Master of Science / Department of Family Studies and Human Services / Elaine M. Johannes / Karen S. Myers-Bowman / The increasing incidence of school-related bullying problems has caught the attention of the media in the United States and rest of the world. The bullying phenomenon has administrators, educators, school site councils, and parents searching for effective prevention programs to reduce youth peer violence and improve the learning environment for students. Many schools are required by state laws to have bullying intervention and prevention programs in place; however, questions arise about the success of popular and widely-used bullying prevention programs. Research data shows that zero-tolerance policies, which appeal to those who demand a strong disciplined reaction to peer violence, are often implemented without using common sense. Many parents or guardians of victimized children are either unaware of the problem, or they do not know what to do when their children are bullied. This report reviews current knowledge about bullying in school during adolescence. It begins by looking at the historical context of bullying and bullying research, and then examines adolescent development in relationship to bullying behaviors. The literature review includes topics regarding types and definitions of bullying, bully, victim, and bully-victim profiles, and well as the role of the bystander. Using Bronfenbrenner’s bio-ecological model of human development, this report then identifies the need for parental involvement as a way to help adolescents cope with bullying incidents.

Doctor of Philosophy / Department of Family Studies and Human Services / Sandra M. Stith / While previous research has shown that some form of processing the trauma of IFCSA seems to occur for many IFCSA survivors, how the trauma of IFCSA is processed remains as a gap in the literature. In this exploratory study, I used qualitative methods to clarify what the nature of processing is and how it happens among IFCSA survivors. A phenomenological framework was utilized to understand the lived experience of processing IFCSA, which guided my main research question (What is the nature of how IFCSA is processed for some survivors?). Participants were recruited from the community via flyers, advertisements, and announcements. Seven eligible female participants completed two separate in-person semi-structured interviews. Participants also completed a timeline to organize their journeys in the first interview, and brought an object, or aesthetic representation, to represent their journeys of processing IFCSA in the second interview to triangulate data collection. To analyze the data, I used a constructivist grounded theory analysis approach. The general categories that emerged from the data in relation to processing IFCSA included the journey of processing IFCSA, the nature of processing IFCSA, and advice about processing IFCSA. The journey of processing included the individual journeys that each participant had been through. Participants described the nature of processing in terms of how they defined and experienced processing IFCSA experiences. For example, one participant’s definition of processing was the “uncomfortable process of really unpacking the implications of what actually happened. … acknowledging all the myriad ways that it’s actually affected you in your life. … And sort of personalizing what it is about that…has an affect on you.” Finally, advice from the participants for individuals, families, and helping professionals are described. Several participants recommended that victims seek help, as one participant discussed, “To me it’s not a stigma, a horrible thing, to go to counseling. That really it is for a healing, that it is another step of medically taking care of ourselves.” Clinical implications derived from this advice as well as from participants’ experiences processing IFCSA are discussed. Suggestions for future research to gain a better understanding about processing IFCSA are also discussed.

Doctor of Philosophy / Department of Family Studies and Human Services / Sandra Stith / Recent years have seen a rise in the medicalization of treatments for erectile dysfunction (ED). While there has been a divide between the medical and psychological communities, some have called for a more collaborative relationship. Little research has been done on the collaboration between medical professionals and psychotherapists in treating ED. This study seeks to increase current knowledge about medical professionals’ referral practices and communication post-referral. An online survey was developed and distributed to the members of the Sexual Medicine Society of North America (SMSNA) (N = 541). Survey questions inquired as to the factors that increased participants’ willingness to refer ED patients, the form of communication participants currently desire to have with psychotherapists and the participants’ desired level of communication with psychotherapists to whom they might refer. Less than ten percent of the medical professionals invited to participate in the study completed the survey (n=50). Those who did complete the survey were primarily male, specialized in urology and practiced in the U.S. Almost half the respondents were employed in an academic setting while just over half of respondents worked in hospital-based, group, or solo practices. Just over half of the survey participants practiced in urban areas. Although the number of medical professionals who completed the survey was small, findings indicated that those who completed a sexual medicine fellowship and who had a larger percentage of their patient population being seen for ED were more likely to refer patients to psychotherapists. Participants who have referred ED patients to psychotherapists reported little-to-no communication between them and the psychotherapists to whom they refer. The study participants expressed a desire to refer patients to psychotherapists who are experienced in working with both sexual and couples issues. Questions about the desires and experiences of medical professionals who have not referred to psychotherapists were not able to be answered because of the limited number of these individuals in the data set. Although the number of participants who completed the survey limits the generalizability of the data, this study demonstrates that most medical professionals who responded to the survey are willing to refer ED patients to psychotherapists.

<p> With the goal of eliminating mother-to-child transmission by 2015, a wide range of governmental and other efforts within low- and middle-income countries have sought to provide services for the prevention of mother-to-child transmission of HIV (PMTCT) to the estimated 1.2 million pregnant women in need. In support of this goal, the World Health Organization (WHO), as the leading normative international body in the area of evidence-based clinical guidelines, issued policy recommendations on the use of antiretroviral drugs for PMTCT. Through various mechanisms, including guidance notes and dissemination workshops, WHO supports countries to adopt and adapt the guidelines within their national policy frameworks. Through three analyses, this dissertation examines the diffusion of WHO PMTCT guidelines in five Eastern and Southern African countries over a 16-year period (1998-2013) and estimates the effect of PMTCT policy adoption on delivery of key services. </p><p> <b>The first analysis</b> of the adoption of specific PMTCT guideline updates between 1998 and 2013 seeks to ascertain which internal factors may explain why and when countries decided to adopt new technical guidance. The policy analysis shows that the five countries adopted a majority of the key international PMTCT technical guidance updates. It can be concluded that international to national policy diffusion was taking place and that national policies converged to be more similar and more in line with international guidelines over the time period studied. Variation in adoption and in the internal determinants at play in each country was minimal, making it difficult to assess the influence of determinants qualitatively. The three internal determinants that appeared to most influence adoption of key PMTCT updates were: 1) the severity of the MTCT problem 2) governance effectiveness, and 3) prior PMTCT policy adoption. The lag between adoption and implementation in these countries is discussed. The findings indicate that in the countries studied, policies promoted by WHO and other international bodies can play a critical role in supporting national policy adoption for program advancement in the area of PMTCT. </p><p> <b>The second and third analyses</b> investigate whether the completeness of a country&rsquo;s body of PMTCT-supporting policies was associated with the delivery of two key PMTCT services &ndash; the offer of an HIV test and the receipt of HIV counseling as a part of antenatal care (ANC) &ndash; in four of the five countries included in the first analysis. Two nationally representative surveys per country were used to conduct a quasi-experimental fixed-effects analysis of the role of policy in predicting a woman&rsquo;s probability of being offered an HIV test or receiving HIV counseling in ANC, controlling for other key individual- and country-level covariates. </p><p> According to the &lsquo;testing&rsquo; model, a one-unit increase in policy score was associated with a 0.042 (p&lt;0.000) increase in the probability that a woman was offered an HIV test as a part of antenatal care. According to the &lsquo;counseling&rsquo; model, a one-unit increase in policy score was associated with a 0.014 (p&lt;0.001) increase in the probability that a woman received HIV counseling as a part of antenatal care. In both the testing and counseling models, the policy/education interaction was statistically significant in the final model, with a greater policy effect estimated at among those with higher education levels. Time statistically significantly influenced the probability of the outcome, as did government health spending, governance effectiveness, and donor health spending. Further study is needed to identify the policy elements that have the most impact on improving service delivery. </p><p> <b>The three analyses</b> presented here support the premise that international health policies influence national-level policy adoption, and that national-level policy adoption in turn influences national service outputs. As countries and their development partners mobilize for the Sustainable Development Goal era, policy adoption at the international level will continue to be an important influence in national policy adoption in the area of PMTCT. This research has described a number of potential internal and external determinants that will influence national adoption in this next round of global health policy advocacy. Looking forward, this study shows that countries and their development partners should continue to invest in the work of policy adoption to complement other efforts to reach health goals, including increased government health spending.</p>

<p> This dissertation explores the relationship between parental incarceration and childhood obesity in African American children by reviewing Adverse Childhood Experiences from the National Survey of Children&rsquo;s Health, revealing the epidemic of childhood obesity, and examining the issues of mass incarceration and its physical, mental, and emotional effect on African American children. </p><p> The results of this study find that we could not show that being an African American child experiencing parental incarceration influences childhood obesity. In this study we could not show that the number of Adverse Childhood Experiences faced by African American children are related to the child&rsquo;s level of obesity. Also, this study finds that we could not show a statistically significant relationship between African American children having incarcerated parents and the rest of the parental-incarcerated population, whites and others, and the difference in obesity. Finally, we could not show an association between obese African American children who experience parental incarceration by gender.</p><p>

<p> This study explored of the practices and routines of one-parent households and the impact on post-secondary educational attainment of African American males. It adopted a post-positivist approach, using a qualitative phenomenological study design to construct descriptions of the lives of one-parent households whose sons are accepted and planning to enter college in the fall or are currently completing their freshman year. </p><p> The study used data from 10 1-parent households with African American sons committed to attend a college in the fall semester of 2018. The population sought to address maximum variability in participants&rsquo; parenting background, and the routines and practices in that existed in the home and contributed to their sons achieving educational attainment beyond high school. In doing so, the study sought to provide a comprehensive understanding of the characteristics of one-parent households who have provided an environment for their African American sons to seek and obtain post-secondary educational attainment. </p><p> The study used multiple methods of data collection for a 5-week period. I collected data through a questionnaire and semi-structured interviews. The study may enhance current knowledge of this subject in a variety of ways. It strove to understand specific ways the parent actions influence African American males to attend post-secondary options by identifying the routines and practices of 10 one-parent households who have African American sons who are committed to attend a college or a university in the fall immediately after graduation from high school. It also sought to identify further significant influences of one-parent households&rsquo; strategies that guided their sons to seek and attain post-secondary options through continuing their education. Additional inquiry seeks to add to our knowledge the ways one-parent households organize their daily routines and support for African American high school males to seek and attain post-secondary options upon graduation from high school.</p><p>

<p> This investigation considered the relationship among attitudes toward interracial relationships, tolerance of ambiguity, and mindfulness using a correlational design. The exploratory research question was: Does a tolerance of ambiguity plays a role in the acceptance of interracial relationships? Adult participants (<i>N</i> = 253) between the ages of 18 and 78 included male, female, and genderqueer adult individuals in the United States. Participants were recruited through online advertisements. They responded to items on a demographic questionnaire, along with four assessment instruments measuring mindfulness (MAAS), tolerance for ambiguity (MSTAT-II), attitudes toward interracial relationships (ATID), and cognitive load (WPM). The key finding in this study was that level of mindfulness was positively related to the level of tolerance for ambiguity (<i>p</i> &lt; .001). However, no significant relationships among mindfulness, cognitive load, or attitudes toward interracial relationships were found. Results for the variable measuring attitudes toward interracial relationships was heavily skewed in the negative direction, indicating a very accepting group, which influenced the nature of data analysis.</p><p>

<p> The purpose of this study was to explore the lived experience of parents who have a child diagnosed with a developmental disability who received Early Intervention services in Thailand. A phenomenological approach was used in the design of the study. Open-ended interviews were conducted with eight participants who lived in Thailand and had a child with a developmental disability. Only participants whose children were 5 years old or younger at the time of the study were interviewed. Five themes emerged from the data, including the journey, helpful versus unhelpful attitudes and actions, systems and services in Early Intervention, challenges, and positive outcomes. Implications for professionals, policy-makers, and society are discussed, including areas for future research on Early Intervention in Thailand.</p><p>

<p> Many U.S. adolescents suffer from sleep disorders. Although poor sleep habits may contribute to health issues, less is known about how parental perspectives influence sleep health in adolescents. The purpose of this descriptive phenomenological study was to address a knowledge gap in understanding parental views to promote better sleep habits in adolescents. The blended theoretical framework included the theories of caring science, social learning, advocacy paradigm, and repair and restoration of sleep. Twenty parents in the Southeastern United States participated in open-ended interviews. Research questions were designed to elicit parental perspectives about recognizing unhealthy sleep habits, improving daily sleep health routines, and identifying conditions that led to consultation with health professionals. Colaizzi&rsquo;s data analysis strategy demonstrated thematic parental reports of declines in attitudes, behaviors, and performances as factors for recognizing unhealthy sleep habits; consistent and routine schedules as options for promoting improved sleep habits; and irregular sleep or health problems as reasons for consultation with health professionals. Recommendations for future research include exploring other geographical locations and investigating school bus schedules interfering with early morning sleep loss. To affect positive social change, dissemination of this study&rsquo;s findings to health practitioners may influence enhanced provider-patient communications and ultimately contribute to improved sleep habits among adolescents. Additionally, this study&rsquo;s findings may inform health care administrators with strategies to develop effective parent and provider education programs while reducing unnecessary health services&rsquo; utilization and resulting costs for adolescent health.</p>

<p> This study examined the mediating effect of separation-individuation on the relationship between parenting style and college adjustment. This study included 150 first year college participants (Caucasian 52%, Latino/Hispanic 17.33%, African-American 7.3%, Asians 17.33%, and Other 6%) between ages 18 to 20 from New York City universities. The instruments used in this study were Parental Authority Questionnaire (PAQ), Dysfunctional Separation-Individuation Scale (DSIS), and Student Adaptation to College Questionnaire (SACQ). Hierarchical Regression Analysis was used for predicting personal emotional adjustment using separation-individuation. PROCESS Macro procedure for SPSS was used to test the hypotheses of this study. The results of this study show a few important and significant findings. First, it was found that maternal authoritarian parenting style was significantly predictive of problems in separation individuation. Secondly, it was found that separation-individuation was predictive of both personal-emotional college adjustment and social college adjustment. It should be noted, however, that problems in separation individuation were predictive of improved social adjustment, contrary to expectations, while it was negatively predictive of personal-emotional college adjustment. Finally, two mediation models were tested that showed that separation individuation mediated the relationship between maternal authoritarian parenting style and two aspects of college adjustment, personal emotional and social adjustment. The strengths and limitations as well as their significance are discussed.</p>