Background: Community gardens have existed in America since the late 1800s and have served multiple purposes from food subsidies to neighborhood beautification. The use of community gardens has grown in popularity and has been recommended as a way to encourage healthy eating habits in youth. Though the health benefits of having a diet high in fruits and vegetables is well known, youth in the United States do not meet recommendations for fruit and vegetable intake. Under-consumption of fruits and vegetables is problematic in youth, as eating habits are established in childhood. Community gardens have been successfully used to improve access, self-efficacy, preference, and consumption of fruits and vegetables. However, few published community garden studies have focused on low socioeconomic youth. The Dan River Partnership for a Healthy Community (DRPHC) was developed according to community-based participatory research (CBPR) principles. With a mission to reduce obesity using healthy lifestyle initiatives, community gardens are an evolving DRPHC initiative. Objective: To evaluate the feasibility (i.e., demand, acceptability, implementation, and limited-effectiveness testing) of a 10-week experiential theory-based gardening and nutrition education program targeting youth living in two public housing sites in the Dan River Region. Methods: Using pre- and post-program questionnaires/interviews, demand and acceptability were measured among youth, parents and site leaders. Implementation was measures via field notes and attendance. Limited-effectiveness was measured among youth using a pre-post design. Three researchers independently coded the qualitative transcripts, met to resolve disagreements, and built consensus through discussion of the codes. Similarly, field notes were reviewed and evaluated for reoccurring themes regarding barriers, facilitators, and other observations. For the quantitative measures, descriptive statistics were used to summarize the variables and Cronbach's alphas used to assess the reliability of each scale at baseline. Overall effects were tested with repeated measures ANOVA. An intent-to-treat analysis using the last observation carried forward method was used. A critical value of .05 was used for significance testing. A standard equation for reporting effect sizes on a single-group, pre-post study design is also reported. Results: Program enrollment included 43 youth, primarily African American. The positive demand and acceptability findings indicate the potential of the program to be used and suitable for the youth, parents, and site leaders. Field notes revealed numerous implementation facilitators and barriers. Youth weekly attendance averaged 4.6 of 10 sessions. Significant improvements (p<0.05) were found for some (e.g., FV asking self-efficacy, overall gardening knowledge, knowledge of MyPlate recommendations), but not all limited-effectiveness measures (e.g., willingness to try FV, FV eating self-efficacy). Study Implications: This study addresses recommendations for utilizing CBPR in community garden efforts and builds on community identified research priorities of the DRPHC. Results demonstrate the feasibility of a gardening and nutrition program targeting youth in public housing. Lessons learned are being used to adapt and strengthen the program for future efforts targeting FV behaviors. Findings will be shared with local community stakeholders and used to adapt and strengthen the program for future efforts in the Dan River Region targeting of fruit and vegetable behaviors. / Master of Science

As defined by the US Department of Health and Human Services, health disparities are "a particular type of health differences that are closely linked with social or economic disadvantages." These disadvantages include, but are not limited to, unequal access to quality health care and health information. Health disparities adversely affect groups of people based on racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion. To address the root cause of health disparities there has been a call for more comprehensive frameworks for detecting, understanding, and designing interventions that will reduce or eliminate health disparities. One such framework is a Community-Based Participatory Research (CBPR) approach. CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of co-learning, mutual benefits, and long term commitment. CBPR also focuses on aspects of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities. The overall goal of this dissertation is to build capacity and address health disparities among youth and adults in the Dan River Region. This region is federally designated as a medically under-served area/population and is located in the health disparate region of south central Virginia and north central North Carolina. This research draws on two CBPR projects, including an 8-week community garden program lead by the Dan River Partnership for a Healthy Community (DRPHC) and a 3-month childhood obesity treatment program, iChoose, led by the Partnering for Obesity Planning and Sustainability (POPS) Community Advisory Board (CAB). Since one of the primary aims for CBPR is to increase community capacity, this approach is the ideal process for engaging communities that suffer from health disparities. Thus, engaging community members as collaborators, our studies reported on the relevance and application of CBPR while simultaneously addressing health and capacity outcomes in the health disparate Dan River Region. / Ph. D.

BACKGROUND: Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities. METHODS: Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support. RESULTS: At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband's behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home. CONCLUSIONS: The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.

Environmental justice communities, those disproportionately affected by pollutants, are simultaneously exposed to multiple environmental stressors and also experience social and cultural factors that may heighten their health risks in comparison to other communities. In addition to being more susceptible to toxic exposures and being exposed to more toxins, such communities may have weakened abilities to combat or rebound from such exposures. Many communities that are overburdened by environmental exposures reject traditional risk assessment approaches that solely consider the effects of single chemicals or mixtures of like chemicals and instead have advocated for the use of place-based approaches and collaborative problem solving models that consider cumulative exposures and impacts. Cumulative risks are the combined risks from aggregate exposures to multiple agents or stressors, including chemical, biological or physical agents and psychosocial stressors. This dissertation adapts three research approaches that each use either publicly available data (“expert” data) or community-generated data about environmental and social factors in Northwest Atlanta’s Proctor Creek Watershed. Through this work, we were able to define cumulative environmental and social impacts experienced by watershed residents and to prioritize geographic areas and environmental challenges for investments in environmental monitoring and further research, community capacity-building, and policy change. A principal finding of the study is that local community knowledge is helpful to fill critical gaps about local conditions and pollution sources than a reliance on expert data alone.

BACKGROUND: School discipline—how schools manage and respond to student misbehavior—is a central component of how schools seek to create safe and productive learning environments. School suspensions have been a popular discipline strategy in recent decades. Yet, recent studies have demonstrated the association between punitive discipline strategies and poor outcomes in youth, including increased high school dropout rates, decreased odds of enrolling in postsecondary school, and increased mental health concerns. There is an urgent need to examine alternate mechanisms for addressing school discipline other than punitive exclusionary or reward-based systems. This dissertation seeks to develop an integrated model of promising approaches and define how such a system could work. OBJECTIVES: This dissertation is made up of three studies addressing three aims: (1) to synthesize the existing literature on how school discipline has been constructed and its impact on student well being; (2) to develop a novel conceptual model for an alternate discipline approach, "kind discipline," and; (3) to develop and validate a measure for assessing the practice of kind discipline in elementary and middle schools. METHODS: Study one is a theoretical review utilizing a social ecological model to frame how school discipline models address an individual, relational, or structural level. Study two is a formative evaluation that develops a novel conceptual model for an alternative discipline approach. This study utilized concept mapping to elicit and integrate perspectives on school discipline from teachers, administrators, school staff, and other stakeholders involved in school programming. The concept mapping included a brainstorming phase, a statement analysis phase, a sorting and rating phase, and multidimensional scaling and hierarchical cluster analysis of the collected data. It culminated in a map that visually represent the group's ideas and how they are interrelated. Study three validated a newly developed measure of kind discipline through an assessment of the measure’s internal consistency, an exploration of convergent and discriminant validity, and a descriptive analysis of the strength of relationships between kind discipline and school-level discipline frequency. RESULTS: The theoretical review illustrated how different school discipline approaches address disparate explanations of what may lead to student misbehavior. The formative evaluation developed a conceptual model for kind discipline in which three core themes emerged from 11 identified clusters in the conceptual model: (1) proactively developing a positive school climate, (2) responding to conflict with empathy, accountability, and skill, and (3) supporting staff skills in understanding and sharing expectations. When mapped onto a social ecological model, the identified components of kind discipline encompassed all levels of that model including the individual, relational, environmental/structural, and even community levels. In the study validating a measure of kind discipline, teacher and student assessments of kind discipline were strongly correlated (Pearson’s Correlation -.772, p=0.005). Convergent validity of the measure was supported by our finding that the more positively students assessed kind discipline in their schools, the lower the school disciplinary action rate (β=-0.759, p=0.05). Mixed linear models showed teachers' perceived kind discipline at the school level predicted individual students' perception of kind discipline. Girls reported higher levels of kind discipline than boys; and students in higher grades reported lower levels of kind discipline than students in lower grades. CONCLUSIONS: Effective school discipline programs may need to operate on multiple levels. There is increasing support for the importance of a relationship-level component to disciplinary approaches. This contrasts with the dominant individual-behavioral discipline approaches that focus on fewer levels and may not lead to sustained student and staff motivation. The findings from the concept mapping illustrate the importance of setting and communicating clear expectations and the need for them to be collaboratively developed. The student and teacher measures for assessing the level of kind discipline in a school show promise as tools for evaluating schools working to improve approaches to discipline and for guiding interventions that aim to promote positive and relational motivation strategies.

Like many American Indian tribes, the Coquille Indian Tribe of Oregon has endured long struggles to preserve its cultural traditions despite the impacts of colonization. Now, advancing climate change poses additional threats to indigenous ways of life. In recent decades, the Coquille have archived historical documents and photographs as a means to protect and assert their tribal sovereignty. There has also been a surge in photography within the Tribe to document contemporary tribal activities. Community photography may be a useful tool for the purpose of asserting tribal culture and self-determination in the face of a changing climate. Photovoice, a type of community photography in which photographs are combined with oral descriptions, may be particularly well suited for tribal purposes. This collaboration explores the value of community photography in general, and photovoice in particular, when used by the Coquille Indian Tribe in the context of climate change.

Urban First Nations and Inuit older adults are aging in a Western-centric sociopolitical environment that is experiencing significant social change due to population aging and urbanization. Consequently, urban communities are facing increasing pressures to respond to the needs of the growing older adult population. As a result of these pressures, older adults are urged to “age well” to reduce their “burden” on society; however, older adults do not all define aging well in the same way and they do not all have the same opportunities to age well. Through my research, I aimed to address a gap in the academic literature concerning urban-dwelling First Nations and Inuit older adults and aging well. Ultimately, my goal was to identify how First Nations and Inuit older adults living in Ottawa could be supported to age well in ways that reflect their urban Indigenous identities, cultural perspectives, and life course. My specific research questions are four-fold: 1) Are Indigenous older adults marginalized through dominant aging well frameworks?; 2) how do community-dwelling First Nations and Inuit older adults (aged 55 years and over) living in Ottawa, Canada, define and negotiate aging well in an urban environment?; 3) what community-level factors contribute to First Nations and Inuit older adults (aged 55 years and over) feeling supported to age well in the city of Ottawa?; and 4) how do community stakeholders in Ottawa produce understandings of supporting urban Indigenous older adults to age well? Informed by a postcolonial theoretical framework, I conducted this research using a community-based participatory research (CBPR) methodology in Ottawa, Ontario, Canada, in partnerships with the Odawa Native Friendship Centre and Tungasuvvingat Inuit. To address my research questions, I conducted semi-structured interviews with nine First Nations older adults, focus groups with 23 Inuit older adults, and photovoice with two First Nations older adults. Additionally, I conducted 13 semi-structured interviews with community stakeholders (i.e., decision-makers and service providers. My doctoral research makes novel contributions to the fields of kinesiology and gerontology by expanding postcolonial theory to issues related to aging research with urban Indigenous older adults; contributing to the emerging literature that brings diverse perspectives into conversations on aging well; challenging assumptions related to urban Indigenous populations and aging well; illustrating the tensions within aging well initiatives that intended to be available for all older adults; and revealing the tensions within efforts to address reconciliation with Indigenous older adults.

Despite a significant increase in the demands for teachers’ professional development, the work environments of teachers have not developed at a comparable rate. Due to research on inequity in teacher work environment, the purpose of this case study was to explore the role of empowerment in the early childhood education (ECE) workforce, using Community Based Participatory Research (CBPR) as a framework. This project was done with 5 educators in a for‑profit ECE center. Over the course of five weekly sessions, the educators completed questionnaires, interviews, and engaged in weekly focus groups geared towards providing the teachers with an opportunity to share their experiences and collaborate on solutions for change in their work environment. Overall, descriptive statistics of the quantitative data did not demonstrate an increase in empowerment over the course of the project. However, the six emerging themes (i.e., Frustration with Center Operations and Corporate, Empowerment, Communication, Emotional and Physical Well‑Being, Teacher Unity, and Teacher Training and Education) provided important insights into the nature of teacher empowerment in the ECE setting, which informed lessons learned and future directions for research.

High attrition rates from community participatory research studies need to be explored more by non-traditional methods and participant profiles need to be developed to prevent high attrition rates. The purpose of this dissertation is to characterize compliance and drop out rates using the cardiovascular disease IQ quiz and the life priorities questionnaire. It is important to examine both compliance and dropouts in this context because both diabetes and cardiovascular disease are emerging as a major focus of public health efforts in the United States and abroad. These diseases are accelerating due to the current trends in obesity, which is a preventable, modifiable risk factor for diabetes and cardiovascular disease. Diabetes and cardiovascular disease continue to be the number seven and number one leading causes of death, respectively. We explore these concepts in a largely Hispanic border community in the Southwest, in the small town of Douglas, Arizona. The Hispanic population is increasing in the United States and is now the most populous minority group. Additionally, among this group are some of the highest rates of pre-diabetes, diabetes, and uncontrolled diabetes, all cardiovascular disease risk factors. We found that the cardiovascular disease IQ quiz was a much stronger predictor for compliance and drop out rates in this sample population than the life priorities questionnaire. Compliance did not seem to differ among the study participants who remained in the study. Interestingly, among the participants who were compliant, especially those who kept their eye check-up, were also those more likely to have health insurance and be employed. Though males only represented about 10% of the population sample, they tended to drop out more frequently than females. Dropouts tended to be younger, gainfully employed, and more educated. Qualitative analysis and logistic regression will further help explain the aforementioned associations.

The Atlanta BeltLine is an innovative redevelopment project re-shaping Atlanta residents’ access to, multi-use trails, parks, public transportation, housing and employment opportunities. The primary purpose of this project was to develop a research proposal to study and analyze the health benefits associated with multi-use trails within BeltLine communities. A secondary purpose of this project was to evaluate the multi-sectoral and multi-institutional partnership that was formed to develop the research proposal and study the influence of the BeltLine on health outcomes. In August 2010 representatives from the Centers for Disease Control and Prevention, Emory University, Georgia Institute of Technology, Georgia State University, the Atlanta BeltLine Inc. and the Atlanta BeltLine Partnership formed the BeltLine Health Proposal Committee. Two online surveys using Survey Monkey were conducted to evaluate how this committee was operating, if roles and responsibilities were clear and to determine if this committee was an effective mechanism to integrate health and the built environment. Findings from the survey indicated that committee members believed this group was a unique partnership comprised of dedicated professionals sharing a common interest. Survey findings indicated there were several challenges that needed attention including improving communication, resolving competing interests, and identifying a lead organization. Findings from this evaluation can help resolve these issues and help the committee transition into a Health Advisory Group. The Health Advisory Group will serve as formal body that will review research proposals, conduct research, leverage funding and disseminate key health findings related to the BeltLine.