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Using Leadership To Address The Problem Of Obesity In The Workplace, Amber Colston Jun 2011

Using Leadership To Address The Problem Of Obesity In The Workplace, Amber Colston

Florida Public Health Review

Obesity is a growing epidemic that affects more and more Americans every year. With the majority ofAmerican adults in the workforce, obesity plays a large part in healthcare costs, absenteeism, and “presenteeism.” Because ofthe large amount oftime adults spend in the workplace, using this setting as an intervention point for healthy lifestyle change could greatly reduce the prevalence of obesity. This paper will review factors that have contributed to the problem of obesity in the workplace, namely the factors at each ofthe five levels ofthe Social Ecology ofHealth Model. Then using leadership frameworks, such as that of Transformational Leadership, this …


A Leadership Solution To Workplace Stress, Monica L. Rousseau Jun 2011

A Leadership Solution To Workplace Stress, Monica L. Rousseau

Florida Public Health Review

Sources of stress can be found nearly everywhere: in school, at home, in traffic, and maybe most importantly –in the workplace. Chronic workplace stress, also known as “burnout”, has been linked with both psychological and physiological illnesses. As most Americans spend about halfoftheir waking hours at work, the workplace is an excellent location to evaluate specific risk factors and implement stress reducing programs. Although a number ofsuch programs are currently in practice, the majority ofthem only offer techniques and coping mechanisms to individuals already exhibiting some, or several, ofthe many severe symptoms ofchronic stress. The purpose ofthis paper is to …


Prostate Cancer Screening: Leadership Implications, Dorothy D. Zeviar Jun 2011

Prostate Cancer Screening: Leadership Implications, Dorothy D. Zeviar

Florida Public Health Review

TheepidemiologyofprostatecancerintheAfricanAmericanpopulationiswell-knowntohealthcarepractitioners; prostate cancer disproportionately impacts African American men 2:1 compared to Caucasian men. The Prostate Cancer Foundation hypothesizes that the increased mortality risk may be due to delayed diagnosis, poor work-up, and less complete treatment, indicating inequitable use of the health care system. The National Cancer Institute suggests that availability of health insurance and physician contact may increase screening and thus, reduce cancer mortality. Because health behaviors and health outcomes are impacted at five different levels according to the Social Ecology Model ofhealth – intrapersonal, interpersonal, organizational, community and social/policy levels – this report proposes that a Collaborative Leadership model …


Perflurorochemical (Pfc) Exposure In Children: Associations With Impaired Response Inhibition, Brooks B. Gump, Qian Wu, Amy K. Dumas, Kurunthachalam Kannan Jun 2011

Perflurorochemical (Pfc) Exposure In Children: Associations With Impaired Response Inhibition, Brooks B. Gump, Qian Wu, Amy K. Dumas, Kurunthachalam Kannan

Falk College Research Center

Background: Perfluorinated chemicals (PFCs) have been used widely in consumer products since the 1950s and are currently found at detectable levels in the blood of humans and animals across the globe. In stark contrast to this widespread exposure to PFCs, there is relatively little research on potential adverse health effects of exposure to these chemicals.Objectives: We performed this cross-sectional study to determine if specific blood PFC levels are associated with impaired response inhibition in children. Methods: Blood levels of 11 PFCs were measured in children (N = 83) and 6 PFCs: perfluorooctane sulfonate (PFOS), perfluorohexane sulfate (PFHxS), perfluorooctanoic acid (PFOA), …


Media Attention On African Americans With Human Immunodeficiency Virus, Charles S. Beverley Jr., Edith M. Williams, Saundra H. Glover Jun 2011

Media Attention On African Americans With Human Immunodeficiency Virus, Charles S. Beverley Jr., Edith M. Williams, Saundra H. Glover

Faculty Publications

Human immunodeficiency virus (HIV) is a disease that has captured the attention of the media in various ways and to varying degrees. One of the ongoing debates and areas of research in HIV that provide many opportunities for discovery is the disproportionate number of African Americans infected with HIV compared to the amount of attention they receive in the media. This manuscript addresses the question that has preoccupied the minds of many people: Why have African Americans infected with HIV received so little media attention? Analysis of this question suggests that there are many reasons for this lack of media …


Patterns Of Fetal Heart Rate Response At ∼30 Weeks Gestation Predict Size At Birth, C. Sandman, C. J. Cordova, E. P. Davis, Laura M. Glynn, C. Buss Jun 2011

Patterns Of Fetal Heart Rate Response At ∼30 Weeks Gestation Predict Size At Birth, C. Sandman, C. J. Cordova, E. P. Davis, Laura M. Glynn, C. Buss

Psychology Faculty Articles and Research

There is evidence that fetal exposure to maternal stress is associated with adverse birth outcomes. Less is known about the association between fetal responses to a stressor and indicators of fetal maturity and developmental outcomes. The purpose of the present study was to determine whether fetal heart rate (FHR) patterns in response to a startling stimulus at ∼30 weeks of gestation were associated with gestational age at birth and birth weight. FHR was measured in 156 maternal–fetal dyads following a vibroacoustic stimulus. All pregnancies were singleton intrauterine pregnancies in English-speaking women who were primarily married, middle class, White and at …


Smoking Cessation And Relapse Among Pregnant African-American Smokers In Washington, Dc, Ayman El-Mohandes, M. Nabil El-Khorazaty, Michele Kieley, Marie G. Gantz Jun 2011

Smoking Cessation And Relapse Among Pregnant African-American Smokers In Washington, Dc, Ayman El-Mohandes, M. Nabil El-Khorazaty, Michele Kieley, Marie G. Gantz

Publications and Research

Smoking is the single most preventable cause of perinatal morbidity. This study examines smoking behaviors during pregnancy in a high risk population of African Americans. The study also examines risk factors associated with smoking behaviors and cessation in response to a cognitive behavioral therapy (CBT) intervention. This study is a secondary analysis of data from a randomized controlled trial addressing multiple risks during pregnancy. Five hundred African-American Washington, DC residents who reported smoking in the 6 months preceding pregnancy were randomized to a CBT intervention. Psycho-social and behavioral data were collected. Self-reported smoking and salivary cotinine levels were measured prenatally …


Exposure Risks And The Chain Of Healthcare-Associated Infection, Amber Hogan Mitchell, Drph, Mph, Cph Jun 2011

Exposure Risks And The Chain Of Healthcare-Associated Infection, Amber Hogan Mitchell, Drph, Mph, Cph

Building the Chain of Safety: Stakeholders Summit

Amber Hogan Mitchell, DrPH(c), MPH, CPH is the Worldwide Director of Professional Education and Learning Solutions for Advanced Sterilization Products (ASP), a Johnson & Johnson Company located in Irvine, CA.  Amber is responsible for educational initiatives for ASP and its customers related to infection prevention, healthcare associated infections, sterilization, disinfection, environmental hygiene, and quality initiatives in healthcare related to safe care and quality patient outcomes.  Amber is a Doctor of Public Health Candidate (all but dissertation) in occupational and environmental health sciences at the University of Texas School of Public Health in Houston, TX.  She was a Centers for Disease …


The Relation Of Fitness Assessment Feedback To Intrinsic Motivation And Physical Activity Among College Students, Laura Chandler Jun 2011

The Relation Of Fitness Assessment Feedback To Intrinsic Motivation And Physical Activity Among College Students, Laura Chandler

Loma Linda University Electronic Theses, Dissertations & Projects

Physical inactivity is a major public health concern in the United States and is no less of a concern among college students. According to the 2000 National College Health Assessment, as cited by Kilpatrick, Herbert, and Bartholomew (2005), only 38% of college students participate in regular vigorous activity, and only 20% participate in regular moderate activity. This study focused on how fitness assessment results affect intrinsic motivation for physical activity in college students. The specific mechanism examined was that between the constructs of intrinsic motivation, competence and autonomy from the self determination theory (SDT) and cognitive evaluation theory (CET). Approximately …


The Association Of Religious Coping On Reports Of Low Back Pain And Inflammatory Markers, Jacqueline D. Bougie Jun 2011

The Association Of Religious Coping On Reports Of Low Back Pain And Inflammatory Markers, Jacqueline D. Bougie

Loma Linda University Electronic Theses, Dissertations & Projects

Chronic pain is the most common cause of disability in the United States with depression, anxiety, and stress often occurring co-morbidly. The purpose of the study was to explore how religion may modulate the frequency of back pain, influence inflammatory markers, influence the use of medications, and impact functional ability.

Participants were from the Biological Manifestations of Religion Study (BioMRS; N= 508) and the Psychological Manifestations of Religion Study (PsyMRS; N = 10,988). All participants completed a 20-page questionnaire and BioMRS participants provided blood, salivary, and urine samples, performance tests, and learning tests all collected within 1 week of …


Predicting Mammography Screening And Breast Self-Examination Among Hispanic And Non-Hispanic White Women In Orange County, California, Sanam Kazemi Jun 2011

Predicting Mammography Screening And Breast Self-Examination Among Hispanic And Non-Hispanic White Women In Orange County, California, Sanam Kazemi

Loma Linda University Electronic Theses, Dissertations & Projects

Background and Purpose. Breast cancer is the second leading cause of cancer deaths among Hispanic/Latina women who are one of the fastest growing ethnic groups in the United States. Although Hispanic women have a lower incidence of breast cancer when compared to non-Hispanic White women, they are more likely to develop breast cancer at an advanced stage. In California, Hispanic women have the lowest rate of insurance coverage compared to other ethnic groups.

Method. The study was a cross-sectional observational study among Hispanic/Latino and non-Hispanic White women, ages 30-64 years. I examined intention to obtain a mammogram or breast self-exam …


Hub City Steps: Methods And Early Findings From A Community-Based Participatory Research Trial To Reduce Blood Pressure Among African Americans, Jamie M. Zoellner, Carol L. Connell, Michael B. Madson, Bo Wang, Vickie Blakely Reed, Elaine F. Molaison, M. Kathleen Yadrick Jun 2011

Hub City Steps: Methods And Early Findings From A Community-Based Participatory Research Trial To Reduce Blood Pressure Among African Americans, Jamie M. Zoellner, Carol L. Connell, Michael B. Madson, Bo Wang, Vickie Blakely Reed, Elaine F. Molaison, M. Kathleen Yadrick

Faculty Publications

Background: Community-based participatory research (CBPR) has been recognized as an important approach to develop and execute health interventions among marginalized populations, and a key strategy to translate research into practice to help reduce health disparities. Despite growing interest in the CBPR approach, CBPR initiatives rarely use experimental or other rigorous research designs to evaluate health outcomes. This behavioral study describes the conceptual frameworks, methods, and early findings related to the reach, adoption, implementation, and effectiveness on primary blood pressure outcomes.

Methods: The CBPR, social support, and motivational interviewing frameworks are applied to test treatment effects of a two-phased CBPR walking …


Control Of Reflexive Saccades Following Hemispherectomy, Patricia A. Reuter-Lorenz, Troy M. Herter, Daniel Guitton Jun 2011

Control Of Reflexive Saccades Following Hemispherectomy, Patricia A. Reuter-Lorenz, Troy M. Herter, Daniel Guitton

Faculty Publications

Individuals who have undergone hemispherectomy for treatment of intractable epilepsy offer a rare and valuable opportunity to examine the ability of a single cortical hemisphere to control oculomotor performance. We used peripheral auditory events to trigger saccades, thereby circumventing dense postsurgical hemianopia. In an antisaccade task, patients generated numerous unintended short-latency saccades toward contralesional auditory events, indicating pronounced limitations in the ability of a single hemicortex to exert normal inhibitory control over ipsilateral (i.e., contralesional) reflexive saccade generation. Despite reflexive errors, patients retained an ability to generate correct antisaccades in both directions. The prosaccade task revealed numerous contralesional express saccades, …


Smoking During Pregnancy: Its Effects On The Prevalence Of Low Birth Weight Infants, Lynda M. Colussi Jun 2011

Smoking During Pregnancy: Its Effects On The Prevalence Of Low Birth Weight Infants, Lynda M. Colussi

Master of Public Health Program Student Publications

Objective: The purpose of this research was to determine what impact demographic characteristics and the smoking status of mothers had on the prevalence and risk for LBW births. Methods: Birth certificate data from Montgomery County, Ohio from 2006-2009 was analyzed. Among the information collected were the infant's birth weight, the mother's age, marital status, education level, race, payer status at time of delivery, WIC status, and smoking status. The impact demographic characteristics and smoking status had on the prevalence of LBW births was determined by a logistic regression model. The effect of when women smoked during pregnancy had on the …


Child And Family Responses To Weight Management Programs : A Qualitative Investigation, Andra Lynn Fjone Jun 2011

Child And Family Responses To Weight Management Programs : A Qualitative Investigation, Andra Lynn Fjone

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction: The purpose of this study is to explore what happens within families in which a child participates in a pediatric weight management program for the treatment of overweight or obesity and identify strategies and processes for successful weight management.

Method: A qualitative approach was used to collect data from seven families. Individual interviews were conducted with parents, target children, and siblings. Data was analyzed within families and compared between families.

Results: Grounded theory analysis revealed three major essential themes: Shared Burden, Family Congruence, and Collaboration. Descriptive analysis was used to identify recommendations for improving family based weight management programs. …


Screening & Assessment Manual, Institute For Public Health And Justice, Screening And Assessment, John Ryals Jr. Jun 2011

Screening & Assessment Manual, Institute For Public Health And Justice, Screening And Assessment, John Ryals Jr.

Policy & Position Papers

No abstract provided.


Rocky Mountain Highs And Lows: Efforts To Improve Health And Reduce Costs In Denver, Michele J. Orza, Jessamyn Taylor May 2011

Rocky Mountain Highs And Lows: Efforts To Improve Health And Reduce Costs In Denver, Michele J. Orza, Jessamyn Taylor

National Health Policy Forum

In late May–early June 2011, the Forum sponsored a site visit to Denver, Colorado, to observe innovative efforts to improve the health of Coloradans and reduce the cost of health care. The three-day agenda was designed to convey the breadth and interconnectedness of the efforts underway in Denver and to highlight both successes and challenges. The exploration concentrated on how three themes of national interest are unfolding in Denver: building and sustaining a robust and effective safety net in an evolving health care market; improving the health of people and their communities to prevent and reduce the need for health …


Cardiovascular Disease And Post Traumatic Stress Disorder In Adults Exposed To The Terrorist Attacks On The World Trade Center, Katie C. Imhof May 2011

Cardiovascular Disease And Post Traumatic Stress Disorder In Adults Exposed To The Terrorist Attacks On The World Trade Center, Katie C. Imhof

Master of Public Health Program Student Publications

Following events of terrorism communities and individuals are subject to the cumbersome responsibilities associated with rescue and recovery efforts. In addition to the loss of life and direct injuries sustained during the incident, long term health outcomes among the exposed population are often seen. Both physical and mental health can be affected as a result of the exposure, and some outcomes do not immediately present themselves. The population exposed to the September 11, 2001 terrorist attacks on the World Trade Center in New York City is no different, and the World Trade Center Health Registries database has been established by …


Cultural Definitions Of Health Care: A Case Study Of Burmese Refugees, Marielena Rose White May 2011

Cultural Definitions Of Health Care: A Case Study Of Burmese Refugees, Marielena Rose White

Undergraduate Honors Thesis Collection

As a result of ongoing civil war and civil unrest in the Southeast Asian country of Myanmar, every year the United States accepts increasing numbers of refugees from Burma of which there is a population of significance within the greater Indianapolis area. When considering options for health care, Burmese refugees may opt for self care as opposed to care from a health care professional as a result of clashing cultural factors or fears of the unknown.

This study aims to uncover how members of the Chin ethnic group have been challenged or confronted by the social, cultural, and political institutions …


Residents' Perceptions Of Social Interaction And Social Activity In An Affordable Assisted Living Facility, Elena Garcia May 2011

Residents' Perceptions Of Social Interaction And Social Activity In An Affordable Assisted Living Facility, Elena Garcia

Honors Scholar Theses

This study is a qualitative study looking at the social interactions and social activities in an assisted living facility, based on the residents’ perceptions. In this study I interviewed 20 residents of an affordable assisted living facility. The participants were male and female, 65 or older, and any ethnicity. Inclusion criteria include: (1) Residing in the assisted living facility at least 6 months and no more than 2 years; and (2) being mentally competent to give informed consent. I recruited the participants based on a list of who was eligible from the facilities administration and then asked the eligible participants …


The Association Between Body Mass Index And Dental Caries In Hispanic Elementary School Children, Mary Creske May 2011

The Association Between Body Mass Index And Dental Caries In Hispanic Elementary School Children, Mary Creske

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Dental caries is the most common chronic disease of children ages 6 to 11. According to the U.S. Department of Health and Human Services, 41% of the children in this age group experience decay in their primary teeth. Since 1980 the number of overweight children ages 6 to 11 has doubled. Childhood obesity is currently the most prevalent nutritional condition of children in the U.S.

Purpose: The purpose of this observational study was to determine if there is an association between childhood dental caries and childhood obesity. The study also explored the effects of diet and other covariates.

Method: …


Bmi Trajectories During The Transition To Older Adulthood: Persistent, Widening, Or Diminishing Disparities By Ethnicity And Education?, Katrina M. Walsemann, Jennifer A. Ailshire May 2011

Bmi Trajectories During The Transition To Older Adulthood: Persistent, Widening, Or Diminishing Disparities By Ethnicity And Education?, Katrina M. Walsemann, Jennifer A. Ailshire

Faculty Publications

Previous research has produced inconsistent results on whether education and ethnic disparities in BMI persist, widen, or diminish over time. We investigate how education and ethnicity, independently and conditionally, influence BMI trajectories during the transition to older adulthood. Employing random coefficient modeling, we analyzed 8 biennial waves of data (1992-2006) from the Health and Retirement Study, a nationally representative longitudinal study of individuals born between 1931 and 1941. After adjusting for health behaviors and health status, education and ethnic disparities in BMI persisted for most groups, but narrowed between high-educated white men and both low-educated Hispanic men and high-educated black …


Understanding Depressive Symptoms Among High-Risk Pregnant African American Women, Kristine M. Molina, Michele Kiely May 2011

Understanding Depressive Symptoms Among High-Risk Pregnant African American Women, Kristine M. Molina, Michele Kiely

Publications and Research

Much has been written about depression and its risk factors, particularly among women. However, a growing body of literature on prenatal depression has begun to emerge, given that depression during pregnancy presents a major public health concern, since it is found to be a common experience among childbearing aged women (Gaynes et al., 2005; Marcus, 2009). In fact, the onset of depressive symptoms is most likely to occur between 20 to 40 years of age, the range when most women become pregnant (Marcus & Heringhausen, 2009). Further, prior studies have found rates of depression among pregnant women to range from …


Playing With Fire Or Arson? Identifying Predictors Of Juvenile Firesetting Behavior, Mary Ellen Britt May 2011

Playing With Fire Or Arson? Identifying Predictors Of Juvenile Firesetting Behavior, Mary Ellen Britt

UNLV Theses, Dissertations, Professional Papers, and Capstones

Firesetting is a complex behavior that spans a wide range of developmental stages in childhood and adolescence and involves varying motivations and intents. A better understanding of this destructive behavior is critical to developing strategies to control its devastating effects. The purpose of this research project was to identify potential predictors of juvenile firesetting behavior by studying youth who were enrolled in a regional firesetting intervention program. Data collected from firesetting assessment instruments completed by parents or guardians of program participants were examined. In the analyses, special emphasis was placed on evaluating associations between juvenile firesetting behavior and the socioeconomic …


Examining Activity Levels And Motor Proficiency: A Comparison Of Children Who Are Overweight And At A Healthy Weight To Their Parents And Peers, Aaron Copeland, Maresa Madsen, Riley Phelps, Brandon Richards May 2011

Examining Activity Levels And Motor Proficiency: A Comparison Of Children Who Are Overweight And At A Healthy Weight To Their Parents And Peers, Aaron Copeland, Maresa Madsen, Riley Phelps, Brandon Richards

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: The purpose of this study was to examine relationships and differences between motor proficiency, activity level, and parental activity level in children who are at a healthy weight and children who are overweight or obese.

Methods: Forty-four children (26 children at a healthy weight and 18 children who were overweight or obese) between the ages of 8-16 (BMI: 14.3-43.6 kg/m2) and 36 parents (BMI: 18.1-44.7) participated in this study. Children and parents wore StepWatch activity monitors (SAM) to measure activity levels over a 72 hour period. Tests reflecting several determinants of motor performance were also administered to …


Effects Of Environment On Children's Motor Scores, Eligibility Status, And Administration Times, Derrick Mittelstadt, Abigail Parker, Kirsten Pickett, Heather Temkin May 2011

Effects Of Environment On Children's Motor Scores, Eligibility Status, And Administration Times, Derrick Mittelstadt, Abigail Parker, Kirsten Pickett, Heather Temkin

UNLV Theses, Dissertations, Professional Papers, and Capstones

Best practices for assessing developmental skills in young children focus on naturalistic observation in everyday settings, but the effects of environment on test scores, eligibility status and administration time have not been explored. The Peabody Developmental Motor Scales-Second Edition (PDMS-2) was administered to 34 children aged 18 to 59 months in natural and pull-out settings. PDMS-2 total, gross, and fine motor quotient (TMQ, GMQ, and FMQ) scores were significantly lower in the natural environment (p’s≤.014). Based on our results, more children would qualify for services when tested in natural environments using TMQ and GMQ scores. It also took significantly longer …


Physical Activity And Sedentary Activity Patterns Among Children And Adolescents: A Latent Class Analysis Approach, Carrie D. Patnode, Leslie A. Lytle, Darin J. Erickson, John R. Sirard, Daheia J. Barr-Anderson, Mary Story May 2011

Physical Activity And Sedentary Activity Patterns Among Children And Adolescents: A Latent Class Analysis Approach, Carrie D. Patnode, Leslie A. Lytle, Darin J. Erickson, John R. Sirard, Daheia J. Barr-Anderson, Mary Story

Faculty Publications

Background: While much is known about the overall levels of physical activity and sedentary activity among youth, few studies have attempted to define clusters of such behaviors. The purpose of this study was to identify and describe unique classes of youth based on their perception in a variety of physical activity and sedentary behaviors. Methods: Latent class analysis was used to characterize segments of youth based on patterns of self-reported and accelerometer-measured participation in 12 behaviors. Children and adolescents (N =720) from 6th-11th grade were included in the analysis. Differences in class membership were examined using multinomial logistic …


Self-Reported Exercise And Risk Of Osteoporosis In Prostate Cancer Patients Receiving Androgen Deprivation Therapy, Lori J. Mennen-Winchell May 2011

Self-Reported Exercise And Risk Of Osteoporosis In Prostate Cancer Patients Receiving Androgen Deprivation Therapy, Lori J. Mennen-Winchell

Loma Linda University Electronic Theses, Dissertations & Projects

Prostate cancer is stimulated to grow in response to testosterone. Androgen deprivation therapy (ADT) leads to chemical castration and suppression of prostate cancer cell production. Testosterone levels less then 300ng/ml decreases bone mineral density and could result in osteoporosis. Studies have shown that during the first year of ADT, fracture risk, mainly in hips and spine increases about 50%. In men, 40% of hip fractures result in death. Exercise may reduce the risk of osteoporosis and thus contribute to the prevention of hip and other fractures. There is limited data regarding whether exercise is associated with a reduced risk of …


Examining Dietary Acculturation In Hispanic Males Residing In South Mississippi, Diana Katherine Cuy Castellanos May 2011

Examining Dietary Acculturation In Hispanic Males Residing In South Mississippi, Diana Katherine Cuy Castellanos

Dissertations

This study explored dietary behavior in terms of dietary intake, dietary intake change and dietary contributing factors in a sample of Hispanic males residing in southern Mississippi that are at various stages of the acculturation process. Grounded theory and the bidimensional acculturation model were incorporated to identify the dietary factors and assess acculturation in each participant. Qualitative and quantitative measures were used in data collection. Qualitative measurements included Semistructured interviews, a focus group, and photovoice with group interviews. The ARSMA-II, Marginality Scale, Fruit/Vegetable and Fat Food Screeners, a psychosocial dietary questionnaire, and the New Vital Signs Food Label for Health …


Youth At The Nexus: Ideology In Hiv Prevention In Nairobi, Kenya, Zohra Ahmed May 2011

Youth At The Nexus: Ideology In Hiv Prevention In Nairobi, Kenya, Zohra Ahmed

Scholarly Works

In the fight against HIV/AIDS, the Behavior Change Communication (BCC) model stands as international best practice in preventive education. Ideally, a BCC intervention aims to changes behaviors and attitudes by facilitating group negotiation and introspection, with a resultant improvement in health. However, introducing this best practice model to a group of youth in Nairobi resulted in suboptimal outcomes: they were unaccustomed to expressing themselves in the ways prescribed by the class. To explain this failure, I examine how local discourses produced by parents and teachers communicate agency, sexuality and health, and highlight the diverging practices invoked at home, school and …