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Introduction: Influenza affected an estimated 9 to 41 million individuals from 2018 to 2023 (CDC, 2023). Despite vaccination being highly effective, rates remain low on college campuses. This project evaluated a new vaccination delivery model at a university in Northeast Florida. The Student Health Center collaborated with undergraduate nursing students and faculty to provide onsite vaccinations via mobile clinics across campus during the influenza season, following the CDC Framework for Program Evaluation. Methods: A retrospective review of the influenza vaccination campaign was conducted over four seasons (2020-2024) using sign-up sheets from vaccine recipients. Nursing faculty and student volunteers compiled data from participating faculty. Comparative analysis identified the most effective dates, times, and locations for mobile clinic vaccination uptake, most reported communication methods, and cost savings from volunteer use. Results: Vaccine uptake decreased by 13% between 2020 and 2021, increased by 75% between 2021 and 2022, and rose by 5.8% between 2022 and 2023. Email was the primary advertisement method for 76% of students. Volunteer use saved $21,505. Discussion: Post-2021 saw increased vaccinations, but missing data limited the evaluation of student-specific outcomes. Email was the most effective communication method among the group. The use of nursing students and faculty demonstrated cost savings. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Community college women do not obtain the HPV vaccine at the same rate as university women. The aim of this study was to discover the perceptions of community college women in relation to the human papillomavirus (HPV) and associated cancers, the perceived barriers and benefits of obtaining the HPV vaccination, and how health behavior decisions may be impacted by self-concept. A qualitative research design incorporating thematic analytic was used to analyze interviews whose questions were specifically guided by the health belief model. Student volunteers aged 18 to 45 years were recruited from a large urban community college. An inductive thematic approach allowed the development of themes and codes based on the interviews conducted with the participants. The results of the study indicated that these women had a persistent lack of knowledge about resources and were confused due to the lack of readily available information regarding HPV and who may be susceptible to the potentially serious impact of having one of the cancer-causing strains. Recommendation include building collaborative initiatives with public health organizations, providing education about HPV at the college level, and making information about prevention and treatment more easily accessible to the public using social media centered on HPV and subsequent cancer prevention. Public health initiatives where sexual health is a topic must include an emphasis on HPV education, prevention, and treatment. Implications for positive social change include advocating for better health education for college students and heightened awareness for parents and families about HPV. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

In an increasingly complex world, it is imperative that undergraduate science courses prepare students to make confident, informed decisions and predictions. The research presented in this thesis focuses on supporting students to engage in mechanistic reasoning (MR) about phenomena in chemistry and biology (that is, thinking about how and why these phenomena occur). Using a resources perspective of student knowledge construction, I investigated and characterized explanations for two phenomena: (1) preferential protein-ligand binding, leveraging ideas about electrostatic forces and interactions; and (2) ATP-driven coupled reactions, leveraging ideas about energy, reactivity, and favorability. We collected and analyzed over a thousand student responses for the protein-ligand binding task, a previously developed task that elicits productive student ideas and MR as a thinking strategy. Students across chemistry and biology courses engaged in MR to varying extents, but the responses that were fully mechanistic nearly always correlated with a correct prediction, suggesting the predictive power of this reasoning strategy. With a large selection of responses and access to demographic characteristics, I then calculated an ordinal regression model to determine if GPA, race/ethnicity, and/or binary gender predicted student engagement in MR. Binary gender identification did not contribute as a predictor; however, students with a higher GPA had significantly higher odds of engaging fully in MR, and being White (compared to Non-White), to a lesser extent than GPA, also resulted in higher odds of engaging fully in MR. In subsequent studies, I investigated student and instructor understandings of the role of ATP, an integral biological molecule that is directly related to energy, a core idea in both chemistry and biology, suggesting another opportunity for interdisciplinary learning. Due to the widespread misconception that breaking bonds releases energy, which is frequently associated with language about the "high-energy bond(s)" in ATP, we aimed to uncover a more coherent, mechanistic way of talking about ATP. To do this, we first interviewed a range of chemistry, biology, and biochemistry faculty to learn how they explain and teach the mechanism by which ATP provides energy. The findings from this study informed my final study, in which we designed a task that supports students' understanding of the mechanism by which ATP drives the unfavorable formation of glutamine from glutamate and ammonium. We focus specifically on the role of ATP in transferring a phosphoryl group to create a reactive intermediate, avoiding the common, yet irrelevant, ideas about ATP hydrolysis and bond energy. After working through this task, both molecular biology and organic chemistry students included more mechanistic resources in their final explanations about the role of ATP, suggesting the potential of formative tasks as learning opportunities for students to advance and refine their productive resources. The findings from these four studies point to the challenge, but importance, of incorporating MR into undergraduate science courses. Leveraging interdisciplinary thinking and MR are ways to support making informed decisions as citizens; for example, reasoning about how and why vaccines prevent the spread of infectious diseases, among other reasoning strategies (e.g., social and historical), can support one to make an informed choice. Further, many of the students we serve are pre-health majors, meaning they will pursue careers which often require deep reasoning and understanding about how or why symptoms occur, potential side effects of treatments, and how to appropriately address challenging decisions. MR is an important tool for certain contexts to ultimately help them do this. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

One of the challenges humans face is making collective decisions with regards to controversial issues related to science, namely socio-scientific issues (SSIs). Genetic modification, nuclear energy, experimental drugs, 5G technology are a few examples of SSIs. Some of the concerns posed by such issues are compromise to privacy and identity, threat to the workforce due to automation, and potential changes to the human genome. To better understand SSI-related decision making, it is important to understand the public perception of SSIs, while also including opinions of rural areas. This research investigated the perception of SSIs for the U.S. public both in a small U.S. rural area, and in the whole country. Study 1 (N=162) focused on a rural area and was conducted through an online survey posted to social media, while Study 2 (N=2002) used a national sample as part of a secondary data analysis from the Pew Research Center. Both studies looked at the relationship between levels of general education, science knowledge, and perception of SSI-related innovations. One of the main findings from Study 1 (which relied on correlation analysis) is that higher levels of education relate to increased support for use of animals for research and increased agreement on the safety of GMO foods. However, Study 2 (which used binary logistic regression analysis) found that as education level increased, the odds of supporting fracking or agreeing that GMO food is safe decreased. Study 1, also showed that as science knowledge increased support for fracking decreased, while agreement on the safety of GMO food increased. Study2, on the other hand indicated that the odds of support for SSIs decreased for use of plant fuel, animals for research, experimental drugs, and artificial organs. Additionally Study 1 looked at holding a science degree and Study 2 looked at keeping up with science news as potential variables related to perceptions of SSIs. T test analysis in Study 1 showed that science degree holders favored virus modification, nuclear energy, use of animals for research and viewed GMO foods as safe, while non-science degree holders did not. In Study 2, as familiarity with science news increased support for offshore oil and gas drilling switched from support to opposition, while view of modification of baby genes for smarter babies switched from taking science too far to appropriate. Lastly, multiple regression analysis in Study 1 showed that mean perception of health-related innovations is a significant predictor of use of the Covid-19 vaccine even though its clinical trials have not been completed. To conclude, an interesting overall finding was that rural area participants indicated more opposition to SSIs than the national sample. And, science news and holding a science degree seemed to behave differently than education level and science knowledge with a leaning towards more support of SSIs. These findings may help shape policies and practices related to media in how science news are produced and shared, increase our awareness of opinions of rural areas, and broaden our conception of science to include human experience and its connection to nature. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

In January 2020, the World Health Organization declared the 2019 novel coronavirus (COVID-19) outbreak to be a public health emergency. More than 500 million cases and more than 6 million deaths have been reported, with these numbers growing each day. A major public health initiative for controlling the COVID-19 pandemic was vaccine development and distribution, with multiple vaccines now available for people 6 months of age and older. However, vaccination hesitancy persists in the United States and threatens the containment of the virus and public health. Young adults aged 18 to 30 are a priority population prone to COVID-19 vaccine hesitancy, and efforts to examine vaccination perceptions among this population early in the vaccine distribution process were needed for effective intervention development and for future outbreak considerations. Manuscript I is a quantitative study that applied the Reasoned Action Approach health behavior theory to determine factors associated with vaccination intentions during the first five months of vaccine distribution. Results were used to develop a university-wide communication campaign in real-time. Manuscript II is a qualitative content analysis that explored perceived disadvantages of COVID-19 vaccination and the role of common COVID-19 vaccine myths and misinformation. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Neisseria meningitides serogroup B, commonly referred to as Meningococcal B or Meningitis B, is a highly contagious bacterial infection primarily afflicting the college-aged population with disease contraction resulting in death or severe debilitation if not expediently diagnosed and treated. Currently, there are two vaccines, Bexsero and Trumenba, approved by the Food & Drug Administration to aid in preventing this disease; however, limited research supports the use of vaccination in stopping disease progression and/or preventing disease. The theoretical framework for this study was the social-ecological model. The purpose of this causal-comparative quantitative study was to determine the effectiveness of vaccination in preventing the transmission of Meningococcal B disease on a university campus in Massachusetts. Secondary data were extracted from the state's Immunization Information System, the state's Bureau of Infectious Disease and Laboratory Sciences infectious disease reporting database, and the research facility's electronic health record software for eligible undergraduate student participants. ANOVA statistical testing in SAS was utilized for data analysis; variables for analysis included both vaccinated and unvaccinated students as independent variables and the incidence/prevalence of Meningococcal B disease on campus as the dependent variable. With a limited number of Meningococcal B disease cases on campus, this study failed to find a possible connection between vaccination and the incidence/prevalence of Meningococcal B disease on a university campus in Massachusetts. The results of this study will be used to encourage further research to gauge the true effectiveness of vaccination in contributing to Meningococcal B disease prevention. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation aimed at examining the predictors of HPV vaccination intentions of college students in a Kenyan university and those in a Midwest university in the United States of America (USA). Using the theory of planned behavior (TPB), the dissertation investigated the most salient factors that predict the vaccination intentions of college male and female students in Kenya and the USA. A mixed method approach was utilized to collect data from the participants. Specifically, interviews with 43 students (22 from Kenya and 21 from USA) were used to collect the qualitative data from the students. The quantitative data were collected using closed-ended surveys with 512 Kenyan students at a large university in Uasin Gishu County and 522 students at the Midwestern university, USA. The qualitative findings revealed that identification had a major influence on how students sought health, ate, and related with their peers. In particular, identification through religiosity influenced the students' attitudes toward sex and perception of oneself. Thus, many respondents reported viewing their bodies as the temple of God and sex as an activity for married couples. Thus, when they engaged in premarital sex, they often felt disconnected with God and they resulted to seeking forgiveness, minimizing their actions, and normalizing their actions. Overall, the quantitative results suggested that college students in Kenya and the USA converged in certain health trends but differed in several others. For example, the Kenyan participants depicted a low understanding of HPV and HPV vaccine compared to the participants at the Midwestern university. The country of the participant also moderated the relationships between subjective norms and intentions, sex attitudes, vaccine attitudes, and intention to get vaccinated. The participants from the USA, for example, reported a stronger relationship between subjective norms and the intention to be vaccinated compared to the participants from Kenya. The results of this study also showed that the gender of the participant had an influence on the attitudes of students toward sex, with male participants having more favorable attitudes toward sex compared to female participants. Overall, subjective norms and cancer worry were the only common vaccine predictors among both female and male participants from Kenya and the USA. Surprisingly, although religiosity was correlated with other variables under consideration, it did not emerge as a direct predictor of the intention to get vaccinated. This might suggest it as a probable indirect predictor. Being a comparative study of students in two countries, this dissertation offers unique insights that can inform theory, research, practice, and policy development. Specifically, the results point to the need for health practitioners designing health campaigns to consider the unique differences that exist among male and female students in Kenya and the USA. Some of the weaknesses of the study include use of self-report measures, which are limited to the memory of participants. This study suggests that researchers continue to explore the role of religiosity in influencing health-seeking behaviors among college students. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The public health problem of ensuring that teens and preteens receive the HPV vaccination series justified this study, using a convenience sample (N=122) of parents, 68 of whom were English-speaking parents (ESP) and 54 were Spanish-speaking parents (SSP). Among ESP, 94.1% (n=64) were females and 5.9% (n=4) were males. Among SSP, 98.1% (n=53) were females and 1.9% (n=1) was male. The mean age for ESP (n=68) was 41.16 years (min=27, max=72, SD=6.72). The mean age for SSP (n=54) was 38.72 years (min=26, max=55, SD =7.31). About 44.1% (n=30) of ESP were Hispanic/ Latino, and 98.1% (n=53) of SSP were Hispanic/Latino. Using backward stepwise regression analysis, in the whole sample (N=122), significant predictors of parents being in an action or maintenance stage for making sure their children received the HPV vaccination was predicted by: if child had received HPV vaccination ([beta]=1.714, SE[subscript B]=0.599, p=0.000) and yearly household income ([beta]=0.142, SE[subscript B]=0.200, p=0.007) in a model accounting for 40.5% of the variance (R[superscript 2]=0.420, AdjR[superscript 2]=0.405). This study determined that a linguistically and culturally tailored (i.e., in English or Spanish) video on HPV and HPV vaccination of preteens and teens served as a brief online e-health intervention that was associated with significant parental movement across the stages of change (i.e., from precontemplation or contemplation stage, to preparation stage) and increased self-efficacy for three key behaviors: (1) talking to a pediatrician or family practice medical provider about the Human papillomavirus (HPV) infection and the HPV vaccination for children; (2) making sure their preteen and teen children receive the HPV vaccination; and (3) making sure their preteen and teen children receive all required doses (e.g., at least two or three doses) of the HPV vaccination. Also, 89.5% (n=17) of healthcare providers recommended the video. Qualitative data produced themes for recommending the video and improving it. Recommendations for an evaluation of the video intervention using a nationally representative sample are advanced, along with implications for widely disseminating and evaluating a new evidence-based approach codified in the video. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Influenza is a well-documented risk for students attending colleges and universities. Despite the expert recommendations, there remains a low vaccination rate amongst undergraduate students. This study was an action research study utilizing the theory of planned behavior to evaluate the intentions of students in receiving the influenza vaccination. This study utilized mixed methodology consisting of quantitative data from a web based survey tool that was distributed to all of the undergraduate students at the university, and qualitative data from focus groups consisting of members recruited from the population who had previously completed the survey. The study found that the theory of planned behavior is effective in determining the behavioral intentions for college students and their intent on receiving the influenza vaccination. Results included the influences of the students having a positive attitude about the vaccine, including the vaccine will provide prevention from serious illness from influenza infection. The influences of social norms demonstrate that the students believe the vaccine is looked favorably upon and recommended by their families, peers and medical providers. This study also demonstrated that students who are self-directed and sought out information about the vaccine had greater intention of receiving it. The study demonstrated the importance of perceived risk and benefits from the vaccine, and previous vaccination as a predictor for intention to receive the vaccination. The review of the data and analysis with the Action Research Committee has led to recommendations for moving forward with a vaccination campaign program at the university. The recommendations include educational programs for students, parents, and healthcare providers utilizing a variety of delivery methods, about influenza illness severity, impaction students, and vaccinations efficacy and availability. Other recommendations include university policy and pedagogical enhancements that will increase student self-directed inquiry. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The Human Papillomavirus (HPV) can cause some types of cancer and is the most common sexually transmitted infection in the US. Because most people turn to the internet for health information, this study analyzed HPV information found online. A content analysis was conducted on 69 web search results (URLs) from Google, Yahoo, Bing and Ask. The content was analyzed for source, tone, presence of science-based content and presence of theory (constructs of the Health Belief Model). In Chapter 1, relationships between these aspects of the URL content were examined. The majority of URLs were pro-HPV vaccine (62.3%) followed by neutral (23.2%) and anti (14.5%). Government and medical sites had the most pro-HPV vaccine sites with 32.6% and 23.3% respectively. Only three types of sites contained anti-HPV vaccine information, news agencies (50%), non-profits (30%) and medical advice (20%). No statistically significant relationship was found between source of URL and tone (?[superscript 2][subscript (14)] = 87.28, p = 0.058) or tone and number of scientific citations (?[superscript 2][subscript (4)]) = 62.81, p = 0.655). However, a statistically significant relationship was found between tone and theory (?[superscript 2][subscript (4)] = 106.90, p = 0.002). There were no statistically significant interaction or main effects found between tone of URL and both science and theory. In Chapter 2, differences in results were analyzed based on the search engines and eight search terms. Descriptive statistics were reported on the 69 URLs included in the study. Google yielded the most "good" searches at 29 (42%). For Google and Yahoo, the highest returns were from medical advice sites, 31.0% and 38.5% respectively. Bing had the highest search returns from government agencies at 50.0%. Ask was the only engine to return a pharmaceutical company (n = 1). For tone, Google, Bing and Ask returned the highest percentages of Pro-HPV sites (75.9%, 72.7% and 50.0% respectively) while Yahoo returned the highest percentage of neutral (46.2). Ask had the second highest neutral returns with 31.3%. While all engines had at least one anti-HPV return, Ask had the highest percent with 18.8. Google was the only engine to return a site with six or more scientific citations (n = 1). For theory, Bing had the highest percent of returns with 4-5 theoretical constructs mentioned (36.3%). For tone, the term "human papillomavirus immunization" had 100% pro-HPV vaccination returns. "Gardasil" had the highest percent of anti-HPV vaccination returns with 50% while "Cervarix" had the same number of neutral as pro-HPV vaccination returns, with 46.2% each. The terms "human papillomavirus vaccine" and "Gardasil" both had 100% of the returns fall in the 0-1 scientific citations category. Three terms, "HPV vaccine," "HPV vaccination" and "human papillomavirus" each had one return with 6 or more citations. For theory, the majority of sites returned had 2-5 of the HBM constructs contained or referred to in the information. "HPV vaccination" and "human papillomavirus immunization" had the highest returns with 4-5 constructs, with 50% and 60% respectively. Recommendations include maintaining consistent monitoring of URLs as well as search optimization tools to ensure that health consumers and healthcare providers can easily find correct and accurate information. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation presents the results of three field experiments implemented to evaluate the effectiveness of strategies to improve the health or education of children in developing countries. In Guatemala, community health workers at randomly selected clinics were given patient tracking lists to improve their ability to remind parents when their children were due for a vaccine; this is found to significantly increase children's likelihood of having all recommended vaccines. This strategy is particularly effective for older children. In Peru, a teacher training program is found to have no effect on how frequently children use their computers through the One Laptop Per Child program. In Costa Rica, learning English as a foreign language using one software program is found to be significantly more effective than studying with a teacher, or with a different software program, confirming the heterogeneity of effects of educational technology. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The purpose of this sequential, explanatory mixed methods research study was to understand what factors influenced African American maternal intentions to get their daughters aged 9 years to 12 years vaccinated in Alabama. In the first, quantitative phase of the study, the research questions focused on identifying the predictive power of eleven variables, representing selected factors associated with maternal intentions to vaccinate their daughters. The data were collected via a self-developed instrument that used a mixed mode survey design that was web-based (N = 14) and paper-based (N = 228). Participant demographics were analyzed using descriptive statistics. A binary, logistic regression analysis identified four variables best predicting maternal intentions towards HPV vaccinating their daughters against HPV: perceived barrier: information; perceived barrier: daughter too young for the vaccine; culture: future-time orientation; and subjective norms. In the second, qualitative phase were selected from the quantitative phase to explore the results from the statistical tests in more depth. Nine participants were selected using a stratified proportional subgroup sampling design and a maximal variation principle. Data collection included use of semi-structured interviews from five participants with positive intentions and four participants with negative intentions. Seven themes related to maternal intentions to vaccinate their daughters against HPV emerged in the thematic analysis of each participant and across the participants: role of knowledge, interpersonal influences, personal experiences, cultural influences, benefits of HPV vaccination, barriers of HPV vaccination, and vaccination uptake recommendations. For each participant, the themes differed in the number and similarity subthemes comprising them. There were similarities and differences among the participants in the study, while there were more similarities among participants in each group (those with positive intentions and those with negative intentions). "Perceived barriers" and "future-time orientation" were the most discussed themes. "Vaccination uptake recommendations" and "interpersonal influences" were other reasons mothers chose to or not to vaccinate their daughters. The results of the quantitative and qualitative phases were integrated while interpreting the outcomes of the entire study. Based on the findings from the quantitative and qualitative phases of the study, recommendations were made for a theoretical, culturally-tailored intervention to promote HPV vaccination uptake among African American girls aged 9 to 12 years. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation evaluates the effectiveness of a customized educational health intervention on sexual health and female cancer prevention among young women in Pakistan and evaluates the applicability of the integrated model of behavior prevention (IM) when predicting three health behaviors among this population. The study used randomized experimental design with one treatment group and one control group. The results of the study suggest that exposure to web-based customized heath information has positive effect on behavioral intentions to perform breast self-exams and get vaccinated for human papillomavirus, but not for condom use. It was also found that exposure to the website did not have an impact on the constructs in the IM model that should predict behavioral intentions. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Today, the majority of American adults uses the internet and looks for health information online. Of interest in this dissertation are people who do not subscribe to mainstream views of health, and may use the internet to discover, bolster, or share their alternative views. Although the Centers for Disease Control and Prevention (CDC) have named fluoridated drinking water and vaccination as two of the top ten public health achievements of the 20th century, there is a significant minority of people who has concerns about the safety and effectiveness of these practices. There are two essential purposes for this dissertation. First, it describes the nature of internet use among people who hold nonmainstream views of health issues. Second, it tests the hypotheses that the extent of people's internet use is a reflection of two classes of influence: 1) individual traits, such as demographic characteristics, feelings of estrangement, and need for cognition, and 2) their inability to find support from other sources, specifically mainstream media and their face-to-face social network. These analyses are informed by three sets of data: interviews with people who have varying views on fluoridation, a pair of nationally representative surveys (one on the MMR vaccine, and one on fluoridated water), and a corresponding pair of purposive surveys. The interview results identified important themes and issues surrounding nonmainstream health beliefs, especially their connection to personal experience and perceived credibility of information sources. The representative surveys found that approximately 10% of Americans believe that the MMR vaccine and fluoridated water are unsafe, with the rest of the population about evenly divided between being uncertain and believing that the health measures are safe. Notably, believing that these measures were unsafe was unrelated to any demographic characteristics, but internet use on those topics was strongly related. Internet use on those topics was associated with youth and college education, as well as perceiving the news media as having a different view from their own. The lack of social network support for one's views on these topics, however, was unrelated to internet use. The implications of these findings and future research directions are discussed. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Background: Pneumococcal vaccination (PV) is important as Streptococcus pneumoniae accounts for one third of all hospitalizations for community-acquired pneumonia. In 2009, 1.1 million people in the U.S. were hospitalized with pneumonia and more than 50,000 people died from the disease. The Centers for Disease Control and Prevention recommend that PV be administered to all patients 65 years or older as well as to younger patients with chronic diseases. Many hospitals are struggling to achieve the National Healthy People 2010 target of a 90% vaccination rate. Computerized provider order entry with use of order sets can help to achieve compliance with vaccine guidelines. In an acute teaching hospital, in an effort to improve PV rates, Pneumococcal Vaccine and Screening Orders (PVSO) were incorporated into the Admission Order Set (AOS) on September 15th, 2008. Before this time period, PVSO was part of the Discharge Order Set (DOS). Purpose: The major goal of this study was to compare the impact of the use of PVSO on pneumococcal vaccination when used at the time of admission and when used at the time of discharge for adult patients in an acute inpatient setting. The secondary goal was to examine factors associated with vaccination with both types of order sets. Methods: A retrospective pre and post design was used for this study. Patients who were discharged from 7 medical inpatient units during the months of March 2008 and March 2009 were included. The sample included 420 DOS cases and 420 AOS cases. Data were analyzed using descriptive statistics to describe the sample's vaccination status using PVSO at admission and at discharge. Chi-square tests were conducted to compare the effect of the use of PVSO between AOS and DOS on PV. Logistic regression was used to examine the influence of patient demographic variables, discharging unit, primary diagnosis, and type of order set on PV administration status. The influence of age group, sex, race, length of stay, and order set type on PV status was also evaluated using generalized estimating equations to adjust for dependency within units. Results: The findings from this study suggest that there is no difference in rate of vaccine administration between vaccines ordered at the time of admission or at the time of discharge. Age and race were significant predictors of vaccine administration. Patients who were 65 or older were more likely to receive vaccination than younger patients. Minorities were more likely to get vaccinated than Caucasians. Rates of PV differed in the different units. Conclusion: Recent advancement in health information systems can have positive impact on clinical practice. When those technologies are implemented, their outcomes must be assessed. This study examined the impact of changes in PV ordering practice assisted by order sets. Findings showed no significant difference in PV according to time of ordering the vaccine. PV rates, however, were influenced by patients' age and race. Younger adults seem to be less likely to be vaccinated than older adults. Providers may need education to identify risk factors in younger adults and training to use appropriate order sets. Vaccine compliance rate was not evaluated as the exact number of eligible patients could not be determined for DOS. Findings suggest that a combination of technology and human factors are needed to successfully implement vaccine guidelines. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Assessments of knowledge and perceptions about influenza were developed for high school students, and used to determine how knowledge, perceptions, and demographic variables relate to students taking precautions and their odds of getting sick. Assessments were piloted with 205 students and validated using the Rasch model. Data were then collected on 410 students from six high schools. Scores were calculated using the 2-parameter logistic model and clustered using the k-means algorithm. Kendall-tau correlations were evaluated at the a = 0.05 level, multinomial logistic regression was used to identify the best predictors and to test for interactions, and neural networks were used to test how well precautions and illness can be predicted using the significant correlates. Precautions and illness had more than one statistically significant correlate with small to moderate effect sizes. Knowledge was positively correlated to compliance with vaccination, hand washing frequency, and respiratory etiquette, and negatively correlated with hand sanitizer use. Perceived risk was positively correlated to compliance with flu vaccination; perceived complications to personal distancing and staying home when sick. Perceived risk and complications increased with reported illness severity. Perceived barriers decreased compliance with vaccination, hand washing, and respiratory etiquette. Factors such as gender, ethnicity, and school, had effects on more than one precaution. Hand washing quality and frequency could be predicted moderately well. Other predictions had small-to-negligible associations with actual values. Implications for future uses of the instruments and development of interventions regarding influenza in high schools are discussed. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The purpose of this phenomenological study was to understand the experiences and perceptions parents of a child with an autism spectrum disorder have had. The study addressed the following research question: What were the parents' experiences and perspectives with regard to their child's diagnosis and treatment options? For this interview study, 12 parents of children diagnosed with an autism spectrum disorder were ultimately selected and interviewed. The audio recorded interviews were transcribed and then examined for "significant statement" sentences. Next, clusters of meaning were developed into themes. These "significant statements" and themes were then used to create the formulated meanings of the participants' experiences. These formulated meanings were shared with three experts in the field of autism spectrum disorders to combat researcher bias. Finally, the formulated meaning statements were compiled to write a composite description that captured the essence of the participants' experience. Seven themes emerged from the data analysis: (a) Despite parents expressing the concern for their child's development, the diagnosis of an autism spectrum disorder was not confirmed until years and/or doctor visits later. (b) Upon learning of their child's diagnosis, there was lack of guidance from medical professionals. (c) There were limited daycare options for parents, resulting in one parent quitting his or her job. This, along with insurance difficulties, was a financial burden. (d) The parents were torn between their child with autism and their other children, family members, and friends. (e) There was a concern for their child's future. (f) Parents expressed feelings of being judged by the public because their child may look "normal" but does not behave in that manner. (g) There was a belief that vaccinations may have played some role in causing their child's autism. Raising a child with an autism spectrum disorder is a difficult endeavor. The barriers and hardships that parents encounter may be lessened if the medical community and education professionals work together to give these parents the guidance they need and desire. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

A practicum was conducted to address the problem of medical exclusion of kindergarteners in a Chicago elementary school serving black, low income children. In order to comply with the state health law, all students entering school for the first time must show evidence of a current physical examination and up-to-date immunizations. Students not in medical compliance by October 15 are excluded from school until they meet these requirements. A review of the literature revealed that the preferred method of achieving medical compliance was to refuse admittance to school to any student lacking these medical requirements. Instead of refusing admittance, a 3-month campaign was waged beginning in the summer of 1984 to give information to parents about available medical services. Since the area was isolated from city health facilities and parents were poor, free and inexpensive medical care was coordinated at facilities near the school. Notices sent home with students and given at parent group meetings disseminated information about medical requirements and the availability of health care. While the goal of 90 percent medical compliance was not achieved by October 15, considerable gains were made and by that date, 71 percent of the students had received the needed health care. Recommendations were made for decreasing parental indifference through parent groups and high school education so that medical exclusions can be further reduced in the future. (Author/CB)

Childhood vaccination coverage globally has increased since the launch of the Expanded Programme on Immunization in 1977 although delayed vaccination and failure to complete the recommended immunization series remains an important obstacle to the control vaccine-preventable disease. In sub-Saharan Africa, where >50% of the world’s preventable deaths under-five years occur, research on the underlying mechanisms of under-vaccination is essential to realizing continued progress in eliminating preventable infectious disease-related morbidity and mortality in infants and young children. This dissertation explores drivers of vaccination disparities in sub-Saharan Africa, focusing on the competing programmatic priorities to innovate with inclusion of new vaccines while also urgently addressing under-vaccination against traditional disease targets. In aim I, we assessed the prevalence of delayed childhood vaccination and its relationship with under-vaccination in the first year of life, pooling Demographic and Health Survey data from 33 sub-Saharan African countries conducted between 2010 and 2018. High prevalence of delayed vaccination (>24%) was found for all doses in the schedule, indicating children were vaccinated >4 weeks after the target age for effective coverage. Delays were strongly associated with incomplete schedules including failure to receive one or more vaccine doses by 12 months of age. In aim 2, we examined the distal relationship between childhood death and immunization utilization patterns among surviving children. Using data from children and their decedent siblings across 33 SSA countries, we found that children with a prior decedent sibling had less favorable vaccination outcomes compared to children who had no prior sibling death. Other measures of child mortality influence were considered at the province-level, which also showed less favorable vaccination outcomes for with surviving children in high U5M strata compared to lower ones. Finally, in aim 3, we evaluated the temporal trends in adherence to age-specific vaccination recommendations in two informal settlement communities in Nairobi, Kenya. In this analysis, we compared trends between defined periods before and after the introduction of new vaccines in the basic immunization schedule using data from the longitudinal Nairobi Urban Health and Demographic Surveillance System between 2007 and 2015. We found no significant differences in the prevalence of delays between the two periods, suggesting no association between the introduction of new vaccines and the timeliness of delivering subsequent routine immunizations. Together, this dissertation examined perspectives not previously considered on how underlying mechanisms inherent to immunization program delivery and prioritization influence overall progress towards aspirational goals for achieving effective coverage. By combining multiple measures, these studies contribute new ways of monitoring the performance of immunization programs in low coverage countries and informing the design of strategies to improve coverage in order to expand protection against vaccine-preventable diseases to all children.