Doctor of Philosophy / School of Family Studies and Human Services / Karen S. Myers-Bowman / Immigrant Muslim mothers is a rapidly growing population in the United States for which there seems to be little or no information about their health values and parenting practices. Approximately 4 million adolescents in the U.S. have Arab Muslim immigrant parents. The goal of this study is to understand how adolescent girls’ health behaviors can be shaped and influenced by sociocutlural factors especially the mother-daughter relationships and the influences of living in a Muslim community in the U.S. The immigrant Muslim mother’s values (religious and cultural) that shape these relationships were examined. Next, the influence of the new dominant culture; the American culture on the mothers’ values, maternal practices and thus the adolescent daughter’s health behavior was addressed. Using criterion sampling strategy, eleven immigrant Muslim mothers and their American Muslim adolescent daughters (N=22) who were born and also raised in the United States were recruited and interviewed. The interviews were transcribed verbatim, coded, and analyzed following phenomenological research methods. Mothers in this study showed that their health values were shaped by Islam, culture origin and the acculturation factor. The majority of the mothers explained that they were more religious in the United States and some of them mentioned that they left out their culture of origin values and accept some values from the new dominant culture. Mothers in this sample explained that in order to share their values with their daughters, they needed to be close, supportive, open minded, good listeners to them. In addition, they followed different maternal practices such as: tried to be available, monitored their health behaviors, had healthy communication with them although there was imposing, and tried to model different health behaviors. However, the daughters’ perception of the mothers’ health values and maternal relationships was an important factor in determining how these values and practices could shape the daughters’ health behaviors. The results revealed that daughters who perceived that their mothers’ values and practices were shaped by the three factors were more likely to follow healthy behaviors. A theoretical model was developed. Implications for family professionals and recommendations for future research are discussed.

Doctor of Philosophy / Department of Educational Leadership / Sarah Jane Fishback / This bounded case study explored ten purposefully selected physician participants’ perceptions of the effectiveness of an eight session, two year in-house physician leadership development program at a major Academic Medical Center (AMC) in the Midwest. While physicians are generally educated to care for patients in their specialty area, reforms necessitate the need for physician leadership involvement in metric tracking by healthcare organizations in order to provide a focus on quality patient care and safety. Participants indicated finding the course effective, especially the negotiations and finance modules. These modules provided new language, a better understanding of processes and an opportunity to develop skills through interactive class exercises such as case studies. Participants described an increased self-awareness of their interpersonal skills and expressed a desire for greater exposure to emotional intelligence principles. Participants experienced a transformational shift in how they constructed their identity as a physicians and leaders, and questioned assumptions about the physician’s role in healthcare. While effective in initiating a process of exploration, this course was not sufficient to meet the goals and objectives of the program. Therefore, recommendations for the advanced course included a focus on leadership competencies identified by Dye and Garman (2006) as cited by Dye and Sokolov (2013), emotional intelligence, and transformational leadership.

Doctor of Philosophy / Department of Family Studies and Human Services / Karen S. Myers-Bowman / This qualitative research study was conducted in order to understand more about the phenomenon of adolescent cigarette smoking and to contribute to the body of knowledge on youth substance abuse prevention. The exploratory study incorporated the personality types associated with True Colors, Inc. (2008), as a tool to use when gathering information from non-smoking adolescents and parents. Adolescent-parent dyads were interviewed about how personality characteristics influenced several factors regarding the adolescents’ choice to not smoke cigarettes. The participants indicated that they were comfortable with the True Colors model for identifying their personality types. Furthermore, the participants tended to provide information that reflected their personality. The “gold” personalities exhibited a strong sense of right and wrong, and it was important for them to be responsible, follow rules and respect authority. The adolescents identified as having “orange” personalities tended to put themselves at the center of conversations and reported that they made many of their own decisions. They were also spontaneous and witty. Personalities that were “blue” types demonstrated the most compassion and empathy. They valued relationships and they did not want to disappoint others when making decisions. The fourth color was the “green” personality. These individuals were visionaries, and were analytical and logical with their responses. They valued knowledge and were apt to get their information from books and television when making decisions. Implications for research include that, rather than studying why adolescents do smoke cigarettes, it may be wise to also study why adolescents choose to not smoke cigarettes in order to more fully understand the phenomenon. The study also provided implications for practitioners regarding adolescent cigarette smoking prevention programs. Because the current study found differences in how the personality types of adolescents received information, youth prevention programs should utilize a variety of strategies to address the unique differences in adolescent personalities in order to be most effective.

Doctor of Philosophy / Hospitality Management and Dietetics / Junehee Kwon / Food allergies affect nearly 15 million Americans, and accommodating customers with food allergies has become a challenge for the restaurant industry. One third of the fatal food allergy reactions occurred in restaurants, and it is important for the restaurant industry to properly communicate and manage the food allergy risks. This study explored perceived risks and risk communication related behaviors of restaurant staff when serving customers with food allergies by using both qualitative (interviews) and quantitative (online survey) approaches. Telephone interviews with 16 restaurant managers were audio-recorded, transcribed verbatim, and organized to identify themes. Most participants were aware of the severity of food allergy reactions but perceived that it was the customers’ responsibilities communicating their food allergies with restaurant staff before placing their orders. Training for service staff on food allergies and risk communication topics were limited, and some managers perceived such training unnecessary for restaurant business. Findings from interviews were used to develop an online survey instrument. The survey instrument was pilot-tested and distributed to restaurant employee panels by an online survey research firm. Of 1,328 accessed the survey, 316 usable survey responses (23.8%) were collected from full-service restaurant service staff. Data analyses included descriptive statistics, independent samples t-test, ANOVA, and regression analyses. Results indicated that limited information about food allergies was provided on printed (35.1%) or online menus (28.2%), and very few restaurants had separate menus (8.5%) or complete ingredient lists (14.6%) for customers with food allergies. Meanwhile, restaurant servers lacked knowledge about common food allergens (12.7% correct), differences between food allergies and intolerances (34.2% correct), and government regulations related to food allergies (15.5% correct). Most restaurant servers (82.0%) agreed or strongly agreed that initiating communication and preventing food allergy reactions were responsibilities of customers with food allergies. Perceived severity of food allergy reactions, previous communication training, sources of media exposure, and perceived responsibilities of preventing food allergy reactions were found to influence restaurant servers’ risk reduction and communication behaviors (R²=0.367, p<0.001). Restaurateurs, foodservice educators, food allergy advocates, and policy makers may use these findings when developing food allergy training and strategies to prevent food allergy reactions in restaurants.

Master of Science / Department of Special Education, Counseling, and Student Affairs / Brandonn S. Harris / The present study examined adolescents’ perceptions of their caregivers’ parenting style as well as their physical activity participation, motivation, and attitudes. High school students completed questionnaires regarding their physical activity participation, motivation, and attitudes, and they assessed both their male and female caregivers’ parenting style. Results indicated that for males, a permissive parenting style was related to more physical activity participation and that males favor physical activity that features long and hard training and as a way to stay healthy and fit. An authoritative parenting style was related to higher rates of physical activity for females, and their attitudes focused on social aspects of physical activity as well as a release of tension. For both genders, identified regulation was associated with higher rates of physical activity, indicating that higher levels of self-determined motivation are important for promoting active behaviors. Cross-gender relationships between caregiver and child emerged and social and gender norms seemed to influence parenting style and attitudes specific to gender. Additional results and implications are discussed.

Master of Science / Department of Human Nutrition / Koushik Adhikari / Obesity in adolescence is associated with a complex web of ecological, psychosocial, and physiological factors, and many of these factors relate to nutrition and physical activity behaviors. Before interventions are developed, researchers need to know what factors specifically influence an adolescent’s food choices and physical activity within the community context. Cultural norms, school environment, and neighborhood attributes are examples of factors that may vary across different communities, and accounting for this variation can be quite challenging, unless community perspectives are acknowledged. The use of qualitative data from focus groups has shown to be an effective way of gathering community perspectives about the diversity of their views and experiences. The current study used focus groups to reveal facilitators and barriers to healthy eating behavior and physical activity engagement in 6th to 8th grade youth in a low-income community in South-Western Kansas. This methodology enabled community members (adolescents, parents, and teachers) to discuss and articulate their perceptions in relation to 6th to 8th grade youth’s eating habits and physical activity, and assessed available resources, needs, and opportunities for developing effective and sustainable intervention approaches in the community. Using the socio-ecological model, individual influences (e.g., taste preferences), social influences (e.g., parent and peer influences), and larger contextual influences (e.g., school) on early adolescent health were assessed. This information will be used to develop interventions addressing factors at these different levels of influence that are needed to improve eating habits and physical activity of youth in the community.

Master of Science / Department of Hospitality Management and Dietetics / Elizabeth B. Barrett / The Centers for Disease Control estimates that each year 48 million Americans become ill, 128,000 are hospitalized, and 3,000 die of foodborne diseases. In 2011, the CDC reported that Norovirus caused the majority of all foodborne diseases and can be eliminated with proper handwashing, which is the number one way to prevent the spread of foodborne disease. The purpose of this study was to use the Health Belief Model to determine differences in university foodservice employees’ beliefs and perceptions about handwashing and foodborne illness. The constructs of perceived susceptiblity, severity, barriers, benefits, and self-efficacy as they relate to handwashing were used to examine the differences in demographics. Instrument development included a review of literature, focus group feedback, a pilot study and a review by industry experts. The final instrument was distributed to all foodservice employees at Kansas State University using Qualtrics and pen-and-paper surveys. Frequencies, means, t-tests, ANOVA, and regression were used for data analysis and to answer research questions. Results indicated respondents who were older (above 23 years of age), full-time employees, had more than three years of experience, and were food safety certified had a higher perception of susceptibility, benefits, and self-efficacy of handwashing and its relationship to reducing foodborne illness. Perceived severity was highest among respondents with food safety certification and more than three years of experience. Supervisor/Manager category did not agree on barriers to handwashing in the workplace with other positions; however, most employees did not rate barriers as a problem. Non-white respondents showed a lower self-efficacy for ability to wash hands correctly. Results of this study highlight the need for self-efficacy focused handwashing training for first year and non-white employees.

Master of Science / Department of Clinical Sciences / Thomas Schermerhorn / Tonicity is property of a solution that is defined as the total effective (impermeable) osmole concentration that drives fluid movement across a semipermeable membrane via osmosis. Tonicity is related to but distinct from solution osmolality, which is a summation of all solute concentrations, regardless of the solute membrane permeability. In the mammalian body, tonicity is tightly regulated at both a cellular and systemic level; tonic derangements cause rapid change in cell and tissue volume leading to significant dysfunction. Input from the central nervous, circulatory, endocrine, gastrointestinal, and urinary systems are integral to osmoregulation, so many diseases in veterinary medicine are associated with tonicity disorders. However, because the homeostatic mechanisms that control tonicity overlap with those regulating electrolyte and acid-base balance as well as hydration and vascular volume, tonic consequences of disease can be difficult to isolate. Understanding of disease-associated changes in tonicity is further complicated by the fact that the tonic contributions of many solutes that accumulate in disease are unknown. Additionally, direct assessment of tonicity is difficult because tonicity is not just a physiochemical property, but it implies a physiologic effect. Thus, simple summation of osmole concentrations is an inadequate measurement of tonicity. The following report includes three studies investigating various aspects of tonicity as it applies to veterinary patients. Chapter 2 reports a study that examines the tonic effects of ketoacids and lactate using two different in vitro red blood cell assays. Results demonstrated that the ketoacids, beta-hydroxybutyrate and acetoacetate, behave as ineffective osmoles while the tonic behavior of lactate is variable, implying a more complex cellular handling of this anion. Two additional studies examine whether the mean corpuscular volume difference (dMCV) is a novel clinical marker for hypertonicity in dogs. Results of separate retrospective (Chapter 3) and prospective (Chapter 4) studies provide evidence that dMCV is a useful clinical marker for hypertonicity in dogs.

Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / The Centers for Disease Control and Prevention estimated that one in six Americans become ill,128,000 are hospitalized, and 3,000 die each year due to foodborne illness. Children are at a higher risk of acquiring foodborne illness than adults for several reasons, including: an immune system that has yet to fully develop, limiting their ability to fight infections; a lack of control over the food they consume because their meals are usually provided by others; and the lack of awareness of food safety risks. Thus, it is critical to ensure that childcare center employees practice safe food handling. The purpose of this study was to explore the food safety knowledge, practices, and barriers to safe food handling practices of childcare center employees. Observations were conducted in 10 childcare centers in Manhattan, Kansas. Each childcare center was observed for two days during lunch preparation and service. Observations of foodservice employees were conducted in the kitchen using a structured observation form. Teacher observations were conducted in the classroom using detailed notes. A questionnaire was used to collect demographic, food safety training, and food safety knowledge information. SPSS (v. 20.0) was used to analyze data. Childcare center employees had high average scores on the safety knowledge assessment. The majority of employees received some type of food safety training. Time pressures, availability of equipment, and small food preparation space were found as the main barriers to implementing safe food handling. Childcare center foodservice workers and teachers were knowledgeable about handwashing and time/temperature control, but failed to utilize on the job. Results of this study will help childcare educators to develop materials to improve food safety practices and encourage owners/managers of childcare centers to enhance their food safety behaviors.

Master of Science / Department of Human Nutrition / Mary Meck Higgins / Because of the ever-changing nature of the economy and the food environment, research as recent as 2010 may not be relevant to today’s discussion on food insecurity, food deserts, obesity rates, and nutritional quality in the U.S. population’s diet. Today, people of low socioeconomic status in the U.S. are at risk for overweight, obesity, and chronic illnesses such as type 2 diabetes, hypertension, and certain cancers. In this report, I investigate published research about low-income populations in the U.S. relative to the food environment and describe implications for healthcare professionals implementing interventions with these populations, discussed in the following categories: Dietary Intake Quality and Socioeconomic Status; Food Insecurity; Barriers to Quality Food Access in the U.S. Food Environment; Communities Alleviating Food Insecurity; Food-Related Perceptions, Attitudes, and Behaviors; Homelessness and Food-Related Behaviors; Why Do People Buy What They Buy?; Nutrition Assistance Programs and Policies; Current U.S. Food Costs; and Comparing the Nutritional Value Versus Price of Foods. Although the literature on the subject of low-income diet quality is thorough, much of it needs to be updated with current data on food prices, food environments, and U.S. diet quality. For this purpose, I compiled the most recent data from the National Bureau of Labor & Statistics on food prices to discuss the elevated food prices of healthful foods as opposed to less healthful foods. I also created a one-month menu based on the U.S. Department of Agriculture’s Thrifty Food Plan budget allowance in order to follow a healthful diet in this harsh economic climate utilizing the Dietary Guidelines for Americans 2010 and the Affordable Nutrients Index.