This thesis describes and assesses existing services for homeless persons with mental illness and suggests improvements. The topic of services for homeless persons with mental illness is of public health significance since the problem has been getting worse in the past few years, with people unable or unwilling to access appropriate services Mental illness in the homeless population is looked at from a social-ecological perspective, including individual, community and policy levels. Current national programs are discussed including Medicaid, SSI, HUD, SAMHSA and ACT. The McKinney Act is discussed as one of the most important pieces of homeless policy. A more in-depth discussion of Allegheny County community capacity and services for homeless persons with mental illness is included. Housing First/Harm reduction, Operation Safety Net, Community Human Services Corporation, Health Care for the Homeless, Mental Health Courts and Police Training are discussed. Key informant interviews reveal frustrations with funding streams, lack of affordable housing and lack of appropriate job opportunities, specific to Allegheny County. An extension of this thesis to include focus groups and interviews with homeless individuals and shelter staff would reveal a more comprehensive view of homeless persons with mental illness. Suggestions for improvements in providing mental health services include, following the housing first/harm reduction model, improving quality of life through increased social supports of this population, advocacy of homeless persons with mental illness, an increase of funding streams that promote collaboration among community agencies, more street outreach for the chronic homeless population and overall more collaboration among different agencies in Allegheny County including, government, social services, education, police and emergency services.

Amyotrophic lateral sclerosis (ALS), an incurable neuromuscular disease, causes progressive paralysis resulting in respiratory failure and ultimately death. Although there are only 30,000 people nationwide living with ALS, this population is of significant public health concern as those afflicted with ALS suffer from progressive symptoms of disability, making them a particularly vulnerable population in need of public health advocacy for improved access to medications and care. As the symptoms of disability become increasing acute in the final months of life, achieving the best quality of life possible is of paramount importance. To achieve this, a number of medications exist to both treat the direct and indirect symptoms of ALS. The purpose of this thesis is to examine barriers terminal ALS patients experience in accessing medications, medication trends as ALS patients near death, and the effect of medications on quality of life for ALS patients in the terminal phase of the disease. Literature pertaining to the terminal phase of ALS was reviewed and an analysis of secondary data was performed. The data analyzed for this thesis was from the National Institute of Mental Health grant funded Living with ALS study, which collected medication data in the preceding months before death from terminal ALS patients. For the purposes of this analysis, patient medications were categorized into four domains: ALS treatment medications, palliative medications, mood medications, and other medications. The correlation between the medication domains and sociodemographic and quality of life indicators were investigated. Changes in medications over time were also investigated. Results of the analysis revealed that those with higher incomes and educational attainment were taking significantly fewer palliative medications. Additionally, those on Medicaid were on significantly fewer other medications. Finally, across all medication domains, medication use declined significantly as patients approached imminent death. These findings suggest that the medications used to treat the symptoms of ALS do little to improve symptoms and even less to improve quality of life. Future research recommendations include exploring patients motivations for discontinuing medications, improving symptom management medications, and improving ALS patients access to both pharmacological and non-pharmacological interventions to improve overall quality of life.

There is a substantial body of evidence that demonstrates an association between religiosity and health outcomes in adults of all ages. Many studies have demonstrated that factors such as religious importance and service attendance may provide social vehicles for factors such as increased access to health care, better management of chronic diseases, and increased availability to preventive health services and education. These religious factors may also influence the way in which a person perceives and copes with his or her health issues. Successful aging theory is a combination of three factors or characteristics: low risk of disease and disease-related disability, high mental and physical function, and active engagement with life. This theory allows for a more holistic approach to aging and health. The overall goal of this observational study using quantitative data from the 1994/95 National Survey of Midlife Development in the United States (MIDUS) was to analyze whether any statistically significant relationships exist between religiosity defined as religious devotion, importance, influence, and service attendance and the three factors of successful aging. The results demonstrated significant relationships between all religiosity variables and active engagement in life. Other statistically significant findings were discovered with the factors: self physical and mental health rating, times in the hospital, routine visits to the doctor, and certain religiosity variables. Many of the findings still existed when analyzed across demographic co-variants. Finally, the use of a theoretical model and logistic regression demonstrated that active engagement in life may be a bridge variable between successful aging health outcomes and service attendance. The results dont show more religion means healthier, but that religion can play an intricate role in an individuals own health. The public health relevance of the study is to make public health professionals aware of the relationships that exist between religiosity and successful aging health outcomes. Religious venues may provide a good resource for preventive health services and education. Most importantly, a persons religious beliefs may affect the way a person deals with physical or mental illness. Public health professionals should embrace the religious beliefs of patients regardless of their own beliefs.

This study looks at the vulnerable population of refugees, specifically refugee youth. Specific attention is paid to mental health issues, notions of belonging, adapting, and acculturation, and the potential role that career guidance education can play in positively impacting the mental health and long-term resettlement success of refugee youth. Results from a search of published literature and interviews with local resettlement organizations in Pittsburgh, PA are summarized. The findings show that the experiences of traumatic events in their country of origin and that life conditions in countries of resettlement, significantly impact the mental health and development of refugee health. Mental health conditions noted in refugee populations include post-traumatic stress disorder, anxiety and depression. Evident in the literature is the hope that the role of education holds for refugee youth and the positive gains that a sense of school belonging has on their depression levels. Career guidance education curricula for general student populations in the United States, has multiple social, educational, and economic benefits. This study suggests that career guidance education curricula targeted to resettled refugee youth, could increase their sense of self-agency, self-efficacy, and empowerment thereby increasing feelings of overall well being and leading to long-term resettlement success. The issue of the status of refugee youths mental health and the potential role that career guidance education can have in helping them understand, think about, and plan for their future is extremely salient to the field of public health. However, it is unknown whether or not career guidance education curricula would be relevant to refugee youth due to differing cultural models dictating career choice and expectations. Recommendations for future research and program development addressing the health and well-being of refugee youth in the Pittsburgh area are provided.

The death of a close family member is a profound insult to a childs developmental course. Though early research assumed that childhood bereavement was a risk factor for mental and behavioral disorders in childhood and adult life, recent research has taken an ecological view of childhood development and considers a childs exposures to risk and protective factors. Yet, it remains unclear as to how many children are affected by the death of a close family member each year and how peer support groups can help children to adapt to such an adverse event. This dissertation represents three distinct stages in the development of a comprehensive evaluation for an agency that provides a peer support service for bereaved children and their families. First, a primary question that arose during initial consultations with the agency was to determine how many children are affected annually within Pennsylvania. This led to an exploration of the epidemiology of childhood bereavement. The methods and data sources used to produce these estimates were critically evaluated and modified to offer a new interpretation of available data. Second, it was important to identify constructs that could be used in an outcomes evaluation of the peer support program. Focus groups were used to explore the perceived benefits of attending peer support groups among caregivers and teens who had attended a spring session at the center. The intention to use focus groups was to increase the validity of constructs and, ultimately, the results of an outcomes evaluation. Third, after identifying evaluation constructs a feasibility study was conducted to pilot an outcomes evaluation instrument. The study involved 30 families who attended the spring 2007 sessions at the center. Results suggested that peer support programs can improve childrens coping efficacy while helping to improve their caregivers perception of social support. The program also improved both children and caregivers sense that they are not alone in their grief. As demonstrated in this dissertation, including the loss of siblings and primary caregiving grandparents in prevalence estimates of childhood bereavement and applying resilience theory to peer support research is of public health relevance.

Being without health insurance or being "underinsured" creates a variety of special problems for women aged, 45 to 64, which is perhaps the most complex of all developmental periods in the lives of American women. "One Thing Leads to Another. . ." explored the relationship between health insurance status and the utilization of primary screening services among women, aged 45 to 64. Secondary data drawn from the 1996 BRFSS was used to develop a non-experimental study that examined the association between health insurance status, and access to selected primary screening services as measured by their responses to the BRFSS and as compared to demographic covariates of interest. Several key findings emerged: 1. Health insurance significantly affects a woman's use of primary health care services; 2. While insurance status or lack of coverage matters tremendously for women, it alone does not guarantee access to health care. Othe determinants, such as income and educational levels, are important forces affecting health behaviors; 3. The rate of being uninsured in the 45-64 females cohort was slightly higher than national averages in 1996; 4. Reduced rates of access were observed across all covariates when women did not have insurance but higher rates of poor outcomes were more consistently associated with uninsured women who were of a race or ethnicity other than "White Non-Hispanic," were unmarried, were unemployed and had lower levels of income and less years of education completed. The public health significance of the study directly relates to one of the "Year 2010 National Health Objectives--to increase the proportion of persons with health insurance to 100 percent." To meet that goal, all Americans should be included in a comprehensive health care system that guarantees timely access to health care, assures a high quality of health services with adequate and stable reimbursement for health care providers and rationally apportions the costs of care. A major focus of that process should include curretn and immediate attention toward improving the health care of all women, with a special emphasis on those aged 45 to 64, who have inadequate insurance coverage. The final chapter includes a review of current state health care reform initiatives and several major approaches to extending coverage to midlife women. Public health and social policy implications along with suggestions for future research and the study's limitations are also provided.

In the United States, obesity is becoming an ever increasing problem, especially among youth. The prevalence of adult obesity-related health complications, until recently were only seen in adults, are arising within the youth population. The increasing rate of childhood obesity is of public health importance; if not properly dealt with now, the current generation of children will grow up and face serious health complications both in their late childhood and adult years. To address this epidemic, two approaches that can be utilized are school-based and clinical based interventions. Even though each type of intervention takes place in a different setting, the same basic principles of nutrition education, healthy eating and physical activity are addressed. While each of the two types of interventions has strengths and weaknesses, the overall goals of both school-based and clinic-based interventions are a reduction in weight and increase in the health of the children participating in the intervention.

The overarching goals of this paper are to promote the use of gardens as a systems approach to education, and propose that they should be evaluated as such. Current literature shows the positive effect of gardening education on nutrition, including consumption of fruits and vegetables and nutrition knowledge. A wealth of anecdotal evidence reveals that gardening education programs affect multiple domains in the lives of participants. The first objective of this paper is to review gardening programs with nutrition education components in literature to understand the areas where these programs are already effective and what gaps still need to be filled. Another objective is to propose evaluative tools for an existing gardening program entitled My Garden Vegetables in Wilkinsburg, PA. These proposed tools will assess both nutrition education components of the program and components related to cooperation, sharing, and the environment. Such evaluations provide information that is vital for reshaping the goals and objectives of future programs. The proposed evaluation tools consist of a food frequency questionnaire, food preference questionnaire, nutrition knowledge game, focus group questions, interview questions, and observations. Once implemented, this evaluation has the potential to add valuable data to the relatively minimal body of research related to systems effects of gardening programs. The public health significance of this paper is that with childhood obesity on the rise, we have the opportunity to create lasting programs that not only influence nutrition knowledge but integrate that knowledge into a childs understanding of his or her role in changing the environment and developing cooperative networks.

Nosocomial, or hospital-acquired, infection is a serious global public health issue that causes the suffering of 1.4 million people at any given time. This thesis uses the social-ecological model to frame the problem of nosocomial infection control in developing countries, and proposes roles for international non-governmental organizations in developing country settings. Using the social-ecological model reveals nosocomial infection control issues at the individual, hospital, and national policy and infrastructure levels. Interviews were conducted with four organizations: two international non-governmental organizations, the Pan American Health Organization, and the University of Pittsburgh Medical Center Infection Control Office. Two case studies are presented from Honduras, showing how the two international non-governmental organizations approached the infection control issue in two public hospitals in that country. Recommendations are given for possible intervention points in developing countries.

Childhood obesity has become of public health importance because of the powerful, adverse impact it has on our Nations youth and on the well-being of our society. Childhood obesity affects all aspects of a childs life; most significantly by contributing to poor health and negative social perceptions by society. Extensive research of this issue has identified numerous causal and risk factors associated with obesity. Given the multifaceted nature of the problem, and its severe implications for the future health and well-being of affected children, I believe that the most effective solutions will be achieved through programs that focus on prevention efforts. In the last decade national attention has increasingly focused on efforts to reduce obesity among our youth. Schools have been the primary setting for prevention program, but these efforts have generally been found to be meet with only limited success. Researchers have increasingly focused on other environmental factors such as the home environment and family influences on childrens behavior. Recent studies have shown that family and social influences are key determinates of the high incidence rate of childhood obesity. I am proposing to build upon the efforts currently taking place in school districts by implementing a family-based prevention program. The program is an eight-week nutrition and physical education program for middle school students. It is intended that it be implemented within the school environment one evening each week, and that participants include both students and parents. The purpose of this program is to provide children and their families with nutritional education and to encourage physical activity. The desired outcomes include inducing positive behavioral changes and creating an environment within the home that encourages healthy habits, thereby decreasing the prevalence of childhood obesity within the school community.