Local communities have the right to participate in decision-making about environmental resources near where they live. Local governments have tried to gather feedback from communities to help improve the decisions they make, but have not always done a good job getting feedback from minority or urban communities. This dissertation provides one step toward obtaining this kind of public input in a majority minority community surrounding the Jordan River in Salt Lake City. Children and adults participated in this research. I present findings from two surveys, from work with children, and from adult interviews to understand how this community relates to their local river, what they like and do not like about it, and what they would like to see improved. This research revealed that communities have both positive and negative views of the river, but overall see it as an important community resource that is highly valued. Communities would like to participate more in river decision-making and have suggestions for how they would like to see that happen. The results in this dissertation can help bridge the gap between local city government officials and this minority community to help improve the river environmental quality and connections to the community.

Master of Public Health / Human Nutrition / Sandra B. Procter / Background: Engaging community has become a fundamental approach to improving health outcomes in resource-limited settings. Community coalitions, comprised of resident activists that mobilize to improve local conditions, are frequently utilized as partners for community-engaged research. However, there is limited research that documents how these partnerships affect the coalitions. The purpose of this study was to evaluate the effects of researcher-coalition collaboration in the pilot year of a four-year intervention program targeting childhood obesity in rural, low-income communities. Methods: Twelve pre-established community coalitions from seven states were selected to partner with academic researchers in a quasi-experimental study, and then assigned to either the control (n=6) or intervention (n=6) group. Both study arms received funding and access to a menu of evidence-based tools, but the intervention groups were also provided a trained community coach. Member survey data from a Coalition Self-Assessment Survey (CSAS) tool was completed at baseline and at one-year follow-up. Results: CSAS data were analyzed to identify factors related to coalition function and efficacy, and significant changes in both experimental groups were identified. Change in measures of membership recruitment, coalition capacity and coalition communication were unique to the intervention group. Problems for participation were alleviated significantly on all measures in the control group. Comparison of the study groups at follow-up demonstrated that greater research involvement positively impacted membership recruitment and coalition action plan. Conclusion: The data suggest that coalitions with a higher degree of partnership interaction may be more successful in addressing problems impacting their communities.

Human activity modifies the behaviour of large vertebrates and their acquisition of key resources. Despite the predation risk and competition for similar food resources that humans impose, wildlife consumers must acquire key foods across the landscape. Predation risk can modify foraging behaviour, yet we know little about the potential consequences, especially on large spatial scales. Humans may also affect food availability for wildlife by competing for shared prey, which most current harvest prescriptions fail to recognize. Against this background of threats to consumer-resource interactions, my research employed new conceptual, analytical, and practical approaches to seek not only new generalizable insight but also applied solutions. Addressing these goals, I characterized foraging behaviour by grizzly bears (Ursus arctos horribilis) on a focal prey, Pacific salmon (Oncorhynchus spp.), at multiple spatial scales. I predicted how human activity – both as modifications to landscapes and as salmon harvest – might affect bear-salmon interactions. I co-conceived, designed, and carried out this work through a framework of community engagement, which I crafted in collaboration with Indigenous communities in coastal British Columbia (BC). The framework (Chapter 2) identifies how scientists and communities can engage throughout the research process to work towards shared priorities, despite potential challenges in differences of knowledge systems or capacities. Methodologically, I used ratios of stable carbon (δ13C) and nitrogen (δ15N) isotopes in bear hair to estimate relative contributions of salmon in the annual diet of bears and employed existing data on landscape modification and salmon fisheries (i.e., escapement and catch) to characterize human activity and to measure associated variation in salmon consumption by bears. My first empirical contribution (Chapter 3) characterized spatial patterns of annual salmon consumption by grizzly bears across BC. I found substantial differences in salmon consumption within and among grizzly and black (U. americanus) bears in a large coastal region and across BC. Visualizing variation in consumer-resource interactions could guide conservation and management efforts that seek to protect predator-prey associations and marine subsidies for terrestrial ecosystems. I also investigated potential drivers of salmon consumption by bears in interior and coastal watersheds that varied in disturbance (Chapter 4). I found that human footprint in riparian areas of salmon-bearing watersheds affected bear diets more than the amount of salmon biomass available, showing that human activity can disrupt an otherwise strong predator-prey association. My community-based research occurred at the scale of a single large watershed, where I demonstrated how the Wuikinuxv First Nation might design their salmon management prescriptions according to their cultural values (Chapter 5). Despite a reduced abundance of salmon in the area, I identified harvest options that would trade-off benefits to local people and bears equally. In general, my dissertation research contributes to our understanding of the role humans increasingly play in mediating consumer-resource interactions. I also highlight how scientific research can support the leadership that local management can provide in mitigating human impacts to sustain an iconic predator-prey interaction of ecological, economic, and cultural importance. / Graduate / 2020-04-23

No description available.

Community engagement in health assessment enables researchers to better understand and prioritize community needs. The value of community engagement is increasingly documented; however, few studies engage youth. Research and assessments are often done for youth, but not with youth. Youth bring a unique contextual lens to community issues; without engagement, the likelihood that resultant efforts would be accepted by or appropriate for youth decreases. This dissertation explores opportunities and methodological approaches for, and contributions and feasibility of engaging youth in non-profit hospital community health needs assessments (CHNAs) mandated through the Affordable Care Act. This study has three specific aims, utilizing multiple methodological approaches: • Aim 1: Assess the current level of youth engagement, and prevalence of youth-focused priority areas in Massachusetts CHNAs. CHNAs were reviewed and analyzed using the Community Health Improvement Data Sharing System’s community engagement template. • Aim 2: Compare assessment results of focus groups and participatory photo mapping (PPM) in documenting youth observations of Boston community conditions. Three focus groups and PPM processes engaged 46 high-school age youth. Data were qualitatively compared, with attention to youth-identified community assets, concerns, and recommendations. • Aim 3: Compare youth results with existing CHNAs and identify potential contributions of youth engagement. Using the social determinants of health framework, youth recommendations were compared to Boston hospital community health improvement (CHI) publications to observe the convergence and divergence of priorities. While all MA hospitals minimally complied with required CHNA community engagement criteria, there was no standard practice or approach. 20% of CHNAs engaged youth, primarily through focus groups; yet, 80% of CHNAs that identified priorities included youth-focused priorities. Youth-driven results focused upon social determinants of health factors; furthermore, PPM results provided more detailed and granular CHI recommendations. Youth-identified CHI recommendations complemented those identified by hospitals, indicating that youth engagement can potentially strengthen CHI priorities and identify salient strategies for addressing youth health, specifically. Findings can be extrapolated to the many institutions conducting assessments, including health departments and Community Action Agencies. Findings will be disseminated through a series of practice briefs that make recommendations to hospitals, assessment practitioners, and youth organizations to consider for future efforts.

Little is systematically known about the collective health and well-being of Virginia American Indian people. This study sought to explore the meaning of health and healing among Virginia American Indian people in the context of a reservation-based, non-federally funded health clinic. Using an emergent approach to qualitative research grounded in a constructivist inquiry paradigm and guided by Indigenous research principles, a total of 24 in-depth, semi-structured interviews were conducted with 17 American Indian service-users of the Clinic. Through an inductive thematic analysis of participant stories, a framework for understanding responsive and responsible health and healing was derived. The framework includes seven dimensions: spirituality, physical processes, mental and emotional processes, social relationships, access to resources, contextual factors, and the interconnection among the dimensions. Personal and collective identity was a significant element woven through the dimensions. From the stories told by participants, health seems to be a continuum and healing seems to be a cycle. With constant motion in each of the dimensions, health has to do with sustained engagement in healing processes that continually seek to bring about functional balance in one’s whole health system. Ill health has to do with when a change in any one of the dimensions overtakes one’s ability to bring about a functional balance in the whole health system. The framework is context-dependent, true for the people who participated in the study at the time of the study.

Although patterns of African American and white women breast cancer incidence and mortality in St. Louis, Missouri is consistent with those seen elsewhere in the United States, rates vary greatly across zip codes within the city of St. Louis. North St. Louis, whose neighborhoods are primarily African American, exhibits rates of breast cancer mortality that are among the highest in the city and higher than the state as a whole. Based on information that up to 50% of women in North St. Louis with a suspicious diagnosis of breast cancer never enter treatment, we conducted three 2-hour group model building sessions with 34 community stakeholders (e.g., breast cancer survivors or family members or caregivers and community support members such as navigators) to identify the reasons why African American women do not begin or delay breast cancer treatment. Participant sessions produced a very rich and dynamic causal loop diagram of the system producing disparities in breast cancer mortality in St. Louis. The diagram includes 8 major subsystems, causal links between system factors, and feedback loops, all of which shed light on treatment delays/initiation. Our work suggests that numerous intersecting factors contribute to not seeking treatment, which in turn may contribute to African American and white disparities in mortality.

This dissertation is about Indigenous and settler health, wellbeing and health policy in rural Manitoba. Across Canada, both sweeping and incremental provincial health system changes have profound effects on marginalized communities facing existing health inequities, including rural settler and Indigenous peoples. Increasingly, the centralization of provincial health care systems has led to the elimination of health services within rural settings. The research I present in this dissertation arose from advocacy efforts in a rural community in southwest Manitoba. The community sought representation and recognition in health decision-making in the midst of the largest health care system transformation in provincial history and called for local research production. The community-led study grew to the larger inquiry and analysis presented here, including a First Nation and Métis community, which were both affected by the transformation. The objectives of this dissertation were to analyze the ideas and structures used to inform provincial decisions, and to understand community experiences of rural health care before and during system transformation. As a settler researcher, I undertake an anti-colonial, strengths-based, community-engaged approach to research, developed through ongoing relationship with the community. In addition to a critical thematic analysis of key policy documents, semi-structured interviews were conducted with settler, First Nations, and Métis community members and service providers regarding their experiences within the health care system, their perceptions of change and the impacts of transformation on health and wellbeing. Arising themes include the importance of relational health care relationships in determining wellbeing, and the sense that the government undertook dehumanized decision-making in developing and implementing health system change. This dissertation concludes with policy recommendations for provincial governments, including the prioritization of community voices, and the visibility and involvement of rural and Indigenous peoples in health system decision-making. / Thesis / Doctor of Philosophy (PhD)

No description available.

Recent policy change allows states to spend federal dollars directly on teen-led driver safety efforts and requires regular evaluations of effectiveness. There are currently no standardized instruments to measure change in teen driving behavior relevant to teen leaders. This study serves the Tennessee Department of Safety and Homeland Security, Tennessee Highway Safety Office and their network of teen leaders to empirically test and refine the I Drive Smart survey developed by partners and grounded in the Theory of Planned Behavior (TPB). The survey is designed to be administered by teen leaders to their peers and produce data relevant for use in improving planning as well as tracking changes occurring from their work. The survey measures attitudes, perceptions of social norms (peer, family, and law enforcement), perceptions of behavior control, and both driving and passenger behavior intentions. The I Drive Smart web survey was administered by a group of teen leaders to 175 of their peers. Findings were used to inform local planning and in this quasi-confirmatory study aimed at optimizing the survey. An exploratory factor analysis revealed a four factor model aligned with TPB that explained 61.618% of variation. Item reliability analysis demonstrated high internal consistency for the behavior intention scale with a Cronbach’s alpha of .884. An ordinary least squares regression test found the predictive validity of the identified components to be strong, explaining 64.5% of variation in the model and identifying perceptions of behavior control as the best predictor of behavior intentions, followed by family and peer norms. The behavior control component retained so much variation that the optimized survey assesses both volitional and non-volitional control concepts. Further, teen leaders were able to successfully administer the survey and found data helpful in supporting their planning. This study demonstrates that teen leaders are capable of directing evaluation activities and that the refined version of the I Drive Smart survey has appropriate psychometric properties for teen leaders in highway safety to use. Standard procedures for using the survey are discussed along with recommendations for analysis that includes triangulation with other local data points.