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- All Subjects: public health
- Genre: Academic theses
- Creators: Ohri-Vachaspati, Punam
- Creators: Adams, Marc
Description
In October, 2009, participants of the Arizona Special Supplemental Nutrition Program for Women, Infants and Children (WIC) began receiving monthly Cash Value Vouchers (CVV) worth between six and 10 dollars towards the purchase of fresh fruits and vegetables. Data from the Arizona Department of Health Services (ADHS) showed CVV redemption rates in the first two years of the program were lower than the national average of 77% redemption. In response, the ADHS WIC Food List was expanded to also include canned and frozen fruits and vegetables. More recent data from ADHS suggest that redemption rates are improving, but variably exist among different WIC sub-populations. The purpose of this project was to identify themes related to the ease or difficulty of WIC CVV use amongst different categories of low-redeeming WIC participants. A total of 8 focus groups were conducted, four at a clinic in each of two Valley cities: Surprise and Mesa. Each of the four focus groups comprised one of four targeted WIC participant categories: pregnant, postpartum, breastfeeding, and children with participation ranging from 3-9 participants per group. Using the general inductive approach, recordings of the focus groups were transcribed, hand-coded and uploaded into qualitative analysis software resulting in four emergent themes including: interactions and shopping strategies, maximizing WIC value, redemption issues, and effect of rule change. Researchers identified twelve different subthemes related to the emergent theme of interactions and strategies to improve their experience, including economic considerations during redemption. Barriers related to interactions existed that made their purchase difficult, most notably anger from the cashier and other shoppers. However, participants made use of a number of strategies to facilitate WIC purchases or extract more value out of WIC benefits, such as pooling their CVV. Finally, it appears that the fruit and vegetable rule change was well received by those who were aware of the change. These data suggest a number of important avenues for future research, including verifying these themes are important within a larger, representative sample of Arizona WIC participants, and exploring strategies to minimize barriers identified by participants, such as use of electronic benefits transfer-style cards (EBT).
ContributorsBertmann, Farryl M. W (Author) / Wharton, Christopher (Christopher Mack), 1977- (Thesis advisor) / Ohri-Vachaspati, Punam (Committee member) / Johnston, Carol (Committee member) / Hampl, Jeffrey (Committee member) / Dixit-Joshi, Sujata (Committee member) / Barroso, Cristina (Committee member) / Arizona State University (Publisher)
Created2013
Description
Determining the factors associated with the availability of healthy and unhealthy foods in the household may help in understanding the varying complexities that contribute to obesity among children and help design interventions to impact children's food consumption behaviors. This study examined factors that are associated with the availability of healthy and unhealthy foods in children's home food environments (HFE). Data was collected from a random-digit-dial telephone survey of 1708 households, with at least one child between 3-18 years of age, located in five low-income New Jersey cities. HFE was assessed based on responses to a set of six items that measured availability of specific healthy and unhealthy foods in the respondent's home. These items contributed to construction of three HFE scales used as dependent variables in these analyses: healthy HFE, unhealthy HFE, and a ratio of healthy to unhealthy foods in the HFE. Independent variables included household socio-demographics, parental perceptions of their own weight and diet health, frequency of family meals, proximity to food outlets, and perception of access to healthy foods in the neighborhood food environment. Significant differences were observed in the HFE by race and ethnicity, with Non-Hispanic black children having fewer healthy foods and Non-Hispanic white children having more unhealthy food items available at home. Parents who reported being overweight or obese had a healthier HFE and those perceiving their own eating as healthy had more healthy and less unhealthy foods in the household. Food-secure households had more unhealthy compared to healthy foods at home. Households located farther from a supermarket had a greater number of unhealthy food items and a lower healthy/unhealthy food availability ratio. Parental perception of better access to fruits and vegetables and low-fat foods was associated with availability of a greater number of healthy food items at home. Overall, the HFE varied by parental and demographic characteristics, parental perceptions about the food environment and the actual features of the built neighborhood food environment.
ContributorsBerry, Andrea (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Johnston, Carol (Committee member) / Wharton, Christopher (Christopher Mack), 1977- (Committee member) / Arizona State University (Publisher)
Created2012
Description
Dopamine (DA) is a neurotransmitter involved in attention, goal oriented behavior, movement, reward learning, and short term and working memory. For the past four decades, mathematical and computational modeling approaches have been useful in DA research, and although every modeling approach has limitations, a model is an efficient way to generate and explore hypotheses. This work develops a model of DA dynamics in a representative, single DA neuron by integrating previous experimental, theoretical and computational research. The model consists of three compartments: the cytosol, the vesicles, and the extracellular space and forms the basis of a new mathematical paradigm for examining the dynamics of DA synthesis, storage, release and reuptake. The model can be driven by action potentials generated by any model of excitable membrane potential or even from experimentally induced depolarization voltage recordings. Here the model is forced by a previously published model of the excitable membrane of a mesencephalic DA neuron in order to study the biochemical processes involved in extracellular DA production. After demonstrating that the model exhibits realistic dynamics resembling those observed experimentally, the model is used to examine the functional changes in presynaptic mechanisms due to application of cocaine. Sensitivity analysis and numerical studies that focus on various possible mechanisms for the inhibition of DAT by cocaine provide insight for the complex interactions involved in DA dynamics. In particular, comparing numerical results for a mixed inhibition mechanism to those for competitive, non-competitive and uncompetitive inhibition mechanisms reveals many behavioral similarities for these different types of inhibition that depend on inhibition parameters and levels of cocaine. Placing experimental results within this context of mixed inhibition provides a possible explanation for the conflicting views of uptake inhibition mechanisms found in experimental neuroscience literature.
ContributorsTello-Bravo, David (Author) / Crook, Sharon M (Thesis advisor) / Greenwood, Priscilla E (Thesis advisor) / Baer, Steven M. (Committee member) / Castaneda, Edward (Committee member) / Castillo-Chavez, Carlos (Committee member) / Arizona State University (Publisher)
Created2012
Description
Objectives: Although childhood obesity has received growing attention, parents still fail to recognize overweight and obesity in their children. Accurate identification of overweight or obesity in their child is associated with the parent's responsiveness to interventions aimed at preventing weight-related health issues. Recent research shows that a child's age and gender are associated with parental misperception of their child's weight status, but little is known about the interaction of these factors across various age groups. This study examined the association between a wide range of parent, child, and household factors and the accuracy of parental perception of their child's body weight status compared to parent-measured body weight status. Methods: Data were collected from a random-digit-dial telephone survey of 1708 households located in five low-income New Jersey cities with large minority populations. A subset of 548 children whose parents completed the survey and returned a worksheet of parent-measured heights and weights were the focus of the analysis. Bivariate and multivariate analyses were performed to determine the factors significantly associated with parental perception of their child's body weight status. Results: Based on parent-measure heights and weights, 36% of the children were overweight or obese (OWOB). Only 21% of OWOB children were perceived by their parents as OWOB. Child gender, child body mass index (BMI) and parent BMI were significant independent predictors of parents' accuracy at perceiving their child's body weight status. Conclusion: Boys, OWOB children, and children of OWOB parents had significantly greater odds of parental underestimation of their body weight status. Parents had better recognition of OWOB in their daughters, especially older daughters, than in their sons, suggesting parental gender bias in identifying OWOB in children. Further research is needed regarding parental gender bias and its implications in OWOB identification in children.
ContributorsBader, Wendy (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Lloyd, Kristen (Committee member) / Crespo, Noe (Committee member) / Arizona State University (Publisher)
Created2013
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
Ensuring access to safe and affordable recreational spaces is vital for promoting well-being, especially in underserved communities facing barriers to physical activity. Shared use agreements, where school facilities are open for public use, offer a promising solution; yet limited research has examined how to maximize usage of these spaces. Framed under Social Cognitive Theory in a socioecological model, this dissertation comprises three studies contributing to this knowledge base to foster active, healthy communities. The first study was a scoping review of usage and physical activity behavior in school shared use spaces, highlighting the potential of shared use agreements to promote physical activity, especially when they included organized activities or space renovations. The study underscores the need for robust evaluations, gender- and population-sensitive interventions, and community engagement to maximize impact. The second study, adopting a pre/post, cross-sectional approach, assessed the impact of a multicomponent intervention on perceptions and usage of a school shared use path in South Phoenix (AZ). No statistically significant changes in usage were observed over time; however, access was a significant predictor of usage. Gender (female, negative) and safety perceptions (positive) were also identified as salient predictors of usage. The findings highlight the critical role of awareness (i.e., perceived access) in enhancing usage of school shared use spaces. The third study was a longitudinal natural experiment, with observational assessments of usage and related physical activity on one school shared use path over 12 months at an elementary school in South Phoenix (AZ). Moderate increases in usage over time were attributed to promotional efforts, social programming, and environmental modifications. Most users (>70%) of the path were observed walking, and were male, Hispanic, and adult. The study suggests that demographic disparities may exist. Implementing broader engagement strategies and understanding safety perceptions may facilitate more representative usage. Collectively, this dissertation provides a comprehensive evaluation of the potential of school shared use spaces to promote physical activity, while underscoring the importance of understanding complex factors influencing the usage of these spaces. Ultimately, the findings contribute knowledge to enhancing the usage of school shared use spaces, adding to the literature on their significance in promoting physical activity and community health, particularly in underserved regions.
ContributorsWilson, Kylie (Author) / Poulos, Allison (Thesis advisor) / Grimm, Kevin (Committee member) / Koskan, Alexis (Committee member) / Kulinna, Pamela Hodges (Committee member) / Ohri-Vachaspati, Punam (Committee member) / Arizona State University (Publisher)
Created2024
Description
The U.S. Department of Agriculture’s (USDA) National School Lunch Program and School Breakfast Program provide nutritious meals to school-age children. USDA’s Community Eligibility Provision (CEP) is designed to extend the reach of these programs by allowing schools in low-income areas to provide free school meals to all students at no cost to families. CEP has been shown to increase school meal participation, nutritional intake, academic achievement, and attendance in previous research studies. This study aims to examine the impact of long-term CEP participation on student weight outcomes. Nurse-measured height and weight data for school years 2013-14 to 2019-20 were collected from 141 K-12 public schools in four low-income cities. School-level prevalence of obesity was calculated from students’ heights and weights using the Centers for Disease Control and Prevention protocol. CEP participation for each school year was obtained from the state Department of Education. Schools in the sample began participating in CEP at different times yielding varying numbers of years of CEP exposure over the study period. Multivariable analyses examined the relationship between school CEP exposure and the prevalence of obesity, controlling for school-level covariates. Multivariable analyses showed that for every additional year of CEP participation, the school-level prevalence of obesity was 0.4% lower (p=0.018). The regression-adjusted obesity prevalence for schools that never participated in CEP was 28.0%, while the obesity prevalence for schools with 6 years of CEP participation was 25.4%. The lower prevalence of obesity in CEP-participating schools was primarily driven by elementary schools. These results suggest that the benefits of CEP participation can cumulate over time, significantly reducing school-level obesity prevalence over time.
ContributorsDykstra, Tatum Nicole (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Acciai, Francesco (Committee member) / McCoy, Maureen (Committee member) / Arizona State University (Publisher)
Created2024
Description
Objective: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federally-funded program that provides supplemental food packages, nutrition education, and healthcare referrals to low-income women, infants, and children under 5, who are at the highest nutritional risk. This study explores if household WIC participation is associated with healthier dietary behaviors among age-ineligible children (5-18-years-old) in WIC households. Consumption frequency of fruits, vegetables, 100% juice, sugar-sweetened beverages (SSBs), and energy-dense snacks (sweet and salty snacks) among children from WIC and income-qualifying non-WIC households were compared.
Methods: Data were obtained from two cross-sectional panels (2009-10 and 2014) of the New Jersey Child Health Study conducted in four low-income New Jersey cities. Questions from previously validated surveys assessed consumption frequency of fruits, vegetables, SSBs, and sweet and salty snacks. Analyses were confined to 570 children between 5-18 yrs; of which 365 (5-11 yrs: 237, 12-18 yrs: 128) resided in WIC participating households and 205 (5-11 yrs: 138, 12-18 yrs: 67) in income-qualifying non-WIC households. Over half of the sample was African American and 43% were Hispanic. Multivariable analyses were conducted to compute incidence rate ratios (IRRs) using negative binomial regression to compare the differences in eating behaviors of children in WIC vs. Non-WIC households
Results: Household WIC participation was associated with a slightly higher frequency of vegetable consumption among 12-18-year-old children (IRR= 1.25, p=.05); differences were significant among older males (12-18-years-old) (p=.006), and not in females.
Frequency of 100% juice consumption was significantly higher among younger females (5-11-years-old) in WIC households who consumed juice about 44% more frequently (p=.02) compared to similar age girls in non-WIC households. Hispanic children in WIC households reported a lower frequency of SSBs consumption (p=.01); this association was only true among males (p=.02).
Conclusions: Household WIC participation is associated with healthier dietary behaviors among age-ineligible children living in the households, suggesting a positive spillover effect of the program. Proposed changes to WIC packages are likely to have dietary implications not only for WIC participants but also for non-participating children residing in WIC households,
Methods: Data were obtained from two cross-sectional panels (2009-10 and 2014) of the New Jersey Child Health Study conducted in four low-income New Jersey cities. Questions from previously validated surveys assessed consumption frequency of fruits, vegetables, SSBs, and sweet and salty snacks. Analyses were confined to 570 children between 5-18 yrs; of which 365 (5-11 yrs: 237, 12-18 yrs: 128) resided in WIC participating households and 205 (5-11 yrs: 138, 12-18 yrs: 67) in income-qualifying non-WIC households. Over half of the sample was African American and 43% were Hispanic. Multivariable analyses were conducted to compute incidence rate ratios (IRRs) using negative binomial regression to compare the differences in eating behaviors of children in WIC vs. Non-WIC households
Results: Household WIC participation was associated with a slightly higher frequency of vegetable consumption among 12-18-year-old children (IRR= 1.25, p=.05); differences were significant among older males (12-18-years-old) (p=.006), and not in females.
Frequency of 100% juice consumption was significantly higher among younger females (5-11-years-old) in WIC households who consumed juice about 44% more frequently (p=.02) compared to similar age girls in non-WIC households. Hispanic children in WIC households reported a lower frequency of SSBs consumption (p=.01); this association was only true among males (p=.02).
Conclusions: Household WIC participation is associated with healthier dietary behaviors among age-ineligible children living in the households, suggesting a positive spillover effect of the program. Proposed changes to WIC packages are likely to have dietary implications not only for WIC participants but also for non-participating children residing in WIC households,
ContributorsSteeves, Stephanie N (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Tasevska, Natasha (Committee member) / DeWeese, Robin (Committee member) / Arizona State University (Publisher)
Created2019
Description
Statistical Methods have been widely used in understanding factors for clinical and public health data. Statistical hypotheses are procedures for testing pre-stated hypotheses. The development and properties of these procedures as well as their performance are based upon certain assumptions. Desirable properties of statistical tests are to maintain validity and to perform well even if these assumptions are not met. A statistical test that maintains such desirable properties is called robust. Mathematical models are typically mechanistic framework, used to study dynamic interactions between components (mechanisms) of a system, and how these interactions give rise to the changes in behavior (patterns) of the system as a whole over time.
In this thesis, I have developed a study that uses novel techniques to link robust statistical tests and mathematical modeling methods guided by limited data from developed and developing regions in order to address pressing clinical and epidemiological questions of interest. The procedure in this study consists of three primary steps, namely, data collection, uncertainty quantification in data, and linking dynamic model to collected data.
The first part of the study focuses on designing, collecting, and summarizing empirical data from the only national survey of hospitals ever conducted regarding patient controlled analgesia (PCA) practices among 168 hospitals across 40 states, in order to assess risks before putting patients on PCA. I used statistical relational models and exploratory data analysis to address the question. Risk factors assessed indicate a great concern for the safety of patients from one healthcare institution to other.
In the second part, I quantify uncertainty associated with data obtained from James A Lovell Federal Healthcare Center to primarily study the effect of Benign Prostatic Hypertrophy (BPH) on sleep architecture in patients with Obstructive Sleep Apnea (OSA). Patients with OSA and BPH demonstrated significant difference in their sleep architecture in comparison to patients without BPH. One of the ways to validate these differences in sleep architecture between the two groups may be to carry out a similar study that evaluates the effect of some other chronic disease on sleep architecture in patients with OSA.
Additionally, I also address theoretical statistical questions such as (1) how to estimate the distribution of a variable in order to retest null hypothesis when the sample size is limited, and (2) how changes on assumptions (like monotonicity and nonlinearity) translate into the effect of the independent variable on the outcome variable. To address these questions we use multiple techniques such as Partial Rank Correlation Coefficients (PRCC) based sensitivity analysis, Fractional Polynomials, and statistical relational models.
In the third part, my goal was to identify socio-economic-environment-related risk factors for Visceral Leishmaniasis (VL) and use the identified critical factors to develop a mathematical model to understand VL transmission dynamics when data is highly underreported. I primarily studied the role of age-specific- susceptibility and epidemiological quantities on the dynamics of VL in the Indian state of Bihar. Statistical results provided ideas on the choice of the modeling framework and estimates of model parameters.
In the conclusion, this study addressed three primary theoretical modeling-related questions (1) how to analyze collected data when sample size limited, and how modeling assumptions varies results of data analysis? (2) Is it possible to identify hidden associations and nonlinearity of these associations using such underpowered data and (3) how statistical models provide more reasonable structure to mathematical modeling framework that can be used in turn to understand dynamics of the system.
In this thesis, I have developed a study that uses novel techniques to link robust statistical tests and mathematical modeling methods guided by limited data from developed and developing regions in order to address pressing clinical and epidemiological questions of interest. The procedure in this study consists of three primary steps, namely, data collection, uncertainty quantification in data, and linking dynamic model to collected data.
The first part of the study focuses on designing, collecting, and summarizing empirical data from the only national survey of hospitals ever conducted regarding patient controlled analgesia (PCA) practices among 168 hospitals across 40 states, in order to assess risks before putting patients on PCA. I used statistical relational models and exploratory data analysis to address the question. Risk factors assessed indicate a great concern for the safety of patients from one healthcare institution to other.
In the second part, I quantify uncertainty associated with data obtained from James A Lovell Federal Healthcare Center to primarily study the effect of Benign Prostatic Hypertrophy (BPH) on sleep architecture in patients with Obstructive Sleep Apnea (OSA). Patients with OSA and BPH demonstrated significant difference in their sleep architecture in comparison to patients without BPH. One of the ways to validate these differences in sleep architecture between the two groups may be to carry out a similar study that evaluates the effect of some other chronic disease on sleep architecture in patients with OSA.
Additionally, I also address theoretical statistical questions such as (1) how to estimate the distribution of a variable in order to retest null hypothesis when the sample size is limited, and (2) how changes on assumptions (like monotonicity and nonlinearity) translate into the effect of the independent variable on the outcome variable. To address these questions we use multiple techniques such as Partial Rank Correlation Coefficients (PRCC) based sensitivity analysis, Fractional Polynomials, and statistical relational models.
In the third part, my goal was to identify socio-economic-environment-related risk factors for Visceral Leishmaniasis (VL) and use the identified critical factors to develop a mathematical model to understand VL transmission dynamics when data is highly underreported. I primarily studied the role of age-specific- susceptibility and epidemiological quantities on the dynamics of VL in the Indian state of Bihar. Statistical results provided ideas on the choice of the modeling framework and estimates of model parameters.
In the conclusion, this study addressed three primary theoretical modeling-related questions (1) how to analyze collected data when sample size limited, and how modeling assumptions varies results of data analysis? (2) Is it possible to identify hidden associations and nonlinearity of these associations using such underpowered data and (3) how statistical models provide more reasonable structure to mathematical modeling framework that can be used in turn to understand dynamics of the system.
ContributorsGonzalez, Beverly, 1980- (Author) / Castillo-Chavez, Carlos (Thesis advisor) / Mubayi, Anuj (Thesis advisor) / Nuno, Miriam (Committee member) / Arizona State University (Publisher)
Created2015
Description
Individual behavior change is a goal of many public policies directed at people of low socioeconomic status. Without evidence of behavioral change, these policies cannot be considered a success: a process of co-production where some level of cooperation between the client and program administrators is required to successfully meet program objectives. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), is one example of a co-production design. WIC encourages women to engage in healthy behaviors by providing healthy food along with nutrition education to improve the health status of low-income families. However, while WIC is one of the most studied nutrition programs, little attention has been paid to the nutrition education portion or to interactions between staff members and participants. This research draws on the public policy and administration literature about street-level bureaucrats and co-production, which provides a framework for understanding the purposeful, inter-dependent relationships between front-line service providers and clients. However, neither literature explicates the process of interactions that is expected to lead to client behavior change and co-production. The primary contribution of this research is the creation of a grounded theory that identifies and explains the WIC interaction process as one of "negotiating healthy self-government". Based on analysis of three months of observations of WIC encounters in two clinics, this research finds that participants and staff members enter into tacit and explicit negotiations concerning the degree to which participants should govern their family's nutrition-related behavior. Clients actively shape the interactions by demonstrating their discipline and efforts to feed their families, while staff members refine and reinforce self-governing behaviors through assessing action, and providing advice to ensure behaviors meet recommendations. Finally, participants and staff members distinctly link self-governing behavior to identity: "good mothers" feed their children healthy food and govern their behaviors to meet nutritional recommendations. This research has implications for the study of behavior change promotion in public programs by introducing the concept of identity as a mechanism for governance and explicating the interaction process between front-line service providers and clients
ContributorsHand, Laura Catherine (Author) / Catlaw, Thomas J. (Thesis advisor) / Ohri-Vachaspati, Punam (Committee member) / Lucio, Joanna (Committee member) / Arizona State University (Publisher)
Created2014