Being without health insurance or being "underinsured" creates a variety of special problems for women aged, 45 to 64, which is perhaps the most complex of all developmental periods in the lives of American women. "One Thing Leads to Another. . ." explored the relationship between health insurance status and the utilization of primary screening services among women, aged 45 to 64. Secondary data drawn from the 1996 BRFSS was used to develop a non-experimental study that examined the association between health insurance status, and access to selected primary screening services as measured by their responses to the BRFSS and as compared to demographic covariates of interest. Several key findings emerged: 1. Health insurance significantly affects a woman's use of primary health care services; 2. While insurance status or lack of coverage matters tremendously for women, it alone does not guarantee access to health care. Othe determinants, such as income and educational levels, are important forces affecting health behaviors; 3. The rate of being uninsured in the 45-64 females cohort was slightly higher than national averages in 1996; 4. Reduced rates of access were observed across all covariates when women did not have insurance but higher rates of poor outcomes were more consistently associated with uninsured women who were of a race or ethnicity other than "White Non-Hispanic," were unmarried, were unemployed and had lower levels of income and less years of education completed. The public health significance of the study directly relates to one of the "Year 2010 National Health Objectives--to increase the proportion of persons with health insurance to 100 percent." To meet that goal, all Americans should be included in a comprehensive health care system that guarantees timely access to health care, assures a high quality of health services with adequate and stable reimbursement for health care providers and rationally apportions the costs of care. A major focus of that process should include curretn and immediate attention toward improving the health care of all women, with a special emphasis on those aged 45 to 64, who have inadequate insurance coverage. The final chapter includes a review of current state health care reform initiatives and several major approaches to extending coverage to midlife women. Public health and social policy implications along with suggestions for future research and the study's limitations are also provided.

In the United States, obesity is becoming an ever increasing problem, especially among youth. The prevalence of adult obesity-related health complications, until recently were only seen in adults, are arising within the youth population. The increasing rate of childhood obesity is of public health importance; if not properly dealt with now, the current generation of children will grow up and face serious health complications both in their late childhood and adult years. To address this epidemic, two approaches that can be utilized are school-based and clinical based interventions. Even though each type of intervention takes place in a different setting, the same basic principles of nutrition education, healthy eating and physical activity are addressed. While each of the two types of interventions has strengths and weaknesses, the overall goals of both school-based and clinic-based interventions are a reduction in weight and increase in the health of the children participating in the intervention.

The overarching goals of this paper are to promote the use of gardens as a systems approach to education, and propose that they should be evaluated as such. Current literature shows the positive effect of gardening education on nutrition, including consumption of fruits and vegetables and nutrition knowledge. A wealth of anecdotal evidence reveals that gardening education programs affect multiple domains in the lives of participants. The first objective of this paper is to review gardening programs with nutrition education components in literature to understand the areas where these programs are already effective and what gaps still need to be filled. Another objective is to propose evaluative tools for an existing gardening program entitled My Garden Vegetables in Wilkinsburg, PA. These proposed tools will assess both nutrition education components of the program and components related to cooperation, sharing, and the environment. Such evaluations provide information that is vital for reshaping the goals and objectives of future programs. The proposed evaluation tools consist of a food frequency questionnaire, food preference questionnaire, nutrition knowledge game, focus group questions, interview questions, and observations. Once implemented, this evaluation has the potential to add valuable data to the relatively minimal body of research related to systems effects of gardening programs. The public health significance of this paper is that with childhood obesity on the rise, we have the opportunity to create lasting programs that not only influence nutrition knowledge but integrate that knowledge into a childs understanding of his or her role in changing the environment and developing cooperative networks.

Nosocomial, or hospital-acquired, infection is a serious global public health issue that causes the suffering of 1.4 million people at any given time. This thesis uses the social-ecological model to frame the problem of nosocomial infection control in developing countries, and proposes roles for international non-governmental organizations in developing country settings. Using the social-ecological model reveals nosocomial infection control issues at the individual, hospital, and national policy and infrastructure levels. Interviews were conducted with four organizations: two international non-governmental organizations, the Pan American Health Organization, and the University of Pittsburgh Medical Center Infection Control Office. Two case studies are presented from Honduras, showing how the two international non-governmental organizations approached the infection control issue in two public hospitals in that country. Recommendations are given for possible intervention points in developing countries.

Childhood obesity has become of public health importance because of the powerful, adverse impact it has on our Nations youth and on the well-being of our society. Childhood obesity affects all aspects of a childs life; most significantly by contributing to poor health and negative social perceptions by society. Extensive research of this issue has identified numerous causal and risk factors associated with obesity. Given the multifaceted nature of the problem, and its severe implications for the future health and well-being of affected children, I believe that the most effective solutions will be achieved through programs that focus on prevention efforts. In the last decade national attention has increasingly focused on efforts to reduce obesity among our youth. Schools have been the primary setting for prevention program, but these efforts have generally been found to be meet with only limited success. Researchers have increasingly focused on other environmental factors such as the home environment and family influences on childrens behavior. Recent studies have shown that family and social influences are key determinates of the high incidence rate of childhood obesity. I am proposing to build upon the efforts currently taking place in school districts by implementing a family-based prevention program. The program is an eight-week nutrition and physical education program for middle school students. It is intended that it be implemented within the school environment one evening each week, and that participants include both students and parents. The purpose of this program is to provide children and their families with nutritional education and to encourage physical activity. The desired outcomes include inducing positive behavioral changes and creating an environment within the home that encourages healthy habits, thereby decreasing the prevalence of childhood obesity within the school community.

Vulnerable populations and communities lacking resources may be disproportionately affected in the event of a public health emergency. Preexisting social conditions among vulnerable populations including low socioeconomic status and poor educational systems, contribute to the vulnerability of communities in the face of disaster. The Duquesne City, Pennsylvania community is a vulnerable population likely to be disproportionately affected in the event of an emergency. The primary objectives for the Duquesne Emergency Preparedness Project were to: 1) Examine the literacy level and assumptions underlying existing preparedness guides; 2) Define risk perceptions and understand information-seeking behaviors of residents in Duquesne, PA; 3) Better understand the challenges faced by low-resource populations in utilizing emergency preparedness materials and use this understanding to make recommendations for the development of educational preparedness materials and a community-based model for emergency preparedness. The literacy level and assumptions underlying existing emergency preparedness educational guides were assessed and evaluated for their relevance for the Duquesne community. In order to make recommendations for the development of emergency preparedness educational materials relevant to low literacy and resource poor communities, the Project also investigated the risk perceptions and information seeking behaviors of Duquesne community members and explored existing strengths, weaknesses and perceived individual and community emergency capabilities through focus group discussions and surveying. Study conclusions include: 1) People in Duquesne and surrounding areas do not view emergencies or disasters as impending high-risk events; 2) A serious communication disconnect exists between local officials, agencies and the public; and 3) Individuals are largely unfamiliar with existing citizen preparedness materials, perhaps because this information has not percolated into these communities, tends to focus on low-probability and abstract events, exceeds the literacy level of these populations and is not consistent with the needs of vulnerable populations. A paucity of information on the emergency preparedness needs of low-resource populations exist in the literature and understanding these needs is essential for community-based public health preparedness. Conclusions of the Duquesne Emergency Preparedness Project reveal important insights about the emergency preparedness needs of vulnerable populations and have important implications for public health approaches to preparedness for low-resource communities.

The focus of this thesis is to present peer-reviewed studies relating to mental illness and television. Up to this point there has not been a review paper exclusively examining mental illness and television exclusively. For this review, only articles with a defined research design were included. Seven content analysis articles were identified measuring images of mental illness on television. Content analysis articles covered children's television, primetime entertainment programs, and soap operas. Five studies were identified surveying attitudes and beliefs of viewers after seeing images of mental illness on television. Research revealed that mental illness is portrayed negatively on television. Commonly, characters with mental illness are shown as violent, villainous, and unintelligent. Attitudes are affected by the number of hours of television watched, the viewers education level, having direct experience with a person diagnosed with a mental illness, as well as seeing negative portrayals of mental illness on television. In the future, collaborative relationships to educate professionals working in media need to be established. Anti-stigma interventions should target specific populations that do not have regular contact with mentally ill patients. Future research needs to include the opinions and experiences of mental health service consumers. Current content analysis research focuses heavily on programs aired on American network television (ABC, NBC, CBS, and Fox); in the future original programs on cable networks should be included in the samples. Similarly, unscripted reality television is gaining popularity and should be considered for analysis in the future. When attitudes and beliefs are measured, the samples of participants surveyed need to be made up of a wide range of ages, education levels, and experiences, instead of the homogenized groups currently being surveyed. Public health professionals have a responsibility to be advocates to the mental health community. It is of public health significance to ensure the most accurate information is disseminated to the general public in order to reduce incorrect assumptions and negative stigmas surrounding mental illness.

More than 2.2 million deaths occur worldwide each year due to diarrheal disease, mostly in children under five years of age, making it a problem of great public health significance. In developing countries, improving water at the household or point-of-use level has decreased the spread of diarrhea-related illnesses more than treatment of water at the source. Additionally, improving the quality of water has been shown to be as important in interrupting disease transmission pathways as increasing the quantity of water and improving general sanitation. Therefore, new technologies are being promoted for use in developing countries as low-cost methods of disease prevention. The current paper reviews interventions designed for water improvement at the household level, paying particular attention to related reductions in diarrhea as a primary disease outcome. Once shown to be effective at reducing disease in field or laboratory trials, the technology must then be promoted among and accepted by its intended users. Drawing upon the principles of community based participatory research, a framework is given for health professionals wishing to implement any novel technology or water quality intervention in a community setting.

Public health has moved away from its original mission to address and promote health on a societal level towards an individually focused, victim-blaming paradigm. In particular, research regarding womens reproductive health is heavily reliant on the biomedical paradigm to document and explain existing health trends related to womens fertility. This research often targets behavior in isolation of its social context. In order to promote the integration of a population health perspective into the current medically dominated realm of womens reproductive health, this dissertation highlights the issue of unintended pregnancy (UIP). The United States (US) continues to have the highest rate of UIP of all industrialized countries. These UIPs, and their negative health consequences, are disproportionately experienced in the high-risk populations of low-income, young and minority women. In efforts to foster greater understanding of UIP and of these disparities, this dissertation encompasses three distinct manuscripts. Based on a review of public health and womens health literature, the first manuscript argues for the adoption of a broadened perspective that focuses on external factors that impact womens reproductive behavior. Manuscript 2 discusses the first component of a mixed-methods research study involving surveys of women at high-risk for UIP who sought pregnancy tests in Pittsburgh, which reveal that assessing womens pregnancy intentions prior to pregnancy testing is feasible and may provide a more accurate portrayal of womens intentions to become pregnant than existing retrospective measures. The third manuscript, which highlights qualitative interviews with ten women from the above sample, presents evidence for the influence of external factors on womens experience of UIP. This dissertation challenges current individually focused paradigms for understanding UIP among US women. The public health significance of this dissertation lies in the findings of the research presented, which demonstrate that a reciprocal relationship exists between the social context of womens lives and their UIP experiences and which emphasize the need to broaden the perspective of current UIP research. Future research, programs, and policy should integrate the perspective and findings highlighted in this dissertation in order to reduce negative health consequences of UIP and promote population-level healthy pregnancy outcomes.

The purpose of this thesis is to propose the use of a program planning model that will address the lack of respite care, or in other words, the lack of a specific place for recuperation after an illness or injury available for homeless people in Allegheny County. This proposal will incorporate a program planning design of a potential respite program in Allegheny County. This respite care intervention is designed to be part of a county wide effort to eliminate homelessness in Allegheny County led by the Allegheny County Homeless Alliance. This proposal will incorporate the Mobilizing for Action through Planning and Partnerships (MAPP) program model for the intervention design. This is a six-phase process that emphasizes community collaboration and assessment as the driving forces for the creation of an intervention. The six phases of the MAPP model are 1) Organizing for Success/Partnership Development; 2) Visioning; 3) The Four MAPP Assessments; 4) Identify Strategic Issues; 5) Formulate Goals and Strategies; 6) The Action Cycle. This proposal will describe how the Allegheny County Homeless Alliance can conduct the phases of the MAPP model using information previously collected as well as ways they can obtain additional information. The proposal will describe a respite care intervention that is an example of a possible respite care program in Allegheny County. The goals of the program are to improve the health of the homeless as well as to create social support for this population and an opportunity to transition into permanent housing. The public health significance of this proposal is that it will create an intervention for the homeless population of Allegheny County that will allow them to achieve better health status through respite and follow-up care, greater social support and, most importantly, the opportunity to obtain permanent housing in a more direct way than what is the norm.