This research project is located in the context of Aboriginal health and education, and in particular, emotional and social wellbeing, recognising the critical need for effective mental health services and resilient, well-trained workers in the field of mental health.Mental health is understood to include a broad spectrum of conditions with extreme and chronic mental illness at one end and resilience or wellbeing at the other – the socalled ‘soft end’ of the social health spectrum. While recognising that the lines of demarcation between one category and another are grey, my thesis addresses the problems at the latter end of the spectrum: problems of excessive pain; the grief and despair caused by dispossession, loss of place, family and identity; and the deep frustration, humiliation and anger that results in family violence and child sexual abuse, intergenerational substance abuse, neglect and poor physical health. It is my position that very many Aboriginal people who need to make changes in their lives in order to feel well and functional in the world are not suffering from a Western disease but from the transgenerational consequences of colonisation. In recognition of the notion that Aboriginal wellbeing is everybody’s business, this PhD research project represents my response to these consequences.While popular assumptions are made about the relevance of art to Aboriginal health and many Aboriginal people testify to the fact that their engagement with art (writing, drama, dance, music and visual art etc.) has brought about significant change in their lives, there is no available research in Australia that supports the development of an arts-based approach to learning/therapy/wellbeing that has, for reasons that are well understood, the potential to suit the needs of Aboriginal people.Addressing this gap in the research, I inquire into an experiential, arts-based, emotionfocused, narrative-orientated, constructivist approach to healing in the tradition of humanistic psychology, which emphasises the importance of an emancipatory, clientcentred processes that facilitates the development of awareness, creativity, clarity of expression and critical reflection. The position I take breaks with the traditions of the biomedical model and conforms to the now widely held view that psychology and counselling treatment programs for Aboriginal people must address the whole person, emotionally/spiritually, mentally and physically, responding to the individual in his/her sociopolitical and historical context. Expressive arts therapy, the multi-modal approach to healing explored in this thesis, lays claim to these intentions.In this project, I locate myself as the researcher/practitioner whose life-stance is expressive of the phenomenological principles of experiential learning and reflexivity. Accordingly, I have drawn on a number of closely related research methodologies all of which, I argue, are consistent with phenomenology and Indigenous, participatory research practices: critical action research, art-based research and phenomenological research methodology. These modes of inquiry are linked through principles that value subjective experience and allow for a diversity of ways of knowing. Embracing an expanded field of ways of knowing respectful of Indigenous epistemologies is at the core of the arts-based therapy program under investigation.Expressive arts therapy, in this research project, was delivered in two modes: one was a series of nine full-day group workshops conducted over an academic semester; the other was a series of ten intensive individual therapy sessions with three participants conducted over the period of a year. The participants or ‘co-researchers’ were drawn from the College of Indigenous Australian Peoples and the Education and Art departments at Southern Cross University. Three mature-age Aboriginal students who had engaged in the Masters of Indigenous Studies program emerged as the core participants who, having contributed to the development stage of the project, followed the program through the group workshops to the final interviews at the end of the series of individual sessions.This thesis is, in part, an illustrated narrative of the in-depth work the core participants did with me in both the context of the group and individually. It invites the active participation of the reader. Insights into the nature and impact of expressive arts therapy are offered through a focus on the lived experience of the three core participants, their reflections on the program and their observations of the changes they made in their lives. An important parameter that I set, determined that the ultimate voices of authority were to be those of the participants. I was not at liberty to look for meanings that went beyond their experience and understanding.I argue that the experiences of expressive arts therapy re-presented in this thesis demonstrate that expressive arts therapy is in principle consistent with current approaches to Aboriginal psychology and counselling currently recommended by Aboriginal professionals and spokespeople in the field of Aboriginal health. Furthermore this body of work demonstrates that expressive arts therapy is a culturally appropriate intervention grounded in a creative process that has the potential to facilitate healing and change in the lives of people suffering from the long-term consequences of damaging childhoods.It is my hope that this approach to healing will be further researched and developed and, with culturally appropriate terms of reference, adapted to a wide variety of existing community services – rightfully, Aboriginal and Torres Strait Islander practitioners working for the wellbeing of their own people.

This research project is located in the context of Aboriginal health and education, and in particular, emotional and social wellbeing, recognising the critical need for effective mental health services and resilient, well-trained workers in the field of mental health.Mental health is understood to include a broad spectrum of conditions with extreme and chronic mental illness at one end and resilience or wellbeing at the other – the socalled ‘soft end’ of the social health spectrum. While recognising that the lines of demarcation between one category and another are grey, my thesis addresses the problems at the latter end of the spectrum: problems of excessive pain; the grief and despair caused by dispossession, loss of place, family and identity; and the deep frustration, humiliation and anger that results in family violence and child sexual abuse, intergenerational substance abuse, neglect and poor physical health. It is my position that very many Aboriginal people who need to make changes in their lives in order to feel well and functional in the world are not suffering from a Western disease but from the transgenerational consequences of colonisation. In recognition of the notion that Aboriginal wellbeing is everybody’s business, this PhD research project represents my response to these consequences.While popular assumptions are made about the relevance of art to Aboriginal health and many Aboriginal people testify to the fact that their engagement with art (writing, drama, dance, music and visual art etc.) has brought about significant change in their lives, there is no available research in Australia that supports the development of an arts-based approach to learning/therapy/wellbeing that has, for reasons that are well understood, the potential to suit the needs of Aboriginal people.Addressing this gap in the research, I inquire into an experiential, arts-based, emotionfocused, narrative-orientated, constructivist approach to healing in the tradition of humanistic psychology, which emphasises the importance of an emancipatory, clientcentred processes that facilitates the development of awareness, creativity, clarity of expression and critical reflection. The position I take breaks with the traditions of the biomedical model and conforms to the now widely held view that psychology and counselling treatment programs for Aboriginal people must address the whole person, emotionally/spiritually, mentally and physically, responding to the individual in his/her sociopolitical and historical context. Expressive arts therapy, the multi-modal approach to healing explored in this thesis, lays claim to these intentions.In this project, I locate myself as the researcher/practitioner whose life-stance is expressive of the phenomenological principles of experiential learning and reflexivity. Accordingly, I have drawn on a number of closely related research methodologies all of which, I argue, are consistent with phenomenology and Indigenous, participatory research practices: critical action research, art-based research and phenomenological research methodology. These modes of inquiry are linked through principles that value subjective experience and allow for a diversity of ways of knowing. Embracing an expanded field of ways of knowing respectful of Indigenous epistemologies is at the core of the arts-based therapy program under investigation.Expressive arts therapy, in this research project, was delivered in two modes: one was a series of nine full-day group workshops conducted over an academic semester; the other was a series of ten intensive individual therapy sessions with three participants conducted over the period of a year. The participants or ‘co-researchers’ were drawn from the College of Indigenous Australian Peoples and the Education and Art departments at Southern Cross University. Three mature-age Aboriginal students who had engaged in the Masters of Indigenous Studies program emerged as the core participants who, having contributed to the development stage of the project, followed the program through the group workshops to the final interviews at the end of the series of individual sessions.This thesis is, in part, an illustrated narrative of the in-depth work the core participants did with me in both the context of the group and individually. It invites the active participation of the reader. Insights into the nature and impact of expressive arts therapy are offered through a focus on the lived experience of the three core participants, their reflections on the program and their observations of the changes they made in their lives. An important parameter that I set, determined that the ultimate voices of authority were to be those of the participants. I was not at liberty to look for meanings that went beyond their experience and understanding.I argue that the experiences of expressive arts therapy re-presented in this thesis demonstrate that expressive arts therapy is in principle consistent with current approaches to Aboriginal psychology and counselling currently recommended by Aboriginal professionals and spokespeople in the field of Aboriginal health. Furthermore this body of work demonstrates that expressive arts therapy is a culturally appropriate intervention grounded in a creative process that has the potential to facilitate healing and change in the lives of people suffering from the long-term consequences of damaging childhoods.It is my hope that this approach to healing will be further researched and developed and, with culturally appropriate terms of reference, adapted to a wide variety of existing community services – rightfully, Aboriginal and Torres Strait Islander practitioners working for the wellbeing of their own people.

Purpose Study explored the relationships of ethnic identity, culture, and social cohesion to mammography, cancer screening, and preventive medical visits among African-American and Afro-Caribbean women in Broward County, FL. Purpose was to understand non-compliance to screening recommendations for breast cancer among disadvantaged Black women in an area of high prevalence. Methods A bounded convenience sample of 117 women (49% African-American and 51% Afro-Caribbean) completed a cross-sectional survey and a subset (n=87) participated in semi-structured discussion groups. Both measured perceptions related to breast cancer, defined ethnic identity or culture, and suggested social and cultural factors influence of ethnic identity, culture, and social cohesion on participation with mammograms and preventive medical care visits. Survey included the Multi-Group Ethnic Identity Measure (MEIM) and Other-Group Orientation Scale (OGO) for ethnic identity and the Risk Behavior Diagnosis Scale for cancer perceptions. Methods were bivariate, Mann-Whitney U, linear, and logistic regression. Results Half of participants (51%) self-identified as Caribbean. OGO was positively associated with overall attitudes (p< 0.01), perceived urgency (p = 0.05), and perceived benefit related to breast cancer. Linear regression indicated that Afro-Caribbean women (referent) would perceive less urgency to screen (p = 0.05) and lower risk for breast cancer (p = 0.03) than African-American women. Participants explained that personal and neighborhood cultural norms along with health perceptions along with structural factors connected to access and use of medical services influence Black women’s participation in preventive medical services and cancer screening. Conclusions Ethnic identity was associated with women’s perceptions of risk, urgency, and benefit for breast cancer screenings. These perceptions may have had a greater influence on the decisions of Afro-Caribbean women not to comply with screening recommendations or participate in preventive medical care actives than for African-American women. Compliance was also mediated by cultural perceptions of fear, relevance, motivation, and sense of support along with other structural factors. All had contributed to the varying degrees that Black women had sought medical care in this community. Thus, tailoring health interventions to account for variations in within-group characteristics is warranted. [This research was supported in part by NIH/NIGMS R25 GM061347.]

This thesis attempts to apply the theory of rational disease dynamics to the human papillomavirus by testing whether HPV vaccinations are prevalence elastic. A prevalence elastic relationship suggests that HPV vaccination rates respond positively to increasing prevalence rates of cervical cancer. Prevalence rates are measured both by incidence rates of cervical cancer and by mortality rates of cervical cancer. Data from the NIS-Teen Survey as well as data from the United States Cancer Statistics branch of the Centers for Disease Controls are used to construct a linear regression that controls for income, education levels, proxies for social culture, and proxies for physician access. Incidence was found to have no statistically significant effect on vaccination rates, while mortality rates were found to have a negative relationship with vaccination rates, suggesting that the rational disease dynamics theory does not apply to human papillomavirus and that vaccination rates for HPV are not prevalence elastic.

Equestrian sport is a popular exercise choice for females of all ages, although the links between this exercise choice, health outcomes, and risk to health have not been thoroughly examined. These issues are of particular interest because the female equestrian has the opportunity to ride and/or compete for decades, from early to very late in life, covering almost the full sequence of the female lifespan. Equestrian sports provide physical activity through riding and caring for the horse, and promote positive mental outcomes through tangible practices, such as engaging in physical activity and hard work, goal-setting, acquisition of skills, and participation in a strong community of practice. Equestrianism is an under-researched activity and sport, but increased understanding of female equestrian health and wellness outcomes may contribute to better health and wellness outcomes for female riders. Since equestrian sports participants are predominantly female, with 74% to 80% of the riding population being women, it is important to understand and potentially improve the health and wellness of female riders. This improved understanding may provide their riding careers with increased longevity, comfort, and healthy. It may allow them to enjoy the sport, whatever their age, minimizing or preventing any health issues. A deeper understanding of mental and physical changes from riding will educate and empower women so they are making informed decisions as they ride, talk to their coaches and doctors, and invest in equipment ranging from sport-specific bras to saddles. Manufacturers may also become aware of the potential opportunity to market female-focused products to this community of practice, which has a demonstrated commitment to the horse and accompanying expenditures. Most research is centered on the horse or major equestrian injuries (death, concussion, bone breakage), but it is hypothesized that having an increased understanding of other health issues, ranging from breast, bladder, and groin health to bone density, weight, and body image, may be of great value. The following master’s thesis will review the current literature related to female health as it relates to equestrian sports; report results of a research survey conducted about female equestrian health and wellness, with a focus on breast health and bra use; discuss the survey results; and make recommendations for future research in this area.

Among women in Haiti, there are a number of factors, including intimate partner violence (IPV), childhood sexual abuse, and alcohol abuse that lead to increased vulnerability to STI/HIV and its sequelae. This study examined the factors associated with IPV and the associations between IPV and HIV in a sample of adult Haitian women. The current study is a secondary analysis of data collected from HIV+ and HIV- women attending the GHESKIO centers in Haiti. The measures include: Self-reported Questionnaire-20 (SRQ-20); Attitudes Towards Gender Roles; Partner Violence; Alcohol Use Disorders Identification Test (AUDIT); Partner Support; Sexual Relationship Power Scale (SRPS); Centers for Epidemiological Studies Depression Scale (CES-D); the State-Trait Anxiety Inventory (STAI); and, Vaginal Episode Equivalent (VEE). Descriptive statistics were used for demographic characteristics. Pearson correlations, t-Test, Generalized linear model, Logistic regressions, and Generalized linear mixed models were used for estimating the strength of associations. The mean (SD) age of the participants was 25.5 (5.4) years. Approximately 68.4% had some secondary school education and only 0.9% had a college or professional degree. The majority of participants (82.2%) had a partner, but did not live with them. Generalized linear mixed modelling showed that lack of family support (β = 0.28, p < 0.05), history of childhood sexual abuse (β = 0.66, p < 0.05), and traditional gender-based attitudes (β = 0.10, p < 0.001) predicted major IPV. Results from logistic regression analysis showed that age at sexual debut (AOR: 0.745; 95% CI: 0.585, 0.948) and physical violence (AOR: 3.482; 95% CI: 2.316, 5.235) were significantly associated with HIV seropositive status. Generalized linear mixed modelling analysis showed that decreased relationship control subscale scores (β = -0.26, p < 0.05) and alcohol use problems (β = 0.18, p < 0.05) were significantly associated with high levels of risky sexual behaviors over time. In summary, a history of IPV was significantly associated with traditional gender based attitudes, history of childhood sexual abuse, and lack of family support. History of IPV and age of first sexual experience were significantly associated with HIV seropositive status. Finally, relationship control and alcohol use problems were significantly associated with sexual risk behavior. These findings indicate potential areas of further study and intervention among Haitian women.

Obesity and related chronic diseases are emerging public health issues among children in Peru, where more than 13 percent of children five years and younger are overweight or obese. Although parents have been identified as one of the most important determinants of healthy weight in young children, there are no known studies that have explored the perceptions of Peruvian parents regarding obesity prevention. This study assessed the nutrition and physical activity knowledge, attitudes and behaviors of Peruvian parents, and sought to determine if there is a relationship between their knowledge, attitudes and behaviors. The cross-sectional survey study sampled 204 parents of three and four-year-old children attending five preschools in a resource-poor Southern Lima setting. The Pen-3 cultural model guided the assessment of parental characteristics using the BAQ-HH survey across three domains; knowledge, attitudes, and behaviors regarding diet and physical activity. Additional data was abstracted from school records to assess children’s BMI and compare parental perceptions of child’s weight with child’s measured weight status. Parent respondents were predominantly female (86%) between 20 and 39 years old (85.1%). Less than one third (30.5%) were receiving information about nutrition or physical activity. Data was available for 147 children of the participants, 53.7 % were female with a mean age of 49.4 months and a mean BMI of 16.7. Nearly half the children (41.3%) exceeded healthy weight. Parents demonstrated healthy knowledge and behaviors, but unhealthy attitudes. Parental knowledge and attitudes were predictive of behaviors (F(2,166)=5.826, p=0.004, R2=0.066). The majority (56.6%) of Peruvian parents accurately perceived their child’s weight status but 9.6% of parents of overweight and obese children were able to do so. Understanding the nutrition and physical activity knowledge and perceptions of Peruvian preschooler parents can advance local and national health ministry and public health obesity prevention initiatives for young children.

This mixed-methods study examined patterns of dental health care utilization in adult Hispanic migrant farmworkers (AHMFW) with special emphasis on non-compliance with the American Dental Association (ADA) and the American Dental Hygienists Association (ADHA) recommendation of visiting the dentist at least once a year; while also exploring the group’s social and cultural construction of oral health. A total of 278 farmworkers responded to a close ended survey. Binary and hierarchical logistic regression analysis were employed in identifying predisposing, enabling, and needs factors associated with non-compliance. Following the survey, fourteen ethnographic interviews were conducted with respondents who volunteered to participate in this phase of the study. Most participants (79.5%) were non-compliant with the ADA and the ADHA recommendation. Binary logistic regression results indicated that AHFW reporting need for dental treatment were compliant with the recommendation. In contrast, those who brushed their teeth more often, experienced oral health impact, and reported poor perception of their mouth condition were non-compliant. Hierarchical logistic regression results pointed to those who used floss and reported need for dental treatment as compliant with the recommendation. Participants reporting poor perception of their mouth condition were non-compliant. Eight themes emerged from the qualitative analysis (understanding of the mouth, meaning of oral health, history of dental care; dental problems, barriers to dental care, caring of the teeth/mouth, medications, oral health quality of life). Farmworkers were knowledgeable of oral health, however, this knowledge, particularly the practice of brushing twice a day, made them less likely to seek regular dental care. Ultimately, a dental visit hinged on their limited finances, lack of dental insurance, and family responsibilities. Together, these decreased access to preventive dental services and increased risk of experiencing oral health problems.

Transitioned perinatally HIV-infected patients may be at increased risk for poor outcomes, yet the impact of transition and of transition programs on health are not well understood. This research examined: (1) post-transition mortality, (2) engagement in adult HIV care, (3) transition experiences, and clinical and sociodemographic influences, including transition program exposure. Data were collected from patients who had transitioned from a Florida pediatric clinic to adult HIV care between January 2003 and September 2012. Post-transition mortality and care engagement were assessed in a retrospective analysis of medical record data. Fisher exact and Kruskal-Wallis tests were used for significance testing. Risk ratios (RRs) were calculated to assess strength of associations. Stratified analysis controlled for confounding. Transition experiences were examined in a mixed-methods study, with qualitative data from a computer-assisted survey subjected to thematic analysis. Of 51 transitioned patients, nine (18%) had died by May 2014, five (56%) in the first post-transition year. Of 42 survivors, 33 were eligible; 27 (82%) provided consent. Post-transition mortality was high, particularly in those severely immunosuppressed (CD4 count <100/mm3; RR =6.0, 95% CI =1.88-19.19 [P=.005]) at transition. When controlled for CD4 count, employment was associated with decreased (adjusted RR= 0.19; 95% CI=0.04-0.88 [P=.02]), and high school non-completion with increased (adjusted RR= 3.0; 95% CI=1.37-6.40 [P=.07]) mortality risk. The number of kept HIV appointments decreased from last pre-transition (Median = 5, IQR 4-6) to first post-transition (Median = 2, IQR 1-10; P=.002) year; the proportion of poorly engaged increased from 3% to 35% (P=.006), with no significant changes between first and second post-transition years. Non-Hispanic black and low-income participants were less likely to be regularly engaged in adult HIV care one year post-transition. Transition program exposure did not significantly affect mortality or care engagement. Most of 27 received transition services, but 59% had trouble doing well in adult care. Needs for patient-centered care, with caring, personal patient-provider relationships and accessible HIV care, characterized post-transition experiences. This research suggested that transitioned perinatally HIV-infected young adults are at risk for poor health outcomes. Systematic programs using a socio-ecological framework to include multi-level interventions and post-transition support may improve outcomes.

The objective of this study was to determine the effectiveness of a 6 week afterschool nutrition and physical activity intervention administered by a registered dietitian with the help of a humanoid robot targeting elementary school aged children aged 6-12 years. The study was conducted across four Young Men’s Christian’s Association (YMCA) sites in Miami-Dade County, Florida (N= 114, Mean age: 8.16 ±1.57 years) using a pretest-posttest quasi-experimental design via randomly assigned intervention (two sites; n=63) and comparison groups (two sites; n=51). The validated Coordinated Approach to Child Health (CATCH) kids club questionnaire and the validated Previous Day Physical Activity Recall (PDPAR) were used to assess nutrition and physical activity knowledge, attitudes/beliefs and behavior change. The Inbody 230 instrument (Biospace, California) was used to calculate body composition and weight. Body Mass Index (BMI) percentiles and associated BMI z-scores for age and gender were calculated based on the Center for Disease Control and Prevention (CDC) growth charts. Data measures were collected at baseline (week 0) and one-week post intervention (week 7). Statistical analysis included independent t-test, paired t-test, chi-squared test, Wilcoxon signed ranks test and logistic regression. Results indicated that nutrition knowledge score significantly increased from 67.43% ±21.03 to 81.31% ±18.47 in the intervention group (p