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ABSTRACTThe purpose of this descriptive cross-sectional study is to examine the factors that contribute to overweight, decreased physical activity and body dissatisfaction in the 12 to 17 year old, ethnically diverse California adolescent and to determine if there are differences among gender and race. Data from the 2005 California Health Interview Survey (CHIS) for adolescents self-identified as Latino, Asian, or White were reviewed. Adolescents reported weight, height, gender, ethnicity, parent education attainment, household income, physical activity, sedentary activity, breakfast consumption, family meals and body satisfaction. Parent information was also used in exploring factors contributing to decreased physical activity and these variables included parent physical activity, acculturation level and BMI. The main findings in this study were that gender and ethnic variations exist in factors contributing to overweight, decreased physical activity and body dissatisfaction in California adolescents. The key factors associated with both overweight and PA included age, gender, ethnicity, SES, screen time, and parent education attainment. The key risk factors that overlapped for body dissatisfaction and PA included general health status and BMI. A higher percentage of Latino adolescents (38%) compared to 25% of whites and 16% of Asians were overweight. Females are 1.5 times as likely to report decreased levels of physical activity compared with males. Asians were the least active and also reported the highest levels of sedentary activity. Across gender and ethnicity reports of poor/fair general health status and overweight were associated with body dissatisfaction. Latina females and Asian males were the least satisfied with their bodies. Overall, there seems to be a relationship between overweight, decreased physical activity and body dissatisfaction in California adolescents. The findings in this study support the need for development of culturally sensitive and gender specific interventions to improve the health behaviors in the adolescent population.

Background. Community -based participatory research (CBPR) is an egalitarian approach to research that is gaining popularity due to its success in achieving long-term sustainable improvements in community health, yet little CBPR is currently underway in Malawi, Central Africa. Malawians suffer from poverty, food insecurity, HIV and AIDS and have a reported life expectancy of 48 years of age. Although non-governmental organizations (NGOs) have pivotal roles in their work with donors and local communities in addressing these issues, little CBPR literature reflects NGO perspectives.Theoretical framework. Ecosocial theory underpins the study with its dual emphasis on social justice and scientific methods. Health disparities are examined in light of social, environmental and economic constructs as well as from a biological basis.Purpose. The purpose of this research was to explore perspectives of NGO staff in order to understand barriers and facilitators in their work with communities. The study addressed three primary questions: 1) How do NGOs build trust and relationships with community members and agencies?; 2) What are the perspectives of NGO staff regarding their interactions or experiences with donors?; 3) How do Malawi women effect change in their communities? Methods. Using a qualitative, public ethnographic method, 26 semi-structured interviews were conducted in the US and Malawi of staff, volunteers, board members and partners of NGOs and community-based organizations (CBOs). Interviews were audio-taped, transcribed and the data input into Atlas.ti, and analyzed. Findings. Three themes emerged: 1) how NGOs gain community trust; 2) donor power; and 3) how socially disempowered Malawi women effect change in their communities. Study participants consistently advised a bottom-up approach when working with communities and stated that donors and NGOs need to respect cultural norms, listen to community members' priorities, engage communities in activities or research and recognize that communities possess important knowledge. Participants cautioned that while it is easy to slip back into top-down roles, the time and patience required to work from a bottom-up approach does produce long-term sustainable results. Although most participants were unfamiliar with CBPR, their recommendations concur with CBPR principles. Conclusion Community -based participatory research is an appropriate approach to working with Malawian communities.

BACKGROUND. Death from all causes during tuberculosis (TB) treatment has remained about 10% in San Francisco County. Estimating risk factors for all-cause mortality was this study's aim.METHODS. A retrospective cohort study design was used to examine 1,730 subjects with TB older than 24 years in San Francisco from 1995 to 2004. The observation period was from the first day of TB treatment to the last day of treatment or death from any cause. Mean follow-up was 35.8 (± 20) weeks. Host characteristics including age, gender, race, immigration, and language; social-environmental factors including residence, incarceration, and unemployment; TB disease characteristics including anatomic site, culture, chest radiograph, resistance, previous TB; comorbid conditions including HIV coinfection and substance use; health care delivery factors including directly observed (DOT) or self-administered therapy (SAT), and public or private TB medical provider were tested for their predictive value on all-cause mortality.RESULTS. All-cause mortality was 10.6% (184/1730); 50% of deaths (92/184) occurred < 8 weeks of treatment. Statistically significant predictors of all-cause mortality were age 45-64 (OR 2.2, 95% CI: 1.3, 3.9), age ≥ 65 (OR 2.5, 95% CI: 1.3, 4.7); male gender (OR 1.6, 95% CI: 1.1, 2.4); homelessness (OR 2.1, 95% CI: 1.2, 3.5); not working (OR 5.9, 95% CI: 3.0, 11.5); HIV coinfection (OR 8.1, 95% CI: 3.8, 17.0); and private TB medical provider (OR 3.8, 95%CI: 2.6, 5.7). Previous TB was associated with protection from all-cause mortality (OR 0.6, 95% CI: 0.3, 0.9); concomitant extrapulmonary TB was not associated with all-cause mortality (OR 1.3, 95% CI 0.9, 1.8). Subset analysis of patients receiving public TB care showed that SAT (OR 0.5, 95% CI 0.2, 0.9) and a combination of DOT and SAT were associated with a protective effect when compared with DOT only (OR 0.3, 95% CI: 0.1, 0.8). CONCLUSION. Middle and older age, male gender, homelessness, not working, positive TB culture, and HIV coinfection predict all-cause mortality. Private TB medical provider was predictive of mortality, and the combination of DOT and SAT is beneficial, suggesting that public-private, TB-care partnerships need to be strengthened and that supervision of therapy should be flexible.

Anne M. Hughes Poverty is a global public health problem with profound moral implications about what it means to be [a]part of the human community. In the United States, one in eight persons lives below the federal poverty line, a metric widely believed to underestimate the scope of the problem. While several ethnographies have described communities affected by poverty, far less research has focused on the personal toll of being poor in an urban area while struggling with a serious illness. Dignity is a concept addressed in human rights declarations, discussed in theological and philosophical descriptions of personhood, and described in clinical contexts relating to end of life care, physician assisted suicide, aging and disabilities. The purpose of this primarily interpretive study was to describe the meaning and experiences of dignity to the urban poor with advanced disease using a mixed methods design. First person in-depth accounts through individual or group interviews and field notes were primary data sources; a survey examined Chochinov's inductively derived model of dignity. Participants included 31 adults, with an average age of 52 years, who were living with cancer, HIV disease or both illnesses. Participants had multiple vulnerabilities: almost 75% were from communities of color and approximately two thirds had histories of homelessness, substance abuse, or other co-morbidities. Ten participants died during data collection. Many participants discussed respect rather than dignity, respect given to and received from others, and self-respect. Most narrated difficult personal biographies that included the loss of beloved family members and other traumas. While describing their illness experiences, difficulties with health care systems and health care providers were noted frequently and described in vivid detail. Participants were significantly (p

The purpose of this cross-sectional study is to: 1) describe the physical activity levels in Thai fourth-grade students in Bangkok; 2) explore factors that determine the level of physical activity in Thai fourth-grade students in Bangkok; and 3) report psychometric data from questionnaires used in this study. A convenience sample of 398 healthy students (mean age: 10.0 yrs; S.D. 0.45 yrs.), from six elementary schools in Bangkok during the 2006 academic year, were enrolled in the study. Parents provided family demographic information, described how their children used their free time (time-use behavior), and assessed their family's support for physical activity. Children wore a pedometer (Walk-for-Life Duo) and filled out a pedometer log for six consecutive days. The children met with research assistants every weekday to record the number of steps they had taken that day. The children also completed four questionnaires (Child's Perceived Barriers to Play Actively, Child's Self-Efficacy to Play Actively, Child's Perceived Physical Activity Enjoyment, and Child's Perceived Social and Physical Environment for Physical Activity Scales). The mean number of steps taken by the children was 10,079 steps/day (SD 2811). The mean number of steps taken on weekdays was 10,407 steps/day (SD 2927) and 8761 steps/day (SD 3317) on weekend days. Boys were significantly more active than girls (Boys 11,021 (SD 2917); Girls 9,168 (SD 2381); P

The purpose of this prospective, longitudinal repeated measures study was to explore the relationships between HIV-infected mothers' perceptions of uncertainty about infant HIV serostatus and maternal stress, distress, and social support during the infants' HIV viral testing. HIV-infected women were eligible to participate if they were at least 18 years old, English speaking, and were the primary caretaker for their infants. Six study visits were required: a visit during the third trimester of pregnancy and 5 postpartum visits clustered around infants' second and final HIV viral testing. Data collection included maternal and infant demographics, clinical variables, standardized questionnaires, and maternal responses to questions addressing their most worrisome concern. During the final study visit, maternal interviews about their infants' HIV testing were audiotaped and transcribed. Descriptive statistics, Pearson's r, and RMANOVA were used to analyze quantitative data; qualitative methods were used to analyze interviews. Twenty mothers enrolled: 40% African American, 40% white, 10% Hispanic, 10% Native American/Other; mean age = 32.25 years; mean education = 14.5 years. All infants in the study were determined to be HIV negative. Mothers were most concerned about infant health during the prenatal and early postpartum period. While infant concerns diminished after the second negative HIV test they rebounded prior to obtaining the final viral test. Family and psychosocial issues were the primary maternal concerns after infant viral testing was completed. Maternal health issues never surpassed infant or psychosocial issues as a primary concern. There was a significant decrease in maternal uncertainty about infant HIV serostatus over time (p

The purpose of this thesis is to describe the experiences of individuals who continue to smoke following a myocardial infarction. This manuscript-based thesis consists of three distinct papers to be submitted to nursing journals for publication. The first manuscript provides a critique of the research literature pertaining to predictors and perceptions of continued smoking for individuals with coronary artery disease. The second manuscript reports the findings of a qualitative study that was conducted to describe the meaning of smoking within the context of a myocardial infarction, and to determine factors that influence continued smoking. The third manuscript explores ethical implications that emerged from the first two manuscripts. This thesis illustrates how addictive behaviours often have underlying meanings, how continued smoking becomes more understandable when viewed in the context of people's lives, and how possibilities for change can be derived from the ways that clients view their heart disease and smoking.

The purposes of the study were to investigate homeless men's experiences of taking medications while living in a homeless shelter and the factors that affect medication adherence; and to describe medication adherence, as it pertains to homeless men residing in a shelter, from the perspective of the shelter staff. This is a manuscript-based thesis. The first manuscript provides a description of a proposed ecological model, based on clinical experience of the author and from the literature. The second paper is a summary of the findings of the qualitative research on medication adherence and homeless men's shelters. The third manuscript, directed at pharmacists, offers recommendations and strategies based on results of the qualitative study, to improve medication adherence. This thesis suggests that when health professionals view adherence to medications as an individual, cognitive choice, it does not take into account the challenges imposed by a homeless individual's environmental context.

Background. In Ontario, the 1994 Tobacco Control Act allowed municipalities to legislate on second-hand smoke in public places. Public health departments were then mandated to promote the passage of smoke-free bylaws in various municipalities. Their efforts have met with varying degrees of success. However, in 2001, the city of Ottawa public health department successfully promoted the adoption of one the cornerstone 100% smoke-free bylaw in Canada. Objective. The purpose of this study was to examine the factors that influenced the process of municipal councillors' adoption of the Ottawa smoke-free bylaw. Methods. This mixed-methods case study focused on the public participation aspect of the case through the analysis of interviews, public opinion surveys and newspaper articles using qualitative, quantitative and triangulation methods. Findings. The study identified four critical elements in the passage of the smoke-free bylaw: (1) Initiation of the bylaw development process, (2) Municipal councillors' position before the final vote, (3) Municipal councillor's final vote and (4) Municipal councillors' position after the final vote. Five lever factors (1) Perceptions of public opinion, (2) Public participation, (3) Dynamics of the democratic process, (4) Context of the smoke-free bylaw development and (5) Context of newness were found to have influenced the critical elements, each in a particular way. Lever factors are presented as characteristics of the context of the bylaw adoption that increased the effect of the strategies and interventions conducted by the groups supporting the passage of the bylaw. Discussion. This case study identifies conditions that enhance the leverage of tobacco control strategies and highlights how the convergence of factors is key to successful tobacco control policy change at the municipal level.

This thesis describes the development of a curriculum for a prenatal breastfeeding workshop and the randomized controlled trial that was completed to test the hypotheses that the workshop would have a positive influence on maternal breastfeeding self-efficacy and that increased self-efficacy would positively affect breastfeeding duration. Breastfeeding self-efficacy, measured with the Breastfeeding Self-Efficacy Scale-Short Form, and breastfeeding duration, recorded as number of days and amount of breastfeeding, were measured at 4 and 8 weeks postpartum. The results of this study suggest that the prenatal breastfeeding workshop had a positive effect on maternal breastfeeding self-efficacy and on the amount women were breastfeeding. Over time, maternal breastfeeding self-efficacy scores increased in both groups with the intervention group having higher scores. At week 4, there was a significant difference in scores (control, M = 53.38 (SD = 9.1); intervention, M = 57.98 (SD = 8.6), t(78) = -2.32, p = .023, d = .523, CI -8.53, -0.65) At week 8, there was a difference in scores, but given the small sample size, these were not statistically significant (control, M = 58.91 (SD = 9.1); intervention, M = 61.70 (SD = 5.8), t(72) = -1.60, p = .115, d = .412). Although there was little difference between the groups in the number of days of breastfeeding, the intervention group had more exclusive breastfeeding (70% vs. 58%) and less weaning (15% vs. 22%) when compared with the control group. The most common reason for weaning was insufficient milk supply. (Abstract shortened by UMI.)

Reducing intimate partner violence levels in southern Africa is a necessary component of an effective HIV primary prevention strategy. A prerequisite to behaviour change is a shift in attitudes. This study sought to identify effective ways of assessing and changing attitudes and behaviours towards IPV to prevent HIV infection in a developing country context. Combining a systematic review of current evidence with advanced statistical analyses of data from a southern Africa regional household survey (n = 20,639), Soul City Regional Evaluation Phase 1, findings indicate that: a gold standard to measure IPV attitudes and behaviours is needed; interventions targeting structural change and based in the community are more effective; the effectiveness of mass media interventions may not be robust; the interaction of different prevention interventions may mediate overall effectiveness. Exploratory factor analysis, multiple imputation, and regression techniques were applied to complex, multileveled, and correlated data with missingness.

A qualitative study, using interpretive description, was conducted at a tertiary paediatric hospital. Its purpose was to determine attitudes and beliefs of nurses and physicians about parental presence during paediatric trauma resuscitations in the Emergency Department. Parental presence was believed to have both benefits and problems for patients, parents and the trauma team. Registered nurses and physicians expressed largely similar attitudes and beliefs related to parental presence. These depended heavily on context. Most participants believed presence was appropriate with stable children and when death was imminent. In between these two ends of the continuum, participants had greater variability in their attitudes and beliefs. Findings provide insight into how health care professionals believe they can deliver the highest quality technical care for the patient while meeting the psychosocial needs of all involved. Relevance of the findings to family centred-care is discussed. Implications for nursing practice, education and research are identified.