The increase in the rate of diabetes has coincided with drastic increases in high fructose corn syrup (HFCS) consumption. There is much controversy over whether these increases are linked. Fructose consumption has been under much scrutiny, as fructose metabolism is not regulated by phosphofructokinase, the major regulator of the glycolytic pathway. Studies have shown that high levels of fructose consumption lead to decreased insulin sensitivity through a mechanism that involves the disruption of insulin signaling by abnormal lipid accumulation. Recent studies have indicated that HFCS consumption similarly affects the body; however, results have been inconsistent. This paper proposes a study that focuses on revealing whether HFCS consumption increases the predisposition to developing type II diabetes by lowering insulin sensitivity, while taking in contributing factors such as amount of consumption, study duration, and subject characteristics. In this proposed study, subjects will moderately consume HFCS at 15% of daily energy requirements (DER) for six months. It is expected that the moderate HFCS consumption will induce insulin resistance through inducing hepatic lipid accumulation.

The purpose of this study was to determine student nurses’ perceptions of (1) the role of the nurse in health promotion, and (2) how the concept of health promotion is presented in nursing curricula. Research questions for this study included the following: 1) Can nursing students explain the difference between health education and health promotion? 2) What have nursing students been exposed to within their curriculum regarding health promotion? 3) What health promoting behaviors are nursing faculty role modeling as perceived by nursing students? 4) What is the role of the nurse in implementing health promotion as perceived by nursing students? 5) How do nursing students define health? Attendees of the 57 Annual National Student Nurse Association (NSNA) Convention were asked to complete an anonymous survey. A total of n= 227 surveys were returned resulting in a participation rate of 47%. The findings from this study indicated that student nurses’ perceptions regarding the role of the nurse in health promotion revolve primarily around the concept of changing individual health behavior. While there are some indications that nursing students were exposed to the idea of health promotion as a socio-ecological approach that incorporates economic, policy, organizational and environmental changes, the majority of student nurses did not see faculty or nurses role-modeling a socio-ecological approach, nor did the students see themselves as participating in a more socio-ecological approach. For nurses to be recognized as health promoters, collaborate with health promotion leaders, and effectively teach nursing education, changes need to be made in the nursing curriculum to reflect appropriate and accurate health promotion concepts.

The purpose of this study was to investigate the influences of smoking on rural and urban pregnant women. More specifically, the variables of the knowledge of health effects, health provider recommendations, subscores from the Health Belief Model (HBM), and social support were explored in relation to the smoking behavior of pregnant women. A secondary purpose was to investigate the accuracy of self-reported smoking during pregnancy using biochemical validation. Pregnant women (N=71) completed an anonymous questionnaire, designed by the researcher, to identify variables that predicted smoking for urban and rural women. Participants also gave a saliva sample for cotinine testing. Approximately 47% of rural participants and 49% of urban participants were classified as smokers. The overall smoking deception rate for the current study was 5.6%. The deception rate for rural and urban participants in this study was 2.8% and 8.6%, respectively. Variables were entered into a standard multiple regression analysis to predict smoking status of the pregnant women. Participants reporting barriers (a component of the HBM) to stopping smoking during pregnancy were significantly less likely to be smokers. Through t-test and chi-square analyses, other variables related to smoking status during pregnancy included: Marital status, financial source for the pregnancy, living with husband or boyfriend, mean scores of the participants‘ knowledge of the health effects of smoking during pregnancy, susceptibility and benefits (constructs of the HBM). Many healthcare providers performed 1A, 2A, and 3A; however, few completed the last step of 4A and none completed 5A. Implications for health promotion specialists include an increase in the education of pregnant women about the health risks of maternal smoking. Additional training for pre-natal healthcare providers is necessary in order to increase the number of healthcare providers that implement all of the 5A‘s. It is important to include the husband/boyfriend in any smoking cessation interventions since they have daily influence on the smoking status of the pregnant woman. Money used to conduct biochemical verification of maternal smoking status could be better spent on patient education of the health risks of smoking during pregnancy and physician education in implementing all 5A‘s in daily practice.

There is limited knowledge on the sexual health behaviors of young adults with physical disabilities, as people with disabilities have traditionally been treated homogenously without acknowledgement of the potential differences between disability types. The objective of this study was twofold. The first goal was to take a novel approach by guidance of the Social Determinants of Health (SDOH) framework to compare how young adults with physical disabilities compare against those without physical disabilities in: 1) vaginal sexual activity, 2) condom usage, and 3) the effect of SDOH factors as potential mediators in predicting unprotected vaginal sex. Relatedly, the second goal was to investigate whether there was a difference in condom usage based on disability type criteria, specifically examining membership into the following impairment groups: physical disability, chronic health conditions, vision impairments, hearing impairments, and stuttering/stammering problems. This study employed secondary data analysis based on data from the National Longitudinal Adolescent to Adult Health Survey (ADD Health) – Wave III, in-home interview, public-use dataset. The variables used for the SDOH proxies were job status, student status, housing type, level of education, mentor status, cohabitation status, and health insurance status. Additionally, other social and demographic factors were also accounted in the model: age, race/ethnicity, gender and sexual orientation. Results from bivariate regression suggest that only those young adults with visual impairments and those with stuttering/stammering issues are less likely to engage in sexual activity when compared to their healthy counterparts. Regarding condom usage among sexually active individuals, those with physical disabilities, chronic health conditions, and hearing impairments may be less likely to use protection than their counterparts. However, further investigation revealed that the associations between condom usage and those disability type groups are mediated by 1 of the 7 measures of SDOH (cohabitation status) and three demographic factors – gender, race, and age. Hence, it is not the disability type that reduces safe sex practices compliance, but rather that those disability groups are associated to social and demographic factors that are, in turn, linked to unsafe sex practices. Furthermore, it appears that irrespective of disability membership, gender, age, race, and cohabitation status are all associated with condom use compliance. Findings advocate for a supplementary investigation of the relative contributions of the particular social factors that mediate the effect between disability status and condom usage.

Background: Since 1965, there have not been any major revisions of the healthcare laws in the United States, until the recent implementation of the Affordable Care Act (ACA). However, ACA is not well understood and is often controversial. The purpose of this study is to: (1) evaluate the relationship between the employers’ and the employees’ perceptions regarding the ACA mandates for small businesses, (2) evaluate the relationship between the self-reported and the tested knowledge of individuals regarding the ACA mandates for small businesses, and (3) determine if socio-demographic factors influence individual’s perception of the law. Based on the gathered information, we aim to develop a socio-ecological model of ACA acceptance to address the barriers and facilitators to implementing the new law and recommend changes to address any deficits. Method: An online questionnaire was distributed anonymously to employees and employers of small businesses. The data gathered included information on the participants' knowledge and perceptions on the law and their socio-demographic information. Kendall correlation test, generalized linear regression models and bootstrapping resampling method were employed to detect differences in the perceptions & knowledge of employees and employers, to evaluate the association between self-reported and tested knowledge, and to generate a SEM model of ACA perception and acceptance. Results: Based on the analysis, we found that job status significantly affects the individual perception of the law (p = 0.004). The study showed a statistically significant negative association between the self-reported knowledge and the actual-tested knowledge of individuals (r= -0.4174, p-value of 0.01159). We found that interpersonal level had the highest impact on perception (coefficient of 5.67, p-value0.05). Conclusion: Individual perception is a key factor in adoption of new policies. A socio-ecological model of ACA acceptance can be a powerful tool in addressing the barriers and facilitators to the successful implementation of the new law and to modify the policies to address any deficits in the law.

The Zika virus is associated with the devastating birth defect microcephaly, and while a vaccine was not yet available in early-2017, several were under development. It is imperative to identify effective communication strategies to promote uptake of a new vaccine, particularly among women of reproductive age. Moreover, though the Zika outbreak has received much social media attention, little is known about these conversations on Instagram. The purpose of this dissertation, therefore, was to understand current Zika-focused communication on Instagram and to inform effective communication strategies to promote future Zika vaccine uptake intent. The study aims were: (1) explore Zika conversations on Instagram; (2) determine effective message characteristics to increase Zika vaccine uptake intent; and (3) explore salient demographic, healthcare, and psychosocial factors related to Zika vaccine uptake intent. A content analysis of 1,000 Zika-focused Instagram posts, found that these messages primarily focus on perceived threat constructs, yet they elicited little engagement. In addition, 10% of all Instagram posts mentioned conspiracy theories, and these messages elicited high engagement. A 2x2 online experiment tested the effect of message framing and visual type on Zika vaccine uptake intent. The 339 participants – all women of reproductive age – each were exposed to one of four messages (gain vs. loss-framed, and infographic vs. photo). There was no interaction effect of framing and visual type (p=.116), nor main effect of either framing (p=.185) or visual type (p=.724) on vaccine uptake intent. When testing the effect of these variables on those known to be predictors of behavioral intent, gain-framed messages were associated with higher subjective norms, perceived benefits, and self-efficacy. Data from the same online survey was used to examine whether demographics, healthcare-related variables, and psychosocial variables predict Zika vaccine uptake intent. Attitude (p<.001), subjective norms (p=.002), perceived benefits (p=.001), self-efficacy (p=.031), perceived susceptibility (p=.030), and cues to action (p=.020) were predictive of higher Zika vaccine uptake intent, as was being African-American (p=.042). In summary, messages promoting the Zika vaccine should be designed to complement the high perceived threat of Zika while activating positive social norms and perceived benefits in order to allow the public to respond efficaciously.

A significant number of youth experience mental health disorders for which they suffer negative consequences. Although there are evidence-based therapies available to help children and their families, most youth do not receive treatment. Parental problem recognition is likely a primary barrier in this process. This study begins to address why parents may have difficulty recognizing mental health problems by extending existing models and integrating evidence about parental perceptions. Specifically, the study aimed to investigate the relationship between parental attributions and parents’ problem determination, and to examine the influence that parental characteristics have on this judgment process. Participants included 164 parents of youth ages 6-11 years. Purposive sampling was used to recruit mothers and fathers from both lower and higher SES communities. Parents completed self-report measures of parental characteristics, including: parental psychopathology, parenting stress, parental tolerance, and parental self-efficacy. Parents read ten brief child behavior vignettes and completed a version of the Written Analogue Questionnaire to rate the cause of each behavior (assuming it was their own child in the vignette) along four dimensions. Parents also rated the extent to which the behavior was seen as a problem. Results indicated that parents’ causal attributions were highly associated with parents’ problem ratings, and the attributions of stability and controllability were particularly robust predictors of problem determination. Hypotheses regarding parental characteristics as moderators of the relationship between attributions and problem determination were not supported. Findings are discussed in light of clinical and public health implications; results suggest that recognizing the influence of parental beliefs and attributions may help to increase the efficacy of outreach efforts for early intervention and help seeking for parental concerns.

Tooth decay is one of the most common chronic conditions that affect children in the U.S. Non-Hispanic Blacks are among the children facing the greatest racial and ethnic disparities in caries experience and treatment. Parents play a significant role in ensuring the success of preventative measures aimed at reducing prevalence of early childhood caries. It is therefore important for public health professionals to understand the oral health, attitudes, beliefs, and behaviors of Black parents in order to effectively design and tailor interventions for caries prevention among preschool children. The twofold purpose of this study was to: (a) determine whether attitudes, beliefs of Black parents predict behaviors about preventative measures against caries for their preschool children, and (b) determine whether the attitudes and beliefs about caries preventive behaviors vary between different ethnic groups of Blacks in Miami-Dade County. The cross sectional study utilized an oral health survey comprised of a modified version of the CDHQ, and the Nutrition Questionnaire for Children to examine attitudes, beliefs and behaviors of Black parents. The study sample included 192 African American, Haitian, and Afro-Caribbean parents of 3-5 year-old children in Miami-Dade County. Logistic regression and Chi Square analysis were used to answer the research questions and hypotheses. Perceived seriousness of decay, parental efficacy to brush child’s teeth, and chance control are significant predictors of children using toothpaste and parents brushing children’s teeth twice a day (pp Health educators can play a major role in designing and delivering quality oral health and disease prevention interventions for parents of preschoolers. Clearly there are opportunities to complement school-based oral health education for preschool children with a culturally appropriate parental component. The between group differences indicate that interventions need to be more specifically tailored to the racial/ethnic group intended to receive the intervention in order to have greater effectiveness.

Purpose: Over half the HIV-infected persons in the Caribbean, the second most HIV-impacted region in the world, live in Haiti. Using secondary data from a parent study, this research assessed the effects of psychological and social factors on antiretroviral therapy (ART) adherence among Haitian, HIV-positive, female alcohol users. Theoretical Foundation and Research Questions: Using the Theory of Planned Behavior/Reasoned Action and the Information, Motivation, Behavior skills model as guiding theoretical frameworks, the study examined the effectiveness of an adapted cognitive behavioral stress management (CBSM-A) intervention in improving ART adherence. The effect of psychological factors (depression, anxiety, beliefs about medicine, and social support), social factors (stigma, relationship status, and educational attainment), and alcohol on adherence to ART was assessed. Methods: The sample consisted of 116 female ART patients who were randomly assigned to the CBSM-A intervention or the wait-list control group. Participants completed intervention sessions as well as pre- and post-test assessments. Analyses of variance, t-tests, and point biserial correlations were used to test hypotheses. Results: Surprisingly, ART adherence rates significantly decreased for both groups combined [F (1, 108) = 8.79, p = .004]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post assessment. On average, depression decreased significantly among participants in the CBSM-A group only [(t (62) = 5.54, p < .001)]. For both groups combined, alcohol use significantly decreased between baseline and post-assessment [(F (1, 78) = 34.70, p < .001)]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post-assessment. None of the variables were significantly correlated with ART adherence. Discussion: Adherence to ART did not improve in this sample, nor were any of the variables significantly associated with adherence. The findings suggest that additional supportive and psychological services may be needed in order to promote higher adherence to ART among HIV-positive females. More research may be needed on this sample; a focus on mental health issues, partner conflict, family and sexual history may allow for better targeting and more successful interventions.

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.