Browsing by Author "Birch, David A."
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Item 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 TuscaloosaBackground. 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.Item Development and validation of a social cognitive theory-based instrument to predict physical activity among people with spinal cord injury(University of Alabama Libraries, 2016) Wilroy, Jereme David; Turner, Lori W.; University of Alabama TuscaloosaBackground: There are over 200,000 people with spinal cord injury in the U.S. alone and each year another 15,000 to 20,000 incidents occur. Massive trauma to the spine can result in a SCI leaving behind devastation to the body including paralyzed muscle and loss of sensation. People with SCI are more susceptible to sedentary lifestyles because of the displacement of physical functioning caused by the spinal cord injury and the overwhelming majority are physically inactive. Benefits of physical activity for people with SCI include physical fitness, functional capacity, social integration and psychological well-being. Theoretical constructs have been operationalized to measure social cognitions towards physical activity for this population; however a valid and reliable instrument is lacking. Purpose: Therefore, the purpose of this study was to develop and validate a social cognitive theory-based instrument to predict physical activity among people with SCI. Methods: An instrument was drafted utilizing previous items from the literature. To examine content validity of the instrument, an expert panel of six people reviewed it, and the instrument was modified based on feedback. Cognitive interviewing with five people with SCI was conducted to assess readability, comprehensibility, and time. The final 64-item version of the instrument was used to collect data from participants via an online survey in order to test the validity and reliability. Results: One-hundred twenty-six people with SCI completed the survey with the majority being male (64.3%), white (79.4%), married (39.7%), with a mean age of 42.8 (± 13.7). The most prevalent level of SCI was complete paraplegia (34.9%) and the mean years from time since injury was 14.0 (±11.6). The physical activity outcome variable was significantly and positively correlated with self-regulatory efficacy (r = 0.575), task self-efficacy (r = 0.491), self-regulation (r = 0.432), social support (r= 0.284), and outcome expectations (r = 0.247). A prediction model for the physical activity outcome consisted of self-regulatory efficacy (B = 4.883; p < .001) and social support (B = 1.389; p = .050). Discussion: Multivariate analysis revealed that self-regulatory efficacy and social support were the strongest predictors of physical activity among people with SCI. Based on findings from the study, physical activity interventions targeted at people with spinal cord injury should focus on improving self-regulatory behaviors and providing social support to increase physical activity. A strategy for increasing self-regulatory efficacy within an intervention may involve the development of an action plan by each participant. The action planning would include setting goals and objectives, scheduling times for physical activity, and identifying barriers and a plan for coping with each barrier. Social support is the perceived support from others concerning the behavior and may include family, friends, or online communities. Targeting social support in an intervention may include peer modeling, peer support, health messages from participant doctor, and family involvement.Item Development and validation of a theory of planned behavior-based instrument to predict human papillomavirus vaccination intentions of college males at a southeastern university(University of Alabama Libraries, 2015) Priest, Hannah Marie; Birch, David A.; Knowlden, Adam P.; University of Alabama TuscaloosaBackground. Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States. College-age males influence acquisition and transmission of HPV due to engagement in high-risk sexual behaviors. HPV vaccination is an efficacious strategy for reducing the burden of HPV-associated morbidity; yet rates of HPV vaccination remain low among college males. The purpose of this study was to operationalize the direct constructs of the theory of planned behavior (TPB) to predict the HPV vaccination behavioral intentions of male undergraduate college students attending a large public southeastern university. Methods. A non-experimental, cross-sectional study design was employed with 256 vaccine-eligible college males. Instrumentation comprised a qualitative elicitation study, face and content validity by a panel of seven experts, readability and comprehensibility by pilot test, stability reliability by test-retest, internal consistency applying Cronbach’s alpha, construct validity applying confirmatory factor analysis, and predictive validity applying structural equation modeling. Results. Approximately one third (31.3%) of the sample was unaware of HPV and nearly half (45.3%) of the sample was unaware of the HPV vaccine. The final structural model exhibited acceptable fit of the data (Chi-square test = 129.78; degrees of freedom, df = 70, p = .000; Kline’s alternative, KA = 1.854; Goodness-of-fit index, GFI = 0.932; Normed fit index, NFI = .948; Root mean square error of approximation, RMSEA = 0.054). Attitude toward the behavior and subjective norm were significant predictors of behavioral intention, accounting for 58% of the variance in behavioral intention. Perceived behavioral control was found to be a non-significant predictor of behavioral intention. Overall, college males reported low behavioral intentions to get the vaccine (M = 8.52; SD = 5.30). Discussion. A valid and reliable instrument designed to measure constructs from the TPB was developed to predict HPV vaccination intentions of college males. Findings from this study provided an instrument that may be applied in the design and evaluation of TPB-based interventions to promote HPV vaccination among undergraduate college males. Future research may examine possible mediators and moderators of TPB constructs to fully operationalize the theoretical framework.Item Development and validation of a theory-based instrument to assess school organizational readiness to advance implementation of the whole school, whole community, whole child model(University of Alabama Libraries, 2018) Conrad, Eric Jordan; Birch, David A.; Knowlden, Adam P.; University of Alabama TuscaloosaBackground: The whole school, whole community, whole child (WSCC) model provides a framework for schools to support student health and academic achievement, however, implementation is a complex organizational change requiring the collective efforts of the school organization to be successful. Over half of all failed complex organizational change efforts, such as WSCC implementation, can be attributed to a lack of readiness. The ability to accurately assess school organizational readiness to implement the WSCC can improve preparation and processes necessary to promote successful and sustainable change. Purpose: The purpose of this study was to develop and validate a theory of organizational readiness for change (TORC)-based instrument to assess school organizational readiness to implement actions that support the WSCC model. Methods: A non-experimental, cross-sectional study design was employed with 271 public school employees from 43 schools. An instrument was drafted which operationalized readiness to implement the WSCC as eight actions supported in the literature to facilitate effective implementation. Instrumentation consisted of face and content validity by a panel of experts, stability reliability by test-retest, internal reliability applying Cronbach’s alpha, interrater agreement and reliability applying intraclass correlations and rwg(J) index, construct validity applying confirmatory factor analysis, and predictive validity applying multiple linear regression analysis. Results: Measures of interrater reliability and agreement supported the aggregation of individual-level readiness perceptions to the organization level of analysis for both general change commitment (GCC) (rwg(J).uniform=0.95, rwg(J).skew=0.79, ICC1=0.43, ICC2=0.91, p<.01) and general change efficacy (GCE) (rwg(J).uniform=0.95, rwg(J).skew=0.80, ICC1=0.49, ICC2=0.93, p<.01). The final structural model exhibited reasonable fit of the data (χ2=751.93, df=295, p<.001; GFI=0.833; AGFI=0.801; NFI=0.901; CFI=0.930; RMSEA=0.076). Both GCC (β=.589, p<.001) and GCE (β=.354, p<.001) were significant predictors of change-related effort, accounting for 77% of the variance. Overall, reported change-related effort was low (M=6.07; SD=2.70) with 74% of the scores below the scale midpoint. Discussion: A valid and reliable TORC-based instrument was developed to assess school organizational readiness to advance implementation of the WSCC model. Future research may seek to examine potential moderators and mediators of the TORC constructs in order to fully operationalize the theoretical framework.Item The examination of mixing alcohol and energy drinks among college undergraduates using the Theory of Planned Behavior(University of Alabama Libraries, 2013) Reddy, Supriya Gillella; Usdan, Stuart L.; Nickelson, Joyce E.; University of Alabama TuscaloosaThe purpose of this study was two fold. First, the study examined whether constructs from the Theory of Planned Behavior (TPB: Ajzen, 1985, 1991) play a role in predicting consumption of alcohol mixed with energy drinks (AmED) among college undergraduates. Second, the study also estimated the prevalence of AmED consumption and provided a better understanding of the theoretical and demographic variables associated with AmED consumption among a large sample of college undergraduates located at a public university in the Southeastern United States. The study used a cross-sectional study design (n=676) to administer a 39-item survey assessing alcohol use, energy drink (ED) use, and the consumption of mixing alcohol with energy drinks (AmED). As part of this assessment, students responded to theoretical questions about AmED consumption in the last 30 days. Analyses exploring the univariate significance of theoretical and demographic predictors revealed that all of the TPB constructs were significant univariately. Additionally, the demographic predictors of class year and Panhellenic affiliation were also univariately significant (p<.05). However, when incorporated into a logistic regression model, the TPB constructs of behavioral intention and attitude were the only significant predictors (p<.05) of AmED consumption among undergraduate college students. Subjective norms and perceived behavioral control were no longer significant. Furthermore, logistic regression analyses also showed that the demographic variables of age, sex, place of residence, and Panhellenic affiliation also did not predict AmED consumption, while class year remained a significant predictor (p<.05) of AmED consumption. Lastly, a mediation analyses was conducted using logistic regression techniques. Results showed that behavioral intention is a complete mediator for the effect of subjective norms on AmED consumption and is also a partial mediator for the effect of attitudes on AmED consumption in the last 30 days. Despite the cross-sectional nature of this study, its primary strength was its application of theory to better understand AmED use among college undergraduates. Findings from this study have implications for future intervention development aimed at targeting preventive efforts among college populations.Item 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 TuscaloosaMarijuana 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.Item 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 TuscaloosaApproximately 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.Item Examining personal and environmental factors related to the co-occurrence of heavy episodic drinking and disordered eating behaviors among college students(University of Alabama Libraries, 2015) Rush, Sarah Elizabeth; Usdan, Stuart L.; University of Alabama TuscaloosaThe co-occurrence of heavy episodic drinking (HED) and disordered eating behaviors (DEB) is both common and dangerous. Because of its' high prevalence and subsequent link to negative health outcomes, these behaviors have attracted the recent attention of university administrators, researchers, and clinicians. Additionally, sexual objectification and self-objectification have become prominent issues in our society that are impossible to escape and are associated with many negative behaviors. To date, most campus programs do not target these behaviors within the context of a reciprocal relationship and no existing campus programs target these behaviors in light of objectification. The main purpose of this study is to examine objectification-related personal and environmental factors associated with the co-occurrence of HED and DEBs in college students. The present study utilized a quantitative, cross-sectional design (n=667) and classroom survey research. Overall, 276 (41.4 percent) respondents reported being engaging in co-occurring HED and DEBs in the past month and a total of 97.9 percent (653 participants) of the sample reported experiencing sexual objectification within the past year. Alcohol outcome expectancies were the strongest predictor of co-occurrence of HED and DEBs (B;=1.015; p<0.001; Odds ratio=2.759), objectification-related constructs were found to significantly predict co-occurrence as well. Further, body shame and expectancies partially mediated relationships between multiple variables under study. Lastly, media consumption significantly moderated the relationship between body shame and thinness and restricting expectancies. This study has promising implications for health education practitioners, university administrators, and health policy experts and provides significant insight for future research. Coordinated efforts are needed to change the social and cultural environment on college campuses and to educate individuals about the potential effects of objectification on their physical, social, and emotional development in an attempt to increase healthy behaviors.Item Gendered racial microaggressions and black college women: A cross-sectional study of depression and psychological distress(Taylor & Francis, 2022-10-13) Burton, Wanda Martin; Paschal, Angelica M.; Jaiswal, Jessica; Leeper, James D.; Birch, David A.Objective: We assessed the association between gendered racism, the simultaneous experience of sexism and racism, depression, and psychological distress in Black college women using an intersectional instrument, the gendered racial microaggression scale. Participants: Black college women enrolled at a predominantly white institution (PWI) in the southeastern U.S. (N=164, response rate = 77%, mean age 21.67). Methods: We used a cross-sectional survey to explore the impact of stress appraisal and frequency of gendered racial microaggressions on depression and psychological distress using validated scales. Results: 30% reported depression and 54% reported severe psychological distress. Correlations indicate significant relationships between gendered racism, depression and psychological distress, with the strongest relation reported between the frequency of gendered racism to depression. Regression analyses suggest significant relationships between gendered racism, depression and psychological distress. Conclusion: Gendered racism has significant bearing on the mental health of Black college women attending a PWI. Implications for interventions are discussed.Item Health mythologies: developing an understanding of health myths and how they stick and spread through the vaccines cause Autism myth(University of Alabama Libraries, 2014) Mocarski, Richard; Black, Jason Edward; University of Alabama TuscaloosaHealth myths are health belief systems which prescribe behaviors thought to be health positive by myth-subscribers which are, according to Western medicine, health negative or neutral. These myths become part of individual, family, and community ethnomedical constructions and can have lasting negative health impacts. This project aims to better understand how health myths become lasting and pervasive through a Foucauldian genealogy of the vaccine cause autism (VCA) myth. Using a variety of critical rhetorical lenses--including mythic analysis, the narrative paradigm, circulation theory, performativity, and collective memory--this project analyzes six cases across three realms. In the realm of popular culture Jenny McCarthy's brand-system and the narratives of autism in TIME and Parenting Magazines are analyzed; in the realm of medicine the diagnostic history of autism in the DSM and foundational articles and the circulation of peer-reviewed scientific articles that arguably link autism to environmental triggers are analyzed; and in the institutional realm Congressional hearings on VCA and the collective memory of autism crafted by non-profits on both side of the VCA debate are analyzed. These analyses demonstrate the commonalities across cases and realms, as well as the points of contradiction, offering a better picture for the ways that macro-social hegemonic discourses coupled with pathos-steeped narratives bind together through sticky affect. This binding creates a bloc of discourses that circulate and re-circulate through popular culture, medicine, and institutions such as government creating many entry points for community construction around VCA. The implications of this project include new insights on affective stickiness, further development of the links between Foucault and critical rhetoric, and a better understanding of popular culture's place in medical discourses.Item Investigating multiple layers of influence on sexual assault in a university setting(University of Alabama Libraries, 2015) Hackman, Christine L.; Usdan, Stuart L.; University of Alabama TuscaloosaSexual assault is a major public issue on college campuses; approximately 20 to 50 percent of female and up to 31 percent of male college students report being sexually victimized while in college. To date, little research has been conducted in this area that investigates interactions between intrapersonal, interpersonal, institutional, community, and societal factors that influence campus sexual assault. The main purpose of this study was to examine interactions between different layers of influence on campus sexual assault. The present study utilized a quantitative, cross-sectional design (n=677) with online delivery of survey research. Overall, 191 (28.0 percent) participants reported being sexually assaulted since the beginning of their college career, and a total of 4.8 percent (32 participants) of the sample reported perpetration since the beginning of their college career. Prior victimization was the strongest predictor of both victimization (β=2.779; p<0.001; Odds ratio=16.100) and perpetration (β=2.551; p<0.001; Odds ratio=12.823) since the start of college. Further, those who received sexual assault prevention education had had better views of the institution than those who did not (F=5.702; p=0.001). Being a victim or perpetrator did not have an effect on institutional variables. Lastly, neither rape myth acceptance nor injunctive peer norms significantly moderated the relationship between binge drinking and perpetration since the start of college. This study has promising implications for future research as well as for public health education practitioners, college administrators, and health policy experts. Coordinated national, state, and local efforts are needed to change the climate in institutions of higher education that truly promote safe, healthy relationships and behaviors in college students.Item Occupational sedentary behavior: application of the social ecological model(University of Alabama Libraries, 2017) Hutcheson, Amanda K.; Usdan, Stuart L.; University of Alabama TuscaloosaSedentary 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.Item 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 TuscaloosaBackground: 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.Item Predictors of depression diagnoses and symptoms in veterans: results from a national survey(University of Alabama Libraries, 2014) Thomas, Katherine Hendricks; Turner, Lori W.; University of Alabama TuscaloosaThe suicide numbers among active duty military personnel eclipsed the number of combat deaths in 2011. Before the wars in Iraq and Afghanistan, the incidence of suicide in active duty US service members was consistently 25% lower than in the civilian population. Currently military and veteran suicide rates exceed those found in the general population, with 22 per day being the most conservative estimates by the Veteran's Administration. The reasons for this are multi-faceted, with the question looming as to whether repeated ground combat tours have a deleterious effect on resilience and overall mental health. Operational tempo in the last ten years has exceeded all previous expectations and metrics; frequent trips to Iraq and Afghanistan are commonplace for this community. The purpose of this study was to examine the relationship between ten key variables and rates of diagnosed depression and symptoms of undiagnosed depression in a national sample of veterans to generate predictive models for the condition in military veterans. This study utilized secondary data analysis of veteran respondents using the 2012 Behavioral Risk Factors Surveillance Survey conducted by the Centers for Disease Control and Prevention. Logistic regression analysis explored associations between diagnosed and undiagnosed depression in veteran respondents and independent variables including: veteran era, sex, ethnicity, race, relationship status, physical activity, binge drinking, smoking, physical disability and pain, and beliefs about mental health care's usefulness. This timely and culturally-relevant line of inquiry offers insight that may guide targeted resilience programming for the veteran community.Item Public Health and School Health Education: Aligning Forces for Change(Sage, 2019) Birch, David A.; Auld, M. Elaine; University of Alabama TuscaloosaThe interdependent relationship between health and education has long been documented by leading health and education scholars. Children who are not physically, mentally, socially, or emotionally healthy will not be ready to learn and thus hampered to achieve their full potential as productive members of society. Despite this evidence, the United States has yet to bridge the divide between the health and education systems. This perspective introduces three manuscripts in this Special School Health Education Collection on the future of school health education in the United States, and provides a context for the challenges and recommendations each article outlines to improve the quantity and quality of school health education for preK-12 youth. Although some of the challenges and recommendations are not novel, what is exciting is the opportunity to move the agenda forward given the Whole School, Whole Community, Whole Child model and the Every Student Succeeds Act of 2015. Aligning the forces of public health and school health educators is essential to make school health education a societal imperative.Item 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 TuscaloosaThe 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.Item Quality Assurance in Teaching K-12 Health Education: Paving a New Path Forward(Sage, 2019) Birch, David A.; Goekler, Susan; Auld, M. Elaine; Lohrmann, David K.; Lyde, Adrian; University of Alabama Tuscaloosa; Indiana University Bloomington; Illinois State UniversityTo be effective, school health instruction should be taught by health educators who have graduated from accredited health education teacher education programs and are certified in health education. Unfortunately, the nation has failed to ensure that all those who teach health in schools are well prepared. States vary in the required coursework for health teachers in terms of initial licensure and continuing education for licensure renewal; most elementary teachers are not required to receive preparation in health education; health education and physical education are often viewed as synonymous disciplines; support for in-service education of health teachers is often lacking; and more research is needed in professional preparation and development of school health educators. This article provides a call to action in five areas to strengthen both the professional preparation and professional development of school health educators. Given that education is a social determinant of health, public health educators must become stronger allies in supporting school health to promote health equity. Public health practitioners can advocate to state and community school decision makers for comprehensive school health education taught by teachers with appropriate professional preparation and certification in health education. Public health faculty can educate their students about the Whole School, Whole Community, Whole Child framework and effective strategies for its implementation, and seek rigorous professional preparation and certification and accreditation standards for their school teacher preparation programs. National health and education organizations can call for new leadership and investments in health education teacher preparation and development for a brighter future.Item Relationships between high school students' health behaviors and perceptions of their 9th grade health education experience(University of Alabama Libraries, 2014) Mitchell, Qshequilla Parham; Birch, David A.; University of Alabama TuscaloosaIn the majority of U.S. schools, health education has been delivered in a fragmented and disorganized way resulting in poor quality. While studies have assessed the perceptions of health education from lead health education teachers and school administrators, a review of the literature revealed no studies of high school students' perceptions of school health education. The perceived experiences and perceptions of school health education among high school students have not been fully explored. The purpose of this study was to a) assess the perceptions of a 9th grade health education course from 10th and 11th graders attending a rural high school in West Central Alabama, b) identify students' self-reported current health behaviors and c) explore the relationship between the perceptions of their 9th grade health education course and reported health behaviors. Results showed that for each of the National Health Education Standards at least 60% of the students indicated that the course helped them to perform the standard. Results also showed that for each of the six CDC risk behaviors at least 50% of students indicated that the course helped them to make decisions about the risk behaviors. Additionally, at least 55% of high school students in grades 10-11 perceived their 9th grade health education course to be effective in helping them to make decisions about their general health and decisions related to the six types of health-risk behaviors that contribute to the leading causes of death and disability among youth and adults, a) behaviors that contribute to unintentional injuries and violence, b) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection, c) alcohol and other drug use, d) tobacco use, e) unhealthy dietary behaviors, and f) inadequate physical activity. Over 60% of 10th grade students and 55.4% of 11th grade students perceived their 9th grade health education course to be effective in preparing them to use decision-making skills to enhance health. Similarly, 10th grade students (70.8%) and 11th grade students (59.5%) perceived their 9th grade health education course to be effective in preparing them to comprehend concepts related to health promotion and disease prevention.Item 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 TuscaloosaAfrican 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.Item 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 TuscaloosaThe 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.”