Background: Low birthweight (LBW, <2500g) is a leading cause of infant mortality, and disparities exist between Blacks and Whites. About 11% of Pittsburgh births in 2003 were LBW, and the racial difference was wide: 8.4% of LBW infants were born to Whites, whereas 16.0% were born to Blacks. Studies suggest an association between contextual factors and LBWlower levels of area-level socioeconomic position (SEP) are associated with increased LBW risk. The dissertations main research hypotheses are whether 1) area-level SEP predicts LBW, 2) racial difference in LBW is partially explained by area-level SEP, and 3) racial difference is explained after controlling for area-level SEP and individual-level factors. Methods: Using U.S. Census 2000 data, area-level SEP measures were created for Pittsburgh: overall neighborhood disadvantage (ONDijk), material and economic deprivation (MEDij), and concentrated disadvantage (CDij). LBW and other individual-level data from 10,830 birth records were obtained from the 2003-2006 Allegheny County birth registry. Multilevel logistic regression was utilized to examine the association between SEP measures and LBW. Results: ONDijk was a significant predictor of LBW (OR: 1.306, p<0.001), remained significant after controlling for race (OR: 1.10, p<0.03), but was no longer significant after controlling for individual-level disadvantage (OR: 1.05, p=0.27). In addition, 74% of Blacks resided in disadvantaged neighborhoods, compared to 13% of Whites. In the unadjusted race model, Blacks were at increased odds of LBW compared to Whites (OR: 2.119, p<0.001), and the race OR decreased after adjusting for ONDijk (OR: 1.917, p<0.001) and individual-level disadvantage (OR: 1.56, p<0.001). Due to the lack of variability of LBW at the block group level, there was insufficient power to test the association between LBW and CDij and MEDij. Conclusions: Findings suggest that contextual factors are associated with LBW: knowing ones race and neighborhood may help predict ones risk for LBW. Public health significance includes using ONDijk as an indicator of areas with higher levels of LBW risk and targeting these neighborhoods for interventions to improve birth outcomes. In addition, understanding racial differences in neighborhood conditions may help further understand the social determinants that contribute to health disparities in LBW between Blacks and Whites.

Mental health promotion is an important public health issue which warrants increased and immediate attention due to the significant impact that mental health can have on physical health, quality of life, and functioning. Immigrants and refugees often have unique and increased mental health needs secondary to their migration to a new country and the acculturative stressors and living difficulties that often accompany resettlement, as well as prior experiences of trauma. However, little to no prior research has been conducted regarding the mental health of African immigrants and refugees living in Sweden. This thesis describes data from a study which was conducted in Stockholm, Sweden from 2002 to 2005 that investigated African immigrant and refugee health and quality of life. Stratified quota sampling based on the 2001 Swedish census was used to recruit a representative sample of participants by gender and country of origin. Four hundred and twenty participants completed semi-structured interviews that utilized cross culturally validated survey instruments to measure depression, anxiety, post-traumatic stress disorder (PTSD), acculturation, traumatic events, and post-migration living difficulties. Twenty percent of participants met symptom criteria indicative of depression, and 18.5% met criteria indicative of anxiety. Eighty-nine percent of participants reported experiencing at least one traumatic event prior to immigration, and 47% met DSM-IV symptomology and functional impairment criteria for PTSD. Mental health outcomes were found to be significantly associated with pre-migration trauma, acculturation level and type, and post-migration stressors. Recommendations for future research, mental health service provision, and integration policies are provided.

The Marcellus Shale formation is being harvested for its methane by gas drilling companies in the state of Pennsylvania. The gas extraction method being used is hydraulic fracturing. This operation has public health significance because the chemicals injected beneath the earths surface during the hydraulic fracturing process are known to have adverse health effects on humans and aquatic life when in their undiluted form. There is much controversy among the communities involved surrounding the use of these chemicals in the Marcellus Shale. Despite communication efforts by government agencies with these affected communities, health concerns continue to run high. A literature review performed in regards to the chemicals found in fracturing fluids and their affects on aquatic life, found eleven chemicals to have adverse affects. A qualitative analysis performed on public comments regarding a proposed EPA assessment on hydraulic fracturing found several common themes. The most prevalent of which were concerns regarding the possibility of hydraulic fracturing affecting water resources and public and environmental health. Themes that emerged from three stakeholder interviews coincided with those found in the public comment analysis. In regards to the issue of hydraulic fracturing and the Marcellus Shale, this paper proposes increased community involvement in government studies, social action methods to help communities achieve the desired change and possible leverage points for interventions to help improve the health of the public and environments involved.

Previous research has found that college students widely participate in HIV risk behaviors, including inconsistent or lack of condom use, multiple sex partners, and sexual activities while under the influence of alcohol. However, most college students do not perceive themselves at risk for HIV and further, the majority of college students have never been tested for HIV. In an effort to understand the reasons undergraduate students may choose or not choose to get tested for HIV, and elucidate possible points for public health intervention, a survey was administered to undergraduate students at the University of Pittsburgh. Survey data was collected from 440 University of Pittsburgh undergraduate students on the pros and cons of HIV testing, their perceived risk for HIV as well as the number of times they had ever been tested. Chi-square tests were used to determine the relationship between decisional balance items and HIV testing as well as perceived risk and HIV testing. One-way ANOVA was used to determine any association between HIV testing and demographic variables. This study found that only 11.8% of students had ever received an HIV test. The likelihood of testing increased with age, while gender and ethnicity were not significant predictors of HIV testing. Students with high perceived risk were significantly more likely to have received an HIV test in their lifetime. Additionally, decisional balance items around the topics of security and responsibility and fear of needles were also found to be significant with HIV testing. The low rate of HIV testing in undergraduate college students is of great public health concern given the high prevalence of risk behaviors in this population. Students who participate in risk behaviors and are not tested for HIV limit their own ability to take advantage of efficacious treatments and put sex or drug partners at risk for contracting the virus. Research that helps uncover the behavioral determinants of HIV testing in the college student population and reveals potential points of intervention is of great public health significance.

Combating excessive rates of binge drinking and alcohol-related harm among college students continues to pose a challenge for public health practitioners and college administrators. While many interventions to decrease binge drinking have proven effective in research settings, these interventions arent as effective in non-research settings, such as on college campuses, where rates of binge drinking continue to rise. One such intervention, Brief Alcohol Screening and Intervention for College Students (BASICS), has garnered particular attention in both the research realm and among college health promotion professionals. This brief motivational intervention uses a harm reduction approach to decrease binge drinking behaviors and related consequences among college students who drink heavily. Despite extensive research on its efficacy, there have been no published reports documenting the outcome of BASICS when it has been implemented on college campuses. This thesis addressed this gap in the literature by exploring how BASICS has been applied in campus research settings. Specifically, it focuses on the characteristics of the settings and samples, the extent to which the program maintained fidelity to the original evidence-based BASICS program, and the use of seven core implementation components derived from the field of implementation science. These seven components have been identified as crucial processes in the successful uptake of an evidence-based program like BASICS by an organization, such as a university. A systematic review of the literature revealed that higher levels of program fidelity are associated with positive program outcomes. Additionally, the presence of many or all of the seven core implementation components is associated with higher levels of fidelity and statistically and clinically significant decreases in binge drinking and related harms. Finally, this thesis presents suggestions on how BASICS should be implemented in order to effectively reduce alcohol consumption on college campuses.

Background: Improving the effect of evidence based programs (EBP) has great public health relevance. Improving implementation strategies is a good way to enhance the effect of EBP's. This paper is a test of concept study that assesses the utility of Fixsen et al.'s implementation model to research implementation. Fixsen et al.'s model consists of seven implementation drivers proposed to be relevant and important to the successful implementation of an EBP. An organization deemed to have successfully implemented an EBP was used to examine the relevance of Fixsen et al.'s implementation model. Results: All seven implementation drivers, as proposed by Fixsen et al., were identified within the organization that has successfully implemented an EBP. Discussion: It was determined by this test of concept study that Fixsen et al.'s model was useful and relevant to the research of implementation. Conclusion: Fixsen et al.'s model of implementation provided a logical and strategic framework on which to approach implementation research. There is still much work to be done to assess the validity and utility of this model. Likewise, there is still much research to be done in implementation science in order to more clearly determine what components and strategies are important to successful implementation and what are not.

Latin American countries show some of the highest incidences of cervical cancer in the world. Many barriers that impact decisions regarding screening behavior have been identified in Mexico; however, the specific role of male partners in the decision-making process is rarely explored. This study investigated the impact of male sexual partners, as well as perceptions of the medical community, on female decisions concerning cervical cancer screenings in Pátzcuaro, Michoacán. It also examined whether the perception of subjection discourages women from seeking medical care. Data were obtained through 75 surveys and 9 interviews conducted in Pátzcuaro, Michoacán, with women between the ages of 25 and 64 years. Cross-tabulations, descriptive statistics, and chi-squares of the survey data, along with the coding of interviews, were performed to examine barriers associated with cervical cancer screening. Survey data shows that 24.2% of women said their partners make their health decisions for them, and 8% said that their partners would not support them if they wanted a pelvic exam. Almost half (48.4%) of the women said their partners would not be comfortable with them being examined by a male medical provider. Additionally, 28% of women stated that they fear a male doctor might take advantage of them during an examination. In the interviews, women discussed male machismo, or exaggerated masculinity, and how it contributes to their feelings of subjection. More educated women were less likely to share these experiences. Women expressed that male influence is indeed a barrier to cervical cancer screenings. Neither male influences nor negative perceptions of medical providers were significantly associated with screening behavior. More research is needed to better understand the contradiction between what women perceive and actually do. Additionally, future research should explore the role of cash incentives for screening on screening behavior. This research is relevant to public health because mortality due to cervical cancer is high in Mexico, and it is important to understand barriers to screening since early detection increases the odds of survival. This study gives insight into the role of female subjection to a patriarchal society as a barrier to cervical cancer screening.

Research focused on the factors that contribute to the practice of health promoting behaviors by racial and ethnic minority adolescents has been limited and inconclusive. The purpose of this study was to identify a subset of factors, including demographic, social, and environmental factors that are highly correlated with differences in the eating habits and exercise patterns of racial and ethnic minority adolescents. The study is of public health significance as the results may be used to improve the methods and strategies currently in practice to reduce and eliminate the disparities in health for racial and ethnic minorities. The sample was drawn from the final sample size for the National Longitudinal Survey of Youth 1997 cohort, which numbered 8,984. The study tested the hypothesis that differences in health-promoting behaviors among racial and ethnic minority groups are related to differences in the associations between the influential factors and the health-promoting behavior by racial and ethnic minority group. Body Mass Index was used to measure adolescent health promoting behaviors such as diet and exercise. Multiple imputation and univariate forward stepwise multiple regression analyses found that associations between demographic, social, and environmental factors and the eating habits and exercise patterns of minority adolescents varied by racial and ethnic minority subpopulation. Study results suggest that policies, programs, and research intent on reducing and/or eliminating racial and ethnic health disparities must capture, analyze, and evaluate information at the racial and ethnic subpopulation level to capture differences between subpopulations. A small sample size due to the removal of non-respondents, the exclusion of health promoting behavior variables from the study due to high non-response rates, and the exclusion of some racial and ethnic subpopulations due to inadequate numbers all served as limitations of the study. Future research should further study the differential impact of the various factors included in the present study, as well as those not examined here, on the dietary and exercise habits of several racial and ethnic adolescent subpopulations and use the findings to inform research, policy and program efforts to reduce and eliminate racial and ethnic health disparities.

Childhood sexual abuse can lead to a lifetime of negative health outcomes and disorders. These outcomes include problems of substance use, other high-risk behaviors, and psychological and biological disorders with increasing rates of morbidity and mortality, thus making this relationship a significant public health issue. This literature review focuses on the relationship of childhood sexual abuse (CSA) to substance use disorders and problem use in women. The rate of substance use and abuse among women is significantly higher in CSA victims than in the general population. However, this relationship is very complex due to various other factors found to play a role in this relationship. Literature on third factors (e.g., PTSD, neurobiological disorders, poor social outcomes, depression, other forms of abuse, and family and environmental factors), are examined for their possible role in this relationship and their implications for treatment of childhood sexual abuse and substance use.

Objectives: This study describes the information practices of the various professions such as emergency management, public health, health and medicine, and public safety, involved in regional disaster preparedness groups. A thorough understanding of the similarities and differences between the professions in information seeking, use, and sharing, will further the development of high-quality information sources and information-sharing channels acceptable to all professions on the team. Methods: A qualitative descriptive study was undertaken. Twelve participants in the Pennsylvania Preparedness Leadership Institute (PPLI), a multi-disciplinary training program attended by members of the Pennsylvania Regional Task Forces, were recruited interviewed. Open-ended individual interviews were conducted at PPLI trainings and in participant workplaces. Interviews focused on information practice in the workplace, including preferences for information seeking and sharing, and barriers and facilitators to information access in the workplace. Analysis used Taylors Information Use Environments model as an organizing framework. Findings: As Taylors model states, information practice is shaped by the educational and training requirements for entry into each profession. Factors not included by Taylor but important to this study include volunteer experience in related fields, and overlap between personal and professional information practice on the Internet. Participants report heavy use of the Internet and email, but not of Web 2.0 social media. They value face-to-face meetings for building the social networks critical to disaster response. Only public health and medical professionals use peer-reviewed literature. All would like tools to filter incoming information, and more access to the lessons learned reports of other agencies engaged in similar work. Conclusions: There are differences between professions in information practice, but also commonalities that can be exploited to further information use in preparedness. Librarians can make a significant contribution to preparedness efforts by incorporating these findings into the design of information services and resources for disaster professionals. Public health significance: Improving information gathering and sharing practices for all disciplines on the disaster planning team is critical to reducing the impact of man-made and natural disasters on the health of the general public.