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.

Alcohol use is often characterized by health researchers and practitioners as a serious, chronic, and still growing public health problem in Latin America. Citing unambiguously disastrous health consequences due to alcohol consumption and the growing consumptive pressures of globalization, well meaning coalitions of public health practitioners, macro-economists, and policy makers at the World Bank, World Health Organization (WHO) and international NGOs have urgently called for the implementation of supply side regulations to curb alcohol use in the developing world. This paper argues that there is a need to take a much more nuanced approach to alcohol interventions than those proposed by supply-side economists or policy makers in these institutions and that those interventions must be based on ethical, culturally centered research that aims to understand the mechanisms by which factors at the intrapersonal, interpersonal, organizational, and community levels interact as fundamental drivers of behavior. To that end, this paper develops a hybrid, unified model of alcohol use that can be used to guide future research initiatives. In the process literature relevant to alcohol consumption patterns written from multiple academic disciplines such as psychology, sociology, anthropology, political science and the study of economics are reviewed. To bridge these diverse perspectives and to link cognitive cultural perceptions with individual behavior, the conceptualization of cultural consonance in two domains, material lifestyle and social support, is introduced. Extending the model, the paper adds a new cultural domain of indigenous identity and two new constructs, consensus intensity and temporal stability, which imbue the framework with broader and stronger descriptive powers to better accommodate the rapidly shifting cultural domains likely to be found in the globalizing world. Implications of knowledge generated by the application of the new expanded model are discussed.

This paper explores the perspectives of grassroots organizers currently engaged in community work in Post-Katrina New Orleans to suggest a framework for Community-Based Participatory Research (CBPR). Engaging grassroots organizers in CBPR projects can prove an invaluable resource as they have longstanding relationships with community members and a proven commitment to the communities they serve. To gain entrée necessary for carrying out CBPR in partnership with grassroots organizers in this context, researchers must foster genuine relationships that serve to empower community members and are not predicated on university obtained degrees or paternalistic ideas of community engagement. Specific to Post-Katrina New Orleans, grassroots organizers have a great deal of insight to share on the state of the citys recovery, why this work is important to the citys devastated communities, and how researchers interested in engaging their communities can be most effective. The framework presented is based on the principles of CBPR and enhanced with special considerations raised during interviews with grassroots community organizers in Post-Katrina New Orleans. This thesis is significant to public health because it serves not only to strengthen Community-Based Participatory Research in the city of New Orleans, but it could set a precedent for the field of Public Health related to their role in post-disaster recovery in any community for years to come.

Disparities in access to mental health care for persons with hearing loss are significant public health problems. Despite federal mandates such as the Americans with Disabilities Act, the Deaf, Deafblind and hard-of hearing populations remain greatly underserved. There is limited data available that define the obstacles that account for these differences. There is a great need for formative research to advance a better understanding of these issues. In Allegheny County persons with hearing loss receive mental health services at a rate far less than the hearing population. A series of focus groups were convened to gather qualitative data to explore perceptions of mental health services and identify any barriers to care and ideas for expansion of existing services. The results of the groups suggest that while there are some differences among the three populations in regard to specific barriers to care, all three populations expressed a lack of knowledge regarding where services exist and how to acquire mental health related information. Many opportunities exist to advance the mental health needs of persons with hearing loss in Allegheny County. One is to develop a standardized protocol for both assessment and treatment of persons with hearing loss within all county mental health centers and physician private practices, including any social supports which exist outside the mental health system. This protocol would make information available regarding where mental health services can be obtained, how they can be accessed, and what kind of accommodations are necessary. Much needs to be done to begin to address the disparities that exist within the mental health system for all persons with hearing loss. Understanding what must be done is only the first step. It will take a commitment from many agencies within Allegheny County to realize a service delivery system that meets the needs of persons with hearing loss that is truly recovery-oriented.