Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / The Centers for Disease Control and Prevention estimated that one in six Americans become ill,128,000 are hospitalized, and 3,000 die each year due to foodborne illness. Children are at a higher risk of acquiring foodborne illness than adults for several reasons, including: an immune system that has yet to fully develop, limiting their ability to fight infections; a lack of control over the food they consume because their meals are usually provided by others; and the lack of awareness of food safety risks. Thus, it is critical to ensure that childcare center employees practice safe food handling. The purpose of this study was to explore the food safety knowledge, practices, and barriers to safe food handling practices of childcare center employees. Observations were conducted in 10 childcare centers in Manhattan, Kansas. Each childcare center was observed for two days during lunch preparation and service. Observations of foodservice employees were conducted in the kitchen using a structured observation form. Teacher observations were conducted in the classroom using detailed notes. A questionnaire was used to collect demographic, food safety training, and food safety knowledge information. SPSS (v. 20.0) was used to analyze data. Childcare center employees had high average scores on the safety knowledge assessment. The majority of employees received some type of food safety training. Time pressures, availability of equipment, and small food preparation space were found as the main barriers to implementing safe food handling. Childcare center foodservice workers and teachers were knowledgeable about handwashing and time/temperature control, but failed to utilize on the job. Results of this study will help childcare educators to develop materials to improve food safety practices and encourage owners/managers of childcare centers to enhance their food safety behaviors.

Master of Science / Department of Human Nutrition / Mary Meck Higgins / Because of the ever-changing nature of the economy and the food environment, research as recent as 2010 may not be relevant to today’s discussion on food insecurity, food deserts, obesity rates, and nutritional quality in the U.S. population’s diet. Today, people of low socioeconomic status in the U.S. are at risk for overweight, obesity, and chronic illnesses such as type 2 diabetes, hypertension, and certain cancers. In this report, I investigate published research about low-income populations in the U.S. relative to the food environment and describe implications for healthcare professionals implementing interventions with these populations, discussed in the following categories: Dietary Intake Quality and Socioeconomic Status; Food Insecurity; Barriers to Quality Food Access in the U.S. Food Environment; Communities Alleviating Food Insecurity; Food-Related Perceptions, Attitudes, and Behaviors; Homelessness and Food-Related Behaviors; Why Do People Buy What They Buy?; Nutrition Assistance Programs and Policies; Current U.S. Food Costs; and Comparing the Nutritional Value Versus Price of Foods. Although the literature on the subject of low-income diet quality is thorough, much of it needs to be updated with current data on food prices, food environments, and U.S. diet quality. For this purpose, I compiled the most recent data from the National Bureau of Labor & Statistics on food prices to discuss the elevated food prices of healthful foods as opposed to less healthful foods. I also created a one-month menu based on the U.S. Department of Agriculture’s Thrifty Food Plan budget allowance in order to follow a healthful diet in this harsh economic climate utilizing the Dietary Guidelines for Americans 2010 and the Affordable Nutrients Index.

Master of Regional and Community Planning / Department of Landscape Architecture/Regional and Community Planning / Mary Catherine (Katie) Kingery-Page / In the United States, minorities are less physically active and in turn at higher risk for heart disease, diabetes and obesity. The purpose of my study is to examine the factors that influence physical activity in neighborhood parks and to answer: What aspects of park design and programming discourage physical activity participation in African American women? My goal is to identify barriers to physical activity and make recommendations for improving design and programming of a neighborhood park. The results of my research are relevant to the planning profession because planners can use public policy to combat inequality in the built environment. Many studies have related recreation access to socioeconomic status, race, ethnicity, age, and gender. While African American women are not the only disadvantaged population when it comes to access to recreation, they do have a higher risk for obesity. In trying to answer why African American women have higher rates of obesity, some studies have found that while willingness to participate in physical activity does not differ in white and black women, duration of physical activity does. My research employs a mixed methods approach to understand the barriers to physical activity experienced by African American women, in context of a neighborhood park. This study uses a physical assessment of James Mulligan Park and the surrounding neighborhood within Alexandria, Virginia. Following the physical assessment I piloted a survey to gather information on the barriers to physical activity. The pilot guided a final survey of seventeen participating African American women in the neighborhood. I hypothesized that the perception of park safety will have an effect on the rate of physical activity in African American women. This hypothesis points to a general barrier for all women. Based on literature review, I also expected to find barriers unique to African American women. The study concluded that African American women in this neighborhood share some barriers with all women and they also expressed some barriers unique to African American women. I found that personal barriers like “exercise tires me” was the most common, rather than perceptions of safety. In addition, I found culturally specific barriers, such as “exercising is not my cultural activity” and “I avoid exercise to protect my hairstyle.” Based on my analysis of the setting and surveys I make several recommendations for the park and neighborhood.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Hyung Jin Kim / Obesity levels—related to an increase of physical inactivity—are rapidly rising in the United States (CDC 2010; Office of Disease Prevention and Health Promotion 2008). Reportedly, African-American women have the highest obesity rates when compared to any other demographic in the United States—especially those residing in crime-plagued urban environments (CDC 2010). Yet active living strategies by designers have been least effective amongst this demographic (Day 2006). Researchers report crime-safety perceptions are one of the biggest environmental factors influencing physical activity levels amongst low-income African-American women (Foster and Giles-Corti 2008; Codinhoto 2009). Crime prevention through environmental design (CPTED) has been the most common practice towards an intervention of criminal activity in the built environment; however, little practice has addressed both CPTED and physical activity. While first and second generation crime prevention through environmental design (CPTED) are inclusive of addressing both physical and social aspects of the built environment (Cleveland and Seville 2008; Griffin et al. 2008; Dekeseredy et al. 2009), they have yet to effectively address crime-safety needs and its potential relationship with physical activity behaviors of low-income African-American women and their neighborhoods. Therefore, what built environment changes tailored for this target population—African- American women—are necessary? This study examines 1) what crime safety perceptions of the built environment are affecting low--income African American women’s physical activity levels in Kansas City, Missouri and 2) what design solutions these women suggest could help increase their physical activity levels, through improving their perceptions of neighborhood safety. As a place-specific study on a low income neighborhood in Kansas City, Missouri, selected through GIS suitability analyses with literature-based criteria, this study used survey and focus group interview methods to identify the target group’s design suggestions. The findings resulted with a connection from research to design solutions—neighborhood and street-level design strategies with CPTED guidelines linking the researched participant’s perceptions of crime in their built environment to the effect of crime on their own physical activity.

Doctor of Philosophy / Food Science / Justin Kastner / Many Chinese aquaculture farmers use unapproved chemicals to treat their fish, many of which are diseased as a result of the country’s poor waste management and environmental practices. During 2006-2007, the United States (U.S.), the European Union, and Japan rejected large amounts of Chinese seafood imports due to the presence of unapproved chemicals or the presence of approved chemicals at concentrations that exceeded permitted levels. This dissertation examines the sources of environmental health and food safety problems in China; it also examines how effective the U.S. and Chinese governments’ regulations are in protecting consumers from hazards in Chinese aquaculture products. The study looks at specific chemical contaminants found in Chinese aquaculture imports, explores their potential toxicity or carcinogenicity, and examines the reasons for their prohibition from human food. The study exploits the available U.S. seafood consumption patterns (courtesy of the National Health and Nutrition Examination Survey—NHANES—database) and then uses probabilistic modeling (courtesy of CREMe Software Limited) to determine the extent to which specific sensitive U.S. consumer subpopulations were exposed to aquaculture chemical contaminants in the food supply in a contrived scenario using real consumption data (from NHANES) and actual contamination data (from the FDA). The study compares exposure between children and adult consumers, and also looks at exposure among women aged 18 years and older and the elderly aged 60 years and older. This study suggests a strong likelihood that NHANES children, as well as female consumers aged 18 years and older and elderly consumers aged 60 years and older, were (in the contrived scenario) all exposed to violative intake levels of chemical contaminants from Chinese aquaculture imports. Children forming the 99.5th and 99.9th percentiles of NHANES seafood consumers were exposed to higher levels of nitrofuran, gentian violet, and malachite green contaminants per kilogram of body weight than were their adult counterparts. Conversely, children were exposed to lower levels of fluoroquinolone contaminants per kilogram of body weight than were their adult counterparts. The 50th, 95th, and 99.9th percentiles of female consumers aged 18 and older and elderly consumers aged 60 years and older were exposed to violative daily intake levels of contaminants in Chinese aquaculture. The study concludes by examining what the U.S. and Chinese governments should do to address aquaculture safety.

Master of Science / Department of Industrial & Manufacturing Systems Engineering / Jessica L. Heier Stamm / In many humanitarian and public health settings, multiple organizations act independently to locate facilities to serve an affected population. As a result of this decentralized decision-making environment, individuals’ access to facility resources may suffer in comparison to a hypothetical system in which a single planner locates the facilities to optimize access for all. Furthermore, due to the unanticipated nature of humanitarian events and the urgency of the need, responders often must cope with a high level of uncertainty regarding the future supply of resources and demand for relief. The contributions of this thesis address the challenges that arise due to the decentralized and dynamic nature of humanitarian response. The first goal of this research is to quantify the difference between decentralized system performance and that possible with a centralized planner. The second goal is to demonstrate the value and feasibility of using a dynamic, rolling-horizon framework to optimize facility location decisions over time. This work compares individuals’ access to health facilities resulting from location decisions made by decentralized decision-makers to the access achieved by a centralized model that optimizes access for all. Access is measured using a special case of the gravity model, the Enhanced Two-Step Floating Catchment Area (E2SFCA) method, which is a distance-weighted ratio of capacity to demand. The E2SFCA method is integrated with integer programming to optimize public access to health facilities. This method is applied to the location of cholera treatment facilities in Haiti, which has been afflicted with a cholera epidemic since October 2010. This research finds that access varied significantly across Haiti, and in the month of February 2011, thirty-seven of the 570 sections, representing 474,286 persons (4.8 percent of the population), did not have adequate access to cholera treatment facilities. Using centralized models to optimize accessibility, performance can be improved but no single model is dominant. This paper recommends use of an efficiency-oriented model in conjunction with an equity constraint to make facility location decisions in future responses. Finally, this work successfully integrates measures of access and equity into a rolling-horizon facility location model and demonstrates that these measures can be incorporated in a full-scale implementation to provide dynamic decision support to planners. This paper advocates for greater awareness of the impact of decentralization in humanitarian response and recommends that future work be undertaken to discover incentives and strategies to mitigate the impact of decentralization in future responses.

The major global concern of preventing the spread of Human Immunodeficiency Virus (HIV) requires that millions of people be tested in order to identify those individuals who need treatment and care. This study’s purpose was to examine the role of social networks in an individual’s decision to test for HIV. The study sample included 62 participants of African and Caribbean origin in Toronto, Canada. Thirty-three females and 29 males, aged 16 to 49 years who had previously tested positive or negative for HIV, participated in interviews that lasted approximately 60 minutes. Measurement instruments adapted from Silverman, Hecht, McMillin, and Chang (2008) were used to identify and delimit the social networks of the participants. The instrument identified four social network types: immediate family, extended family, friends, and acquaintances. The study examined the role of these network types on the individuals’ decisions to get HIV testing. A mixed method approach (Creswell, 2008) was applied, and both qualitative and quantitative data were collected simultaneously. Participants listed their social networks and retrospectively described the role of their network members in influencing their decision to test for HIV. The participants’ narratives of the influence of social networks in HIV testing were coded. A thematic analysis of the qualitative descriptions of the network members’ influence was performed. The quantitative and the qualitative analysis results were then tallied. The results of the study demonstrated that the influence of social networks was evident in the individuals’ decisions to test for HIV. The most influential group was friends, followed in descending order of influence by immediate family, acquaintances, and extended family. These social network ties provided informational, material, and emotional support to individuals deciding to seek HIV testing. For policy makers and health professionals, coming to a more complete understanding of these dynamics will enable them to make institutional decisions and allocate resources to improve and enhance the support available from within these social networks, thus encouraging, promoting, and leading to increased testing for HIV.

The major global concern of preventing the spread of Human Immunodeficiency Virus (HIV) requires that millions of people be tested in order to identify those individuals who need treatment and care. This study’s purpose was to examine the role of social networks in an individual’s decision to test for HIV. The study sample included 62 participants of African and Caribbean origin in Toronto, Canada. Thirty-three females and 29 males, aged 16 to 49 years who had previously tested positive or negative for HIV, participated in interviews that lasted approximately 60 minutes. Measurement instruments adapted from Silverman, Hecht, McMillin, and Chang (2008) were used to identify and delimit the social networks of the participants. The instrument identified four social network types: immediate family, extended family, friends, and acquaintances. The study examined the role of these network types on the individuals’ decisions to get HIV testing. A mixed method approach (Creswell, 2008) was applied, and both qualitative and quantitative data were collected simultaneously. Participants listed their social networks and retrospectively described the role of their network members in influencing their decision to test for HIV. The participants’ narratives of the influence of social networks in HIV testing were coded. A thematic analysis of the qualitative descriptions of the network members’ influence was performed. The quantitative and the qualitative analysis results were then tallied. The results of the study demonstrated that the influence of social networks was evident in the individuals’ decisions to test for HIV. The most influential group was friends, followed in descending order of influence by immediate family, acquaintances, and extended family. These social network ties provided informational, material, and emotional support to individuals deciding to seek HIV testing. For policy makers and health professionals, coming to a more complete understanding of these dynamics will enable them to make institutional decisions and allocate resources to improve and enhance the support available from within these social networks, thus encouraging, promoting, and leading to increased testing for HIV.

This thesis is an analysis and evaluation of a case study in deinstitutionalisation of people with intellectual disabilities. The process has been viewed as an example of organisational change and the focus is on the relationship between formal and informal caregivers and the notion of care. Three key groups were included in the study, families of residents, the residents and staff. A qualitative approach was taken. The theoretical perspective that was developed attempted to account for links between social movements, organisations and individual experience in the arena of intellectual disability. This was based on the approach of New Institutionalism in organisational theory. The focus was primarily on the process--of change, and in caregiving. Three models of intellectual disability, which have informed policy and the recent changes to a preference for community care, have been identified and the links between these and the elements of organisations developed for providing care explored. The experience of families and residents within the hospital setting and then the community care setting has been examined in relation to the nature of the organisation. Outcomes for the three groups have been examined in terms of their needs and the extent to which these needs were met by the arrangements over a given time. It is concluded that community care has the potential to better meet the needs of those involved, than has hospital based care. A number of factors in the process of change and in the delivery of care have been identified as impacting on outcomes for those involved. Consideration is given to the practical implications of these findings. / Subscription resource available via Digital Dissertations only.

This thesis is an analysis and evaluation of a case study in deinstitutionalisation of people with intellectual disabilities. The process has been viewed as an example of organisational change and the focus is on the relationship between formal and informal caregivers and the notion of care. Three key groups were included in the study, families of residents, the residents and staff. A qualitative approach was taken. The theoretical perspective that was developed attempted to account for links between social movements, organisations and individual experience in the arena of intellectual disability. This was based on the approach of New Institutionalism in organisational theory. The focus was primarily on the process--of change, and in caregiving. Three models of intellectual disability, which have informed policy and the recent changes to a preference for community care, have been identified and the links between these and the elements of organisations developed for providing care explored. The experience of families and residents within the hospital setting and then the community care setting has been examined in relation to the nature of the organisation. Outcomes for the three groups have been examined in terms of their needs and the extent to which these needs were met by the arrangements over a given time. It is concluded that community care has the potential to better meet the needs of those involved, than has hospital based care. A number of factors in the process of change and in the delivery of care have been identified as impacting on outcomes for those involved. Consideration is given to the practical implications of these findings. / Subscription resource available via Digital Dissertations only.