Theses and Dissertations - Department of Health Science

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Breast cancer knowledge, beliefs, and screening behaviors of college women: utilization of the health belief model
(University of Alabama Libraries, 2011) Guilford, Kendra; Turner, Lori W.; University of Alabama Tuscaloosa
Aside from skin cancer, breast cancer is currently considered the most common cancer and the second leading cause of cancer death among women in the U.S. It is unique from other cancers in that it presents extreme financial costs, coupled with both physiological and psychological consequences for the impacted women and their families. Lifestyle factors are known contributors to rates of breast cancer, and knowledge is essential to its prevention. Women who are classified as "emerging adults" offer a vital window of opportunity for intervention, as lifestyle patterns are often set during this time. This cross-sectional, descriptive study examined the level of breast cancer knowledge, beliefs, and screening behaviors among a sample of emerging adult college women (n = 342) in the southeastern U.S. by measuring participants' confidence, health motivation, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers, in addition to their degree of worry in relation to breast cancer. Participants responded to a written, self-report 86-item questionnaire. All analyses were conducted using SAS® 9.0. Results of the study showed participants had a low level of perceived susceptibility towards breast cancer, as well as relatively low overall breast cancer knowledge. Findings also revealed a significant association between ethnicity, year in school, and family history of breast cancer and participants' general degree of breast cancer-related worry. Of the Health Belief Model constructs, confidence and perceived barriers were found to significantly predict breast self-examination. The college years provide a great opportunity for health intervention strategies. Health program planners should aim to develop interventions that are adapted to address the unique needs of women who are transitioning from adolescence to adulthood. These interventions should center on enhancing self-efficacy of breast cancer screening and reducing barriers. Education-based programs are also needed to increase women's overall knowledge and awareness of breast cancer-related issues. Such strategies have great potential to enhance women's quality of life and positively influence those with whom they closely interact.
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.
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.
An evaluation of the intention of college students to utilize calorie labeling in fast food and full-service restaurants: application of the Theory of Planned Behavior
(University of Alabama Libraries, 2013) Stran, Kimberly; Knol, Linda L.; Turner, Lori W.; University of Alabama Tuscaloosa
The Restaurant Nutrition Menu Labeling Requirement of the Affordable Care Act will require chain restaurants to provide calorie information on menus. The Theory of Planned Behavior (TPB) includes attitudes, subjective norms, and perceived behavioral control constructs, and explains attributes that lead to behavior intention and use of menu labeling in meal selection. Studies on characteristics of college students who use menu labeling in restaurants are limited. The purposes of this study were to determine predictors of intention to use calorie information, whether students changed meal choices after viewing calorie information, and describe groups of students most likely to change meal selections in fast food and full-service restaurants. Two hundred undergraduate students, 19 years or older, participated in this quasi-experimental study. Students participated in the full-service (n=100) or fast food (n=100) portion of the study. Participants selected a meal from a menu without calories, selected a meal from the same menu with calorie information, and completed a survey that addressed TPB constructs, intention, and potential barriers. Backward elimination was used to determine significant predictors of intention to use labels and changes in calories of meals ordered. Students ordered significantly fewer calories with posted calorie information on both fast food (909 versus 838 calories, p=0.02) and full-service (1370 versus 1203 calories, p<0.01) menus. Subjective norms (p<0.01) and perceived behavioral control (p=0.03) were predictive of greater intention to use calorie information on fast food menus but not of a change in caloric intake. Barriers such as cost (p=0.07) and perceived ease of label use (p=0.01) were associated with fewer calories ordered while lack of time (p=0.05) and hunger (p=0.02) were associated with an increase in calories ordered with posted information on fast food menus. Attitudes (p=0.04), subjective norms (p<0.01), and perceived behavioral control (p<0.01) predicted greater intention to use calorie information on full-service menus. Lack of time (p=0.08), frequent Nutrition Facts panel use (p=0.05), and positive attitudes (p<0.01) towards menu labeling predicted decreases in calories ordered with posted information on full-service menus. Menu labeling could provide information that college students need to select lower calorie items at both fast food and full-service restaurants.
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.
Internal and external factors influencing registered dietitians' recommendations for feeding tube use among older adults with advanced dementia: an application of the social ecological model
(University of Alabama Libraries, 2017) Douglas, Joy W.; Lawrence, Jeannine C.; Turner, Lori W.; University of Alabama Tuscaloosa
Background: While feeding tubes are commonly used to provide nutrition to patients with advanced dementia, research indicates that this fails to improve nutritional status or survival, and often yields harmful complications. As Registered Dietitians (RDs) are often consulted to provide clinical recommendations for older adults with advanced dementia, is important to understand factors influencing RDs’ feeding tube recommendations. Purpose: This study developed and validated a theory-based instrument to assess knowledge, beliefs, attitudes, and perceptions of RDs regarding feeding tube use among older adults with advanced dementia. Additionally, internal and external factors that influenced RDs’ recommendations were explored. Methods: The standardized survey development process included a comprehensive literature review, expert panel review, pilot testing, an efficacy survey, and test-retest analysis. A random sample of U.S. RDs was invited to participate. Exploratory factor and regression analyses determined factors associated with RDs’ feeding recommendations for people with advanced dementia. Results: Of the 662 RDs who completed the survey, 72.2% responded that they were unlikely to recommend feeding tubes for patients with advanced dementia. Factor analysis yielded five factors, each with adequate internal consistency: I) Knowledge Self-Efficacy, II) Religion/Spirituality/Culture, III) Personal Values, IV) Perceived Organization and Training, and V) Perceived Policy. Test-retest correlation coefficients ranged .602 - .812. The multivariate regression analysis included 580 RDs who were either likely or unlikely to recommend a feeding tube (‘neutral’ responses were removed), revealing five factors associated with RDs making evidence-based recommendations: Total Knowledge [OR = 1.40, 95% CI (1.26, 1.57)], Personal Values [OR = 1.30, 95% CI (1.19, 1.43)], Perceived Policy [OR 1.20, 95% CI (1.02, 1.40)], Perceived Organization and Training [OR = .87, 95% CI (.77, .99)], and working in long-term care or hospice settings [OR 3.68, 95% CI (1.51, 8.93)]. This model predicted 53.2% of the variance in RDs’ recommendations. Discussion: The instrument was deemed valid and reliable. Factor analysis indicated that internal and external factors influenced RDs’ recommendations, findings consistent with the Social Ecological Model. Most RDs made recommendations consistent with evidence-based guidelines, an encouraging finding. Work setting and RD knowledge were important modifiable influences, providing direction for future continuing professional education.
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.
Spatio-temporal model for mapping COVID-19 risk
(University of Alabama Libraries, 2021) Amelia, Lia; Higginbotham, John; University of Alabama Tuscaloosa
The COVID-19 was a major threat to public health around the world from the beginning of COVID-19 pandemic. The U.S. was one of the countries with the most COVID-19 cases. Despite the mitigation efforts to control the disease at both local and national levels, the number of COVID-19 cases in the U.S. remained high throughout the pandemic. This study focused on Cook County in Illinois. During the COVID-19 pandemic, Cook County was one of the counties with the highest COVID-19 cases in the U.S. This study described the spatial and temporal dynamics of COVID-19 risk in two-week periods from August 2020 to December 2020 in Cook County. This study also assessed the impact of neighborhood socioeconomic and demographic on COVID-19 incidence. The Bayesian spatio-temporal model was used to produce COVID-19 risk maps and to evaluate covariates' effects. The results show the spatial heterogeneity in COVID-19 risk from time to time, with the risk peaked in the first weeks of November. Over different time points, some parts of the county exhibited constant COVID-19 high-risk levels. Among these high-risk areas, many of them were majority-Hispanic neighborhoods in Chicago (i.e., Chicago west side) and Cook County suburbs (i.e., Franklin Park and Elgin). The model summary shows that the percentage of Hispanic population, health insurance coverage, and public transit commuters were associated with COVID-19 incidence. The posterior median and the 95% credible interval for the relative risk of a 1% increase in the percentage of Hispanic population was 1.009 (1.007, 1.011), indicating that a 1% increase in the percentage of Hispanic population corresponds to an increase in COVID-19 risk of 0.9%. The corresponding relative risk for a 1% increase in health insurance was 1.015 (1.006, 1.025), while for a 1% increase in the percentage of public transit commuters, the relative risk was 0.991 (0.987, 0.995). This study's findings highlight the importance of integrating the geographical information system into disease routine surveillance programs and transforming routinely collected health data into critical information. This information can be used to identify risk factors that could be addressed by allocating resources or implementing health policies.
Understanding prevalence and attitudes: dietary and exercise behaviors among African American collegiate athletes
(University of Alabama Libraries, 2012) Lewis, Dwight William; Leaver-Dunn, Deidre; University of Alabama Tuscaloosa
Context: Eating disorders, a serious public health issue, affect an estimated 8-11 million Americans (Hudson, Hiripi, Pope & Kessler, 2007; National Institutes of Mental Health [NIMH], 2010). The lack of inclusion of diverse minority populations from robustly-designed eating disorder research has produced limitations to the generalizability for theory-based prevention, diagnosis, and treatment programs, particularly among non-Caucasian populations. Objectives: The purpose of this study was to examine eating and exercise behaviors among student-athletes enrolled at historically black colleges and universities (HBCUs) through application of existing disordered eating, exercise dependence, and body image instruments. Participants: A battery of surveys was disseminated to 601 varsity level athletes enrolled at HBCUs, of which 71% (N = 427) were used in the analysis. Outcomes and Procedures: The main outcomes of interests were eating disorder (ED) risk, exercise dependence (ExD) risk, and orthorexia nervosa (ON) risk, and difference between perceived and ideal body stature. These outcomes were operationalized through application of the Eating Attitudes Test (EAT-26), Exercise Dependence Scale (EDS-21), ORTO 15 questionnaire (ORTO 15), and Pulvers and colleagues' (2004) Figural Stimuli. Regression (Logistical and Simple), chi-square, ANOVA/ANCOVA, and simple descriptive statistical analyses served as quantitative means of measurement. Results: Findings revealed that among HBCU student-athletes in this study, 10.8% were at risk for an ED, 10.3% were at risk for ExD, and 66.3% were at risk for ON. With respect to ED and ON risk, between group differences did not exist among most men's sports, while race and academic classification group differences were present among several women's sports. The Theory of Planned Behavior (TPB) construct, attitude, exhibited the largest influence on future intentions to engage in disordered eating among both male (p = .005) and female (p = .001) participants. Significant differences between ideal and perceived body stature exist among female subjects (p < .001). Conclusions: The ED risk findings among HBCU student-athletes failed to challenge current literature as to populations at increased risk for an ED. Also, individual treatment for EDs and ExD among HBCU student-athletes at risk should occur concurrently. ON risk findings among HBCU athletes exceed levels reported for European populations. Since ON is a novel phenomenon in the US, future research is warranted with respect to other American populations and the at-risk ORTO 15 threshold for athletes.

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