Master of Public Health / Department of Diagnostic Medicine/Pathobiology / David G. Renter / As a Governor’s Internship award winner, I had the pleasure of working as an epidemiologist intern in the chronic disease program within the Kansas Department of Health and Environment, Bureau of Health Promotion (KDHE). The Centers for Disease Control and Prevention (CDC) awards millions of dollars each year in grants to health departments across the country and KDHE was among the top recipients of grants this past year. Specifically, I was involved with two grants given to the chronic disease program to address the major issues of tobacco use and levels of sodium in diets. Tobacco is a leading cause of death and illness in this country and efforts need to be made in reducing this reality. Heart disease is the number one cause of death in the U.S. and is directly related to sodium levels. The main CDC funded project I assisted with was a chronic disease risk reduction grant regarding tobacco prevention and cessation among all age groups across the state. This project was a statewide initiative allowing each county or group of counties to propose their own programs to reduce tobacco use. It was composed of three stages: planning, capacity building, and sustainability and maintenance. For each stage, grantees proposed programs within their own communities to prevent and reduce tobacco use. The second CDC funded project I assisted with was an observational study of sodium intake in Shawnee County, Kansas. This project produced baseline data of sodium consumption patterns in the county. The study was composed of a telephone questionnaire, a 24-hour dietary recall, and ending with educating the participants of sodium amounts. As an epidemiologist intern, I evaluated data, compiled research information, and interacted with counties regarding initiatives. Both projects allowed me to use, in a state government setting, the skills and techniques I have learned in the MPH program. These public health issues are impacting the health of Kansans, and state and local health departments are utilizing these programs to increase public awareness and decrease illness.

Master of Public Health / Department of Human Nutrition / Sandra B. Procter / Nutritionally vulnerable women are more apt to give birth to low birth weight, small for gestational babies who have increased medical complications and higher risk of mortality. Participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) prenatally has been found to enhance positive pregnancy outcomes for women; reduced risk of low birth weights and nutrient deficiencies thus reducing the costs associated with medical care for infants covered by Medicaid, the joint federal and state insurance program for low income women, which covers 40% of infants in the United States. Pregnant women covered by Medicaid insurance are normally at the most risk but are adjunct eligible for the WIC program. This descriptive cross-sectional research study determined the demographic and nutritional characteristics of Medicaid births in the WIC program compared to non-Medicaid births for the 2009 WIC program year, using the Kansas birth certificate, WIC program data linked to the birth certificate by unique identifying code. Results from the study show that the Kansas WIC and Medicaid programs are serving the target population for the objectives of the programs. Mothers of Medicaid births who received WIC food during pregnancy and those in the WIC program are of low socioeconomic status and they are more likely to be younger in age, of minority racial group, less educated, never married and less likely to breastfeed infants at discharge and high likelihood of smoking. Compared to Medicaid births that did not participate in the WIC program, women at the lower margins of low socioeconomic status participated in WIC, signaling that the most vulnerable were getting the needed services. Distinct findings from the Kansas WIC program reveal that Medicaid births in the WIC program were more likely to be breastfed at discharge, compared to Medicaid births not in the WIC program, even though WIC recipients had demographic characteristics associated with low breastfeeding patterns. A study investigating the reasons for not enrolling in WIC by Kansas Department of Health would be beneficial to the WIC program’s goal to provide nutrition support to low income eligible women, infants and children in Kansas.

Doctor of Philosophy / Department of Agricultural Economics / Vincent R. Amanor-Boadu / Public health policies seek to address health issues that pose significant concerns to public health policymakers. Because these initiatives have economic costs, economic agents’ response to them would be driven by the outcome of their benefit-cost assessment of the policies. Therefore, the congruence between perception and reality of economic agents’ health becomes important in evaluating the potential effectiveness of these initiatives. This research sought to determine the extent of congruence between objective and subjective health status at the individual level. The results would contribute to the framing and implementation of health policies that have higher probability of adoption by economic agents. The National Health and Nutrition Examination Survey (NHANES) 2005-2006 data were used for this research. The dependent variables defined in the study are subjective health status perception and objective metrics of individuals’ health status proxied by their body mass index (BMI), waist circumference, high density lipoprotein (HDL) cholesterol level, and fasting blood glucose. The nature of these dependent variables demanded that both categorical dependent variable and ordinary least squares models be employed in the estimation of the models. Chow tests were used to determine the extent of congruence between perception and reality of respondents’ health status. The study did not find any differences between perception and reality based on waist circumference but the same could not be said about BMI. Additionally, there were differences between subjective health perceptions and objective measures of health status based on receiving information about their health status from a health care professional. If it is assumed that the cost of responding to health policies are reduced with higher congruence between subjective and objective health status, then this study’s results suggest that policy must begin with increasing the objective information that people have about their health. While the provision of this information at the individual level could be expensive, it will improve the success rate of health promotion initiatives. The increase in these initiatives’ success should contribute to a reduction in the nation’s health care costs attributable to lifestyle related diseases such as obesity.

Master of Public Health / Department of Diagnostic Medicine/Pathobiology / Katherine Stenske / Over the past few decades, animal and public health professionals have become increasingly concerned about the global animal population’s vulnerability to Transboundary Animal Diseases (TADs). Through analysis of the lessons learned by the United Kingdom (UK), Taiwan, and Egypt in responding to FMD outbreaks in their countries, it becomes apparent that even with response plans in place at the time of an outbreak, problems still arose as the outbreaks progressed. To better understand why these deviations from the planned course occur, the concept of “disconnects” in the various “domains” of TAD emergency preparedness and response were explored for the United States (U.S.). Particular emphasis was placed on issues related to the collaboration and cooperation between the federal and state levels of government. The domains of communication, knowledge, and resourcing were selected to be analyzed due to their importance in TAD emergency outbreak preparedness and response. The research questions this thesis explores concern three domains of TAD emergency preparedness and response that experience disconnects between federal and state levels of government. They also explore how these disconnects affect Food and Agriculture Security in the U.S. Three different methods were used to research these topics. Literature reviews of lessons learned and after action reports from TAD outbreak exercises and real events were conducted. Direct observations of the author’s experiences at conferences, seminars, and training events were also included. Finally, personal interviews were conducted with Food and Agriculture Security experts. Through this analysis, numerous disconnects emerged in each of the domains. Several disconnects traverse all three domains. These disconnects related to laboratory collaboration with the federal government, the process of declaring a federal emergency, and the roles and responsibilities of individuals and groups involved in TAD outbreak preparedness and response. Overall, the disconnects affect the ability of state and federal governments to rapidly respond to and coordinate response efforts. This affects Food and Agriculture Security by compromising the safety, security, and ongoing operation of the food and agriculture sector. Further study will be needed to alleviate these disconnects so that better cooperation and collaboration can occur between federal and state levels of government.

Master of Science / Department of Horticulture, Forestry, and Recreation Resources / Candice A. Shoemaker / Professionals in health promotion are starting to look at gardening as a strategy for health behavior change. This popular leisure time activity provides access to physical activity and fresh fruits and vegetables for consumption, two behaviors consistently recommended for optimum physical health. Coupled with a lifestyle low in sedentary behavior these behaviors can offset the health risks of the prevailing trends of overweight and obesity. Spending time outdoors is associated with higher levels of physical activity, while screen based behaviors are associated with unhealthy eating. No studies to date have looked at the health behaviors of gardeners, or the effects it may have on their family’s health behaviors. The purpose of this report is to examine, through descriptive research, the health behaviors of gardening and non-gardening parents and their fourth or fifth grade child. Surveys were administered to a convenience sample of 366 fourth and fifth grade students and their guardians within a school district in Riley County, Kansas. The survey assessed the physical health behaviors mentioned above; comparisons were made according to parental classification of gardener (n=189) or non-gardener (n=177). Significant association was found with gardening classification and adult self-reports of the number of days and amount of time respondents participated in moderate to vigorous physical activity. The median days per week parents reported participation in moderate to vigorous physical activity was 3 for non-gardeners, and 4 for gardeners and was influenced by gender. Eighty-seven percent of gardeners compared to 59.3% of non-gardeners reported meeting the current physical activity recommendation of 150 minutes per week of moderate intensity activity.

Master of Public Health / Public Health Interdepartmental Program / Manuel Moro / Activities of a state public health veterinarian.

Doctor of Philosophy / Department of Sociology, Anthropology, and Social Work / Robert Schaeffer / World-system theorist Immanuel Wallerstein made two theoretical assertions in Historical Capitalism that (a) significant inequalities in the “margin of safety against…endemic dangers and erratic violence” for people in different zones of the world economy persisted over long periods of time and (b) that the “margin of safety” for people in the periphery has actually deteriorated. This study set out to test this theory by examining mortality data for countries in different zones of the world-economy. It identified a set of health-related proxies for “endemic dangers and erratic violence”, infectious diseases (malaria, polio, tuberculosis, and influenza), chronic diseases (cancer, diabetes, and cardiovascular), erratic violence (homicide, suicide, and motor vehicle accidents), and also infant mortality and life expectancy for women and men. It gathered data from the United Nations Statistical Division’s Demographic Yearbook for a select sample of countries in different zones of the world-economy (core, semiperiphery, and periphery) from 1950 to 2010, and examined how mortality from these dangers changed during this period. This study found that mortality data for infectious diseases did not provide much support for Wallerstein’s theoretical assertions. But the mortality data for chronic disease and erratic violence provided strong support for Wallerstein’s assertions. The data on life span provided some support for Wallerstein’s first assertion, but not for his second. Overall, the findings generally support Wallerstein’s theories and suggest ways that health-related inequalities might be addressed.

Master of Regional and Community Planning / Department of Landscape Architecture/Regional and Community Planning / Hyung Jin Kim / Accessing healthy food can be a challenge for people living in both rural and urban environments. A broad range of factors influences one’s food security, including the accessibility and affordability of food retailers, travel time to shopping, availability of healthy foods, and food prices. The connections between planning and food systems have begun to emerge and be examined but planners face many barriers when tackling food system issues that range from turf problems, a lack of knowledge that any problem exists, to a lack of funds. The study purposes were to 1) identify areas with low access to healthy food sources; 2) discover barriers and perceptions of healthy food accessibility among community members; and 3) explore current planning policies and practices for increasing healthy food accessibility. The study area of this case is Riley County, Kansas, which has lower food accessibility especially to health foods in low income areas located in urban neighborhoods, even though rural areas are further away from a healthy food store. The research has the potential to inform the local food system framework and provide guidance for local policy makers and stakeholder groups. Surveys were collected from 150 households in order to identify challenges and barriers respondents face when obtaining healthy food. Food prices and low income were the largest barriers survey respondents faced when obtaining healthy food. Interviews conducted among 6 individuals from planning offices, market, and community stakeholder groups and both urban and rural issues were discussed. Currently, there is understanding of the importance of healthy food but little action that follows. There are opportunities for planners and policy makers to get involved with planning for the local food system. Partnerships must be established to share resources and technical skills among stakeholders in order to plan for healthy community food systems.

Master of Public Health / Human Nutrition / Sandra B. Procter / Background: Engaging community has become a fundamental approach to improving health outcomes in resource-limited settings. Community coalitions, comprised of resident activists that mobilize to improve local conditions, are frequently utilized as partners for community-engaged research. However, there is limited research that documents how these partnerships affect the coalitions. The purpose of this study was to evaluate the effects of researcher-coalition collaboration in the pilot year of a four-year intervention program targeting childhood obesity in rural, low-income communities. Methods: Twelve pre-established community coalitions from seven states were selected to partner with academic researchers in a quasi-experimental study, and then assigned to either the control (n=6) or intervention (n=6) group. Both study arms received funding and access to a menu of evidence-based tools, but the intervention groups were also provided a trained community coach. Member survey data from a Coalition Self-Assessment Survey (CSAS) tool was completed at baseline and at one-year follow-up. Results: CSAS data were analyzed to identify factors related to coalition function and efficacy, and significant changes in both experimental groups were identified. Change in measures of membership recruitment, coalition capacity and coalition communication were unique to the intervention group. Problems for participation were alleviated significantly on all measures in the control group. Comparison of the study groups at follow-up demonstrated that greater research involvement positively impacted membership recruitment and coalition action plan. Conclusion: The data suggest that coalitions with a higher degree of partnership interaction may be more successful in addressing problems impacting their communities.

Master of Public Health / Department of Human Nutrition / Tandalayo Kidd / Parenthood is a major life event that requires considerable lifestyle changes. As young adults become married they start a change in lifestyle that influences their health and their future children. Some couples understand that they need to change their behavior, but do not know how to do so healthfully. The poor lifestyle behaviors that produce excessive weight gain place an increased risk for premature death, heart disease, diabetes, other health problems as well as threatens their quality of life. These transitional experiences present a unique challenge that warrants exploration in the context of the young adult life stage and perceptions about health and quality of life. Currently, there is limited research of the concerns or perceptions young adults have regarding quality of life and diet related health behaviors. The purpose of this study is to identify behaviors that impact life satisfaction and health of young adult families. Two-90 minute focus groups were conducted, with pre-recruited community members 18-24 years of age. All participants were recruited from community service organizations, day care facilities and university educational classes. Participants were parents and/or married. Nutrition and Exercise majors were excluded. Both focus groups were asked seven key questions along with probing questions. All focus groups were audio taped and then transcribed verbatim. The transcriptions were coded manually by assigning a label in the margins of the transcripts for each quality of life issue that appeared. Coding allowed the data to be assembled into categories that can be used to develop quality of life and health interventions for young adults. Several issues impacting satisfaction with life and barriers to a healthy lifestyle were identified. However, money, time, family, stress, and children were primary concerns. This study identified the need to completed additional assessments to quantify the needs of young adult parents and families, so community-based partnerships can effectively develop programming and interventions.