Theses and Dissertations - Department of Health Science

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Application of the diffusion of innovations theory and the health belief model to describe EMR use among Alabama family medicine physicians: a rural and urban analysis
(University of Alabama Libraries, 2009) Tucker, Melanie Tara; Higginbotham, John C.; University of Alabama Tuscaloosa
The Alabama Black Belt region consists of twelve counties which are characterized by a high percentage of African Americans, acute poverty, rural decline, inadequate education programs, and significantly poor health outcomes. The Alabama Black Belt region suffers significantly with health disparities which, in part, may be attributed to low physician/patient ratio and physician isolation. These physicians tend to practice in private, solo establishments, which often lead to limited communication with other physicians and medical educators. Without continued communication and continuing medical education, rural physicians could lag behind their urban counterparts. In fact it has been shown that some physician practices lag as far as two decades behind their urban counterparts due to such things as limited access to new technologies. With the advent of the electronic medical record (EMR) this lag is likely to decrease exponentially for those in rural areas and could lead to an increase in quality of care for the rural communities. The purpose of this study was to evaluate the adoption and implementation of electronic medical records (EMR) by rural and urban Alabama Family Medicine physicians. The Diffusion of Innovations Theory and Health Belief Model were used to guide the study and develop the survey questions. EMR adoption was assessed in rural areas and compared to their urban counterparts while evaluating the individual characteristic (gender, race, age, and years of practice), organizational characteristics (practice size, patients seen per day, practice location) and individual perceptions regarding adoption (perceived threat, perceived barriers and self-efficacy). Thirty percent (30%) of the 1,205 Alabama Family Medicine physicians responded to the electronic or paper survey. Almost half (49.3%) of the physicians surveyed reported having EMR in their practice; however, 16.3% reported using it to its fullest capacity. Significant differences emerged with respect to EMR use among physicians based on age, years in practice, patients seen per day, practice size and with respect to elements of perceived threat, barriers to adoption and the self-efficacy. Throughout the analysis, differences emerged between Family Medicine physicians from urban Alabama settings and their counterparts from rural and Black Belt region practices.
Association between stroke risk factors and access to care
(University of Alabama Libraries, 2011) Parton, Jason Michael; Higginbotham, John C.; University of Alabama Tuscaloosa
A number of medically diagnosed risk factors are associated with an increased risk of having a stroke. Individuals recognized with hypertension, diabetes, and dyslipidemia all show greater probability of experiencing a stroke. Rural inhabitants are often considered to have limited access to health care, thus frequently decreasing the likelihood of their being aware of, treated, or controlled for these and other stroke-risk factors. This investigation provides an avenue for exploration into the association nontraditional risk factors for stroke, rural/urban designation, and travel time to a usual source of health care have on awareness, treatment, and control of hypertension, diabetes, and dyslipidemia. The association between awareness, treatment, and control of stroke-risk factors and an individual's rural/urban status was investigated to identify geographic disparities. Furthermore, travel time to a participant's usual source of medical care was explored for its relationship to these stages of stroke-risk factors and to investigate how travel time might influence the association between these factors and rural/urban status. No associations were identified for the main effects between the likelihood of being aware of, treated, or controlled for stroke-risk factors, and living in rural and urban settings. Drive time showed no relationship with these stages of stroke-risk factors, nor did it modify the effect rural or urban status had on the dependent variables. Disparities were noted for demographic, socioeconomic, and health behavioral traits for all three risk factors. This project made use of REGARDS study data sources to provide an understanding of stroke disparities for a certain geographic dimension. However, these data alone are unable to specifically identify rural and urban differences in stroke-risk factors and assess what effects access to health care has on the management of stroke-risk factors. The results from this investigation specify limited variability for management of these conditions by this study's measures of access to care.
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.
Coping at the intersection: a transformative mixed methods study of gendered racism as a root cause of mental health challenges in black college women
(University of Alabama Libraries, 2017) Burton, Wanda Martin; Birch, David A.; Paschal, Angelia M.; University of Alabama Tuscaloosa
Background. Racism negatively impacts mental health. Racial identity has been suggested as a buffer against the impact of racism. But women of color are exposed to gendered racism; based on intersectionality theory. The purpose of this study was to understand the impact of and coping strategies used to deal with gendered racism on the mental health of Black college women. Methods. The mixed methods design included a nonrandom sample of 213 Black college women. Mental health was operationalized as depression (PHQ-9) and psychological distress (K-6). Correlation and regression analyses tested the impact of gendered racism on mental health; examined the role of racial identity; and, explored coping strategies. Through intensity sampling, the qualitative phase included individual interviews (n=12) and a focus group (n=6). Narrative inquiry was used to construct composite counter-narratives, using thematic narrative analysis. Findings. Quantitative results suggested that 84% of the sample require mental health treatment. Gendered racism negatively correlated with mental health; the most significant correlation was between depression and the frequency of gendered racism, r(95) = .405, p ≤ .01. Racial identity was not related to mental health and therefore could not be tested as a mediating factor. The qualitative phase revealed narratives of gendered racism across multiple levels. The institutional level helped to create the normative experience of gendered racism through lack of effective policy; it also impacted the individual and interpersonal levels. Internalized gendered racism resulted in an acceptance of limitations to one's full humanity. The interpersonal level included narratives of sexual assault, being mistaken as ‘the help,’ and assumptions about communication style and educational level. The mixed methods results suggested that effective coping depends on increased education and the deconstruction of gendered racism followed by the use of humor and social support. Discussion. Gendered racism negatively impacts the mental health of Black college women. Interventions should include an emphasis on gendered racism. Narratives revealed how Black college women accept and resist the normative experience of gendered racism. The mixed methods design provided a more nuanced understanding of how Black women cope with gendered racism.
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.
Development and validation of an instrument to assess college students' oral health knowledge, beliefs, and behavior
(University of Alabama Libraries, 2010) Aubuchon, Stellina Marie; Turner, Lori W.; University of Alabama Tuscaloosa
Oral health education emphasizes the importance of brushing, flossing, and getting regular dental exams. Some examples of oral health problems that can occur without proper oral hygiene and dental care are dental caries and gingivitis. Research has shown that a relationship exists between oral health and other health related problems. The lack of awareness, education, and services regarding oral health and hygiene can cause severe unfavorable outcomes later in life. Unique oral health issues that affect today's college students include the use of smokeless tobacco, sexually transmitted diseases, and oral piercing. Although there are many studies conducted on oral health, few are targeted towards the college aged population. The purpose of this study was to develop a valid instrument based on constructs from the Health Belief Model to measure the knowledge, beliefs, and behaviors of college students' regarding oral health and hygiene. The present study utilized a review of the literature and an eight-step process to develop and validate College Students Oral Health Knowledge, Beliefs, and Behaviors (OHKBB). The most effective way to treat oral health related problems is through prevention. Oral health education is needed to ensure that college students are aware of not only the risks but also the prevention of oral diseases. The proposed research will pave the way for programs to help individuals improve their oral hygiene and reduce their risks of oral health related problems through education by identifying the specific oral health related knowledge, beliefs, and behaviors that affect college students oral health.
Development of a theory based instrument to predict the influence of sexually-oriented music lyrics on the sexual attitudes, beliefs, and intentions of African-American adolescents
(University of Alabama Libraries, 2010) Gordon, Brian C.; Perko, Mike; Turner, Lori W.; University of Alabama Tuscaloosa
Early sexual initiation among American adolescents represents a major public health problem. African-American adolescents (AAas) report earlier age of sexual initiation, which places them at an increased risk of ill health outcomes. Approximately 3 million adolescents are infected with a STI yearly, with the highest incidence occurring in African Americans from impoverished, inner city environments. A relationship among media exposure and media's influence on adolescents' sexual perceptions, attitudes, and intentions has been suggested. However, answers as to whether sexually-oriented music lyrics influence adolescent sexual initiation are unclear. The purpose of this study was to develop a reliable and valid instrument based on the Theory of Reasoned Action to enable researchers to predict the influence of sexually-oriented music lyrics on the sexual attitudes, beliefs, and intentions of AAas. A nine step process was followed to develop a survey to enable researchers to predict the influence of sexually-oriented music lyrics on the sexual attitudes, beliefs, and intentions of African-American adolescents. The steps were: 1) identify the attitudinal object, 2) collect a pool of opinion items, 3) submit pool of items to expert panel for review, 4) pilot test draft of the survey, 5) administer item pool to a group of respondents, 6) score each item for each respondent, 7) sum respondents' item scores, 8) correlate item scores with total scale scores for all respondents, and 9) apply statistical criteria for elimination of test items. One hundred eighty-five (n =185) AAas in grades 6-8 residing in rural and urban communities in Alabama participated in the study. An initial pool of items (n =95) was developed based on the TRA, a review of the literature, and input received through focus group interviews with the target audience. Items were eliminated through expert panel review (n =49), item response discrimination, factor analysis (1), and Cronbach's alpha (3). Four subscales were identified with reliability statistics ranging from .722-.940. The final instrument consisted of 44 items with a Cronbach's alpha of .846. Future research should utilize this survey to determine the influence sexually-oriented music lyrics may have on the sexual attitudes, beliefs, and intentions of African-American adolescents.
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.
Emotional determinants of health: exploring prevalence and the impact of adverse childhood experiences on physical and mental health outcomes of black adult men using the 2012 behavioral risk factor surveillance system
(University of Alabama Libraries, 2020) Johnson III, Lee Presley; Paschal, Angelia M.; Burton, Wanda M.; University of Alabama Tuscaloosa
Background. In the United States, Black men face a disproportionate burden of preventable mortality and morbidity rates. Among the possible factors associated with the disproportionality in these rates among Black men, studies suggest, are adverse childhood experiences (ACEs). Moreover, depression, one of the world’s most pervasive psychiatric disorders, researchers suggest, also contributes to disparate mortality and morbidity rates among Black men. Purpose. The purpose of this study and research inquiry was to describe the relationship between differential exposure to ACE’s and depression in Black men, controlling for effects of social demographic factors, presence of chronic medical conditions, and behavioral health risks using the 2012 Behavioral Risk Factor Surveillance System (BRFSS) data. Methods. A secondary data analysis was employed using a community sample of 3,084 Black men originating from the 2012 BRFSS. The 2012 BRFSS included an ACE module questionnaire. ACE module survey questions were used to determine the presence (yes/no) for types (e.g., direct or environmental) of ACEs. Composite measures of the ACE type subscales were computed to determine the total number of ACEs that could be reported (e.g., range 0 to ≥ 5). Additional BRFSS questions assessed depression, chronic medical conditions, and health risk behaviors. Results. Physical abuse, a direct ACE, and household member incarceration, an environmental ACE, was significantly associated with current depressive symptoms. Approximately 32.1% of Black men reported exposure to verbal abuse before age 18, the most prevalent direct ACE. In contrast, a larger proportion (48.6%) of Black men reported exposure to divorce before 18, the most prevalent environmental ACE. Physical abuse and stroke were statistically significant (OR = 4.14; 95% CI [1.69, 10.12]; p < 0.05). Approximately 9.2% of the Black men in the study reported experiencing five or more ACEs. Health risk behaviors did not mediate depression among Black men. Conclusion. Physical abuse and household member incarceration exert a significant impact on current depression. Indeed, verbal abuse and divorce demonstrated a significant relationship with a lifetime diagnosis of depression. The study findings have implications for health education practitioners, researchers, and policymakers interested in improving mental health through prevention and reducing childhood exposure to abuse.
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.
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 Tuscaloosa
The 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.
Examining college students' use, perception, and knowledge of marijuana and marijuana laws
(University of Alabama Libraries, 2019) Burroughs, Meghan Elizabeth; Birch, David A.; Usdan, Stuart L.; University of Alabama Tuscaloosa
Marijuana is a highly utilized drug on college campuses that has a variety of adverse health effects. Since the 1970s, state marijuana laws have been consistently evolving throughout the United States, increasing accessibility and normalizing marijuana use, especially among college students. Therefore, the purpose of this study was to examine the association that state marijuana laws have had on undergraduate students at one university in a southeastern state that only has a limited medical marijuana law, specifically in terms of use, perceptions of risk, diversion of marijuana, and marijuana law knowledge. The Theory of Planned Behavior (TPB) was the theoretical framework for this study. A quantitative, cross-sectional design was utilized through the administration of paper and pen surveys from a convenience sample of 391 undergraduate students. No significant relationships were found between the type of marijuana law from students’ state of permanent residence and college student marijuana use, perceptions of risk, or diversion of marijuana. Additionally, no significant relationships were found between marijuana law knowledge and student marijuana use in the state of Alabama during the past 12 months or 30 days. Individually, all TPB constructs were significant in predicting behavioral intention to use marijuana in the state of Alabama in the next 12 months. However, only subjective norms (β = .189, p < .05) and attitudes (β = .406, p < .001) were significant in predicting behavioral intention to use marijuana in the state of Alabama in the next 30 days. When examining all constructs together, only attitude was a significant predictor of intention to use marijuana in the next 12 months (β = .484, p < .001) and in the next 30 days (β = .392, p < .001) in the state of Alabama. Although the results of this study did not find much significance between the variables, students did report high levels of marijuana use, low perceptions of risk, and endorsed several diversion behaviors within a state with a limited medical marijuana law. Public health education researchers and practitioners should continue to explore the influence of marijuana laws and marijuana use in college students.
Examining college women's hookup behaviors and condom negotiation strategies used with their online and offline partners
(University of Alabama Libraries, 2019) Evans, Jennifer Lynn; Birch, David A.; Usdan, Stuart; University of Alabama Tuscaloosa
Approximately 60-80% of college students report engaging in a hookup at some point during their college career. College students find hookup partners through traditional meeting contexts, but dating apps and social media have become a new resource to identify potential sexual partners. Because males are the ones who physically wear condoms, safer sex efforts may require the female to possess condom negotiation skills to persuade her male partners to use a condom. Previous research has not investigated the use of condom negotiation strategies with partners identified online or offline. The primary purpose of this study was to identify differences between the mode in which college women seek male hookup partners (online, offline, and both online and offline) and the condom negotiation strategies used with these partners. A secondary purpose of the study was to utilize the constructs of the Theory of Planned Behavior (TPB) to predict and identify differences in condom negotiation intention with male hookup partners met online, offline, and both online and offline. The present study utilized a quantitative, cross-sectional design paper and pen survey administered through a convenience sample of 296 undergraduate women enrolled in courses in the College of Human Environmental Sciences at The University of Alabama. Overall, 155 (52.4%) reported engaging in hookups over the previous six months. No significant differences were found between where college women identified their hookup partners and their behavioral intention to negotiate condom use. Nonverbal indirect condom negotiation strategies (F (2, 151, 3.55. p < 0.05) were significant among those who found partners offline (M = 13.38, sd = 4.59, p = 0.048). Perceived behavioral control (p = 0.043) had a significant interaction with behavioral intention when examining the TPB constructs by where college women identified their hookup partners. After adding past condom use with hookup partners to the same model, subjective norms (p = 0.047) was a significant predictor of behavioral intention. Based on the findings of this study, public health educators should continue to explore condom negotiation utilizing the TPB and develop interventions to educate college women how to negotiate condom use with their hookup partners.
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 determinants of community led total sanitation (clts) on latrine adoption among rural cambodians utilizing the diffusion of innovation theory: a pragmatic approach
(University of Alabama Libraries, 2020-12) Hendrix, Sara; Ross, Levi; University of Alabama Tuscaloosa
Open defecation is a global health problem in which 90% of the cases observed occur in rural settings among developing countries. Individuals exposed to open defecation may face higher risks of diarrheal diseases and health consequences. Basic sanitation facilities may mitigate adverse health effects associated with open defecation. In Cambodia, the lowest percentage of basic sanitation (48.3%) has been reached compared to neighboring countries. This dissertation research explored determinants of Community Led Total Sanitation on latrine construction and usage among rural Cambodians. This exploration was guided by diffusion of innovation theory. This multi-site study included a stratified sample of six community meetings (n=61) conducted across six villages in two districts of Pursat Province, Cambodia in August 2019. Small connected community methodology was employed to gather qualitative data and semi-structured community meetings were utilized to collect data. Thematic analysis and diffusion of innovation theory was used to analyze data derived from this study. Qualitative findings identified the following facilitators of latrine construction: relative advantage (overall health and well-being, convenience, and environmental awareness); complexity (perceived level of simplicity); compatibility (obligation to others); and observability (demonstrations, observable improved health of others). Latrine construction barriers included complexity (lack of resources) and compatibility (interferences to daily life). Facilitators of latrine construction included: relative advantage (overall health and well-being, convenience, economic advantages, and environmental impacts), complexity (ease of use); compatibility (obligation to others); and observability (demonstrations). The latrine uptake barrier was compatibility (misalignment with current practices). Compared to neighboring countries, basic sanitation within Cambodia continues to be a challenge. Rural Cambodians lack resources pertaining to knowledge (of how to build latrines) and cost (of materials). The development and implementation of health education and health promotion programs may effectively address the sanitation challenges in rural communities in low income and developing countries, while simultaneously enhancing the quality of life and well-being of communities.
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.

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