High PM2.5-related mortality and morbidity has become a public health concern in China. To date, there have been few studies investigating individual implementation and use of protective behaviors to counter outdoor PM2.5 air pollution levels in China. This study, therefore, aimed to investigate adults’ attitudes toward evidence-based protective behaviors against outdoor PM2.5 air pollution, the results of which might inform health educators and health promotion specialists about what they should emphasize when educating communities about protective behaviors in the PM2.5 air pollution days. Utilizing the purposing sampling method, a WeChat-based survey was conducted among 300 adult participants living in B residential area in Yuhuatai district of Nanjing, which is a representative city of high urbanization level and PM2.5 air pollution in China. The survey included total 16 items assessing participants’ background information, attitudes toward four evidence-based protective behaviors against PM2.5 air pollution, and knowledge regarding possibly effective protective approaches specifically related to Chinese medicine in the PM2.5 air pollution. The results showed that the importance adults in Nanjing attached to wearing N95 respirator when walking outside, putting air filter (HEPA) at home, and avoiding unprotected outdoor sports activities in the PM2.5 air pollution was greater than closing all the doors, windows, and many openings in the PM2.5 air pollution. Regarding comparison of attitudes between pre- and post-controlled COVID-19 periods, the value adults gave to closing all the doors, windows, and many openings in the PM2.5 air pollution was higher during pre-COVID-19 period, whereas the opposite of circumstance took place when referring to other three protective behaviors. Regarding comparison of attitudes between biographic variables, adults aged 18-50 (including 50) attached greater importance to all the four protective behaviors than those aged 50+. In addition, adults having the habit of checking daily AQI ranked the behaviors of avoiding outdoor sports activities and wearing N95 respirator when walking outside in the PM2.5 air pollution in a higher position than those not. Implications for future research and practice are discussed, based on a critique of the present work.

IntroductionEndocrine disrupting chemicals (EDCs) are agents, found either singly or used in mixtures, that disrupt the endocrine system or its production of hormones and may cause adverse effects in the exposed individuals or populations and, in the case of pregnant women, their offspring. It is presumed that maternal thyroid hormones contribute to fetal brain development. The EDCs that could impair maternal thyroid hormone function might result in subtle deficits in neurodevelopmental outcomes in children. Polychlorinated biphenyls (PCBs) are a class of EDCs produced in the past century and are still found in the environment. This dissertation aims to explore, elaborate, and embellish the associations between prenatal exposure to PCBs, the metabolites associated with PCBs, and child cognitive and motor development. The next aim of this dissertation is to explore the associations between prenatal exposure to PCBs, the metabolites associated with PCBs, and maternal thyroid hormones. Five chapters are included in this dissertation: First, an introduction to PCBs and specific aims; second, a systematic review of the literature, including the studies where prenatal exposure to PCBs or the hydroxylated PCB metabolites (OH-PCBs) and their relationship with various domains of children's neurodevelopment were investigated; third, an empirical study of exploring the associations between prenatal exposure to a mixture of PCB, OH-PCBs and children cognitive and motor skills measured in different ages; fourth, an empirical study of investigating the associations between prenatal exposure to a mixture of PCB, OH-PCBs and maternal thyroid hormones with potential for investigating the mediation of possible associations observed in the third chapter by maternal thyroid hormone concentrations; fifth, a discussion of the findings, implications for public health research, and practice and conclusions. Materials and Methods The systematic review included peer-reviewed studies indexed in several repositories (N=71 studies) from the inception of the repositories. This systematic review of the studies measured the PCBs directly in prenatal or immediately after delivery in maternal serum, cord blood, placenta, or breast milk. The empirical studies used the data available on mothers and children from "Child Health and Development Studies." Eleven PCB congeners and five OH-PCB metabolites were measured in the maternal serum post-partum among a random subset of the participants. I used a mixture analysis, Bayesian Kernel Machine Regression (BKMR), and generalized linear models (GLM) to assess the association between concentrations of PCB congeners and OH-PCB metabolites measured three days post-partum and children's cognitive and motor skills scores at age five, and cognitive skills measured at a follow-up at ages 9-11. BKMR and GLM were also used to explore the associations between PCB congeners and OH-PCB metabolites and maternal free thyroxine (FT4) and thyroid-stimulating hormone (TSH). Results The systematic review found that prenatal exposure to PCBs was possibly associated with poor cognitive development and poor attention in early and middle childhood. The evidence regarding motor development, behavior, and other neurodevelopmental outcomes were not conclusive at any stage in childhood. There was an indication for sex-specific associations with worse cognition and attention scores among boys. There was also evidence in individual studies regarding the possible association between prenatal exposure to OH-PCBs and neurodevelopmental outcomes. There were significant differences between the studies in markers of exposure, exposure assessment timing, outcome assessment, and the methodological approaches to assess the association. In the second empirical study, I found that in the crude and adjusted BKMR models among the OH-PCB metabolites, cognitive skills test scores at age five increased with each decile increase in the mixture of OH-PCB metabolites compared to when all of the metabolites were fixed at their 50th percentile among all the children and the boys and girls. These associations were largely driven by OH-PCB153 and OH-PCB146, metabolites associated with the congener PCB153. In the third empirical study, among OH-PCB metabolites attributed to PCB congeners, I observed suggestive evidence for a positive association with maternal FT4, particularly in the highest percentile of exposure to overall OH-PCB metabolites. I did not observe an association between exposure to the mixture of PCB congeners and Maternal FT4 or TSH. Nonetheless, the overall patterns suggested a positive association between exposure to PCB congeners and maternal FT4.No associations of the overall mixture of PCBs and OH-PCB metabolites were observed with maternal TSH concentrations in the BKMR models. Nonetheless, in single metabolite risk estimates, I found that 3’-OH-PCB138 was positively associated with maternal TSH values when the 3’-OH-PCB138 was fixed at its 90th percentile compared to when it was in its 10th percentile, fixing all the other congeners in their 10th, 50th, and 90th percentiles. Finally, there was an indication of a possible antagonistic interaction between 4-OH-PCB107 and 3’-OH-PCB-138 in the association of OH-PCBs with maternal FT4 such that 3’-OH-PCB138 tended to have a positive association with maternal FT4 when 4-OH-PCB107 was fixed in the 90th percentile and tended to have a negative association with maternal FT4 when 4-OH-PCB107 was fixed in their 10th percentile when all the other metabolites were fixed in their median value. Conclusions There were patterns of positive associations of OH-PCB metabolites with the children’s cognitive outcomes and maternal FT4 and maternal TSH. Nonetheless, the observed associations were weak in magnitude, often including the null value. The BKMR allowed me to explore and investigate the interactions between different components of the mixture and the overall mixture effect on the outcomes. My dissertation indicated the necessity of a holistic approach to address the impact of exposure to environmental toxins, specifically due to the detected findings regarding interactions between OH-PCB metabolites.

Background: Evidence has indicated a high prevalence of physical inactivity and insufficient consumption of fruit and vegetables among Chinese college students. As college students are in a crucial transition stage from adolescent to adulthood, such unhealthy lifestyle behaviors at this stage can result in nemerous negative consequences for both individuals and society. Therefore, it is urgently necessary to promote health-enhancing physical activity (HEPA) and fruit-vegetable consumption (FVC) among Chinese college students. Interventions focused on multiple health behavior change (MHBC) have shown advantages over those targeting only a single health behavior, and have therefore gained popularity over the last decade. Despite the increasing use of Internet technology and apparent promise of web-based MHBC interventions, there have been few such interventions for HEPA and FVC among Chinese college students. In addition, within the overarching scope of web-based MHBC interventions, there are several remaining questions that need to be addressed, including the timing of MHBC intervention delivery, the high dropout rate of participants, and the psychological mechanisms behind MHBC. Purpose: The main purposes of the thesis were to (1) examine the comparative effectiveness of sequentially delivered web-based MHBC interventions for HEPA and FVC in Chinese college students from both quantitative and qualitative perspectives; (2) investigate characteristics of dropouts (using quantitative method) and the underlying reasons (using qualitative method); and (3) identify the active ingredients ("key mediators") of successful health interventions for changing single health behavior (HEPA or FVC), and examine the psychological mechanisms of MHBC (HEPA and FVC) in Chinese college students based on an integrated social-cognitive model. Method: In Study 1, two web-based MHBC interventions were developed based on the health action process approach (HAPA) model. In a randomized controlled trial (RCT), 552 eligible college students (M = 19.99 years, SD = 1.04, 58.3% female) were randomly assigned to one of three groups: HEPA-first (4 weeks of HEPA followed by 4 weeks of FVC intervention), FVC-first (4 weeks of FVC followed by 4 weeks of HEPA intervention), and a control group (8 weeks of placebo treatment unrelated to HEPA or FVC). All of the participants were asked to complete online questionnaires at four time-points: at baseline (T1, the beginning of the intervention), after 4 weeks (T2, after the first behavior intervention), after 8 weeks (T3, after the second behavior intervention), and after 12 weeks (T4, 1-month post-intervention follow-up). The questionnairs addressed health behaviors (HEPA and FVC), social- cognitive determinants of behavior change (intention, self-efficacy, planning, and social support for each behavior) and health outcomes (BMI, depression and perceived quality of life). All of the data were analyzed using IBM SPSS 25.0, applying a series of generalized linear mixed models (GLMMs) to evaluate the intervention effectiveness. The mediation analysis was performed using IBM SPSS Process, with residualized change scores and the bias-corrected bootstrap approach (5000 resamples). Following the quantitative intervention study, to further evaluate the effects of aforementioned web-based MHBC interventions and to address dropout issues from a qualitative perspective, 30 students (M = 19.53 years, SD = 0.92, 56.7% female) who had participanted in Study 1 (18 completers and 12 dropouts), were invited to attend one-to-one and face-to-face semi-structured interviews (Study 2). The interviews covered three topics: 1) students' perceptions about their changes after participating in the web-based health program, 2) students' user experience and suggestions related to the design of the intervention content and the website layout and functionality, and 3) the reasons for dropping out. The audio-recorded interview data was transcribed orthographically and organized using QSR NVivo 11. Thematic analysis was adopted to analyze the qualitative data. In addition, a two-layer integrated social-cognitive model was hypothesized in Study 3 based on the HAPA model and Carry-over and Compensatory Action Model (CCAM). With a prospective design, 322 college students (M = 19.47 years, SD = 0.99, 55.6% female) were invited to report their past HEPA and FVC behavior, HEPA and FVC intentions, and demographics at baseline. After two months, an online questionnaire survey was used to collect data on their compensatory cognitions, combined volitional predictors of behavior change (self-efficacy + planning), and current HEPA and FVC behavior. All of the data were analyzed using Mplus 8.0. The proposed model was examined using structural equation modeling (SEM) with path analysis approach. Results: (1) Both the quantitative and the qualitative data fully supported the effectiveness of the web-based MHBC interventions for HEPA and FVC behavior. In addition, the effects on social-cognitive determinants of behavior change were partially supported by the quantitative data, and fully supported by the qualitative data. For health outcomes, the quantitative data supported the intervention effects on body mass index (BMI), and the qualitative data supported the effffects on both BMI and perceived quality of life. Moreover, the two delivery sequences did not show significantly different effects on HEPA after either 8 weeks or 12 weeks, whereas the FVC-first sequence showed superior effects over the HEPA-first sequence for FVC behavior after 12 weeks. (2) In terms of dropout, more male than female students withdrew from the interventions, and the dropouts showed lower HEPA self-efficacies, lower FVC planning, and inferior BMI status than completers. The interview results indicated two themes of dropout reasons: internal reasons (e.g., participants perceiving the health interventions as less necessary and less important) and external reasons (e.g., unfavorable living surroundings and problems with the program's delivery mode, intervention content, and technology). (3) In terms of the mediators of successful interventions for changing each single health behavior, the RCT results indicated that self-efficacy and intention mediated the effectiveness of the intervention on immediate changes (after 8 weeks) in HEPA and FVC, and that intention had a mediating effect on sustained change (after 12 weeks) in both HEPA and FVC. In addition, the prospective study found that the two- layer integrated social-cognitive model proposed in this thesis successfully explained the psychological mechanisms of MHBC in Chinese college students. In particular, the first layer identified the mediating effects of the volitional predictors on the intention-behavior relation for each type of health behavior. The second layer identified a positive association between volitional predictors of HEPA and volitional predictors of FVC, as well as a mediating effect of compensatory cognition between FVC intention and HEPA behavior. Discussion and Conclusions: To the best of our knowledge, this is the first study to examine the comparative effectiveness of sequentially delivered web-based MHBC interventions on HEPA and FVC in Chinese college students, and the first to identify the psychological mechanisms of MHBC in a Chinese context. The findings provide both theoretical and practical implications for future research and the application of MHBC. Future studies should more comprehensively compare simultaneous vs. sequential designs, more systematically examine dropout and its determinants, and further explore the psychological mechanisms of MHBC, especially the transfer mechanisms between the volitional predictors of one health behavior on another

The purpose of this study was to describe the relationship between mental, physical, and social activity, and episodic memory (EM) of cognitively intact older persons. The specific aims were (a) to describe the relationship between EM and mental, physical, and social activity, (b) to describe the role of gender, marital status, and race on EM, (c) to describe the moderating effects of each activity on the relationship between each of the remaining two activities and EM, and (d) to describe the moderating effects of gender, marital status, and race on the relationship between each activity and EM. Two theoretical frameworks: Cognitive Reserve Theory (Stern, 2002) and Theory of Nursing as Caring (Boykin & Schoenhofer, 1993) guided the study. This study was designed as a correlational and retrospective secondary analysis of data sets from the Health and Retirement Study. The sample consisted of 3,903 cognitively intact persons who were 50 years and older and completed immediate and delayed recall tests in the 2016 HRS and the 2015 Consumptions and Activities Mail Survey. Descriptive statistics included the means for age: 67 (SD 9.54), education:13.85 (SD 5.89), and total cognition 16.86 (SD 3.11). The sample was predominantly Caucasian (78.3%), female (59.8%), and married (60.9%). / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

Air pollution is one of the leading environmental problems of the 21st century, and the rise of global urbanization has increasingly exacerbated air pollution’s public health impact. Existing epidemiologic studies have tackled the relationship between air pollution and health from a variety of perspectives, but many areas of research remain lacking, including studies originating from developing countries, the assessment of exposure windows and sensitivity of modeling choices, and a better understanding of the climate change impacts on air pollution and health. In this dissertation, I address all of the issues mentioned above. Chapter 1 formally introduces the topics of this dissertation and summarizes background information on several major air pollutants. It then provides an overview of existing research on air pollution epidemiology and describes key knowledge gaps. In Chapter 2, we conduct a systematic review of the scientific literature for data on fine particulate matter (PM2.5) in China, where historical PM2.5 data are not widely available prior to 2013. Using the 574 PM2.5 measurements we identified from the literature, we detected differences in PM2.5 levels across both geographic and economic regions of China. In Chapter 3, we investigate the associations between short- and intermediate-term exposure of nitrogen dioxide (NO2) and mortality in 42 counties in China from 2013 to 2015, and find evidence of significant associations up to seven days prior to exposure. In Chapter 4, we investigate the association between PM2.5 and hospitalizations in New York State using five separate exposure datasets from 2002 to 2012. We find that despite some fluctuations in effect estimates, the majority of models yielded consistently significantly harmful associations. In Chapter 5, we utilize a global chemistry-climate model to project ozone levels in 2050 under a variety of emissions scenarios and quantify the mortality impact associated with changes in ozone concentrations between 2015 and 2050 according to each scenario. We find that under climate change alone and adherence to current legislation, ozone-related deaths would increase. However, under a best-case scenario of maximum technologically feasible reductions in emissions, over 300,000 premature deaths related to ozone can be avoided. Finally, Chapter 6 summarizes the findings of this dissertation and discusses potential directions in future research. While much work remains to be done, this dissertation work takes an important step forward in closing existing knowledge gaps in the field of air pollution epidemiology. More importantly, we hope that our work sends a strong public health message on the importance of continuing research on air pollution and health.

Sleep has been recognized as a major determinant of physical and mental health. Emerging studies suggested that social and built environments should be considered as important determinants of sleep health, however causal mechanisms between neighborhood factors and sleep health still remain unclear. The proposed dissertation is a connected set of papers including a systematic review and longitudinal studies investigating associations between neighborhood stressors and sleep health as well as potential causal mechanisms via psychological distress and physical activity. The longitudinal studies employed comprehensive measures of neighborhood characteristics and sleep health along with g-estimation and mediation analysis techniques. Neighborhood social and built environments may contribute to poor sleep health, particularly in low-income and racial/ethnic minority neighborhoods, and psychological distress can be a salient pathway linking these neighborhood characteristics and sleep health. Based on our findings, interventions to improve sleep should target modifiable factors and enhance neighborhood environments. These sorts of strategies have the potential to improve not only sleep health but also other health outcomes.

A research project submitted in partial fulfillment of the requirements for the degree of MA by coursework and Research Report in the field of Organisational Psychology in the Faculty of Humanities. University of the Witwatersrand, Johannesburg, November 2017 / The current study utilized the Attention Restoration Theory to investigate whether plants in an office context produced restorative effects that enable employees to perform better. The Attention Restoration Theory asserts that individuals will experience increased concentration after spending time in or viewing nature. This study was one of the first attempts to empirically investigate the effect of indoor plants on experiences of performance outcomes and perceptions of Indoor Environmental Quality (IEQ) within South Africa. The researcher aimed to assess whether the individual’s nature identity moderated the impact of the plants. Most previous studies on the outcomes of indoor plants have been conducted in Western, Northern hemisphere contexts. In this experimental study, 120 participants were randomly assigned to one of three conditions: (1) no plants or pictures of plants; (2) only plants; (3) only canvas pictures of plants. The rooms were identical in every other respect. Participants completed two tasks (a card-sorting task and a reading task) and two questionnaires, namely the connectedness to nature scale to assess participant’s nature identity and a previously developed questionnaire that aimed to assess task performance. Additionally, SE controls IEQ monitors were positioned in each office to measure fluctuations of air quality (i.e. temperature, humidity and carbon dioxide levels) in order to assess IEQ. The results from a series of ANOVA’s demonstrated a reduction in participants’ errors (F (2, 117) = 7.137, p = 0.001), a positive reaction to the given task (F (2, 117) = 8.904, p = 0.000), as well as a reduction in participants’ task completion time (F (2, 117) = 43.422, p = 0.000) in the plants condition. These results demonstrated a statistically significant effect on performance in the presence of plants as well as an improvement in air quality through a reduction of carbon dioxide (F (2, 117) = 6.429, p = 0.000). The results revealed that the plants condition was statistically significantly different from that of the pictures of plants and the control condition with regards to the performance outcomes. The result from the two-way ANOVA’s demonstrated that nature identity did not moderate the above relationships (Errors: F (1, 114) = 2.060, p = 0.132; Completion time: F (1, 114) = 0.967, p = 0.383; Reaction to the task: F (1, 114) = 0.017, p = 0.983). This study enhances knowledge regarding indoor plants within the South African context as well as practically influencing working environments where employees are expected to be productive. / MT 2019

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