Health inequalities take many forms related to race, gender, socioeconomic status, ethnic, language and many other axes throughout communities around the world. Type two diabetes, high blood pressure, and high cholesterol are examples of conditions (among many others) that disproportionately affect Latino@s in the U.S.. The research of this dissertation is based on fieldwork conducted throughout several predominantly Latin@ neighborhoods in Chicago, IL. This dissertation examines how Latin@s in Chicago navigate health and well-being, and how they engage in agentive strategies in the face of chronic disease. I recorded individual life histories and semi-structured interviews, focus groups, and participant observation at various community events and settings. The stories of these Chicago Latin@s are shared here in an effort to de-homogenize the depiction of Latin@s in the U.S. by paying attention to local narratives, and especially to those related to living with chronic disease.

Objective: Measures the impact of the Farmers’ Market Voucher program on weight, body mass index, waist circumference, during the 2016 summer on a rural, low-income population residing in Appalachian Kentucky. Background: Rural communities often have limited access to fresh fruits and vegetables (FV) which contributes to low levels of consumption. FV are calorie poor, nutrient dense and are inversely associated with inflammation markers, obesity, hypertension, and high blood glucose levels. Appalachian rural communities have a higher prevalence of obesity, diabetes, strokes, and death by heart attack when compared to the U.S. Farmers’ markets Methods: Pre-experimental intervention design examining FV consumption and variety. T-test used measuring biochemical outcomes, pre and post, participation, and voucher amount. Results: Medical clinic patients (n=308) and household members (n=89) participated in study. Patients had a decrease in blood glucose and waist circumference (p=0.0231, p=0.0014 respectively). Patients had greater blood glucose reductions when compared to household members (p < 0.001). Patients reported consuming more FV with greater variety. Conclusion: The Farmers’ Market Voucher program successfully increased FV consumption and had a positive effect on blood glucose and waist circumference. Future studies should examine cooking methods of this population.

In the early 1990s, a series of seminal research studies were published on substance use disorders among Latino adolescent males in Miami-Dade County, Florida. Expanding upon these studies, the aims of the present dissertation project were to (1) Determine whether the following adolescents’ and parents’ characteristics/cultural values are associated with current (past 30 days) or lifetime (ever) alcohol or marijuana use among Latino adolescents: sex, age, country of birth, GPA, family’s socio-economic status, living with both parents, mother’s highest level of education, father’s highest level of education, Familism Support, Familism Obligations, Familism Referents, Respect, Religion, Traditional Gender Roles, Independence and Self-Reliance; (2) Assess if recreational activities (sports participation, after-school activities and volunteering) moderate the association between Latino adolescents’ friends’ age, sex, and ethnicity and Latino adolescents’ current alcohol or marijuana use and; (3) Assess if recreational activities moderate the association between Latino adolescents’ perceptions of their friends’ alcohol or marijuana use and Latino adolescents’ current alcohol or marijuana use. This cross-sectional dissertation study used survey data from 193 Latino adolescent males and females (15.7 ± 1.6 years old; 55.4% females, 44.6% males) in Miami-Dade County collected in 2016-2017. Analyses included t-tests, chi-square tests and logistic regressions. Being born in the U.S. increased the risk of current alcohol use. Identifying more strongly with the cultural value religion decreased risk of current alcohol use and current marijuana use. Participants who reported having no close friends who use alcohol were less likely to currently (within past 30 days) use alcohol themselves when compared to participants who reported having at least one close friend who uses alcohol. The interaction between participation in sports activities and reporting having friends who use alcohol on outcome currently using alcohol was significant. Participants who reported having no close friends who use marijuana were less likely to currently use marijuana themselves. Findings from this study suggest that factors contributing to substance use among Latino adolescents throughout the United States may be different than those which play a role among the unique Latino adolescent population in Miami-Dade County. This study further validated what has been shown in the general U.S. population: adolescents who perceive their friends to be using alcohol or marijuana are more likely to use alcohol or marijuana, respectively, themselves. Further research is suggested to determine the role of recreational activities in alcohol and marijuana use among Latino adolescents.

Cervical cancer, caused by oncogenic (high risk [hr]) human papillomavirus (HPV) subtypes, is the most common cancer in women in Guatemala and the most common cause of cancer mortality in women aged 15-44 years. Visual inspection with acetic acid (VIA) with onsite cryotherapy “test-and-treat” is recommended for underserved Guatemalan indigenous rural women. This research assessed: 1) hrHPV infection prevalence in women screened by VIA; 2) Sensitivity and specificity of VIA in detecting hrHPV infection and cytologically identified precancerous and cancerous lesions; and 3) Factors associated with hrHPV infection. Analysis of anonymous data collected during VIA clinics in 2013 (N = 205) and 2017 (N = 234) for indigenous women aged 21-65 years in six villages showed 22.6% (95% confidence interval [CI]=18.7%-27.2%) had hrHPV cervical infection. VIA results were abnormal in 5.9% (95%CI=3.8%-8.8%). Only nine VIA exams in 89 women with hrHPV were abnormal (Sensitivity=10.1%, 95%CI=4.7%-18.3%), although abnormal VIA was associated with hrHPV (Prevalence Ratio [PR])=1.8; 95%CI=1.1-3.1; P=.05). Of 221 women who had VIA, hrHPV nucleic acid testing and liquid preparation cytology (equivalent to Papanicolaou or “Pap”) testing, 10 (4.7% [95%CI=2.3%-8.5%]) had abnormal cytological results, including one cancer, four high- and five low-grade squamous intraepithelial lesions. VIA sensitivity and specificity for detection of precancerous cytological abnormalities and cancerous lesions were 20.0% (95%CI=2.5%-55.6%) and 96.0% (95%CI=92.3%-98.3%) respectively. In contrast, hrHPV sensitivity and specificity were 100% (95%CI=71.7%-100%) and 88.7% (95%CI: 83.9%-92.7%). In both years combined, women aged fewer than 29 years or reporting fewer than four pregnancies were more likely to have hrHPV cervical infection (36.8%, 27.3%, respectively) than those who were older or reported more pregnancies (18.7; P=.025, respectively); 60.0% reported some form of modern contraception. Progesterone injections or implant users were more likely to have hrHPV infection (31.9%) than women using other or no contraceptives (19.5%); PR=1.6; 95%CI=1.1-2.4; P=.01). These data suggest that VIA may not be sufficiently sensitive for use in cervical cancer screening. “Test-and-treat” screening using hrHPV real-time testing, as recommended by the World Health Organization may be preferable to VIA, and may be acceptable using self-collected specimens.

The purpose of this research study was to describe course content on unintentional injuries in undergraduate personal health and wellness courses at four year public and private colleges and universities identified by the Eta Sigma Gamma directory in the United States. An instrument was created, validated and tested for reliability, and used to assess course content areas related to unintentional injuries in undergraduate personal health and wellness courses. The sample for the study included 106 participants (N=106) from public and private colleges and universities in 36 states. Chi-square analysis, ANOVA, factor analysis, and MANOVA tests were used to determine if significant differences existed in course content areas based on selected demographic characteristics. Results indicated that college and university faculty members report teaching about unintentional injuries. Findings indicated that significant differences do exist in unintentional injury course content areas. The top five content areas identified by faculty members include water-related injuries, firearm safety, motorcycle injuries, motor vehicle passenger safety, and motor vehicle impaired driving. Factor analysis results revealed that unintentional injury course content areas can be categorized into three groups: personal content, motor vehicle content, and injury content. The level of statistical significance was set at 0.05.

All terrain vehicles (ATVs) are a popular source of recreation. For some rural adolescents, ATVs are frequently used for agricultural work. Whether for work or recreation, many adolescents operate ATVs improperly either from a lack of knowledge, poor judgment or they engage in risky behaviors resulting in injuries and fatalities. The Kentucky Department of Agriculture (KDA) has devoted resources to provide ATV safety programs to educate adolescents statewide. However, there are no known studies evaluating the effectiveness of this KDA intervention. Therefore, a pilot study was proposed to determine the effectiveness of The KDA ATV safety program in improving ATV safety knowledge, attitudes and behaviors of adolescents ages 12 to 18. Following HSRB approval, a pre-experimental one group, pre-test, post-test design pilot study was conducted. A convenience sample (n=18) was drawn from adolescents registered to attend an ATV safety program provided by the KDA. The study was conducted in a south central Kentucky city. Haddon’s Matrix was used as the theoretical framework using the dual axis approach to injury prevention and injury control. On one axis are the host, the agent and the environment. In this study the host is the adolescent ATV driver, and the agent is the all-terrain vehicle. The environment includes the terrain, applicable ATV laws and societal attitudes toward ATV safety. On the second axis are the pre-event, event and post-event phases. Haddon’s Matrix is a process mechanism in which opportunities to reduce ATV related injuries and fatalities can be identified. It is believed that knowledge, attitudes and behaviors regarding ATV safety can be positively influenced through effective educational strategies, ATV engineering design changes and ATV law enforcement issues as identified through the use of Haddon’s Matrix. Descriptive statistics and paired t-tests were used to analyze the data. The analysis revealed no statistically significant changes in adolescent knowledge following the intervention. However, there were statistically significant improvements in ATV related safety attitudes and behaviors. In conclusion, efforts should continue to prevent ATV-related injuries and fatalities via educational strategies to change behaviors and attitudes regarding ATV safety in communities and individuals. Implications include the need for further research to determine best practice ATV educational strategies that create positive change.

Tuberculosis is one of the deadliest communicable diseases in the world, and consequently remains one of the biggest global healthcare challenges. Tuberculosis is treatable and curable. However, within many low resource settings, underdeveloped medical infrastructure limits the effectiveness and accuracy of existing diagnostics. These limitations severely impede the timely diagnosis of the disease, and thus contribute to the disease spreading, developing drug resistance, and killing more individuals. There is an urgent need for an inexpensive, portable, rapid, easy-to-use point of care diagnostic that can function outside of the laboratory at the community level. Currently, there is a wide range of available tuberculosis diagnostics ranging from sputum smear microscopy to nucleic acid amplification tests. Yet, none have met every standard of the ideal point of care diagnostic. Since the World Health Organization’s endorsement of Xpert MTB/RIF in 2010, there has been a resurgence of interest in point of care diagnostic development. This investigation reviewed diagnostic development projects funded by the National Institutes of Health in 2008 and 2014 in order to examine the technologies being developed, how researchers in industrial and academic sectors are addressing this problem, and what challenges still need to be overcome. More projects in 2014 were expected to rely on sample types other than sputum and be funded than those in 2008. The results of this investigation confirm this hypothesis, and that the development of a point of care device is a multi-faceted challenge with numerous underlying issues that need to be addressed before such a device can be successfully implemented.

This study examined the knowledge, sources of information, reasons for and against Gardasil® uptake, and possible relationships between unhealthy behaviors and vaccination for undergraduate college females at a public university. Utilizing an online survey, 2400 random students were emailed as well as recruited through online classes. The final sample size was 516 females. The study determined how many participants had been vaccinated and their rationale for or against vaccination. The majority of study participants were knowledgeable about HPV and Gardasil®. The primary sources of information about HPV and Gardasil® were doctors and television; however parents and friends were also common sources of information. Predictors for HPV inoculation included race, the belief that the vaccine would protect against HPV, alcohol use, and engagement in anal intercourse. Over 50% of participants had received at least one dose of Gardasil®, and 82% had completed the series. The most common rationale for not getting the vaccine, or not completing the vaccination series, was concern about side effects. The most common rationale for completing the vaccination or intending to complete the series was protection from cervical cancer. In conclusion, there is a continued need provide health education about HPV and HPV vaccination for college females.

Knowledge alone is not enough to ensure that the individual will act in a healthy manner or choose positive health behaviors. However, knowledge may enable one to engage in sound health practices. Health education must respond to the changes in American culture by developing approaches that achieve maximum communication and learning. The purpose of this thesis is to assess the suitability of the Health Knowledge Inventory – High School Version (HKI-HS) for testing with high school seniors. A field test was performed to assess whether the HKI-HS is an appropriate measurement instrument of personal health knowledge among high school seniors. During the spring of 1990 the HKI-HS was administered to 418 students at four high schools in Western Kentucky. Estimates of construct validity, internal consistency reliability, and test-retest reliability were obtained. Within the context of this study and its limitations, the HKI-HS was demonstrated to be a valid and reliable test for the high school population. Potential uses of the HKI-HS include measuring knowledge gained through high school personal health courses.

The health benefits of physical activity include improved cardiovascular health, reduced rates of diabetes and other metabolic diseases, weight maintenance and improved bone and mental health (United States Department Health & Human Services (2008). According to the American College Health Association National College Health Assessment (ACHA-NCHA, 2013), only 20.0% of college students in the United States meet this recommendation. The Theory of Planned Behavior (TPB) attempts to explain the intention to perform behaviors that are not under an individual’s complete volitional control and has been highly utilized in predicting intention and performance of physical activity (Courneya, Nigg & Estabrooks, 1998). This study aimed to understand the behavior and intentions of WKU students towards physical activity using the Theory of Planned Behavior as a guiding framework. This study utilized the TPB as a framework to examine health promoting and health inhibiting factors impacting participation in physical activity among college students. The study was a one-time, cross-sectional survey administered to students in a Personal Health (PH 100) course. Institutional Board Review (IRB) approval was obtained for the study. Information was collected on demographic variables and other factors influencing physical activity behavior among PH-100 students. Statistical analysis was conducted on the data collected to determine the associations between the TPB constructs and intentions to perform physical activity. About 38% of participants were classified as having BMI greater than 25, classifying them as overweight or obese. Males were found to be more likely to be overweight or obese than females. A total of 54.6% of participants met the current American College of Sports Medicine (ACSM) recommendations for physical activity. Lack of time and lack of energy were the most significant perceived barriers. Attitudes and perceived behavioral control (PBC) were found to significantly impact intention to perform physical activity. In conclusion, the current levels of physical activity among college students can still be improved. The TPB provides a useful framework for predicting intentions to perform physical activity in college students. It can also serve as a useful guide for the development of programs geared toward increasing rates of physical activity among students.