Master of Science / Department of Industrial & Manufacturing Systems Engineering / Todd W. Easton / With the present threat of bioterrorist attacks and new natural disease strains developing, efficient and effective countermeasures must be in place in case of an epidemic outbreak. The best strategy is to stop the attack or natural phenomenon before it happens, but governments and individual citizens must have measures in place to limit the spread of a biological threat or infectious disease if it is ever introduced into society. The objective of this research is to know, before an outbreak, the best quarantine areas. Quarantines force similar individuals together and can be mathematically modeled as clustering people into distinct groups. In order to effectively determine the clustering solution to use as a quarantine plan, this research developed a simulation core that is highly adaptable to different disease types and different contact networks. The input needed for the simulation core is the characteristics of the disease as well as the contact network of the area to be modeled. Clustering is a mathematical problem that groups entities based on their similarities while keeping dissimilar entities in separate groups. Clustering has been widely used by civilian and military researchers to provide quality solutions to numerous problems. This research builds a mathematical model to find clusters from a community’s contact network. These clusters are then the preplanned quarantine areas. To find quality clusters a Clustering Heuristic using Integer Programming (CHIP) is developed. CHIP is a large neighborhood, hill-climbing heuristic and some computational results verify that it quickly generates good clustering solutions. CHIP is an effective heuristic to group people into clusters to be used as quarantine areas prior to the development of a disease or biological attack. Through a small computational study, CHIP is shown to produce clustering solutions that are about 25% better than the commonly used K-means clustering heuristic. CHIP provides an effective tool to combat the spread of an infectious disease or a biological terroristic attack and serves as a potential deterrent to possible terrorist attacks due to the fact that it would limit their destructive power. CHIP leads to the next level of preparation that could save countless lives in the event of an epidemic.

Master of Science / Department of Programs in General Human Ecology / Karen S. Myers-Bowman / The alarming incidence of sex-related health problems among American adolescents has health educators searching for effective curricula-based programs aiming at behavioral changes. Such desire and urgent need to find or create programs and curricula that work have generated different approaches, philosophies, and educational strategies. However, this also may have produced a number of programs that have not benefited from a careful and thorough evaluation: neither evaluation of content, message, and cognitive and/or behavioral effect. The focus of this paper is on the curricula utilized in sexuality health programs in middle and high schools. Questions arise about the impact of these programs. Currently, abstinence-based programs are the only ones funded by the government. Research data does not convincingly show that abstinence-only sexuality education significantly decreases the number of adolescents engaging in sexual intercourse prior to marriage. This paper attempts to review current research about abstinence and comprehensive curricula. I begin by discussing the different approaches and their supporters. The importance of adolescent development and theory will be incorporated into my review. Effectiveness of each approach, as well as evaluation studies will be examined. From this review, I composed my own assessment of one abstinence-based curriculum and one comprehensive based curriculum.

Master of Public Health / Department of Diagnostic Medicine/Pathobiology / Justin J. Kastner / David G. Renter / The history of veterinary medicine is intimately intertwined with duties to public health. This has remained true over centuries, and is becoming even more important with recent significant threats to public health. Despite this, the veterinary profession is failing to meet increasing needs for veterinarians trained in population medicine and public health, nationally and internationally. Current accreditation requirements for veterinary schools and colleges are vague with regard to public health education, leaving each college or school of veterinary medicine to implement its own perception of veterinary public health education. Is the public health education in veterinary curricula adequate among U.S. veterinary colleges and schools? Our inventory of the veterinary curricula in the 28 U.S. veterinary schools and colleges revealed inadequacies in veterinary public health education delivery. We found that most colleges and schools are lacking in the major veterinary public health subjects as recommended by the American College of Veterinary Preventive Medicine and the World Health Organization. The issue of inadequacies, even deficiencies, within health professional curricula is not unique to the veterinary profession. What have other health professions proposed to correct their own perceived deficiencies within their educational curricula? We identified deficiencies and proposed solutions from three health professions and discussed their solutions as potential approaches to remedy the inconsistency in public health delivery in veterinary curricula. The dental profession addressed lack of faculty effectiveness with faculty development programs. The medical profession identified an outdated and irrelevant pre-medical curriculum and is currently considering reforming it. The chiropractic profession identified a lack of public health education in its curriculum and organized a standardized public health course. Health professions are similar in content of curricula and length of professional program. In addition, the health professions have similar pre-requisites. They also share similar challenges: faculty shortages, high student debt loads, and rising educational costs. Because of these similarities, solutions to perceived curricular deficiencies proposed in one health profession can be used to address deficiencies in other health professions. Therefore, the dental, medical, and chiropractic professions have proposed solutions that should be considered in addressing the veterinary profession's curricular deficiency of inadequacy in public health education.

Master of Regional and Community Planning / Department of Landscape Architecture/Regional and Community Planning / Claude A. Keithley / This report examines what planners can do to increase healthy lifestyles within their communities by presenting development recommendations. In the beginning of the twentieth century the discipline of city planning was dedicated to stopping the spread of infectious diseases through improved sanitation and housing. Over the years planning separated from its origins in public health. Mobility and increased technology began to drive community development and planning, and our society created environments that devalue healthy lifestyles. A wide array of activities contribute to healthy lifestyles. Five characteristics have been shown to be the most promising in promoting health. They are regular physical activity, maintaining a healthy weight, moderate alcohol consumption, not smoking, and a prudent diet. To achieve its purpose this report will explore the prevalence of adhering to healthy lifestyle characteristics and recount a brief history of community development that has contributed to decreased healthy lifestyle adherence. Through the review of past destructive practices and current initiatives to create healthy communities, a guide to community development for healthy lifestyles is laid out. This guide will allow communities to determine their location in the process of becoming a health conscious community and give them recommendations about what they can do to promote health.

Doctor of Philosophy / Department of Human Nutrition / David A. Dzewaltowski / David A. Dzewaltowski / Insufficient physical activity, excessive sedentary behavior and insufficient fruit and vegetable consumption may contribute to childhood obesity. Parents and other adults provide social and physical environments, and build children’s skills for these healthful behaviors. The purpose of this dissertation was to examine parent and adult practices that contribute to the prevention of obesity in children. Chapter one reviewed the literature examining the influence of parent and adult practices on the development of young children’s eating and activity self-regulation skills. Recently, studies have provided evidence that children who lack self-regulation skills are more likely to be overweight. However, there is a gap in the literature addressing practices necessary to foster young children’s self-regulation. Thus, a need exists to identify parent and adult practices that foster the development of children’s eating and activity self-regulation skills. Chapter two described the development, validity and reliability of a self-report measure of parenting practices that may foster children’s self-regulation skills. Parents of overweight/obese children use less parenting practices that foster self-reflection of screen time than parents of normal weight children. Chapter three described the development and evaluation of an intervention designed to develop children’s self-regulation skills to ask parents for healthful home environments. The 12-week intervention was delivered to children and their parents through training child care providers. Children’s self-regulation for asking for healthy foods and activities increased after intervention, as well as increases in child eating and physical activity behaviors. In addition to parents, other adults can impact children’s environments to increase energy expenditure. Chapter four examined the influence of adult leader participation compared to no leader participation among children participating in active games. Results showed no effect of leader participation on children’s physical activity. It may be that adult participation could not increase physical activity because the children were already exhibiting high levels of moderate-to-vigorous physical activity. This dissertation provides preliminary evidence that parent/adult practices play a key role in the development of healthy eating and physical activity in children. Future research is necessary to identify the most important parent/adult practices that can be targeted by interventions to provide healthful options and build children’s skills to promote healthful behavior to prevent obesity.

Master of Public Health / Department of Diagnostic Medicine and Pathobiology / Katherine S. KuKanich / Hand hygiene by healthcare workers is an effective means of preventing healthcare-acquired infections. However, hand hygiene compliance can be low among healthcare workers. This study used introduction of a gel sanitizer and informational poster as interventional tools in attempt to improve hand hygiene in two outpatient healthcare clinics. Healthcare workers at two outpatient clinics were observed for frequency of hand hygiene (attempts vs. opportunities). Gel sanitizer and informational posters were introduced together as an intervention. Direct observation of hand hygiene frequency was performed during baseline, intervention, and follow-up. A post-study survey of healthcare workers was collected. In both clinics, baseline hand hygiene was poor (11% and 21%) but significantly improved (p[less than or equal to]0.0001) after interventions (36 and 54%), and was maintained (p>0.05) through the follow-up period (32 and 51%). Throughout the study, post-contact hygiene was statistically observed more than pre-contact hygiene. In both clinics, healthcare workers self-reported a preference for soap and water, yet observations showed that sanitizer use predominated over soap and water use when sanitizer was available after the intervention. Fifty per cent of the surveyed healthcare workers considered the introduction of gel sanitizer to be an effective motivating tool for improving hand hygiene. Hand hygiene performance by healthcare workers in outpatient clinics may benefit from promoting gel sanitizer and using informational posters. Direct observation by trained observers may provide more accurate information of hand hygiene tool preference compared with survey results.

Master of Public Health / Department of Diagnostic Medicine/Pathobiology / Douglas Powell / Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. These outbreaks demonstrate that although contact with animals in public settings can provide educational and entertainment opportunities, the potential to spread disease exists if risk-reduction tools are not implemented, proper hygiene measures aren’t practiced, and precautions are not taken and reinforced. This thesis is divided into two parts. Part one is an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas and Missouri, U.S., petting zoos. Part two delineates best practices for organizing events where human-animal interactions are encouraged, in hopes it will lower the risk of zoonotic disease transmission. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors performed hand hygiene more often when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; P < 0.001, OR = 4.863, 95% CI = 3.380–6.998), and in petting zoos where animal contact occurred over a fence (188/460, 40.9%) as opposed to visitors entering an animals’ yard for contact (26/114, 22.8%; P < 0.001, OR = 2.339, 95% CI = 1.454–3.763). Inconsistencies existed in tool availability, signage, and supervision of animal- contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks. Recommendations made in the second part of this thesis were based on these observations, recent publications, and the suggestions of many health agencies. It focuses on what event planners can do to design and plan a safer event, and what staff working at the event should be aware of in order to inform visitors and lower the risk of zoonotic disease transmission. Part two discusses two primary tools to reduce risk of zoonotic disease transmission: sanitation and awareness of risk behaviors. Keeping facilities, animals, and visitors clean, and informing visitors of risky behaviors to avoid, while reinforcing positive messages within the animal- contact area, can lower the risk of zoonotic infection. Included with the second part, is a checklist (see appendix A) designed for visitors to assess whether an event that encourages human-animal interaction poses a high or low risk. By identifying possible risk factors, teachers and parents will be able to make an informed decision about the safety of the human-animal encounter.

Master of Science / Department of Human Nutrition / Tonatiuh Melgarejo / It will be almost impossible to find a household or an informed consumer, completely oblivious to the health risks posed by foods. According to scientific estimates, 48 million cases of foodborne illness occur each year in the United States, causing 128,000 hospitalizations, 3,000 deaths, which costs $6.4-$77.7 billion in expenses by medical care and lost productivity. These illnesses pose a very big constant, perhaps growing, threat to a vast population. Salmonella is the most prevalent foodborne bacteria with more than 1.1 million cases annually in the United States. Increased international trade and distribution, rapid growth in antibiotic resistant bacteria, increase in the number of immunocompromised consumers and changes in agronomic and processing practices poses a very big challenge to monitor, contain and avoid foodborne outbreaks. This can result in contaminated food causing rapid, geographically widespread outbreak. In the wake of numerous recent foodborne illness outbreaks, this report focuses on current safety practices established by research and available to all the consumers. It studies a significant foodborne bacterium (Salmonella), its nature, significance, prevalence, mechanism of action, health risks and preventive safety measures. General food safety practices, to reduce or eliminate the risk, common to all the foodborne bacteria and specially Salmonella, include avoiding cross-contamination, thoroughly cooking foods to right lengths of time and temperature, washing fresh produce and fruits prior to consumption and storing foods at the right temperatures. Strict regulations in safe production, safe processing and consumer awareness is highly recommended. People participation is a must.

Master of Science / Department of Human Nutrition / Tandalayo Kidd / Objective: The aims of this study were to test the effectiveness of a 15-month intervention in reducing sugar-sweetened beverage (SSB) consumption among college students and to assess fruit and vegetable intake and physical activity habits and their relationship to SSB consumption in order to improve health outcomes. Design: Randomized, controlled study. Participants: One hundred and fifty-six college students (18-24 y) from a Midwestern university, primarily female (72%), white (89%) and freshmen (51%). Intervention: Participants were randomized to control and intervention groups. Participants in the control group received no information on healthful behaviors. The intervention occurred in two stages: 1) Participants received three stage-tailored messages on healthful behaviors weekly for 10 weeks; 2) After the 3-month physical assessment, participants received 3 stage-tailored messages monthly and one email encouraging them to visit the portal page. Main Outcome Measure(s): Stages of Change for physical activity and fruit and vegetable intake; self-reported physical activity scores, self-reported fruit and vegetable intake and SSB consumption habits. Analysis: Changes in SSB consumption patterns were determined using generalized linear mixed models and linear regression models tested associations between fruit and vegetable intake, physical activity and SSB consumption. Linear mixed models were used to explore relationship between stage of change and fruit and vegetable intake and physical activity. Results: The 15-month intervention did not significantly reduce SSB consumption in the intervention group (p > 0.05). Participants recorded low fruit and vegetable intake and moderate physical activity scores. Conclusions and Implications: The high SSB consumption and low fruit and vegetable intake observed could increase students’ risk for weight gain and obesity-related conditions. Thus, college campuses can help student maintain physical activity behavior while helping them to improve their eating habits.

Master of Agribusiness / Department of Agricultural Economics / Hikaru Hanawa Peterson / This thesis focuses on the question of the effect of commodity pricing and Federal programs on the cost of food in the United States. For many decades the debate around subsidy payments has been argued in the halls of Congress and in farm fields across the country. Corn, wheat, and soybeans are the three largest crops subsidized in the United States today; arguably, the prices of these crops are influenced by subsidy payments. The goal of this thesis is to determine the effects of the prices of the top three subsidized crops on the thrifty market basket for families for four published by the USDA, factoring in transportation costs, market spread, agricultural technology advancements, and market value share. Previous studies have focused on direct subsidy payments as a whole and their aggregate influence on the price of food. This paper builds on the past studies by evaluating the effects of crop-specific programs on the cost of food. Econometric regression analysis was used to analyze the data gathered to support or refute the hypothesis that commodity prices and Federal payments do influence the cost of food. Initially data were gathered from January 1960 to December 2012. The data were adjusted for inflation using the Producer Price Index and Consumer Price Index where appropriate. After multiple attempts of modeling it was discovered that data from 1960 to 1970 needed to be discarded due to the difference in the market basket price calculations from the rest of the series. Furthermore, the model was adjusted based on the presence of multicollinearity, and the Hildreth-Lu Method was utilized to correct for the autocorrelation in error. The regression results illustrated that the only commodity of the three considered in the study that had a positive and statistically significant impact on the cost of food over the sample period was corn (p-value = 0.005). The coefficients on wheat and soybean prices were statistically insignificant. The historical fuel price had the expected positive sign and was statistically significant. The agricultural technology factor was not significant. The results also suggested that the cereal grains supply chain has significantly increased the cost of food. Both the cereal grain farm value share and the retail-to-farm spread for cereal grains were statistically significant (p-value < 0.000) with positive coefficients. The price spread of fruit was statistically significant, (p-value = 0.000), but the farm value was not. The regression results were initially surprising for the crop price variables. The overall analysis supports previous studies that crop subsidies alone may not have impacted food prices per se, but biofuel policies may have had unintended consequences. Crop-specific results provide more information to consider when discussing The Farm Bill and the implications of such a complicated and omnibus piece of legislation.