▼ Background: Since the outbreak of HIV/AIDS in the 1980s, governments, nongovernmental organizations and public health professionals have been trying to find treatment and prevention strategies that can help control the transmission of the disease. However, after three decades, the disease continues to remain a global menace. African immigrants in the United States are at high risk of HIV/AIDS because of their sexual behaviors and their unwillingness to communicate about their sexual behaviors to their partners, but they are the least studied subpopulation in the U.S. Purpose: Therefore, the purposes of this study were to examine the extent to which: (a) the constructs of the Health Belief Model (HBM) predict safer sexual behavior and sexual communication of African immigrants, (b) the level of acculturation predicts African immigrants' safer sexual behavior and sexual negotiation, and (c) sexual communication predict safer sexual behavior. Methods: The design for the study was cross-sectional in nature as such the data were collected at one point in time. A 64-item questionnaire based on constructs of HBM and acculturation levels was administered to a convenience sample of 412 African immigrants in Ohio. A snowball method was used in the recruitment process. Content and face Validities of the instrument were established by a panel of six experts. The readability, comprehension and the appropriateness of the instrument were also established through a pilot test. The reliability of the instrument was tested using test-retest reliability and internal consistency methods. The Cronbach's alpha and correlation coefficient for the subscales were found to be more than .70 alpha level established a priori. An extended version of exploratory factor analysis and confirmatory factor analysis using Structural equation model were used for the construct validity of the instrument. Results: The results for both approaches yielded acceptable factor loadings (.30) for the instruments. The binary logistic regression analysis revealed the HBM and acculturation as a set significantly accounted for the variance of condom use, monogamous and sexual communication behaviors of the participants. The major findings showed that the HBM constructs of perceived susceptibility (OR = 1.10), perceived barriers (OR = 1.10), cues to action (OR = 1.19), and self-efficacy (OR = 1.21) were significant predictors of condom use among the participants (p < .05). Also, there was a significant association between perceived barriers (OR = 1.53) and monogamous relationships among the participants (p < .05). However, the self-efficacy construct had a negative correlation with the participants' monogamous behaviors. The results also showed that there were significant relationships between participants' sexual communication behaviors and cues to action (OR = 1.22), perceived benefits (OR = 1.45), and perceived susceptibility (1.14). Acculturation was found to be contributing to the variance in the participants' sexual communication behaviors (OR = 1.08). However, acculturation did not have any association between the participants' condom use and monogamous behaviors. Conclusion: Based on the findings, a future HIV/AIDS risk reduction program among African immigrants should include perceived susceptibility, cues to action, self-efficacy, perceived barriers, and perceived benefits of condom use and sexual communication behaviors. Advisors/Committee Members: Sharma, Manoj.

▼ During the past three decades the prevalence of child and adolescent obesity has tripled and currently 31.7% of children and adolescents are either overweight or obese. This is of concern due to the reported metabolic, psychological and social consequences associated with excess weight gain. While obesity occurs as the result of a sustained energy imbalance, there are many reported factors associated with its etiology. Interventions that can favorably impact such factors such as a healthy diet and physical activity could help prevent its onset early in life and spare children from reported metabolic and psychological consequences. Schools are one place intervention strategies are needed, however many obesity prevention interventions that have been implemented in this setting have produced mixed or modest outcomes. The after-school time frame is another excellent opportunity for such strategies, however less work has been done in this area compared with school-based interventions and more studies are needed. The purpose of this study was to evaluate the efficacy of a social cognitive theory based childhood obesity intervention with children in the after-school environment. This study employed a group randomized controlled design, whereby a convenience sample of twelve after-school programs were randomized into either an experimental (social cognitive theory based) or comparison (knowledge-based) intervention. A pretest, post-test and three month follow up test was conducted to evaluate the programs effects on BMI-percentile, key obesity prevention behaviors (fruit & vegetable consumption, sugar-sweetened beverage consumption, sugar-free drink & water consumption, the engagement of physical activities, and the engagement of sedentary activities), and three constructs of social cognitive theory (self-efficacy, expectations (comprising of outcome expectations and outcome expectancies), and self-control) related to each behavior. Both interventions consisted of four-30 minute sessions that were implemented over a four-week period. Process evaluations were used during each session to evaluate program fidelity and dose. A convenience sample of 71 children (37 in the experimental and 34 in the comparison) completed the interventions and were used for the final data analyses in this study. Results indicated that study variables and demographic variables were not different for children in the assigned groups at baseline. Process evaluations suggested that both programs were implemented as planned. It was found that BMI-percentile, all obesity related behaviors, and social cognitive theory constructs did not change between groups over the course of the intervention. There was however a significant main effect, indicating an improvement in both groups for fruit and vegetable consumption, the engagement in physical activity, the engagement in screen time, water and sugar free beverage consumption and self efficacy for fruit and vegetable consumption and physical activity. It can be concluded that the two interventions in this study may not have been very different from each other to discern changes. It is also likely that the experimental intervention may not have been of adequate length to truly produce the desired changes targeted in this study. More work is needed in this area to find appropriate, theory-based, health education programs that can complement larger health promotion efforts. Advisors/Committee Members: Sharma, Manoj.

▼ The purpose of this study was to examine university students’ perceived importance of knowledge of eating disorders, overall confidence in appropriately intervening with a friend who has an eating disorder and whether their perceived importance of knowledge and confidence levels differed based on sex, current involvement in disordered eating and extent of social connections. This study sought to fill current gaps in the literature regarding disordered eating. This information is important to strengthen future educational efforts related to the identification and acknowledgement of eating disorders with friends and family. A total of 421 participants were surveyed during the spring 2010 quarter at a Midwest university. The sample included students from a variety of courses. Valid and reliable subscales were developed for the 86-item questionnaire. Descriptive statistics, multivariate analysis of variance, Chi-square analysis, and Pearson correlations were used to analyze the data. Results indicated participants’ confidence addressing disordered eating in their friends was moderate. Further, participants felt having knowledge about disordered eating was important and that disordered eating is a significant issue on college campuses. Both importance of having information and confidence addressing disordered eating differed significantly based on sex. Females felt this issue was of greater importance, in addition to expressing more confidence addressing the issue. Recommendations have been included for future studies. Advisors/Committee Members: King, Keith.

▼ Background: Of children and teenagers aged 6–19, 16% (almost 9 million) were obese (i.e. Body Mass Index at or above the 95th percentile for children of the same age and sex) and this number has continued to increase. Increased understanding of proper nutrition and the need for physical activity among adolescents will likely prevent health problems associated with overweight and obesity, and improve quality of life into adulthood. In particular, when considering determinants of obesity responsive to change, a focus on modifiable, prevalent, and relevant behaviors among adolescents should be taken. Purpose: The purpose of this study was to examine the extent to which constructs of the Theory of Planned Behavior (TPB) (behavioral intent, attitudes, social norms, and perceived behavioral control) predicted four behaviors linked to childhood obesity in middle school children: daily physical activity, sedentary behaviors, fruit and vegetable intake, and water versus sweetened beverages consumption. In addition, a valid and reliable instrument which adequately reified the constructs of the TPB in relation to the aforementioned behaviors was developed. Methods: A cross-sectional design was implemented to obtain a convenience sample of 318 middle school students. Prior to the administration of the instrument to the entire student population, factor analysis and reliability estimates were conducted with a sub-group of students. The 129-item instrument was administered during health, physical education, and art classes. Multiple regression and structural equation modeling were used to establish the predictors for each behavior. Results: Almost 25 % of the students were considered overweight or obese. Students did not meet the recommended five servings of fruit and vegetables per day (M = 3.67); participated in more than the 1-2 hours recommended screen time (M = 187.42 minutes); and had an increased risk of obesity with their sweetened beverage consumption (M = 1.59 glasses) per day. The mean behavioral intention scores for the behaviors were as follows: screen time behaviors (M = 12.31, SD = 5.42); physical activity (M = 12.84, SD = 7.18); fruit and vegetable consumption (M = 12.18, SD = 5.74); sweetened beverages versus water consumption (M = 12.42, SD = 6.07) – denoting a moderate intent to participate in the behavior. Regression results showed that behavioral intention was predictive for screen time among overweight and obese students, participation in physical activity among all students, consumption of fruits and vegetables among overweight and obese students, and consumption of water versus sweetened beverages in normal weight students (p < 0.05). The most predictive constructs of the Theory of Planned Behavior were subjective norms and perceived behavioral control – accounting for up to 11.4% of variance in the behaviors. Conclusion: Behavioral intention was linked to the four behaviors suggested for obesity prevention in adolescents. Differences among those students who were considered normal weight and overweight/obese existed, and should be considered when designing future programs. The Theory of Planned Behavior presented a beneficial framework for improving behavioral intention among adolescents, with hopes to progress toward positive behavior change in nutrition and physical activity behaviors. Advisors/Committee Members: Sharma, Manoj.

▼ Diabetes Mellitus was a disease that made its presence known in all races, ethnicities, ages, and genders, for it did not discriminate. African Americans were the second largest prevalence of diabetes following Alaskan Natives/Americans Indians. Through the implementation of the levels of disease prevention, African Americans were seen in the secondary or tertiary levels due to lack of access to resources located in the primary level. Thus, African Americans were at high risk for delayed diagnosis of type 2 diabetes when they were already experiencing complications of the disease. The purpose of this study was to examine knowledge and attitude differences among African Americans and Caucasians prior to and after attending a diabetes education program considered a “best practice” in the field of diabetes. Racial differences in knowledge and attitudes were assessed specifically among newly diagnosed patients with type 2 diabetes. Through the use of a medical chart review, a quasi-experimental design, patients (n = 100, 50 African Americans, 50 Caucasians) completed pre-tests and post-tests assessing knowledge and attitudes about diabetes before and after completion of a diabetes education program. Some significant findings included lower knowledge levels among African American patients on pre-test (p = 0.012). Patients who attended individual education sessions had significantly higher knowledge levels on their post-tests (p = 0.022). Although 63% of the patients were female (37% male), no significance was found when to sex was used as a variable in relation to knowledge and attitude scores among African Americans and Caucasians. Recommendations for further research would be to use the same pre-test, post-tests instrumentation for evaluation, however at another American Diabetes Association (ADA) recognized diabetes education program to assess these findings on a larger scale. Advisors/Committee Members: Sharma, Manoj.

▼ Sleeping 7 to 8 hours on a daily basis is an essential element of optimal health. The purpose of this study was to operationalize the constructs of the Theory of Planned Behavior (TpB) to predict the sleep intentions and behaviors of undergraduate college students attending a Midwestern University. Data were collected from cross-sectional convenience samples over three phases. Phase I encompassed collecting qualitative data (n=11) for instrument item generation. Phase II entailed collecting data (n=37) for reliability testing. Phase III data (n=197) assessed the efficacy of the instrument to predict the sleep intentions and behaviors of the sample. For phase III, a power analysis was conducted to determine a sufficient sample size (α = 0.05, β = 0.80, ρ = 0.20). Instrumentation included readability by Flesch-Kincaid ease and grade level tests, face and content validity by a panel of six experts, reliability by test-retest, construct validation applying confirmatory factor analysis, and internal consistency by Cronbach's alpha. Multiple linear regression modeled the predictors of perceived behavioral control (β =0.457, t=7.882, p < 0.001), subjective norm (β =0.179, t=3.000, p = 0.003), and attitude toward the behavior (β=0.231, t=3.865, p < 0.001) on behavioral intention. Collectively, the significant predictors produced an R2 adjustedvalue of 0.362 (F (3, 196) = 38.133, p < 0.001), suggesting the model accounted for 36.2% of the variance in the behavioral intention to obtain adequate sleep in the sample of participants. Binary logistic regression was employed to model adequate sleep behavior. Behavioral intention (B=0.067, Wald χ 2 (1) = 4.440, p = 0.036) and sleep hygiene (B=0.055, Wald (χ 2 (1) = 10.006, p = 0.002) were found to be significant predictors of sleep behavior; conversely, gender was not significant in the prediction of sleep behavior (B=0.475, Wald χ 2 (1) = 1.670, p = 0.196). Analysis revealed that for each one unit increase in behavioral intention the odds of obtaining adequate sleep increased by 7.0%. Similarly, for each one unit increase in sleep hygiene the odds of obtaining adequate sleep behavior increased by 5.7%. The TpB was found to be a useful framework for designing health promotion and education interventions for improving the sleep intentions and behaviors of undergraduate students. The results of this investigation provided a valid and reliable instrument for application in the measurement of TpB based interventions targeting undergraduate sleep health. Advisors/Committee Members: Sharma, Manoj.

▼ Engaging in risky sexual behaviors poses serious risks to university students across the United States. Sexually transmitted infections and unplanned pregnancies are highest among the age group of university students. A low level of body image satisfaction is another prevalent issue among university students that may be linked to risky sexual behaviors. Specifically regarding university students, more research is needed to thoroughly understand the relationship between risky sexual behaviors and body image. A comprehensive review of literature revealed several studies that had examined body image and general sexual activity. However, a gap in the research literature was found regarding the potential impact of body image and involvement in risky sexual behaviors. Therefore, the present study was conducted. The purpose of this study was to examine the impact of body image on students’ involvement in risky sexual behaviors, including age at first sexual intercourse, number of lifetime sexual partners, number of recent sexual partners, ever having engaged in a one-night stand, ever having engaged in sexual intercourse under the influence of alcohol or other drugs, ever having engaged in sexual intercourse while intoxicated, ever having engaged in sexual intercourse without the use of a condom, use of a condom during last sexual intercourse, number of lifetime sexual intercourse partners without the use of a condom, frequency of condom use during sexual intercourse and perceived-self efficacy regarding condom use. This study also examined whether body image satisfaction differed significantly among sexually active university students based on: sex, grade, and level of social support. A total of 465 university students in general education courses at a Midwestern University completed surveys during the 2011 spring quarter (93% response rate). A two-page, 51-item survey was developed and tested for validity and reliability. Descriptive statistics, independent sample t-tests, chi-square tests, multivariate analyses of variance, and univariate F-tests were performed to analyze the data. Results indicated that most students (78.9%) had engaged in sexual intercourse during their lifetime and 80.5% of sexually active students had engaged in sexual intercourse without the use of a condom. In addition, more than half (53.8%) reported having a low level of body image satisfaction. Engaging in sexual intercourse significantly differed based on level of body image satisfaction. More specifically, students who had high body image were significantly more likely than students who had low body image to have ever engaged in sexual intercourse. However, results indicated no significant relationship between body image and involvement in risky sexual behaviors such as those noted above. Body image satisfaction among students did significantly differ based on level of social support. Students who had high levels of social support had significantly higher levels of body image satisfaction. Recommendations have been included for future studies. Advisors/Committee Members: King, Keith.

▼ Teenagers experience feeling of stress, confusion, pressure to succeed, self-doubt, and other fears while navigating their way to adulthood. Teens have common experiences of stress across race, ethnicity and economic background, but there are stressful experiences during the teen years that differ due to the context of the community and school environment. Research related to stress in high-achieving schools is limited. With the increasing pressures of achievement and competition for college entrance, particularly in a community with higher parental expectations and a long standing history of academic excellence, exploring stress through the eyes of those living the experience is needed to understand their experiences, identify the supports that exist to help them cope and initiate additional resources that may be needed to further support their healthy journey through high school and beyond. Photovoice has been an effective method for conducting participatory needs assessments. Students, parents, and high school faculty/staff in a high-achieving, Midwestern, suburban high school were engaged in conducting a participatory needs assessment. Students used a three-round, six-week photovoice project to depict their stressors and coping, whereas parents and faculty/staff participated in focus groups to discuss their perceptions of the high school student stress and coping. The overarching themes related to stress identified by the students, parents and faculty/staff included a sense of belonging and acceptance, time, expectations of school and success, and substance use. The themes related to coping identified by the students included reflections of self and situation, using nature and animals, positive relationships, finding an escape or distraction, and making choices to move on. Students also identified a two-stage process of coping which involved using emotion-focused coping strategies to deal with the stressful situations in the moment and then using problem-focused coping strategies to effectively “move on” through the stress. The parents and faculty/staff identified the major theme of student use of distractions or procrastination to cope. Students recommended increasing opportunities for peer connection as a way to decrease the stress of social acceptance. Both students and parents identified that students needed more training and better coping skills. Parents also suggested that the role of the school nurse be strengthened and expanded to include specific mental health training and to be a more visible resource for the students and also suggested that a more detailed guide be designed for parents and students (junior year) for the college search to assist in managing the stress related to that process. The faculty/staff identified enhanced emotional capacity of parents and teachers (or other adult resources at the school) as a critical coping resource for students and suggested that emotional capacity be included in screening of new faculty/staff hires. In addition it was recommended that current faculty/staff receive education and training in enhanced emotional capacity as part of professional development and could be offered as part of a district wellness program for employees. The findings from this study support the concept of coordinated school health as well as school connectedness, which have been shown to improve adolescent health and well-being. School health and wellness professionals and wellness teams can use this research to guide health and wellness needs assessments and evaluations within their school district. Health education professionals within the school can use this information to creatively engage students in exploring their perceptions of various health topics through the photovoice process. Other educators can use an adapted photovoice process as an innovative teaching strategy to stimulate discussion and writing about various topics. Advisors/Committee Members: Bernard, Amy.