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Tobacco use is the leading cause of preventable disease and premature death in the United States. In 2014, an estimated 16.8% of adults were current cigarette smokers, and 9.2% of high school students smoked cigarettes. Nearly 90% of smokers developed their habit as teenagers, and students' tobacco use in high school influences their behaviors later in adulthood. Smoking behaviors appear to be inseparable from the social environment, physical environment, small social groups, and cognitive and affective processes. Preventive strategies, such as advertising bans, clean indoor air laws, education programs, increased taxes, labeling limitations, mass-media campaigns, and youth access regulations, have been commonly used to prevent and reduce youth tobacco use nationwide. In Florida, local public school districts were authorized to develop new tobacco-free school policies through an amendment to the Florida Clean Indoor Air Act in June 2011. The purpose of this study was to determine the impact of the recently implemented smoking cessation policies, as well as individual-level factors and interpersonal-level factors, on youth tobacco use in Florida public schools. This study employed a pooled cross-sectional design with data for high school students from the Florida Youth Tobacco Survey (FYTS) in 2010 (n=37,797) and 2014 (n=32,930). It was guided by a theoretical framework based on the reasoned action approach and the social ecological model. Hierarchical logistic regression was used to analyze the data. The four models were binary logistic regression for cigarette use, multinomial logistic regression for cigarette use, binary logistic regression for cigar use, and multinomial logistic regression for cigar use. The results of this study support the importance of the individual-level constructs of background factors, behavioral beliefs, and control beliefs, the interpersonal-level construct of normative beliefs, and the policy-level construct of actual behavioral control when applied to youth tobacco use. These findings led to a better understanding of which policies, environments, and cognitions contribute to preventing and reducing teenage tobacco use, which is imperative in controlling the risks related to smoking and improving youth health. Now that the individual-level factors, interpersonal-level factors, and policy-level factors that contribute to youth tobacco use were recognized, preventative and therapeutic programs and interventions can be suggested and improved. This study provided evidence-based knowledge for improving public policies and interventional strategies towards smoking prevention and cessation for youth.

Prior research has found equity theory explains employee responses to falling wages in relation to other comparable workers. The present research attempts to contribute to the criminal justice literature by directly testing equity theory within the policing context, something no study has done to date. Applied to policing, equity theory predicts sworn officers employed by departments with falling or inequitable salaries (i.e., their salaries fail to keep up with those at other regional agencies) will reduce their work input (i.e., discretionary arrests) and/or quit in higher numbers than before (i.e., increase attrition). The present study also attempts to quantify how far officer salaries can fall behind the mean regional police pay before a municipal agency experiences negative outcomes. The research questions are examined using data from Criminal Justice Agency Profile (CJAP) Reports from the Florida Department of Law Enforcement (FDLE), with historical salary and attrition data for 122 municipal law enforcement agencies in Florida from 2001-2011, and Uniform Crime Reporting (UCR) Part II Arrest Data from the Federal Bureau of Investigation (FBI) for the same time period. A time-series cross-sectional (TSCS) analysis is conducted over 11 annual data points. This study attempts to bring an additional theory into the fold of the policing literature by testing it against a large, law enforcement specific data set. This is in part an effort to answer the call for what has been described as a need for more theory in the criminal justice and policing literature (Cooper & Worrall, 2012; Mears, 2010). It should also enable police administrators to gauge, relative to regional competitor salaries, at what point to anticipate negative consequences from the underpaid condition of police officers working at their municipal police agencies. The findings suggest Florida municipal police officers do not reduce their work inputs, as measured by UCR Part II arrests, but do quit their jobs in larger numbers in response to stagnant or falling salaries as predicted by equity theory. Policy implications include a better understanding by police administrators as to what they can expect and prepare for when municipal police officers' salaries become stagnant or fall as compared to pay at other regional law enforcement agencies.

Community foundations have considerable potential for positive social change in the communities they serve yet are understudied in nonprofit management and leadership literature. Recently, community foundations have become one of the largest avenues of organized philanthropy. The boards of community foundations frequently consist of a different composition of members than other nonprofit organizations, making a focus on individual characteristics of board members a worthwhile area of study. This exploratory study considers board capital through human capital, structural capital, and social capital and the impact this has on board effectiveness. In addition, it considers the impact of servant leadership on board effectiveness. The purpose of the study is to assess capital and leadership factors of community foundation board members and examine their influence on perceived board effectiveness. Based on survey data from 71 community foundation board members and executive directors representing 13 different community foundations associated with the Florida Philanthropic Network, the dissertation uses ordinal regression to test hypotheses. Additional data was also collected with follow up focus groups. The study finds that board capital, measured by human capital, structural capital, and social capital, as well as servant leadership, do play a factor in board effectiveness. Further, community foundation boards in the survey population are highly effective, and have unique attributes that make them distinct from other types of nonprofit boards. Follow up focus groups suggested that, although board members define board effectiveness in a number of ways, boards are creating social change within their communities in different ways. Findings have potential for significant insight on an important segment of nonprofit sector organizations, particularly for strengthening communities through philanthropy.

This dissertation is conducted to examine the factors which contribute to the reporting of incidents of violence or aggression perpetrated by patients against health care providers in non-institutional health care settings. With a theoretical foundation grounded in community science, applying stress theory, broken windows theory and the theory of reasoned action, the following cross sectional study examines the contribution of characteristics of the healthcare provider, characteristics of the patient perpetrator and the form of violence to the providers' reporting or failing to report incidents. A self-administered survey was disseminated to a sample of non-institutional healthcare providers to test the research hypotheses about variables associated with reporting of incidents. The final sample size included 218 respondents, of which 213 met inclusion criteria for the study. 79.4% (N=169) of respondents had experienced at least one form of patient violence or aggression and were thus eligible for inclusion in the statistical analysis. The collected data was then analyzed through use of logistic regression to determine the contribution of each variable and the relative impact on the dependent variable of incident reporting. Findings indicated that there is a statistically significant contribution of the form of abuse, specifically verbal abuse in comparison to sexual abuse, to incident reporting. Specifically, the odds of reporting abuse are four times higher among individuals experiencing verbal abuse in contrast to providers subjected to patient-perpetrated sexual abuse.

This study focuses on the effect of leadership in the federal government. Using a slightly revised version of Bass's Full Range Leadership Model, the study examines the influence of transformational leadership, transactional leadership, and combination of the two on the perception of leadership effectiveness and follower satisfaction in the federal government. To establish if this revised model is consistent with federal employees' perception of effective leadership, if leadership in the federal government increases follower satisfaction, and if both the transactional and transformational leadership are important to followers' perception of leadership and their satisfaction, data from the 2002 Federal Human Capital Survey was used. Multiple regression analyses were conducted using transactional leadership, transformational leadership, and a combination of the two as independent variables and perceived leadership effectiveness and follower satisfaction as the dependent variables. Control variables that accounted for personal demographics (gender, minority status, and supervisory status) and organizational/job dimensions (pay, benefits, career path, personal fulfillment of the job, the physical conditions, organizational training, workplace flexibilities, coworkers and communication) were also included. Results indicate that the revised model does capture federal employees' perception of effective leadership, that leadership does increase follower satisfaction in the federal government, and that both transactional and transformational elements are important to this perceived effectiveness and follower satisfaction.

A personal health record (PHR) allows a patient to exert control over his/her healthcare by enhancing communication with healthcare providers. According to research, patients find value in having access to information contained in their medical records. Often a glossary is required to aid in interpreting the information and understanding the content. However, giving patients the ability to speak with providers about their medical conditions empowers them to participate as informed healthcare consumers. The majority of patients (75%) at Medical Specialists expressed their intention to adopt the PHR if it is made available to them. Although the perceived usefulness of a PHR was a significant determining factor, comfort level with technology, health literacy, and socioeconomic status were indirectly related to intention to adopt as well. Perceived health status was not found to be a significant factor in this population for determining intention to adopt a PHR. The majority of patients in each category of gender, age, marital status, and race/ethnicity (except American Indian/Alaska Native) expressed interest in adopting a PHR, with most categories being above 70%. Findings indicate a broad acceptance of this new technology by the patients of Medical Specialists. Improvement of adoption and use rates may depend on availability of office staff for hands-on training as well as assistance with interpretation of medical information. Hopefully, over time technology barriers will disappear, and usefulness of the information will promote increased demand.

Active interdepartmental participation of the biomedical engineering technician (BMET) with clinicians is an opportunity to reduce systemic events guided by empirical evidence that 1) establishes adverse events with medical equipment and 2) associates nursing effectiveness with access to functioning equipment. Though prior research has documented interdependency in nurse-physician relationships (and in such non-clinical health support services as laboratory and pharmaceutical departments), few studies in mainstream literature on quality have related medical professional interdependencies to the BMET. The promotion of National Patient Safety Goals, federal legislation (the Safe Device Act of 1990), and recommendations from agencies— The Joint Commission and the United States Center for Disease Control and Prevention (CDC), all point to a multidisciplinary approach for detecting and resolving systemic problems. Therefore, comprehending the interdependent role of the BMET in hospital care is important for reducing persistent problems like Nosocomial Infections (NI) and other adverse systemic events that affect clinical outcomes. Industry research documents the positive contributions of BMET professional integration into facility management in Management Information Systems (MIS), and empirical evidence has shown that their professional contributions influence nursing performance and thus, patient outcomes. Yet, BMET integration to departments like Infection Control and Central Sterile where BMETs' specific knowledge of medical equipment can apply directly is rare, if not entirely absent. Delaying such professional integration can hamper effective response to offset the Centers for Medicare and Medicaid (CMS) payment reductions that went into effect on October 1, 2008. The CMS denies payment for treatment of infections it deems 'preventable' by proper interdependent precautions. Infections already under scrutiny as preventable include mediastenitis, urinary tract infections, and catheter-related blood stream infections. Furthermore, formal Medicare Conditions of Participation (CoP) now require hospitals to develop initiatives to reduce medical errors by identifying and addressing threats to patient safety. In both these challenges the medical equipment used in clinical care can adversely affect patient outcomes. Clearly, the health care system must tackle the common healthcare associated infections (HAI) just mentioned as well as others that may be added to the CMS list, or face overwhelming financial costs. Understanding the BMET professional relationship with nursing, given the structural and process considerations of the level of quality (LOQ) as measured by Clinical Effectiveness, Clinical Efficiency, and Regulatory Compliance, will be essential for meeting this challenge. This study's extensive literature review led to the development of a conceptual hypothesized model based on Donabedian's 1988 Triad of Structure, Process, and Outcome and fused with Integrated Empirical Ethics as a foundation for BMET professional interdependency and for consolidated attack on adverse systemic events. This theoretical integration has the potential to advance quality of clinical care by illuminating the factors directly or indirectly influencing patient outcomes. Primary data were gathered through the Biomedical Engineering Interdepartmental Survey that collected BMETs' professional perceptions of organizational factors (Structural Complexity), process factors (Process Adequacy), and Level of Quality and Control variables yielding information about the individual respondents and the facilities where they work. The unit of analysis in this study is the biomedical engineering technician functioning in hospital support services to ensure patient safety and quality of care. Initial survey results underwent data cleansing to eliminate the impact of missing items. Next, Confirmatory Factor Analysis applied to the survey data determined the construct validity and reliability of the measurement instrument. Statistically tested regression models identified structure and process factors that may affect the LOQ in terms of systemic adverse events and lack of compliance. The statistical analysis and assumption tests that confirm internal validity infer that hospital Level of Quality is significantly influenced at R2 = 88.1% by Structural Complexity. The combined measurement model and models for each latent construct achieved Cronbach α results > 0.7, indicating internal reliability of the Biomedical Engineering Interdepartmental (BEI) survey instrument. The final measurement models of the latent constructs—structural complexity (six factors), process adequacy (five factors), and level of quality (six factors) are correlated and significant at t > 1.96, p < .001 (2-tailed). The Structural Equation Model without controls are correlated and significant at t > 1.96 on all factors, indicating an approximate standard distribution at p < .001 level (2-tailed). Goodness of fit model analysis findings indicates that the models reasonably fit the data. The largest correlation is expressed between structural complexity and process adequacy (0.217 to 0.461), p=.01 (2-tailed). Respondent and facility control variables added to the Structural Equation Model are correlated with low impact but not statistically significant. The findings have implications for theory, methodology, external policy, and internal hospital administrative management. The theoretical contributions of the study include the instrument development, measurement models, and the Structural Equation Model for hospital level of quality. The statistical analysis of the relationships of Donabedian's Triad indicates that both structural complexity and process adequacy are explanatory for the outcome variable of level of quality. Several statistically significant predictors of quality support an integrated approach to systemic problems. They are Uniform Standards, Inter-Professional Training, Coordination Evidence, Interdepartmental Work and Device Failure Recognition. Moreover, the application of Integrated Empirical Ethics provides a foundation for management resolution that can improve the hospital level of quality by consolidating divergent internal and external controls by providing implementation guidance to overcome medical plurality as empirical evidence continues to emerge. The study defines the outcome measures of Quality—Effectiveness, Efficiency, and Regulatory Compliance in the context of Clinical Engineering. The study results suggest pertinent external policy recommendations, foremost of which arises from the responses to the item concerning Uniform Standards: "Standards are applied equally across all departments." In the BMET community, only about 20 per cent strongly agree with this statement; approximately 33 per cent agree. Because of divergent ethical and national regulatory policies applied to professional affiliations rather than the medical community at large, a policy adapting regulatory initiatives having the same focus on patient outcomes (e.g., CMS CoP; National Patient Safety Goals) would generate the best initiatives for reducing systemic adverse events and policy conflicts. Finally, results suggest that internal hospital administrators can improve the level of quality through internal process changes, in particular by addressing the process adequacy factor of Regular Meetings for the survey item: "Nursing and biomedical engineering conduct regularly scheduled meetings on equipment issues." Less than 10 per cent of the BMETs surveyed strongly agreed and about one-third agreed that this aspect of interdepartmental teamwork was accepted. The study confirms the evolution of the interdependent professional dynamic within healthcare exemplified by the combination of multiple predictors of the Level of Quality from Organizational Culture, Level of Coordination and Interdepartmental Medical Device Management. Hospital administrators can find simple, cost-effective solutions to improve clinical effectiveness (a key indicator of quality) in the components of the intervening variable of process adequacy. For example, statistical evidence shows that regular meetings between nursing and biomedical staff about equipment issues and/or linking the BMET department goals to Organization Objectives are ways to improve quality.