Health care utilization behavior of elders in a multicultural urban environment

The objective of this research is to determine the influences of social, environmental, behavioral, and economic forces on the health care service utilization of four racial/ethnic groups of non-institutionalized elders in a multicultural urban environment. To address these issues this dissertation examines three intertwined themes of culture, aging, and health, using a sample of elders residing in Miami-Dade County, FL in four racial/ethnic groups: white non-Hispanic; black non-Hispanic English speakers; Cuban; and non-Cuban Hispanic. ^ The research questions were analyzed using both quantitative and qualitative data. Data for the quantitative component uses telephone survey data from the Dade County Needs Assessment. The purpose of this component is to develop a more comprehensive model of elder health care utilization behavior. The qualitative component uses data from focus groups from Dade County Needs Assessment, archival data and a literature review of previous ethnographic research. The purpose of this component is to gain a better understanding of the social construction of the terms “age”' and “aging,” as well as to place issues of health and health care in the lives of elders. ^ The findings raised several important issues. First, just because people share a common chronological age does not mean that they are the same in every other respect. Examining elders as a homogeneous group of users of formal health care services in a community is simplistic. Placing “aging” and “health” in a cultural context is important. My findings confirm that the meaning of “aging” and “old” are socially constructed. Further, the term “aging” is NOT synonymous with ill health or frailty. This was a consistent finding in both the quantitative and qualitative results. ^ While all aging individuals share a mutual orientation toward aging (i.e., biological process), they do not age the same way (i.e., social construction of “aging”). Thus, policymakers and others serving the elder population must be aware of the particular cultural context, as well as the previous life experiences of the individuals that they serve. This analysis documents the importance of culture and geographic community in understanding health care service utilization of elders. ^

Use of structural equation modeling to examine the association between breast cancer risk perception and repeat screening mammography among United States women

Breast cancer is the second leading cause of cancer death in United States women, estimated to be diagnosed in 1 out of 8 women in their lifetime. Screening mammography detects breast cancer in its pre-clinical stages when treatment strategies have the greatest chance of success, and is currently the only population-wide prevention method proven to reduce the morbidity and mortality associated with breast cancer. Research has shown that the majority of women are not screened annually, with estimates ranging front 6% - 30% of eligible women receiving all available annual mammograms over a 5-year or greater time frame. Health behavior theorists believe that perception of risk/susceptibility to a disease influences preventive health behavior, in this case, screening mammography The purpose of this dissertation is to examine the association between breast cancer risk perception and repeat screening mammography using a structural equation modeling (SEM) framework. A series of SEM multivariate regressions were conducted using self-reported, nationally representative data from the 2005 National Health Interview Survey. Interaction contrasts were tested to measure the potential moderating effects of variables which have been shown to be predictive of mammography use (physician recommendation, economic barriers, structural barriers, race/ethnicity) on the association between breast cancer risk perception and repeat mammography, while controlling for the covariates of age, income, region, nativity, and educational level. Of the variables tested for moderation, results of the SEM analyses identify physician recommendation as the only moderator of the relationship between risk perception and repeat mammography, thus the potentially most effective point of intervention to increase mammography screening, and decrease the morbidity and mortality associated with breast cancer. These findings expand the role of the physician from recommendation to one of attenuating the effect of risk perception and increasing repeat screening. The long range application of the research is the use of the SEM methodology to identify specific points of intervention most likely to increase preventive behavior in population-wide research, allowing for the most effective use of intervention funds.^

Character education in a Muslim school: A case study of a comprehensive Muslim school's curricula

Deteriorating social behavior, negative media influence and violence among adolescents have given cause to pause and assess character development for the youth of this country. The purpose of this case study was to examine how a Muslim school’s curricula implemented character education. This study used a qualitative single-case methodology to examine character education as it was experienced by the participants in a private Muslim school. Data were collected from participant interviews, document analysis, and observations of classrooms, daily activities and special events. Data were analyzed to determine how character education was defined by the school, the method of delivery for the character education initiatives and the implementation of character education in this Muslim school. Analysis was based on Character Education Partnership’s (CEP) Eleven Principles of Effective Character Education (2007). The results of the study revealed: (a) participants defined character education using varied traits, processes, and expected behaviors. (b) The school delivers its character education curriculum primarily through the Islamic studies division; an add-on delivery method. Still, there was evidence of partial integration of character education in the core courses and (c) based on CEP’s Eleven Principles four were present and five were partially present in the school’s character education initiatives. Findings also revealed that the school’s emphasis on values, morality and spirituality was instrumental in their teaching character. Findings suggest that if participants in the school community work together they might formulate a definition of character education based on common process and expected behavior and create a collaborative working relationship to implement a character education program. Finally, addressing the absent and partially absent elements of the eleven principles could enhance the school’s character education initiatives. The study provides a process by which religious schools could examine their character education programs. The criteria used to measure the use of character education elements are transferable to other settings; however, this method of study does not allow generalization of findings.

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

Purpose: Over half the HIV-infected persons in the Caribbean, the second most HIV-impacted region in the world, live in Haiti. Using secondary data from a parent study, this research assessed the effects of psychological and social factors on antiretroviral therapy (ART) adherence among Haitian, HIV-positive, female alcohol users. Theoretical Foundation and Research Questions: Using the Theory of Planned Behavior/Reasoned Action and the Information, Motivation, Behavior skills model as guiding theoretical frameworks, the study examined the effectiveness of an adapted cognitive behavioral stress management (CBSM-A) intervention in improving ART adherence. The effect of psychological factors (depression, anxiety, beliefs about medicine, and social support), social factors (stigma, relationship status, and educational attainment), and alcohol on adherence to ART was assessed. Methods: The sample consisted of 116 female ART patients who were randomly assigned to the CBSM-A intervention or the wait-list control group. Participants completed intervention sessions as well as pre- and post-test assessments. Analyses of variance, t-tests, and point biserial correlations were used to test hypotheses. Results: Surprisingly, ART adherence rates significantly decreased for both groups combined [F (1, 108) = 8.79, p = .004]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post assessment. On average, depression decreased significantly among participants in the CBSM-A group only [(t (62) = 5.54, p < .001)]. For both groups combined, alcohol use significantly decreased between baseline and post-assessment [(F (1, 78) = 34.70, p < .001)]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post-assessment. None of the variables were significantly correlated with ART adherence. Discussion: Adherence to ART did not improve in this sample, nor were any of the variables significantly associated with adherence. The findings suggest that additional supportive and psychological services may be needed in order to promote higher adherence to ART among HIV-positive females. More research may be needed on this sample; a focus on mental health issues, partner conflict, family and sexual history may allow for better targeting and more successful interventions.

The effects of attribute quality information and sources of information on consumers' perceptions and behavior: A model of Pre-purchase Information Utilization in Service Physical Environments

The search-experience-credence framework from economics of information, the human-environment relations models from environmental psychology, and the consumer evaluation process from services marketing provide a conceptual basis for testing the model of "Pre-purchase Information Utilization in Service Physical Environments." The model addresses the effects of informational signs, as a dimension of the service physical environment, on consumers' perceptions (perceived veracity and perceived performance risk), emotions (pleasure) and behavior (willingness to buy). The informational signs provide attribute quality information (search and experience) through non-personal sources of information (simulated word-of-mouth and non-personal advocate sources).^ This dissertation examines: (1) the hypothesized relationships addressed in the model of "Pre-purchase Information Utilization in Service Physical Environments" among informational signs, perceived veracity, perceived performance risk, pleasure, and willingness to buy, and (2) the effects of attribute quality information and sources of information on consumers' perceived veracity and perceived performance risk.^ This research is the first in-depth study about the role and effects of information in service physical environments. Using a 2 x 2 between subjects experimental research procedure, undergraduate students were exposed to the informational signs in a simulated service physical environment. The service physical environments were simulated through color photographic slides.^ The results of the study suggest that: (1) the relationship between informational signs and willingness to buy is mediated by perceived veracity, perceived performance risk and pleasure, (2) experience attribute information shows higher perceived veracity and lower perceived performance risk when compared to search attribute information, and (3) information provided through simulated word-of-mouth shows higher perceived veracity and lower perceived performance risk when compared to information provided through non-personal advocate sources. ^

Decision-making under extreme *uncertainty: Rethinking hazard -related perceptions and action

Understanding who evacuates and who does not has been one of the cornerstones of research on the pre-impact phase of both natural and technological hazards. Its history is rich in descriptive illustrations focusing on lists of characteristics of those who flee to safety. Early models of evacuation focused almost exclusively on the relationship between whether warnings were heard and ultimately believed and evacuation behavior. How people came to believe these warnings and even how they interpreted the warnings were not incorporated. In fact, the individual seemed almost removed from the picture with analysis focusing exclusively on external measures. ^ This study built and tested a more comprehensive model of evacuation that centers on the decision-making process, rather than decision outcomes. The model focused on three important factors that alter and shape the evacuation decision-making landscape. These factors are: individual level indicators which exist independently of the hazard itself and act as cultural lenses through which information is heard, processed and interpreted; hazard specific variables that directly relate to the specific hazard threat; and risk perception. The ultimate goal is to determine what factors influence the evacuation decision-making process. Using data collected for 1998's Hurricane Georges, logistic regression models were used to evaluate how well the three main factors help our understanding of how individuals come to their decisions to either flee to safety during a hurricane or remain in their homes. ^ The results of the logistic regression were significant emphasizing that the three broad types of factors tested in the model influence the decision making process. Conclusions drawn from the data analysis focus on how decision-making frames are different for those who can be designated “evacuators” and for those in evacuation zones. ^

Endogenous Risk Perception, Geospatial Characteristics and Temporal Variation in Hurricane Evacuation Behavior

The main focus of this thesis was to gain a better understanding about the dynamics of risk perception and its influence on people’s evacuation behavior. Another major focus was to improve our knowledge regarding geo-spatial and temporal variations of risk perception and hurricane evacuation behavior. A longitudinal dataset of more than eight hundred households were collected following two major hurricane events, Ivan and Katrina. The longitudinal survey data was geocoded and a geo-spatial database was integrated to it. The geospatial database was composed of distance, elevation and hazard parameters with respect to the respondent’s household location. A set of Bivariate Probit (BP) model suggests that geospatial variables have had significant influences in explaining hurricane risk perception and evacuation behavior during both hurricanes. The findings also indicated that people made their evacuation decision in coherence with their risk perception. In addition, people updated their hurricane evacuation decision in a subsequent similar event.

The influence of perception of forgetting and gender, ethnicity, and closeness on likelihood of caregiving

As life expectancy increases, the population of older adults is increasing rapidly. The caregiving of older parents by adult children has become a normative experience. Much of the gerontological literature has examined the caregiving experience, particularly in terms of the stresses involved. However, research is only beginning to examine the factors which motivate adult children to begin caregiving. The research described here examined how an elderly parent's memory behavior might influence caregiving decisions. In addition, gender, ethnicity, and parent-adult child closeness were examined to explore how these individual difference variables might influence those caregiving decisions.^ Participants read one of two vignettes describing a social visit with an elderly widow (target). In the vignette, the elderly target experiences several instances of forgetting. The vignettes depicted forgetting behavior established in pilot work as normal or serious. The normal forgetting vignette did not arouse concern and the serious forgetting vignette did arouse concern when the middle-aged participants imagined their mothers in the role of the vignette target. Participants rated their likelihood of engaging in eight caregiving behaviors if their mothers behaved like the vignette target. They also rated their closeness with their own mothers.^ Multivariate analyses of variance indicated main effects for vignette type, gender, ethnicity, and attachment. The likelihood of caregiving was higher when forgetting was more serious and when participants were female, Hispanic, and were highly attached to their mothers. Interaction effects showed that gender differences decreased with increased seriousness of forgetting, and ethnic differences were only significant for the normal forgetting condition.^ Multiple regression analyses indicated that attachment was the most significant predictor of likelihood of caregiving. Gender and ethnicity predicted specific caregiving behaviors. Females were more likely to engage in phoning and cooking, and Hispanics were more likely to engage in visiting and suggesting mother move in. ^

Predicting employee compliance with safety regulations, factoring risk perception

The purpose of this research was to develop a methodology that would evaluate employees' personality traits, demographic characteristics, and workplace parameters to predict safety compliance along with the moderating effect of risk perception. ^ One hundred and twenty five employees of a manufacturing facility were given questionnaires to gather their demographic and perception information. Surveys were also used to measure their personality characteristics, and periodic observations were recorded to document employee's safety compliance. A significant correlation was found between compliance and the worker's perception of management's commitment to safety (r = 0.27, p < 0.01), as well as with gender (r = −0.19, p < 0.05). Females showed a significantly higher average compliance (78%), than males (69%). These findings demonstrated the value of developing a model to predict safety behavior that would assist companies in maintaining a safe work environment, preventing accidents, ensuring compliance, and reducing associated costs. ^

Understanding the cycle of violence: An examination of bully and victim social roles in early childhood

The purpose of this study was to assess the prevalence of bullying and victimization in a metropolitan area. A cross-sectional study with kindergarten (n = 127) and first grade (n = 126) children was conducted in two Miami-Dade County Public Schools and three private schools in the same area. Bullying and victimization behavior and social acceptance were assessed through peer nomination and the mental health outcomes of depression and anxiety were assessed through children's self-report. Teachers and parents also completed a social behavior scale for each child. Three areas of analyses were conducted pertaining to membership classification of social roles and the social acceptance and mental health outcomes associated with those roles, reporter agreement within the social roles, and the psychometric properties of the Childhood Social Behavior Scale. Results showed an overall negative pattern of adjustment for children identified as a member of any of the negative social roles. Also, the results support a new analytic approach to the investigation of social roles. The implication of these findings for early identification, social policy, and effective prevention strategies are discussed. ^

A study of moderating influences of adolescent alcohol drinking conditioned by perception of peer alcohol drinking

Despite a long history of prevention efforts and federal laws prohibiting the consumption of alcohol for those below the age of 21 years, underage drinking continues at both a high prevalence rate and high incidence rate. The purpose of this research study is to explain underage drinking of alcohol conditioned by perception of peer drinking. An acquisition model is conjectured and then a relationship within the model is explained with a national sample of students. From a developmental perspective, drinking alcohol is acquired in a reasonably ordered fashion that reflects the influences over time of the culture, family, and peers. The study measures perceptions of alcohol drinking during early adolescence when alcohol use begins the maintenance phase of the behavior. The correlation between drinking alcohol and perception of classmate drinking can be described via social learning theory. Simultaneously the moderating effects of grade level, gender, and race/ethnicity are used to explain differences between groups. Multilevel logistic regression was used to analyze the relations. The researcher found support for an association between adolescent drinking and perceptions of classmate drinking. Gender and grade level moderated the relation. African-Americans consistently demonstrated less drinking and less perception of classmate drinking than either whites or other students not white nor African-American. The importance of a better understanding of the process of acquiring drinking behaviors is discussed in relation to future research models with longitudinal data. ^

An automatic tuning strategy for local fuzzy logic ramp metering algorithm using Particle Swarm Optimization (PSO)

Freeway systems are becoming more congested each day. One contribution to freeway traffic congestion comprises platoons of on-ramp traffic merging into freeway mainlines. As a relatively low-cost countermeasure to the problem, ramp meters are being deployed in both directions of an 11-mile section of I-95 in Miami-Dade County, Florida. The local Fuzzy Logic (FL) ramp metering algorithm implemented in Seattle, Washington, has been selected for deployment. The FL ramp metering algorithm is powered by the Fuzzy Logic Controller (FLC). The FLC depends on a series of parameters that can significantly alter the behavior of the controller, thus affecting the performance of ramp meters. However, the most suitable values for these parameters are often difficult to determine, as they vary with current traffic conditions. Thus, for optimum performance, the parameter values must be fine-tuned. This research presents a new method of fine tuning the FLC parameters using Particle Swarm Optimization (PSO). PSO attempts to optimize several important parameters of the FLC. The objective function of the optimization model incorporates the METANET macroscopic traffic flow model to minimize delay time, subject to the constraints of reasonable ranges of ramp metering rates and FLC parameters. To further improve the performance, a short-term traffic forecasting module using a discrete Kalman filter was incorporated to predict the downstream freeway mainline occupancy. This helps to detect the presence of downstream bottlenecks. The CORSIM microscopic simulation model was selected as the platform to evaluate the performance of the proposed PSO tuning strategy. The ramp-metering algorithm incorporating the tuning strategy was implemented using CORSIM's run-time extension (RTE) and was tested on the aforementioned I-95 corridor. The performance of the FLC with PSO tuning was compared with the performance of the existing FLC without PSO tuning. The results show that the FLC with PSO tuning outperforms the existing FL metering, fixed-time metering, and existing conditions without metering in terms of total travel time savings, average speed, and system-wide throughput.

Ecological indicators for system-wide assessment of the greater everglades ecosystem restoration program

Developing scientifically credible tools for measuring the success of ecological restoration projects is a difficult and a non-trivial task. Yet, reliable measures of the general health and ecological integrity of ecosystems are critical for assessing the success of restoration programs. The South Florida Ecosystem Restoration Task Force (Task Force), which helps coordinate a multi-billion dollar multi-organizational effort between federal, state, local and tribal governments to restore the Florida Everglades, is using a small set of system-wide ecological indicators to assess the restoration efforts. A team of scientists and managers identified eleven ecological indicators from a field of several hundred through a selection process using 12 criteria to determine their applicability as part of a system-wide suite. The 12 criteria are: (1) is the indicator relevant to the ecosystem? (2) Does it respond to variability at a scale that makes it applicable to the entire system? (3) Is the indicator feasible to implement and is it measureable? (4) Is the indicator sensitive to system drivers and is it predictable? (5) Is the indicator interpretable in a common language? (6) Are there situations where an optimistic trend with regard to an indicator might suggest a pessimistic restoration trend? (7) Are there situations where a pessimistic trend with regard to an indicator may be unrelated to restoration activities? (8) Is the indicator scientifically defensible? (9) Can clear, measureable targets be established for the indicator to allow for assessments of success? (10) Does the indicator have specificity to be able to result in corrective action? (11) What level of ecosystem process or structure does the indicator address? (12) Does the indicator provide early warning signs of ecological change? In addition, a two page stoplight report card was developed to assist in communicating the complex science inherent in ecological indicators in a common language for resource managers, policy makers and the public. The report card employs a universally understood stoplight symbol that uses green to indicate that targets are being met, yellow to indicate that targets have not been met and corrective action may be needed and red to represent that targets are far from being met and corrective action is required. This paper presents the scientific process and the results of the development and selection of the criteria, the indicators and the stoplight report card format and content. The detailed process and results for the individual indicators are presented in companion papers in this special issue of Ecological Indicators.

Middle school teachers' intentions to refer eating disorder students for professional counseling

Eating disorders can lead to a negative impact on students' academic growth, nutrition and can cause death (Claude-Pierre, 1997; Manley, Rickson, & Standeven, 2000; Romeo, 1996). Early intervention by referring students to professional counseling might help counter these negative consequences. The teacher is in the position to assist students by providing health information, identifying those with problems, and intervening for a variety of dysfunctions that may include the eating disorders called anorexia nervosa and bulimia nervosa (Myers-Clark & Christopher, 2000). However teachers are in a difficult position to know when to address student concerns and judge what action to take (Ransley, 1999). Teachers' engagement seems crucial (Smolak, Harris, Levine, & Shisslak, 2001) since eating disorders are being identified in younger children. The purpose of this study was to examine (a) the relationships of the theoretical constructs, attitude, subjective norm, and perceived behavioral control of the theory of planned behavior as predictors of behavioral intention (Ajzen & Fishbein, 1980) of middle school teachers to identify and refer suspected anorexia nervosa (AN) and/or bulimia nervosa (BN) students for professional help; and (b) the actual behavior of middle school teachers who reported having ever referred a student suspected of having AN and BN and those teachers who reported not having made such a referral. One hundred fourteen middle school teachers in Broward County, Florida volunteered to participate in the ex post facto research. Data were collected from a questionnaire. Multiple regression analysis revealed that the constructs of subjective norm (perception of what others think about one's performance of behavior combined with motivation to comply) and perceived behavioral control (perception regarding the extent of the difficulty of performing the behavior) were predictive of teachers' intent (likelihood of engaging in a behavior) to refer. However, the analysis revealed that attitude (overall positive or negative feeling with respect to performing the behavior) was not predictive of teachers' intent. Discriminant function analysis revealed that both intent and perceived behavioral control were predictive of group membership, either having referred a student suspected of having an eating disorder for counseling or not having made such a referral. Attitude and subjective norm were not predictive of group membership.

Predictors of adolescent sexual intentions and behavior: Attitudes, parenting, and neighborhood risk

The current study was a cross-sectional examination of data collected during an HIV risk reduction intervention in south Florida. The purpose of the study was to explore the relationships between neighborhood stress, parenting, attitudes, and adolescent sexual intentions and behavior. The Theory of Planned Behavior was used as a model to guide variable selection and propose an interaction pathway between predictors and outcomes. Potential predictor variables measured for adolescents ages 13–18 (n=196) included communication about sex, parent-family connectedness, parental presence, parent-adolescent activity participation, attitudes about sex and condom use, neighborhood disorder, and exposure to violence. Outcomes were behavioral intentions and sexual behavior for the previous eight months. Neighborhood data was supplemented with ZIP Code level data from regional sources and included median household income, percentage of minority and Hispanic residents, and number of foreclosures. Statistical tests included t-tests, Pearson's correlations, and hierarchical linear regressions. Results showed that males and older adolescents reported less positive behavioral intentions than females and adolescents younger than 16. Intentions were associated with condom attitudes, sexual attitudes, and parental presence; unprotected sexual behavior was associated with parental presence. The best fit model for intentions included gender, sexual attitudes, condom attitudes, parental presence, and neighborhood disorder. The unsafe sexual behavior model included whether the participant lived with both natural parents in the previous year, and the percent of Hispanic residents in the neighborhood. Study findings indicate that more research on adolescent sexual behavior is warranted, specifically examining the differentials between variables that affect intentions and those that affect behavior. A focus on gender and age differences during intervention development may allow for better targeting and more efficacious interventions. Adding peer and media influences to the framework of attitudes, parenting, and neighborhood may offer more insight into patterns of adolescent sexual behavior risk.