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Background: University scholars and community members formed the Prescription Drug Abuse and Misuse Working Group in response to the prescription drug abuse/misuse epidemic plaguing the Appalachian region. Their collaboration has yielded no fewer than four funded and six volunteer service projects in the community. A concern voiced by key community stakeholders has been the non-medical use of prescription drugs (NMUPD) among the workforce. The team discovered that the relationship between NMUPD and workplace characteristics is understudied. This study aimed to show the overall and industry-specific prevalence of NMUPD, and to examine workplace characteristics associated with NMUPD. Methods: Data from the 2011-2012 National Survey on Drug Use and Health (NSDUH) were used. Multiple logistic regression assessed workplace characteristics on past-year NMUPD among employed adults 18 years and older, controlling for demographic variables. Results: The overall prevalence of NMUPD was 9.23% (95% CI: 8.98-9.48). The industries with the highest prevalence were: arts, entertainment, recreation, accommodation, and food services (14.48%; 95% CI: 13.70-15.27), construction (10.82%; 95% CI: 9.77-11.87), and retail trade (10.04%; 95% CI: 9.34-10.74). NMUPD was significantly associated with industry type (p Conclusions: Results suggest alcohol or drug use workplace policies and employee assistance or other counseling programs may protect against NMUPD. Workplace prevention efforts for NMUPD could benefit from incorporating these approaches.

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The present study addresses two major issues . First, the need for children to develop the skills necessary t o prevent themselves fro m being molested. Second, the need for hearing impaired children to receive the same information, coping s kills, and defense strategies as their hearing counterparts. The "Safety with Strangers slide series was presented in classrooms of hearing impaired students at both the middle school level and elementary school level. Program trainers gave students information regarding stranger approaches, demonstrated the safe, appropriate (role-modeling) and gave the children opportunities to practice these safe, appropriate behaviors (behavioral rehearsal). This program was extremely effective with the middle school students, while there was no treatment effect with the younger children.

Many crisis intervention programs have been developed for child abuse but very few primary prevention programs exist. Teaching prospective parents to cope with aversive child behaviors might prevent the occurrence of child abuse later. The purpose of this study was to compare the effectiveness of using peer (high school students) and college students as trainers in a preventative approach to child abuse for high school students. It was proposed that peers would be better trainers because the trainees would be more likely to model their behavior and more at ease when asking the trainers questions. One hundred and thirty-four high school seniors were randomly assigned to one of three groups: control, college trained, or peer trained. These students rated their responses to potentially aversive child behavior situations and also role played their responses in these situations. Results indicated that there were no significant effects of training or types of trainers but the author concluded that more work should be done on the type of peer trainers used.

Recent advance in health and technology has made mobile apps a viable approach to delivering behavioral interventions in areas including physical activity encouragement, smoking cessation, substance abuse prevention, and mental health management. Due to the chronic nature of most of the disorders and heterogeneity among mobile users, delivery of the interventions needs to be sequential and tailored to individual needs. We operationalize the sequential decision making via a policy that takes a mobile user's past usage pattern and health status as input and outputs an app/intervention recommendation with the goal of optimizing the cumulative rewards of interest in an indefinite horizon setting. There is a plethora of reinforcement learning methods on the development of optimal policies in this case. However, the vast majority of the literature focuses on studying the convergence of the algorithms with infinite amount of data in computer science domain. Their performances in health applications with limited amount of data and high noise are yet to be explored. Technically the nature of sequential decision making results in an objective function that is non-smooth (not even a Lipschitz) and non-convex in the model parameters. This poses theoretical challenges to the characterization of the asymptotic properties of the optimizer of the objective function, as well as computational challenges for optimization. This problem is especially exacerbated with the presence of high dimensional data in mobile health applications. In this dissertation we propose a regularized greedy gradient Q-learning (RGGQ) method to tackle this estimation problem. The optimal policy is estimated via an algorithm which synthesizes the PGM and the GGQ algorithms in the presence of an L₁ regularization, and its asymptotic properties are established. The theoretical framework initiated in this work can be applied to tackle other non-smooth high dimensional problems in reinforcement learning.

In 2007 South Carolina funded 15 regional coordinators to work with local law enforcement agencies and alcohol and drug commissions to create 16 community alcohol enforcement teams to improve enforcement of underage drinking laws. Previous researchers have suggested that collaborative leadership is needed for effective teams, yet little is known about the factors that serve as barriers to and facilitators of, collaborative leadership in alcohol enforcement teams. The purpose of this phenomenological study was to explore the lived experiences of coordinators involved in leading the alcohol enforcement teams in South Carolina. The theoretical framework used was Cameron, Quinn, DeGraff, and Thankor's conceptualization of the competing values framework. Data were collected through in-depth interviews with a purposive sample of 12 alcohol team coordinators. These data were inductively coded and then subjected to a modified Van Manen and Vagle analysis. Key findings indicate strong support for the idea that existence of positive community relationships and supportive champions from community partners were crucial to building and maintaining successful teams. These findings were consistent with the theoretical framework. Recommendations include implementing leadership and collaboration training for the coordinators and team members. These findings have implications for positive social change by increasing awareness among policy makers about collaborative leadership factors, which in turn could lead to policies that generate more effectual teams, improve enforcement of underage drinking laws, and consequently, result in safer communities.

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Sexual violence against children (SVAC) is a complex, global challenge that negatively impacts the health and human rights of hundreds of millions of children. Over the last 50 years, SVAC has increasingly been viewed as a public health problem, and significant progress has been made in understanding its prevalence, identifying risk factors, and developing prevention approaches. While practitioners recognize that children’s experiences of sexual violence are diverse, there is an absence of evidence on different forms of SVAC. In this dissertation, I introduce the construct of “SVAC subtype,” which aims to capture the heterogeneity in children’s experiences of sexual violence. SVAC subtype refers to the characteristics associated with an SVAC experience, including the survivor’s characteristics (age, gender, etc.), the perpetrator’s characteristics (age, relationship to survivor, etc.), and the event’s characteristics (the location, the specific acts, etc.). Greater insight into SVAC subtypes provides policymakers, implementers, and researchers with information they can use to assess how well existing SVAC interventions prevent the identified subtypes, to tailor and target prevention interventions to better reach and meet the needs of children, and to improve research on SVAC and evaluations of prevention programs. In this dissertation, I describe how to identify and apply SVAC subtypes to ensure that no children are left behind in SVAC primary prevention efforts. I developed Chapters 1 and 2 in partnership with the AfriChild Centre, a Uganda-based research institute that promotes the well-being of African children. In Chapter 1, I describe the application of the Latent Class Analysis (LCA) methodology to identify subtypes of children’s first SVAC incidents across five Eastern and Southern African countries (Kenya, Malawi, Mozambique, Uganda, and Zambia). This analysis used nationally representative Violence Against Children Survey (VACS) data to identify eight subtypes of first SVAC incidents, four among boys and four among girls. Among boys, the identified subtypes were Boys’ SVAC subtype 1: Peer-perpetrated sexual touching at school; Boys’ SVAC subtype 2: Preadolescent survivors, known perpetrator; Boys’ SVAC subtype 3: Partner-perpetrated, forced or pressured sex at survivor’s home; and Boys’ SVAC subtype 4: Older adolescent survivors, attempted forced sex on a road, estimated to represent 25%, 29%, 14% and 32% of boys’ first SVAC incidents, respectively. Among girls, the identified subtypes were Girls’ SVAC subtype 1: Peer-perpetrated sexual touching at school; Girls’ SVAC subtype 2: Preadolescent survivors in their own home, known perpetrator; Girls’ SVAC subtype 3: Partner-perpetrated forced or pressured sex at perpetrator’s home; and Girls’ SVAC subtype 4: Adolescent survivors, attempted forced sex on a road, estimated to represent 13%, 15%, 31% and 40% of girls’ first SVAC incidents, respectively. Experiencing emotional violence, physical violence, or parental absence prior to SV was predictive of experiencing certain SVAC subtypes compared to others. In Chapter 2, the same approach was applied to understand SVAC subtypes in Uganda using VACS data. Among boys, the identified subtypes were: Boys’ SVAC subtype 1: Peer-perpetrated sexual touching at school; Boys’ SVAC subtype 2: Preadolescent survivors, forced or pressured sex, family member perpetrator; Boys’ SVAC subtype 3: Older adolescent survivors, repeated, partner-perpetrated SV, outdoors; and Boys’ SVAC subtype 4: Young adolescent survivors, attempted forced sex, neighbor perpetrator, estimated to represent 27%, 14%, 24% and 34% of boys’ first SVAC incidents, respectively. Among girls, four subtypes were identified: Girls’ SVAC subtype 1: Peer-perpetrated sexual touching at school; Girls’ SVAC subtype 2: Preadolescent survivors, attempted or forced sex, neighbor or family member perpetrator; Girls’ SVAC subtype 3: Older adolescent survivors, repeated, partner-perpetrated SV; and Girls’ SVAC subtype 4: Stranger-perpetrated SV, outdoors, estimated to represent 21%, 12%, 26% and 41% of girls’ first SVAC incidents, respectively. Among boys and girls reporting SVAC, physical violence or parental absence prior to SV significantly increased the odds of reporting SVAC subtype 2, compared to SVAC subtype 1. Stakeholders in Eastern and Southern Africa can use the findings of Chapters 1 and 2 to assess how well existing SVAC interventions are expected to prevent the identified subtypes and take corrective actions to ensure any overlooked SVAC subtypes are prevented. In both chapters, I present brief, non-exhaustive assessments of this issue, which revealed misalignment between prevention programs and prevalent SVAC subtypes. Practitioners can also use the identified SVAC subtypes to target and tailor SVAC primary prevention programs in the region to increase their effectiveness and sustainability. Finally, researchers can use the findings to design surveys that better capture the heterogeneity of survivors’ experiences, allowing them to ascertain the prevalence of SVAC subtypes across time and settings and to determine which programs are effective in preventing specific subtypes. In Chapter 3, I present additional recommendations for how identified SVAC subtypes can be utilized, introducing the Plan2Prevent roadmap, which provides guidance to implementers on how to consider SVAC subtypes and other contextual factors to design or refine SVAC prevention approaches. This chapter describes a partnership with Pathfinder Tanzania to pilot the Plan2Prevent roadmap to refine an SVAC prevention program in Zanzibar. Plan2Prevent has the potential to support practitioners to use data to design or refine SVAC prevention programs that are informed by evidence and aligned with the local context, with the aim of more effectively and sustainably preventing SVAC. Analyzing data to better understand the heterogeneity of children’s experiences of sexual violence by identifying SVAC subtypes can support stakeholders to move away from viewing SVAC as a one-dimensional issue. Chapters 1 and 2 demonstrate the utility of LCA as a means of identifying SVAC subtypes, and all three chapters provide guidance on how SVAC subtypes can be used to improve SVAC primary prevention efforts. A deeper understanding of SVAC subtypes can help policymakers, implementers, and researchers to assess the state of SVAC prevention programming and improve SVAC prevention interventions, research, and evaluation. Overall, this dissertation posits that the application of more nuanced, data-based understanding of SVAC can improve prevention programs so that more children can live free from sexual violence.

In the 1985 "National Family Violence Resurvey'' conducted by Gelles & Straus (1988) one out of every six couples experienced a physical assault during 1985. At this rate, 8.7 million couples experienced at least one assault during the year. Shelter and assistance for the abused wife have been viewed as important and forthcoming. However, spouse abuse will not stop until effective treatment for men, more often the abuser, is offered. In response to the incidence of abuse in the military, services and programs for both the abusers and their wives have been developed. One treatment program for the abuser which was assessable for this study was the Prevention through Anger Control and Education (PACE) treatment program. The purpose of the research was to study the reactions and progress of abusers as they moved through the PACE treatment program. Five subjects participated in the study. Data were collected throughout the course of treatment by interviews and questionnaires which were administered to the abuser, wife, and group facilitator. A follow-up interview was conducted with the subjects one year after treatment to collect post treatment data. Quantitative data were also collected but later used only for descriptive purposes. Findings from the case study method showed that the PACE treatment program may have had limited impact on the abusers. While the outcomes were not strong, some changes in subjects' behavior, feelings, and thinking were evident. Abusers tended to respond with socially acceptable answers and behaviors during treatment. Interview with wives and the group facilitator were helpful in establishing the accuracy of these reports. Subjects reported a cessation of abuse, but it could not be ascertained whether coping strategies learned from the group had made a difference in the relationships because four of the five couples had divorced by the follow-up. However, they reported that the skills learned from the group allowed them to seek a divorce in a non-abusive manner. The abuser with the intact marriage did report utilizing several of the newly learned coping strategies. The abusers did report that the skills learned from the program helped them handle stress: better, decrease their propensity to provocation in other situations, and expected them to help in future relationships. / Ed. D.