To date, traditional behavioral interventions have done little to reduce the prevalence and transmission of HIV among African American men who have sex with men (AAMSM), a highly at risk group. Some researchers theorize that the lack of success may be because these interventions do not address contextual factors among AAMSM. Community-based participatory research (CBPR) is one approach to research with the potential to lead to effective interventions in the future. CBPR is a collaborative, mixed-methods and multidisciplinary, approach to scientific inquiry, which is conducted with, and within, the community. The current study follows the CBPR approach to engage and develop a relationship with the African American communities in the Dallas/Fort Worth Metroplex. Contextual issues were discussed in order to identify emerging themes regarding HIV health related issues among AAMSM to provide the groundwork for continued CBPR research and future interventions with AAMSM in the Dallas/Fort Worth Metroplex. To accomplish this goal, researchers began the CBPR process by conducting interviews and focus groups with a sample of approximately 62 (34 from key informant interviews, 28 from focus groups [gender balanced]) AIDS service organization leaders and workers, advocates, medical doctors and community members with first-hand knowledge of HIV health issues in the AAMSM community. Transcripts of these interviews and focus groups were analyzed to identify emerging themes at the societal (religious doctrine, African American Culture, age-related norms and stigma), community (education, religious views/policy and community norms) and individual (disclosure, personal identity, sexual behavior/risk, accessing care and communication) levels. This data was used to create a holistic narrative report that will be used to direct the community advisory board (CAB) and guide future research and interventions.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background: Spinal manipulative therapy (SMT) is a commonly used treatment for many musculoskeletal conditions although the exact mechanism explaining its effectiveness is not well understood. Several studies have investigated the effect of SMT on the paraspinal muscles where neuromuscular effects have been observed, however few studies have assessed whether these changes result in a change in the functioning of the paraspinal muscles. This study aimed to determine the effect of lower thoracic spinal manipulation compared to a placebo intervention on lumbar extensor muscle endurance in asymptomatic participants. Methodology: This was a quantitative, pre-test post-test, placebo controlled trial involving 40 male participants between the ages of 20 and 40 years. The participants were randomly allocated to either the lower thoracic spinal manipulation group or a placebo group. Manipulation was delivered using the Impulse Adjusting Instrument®. Objective measures included lumbar spinal range of motion, a paraspinal muscle endurance test, and surface electromyography readings. Subjective measures were the verbalisation of pain and/or discomfort during the paraspinal muscle endurance test. IBM® SPSS® statistics version 21 and STATA 11 were used to analyse the data. A p-value of <0.05 was considered statistically significant. Results: There were no statistically significant differences between the groups in terms of subjective and objective measurements. A trend of treatment effect was observed for paraspinal muscle endurance where the intervention group showed noticeable improvements in endurance scores. Conclusion: Further studies need to be conducted to determine if the trends observed would occur in a larger study population.

Prostate cancer is the most commonly occurring cancer and the second leading cause of cancer death for men in the United States. Because early prostate cancer is frequently without symptoms and data on how to prevent prostate cancer is lacking, early detection has the greatest potential for decreasing mortality. Studies have shown Hispanics/Latinos to be less likely than whites or African-Americans to utilize prostate cancer screening exams. The purpose of this descriptive study was to design a social marketing plan which could be used as a model to promote Hispanic/Latino participation at prostate cancer screenings. Information obtained through medical and marketing literature review, the author's experiences serving on the promotion committee of a community-sponsored prostate cancer screening project, and interviews with 51 Hispanic/Latino prostate cancer screening participants is described and incorporated into a guide with recommendations for future program planners.

This thesis focused on the development of a curriculum guide for a cancer awareness program for older men. The background of the problem -- a lack of programs for older men -- and the methods used in developing the guide are detailed in Chapter One. The second chapter consists of current information on disease prevention, aging and cancer with the emphasis on age-related changes and learning needs of older adult men. Chapter Three is the completed instructor's curriculum guide, and the final chapter includes recommendations on implementing the program as part of a community wellness program. The guide could also be used in senior centers, hospital educational programs, or adapted for use in staff inservices.

Black South African men who have sex with men (MSM) face a set of adverse circumstances, including economic hardship and stigmatization, that combine to put them at an elevated risk for hazardous substance use and HIV infection. This creates a context where substance use is normative and high-risk sexual behavior is often engaged in covertly and under the influence of intoxicating substances. The overarching objective of this dissertation was to explore determinants of hazardous drinking and HIV risk behavior among black South African MSM with a particular focus on the role of social networks. In order to achieve this, I used data drawn from the study, “HIV and Sexual Risk in African MSM in South African Townships” (R01-MH083557; PI: Sandfort, PhD). First, I conducted a systematic literature review to identify studies that used social network analysis to evaluate alcohol use among adults in order to answer the question: how have social network characteristics been shown to influence adults’ drinking behaviors, both in terms of characteristics of their network structures and characteristics of their network ties? Results of the review demonstrated that characteristics of one’s peers as well as social network structure influenced egos’ alcohol consumption in a variety of ways and across settings. Second, I described drug and alcohol use among black South African MSM and identified determinants of hazardous drinking, a highly prevalent form of alcohol use identified in the sample. The results showed that hazardous drinking was highly prevalent and multiple indicators of social vulnerability were identified as independent determinants of hazardous drinking. Third, I assessed the relationship between substance use and sexual risk behavior and explored the moderating effects of psychosocial factors. The results showed that there was not a main effect between substance use and sexual risk behavior; however, among men with high intentions to engage in safer sex, substance use was associated with increased risky sexual behavior. Overall, this dissertation increased our understanding of social networks, substance use and HIV risk behavior among black South African MSM. Our results suggest the importance of using pre-existing social networks to deliver potential interventions. The results also suggest that the most vulnerable members of this community are at increased risk of hazardous drinking. Lastly, efforts to reduce HIV risk behavior should focus on both increasing safer sex intentions and negating the impact of substance use on sexual risk behavior. Taken together, these studies provide insight for developing potential interventions, including intervention that use social network data to facilitate behavioral change, as well as undertaking further research among a critical population.

There is a need to increase awareness among African American men regarding their potential risk of prostate cancer and inform them of screening and treatment options, given the health disparities that affect their group. To do so, an innovative e health video was developed, using an animated avatar video to educate African American males about prostate cancer and potential screening methods in a way that is culturally appropriate. Effectiveness of this e-health intervention was tested on a sample of 41 African American males. Efficacy was measured using a repeated measures design that used pre- and post-measures of four target behaviors regarding prostate cancer screening. These four target behaviors include: (1) getting an annual physical exam, (2) discussing the possibility of getting a digital rectal exam to screen for prostate cancer with a doctor, (3) discussing the possibility of getting a PSA exam to screen for prostate cancer with a doctor, and (4) spreading awareness about prostate cancer among other African American men. The stage of change, which is a theoretical framework adapted from Prochaska and DiClemente (1983), measures changes in human behavior from precontemplation and contemplation on the low end to action and maintenance on the high end. Self-efficacy was also measured before and after the intervention for each of the four target behaviors. Paired t-tests show that the stage of change for the third and fourth target behaviors and self-efficacy for the second, third, and fourth target behaviors were significantly increased by the e-health intervention, indicating that the intervention was successful. Additionally, participant ratings about the intervention were largely positive. In effect, this study finds that the e-health intervention developed in this study not only works, but is an affordable, scalable, and practical tool that can educate African American males about prostate cancer screening practices.

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Obesity is a major epidemic and is increasing in prevalence worldwide. The health problems and consequences of obesity include cardiovascular disease (CVD) risk factors, such as hypertension, hyperlipidemia, glucose intolerance and diabetes mellitus. Each of these abnormalities directly promotes atherosclerosis. More recently, visceral obesity has been shown to be independently associated with abnormalities of both the ventricular and vascular structure and function. The mechanisms by which they occur remain incompletely defined. Cardiovascular magnetic resonance imaging (CMR) offers several advantages for evaluation of cardiac structure and function in the obese. The high accuracy and reproducibility of the technique allows for detection of very small changes in ventricular volumes, mass, ejection fraction, and cardiac output with a relatively small sample size, as compared with echocardiography. In this thesis we investigated whether cardiovascular magnetic resonance imaging can better characterize possible cardiac abnormalities associated with obesity, in the absence of other confounding comorbidities. Obesity is associated with myocardial and vascular function, the extent of reversibility of these abnormalities with rapid acute weight loss remains uncertain. Therefore the first aim of the study was to (i) determine the relationship between obesity and left ventricular structure and function using magnetic resonance imaging, and (ii) the acute effects of rapid diet-induced weight loss on cardiac and vascular function in normal obese and obese diabetic men. Erectile dysfunction is related to cardiovascular risk factors such as obesity by an impairment of endothelial function. Therefore, symptoms of erectile dysfunction are probably to precede cardiovascular disease and events. The second aim of this study was to (i) determine the relationship between obesity and erectile function (EF), sexual desire (SD), lower urinary tract symptoms (LUTS) and quality of life (QOL) measures in obese males, and (ii) determine the effects of rapid diet-induced weight loss on EF, SD, LUTS and QOL measures in normal obese and obese diabetic men. In this group of men, obesity was associated with mild/moderate erectile dysfunction, and significant LUTS, which together with sexual desire improved following rapid diet induced weight loss, but was not directly related to the amount of weight loss or changes in measured metabolic state. Pericardial adipose tissue (PAT) covers 80% of the heart and constitutes 20% of its weight. PAT mass is related to the amount of abdominal fat and the risk of coronary atherosclerosis. Epicardial fat mass may be a sensitive indicator of cardiovascular risk. The third aim of this study was to (i) determine the relationship between obesity and PAT volume and (ii) effectively evaluate the impact of caloric restriction and associated weight reduction on epicardical fat volume via cardiac magnetic resonance imaging (CMR). This is the first study to show a reduction in PAT volume is associated with caloric restriction. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352389 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

Obesity is a major epidemic and is increasing in prevalence worldwide. The health problems and consequences of obesity include cardiovascular disease (CVD) risk factors, such as hypertension, hyperlipidemia, glucose intolerance and diabetes mellitus. Each of these abnormalities directly promotes atherosclerosis. More recently, visceral obesity has been shown to be independently associated with abnormalities of both the ventricular and vascular structure and function. The mechanisms by which they occur remain incompletely defined. Cardiovascular magnetic resonance imaging (CMR) offers several advantages for evaluation of cardiac structure and function in the obese. The high accuracy and reproducibility of the technique allows for detection of very small changes in ventricular volumes, mass, ejection fraction, and cardiac output with a relatively small sample size, as compared with echocardiography. In this thesis we investigated whether cardiovascular magnetic resonance imaging can better characterize possible cardiac abnormalities associated with obesity, in the absence of other confounding comorbidities. Obesity is associated with myocardial and vascular function, the extent of reversibility of these abnormalities with rapid acute weight loss remains uncertain. Therefore the first aim of the study was to (i) determine the relationship between obesity and left ventricular structure and function using magnetic resonance imaging, and (ii) the acute effects of rapid diet-induced weight loss on cardiac and vascular function in normal obese and obese diabetic men. Erectile dysfunction is related to cardiovascular risk factors such as obesity by an impairment of endothelial function. Therefore, symptoms of erectile dysfunction are probably to precede cardiovascular disease and events. The second aim of this study was to (i) determine the relationship between obesity and erectile function (EF), sexual desire (SD), lower urinary tract symptoms (LUTS) and quality of life (QOL) measures in obese males, and (ii) determine the effects of rapid diet-induced weight loss on EF, SD, LUTS and QOL measures in normal obese and obese diabetic men. In this group of men, obesity was associated with mild/moderate erectile dysfunction, and significant LUTS, which together with sexual desire improved following rapid diet induced weight loss, but was not directly related to the amount of weight loss or changes in measured metabolic state. Pericardial adipose tissue (PAT) covers 80% of the heart and constitutes 20% of its weight. PAT mass is related to the amount of abdominal fat and the risk of coronary atherosclerosis. Epicardial fat mass may be a sensitive indicator of cardiovascular risk. The third aim of this study was to (i) determine the relationship between obesity and PAT volume and (ii) effectively evaluate the impact of caloric restriction and associated weight reduction on epicardical fat volume via cardiac magnetic resonance imaging (CMR). This is the first study to show a reduction in PAT volume is associated with caloric restriction. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352389 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

As rates of HIV transmission have accelerated in Kazakhstan over the past ten years, gay, bisexual, and other men who have sex with men (MSM) in Kazakhstan have experienced a disproportionate burden of the HIV epidemic, including a seven-fold increase in HIV prevalence. Earlier age of first sexual activity (i.e., earlier sexual debut) has been associated with long-term health trajectories among MSM at risk of HIV, however, no previous research has examined associations between earlier sexual debut and HIV-related risk factors among MSM in Kazakhstan. This dissertation tests hypotheses examining whether earlier sexual debut is associated with the following factors associated with HIV infection during adulthood among MSM in Kazakhstan: substance use, exchange sex, and experiences of anti-gay violence. Study data were obtained through a NIDA-funded clinical trial of a behavioral intervention seeking to increase the engagement of MSM who use substances in Kazakhstan in the HIV care continuum. Findings indicate that earlier sexual debut is significantly associated with increased risk of substance use, exchange sex behaviors, and experiences of anti-gay victimization among MSM in Kazakhstan. Future research should examine the contexts of MSM’s sexual debut, including whether this experience was consensual or involved other forms of adverse childhood events. Policy recommendations include increased access to sexual and gender expansive-inclusive comprehensive sexual education, and anti-discrimination policies. Clinical considerations include trauma-informed HIV prevention resources for MSM that recognizes that individuals seeking care may have complex, intersecting, and marginalized life histories, including experiences of violence across the life course.