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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- Genre: Masters Thesis
- Creators: Whisner, Corrie
Description
Background: Adequate consumption of fruit and vegetables has been shown to prevent chronic diseases, such as cardiovascular disease, high blood pressure, and type two diabetes. The majority of Americans still consume inadequate daily servings of fruit and vegetables, which include women. Inadequate consumption of fruit and vegetables can be contributed to multiple barriers that hinder consumption in both urban and non-urban areas. The Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) has been shown to positively influence fruit and vegetable consumption by providing healthy foods, such as fruit and vegetables. This study aims to compare the fruit and vegetable consumption of WIC and non-WIC participants between urban and non-urban Rural-Urban Commuting Area (RUCA) codes. Methods: This study was a cross-sectional, secondary analysis of a single time point from the Snuggle Bug/Acurrucadito Study, which had a sample size of (n=53) participants. The participants were separated into two groups, WIC participants, and non-WIC participants, and then further divided based on their respected RUCA code for comparison purposes. The assessment of fruit and vegetable consumption assessment derived from the participant’s 3-day food record. Results: The average consumption of fruit and vegetable consumption among participants was 3.8±2.5 servings There was an inverse relationship between WIC participation and fruit and vegetable consumption among all categories (fruit no juice -0.79, vegetables -0.32, vegetables no potato -0.32, fruit no juice and vegetables -1.1, and fruit no juice and vegetables no potato -1.1). However, none of the results were considered statistically significant. In addition, our study was unable to identify an association between fruit and vegetable consumption and locale due to the small sample size. Conclusions: There was no link observed between fruit and vegetable consumption and WIC participation. Further research of high quality is needed to confirm the relationship between fruit and vegetable consumption of WIC and non-WIC participants in urban and non-urban populations.
ContributorsOrtiz, Steven Michael (Author) / Bruening, Meg (Thesis advisor) / Whisner, Corrie (Committee member) / Shepard, Christina (Committee member) / Arizona State University (Publisher)
Created2022
Description
Purpose: Although numerous studies exist regarding the health impact of the Special, Supplemental Program for Women, Infants and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) on their participants’, limited studies have examined how participation in one federal nutrition assistance program, may impact participation or perceived benefit of the other. This study aimed to examine how SNAP participation may impact weight-related pregnancy outcomes and participation of pregnant WIC participants. Methods: The present study is a cross-sectional, secondary data analysis of data available from the Arizona Department of Health Services. A total of 35,659 pregnant woman participated in the Arizona WIC program during 2018 and were included in the study. Pregnant participants were assigned to Group WIC or Group WIC+SNAP respectively. Data was aggregated to the clinic level and clinics with less than 10 pregnant participants were combined for a total of 101 clinics included in the analysis. Weight-related pregnancy outcomes measures included average pre-pregnancy weight, average gestational weight gain, BMI class, and delivery weight. Participation indicator outcomes included average number of visits during pregnancy, timing of first prenatal and postnatal WIC appointment, and entry into WIC within the first trimester. Race, ethnicity, language, and education were also analyzed.
Results: This study found average pre-pregnancy weight was statistically significant for women in group SNAP+WIC weighing 2.8 kg more than women in group WIC(p<0.001). Group WIC had a lower delivery weight average (p<0.001) and a higher amount of women beginning pregnancy with a normal BMI (p=0.004). Group WIC participants were statistically more likely to not enroll in WIC during the first trimester compared with Group WIC+SNAP (p=0.049). Group WIC was more likely to enroll in the 8th (p=0.045) and 9th month (p=0.009) of pregnancy and attend their first postpartum visit 6 months after delivery (p=0.007) as compared to Group WIC+SNAP.
Conclusions: This study found that pregnant WIC participants, not enrolled in SNAP have a lower pre-pregnancy weight and are more likely not to enroll within the first trimester. Future research should focus on individualized characteristics of WIC participants to further improve prenatal and postnatal support.
ContributorsStolworthy, Alexandra (Author) / Bruening, Meg (Thesis advisor) / Wadhera, Devina (Committee member) / Whisner, Corrie (Committee member) / Arizona State University (Publisher)
Created2022
Description
Grains are a major dietary staple in many cultures and countries. Corn can be consumed as either a fruit, vegetable, or grain. In the case of the Corn and Heart Health Study (CHS), the effect of corn flour was examined. The study used three varieties of corn flour (whole grain, refined, and a refined plus bran blend), provided by the North American Millers Association (NAMA), to examine the effectiveness of corn flour on lowering low-density lipoprotein (LDL) cholesterol as well as its effects on the diversity of the gut microbiome. The objective of this analysis was to determine the magnitude of change between pre- and post- intervention serum blood samples and the changes in alpha (within-sample) diversity in the gut microbiome. The study utilized a randomized-single blinded, crossover model. The study was 16 weeks long, with three 4-week long treatment periods with two-week washout periods in between. During each treatment period blood samples, stool samples, a diet record, and questionnaires were collected from participants. Two blood samples were collected at the beginning and end of each treatment period to account for potential day to day changes on LDL cholesterol. For the purpose of this study, the results of blood and fecal analysis were used to determine the effectiveness of the intervention. Fecal analysis using the Shannon Index showed that there was no significant difference in the within-sample microbiome diversity by corn flour type (H=2.86, p=0.72). Pre-treatment plasma LDL levels were subtracted from post-treatment levels and analyzed using a general linear model that controlled for sequence, period and a nested (ID[sequence]) variable to account for the within-person crossover design. This showed that the bran-enriched flour had the highest mean reduction in LDL cholesterol while the refined and whole grain flour resulted in increases in LDL cholesterol. The change in LDL cholesterol for bran-enriched flour was significantly different from the refined flour (Mean Difference of -14.97 mg/dL; P=.041). The results of this study indicate that refined corn flour enriched with bran could be a recommended addition to the diet to prevent cardiovascular disease and reduce LDL cholesterol in individuals who are at low risk.
ContributorsHarris, Michelle Lynn (Author) / Whisner, Corrie (Thesis advisor) / Grant, Shauna (Committee member) / Mayol-Kreiser, Sandra (Committee member) / Arizona State University (Publisher)
Created2024
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
The Association Between Time to Eat and Students Fruit & Vegetable Consumption, Selection, and Waste
Description
Background: Studies have examined student fruit/vegetable (FV) consumption, selection, and waste related to lunch duration and found that longer duration at lunch was associated with greater consumption, selection, and reduced waste. However, few studies have investigated the relationship between time to eat and FVs. The aim of this research is to analyze the relationship between objective time to students took to eat (“time to eat”) as it relates to their fruit and vegetable consumption, selection, and plate waste.in elementary, middle, and high schools. Methods: A secondary analysis of cross-sectional study of 37 Arizona schools to discover the differences in the selection, consumption, and waste of FVs from students (Full N = 2226, Elementary N = 630, Middle School N = 699, High School N = 897) using objective time to eat measures. Zero-inflated negative binomial regressions examined differences in FV grams selected, consumed, and wasted adjusted for sociodemographics including race, ethnicity, eligibility for free or reduced lunch, academic year, and sex and clustering for students within schools. Results are presented across school level (elementary, middle, and high school).
Results: The average time taken to eat ranged from 10-12 minutes for all students. The association of time to eat and lunch duration were not closely related (r=0.03, p = 0.172). In the count model for every additional minute spent, there was a 0.5% greater likelihood of selecting FVs for elementary kids among those who took any FVs. In the zero-inflated model, it was found that there was a statistically significant relationship between time spent eating and the selection of fruits and vegetables. For the total sample and high schoolers, a minute more of eating time was associated with a 4.3% and 8.8% greater odds of selecting FV. This means that longer eating time increased the likelihood of choosing fruits and vegetables. The results indicated that the longer students took to eat, the higher the likelihood of consuming more of FVs. Each 10 more minutes spent eating (i.e., time to eat) is associated with a 5% increase in grams of FV selected relative to mean (for those that chose FV) over 1 week this equates to 32 g increase of FV selected. However, for middle schoolers, the time to eat was not found to be significant in relation to the grams of fruits and vegetables consumed. There was some significance in the sociodemographic factors such as gender (all) and other (middle school). There was a relationship between time taken to eat and waste as a proportion for fruits and vegetables. For example, among those among the students who wasted something (as a proportion of selection), each additional 10 minutes of eating time was associated with a .6% decrease in waste relative to the mean (for those who chose fruits and vegetables) over a week, resulting in a decrease in waste percentage of 16.5%. Among high schoolers, males had a slightly higher odds of wasting a proportion of fruits and vegetables.
Conclusions: This study aimed to examine the association between the time students take to eat during lunch and their fruit and vegetable (FV) consumption, selection, and plate waste. The findings revealed that the time to eat was related to FV consumption, depending on the school level. However, it was not significantly associated with FV selection or waste. The study emphasized the need for further research on time to eat, distinguishing it from the duration of lunch. Longer lunch periods and adequate time could influence better food choices, increased FV consumption, and reduced waste. The study highlighted the importance of interventions and school policies promoting healthier food choices and providing sufficient time for students to eat. Future research should validate these findings and explore the impact of socialization opportunities on promoting healthier eating habits. Understanding the relationship between lunch duration, time to eat, and students' dietary behaviors can contribute to improved health outcomes and inform effective strategies in school settings.
ContributorsDandridge, Christina Marie (Author) / Adams, Marc (Thesis advisor) / Whisner, Corrie (Committee member) / Bruening, Meg (Committee member) / Arizona State University (Publisher)
Created2023
Description
In 2020, approximately 55% of households facing food insecurity participated in one or more of the three largest federal nutrition assistance programs. Food insecurity rates have been relatively unchanged since 2019 but federal nutrition assistance programs have continued to see a decline in participation. Many families meet the income guidelines to participate in both the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) programs, yet almost half of those participants are not utilizing WIC. The WIC program is an essential safety net for low-income families to combat food insecurity and improve diet quality. The purpose of this study was to examine differences in household characteristics among families participating in SNAP only and households participating in both SNAP and WIC. Additionally, we examined potential barriers and facilitators to participating in WIC among WIC-eligible SNAP participants. Hispanics made up 40% of SNAP Only households and about 65% of SNAP and WIC. Households with a larger number of beneficiaries and those with an infant in the household were more likely to participate in both SNAP and WIC. The main barriers identified by respondents previously enrolled in WIC were a lack of knowledge regarding WIC eligibility and issues with appointments. The two most common misconceptions regarding WIC eligibility were being unaware that simultaneous enrollment in both programs was allowable, and being unaware that household members were still eligible for WIC services. For the facilitators toward WIC enrollment, more than half of respondents knew to enroll in WIC when they needed nutrition or breastfeeding assistance. Results from this study suggest the need for targeted outreach campaigns that highlight the possibility and benefits of dual participation in SNAP and WIC. Understanding how SNAP can increase enrollment in WIC demonstrates to policymakers the benefits of streamlining the certification process.
ContributorsWaxman, Cayla (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Wadhera, Devina (Committee member) / Whisner, Corrie (Committee member) / Melnick, Emily (Committee member) / Arizona State University (Publisher)
Created2023
Description
Food insecurity affects more than 10 million households in the United States and has been shown to impact what and how a child is fed. Additionally, there is some evidence to suggest that food insecurity may affect how an infant is soothed (either with food or another mechanism), but no study has examined the possible relationship between soothing techniques and the incidence of food insecurity. To evaluate whether food security status and nighttime soothing techniques have a relationship, surveys were administered to a sample of mothers from various racial and socioeconomic backgrounds at 3-weeks, 8-weeks, and 3-months postpartum. Of the 69 participants sampled, 61 had data that could contribute to evaluations of food security status and soothing techniques used at night. A chi-square model was utilized to determine what, if any, relationship existed between the two variables. The chi-square model did not yield statistically significant results (Pearson Chi-Square= .506, p=.477) and descriptive statistics showed that just six of the 61 participants sampled did not use food to soothe at the time their baby was 3-weeks-old. Further examination of descriptive statistics revealed that, between breastfeeding and bottle-feeding as a means to soothe an infant, breastfeeding was used twice as much as bottle-feeding. For participants enrolled in the Special Supplemental Nutrition Program for Women, Infants, Children (WIC), the use of food to soothe increased at each of the three time points. Among participants found to be food-insecure, the use of breastfeeding and bottle-feeding as means to soothe varied from time point to time point. The physical and mental toll of the postpartum period may contribute to the high use of food-to-soothe among mothers seen in this study. Future research efforts in this area should examine whether the observations reported in this study are similar among larger samples, and if more mental health support for mothers has any effect on whether food is used to soothe.
ContributorsKoelbel, Megan (Author) / Whisner, Corrie (Thesis advisor) / Petrov, Megan (Committee member) / Bruening, Meg (Committee member) / Arizona State University (Publisher)
Created2023
Description
Immigrants and their U.S.-born children account for 26% of the American population as of 2020. Despite this large proportion, 14% of immigrants live below the federal poverty line compared to 12% of U.S.-born citizens. The immigrant population is vulnerable to food and housing insecurity and limited access to social services and medical care, on top of navigating the increasingly convoluted immigration system. Migrant women and children are especially at risk for systemic, poverty-related adversities. Periods of pregnancy and postpartum are particularly financially straining due to employment disruptions and additional expenses. Migrant mothers experience adverse health outcomes due to chronic stress, unstable living situations, integration barriers, and an unfavorable occupational environment during pregnancy. In addition to the postpartum needs of a new mother and her baby, these challenges may be barriers to maintaining breastfeeding. The unanticipated COVID-19 pandemic exasperated many existing systemic inequities and brought additional hardship. This study aims to investigate breastfeeding rates among immigrant mothers compared to U.S.-born mothers and other social disparities that affect health. While this study did not find a statistical difference between breastfeeding adherence and immigrant status during the COVID-19 pandemic, other risk factors relating to maternal-child health were identified. Immigrant families were more likely to experience job or income loss and a higher frequency of food insecurity compared to families with U.S.-born parents. The risks of being impoverished greatly reduce the incidence of breastfeeding, which can offer tremendous health benefits both to mother and baby. Most immigrants migrating to the U.S. are ethnic minorities who face additional societal disparities in culture, employment, economic stability, safety, and healthcare. The burden of social determinants of health that impact this population is not unique to adults. The moment a child is born into an immigrant family, particularly if they are also an ethnic minority, they inherit risk factors that can impact their entire lifespan. Ultimately, the risks associated with pregnancy and infant feeding are issues of social justice and health equity.
ContributorsFahmy, Gabriella (Author) / Whisner, Corrie (Thesis advisor) / Schuster, Roseanne (Thesis advisor) / Mayol-Kreiser, Sandra (Committee member) / Arizona State University (Publisher)
Created2023
Description
The prevalence of cardiovascular diseases, closely associated with elevated cholesterol levels, remains a significant public health concern worldwide. Dietary interventions, particularly the consumption of whole grains, have been advocated for their potential in reducing cholesterol levels and mitigating cardiovascular risk. However, the specific impact of corn flour, a staple in many diets, on cholesterol modulation remains underexplored. This thesis aims to address this gap by exploring how three varieties of corn flour (refined, whole grain, and excellent fiber mixture) provided by the North American Millers Association Corn Division (NAMA) affect both LDL cholesterol levels and triglycerides. This study was conducted using a randomized-single blinded crossover design. There were three treatment periods that were each 4-weeks long, each treatment period consisting of a different flour treatment. There was a 2-week washout period in between each treatment making the study a total of 16 weeks. During each treatment period, blood samples were collected from each participant to analyze LDL and triglyceride levels. At the beginning and end of each treatment period, two blood samples were taken to account for day-to-day variability. Pre-intervention LDL cholesterol levels were compared to post-intervention LDL cholesterol levels using a general linear model. This study found that LDL cholesterol levels were significantly reduced by the excellent fiber mixture by ~10 mg/dL. Whole grains and refined grains, however, had no significant effect on LDL cholesterol levels. None of the corn flour treatments had a significant effect on triglyceride levels. The overall results of the study indicated that implementing the excellent fiber mixture into the diet could be effective in reducing risk for cardiovascular disease.
ContributorsProbst, Amanda Grace (Author) / Whisner, Corrie (Thesis advisor) / Grant, Shauna (Committee member) / Mayol-Kreiser, Sandra (Committee member) / Arizona State University (Publisher)
Created2024
Description
This study evaluates the effects of feeding modes on the infant gut microbiome, especially focusing on the unique microbial composition provided by human milk. It analyzed the gut microbiome of 51 mother-infant dyads and identified significant differences in microbial diversity related to feeding practices. Alpha diversity results, measured using the Shannon diversity index (H = 38.134, p = 1.05e^-7) and Faith's Phylogenetic Diversity (H = 45.999, p = 2.45e^-9), showed that breastfeeding, in any form, supports microbial alpha diversity comparable to exclusive breastfeeding that was lower in infants receiving breast milk compared to formula and cow’s milk. In contrast, formula or cow's milk led to a distinctly different microbiome. This study utilized both unweighted and weighted UniFrac metrics to assess the impact of feeding modes on microbial community structure or beta diversity. Using these metrics, and PERMANOVA testing, significant differences were observed between several feeding modes. Cow’s milk and formula did not differ for gut microbiome community structure but all modes of feeding that included breastmilk were significantly different from both cow’s milk and formula (q < 0.005). Additionally, breastmilk fed at breast resulted in a significantly different community structure than in infants fed breastmilk at breast and pumped for bottle feeding. Multivariate models of beta diversity metrics, including both subject ID and time, suggested that individual differences accounted for 48% of the variance, while feeding mode accounted for 2%. Despite the smaller explained variance of feeding mode, the association between feeding mode and unweighted UniFrac was statistically significant (p = 0.01). Interestingly, while feeding mode was a significant factor in microbial community diversity, it did not significantly associate with the abundance of Bifidobacterium (p = 0.31) or Lactobacillus (p = 0.21). Covariate inclusion in models revealed that subject ID (individual baby) was the only substantial contributor (p < 0.0001) to the variance in Bifidobacterium abundance. These findings emphasize breast milk's critical role in the development of a healthy gut microbiome and highlight the complex interplay between diet, genetics, and microbial colonization. These insights suggest that while individual genetics are a driving force, breast milk consumption contributes significantly to the gut microbiome diversity and community composition, particularly when compared to formula or cow’s milk consumption. Further research into the mechanisms driving the establishment and maintenance of the infant gut microbiome are warranted.
ContributorsLiedike, Bethany Patricia (Author) / Whisner, Corrie (Thesis advisor) / Sears, Dorothy D. (Committee member) / Hinde, Katie (Committee member) / Arizona State University (Publisher)
Created2024