abstract: Dominant discourses of health and fitness perpetuate particular ideologies of what it means to be “healthy” and “fit,” often conflating the two terms through conceptualizing the appearance of physical fitness as health. The discourse of healthism, a concept rooted in the economic concept of neoliberalism, fosters health as an individual and moral imperative to perform responsible citizenship, making the appearance of the “fit” body a valued representation of both health and self-discipline. This perspective neglects the social determinants of health and ignores the natural variation of the human body in shape, size, and ability, assuming that health can be seen visually on the body. Through a case study of one particular location of a popular commercial gym chain in an urban city of the Southwestern United States, this study employs a critical discourse analysis of the gym space itself including a collection of advertisements, photographs, and signs, in addition to participant observation and semi-structured interviews conducted with diverse women who exercise at this gym to explore how women resist and/or (re)produce discourses of healthism related to health, fitness, and body image. Ultimately, critical analysis shows that the gym itself produces and reifies the discourse of healthism through narratives of simultaneous empowerment and obligation. Though women in the gym reproduced this dominant narrative throughout their interviews, internal contradictions and nuggets of resistance emerged. These nuggets of resistance create fractures in the dominant discourse, shining light into areas that can be explored further for resistance practices through sense-making, necessitating a language of resistance. / Dissertation/Thesis / Doctoral Dissertation Communication 2019

This research examines the increase of personal narratives in the past several decades, particularly the autoethnographic approach. The project begins with a historical contextualization of personal writing and autoethnography in relation to the crisis of representation and other diverse socio-political shifts. One outcome of these cultural transitions was a proliferation of illness narratives, narrative therapy, therapeutic writing, and narrative health communication. Also included in this research are data from interviews with emerging autoethnographers and participant observation that occurred at the Third International Qualitative Inquiry Congress. The conference served as prism through which to view qualitative scholarship as a whole, as well as current issues in autoethnography and its possible futures. Issues that are explored include what motivates scholars to write autoethnographically, how they define and evaluate autoethnography, their views on its use as therapeutic practice, and their vision for the future of the autoethnographic approach. Qualitative research methods are flourishing globally, and autoethnography is uniquely positioned to expand in the years ahead, particularly in the area of health communication, cross-disciplinary academic studies, and mainstream publishing venues.

Eating disorders (EDs) are strikingly common among American adults. Past research has indicated that athletes in general are particularly vulnerable to developing EDs due to media pressure, athletic drive, and the population’s proclivity to perfectionism. Most ED research, both in athletic and non-athletic populations, is female-focused, as women are more likely to develop EDs. However, men are still susceptible to develop EDs and are understudied. Links between lack of autonomy and EDs exist in familial settings, but have yet to be applied in organizational settings. This quantitative thesis sought to bridge a research gap by assessing ED levels in male NCAA Division 1 athletes and examining the relationships with perceived levels of concertive, institutional, and simple control present in athletic settings. Findings indicated that although athletes perceived different forms of control in their sport, these forms of control did not negatively affect their eating habits. Implications and direction for future research are explored.

Situated within the context of college students’ excessive drinking behaviors, the current study drew from dissonance theory, self-consistency theory, and hypocrisy induction methodology to evaluate the utility of the Communication Theory of Identity within persuasive health message design. Specifically, it examined whether hypocrisy induction manipulations that focused participants on salient identity layers made them mindful of corresponding identity gaps, which in turn caused them to experience cognitive dissonance that they sought to resolve by reporting intentions to change their excessive drinking behavior. Participants (N = 279) completed an online experiment in which they were randomly assigned either to one of four treatment conditions (i.e., traditional hypocrisy, personal-enacted identity gap hypocrisy, relational-enacted identity gap hypocrisy, communal-enacted identity gap hypocrisy) or one control condition. When compared to those in the control condition, participants in the personal-enacted and communal-enacted identity gap hypocrisy conditions reported significantly lower future intentions to engage in excessive drinking. There were no significant differences across conditions, however, in terms of identity gap magnitude or level of cognitive dissonance. These findings are noteworthy, considering that identity gap magnitude was significantly positively related to levels of cognitive dissonance and significantly negatively related to future intentions to engage in excessive drinking. Analyses also explored potential moderating variables in this process, finding that issue involvement moderated the relationship between level of cognitive dissonance and future intentions to engage in excessive drinking, such that intentions were lowest when cognitive dissonance was high and issue involvement was low. Finally, analyses indicated that there was a significant association between experimental condition and level of state reactance, such that participants in the personal-enacted identity gap hypocrisy condition experienced significantly lower levels of state reactance than participants in other conditions. Moreover, there was a significant positive relationship between identity gap magnitude and level of state reactance. The theoretical and contextual implications of these results are discussed. Namely, these results affirm that making message recipients mindful of identity gaps can be a viable persuasive health message design strategy; however, they also suggest that more research is needed to understand how best to make message recipients mindful of identity gaps and how best to integrate identity gaps into persuasive health messages.

Mental illness is a pervasive health epidemic in the United States and worldwide, and available data suggest that mentally ill adults are statistically more likely to be parents than non-parents. The prevalence and continued growth of parental mental illness means that millions of children in the United States have a parent with some form of mental health issues. This dissertation contributes to and extends existing literature on children of mentally ill parents by exploring 15 adult children’s subjective perspectives on how they navigate the tension-wrought experience of having a mentally ill parent, and how this has implications for the management of their identity, relational, and instrumental goals. Examined through the lens of relational dialectics theory (Baxter & Montgomery, 1996) and a multiple goals perspective, analysis revealed that adult children of mentally ill parents confront conflicting, contradictory forces in making sense of their parent’s illness and the role that it plays in their lives. Specifically, adult children reported feeling a strong sense of interdependence with their parent and a desire to have a closer relationship with them, but simultaneously expressed a strong need and desire for disconnection and maintenance of a life separate from their parent’s challenges. Additionally, adult children noted conflicting goals with regard to privacy management about their parent’s illness, acknowledging that an underlying, but pervasive societal stigma surrounding mental health keeps them from freely disclosing to others about their parent’s illness, but indicating that a certain strategic degree of openness was required in order to meet certain instrumental and relational goals. Finally, participants revealed many fears and anxieties that they had about the future as a result of the unstable nature of their parent’s mental illness, while at the same time expressing a sense of acceptance and stability with the predictably unpredictable nature of their lives. After presenting an analysis of the data, the implications of the findings for children of mentally ill parents are explored, including, but not limited to, how the results of this exploratory study could be integrated into therapeutic and support interventions for families of those struggling with mental health issues. Finally, the limitations of the study are addressed.

Emotion has long been implemented in persuasive messages and campaigns to influence attitudes and health behavior. Research demonstrates that messages often evoke more than one emotion during and after exposure, and this was previously viewed as an undesirable outcome; however, the literature suggests that the intentional inclusion of multiple emotions, or emotional flow, could positively impact persuasive outcomes, such as attitudes and behavioral intention. The proposed study employs the concept of emotional flow, the intentional inclusion of more than one discrete emotion, in the context of narrative health blogs addressing mental health topics relevant to college students. The study specifically examines how the inclusion of a second discrete emotion influences transportation, identification, and attitudes. Participants were randomly assigned to one of six conditions and read a narrative health blog designed to evoke either one or two discrete emotions. After message exposure, they responded a brief survey to assess discrete emotions, transportation, identification, attitudes, and demographics. Data were analyzed using ANOVAs and ANCOVAs. The findings revealed that although the narratives elicited moderate levels of transportation and identification, there were not significant difference between conditions. Theoretical and practical implications for the study of narratives and emotional flow are discussed, in addition to practical implications for studying mental health.

The goal of this study is to determine issues rural Appalachian residents consider most important, their perceived environmental health risk, and how community engagement can potentially improve those issues. The University of Kentucky Superfund Research Center held the Appalachian Community Health and Well-being Forum at the Letcher County Cooperative Extension Office in Eastern Kentucky. A four-member panel consisted of two local health officials, a nutrition expert, and a federal scientist; answered questions from community members. The expert panel and audience members shared concerns, success stories, and highlighted efforts to promote health in the region. Community members completed a questionnaire collecting information on perceived environmental health risk, fruit and vegetable intake, and basic demographic information. The concerns raised by community members were chronic disease, poverty, pollution, mental health, and wellness. Proposed solutions were compliance, nutrition, physical activity, education, empathy, funding, community engagement, awareness, holistic health, prevention, and insurance/policy change. The programs in place to combat these issues are FARMACY, Community Health Workers, transportation services, mobile dental vans, Kentucky River Watershed Watch, research, policy changes, and the CLIK program. The questionnaire showed that residents are aware of the types of pollution in their community and believe that illness is caused by pollution in their environment. Community residents feel that pollution is not something they should have to live with, they act to protect themselves from pollution, and likely to engage in community efforts to stop pollution in their community.

Inoculation is a robust theory applied to a variety of health behaviors. Social marketing is designed to change behavior by applying marketing tactics in the context of social change. This study combines inoculation theory with social marketing in the context of substance abuse disorders to promote long-term recovery. This is a pilot project that specifically focuses on the Beacon House, a residential recovery treatment center in Louisville, Kentucky. With the growing drug problem in America, it is necessary to implement effective recovery strategies in treatment programs. The social marketing plan focuses on the target audience to outline potential barriers, motivators, and competition to remaining in long-term recovery. Three intervention strategies were developed as part of the project: a core inoculation message, booster messages, and refusal skills training. These strategies utilize inoculation messages in various ways to address the complexity of long-term recovery. While this study focuses on the Beacon House treatment facility, the concepts can be applied to similar treatment centers.

During high-impact weather events like Hurricane Harvey, broadcast meteorologists take on the role of sensegiver, as they develop frameworks to help their viewers make sense of the storm. These frameworks are communicated through rhetorical choices evident in the language the meteorologists use to describe the storm’s threat and impact. This study investigates the rhetorical choices of KHOU broadcast meteorologists during Hurricane Harvey in order to make sense of the disaster, using an inductive thematic analysis. The results indicate that the KHOU broadcasters framed Harvey figuratively as an all-encompassing monster and a heat-seeking machine. The meteorologists used emotionally intense language to emphasize their concern about the forecast, to compare the event to previous flooding disasters, to describe Harvey’s catastrophic impact, and to express disbelief regarding the situation unfolding around them. These results show how sensegiving can be articulated rhetorically via specific language features like describing Harvey as a monster, or comparing Harvey’s impact to Hurricane Katrina. These specific language features identified here should be tested for their effectiveness in order to allow meteorologists across the weather enterprise to speak about threats and impacts in a more consistent manner.

This study reports on the application of decision theory to 12 members of a dialysis program through the use of a survey and an interview. This application resulted in the determination of five salient issues which contribute to identifying decision making practices. In addition, this application determined the overall decision method, the participant's perception of the process, and the perceived affects of the crisis on patient care. To determine the decision making methods employed prior to and following the "crisis" date two methods were used, a survey and a follow-up interview. These two methods served to address the following: A. The Decision Making Survey addressed the characteristics of the decision making process. These characteristics were then applied to a participative decision making continuum. B. The Decision Making Interview determined the validity of the survey responses, acted as a second method for determining decision making characteristics, and addressed the secondary issues of this study, i.e., decision alternatives and patient care.