Theses and Dissertations - Department of Health Science

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Correlates for metabolic syndrome among employees at a Southeastern university
(University of Alabama Libraries, 2013) Johnson, Paige Turner; Turner, Lori W.; University of Alabama Tuscaloosa
Presently, it is estimated that thirty-four percent of Americans, over the age of twenty years, have a combination of risk factors known as metabolic syndrome. OBJECTIVES: This study examined the relationship of the risk factors for metabolic syndrome and multiple lifestyle variables. METHODS: Data was collected on 1358 employees from a southeastern university that participated in a wellness program. After controlling for missing variables, 1156 employee records were used to identify the relationship between risk factors for metabolic syndrome and lifestyle variables. Metabolic syndrome risk factors were analyzed along with covariates of demographics and self -reported overall physical health status. RESULTS: Significant relationships were identified to explain lifestyle variables and the cluster of risk factors in metabolic syndrome. CONCLUSIONS: These findings suggest that metabolic syndrome is associated with the modifiable risk factors of sleep and physical activity. Metabolic syndrome is also predictive of poor self-reported overall physical health status. Some findings from this study support previous research efforts, while some are unique to this southeastern population. The findings from this research will translate into health promotion activities aimed at decreasing risks of metabolic syndrome in individuals that are most susceptible.
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.
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 Tuscaloosa
Background: 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.
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 Tuscaloosa
Background. 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.
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 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 Tuscaloosa
The 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.
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.
Exploring personal values, attitudes, perceived injunctive and descriptive norms, and intrapersonal value-attitude relationships in relation to alcohol use and alcohol-related problems among college students
(University of Alabama Libraries, 2011) Sheppard, Meg E.; Usdan, Stuart L.; University of Alabama Tuscaloosa
Alcohol use among college students continues to be a public health issue in spite of health promotion activities and programming. College alcohol use literature regularly examines the impact of perceived norms on alcohol use; however, little research has been done on the influence of personal values on alcohol use and alcohol-related problems. The purpose of this study was to examine the relationships between personal values, attitudes, perceived injunctive and descriptive norms, alcohol, and alcohol-related problems. The study also conceptualized and tested an idea termed intrapersonal value-attitude relationship, which was an interaction between values and attitudes. The current study employed a cross-sectional design utilizing a paper-and pencil survey administered to college students (n=910) within the classrooms. Personal attitudes and perceived descriptive norms of alcohol-related problems consistently predicted alcohol use and alcohol-related problems even after controlling for potential confounding variables. The exploration of the innovative concept of intrapersonal value-attitude relationship is a first step to examine the complex relationships between values and attitudes. Findings from this study suggest that the examination of values, attitudes, injunctive and descriptive norms are relevant and worth investigating further in regard to alcohol use and other health behaviors.
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.
Investigating campus cycling environment of a large southeastern university from an ecological perspective
(University of Alabama Libraries, 2015) Shields, Margaret Mary; Paschal, Angelia M.; University of Alabama Tuscaloosa
Cycling is an effective method to address physical, psychological, and environmental health. As an alternative mode of transport, it can also be more economical compared to motor vehicles. Despite these benefits, cyclists run a moderately high risk of being injured on the road or in a vehicular accident. According to a survey completed by the National Highway Traffic Safety Administration, 88% of cyclists felt most threatened by motorists on the road and 37% perceived uneven walkways and roadways were a threat to personal safety. The purpose of this study was to examine college student perceptions of safety and factors contributing to campus cycling from an ecological perspective. Intrapersonal, interpersonal, and institutional factors associated with safety and campus cycling were assessed as well as how they interacted with each other. A survey was developed and administered to students on a large southeastern public university. The sample of 356 participants indicated that certain intrapersonal level factors were predictors of cycling, including bike specific issues (e.g., concerns about general bike maintenance) and personal appearance (e.g., looking "silly while wearing a helmet). Interpersonal cycling factors (e.g., concerns about interacting with motor vehicle drivers) were not statistically significant. However, institutional cycling factors, including institutional barriers (e.g., busy roads) and institutional facilitators (e.g., establishing more bike lanes and covered parking), were predictors of cycling. The study findings provide guidance to university stakeholders about what specific factors are prioritized and deemed more likely to facilitate cycling among students. Cycling has been found to be very beneficial, as it has been associated with reduced traffic, improved parking, and better ease of transport on campus. Therefore, these suggestions have implications for environmental and structural changes, policy development, and program planning.
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 Tuscaloosa
Sexual 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.
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.
Potential and realized food environments: an application of the social cognitive theory in Alabama food deserts
(University of Alabama Libraries, 2014) Gaines, Alisha; Knol, Linda L.; Turner, Lori W.; University of Alabama Tuscaloosa
Evidence from the United States (US) suggests that low-income, racial/ethnic minority, and rural populations often live in food deserts - areas underserved by grocery stores. Food deserts increase risk for diet-related disease among already at-risk populations; however, food access research has often included limited types of food outlets and has made assumptions about individual food procurement patterns. Framed by the Social Cognitive Theory, this mixed methods study was conducted in two phases in order to investigate Greene County, Alabama food retailers (potential environment) and assess residents' food access patterns (realized environment). In Phase One, all county food retailers were identified and classified in order to describe variances in distribution between the two census tracts considered a food desert (FDT) by the US Department of Agriculture (USDA) and the non-food desert tract (NFDT). USDA designations were confirmed, meaning FDT did not have grocery stores. However, the NFDT contained more of almost every store type, contrasting research suggesting increased presence of other retailers, such as convenience stores and fast food restaurants, in the absence of grocery stores. In Phase Two, semi-structured interviews were conducted in order to describe household food procurement patterns of 30 Greene County Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants, highlighting differences based on whether or not participants lived in a food desert. Patterns identified did not vary significantly based on residential area. Participants were utilizing 59% of county stores, identifying NFDT grocers and dollar stores as more important to meeting household food needs than FDT outlets. However, 53% of participants were leaving the county to do the bulk of their food shopping, using local stores to top off monthly food supply. Participants used a variety of shopping strategies, encountering a range of monetary and opportunity costs. Though not assessed directly, perception of Greene County stores was generally poor. Results demonstrate the value of using USDA food desert designations with in-depth exploration of potential food environments to best describe area foodscapes. Additionally, resident-informed data describing realized food environments can support research about residential attitudes and perceptions to inform food desert solutions.
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.
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 Tuscaloosa
The 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.
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.
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 Tuscaloosa
In 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.
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.
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.”

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