Theses and Dissertations - Department of Health Science

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Factors Influencing the Utilization of Best Practice Guidelines for Exertional Heat Illness by High School Athletic Trainers
(University of Alabama Libraries, 2020) Gannon, Jennifer; Hibberd, Elizabeth; University of Alabama Tuscaloosa
Athletic trainers (ATs) are healthcare professionals who are responsible for the prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions in the physically active.1 Part of an AT’s knowledge and skill set involves recognition and care of exertional heat illness EHI. Despite consistent support from the literature on best practices for prevention, recognition, and treatment of EHI, negative outcomes still occur. Reasons why high school ATs fail to implement and execute evidence based protocols may be explained through use of the Social Cognitive Theory (SCT). To date, no current research takes a theoretical approach when exploring an AT’s prevention, recognition, and treatment of EHI. Therefore, the purpose of this study was to describe ATs’ utilizations of best practice guidelines for prevention, recognition, and treatment of EHI in high school athletes relative to constructs of the SCT. A secondary purpose was to provide a foundation for the development of theory-based education programs for ATs to evoke long-term behavioral changes towards compliance with EHI guidelines. This information provides a foundation for the development of theory-based education programs for ATs to evoke long-term behavioral changes towards compliance with EHI guidelines. The most common barrier to having a set heat acclimatization plan selected was “other” which included the use of basic “state guidelines” or state regulations preventing individual plans. The most common barrier to the utilization of rectal temperature was invasiveness/privacy, and the most common barrier to the utilization of CWI was limited resources/staff. Findings of this study indicate that barriers to the use of rectal temperature and CWI are based on individual factors as opposed to circumstances outside of their control. This concludes that intervention strategies may need to be implemented on the individual level as opposed to the institutional level. It is also noted that questions relating to all constructs of the SCT had a significant relationship with the utilization of rectal temperature. The long-term goal of this line of research is to increase ATs’ utilization of best practice guidelines regarding EHI which could prevent heat-related illness and death in the patients that they treat.
Informing Best Practice for the Comprehensive Community Dental Care of Adults with Developmental Disabilities: a Grounded Theory Study
(University of Alabama Libraries, 2021) Tupea, Casey Renee; Morales-Aleman, Mercedes; University of Alabama Tuscaloosa
Background: Dental care for the persons with Intellectual Disabilities/Developmental Disabilities (ID/DD) is an underdeveloped specialty within the field of Dental Healthcare. There are no consistent and agreed upon training or licensing guidelines. Patients with ID/DD are 13% less likely to receive a routine dental appointment one time per year compared to young adults without a disability. Further, patients’ negative experiences with dental care can affect the overall success of dental appointments and likelihood that the patient will engage in continuing care. To address this gap in the literature, this study sought to, take the first steps toward establishing a set of core competencies for a patient centered dental care provision among patients with DDs utilizing a grounded theory approachMethods and procedures: In 2020, semi-structured qualitative interviews were conducted with 13 dental care professionals including 8 Dentists and 5 Dental Hygienists. There were 6 female participants and 7 male participants. NVivo software was used to conduct thematic data analyses. A grounded theory research approach was utilized to integrate the findings into some preliminary theories. Outcomes and Results: Three main themes emerged from the analyses: Perceptions of dental care providers regarding best practices for inclusive practice: Techniques and provider characteristics; Barriers to inclusive practice and Facilitators to inclusive practice. Many of the participants had personal relationships with at least one person with developmental disabilities which influenced their decision to specialize in that type of dentistry. Providers mentioned empathy and patience as key qualities among those conducting comprehensive dental care in the community setting. Some of the significant barriers to comprehensive community care were the lack of formal education in patient centered ID/DD dental care provision, lack of practice preparation of dental providers, and a lack of dental funding. Conclusions and implications: Most providers had no formal knowledge of PCC and the majority of the clinicians interviewed had no formal training on the dental care of persons with DDs. Dental programs should increase the availability of training that facilitates PC community care for this population (e.g. sedation methods). More structured educational programs are needed in order for both medical and dental providers to feel better prepared for comprehensive care of persons with DDs in the community setting. Further, future research should examine the perspectives of ID/DD patients and their caregivers with regard to dental care to better address their specific needs.
Spatio-temporal model for mapping COVID-19 risk
(University of Alabama Libraries, 2021) Amelia, Lia; Higginbotham, John; University of Alabama Tuscaloosa
The COVID-19 was a major threat to public health around the world from the beginning of COVID-19 pandemic. The U.S. was one of the countries with the most COVID-19 cases. Despite the mitigation efforts to control the disease at both local and national levels, the number of COVID-19 cases in the U.S. remained high throughout the pandemic. This study focused on Cook County in Illinois. During the COVID-19 pandemic, Cook County was one of the counties with the highest COVID-19 cases in the U.S. This study described the spatial and temporal dynamics of COVID-19 risk in two-week periods from August 2020 to December 2020 in Cook County. This study also assessed the impact of neighborhood socioeconomic and demographic on COVID-19 incidence. The Bayesian spatio-temporal model was used to produce COVID-19 risk maps and to evaluate covariates' effects. The results show the spatial heterogeneity in COVID-19 risk from time to time, with the risk peaked in the first weeks of November. Over different time points, some parts of the county exhibited constant COVID-19 high-risk levels. Among these high-risk areas, many of them were majority-Hispanic neighborhoods in Chicago (i.e., Chicago west side) and Cook County suburbs (i.e., Franklin Park and Elgin). The model summary shows that the percentage of Hispanic population, health insurance coverage, and public transit commuters were associated with COVID-19 incidence. The posterior median and the 95% credible interval for the relative risk of a 1% increase in the percentage of Hispanic population was 1.009 (1.007, 1.011), indicating that a 1% increase in the percentage of Hispanic population corresponds to an increase in COVID-19 risk of 0.9%. The corresponding relative risk for a 1% increase in health insurance was 1.015 (1.006, 1.025), while for a 1% increase in the percentage of public transit commuters, the relative risk was 0.991 (0.987, 0.995). This study's findings highlight the importance of integrating the geographical information system into disease routine surveillance programs and transforming routinely collected health data into critical information. This information can be used to identify risk factors that could be addressed by allocating resources or implementing health policies.
Exploring determinants of community led total sanitation (clts) on latrine adoption among rural cambodians utilizing the diffusion of innovation theory: a pragmatic approach
(University of Alabama Libraries, 2020-12) Hendrix, Sara; Ross, Levi; University of Alabama Tuscaloosa
Open defecation is a global health problem in which 90% of the cases observed occur in rural settings among developing countries. Individuals exposed to open defecation may face higher risks of diarrheal diseases and health consequences. Basic sanitation facilities may mitigate adverse health effects associated with open defecation. In Cambodia, the lowest percentage of basic sanitation (48.3%) has been reached compared to neighboring countries. This dissertation research explored determinants of Community Led Total Sanitation on latrine construction and usage among rural Cambodians. This exploration was guided by diffusion of innovation theory. This multi-site study included a stratified sample of six community meetings (n=61) conducted across six villages in two districts of Pursat Province, Cambodia in August 2019. Small connected community methodology was employed to gather qualitative data and semi-structured community meetings were utilized to collect data. Thematic analysis and diffusion of innovation theory was used to analyze data derived from this study. Qualitative findings identified the following facilitators of latrine construction: relative advantage (overall health and well-being, convenience, and environmental awareness); complexity (perceived level of simplicity); compatibility (obligation to others); and observability (demonstrations, observable improved health of others). Latrine construction barriers included complexity (lack of resources) and compatibility (interferences to daily life). Facilitators of latrine construction included: relative advantage (overall health and well-being, convenience, economic advantages, and environmental impacts), complexity (ease of use); compatibility (obligation to others); and observability (demonstrations). The latrine uptake barrier was compatibility (misalignment with current practices). Compared to neighboring countries, basic sanitation within Cambodia continues to be a challenge. Rural Cambodians lack resources pertaining to knowledge (of how to build latrines) and cost (of materials). The development and implementation of health education and health promotion programs may effectively address the sanitation challenges in rural communities in low income and developing countries, while simultaneously enhancing the quality of life and well-being of communities.
Emotional determinants of health: exploring prevalence and the impact of adverse childhood experiences on physical and mental health outcomes of black adult men using the 2012 behavioral risk factor surveillance system
(University of Alabama Libraries, 2020) Johnson III, Lee Presley; Paschal, Angelia M.; Burton, Wanda M.; University of Alabama Tuscaloosa
Background. In the United States, Black men face a disproportionate burden of preventable mortality and morbidity rates. Among the possible factors associated with the disproportionality in these rates among Black men, studies suggest, are adverse childhood experiences (ACEs). Moreover, depression, one of the world’s most pervasive psychiatric disorders, researchers suggest, also contributes to disparate mortality and morbidity rates among Black men. Purpose. The purpose of this study and research inquiry was to describe the relationship between differential exposure to ACE’s and depression in Black men, controlling for effects of social demographic factors, presence of chronic medical conditions, and behavioral health risks using the 2012 Behavioral Risk Factor Surveillance System (BRFSS) data. Methods. A secondary data analysis was employed using a community sample of 3,084 Black men originating from the 2012 BRFSS. The 2012 BRFSS included an ACE module questionnaire. ACE module survey questions were used to determine the presence (yes/no) for types (e.g., direct or environmental) of ACEs. Composite measures of the ACE type subscales were computed to determine the total number of ACEs that could be reported (e.g., range 0 to ≥ 5). Additional BRFSS questions assessed depression, chronic medical conditions, and health risk behaviors. Results. Physical abuse, a direct ACE, and household member incarceration, an environmental ACE, was significantly associated with current depressive symptoms. Approximately 32.1% of Black men reported exposure to verbal abuse before age 18, the most prevalent direct ACE. In contrast, a larger proportion (48.6%) of Black men reported exposure to divorce before 18, the most prevalent environmental ACE. Physical abuse and stroke were statistically significant (OR = 4.14; 95% CI [1.69, 10.12]; p < 0.05). Approximately 9.2% of the Black men in the study reported experiencing five or more ACEs. Health risk behaviors did not mediate depression among Black men. Conclusion. Physical abuse and household member incarceration exert a significant impact on current depression. Indeed, verbal abuse and divorce demonstrated a significant relationship with a lifetime diagnosis of depression. The study findings have implications for health education practitioners, researchers, and policymakers interested in improving mental health through prevention and reducing childhood exposure to abuse.
Seeking but not finding: a qualitative exploration of the influence of college women's perceptions of feminism on their sexual health service- and information-seeking behaviors
(University of Alabama Libraries, 2020) Rich, Rebecca; Paschal, Angelia M.; University of Alabama Tuscaloosa
The connection between feelings of empowerment and improved health behavior demonstrates the relevance of feminism in sexual health. A segment of the population that is at great risk of negative sexual health outcomes is college women. Health education and promotion efforts targeting this population could have many benefits, but those benefits could be even greater if feminist tenets are incorporated. Undergraduate public health women are in a position of expertise and possess a sense of agency related to this topic. This study utilized a Feminist Theoretical framework informed by bell hooks’ understandings of feminism to explore the influence of college women’s perceptions of feminism on their sexual health information- and service-seeking behaviors. In eight narrative interviews, qualitative data related to perceptions of feminism and experiences with seeking sexual health services and information were collected from undergraduate public health women at a large southeastern university. Thematic analysis was used to evaluate the transcripts of those interviews, and found poetry was used to represent the women’s experiences with seeking sexual health services and information. Findings showed that these women have positive perceptions of feminism, which makes them feel frustrated with the experiences that they have had of “seeking but not finding” what they know they need when it comes to sexual health services and information. This caused the women to emphasize the impact of the quality of sexuality education that young girls receive, and stress the need for improved, quality, comprehensive sexuality education for all people. Their understandings of feminism made them believe that this “seeking but not finding” is unacceptable. Undergraduate public health women have a deep understanding of health and the influence that sociopolitical factors play on individuals’ well-being. Their feelings of empowerment from feminism intensify this understanding of the need for health equity, and the changes that need to be made to get there. The “hush hush” taboo nature surrounding sexuality does more harm than good. The findings of this study, through the use of language and narratives, elucidate the experiences of these women and give examples of what must be done better in the field of health education to prevent future generations from “seeking but not finding.”
Effect of internet and conventional advertisement exposure on electronic cigarette use among adolescents: findings from the National Youth Tobacco Survey
(University of Alabama Libraries, 2019) Leung, Rebecca Wai-Chee; Paschal, Angelia M.; University of Alabama Tuscaloosa
Background: The use of e-cigarettes has increased dramatically among American adolescents since 2011 and has become a major public health concern. About 2.4 million middle and high students were current (past 30 days) users of electronic cigarettes or e-cigarettes in 2014 (CDC, 2017a). Exposure to e-cigarette advertisements may be a contributing factor to the sharp rise in e-cigarette use among adolescents, as 69% of middle and high school students reported to have exposure to e-cigarette advertisements on the Internet, in convenience stores, in magazine or newspapers, and on television (CDC, 2017a). Purpose: To examine the impact of Internet and conventional advertisement exposure on use of e-cigarettes among American adolescents. To investigate the individual, interpersonal, community and policy factors associated with e-cigarette use. Methods: This study is a secondary data analysis of data originating from the 2017 National Youth Tobacco Survey (NYTS). This database is an annual, school-based, cross-sectional survey that collects information on major tobacco use indicators from middle school (grade 6-8) to high school (from grade 9 to 12) students. Results: Out of the 17,872 adolescents included in the analysis, most participants were White (44.1%). A sample of racial and ethnic minority youths also participated: 25.8% Hispanic, 16.7% African American, and 10.9% other. Approximately 20% of the youths in the study reported e-cigarette use. The relationships between e-cigarette use and current cigarette smoking status, age, race, grade in school, perceived harmfulness, perceived addictiveness, presence of tobacco user in household, Internet advertisement exposure, access to tobacco products and warning label exposure were all significant (p<0.001). Specifically, Internet advertisement exposure was significantly associated with e-cigarette use (p<0.001). Participants who were “always” exposed to Internet e-cigarette advertisements were 2.15 times more likely to use e-cigarettes than those who were never exposed (OR=2.15; 95% CI [1.72, 2.70]; p<0.001). Conclusion: Internet advertisement exposure exerts a greater impact on e-cigarette use than other conventional advertisement methods. Health educators and health professionals should educate the target population about the harms of e-cigarette use at an early stage of adolescence, and serve as advocates for policy changes regarding tighter regulations on e-cigarette advertisements, especially on the Internet.
Examining college students' use, perception, and knowledge of marijuana and marijuana laws
(University of Alabama Libraries, 2019) Burroughs, Meghan Elizabeth; Birch, David A.; Usdan, Stuart L.; University of Alabama Tuscaloosa
Marijuana is a highly utilized drug on college campuses that has a variety of adverse health effects. Since the 1970s, state marijuana laws have been consistently evolving throughout the United States, increasing accessibility and normalizing marijuana use, especially among college students. Therefore, the purpose of this study was to examine the association that state marijuana laws have had on undergraduate students at one university in a southeastern state that only has a limited medical marijuana law, specifically in terms of use, perceptions of risk, diversion of marijuana, and marijuana law knowledge. The Theory of Planned Behavior (TPB) was the theoretical framework for this study. A quantitative, cross-sectional design was utilized through the administration of paper and pen surveys from a convenience sample of 391 undergraduate students. No significant relationships were found between the type of marijuana law from students’ state of permanent residence and college student marijuana use, perceptions of risk, or diversion of marijuana. Additionally, no significant relationships were found between marijuana law knowledge and student marijuana use in the state of Alabama during the past 12 months or 30 days. Individually, all TPB constructs were significant in predicting behavioral intention to use marijuana in the state of Alabama in the next 12 months. However, only subjective norms (β = .189, p < .05) and attitudes (β = .406, p < .001) were significant in predicting behavioral intention to use marijuana in the state of Alabama in the next 30 days. When examining all constructs together, only attitude was a significant predictor of intention to use marijuana in the next 12 months (β = .484, p < .001) and in the next 30 days (β = .392, p < .001) in the state of Alabama. Although the results of this study did not find much significance between the variables, students did report high levels of marijuana use, low perceptions of risk, and endorsed several diversion behaviors within a state with a limited medical marijuana law. Public health education researchers and practitioners should continue to explore the influence of marijuana laws and marijuana use in college students.
Examining college women's hookup behaviors and condom negotiation strategies used with their online and offline partners
(University of Alabama Libraries, 2019) Evans, Jennifer Lynn; Birch, David A.; Usdan, Stuart; University of Alabama Tuscaloosa
Approximately 60-80% of college students report engaging in a hookup at some point during their college career. College students find hookup partners through traditional meeting contexts, but dating apps and social media have become a new resource to identify potential sexual partners. Because males are the ones who physically wear condoms, safer sex efforts may require the female to possess condom negotiation skills to persuade her male partners to use a condom. Previous research has not investigated the use of condom negotiation strategies with partners identified online or offline. The primary purpose of this study was to identify differences between the mode in which college women seek male hookup partners (online, offline, and both online and offline) and the condom negotiation strategies used with these partners. A secondary purpose of the study was to utilize the constructs of the Theory of Planned Behavior (TPB) to predict and identify differences in condom negotiation intention with male hookup partners met online, offline, and both online and offline. The present study utilized a quantitative, cross-sectional design paper and pen survey administered through a convenience sample of 296 undergraduate women enrolled in courses in the College of Human Environmental Sciences at The University of Alabama. Overall, 155 (52.4%) reported engaging in hookups over the previous six months. No significant differences were found between where college women identified their hookup partners and their behavioral intention to negotiate condom use. Nonverbal indirect condom negotiation strategies (F (2, 151, 3.55. p < 0.05) were significant among those who found partners offline (M = 13.38, sd = 4.59, p = 0.048). Perceived behavioral control (p = 0.043) had a significant interaction with behavioral intention when examining the TPB constructs by where college women identified their hookup partners. After adding past condom use with hookup partners to the same model, subjective norms (p = 0.047) was a significant predictor of behavioral intention. Based on the findings of this study, public health educators should continue to explore condom negotiation utilizing the TPB and develop interventions to educate college women how to negotiate condom use with their hookup partners.
Development and validation of a self-efficacy theory-based instrument to measure breastfeeding self-efficacy and breastfeeding intention among pregnant women
(University of Alabama Libraries, 2017) McKinley, Erin Marie; Knol, Linda L.; Turner, Lori W.; University of Alabama Tuscaloosa
Breastfeeding is the feeding of a child with breast milk, either directly from the breast or by expression. Breastfeeding offers tremendous benefits to both the infant and mother. Individuals choose tasks they feel are within the boundaries of ability. The choice to engage in breastfeeding may be related to the level of self-efficacy a woman has to complete the task. Theoretical constructs have been operationalized to measure perceived self-efficacy for breastfeeding in pregnant populations; however, a guideline based, self-efficacy theory driven, valid, and reliable instrument is lacking. The purposes of this study were to create, test, and validate a new scale to measure prenatal breastfeeding self-efficacy, test the reliability of the scale, determine the correlation between prenatal breastfeeding self-efficacy and breastfeeding intention, and assess the differences in prenatal breastfeeding self-efficacy by the sociodemographic factors. One-hundred and twenty-four pregnant women, 18 years or older, participated in this cross-sectional study. All participants completed the survey and any interested participant took a second retest reliability survey home to complete and mail back to the researcher. Confirmatory factor analysis did not confirm the proposed model; therefore, an exploratory factor analysis was conducted to examine the construct validity using maximum likelihood factor analysis with varimax rotation. This revealed a valid (α=.980) and reliable (r=0.920) four factor questionnaire for total prenatal breastfeeding self-efficacy – The Prenatal Rating of Efficacy in Preparation to Breastfeed (PREP to BF) Scale. Total PREP to BF score was significantly correlated to breastfeeding intention (r=.615; P<.001). Women who had at least some college education (P=.003), were currently married (P=.027), had breastfed previously (P=.035), and planned to deliver vaginally (P=.043) had significantly greater PREP to BF scores than their counterparts. Measuring the level of breastfeeding self-efficacy at the prenatal stage could alert prenatal women and health professionals to particular individual skill sets needed to successfully initiate breastfeeding after birth. A strong understanding of which pregnant women may or may not be at risk for non-initiation of breastfeeding may help healthcare professionals create and provide the most appropriate support to their patients.
Internal and external factors influencing registered dietitians' recommendations for feeding tube use among older adults with advanced dementia: an application of the social ecological model
(University of Alabama Libraries, 2017) Douglas, Joy W.; Lawrence, Jeannine C.; Turner, Lori W.; University of Alabama Tuscaloosa
Background: While feeding tubes are commonly used to provide nutrition to patients with advanced dementia, research indicates that this fails to improve nutritional status or survival, and often yields harmful complications. As Registered Dietitians (RDs) are often consulted to provide clinical recommendations for older adults with advanced dementia, is important to understand factors influencing RDs’ feeding tube recommendations. Purpose: This study developed and validated a theory-based instrument to assess knowledge, beliefs, attitudes, and perceptions of RDs regarding feeding tube use among older adults with advanced dementia. Additionally, internal and external factors that influenced RDs’ recommendations were explored. Methods: The standardized survey development process included a comprehensive literature review, expert panel review, pilot testing, an efficacy survey, and test-retest analysis. A random sample of U.S. RDs was invited to participate. Exploratory factor and regression analyses determined factors associated with RDs’ feeding recommendations for people with advanced dementia. Results: Of the 662 RDs who completed the survey, 72.2% responded that they were unlikely to recommend feeding tubes for patients with advanced dementia. Factor analysis yielded five factors, each with adequate internal consistency: I) Knowledge Self-Efficacy, II) Religion/Spirituality/Culture, III) Personal Values, IV) Perceived Organization and Training, and V) Perceived Policy. Test-retest correlation coefficients ranged .602 - .812. The multivariate regression analysis included 580 RDs who were either likely or unlikely to recommend a feeding tube (‘neutral’ responses were removed), revealing five factors associated with RDs making evidence-based recommendations: Total Knowledge [OR = 1.40, 95% CI (1.26, 1.57)], Personal Values [OR = 1.30, 95% CI (1.19, 1.43)], Perceived Policy [OR 1.20, 95% CI (1.02, 1.40)], Perceived Organization and Training [OR = .87, 95% CI (.77, .99)], and working in long-term care or hospice settings [OR 3.68, 95% CI (1.51, 8.93)]. This model predicted 53.2% of the variance in RDs’ recommendations. Discussion: The instrument was deemed valid and reliable. Factor analysis indicated that internal and external factors influenced RDs’ recommendations, findings consistent with the Social Ecological Model. Most RDs made recommendations consistent with evidence-based guidelines, an encouraging finding. Work setting and RD knowledge were important modifiable influences, providing direction for future continuing professional education.
Pedestrian crossing behavior in college students: exploration using the theory of planned behavior
(University of Alabama Libraries, 2017) Piazza, Andrew John; Knowlden, Adam P.; University of Alabama Tuscaloosa
Background. In the United States, pedestrian fatalities make up a substantial proportion of total traffic fatalities. High use of mobile data and exposure to high-traffic environments place college students at increased risk. The present study aimed to utilize the theory of planned behavior (TPB) to examine college students’ behavioral intention to cross the street on campus while using a mobile device. A secondary aim was to estimate the incidence of distracted mobile device use among street-crossing pedestrians at a large public southeastern university. Methods. Questionnaire data were collected from undergraduate college students attending a Southeastern university. Questionnaire development involved a literature review, face and content validity by expert panel, readability and comprehensibility by pilot test, stability reliability by test-retest, and internal consistency using Cronbach’s alpha. Construct validity of the TPB for predicting behavioral intention to cross the street on campus while using a mobile device was assessed using linear regression analyses. The second aim involved performing observations to estimate the incidence of distracted mobile device use among street-crossing pedestrians. Results. The TPB constructs of attitude toward the behavior (B = .395, p < .001), subjective norm (B = .328, p < .001), and perceived behavioral control (B = .158, p < .001) were significant predictors of behavioral intention and explained 48.4% of the variance. Observations yielded 4,878 crossing instances (33.9% male and 66.1% female). Overall, 1,201 (24.6%) cases involved device use with 16.8% of male crossings and 28.6% of female crossings involving distraction. A significant difference in device use while crossing was found between some observation locations, X^2(3) = 8.866, p = .031. Discussion. A questionnaire was developed to measure TPB constructs predictive of college students’ behavioral intention to cross the street on campus while using a mobile device. Such a questionnaire can be used in the design and evaluation of TPB-based interventions to decrease distracted mobile device use while crossing the street among college students. Observation data provide an estimate of distracted mobile device use while crossing the street. Future research should focus on improving understanding of the problem and evaluation of interventions to influence behavioral intention.
A qualitative application of the integrated model of behavioral prediction to graduate student eating behaviors
(University of Alabama Libraries, 2017) Pember, Sarah Elizabeth; Usdan, Stuart L.; University of Alabama Tuscaloosa
The clear relationship between diet and disease supports the importance of nutrition-related health promotion efforts across the population. One group at risk for diet-related diseases is the growing population of graduate students in the United States, who represent a diverse array of adults, covering a wide age range and many racial and ethnic designations. Health promotion efforts for graduate students could have far-reaching benefits, but these efforts must be tailored to this population. This study applied phenomenological hermeneutic methodology within the theoretical framework of the Integrated Model of Behavioral Prediction to interpret the eating behaviors of graduate students. Through a series of thirty-two semi-structured interviews, qualitative data related to dietary intake, food choice, and eating-related behaviors were collected from graduate students at a large, public southeastern university. Thematic analysis was used to evaluate the transcriptions and develop an understanding of the food choice beliefs and intentions of graduate students. Findings revealed that graduate students feel different from non-graduate student peers, and that perception affects how they make choices regarding their lives and their health. They are not only working within an ambiguous space between undergraduate/graduate student and faculty member but also between young adulthood and adulthood. While negotiating their role as both student and researcher, they simultaneously find themselves negotiating new roles as they move out of young adulthood and into a life stage with transitions such as living on their own for the first time without financial support, finding a partner, getting married or engaged, cohabitation, and having children, although not necessarily in that order, or at all. Graduate students are well-educated individuals, with a general awareness and knowledge of nutrition and healthy eating practices. However, many graduate students do not consistently perform behaviors that will promote their health and well-being. Making a conscious choice to prioritize their health over other obligations and responsibilities is not perceived as culturally supported during the graduate school experience. The findings of this study help elucidate the strongest beliefs and barriers related to healthy eating practices within this population, which can later be targeted and tested for future health communications and interventions.
The role of social and cultural factors on preventive health services use among young, rural, African American men: a narrative inquiry
(University of Alabama Libraries, 2017) White, Ashley White; Birch, David A.; University of Alabama Tuscaloosa
African American men suffer disproportionately from preventable illnesses such as cancer and heart disease. Yet, African American men are least likely to use preventive health services that could potentially decrease their risk of developing these diseases in older age. The purpose of this study was to explore social and cultural factors that influence the use of preventive health services in a community-based sample of rural African-American men ages 18-34 in the Mississippi Delta county of Quitman. The Andersen Behavioral Model of Health Services Use and Critical Race Theory were the guiding frameworks for this study. Narrative inquiry was the method used for this study. Data for this study were collected from 10 African American men between the ages of 18-34. Participants of this study were residents of Quitman County, Mississippi, a rural area in the Mississippi Delta. The findings from this study were organized into three manuscripts that detail important concepts from the overall dissertation study. Several methods were used to analyze the data including: narrative analysis, thematic narrative analysis, and poetic transcription. Findings from this study indicated predisposing factors such as age and attitudinal beliefs, resources within the community and illness level affected the decision of African American men within this age group, to engage in preventive care. In addition to these findings, data also revealed the influence of experiences of fear and the struggle to create healthy identities. Lastly, data from this study suggest fathers as important role models for young men. Implications and recommendations are provided throughout each article.
Theory of planned behavior-based predictors of playing-related musculoskeletal disorders prevention practices
(University of Alabama Libraries, 2017) Burns, Nancy Jean; Leaver-Dunn, Deidre; University of Alabama Tuscaloosa
Playing-related musculoskeletal disorders inhibit musicians from playing at a level to which they are accustomed. Music performance occurs at submaximal physical activity levels, but musculoskeletal injury can happen at any age or experience level. Physical conditioning as a measure to prevent injuries is unstandardized. College marching band members are a subgroup of performing artists that lack attention, despite the high prevalence of musculoskeletal injury. Prevention-programs musicians have not included marching musicians and did not seek to predict the use of predictive exercise, only symptoms were tracked studied. Therefore, the purpose of this study was to develop and validate a theory of planned behavior-based questionnaire to predict the use of preventive exercises to prevent playing-related musculoskeletal disorders. The Playing-Related Musculoskeletal Disorder Care Questionnaire, a 34-item questionnaire was constructed following an elicitation study of former marching band members (N = 12). An expert panel (N = 4) determined the face and content validity of the questionnaire and its reliability determined by test-retest (N = 22). Only the perceived behavioral control construct (rs = 0.828, p < .01) was found to be reliable. However, the internal consistency, assessed using Cronbach’s alpha, was shown to be moderately-adequate high11. Lastly, structural equation modeling via confirmatory factor analysis maximum likelihood method specified the interplay between the measurement model and the structural model. Thus, the relationship between the TPB constructs (attitude toward the behavior, subjective norms, and perceived behavioral control) and behavioral intention was non-significant despite adequate model fit (χ2 = 134.175, df = 74, p = .000; KA = 1.8; GFI = .891; NFI = .915; RMSEA = .073). Findings from the present research showed the Playing-Related Musculoskeletal Disorder Care Questionnaire to be reliable, but not valid. However, the rigorous methodological approach emphasized (1) the uniqueness of the population, (2) highlights the critical elements that drive individual beliefs, and (3) provide strategies for improving health outcomes.
Coping at the intersection: a transformative mixed methods study of gendered racism as a root cause of mental health challenges in black college women
(University of Alabama Libraries, 2017) Burton, Wanda Martin; Birch, David A.; Paschal, Angelia M.; University of Alabama Tuscaloosa
Background. Racism negatively impacts mental health. Racial identity has been suggested as a buffer against the impact of racism. But women of color are exposed to gendered racism; based on intersectionality theory. The purpose of this study was to understand the impact of and coping strategies used to deal with gendered racism on the mental health of Black college women. Methods. The mixed methods design included a nonrandom sample of 213 Black college women. Mental health was operationalized as depression (PHQ-9) and psychological distress (K-6). Correlation and regression analyses tested the impact of gendered racism on mental health; examined the role of racial identity; and, explored coping strategies. Through intensity sampling, the qualitative phase included individual interviews (n=12) and a focus group (n=6). Narrative inquiry was used to construct composite counter-narratives, using thematic narrative analysis. Findings. Quantitative results suggested that 84% of the sample require mental health treatment. Gendered racism negatively correlated with mental health; the most significant correlation was between depression and the frequency of gendered racism, r(95) = .405, p ≤ .01. Racial identity was not related to mental health and therefore could not be tested as a mediating factor. The qualitative phase revealed narratives of gendered racism across multiple levels. The institutional level helped to create the normative experience of gendered racism through lack of effective policy; it also impacted the individual and interpersonal levels. Internalized gendered racism resulted in an acceptance of limitations to one's full humanity. The interpersonal level included narratives of sexual assault, being mistaken as ‘the help,’ and assumptions about communication style and educational level. The mixed methods results suggested that effective coping depends on increased education and the deconstruction of gendered racism followed by the use of humor and social support. Discussion. Gendered racism negatively impacts the mental health of Black college women. Interventions should include an emphasis on gendered racism. Narratives revealed how Black college women accept and resist the normative experience of gendered racism. The mixed methods design provided a more nuanced understanding of how Black women cope with gendered racism.
Occupational sedentary behavior: application of the social ecological model
(University of Alabama Libraries, 2017) Hutcheson, Amanda K.; Usdan, Stuart L.; University of Alabama Tuscaloosa
Sedentary behavior is recognized as a significant public health problem. One of the primary domains to target sedentary behavior is in the workplace. Although research has called for the incorporation of an ecological perspective to investigate influences on occupational sedentary behavior, there are still numerous inconsistencies and gaps in the literature with regard to domain-specific ecological influences on sedentary behavior. The purpose of this study was to explore factors contributing to occupational sedentary behavior at multiple levels (intrapersonal, interpersonal, and institutional) using the social ecological model as a framework. The study utilized a quantitative, cross-sectional design through the administration of an online questionnaire. A convenience sample of 527 employed adults at a large Southeastern institution were recruited for this study. Occupational sedentary behavior among participants was 342.45 minutes (SD = 133.25). Significant differences in occupational sedentary behavior were observed by gender (p = .007), education level (p = .026), and employment classification (p = .006); where women, participants with a higher education, and professional staff reported significantly longer time spent in occupational sedentary behavior. Barrier self-efficacy ( = -.15, p = .001), local connectivity ( = -.10, p = .046), and overall connectivity ( = -.11, p = .018) emerged as significant predictors of occupational sedentary behavior (R2 = .058, F(3, 478) = 9.74, p < .001). Barrier self-efficacy (F[1, 457] = 8.51, p = .007, partial η2 = .016) and employment classification (F[2, 457] = 4.40, p = .013, partial η2 = .019) were significant predictors of occupational sedentary behavior. Findings from this study provide new information regarding the potential impact of psychosocial factors and workplace environmental configurations, such as barriers and connectivity, on employee sitting time during the workday and support the use of an ecological perspective to understand occupational sedentary behavior. Public health education researchers and practitioners should continue to explore ecological influences on occupational sedentary behavior and develop comprehensive interventions to address the negative health effects of occupational sedentary behavior.
Exploring risky sexual behaviors of southern African American men and their readiness for barbershop-based HIV prevention programs
(University of Alabama Libraries, 2016) Gardner, Antonio; Paschal, Angelia M.; University of Alabama Tuscaloosa
African Americans are disproportionately affected by HIV, and males make up most of the cases by gender. Innovative methods for addressing the gap in the HIV epidemic are needed. Barbershops have been identified as one locale to address health disparities among African American males. Few studies have used barbershops as sites to provide HIV prevention information. Though barbershops have been sites for a few urban-based HIV prevention programs for African American men, none have been inclusive of rural men and only one was conducted in the southern United States. The purpose of this study was to explore the risky sexual behaviors of African American men in Alabama, and assess their readiness for a barbershop-based HIV prevention program. The study was guided by the Theory of Planned Behavior. A paper-and-pencil survey was administered to adult African American males at three barbershops in Alabama. The results of this study suggested that over half the men in the study did not consistently use condoms in the preceding three months. About one-fourth of the men reported having multiple sexual partners, and over half of all sexually active men used drugs and/or alcohol during a sexual encounter in the last three months. Attitudes were a significant predictor of having multiple sexual partners. Overall, the men were moderately ready for a barbershop-based HIV prevention program. Neither engagement in risky sexual behaviors nor the antecedents to engagement in risky sexual behaviors were predictive of readiness for barbershop-based HIV prevention programs. The findings of the study provide valuable insight to stakeholders who are interested in reducing the spread of HIV among African American men. Improving attitudes toward condoms in the barbershop setting may lead to less frequent engagement in risky sexual behaviors, which could curb the HIV acquisition rate among African American males.
Predicting intentions to be physically active among volunteer firefighters in rural North Carolina: a study utilizing a modified theory of planned behavior
(University of Alabama Libraries, 2016) Lindsay, Kayla Lindsay; Nickelson, Joyce E.; University of Alabama Tuscaloosa
Background: In 2015, the United States Fire Association (USFA) reported 51% of firefighter deaths were from sudden cardiac incidents. Sudden cardiac death has consistently accounted for the largest share of on-duty firefighter deaths since the National Fire Protection Agency (NFPA) began gathering firefighter health data in 1977 (USFA, 2015a). Physical activity is a protective factor against cardiovascular disease, but most firefighters do not meet recommended levels of physical activity (Baur, Christophi, Cook & Kales, 2012a). The theory of planned behavior (TPB) offers suggestions for why people do or do not engage in desirable behaviors, such as physical activity, and proposes that the primary determinant for behavior is the intention to perform the behavior (Glanz & Bishop, 2010). This study used the TPB, modified to include past behavior and perceived risk, in an attempt to understand firefighters’ intentions to be physically active. Methods: This study used cross-sectional, descriptive, and predictive correlational research designs using survey methodology (n=123). Findings: Results from logistic regression analyses found that TPB constructs of attitudes, past physical activity behavior, and perceived behavioral control (PBC) were significantly related (p<.05) to intentions to be physically active among volunteer firefighters in rural North Carolina. Past moderate-intensity cardiovascular exercise was most strongly related to intentions to be physically active, explaining 35% of the variance. No other factors significantly influenced intentions to be physically active. Body mass index (BMI) of the firefighters classified 35.9% as overweight and 44.4% as obese. Volunteer firefighters in this study did not perceive themselves at a high risk of heart disease, even though statistically 51% of firefighter deaths are from cardiac incidents (Haynes & Stein, 2016). Implications: Data obtained from a second examination should be used to further validate the reliability of the modifications to the TPB and past physical activity scales. The addition of perceived risk to the TPB added little to our understanding of intentions to be physically active, but the relationships among all these variables should be explored more fully by quantitative and qualitative methods. Findings from this study have implications for future intervention development aimed at targeting preventive efforts for volunteer firefighter populations.
Examining the determinants of condom use among African American college students attending predominantly white institutions
(University of Alabama Libraries, 2016) Aduloju-Ajijola, Natasha Aduloju-Ajijola; Paschal, Angelia M.; University of Alabama Tuscaloosa
African American college students at predominantly White institutions (PWIs) are disproportionally at risk for experiencing negative sexual health outcomes. African Americans between the ages of 18 and 24 are disproportionally affected by unplanned pregnancy and sexually transmitted infections, which are associated with risky sexual behaviors, including sex without a condom. The risks and stress associated with living at the intersection of both African American risk factors and college risk factors may play a role in the sexual behavior of African American college students. The purpose of this study was to examine the determinants of condom use among African American undergraduates at predominantly White Institutions (PWIs). This study used the constructs of the Theory of Planned Behavior (TPB) to examine the factors that contribute to condom use. An added factor the study examined was the relationship between different types of stress and condom use. The relationship between stress, intention to use condoms, and actual condom use was also investigated. The study employed a cross-sectional design and used surveys to collect data on African American college students between the ages of 18 and 24 years old at PWIs. The survey was disseminated through Qualtrics online survey software. The sample of 202 students engaged in a range of sexual behaviors (vaginal, oral, and anal sex) and had inconsistent condom use during these activities. The study found that constructs of the Theory of Planned Behavior, namely intentions and attitudes, were independently significant at predicting condom use. However, the interaction between intentions and overall stress was more significant in predicting condom use among African American college students attending PWIs over the past 30 days. The study findings have promising implications for health education practitioners, university stakeholders, and researchers who are interested in reducing sexual health disparities. Coordinated efforts are needed to reduce the risk factors that contribute to unsafe sexual behaviors among college students, especially among those at greater risk such as African American college students at PWIs.

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