Master of Public Health / Department of Diagnostic Medicine/Pathobiology / Deon Van der Merwe / Cyanobacteria are Gram-negative photosynthetic bacteria capable of producing toxins responsible for morbidity and mortality in humans and domestic animals. Many are capable of forming concentrated blooms that impact the environment by limiting the growth of sub-surface plants and phytoplankton. Harmful algal blooms (HABs) are also capable of producing multiple types of toxins, creating a potential hazard to recreational water users and animals drinking water from or near a bloom. Characterization of HABs is necessary to prevent these human and animal exposures and includes classifying of the type of cyanobacteria present and whether or not they are capable of toxin production, and the exact type of cyanotoxin that is actually present in bloom. Current methods used to classify cyanobacteria and cyanotoxins include microscopy, bioassays, ELISA, PCR, HPLC, and LC/MS. All of these methods, however, have limitations that include time, labor intensity, or cost. Fourier-Transform Infrared Spectroscopy (FTIR) is another potential tool for cyanobacterial classification that is not limited by these factors. To examine the practicality of this method, library screening with default software algorithms was performed on diagnostic samples received at the Kansas State University Veterinary Diagnostic Lab, followed by PCA of samples meeting minimum quality requirements to produce cluster analyses and dendrograms. Both spectrometers and software packages used were successful at distinguishing cyanobacteria from green algae in clean samples with 89.13% agreement. PCA resulted in clear classification of cyanobacteria or green algae demonstrated by a large order of magnitude difference produced by average Euclidian distance dendrograms. While this method is only capable of differentiating cyanobacteria from green algae or other aquatic environmental constituents, its simple, rapid use and low cost make it a beneficial screening tool when coupled with toxin-detection methods to characterize HABs.

Hepatitis B virus (HBV) infection is a global leading cause of death as a result of its role in the development of cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). In industrialized nations such as the United States, chronic hepatitis B infection represents a significant and disproportionate disease burden among the foreign-born population. A Markov cohort decision model was developed to determine the cost-effectiveness of HBV screening among new immigrants for the purposes of early detection and treatment, as compared to usual care. The incremental cost-effectiveness ratio for the screening strategy was $45,570 per quality adjusted life year saved. Given the potential for health gains for the immigrant cohort as well as the economic attractiveness of the intervention, some consideration should be given to the addition of a universal HBV screening program to U.S. immigration policy.

Hepatitis B virus (HBV) infection is a global leading cause of death as a result of its role in the development of cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). In industrialized nations such as the United States, chronic hepatitis B infection represents a significant and disproportionate disease burden among the foreign-born population. A Markov cohort decision model was developed to determine the cost-effectiveness of HBV screening among new immigrants for the purposes of early detection and treatment, as compared to usual care. The incremental cost-effectiveness ratio for the screening strategy was $45,570 per quality adjusted life year saved. Given the potential for health gains for the immigrant cohort as well as the economic attractiveness of the intervention, some consideration should be given to the addition of a universal HBV screening program to U.S. immigration policy.

This study examines the perception of K-12 principals about school social work consultation, collaboration and program development in a large urban school district in Georgia. The primary survey participants consist of one hundred eight K-12 school principals selected using non-probability sampling. Twenty seven school social workers in the same school district also selected by convenience sampling responded to the survey questionnaire which is designed using a four point Likert scale. The fmdings of the study indicate that responding principals and school social workers perceive consultation, collaboration and program development as expected activities. Responding principals also perceive that it is the responsibility of the principal to ensure that these activities occur. A greater percentage of principals in schools with special education and/or homeless enrollments expect consultation with the school social worker. Principals in schools with special education and homeless enrollments are more likely to 1 include the school social worker as an integral partner in school leadership and decision making than principals in schools with Title I or English to Speakers of Other Languages (ESOL) student enrollments.

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.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Stephanie A. Rolley / Complex issues and exciting opportunities lie at the intersection of public health and park design. One component of the recently emerging field of design for active living explores the relationship between design and physical activity as part of a transdisciplinary area of study. This study provides the opportunity to view the design strategies that landscape architects have used to design parks through a lens of promoting physical activity. The purpose of this study is to understand design strategies incorporated in two fitness parks in Louisville, Kentucky assist in meeting public health goals for the citizens of Louisville. Two topical areas were explored: the physical design strategies used in the parks; and the collaborative efforts among stakeholders to further the public health agenda for promoting physical activity in the parks. A case study of two community scale fitness parks profiled the characteristics and design philosophies engaged in park development. The methodology, based on qualitative procedures incorporated three types of investigation: 1) collection of background data and documentation of Louisville’s parks and Mayor’s Healthy Hometown Movement; 2) interviews with key stakeholders from public agencies, private non-profit foundations, and selected consultants who have completed parks design work in Louisville; and 3) a case study analysis of two of the fitness parks in the city, based on the background data and input from subject interviews, and an identification of physical design strategies in each park. Identification of design strategies was based on a conceptual framework developed from the disciplines of public health promotion and landscape architecture, and input from local agency stakeholders. A physical activity design strategy inventory form was developed to aid in analysis. Anticipated results were two-fold: 1. Presentation of information to assist landscape architects in designing parks that intentionally provide engaging opportunities for physical activity; and 2. Contribution to the dialogue between landscape architects and public health professionals, informing collaboration on design projects and community programs. Findings revealed that the two parks studied incorporated several physical design strategies that promote physical activity, reflecting the mature park culture in Louisville, Kentucky, home to one of five designed Olmsted Parks and Parkways systems in the United States. The physical activity design strategy inventory form developed in this study as an audit tool warrants additional study as a potential audit and design tool to engage landscape architects designing for physical activity and informing others of ways that park design can play a role in physical activity.

Doctor of Philosophy / Department of Geography / Bimal K. Paul / According to the UNAIDS (2008) estimated, in 2005, that about 2.4 million Indians were living with Human Immunodeficiency Virus (HIV). This makes India one of the most HIV vulnerable countries in Asia and thus this problem cannot be ignored. The main purpose of this study was to gain an in-depth understanding of the awareness about HIV/AIDS preventive measures of female college students (in the 18 to 24 age group) in Kolkata, India, who were widely believed to be members of the low risk group. Specifically, the study measured the willingness to comply with HIV/AIDS preventive measures of the female college students. Few studies have investigated the perception, knowledge and opinions of female students regarding the effectiveness of HIV preventive measures, this study will add a new dimension to HIV/ AIDS literature. In order to assess the information available to the students an attempt has been made to examine the knowledge of the respondents concerning the modes of transmission of HIV and HIV prevention methods. The study also identified the significant sources of information that the respondents used to derive pertinent information enabling them to protect themselves from the virus. A host of variables (e.g. socio-economic and behavioral) have been studied in order to identify the factors influencing the willingness to comply with the preventive measures of these college students. From the results it was evident that religion, income and age play a role in influencing the students’ willingness to comply. This study has important public health implications because the information collected can be used to design HIV prevention interventions that can reduce HIV transmission in West Bengal and other states of India.

Master of Public Health / Department of Human Nutrition / Mark Haub / Background: Time spent in sedentary behaviors, independent of physical activity levels, is a risk factor for chronic diseases and all-cause mortality. It is unknown whether physically active adults alter their dietary and/or physical activity behaviors in response to imposed sedentary time. The aim of this study was to determine whether imposing 10 hours of sedentary time per week for 8 weeks would alter physical activity and/or dietary profiles of physically active adults. Methods: Sixteen physically active, healthy young adults were randomized into either the no-intervention control (CON) group (n=8) or the sedentary-intervention (SIT) group (n=8). SIT participants attended monitored sedentary sessions for 10 hours per week (4 days; 2.5 hours) for 8 weeks. Assessments occurred at baseline, and weeks 4 and 8. Dietary information was collected through 3-day food records and physical activity was assessed through 7 days of accelerometry (Actical at the wrist). Results: There were no differences in physical activity profiles in SIT or CON groups when baseline and week-8 average (average weeks) were compared to the week-4 assessment. Differences in step counts comparing the average weeks and week 4 were not significantly different between CON and SIT groups (CON = 615.1 ± 3019.1, SIT= -1158.0 ± 3373.0 steps, p=0.287). There were no differences in sedentary (p=0.366), light (p=0.293), moderate (p=0.656) or vigorous (p=0.701) physical activity when average weeks were compared to one of imposed sedentary behavior. A greater number of SIT (4/8) participants had lower step counts during the imposed sedentary week, when compared to CON (1/8) participants. There was no difference (p>0.05) between CON and SIT groups for total calories consumed at any time-point. Caloric intake decreased significantly in the SIT group compared to the CON group (SIT = -27.9 ± 22.8%, CON = 10.0 ± 37.6%, p=0.028). More SIT (7/8) than CON (3/8) participants decreased caloric intake from baseline to 8 weeks (p>0.05). Conclusion: Physically active young adults did not alter physical activity profiles, but did decrease their caloric intake, in response to 8 weeks of imposed sedentary time. These findings may indicate a compensatory mechanism to imposed sitting in physically active adults.

Master of Public Health / Human Nutrition / Richard R. Rosenkranz / Background: Type 2 diabetes mellitus (T2DM) is a costly and burdensome lifelong disease, and without proper glycemic control, severe life-threatening complications result. In Southeast Asia, the prevalence of T2DM is forecast to increase markedly from 2000 to 2030. Although literature reviews on lifestyle modification for glycemic control are available, these are mainly for the Western context, and there is a dearth of evidence for Southeast Asians who are at greater risk of T2DM and have differing patterns of diet, physical activity and body composition than Western populations. Objective: To systematically review literature on the effectiveness of lifestyle modification interventions for glycemic control in T2DM patients from Southeast Asia. Methods: Randomized controlled trials (RCT) with interventions ≥ 8 weeks that compared HbA1c or blood glucose for intervention (lifestyle modification) versus control groups were identified from searches in Cochrane Library, CINAHL, PubMed, ProQuest, Science Direct, SPORTDiscus, Scopus and Web of Science. Results: Seven RCTs (679 participants) meeting inclusion and exclusion criteria were identified. There was a significant reduction in HbA1c% (MD = -0.56%; 95% CI = -0.95,-0.16%; p = 0.006; n = 5 studies) and in blood glucose mg/dl (MD = -16.76 mg/dl; 95% CI = -31.36, -2.17 mg/dl; p = 0.02; n = 4 studies) over 3 months for lifestyle modification intervention groups. Lifestyle interventions included diet (n = 2), exercise (n = 2), and general lifestyle interventions (n = 3). Duration of interventions ranged from 12 weeks to 6 months. Studies included populations from Thailand (n = 5) and Malaysia (n = 2). Conclusion: Overall, lifestyle modification interventions are effective for the glycemic control of T2DM patients in countries of Southeast Asia.

Doctor of Philosophy / Department of Family Studies and Human Services / Anthony Jurich / Ann Murray / Despite the intensified research efforts into the field of Infant Mental Health and Marriage and Family Therapy, a truly systemically designed program has not been developed. This formative evaluation study illuminates the design phase, its developmental process, and the professional staff member’s experience of this newly implemented “Options” program. I focused specifically on Crawford County Community Mental Health Center’s innovative systemic approach to issues related to infant mental health. In this body of work, I describe the process of creating this innovative approach, identified how the program originators made decisions about their approach and how the approach is being operationalized on a daily basis by interviewing the clinicians, who are providing the services and the administrators who created and oversee the program. I utilized a qualitative approach in the design, transcription categorization, and data analysis. This formative evaluation used the “flashback approach” to tell the story of the evaluation findings, this included an Executive Summary. This study’s exploration yielded a clearer understanding of the developmental process of the infant mental health program and its initial implementation. The results of this evaluation revealed that there are a number of core program components (three levels of focus: child and family, program, and community and catchment area) that were organized and clearly disseminated throughout the staff. The interviews revealed that the program has encountered problematic issues including; policy and procedural agreements and mandates, staff turnover, program ownership and funding limitations. It grew increasingly clear that the value of the program’s positive impact on families outweighed the perceived hassle of establishing and implementing the program. This evaluation produced a number of program recommendations for program perpetuation and potential improvements. The program recommendations addressed the challenges facing the “Options Program” are explained. The future research implications of this formative evaluation are enumerated.