This dissertation is based on an anthropological research project that was conducted over a period of eight months in Guyana, South America. The exploratory study used ethnographic methodologies, including participant observation of voluntary HIV counseling sessions, 50 in-depth interviews with HIV-positive and HIV-negative patients, and 10 in-depth interviews with doctors, nurses, counselors, government officials, and program administrators who work in HIV programs in Guyana. In addition, a range of other HIV program and policy materials were analyzed with regard to the risk and prevention messages being promoted among vulnerable individuals in Guyana. Research questions guiding the study were: How is AIDS contextualized in the rhetoric of local governments, regional laboratory centers, and international donors in the Caribbean? How do these entities collectively and individually shape conceptions of HIV risk, individual responsibility, and prevention in a local VCT program in Guyana? How do patients and providers in the local clinical setting interpret and utilize these concepts in their interactions with each other, their families, and their communities? The study used two U.S. government-funded HIV prevention projects as case studies for understanding the use of "universal templates" among vulnerable populations in Guyana: (1) a CDC-sponsored mobile HIV testing unit and (2) a USAID-sponsored Prevention of Mother-to-Child Transmission (PMTCT) program. Findings focused on the disconnect between the HIV prevention messages to "Abstain. Be Faithful. Wear a Condom." and the lived experiences and realities of primarily Afro-Guyanese women who find it difficult to adopt these behavior changes. Recommendations for program policy changes and suggestions for future research are included.

BACKGROUND AND OBJECTIVES: In the U.S., smoking accounts for significant morbidity and mortality. While U.S. smoking rates have declined since the 1960s, they remain high, especially within the homeless population. However, effective smoking cessation programs have not been developed for this population. The primary goal of this project proposal is to facilitate smoking cessation among homeless populations. The secondary goal is to reduce the number of cigarettes smoked per day in this population. To achieve these goals, this project couples pharmacotherapy with nicotine patch and behavioral group therapy to reduce tobacco smoking among homeless adults. The greatest challenge to quitting smoking is nicotine addiction. Nicotine, a highly addictive substance, is the primary molecule in tobacco. Nicotine, when consumed, usually by smoking cigarettes or via chewing tobacco, produces the effects of reward and pleasure, which then become associated with smoking or chewing tobacco. The homeless have a unique challenge regarding smoking cessation for two reasons. The first is that this population has a higher rate of smoking compared to the general population. Secondly, the homeless have a higher rate of mental illness than the general population and those with mental illness have higher rates of smoking. This raises unique challenges for the homeless population and their healthcare providers whose goal is to help them quit smoking and maintain their health. Nicotine replacement therapy (NRT), with nicotine patch, has been shown to be an effective smoking cessation tool for the general population. These therapies, available over the counter, are relatively easy to access, affordable and easy to store, making NRT a useful tool for smoking cessation in the homeless population. In addition, cognitive behavioral therapy (CBT) has been shown to be effective in both smoking cessation and as therapy for mental illness. Therefore, NRT coupled with CBT could be a useful tool for smoking cessation programs for the homeless. PROPOSAL: A group of 50–60 participants will be recruited from Boston Health Care for the Homeless Program where they will receive 24 weeks of NRT in the form of a 21-mg/day nicotine patch coupled with 3 months of weekly CBT. CONCLUSION: The primary goal for this study is to increase smoking cessation amongst the homeless population in Boston. The secondary goal is to decrease the number of cigarettes smoked daily for the program participants. If these goals are met, this study can be implemented as a standard smoking cessation program for the homeless.

Near-field tsunamis are a type of natural hazard that provide at-risk individuals with short warning periods that can severely hinder effective response. The Protection Action Decision Model (PADM) is an established theoretical framework that has been used to describe human response to natural hazards. Variables from the PADM have been used to understand individual and household responses during hazards such as hurricanes and floods but seldom for tsunamis. This study surveyed 300 adult American Samoan survivors of the September 29, 2009, Mw 8.1 South Pacific earthquake and tsunami. The primary objectives were to use variables from the PADM to: a) determine the relative importance of determinants of threat perception, b) examine tsunami survivors’ ratings of 4 social stakeholder groups regarding tsunami knowledge, trustworthiness of source of information, and protection responsibility, and c) establish whether household characteristics such as distance to shoreline, household income, and family size were situational impediments to response. Study findings showed that ground motion from the earthquake was found to be the strongest predictor of threat perception. Respondents rated themselves higher than officials and media for the 3 stakeholder characteristics. Occupational status had the most apparent effect on stakeholder perceptions. Those who reported being employed were more likely to have higher mean ratings across the social stakeholder groups for most characteristics. Respondents living closer to the shoreline and having an income of ≥ $15,000 proved to be slightly more likely to evacuate. Overall, findings suggest that the people of American Samoa displayed a remarkable response to the earthquake by evacuating upon feeling the ground shaking. Thousands of people were in the inundation zone but only 34 died, even though the first wave arrived onshore in as little as 15 minutes. The adaptive response during this event is frequently attributed to the success of recent educational outreach conducted in the months and week just prior to the event but other factors may also be important. This research represents a novel study that examines various aspects of tsunami evacuation behavior for a near-field tsunami using the PADM with a population outside of the contiguous 50 states.

This study examines drug use behavior in a self-described sample of users. Comparisons are made between subjects whose only illicit drug use is marijuana and those who use both marijuana and other drugs. Data are from the DRUGNET study (1996, 1998, 1999), a multi-panel study conducted over the internet from 1996 - 1998. This sample was predominately white, male, young, and college educated. The majority of respondents were employed with incomes in the $50,000 - $60,000 (USD) range. A subset of respondents to the DRUGNET survey was selected for this analysis. Respondents had to be at least 18 years of age, a US citizen and report marijuana drug use (n = 283). The major finding from this study is that there were no significant differences between the two groups on any variable measured other than gender, household income and the age of onset of marijuana use. Women are more likely to report using marijuana alone while males are more likely to report using marijuana and other drugs. The individuals having low and middle class household income were more likely to report the use of marijuana and other drugs compared to the upper middles class income groups who were more likely to report the use of marijuana alone. After Bonferroni's adjustment was done, it was observed that the mean age of onset for the group who used marijuana alone was greater in comparison to the group who used marijuana along with other drugs. While this study is the first one to make this comparison and may have implications for drug education, policy, and treatment. The result obtained from this study may be an artifact of the study design and/or sample.

Obesity rates have aggressively climbed in both children and adults, and notably for particular ethnic and lower socioeconomic status groups. National data from 1999-2002 have shown that approximately one-half of African-American women were obese, as compared to one-third of Caucasian women. It has been substantiated that a significant portion of overweight or obese children will become obese adults, with a number of factors identified that may influence obesity in children including gender, ethnicity, and environment. This study analyzed secondary data from The Youth Behavioral Risk Factor Survey administered to students at BGHS to identify variations in body image for particular ethnic groups and gender. SPSS was used to analyze data descriptively and inferentially to test hypotheses. Results revealed that 54.9% of participants did not report their weight status accurately, with approximately 83.8% of those participants who reported their weight to be lower than their actual weight. However, participants were more accurate when assessing the weight status of others. Significant differences were detected between males and females on self-perceived weight status. Males were more likely to underestimate their weight status significantly more than females. Results also showed that significantly more females were trying to lose weight, as well as females using a greater number of weight loss strategies in the past 30 days. No significant ethnic differences in perception of weight status, nor in the accuracy of perceived versus actual weight status was detected. Number of and types of weight loss strategies did reveal significant differences for ethnicity, with American Indian, Biracial, and Caucasian groups using exercise more often as a weight loss strategy. There was no significant difference detected between immigrants versus non-immigrants related to accuracy of perceived weight status, although a significant difference was identified with immigrants more likely than non-immigrants to perceive their weight status as lower than actual weight. While previous studies have demonstrated a relationship between ethnicity and perceived body image, this study failed to do so. However, significant gender and immigrant differences in body image perception were detected in this study. Further study of the relationship between body image, gender, and ethnicity is essential.

The purpose of this research was to assess the lifestyle of international students at Western Kentucky University (WKU) and to compare the lifestyles of international and American students and subgroups of international students. The Lifestyle Questionnaire (LSQ), was a 26-item personal health lifestyle test, which had six sections (nutrition, exercise, smoking, alcohol and drugs, safety, and stress). The test-retest reliability of LSQ was evaluated by Pearson Correlation Coefficient (r) and was .89. During October and November 1997, 55 international students and 64 American students at WKU finished the LSQ. Significant differences were found between the American student group and the international student group on the total LSQ score (t=3.47) and the scores on the sections of Smoking (t=2.17), Alcohol and Drugs (2.91), and Safety (3.91) after analysis by a t-test. International students had higher scores on the above areas. No significant differences were indicated between the two groups in nutrition, exercise, and stress. The above results were discussed and analyzed on possible causes, consistency with previous research, and limitations of this study. Recommendations about the potential use of LSQ and the work effectiveness of international student health services were also presented.

There is presently a lack of research on the types of communication barriers faced by the rural elderly when accessing health care. Furthermore, much of the research on the rural elderly is old and outdated. Thus, this thesis research sought to identify and explore communication barriers faced by the rural elderly when accessing healthcare. Specifically, the research in this thesis seeks to answer the following research questions: What types of communication barriers do rural elderly face when seeking health care? More specifically, what sorts of patient-provider communication barriers will the rural elderly of South Central Kentucky identify? An interview guide was developed to explore the perceived communication barriers encountered when accessing healthcare. The data were collected from subjects, who must have been at least 65 years of age and must have visited a senior center in the Barren River Area Development District on the date of interviews (n=59). The data was analyzed using frequencies and central tendencies with SPSS. The study satisfied the purpose of expanding and updating what is known about the communication barriers faced by the rural elderly when accessing health care. The study also, demonstrates that further research is needed on this topic to update the current knowledge even more so.

The purpose of this research was to determine whether personal health assessments would increase Personal Health 100 students' health knowledge and healthy behaviors. This research is important because of the objectives set by Healthy People 2000 to promote health and because of the need for comprehensive school health education programs. By focusing on health promotion in the school setting, more effective preventive programs can be devised. The factors investigated included health knowledge and the following health behaviors: exercise, alcohol consumption, use of tobacco, sleep, breakfast, sexual activity, and seatbelt use. These factors were chosen based on a longevity theory. Data were collected for this study in the spring semester 1996 at Western Kentucky University. The responses from 244 undergraduate students were collected using the HKI (Health Knowledge Inventory) and a behavioral assessment. The data were analyzed using an analysis of covariance and a chi- square analysis. None of the factors^ were found to be significantly affected by the personal health assessments. The results revealed that the methods to increase health knowledge and healthy behaviors had no short-term effects on the undergraduate students.

The increase in preventable diseases in many parts of Africa is becoming quite a concern for the African community as well as for epidemiologists all over the world. There is a general consensus among African epidemiologists that a lack of health education and traditional cultures contribute to this trend. The purpose of this thesis is to report the results of a survey of health knowledge among college students in the southern region of Nigeria, specifically, in Enugu and it's surrounding environ. First year students at the two universities in this region completed the health knowledge inventory (HKI). These students were enrolled in classes in general education-- which covers topics ranging from history, geography, and government, to personal hygiene. The HKI was utilized in measuring the health knowledge of these students. The result of the survey indicates a need for improvement in the health knowledge of Nigeria students. The Nigerian students scored lower than a large sample of American college students on human sexuality, chronic disease, communicable disease and mental health subscales. On the rest of the subscales the students' scores were above average. The results from this survey may be relevant in the development of health care programs for the area.

The harmful effects on health caused by exposure to enviromental tobacco smoke (ETS) are well documented. In 1987 and 1996 mail surveys were conducted to determine the change in practices, attitudes and knowledge of food service owners and managers of south central Kentucky on some issues relating to environmental tobacco smoke (ETS). Study subjects included all food service owners and managers of south central Kentucky that have a permit on file at the Barren River District Health Department. In 1987, a total of 127 out of 431 questionnaires were received ( 29.5% response rate). In 1996 the response rate was 30.6% (190 responses out of 620 questionnaires mailed). Most of the responses in the 1996 survey (42.6%) were from Warren county. Retail food services and school cafeterias made up 57.9% of the respondents. It was hypothesized that there has not been any changes in the percentages of food services establishments that offer a nonsmoking area to the customers between 1987 and 1996, that the percentage of food service owners that recognize the hazards of ETS has not changed, and that the percentage of food service owners that agree that the prohibition of smoking would result in a loss of customers has not changed since 1987. Using Chi-squares, frequencies and percentages it was determined that there has been an increase in the percentage of places that have a nonsmoking area 20.6% in 1987, 57.4% in 1996 (significant to 0.0001). It was also determined that there was a significance of 0.01 between the percentage of managers that agree that ETS is harmful to nonsmokers [ 71.2% in 1987 vs 98.1% in 1996 (item #3), and 43.5% in 1987 vs. 54.1% in 1996 (item #4)]. A significance of 0.0001 was found on the question of believing that a change to a smoke-free facility will result in a loss of customers. In 1987, 79.4% agreed on the statement being true vs. 53.5% in 1996.