<p> The United States (US) is plagued by a high-cost health care system producing lower than desired patient quality outcomes. In 2012, the Patient Protection and Affordable Care Act was enacted to financially incentivize cost-effective models of care that improve the health of US citizens. One emerging solution is engaging patients with chronic conditions in self-management practices. </p><p> Guided by Krieger's Eco-Social Theory, this study used semi-structured interviews, scales and a questionnaire to detect factors that facilitate patient activation of self-management in patients with type 2 diabetes. Managed and unmanaged participants were equally represented in the study sample. White participants and participants from two American Indian tribes located in Northeast Wisconsin were included in this study. Findings indicated the establishment of routine behavior and the ability to identify healthy alternatives when routines were disrupted support patient activation of self-management. Experiencing success such as weight loss was also identified as a factor in facilitating patient activation. Social roles and responsibilities challenged unmanaged patients. </p><p> The study concluded that community, culture and environment have both a negative and positive influence on patient activation of self-management of type 2 diabetes. The current epidemics of obesity and diabetes create an apathetic response to the type 2-diabetes diagnosis that affects subsequent treatment and self-management in the communities studied. Aspects of local cultures such as unhealthy regional and tribal foods, lack of options for menu items low in carbohydrates and sugar in restaurants, high consumption of soda and alcohol and holidays/tribal events provide significant challenges for unmanaged patients. Workplace policies surrounding health insurance premiums had an impact on attendance at educational events but not on sustaining self-management behaviors. Positive aspects of the workplace include the imposition of structure and routine and the emotional support of colleagues. Warm seasons were also found to activate self-management by providing an opportunity for outdoor exercise and healthier modes of food preparation. </p><p> Consistent with a previous study, high rates of childhood trauma were found among the study groups. However, findings did not support the hypothesis that levels of childhood trauma were linked to self-management. While some evidence of historical grief and loss along with associated symptoms was found among the American Indian populations, there was no correlation between managed condition and level of grief and loss. Further examination of the connection between childhood and historical trauma to the current obesity and diabetic epidemics in these communities is recommended. Recommendations for changes to public health and health care policy are included.</p>

<p> The Internet has long been utilized by gay men and men who have sex with men (MSM) as a space for the seeking-out of deviant behaviors such as condomless sex and the use of popular "party drugs." Within criminal justice, however, there is a tendency to separate such deviant sex- and drug-related behaviors from culture; thus, these behaviors often become criminalized without recognizing the meaning they may have for the "offenders"; meaning that, in addition to being borne out of oppression and marginalization, is also borne out of stigmatizing experiences.</p><p> Through an exploration of gay culture, this thesis explores the underlying meanings of a subset of drug-seeking gay men who "party and play" (PnP). Such an analysis is important not only for criminal justice, but also for the field of cultural criminology, which seeks to inform both the criminal justice system and law enforcement professionals of the need for cultural sensitivity.</p>

<p>Body image refers to how a person perceives herself physically. A woman's perception of her physical appearance and her adherence to a cultural ideal of beauty informs her body image. Several determinants shape the development of body image, including sociocultural, psychological, and interpersonal factors, as well as adolescent physique and maturation, history of abuse, and certain types of media exposure (e.g., fashion magazines and a variety of television programming). </p><p> Much scholarly critique has argued that popular media perpetuate a "thin ideal" to viewers. Consumers receive distorted information. Heavy media consumers, through sheer volume of exposure, may be more aware of and likely to internalize the societal ideal, which could lead to disturbed body image and eating disorders. Substantial body image and media effects research focuses on print images, while television images are far less studied. Furthermore, Caucasian females are studied more frequently than members of other ethnic groups, such as Latinas (Hispanic females). Existing research examining Latinas tends to aggregate ethnic sub-groups (e.g. Mexican Americans, Puerto Ricans, etc.) into one homogenous group despite differences in national origin. The present study addresses a paucity of research focusing on ethnicity and ethnic sub-group identification related to body image across disciplines. </p><p> A sample comprising 305 self-identified Latinas completed an online survey about television consumption and body image. Television consumption was not predictive of social comparison; however, television consumption did predict awareness of the Eurocentric idealized thin body type. Moreover, sociocultural pressure from friends and family predicted awareness of the idealized thin. Awareness of the idealized thin was positively associated with social comparison, and internalization was positively associated with social comparison. Likewise, social comparison was positively associated with body dissatisfaction and with drive for thinness. The results lend further support for the sociocultural paradigm of body image disturbance. Limitations of the present work are posed along with suggestions for future research. </p>

<p> <b>Purpose:</b> Empirical evidence on impact of CABG report cards on the quality of CABG surgery is patchy, mixed and mainly comes from uncontrolled and short term studies. CABG report cards are associated with a small decline in mortality after controlling for an overall declining trend. Whether report card publication has caused this decline is not known. </p><p> <b>Methods:</b> I use difference-in-differences and difference-in-differences-in-differences with fixed and random effects in OLS, Logistic, FGLS and GMM regression frameworks in a quasi-experiment set up in State-level and patient-level HCUP data with risk-adjustment to assess long term impact of CABG report cards on CABG mortality and provider market share and volume. This study uses counterfactuals, and multiple States as treatment and control States. </p><p> <b>Results:</b> CABG shows steadier and 17% steeper decline in in-hospital mortality rate when compared with other equally complex surgeries, and 30% steeper improvement when compared with pneumonectomy. There is a strong secular and statistically significant trend of decreasing CABG mortality. States with and without report cards were similar in terms of CABG mortality at baseline. We do not see long term impact of CABG report cards, State-mandated or voluntary, on CABG in-hospital mortality. Nevertheless, report cards have caused a gain in market share of 6% and 5% for low mortality hospitals and surgeons respectively in face of a secular trend of rising market share of average mortality hospitals and surgeons. CABG report card policy was also associated with decrease in hospital volume by 152 surgeries and decrease in surgeon volume by 14 surgeries a year over and above the secular trend of declining CABG volumes. </p><p> <b>Conclusions:</b> Concurrent Society of Thoracic Surgeons intiative and spillover of effects across States may explain why we do not see impact of CABG report cards in long term on improvements in quality of CABG surgery. National and regional system interventions with State CABG report cards appear to have created a perfect storm leading to a rising tide of CABG quality which has benefitted all States. It appears the report cards are associated with a change in today's culture of medicine biased in favor of interventions and procedures.</p>

<p> As the rates of breast cancer continue to increase, researchers and medical professionals struggle to give a definitive cause of the disease or find a cure. Unfortunately, it seems that the chance of having a cancer diagnosis within one's lifetime is only increasing. Since breast cancer is somewhat unpredictable, the medical field has taken the pathway of attempting to minimize the risk of mortality through regular screening mammograms. Even with multiple initiatives to increase mammogram utilization, multiple demographic factors such as race, income status, and insurance coverage continue to be underserved. The present study will focus on income status and insurance coverage as barriers to regular screening mammograms. It is hypothesized that those women with low-income status and no insurance coverage are less likely to receive regular screening mammograms than those women with higher income and some type of insurance. After completing a statistical analysis, both hypotheses were supported.</p>

<p> The purpose of this qualitative case study was to explore and describe the perceptions of breast-health screening among Chinese Canadian immigrant females, aged 30 to 69 and barriers that prevented them from having breast-health screening. Fifteen in-depth interviews and two focus groups of six Chinese Canadian immigrant women were conducted. The study was aided by NVivo 9 software in coding process, six themes were identified. The findings revealed Chinese Canadian immigrant women were influenced by the Chinese cultural beliefs and practices rather than practicing screening for prevention of diseases. Majority of the participants were aware of the impact of breast cancer, benefits of screening but not aware of the screening program. The findings provided policymakers, health care leaders, and officials of public health units evidence-based information to address low participation rates in breast-health screening among Chinese Canadian immigrant females. Recommended strategies to promote breast-health screening included culturally sensitive linguistic educational programs, recommendations by physicians, extension of the operating hours of breast-health screening clinics, and community-based outreach educational program.</p>

<p> Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this study with support from Bertalannffy's general systems theory. This study sought to relate community support services to PPRs in Prince George's County in contrast to other Maryland counties. To evaluate relationships between community support services and the reduction of PPAs, secondary data were provided by CMS in conjunction with the Robert Wood Johnson Foundation and the University of Wisconsin. The data included 26 behavioral community support factors from 53,229 Medicare paid claims in Maryland residents from July 1, 2008 to June 30, 2011. Lack of diabetes screening is a community support factor within quality of care. Using multiple regressions, there was a statistically significant relationship found between diabetic screenings and pneumonia readmission rate. The implication for social change is that reimbursement of key screening recommendations to CMS, local government, and hospitals in Prince George's County may reduce readmission rates, thereby positively affecting patients, improving community health, and decreasing health care costs in Prince George's County.</p>

<p> Obesity in the United States has reached epidemic proportions and is affecting younger generations. Research indicates that media usage contributes to adolescent obesity. Data shows that technology use (television, video games, and computer, etc.) is specifically higher among Latinos than their White counterparts. However, limited research exists on the effects that technology use has on Latino adolescents' adiposity. A cross-sectional baseline analysis was conducted using a sample of (<i>N</i>=131) at-risk Latino middle school adolescents from the Youth Empowerment for Success <i> S&iacute; Se Puede</i> Project. Body fat percent was used as the dependent variable; while television time, video or computer game time, and frequency of personal computer use were the independent variables. Results indicated that only video or computer game time had a positive association with Latino youth body fat percent, even after controlling for socioeconomic status. The implications and limitations of the study are discussed.</p>

<p> Open and sincere communication produces an atmosphere that allows family members to articulate love and respect for one another. Results make it obvious that family communication is an important untapped resource when discussing increasing rates of HIV/AIDS infections. This study examines family communication, African Americans and HIV/AIDS prevention.</p><p> With 32% of the reported cases of AIDS are African Americans and only 12 % of American population is African American. It is essential to find new preventative measure to suppress HIV rates in African American communities. By assessing the communication orientation(s) that work best when providing sex education to teenagers it can establish a foundation for further research on communication about sex education, HIV and STD prevention. With the findings of what communication style(s) work best it can alter the stigmas of homosexuality tied to HIV in the African American community, delineating the discouragement of homosexual sex education lowering the rate of HIV and STD transmission. </p><p> Using semi-structured interviewing with open-ended questions made interviews more informal and easy for participants to divulge specific information. Participants were African American men and women, between the age of 18-25, residing in Southern Maryland and had a younger sibling. With the use of spiral of silence theory the study found that mass opinion given by the black church of abstinence and the lack of education on HIV/AIDS prevention due to biblical text has created a moral divide for those within the congregation that would like to speak out for preventative provisions.</p>

<p> According to U.S. Census figures and the Michigan Department of Community Health (2011), there are approximately 5% - 6% of children in the State of Michigan who are uninsured and it is estimated 70% of these uninsured children may be eligible for State subsidized health insurance. While the percent of uninsured children in Michigan consistently rates well below the national average, it is concerning the rate of uninsured children in Michigan is relatively stable. There are strong financial and social incentives to design outreach efforts to reach all children in the State and make these efforts an "everyday event." </p><p> This research examines the question of whether or not a school-based outreach program is effective in reaching children who are eligible for State subsidized health insurance but are uninsured and will test the following two hypotheses: </p><p> Ho1: Incorporating health status outreach into routine school district operations does not identify a statistically significant number of uninsured children. </p><p> Ho2: There is no statistical difference in the number of applications received from a school-based outreach program during the pilot period. </p><p> The pilot program takes place in six of the eleven school districts that operate in Van Buren County, MI. School districts were provided two health insurance status collection forms. Form A is designed to be distributed with the Free and Reduced Lunch Application. Form B is designed to be distributed as part of the student registration packet and welcome material. The completed Form A and Form B are sent to a State of Michigan registered application assisting agency for SCHIP application assistance and enrollment. </p><p> As a result of the survey, 156 children were identified as not having health insurance. This represents more than 44% of the 358 children who are eligible for State subsidized health insurance, in the participating school districts, but are uninsured. Enrolling these children will help the State of Michigan to meet targeted enrollment gains and earn CHIPRA performance bonus payments. The additional funds from higher CHIPRA bonus payments could be used to provide the resources to fund the following specific recommendations: </p><p> 1. The Michigan Department of Community Health should lead the effort to work with the Michigan Department of Education to modify the Free and Reduced Lunch Application to capture whether or not the applicant has health insurance. </p><p> 2. The Michigan Department of Community Health should lead the effort to incorporate into the direct certified free and reduced lunch eligibility process a systematic check as to whether or not the applicant has State subsidized health insurance. </p><p> 3. The Michigan Department of Community Health should provide resources from the expected performance bonus to work with schools across the State to implement these changes. (Abstract shortened by UMI.)</p>