Theses and Dissertations
This collection includes both ASU Theses and Dissertations, submitted by graduate students, and the Barrett, Honors College theses submitted by undergraduate students.
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- All Subjects: Nutrition
- Creators: Reifsnider, Elizabeth
Description
Background: The Special Supplemental Nutrition Program for Women, Infant andChildren (WIC) provides participants with a supplemental food package that follows the
Dietary Guidelines for Americans (DGA’s). The WIC food package has been shown to
improve the diet quality and overall health status of WIC participants. Since the 2009
WIC food package revision, standard issuance of 1% or fat-free milk has been practiced
for participants 24 months or older. Improving the value that participants have on the
WIC foods can be an effective method to improve redemption of WIC foods and improve
overall participation. The aim of this study was to examine if allowing issuance of 2%
milk when clients refuse issuance of 1% or skim milk would affect benefit redemption of
milk and other WIC foods. The study also examined how providing clarification through
training on policy change for issuance of 2% milk would improve staff and director
knowledge of this change in policy.
Methods: This study was an observational, longitudinal study that used linear regression
analysis of aggregated data at the local agency-level from the Arizona WIC program.
Redemption data were analyzed using the Arizona WIC Health and Nutrition Delivery
System (HANDS) at three different intervals throughout the study. The three months
prior to the policy introduction (March-May 2020), redemption after policy introduction
(July-September 2020), and redemption after policy clarification with 2% milk policy
trainings (December 2020-February 2021). Redemption was measured as benefits issued
versus benefits redeemed. Two separate surveys were delivered (via Qualtrics) to the 18
local agency directors (n=18) and their staff members (n=287). These surveys were used
for descriptive purposes.
Results: The results of this study found that there was a decrease in redemption of 2%
milk and all foods at the post intervention stage of the study. WIC staff were found to
have a better understanding of policy to issue 2% milk. Conclusion: Although these
findings are consistent with other current research, further research is needed to examine
how changing policy on current food restrictions placed on WIC foods affects redemption
and how this may improve overall participation.
ContributorsZacarias, Ivan (Author) / Bruening, Meg (Thesis advisor) / Reifsnider, Elizabeth (Committee member) / Whisner, Corrie (Committee member) / Arizona State University (Publisher)
Created2022
Description
Breastfeeding is considered the optimal source of nutrition for infants because of the protection it offers against many adverse maternal and child health consequences. The greatest health benefits are associated with exclusive breastfeeding, but employees must often return to work before establishing a full milk supply. Although federal and California law mandate space and time provisions for workplace lactation accommodation, women employed in manual labor jobs, including agricultural field work, face challenges to expressing (pumping) their breast milk. Mexican-descent women, who represent more than a quarter of the California farmworker population, are particularly at risk for supplementing their breastfed infants with formula. Using a socio-ecological model (SEMBA) to guide the research process, this qualitative case study examined the experiences of five Mexican immigrant women who expressed their milk in the California agricultural workplace. The investigator conducted semi-structured interviews to explore how each level of SEMBA influenced their decision to initiate and then continue pumping in the field. Sociodemographic questionnaires were also completed for each participant. Qualitative content analysis led to the discovery of three themes: Honoring Culture, Running the Gauntlet, and Blazing a Trail. Enabling factors for milk expression in the workplace were found at all levels of SEMBA, except for the work environment. At the individual level, self-efficacy, strengthened by social support (interpersonal), was a major contributor to continuance of milk expression. Significant challenges were found at the interpersonal (coworker) and work environment levels, represented by the theme of Running the Gauntlet. Social support at the interpersonal level was provided by family members, child care providers, and WIC breastfeeding peer counselors and buffered the hardships of the workplace. Community level enablers included cultural values, reflected by the theme of Honoring Culture. Trusting in the (lactation) law at the systems level was mentioned by all study participants as a facilitator for workplace milk expression within the theme of Blazing a Trail. Improved understanding of the factors that enable or challenge success at milk expression on the job may lead to appropriate interventions that support optimal breastfeeding, especially among employees in agriculture or other manual labor jobs.
ContributorsVaughan, Janet Copeland (Author) / Reifsnider, Elizabeth (Thesis advisor) / Evans, Bronwynne C (Committee member) / Williams, Deborah L (Committee member) / Arizona State University (Publisher)
Created2023
Description
OBJECTIVE: In 2020, the COVID-19 pandemic disrupted the health and wellbeing offamilies and communities alike. The purpose of this qualitative research study was to better understand the perspectives and experiences of Arizona mothers who gave birth and transitioned to parenthood during the COVID-19 pandemic. METHODS: This research study was a qualitative thematic analysis. Arizona residents aged 18 and older who gave birth after March 2020 and spoke English proficiently were eligible to participate in this research study. Participants completed a 90-minute virtual interview, answering questions about their overall perinatal experiences during the pandemic. Interviews were recorded, transcribed and reviewed for accuracy. A codebook of themes was created. The transcriptions were analyzed and coded using Delve software. RESULTS: In total, 18 interviews were coded for this study when saturation was reached. The average participant age was 31.78 ± 5.52 years and was predominantly White (89%). In total, 61% reported experiencing birth-related trauma and approximately 60% of participants were able to take parental leave, while 40% did not. Four principal themes emerged from data describing the transition to parenthood during the COVID-19 pandemic: 1) Maternal Experiences During COVID, 2) Navigating the Support System, 3) Perinatal Healthcare Insufficiencies, and 4) Retrospective Insights. Of these four primary themes, fourteen associated subthemes were also identified. CONCLUSION: The transition to parenthood is a multidimensional ecosystem centered around maternal and infant wellbeing with family, friends, community, and healthcare providers serving as primary influences. Inadequate healthcare, broken social networks, and diminished health promotion skills that bridge families to the care and support to thrive in parenthood have been reduced during the pandemic as women in this study exhibited poor mental health, faded self-efficacy, and reduced access to care.
ContributorsHoovler, Megan (Author) / Bruening, Meg (Thesis advisor) / Bever, Jennie (Committee member) / Reifsnider, Elizabeth (Committee member) / Arizona State University (Publisher)
Created2022