Obesity is a national health crisis that demands immediate action from multiple stakeholders, both within and outside of traditional health domains. As interventions are developed to address this epidemic, this paper serves as a resource of public health importance as it discusses potential roles that retail grocers can play to improve national nutrition. By synthesizing literature from the health and marketing fields as well as publications from the grocery industry, three primary recommendations are presented: Contribute to nutritional assessments, influence dietary choices in the retail setting, and partner with local stakeholders. Additionally, the Social Ecological Theory is applied as a guiding framework to evaluate and plan grocery store interventions. Suggestions for future research and next steps are also provided. This report is potentially useful for health professionals interested in community nutrition and for store operators concerned with their stores image and meeting their customers needs.

Although levels of disability among adults are relatively stable, the number of children with disabilities is steadily rising. It is increasingly the case that medically fragile children are receiving care in their homes due to early discharges from hospitals and other related service programs. These children and their families have needs that require interventions from many different services, such as health, education, social services, housing, transportation and benefits. This thesis explores the present state of affairs by considering typical problems and decisions these families face on a day-to-day basis, family coping strategies, and local family resources. I propose a social ecological approach to addressing the special health care needs of children. The social ecology model explains the need for interventions to approach this complex problem on several levelsthe individual, interpersonal, community, and policy. The model examines the inter-relationships between these levels and explains some of the barriers to care on each of the different levels. The implications for public health educators and researchers are the possible collaboration with community-based institutions to assess, plan, develop, and evaluate interventions within the context of children with special health care needs and their families. Based on my review, I propose strategies for intervention at four different levelsindividual, interpersonal, community, and policy. My assumption is that if each of the proposed strategies is successful at it respective level, then childrens access to coordinated community-based social and health services would improve.

This project was designed as an assessment of the overweight and obesity resources available in the City of Pittsburgh and the two boroughs of Braddock and Wilkinsburg. This project also designs a participatory action research intervention to address the specific needs and barriers of the region in regard to healthy lifestyles. This project was designed to address three objectives of HealthyPeople 2010: 1) to increase the proportion of adults who are at a healthy weight, 2) to increase the proportion of adults who exercise for at least 30 minutes daily and 3) to increase worksite accessible nutrition and weight management counseling. Methodology Two assessments of the region, a physical activity resource assessment and assessment of health and wellness opportunities offered by the regions top ten employers were facilitated. The physical activity resource assessment surveyed five parks in the region for walkability, barriers and incentives for community use. In conjunction with the assessment a participatory action research intervention with 13 collaborative partners was designed. The next stage assessments include focus groups and surveys. Results The five parks were found to offer a refuge from urban life within the city limits. Amenities in regard to public toilets, park information, parking and exercise information such as mile markers were often lacking. Eight of ten region employers offer health and wellness programs. The scope of services varied as did employee utilization of such services. Conclusions Allegheny County offers excellent venues for outdoor recreation. Unfortunately the public does not access these facilities. Employers in the region offer health and wellness programs but without substantial incentives, employees may abstain from participation. Determining the specific barriers to healthier lifestyle choices through participatory action research methodology is a first step to improving the overall health in the region.

Disasters vary in scope, size, and cause. Relevant public health aspects of disasters include community impact and the response of health professionals to alleviate stress and dangerous conditions surrounding the disaster. Public health focuses on the prevention of disease and the promotion of health. Disaster preparedness and response are significant areas in the field of public health. Disasters pose threats to the general public through increases in injury, death, and changes in infrastructure. The public health response to disaster includes assessments of the community impact, surveillance for disease, addressing sanitary health concerns, and providing information to the public. Mental health professionals also have important roles in responding to disaster in the community. In addition to physical aspects, disasters also may pose psychological risks to individuals and to the effected community. These risks may include stress, anxiety, and depression. Mental health workers provide counseling, support, and education to assist people affected by disaster in returning to their pre-disaster level of functioning. Traditionally there has been a separation between the disciplines of public health and mental health. Public health is population-based and mental health has been traditionally regarded being more individually based. During a disastrous event communication and organization among agencies is critical to an effective response. Increased collaborations between public health and mental health are needed to facilitate an appropriate and effective disaster response. Both areas aim to improve overall health and well being, and therefore are inter-related. Each discipline needs to become more familiar with the nature of each others work. Overall increases in public and mental health research, planning, training, and education programs are needed to understand and appreciate both the public health and mental health consequences of disaster and to improve community participation and preparedness.

This paper will discuss the power differential between women and men and its role in the intersection of HIV/AIDS and intimate partner violence among women in sub-Saharan Africa. Both HIV and intimate partner violence are of tremendous public health relevance. Since its discovery over 20 years ago, HIV has been and continues to be a world health problem. Nearly 40 million people worldwide are living with HIV/AIDS; about half of them are women. Fifty seven percent of the people living with HIV/AIDS in Sub-Saharan Africa are women. HIV prevention continues to be an urgent health priority in sub-Saharan Africa and throughout developing countries around the world; yet interventions preach abstinence and safer sex practices without recognizing the sociocultural context of HIV/AIDS or of sexual behavior and practices. Traditional concepts of gender roles and the power differential intrinsic in relationships between women and men must be accounted for not only in the design of HIV interventions, but also acknowledged as risk factors for violent relationships. Suggestion of condom use by the female partner, for example, is often met with suspicion, hostility, even violence from her male partner. Intimate partner violence is researched in this paper because it is the ultimate manifestation of the gendered power differential. This paper will critically review existing HIV interventions targeting women, explore different gender norms throughout sub-Saharan Africa and the gendered power differential as exemplified by IPV. The paper will conclude with recommendations for future public health efforts and a proposal for an intervention that addresses both public health issues.

Childhood obesity is the most prevalent nutritional disease of children and adolescents, affecting approximately 24% of the United States population ages 2-17. Childhood obesity is of public health significance because of increasing prevalence, costly consequences on disability and mortality, and the potential to promote health disparities. The Fun to Be Fit curriculum was piloted in nine Pittsburgh Public School System elementary schools during the 2001-2002 academic year. The curriculum incorporates two evidence-based programs: FRESH (Food Re-Education for Elementary School Health) and SPARK (Sports, Play and Active Recreation for Kids). The curriculum included 10 minutes of nutrition education and 40 minutes of physical fitness activities, offered twice a week. A total of 576 third and fourth grade children from five treatment schools (n=332) and four control schools (n=244) participated. Treatment school teachers received training in SPARK and FRESH, fitness assessments, and coaching strategies. The nutrition component was evaluated with a 20 item nutrition knowledge survey and a 51 item food frequency questionnaire. Fitness was assessed through curl-ups and push-ups completed in 30 seconds, and a half mile run/walk test. Both treatment and control schools completed the nutrition surveys and fitness assessments at the beginning and end of the school year. The purpose of this study was to determine whether the Fun to Be Fit curriculum was more effective than the existing physical education curriculum offered in the control schools in improving nutrition and fitness behaviors. An analysis of covariance (ANCOVA) examined between-group differences at post-test in nutrition and physical activity scores, statistically controlling for gender, grade level, and variation in pre-test scores. Results showed a greater increase in nutrition knowledge among Fun to Be Fit students (p=.002), and greater reductions in the consumption of high fat (p=.001), high sodium (p < .001), and high sugar (p < .001) foods as compared to the control students. Physical activity outcomes were mixed, with Fun to Be Fit students showing greater increases in push-ups (p <.001) but significantly fewer curl-ups (p= .033) as compared to the control students. There were no significant differences (p > .05) for the half mile run/walk assessment. The Fun to Be Fit program appears to be an effective strategy for improving nutrition knowledge in elementary school students and to some degree for increasing physical activity.

Environmental health and chronic disease are among the greatest public health challenges facing America today. A body of literature exists to support the causal relationships of various chemical, biological, physical, and social factors on health outcomes. Effects of these environmental influences on health have been found to include social, economic, psychological, biological, and physical dimensions, all of which are major contributors to the prevalence of chronic disease. In recent years, health promotion efforts have been broadened to encompass more environmentally-focused strategies, such as improving air and water quality, reducing exposures to hazardous materials, and planning land use for the design of healthier communities. While such advocacy efforts are critical for policy changes related to environmental health, these interventions, alone, are not sufficient to combat the deteriorating conditions that threaten human health and quality of life. First, given the public health significance of this problem, a need exists for greater collaboration among professionals in the fields of environmental health, community planning and development, health promotion, as well as other disciplines. Second, effective environmental health promotion requires a socio-ecological approach, which necessitates that the individual, organizational, and community-level influences on the environment be addressed. Finally, interventions that promote environmental health at these levels should be based upon sound social and behavioral theory, rather than relying solely upon the technological approaches to risk management that have predominated in the past. Examination of urban greening interventions illustrates both the benefits and practical challenges of utilizing these methods to promote environmental health. Based upon a review of literature in the field, I explore the strengths and limitations of a community-based intervention in the East End of Pittsburgh. Specifically, I evaluate the theory and processes of this program, entitled MERGE II (Methods to Engage Residents and Grassroots in the Environment II), and conclude by translating evaluation findings into recommendations for future environmental health promotion interventions. These recommendations are intended to engage and inform diverse stakeholders in efforts to promote environmental health, and ultimately, to provide effective strategies for reducing morbidity and mortality related to environmental causes.

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.