The study of health disparities and the social determinants of health has resulted in the call for public health researchers to investigate the mid- and upstream factors that influence the incidence of chronic diseases (Adler & Rehkopf, 2008; Berkman, 2009; Braveman P. , 2006; Braveman & Gottlieb, 2014; Krieger, 2011; Rose, 1985). Social ecological models (SEMs) provide important conceptual tools to inform this research and practice (Krieger, 2011; Golden & Earp, 2012; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008; Glanz, Rimer, & Lewis, 2002). These models can help us look at the social and physical environments in rural Arizona communities and consider how health policies and environmental interventions address mediating factors, such as disparities in access to fresh food, that contribute to ill health in marginalized, rural, populations. Rural residents are at greater risk for obesity than their urban counterparts (Jackson, Doescher, Jerant, & Hart, 2006; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008). And while human life expectancy has steadily increased over the past thousand years, current projections indicate that the rise in obesity-related illnesses will soon result in its decline (Olshansky, et al., 2005). One reason for this decline, may be the reduced availability of healthy food – an important predictor of positive health outcomes including reduced obesity and chronic disease - in many parts of the United States (Brownson, Haire-Joshu, & Luke, 2006; Ahen, Brown, & Dukas, 2011; Braveman & Gottlieb, 2014; Braveman, Egerter, & Williams, 2011). The United States Department of Agriculture (USDA) defines food deserts as geographic areas in which there is limited access to grocery stores and whose populations have a high rate of poverty. In Arizona, 24% of the rural census tracts are considered food deserts; compared to an average of eight percent of rural census tracts across the nation (United States Department of Agriculture, 2013). Food deserts are one example of the upstream factors influencing the health of rural populations. Local health departments have been encouraged through the National Association for City and County Health Officials (NACCHO) and through the Public Health Accreditation Board (PHAB) to conduct community health assessments (CHAs) in order to identify unique contexts and community resources, health disparities, and the social determinants of health as well as potential areas for advocacy, policy change, environmental interventions, and health promotion interventions. Public health challenges like chronic diseases, which have multiple causes, can be explored in-depth through CHAs. CHAs often contain recommendations for action and/or are followed by community health improvement plans (CHIPs) which help local health departments prioritize resources and set measurable goals. In Florence, AZ recommendations made in a CHA are being acted upon by a non-profit agency, the Future Forward Foundation (3F). This investigation explores two interrelated issues regarding the use of CHAs and CHIPs as practical tools to set public health priorities. First, what makes a CHA useful to rural public health practitioners? What methods of conducting a CHA and subsequently analyzing the data results in actionable policy recommendations and/or environmental level interventions? Second, to what extent can public health agencies engage nontraditional partners to work in partnership to address the social determinants of health? As an example, I will look at the impact of a volunteer-based non-profit agency, located in a rural food desert on improving the social and physical nutrition environment as recommended by a local CHA. This inquiry will provide insights to public health practitioners seeking to identify and implement policy and environmental change addressing complex, multi-causal, public health issues, and provide insights regarding engaging nontraditional partners who may not self-identify as public health agencies.

Mental illness affects more women than men in the United States. Poor mental health in reproductive-age women has negative implications on population health. The purpose of this quantitative, correlational study was to examine the relationship between household structure and frequency of mental distress, with consideration of the mediation social-emotional support provides for reproductive-age women. The social ecological model was the theoretical framework for this research, in which frequency of mental distress related to the individual-level of the human-environment interaction construct. Household structure and social-emotional support were examined at the relationship-level. Pearson's correlation coefficient and linear regression were used to conduct a cross-sectional analysis of the 2010 Behavioral Risk Factor Surveillance System data set with a total sample size of 65,269 women, 18-44 years old. The confounding variables, health care access, race, income, marital status, number of children in the household, and pregnancy status, were included in the analysis. Although social-emotional support significantly influenced both household structure and frequency of mental distress, significance was not found between household structure and frequency of mental distress indicating that mediation does not exist. This study provides researchers and practitioners information about household structure that should be considered when designing innovative, nonprofessional support programs at the community-level. Positive social change implications include an understanding of the relationship between complex variables associated with social-emotional support, which could improve community support programs focused on mental health wellness of reproductive-age women.

A lack of adequately built environments can negatively affect obesity rates among adolescents. The purpose of this quantitative cross-sectional study was to determine if there is a relationship between the presence of built environments and childhood obesity among the immigrant population living in Cobb County Georgia. The social ecological model was used to explain how environmental factors may influence behavior. The research questions addressed whether walkability and elements of built environments such as to healthy foods and access to parks and recreational areas of census tracts affect childhood obesity when adjusting for race/ethnicity and immigrant population in Cobb County. Data was collected from government websites. Student enrollment, school ethnicity, and free/reduced lunch data were retrieved from the website, School Digger, which gathered their information from the National Center for Education Statistics, U.S. Department of Education, the U.S. Census Bureau, and the Georgia Department of Education data sources. Average BMI data were gathered from the Georgia Department of Education 2016-2017 Georgia fitness assessment report. Data were analyzed using independent t-test, Pearson correlation and 1-way ANCOVA. Findings showed a statistical significance with the existence of farmer's markets and child obesity but no significance among the other built environment variables. The results from this study can help community leaders develop an inclusive plan to reduce the occurrence of obesity in adolescents within the target area.

Cyberbullying, defined as any behavior performed through electronic or digital media by individuals or groups that repeatedly communicates hostile or aggressive messages intended to inflict harm or discomfort on others, is a widespread problem. Bystanders play an integral role in the initiation, maintenance, and prolonged presence of such aggressive behaviors, but have thus far been overlooked in cyberbullying literature. Cyberbullying bystanders are defined in this study as those who witness cyberbullying, either within or outside their personal social network(s) and whose available responses range from inaction to intervention. Operating from a social-ecological perspective and guided by multiple goals theories, this study used focus group methodology and found that cyberbullying bystanders have an impact on perpetration and victimization by way of multiple, distinct goals, which impact their choice of behavioral response. Bystanders’ goals and behaviors served to inform the creation of a cyberbullying bystander typology inclusive of five types: the oblivious/distant bystander, the entertained bystander, the conspiring bystander, the unintentional instigating bystander, and the active/empowered bystander. By allowing a thorough, nuanced understanding of bystanders’ role in cyberbullying, the study has significant implications for communication theory and practical application in the development of prevention and intervention efforts.

This thesis looks at the impact of migration and place on the traditional healing knowledge and practices of a Mexican immigrant mother from Guanajuato, Mexico: Sofia Perez. Through the use of oral history methodology and the application of the Traditional Ecological Knowledge and Wisdom (TEKW) model and the Social Ecological Model (SEM) to analyze the narratives, this study looks at the origin of Sofia's healing knowledge and practices and at how she has managed to keep these traditions alive despite migrating to the United States and living in a society that may not believe in the efficacy of these healing traditions. The application of the Traditional Ecological Knowledge and Wisdom (TEKW) model provided insight into the healing traditions of Sofia's home community and the ways in which these were learned, practiced, and preserved and proved useful in looking at how this was done by Sofia before and after migrating. Next, the Social Ecological Model (SEM) proved useful in looking at how place and its various social, cultural, and ecological aspects have influenced Sofia's use of traditional medicine since she migrated. Overall, Sofia's knowledge and practices have been impacted by migration and place; however, she continues to practice these traditions as best as she can.

Bakgrund: Brist på daglig fysisk aktivitet ökar risken för folksjukdomar samt påverkar ungdomars fysiska förmåga negativt. Ungdomar som gör värnplikten i Försvarsmakten behöver ha en viss nivå av fysisk förmåga för att klara av krav och träning som militärtjänstgöring kräver. Social Ecological Model används för att förklara hur ungdomars fysiska förmåga påverkas av många faktorer i ungdomarnas omgivning. Syfte: Studiens syfte är att studera vilka uppfattningar anställda i Försvarsmakten har kring förutsättningar och påverkansfaktorer för ungdomars fysiska förmåga innan och under värnplikten. Metod: Studien har använt en kvalitativ metod och semistrukturerade telefonintervjuer har genomförts med tre anställda inom Försvarsmakten. Data har analyserats med manifest innehållsanalys. Resultat: Skolidrott samt förberedelser lyfts fram som förutsättningar inför värnplikten medan tidig elitsatsning och idrottsspecialisering upplevs som problem för den fysiska förmågan innan värnplikten. Ungdomars fysiska förmåga under värnplikten upplevs ha försämrats och skador är vanligt. Under värnplikten påverkas den fysiska förmågan av kravnivåer, träning samt psykiskt välmående. Slutsats: För att förbättra ungdomars förutsättningar innan samt höja den fysiska förmågan under värnplikten krävs att skolan, föreningsidrotten och Försvarsmakten möjliggör ungdomars fysiska aktivitet. I bedömningen av den fysiska förmågan under värnplikten måste även krav, träning och psykiska påverkansfaktorer beaktas.

Mass shootings have been a persistent issue in the United States, and the underlying factors that continue to influence this crime are not yet evident. This study explored the effects of social media as an influence on mass shootings in the United States. Its purpose was to address the role of social media in spreading opinionated ideologies. The research question addressed the role of social media in influencing the actions of perpetrators of mass shootings in the United States. The study framework was based on the social-ecological model to facilitate classification of the susceptibilities of social media users to adverse ideologies; 7 experts on mass shootings were interviewed in the study. Findings revealed that social media tend to influence mass shooting in 4 capacities: as enablers of the conceptualization process of the crime until the final act of mass violence; as facilitators of the individual or personal agenda of the mass shooter; as platforms that harness emerging technology for knowledge building during the planning phase and create operational efficiency for the final act; and as coordinators of group or symphonic terrorism. Government authorities in charge of combating mass shootings perform their tasks through actionable intelligence, legislation and policy, training of police and other first responders, mechanical barriers or deterrents, and brainstorming for new techniques and strategies. They are, however, constrained by considerable odds, which often come conjointly with their methods of crime resolution and strategies. Predictive technologies, as vehicles to fight or prevent mass shootings, have limiting influences on government action, particularly relating to the First and Fourth Amendments and the culture of hate that is nurtured and sustained through social media.

Literature has found that some minority groups with diabetes have a negative perception of medical professionals when a health problem occurs. This trend is particularly problematic with the diabetes epidemic in the United States. African Americans are more than 2 times as likely to die from diabetes than are Whites, and diabetes prevalence has increased exponentially in New York City where a majority of Afro-Caribbeans live. To address this problem, a cross-sectional design was used to recruit Afro-Caribbeans diagnosed with type 2 diabetes across 7 churches to examine whether shared knowledge, attitudes, beliefs, and behaviors about diabetes screening and its complications exist, and whether they would attend a type 2 diabetes class or workshop at their church. A 114-item questionnaire, adapted from reliable and validated national health surveys, was administered to a convenience sample of 67 participants aged 35 to 90 to collect demographic, health, and cultural belief information. The conceptual frameworks of the social ecological and cultural consensus models were used for discovery of social influences and shared knowledge of type 2 diabetes. A cultural consensus analysis of 28 eligible participants was used to infer trustworthy answers to cultural questions. Participants demonstrated an above-average knowledge of type 2 diabetes, with a level of agreement of .52 ('.192 SD); further, 85.2% reported that they would attend a diabetes class or workshop at their church. These findings promote social change by educating Afro-Caribbeans about diabetes, and by facilitating partnerships between churches and doctors. Future community-based research with churches could help to improve glycemic control and delay the onset of type 2 diabetes.

The prevalence of childhood overweight and obesity is increasing at an alarming rate in the United States. Currently more than 1 in 3 children aged 2-19 are overweight or obese. This is of major concern because childhood overweight and obesity leads to chronic conditions such as type II diabetes and tracks into adulthood, where more severe adverse health outcomes arise. In this study I used the premise of the social ecological model (SEM) to analyze the common levels that a child is exposed to daily; the intrapersonal level, the interpersonal level, the school level, and the community level to better understand what risk factors are significantly associated with child weight status. Data came from the 2012 National Survey of Children's Health (NSCH) (n=41,361). Frequencies and confidence intervals were used to describe risk factors at each level. Bivariate analyses were conducted between each risk factor and the outcome variable. Using all risk factors that were significantly associated with overweight and obesity in the bivariate analyses, multinomial logistic regressions were performed for each SEM level. The 4 SEM levels were then analyzed together using stagewise multinomial logistic regression. A significance level cutoff of 0.05 was applied to all analyses. Thirty-three percent of participants were overweight or obese. Child sex, race, age, child physical activity participation, mother’s education and health, the child’s family structure, the child’s participation in extracurricular activities, frequency of family meals at home, safety and engagement in school, the number of amenities and the safety and support within their communities were found to be significantly associated with child weight status. The odds ratios of the covariates in the final stagewise model were similar to those in each individual model. Understanding both the risk factors associated with child overweight and obesity in each individual level and in the complete socio-ecological perspective is important when working toward more effective policy and program creation and the reduction of childhood obesity. Recognizing that all levels of a child's SEM influence his or her likelihood of being overweight or obese can lead to more effective strategies that tackle multiple SEM levels collectively instead of each level independently.

Active school transport (AST; e.g. the use of non-motorized modes such as walking and cycling to travel to/from school) is an inexpensive, accessible and environmentally-friendly source of physical activity (PA). This dissertation addresses two overarching objectives: 1) to measure the relationships of AST with PA and health-related outcomes; and 2) to examine the correlates of AST immediately before and after the transition from primary to secondary school (the “school transition”). First, a systematic review revealed increasing evidence showing that AST is associated with greater daily PA levels, and that cycling to/from school is associated with higher cardiovascular fitness. Cycling for transportation (not only for school trips) was also associated with lower values for total cholesterol and total cholesterol/HDL cholesterol ratio in the nationally-representative 2007-2009 Canadian Health Measures Survey. Moreover, the present dissertation provides preliminary evidence suggesting that AST may help attenuate the decline in PA across the school transition. However, the relationship between AST and body composition indicators remains unclear. With respect to the correlates of AST, distance was the strongest barrier to AST at both time points, but several road safety concerns, and the perception of having too much stuff to carry were also associated with engagement in motorized travel. At follow-up, AST was more common in children whose parents owned less than 2 cars. In contrast, children were more likely to engage in AST if their parents reported that they chose to live in their current neighbourhood so that their children could walk or bike to school. The associations of neighbourhood walkability (as measured with the Walk Score® application) with AST and PA were generally stronger after the school transition. While AST may improve health among children and youth, an ecological approach targeting multiple levels of influence will likely be needed to alleviate current barriers to AST.