Type 2 diabetes mellitus, or T2DM, is a leading cause of preventable death in the United States. Multiple studies have found that certain dietary patterns can significantly influence the risk of T2DM. The purpose of this study was to understand the dietary patterns associated with diabetes by comparing the relative adherence to these dietary patterns by individuals in 5 stages of diabetes: no diabetes, undiagnosed prediabetes, diagnosed prediabetes, undiagnosed diabetes, and diagnosed diabetes. Using the health belief model as the theoretical foundation, the primary research question examined whether adherence to specific dietary patterns significantly differed between individuals in different stages of diabetes. This question was important for understanding the dietary behaviors of individuals in early or unknown stages of diabetes that may lead to more harmful health consequences. Using data from the National Health and Nutrition Examination Survey (n = 15,237), multiple logistic regression analyses compared the odds of adherence to specific dietary patterns, adjusting for covariates. There was no statistically significant association between dietary pattern adherence and diabetes status. However, certain covariate factors-such as age and gender-were found to significantly influence the odds of high adherence to certain dietary patterns. Specifically, males were significantly more like than were females to adhere to diets associated with increased T2DM risk, and adults aged 50 years and older were significantly more likely than were younger adults to adhere to diets associated with decreased T2DM risk. The impact of these findings could lead to more targeted interventions promoting better eating habits and reduced T2DM incidence among U.S. adults aged 20 years older.

Maternal health services (MHS) provide primary, secondary, and tertiary levels of prevention to achieve better pregnancy outcomes. However, use of prenatal and natal services among Nigerian women has been ranked among the lowest in the world and, consequently, the country is among the 10 countries with the highest maternal mortality ratio. Moreover, nationwide community-based studies on the use of maternal health services in Nigeria are limited. To address this gap, this quantitative, cross-sectional study analyzed the 2008 Nigerian Demographic and Health Survey (NDHS) data to identify whether Nigerian women's biological, cultural, and socioeconomic characteristics are associated with their use of MHS and pregnancy outcome as measured by number of antenatal visits, place of delivery, and fetal outcome. The Anderson's health behavior model was used as the theoretical framework for this study. Respondents were women aged 15 - 49 years (N= 31,985), who had given birth between January 2003 and December 2008. Bivariate and multiple logistic regressions were conducted. The results indicated that religion, education, income, and availability of skilled health workers showed consistent significant statistical association with both the number of ante natal care (ANC) visits and place of delivery even after controlling for covariates. Overall, these findings have potential for social change on the choice of public health interventions with collaboration with social services such as education, community, and labor sectors. Further, a systematic involvement of local communities is needed to drive specific culturally-sensitive interventions.

With the number of people living longer and with more chronic problems, it is important that health educators examine who they are educating as well as the methods and circumstances of the education. The purpose of this study was to identify the relationship between self-directedness and health promotion in the elderly. A convenience sample of 108 elders who use Senior Centers in rural East Tennessee comprised the study group. The sample was asked to complete the Self-Directed Learning Readiness Scale, the Health Promoting Lifestyle Profile II, and a demographic information survey at a regular meeting of a Senior Center. A positive relationship (r=.394; p<.005) was found between self-directedness as a measure of intrinsic motivation with participation in health promoting behaviors. Demographic information was used to describe the sample and was also used to determine if there was a relationship between any of the demographic items and health promotion practices or self-directed learning readiness. Participation in religious/spiritual activities was significant for both self-directed learning readiness and health promotion practices. Pender’s Revised Health Promotion Model and the Personal Responsibility Orientation Model provided an excellent basis for this study. The study confirmed the need for personal motivation in the elderly to accomplish increased participation in health promotion practices. Both self-directed learning readiness and health promoting behaviors were reviewed for consideration of previous research in the area, and theoretical perspectives. The key implication for practice is that health educators need to understand the motivation of their client prior to educating them regarding an aspect of health promotion. Recommendations for research include more qualitative studies. Almost all the studies available at present are quantitative and the reason for participation needs further investigation. Qualitative studies would enhance the information regarding the reasons for participation in health promotion.

Thesis (M.A.)--University of Central Florida, 2009. / Adviser: Jonathan Matusitz. Includes bibliographical references (p. 91-101).

Parents' refusal to immunize their children with the measles, mumps, and rubella (MMR) vaccine has resulted in a surge of measles outbreaks in the United States. The purpose of this correlational study was to examine the relationships between parental knowledge and trust of the MMR vaccine, and their trust in government and medical authorities. The theoretical foundation for this study was the health belief model (HBM). This study determined if there was any relationship between general trust in doctors/governments (i.e., the predictor variable) and attitudes toward MMR vaccine (i.e., the sole dependent variable), and whether gender, age group, or level of education moderated that general trust. A Survey Monkey subscriber database and researcher-developed survey was used to identify and email 2,500 parents of immunization-aged children, resulting in 237 respondents who met the required parameters. The analysis revealed a significant, positive relationship between the criterion and predictor variables, R = .32, R2 = .10, F(1, 235) = 26.39, p. < .001, regardless of gender, age, or education, suggesting an association between higher trust and greater likelihood of a parent allowing vaccination. This study offers significant insights for positive social change by providing pediatricians, primary health care providers, and vaccine educators, with information for communicating with vaccine-hesitant parents: It is not enough to address parental concerns of vaccine safety, efficacy, and necessity. It is also not enough to provide evidence-based scientific data, as doing so has been proven to be ineffectiveâ??and for some parents counter-productiveâ??when government and medical authorities are sited as the source. What we need to do is start focusing upon the role of parental trust, including how to best establish that trust, and equally important, what steps are necessary to sustain that trust.

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Background: People with intellectual disability constitute approximately 2% of the population. They die prematurely, and often have a number of unrecognised or poorly managed medical conditions as well as inadequate health promotion and disease prevention. Methods: A cluster randomised controlled trial with matched pairs was carried out. The participants were adults with intellectual disability (n=453 in 34 clusters). The intervention was a health assessment program to enhance interactions between the adult with intellectual disability, their carer, and their general practitioner (GP). It promoted the systematic gathering of a health history and, subsequently, access to a GP for a guided health review and development of a health action plan. It also provided information about the health of adults with intellectual disability. Follow-up was for one year post-intervention, with outcomes extracted from GPs' clinical records. Interviews of adults with intellectual disability, their residential support staff and GPs were performed prior to and after the intervention period. Results: Increased health promotion, disease prevention and case-finding activity was found in ther intervention group. Compared with the control group there was a 6.6-fold increase in detection of vision impairment [95% confidence interval 1.9-40]; a 30-fold increase in hearing testing [4.0-230]; an increase in immunisation updates (tetanus/diphtheria a nine-fold increase [4.2-19]), and improvements in women's health screening (Papanicolau smears were eight times more common [1.8-35]). The intervention increased detection of new disease by 1.6 times [0.9-2.8]. Residential support staff and GPs largely supported the implementation of the health assessment process however interviews of adults with intellectual disability were uninformative. Conclusions: The Comprehensive Health Assessment Program (CHAP) produced a substantial increase in GPs' attention to the health needs of adults with intellectual disability with noncomitantly more disease detection, and the process was supported by residential support staff and GPs. The presumption that these will yield longer-term health benefits, while suggestive, remains unexamined.

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