Background: Nursing staff are often involved in counseling patients with regard to health behavior. Although care promoting healthy lifestyle choices is included in the curriculum of nursing students in Germany, several studies of nursing students have reported a high prevalence of unhealthy behavior. This paper focuses on the behavior of female nursing students with regard to body mass index (BMI), physical activity, and cigarette and alcohol consumption. It describes trends through the comparison of results from 2008 and 2013. Methods: Data was collected in two waves at a regional medical training college. First, 301 nursing students were asked to fill out a 12 page questionnaire on health behavior in 2008. The questioning was repeated in 2013 with 316 participating nursing students using the previous questionnaire. Results: 259 female nursing students completed the questionnaire in 2013. 31.6% of them were either overweight or obese, 28.5% exercised less than once a week, 42.9% smoked between 10 and 20 cigarettes a day and 72.6% drank alcohol, wherefrom 19.7% consumed alcohol in risky quantities. In comparison to the data of 266 female nursing students from 2008, there were significant differences in the BMI and alcohol consumption: The percentage of overweight and obese students and the percentage of alcohol consumers at risk increased significantly. Conclusions: Health behavior of female nursing students is often inadequate especially in regard to weight and cigarette and alcohol consumption. Strategies are required to promote healthy lifestyle choices.

Bakgrund: Förekomsten av övervikt och fetma bland barn ökar i stora delar av världen. Brist på fysisk aktivitet är en av orsakerna bakom övervikt och fetma. För barn med fetma kan små mängder fysisk aktivitet ha stora positiva hälsoeffekter. Det finns ett behov av att utveckla nya effektiva strategier för att öka mängden fysisk aktivitet bland barn med övervikt eller fetma. Mobil hälsa (m-hälsa) används som ett paraplybegrepp för hälsotjänster förmedlade genom mobila enheter och definieras som ”medicinsk eller offentlig hälsoutövning som stöds av mobila enheter så som mobiltelefoner, anordningar för patientövervakning, personliga digitala assistenter och andra trådlösa enheter”. En potentiell strategi för att påverka mängden fysisk aktivitet bland barn med övervikt eller fetma är m-hälsa genom användning av mobiltelefon. Syfte: Att kartlägga och beskriva vilka interventioner med m-hälsokomponent genom användning av mobiltelefon som utvärderat fysisk aktivitet eller Body Mass Index (BMI) bland barn med övervikt eller fetma. Metod: En systematisk litteraturstudie där studier som beskrev interventioner med mhälsokomponenter för målgruppen barn 0-18 år med övervikt eller fetma inkluderades. Sökning genomfördes i tre vetenskapliga databaser. Resultat: Sökningarna resulterade i 649 studier av vilka 16 mötte uppsatta inklusionskriterier. M-hälsokomponenten innefattade i de flesta studier användning av sms och i några studier användning av app. Funktionen med m-hälsokomponenten studerades och delades in i självregistrering, kommunikation, uppmuntran, utbildning och påminnelse. De inkluderade studierna rapporterade olika former av BMI där två studier visade på signifikanta skillnader mellan interventions-och kontrollgrupp med störst minskning för interventionsgruppen. Få studier rapporterade objektivt mätt tid i fysisk aktivitet på måttlig till hög intensitet. Slutsats: Den vanligast förekommande interventionen med m-hälsokomponent genom användning av mobiltelefon bland barn med övervikt eller fetma var sms. För att kunna förstå och jämföra på vilket sätt m-hälsa kan användas skulle ett ramverk för beskrivning av dessa interventioner underlätta. / Background: The presence of overweight and obesity among children is increasing in large parts of the world. Lack of physical activity is one of the causes of overweight and obesity. For children with obesity, small amounts of physical activity may have major positive health effects. There is a need to develop new effective strategies to increase the amount of physical activity among children with overweight or obesity. Mobile health (mHealth) is used as an umbrella term for health services transmitted by mobile devices and is defined as "medical or public health practice supported by mobile devices such as mobile phones, patient monitoring devices, personal digital assistants and other wireless devices." A potential strategy for influencing the amount of physical activity in children with overweight or obesity is mHealth through the use of mobile phones. Objective: To examine and describe what interventions with mHealth component through the use of mobile phones that evaluated physical activity or Body Mass Index (BMI) in children with overweight or obesity. Methods: A systematic literature study in which studies describing interventions with mHealth components for the target group of children 0-18 years of overweight or obesity were included. Search was conducted in three scientific databases. Results: The searches resulted in 649 studies, of which 16 met set inclusion criteria. In most studies, the mHealth component included the use of text messaging and in some studies the use of app. The function of the mHealth component was studied and divided into self-registration, communication, encouragement, education and reminder. The included studies reported different forms of BMI where two studies showed significant differences between the intervention and control group with the greatest reduction for the intervention group. Few studies reported objectively measured time in physical activity of moderate to high intensity. Conclusion: The most common intervention with mHealth component through the use of mobile phones among children with overweight or obesity was text messaging. In order to understand and compare how mHealth can be used, a framework for the description of these interventions would facilitate.

Background: Nursing staff are often involved in counseling patients with regard to health behavior. Although care promoting healthy lifestyle choices is included in the curriculum of nursing students in Germany, several studies of nursing students have reported a high prevalence of unhealthy behavior. This paper focuses on the behavior of female nursing students with regard to body mass index (BMI), physical activity, and cigarette and alcohol consumption. It describes trends through the comparison of results from 2008 and 2013. Methods: Data was collected in two waves at a regional medical training college. First, 301 nursing students were asked to fill out a 12 page questionnaire on health behavior in 2008. The questioning was repeated in 2013 with 316 participating nursing students using the previous questionnaire. Results: 259 female nursing students completed the questionnaire in 2013. 31.6% of them were either overweight or obese, 28.5% exercised less than once a week, 42.9% smoked between 10 and 20 cigarettes a day and 72.6% drank alcohol, wherefrom 19.7% consumed alcohol in risky quantities. In comparison to the data of 266 female nursing students from 2008, there were significant differences in the BMI and alcohol consumption: The percentage of overweight and obese students and the percentage of alcohol consumers at risk increased significantly. Conclusions: Health behavior of female nursing students is often inadequate especially in regard to weight and cigarette and alcohol consumption. Strategies are required to promote healthy lifestyle choices.

In der Literatur wird von einem kontinuierlichen, weltweiten Anstieg der Inzidenz des Typ 1 Diabetes mellitus unter Kindern und jungen Erwachsenen, insbesondere in der Altersgruppe der unter 20-Jährigen, berichtet. Die multizentrische Studie EURODIAB untersuchte in den Jahren 1989-2003 die Inzidenz des Typ 1 Diabetes in 17 europäischen Ländern und bestätigte mit deren Ergebnissen diese weltweite Tendenz. Die Akzelerator Hypothese von Wilkin aus dem Jahr 2001 sieht die Ursache hierfür durch einen übermäßigen Gewichtsanstieg bedingt, da auch die Inzidenz übergewichtiger Kinder innerhalb der letzten Jahre zugenommen hat. Demnach sei die Anzahl Betroffener insgesamt gleich, jedoch in jungen Jahren (bis 15 Jahre) erhöht. Folglich sei Übergewicht mit Insulinresistenz ein Triggerfaktor für eine raschere Progression der Erkrankung und würde zu einem vorzeitigen klinischen Ausbruch des Typ-1-Diabetes beitragen. Im Rahmen dieser Dissertation verglichen wir anthropometrische Geburtsdaten von 1.117 Kindern mit Typ 1 Diabetes mellitus, deren Erstmanifestation zwischen 1988 und April 2013 lag, mit einer Kontrollgruppe, die bezüglich Geschlecht, Alter und Schwangerschaftswoche angepasst wurde (n=54.344). Des Weiteren wurden die Kinder mit Diabetes entsprechend ihres Alters bei Manifestation bestimmten Gruppen zugeordnet: G1:0-4,9 Jahre; G2:5 9,9 Jahre; G3:10-20 Jahre. Diese Unterteilung wurde vorgenommen, um festzustellen, ob Kinder, bei denen eine Diabetes Erkrankung früher klinisch manifest wird, zur Geburt bzw. zum Zeitpunkt der Diagnosestellung einen höheren Gewichts SDS aufweisen als Kinder, welche erst in späteren Jahren betroffen sind. Zusätzlich wurden Verlaufsdaten des BMI SDS von 540 Studienkindern vor, zu und nach Manifestation ermittelt und mit einer gesunden Kontrollpopulation (n=134.249) verglichen. Hierbei zeigten Kinder und Jugendliche mit Typ 1 Diabetes im Vergleich zu Stoffwechselgesunden signifikant erhöhte Geburtsgewicht SDS Werte. Es konnte jedoch keine signifikante Abhängigkeit zwischen einer vorzeitigen Diabetes-Manifestation und einem erhöhten Geburtsgewichts bzw. einem erhöhten BMI SDS zum Zeitpunkt der Manifestation gezeigt werden. Ebenso blieb der laut Wilkin zu erwartende Gewichtsanstieg 4 Jahre vor Ausbruch der Erkrankung aus. Kinder mit Diabetes verlieren, wie erwartet, zur Manifestation an Gewicht und erreichen nach ungefähr einem Jahr ihr Ausgangsgewicht. In den Folgejahren sind Kinder mit Typ 1 Diabetes signifikant schwerer als die Kontrollgruppe. Aufgrund dieser Ergebnisse müssen wir die von Wilkin postulierte „Akzelerator Hypothese“ widerlegen.:Inhaltsverzeichnis: Bibliographische Beschreibung 3 Abkürzungsverzeichnis 5 1 Einführung in die Thematik 6 1.1 Diabetes mellitus 6 1.2 Typ 1 Diabetes mellitus 6 1.2.1 Ätiologie 7 1.2.2 Gewichtsanstieg als Triggerfaktor des Typ 1 Diabetes 9 1.2.3 „Akzelerator Hypothese“ 10 1.3 Promotionsprojekt- Ziel und Fragestellung 11 1.3.1 Hintergrund und Fragestellung 11 1.3.2 Methoden 11 1.3.3 Ergebnis 12 2 Publikation 14 3 Zusammenfassung und Interpretation der Arbeit 22 4 Literatur 26 I Erklärung über das eigenständige Abfassen der Arbeit 31 II Publikation 32 III Danksagung 33

Doctor of Education / Curriculum and Instruction Programs / John A. Hortin / A growing concern for the United States and the World Health Organization is that Americans are getting fatter. The obesity rates continue to rise in 23 states (Science & Technology, 2009). There is also a high incidence of childhood obesity among children ages 10-17. The epidemic of obesity goes far beyond being an individual problem. It has become a national crisis. The obesity epidemic calls for a well-formulated strategy. This study involved a physical education program with 12 African American female teenagers ranging from grades 7 – 11. The program was designed to help students realize the importance of preparing for a healthy future. The African American females met one hour a day for three days a week. As part of the program, each student’s fitness performance was evaluated using the FitnessGram protocol. Pretesting begins at the start of school and post testing during second semester. The FitnessGram report gives the performance levels for the Healthy Fitness Zone (HFZ) and the “Needs Improvement” zone. Attaining the HFZ for a test indicates that the student has a sufficient fitness level to provide important health benefits. The “Needs Improvement” zone indicates that the student may be at risk of health issues if that level of fitness remains the same over time. The Healthy Fitness Zone and Needs Improvement consists of three basic components: (1) Aerobic capacity; (2) muscle strength, endurance, and flexibility; (3) body composition (Meredith, FitnessGram, 2007). Students’ personal fitness information was charted daily during the program. The data collected for the personal profile assisted teenagers in setting goals related to reducing their weight and building self-esteem (Bronson, Glencoe Health, 2004). Monitoring and charting profiles provided guidelines for accomplishing goals that were necessary for changing students’ body image. The findings of this study indicated that the African American teenage participants did not want to commit to the exercise needed to improve their cardiovascular and personal fitness levels. Participants realized that skipping meals did not help with losing weight. When the students did eat, they tended to overeat and make unwise food choices.

Previous research described the value farmers place on their ability to work. The impact of obesity on workers is an increasing concern in occupational health research; yet, knowledge regarding the impact of obesity on the performance of farm work is limited. Identifying the impact of obesity on farmer’s work ability can guide healthcare workers in promoting and motivating farmers to implement lifestyle changes to improve health and sustain longevity in their ability to work. The purpose of this dissertation was to examine the impact of obesity on the work ability of U.S. farmers. Specific aims were to 1) examine the current state of the science regarding obesity in farmers; 2) to evaluate the psychometric properties of the Work Ability Index; 3) identify the relationship between obesity and work ability; and 4) compare central versus general obesity as predictors of decreased work ability in U.S. farmers. Key findings of this research support obesity as an increasing concern among U.S. farmers which can result in a decline in work ability. Psychometric evaluation of the Work Ability Index also supports the use of this tool for research and clinical assessment in this population. Implications for clinical practice and nursing research are also discussed.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Using data from the Black Women's Health Study (BWHS) and building on what is currently known about perceptions of racism and discrimination and its mechanisms, this study attempts to demonstrate the value of identifying additional variables that may serve as potential risk factors for obesity among African American women. Using secondary data analysis, the purpose of this study was to expand the scope of existing obesity research by examining a 1997 cross-sectional dataset of self-reported questionnaire responses among a random sample of African American women enrolled in the Black Women's Health Study (BWHS) to examine the association between perceptions of racism and discrimination within 3 domains (e.g., perceived racism, institutional racism, race consciousness) and body mass index (BMI) after controlling for selected sociodemographic, psychological, behavioral, and reproductive factors. The general hypothesis of the study was that self-reported responses to perceptions and experiences of racism and discrimination would be significantly associated with differences in weight (as measured by BMI) among the sample utilized for the current study. A convenience sample of 5,044 African American women enrolled in the BWHS was included for analysis in this non-probability cross-sectional study. A biopsychosocial theoretical framework was used to understand the unique role of perceived racism, institutional racism and race consciousness had on body mass index (BMI) among the BWHS cohort. These factors were examined because of their relevance to African American females' experiences. The data were analyzed through hierarchical multiple and logistic regression through SPSS 14.0.The major findings of this research indicate that a large random sample of African American women enrolled in the Black Women's Health Study found a clear relationship between perceived racism and body mass index (BMI). Results revealed consistent with the study's main hypothesis that self-reported responses to perceptions and experiences of racial discrimination would be significantly associated with differences in weight (as measured by BMI), the summary variable for perceived racism was significantly correlated with body mass index (BMI) among the BWHS cohort. Elevated odds ratios were observed for the variable that summarized perceived racism. Elevated odds ratios were also observed for most of the individual perceived racism questions. Results also revealed the variable for race consciousness was a significant individual predictor of body mass index (BMI) among the sample. Notably, perceptions and experiences of racial discrimination did not predict differences in the level of obesity among the sample. Overall, the finding that the summary variable for perceived racism was predictive of the odds of being obese (BMI > 30kg/m') vs. non-obese (BMI ≥ 30kg/m 2 ) in the regression analyses, even in the presence of other theoretically related variables, provides strong support for the unique role of perceived racism as a risk factor for obesity in African American women. The major implications of this research include (a) gaining a better understanding of the factors associated with perceived racial discrimination and reported frequency among African American women; (b) use of social health indicators in Healthy People 2010 and 2020 that consider the influence of racial discrimination in health outcomes that can be used to develop strategies to generate public dialogue and create a better defined policy landscape and health agenda informed by social justice and reflects multiple levels of influence (e.g., individual behavior, community or neighborhood attributes, and broad policy change) as it pertains to the ethnic and racial disparity in obesity; lends further support to both HP2010 and HP2020 goals and objectives for future policy actions to guide the development of culturally competent prevention programming aimed at reducing the prevalence of obesity among African American women; (c) recognition of race-related stress as a contributing risk factor for obesity in African American women; (d) recognition of the need to improve the measurement of perceived racial discrimination through questions that adequately measure the stress and coping related to the experiences of racism; (e) better restructuring of selected agencies that fund health research to broaden research topics regarding African American women as a homogeneous group; and (f) expansion of the U.S. healthcare system to incorporate established cultural competence guidelines and practices to address social and structural causes of race-related stressors that negatively impact the health status of African American women and similar minority populations at-risk for obesity.

This study evaluated the relationship of varying body mass index and average annual health care costs and absenteeism in a group of 524 municipal employees. The 269 employees with health care claims and the 487 employees with attendance records were categorized into five different BMI categories based on self-reported weight and height. Findings from the study suggest that as BMI increases, average annual health care costs and average annual absenteeism increase. However, BMI was only significantly related to absenteeism. The study also found significant relationships between education and health care costs and absenteeism. No significant differences for health care costs or absenteeism were found based on race, age, gender, wellness center membership, or smoking status.

Obtaining variances for the plug-in estimator of the Gini coefficient for inequality has preoccupied researchers for decades with the proposed analytic formulae often being regarded as being too cumbersome to apply, as well as usually based on the assumption of an iid structure. We examine several variance estimation techniques for a Gini coefficient estimator obtained from a complex survey, a sampling design often used to obtain sample data in inequality studies. In the first part of the dissertation, we prove that Bhattacharya’s (2007) asymptotic variance estimator when data arise from a complex survey is equivalent to an asymptotic variance estimator derived by Binder and Kovačević (1995) nearly twenty years earlier. In addition, to aid applied researchers, we also show how auxiliary regressions can be used to generate the plug-in Gini estimator and its asymptotic variance, irrespective of the sampling design. In the second part of the dissertation, using Monte Carlo (MC) simulations with 36 data generating processes under the beta, lognormal, chi-square, and the Pareto distributional assumptions with sample data obtained under various complex survey designs, we explore two finite sample properties of the Gini coefficient estimator: bias of the estimator and empirical coverage probabilities of interval estimators for the Gini coefficient. We find high sensitivity to the number of strata and the underlying distribution of the population data. We compare the performance of two standard normal (SN) approximation interval estimators using the asymptotic variance estimators of Binder and Kovačević (1995) and Bhattacharya (2007), another SN approximation interval estimator using a traditional bootstrap variance estimator, and a standard MC bootstrap percentile interval estimator under a complex survey design. With few exceptions, namely with small samples and/or highly skewed distributions of the underlying population data where the bootstrap methods work relatively better, the SN approximation interval estimators using asymptotic variances perform quite well. Finally, health data on the body mass index and hemoglobin levels for Bangladeshi women and children, respectively, are used as illustrations. Inequality analysis of these two important indicators provides a better understanding about the health status of women and children. Our empirical results show that statistical inferences regarding inequality in these well-being variables, measured by the Gini coefficients, based on Binder and Kovačević’s and Bhattacharya’s asymptotic variance estimators, give equivalent outcomes. Although the bootstrap approach often generates slightly smaller variance estimates in small samples, the hypotheses test results or widths of interval estimates using this method are practically similar to those using the asymptotic variance estimators. Our results are useful, both theoretically and practically, as the asymptotic variance estimators are simpler and require less time to calculate compared to those generated by bootstrap methods, as often previously advocated by researchers. These findings suggest that applied researchers can often be comfortable in undertaking inferences about the inequality of a well-being variable using the Gini coefficient employing asymptotic variance estimators that are not difficult to calculate, irrespective of whether the sample data are obtained under a complex survey or a simple random sample design. / Graduate / 0534 / 0501 / 0463 / aahoque@gmail.com