Doctor of Philosophy / Department of Psychology / James C. Shanteau / Four variables from the HBM of healthcare behavior were used to examine immunization decision making by the lay public. Although there was evidence to support the HBM in general, results of these studies suggest that up to 70% of the variance in immunization decision-making could be explained by disease base rates alone. When there is a main effect of immunization side effects, this effect was entirely within the most severe category of side effect. In initial four experiments, there was a consistent interaction between the variable of disease type and the variables of disease severity and immunization side effects. The fifth experiment showed an interaction between disease type and immunization efficacy. Functional measurement was used to examine the nature of the interaction between the variables of disease base rates and immunization efficacy. This interaction is neither clearly additive nor multiplicative. Disease base rate dominates the other variables, although each modifies immunization likelihood somewhat in interaction with disease base rates. Furthermore, results suggest that participants did not appear to react to the difference between different disease base rates when the probabilities are small. Participants also did not conceptualize immunization efficacy as a conditional probability. Suggestions for how to address these issues via decision support were made. The principle contribution of this study, however, is development of a methodology. The method developed here investigates the variables of the HBM in an ecologically valid factorial design. This approach takes the HBM beyond description of variables to provision of prediction and generalizable results.

Master of Public Health / Department of Diagnostic Medicine/Pathobiology / John A. Pickrell / Beef cattle feed lots produce significant, local point source pollution of the atmosphere. The dusts generated in the CAFOs are complex mixture of fine and ultra fine particles, organic compounds, transition metals, and adsorbed toxic gases. Since each component is toxic in itself, we do not fully understand the relative importance of each component in the dust and their interactions to inducing inflammatory changes in the lung. We did extensive literature searches to understand the mechanism of dust toxicity in respiratory system. This lead to focusing on solubility of dust in lung simulant fluid, and in-vitro study of release of two common biomarkers of inflammatory processes IL-6 and IL-8 from lung epithelial cells. Various concentrations (1 to 50%) of the dust extract induced release of IL-6, and IL-8 from lung epithelial cell as indicators of pro-inflammatory changes (IL-6), and amplification and maintenance of inflammation (IL-8). IL-6 release had dose dependence; peak production was seen with 25% dust extract. IL-8 production went down as the concentration of the dust extract increased from 1% to 25%. However, 50% dust extract was cytotoxic to the cell leading to 10-15% cell viability. At non-cytotoxic concentrations for lung epithelial cells, production of IL-8 was reduced. These findings suggested that higher exposure concentration were required to initiate inflammation as indicated by IL-6 release. Lower exposure concentrations (1 and 5% extracts) were related to optimal release of IL-8 needed to amplify and maintain the inflammatory response. Inhibition of endotoxin didn't significantly change the pattern of IL-6 or IL-8 release from epithelial cells. This finding suggested that at least a portion of the mechanism by which particle induced cytokine release from the lung epithelial cells was not endotoxin dependent. Heating samples at 1200C for 5 minutes modified some of the toxic properties of the dust extracts but didn't completely detoxify it. We observed that longer incubation period was required to peak release for both IL-6 and IL-8. However, the higher concentration of sample (50% extract) found to be cytotoxic in non-heat treated sample was no longer cytotoxic and induced both IL-6 and IL-8 release from the lung epithelial cells. This result suggested that heat treatment could reduce some of the dust extract's cytotoxic properties. However, the extract's potential to induce peak cytokine release increased.

Master of Public Health / Public Health Interdepartmental Program; Kinesiology / David A. Dzewaltowski / After-school programs are considered to have great potential to provide opportunities for increasing physical activity. One factor that may influence the success of a physical activity intervention is program implementation. The purpose of this study is to understand factors that influence implementation of a 30 minutes structured physical activity session in an after-school program. After-school staff (organizational leaders, site program managers and fourth grade group leaders), from four after-school sites attended three trainings over the academic year and were given the goal to implement 30 minutes of daily structured after-school physical activity to fourth grade children following CATCH guidelines. At the end of the year two organizational leaders (mean age = 55.0), four program managers (mean age = 27.3), and 13 group leaders (mean age = 21.3) were interviewed (N = 19) and completed a survey. Interviews were recorded, transcribed and analyzed using QSR NVivo software. Several factors influencing implementation were revealed. First, program managers and group leaders believed that they were successful in leading structured physical activity. However, their definition of success was less than the evidence-based protocol that required structured physical activity five days a week for 30 minutes. Staff believed that increasing the amount of unstructured activity offered and offering structured physical activity three days a week met the standard. Second, structured physical activity was not implemented as intended due to several organizational and staff barriers. The organizational barriers included: prioritizing physical activity, lack school administration support, lack program manager support, high group leader turnover, and low training attendance. The staff barriers included: low group leader motivation, and providing children with enjoyable CATCH games. Third, implementation of structured physical activity was facilitated by several organizational and staff variables. These facilitators included equipment/gym space, training, scheduling structured physical activity, support from the organizational leaders, and program manager and group leader self-efficacy. The final factor influencing program implementation was the use of individual strategies by program managers and group leaders. These individual strategies included restructuring the after-school program, obtaining physical education teacher support, and participating with the children in structured physical activity. Findings from this study suggest that the success of the after-school intervention is dependent on many factors, including several organizational system variables, as well as several staff variables. Program managers and group leaders negotiated these organizational and staff barriers and believed that they were successful in leading structured physical activity. However, their definition of success was less than the evidence-based protocol that required structured physical activity five days a week for 30 minutes. They defined successful implementation as increasing the amount of structured and unstructured physical activity daily. Future research should examine if targeting the organizational and staff variables identified in this study leads to greater program implementation.

Master of Science / Department of Kinesiology / David A. Dzewaltowski / Physically active games are one way to increase caloric expenditure in children. It is unknown if the structure of physically active games impacts physical activity levels. Furthermore, there has been no research examining psychosocial responses during a single game session. This study examined the effects of elimination games (EG) and non-elimination games (NEG) on physical activity (PA), self-efficacy (SE), peer victimization (PV), and enjoyment in children. Children (n=29) in 4th-6th grade (65.5% male) participated in two sessions where they played either NEG or EG. Children were stratified according to gender and weight status into game sessions that were counter-balanced across two days. Each session consisted of playing two games 20 min. in duration. NEG were adopted from the evidence-based Coordinated Approach to Child Health (CATCH) games curriculum and modified for EG. Each child wore an Actigraph GT1M accelerometer and completed an 11-item questionnaire measuring self-efficacy, peer victimization, and enjoyment before and after each game session. Accelerometer data was analyzed using resting energy expenditure (METs). A mixed effects regression model was conducted with child and day nested within child as random effects and observation, game session, weight status, and gender as fixed effects. Overall, girls spent more time in sedentary PA compared to boys (p=0.0123). Children engaged in significantly more moderate-vigorous PA during NEG compared to EG (p=0.0013), ostensibly because of more time in moderate PA during NEG (p=0.0002) and less time in sedentary PA (p<0.0001). Furthermore, children significantly increased SE after playing both game sessions (p=0.0349), but a significant interaction between game session and time of measurement in the prediction of enjoyment showed that enjoyment increased after EG and decreased after NEG (p=0.0138). There were no differences in PV or weight status. These results provide preliminary evidence that NEG provide a greater amount of moderate-vigorous PA compared to EG and introduces differences in enjoyment responses during EG and NEG. Therefore, it is important to promote NEG to increase physical activity, but also important to monitor enjoyment responses to promote a healthy, but fun environment for children.

Master of Public Health / Public Health Interdepartmental Program / Tandalayo Kidd / Heart disease, cancer, stroke, and diabetes are the leading causes of death in the United States. In addition, the prevalence of obesity has significantly increased since the 1970s. In Kansas, 37% of adults are overweight and 24% are obese. These chronic diseases and conditions tend to be prevented by and/or managed with both adequate physical activity and a healthy diet rich in fruits, vegetables, and whole grains. In Kansas 48.5% of adults meet the current recommendations for physical activity set by the American Heart Association, while 20% of adults consume the recommended amounts of fruits and vegetables. Public health officials need to work together to encourage Kansas adults to increase their participation in physical activity and consumption of fruits and vegetables to help prevent future health problems or manage current chronic diseases. To help address these health issues in Kansas, Kansas State University Research and Extension developed the 8-week Kansans Move into Health nutrition and physical activity program, building its framework around the Theory of Planned Behavior (TPB). Using TPB, participants address attitudes and perceived norms as well as perform specific behaviors associated with healthy eating and physical activity. The purpose of this study was to evaluate the effectiveness of condensing the 8-week nutrition and physical activity program into four one-hour classes using a pre- and post-survey. Nineteen participants from the Johnson County community signed up to participate with 63% (n=12) completing the program. Results indicated that participants changed their belief that nutritious foods are more expensive (p≤0.05). Furthermore, participants gained knowledge in how to prepare healthy snacks that are quick and easy. All other measures did not change (n=19; p>0.05). Future research evaluating longer program interventions could better assess attitudes and perceived norms associated with healthy behaviors and determine whether the increase in knowledge leads to behavior change.

Doctor of Philosophy / Department of Human Nutrition / David A. Dzewaltowski / Consumption of fruits and vegetables (FV) contributes to healthy growth and development among youth. For effective intervention development, an understanding of the underlying casual influences on consumption is needed. The current dissertation is intended to identify whether influences on youth fruit and vegetable consumption (FVC) vary by age, gender, ethnicity and socioeconomic status (SES). The series of four chapters focus on self-efficacy for FVC and proxy efficacy to influence other adults to provide supportive FV environments. Chapter One reviews studies examining the influences on youth FVC. Consistently across studies, FV preferences and FV availability influenced youth FVC. Chapter Two and Chapter Three report studies documenting that children's confidence (proxy efficacy) to influence parents to make FV available and to influence other adults (after-school staff) to make FV available are independent but related constructs to self-efficacy to eat fruits and self-efficacy to eat vegetables. Differences were found in these constructs according to school demographic variables and youth demographic variables. Chapter Two reports that youth attending elementary schools with lower concentrations of racial/ethnic diversity and higher concentrations of high SES were more confident in influencing their parents to make FV available than youth attending schools with higher concentrations of racial/ethnic diversity and higher concentrations of low SES. Although analyses of cross sectional data collected on elementary-aged youth presented in Chapter 3 showed no demographic differences at the school level, Chapter Four examined longitudinal data across sixth-, seventh- and eighth-grade and found demographic differences using youth level variables. Across the middle school years, youth declined in proxy efficacy and racial/ethnic minority youth declined at a significantly faster rate than white youth. Each year, male and lower SES youth were significantly lower in proxy efficacy than females and higher SES youth, respectively. Thus, school or youth demographic differences in self-efficacy and proxy efficacy may contribute to the understanding of why males and lower SES youth eat less FV than females and higher SES youth.

Master of Public Health / Public Health Interdepartmental Program / Daniel Y.C. Fung / In the military, documenting the occurrence of foodborne illnesses is a challenge. During peacetime only about ten percent of all foodborne illnesses are reported or properly diagnosed. Between 1998 and 1999, the Army had documented over 800 cases involving food or waterborne diseases. Service members are classified as highly susceptible when they are deployed or participating in extended field training exercises. Physical and emotional stress weakens the immune system, as does fatigue. These situations can be further aggravated by soldiers taking medications and/or exposed to exotic diseases or extreme environmental conditions. Thus it is very important for the United States Army to have a very good food safety, security, and protection system in place to maintain a readily deployable force. The United States Army monitors food safety, security, and defense through an extensive network of multiple organizations within and outside the army by researching from the fields of microbiology, sociology, economics, bioterrorism, etc. This network monitors food procured by the army from the source to the consumer and maintains accountability throughout the process. This report takes a look at the multiple organizations and the various strategies entailed in implementing food safety, security, and protection within the army and the entire Department of Defense. It emphasizes on some of the strategies that can be developed and applied in civilian establishments to improve the efficiency of the establishments. Such strategies include the implementation of the Prime Vendor System and the World Wide Web directory of sanitary approved sources which help to improve the ability to monitor the food with fewer personnel and also improve security and defense through solicitations and contracts. These strategies have been so effective that they are being used not only for food but for general logistics.

Doctor of Philosophy / Department of Human Nutrition / David A. Dzewaltowski / The prevalence of obesity within the U.S. has risen dramatically in the past thirty years. Recent changes in food and physical activity environments may contribute to increased obesity prevalence, suggesting that disparities in these environments may be linked to the increased risk of obesity observed in low-income, and racial/ethnic minority women. This dissertation characterizes the local food environment experienced by low-income women who participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Kansas, evaluates whether characteristics of the local food environment contribute to obesity risk, and examines how these relationships vary across the urban-rural continuum. Chapter One reviews the relevant literature examining the association between obesity and local food environments, and identifies three testable hypotheses that serve as the framework for later chapters. Chapter Two characterizes the local food environment and examines geographic, racial, ethnic, and socioeconomic disparities in the availability of small grocery stores and supermarkets. Chapter Three examines the association between store availability and obesity risk at an individual level among participants in the WIC Program, while Chapter Four utilizes multi-level modeling to examine the relationships between tract deprivation, tract store availability and body mass index (BMI). Significant geographic disparities were observed in the availability of small grocery and supermarkets. Racial and ethnic disparities observed within tracts were not observed when examining store availability in a 1-mile radius around the residence of WIC mothers. The majority of women participating in the WIC program resided within a 1-mile radius of a small grocery store, and micropolitan and metropolitan WIC mothers had a multiplicity of food stores available within a 3-mile radius of residence. Food store availability was associated with increased obesity risk only in micropolitan areas. The availability of food stores did not mediate the association between tract deprivation and BMI, which varied across the urban-rural continuum. Overall, these results suggest that the relationship between local food environments and eating behaviors is complex, that limited store availability does not contribute to increased obesity risk in vulnerable populations, and that the association between local food environments and obesity risk varies across the urban-rural continuum.

Master of Science / Department of Journalism and Mass Communications / Joye C. Gordon / This experimental research adopts a typology of frames by Levin, Gaeth, and Schneider (1998) and seeks to a) determine what combination of attribute and goal frames produces the strongest effect on vaccination behavior; b) ascertain to what extent personal relevance of vaccination moderates this framing effect; and c) explore how individual pre-existing characteristics, such as recent vaccination history, vaccine risk perception, vaccine dread, and general attitude toward vaccination influence the persuasive power of framed messages. The study, designed as field experiment 2 (+/- attribute frame) x 2 (+/- goal frame) x 2(involvement), recruited 476 adult female participants that were exposed online to four experimental framing manipulations and a control condition. The main effect is consistent with the typology of frames — the combination of the positive attribute and the negative goal frame was the only condition that was significantly more persuasive than the control condition. Participants who had children or were pregnant, for whom vaccination was more relevant and meaningful, have not reacted to message framing differently. However, general pre-existing attitudes towards vaccines, perception of vaccine safety, perception of vaccine efficacy, vaccine dread, and vicarious experience with vaccine side effects, appear to be associated with antecedents of vaccination behavior. Overall, this study has focused on ecological validity,aiming at the applicability of framing theory in the context of health communication.

Doctor of Philosophy / Department of Psychology / James C. Shanteau / Unintentional injuries represent the leading cause of death among Americans aged 1-44 years. While there have been many life-saving advances in engineering, attempts to save lives by changing people's behavior have been less successful. For instance, safety and health communications have sometimes led to increased knowledge and self-reported intentions to comply with recommendations, but traditional efforts to demonstrate changes in actual target behaviors have often failed. Research in many settings has shown that narrative communications have exceptional power to persuade and affect peoples' decisions. This suggests that safety and health messages might be more effective if they include narratives, such as brief stories about people who have been injured. The purpose of this dissertation is to determine if safety communications that include stories about injuries result in superior behavioral compliance when compared with traditional abstract safety messages. Teams of two participants assembled a swing set, using written instructions that contained relevant safety messages. Fifty-four teams were randomly assigned to three conditions: story-based safety messages, concrete nonstory safety messages, and traditional abstract safety messages. Compliance with safety messages was defined as the number of compliant components in the finished swing set. After adjustment for covariates, story-based messages resulted in a 20 percent improvement in compliance, compared with concrete nonstory and traditional abstract messages. Covariates included age, gender, (log) childcare experience, equipment assembly experience, presence of observer, and a final covariate related to timing of experimental sessions conducted by different experimenters. A positive relationship was noted between behavioral compliance and immediate (but not delayed) recall of message content. Narrative transportation was also positively related to compliance, but only within the story-based condition. Behavioral compliance was not related to remindings or judgments about the likelihood of injuries. The research is important because of its potential for improving safety communications and saving lives. Stories about injuries improved safety behavior even though the stories were brief and not designed to be entertaining or transporting. In contrast, the lack of correspondence between observed behavior and many surrogate measures suggests caution is in order when evaluating interventions using self-report measures, delayed memory, and other common dependent variables.