Physical activity is associated with many health benefits to include weight management, lower risk for chronic diseases, and improved mental health and self esteem. The built environment has been linked to lower physical activity levels and overweight and obesity in children living in low income communities but the exact causes need further investigation. The purpose of this quantitative, cross sectional study was to examine the association between parents' perception of safety and body mass index (BMI) percentile and children's physical activity/ inactivity levels and children's BMI as measured by the National Survey of Children's Health (2011/12 NSCH). The sample consisted of low income African American and Hispanic parents and their children between the ages of 6 to 17 (n=109) who live in Pennsylvania. The study used social ecological theory as the theoretical framework. Data analysis included descriptive analysis and Chi square analysis of variables related to safety, physical activity and children's BMI percentile. The results indicated a strong negative correlation of Hispanic parent's perception of safety and their children's BMI percentile, and a moderately negative correlation of African American parents' perception of safety and their children. In addition, a strong negative correlation of Hispanic parent's perception of vandalism and their children's BMI percentile was found. The study contributes to social change by increasing awareness of public health policy makers and officials that parental concerns for safety and vandalism should be considered in the creation of policies geared at reducing unsafe aspects of the community, the design of educational programs for parents and children, and alterations within communities to improve health.

Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers to medical care, and the perceptions of patients and medical personnel concerning the complexities of OF. In-depth interviews were performed over a 2-month period with 12 patients and 8 medical personnel at the Aberdeen Women's Center in Freetown, Sierra Leone. Results showed that patients face multiple medical barriers including high costs, fear of hospital treatment, severely inadequate treatment, and severe physical sequelae including paralysis and foot dragging. Multiple emotional, social, and financial harms related to OF were also reported, including stigmatization, abandonment by family, embitterment, depression, and job loss. Most patients expressed a preference for traditional birth assistants over medical personnel. However, many also benefitted from the intervention of friends or other good Samaritans. The results and recommendations from this study should be helpful in informing the general public and policy-makers about OF as a major public health problem, and in the design and delivery of programs to eradicate or alleviate the problem of OF in Sierra Leone.

The incidence and knowledge of the risk factors of stroke across ethnic groups in the United States have been examined in multiple studies. However, it is not well known if the foreign-born African immigrants who constitute about 4% of the U.S. immigrant population are at a higher risk of the incidence of stroke than are other nonimmigrant population in the U. S. This ethnographic study explored the perceptions of Anglophone African male immigrants residing in San Diego on the risk factors of stroke. The theoretical framework for this study included the health belief model and the health promotion model. Data were collected through unstructured, in-depth interviews with 8 male participants. Interview transcripts were analyzed using Nvivo 10 computer software and reviewed manually. A key finding was that most of the participants reported a lack or limited knowledge of stroke disease and no knowledge of the warning signs of stroke prior to migrating to the United States, but that they acquired some knowledge after integrating into mainstream U.S. society. Other findings were that using preventive services such as engaging in periodic medical check-ups and screening for high blood pressure, diabetes, and high cholesterol were not common practices in the home countries of the participants; that the participants considered women as resource persons on health issues; and that the participants struggled with negative attributes associated with sickness and hospitals. Results of this study might encourage changes in the health behaviors and beliefs of the African-born male adults by raising their knowledge and awareness of the prevalence of stroke and preventive measures available to them in the community.

Multiple studies have indicated a higher burden of overweight/obesity and exposure to environmental toxins, such as alcohol and tobacco smoke, in association with higher prevalence of cardiovascular disease (CVD) in the African American population. Thus, the purpose of this research was to determine if there was a significant difference in the use of lifestyle adjustments such as moderating alcohol consumption, weight loss, and smoking cessation on the prevalence of CVD in the African American population. The theoretical foundation was social cognitive theory and the social ecological model that posits the interplay of individual, social, and environmental factors. This cross-sectional quantitative study was designed to assess the effects of lifestyle adjustments of weight loss, moderating alcohol consumption, and smoking cessation in the prevalence of CVD in African Americans between 40 and 60 years of age. Analysis of secondary data from the National Health and Nutrition Examination survey for the years 2013-2014 was conducted using binary logistic regression. The findings showed no significant difference in the use of weight loss, moderating alcohol consumption, and smoking cessation in the prevalence of CVD in African Americans between 40 and 60 years of age. However, the odds of moderate alcohol consumption and weight loss were greater than 1. Thus, this study may have a small potential impact on CVD in African Americans by encouraging lifestyle adjustments, and may contribute to positive social change by increasing life expectancy, improving quality of life, and reducing the burden of certain chronic diseases and reduction of healthcare cost.

This study was undertaken for the purpose of seeing how a health counseling program for overweight adolescent girls could be developed in a secondary high school setting. Initially, the study developed out of an awareness and concern for the problem of obesity among teenage girls, especially those in a secondary school. To provide a strong background for the use in both planning and executing a health counseling program, the study reviewed the health literature dealing especially with several topics: a. The prevalence of obesity. b. The relationship of obesity to mental and physical health. c. The influence of food faddisms and quackery on obesity. d. The etiology of obesity including hereditary, endocrine, metabolic, environmental and psychological factors. In addition, the study involved a survey of school nurse-teacher health counseling programs in schools within the administrative area established for health programs by the New York State Department of Education. To provide information about the general social and communal context of the adolescent girls to be included in the health counseling program, the study drew on the summary of community characteristics provided by an eleven. member North Shore High School Faculty Committee in preparation for the school's evaluation by the Middle States Association of Colleges and Secondary Schools. From the information about the problem of obesity and the scarcity of school health counseling programs, the school nurse-teacher with the cooperation of members of the Physical Education, Home Economics, and Guidance Departments as well as the Psychological and Medical Services, devised a six-month pilot health counseling program. The program included a careful selection of sateen overweight girls who were twenty or more pounds over their desired weight according to the Baldwin-Wood standardized Weight-Height-Age Table. Weekly individual counseling sessions followed by monthly group meetings were established. A physical exercise program came about as an outgrowth of the monthly group meetings. Nutritional education, retraining of eating habits, stimulation of diverse interest and encouragement of physical activity formed the nucleus of the counseling sessions. The primary focus centered around appearance and dress with the basic aim to establish good nutritional habits and a healthy, wholesome pattern of daily living. Social reinforcement and supportive reassurance were paramount in the relationship between the health counselor and counselee. The results of the six-month pilot study showed an overall weight loss of 22 pounds among the sixteen counseled girls as contrasted to a weight increase of 76 pounds among the sixteen uncounseled group. An improvement in personal appearance, attitudinal realism about the weight problem, along with self-acceptance, were changes evident with the counseled group. The results of this pilot study have implications both within the high school and beyond. The program developed in the pilot study is continuing in the high school. Programs based upon the design offered in this study could be extended throughout the community starting in the elementary schools and reaching out into the community health agencies. The study shows that a thoroughly informed school nurse-teacher by means of detailed planning and program execution is in a strategic position to offer her expertise in assisting the student with a weight problem. If additional studies beyond this pilot study bear out the results of this study, then adeqt.1ately prepared health counseling programs can serve as one means of prevention and control of the problem of overweight among the high school students.

Female genital cutting (FGC) is the partial, or total excision of the female outer genitalia, or different forms of lacerations to the female genital organs for nonmedical reasons such as social, cultural, religious, or other nonmedical intentions. Many girls and women around the globe who have gone through FGC or are at the risk of being forced into it. The purpose of this qualitative case study was to explore the place of culture, religion, social beliefs, and men's views, attitudes, and knowledge regarding the FGC within the Nigerian immigrant community in the northwest US. The social convention theory served as the framework for the study. Data were gathered from 22 adults, 18 years old and above, who have lived in the Portland, OR area for at least 2 years. Fourteen open-ended questions with subheading were used to carry out a face-to-face interview. The data were analyzed manually. The participants (parents with daughter[s]) in this study supported the possible eradication of FGC in all manner; using sound education and legislation. Even though FGC is filled with so much pain and in some cases, lifetime scares, people still carry it out because it is a traditional rite which has been passed down from generation to generation. Possible implications for positive social change include education of young parents and everyone else regarding the dangers that are associated with FGC, especially in the rural areas where FGC is believed to still thrive. If men were to speak up and stress their dissatisfaction with FGC and show sympathy to those who may have gone through FGC, they may shield their daughters from the practices. The eradication of FGC would enhance the lives of young women and girls and reduce the morbidity and mortality connected to this practice.

More than 49,081 people were diagnosed with HIV in the United States in 2011. Of those 49,081 HIV-infected persons, 1 in 6 was not aware of being HIV positive. In 2011, Georgia had the 5th highest number of HIV diagnoses among the 50 U.S. states. This phenomenological study aimed to understand the lived experiences of HIV-infected adults, ages 30 to 49 years in Atlanta, Georgia, by understanding their perceptions of risk prior to contracting HIV. The health belief model was used to guide this study because it explains and predicts health-related behaviors and it has been used in previous studies to identify preventive behaviors specific to sexual behaviors. Purposive sampling was used to obtain 12 HIV-positive persons ages 30 to 49 years who lived in the metropolitan Atlanta area at the time of the study, were knowledgeable about HIV perceptions, and were able to discuss their lived experiences. Interviews were conducted to collect the data. The data analysis procedures included creating codes and categorizing the data, checking the validity of the codes, identifying patterns and themes, interpreting the data, and conducting member checks. Results showed that most participants did not perceive themselves to be at risk of HIV. Participants also experienced stigmatization and had challenges maintaining social relationships after their HIV positive diagnosis. Future priorities should focus on identifying best practices relevant to individual, familial, organizational, societal, environmental, economic, and policy factors to reduce the risk of HIV. This study is important for public health and social change because the findings might be used by healthcare professionals to identify and allocate the resources necessary to strengthen HIV/AIDS care and services to the populations who need them the most.

In the Republic of Chad, primary care physicians play a central role in the detection and control of outbreaks and are critical actors in the integrated disease surveillance system through mandatory reporting. Feedback on such surveillance must reveal the needs and perceptions of these physicians. These needs and perceptions were examined using a questionnaire survey distributed to a sampling of 20 physicians in Chad. The purpose of this qualitative study was to investigate the role of primary care providers in the integrated disease surveillance to identify factors that impact complete, quality, and timely reporting. The theory of planned behavior was used for the theoretical framework. Interview data collected from the physicians via a purposive sampling strategy were analyzed. The questionnaire used a standardized, validated tool to assess the role and factors that impact complete, quality, and timely reporting related to the integrated disease surveillance system among primary care physicians. Demographics and descriptive analysis of the frequency of responses was performed. Key findings were positive for the importance of the provider's role in case detection and case reporting. These findings offer an understanding of factors that affect the complete, quality, and timely reporting and give insight into how the integrated disease surveillance system might be improved. The data show the physicians understood how to conduct disease reporting, and provide solutions for enhancing the integrated disease surveillance system. These findings support social change by informing the important practice of early detection and reporting of infectious diseases to detect and control future outbreaks.

acase@tulane.edu / My dissertation is a collection of three essays in applied microeconomics. Chapters 1 and 2 are sole-authored papers. In Chapter 1, I investigate the impact the Affordable Care Act's 2014 Medicaid expansion had on Medicaid spending by the government. I apply a difference-in-differences study design using data from the Centers for Medicare and Medicaid Services on all Medicaid expenditures over an 18 year period, including three years post-expansion. I find that the expansion increased total Medicaid spending by 14 percent in participating states, but this masks the substantive heterogeneity in Medicaid spending across the 21 health care service categories. Most notably, dental and rural health clinic services increased by 201 and 99 percent, respectively. In Chapter 2, I study the effect of the first multi-country antimalarial subsidy on the type and source of treatment taken for children under five years of age reporting a fever. I use nationally representative, repeated cross-sectional survey data from 15 malaria endemic African countries over an 11 year period. Among children reporting a fever, countries offering subsidized ACTs increased ACTs taken in the private sector by 8.2 percentage points and decreased treatment with lesser effective antimalarial monotherapies by 7.9 percentage points. In Chapter 3, I collaborate with economists at RAND Corporation to investigate the direct effects of the 2010 Deepwater Horizon oil spill on the Gulf fisheries industry. Our research shows that the dynamic path of certain indicators, such as fisheries landings and revenues, can provide information about the resilience of fisheries to oil spill events at the sectoral level, aggregating the various physical, policy, and behavioral responses that combine to form the latent resilience construct. / 1 / Jacqueline Anne Fiore

Aim: The purpose of this in-vitro study was to look at the effectiveness of the ICON on prevention of caries on the smooth surface in comparison to resin based sealant. Methods: The study was an in-vitro study to compare the effectiveness of ICON and a sealant material in prevention of secondary demineralization. Sound teeth with no defects were cleaned and divided into 3 groups and lesions created. Both the groups were treated with respective materials (ICON and sealant), but the control group was left untreated. Once treated fresh demineralization solution was created and subject to deminralization cycles to see which material performed better in prevention of secondary demineralization. Results: In the present study, primary analysis was done using the quantitative light induced fluorescence technique. At the end of the secondary demineralization the results showed no statistically significant difference among the treatrment groups and the control group. However, the polarized light microscopy was done to assess the amont of infiltration of the material into the lesions. The ICON showed substantial penetration into the lesions where as the sealant material did not penetrate but formed resin tags on the surface of the lesion. Therefore, the ICON material did not fare any better than the sealant in prevention of secondary demineralization on smooth surface initial carious lesions.