Alcohol misuse and related harm costs money, drains resource and takes lives. Alcohol brief interventional advice forms an important method to moderate alcohol consumption at both individual and population level. Alcohol exerts a significant negative influence on the oral cavity and is implicated in the development of oro-mucosal and dental disease. Alcohol and tobacco smoking are recognised a key aetiological agents in the development of oral cancer which is the 14th most common cancer, accounting for approximately 2% of new cases, killing over 2300 people in the UK every year. A crucial weapon to tackle the disease is prevention through management of those modifiable lifestyle factors. The role of the general dental practitioner (GDP) in providing alcohol advice has received sparse attention, however evidence suggests that GDPs do not routinely engage in this activity. The aim of this research was to identify factors preventing or facilitating GDP engagement and develop strategies to support them to deliver alcohol advice. GDPs salient beliefs were applied, using behaviour change theories (the Theory of Planned Behaviour and Social Cognitive Theory), to formulate a theory based questionnaire. A postal survey (n=300, RR 60%) identified that few (17%) GDPs routinely provide advice to patients exposing potential for improvement. Subsequent exploratory multiple regression analysis identified 5 key items which might act as targets. The resultant five-item model accounted for 41% of the variance in intention [Adjusted R2 for this model is .41; F = 15.34 (.001)].A theoretically informed intervention was administered as a multi-centre, parallel group, three-arm randomized controlled pilot study. The aims were to test the feasibility and acceptability of implementing an alcohol advice intervention in dental primary care. The intervention was not entirely acceptable to patients or dentists. Qualitative analysis revealed factors (not limited) to remuneration, perceived relevance, confidence, embarrassment and fear of consequences mar progress. Modifications to study processes and methods would seem a sensible prior to further study.

Health psychologists with training in integrated care are ideal candidates to work in Federally Qualified Health Centers (FQHCs). However, despite the large documented need for more behavioral health providers in FQHCs, psychologists are underrepresented in this setting compared to other behavioral health professions. The purpose of this study was to: 1) examine the specific beliefs that are most relevant to executives’ intentions to hire psychologists, 2) determine how executives’ perceived control over hiring psychologists varies by several demographic variables, and 3) examine how well the Theory of Planned Behavior (TPB) predicts executives’ intentions to hire psychologists. Method: Executives (N = 222) from every US Census defined division of the country completed an online TBP survey assessing demographics and beliefs about hiring psychologists. Path analysis was used to examine the relationships between TPB variables. Results: Executives ranked psychologists as highly proficient in integrated care and general clinical skills but less proficient in research and leadership skills. Compared to other skills, executives ranked research skills as lower in importance for clinical staff to possess. Longer executive job tenures (but not FQHC budget or rural status) predicted more perceived control over hiring practices. The standard TPB was a poor fit with the data, but a modified version explained 78% of the variance in executives’ intent to hire psychologists. In this model, executives’ normative beliefs were most predictive of their intent to hire. Implications: Results point to the importance of internal champions within FQHCs who advocate for psychologists as well as the need for early interprofessional education. Opportunities exist for health service psychologists to promote the value of research to executives and to differentiate themselves by emphasizing their skills in research and implementation science.

The enormous amount of household food waste in developed countries is a global environmental and climate threat. To reduce household food waste, various behavior change campaigns and interventions are conducted. Most conventional behavior change interventions designed to reduce household food waste are based on the Theory of Planned Behavior (TPB) and are information heavy. These have shown, however, to not be effective enough to result in a fast and sizable enough decrease of household food waste in developed countries, thus reducing climate and environmental impact in a timely and sizeable enough way. The more systemic, holistic and practically oriented Social Practice Theory (SPT) theoretical framework is proposed by different authors as an alternative to the conventionally used TPB theoretical framework to design (behavior) change interventions. SPT is thought to lead to greater and faster reduction of food waste at the household level and to a general change in the food supply system. Nevertheless, interventions are oftennot created according to their proposed theoretical framework and no “direct” comparison between both theoreticalframeworks at the intervention level has been conducted. This thesis compares two case studies describing food waste reduction interventions, one with a TPB theoretical framework and the other with a SPT theoretical framework. The results show that when considering food waste reduction interventions at the household levels in developed countries the SPT might be a more effective theoretical framework for an intervention design compared to a TPB theoretical framework. Specifically, the SPT theoretical framework includes more relevant system stakeholders in the intervention creation leading to a more context specific design. Additionally, the emphasis of actual “doing” in an intervention based on an SPT theoretical framework createsa potential for more long-term change, compared to a TPB theoretical framework. However, this thesis also suggests that merging of the two theories should be further research and discussed, because of the potential greater effectiveness in actual food waste reduction.

The proportion of obese adolescents in Southern Appalachia is among the highest in the nation. Through funding from the National Institute on Minority Health and Health Disparities — National Institutes of Health, the Team Up for Healthy Living project was a cluster-randomized trial targeting obesity prevention in adolescents through a cross-peer intervention. The specific aims of the project were to: 1) develop a peer-based health education program focusing on establishing positive peer norms towards healthy eating and physical activity (PA) among high school students, 2) test program efficacy, and 3) explore mechanisms underlying the program. The study was guided by the Theory of Planned Behavior, which presupposes that human behavior is primarily driven by attitude, subjective norms, perceived behavioral control, and social support. To deliver the intervention, undergraduate students from the disciplines of public health, nutrition, and kinesiology were hired as peer facilitators. Ten area high schools were invited to participate, were matched on demographics and then randomized to intervention or control. The primary outcomes of the study included body mass status, dietary behaviors, PA, and sedentary behaviors which were assessed at baseline and at three and twelve months post baseline. Intervention schools received Team Up for Healthy Living curriculum, which consists of eight 40-minute sessions. The curriculum focused on improving nutrition awareness, PA, leadership and communication. Control schools received their regularly scheduled Lifetime Wellness curriculum. The long-term goal of the study was to establish an effective academia–community partnership program to address adolescent obesity disparity in Southern Appalachia.

Computer technologies have increased the opportunities for employees to engage in cyberloafing by using the Internet at work for personal purposes. Uncontrolled cyberloafing is a threat to organizational effectiveness because it affects organizational productivity. The purpose of this single case study was to explore successful strategies functional managers use to control cyberloafing behaviors of their employees at an e-learning organization located in the northeastern United States. The theory of planned behavior, which emphasized behavioral, normative, and control beliefs as key elements to predict individuals' intentions to behave was the conceptual framework. Data collection included semistructured face-to-face interviews with 11 functional managers and an exploration of organizational policies, procedures, and handbooks. Data analysis included examination of word frequencies, keyword coding, and theme identification. Using Yin's 5 steps for data analysis, 3 themes emerged: create engaging jobs, communicate clear expectations, and promote a positive work environment. Functional managers in the e-learning organization in this study may control cyberloafing by ensuring that social norms convey disapproval, combining deterrence policies and performance metrics; and showing attitudes that promote citizenship behaviors. The implications for positive social change include the potential to provide the e-learning organization in this study with best practices that support employees' needs for work-life balance, thus promoting employee satisfaction while maximizing employee productivity. As a result, the findings of this study can decrease stress, increase morale and positively impact the overall well-being of the organization's workforce.

Parent-child sexual health communication (PCSHC) can have a positive impact on adolescents’ sexual health choices, outcomes, and capabilities for communicating with others about sexual health. Many parents are hesitant and feel unprepared for and uncomfortable with communicating about sexual health with their children. Other parental factors as well as child factors can impact the quality, frequency, coverage, and effectiveness of PCSHC. Some adolescent sexual health outcomes have improved, however, teen birth rates in the United States are elevated compared to other developed countries and half of all sexually transmitted infection (STI) diagnoses are made to adolescents and emerging adults. This emphasizes the importance of PCSHC as a protective factor for children and opportunity for them to develop understanding and skills for good sexual health decision-making. While challenging to recruit and retain participants, parent sex education programming designed to promote PCSHC can instill a sense of parental necessity and responsibility, and equip parents with knowledge and skills to confidently and successfully engage their children. The theory of planned behavior (TPB) provided the framework for this mixed methods study designed to learn more about PCSHC, differences in PCSHC based on gender of children, parental beliefs about PCSHC, intentions for and actual engagement in PCSHC. Included in the literature review for this study is a systematic review of literature focused on parent education programming designed to improve PCSHC. Parents of children in grades 4 – 11 completed a pencil/paper or an electronic Qualtrics baseline survey containing questions about their perceptions of and engagement in PCSHC. The quantitative data collection instrument included items measuring TPB constructs of behavioral, normative, and control beliefs, intentions for and actual engagement in PCSHC and condom use instruction delivery, communication openness, communication ability, sexual health topics discussed with children, and respondents’ demographics Many of the respondents (N = 205) were residents of the program target community, Winchester/Clark County, Kentucky, and were eligible to participate in parent programming, as were all residents that were parents of children in grades 4 – 11. The program, I’ll Have a Side of Sex Education, was designed as a six-week series of 50 minute lunch time sessions with the intention to improve parents’ sense of comfort, confidence, and skills in communicating with their children in general, and particularly about sexual health. Of the 205 parents who completed the baseline survey, 50 enrolled in and attended some or all of one of five offerings of the six-week parent education series and were invited to complete a post-program and six-week follow up surveys. Post-program data were collected with a paper- pencil survey and six-week follow up data were collected with a Qualtrics survey. The systematic review of parent sex education literature provided insight into components of programming related to successful program delivery and positive parental outcomes. The systematic analysis of the baseline data including examining PCSHC factors from the parental perspective and how these related to the gender of children and determining the usefulness of the TPB constructs for understanding PCSHC Results of Chi-square tests of mean differences showed a significant difference in parents actually providing their children with instructions for correct condom usage, χ2(2, N = 203) = 6.96, p = 0.03, and MANOVA results revealed the degree to which parents address certain sexual health topics with their children related to the gender of their children. Results of logistic regression showed behavioral beliefs having the greatest predictive power of parents’ intentions to give condom use instructions (p < 0.01) and actual delivery of condom use instructions (p = 0.04) and engagement in PCSHC, generally (p = 0.03). The current study contributes to the greater body of literature addressing parental and child factors related the promotion, delivery, and effectiveness of PCSHC and parent education programming designed to improve the quality, frequency, and impact of PCSHC. Its findings expand our understanding of how gender of children and parental beliefs relate to PCSHC and lend themselves to the consideration of the greater social influences impacting parents’ ability and motivation to engage their children in communication about sexual health. Differences in communication based on gender of children signal to a double standard in the messaging about sexual health and behaviors related to gender and these discrepancies leave adolescents and emerging adults, both males and females, vulnerable at worst to poor sexual health choices and outcomes and at least to being undereducated about sexual health topics. Although these findings give little support for the overall TPB model contributing to the understanding of parental intentions and behavior related PCSHC, the relationship between behavioral beliefs informed by attitudes about the value of PCSHC and parental intentions and behaviors does provide insight to health promoters and educators. Assessing parental attitudes toward PCSHC and tailoring messages and educational opportunities that may improve these attitudes and motivate parents to engage in and seek support for effective PCSHC holds promise. The piloting of a parent education program adapted from a previously evaluated parent sex education programming and the summative evaluation offered by participants gives support for efforts on the part of health promotion and education professionals to invest time, energy, and resources into program design and delivery and recruitment and retention of parents.

Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important. The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using a Theory of Planned Behavior (TPB) framework, the influences on mothers’ toddler feeding decisions. These included attitude, subjective norms, and perceived behavioral control. These constructs were derived from discussions about what sources of nutrition information mothers use and trust. The aim of the subsequent study was to use the TPB to assess factors affecting a mother’s behavioral intention to provide their toddler with a healthy diet and to see if the addition of the parental role construction variable strengthened the TPB’s ability to significantly predict the mother’s behavioral intention. The first study used a qualitative approach to gather data from three focus groups that consisted of mothers of toddlers (N = 15). Qualitative thematic analysis was used to define prominent themes. Four major themes emerged from the data analysis: (1) attitudes (subthemes: positive towards maternal role of feeding and negative towards the maternal role of feeding); (2) subjective norms positively accepted (subthemes: social media, pediatricians, and registered dietitians); (3) subjective norms negatively accepted (subthemes: pediatricians and registered dietitians); (4) perceived behavioral control (subthemes: acceptance, scarcity of time and outside influences). An online survey was created using data gathered from the focus groups and a previously validated survey that fit the theoretical basis of the study. The survey utilized the TPB to assess the connections between the constructs and the mothers’ behavioral intentions surrounding toddler feeding. The final sample consisted of 148 mothers. The mean age was 32.83 (SD = 6.16) years. The majority of participants were married (87.2%), had earned a college degree or higher (79.7%), held part-time or fulltime employment, (60.8%), and were White (90.3%). The TPB model predicted 53% of the variance in mother’s behavioral intention surrounding the behavior of providing meals that include a wide variety of the five food groups in appropriate amounts. The addition of the parental role construction variable added 6% more predictive power to the model. The most salient predictors included attitude, perceived behavioral control, and parental role construction. Mothers positively and negatively receive information from a variety of sources, they have many strong emotions associated with feeding that are deeply rooted in their roles as mothers, and their feeding decisions were strongly influenced by the TPB constructs. Health promotion efforts should aim to increase the mother’s sense of behavioral control and parental responsibility rather than focusing on the benefits of healthy eating. Programs should provide tangible ways to help mothers overcome perceived barriers and, in turn, increase mothers’ beliefs in their ability to provide toddlers with a balanced diet.

Environmental sustainability in buildings is an important part of preserving the environment and reducing climate change. The increasing amount of physical infrastructure systems in Malawi has not been accompanied by policy-makers clearly understanding perceptions and attitudinal behaviors of building designers to promote environmental sustainability. Some building designers in Malawi might not be practicing sustainability innovations adequately, requiring more research to understand their perceptions and behaviors. The purpose of this mixed methods sequential and explanatory study was to explore how building designers' behaviors relate to the implementation of sustainability innovations in Malawi. Ajzen's theory of planned behavior explaining how attitudinal behaviors relate to individual's actions, served as the conceptual framework. The central research question investigated perceptions and attitudinal behaviors building designers hold about sustainability, and how these behaviors connect with practicing sustainability innovations. Data collection used a Likert scale questionnaire to capture behavior items. A sample of 99 individuals working in building organizations completed the questionnaire. Multiple linear regression analysis showed attitude behavior influenced practicing sustainability more than the subjective and perceived control behaviors. Interviews with 24 participants supported the analytical finding. Government and policy-makers were the target audience. Knowledge about behaviors toward sustainability innovations enables government and policy-makers strategize and change stakeholders' mindset to increase sustainability practices thereby impacting societal change in the construction communities.

In the first 3 years of the Obama Administration, 2009-2011, the number of warning letters issued to pharmaceutical firms for manufacturing and quality issues increased by 81% to 49 letters. Only 9 letters were issued in the last 3 years of the George W. Bush Administration. Shortfalls in compliance and product quality led to medicine shortages that affected patients' treatment and health. This quantitative study sought to learn to what extent, if any, the independent variables, management behaviors and financial indicators at pharmaceutical firms in the United States, correlated with, or predicted, the dependent variable, compliance with the FDA regulations. FDA's enforcement actions on the firms were the treatment event. A shift in the relationship between the variables occurred after the FDA interventions, which highlighted a new level of compliance. Of the 1144 SurveyMonkey invitations sent to the members of the International Society of Pharmaceutical Engineers, only 21 completed the survey's 133 questions. Three research questions were addressed using correlations and linear regressions. The theory of planned behavior was applied to correlate behavioral constructs with the compliance of the firms leading to the rejection of the null hypothesis. By establishing an inverse relation between financial indicators and the firms' level of compliance, the study offers awareness and insight to senior leaders regarding their behaviors and the decision-making process. Enhancing managers' decision-making processes in light of their beliefs, along with their control over financial indicators, could reinforce the presence of effective quality systems among pharmaceutical manufacturers minimizing medicine shortages.

Marijuana is the most common illicit drug that is abused by pregnant women, and recently many states have adopted various levels of relaxed marijuana policies. The purpose of this study was to evaluate a potential association between residing in a state that allows medical marijuana use and maternal marijuana usage. Grounded in the theory of planned behavior, this study evaluated the prevalence and extent of maternal marijuana use in states that allow and states that do not allow medical marijuana use using the National Survey of Drug Use and Health (NSDUH). It was anticipated that more lenient subjective norms toward marijuana use and increased availability would support an increase of maternal marijuana use. The 2014 NSDUH was queried and analyzed using chi-square and logistic regression. The study revealed an increase of maternal marijuana use in states where medical marijuana was allowed, but the increase was not statistically significant. An increase of heavy users was observed in states where medical marijuana was allowed (54% versus 37%). Consistent with other research findings, this study revealed that young (OR = 3.56; 95% CI: 1.379, 9.213; p = 0.009) and unmarried (OR = 6.81; 95% CI: 2.485, 18.661; p < 0.001) pregnant woman were at higher risk for past month maternal marijuana use and had similar results for past year use. The unintended consequences of increased in utero marijuana exposure and its subsequent negative public health effects have been missing from the discussion of the relaxation of statewide marijuana policies. This study will provide policy makers responsible for changing marijuana policy with useful evidence on the unintended consequences of increased maternal marijuana use in areas where medical marijuana is allowed.