This research sought to better understand the antecedents of consumers' perceptions of risk (health and safety risks specifically), and the relationship between the perceived risk of an option, and judgments about the acceptability of that option. The specific objective of the proposed research was to build a model of risk perception and risky option acceptability for hazardous products and activities (i.e., that present downside risks to a consumer's health and safety), using several variables that have been postulated to be important, using a multiple linear regression model building approach. One goal was to integrate the study of perceived risk in consumer behavior with various concepts and models of risk perception and risk acceptability from the behavioral decision sciences, an integration suggested previously by Jacoby (1981). Emphasis was placed on conceptual and methodological issues that confront researchers from either domain that need to be resolved if risk is to occupy a central place in marketing theory. Two of the variables included in the study of the determinants of perceived risk comprise the conceptual definition of perceived risk used in this research: probability of a negative outcome, and severity of a negative outcome. Specifically, both were hypothesized to be positively correlated with perceptions of risk. Six additional variables were also examined as determinants of perceived risk. Given the definition of risk used in this research, these variables relate to either or both of the constructs probability and severity, and implicitly were also hypothesized to be significant determinants of risk perception. The variable examined that relates to probability exclusively was controllability. Specifically, a negative relationship was hypothesized between the perceived risk of a product and the controllability of the negative outcome associated with that product. Variables which relate to severity exclusively include reversibility, dreadedness, and immediacy. Specifically, judgments of negative consequences as immediate, dreaded, and irreversible were hypothesized to be positively correlated with perceptions of risk. Finally, two variables that relate to both probability and severity included availability and catastrophic potential. Specifically, there should be a positive relationship between the perceived risk of a product and the availability and catastrophic potential of the negative outcome associated with that product. All hypotheses with the exception of those relating to immediacy were supported; the hypotheses relating confidence to acceptability was only partially supported. All variables with the exception of immediacy were concluded to belong in a comprehensive model of perceived risk and option acceptability. / Ph. D.

The focus of this research project was to evaluate individual stakeholder perceptions of the implementation of Structured Decision Making (SDM) as a tool in risk assessment of elder abuse/neglect case referrals in Riverside County Adult Protective Services (APS). The researchers interviewed ten social workers from Riverside County APS, from line workers up to Deputy Director. Constructivist theory was used to develop a joint construct which indicated that the primary benefit of SDM was consistency. Consistency resulted in safety and proctection of the client, social worker and the agency.

Bushfires are an integral part of the Australian environment, and consequently Australian fire fighters are regularly confronted with the challenge of bushfire fighting activities. Bushfires can be extensive and long-lasting, and as a result fire fighters can be exposed to bushfire smoke for long periods without respite. Anecdotal evidence suggests that bushfire smoke exposure can lead to respiratory symptoms such as coughing, wheezing, and shortness of breath. In an optimal environment, fire fighters are equipped with respirators and protective filters to prevent the inhalation of the air toxics in bushfire smoke. Yet, reports from the fire ground indicate that the protective filters are not effective in preventing the inhalation of bushfire smoke. As a result, fire fighters have increasingly expressed concern about the ineffective equipment and the resultant respiratory symptoms during and after bushfire fighting. This research aims to establish a scientific data base to support the anecdotal evidence. The objectives of the research were: (1) to identify and quantify the air toxics in Western Australian bushfire smoke; (2) to profile the acute respiratory health effects associated with bushfire smoke exposure; (3) to assess the effectiveness of three different types of filters under controlled conditions in a smoke chamber, and in the field during fuel reduction burn-off; (4) to formulate recommendations for reducing fire fighters' exposure to bushfire smoke; and (5) to inform policy decision makers about the most effective form of respiratory protective equipment for bushfire fighting. Exposure trials were conducted in an experimental setting utilising bushfire smoke conditions in a smoke chamber and during prescribed burn-offs. Repeated measurements of respiratory symptoms, pulmonary function and oximetry were undertaken before and after bushfire smoke exposure. In addition, personal air sampling inside the respirators was undertaken to quantify and compare the levels of filtered air toxics. The analysis of the collected data demonstrated that, of those compared, the particulate/organic vapour formaldehyde filter was most effective in protecting fire fighters' respiratory health during the smoke exposure period of maximally 120 minutes. Further research would be useful to determine the v effectiveness of the filters under more realistic conditions during bushfire fighting activities. The findings of this research have resulted in a policy review in Western Australia. In 2006, the Fire and Emergency Services Authority of Western Australia (FESA) reviewed its Bush Fire Smoke Exposure Standard Operational Procedures 51, and now issues the recommended particulate/organic vapour/formaldehyde filters to the 1,000 FESA career fire fighters. The use of protective equipment for bushfire fighters is inadequately regulated worldwide and the recommendation implemented by FESA can be seen as proactive and in advance of national and international best practice. In conclusion, this project was instrumental in the translation of public health research into best practice that protects occupational health, without the need for the lengthy process of legislative reform. Fire fighter organisations in other countries with high frequencies of bushfires could learn from this example, and move to review their policies and introduce adequate personal protection for fire fighters.

Human activities over the years, especially the unconventional exploitation of oil sands deposits, downstream on the Athabasca River (AR), might have affected the water quality and ecological integrity of the river basin, thereby presenting a threat to the environment and human health. There have been concerns that the oil sands process-affected waters stored in tailing ponds may be percolating to surface waters as well as underground waters, contaminating neighboring watersheds with a cocktail of chemicals including Polycyclic aromatic hydrocarbons (PAHs). PAHs are present both naturally and from human activities as pollutants in the environment. Forest fires, geologic activities, and oil seeps are examples of natural sources of PAHs in the environment. The major sources of PAHs in the Athabasca region are leaching of oil sands deposits and contamination from oil sands production. On occasions, forest fires contribute PAHs in the area. There has been no comparative data on the exposure of PAHs to fish along the AR and Slave River. I used an integrative monitoring of selected fishes as an indicator to achieve four objectives: i) describe the spatial and seasonal distribution of measurable concentrations of products of biotransformation of polycyclic aromatic hydrocarbons (PBPAH) in bile of fish; ii) determine the levels of parent PAHs in the muscle of fish, and extrapolate the data to estimate potential risk to human consumers, and to identify which species and geographic regions, if any, pose the greatest risk to humans; iii) use patterns of contamination to provide a scientific basis for elucidating the source of contamination; and iv) perform fish health investigation by collecting morphometric health measures and perform a systematic assessment of the occurrence of lesions in the fishes. I sampled whitefish (Coregonus clupeaformis), jackfish/northern pike (Esox luscius), walleye (Sander vitreus), goldeye (Hiodon alosoides) and burbot (Lota lota) from Fort McMurray, Fort McKay, and Fort Chipewyan in Alberta, and from Fort Smith and Fort Resolution on the Slave River in the Northwest Territories. The rationale for selecting fishes included: their abundance along the basin (some have short ranges, e.g., northern pike); their dietary/nutritional and cultural significance to communities in the area; their feeding strategy, such as benthic, supra-benthic, or pelagic, trophic status, and patterns of migration and habits of spawning. I addressed the first objective in Chapter 2, where the total PBPAHs were determined. Concentrations of products of biotransformation of 2 and 3-ringed, 4-ringed, and 5-ringed PAHs were measured using synchronous fluorescence spectroscopy. Spatial and seasonal differences were observed with greater concentrations of PBPAHs in samples of bile of fish collected from Fort McKay as well as greater concentrations of PBPAHs in bile of fish collected during summer compared to those collected in other seasons. Overall, PBPAHs were greater in fishes of lower trophic levels and fishes more closely associated with sediments. In particular, goldeye (Hiodon alosoides), consistently contained greater concentrations of all the PBPAHs studied. In Chapter 3, I achieved the second objective by measuring levels of parent PAHs in muscle of selected fishes and extrapolated the results to determine potential human health risks due to fish consumption. Dorsal muscle of fishes from upstream reaches of the AR close to oil sands extraction and upgrading activities, contained greater concentrations of individual PAHs than concentrations in muscle of fishes from further downstream in the Slave River. Risks posed by PAHs to humans were assessed using a B[a]P equivalents approach. According to the risk assessment results, the average lifetime risk of additional cancers for humans who consumed fish was less than 10-6. In Chapter 4, alkylated PAHs were also measured in fish muscle to achieve the third objective. The general presence of naphthalenes and phenanthrenes and the evaluation of molecular ratios (i.e., LMW/HMW alkyl-PAHs) allowed me to conclude that the major source of pollution is petrogenic, probably due to increases in oil sand activities around Fort McMurray and Fort McKay. I achieved the fourth objective in Chapter 5 by studying the health status and potential effects of industrial development on individuals of economically and culturally significant fishes. A resurgence in condition factor of all species after a low in 2011 was observed. Annual variation was also observed in condition factor and the incidence of anomalies or lesions. Morphometric data demonstrated relatively consistent health among fishes in both the Athabasca and Slave rivers. Analysis of condition factor and somatic indices did not demonstrate consistent differences along the river system. Overall, the health of fish as determined by the metrics employed in this study, does not appear to be adversely affected by the current level of development in the Alberta oil sands region. The data presented in this dissertation make invaluable contribution to the much needed monitoring program in the Athabasca and Slave Rivers. Overall, my findings provide baseline data on fish health, concentrations of parent and alkylated PAHs, and products of biotransformation of PAH in five species of large-bodied fishes consumed by humans in communities in the Lower Athabasca and Slave River basin. These results will be useful for establishing the status and trends and spatial distribution of PAHs during monitoring of the lower Athabasca basin and most importantly, as a valuable reference point before any potential permitted discharges of wastewaters from processing of oil sands to the AR.

HORMONAL CONTRACEPTION - USERS̕ KNOWLEDGE Student: Křiklánová, J. Tutor: Marešová, H. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Czech Republic Introduction: Hormonal contraception is a broadly used and very reliable birth control method. Nonetheless, it is not entirely risk-free. This thesis deals with the awareness of those risks in women who are currently using hormonal contraception or have ever used it before. Aim of the thesis: The main aim was to determine the extent of the users' awareness of hormonal contraception and its risks, undesirable side effects and contraindications, as well as their source of information. Furthermore, the awareness of the environmental impact, the reasons for using hormonal contraception and user satisfaction were examined. Methodology: The research was carried out by means of online questionnaires, which were spread among current or former users of hormonal contraception regardless of age, educational background or place of residence. 148 completed questionnaires were gathered and the data which were obtained were statistically evaluated. Results: It was discovered that women feel informed (25 %) or rather informed (44,6 %) more often than uninformed; the most frequent source of information is patient...

Thesis (Masters Diploma in Technology (Public Health)) -- Cape Technikon, Cape Town, 1992 / In order to evaluate a health education programme for food handlers at a meat plant, a bakery/confectionery and a catering premises, changes in hygiene were assessed by the bacteriological analysis of swabs for hygiene indicator organisms from food contact surfaces. In this evaluation three phases were established on the basis of bacteriological assessment prior to, during and after the education programme. The first phase involved the establishment of a base line for hygiene indicator organisms prior to the education programme by taking 5 sets of bacteriological swabs over a two month period at each of the three premises, each swab set consisting of 14 swabs of food contact surfaces making a total of 210 swabs. During this time the food hygiene educational needs of the employees were assessed and on this basis a set of three video taped presentations were produced relating respectively to personal hygiene, environmental hygiene and food handling practices. The second phase consisted of the implementation of a health education programme involving consecutive tutorial sessions at one month intervals during which the video taped programme was presented. At this stage a further 5 sets of bacteriological swabs was taken at each of the premises. The third phase involved the assessment of hygiene shortly after completion of the education programme by taking a final 5 sets of bacteriological swabs of food contact surfaces at each of the premises over a further two month period. Statistically significant reductions in a number of the indicator organisms were observed during the course of the study.

Currently, there are an estimated 2.8 million breast cancer survivors in the United States. Due to modern screening practices and raised awareness, the majority of these cases will be diagnosed in the early stages of disease where highly effective treatment options are available, leading a large proportion of these patients to fail from causes other than breast cancer. The primary cause of death in the United States today is cardiovascular disease, which can be delayed or prevented with interventions such as lifestyle modifications or medications. In order to identify individuals who may be at high risk for a cardiovascular event or cardiovascular mortality, a number of prognostic models have been developed. The majority of these models were developed on populations free of comorbid conditions, utilizing statistical methods that did not account for the competing risks of death from other causes, therefore it is unclear whether they will be generalizable to a cancer population remaining at an increased risk of death from cancer and other causes. Consequently, the purpose of this work is multi-fold. We will first summarize the major statistical methods available for analyzing competing risk data and include a simulation study comparing them. This will be used to inform the interpretation of the real data analysis, which will be conducted on a large, contemporary cohort of breast cancer survivors. For these women, we will categorize the major causes of death, hypothesizing that it will include cardiovascular failure. Next, we will evaluate the existing cardiovascular disease risk models in our population of cancer survivors, and then propose a new model to simultaneously predict a survivor's risk of death due to her breast cancer or due to cardiovascular disease, while accounting for additional competing causes of death. Lastly, model predicted outcomes will be calculated for the cohort, and evaluation methods will be applied to determine the clinical utility of such a model.

Le transport est un facteur important de la croissance urbaine et de la viabilité des centres urbains mais il est également responsable de nombreuses nuisances telles que le bruit, la pollution de l'air et les accidents de la route, qui causent aujourd'hui de nombreux impacts sur la santé, telles que la gêne. L'objectif principal de notre thèse était d'identifier les déterminants (sociodémographiques, socioéconomiques, liés à la mobilité quotidienne) d'une gêne ressentie vis-à-vis du bruit, de la pollution de l'air et des accidents de la route. L'objectif secondaire était d'identifier les déterminants de la perception du risque sanitaire vis-à-vis de ces trois nuisances et du ressenti des effets du bruit et de la pollution de l'air sur sa propre santé ou celle de son entourage ; dans le but in fine de voir si des inégalités sociales se dessinaient dans le champ de cette problématique. Pour ce faire, deux études transversales ont été menées en population générale, dans le département du Rhône en 2013 puis en 2014 respectivement. La principale conclusion de notre étude est que le milieu socioéconomique ne joue un rôle prédominant ni dans l'expression de la gêne ni dans la perception du risque sanitaire. En revanche, les usagers des modes doux (marche, vélo) et des transports publics sont plus gênés par la pollution de l'air et le bruit du trafic routier comparés aux usagers motorisés. Par ailleurs, la gêne liée à la pollution de l'air influencerait le ressenti des effets du bruit et de la pollution de l'air sur sa propre santé. Nos résultats devraient être utiles aux décideurs politiques dans le cadre des politiques urbaines. Créer un environnement plus « friendly » en réduisant l'utilisation des voitures, en promouvant l'utilisation des modes doux, en améliorant les transports en commun et leur utilisation, en développant des installations pour les piétons et pour les cyclistes - toutes ces mesures sont autant de mesures nécessaires pour réduire les nuisances dus au trafic routier et ainsi le sentiment de gêne et d'insécurité / An important factor supporting urban growth, and the viability of the urban centers, is transportation but road transport is still a common important source of traffic accidents, noise, and air which have heavy consequences on public health such as annoyance. The main objective of our thesis was to identify the determinants of each kind of trafficrelated annoyance (sociodemographic, socioeconomic, daily mobilty). The secondary objective was to identify the determinants of health risk perception and the feelings of health effects on his own health. Then, tow cross-sectional studies have been conducted in the general population, in the Rhône Department, in France. The main finding of our study is that the socioeconomic level doesn’t play a rule neither in the expression of annoyance nor in the health risk perception. However, active travel modes and public transport users are highly annoyed by traffic air pollution and road-traffic noise more than motorized users. Moreover, annoyance related to air pollution seemed to influence the feeling of health effects of noise and air pollution. Our results should be useful for urban policies. Create a friendly environment by reducing the use of cars, promoting non-motorized or “active” travel mode use (walking, cycling), to improve public transport and to promote the use of public transport, avoiding to add noisy road infrastructure near population centers, to develop facilities for pedestrians and for cyclists - all of these measures are needed to reduce road-traffic nuisances and the feeling of annoyance

Sexual risk behaviors pose a major public health problem. However, sufficient research has not been done on the relationship between health risk behaviors and emotional intelligence. The purpose of this study was to examine the relationship between emotional intelligence, and sexual, smoking, and alcohol behavior among young adults. As well as explore the relationship between health risk behaviors. Emotional intelligence and sexual, alcohol, and smoking behavior of undergraduate college students from the greater Los Angeles area was assessed through an anonymous online questionnaire (n=80). There was no significant difference found in emotional intelligence between college students engaging in risk behaviors and college students not engaging in risk behaviors, for all risk behaviors assessed. However, there was a strong correlation found between college students engagement in different risk behaviors. These results indicate there is no significant relationship between emotional intelligence and health risk behaviors. Research about this relationship can be useful in designing interventions that reduce negative health outcome associated with health risk behaviors.

Healthy People 2020 identified hypertension (HTN) as a controllable risk factor to prevent cardiovascular disease and stroke. Adhering to regular antihypertensive (AHT) medications improves outcomes in patients diagnosed with HTN by controlling blood pressure, reducing hospital visits, and promoting patient wellness. Medication adherence occurs when prescribed medicine regimens are utilized by the patient as directed to manage illness or disease, as evidenced by patients receiving medications at their pharmacy. The practice-focused question for this quality improvement project asked whether implementation of health literacy tools from Million Hearts® HTN Control: Action Steps for Clinicians, increased medication adherence as evidenced by regular medication pickups by adult hypertensive patients. Additionally, this project provided an assessment to identify the patient's current health literacy level using the Newest Vital Sign. The purpose of this quality improvement project was to improve health literacy about AHT medications to increase medication adherence in adults diagnosed with HTN. The logic model allowed for communication of resources, activities, and guidance during project implementation. Data related to medication pickups from adult participants, 1 male and 4 females aged 21-76, were analyzed using descriptive statistics via percent difference pre-post program. Results showed an 80% rate of medication adherence, however increased medication adherence was not achieved. Results also revealed a knowledge deficit in 20% of participants indicating they were unaware they had been prescribed combination AHT medication to control their blood pressure, and not knowing their most recent blood pressure results, or how their specific AHT medication regimen worked at controlling their HTN needs. These findings could lead to exploring additional underlying factors that impede medication adherence such as income, medication cost, insurance cost, and transportation needs. This project supports the need for health literacy to be addressed to improve knowledge and understanding about HTN, and implied the need to address the problem of low health literacy in patients with HTN. Implications for nursing practice include health literacy tools for community-based ambulatory clinics to influence medication adherence and self-care management of adults with HTN. Positive social change was demonstrated by providing health literacy to adult HTN population to improve medication adherence thus reducing health risk.