Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes and is the most common chronic disease of childhood, exceeded only by asthma. Because most children and adolescents spend the majority of their waking hours in a school setting, having trained school personnel on-site to assist with their daily diabetes management regimen is a high priority. However, this presents a challenge in that there is a national shortage of school nurses in the United States. This deficiency is of great public health significance because the lack of assistance in the school setting makes it more challenging for children with type 1 diabetes to achieve optimal management for their disease. The purpose of this thesis is to describe the needs of a child with diabetes, review issues that relate to their safety in the school setting, and propose a set of recommendations for schools to consider in order to provide care. Examination of whether school nurses have the appropriate knowledge in order to appropriately care for a child with type 1 diabetes will also be addressed. Finally, in light of the national school nurse shortage, this study will explore whether other school personnel can be trained to provide support to these children during the school day.

Women are the fastest growing segment of the correctional population in the United States. Most are imprisoned for non-violent drug offenses and property crimes. These women are disproportionately of color and low socioeconomic status, and often have endured lives of abuse, chaotic personal relations, and homelessness. The prime health challenges facing this population are substance abuse, mental health issues, communicable diseases, and poor reproductive health outcomes. An analysis of current and proposed correctional health services demonstrates the service gap between actual and idealized care for these women. Specific program components are introduced for the Allegheny County Jail in Pittsburgh, Pennsylvania. A broad-based womens health curriculum, peer education, and increased provision of women-specific correctional health services are all suggested future directives. This project is highly relevant to public health, as it not only addresses the health disparities that exist between the general and correctional populations, but also because it seeks to ameliorate these conditions though a multifaceted health intervention.

This thesis is of public health significance because it examines the level of preparedness in personal care homes in Allegheny County and helps to obtain a better understanding of whether disaster preparedness education and training is sufficient for the residents and employees of personal care homes. Emergency preparedness education and training, in particular special populations, have been getting more attention since Hurricane Katrina in August 2005 and other recent disasters. This project questions if Personal Care Homes receive proper emergency preparedness education and training for both residents and employees. The Personal Care Home Facility Preparedness Education and Training Survey investigates the level of preparedness of the Personal Care Homes by assessing preparedness factors. There are factors that are required for compliance and there are factors that in past disasters have been found to decrease vulnerability. The survey includes questions about the emergency preparedness plan, financial plans of the facilities and training requirements. Demographic information was collected along with the number of residents in the facilities with disabilities. A correlation was found between the percentage of residents with a hearing impairment and the total number of residents in the facility. The level of preparedness is determined by the sum of preparedness factors that were analyzed. The Preparedness factors were analyzed by required, non-required and a combined analysis was also completed. The required preparedness factors were established by using the PA Title 55 Licensing Requirements for the Personal Care Homes. The required preparedness factor analysis discovered that 48% of the Personal Care Homes surveyed were not compliant with state of Pennsylvania state regulations. The non-required preparedness factor analysis showed a lack of preparedness and the combined analysis had only 2 Personal Care Homes in the 95 percentile. In conclusion, residents of personal care homes in Allegheny County are more vulnerable during a disaster due to the lack of education and training of the staff and volunteers and the training and education requirements should be assessed by the Department of Public Welfare to improve preparedness.

Violence and Injury Prevention has risen to the top of the nations list of important public health mandates. As one of the most pervasive forms of violence facing our country today, Intimate Partner Violence (IPV) therefore constitutes a significant public health concern. Although screening for IPV with women by healthcare providers offers opportunities for intervention and treatment, little is known about screening for IPV in emergency psychiatric settings. This descriptive study was aimed at identifying women presenting for psychiatric emergency treatment who had been exposed to IPV and the demographic characteristics, clinical factors and/or patient-centered provider behaviors that were associated with disclosure of the abuse in this setting. The subjects for this study consisted of 216 women presenting to an emergency psychiatric setting. A self-report questionnaire elicited demographic information, history of mental illness, exposure to abuse, and screening by the provider. Respondents also scored providers on four patient-centered behaviors, including measures of trust, interpersonal interactions, communication, and knowledge of them as a person. The findings indicated that 75% of the respondents reported exposure to IPV. Those exposed to IPV attested to varying types of IPV abuse, including psychological, physical and sexual abuse. They also reported higher rates of depression, anxiety, post-traumatic stress disorder (PTSD), and bipolar disorder. The rate of abuse disclosure was then determined among the group of female abuse victims. Respondents were more likely to disclose abuse when screened by clinical staff. Other factors associated with an increase in disclosure included being unmarried and having PTSD, as well as the perception of a provider as being knowledgeable about the patient on a personal level. Emergency psychiatric providers should be alert to the potential for IPV among their patients. Additional research is needed into the factors that improve disclosure of IPV.

Coalitions are voluntary collaborations and interactions between two or more agents that yield synergy for problem solving. Their use as means of addressing community health concerns has increased during the past decades. This study uses the Community Health Governance (CHG) model to describe and analyze the interaction between various coalition components from data derived from the Pennsylvania Cancer Control Consortium (PAC3). The study used an already established questionnaire, designed to measure concepts of Leadership, Management, and Critical characteristics of the process, Empowerment, Synergy and Bridging Social Ties as put forth by the CHG model. An electronic invitation was sent to current PAC3 members to complete the questionnaire. Using PAC3 survey responses, I compared the association between variables using the Chi Square test of independence. A total of 162 survey responses were included in the analysis (RR=21.6). PAC3 members' Empowerment was significantly associated with three of the four Leadership measures, three of the five variables measuring the concept of Management and two of the four measures of Critical characteristics of the process (p<0.05). Member's ability to Bridge social ties showed a statistically significant association with most measures of Leadership, two of five measures of Management, and two of the four variables measuring Critical characteristics of the process (p<0.05). Synergy showed a statistically significant association with two of the four variables measuring Leadership, two of the five variables measuring Management and one of the four Critical characteristics of the process variables (p<0.05). This study reports the observed interaction of the various coalition components. It presents recommendations on potential improvement to coalition building practices and reinforces the importance of evidence based best practices. The public health significance of this study corresponds to the potential use of the study results in public health practices, such as coalition building, improvement and maintenance. Specifically regarding the Pennsylvania Cancer Control Consortium, the study results will facilitate the fulfillments of its missions.

In the Black community, faith, spirituality and religion appear to influence health and health care decisionmaking. Therefore, the purpose of this research was to investigate the synergy between faith, health and health care practices of Black Baptists using a Model of Authentic Culturecology as the conceptual framework. The public health importance of this study relates to expanding the understanding of factors that influence health and health care decisionmaking. The study objectives are related to communication between pastor and congregants about health and health care issues, prayer and rating of general health status, and belief in God/Jesus as a healer and health care utilization behaviors. A secondary analysis was conducted using a cross-sectional dataset of 1,327 African American men and women who attended the first Joint Black National Baptist Convention held in Nashville, Tennessee from January 24-28, 2005. A series of regression analyses were completed to determine the relationships regarding pastor-congregant communication, and faith and religious influences on health and health care decisionmaking. Having been told that you have hypertension or asthma was a significant predictor for talking to a pastor when sick. Males and females differed significantly in talking to their pastor about personal health issues. Men communicated more often than women. Eating vegetables daily was a significant predictor for communicating with a pastor about physician interactions. Participants who pray before and/or after making a medical decision were more likely to report their health status as excellent or good. Additionally, the belief that God/Jesus is a healer was a significant predictor for the last visit to a physician when the respondents sex was considered. It appears that faith positively influenced the respondents perception of health and health care decisionmaking, and their relationship with their pastors is an important factor. More research is needed for further clarification of these synergistic interactions.

This project resulted in the development of a new caregiver-administered health assessment instrument, Lets Get Healthy Together!, for adults with mental retardation who live with their families. The instrument, which consists of 64 questions over 20 pages and has a completion time of about 17 minutes, addresses a wide range of health issues, including oral health, social supports, preventive screenings, diet, exercise and smoking. This project is of public health significance as health disparities exist for those with mental retardation compared to the general population. This instrument can address those disparities on two levels: individually to identify health concerns that may need further attention, and on a large scale to identify population based health issues that may merit intervention on a systemic level. The project was undertaken in cooperation with, and for the benefit of, the Commonwealth of Pennsylvania Office of Mental Retardation (OMR). The instrument was developed based on a qualitative study of the health issues and risk factors for this population, using focus group and telephone interviews with caregivers and individuals, a literature review, and expert interviews. A pretest, consisting of telephone and expert interviews, was conducted, and a final version of the instrument prepared. The primary finding from the preliminary research done with caregivers was that while most saw no benefit in using a health assessment instrument, a subset of them who later tested the Lets Get Healthy Together! instrument, relayed comments that were very positive overall. The only negative reaction was that the instrument was not comprehensive enough to address the specific clinical needs of someone with Down syndrome. Participants expressed greater concern with systemic issues and barriers, such as the quality of the health care system, than for the individual issues for their family members. The instrument that is presented to OMR addresses the primary health issues and risk factors for adults with mental retardation. Further pretesting, and a comprehensive pilot test, is recommended before implementing the Lets Get Healthy Together! instrument.

Tremendous growth is projected for the elderly population in the coming decades with regard to size and diversity. This research examined the perspectives of low income well individuals age 60 and older living in congregate subsidized urban housing. It explored how they perceive their communities, their health care practices, and their health and well-being. This inquiry utilized qualitative phenomenological methods, specifically face-to-face indepth interviews. The qualitative approach was supplemented by quantitative data in the form of standardized health-related quality of life measurement. An evaluation component also investigated the reasons residents used or did not use an on-site nursing service. The study noted several noteworthy findings, but the need for social interaction permeated all domains. The participants demonstrated an adherence to regular schedules. More than half felt positive about living in their settings and more than a quarter felt neutral about their living situation. More than four-fifths of participants felt that they were in good health or had minor problems. The majority had usual sources of medical care and visited their physicians regularly. None experienced any difficulty in getting the care they needed. As a group, the participants scored lower on health-related quality of life than national norms in the physical domain and about equal in the mental domain. The on-site nursing service was not effective with this population. Recommendations included conducting a comprehensive needs assessment with the actual service users, i.e., the residents, before instituting any service. Such services may include a variety of models, e.g., nursing, social, system navigation. The public health significance of this inquiry is grounded in public healths more holistic view of health physical, emotional, social, and community domains than that of traditional medicine. It is the more inclusive view that will inform the development and institution of housing and health services that are more responsive to the needs of the population, incorporating a variety of services that should better address the needs of an increasingly diverse older population and help to achieve the goals of Healthy People 2010, the first of which is Increase quality and years of healthy life.

Objective: An effective human papillomavirus (HPV) vaccine must be accepted by young persons in order to achieve its full public health benefits. This study examines the intention to receive an HPV vaccine among college age men and women. Methods Summary: 340 university students, 138 men and 202 women, ages 18 to 32 (mean age of 20.8) completed self-administered questionnaires. Intention was measured by asking participants how likely they would be to accept an HPV vaccine that prevented 1) all HPV, 2), cervical cancer but not genital warts, 3), warts but not cancer, or 4) both warts and cancer Results: Both men and women reported high intent to receive an HPV vaccine, though women significantly more so, 77.5% and 88.6% respectively (p < .01). Men were less willing to receive a vaccine that prevents cervical cancer in women (men can transmit HPV to their sexual partners) compared to one that prevents cervical cancer and genital warts (34.1% vs.77.5%, p < .001). Intent to receive the HPV vaccine was significantly greater among participants having more than five partners compared to those having no partners (OR = 4.4; 95% CI = 1.4, 14.4). Intent was also significantly greater among those answering two or three HPV knowledge questions correctly compared to those getting none or only one question correct (OR = 3.6; 95% CI = 1.3, 9.9). Conclusions: A great majority of university students in this study were willing to receive the vaccine. Interest varied according to sexual history and knowledge about HPV, and in men, according to whether the vaccine targeted genital warts. Public Health Significance: An effective HPV vaccine, and one that is accepted, could have enormous public health benefits as vaccinations are one of the most successful public health approaches to preventing and controlling many infectious diseases.

African Americans, particularly those who reside in rural areas, are at increased risk of developing several preventable health conditions, including type 2 diabetes, cardiovascular disease, and overweight/obesity. Because of several professional and personal experiences, I was inspired to use this thesis as an opportunity to propose an intervention that addresses these preventable health conditions. The proposed intervention, Project HEAL (Healthy Eating and Activity for Life), is a faith-based, theory driven education and comprehensive lifestyle management intervention for rural African Americans. This program is of public health importance because it may be particularly useful in positively impacting the health of rural African Americans, a traditionally hard-to-reach population, and in significantly reducing racial/ethnic and geographic health disparities. Project HEAL is informed by the Social Cognitive Theory and Health Belief Model. These theories were chosen because of their emphasis on self-efficacy, the individual, and the environment. Much of the content of Project HEAL was derived from the curriculum of the evidence-based lifestyle modification intervention of the Diabetes Prevention Program. The Project HEAL curriculum is a modified version that addresses specific constructs of the previously mentioned theories and that is more appropriate for rural African Americans churches and for small group settings. To ensure a comprehensive evaluation of the program, Project HEALs evaluation strategy will be guided by the Reach, Efficacy, Adoption, and Implementation, and Maintenance framework for health behavior programs. Project HEAL will be implemented with the guidance of an advisory committee and with the help of lay health educators. Therefore, while this thesis describes the Project HEAL development and implementation in detail, there are several aspects of the program will need additional modifications to suit the participating church and its congregants. It is my sincere wish to implement this program to determine its feasibility and translatability to public health policy and research regarding rural African Americans.