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.

Physical activity guidelines encouraging activity among healthy pregnant women have been issued by the Centers for Disease Control and Prevention, yet Latina women remain more sedentary than non-Latina white women. Latina women are also at higher risk for gestational diabetes mellitus and, among Latina women, Puerto Rican women have the highest rates of low birth weight and preterm-related infant death. This dissertation utilized data from the Latina GDM study, a prospective cohort study of 1,231 Latina women recruited early in pregnancy and followed through delivery. Participants were interviewed in early and mid pregnancy for assessment of sociodemographics, acculturation, medical, and behavioral factors, in addition to administration of the Kaiser Physical Activity Survey for assessment of physical activity and sedentary behaviors. Birth outcomes were abstracted from medical records following delivery. In the first chapter, we assessed the prevalence of three health behaviors (meeting physical activity guidelines, meeting fruit/vegetable consumption guidelines, and cigarette smoking) in early and mid pregnancy and identified multiple factors associated with meeting health behavior guidelines in pregnancy. In the second chapter, we examined participation in sedentary behaviors, such as time spent TV watching, sitting at work, and low levels of sports and exercise, in pre, early and mid pregnancy in relation to maternal glucose intolerance and gestational diabetes mellitus. In the final chapter, we analyzed four types of physical activity (sports/exercise, household/caregiving, occupational, and active transportation) as well as total activity in relation to risk of preterm birth and small-for-gestational age. Findings represent the first study of physical activity and maternal/fetal outcomes conducted exclusively among Latina women, a group largely understudied in epidemiologic research. Results will guide culturally specific intervention programs in this high risk population.

College students between the ages of 18 and 24 are considered high-risk for alcohol-related negative consequences due to drinking at high-risk levels (Barry, Howell & Salaga, 2015). Within that population, varsity student athletes are considered at even greater risk for those issues (Druckman, 2015; Wechsler, 2002). With football and men’s basketball being considered the only revenue-generating NCAA Division I sports, non-revenue-generating sports consist of the majority of student athletes (NCAA, 2016). This study is designed to examine high-risk drinking as well as alcohol-related consequences among non-revenue-generating student athletes attending a National Collegiate Athletic Association (NCAA) Division I school. The sample population for this study attends a large, Power 5 Conference, NCAA Division I institution located in the United States. Of the sample, there are 228 respondents representing the majority of non-revenue-generating sports and nearly 68% of the total population of student athletes who participated in non-revenue-generating sports. Utilizing the Athletic Identification Measurement Scale (AIMS), the Identification of Psychological Group scale (IDPG), and the Harvard College Alcohol Study (Wechsler, 2002), this study identifies factors that may associate with high-risk drinking and alcohol-related consequences set within the framework of the Social Ecological Model of Prevention (Brewer Van Raalte & Linder, 1993). Through descriptive statistics and basic correlation methods, the study examines the role of factors in four of the five levels of the Social Ecological Model of Prevention (individual, relationship, organizational, and community—public policy is not used for this study) as compared to high-risk drinking and alcohol-related negative consequences. The findings of this study indicate that this population experiences negative consequences in greater volume than respondents to the College Alcohol Study (Wecshler, 2002) and the NCAA Alcohol Study (2014), which may imply that non-revenue-generating student athletes are at a higher risk than revenue-generating athletes. Additionally, teams with the most dissonance regarding the team alcohol policy are more likely to experience alcohol-related negative consequences. Teams that are consistent in their understanding of the team alcohol policy experience fewer alcohol-related negative consequences, regardless of the overall levels of high-risk drinking.

Cancer is the second leading cause of death in America. It’s been suggested that regular physical activity (PA) can improve health outcomes in cancer survivors. An estimate from BRFSS data (2009) suggested that 47% of all cancer survivors met recommended guidelines and that this estimate was not different from the population at large (48%). Several factors were examined from these BRFSS data to determine whether subgroups of survivors existed who might benefit from interventions aimed at improving their PA status. The purpose of this investigation was to obtain more recent estimates of adherence to established PA guidelines for cancer survivors. Data from 2015 NHIS were obtained from the CDC website. Of the survivors, 40% met PA guidelines. Additionally, 79% were 54 years or older, more likely to be female (60%), predominantly white (80%), with more than 2 comorbidities (41%), and with some form of functional limitation (66%). Compared to a study based on 2009 BRFSS data, an even smaller proportion of survivors met PA guidelines in this study. This might be due to differences in age distributions and no limitation of the analysis according to time since diagnosis. Targeted interventions to increase activity in cancer survivors continue to be warranted.

In an effort to bridge the gap between public health practice and academia, the Health Resources and Services Administration (HRSA)-funded Tennessee Public Health Training Center (LIFEPATH) has supported establishment of an Academic Health Department (AHD) involving the East Tennessee State University (ETSU) College of Public Health (COPH) and the Sullivan County Regional Health Department (SCRHD). The SCRHD identified a need to increase internal capacity to conduct ongoing community health assessments and community-oriented practice. Similarly, the COPH recognized the need to expand field-based public health practice opportunities for students. Personnel from SCRHD, LIFEPATH, and COPH developed a formal AHD memorandum of understanding during the summer of 2012, launching the program in fall 2012. The COPH/SCRHD model addresses financial barriers experienced by other AHDs by competitively awarding the Coordinator position to a Doctor of Public Health (DrPH) student from the COPH, demonstrating investment in the model by the COPH. The DrPH student gains valuable leadership experience through project management, coordination of the local health council, and day-to-day facilitation of undergraduate and master's student interns. SCRHD benefits from formally trained graduate-level interns dedicated to long-term work within the community. This AHD offers a unique opportunity for doctoral-level students to develop practical leadership skills in a functioning health department, while enhancing the capacity of SCRHD and COPH to serve their community and stakeholders.

Maintaining the health of Tennesseans depends heavily on a well-trained, efficient public health workforce that can work effectively in a complex environment. In order to assess the training needs of this group, the Tennessee Public Health Training Center-LIFEPATH administered a survey to all governmental public health employees in Tennessee during the summer of 2012. This instrument was modeled after previous assessments conducted by health agencies outside of Tennessee which utilized as their rubric the Core Competencies for Public Health Professionals developed by the Council on Linkages between Academia and Public Health Practice. The goal of this research was to inform and streamline educational efforts of the Tennessee Department of Health (TDOH), LIFEPATH and their partners across the state by identifying specific competency driven training opportunities within the workforce. Participants were recruited via email and directed to SurveyMonkey, an online survey toolkit, where they could complete the questionnaire. Of the 5178 TDOH employees who received the recruitment email, 3086 individuals completed at least one of the competency questions for a response rate of 59.6%. The survey assigned questions pertinent to the eight core competency areas to respondents based on one of three Tiers – Tier 1: Entry Level, Tier 2: Management Level, Tier 3: Leadership Level. Once the data were collected, responses from all three tiers were dichotomized to generate a “Needs Score” which when summarized represented the percentage of responses indicating a lack of knowledge or proficiency in a competency area. Tier 1 respondents had an average needs score of 60.46% in each of the eight core competency areas. Tier 2 had an average needs score of 49.50%, and Tier 3 respondents had an average needs score of 28.91%. This trend shows that individuals in leadership positions within TDOH were more likely to be knowledgeable or proficient in the eight core competency areas. Prior to administering the survey, TDOH job classifications were submitted to an expert panel within the health department. This body was tasked with assigning tiers to specific job classifications. Previous needs assessments that used the eight core competencies had respondents self-select their tier. As a test of validity the LIFEPATH survey asked TDOH employees to select their job classification in addition to tier. A Kappa test of agreement between self-selection of tier and their actual tier determined by TDOH leadership showed moderate agreement (Kappa=0.5089), suggesting that while most respondents selected the correct tier; there remained some confusion regarding tier definitions. This must be considered when evaluating the results of previous studies that utilize only the self-selected tiers to drive their survey. This data has already begun to direct training goals at the state, regional and local levels across Tennessee and will serve as a baseline measure for future evaluations of educational programing’s impact on workforce competency.

Introduction: This study moves to examine the prevalence of risky driving behaviors and deficiency of communication pertinent to topics related to safe driving among adolescents in central Appalachia. Even though plenty of research displays the consequences associated with driving, drivers continue to take part in risky behaviors such as texting while driving, riding in a vehicle without wearing a seatbelt, and riding in a vehicle with someone who has been drinking. Methods: Participants of the study included three high schools in Southwest Virginia consisting of 385 11th and 12th grade students. Students were administered a paper-pencil survey either during homeroom or last period with questions taken from the Youth Risk Behavior Surveillance Survey. Results: The results of the study indicate the frequent occurrence of young drivers engaging in risky driving behaviors associated with texting while driving and not wearing a seatbelt as both passenger and driver in a vehicle. Additionally, the results of the study indicate that there is a lack of healthcare provider communication related to risks associated with driving. This information is crucial because the data demonstrates the missed opportunity to provide better education to adolescents on how they can prevent harm to their lives or the lives of other citizens while driving. Conclusion: After analyzing these results, it becomes evident that more education about safe driving behaviors is crucial for benefiting the young drivers of this region. Because road injury is the leading cause of death among adolescents, it is paramount to provide educational resources to young drivers to decrease the impact of injuries and deaths related to risky driving behaviors. There resides a missed opportunity to educate adolescents about behaviors that may risk their lives or those of their peers and loved ones. In addition, researchers can conduct further studies to examine effective safe driving education programs to decrease the risk behaviors commonly engaged in by adolescent drivers.

Opioid overdose fatalities have quadrupled in the United States since the turn of the century, and are becoming increasingly recognized as a nationwide epidemic. While naloxone (narcan) has long been the standard treatment for overdose in clinical settings, it has not been issued to opioid users or their family members in the U.S. until relatively recently. As naloxone distribution and overdose training become more widespread, they are being incorporated into more and more abstinence-oriented settings including detoxes, halfway houses, and outpatient methadone and suboxone treatment programs. This qualitative study explored whether the staff at such programs found that training their patients to use naloxone was disruptive or controversial, and whether they found it difficult to reconcile these trainings’ basis in harm reduction with their personal and organizational philosophies about substance use and recovery. Ten subjects from Eastern and Central Massachusetts were interviewed about their experience introducing naloxone to their patients under the aegis of the Massachusetts Department of Public Health’s Opioid Overdose Prevention Pilot Program, and their interviews were analyzed from a descriptive phenomenological perspective. This approach seeks to distill the essence of a phenomenon by analyzing the narratives of those who have experienced it, and has been found especially useful when exploring questions that have not yet been studied in depth. The analysis identified eleven recurring themes, grouped into four broad domains (What is overdose prevention training? What is narcan? What is harm reduction? What is the goal of treatment?). These themes suggested that while subjects overwhelmingly experienced naloxone distribution and overdose prevention training as positive additions to their workplace, this experience did not necessarily lead to more engagement with the broader concept of harm reduction.

Mobile produce markets (MPM) are a community-based strategy to improve produce access in areas with few fruits and vegetables (FV) retail options. The purpose of this thesis is to assess the functionality of MPM in low-income urban neighborhoods. This thesis includes three studies. Study 1 investigates FV availability in areas around MPM locations (n=13). We found limited fresh FV availability in stores, but high prevalence of 100% juice, and canned FV and beans. Study 2 applied questionnaire data from MPM shoppers (n=143) to assess MPM experiences. Chi Square was used to compare shopping behaviors between older (≥ 60) and younger (18-59.9 years) adults. Separate logistic regression models were used to predict Electronic Benefit Transfer (EBT) use, money spent, shopping frequency, and distance travelled to MPM, with age, race/ethnicity, sex, living alone/with others, and EBT in models. Participants indicated positive experiences with five dimensions of access: availability (variety), accessibility (location), affordability (price), acceptability (freshness), and accommodation (EBT use). Older shoppers were more likely to be long-term shoppers (P=0.002) and use EBT (P=0.012). Living alone predicted EBT use (P=0.03), shopping weekly (P=0.03), and traveling < 1 mile (P=0.02). In Study 3, we interviewed 16 farmers to investigate experiences and perceptions of local markets including MPM. Income and community interaction were prominent themes. Farmers identified community organizations as important liaisons to coordinate MPM distribution and communicate community needs. MPM offer a promising strategy for serving low-income and minority populations—to be organized by communities themselves and to bring needed food directly to neighborhoods.

INTRODUCTION: Motivational Interviewing (MI) is an evidenced based counseling style to elicit health behavior change. Team-based student clinics are an ideal climate for students to learn and practice team-based care, yet little is understood as to how client-centered communication styles such as MI are implemented in a team setting. PURPOSE: The purpose of this dissertation was to conduct an exploratory study using mixed methods to better understand how an MI training translates to team-based communication with clients, the factors impacting team-based implementation of MI, and how team-based MI impacts clients’ perceived autonomy at a student-led, interprofessional, team-based wellness clinic for low-income seniors. METHODS: Fifty-five clinic sessions were audio recorded and participants completed the Health Care Climate Questionnaire to measure perceived autonomy support, 16 clinic participants were interviewed, and 15 health care students participated in four focus groups. The recordings were coded with the Motivational Interviewing Treatment Integrity code (MITI 4.2.1). Independent t-tests, and multiple regression models were used to assess differences in MITI scores, association between MITI scores and team/patient characteristics, and associations between MITI scores and perceived autonomy support. Interviews and focus groups were qualitatively analyzed to identify themes. RESULTS: A short training in MI was not associated with MI proficiency as measured by the MITI, and student teams were found to overstate their use of MI on team-report measures. Less education, older age, and a larger team size were associated with lower MITI scores. High levels of perceived autonomy support were found across all clients, but MITI scores were not associated with perceived autonomy support. Clinic participant interviews identified benefits to engaging with the student teams including opportunities to socialize, as well as support in managing their health. The students found the MI training to be beneficial but noted that team dynamics ultimately effected MI use. CONCLUSION: It is possible to implement MI in team-based settings, but sufficient training and ongoing coaching is needed to ensure translation to practice. As health care programs continue to promote team-based care, further research is needed to fully understand how teams can effectively communicate with clients, and how they can provide the autonomy supportive environment needed to elicit internal motivation to engage clients in their own health management.