No description available.

No description available.

No description available.

No description available.

Current research identifies gender, age, and ethnic patterns for the healthy immigrant effect related to mental health, but little research explores what determines immigrants’ mental health and how mental health deterioration occurs. This dissertation investigates the ‘what’ and the ‘how’ questions by applying the Social Determinants of Health (SDOH) Perspective and the Stress Process Model. To answer the ‘what’ question, this dissertation draws on the SDOH framework to examine potential social determinants—in the form of structural conditions, behavioral risks and psychosocial demands—affecting long-term immigrants’ lower mental health status. To approach the ‘how’ question, it employs the Stress Process Model to investigate the differential exposure to behavioral risks and psychosocial demands between recent and long-term immigrants. The analysis of the data from the Canadian Community Health Survey-Mental Health 2012 and the General Social Survey-Social Identity 2013 indicates that structural conditions, behavioral risks, and psychosocial demands co-influence immigrants' mental health to some extent. Behavioral risks have independent contributions to mental health, but the contributions are small. Psychosocial resources and demands, however, have the greatest impact on mental health. An examination of the relationships between length of migration and psychosocial resources indicates that, compared to recent immigrants, long-term immigrants are in the state of 'high support and high strain,’ and the differences in these psychosocial resources and demands translate into mental health differences (the so-called healthy immigrant effect) between long-term and recent immigrants. / Thesis / Doctor of Philosophy (PhD)

Associations between the experience of traumatic events and illness behaviors such as health complaints and healthcare use are reported in recent studies. Posttraumatic Stress Disorder (PTSD) symptoms and diagnosis have been found to mediate this trauma-illness relationship. Differences in health behaviors have additionally been noted in the literature, with trauma victims engaging in more negative health behaviors, which may subsequently affect illness status. Further, illness behaviors such as somatic complaints and healthcare utilization are influenced by modeling and reinforcement of such behaviors. The current study sought to evaluate the contributions of negative health behaviors, illness-related learning history, and PTSD symptoms on trauma victims' health complaints, functional health status, and utilization of healthcare services. The final sample included 298 undergraduate students at a large southeastern university. Participants provided information about their trauma histories, health behaviors, illness-related learning history and current illness behaviors on group-administered self-report questionnaires. Consent to obtain utilization information from the university health center was also obtained. Hierarchical regression analyses were used to assess the additive contributions of the predictor variables. The results indicated that health complaints, functional health status, and utilization behavior are each influenced by trauma history, with more illness behavior associated with greater trauma severity. In addition, health behaviors, illness-related learning history and PTSD symptoms all contribute to the prediction of health complaints and functional health status. Utilization behavior, however, was predicted only by trauma history and learning history. Further, the different types of learning history (modeling, reinforcement, priming) appear to affect different illness behaviors. Implications of the study are discussed. / Ph. D.

The current study was designed to test the utility of a multivariate rnodel to predict health care utilization, absenteeism, and achievement functioning. The model included demographic factors and measures of physical health status as well as psychosocial predictors (child mental health, child developmental status, and family functioning). Four dependent variables were used including encounters with the health clinic at schoot primary care utilization, absenteeism (partial and whole days for the current year), and achievement status. Multiple regression analyses were performed to determine whether psychosocial factors would account for significant portions of the variance beyond that predicted by health and demographic factors. Results revealed that psychosocial predictors contributed significantly to the prediction of school and primary care health encounters. Predictors of absenteeism and achievement also included contributions of psychosocial factors although they were less robust. / Ph. D.

A computer-mediated communication (CMC) system oriented towards changing health-related behavior was developed and evaluated. Stress management training was used to demonstrate the basic technology. Formative research and pilot-testing was conducted, to identify psychological and communication variables that are potentially critical to facilitating behavior change through the CMC medium. The resulting system was used to compare two forms of CMC training with face-to-face intervention: CMC Intensive Intervention (CII) and CMC Non-Intensive Intervention (CNI), with 9 matched subjects per treatment condition. CII subjects used their personal computers and modems to exchange messages with a therapist (the author), as well as to interact with automated system functions. Such functions included cognitive/behavioral assessment, l recording of self-monitored progress in applying specific and general coping strategies to managing stress, and instantaneous graphic and verbal feedback on such progress. The CNI form of intervention relied primarily on message exchanges with the therapist, and presentation of general information on stress management. The face-to-face (FFI) treatment was a "traditional" stress management workshop, comprising weekly one-hour sessions over a six-week period. FFI subjects’ assessment, information presentation, self-monitoring, and feedback were analogous to their CII counterparts. Major findings were that the CII treatment was as effective as the FFI treatment, while the CNI intervention was less effective than the other two treatments, through 3 months follow-up. This finding suggests that active involvement of subjects in practicing specific coping strategies may be critical to efficacious intervention through the CMC medium. Other findings were that: (1) The CMC message-exchange function can establish a "client-therapist relationship", which potentially overcomes a limitation of "computerized treatment" identified by previous researchers. (2) CMC-based intervention, at least for stress management-related problems, appears to be more cost-effective than face-to-face intervention, for individual treatment but not for group treatment. Implications for extensions to other types of behavior-change intervention and research are discussed. / Ph. D. / incomplete_metadata

Background: Low health literacy and increased sugar-sweetened beverage (SSB) consumption are two broad public health concerns facing the United States. For example, it is estimated that 90 million Americans have insufficient literacy skills (IOMC, 2004) and low health literacy is associated with poorer health outcomes (Berkman et. al., 2011). Furthermore, SSBs contribute about 80% of added sugars in the diet (Nielsen & Popkin, 2004) and have been associated with poor health outcomes, including obesity, type II diabetes, bone fractures, dental caries, and coronary heart disease. Despite these findings, there is limited research related to how to effectively decrease SSB intake among adults. Additionally, there have been few studies investigating health literacy interventions that target health behaviors in community settings (Allen et.al, 2011). Objective: As guided by the Theory of Planned Behavior (TPB) and constructs of health literacy, this 5-week, 2-arm randomized controlled pilot trial, used mixed methods to examine the effects of an intervention to decrease SSB (SipSmartER), as compared to a matched-contact control condition targeting physical activity (Move More). The primary aims of this pilot project were to evaluate participant's feedback through process and summative evaluation as well as evaulate intervention content and/or delivery through process evaluation by staff tracking for quality improvements. Secondary aims included the assessment of changes in theorized mediating variables and health behaviors among participants. Methods: Twenty-five participants (mean age = 42±14 years, mean BMI = 34.3±7.5 kg/m₂, 19 females, 12 African Americans, 9 (high school education) residing in Roanoke, VA were randomized to either SipSmartER (n=14) or Move More (n=11) to begin the 5-week intervention. Inclusion criteria consisted of participants being 18 years of age or older, English speaking, consuming greater than 200 kcal/day of SSB, and being without medical conditions in which physical activity would be contraindicated. Both 5-week interventions included two interactive small group sessions (Weeks 1 & 5) and three support telephone calls (Weeks 2, 3 & 4). Pre-post data was obtained using previously validated instruments including Beverage Intake Questionnaire (Bev-Q), Theory of Planned Behavior constructs addressing SSB and physical activity, media literacy, subjective numeracy, Stanford Leisure-Time Activity Categorical Item (L-CAT), and quality of life. Descriptive statistics, ANOVA, and regression models were used in data analysis. Results: Although SSB consumption decreased more among the SipSmartER participants (-257±622.6 kcal/day) than Move More (-200±404.6 kcal/day) there were no significant group by time differences. However, among all participants, changes in TPB constructs significantly predicted changes in SSB (R²=0.592; F=2.485; p=0.080) and physical activity behaviors (R2=0.621; F=2.813; p=0.056). Participant and staff feedback were very positive, ranging from 4.2-5.0 on a 5-point likert scale that included questions about intervention organization, flow, effectiveness, engagement, and enjoyment. Favorite themes that emerged with SipSmartER participants when asking about small group sessions included, realizing how much sugar is found in SSBs, understanding the health risks associated with drinking too much sugar, realizing how much sugar was being consumed during the day, and learning about better alternatives. Conclusion: Findings suggest promise for the piloted intervention to reduce SSB consumption through targeted TPB and health literacy strategies. This pilot study has allowed further refinement and execution of a larger trial that includes a larger sample and longer study duration (i.e. 6-months) and follow-up period (i.e. 18-months). / Master of Science

Yes / To assess physical activity outcomes of a pedometer-based physically active learning (PAL) intervention in primary school children. Methods: Six paired schools were randomly allocated to either a 6-week teacher-led pedometer-based physically active learning intervention or a control (n = 154, female = 60%, age = 9.9 [0.3] y). Accelerometers assessed total daily sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Preintervention mean daily MVPA minutes grouped participants as Low Active (<45 min/d) and High Active (≥45 min/d). Results: From the final sample size, the intervention (n = 52) significantly improved LPA versus control (n = 31, P = .04), by reducing sedentary time. More intervention (+10%) than control (+3%) pupils met the 60 minutes per day guidelines. In both intervention subgroups, pupils spent less time in LPA (P < .05) versus control. The greatest nonsignificant increase was found in the Low Active pupils MVPA levels. Conclusions: Improvements in LPA were statistically significant in the intervention versus control group. In subgroup analysis, Low Active pupils in the intervention showed the greatest beneficial effects and the Most Active pupils may have replaced MVPA and sedentary time with LPA. The intervention group housed clusters of pupils showing variable responsiveness, justifying routine examination of subgroup variability in future studies.