Young people are often constructed in academic and lay explanations as an inherently risky population. They are the age group most likely to feature in public health statistics, especially those of intentional and unintentional injury. A common risk factor cited in these statistics is conflict within or breakdown of an inter-personal relationship, in particular intimate heterosexual relationships. Intimate relationships serve as markers of normal adulthood in New Zealand society, and many young people invest significantly in them for their emotional and material rewards. This study investigated the social processes and experiences that influence young adult New Zealanders' perceptions of their own and others' intimate relationships. It employed an inter-disciplinary framework of critical interpretive medical anthropology and a public health approach with a lifecourse perspective. A multi-interview method was used involving more than 90 people interviewed either in focus groups, as couples, or as individuals. Interviews focused on young people's ideas and experiences of healthy and unhealthy relationships, as well as the influence of families, friends, and popular culture on relationships. Intimate relationships are based on naturalised gender differences that work to construct men as masculine/active and women as feminine/passive and hide disparities based on gender within a discourse of equality. The ideal healthy relationship is based on ideas of individualism, emotional and material inter-dependence, and the addition of other social networks into a partner relationship. Families are primary sources of information about and models for relationships. Friends are significant in establishing an adult identity separate to one's parents. Both families and friends are emotional safety nets in times of relationship difficulties. Understandings of popular culture and its products are most commonly experienced through gendered romantic narratives. Because of their ubiquity and popularity, information produced by mass media is particularly influential for young people. Overall, young people reported that relationships are a considerable source of joy to them. However, when problems occur, they tend to revert to stereotypical and gendered cultural scripts rather than relying on individual knowledge. To mitigate the possible negative effects of these scripts, knowledge of the skills required to overcome relationships difficulties need to be made explicit and fostered by relevant public health and education policy and promotion activities. / Subscription resource available via Digital Dissertations only.

Master of Public Health / Kinesiology / Brandon Irwin / Background: Emerging technologies (i.e. smartphones, Internet) may be effective tools for promoting physical activity (PA); however few studies have provided effective means of using them to enhance social support. Face-to-face programs that use group dynamics-based (GDB) principles of behavior change have been shown to be highly effective in promoting group cohesion and PA however few studies have examined their effects in web-based programs. The present study examines the effect of a GDB application on group cohesion and PA. We expected partner’s level of presence to moderate this effect. Methods: Subjects (n=135) were randomized into same-sex dyads and randomized to an experimental condition: low cohesion/low presence (LC-LP), high cohesion/low presence (HC-LP), high cohesion/high presence (HC-HP), or individual. Participants performed two blocks of planking exercises (pre-post). Between blocks, participants in partnered conditions were met their partner using either a standard social support application (LC-LP) or a GDB social support application (HC-LP and HC-HP), where they participated in a series of team-building exercises. Individual subjects were given a rest period. Participants in the HC-HP saw a live video stream of their partner exercising during Block 2. Perception of cohesion was measured using a modified Physical Activity Group Environment-Questionnaire (PAGE-Q). PA was calculated as performance during Block 2 controlled for by performance during Block 1. Results: Findings show that perception of cohesion was higher for the HC-LP condition compared to the LC-LP conditions in three of the four cohesion dimensions: ATG-S(p=0.002), GI-T(p=0.002), GI-S(p=0.022), but not ATG-T(p=0.170). Cohesion means did not differ between HC-LP and HC-HP conditions. Only the HC-HP condition produced significant gains in PA compared to other conditions (HC-LP: p=0.044; LC-LP: p=0.018; Individual: p=0.001). Conclusions: Findings suggest that a GDB application may be an effective method of improving group cohesion, however it may be insufficient on its own to improve PA. Increasing presence may be an effective method of improving performance during a single session of PA, however further research is needed to determine its effect on long term behavior change.

Doctor of Philosophy / Department of Psychology / James C. Shanteau / Four variables from the HBM of healthcare behavior were used to examine immunization decision making by the lay public. Although there was evidence to support the HBM in general, results of these studies suggest that up to 70% of the variance in immunization decision-making could be explained by disease base rates alone. When there is a main effect of immunization side effects, this effect was entirely within the most severe category of side effect. In initial four experiments, there was a consistent interaction between the variable of disease type and the variables of disease severity and immunization side effects. The fifth experiment showed an interaction between disease type and immunization efficacy. Functional measurement was used to examine the nature of the interaction between the variables of disease base rates and immunization efficacy. This interaction is neither clearly additive nor multiplicative. Disease base rate dominates the other variables, although each modifies immunization likelihood somewhat in interaction with disease base rates. Furthermore, results suggest that participants did not appear to react to the difference between different disease base rates when the probabilities are small. Participants also did not conceptualize immunization efficacy as a conditional probability. Suggestions for how to address these issues via decision support were made. The principle contribution of this study, however, is development of a methodology. The method developed here investigates the variables of the HBM in an ecologically valid factorial design. This approach takes the HBM beyond description of variables to provision of prediction and generalizable results.

Master of Public Health / Department of Diagnostic Medicine/Pathobiology / John A. Pickrell / Beef cattle feed lots produce significant, local point source pollution of the atmosphere. The dusts generated in the CAFOs are complex mixture of fine and ultra fine particles, organic compounds, transition metals, and adsorbed toxic gases. Since each component is toxic in itself, we do not fully understand the relative importance of each component in the dust and their interactions to inducing inflammatory changes in the lung. We did extensive literature searches to understand the mechanism of dust toxicity in respiratory system. This lead to focusing on solubility of dust in lung simulant fluid, and in-vitro study of release of two common biomarkers of inflammatory processes IL-6 and IL-8 from lung epithelial cells. Various concentrations (1 to 50%) of the dust extract induced release of IL-6, and IL-8 from lung epithelial cell as indicators of pro-inflammatory changes (IL-6), and amplification and maintenance of inflammation (IL-8). IL-6 release had dose dependence; peak production was seen with 25% dust extract. IL-8 production went down as the concentration of the dust extract increased from 1% to 25%. However, 50% dust extract was cytotoxic to the cell leading to 10-15% cell viability. At non-cytotoxic concentrations for lung epithelial cells, production of IL-8 was reduced. These findings suggested that higher exposure concentration were required to initiate inflammation as indicated by IL-6 release. Lower exposure concentrations (1 and 5% extracts) were related to optimal release of IL-8 needed to amplify and maintain the inflammatory response. Inhibition of endotoxin didn't significantly change the pattern of IL-6 or IL-8 release from epithelial cells. This finding suggested that at least a portion of the mechanism by which particle induced cytokine release from the lung epithelial cells was not endotoxin dependent. Heating samples at 1200C for 5 minutes modified some of the toxic properties of the dust extracts but didn't completely detoxify it. We observed that longer incubation period was required to peak release for both IL-6 and IL-8. However, the higher concentration of sample (50% extract) found to be cytotoxic in non-heat treated sample was no longer cytotoxic and induced both IL-6 and IL-8 release from the lung epithelial cells. This result suggested that heat treatment could reduce some of the dust extract's cytotoxic properties. However, the extract's potential to induce peak cytokine release increased.

Master of Public Health / Public Health Interdepartmental Program; Kinesiology / David A. Dzewaltowski / After-school programs are considered to have great potential to provide opportunities for increasing physical activity. One factor that may influence the success of a physical activity intervention is program implementation. The purpose of this study is to understand factors that influence implementation of a 30 minutes structured physical activity session in an after-school program. After-school staff (organizational leaders, site program managers and fourth grade group leaders), from four after-school sites attended three trainings over the academic year and were given the goal to implement 30 minutes of daily structured after-school physical activity to fourth grade children following CATCH guidelines. At the end of the year two organizational leaders (mean age = 55.0), four program managers (mean age = 27.3), and 13 group leaders (mean age = 21.3) were interviewed (N = 19) and completed a survey. Interviews were recorded, transcribed and analyzed using QSR NVivo software. Several factors influencing implementation were revealed. First, program managers and group leaders believed that they were successful in leading structured physical activity. However, their definition of success was less than the evidence-based protocol that required structured physical activity five days a week for 30 minutes. Staff believed that increasing the amount of unstructured activity offered and offering structured physical activity three days a week met the standard. Second, structured physical activity was not implemented as intended due to several organizational and staff barriers. The organizational barriers included: prioritizing physical activity, lack school administration support, lack program manager support, high group leader turnover, and low training attendance. The staff barriers included: low group leader motivation, and providing children with enjoyable CATCH games. Third, implementation of structured physical activity was facilitated by several organizational and staff variables. These facilitators included equipment/gym space, training, scheduling structured physical activity, support from the organizational leaders, and program manager and group leader self-efficacy. The final factor influencing program implementation was the use of individual strategies by program managers and group leaders. These individual strategies included restructuring the after-school program, obtaining physical education teacher support, and participating with the children in structured physical activity. Findings from this study suggest that the success of the after-school intervention is dependent on many factors, including several organizational system variables, as well as several staff variables. Program managers and group leaders negotiated these organizational and staff barriers and believed that they were successful in leading structured physical activity. However, their definition of success was less than the evidence-based protocol that required structured physical activity five days a week for 30 minutes. They defined successful implementation as increasing the amount of structured and unstructured physical activity daily. Future research should examine if targeting the organizational and staff variables identified in this study leads to greater program implementation.

Master of Science / Department of Kinesiology / David A. Dzewaltowski / Physically active games are one way to increase caloric expenditure in children. It is unknown if the structure of physically active games impacts physical activity levels. Furthermore, there has been no research examining psychosocial responses during a single game session. This study examined the effects of elimination games (EG) and non-elimination games (NEG) on physical activity (PA), self-efficacy (SE), peer victimization (PV), and enjoyment in children. Children (n=29) in 4th-6th grade (65.5% male) participated in two sessions where they played either NEG or EG. Children were stratified according to gender and weight status into game sessions that were counter-balanced across two days. Each session consisted of playing two games 20 min. in duration. NEG were adopted from the evidence-based Coordinated Approach to Child Health (CATCH) games curriculum and modified for EG. Each child wore an Actigraph GT1M accelerometer and completed an 11-item questionnaire measuring self-efficacy, peer victimization, and enjoyment before and after each game session. Accelerometer data was analyzed using resting energy expenditure (METs). A mixed effects regression model was conducted with child and day nested within child as random effects and observation, game session, weight status, and gender as fixed effects. Overall, girls spent more time in sedentary PA compared to boys (p=0.0123). Children engaged in significantly more moderate-vigorous PA during NEG compared to EG (p=0.0013), ostensibly because of more time in moderate PA during NEG (p=0.0002) and less time in sedentary PA (p<0.0001). Furthermore, children significantly increased SE after playing both game sessions (p=0.0349), but a significant interaction between game session and time of measurement in the prediction of enjoyment showed that enjoyment increased after EG and decreased after NEG (p=0.0138). There were no differences in PV or weight status. These results provide preliminary evidence that NEG provide a greater amount of moderate-vigorous PA compared to EG and introduces differences in enjoyment responses during EG and NEG. Therefore, it is important to promote NEG to increase physical activity, but also important to monitor enjoyment responses to promote a healthy, but fun environment for children.

Master of Public Health / Public Health Interdepartmental Program / Tandalayo Kidd / Heart disease, cancer, stroke, and diabetes are the leading causes of death in the United States. In addition, the prevalence of obesity has significantly increased since the 1970s. In Kansas, 37% of adults are overweight and 24% are obese. These chronic diseases and conditions tend to be prevented by and/or managed with both adequate physical activity and a healthy diet rich in fruits, vegetables, and whole grains. In Kansas 48.5% of adults meet the current recommendations for physical activity set by the American Heart Association, while 20% of adults consume the recommended amounts of fruits and vegetables. Public health officials need to work together to encourage Kansas adults to increase their participation in physical activity and consumption of fruits and vegetables to help prevent future health problems or manage current chronic diseases. To help address these health issues in Kansas, Kansas State University Research and Extension developed the 8-week Kansans Move into Health nutrition and physical activity program, building its framework around the Theory of Planned Behavior (TPB). Using TPB, participants address attitudes and perceived norms as well as perform specific behaviors associated with healthy eating and physical activity. The purpose of this study was to evaluate the effectiveness of condensing the 8-week nutrition and physical activity program into four one-hour classes using a pre- and post-survey. Nineteen participants from the Johnson County community signed up to participate with 63% (n=12) completing the program. Results indicated that participants changed their belief that nutritious foods are more expensive (p≤0.05). Furthermore, participants gained knowledge in how to prepare healthy snacks that are quick and easy. All other measures did not change (n=19; p>0.05). Future research evaluating longer program interventions could better assess attitudes and perceived norms associated with healthy behaviors and determine whether the increase in knowledge leads to behavior change.

Master of Science / Department of Special Education, Counseling, and Student Affairs / Brandonn S. Harris / The present study examined adolescents’ perceptions of their caregivers’ parenting style as well as their physical activity participation, motivation, and attitudes. High school students completed questionnaires regarding their physical activity participation, motivation, and attitudes, and they assessed both their male and female caregivers’ parenting style. Results indicated that for males, a permissive parenting style was related to more physical activity participation and that males favor physical activity that features long and hard training and as a way to stay healthy and fit. An authoritative parenting style was related to higher rates of physical activity for females, and their attitudes focused on social aspects of physical activity as well as a release of tension. For both genders, identified regulation was associated with higher rates of physical activity, indicating that higher levels of self-determined motivation are important for promoting active behaviors. Cross-gender relationships between caregiver and child emerged and social and gender norms seemed to influence parenting style and attitudes specific to gender. Additional results and implications are discussed.

Master of Agribusiness / Department of Agricultural Economics / John A. Fox / Child mortality is defined as the death of children under five years old. Worldwide, child mortality was about 8.1 million in 2009, of which over fifty percent is related to diarrhea, pneumonia and malaria. Food and water borne pathogens are an important cause of deaths related to diarrhea and pneumonia. Illiterate or semi-literate populations are often slow to adopt food and water safety standards. Practices such as washing of food in sewage water, which would repulse most westerners might be considered normal in some parts of the world. Understanding some of the basic science underlying food safety standards is important for the farm worker in California, the villager in Africa and the child in Afghanistan. Ultimately, food safety practices in production can affect the consumer of agricultural products no matter where they are in the world, and inadequate food safety standards can affect the producer as a result of diminished consumer confidence in their product, or lack of access to export markets. In the instance of food contamination, young children and the elderly are typically most at risk. Perhaps the most sobering consequence of inadequate food safety standards is child mortality. This thesis uses a regression model to investigate determinants of the level of child mortality. We find that income distribution and levels of tertiary education, particularly for females, are significantly correlated with child mortality rates. Estimates suggest that a one percent increase in tertiary education in the female workforce is associated with a reduction of almost seven percent in the child mortality rate in countries where the rate of female tertiary education is below fifteen percent.

Master of Science / Department of Industrial & Manufacturing Systems Engineering / Jessica L. Heier Stamm / The main goal of public health emergency preparedness efforts is to mitigate the impact of events on the health of the population. However, decision-makers must also remain conscientious of the costs associated with these efforts. Planning is further complicated by uncertainty about the location and volume of demand that will need to be met in an emergency, the speed with which demand must be met, and the potential scarcity of needed items once an emergency occurs. To address these challenges, public health emergency planners often keep inventory stockpiles that are distributed when an event happens. Managing these stockpiles is a difficult task, and inefficient stockpile location and equipment distribution strategies can be costly both in terms of cost and public health impact. This research is motivated by challenges faced by state public health departments in creating stockpile location and equipment distribution strategies. The primary emphasis is on facemasks and respirators used by health workers during an influenza pandemic, but the approach is generalizable to other scenarios. The model proposed here uses a two-stage approach to generate a holistic solution to the problem. The first stage uses a pull distribution strategy to make stockpile location decisions. Additionally, it determines how counties should be assigned to stockpiles to minimize both storage and distribution costs. The second stage adopts a push distribution strategy to determine optimal delivery routes based on the county assignments made in stage one. This stage offers guidance for public health planners who have made location-allocation decisions but who then face a different distribution scenario than what was anticipated in the original planning phase. Recourse methods for managing demand uncertainty are also proposed. A case study of the state of Kansas is conducted using the methods introduced in the thesis. The computational results yield several significant insights into the tradeoffs and costs of various facility location-allocation and vehicle routing decisions: • For the tested range of storage and distribution cost parameters, multiple stockpile locations are preferred over a single location. • In a pull distribution system, storage costs play a greater role in location-allocation decisions than distribution costs. • In the push distribution system, finding an optimal vehicle routing plan is computationally intensive for stockpiles with a large number of assigned counties. • Efficient heuristics perform well to design recourse routing plans when realized demand is greater than expected. • In the event that planners wish to specify routes well in advance, the results of this research suggest adopting a robust routing plan based on higher-than-expected demand levels. This thesis makes three important contributions. The first is an optimization approach that considers multiple distribution strategies. This is especially relevant when stockpiling for an influenza pandemic where stockpiles need to be located significantly before the material is needed, during which time the distribution strategy may change. Second, the case study demonstrates that the proposed methods are applicable to a large-scale problem arising in practice. Finally, this research illustrates for decision-makers the tradeoffs between different stockpile management strategies and between optimal and heuristic methods.