli, adapted for fieldwork, provided easily interpreted results of contamination that correlate with WHO's disease risk categories. Simple and effective household water treatment options 'solar pasteurization and/or chlorination' were provided to all 14,400 families and 42 schools in Lower Nyakach, Kenya. From February to May, 2015, adjacent districts had serious cholera outbreaks, but in Lower Nyakach, where education and the use of chlorine were nearly universal, there were no cases of cholera and steadily decreasing rates of diarrhea. A cross-sectional study was conducted to verify self-reported water treatment practices with evidence-based microbiological testing. A random sample of 377 households revealed that 95% treat their water each and every time they collect. Microbiological verification found 96% of household safe water storage vessels were low risk compared to their very high risk source water. A strong association (p < 0.001) existed between the observed decrease in diarrhea trends from health facilities in Lower Nyakach and exposure to the novel training. The strategy used by FOTO could be replicated to empower communities worldwide to identify contaminated drinking water sources and to reduce the incidence of waterborne disease.