This study compared perceptions of prescribers and pharmacists (N = 89) regarding multiple aspects of prescription drug abuse. Questionnaires were developed to assess perceptions regarding the prevalence of prescription drug abuse, self-perceived communication competence, and additional communication and prescription drug abuse domains. Pharmacists perceived a larger percentage of patients (41%) to be abusing opioid pain relievers as compared with their prescriber colleagues (17%). Both prescribers and pharmacists indicated improvements in prescriber–pharmacist communication would serve to deter prescription drug abuse. Self-efficacy beliefs for detecting and discussing prescription drug abuse with patients were low for both cohorts. Implications and limitations are noted.

This dissertation examines the associations between adult Latina daughters’ HIV risk behaviors and that of their older Latina mothers’ HIV risk behaviors. The central hypothesis of the study is that adult Latina daughters’ influence their older mothers’ behaviors and that such behaviors interact with the level of their attachment. Older Latinas are a vulnerable population that face cultural risk factors, health care provider bias, and engage in low rates of HIV testing. The primary mode of HIV infection for Latinas is through heterosexual contact. Yet, traditional gender norms such as marianismo belief place pressure on Latina women to be submissive to their partners, disregard their infidelities, and not attempt to negotiate condom use, increasing the risk of HIV infection among Latinas via heterosexual sex with their primary partners. Efforts by the CDC to increase HIV testing have emerged as a critical part of HIV prevention. However, research has indicated that older Latinas are less likely to speak to a health care provider about safe sex practices or HIV testing than their younger counterparts. Despite health care providers having strong influences over Latinas’ decisions to perform health related tests, physicians are not endorsing HIV testing for their older patients. This in part, leads to a disproportionate number of late stage diagnoses among older adults. Evidence suggest that adult daughters are a source of support and assistance in health-related issues for their aging mothers and are uniquely positioned to influence their mothers’ health-related behaviors and decisions. Additionally, mother-daughter attachment has been found to be a protective factor to other risky health behaviors. The present study (1) Examined the association between recurrent HIV risk behaviors of adult Latina daughters and those of their older Latina mothers and (2) examined the moderating effect mother-daughter attachment have on those associations. No statistical significance was found in examining the association between adult Latina daughters and their older mothers, nor was attachment found to be a moderator on those associations. Findings show culture may be the significant factor influencing the lack of association between adult Latina daughters and their older mothers. Results add to the literature and scientific field of social work and public health. Additionally promoting studies on cultural barriers that may exist in adult Latina daughter and older mother upward communication as techniques to promote healthy behaviors among older Latinas.

The objective of this study was to understand the influence of eating episodes and snack quality on body weight of children ages 3-4.9 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC).Additional objectives were to evaluate obesity risk factors and to examine the effect of childcare arrangements on body weight. Data was collected from 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data was extracted from the WIC data system. BMI-for-age percentiles were used to categorize children by weight according to Centers for Disease Control (CDC) guidelines, which were further categorized into under/normal weight and overweight/obese. There were 197 participants included (45.7% boys), 3.6% of the children were underweight, 64.4% normal weight, 16.8% overweight, and 15.2% were obese. Most children consumed 3 meals (97.5%) and 2 to 3 snacks per day (33.0% and 37.1% respectively), with a significantly higher intake of snacks on the weekends when compared to weekdays (p=0.001). Children consumed more nutritious snacks more often (66%) than the nutrient-poor snacks (33.5%). We observed a marginally significant trend in which the WIC preschool children that more frequently consumed nutrient-poor snacks had a higher prevalence of overweight/obesity (p=0.090). In multivariate analyses, the children who consumed more than 4-oz of sugar sweetened beverages (SSB) per day, exercised for less than 1 hour per day, and had a higher birth weight had increased odds of being overweight/obese. Race and ethnicity were not predictive of body weight status, but Blacks or African Americans were at a higher risk for many of the risk factors. Children spent on average 20 hours per week under some type of nonparental care arrangement. There was no significant relationship between childcare and weight status. Our findings indicate that WIC children are at a greater risk for overweight and obesity, however there is potential for successful prevention interventions addressing prevalent risk factors. Longitudinal studies including a large sample of racial and ethnic diverse preschool children from low socioeconomic families could help elucidate the results from our study. This study was approved by FIU IRB (Protocol Approval #15-0369) the State of Florida Department of Health IRB (Protocol Title: Meal Frequency and the Role of Snacking on Weight of Minority Preschool Children).

Metabolic syndrome (MetS), a global public health problem, is the primary cause of type 2 diabetes and cardiovascular disorders. Lifestyle modification interventions (dietary and physical activity modifications) are effective in preventing and ameliorating MetS and associated comorbidities. However, the impact of lifestyle changes on MetS among Mexican Americans has yet to be investigated, particularly due to high attrition rates in this population. The overall goal of the explanatory mixed-methods study presented in this dissertation was to identify efficacious lifestyle modification efforts directed towards Mexican Americans to promote their retention in lifestyle modification programs, ameliorate the severity of MetS, and understand underlying behavior modification process. In particular, we examined secondary data from an extensive study Beyond Sabor to 1) examine predictors of program completion, 2) compare variation in MetS severity scores (z-scores) between intervention (Beyond Sabor) and attention control (Healthy Living) groups, over time and, 3) investigate processual development of self-efficacy in a sample of 1153 disadvantaged Mexican Americans participants. Findings suggest that program completers were more likely to be older, had more years of education, lower fasting blood glucose levels, and participated in sites with high group cohesiveness. Results also revealed that when compared with the standard nutrition program, Healthy Living, the lifestyle modification intervention, Beyond Sabor, was more effective in ameliorating MetS severity, systolic blood pressure, triglyceride, and fasting plasma glucose levels among study participants. Qualitative results demonstrate the high acceptability of Beyond Sabor intervention. Four sub-themes emerged illustrating important underlying conditions contributing to participants’ improved self-efficacy: desire to gain knowledge about ways to improve health, development of social support, adoption of program teachings in family lifestyle, and improvement in health outcomes. Findings of the current study may allow researchers to identify Mexican Americans at risk of non-completion and to develop strategies to improve lifestyle modification program attendance, and thus health outcomes. Qualitative findings underscore the importance of sociocultural context on individuals’ attempts to make lifestyle changes to manage their chronic illnesses. Successful adaptation of lifestyle interventions such as Beyond Sabor for at-risk populations in community-based settings will be critical in stemming the tide of MetS.

En los Estados Unidos, los latinos suelen tener menos acceso a la educación, el trabajo, y el seguro médico en comparación con los blancos no-latinos, pero aun así el grupo parece superar ciertos obstáculos de la salud. Las estadísticas de la población latina muestran mayor longevidad y otras tasas favorables en comparación con los blancos no-latinos. Los expertos han titulado esta contradicción “La Paradoja Hispana Epidemiológica”. Desafortunadamente, la investigación de la paradoja está llena de generalizaciones y presuposiciones erróneas sobre la población latina diversa. Esta tesis investiga los participantes que producen generalizaciones sobre la supuesta paradoja para mostrar que estas generalizaciones impiden un entendimiento claro. Antes de llegar a conclusiones e implicaciones, es necesario diseccionar la paradoja para poder entender esta diversidad y especificar los aspectos que realmente necesitan explicaciones. El análisis de la aparente paradoja tiene mucho que decirnos no sólo sobre la población latina, sino también sobre las maneras en que se estudia la salud y cómo se presenta información sobre la salud al público. Una examinación de las investigaciones de la paradoja puede dar luz a estos discursos generales.

Despite the well-recognized benefits of exercise, Americans are gaining weight in astounding proportions and levels of physical activity are on the decline. The purpose of this study was to investigate a relationship between physical fitness, self-concept and sexual health. There is a dearth of knowledge on this relationship specifically in the context of sex-negative curricula, which is the dominate discourse in the United States. One hundred and thirty-three participants between the ages of 18 - 50 volunteered for fitness testing and data collection. Physical fitness was assessed through body fat, resting metabolic rate, cardiovascular endurance, muscular strength, muscular endurance and flexibility. Self-reported exercise was measured using the International Physical Activity Questionnaire. Self-concept was measured by the Six Factor Self-Concept Scale, which presented a total self-concept score and as six individual concepts of self (likability, morality, task accomplishment, giftedness, power and vulnerability). Additionally, sexual function was measured by Derogatis Interview for Sexual Functioning and presented as both an aggregate score and five separate constructs of sexual functioning (fantasy/cognition, arousal, orgasm, behavior/experience, and drive/desire). Questions pertaining to sexual partners, sex education, and demographic information were also included. The results of the General Linear Model indicated significant relationships between physical fitness, self-concept and total sexual functioning. The sexual behavior/experience of men was predicted by body fat percentage and flexibility. In women, behavior/experience was predicted by body fat percentage and arousal was predicted by cardiovascular endurance. Total self-concept was related to muscular endurance. When men were isolated in the analysis, likability was positively related to sexual behavior/experience, and task accomplishment was inversely related to sexual behavior/experience. In women, giftedness was related to cognition/fantasy, arousal, orgasm and total sexual functioning. No relationships were found between physical fitness and the number of sexual partners in men; however, both muscular strength and the power self-concept were significantly related to number of sexual partners in women. As a result of these findings, women may be inclined to exercise to improve arousal and sexual functioning. Furthermore, educators should note the findings of a positive relationship between physical and psychological health and sexual well-being because they provide support for the development and adoption of sex-positive curricula that incorporate potential benefits of sexual activity.

Memory deficits and executive dysfunction are highly prevalent among HIV-infected adults. These conditions can affect their quality of life, antiretroviral adherence, and HIV risk behaviors. Several factors have been suggested including the role of genetics in relation to HIV disease progression. This dissertation aimed to determine whether genetic differences in HIV-infected individuals were correlated with impaired memory, cognitive flexibility and executive function and whether cognitive decline moderated alcohol use and sexual transmission risk behaviors among HIV-infected alcohol abusers participating in an NIH-funded clinical trial comparing the efficacy of the adapted Holistic Health Recovery Program (HHRP-A) intervention to a Health Promotion Control (HPC) condition in reducing risk behaviors. A total of 267 individuals were genotyped for polymorphisms in the dopamine and serotonin gene systems. Results yielded significant associations for TPH2, GALM, DRD2 and DRD4 genetic variants with impaired executive function, cognitive flexibility and memory. SNPs TPH2 rs4570625 and DRD2 rs6277 showed a risk association with executive function (odds ratio = 2.5, p = .02; 3.6, p = .001). GALM rs6741892 was associated with impaired memory (odds ratio = 1.9, p = .006). At the six-month follow-up, HHRP-A participants were less likely to report trading sex for food, drugs and money (20.0%) and unprotected insertive or receptive oral (11.6%) or vaginal and/or anal sex (3.2%) than HPC participants (49.4%, p

The obesity epidemic is a global health concern. In the United States alone, 68.5% of adults are categorized as overweight or obese; of these, 35.1% are considered obese. Obesity is a leading cause of morbidity and mortality from diabetes and cardiovascular disease, two diseases adversely affecting minority groups such as Mexican Americans. Yet, a modest 5% decrease in weight, through changes in diet and physical activity, can help control type 2 diabetes. The current study extracted the dietary data and selected outcome variables from Beyond Sabor, a 12 week intervention conducted in the Lower Rio Grande Valley, Texas, a predominantly Mexican American disadvantaged community. Social Cognitive Theory, guided the design of this culturally tailored intervention. Community resources and natural helpers emerged through the utilization of community based participatory research methods. Study participants (n= 1,273) were recruited from local food bank sites and randomized into treatment and control groups. The treatment group received 12 weekly sessions focusing on healthier eating habits, cooking methods, and physical activity. The control group received 6 nutrition education sessions on similar topics. The study measured changes in several food groups including consumption of soda, fruit juice, and fruit and vegetables. A repeated measures Analysis of Variance was employed to determine changes in treatment and control groups from baseline, post intervention and 40 week follow up. The results showed a significant decrease in soda (F= 8.48, p< .001) and fruit juice (F= 3.12, p= .045) consumption for both groups, with a particular decrease in soda for the treatment group. In addition, there was a significant increase in fruit (F=15.32, p< .001) and vegetable (F=3.16, p= .04) consumption in both groups. The outcome variables selected were weight, body mass index (BMI), and fasting plasma glucose (FPG). There were significant changes for all three variables over time. The intervention resulted in changes in dietary behaviors that ultimately led to changes in weight, BMI, and FPG. It is evident from the current study, that the use of community based helpers facilitated changes in food habits. This study serves as a prognosticator for future interventions.

Background: Muscular strengthening activity (MSA) has been shown to be inversely associated with insulin resistance (IR). The associations between quartiles of the homeostatic model assessment of insulin resistance (HOMA-IR) and self-reported MSA in a nationally representative sample of euglycemic U.S. adults were examined. Methods: Sample included adult participants (≥20 years of age [n=2,543]) from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). HOMA-IR was categorized into quartiles based on every 25th percentile. No MSA was the dependent variable. Results: Following adjustment for covariates, those with HOMA-IR values in third (p Conclusions: Having a higher HOMA-IR value is associated with greater odds of reporting no MSA in euglycemic U.S. adults.

Background: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.