To improve U.S. residents' health, advocates are focusing their efforts on workplace health. Researchers have found that unionization is a positive influence on workers' participation in health promotion programs relating to smoking and obesity prevention. However, the effect of union membership on other health promotion initiatives, such as influenza vaccination compliance among health care workers, has not been examined. The purpose of this quantitative study was to address this knowledge gap between a union and a nonunion health care facility in the U.S. state of Pennsylvania. The health belief model was used to determine if different domains of influenza vaccination perception predicted vaccination behaviors among union and nonunion health care workers. A secondary analysis was performed on the 2013-2014 Influenza Vaccination Survey, which was completed by 2,480 health care workers. While a chi-square analysis showed that vaccination compliance was not statistically different between facilities, a binary logistic regression revealed a significant difference in predicted vaccination behaviors for each domain of influenza vaccination perceptions. Among union health care workers, perceived barriers yielded the highest positive predictability of vaccination compliance, whereas perceived benefits were positively associated with vaccination compliance among nonunion workers. These study findings affect social change by identifying vaccine compliance predictors among union and nonunion health care workers. By focusing on these predictors, health care facilities may be able to improve levels of vaccination compliance and achieve the Joint Commissions' vaccination goal of 90% compliance amongst all healthcare workers.

The United States has experienced an increase in older workers as individuals born between 1946 and 1964 have remained in the labor force. Preventive health screening education, such as an immunization flyer, is necessary to avert preventable illness among older workers. Based on previous research, there is a gap regarding age-specific methods for educating the older worker about preventive health. Therefore, the purpose of this study was to explore the relationship between various media providing preventive health screening information and the assessed health literacy of the older worker. Based on the health belief model, a quantitative, cross-sectional method was used. A population of older workers (n = 159), starting at age 45, of diverse racial groups and job types, was surveyed to determine their health literacy, preventive health screening knowledge, and frequency of exposure to diverse types of media that facilitate preventive health education. Analysis of variance was used to evaluate the relationship between the various media providing preventive health screening used by the older worker and the health literacy of the older worker. According to the study, the 45-54 age group had the lowest health literacy scores, and all age groups possessed comparable knowledge of preventive health screening education. Finally, 2 types of media 'television and radio' were effective in improving health literacy by exposure, and 4 types of media 'television, radio, newspaper, and Internet' were perceived effective in providing preventive health education. Implications for positive social change included age-specific methods for educating the older worker about preventive health, which could, in turn, reduce morbidity and mortality caused by preventable diseases such as cancer and heart disease.

Low-income Hispanic women are the fastest growing minority population in the United States, and they have increased risks of obesity and secondary health issues, such as diabetes, related to their obesity. The purpose of this phenomenological study was to explore the barriers to lifestyle change among obese, low-income Hispanic women (OLHW). A health belief model lens was used. The study sample consisted of 15 OLHW who were clinic patients and ranged in age from 20-59. Recruitment occurred in a low-income, Southern California, outpatient clinic setting through volunteer participation from recruitment flyers. Fifteen women took part in 1-hour, in-depth interviews, which were digitally audio-taped with their consent. All interviews were transcribed and analyzed using both NVivo 11, and hand coding to identify common themes after word frequency and concept frequency analysis. Common themes identified included barriers of cost, time, physical health, family care, location, knowledge and education, depression and stress, and sleep issues. These findings contribute to the existing literature by increasing public health researchers' and program planners' knowledge of the experiences and obesity-related barriers to health behavior change within this underrepresented minority group, which can provide guidelines for future public health interventions in addressing these barriers. Obesity reduction efforts may help increase quality of life and create a new paradigm of public health interventions based on the stated needs of OLHW.

The predominately rural state of Mississippi responded to high teenage pregnancy rates by enacting a 2011 law requiring school districts to choose between an abstinence-only and an abstinence-plus program for their high schools. However, there is limited extant research on Mississippi's sex education policies, creating a research gap that inhibits developing successful programs to reduce teenage pregnancy rates. There is specifically a need to compare the two types of allowed programs with a focus on rural areas. This study compared programs by examining students' abstinent sexual attitudes, social norms, self-efficacy, sexual abstinence behaviors, and perceived effectiveness of sexual education and decision making to address whether those variables differed by program and if programs and genders interacted. The study was informed by the health belief model, social cognitive theory, and the theory of reasoned action. The study collected data from 366 students who had taken one of the two programs completed 4 surveys: a demographic survey, the Sexual Risk Behavioral Belief and Self-Efficacy scale, the Sexual Abstinence scale, and the Effectiveness of Sexual Education scale. Students who completed the abstinence-plus program had higher levels of abstinent sexual attitudes, abstinent social norms, abstinent self-efficacy, and sexual decision-making self-efficacy when compared to students who completed the abstinence-only program, with a small effect size for abstinent social norms. Sexual abstinence behavior scores did not differ by program and programs and genders did not interact. Future studies should include a pretest and posttest evaluation. Analyzing these programs facilitates social change by informing the design of effective programs that focus on at-risk youth sexual behaviors.

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Pulmonary Arterial Hypertension (PAH) is a rare incurable condition affecting both the cardiac and respiratory systems. Patients living with PAH face the burden of both intensive medication regimens and debilitating disease symptoms. This study’s primary aim was to identify patients’ medication-taking behaviours and beliefs using a framework derived from the extended health belief model (EHBM), and to use this information to deliver personalised interventions to improve medication-taking behaviours. A mixed-methodology longitudinal study design recorded patients’ parameters over a 12-month period. Thirteen participants from Northern Ireland completed the study. The results showed that the level of high-adherence to PAH medicines, as assessed using the MARS questionnaire was 80%, but this value differed when assessed via pill counting and interview data. There was a trend to improvement in observed and predicted medication adherence over the study duration. Participants’ beliefs showed a non-statistical increase in the specific-necessity beliefs and a reduction in general-overuse belief. This study added to the EHBM new constructs of trust and support in being able to better predict nonadherent behaviours. Key medication-taking themes were self-confidence, perceived ranking of medicines, uncertainty and knowledge. This study developed important learning that can be applied to future research on behavioural health studies. / Heart Trust Fund; Actelion Pharmaceuticals

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Osteoporosis is a disease of the bone and skeletal system which weakens bone structure and results in fractures. The disease has caused a heavy economic burden in the U.S., especially among Americans over the age of 50. According to The Surgeon General's report on bone health in 2004 (U.S. Department of Health and Human Service (USDHHS), 2004), an estimated 10 million Americans over age 50 have osteoporosis, and another 34 million have osteopenia and are at risk of osteoporosis. The projected cost directly associated with osteoporosis is $34.0 billion in 2005 and will rise to more than $41.4 billion in 2025 (Vanness & Tosteson, 2005). Osteoporosis also results in serious and often devastating health problems for affected individuals (Riggs & Melton, 1995) because of the fractures it causes. Riggs and Melton (1995) estimated that each year 1.5 million people suffer an osteoporosis-related fracture. Unlike genetic risk factors that can be nearly impossible to modify, living on a calcium-rich diet is a lifestyle choice. Effective intervention programs can be useful tools to educate people to adopt a calcium-rich diet. Studies have shown that a calcium-rich diet can increase bone mineral density and intervention programs can facilitate the process of the lifestyle change (Wong, Lau, E.M., Lau, W.W., & Lynn, 2004; Lv & Brown, 2011). However, effective intervention programs against osteoporosis are limited for minorities, and specifically, for elderly Chinese women. The prevalence of osteoporosis in Chinese women is high but the knowledge level is low (Babbar et al., 2006; Lau, Woo, Leung, Swaminathan, & Leung, 1992), which provides an opportunity for intervention. A community-based intervention program was designed based on the modified health belief model (HBM). Its content was specifically tailored to the cultural background and the characteristics of the Chinese women living in the Greater Philadelphia area, based on the findings from previous studies. The intervention program was implemented and its effectiveness was evaluated in a 2-group quasi-experimental study. The study recruited eight (8) Chinese community organizations and assigned them to receive either the intervention program or the control program according to the timing of their agreement to participate and the balance of total participants recruited for each study group at the time. A total of 102 Chinese women were enrolled from the three (3) organizations that were assigned to the Intervention Group and 90 from the five (5) organizations that were assigned to the Control Group. Participants in the Intervention Group received a 30-mintue education session delivered in Chinese (Mandarin). The education focused on the Health Belief Model constructs in the context of osteoporosis intervention. It provided information about osteoporosis, including the functions of the bones, prevalence and risk factors. It highlighted participants' susceptibility to osteoporosis, the consequences and severity of the disease, and targeted messages to increase self-efficacy and decrease barriers. The contents were tailored to the study population. The osteoporosis education was delivered in plain language to suit the population's low educational level and used examples relevant to their cultural background. Participants in the Control Group watched a 30-minute video about liver functions and hepatitis B transmission and prevention. The study tested three (3) primary hypotheses that, compared with the Control Group, the Intervention Group at post-intervention would have 1) a higher knowledge level of osteoporosis, 2) a higher self-efficacy for adopting a calcium-rich diet, and 3) a higher intention level to consume more calcium-rich food items. The data were collected at three time points: baseline, post-intervention, and three months after the intervention. The scores of knowledge level and self-efficacy were analyzed by mixed linear regression models with adjustment of the baseline variables and accounted for the correlations among the participants from the same site. The intention stage was analyzed by a multinomial logistic regression model with adjustment of baseline intention stage and the baseline variables. The results for the study were consistent with all three primary hypotheses. The intervention program increased the knowledge level of osteoporosis and perceived self-efficacy in the Intervention Group. At post-intervention, the differences between the two study groups was 0.17 (95% CI: 0.02, 0.32; p-value<0.037) for the knowledge scores, and 0.34 (95% CI: 0.12, 0.56; p-value<0.001) for the self-efficacy scores. The results also suggested that the intervention program moved the participants in the Intervention Group to higher intention stages. The odds ratio (Intervention/Control Group) of being at a higher intention stage was 3.29 (95% CI: 1.23, 8.82; p-value=0.016). The study showed that the community-based and culturally tailored intervention program designed for the elderly Chinese women was effective. It increased the osteoporosis knowledge level and self-efficacy for adopting a calcium-rich diet and moved participants to a higher intention stage of consuming more calcium-rich food items. Additionally, the study showed that more than 50% of the participants had low bone mass. In conclusion, this intervention program reached a hard-to-reach population of elderly Chinese women and provided public health professionals a useful tool to work with. The high provalance of low bone mass in this population provided the public health agencies useful information to aid their decisions on resource allocation. / Public Health

The overall aim of this study was to investigate the knowledge, awareness and practices regarding TB at a selected gold mine in Tanzania in order to enhance the paucity of knowledge in this area of public health. The mining population is considered to be at high risk of tuberculosis infection and illness. However, there is little data available on the knowledge, awareness and practices in the mining population in Tanzania. A quantitative, descriptive study, using the Health Belief Model as the conceptual framework, was conducted among 100 workers in order to give a detailed description of the knowledge and awareness of tuberculosis. The study confirms the role of the media, particularly radio broadcasting, health workers, teachers, and the community in promoting information and education on TB. Fever as a symptom was a problem. The study area is a malaria endemic area where fever is the commonest presentation hence every fever is regarded as malaria. This complicated picking up and identifying other causes of fever. Despite feeling compassion for and wanting to help TB sufferers, most avoided them, which emphasised people’s general fear of TB. This indicated the general isolation and stigmatisation of TB sufferers. The findings highlighted the need for on-going education about TB and its treatment, especially early diagnosis and adherence to treatment. / Health Studies / M.A. (Public Health)