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- Genre: Doctoral Dissertation
Description
Health care providers (HCPs) are an important source of physical activity (PA) information. Two studies were conducted to qualitatively and quantitatively examine nurse practitioners'(NPs) and physician assistants' current PA counseling practices, knowledge and confidence to provide PA counseling and providers' perceptions about their current PA counseling practices. The specific aims for these two studies included quantitatively and qualitatively identifying the prevalence of PA counseling, perceived counseling knowledge and confidence, and educational training related to counseling. In study 1, survey respondents were currently practicing NPs and physician assistants. Participants completed a modified version of the Promotion of Physical Activity by Nurse Practitioners Questionnaire either online or in person during a population specific conference. The majority of both NP and physician assistant respondents reported routinely counseling patients about PA. There were no differences in perceived knowledge or confidence to provide PA counseling between the two populations. Approximately half of all respondents reported receiving training to provide PA counseling as part of their educational preparation for becoming a health practitioner. Nearly three-quarters of respondents reported interest in receiving additional PA counseling training. In study 2, five focus groups (FGs), stratified by practice type, were conducted with NPs and physician assistants. Both NPs and physician assistants reported discussing PA with their patients, particularly those with chronic illness. Participants reported that discussing lifestyle modifications with patients was the most common type of PA counseling provided. Increased confidence to counsel was associated with having PA knowledge and providing simple counseling, such as lifestyle modifications. Barriers to counseling included having more important things to discuss, lack of time during appointments, the current healthcare system, lack of reimbursement and perceived patient financial barriers. PA recommendation knowledge was highly variable, with few participants reporting specific guidelines. FG participants, while not familiar with the American College of Sports Medicines' "Exercise is Medicine" initiative indicated interest in its use and learning more about it. The findings of these two studies indicate that while NPs and physician assistants are knowledgeable, confident and currently providing some amount of PA counseling to patients, additional training in PA counseling is needed and desired.
ContributorsGrimstvedt, Megan (Author) / Der Ananian, Cheryl (Thesis advisor) / Ainsworth, Barbara (Committee member) / Keller, Colleen (Committee member) / Sebren, Ann (Committee member) / Woolf, Kathleen (Committee member) / Arizona State University (Publisher)
Created2011
Description
It is broadly accepted that physical activity provides substantial health benefits. Despite strong evidence, approximately 60% to 95% of US adults are insufficiently active to obtain these health benefits. This dissertation explored five projects that examined the measurement properties and methodology for a variety of physical activity assessment methods. Project one identified validity evidence for the new MyWellness Key accelerometer in sixteen adults. The MyWellness Key demonstrated acceptable validity evidence when compared to a criterion accelerometer during graded treadmill walking and in free-living settings. This supports the use of the MyWellness Key accelerometer to measure physical activity. Project two evaluated validity (study 1) and test-retest reliability evidence (study 2) of the Global Physical Activity Questionnaire (GPAQ) in a two part study. The GPAQ was compared to direct and indirect criterion measures including object and subjective physical activity instruments. These data provided preliminary validity and reliability evidence for the GPAQ that support its use to assess physical activity. Project three investigated the optimal h.d-1 of accelerometer wear time needed to assess daily physical activity. Using a semi-simulation approach, data from 124 participants were used to compare 10-13 h.d-1 to the criterion 14 h.d-1. This study suggested that a minimum accelerometer wear time of 13 h.d-1 is needed to provide a valid measure of daily physical activity. Project four evaluated validity and reliability evidence of a novel method (Movement and Activity in Physical Space [MAPS] score) that combines accelerometer and GPS data to assess person-environment interactions. Seventy-five healthy adults wore an accelerometer and GPS receiver for three days to provide MAPS scores. This study provided evidence for use of a MAPS score for future research and clinical use. Project five used accelerometer data from 1,000 participants from the 2005-2006 National Health and Nutrition Examination Study. A semi-simulation approach was used to assess the effect of accelerometer wear time (10-14 h.d-1) on physical activity data. These data showed wearing for 12 h.d-1 or less may underestimate time spent in various intensities of physical activity.
ContributorsHerrmann, Stephen (Author) / Ainsworth, Barbara (Thesis advisor) / Gaesser, Glenn (Committee member) / Der Ananian, Cheryl (Committee member) / Kang, Minsoo (Committee member) / Vega-Lopez, Sonia (Committee member) / Arizona State University (Publisher)
Created2011
Description
"Globesity," as defined by the World Health Organization, describes obesity as a pandemic affecting at least 400 million people worldwide. The prevalence of obesity is higher among women than men; and in non-Hispanic black and Hispanic populations. Obesity has been significantly associated with increased all-cause mortality, and mortality from cardiovascular disease, obesity-related cancers, diabetes and kidney disease. Current strategies to curb obesity rates often use an ecological approach, suggesting three main factors: biological, behavioral, and environmental. This approach was used to develop four studies of obesity. The first study assessed dietary quality, using the Healthy Eating Index (HEI)-2005, among premenopausal Hispanic and non-Hispanic white women, and found that Hispanic women had lower total HEI-2005 scores, and lower scores for total vegetables, dark green and orange vegetables and legumes, and sodium. Markers of obesity were negatively correlated with total HEI-2005 scores. The second study examined the relationship between reported screen time and markers of obesity among premenopausal women and found that total screen time, TV, and computer use were positively associated with markers of obesity. Waist/height ratio, fat mass index, and leptin concentrations were significantly lower among those who reported the lowest screen time versus the moderate and high screen time categories. The third study examined the relationship between screen time and dietary intake and found no significant differences in absolute dietary intake by screen time category. The fourth study was designed to test a brief face-to-face healthy shopping intervention to determine whether food purchases of participants who received the intervention differed from those in the control group; and whether purchases differed by socioeconomic position. Participants in the intervention group purchased more servings of fruit when compared to the control group. High-income participants purchased more servings of dark green/deep yellow vegetables compared to those in the low-income group. Among those who received the intervention, low-income participants purchased foods of lower energy density, and middle-income participants purchased food of higher fat density. The findings of these studies support policy changes to address increasing access and availability of fruits and vegetables, and support guidelines to limit screen time among adults.
ContributorsMilliron, Brandy-Joe (Author) / Woolf, Kathleen (Thesis advisor) / Vaughan, Linda (Committee member) / Ainsworth, Barbara (Committee member) / Wharton, Chris (Committee member) / Der Ananian, Cheryl (Committee member) / Appelhans, Bradley (Committee member) / Arizona State University (Publisher)
Created2010
Description
Traditional public health strategies for assessing human behavior, exposure, and activity are considered resource-exhaustive, time-consuming, and expensive, warranting a need for alternative methods to enhance data acquisition and subsequent interventions. This dissertation critically evaluated the use of wastewater-based epidemiology (WBE) as an inclusive and non-invasive tool for conducting near real-time population health assessments. A rigorous literature review was performed to gauge the current landscape of WBE to monitor for biomarkers indicative of diet, as well as exposure to estrogen-mimicking endocrine disrupting (EED) chemicals via route of ingestion. Wastewater-derived measurements of phytoestrogens from August 2017 through July 2019 (n = 156 samples) in a small sewer catchment revealed seasonal patterns, with highest average per capita consumption rates in January through March of each year (2018: 7.0 ± 2.0 mg d-1; 2019: 8.2 ± 2.3 mg d-1) and statistically significant differences (p = 0.01) between fall and winter (3.4 ± 1.2 vs. 6.1 ± 2.9 mg d-1; p ≤ 0.01) and spring and summer (5.6 ± 2.1 vs. 3.4 ± 1.5 mg d-1; p ≤ 0.01). Additional investigations, including a human gut microbial composition analysis of community wastewater, were performed to support a methodological framework for future implementation of WBE to assess population-level dietary behavior. In response to the COVID-19 global pandemic, a high-frequency, high-resolution sample collection approach with public data sharing was implemented throughout the City of Tempe, Arizona, and analyzed for SARS-CoV-2 (E gene) from April 2020 through March 2021 (n = 1,556 samples). Results indicate early warning capability during the first wave (June 2020) compared to newly reported clinical cases (8.5 ± 2.1 days), later transitioning to a slight lagging indicator in December/January 2020-21 (-2.0 ± 1.4 days). A viral hotspot from within a larger catchment area was detected, prompting targeted interventions to successfully mitigate community spread; reinforcing the importance of sample collection within the sewer infrastructure. I conclude that by working in tandem with traditional approaches, WBE can enlighten a comprehensive understanding of population health, with methods and strategies implemented in this work recommended for future expansion to produce timely, actionable data in support of public health.
ContributorsBowes, Devin Ashley (Author) / Halden, Rolf U (Thesis advisor) / Krajmalnik-Brown, Rosa (Thesis advisor) / Conroy-Ben, Otakuye (Committee member) / Varsani, Arvind (Committee member) / Whisner, Corrie (Committee member) / Arizona State University (Publisher)
Created2022
Description
Falls are a public health concern for older adults with or without cognitive impairment, including clinical Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD) dementia. Executive function (EF) is linked to falls and is notably impaired in individuals with MCI and AD dementia. However, it is unclear which EF assessments are associated with falls in older adults with intact cognition, MCI, and AD dementia. Apolipoprotein E4 (ApoE4) increases the risk of MCI and AD dementia, with limited information suggesting decreased EF and gait impairment in ApoE4 carriers. The purpose of this study was to 1) investigate the relationships between EF assessments and falls (fall history and future fall) by cognitive status (intact cognition, MCI, AD dementia) and 2) determine if ApoE4 moderates the relationship between EF and falls across cognitive status. EF assessments included Digit Span (DS), Trail Making Test (ΔTMT), Stroop Interference Test, Controlled Oral Word Association assessments of phonemic and semantic fluency (COWAC), and Clock Drawing Test. Binary logistic regression was used with secondary data to analyze the EF and falls relationship. Results showed a significant association of the ΔTMT with fall history but may not be appropriate for use with people with AD dementia due to a floor effect. Significant interaction effects were shown between AD dementia and DS, ΔTMT, and EF as a latent variable, where individuals with a fall history had better EF performance. The interaction effects are influenced by the lower percentage of reported falls in people with severe AD dementia. In the second aim, a confounding effect exposed a potential four-way interaction where higher EF in ApoE4 non-carriers with AD dementia experienced a future fall without a fall history. Overall, more research is needed to determine which EF assessments are best suited for fall risk assessment and whether ApoE4 plays a role in the relationship between EF and falls. Since the low percentage of reported falls in people with severe AD dementia exposed a differing trend between EF and falls, more research is needed to develop valid and reliable tools for collecting fall data in individuals with severe AD dementia.
ContributorsDelgado, Ferdinand (Author) / Der Ananian, Cheryl (Thesis advisor) / Yu, Fang (Thesis advisor) / Mackinnon, David P (Committee member) / Peterson, Daniel S (Committee member) / Ofori, Edward (Committee member) / Arizona State University (Publisher)
Created2023
Description
Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food, which may include inadequate finances, transportation, skills, and information. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of hunger, nutritional deficiencies, and chronic disease among vulnerable populations. This dissertation tested a novel food insecurity intervention using informational nudges to promote food security through the elimination of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity. The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group. Qualitative findings revealed how the intervention group found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food.
ContributorsRoyer, Michael F. (Author) / Wharton, Christopher (Thesis advisor) / Buman, Matthew (Committee member) / Der Ananian, Cheryl (Committee member) / MacKinnon, David (Committee member) / Ohri-Vachaspati, Punam (Committee member) / Arizona State University (Publisher)
Created2023
Description
Postpartum depression affects approximately 15% of the childbearing population in the United States and has been linked to a number of negative maternal and infant outcomes. Mothers who rate low in areas of confidence and self-efficacy tend to have lower satisfaction and view their infants as having more negative temperaments. Infants of depressed mothers have been found to have delays in social and emotional growth which can impair their health and future developmental outcomes. The purpose of this study was to determine if there is any evidence to support the hypothesis that maternal depression is associated with infant social and emotional development and maternal role satisfaction among low-income women in rural Arizona. This study employed a repeated measures correlational descriptive prospective longitudinal design using chart reviews analyzing existing clinical data. Purposive sampling was used to select charts of women who participated in the Verde Valley Medical Center branch of the Arizona Healthy Families program. Chart reviews were used to identify charts that met the inclusion criteria of mothers and their infants who completed at least 18 months of the Arizona Healthy Families Program.
Findings of this study indicated evidence of a relationship between depression, infant social and emotional development, and maternal role satisfaction. Mothers who had infants that scored higher, with higher being indicative of concern, on the Ages & Stages Questionnaire: Social-Emotional Edition 2 (ASQ:SE 2) had lower role satisfaction scores on the Healthy Families Parenting Inventory (HFPI) and mothers who indicated dissatisfaction at 6 months postpartum were more likely to continue to indicate lower maternal satisfaction at 12 and 18 months postpartum when infant ASQ:SE 2 scores were higher.
Investigating the role of the visiting service providers, such as Healthy Families, and their impact on young families for risk identification and resource support will provide information to policy and lawmakers to aid in decisions for funding and help support young families with the goal of growing strong, healthy families in healthcare deserts like rural Arizona. Keywords: Postpartum depression, maternal depression, infant social and emotional development, maternal role, maternal role satisfaction
ContributorsArgent, Autumn Leif (Author) / Reifsnider, Elizabeth (Thesis advisor) / Hinde, Katie (Committee member) / Todd, Michael (Committee member) / Whisner, Corrie (Committee member) / Arizona State University (Publisher)
Created2024
Description
Background: Hispanic women are at high risk for Type 2 Diabetes (T2D), in part due to their high prevalence of obesity, which may influence the development of insulin resistance and disease onset. Unhealthy eating contributes to T2D risk. Dietary patterns are the combination of total foods and beverages among individual’s over time, but there is limited information regarding its role on T2D risk factors among Hispanic women. Objective: To identify a posteriori dietary patterns and their associations with diabetes risk factors (age, BMI, abdominal obesity, elevated fasting blood glucose, and hemoglobin A1c) among overweight/obese Hispanic women. Design: Cross-sectional dietary data were collected among 191 women with or at risk for T2D using the Southwestern Food Frequency Questionnaire capturing the prior three months of intake. Dietary patterns were derived using exploratory factor analysis. Regression scores were used to explore associations between dietary patterns and diabetes risk factors. Results: The patterns derived were: 1) “sugar and fat-laden”, with high loads of sweets, drinks, pastries, and fats; 2) “plant foods and fish”, with high loads of vegetables, fruits, fish, and beans; 3) “soups and starchy dishes”, with high loads of soups, starchy foods, and mixed dishes; 4) “meats and snacks”, with high loads of red meat, salty snacks, and condiments; 5) “beans and grains”, with high loads of beans and seeds, whole-wheat and refined grain foods, fish, and alcohol; and 6) “eggs and dairy”, with high loads of eggs, dairy, and fats. The “sugar and fat-laden” and “meats and snacks” patterns were negatively associated with age (r= -0.230, p= 0.001 and r= -0.298, p<0.001, respectively). Scores for “plant foods and fish” were associated with fasting blood glucose (r= 0.152, p= 0.037). There were no other statistically significant relationships between the dietary patterns and risk factors for T2D. Conclusions: A variety of patterns with healthy and unhealthy traits among Hispanic women were observed. Being younger may play an important role in adhering to a dietary pattern rich in sugary and high-fat foods and highlights the importance of assessing dietary patterns among young women to early identify dietary traits detrimental for their health.
ContributorsArias-Gastelum, Mayra (Author) / Vega-Lopez, Sonia (Thesis advisor) / Der Ananian, Cheryl (Committee member) / Whisner, Corrie (Committee member) / Bruening, Meg (Committee member) / Hooker, Steven (Committee member) / Arizona State University (Publisher)
Created2018
Description
The prevalence of obesity and obesity-related disorders have increased world-wide. In the last decade, the intestinal microbiome has become a major indicator of metabolic and gastrointestinal health. Previous research has shown that high-fat diet (HFD) consumption can alter the microbial composition of the gut by increasing the abundance of gram-positive bacteria associated with the onset of obesity and type 2 diabetes. Although, the most common form of obesity and metabolic syndrome intervention is exercise and diet, these recommendations may not improve severe cases of obesity. Thus, an important relevance of my project was to investigate whether the intake of an organometallic complex (OMC) would prevent the onset of metabolic and gastrointestinal complications associated with high-fat diet intake. I hypothesized that the consumption of a HFD for 6 weeks would promote the development of metabolic and gastrointestinal disease risk factors. Next, it was hypothesized that OMC treatment would decrease metabolic risk factors by improving insulin sensitivity and decreasing weight gain. Finally, I hypothesized that HFD-intake would increase the abundance of gram-positive bacteria associated with gastrointestinal disease. My preliminary data investigated the effects of a 6-week HFD on the development of hepatic steatosis, intestinal permeability and inflammation in male Sprague Dawley rats. I found that a 6-week HFD increases hepatic triglyceride concentrations, plasma endotoxins and promotes the production of pro-inflammatory cytokines in the cecum wall. I then investigated whether OMC treatment could prevent metabolic risk factors in male Sprague-Dawley rats fed a HFD for 10 weeks and found that OMC can mitigate risk factors such hyperglycemia, liver disease, impaired endothelial function, and inflammation. Lastly, I investigated the effects of a 10-week HFD on the gastrointestinal system and found an increase in liver triglycerides and free glycerol and alterations of the distal gut microbiome. My results support the hypothesis that a HFD can promote metabolic risk factors, alter the gut microbiome and increase systemic inflammation and that OMC treatment may help mitigate some of these effects. Together, these studies are among the first to demonstrate the effects of a soil-derived compound on metabolic complications. Additionally, these conclusions also provide an essential basis for future gastrointestinal and microbiome studies of OMC treatment.
ContributorsCrawford, Meli'sa Shaunte (Author) / Sweazea, Karen L (Thesis advisor) / Deviche, Pierre (Thesis advisor) / Al-Nakkash, Layla (Committee member) / Whisner, Corrie (Committee member) / Hyatt, Jon-Philippe (Committee member) / Arizona State University (Publisher)
Created2019
Description
Vitamin B12, found only in animal products, is a water-soluble vitamin important for DNA methylation, purine and pyrimidine synthesis, and the myelination of nerves. Symptoms of vitamin B12 deficiency include anemia, gait disturbances, altered vibration proprioception, impaired vision, psychosis, depression, dementia-like illness, and ultimately death. Because vegetarians and vegans consume fewer animal products in their diet than omnivores, they are inherently more at risk for developing these symptoms of vitamin B12 deficiency. Thus, the purpose of this study is to examine the correlation between nervous system markers (balance, dexterity, and vibration sensitivity) and markers of vitamin B12 nutriture (serum B12 and serum holo-transcobalamin II) in a cross-sectional study (n=38). In addition, the impact of daily oral vitamin B12 supplementation on these markers in an 8-week randomized controlled trial was also examined (n=18). The results of the cross-sectional study revealed a moderate correlation (R=-0.351, p=0.031) between serum B12 and left-hand functional dexterity. The results of the intervention study revealed no significant time*group interactions for markers of nervous system functions and biochemical values (after the removal of outliers). In addition, the time*group interaction appeared to be larger for those individuals with a baseline serum B12 of less than 303 pmol/L. These results suggest that vitamin B12 supplementation may have a more pronounced effect on those individuals who are in a state of vitamin B12 depletion (<303 pmol/L serum concentration). In addition, the results also suggest that 8 weeks of oral supplementation is not a long enough period to create significant clinical change, and it is likely that improvements in neurological measures would require long-term supplementation.
ContributorsArnold, Taylor (Author) / Johnston, Carol (Thesis advisor) / Whisner, Corrie (Committee member) / Ohri-Vachaspati, Punam (Committee member) / Lee, Chong (Committee member) / Aleck, Kyrieckos (Committee member) / Arizona State University (Publisher)
Created2016