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Purpose: This study examines the role of social support on adjustment to widowhood. Past research has indicated that the role of social support on adjustment to widowhood remains inconclusive, and needs further examination. This study examines the varying coping trajectories of middle-aged and retired bereaved spouses. Additionally, this study examines

Purpose: This study examines the role of social support on adjustment to widowhood. Past research has indicated that the role of social support on adjustment to widowhood remains inconclusive, and needs further examination. This study examines the varying coping trajectories of middle-aged and retired bereaved spouses. Additionally, this study examines how bereavement stage may also influence one's adaptation to widowhood. Methods: This study used in-depth and semi-structured interviews as a means of understanding the role of social support on adjustment to widowhood. Participants were recruited through two hospice services available in a major metropolitan area in the United States. Convenient and purposive samplings are used in this study; this study will execute a grounded theory approach in order to determine the inconclusive role of social support on adjustment to widowhood. This study is contrasting between two stages- life course stages (middle aged versus retirement aged people) and bereavement stages (a year or less time following the death of a spouse versus three or more years following the death of a spouse). As a means of reducing bias and subjectivity, all data collected during the interview will be transcribed immediately. Results: Middle-aged bereaved spouses reported higher levels of motivation for adjusting positively and quickly towards widowhood due to their concern for protecting the well-being of their surviving young children compared to retired bereaved spouses. Differences between middle-aged widows and widowers have been found in this study; middle-aged widowers have a higher linkage to negative health behaviors. Retired bereaved spouses may fare better depending upon their housing location. Living in a retirement center may lower negative effects of bereavement on retired spouses' health. Conclusions: Types of social support received and expected varied between middle-aged widows and widowers. Gender norms may influence the type of social support widows and widowers receive. Middle-aged widowers are less likely to receive emotional support which may explain their higher linkage to negative health behaviors. Bereavement stage and housing location may be the key factors that influence widowhood trajectories of retired bereaved spouses. Living in a retirement center may lower the negative effects of bereavement on overall health.
ContributorsRafieei, Noshin (Author) / Kronenfeld, Jennie (Thesis advisor) / Haas, Steven (Committee member) / Damgaard, Anni (Committee member) / Arizona State University (Publisher)
Created2013
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Description
Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team. Such team-based

Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team. Such team-based procedures include surgical and clinical procedures, some of which are protocol-driven. Cost and time required for individual team-based training sessions, along with other factors, contribute to making the training complex and challenging. A great deal of research has been done on medically-focused collaborative virtual reality (VR)-based training for protocol-driven procedures as a cost-effective as well as time-efficient solution. Most VR-based simulators focus on training of individual personnel. The ones which focus on providing team training provide an interactive simulation for only a few scenarios in a collaborative virtual environment (CVE). These simulators are suited for didactic training for cognitive skills development. The training sessions in the simulators require the physical presence of mentors. The problem with this kind of system is that the mentor must be present at the training location (either physically or virtually) to evaluate the performance of the team (or an individual). Another issue is that there is no efficient methodology that exists to provide feedback to the trainees during the training session itself (formative feedback). Furthermore, they lack the ability to provide training in acquisition or improvement of psychomotor skills for the tasks that require force or touch feedback such as cardiopulmonary resuscitation (CPR). To find a potential solution to overcome some of these concerns, a novel training system was designed and developed that utilizes the integration of sensors into a CVE for time-critical medical procedures. The system allows the participants to simultaneously access the CVE and receive training from geographically diverse locations. The system is also able to provide real-time feedback and is also able to store important data during each training/testing session. Finally, this study also presents a generalizable collaborative team-training system that can be used across various team-based procedures in medical as well as non-medical domains.
ContributorsKhanal, Prabal (Author) / Greenes, Robert (Thesis advisor) / Patel, Vimla (Thesis advisor) / Smith, Marshall (Committee member) / Gupta, Ashish (Committee member) / Kaufman, David (Committee member) / Arizona State University (Publisher)
Created2014
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Description
The overarching purpose of my dissertation is to offer one Pueblo perspective about research and health education to contribute to critical dialogue among Pueblo people so that relevant research and health education approaches grounded in Pueblo thinking can emerge. Research was a pebble in my shoe that caused me great

The overarching purpose of my dissertation is to offer one Pueblo perspective about research and health education to contribute to critical dialogue among Pueblo people so that relevant research and health education approaches grounded in Pueblo thinking can emerge. Research was a pebble in my shoe that caused me great discomfort as I walked within academia during the many years I worked as a health educator at a university, and continues to bother me. The purpose of my journal article is to discuss why much mainstream research is problematic from a Pueblo Indian standpoint and to explore considerations for research with Pueblo people. The purpose of my book chapter is to reflect on my experiences as a Pueblo Indian health educator to add to the discussion about the importance of grounding Pueblo health education in local Pueblo knowledge systems and to discuss the limitations of delivering health education primarily grounded in a western biomedical disease model. Finally, my policy brief is an urgent call to action for tribal leaders regarding a recent change to the New Mexico Department of Health's race and ethnicity presentation in health data standard. This change resulted in 39,636 American Indians and Alaska Natives in New Mexico being reclassified as Hispanic. It is my intention to connect my ideas about research and health education with the work of other Pueblo scholars to add to the growing body of Pueblo informed writing to contribute to current and future scholarship that will ultimately benefit Pueblo people.
ContributorsSuina, Michele (Author) / Sumida Huaman, Elizabeth (Thesis advisor) / Brayboy, Bryan (Thesis advisor) / Gomez, Alan (Committee member) / Arizona State University (Publisher)
Created2015
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There are multivariate factors that not only play a role in an individual's ability to lose weight, but may create barriers to his or her success. One such factor is internalized weight bias (IWB), which is inversely associated with weight loss outcomes and body satisfaction, and directly associated with psychosocial

There are multivariate factors that not only play a role in an individual's ability to lose weight, but may create barriers to his or her success. One such factor is internalized weight bias (IWB), which is inversely associated with weight loss outcomes and body satisfaction, and directly associated with psychosocial maladjustments such as depression and binge eating. This study examined the relationship between internalized weight bias and weight loss outcomes using a coding scheme developed for an online weight loss forum to see whether results would be consistent with self-administered surveys that measure IWB. The coding scheme was developed using an exploratory factor analysis of a survey composed of existing measures of IWB. Participants' posts within an online weight loss forum were coded and participants given a weekly IWB score that was compared to weekly weight loss using mixed model analysis. No significance was found between IWB and weight loss outcomes in this study, however, the coding scheme developed is a novel approach to measuring IWB, and the categories identified from latent constructs of IWB may be used in the future to determine the dimensions that exist within it. Ultimately, a better understanding of IWB could lead to the development of targeted weight loss interventions that address the beliefs and attitudes held by individuals who experience it.
ContributorsEscajeda, Janessa (Author) / Hekler, Eric (Thesis advisor) / Barroso, Cristina (Thesis advisor) / Dixon, Kathleen (Committee member) / Arizona State University (Publisher)
Created2015
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Description
Other studies have previously demonstrated that perceived stress and maladaptive stress management can lead to harmful outcomes including depression, morbidity, and mortality. College students (especially freshmen) have more difficulty dealing with stress, which can increase their susceptibility to engage in high risk behaviors. The importance of conducting this research is

Other studies have previously demonstrated that perceived stress and maladaptive stress management can lead to harmful outcomes including depression, morbidity, and mortality. College students (especially freshmen) have more difficulty dealing with stress, which can increase their susceptibility to engage in high risk behaviors. The importance of conducting this research is to discover the effects that perceived stress levels may have on depression outcomes in college students, and to evaluate the influence of health related behaviors on this relationship. This study used a retrospective cross-sectional correlational design to examine correlations between perceived stress, physical activity, and other health behaviors on clinical and perceived depression in college students. A random sample of 20,000 students was drawn from 62,476 students enrolled at Arizona State University (ASU). Participants included 2,238 students who volunteered to take the American College Health Association-National College Health Assessment (ACHA-NCHA) in spring 2009. Supplemental questions for ASU students were developed by ASU Wellness and administered as a part of the ACHA-NCHA II. The university sent an invitation email, wherein students were directed through a hyperlink to the survey website. ACHA provided institutional survey data in an SPSS file for analysis. The data were evaluated with Spearman Rho Correlation Analysis and Wilcoxon-Mann-Whitney test. There were more female participants (n = 580) than males (n = 483), both averaged 23 years of age. Men had greater height, weight, and body mass index than females, all were significant mean differences. There were more significant correlations between health factors and having perceived depression than with having real or diagnosed depression. Logistic regression showed that out of all variables and behaviors studied, only high levels of stress, poor general health, substance use, and gender (female) resulted in significant odds in predicting that a participant would be in one of the depression categories. This research suggests that addressing these factors may be important to prevent and reduce depression among college students. This study provides empirical evidence that there is a significant relationship between perceived stress and depression among college students, and that health behaviors such as substance abuse have a negative mediating effect on this relationship.
ContributorsSkipworth, Katherine (Author) / Swan, Pamela (Thesis advisor) / Woodruff, Larry (Committee member) / Moses, Karen (Committee member) / Arizona State University (Publisher)
Created2011
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Introduction: Several faith-based or faith-placed programs have focused on the physical dimension of wellness in efforts to improve health by increasing physical activity and improving diet behaviors. However, these programs were not designed to intervene on the mental dimension of wellness which is critical for stress reduction and health behavior

Introduction: Several faith-based or faith-placed programs have focused on the physical dimension of wellness in efforts to improve health by increasing physical activity and improving diet behaviors. However, these programs were not designed to intervene on the mental dimension of wellness which is critical for stress reduction and health behavior change. Purpose: To evaluate the feasibility of a spirituality-based stress reduction and health behavior change intervention using the Spiritual Framework of Coping (SFC) model. Methods: This study was a quasi-experimental one group pretest posttest design. The study was a total of eight weeks conducted at a non-denominational Christian church. Participants were recruited from the church through announcements and flyers. The Optimal Health program met once a week for 1.5 hours with weekly phone calls during an additional four week follow-up period. Feasibility was assessed by the acceptability, demand, implementation, practicality, integration, and limited efficacy of the program. Analysis: Frequencies for demographics were assessed. Statistical analyses of feasibility objectives were assessed by frequencies and distribution of responses to feasibility evaluations. Limited efficacy of pretest and posttest measures were conducted using paired t-test (p <.05). Results: The Optimal Health Program was positively accepted by participants. The demand for the program was shown with average attendance of 78.7%. The program was successfully implemented as shown by meeting session objectives and 88% homework completion. The program was both practical for the intended participants and was successfully integrated within the existing environment. Limited efficacy changes within the program were mostly non-significant. Conclusion: This study tested the feasibility of implementing the Optimal Health program that specifically targeted the structural components of the Spiritual Framework of Coping Model identified to create meaning making and enhance well-being. This program may ultimately be used to help individuals improve and balance the spiritual, mental, and physical dimensions of wellness. However, length of study and limited efficacy measures will need to be reevaluated for program success.
ContributorsWalker, Jenelle R (Author) / Swan, Pamela (Thesis advisor) / Ainsworth, Barbara (Committee member) / Chisum, Jack (Committee member) / Fleury, Julie (Committee member) / Hooker, Steven (Committee member) / Arizona State University (Publisher)
Created2012
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Description
Research on the impact of stress on the academic performance of Hispanic undergraduate students is limited, leaving institutions of higher education without needed information about how to better support this growing population of students. The purpose of this study was to identify stressors that have a negative impact on academic

Research on the impact of stress on the academic performance of Hispanic undergraduate students is limited, leaving institutions of higher education without needed information about how to better support this growing population of students. The purpose of this study was to identify stressors that have a negative impact on academic performance of Hispanic undergraduate students. Themes were derived from focus groups and interviews regarding stress, stressors and related academic performance impacts of Hispanic undergraduate students attending a large multi-campus urban university and incorporated into a survey addressing common stressors, their impact on academic performance, stress impact on other areas of life, stress management ability, and demographic characteristics. The survey was administered to a random sample of Hispanic undergraduate students using an online format (n = 169). Descriptive statistics were used to examine frequencies. Stressors were placed into themes and tested for reliability of fit using Cronbach's Alpha. Pearson's Chi-Square and Cramer's V were used to measure association. Significance was set at ¡Ü .05. Overall stress of respondents resulted in serious performance effects among 32.5% of respondents and moderate performance effects among 43.8% of respondents. Stress impeded academic performance at least weekly among 36.1% of respondents. Stressors resulting in the most serious stress and academic performance effects included family, time factors, finances, and academics. Moderate stress and academic performance effects were evident in stressors related to mental health, technology, commuting, personal concerns, physical health and legal problems. The majority of respondents indicated doing a fair (n = 84, 49.7%) or good (n = 52, 30.8%) job managing stress. The remaining 20.0% (n = 33) of respondents did a poor job managing stress. Students with lower grade-point averages managed stress poorly compared to students with higher grade-point averages, X2 (6, N = 163) = 15.222, p = .019, Cramer's V = .019. These findings provide evidence that stressors related to family, time factors, finances, and academics, and overall stress have considerable negative effects on the academic performance of Hispanic undergraduate students. Institutions of higher education can improve academic outcomes among this student population by addressing and reducing the impact of common stressors affecting these students.
ContributorsMoses, Karen S (Author) / De Los Santos, Jr., Alfredo G. (Thesis advisor) / Ewing, Kris (Thesis advisor) / Melnyk, Bernadette (Committee member) / Arizona State University (Publisher)
Created2012
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This research addressed concerns regarding the measurement of cyberbullying and aimed to develop a reliable and valid measure of cyberbullying perpetration and victimization. Despite the growing body of literature on cyberbullying, several measurement concerns were identified and addressed in two pilot studies. These concerns included the most appropriate time frame

This research addressed concerns regarding the measurement of cyberbullying and aimed to develop a reliable and valid measure of cyberbullying perpetration and victimization. Despite the growing body of literature on cyberbullying, several measurement concerns were identified and addressed in two pilot studies. These concerns included the most appropriate time frame for behavioral recall, use of the term "cyberbullying" in questionnaire instructions, whether to refer to power in instances of cyberbullying, and best practices for designing self-report measures to reflect how young adults understand and communicate about cyberbullying. Mixed methodology was employed in two pilot studies to address these concerns and to determine how to best design a measure which participants could respond to accurately and honestly. Pilot study one consisted of an experimental examination of time frame for recall and use of the term on the outcomes of honesty, accuracy, and social desirability. Pilot study two involved a qualitative examination of several measurement concerns through focus groups held with young adults. Results suggested that one academic year was the most appropriate time frame for behavioral recall, to avoid use of the term "cyberbullying" in questionnaire instructions, to include references to power, and other suggestions for the improving the method in the main study to bolster participants' attention. These findings informed the development of a final measure in the main study which aimed to be both practical in its ability to capture prevalence and precise in its ability to measure frequency. The main study involved examining the psychometric properties, reliability, and validity of the final measure. Results of the main study indicated that the final measure exhibited qualities of an index and was assessed as such. Further, structural equation modeling techniques and test-retest procedures indicated the measure had good reliability. And, good predictive validity and satisfactory convergent validity was established for the final measure. Results derived from the measure concerning prevalence, frequency, and chronicity are presented within the scope of findings in cyberbullying literature. Implications for practice and future directions for research with the measure developed here are discussed.
ContributorsSavage, Matthew (Author) / Roberto, Anthony J (Thesis advisor) / Palazzolo, Kellie E (Committee member) / Thompson, Marilyn S (Committee member) / Arizona State University (Publisher)
Created2012
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ABSTRACT Approximately 3.5% of adolescents in the United States have chronic daily headache (CDH). Chronic daily headaches in adolescents are often refractory to the adult pharmacological interventions. And as a result, adolescents typically experience increased levels of stress, which exacerbates their headaches. Chronic daily headaches negatively impact both the adolescent

ABSTRACT Approximately 3.5% of adolescents in the United States have chronic daily headache (CDH). Chronic daily headaches in adolescents are often refractory to the adult pharmacological interventions. And as a result, adolescents typically experience increased levels of stress, which exacerbates their headaches. Chronic daily headaches negatively impact both the adolescent and their family. Adolescents with CDHs frequently exemplify comorbid psychiatric symptoms such as anxiety, depression, and increased risk for suicide. Risk factors for CDH in adolescents have been well studied; however, few studies have focused on psychologically based interventions to enhance effective coping, positive mental health, and pain relief in this group of teens. Given the paucity of psychologically focused interventions in this group, further research is necessary to test and develop the effectiveness of cognitive behavioral skills building (CBSB) interventions. This pilot study focused on the use of a CBSB intervention that emphasized problem solving, cue recognition, effective communication, behavior modeling, cognitive reappraisal, stress management, effective coping, and positive thinking. A randomized controlled trial pilot study was conducted. The intervention group received a seven-week intervention focused on CBSB techniques and headache education, while the comparison headache education group received a seven-week program focused on basic headache hygiene measures (e.g., adequate sleep, adequate hydration, dietary triggers, environmental triggers). The total sample included 32 adolescents inclusive of the ages 13 and 17 years. Paired t-tests resulted in significant preliminary positive effects for COPE-HEP on anxiety, depression, beliefs, headache disability, headache frequency, and headache duration. Comparison group education resulted in significant preliminary positive effects on anxiety, depression, headache disability, headache frequency, headache pain level, headache duration, and medication frequency. There were no significant changes over time in means of parent perception of pain interference for both groups. Independent t-tests revealed that COPE-HEP teens had significantly less anxiety and headache duration at post-intervention. The acceptability of the COPE-HEP intervention with adolescents with CDHs in a specialty care setting is supported by this study, while the feasibility of conducting this study in a specialty care setting is partially supported. These findings support a need to refine the intervention and test both its short and long-term effects in a full-scale randomized controlled trial with adolescents who have CDHs.
ContributorsHickman, Carolyn (Author) / Melnyk, Bernadette M (Thesis advisor) / Jacobson, Diana (Thesis advisor) / Gance-Cleveland, Bonnie (Committee member) / Szalacha, Laura (Committee member) / Arizona State University (Publisher)
Created2012
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Salad bars are promoted as a means to increase fruit and vegetable consumption among school-age children; however, no study has assessed barriers to having salad bars. Further, it is not known if barriers differ across school level. This cross-sectional study investigated the barriers to having salad bars across school level

Salad bars are promoted as a means to increase fruit and vegetable consumption among school-age children; however, no study has assessed barriers to having salad bars. Further, it is not known if barriers differ across school level. This cross-sectional study investigated the barriers to having salad bars across school level among schools without salad bars in Arizona (n=177). Multivariate binominal regression models were used to determine differences between the barriers and school level, adjusting for years at current job, enrollment of school, free-reduced eligibility rate and district level clustering. The top five barriers were not enough staff (51.4%), lack of space for salad bars (49.7%), food waste concerns (37.9%), sanitation/food safety concerns (31.3%), and time to get through the lines (28.3%) Adjusted analyses indicated two significant differences between barriers across school level: time to get through lines (p=0.040) and outside caterer/vendor (p=0.018) with time to get through lines reported more often by elementary and middle school nutrition managers and outside caterer/vendor reported most often by high school nutrition managers. There were several key barriers reported and results indicate that having an outside vendor/caterer for their meal programs and time to get through the service lines varied across school level. High schools report a higher percent of the barrier outside caterer/vendors and elementary and middle schools report a higher percent of the barrier time to get through the lines. Results indicate that research determining the approximate time it takes students to get through salad bar lines will need to be considered. More research is needed to determine if the barrier time to get through the service lines is due to selection of food items or if it is due to the enrollment size of the lunch period. Future research interventions may consider investigating food safety and sanitation concerns of middle school nutrition managers. Findings may be used to guide ways to decrease barriers in schools without salad bars.
ContributorsKebric, Kelsey (Author) / Bruening, Meg (Thesis advisor) / Ohri-Vachaspati, Punam (Committee member) / Adams, Marc (Committee member) / Arizona State University (Publisher)
Created2016