Background. Street food stands (SFS) are common ways in which people in Mexico access food, having been a part of the environment and culture of Mexican food for generations. However, no studies have used a validated assessment tool to reliably measure food and beverage availability at a variety of SFS. Nor have the availability, density, variety, and distribution of SFS and street foods and beverages been assessed across neighborhood income levels.Objective: This dissertation’s goal was to decrease gaps in knowledge about the role SFS may play in food availability in the Mexican food environment.
Methods: Survey design and ethnographic field methods were used to develop, test, and validate the Street Food Stand Assessment Tool (SFSAT). Geographic information system and ground-truthing methods were used to identify a sample of street segments across 20 neighborhoods representing low-, middle- and high-income neighborhoods in Mexico City on which to assess the availability, density, variety, and distribution of SFS and the foods and beverages sold at these food venues using the SFSAT.
Results: A sample of 391 SFS were assessed across 791 street segments. Results showed that SFS were found in all neighborhoods. Contrary to the initial hypothesis, most SFS were found in middle-income neighborhoods. While the availability of street foods and beverages was higher in middle-income neighborhoods, the variety was less consistent: fruit/vegetable variety was high in high-income neighborhoods whereas processed snack variety was higher in low-income neighborhoods. SFS were most often distributed near homes, transportation centers, and worksites across the three neighborhood income levels.
Conclusion: This study bridged the gap in knowledge about the availability, density, variety, and distribution of SFS and products sold at these sources of food by using an assessment tool that was developed, tested, and validated specifically for SFS. The findings showed that SFS were found across all neighborhoods. Furthermore, results also suggested that SFS can be a source of healthy food items. Additional studies are needed to understand the relationship between SFS availability, food consumption, and health outcomes in the Mexican population.

The United States has been facing a resurgence of vaccine preventable infectious diseases. Non-medical vaccination exemptions (NMEs) which include religious exemptions and philosophical vaccine exemptions are contributing factors in state vaccination rates dropping. The policies surrounding such exemptions vary from state to state. Some states with higher rates of nonmedical vaccine exemptions are dealing with repercussions for this including vaccination rates falling below desired herd immunity and thus putting vulnerable populations such as those who are immunocompromised, too young for vaccination and the elderly at a higher risk.

This thesis aims to examine vaccine preventable re-emerging infectious diseases in the United States with the objective of reaching vaccine hesitant populations and providing them with the tools to make informed decisions to seek out immunizations. This will be done by exploring five different diseases and infections, discussing why some individuals feel hesitant to get immunizations, examining how nonmedical vaccine exemptions are correlated to increased cases of disease outbreaks, looking into state laws specifically focused on countering nonmedical vaccine exemptions and the steps that can be taken moving forward.

Objective: To provide insight into the World Health Organization SAGE Working Group Vaccine Hesitancy Survey by applying the tool to populations across Maricopa County, Arizona. Design: An online survey was conducted using the Qualtrics Survey Software, of individuals residing in Maricopa County, Arizona during the month of October 2019. Results: Of 209 respondents, the followed demonstrated to be the top 3 reasons for either having not received the flu shot yet or having not planned to receive the flu shot: “I’m healthy, I don’t need it”(20.1%); “Worried I might get the flu from it”(17.7%); “I don’t think it works”(17.7%) Statistical analysis demonstrated that vaccine hesitant and non-hesitant respondents are likely to respond differently to topics covering: safety of vaccines; self-perceived health status; importance of the flu shot among one’s peers; flu vaccine related knowledge Conclusions: The WHO VHS applied to the population of Maricopa County, Arizona reported little hesitancy towards the seasonal flu vaccine. Statistical analysis of Vaccine Hesitant respondents vs. Non-Hesitant respondents demonstrates that specified public health education focused on the immunological implications of vaccines may be needed for the hesitant population to gain confidence in vaccine efficacy. A more diverse respondent group that consists of residents beyond the county lines of Maricopa is needed to understand the full scope of vaccine hesitancy that exists in Arizona.

Human health risk assessment is the process by which regulatory agencies estimate the potential for adverse health outcomes as a result of exposure to contaminated food, water, or environmental conditions (US EPA, 2014). However, the risk assessment process typically does not require inputs to be culturally sensitive to the groups facing the potential health outcomes, and the guidelines suggest little emphasis on food security or food sovereignty, concepts which highlight the importance of access to healthy and culturally appropriate foods. This thesis outlines the theoretical concepts of food and environmental justice, framing them in the context of application to land based, rural communities such as Native American groups. This is significant due to the historically disproportionate contamination of Native lands by hazardous waste or other toxins. Three noteworthy case study examples featuring elements of oral exposure pathways to environmental contamination will be outlined and analyzed to articulate how, by incorporating locally-grounded knowledge, a risk assessment could uncover more accurate information, leading to more appropriate and effective mitigation techniques that uphold food and environmental justice principles. Finally, the trade offs between the expansion of local knowledge and the limitations on cultural consumption are discussed, with the conclusion that supports balancing these trade offs through locally grounded, community-driven assessment and mitigation of contamination.

The overall goal of the research study was to determine if the City of Phoenix is going to attain their 90-90-90 targets for 2020 as part of the Fast-Track Cities initiative. The Fast-Track Cities plan includes that by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are on treatments, and 90% of people on treatment have suppressed viral loads. In order to achieve the Fast-Track Cities Initiative goals, the number of people who are aware of their status will need to increase by an additional 5%. The number of people living with HIV who are on HIV medications will need to increase 39%, and the number of people virally suppressed will need to increase 40% (City of Phoenix, 2016). This study was executed by first comparing HIV/AIDS epidemiology reports from the years of 2015-2017 to see the incidence trends. The city of Phoenix was also compared to the second largest city in Arizona, Tucson, to see if Phoenix was making more advances towards ending the HIV/AIDS epidemic in 2030. Next, interviews were conducted with members of the Ad-Hoc committee to gain their opinion on whether Phoenix is going to meet their 90-90-90 goals for the upcoming year. It was concluded that the City of Phoenix is making great progress, however, is not going to achieve their goals by 2020. The Ad-Hoc committee still is aiming to end the HIV/AIDS epidemic by 2030 and have implemented various projects such as the rapid-start protocol and the HIV home test kit initiative to meet this goal. Future improvements for the Fast-Track cities initiative include obtaining more accurate data and improving funding for the HIV stigma focus group as well as recruiting more political leaders.

A nonprofit organization’s ability to help its target population depends strongly on the collaboration of the organization’s staff and leadership. An organization that spans across international borders must overcome adversity, particularly communication and power inequity. The International Alliance for the Prevention of AIDS (IAPA) is a nonprofit with staff in the U.S. and India, making it an international partnership. This research evaluates to what extent the Indian partners believe IAPA meets Sustainable Development Goal 17: “to revitalize the global partnership for sustainable development.” I developed three semi-structured interview protocols for volunteers, employees, and IAPA beneficiaries. After interviews were conducted and transcribed, 5 major themes were identified from coding keywords. First, I grouped definitions of "success" in a partnership to create a baseline of expectations. Second, I assessed the extent of participants' knowledge about the U.S. role in IAPA. Third, I identified areas of strength. Fourth, I identified areas of improvement and grievances. Fifth, I assessed the Indian partners' views on mutualism within IAPA. Results indicated that participants believed communication, cooperation, and respect were traits of a successful partnership. The participants believe IAPA mostly exhibit these values, but that the U.S. role as a decision maker can hinder these. They desire more transparency but overall believe IAPA is beneficial and mutualistic. These findings can be furthered by assessing U.S. staff and board member perceptions of the partnership. By continuously investigating the state of international partnerships, we can learn more about how to create sustainable models for the future.

This study examines associations between clean water, sanitation, mosquito net usage, and immune biomarkers among the Tsimane, a remote subsistence population of forager-horticulturalists with a high pathogen load. Interviews with heads of household (n=710, aged 18-92, median age 40 years) were conducted to ascertain household water sources, ownership and usage of mosquito nets, and latrine use. In this sample, 21% of households used latrines, 20% always boiled their water, and 85% used mosquito nets. Regression models estimate their associations biomarkers of pathogen exposure, including white blood cell count (WBC), hemoglobin (Hb), eosinophils, and sedimentation rate (ESR). Controlling for age, sex, and distance from the closest market town, latrine use (Std. β = -0.11, p= 0.017) and boiling water (Std. β = -0.08, p= 0.059) are associated with lower WBCs. Latrine use is marginally associated with higher hemoglobin (Std. β = 0.09, p= 0.048), but not boiling water (p= 0.447). ESR trends toward lower levels for households that always boil water (Std. β= -0.09, p= 0.131), but is not associated with latrine use (p=0.803). Latrine use was significantly associated with lower eosinophil counts (Std. β= -0.14, p=0.013), but not boiling water (p=0.240). Mosquito nets are not associated with any of these biomarkers. Both boiling water and latrine use are associated with better health outcomes in this sample. These results suggest that scarce public health resources in rural subsistence populations without malarial risk may wish to prioritize boiling water and latrine use to improve health outcomes.

Advancements in both the medical field and public health have substantially minimized the detrimental impact of infectious diseases. Health education and disease prevention remains a vital tool to maintain and propagate this success. In order to determine the relationship between knowledge of disease and reported preventative behavior 180 participants amongst the ASU student population were surveyed about their knowledge and prevention behavior for 10 infectious diseases. Of the 180 participants only 138 were completed surveys and used for analysis. No correlation was found between knowledge or perceived risk and preventative measures within the total sample of 138 respondents, however there was a correlation found within Lyme disease and Giardia exposure to information and prevention. Additionally, a cultural consensus analysis was used to compare the data of 17 US-born and 17 foreign-born participants to analyze patterns of variation and agreement on disease education based on national origins. Cultural consensus analysis showed a strong model of agreement among all participants as well as within the US-born and foreign-born student groups. There was a model of agreement within the questions pertaining to transmission and symptoms. There was not however a model of agreement within treatment questions. The findings suggest that accurate knowledge on infectious diseases may be less impactful on preventative behavior than social expectations.

The number of undergraduate students participating in short-term experiences in global health (STEGHs) abroad has increased dramatically in recent years (Eyler 2002, Drain et al. 2007). These experiences, in tandem with classroom learning, are designed to help students master skills related to global health competencies, including cultural humility and sensitivity, collaborating with community partners, and sociocultural and political awareness. Although STEGHs offer potential benefits to both students and to sending institutions, these experiences can sometimes be problematic and raise ethical challenges. As the number of students engaged in STEGHs continues to increase, it is important to better understand the impact of these programs on student learning. Current ethical and best practice guidelines for STEGHs state that programs should establish evaluation methods to solicit feedback from students both during and on completion of the program (Crump et al. 2010). However, there is currently no established method for gathering this feedback because of the many different global health competency frameworks, types and duration of programs, and different models of student engagement in such programs. Assessing the quality of a STEGH is a profoundly important and difficult question that cannot be answered as succinctly and quantitatively as classroom performance, which has more standard and established assessment metrics. The goal of this project is to identify the most appropriate and useful assessment metric(s) for determining educational quality and impact for STEGHs at ASU by comparing a typical quantitative evaluation tool (pre-post survey with brief open-ended questions) to a more in-depth qualitative method (key informant interviews). In performing my analysis I seek to examine if the latter can produce a richer narrative of student experiences to inform ongoing program evaluations. My research questions are: 1. What are the current qualitative and quantitative evaluation methods available to assess student learning during short-term experiences in global health? 2. How can current methodology for assessing student experiences with short-term experiences in global health be adapted to collect the most information from students? 3. How do student knowledge and attitudes change before and after their short-term experience in global health? Why is understanding those changes important for adapting programs? My end goal would be to use these new, optimal assessment methods for gathering student perspectives and experiences to adapt pre-departure trainings and post-experience debriefings for study abroad programs, both of which I believe will lead to more sustainable partnerships and a healthier understanding of global health work for students.

Homelessness is a pervasive in American society. The causes of homelessness are complex, but health and homelessness are inextricably linked. Student-run free clinics care for underserved populations, including people experiencing homelessness, but they have multiple agendas—to provide care but also to give students hands-on experience. It is plausible that these two agendas may compete and give patients sub-par quality of care.
This study examines patient care in the SHOW free clinic in Phoenix, Arizona, which serves adults experiencing homelessness. This study asks two questions: First, do clinicians in Phoenix’s SHOW free clinic discuss with patients how to pay for and where to access follow-up services and medications? Second, how do the backgrounds of patients, measured by scales based on the Gelberg-Anderson behavioral model for vulnerable populations, correlate with patient outcomes, including number of unmet needs in clinic, patient satisfaction with care, and patient perceived health status? To answer these questions, structured surveys were administered to SHOW clinic patients at the end of their visits. Results were analyzed using Pearson’s correlations and odds ratios. 21 patients completed the survey over four weeks in February-March 2017. We did not identify any statistically significant correlations between predisposing factors such as severity/duration of homelessness, mental health history, ethnicity, or LGBTQ status and quality of care outcomes. Twenty nine percent of surveyed patients reported having one or more unmet needs following their SHOW clinic visit suggesting an important area for future research. The results from this study indicate that measuring unmet needs is a feasible alternative to patient satisfaction surveys for assessing quality of care in student-run free clinics for homeless populations.