Indoor tanning (IT) before the age of 35 increases one’s risk for melanoma by 75%, and epidemiological data show a 6.1% annual increase in the incidence of melanomas in white women younger than age 44 in the US. Population-based studies reveal that 15% of adolescents and 8% to 14% of their primary caregivers have engaged in IT in the past year. The compelling case for IT being a significant risk factor for melanoma, together with the high rates of IT in teen girls and their mothers, provided a strong rationale for conducting an antitanning intervention directed at mother-daughter dyads. This study evaluated a strategy designed to prevent skin cancer in adolescent girls by using mothers as change agents to effectively communicate the risks of IT and to encourage teens to avoid high risk IT behaviors. Mother-daughter dyads were recruited over the telephone, randomly assigned to the intervention or control group, and surveyed on IT risk constructs including tanning-specific knowledge and communication. Forty-two mother-daughter dyads completed baseline surveys in the summer of 2012. Mothers in the intervention group were given a handbook educating them on the dangers of IT and how to convey information about skin cancer prevention to their daughters and encouraged to talk with their daughters about the issues covered in the handbook over a 1-month period. Participants completed follow-up assessments in October 2012 and January 2013. Among teens, past 3-month IT frequency, intentions, and willingness decreased in intervention group teens, while intentions and willingness increased among control teens. Intervention teens exhibited lower IT attitudes and higher levels of perceived susceptibility to appearance damage and health effects from IT when compared to control teens. Intervention teens reported higher levels of maternal monitoring and lower levels of maternal permissiveness toward IT. Qualitative data indicated mothers responded positively to the handbook, and it encouraged tanning-specific discussions with their daughters. Mothers provided suggestions on how to improve the handbook, that once incorporated, should lead to improved intervention efficacy. Overall, study results indicated this intervention strategy is feasible, as mothers did communicate with their teens and were able to convey the antitanning messages.

Background: The utilization of telehealth has had a substantial impact on transforming and enhancing the methods by which healthcare is presently delivered. The potential benefits of telehealth in improving the health of vulnerable populations and underserved communities are substantial. The aims of this study were to examine the association between social determinants of health and patient perceptions of their experiences with telehealth. We will analyze how perceptions differ across specialization, race, gender, and other key determinants; examine how patient’s self-rated physical health and mental health influences perceptions and attitudes about telehealth utilization; and evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences between mental health providers and non-mental health providers. Methods: A scoping review was completed to explore literature regarding telehealth administration and underserved populations following the PRIMSA-ScR guidelines. Multivariable logistic regression was then conducted to assess the relationship between self-rated mental health and self-rated physical health and the primary predictor variables telehealth usability, telehealth satisfaction, and telehealth experiences. Finally, a mixed-methods study was conducted to evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences mental health-care providers and non-mental healthcare providers. Results: The scoping literature review highlights how telehealth is used in diverse settings, but more research needs to be done to determine best practices for both healthcare providers and patients utilizing telehealth. The study focused on self-reported health found significant associations between high mean scores on telehealth usability, telehealth satisfaction, and telehealth experiences and good self-reported mental and physical health. Lastly, the study looking at provider differences highlighted that the reliability of the telemedicine platform, the ability to trust the telemedicine application, and video visits being a convenient form of healthcare delivery was greater for mental healthcare providers than non-mental healthcare providers. Implications: These findings highlight the need for studies examining telehealth satisfaction, telehealth usability and telehealth experiences amongst providers and patients in underserved areas. Further research is needed to gain a deeper understanding of the telehealth access requirements of underserved communities and can aid in the development of evidence-based guidelines for the delivery of telehealth services.

Tennesseans have been experiencing increasing rates of sexually transmitted diseases since the year 2000. Those rates are highest among those 15- to 24-year-olds. At the same time, Tennessee policy requires the teaching of abstinence as the primary form of sexual health education and emphasized the use of abstinence-only curriculum. The school nurse represents an available resource in the Tennessee public schools. The purpose of the qualitative study was to explore, describe, and interpret the perceptions and experiences of public-school nurses from rural, suburban, and urban areas of Tennessee related to the sexual health and sexual health education of students. School nurses were recruited from across the state and from a variety of communities to complete an electronic survey and to participate in individual interviews. Critical Discourse Analysis was used to analyze results in the context of the existing sociocultural and power structures. The research plan included a comparison of results from participants in rural, suburban, and urban areas that could not be done because of the limited responses obtained from potential participants. Emerging themes in light of the limited participant responses created a view of power structures within the context of existing conditions that may be impacting the sexual health of students.

The purpose of this study is to determine the effects of increased resistance training frequency on strength and hypertrophy in trained individuals. Six Studies were deemed eligible based on the inclusion exclusion criteria. The inclusion criteria for this review were healthy trained individuals. “Trained” refers to over one year of resistance training experience. Exclusion Criteria were study’s that examined either untrained or obese individuals as participants. The evidence indicates a dose-response trend in frequency. Resistance training each muscle group twice a week may be superior compared to once per week. Further more, resistance training each muscle group three times a week may enhance hypertrophy and strength adaptations even more compared to either once or twice a week. Recovery of the muscle may be reached in approximately 72 hours or 3 days. Mechanisms that may correlate to this phenomenon could be related to the more frequent elevations in muscle protein synthesis and physiological anabolic hormones. These results may help develop more specific guidelines in programming for intermediate to advanced athletes as well as lead way to more research on acute training variable manipulation.

Childhood obesity is a foremost concern throughout the health care community. Approximately 17.6% of the pediatric population meet the criteria for obesity, which can lead to health disparities later in life, such as hypertension, type 2 diabetes mellitus, and metabolic syndrome. Emerging mobile and wearable lifestyle tracking devices can be a viable solution to the challenging problem of childhood obesity through behavior changes, feasibility, and adherence. The purpose of this literature review was to determine the effect that mobile and wearable activity tracking devices have on the obese pediatric population. A centralized review of the literature was conducted using various data basesand resulted in 19 articles. 5 articles were chosen to review in more detail. 13 other articles were hand searched through credible resource citations, rendering 14 articles that met all criteria. The three general themes found in this literature review suggest that wearable activity tracking devices can be designed and effectively used by the pediatric population. Also, wearable activity tracking devices are accurate in conveying information on physical activity, calories, and heart rate. Lastly, wearable activity tracking devices can initiate behavioral changes in children leading to an increase in physical activity, resulting in the prevention and treatment of pediatric obesity.While in a majority of the studies analyzed trails were short. The research suggests wearable activity tracking devices will produce the desired results of increased activity in pediatric populations when they are worn correctly, are adequately engaging, and when they are designed in a feasible manner that is appealing to children.

<p>The purpose of this thesis was to explore how health units servicing large rural populations in Ontario are integrating the built environment into public health interventions related to physical activity for the purpose of fostering healthy and sustainable communities. Additionally, this research sought to identify barriers and/or enabling structures that rural health units face in addressing the built environment within physical activity programming.</p> <p>This exploratory research study employed a descriptive qualitative approach. Semi-structured interviews were conducted with a purposeful sample of public health practitioners and managers identified by participating health units (n=12) as those most knowledgeable about program planning, implementation, and policy development in relation to physical activity and the built environment. Key themes were identified using qualitative content analysis and an inductive approach.</p> <p>The types of interventions were: engagement with policy work at a county or municipal level; building and working with community partners; gathering and providing evidence; hosting knowledge sharing opportunities; program development and implementation; social marketing, information sharing and awareness raising; and resource development and dissemination. Barriers and enabling processes and structures were identified at an organizational, community, and systemic level. Specific rural contextual enablers and barriers were also identified.</p> <p>This was the first study to the researchers’ knowledge that has examined current practices of Ontario’s rural health units related to built environment initiatives. In-depth perspectives elicited from public health practitioners and managers address gaps in the literature and contributes to new knowledge regarding built environment interventions to enhance physical activity in rural settings.</p> / Master of Science (MSc)

<p>We defined hypertension in pregnancy as a composite of gestational hypertension, preeclampsia and eclampsia. The etiology of hypertension in pregnancy remains controversial. The three chapters of this thesis explore the risk of hypertension in pregnancy from various kidney conditions. Chapter 1 introduces the reader to the thesis. Chapter 2 is a systematic review that studied the risk of developing hypertension in pregnant women with chronic kidney disease but not on dialysis. We found that women with chronic kidney disease had at least a twofold higher relative risk of developing hypertension during pregnancy compared with women having no chronic kidney disease. Chapter 3 is a retrospective study looking at the risk of developing gestational hypertension and preeclampsia in women who had symptomatic gastroenteritis after drinking water infected with <em>E. coli</em> O157:H7 during the Walkerton outbreak in May 2000. We conducted this study using linked datasets at the Institute of Evaluative Sciences (ICES) Toronto, Ontario. We observed that there was no increased risk of developing gestational hypertension or preeclampsia among the symptomatic women compared with women from the neighbouring towns who were asymptomatic or did not drink the water. Chapter 4 is a protocol of a prospective cohort study recruiting female kidney donors and healthy non-donors as the comparative group to study pregnancy outcomes in these individuals. This is a multicentre study involving 12 transplant centres throughout Canada. There are 59 participants in this study to date (Feb 28, 2013) of which seven have been pregnant so far. Data collection for this study is ongoing.</p> / Doctor of Philosophy (PhD)

Introduction The prevalence of prediabetes in adults aged 18 or older was as high as 38% between 2017-2020. Youth-onset T2DM is a more aggressive phenotype than T2DM that occurs later in life. Young adults with T2DM have poorer health outcomes, lose an average of 15 years of life, all resulting in significant economic burden impacting the person. Current self-management interventions do not improve health outcomes in young adults with T2DM. Purpose The purpose of this research was to explore the self-care experiences of young adults living with T2DM. Methods Existential hermeneutic phenomenology informed the research. Inclusion criteria as follows: adults aged 18 to 30 with a self-reported diagnosis of T2DM, physical presence in the United States, English proficiency. Purposive and snowball sampling were used. Nineteen participants were interviewed: 16 self-identified as Black, 2 as White, and 1 as Latino. Interviews were transcribed verbatim. Transcripts were analyzed using an iterative approach for meaning units and themes. Thematic meanings were identified from the data. Results The grand theme my journey and two themes: finding out and navigating, three subthemes include distress, around me, and my duties. The second subtheme, around me, included two micro themes: support and juggling. The third subtheme, my duties, included three micro themes: exercise, education, and trigger surveillance. Several factors were unique to young adults' perception of self-care. Perceptions of time, support networks, novel coping strategies, and search for disease literacy impacted self-care perceptions and understanding. Results suggest the need for future person-centered, self-care intervention research with young adults that could result in improved health outcomes.

Objective: Evaluate how a social marketing approach compares to traditional nutrition education curriculum for promoting behavioral changes related to eating and food. Design: Nonequivalent comparison group, entry-exit design. Participants from 12 Kentucky counties assigned either comparison or pilot group. Comparison group received traditional nutrition education curriculum and pilot group received the social marketing program, Cook Together, Eat Together (CTET) curriculum. EFNEP’s Behavior Checklist and 24-Hour Dietary Recall were administered at entry and exit of the 8-week programs. Participants: Females (18-72 years of age) from families eligible to receive SNAP benefits (n=64 comparison group participants, n=60 pilot group participants). Intervention: Comparison group completed an 8-week standard lesson and pilot group completed CTET program in varying time frames (1-8 weeks). Main Outcome Measures: Eating behavior changes between entry and exit for comparison versus pilot. Analysis: Quantitative data were analyzed using independent and paired t-tests with significance of P≤ 0.05 and 0.10. Results: Groups were demographically similar. Both had significant differences in entry and exit scores for Behavior Checklist and 24-Hour Recall (P≤ 0.05). Conclusion and Implications: Positive behavior change was observed in both comparison and pilot groups. A social marketing program proves to be a promising approach to nutrition education.

Cervical cancer rates among Vietnamese American women are the highest when compared to other women of color and white women. In an article by Taylor, Nguyen, and McPhee, a majority of Vietnamese Americans immigrated to the United States over the last three decades; and the President's Advisory Commission on Asian Americans identified cervical cancer among Vietnamese women as one of the most important health disparities experienced by the Asian American population. HPV vaccination, according to the CDC, helps prevent cervical cancer and it is recommended that female and male preteens, ages 11 or 12, receive the vaccination. My research aims to better understand what second generation Vietnamese American women know about the HPV vaccination, their relationship to healthcare, and their overall health. By interviewing second generation Vietnamese American women, I hope they become more empowered to ask their doctors about health disparities that affect their communities. In looking at preventative measures to cervical cancer and trying to better understand a vulnerable population's relationship to healthcare, I hope that the rates of cervical cancer will go down in Vietnamese American women. Furthermore, I hope to push for greater disaggregation of data collection among Asian American populations to better understand the health disparities that affect the various ethnicities that fall under the umbrella term, Asian American.