abstract: Despite the arid climate of Maricopa County, Arizona, vector-borne diseases have presented significant health challenges to the residents and public health professionals of Maricopa County in the past, and will continue to do so in the foreseeable future. Currently, West Nile virus is the only mosquitoes-transmitted disease actively, and natively, transmitted throughout the state of Arizona. In an effort to gain a more complete understanding of the transmission dynamics of West Nile virus this thesis examines human, vector, and environment interactions as they exist within Maricopa County. Through ethnographic and geographic information systems research methods this thesis identifies 1) the individual factors that influence residents' knowledge and behaviors regarding mosquitoes, 2) the individual and regional factors that influence residents' knowledge of mosquito ecology and the spatial distribution of local mosquito populations, and 3) the environmental, demographic, and socioeconomic factors that influence mosquito abundance within Maricopa County. By identifying the factors that influence human-vector and vector-environment interactions, the results of this thesis may influence current and future educational and mosquito control efforts throughout Maricopa County. / Dissertation/Thesis / M.S. Sustainability 2013

Masters of Art / Intimate partner violence (IPV) has reached epidemic proportions in South Africa, prompting the government to pass the Domestic Violence Act 116 (1998). However, numerous scholars still believe that legislation is lacking due to inadequate implementation of protocol in the healthcare sector. In the healthcare setting, nurses are usually the first people that abused women make contact with and so they are in an excellent position to identify IPV victims and prevent further abuse. Routine universal screening in the healthcare setting is recommended as a means to identify women who suffer in abusive relationships. However, several problems have been encountered with the attempts to implement screening practices. In this study the various perceived barriers to IPV screening among nursing students were examined by use of a descriptive survey approach. The research participants were 103 nursing students from the University of the Western Cape. Data were collected by means of a selfadministered questionnaire and analysed using descriptive as a means to uncover the relationship between perceived barriers and the screening practices of the participants. The aim of this study was to identify the barriers that will discourage a nurse from routinely screening for intimate partner violence in a healthcare practice. The present study’s results indicated that the majority of variance in routinely screening for IPV can be explained by barriers related to HCP knowledge of managing IPV disclosure; the perceived responses of patients to screening; the privatisation of abuse; and whether HCP regard IPV as a healthcare issue. Information, regarding the beliefs of healthcare providers (HCP) with regard to IPV as well as the barriers they perceive toward screening, will be helpful in designing curricula that will successfully teach HCP how to screen for IPV and it will also be useful in making positive changes to the screening conditions in healthcare settings.

Approximately one in every seven American men will be diagnosed with prostate cancer during his lifetime. Men of African descent have higher incidence and mortality rates than others. Prostate cancer screening is important because the five-year survival rate is only 31% post-metastasis. The purpose of this study was to assess the likelihood of action for and factors influencing choice regarding prostate screenings. It was also to determine if a relationship existed between ethnicity (African American and Afro-Caribbean American men) and knowledge of prostate health, self-efficacy, perceived barriers to and belief regarding prostate screening. Data collection methods included a focus group (n = 8) among African American and Afro-Caribbean American men (M = 53.8, 10.3) and self-administered surveys (n = 113) among African American (n = 49, 45.4%) and Afro-Caribbean American (n = 38, 35.2%) men (M = 59.5, 16.4) from churches in South Florida using convenience sampling and the Health Belief Model (HBM) as a framework. Knowledge was assessed using a combined version of the Knowledge and Practice of Prostate Health Questionnaire and Prostate Cancer Screening Education (PROCASE) Knowledge Index. Self-efficacy was measured as decisional conflict reported from the Low Literacy Decisional Conflict Scale. Barriers were identified from a Perceived Barriers Survey. Beliefs were measured as spiritual well-being and evaluated using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, a modified version for non-illness (FACIT-Sp Non-Illness). Almost half of African American (47.9%) and nearly a third (29%) of Afro-Caribbean American participants were unaware of participation or did not participate in prostate-specific antigen (PSA) testing. Findings indicated prostate screening concerns, inadequate knowledge, past negative experiences, and cost may contribute to low prostate screening rates. Both ethnicities did not differ in knowledge of prostate health or self-efficacy for making an informed decision regarding prostate screening. Potential targets for outreach efforts among these ethnic groups could include faith-based medical partnerships to diminish health disparities. Future intervention studies would benefit from a focus on diverse cultures and ethnicities in different settings and culturally appropriate strategies for nurses and other health professionals to use when assisting patients with informed decision making regarding prostate cancer screening.

Medication adherence is a formidable challenge for the elderly who may have several prescribed medications while dealing with limited incomes and declining health. The primary purpose of this study was to evaluate the Liberty 6000, an automated capsule and tablet dispenser that provides proper medication dosages and is intended to encourage and track medication adherence. Seven focus groups were assembled; these comprised 49 men and women ages 65 to 98 years of Black, Anglo, and Hispanic descent who met the following criteria: living independently or semi-independently, had suffered one or more impairments, and were taking at least three prescription medications. Each focus group session lasted 90 minutes and was tape-recorded and transcribed verbatim, resulting in about 2,600 lines of text. Each question was designed to be open-ended to avoid introducing any bias that might influence the response. The Health Belief Model conceptually guided the study that addressed perceptions of illness susceptibility and severity, barriers, benefits, and cues to action associated with medication adherence. Main benefits of taking medications included avoiding inherited illnesses (or tendencies for illnesses), and reducing illness symptoms. Barriers to taking medications included forgetting, dexterity problems, and high cost. Benefits of the proposed intervention included reminding, caregiver notification, and providing a printed log of medications taken and missed. Barriers associated with the Liberty 6000 included its relatively large size, the difficulties that confronted older adults when loading the device, and its perceived cost. Using an adoption prediction model proposed a way to overcome barriers and encourage acceptance as well as a strategy to maintain acceptance over time. The model also can be used to evaluate a wide variety of medical devices for elderly people. This study identified the advantages and disadvantages of the Liberty 6000. Findings also suggest areas for further investigation by the nursing community and healthcare policy makers in finding solutions to the myriad problems faced by older people in medication adherence.

Sex education through the public school system has been identified by the Centers for Disease Control and Prevention as an excellent vehicle by which HIV prevention education can be presented to students, thereby decreasing the rate of HIV infection among young men who have sex with men (YMSM). However, YMSM continue to be at high risk for HIV infection in the United States despite educational efforts to prevent infection. The purpose of this qualitative study using a phenomenological approach was to explore what impact school-based HIV prevention education had on YMSM in the past, and what effect that education has had on their current sexual behaviors. The theoretical foundation for this study was the health belief model. Individual 1-hour interviews were conducted with 13 YMSM (ages 21-35) who received HIV prevention education in California. Interviews were analyzed for common themes using a phenomenological approach. Results of this study suggest that participants were not utilizing safer techniques taught in the school HIV prevention education because there was a lack of curriculum consistency, LGBTQ content, and classroom management, and the impact of stigma and homophobia on YMSM. These results support the health belief model. Findings support that positive social change can be achieved by providing standardized, all-inclusive, non-judgmental, HIV prevention education program, in a classroom environment where it is safe to receive same-sex sexual information. This should decrease the number of HIV+ test results among YMSM.

African Americans suffer worse health outcomes related to chronic disease than any other racial or ethnic group. The negative effects associated with poor dietary habits and a low propensity to exercise impact young adult African Americans who attend Historically Black Colleges/Universities (HBCUs) and can lead to higher mortality rates. It is important for HBCU campus health centers to address the perceptions and beliefs of students to positively impact health behaviors associated with diet and exercise. At the time of this study, there was limited research on-campus health centers and their impact on HBCU student health beliefs and behaviors. Therefore, this qualitative study was developed to help gain a better understanding of how HBCU health centers can influence student attitudes, perceptions, beliefs, and behaviors related to diet and exercise. This qualitative descriptive study used semistructured focus groups made up of currently enrolled HBCU students informed by the health belief model. Focus groups were conducted with a total of 13 participants who met predetermined criteria. Data were collected using an audio recording device and analyzed using NVivo to group and code like themes and patterns. Results yielded 4 distinct themes; (a) words of family and friends matter, (b) impact of campus environment, (c) internal motivation for action, and (d) involvement from the health center. Overall peers, social media, and health center marketing had the largest influence over behaviors related to physical activity and decisions on healthy eating. The social change implication of this study is to assist campus health centers in providing more effective care by understanding student health behaviors which can improve long-term health outcomes for African Americans.

Influenza is a preventable infectious disease, against which vaccination is the primary means of protection. Health care workers (HCW) are among the most vulnerable to the illness and are likely to be sources of infection transmission while caring for patients. Circumstantial evidence suggests higher rates of vaccination coverage by HCW will coincide with a lower incidence of influenza transmission, yet a gap remains in the literature regarding governing health agencies' (i.e., licensing boards, medical and nursing associations) influence on the influenza vaccination practices of their constituents. Moreover, discrepancies exist between governing health agencies' and the National Vaccine Advisory Committee's recommendations on mandatory influenza vaccination for HCW. The main purpose of this quantitative cross-sectional study was to explore the relationship between influenza vaccination uptake by HCW and guidance from governing health agencies to vaccinate. The health belief model and social cognitive theory were used to identify the most influential determinant for HCW to vaccinate against influenza. The sample consisted of 388 HCW who provided direct patient care at the same hospital. Data were analyzed using Fisher's exact test. Study findings suggest that a workplace mandate for influenza vaccination has an influence on HCW uptake of the vaccine and that governing agencies' lack of uniformity on the matter has minimal impact on their constituents' beliefs and behavior. It is recommended that a universal policy be adopted for health agencies' implementation of an influenza vaccine mandate, which could lead to positive social change by supporting preventive self-care practices, minimizing spread of the disease to workers and patients, and maintaining workplace productivity.

Heart disease has been the primary cause of death among both men and women in the United States. More African American women are developing and dying from heart disease than any other ethnic group; yet, they are less likely than European American women to know that they have the major risk factors for heart disease. The purpose of this study was to determine the overall knowledge and health beliefs about heart disease among African American women. Five health belief model constructs of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action were applied as the theoretical framework for the study. Linear multiple regression was used to analyze the association between participants' (a) knowledge of heart disease risk factors, (b) knowledge of heart attack symptoms, (c) perceptions of personal risks for heart disease, and (d) demographic background and their awareness of heart disease. Snowball sampling was used to recruit participants. E-mail, LinkedIn, and Facebook invitations with the American Heart Association Women's Health Study Google doc was sent to all family, friends, and associates who met the criteria for participation (N = 389). Results showed that the variables of African American women's knowledge of heart disease risk factors, perceptions of personal risks for heart disease, age, and family history of heart disease were statistically associated with awareness of heart disease. The positive social change implications include bringing more awareness of heart disease to African American women and encouraging them to have heart health dialogue with their friends and family.

In 2014, breast cancer was the second leading cause of death among Canadian women, with women over age 50 years making up 82% of the identified cases. To address this issue, the Ontario Breast Screening Program developed a media campaign that promoted the benefits of mammogram screening, but not the associated risks (i.e., false-positive, false-negative, radiation exposure, and overdiagnosis). This study was designed to determine whether there was a statistically significant relationship between knowledge of overdiagnosis and participation in mammogram screening. This cross-sectional, correlational study used schema theory supported by the effective health communication model. Forty-one women were invited to listen to a brief presentation on the benefits and risks of screening mammograms and then completed a modified Champion Health Belief Model Scale survey. Two sample t tests and logistic regression analyses of the survey scores showed that the data did not support any correlations with education and screening, but did indicate a correlation between overdiagnosis and participation. The less a participant felt that overdiagnosis was a negative consequence, the more likely they were to participate in breast screening. Survey participants also stated that promotions of mammograms should present balanced information about the benefits and risks of screening. The positive social change and policy implications of this study include providing women aged 50-69 years more information on overdiagnosis in mammograms so they are more informed participants in the decision-making process, and educating Ontario government policymakers with information about the barriers that women aged 50-69 years face in getting balanced information on mammography programs.

No description available.