<p> This dissertation consists of two substudies. The objectives of Substudy 1 were as follows: 1) to examine changes in obesity rates throughout elementary school in a large sample of children with respect to socioecological factors, especially trends in body mass index (BMI) and the prevalence of &ldquo;severe high obesity&rdquo; during elementary school, and 2) to explore the longitudinal effect of socioecological obesogenic factors (including individual, parental, familial, and environmental factors) on the transition from a normal/healthy weight to being overweight or obese among children aged three to 13 years old. This longitudinal panel study used the Early Childhood Longitudinal Study Program (ECLS-K). A modified socioecological model was used as a conceptual framework to guide the investigation of this study&rsquo;s research questions. Two longitudinal ordered regressions were performed to determine the associations between socioecological obesogenic variables (e.g., family activity and parental involvement) and changes in obesity rates, as well as the transition from a normal/healthy weight to being overweight, obese, or severely obese. A total of 1,264 children (representing 379,297 at the population level) were identified for this study (mean age: 5.24 years; female: 48.7% at baseline). Hispanics and other nonwhite children, children with less socioeconomic and environmental support, and children living in households with fewer family members were more likely than their counterparts to gain weight (all <i>p</i>s &lt; 0.05). This study revealed multiple dimensions of how sociological obesogenic factors influence children&rsquo;s weight increases and transitions in a longitudinal setting. Unhealthy BMI status among children was affected not only by individual factors but also by parents, family, and environments. Parents and family play a crucial role in children&rsquo;s physical activity and nutrition, and obtaining family and environmental support is critically important for maintaining a healthy BMI status. The findings suggest that a greater focus on family and social support is necessary to help children maintain a healthy weight over time. </p><p> Substudy 2 aimed to investigate the association between the Head Start Program and children&rsquo;s BMI status, as well as their quality of life with respect to socioecological obesogenic factors. This cross-sectional study employed the ECLS-K as well. A propensity-score matching analysis was performed to examine the association between the Head Start Program and children&rsquo;s BMI status, as well as the quality of life, controlling for socioecological obesogenic factors. A total of 3,753 children (representing 1,284,209 at the population level) were recruited for this study (mean age: 13.69 years; female: 49.42%). In the final matched model, the Head Start Program did not have a statistically significant effect on children&rsquo;s obesity. Children who were African American, had less participation in school-sponsored activities, perceived themselves as overweight, lived in a household with fewer family members, and had less strict TV regulations were more likely to be overweight than their counterparts (all <i>p</i>s &lt; 0.05). Evidence suggests that multiple dimensions of sociological obesogenic factors&mdash;including individual as well as parental, familial, and community support factors&mdash;affect the weight of children from low-income families and should be considered when establishing behavioral and policy interventions to thwart the childhood obesity epidemic.</p><p>

<p> Today, obesity has become the number one concern of kids and teens. About one in three Americans are overweight or obese. This in part is due to the consumption of highly commercialized and processed foods that lack the essential nutrients in maintaining a healthy weight in addition to normal cholesterol and blood pressure levels. Studies have shown that eating habits are learned early in life and are carried on throughout the rest of their lives. As children grow older into their adolescent years, they are more aware of their eating habits and have gained more autonomy in regards to food choices. </p><p> Plant-based foods have shown to drastically improve the overall health of individuals with high cholesterol, high blood pressure, and excess weight. </p><p> Power Plant is a facility that intends offer plant-based nutritional services in the form of informative lectures, interactive workshops, one-on-one nutritional guidance by appointment, with access to peer-mentors for additional support and guidance. Power Plant will dedicate their services to the Whittier Union high school district, surrounding community colleges, and universities in the Los Angeles County area. </p><p> Power Plant&rsquo;s unique program design, physician referrals and the critical need of our generations to come, are all factors that will contribute to its success in the Los Angeles County community and for years to come.</p><p>

<p> While obesity is a nationwide phenomenon, African Americans &ndash; especially women &ndash; continue to be more severely affected than any other ethnic group. According to the Centers for Disease Control and Prevention, over 20% of African American women are obese compared to 15.6% of Caucasian women. The church is an important community center for many African Americans, and is often a site for health promotion programs, though little is known of the effectiveness of these programs. The purpose of this qualitative study was to study the experiences and attitudes of African American women who have gone through a church-based weight-loss program. Questions were asked about the cultural, environmental and social barriers to weight loss, and the components of effective church-based weight loss programs. Using a phenomenological approach, this study was designed to capture new data for the development of sustainable church-based weight-loss programs. The theory of social support was used as a theoretical framework. The major themes arising from the data concerned the importance of: (a) social support on all levels; (b) the involvement of the pastor, his spouse, or other church leadership; (c) the inclusion of weight-loss participants in program design; (d) a holistic program design to meet the needs of the entire family; and (e) a culturally sensitive program. The inclusion of all these elements is recommended for future programs. The social change implication is that these recommendations could be helpful in the design, development, and implementation of sustainable church-based weight-loss programs for African American women.</p><p>

<p> Gross inequality in access to health services is a common problem in developing countries like Panama. This study responds to the current shortage of physicians from economically depressed communities in Panama. By using qualitative research methods, I examined the personal, financial, curricular and environmental factors that shape low-income students&rsquo; commitment to become physicians; the forces that shape these medical students to practice medicine once they graduate; and how policies and institutional practices in medical schools in Panama influence rates at which low-income students become physicians. Specifically, data sources were used to explore how the nation&rsquo;s educational policies, as well as recruitment, admissions, and student support practices in medical schools, influence rates at which low-income students become physicians. Documents were analyzed to determine statistical trends in medical school enrollment and completion for some of the selected medical schools; and the availability and effectiveness of various policy initiatives enacted to increase the production of physicians across the country. </p><p> Interviews were conducted with senior academic officers of medical schools (e.g., vice provost, deans and directors) and others who know much about the country&rsquo;s current human resources challenges in medicine (e.g., a former minister of health, the deputy minister of education, and the health senior adviser to the president of Panama). Interviews with these stakeholders provided insights into the educational, political, and economic forces that shape whoever enrolls in and ultimately completes medical school. Additionally, recent graduates or students in their final year of medical school from four schools of medicine in the Republic of Panama participated in focus groups, to offer information into the personal, familiar and institutional factors that supported and undermined low-income students&rsquo; goals of becoming doctors. Some attention was paid to socioeconomic demographics of communities in which certified physicians ultimately choose to practice. </p><p> The findings of this study provide Panamanian policymakers with valuable information for defining better approaches to train physicians for underserved areas and may help Panama achieve compliance with the millennium objectives that were agreed to by member countries of the World Health Organization in 2000. Finally, implications for future research on the training of low-income students to become physicians in underserved communities are proposed.</p>

<p> Caregivers&rsquo; compliance with polio vaccine regimens and timely receipt of the recommended 4 doses of polio vaccine are pivotal to eliminating polio. This cross sectional study, conducted in Lagos State, Nigeria, examined polio vaccine compliance and demographic attributes of caregivers&rsquo; for statistically significant associations. Using an adapted health belief model theoretical framework, 1,200 participants were recruited from well-baby clinics in 8 local government areas in Lagos State. Participants completed a brief demographic survey providing data on caregivers&rsquo; age, gender, residence (rural or urban), and their level of education as well as records from their children&rsquo;s immunization cards. Data obtained were tested for associations between caregiver&rsquo;s demographic information and their children&rsquo;s receipt of polio doses within specified timelines using chi-square and logistic regression analysis. Fisher&rsquo;s exact analysis were conducted for variables with frequencies less than 5. The only significant association recorded was between the receipt of Polio Dose A and location of caregivers&rsquo; residence: Rural dwelling caregivers were less likely to receive the first dose of polio. Results showed Polio Dose D to be the dose most likely received in an untimely manner as well as most likely missed of the 4 doses. Logistic regression analysis did not show any variable to be of greater odds in predicting completion of the 4 doses or compliance with timelines of their receipt. Study&rsquo;s results may inspire polio program planners to develop interventions that broaden the immunization coverage for rural dwellers to include nontraditional maternity locations. Positive social change will ensue by the improvement caregivers&rsquo; compliance with full polio dose receipts with timelines, maximizing immunity. </p><p>

<p> The Human Papillomavirus (HPV) is a common sexually transmitted infection (STI) and etiological agent of cervical cancer. It has been suggested that religiosity may promote a generalized disassociation between all STIs/STDs, including HPV, and personal relevance thus contributing to lower levels of HPV awareness and knowledge among certain groups. This study sought to identify the role of religiosity as a predictor of HPV awareness and knowledge among women in a Christian university. Religiosity was defined and measured using the Duke University Religion Index (DUREL). The schemata and social identity theories provided the theoretical framework for this study. A total of 173 women completed the modified survey instrument to assess level of HPV awareness and knowledge, attitudes toward premarital sex, and level of religiosity. Multiple linear regression analysis was used to test the hypotheses. Religiosity, as defined by the intrinsic religiosity subscale of the DUREL significantly contributed to HPV awareness (<i>p</i> = .002) and HPV knowledge (<i>p</i> = .036). The positive social change implications of this study include a better understanding of the role of religiosity in HPV awareness and knowledge; consideration of religiosity in dissemination of health information by informing public health policies and programs to ensure adequate and culturally relevant education and awareness about HPV transmission, HPV-related cancers, and HPV vaccination.</p><p>

<p> Public health leaders lead a diverse workforce and organizations that are comprehensive in their breadth and scope of services. The purpose of this descriptive quantitative study was to describe the transformational and transactional leadership behaviors of federal public health leaders, their coaching practices, and the relationship between those leadership and coaching behaviors. Researcher recruited a convenience sample of 91 U.S. Public Health Service (USPHS) officers from training events between March-July 2014. Participants self-selected to voluntarily complete an internet-based survey comprising a researcher-designed questionnaire, the Multifactor Leadership Questionnaire 5X Form, and Get Fit for Coaching self-assessment. The first two research questions related to leadership and coaching behaviors were analyzed in SPSS 22 using Kruskal-Wallis H, Yates&rsquo; correction, and Monte Carlo significance tests. The Pearson&rsquo;s product-moment correlation analyzed the third research question examining the relationship between leadership and coaching behaviors. No difference was found in the leadership or coaching behaviors of junior and senior officers when examined by actual rank or seniority. The data revealed several relationships between leadership and coaching behaviors, with significant correlations found for 24 dichotomous pairs, indicating transformational and constructive transactional leadership and coaching behaviors as similar, complementary, and interrelated. The findings showed the act of providing feedback improved performance, while failure to take action or implement change stifles learning and growth. Recommendations for future research included: examining these behaviors among non-uniformed and non-federal public health leaders; exploring their leadership outcomes; and the inclusion of the 360-assessment to validate the self-reported leader data.</p><p>

<p> Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers to medical care, and the perceptions of patients and medical personnel concerning the complexities of OF. In-depth interviews were performed over a 2-month period with 12 patients and 8 medical personnel at the Aberdeen Women's Center in Freetown, Sierra Leone. Results showed that patients face multiple medical barriers including high costs, fear of hospital treatment, severely inadequate treatment, and severe physical sequelae including paralysis and foot dragging. Multiple emotional, social, and financial harms related to OF were also reported, including stigmatization, abandonment by family, embitterment, depression, and job loss. Most patients expressed a preference for traditional birth assistants over medical personnel. However, many also benefitted from the intervention of friends or other good Samaritans. The results and recommendations from this study should be helpful in informing the general public and policy-makers about OF as a major public health problem, and in the design and delivery of programs to eradicate or alleviate the problem of OF in Sierra Leone.</p><p>

Colorectal cancer (CRC) is a deadly and costly cancer, especially among African Americans. The purpose of this quantitative, retrospective, cross-sectional study was to examine African Americans' health behaviors that may have an association with CRC. The Health Belief Model was used to guide this study. The study addressed whether there is a statistical association between fruit intake, vegetable intake, and physical activity, and the occurrence of CRC while controlling for confounders, such as body mass index, smoking status, and income level. After conducting an overall analysis, the final research question examined if the association varied by race. In this study, data from 14,451 people in the Health Information National Trends Survey database were analyzed using binary logistic regression analysis. There was no association between the intake of fruits and vegetables and the occurrence of CRC in this population. Physical activity had a statistically significant association with CRC, with physical activity being protective against the occurrence of CRC among the whole sample population (adjusted OR = .671, 95% CI = [.458-983], p = .040). When stratified by race the association between Physical activity and CRC was only significant among Whites. The findings of this study have positive social change implications for practitioners designing CRC prevention programs, who should focus on increasing physical activity levels yielding healthier living in general. Future research should focus on addressing other possible risk factors in the African American population including genetic predispositions and gene-environment interactions.

Menthol is added to cigarettes to make smoking more convenient. Menthol is considered a contributing factor that makes smoking appealing to youths and their continuous smoking initiation, which progresses to regular cigarette smoking and addiction, especially among youths ages 12 to 19. Menthol encourages approximately 4,000 youths to experiment with smoking daily in the United States, of which approximately 1,000 become active smokers. Not enough is known regarding the influence of menthol on youth smoking initiation/smoking behavior. A quantitative analysis of data from the 2014 National Youth Tobacco Survey (NYTS) was used to explore the association between age, race/ethnicity, gender, grade (education level), and menthol cigarette smoking among youth ages 12 to 19. The sample size for this study consisted of 115 adolescents aged 12 to 19 years, in the United States taken from the 2014 NYTS data. The theoretical framework for this study was the theory of planned behavior (TPB). The independent variables were ethnicity/race, gender, age, and grades (education level), while the dependent variable is the type of smoking: menthol versus nonmenthol. Bivariate analysis revealed that there was a statistically significant relationship between age (p = <.001), race/ethnicity (p = <.001), gender (p = <.001), grade (education level) (p = <.001), and menthol cigarette smoking; however, no statistically significant results were obtained in the multivariate regression analysis. Future research is needed to better determine and understand the factors associated with youth smoking initiation and behavior. The potential positive social change impact of this study is a better understanding of youth smoking behavior and the development of more effective prevention interventions to protect the health of this vulnerable population.