Functional health literacy is one path through which the educational system, health system, culture and society intersect to influence health outcomes and their associated costs. Inadequate functional health literacy can impair oral and written communication and subsequently the ability to understand the prevention and self-management of disease. Despite these concerns, the national prevalence of inadequate, marginal and adequate functional health literacy and their association with health status, health care utilization and subsequent health care outcomes remain largely unknown. For those tasked with the responsibility of managing population health, there is a void of tools and techniques that can be used to efficiently identify those at greatest risk of inadequate functional health literacy. Using standard regression modeling and diagnostic techniques, this study was the first to develop and validate a model to estimate functional health literacy and to confirm its direct relationship with preventive health services utilization in a nationally representative sample of elderly >= 65 years of age. The national prevalence of inadequate and marginal functional health literacy was estimated to be 39%. Preventive health care utilization varied by functional health literacy category. Individuals with inadequate or marginal functional health literacy had odds of not receiving a flu shot within the past 12 months that was 1.26 times that of individuals with adequate functional health literacy (OR = 1.26, 95% CI (1.11 - 1.43)) after controlling for income, insurance coverage, having a usual source of care, and self-reported general health status. Women with inadequate or marginal functional health literacy had odds of not ever having a mammogram that was 2.21 times that of women with adequate functional health literacy (OR = 2.21, 95% CI (1.85 - 2.65)) in multivariate analysis. This research confirms the national public health relevance of functional health literacy in preventive health care utilization in the elderly. Race, education and age-related disparities in preventive health care utilization may, in part, be mediated through functional health literacy. As we move to equalize health care access, utilization and quality for all, functional health literacy must be considered part of the solution if we are to empower those in greatest need.

There were approximately 3,000 international students, scholars and their dependent spouses and children associated with the University of Pittsburgh in 2003-2004. As the accompanying wife of an international student or scholar proceeds to take care of practical home and family tasks in a new and unfamiliar environmentthe U.S.she may experience negative mental health outcomes such as anxiety, frustration, depression, isolation, etc. These adverse outcomes are a significant public health problem for the population of international wives because they decrease quality of life and sense of wellbeing. The symptoms can also have negative affects on the husbands and dependent children of the international wives. Using an ecosystemic approach, the current study contributes to the literature on international student wives by exploring the following research questions at the intersection of the individual and meso-system levels of interaction: (1) What tasks must international wives accomplish in the U.S.? (2) How do international wives access community in order to more successfully accomplish these tasks? (3) What ideas do wives have for how their communities could be enhanced? Using qualitative, in-depth, semi-structured interviews with seven Asian wives of Asian international students and scholars, the current study is an exploration of the tasks that international wives feel they need to accomplish in Pittsburgh and the social systems they access. Three themes emerged from the interviews which described the wives transition from dependency to agency, their strategies for maintaining cultural identity and the use of virtual communities. The study concludes with practical recommendations of population-specific social support interventions which may be implemented by public health practitioners and other interested purveyors of mental and social support.

During a two-year term as an admissions counselor, I had the opportunity to interview over 60 students at Armand Hammer United World College (UWC) of the American West in Montezuma, New Mexico. I learned that the internationally diverse population of secondary students there and at ten other UWCs across the globe were united under the UWC mission: to become responsible citizens, politically and environmentally aware, and committed to the ideals of peace and justice, understanding and cooperation, and the implementation of these ideals through action and personal example. All that I learned, combined with personal aspirations to a career in public health and an interest in helping young people reach their potential, led me to set a goal of some day teaching public health to UWC students, and students with a similar sense of purpose at other schools. This thesis addresses my aspirations as it presents a public health curriculum that could be applied to the UWC movement. Within the thesis, I summarize existing public health curricula that target youth; describe theories and concepts that demonstrate the importance of public health curricula for adolescents; present my current progress in creating a partnership with the United World Colleges, basing the discussion in community development concepts; consider project limitations and devise strategies that may drive the collaboration process forward in the future; outline the curriculum development process; and present the preliminary course. This work is of great public health significance because existing and future public health issues the world over require the most creative, culturally sensitive professionals for solutions. I argue that the future professionals best suited to tackle such an important task are the adolescents of the present because they stand in a unique position to realize their potential as individuals, family and community members, citizens, and future leaders in their chosen vocations. Investing in the public health education of adolescents is a health intervention we can all participate in and benefit from with dividends to spare.

Obesity is a national health crisis that demands immediate action from multiple stakeholders, both within and outside of traditional health domains. As interventions are developed to address this epidemic, this paper serves as a resource of public health importance as it discusses potential roles that retail grocers can play to improve national nutrition. By synthesizing literature from the health and marketing fields as well as publications from the grocery industry, three primary recommendations are presented: Contribute to nutritional assessments, influence dietary choices in the retail setting, and partner with local stakeholders. Additionally, the Social Ecological Theory is applied as a guiding framework to evaluate and plan grocery store interventions. Suggestions for future research and next steps are also provided. This report is potentially useful for health professionals interested in community nutrition and for store operators concerned with their stores image and meeting their customers needs.

Although levels of disability among adults are relatively stable, the number of children with disabilities is steadily rising. It is increasingly the case that medically fragile children are receiving care in their homes due to early discharges from hospitals and other related service programs. These children and their families have needs that require interventions from many different services, such as health, education, social services, housing, transportation and benefits. This thesis explores the present state of affairs by considering typical problems and decisions these families face on a day-to-day basis, family coping strategies, and local family resources. I propose a social ecological approach to addressing the special health care needs of children. The social ecology model explains the need for interventions to approach this complex problem on several levelsthe individual, interpersonal, community, and policy. The model examines the inter-relationships between these levels and explains some of the barriers to care on each of the different levels. The implications for public health educators and researchers are the possible collaboration with community-based institutions to assess, plan, develop, and evaluate interventions within the context of children with special health care needs and their families. Based on my review, I propose strategies for intervention at four different levelsindividual, interpersonal, community, and policy. My assumption is that if each of the proposed strategies is successful at it respective level, then childrens access to coordinated community-based social and health services would improve.

This project was designed as an assessment of the overweight and obesity resources available in the City of Pittsburgh and the two boroughs of Braddock and Wilkinsburg. This project also designs a participatory action research intervention to address the specific needs and barriers of the region in regard to healthy lifestyles. This project was designed to address three objectives of HealthyPeople 2010: 1) to increase the proportion of adults who are at a healthy weight, 2) to increase the proportion of adults who exercise for at least 30 minutes daily and 3) to increase worksite accessible nutrition and weight management counseling. Methodology Two assessments of the region, a physical activity resource assessment and assessment of health and wellness opportunities offered by the regions top ten employers were facilitated. The physical activity resource assessment surveyed five parks in the region for walkability, barriers and incentives for community use. In conjunction with the assessment a participatory action research intervention with 13 collaborative partners was designed. The next stage assessments include focus groups and surveys. Results The five parks were found to offer a refuge from urban life within the city limits. Amenities in regard to public toilets, park information, parking and exercise information such as mile markers were often lacking. Eight of ten region employers offer health and wellness programs. The scope of services varied as did employee utilization of such services. Conclusions Allegheny County offers excellent venues for outdoor recreation. Unfortunately the public does not access these facilities. Employers in the region offer health and wellness programs but without substantial incentives, employees may abstain from participation. Determining the specific barriers to healthier lifestyle choices through participatory action research methodology is a first step to improving the overall health in the region.

Disasters vary in scope, size, and cause. Relevant public health aspects of disasters include community impact and the response of health professionals to alleviate stress and dangerous conditions surrounding the disaster. Public health focuses on the prevention of disease and the promotion of health. Disaster preparedness and response are significant areas in the field of public health. Disasters pose threats to the general public through increases in injury, death, and changes in infrastructure. The public health response to disaster includes assessments of the community impact, surveillance for disease, addressing sanitary health concerns, and providing information to the public. Mental health professionals also have important roles in responding to disaster in the community. In addition to physical aspects, disasters also may pose psychological risks to individuals and to the effected community. These risks may include stress, anxiety, and depression. Mental health workers provide counseling, support, and education to assist people affected by disaster in returning to their pre-disaster level of functioning. Traditionally there has been a separation between the disciplines of public health and mental health. Public health is population-based and mental health has been traditionally regarded being more individually based. During a disastrous event communication and organization among agencies is critical to an effective response. Increased collaborations between public health and mental health are needed to facilitate an appropriate and effective disaster response. Both areas aim to improve overall health and well being, and therefore are inter-related. Each discipline needs to become more familiar with the nature of each others work. Overall increases in public and mental health research, planning, training, and education programs are needed to understand and appreciate both the public health and mental health consequences of disaster and to improve community participation and preparedness.

This paper will discuss the power differential between women and men and its role in the intersection of HIV/AIDS and intimate partner violence among women in sub-Saharan Africa. Both HIV and intimate partner violence are of tremendous public health relevance. Since its discovery over 20 years ago, HIV has been and continues to be a world health problem. Nearly 40 million people worldwide are living with HIV/AIDS; about half of them are women. Fifty seven percent of the people living with HIV/AIDS in Sub-Saharan Africa are women. HIV prevention continues to be an urgent health priority in sub-Saharan Africa and throughout developing countries around the world; yet interventions preach abstinence and safer sex practices without recognizing the sociocultural context of HIV/AIDS or of sexual behavior and practices. Traditional concepts of gender roles and the power differential intrinsic in relationships between women and men must be accounted for not only in the design of HIV interventions, but also acknowledged as risk factors for violent relationships. Suggestion of condom use by the female partner, for example, is often met with suspicion, hostility, even violence from her male partner. Intimate partner violence is researched in this paper because it is the ultimate manifestation of the gendered power differential. This paper will critically review existing HIV interventions targeting women, explore different gender norms throughout sub-Saharan Africa and the gendered power differential as exemplified by IPV. The paper will conclude with recommendations for future public health efforts and a proposal for an intervention that addresses both public health issues.

Childhood obesity is the most prevalent nutritional disease of children and adolescents, affecting approximately 24% of the United States population ages 2-17. Childhood obesity is of public health significance because of increasing prevalence, costly consequences on disability and mortality, and the potential to promote health disparities. The Fun to Be Fit curriculum was piloted in nine Pittsburgh Public School System elementary schools during the 2001-2002 academic year. The curriculum incorporates two evidence-based programs: FRESH (Food Re-Education for Elementary School Health) and SPARK (Sports, Play and Active Recreation for Kids). The curriculum included 10 minutes of nutrition education and 40 minutes of physical fitness activities, offered twice a week. A total of 576 third and fourth grade children from five treatment schools (n=332) and four control schools (n=244) participated. Treatment school teachers received training in SPARK and FRESH, fitness assessments, and coaching strategies. The nutrition component was evaluated with a 20 item nutrition knowledge survey and a 51 item food frequency questionnaire. Fitness was assessed through curl-ups and push-ups completed in 30 seconds, and a half mile run/walk test. Both treatment and control schools completed the nutrition surveys and fitness assessments at the beginning and end of the school year. The purpose of this study was to determine whether the Fun to Be Fit curriculum was more effective than the existing physical education curriculum offered in the control schools in improving nutrition and fitness behaviors. An analysis of covariance (ANCOVA) examined between-group differences at post-test in nutrition and physical activity scores, statistically controlling for gender, grade level, and variation in pre-test scores. Results showed a greater increase in nutrition knowledge among Fun to Be Fit students (p=.002), and greater reductions in the consumption of high fat (p=.001), high sodium (p < .001), and high sugar (p < .001) foods as compared to the control students. Physical activity outcomes were mixed, with Fun to Be Fit students showing greater increases in push-ups (p <.001) but significantly fewer curl-ups (p= .033) as compared to the control students. There were no significant differences (p > .05) for the half mile run/walk assessment. The Fun to Be Fit program appears to be an effective strategy for improving nutrition knowledge in elementary school students and to some degree for increasing physical activity.

Environmental health and chronic disease are among the greatest public health challenges facing America today. A body of literature exists to support the causal relationships of various chemical, biological, physical, and social factors on health outcomes. Effects of these environmental influences on health have been found to include social, economic, psychological, biological, and physical dimensions, all of which are major contributors to the prevalence of chronic disease. In recent years, health promotion efforts have been broadened to encompass more environmentally-focused strategies, such as improving air and water quality, reducing exposures to hazardous materials, and planning land use for the design of healthier communities. While such advocacy efforts are critical for policy changes related to environmental health, these interventions, alone, are not sufficient to combat the deteriorating conditions that threaten human health and quality of life. First, given the public health significance of this problem, a need exists for greater collaboration among professionals in the fields of environmental health, community planning and development, health promotion, as well as other disciplines. Second, effective environmental health promotion requires a socio-ecological approach, which necessitates that the individual, organizational, and community-level influences on the environment be addressed. Finally, interventions that promote environmental health at these levels should be based upon sound social and behavioral theory, rather than relying solely upon the technological approaches to risk management that have predominated in the past. Examination of urban greening interventions illustrates both the benefits and practical challenges of utilizing these methods to promote environmental health. Based upon a review of literature in the field, I explore the strengths and limitations of a community-based intervention in the East End of Pittsburgh. Specifically, I evaluate the theory and processes of this program, entitled MERGE II (Methods to Engage Residents and Grassroots in the Environment II), and conclude by translating evaluation findings into recommendations for future environmental health promotion interventions. These recommendations are intended to engage and inform diverse stakeholders in efforts to promote environmental health, and ultimately, to provide effective strategies for reducing morbidity and mortality related to environmental causes.