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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
As part of the recently passed Patient Protection and Affordable Care Act, chain restaurants with 20 or more locations nationwide are required to post calorie information on menus and menu boards in order to help consumers make healthier decisions when dining out. Previous studies that have evaluated menu-labeling policies show mixed results and the majority have been conducted in urban cities along the east coast. This study was the first to look at the effectiveness of menu labeling in a southwest population. The primary objective of this cross-sectional study was to determine if noticing or using calorie menu labels in a fast food restaurant was associated with purchasing fewer calories. A second aim of this study was to evaluate the relationship between socio-demographic characteristics and the likelihood of noticing and using menu labeling. Customer receipts and survey data were collected from 329 participants using street-intercept survey methodology at 29 McDonald's locations in low- and high-income neighborhoods throughout the Phoenix metropolitan area. The study population was 63.5% male, 53.8% non-Hispanic white, and 50.8% low-income. Results showed that almost 60% of the study sample noticed calorie menu labeling and only 16% of participants reported using the information for food or beverage purchases. Income was the only socio-demographic characteristic that was associated with noticing menu labeling, with higher-income individuals being more likely to notice the information (p=0.029). Income was also found to be associated with using menu labels, with higher income individuals being more likely to use the information (p=0.04). Additionally, individuals with a bachelors degree or higher were more likely to use the information (p=0.023) and individuals aged 36 to 49 were least likely to use the information (p=0.046). There were no significant differences in average calories purchased among those who noticed menu labeling; however, those who reported using calorie information purchased 146 fewer calories than those who did not use the information (p=0.001). Based on these findings it is concluded that calorie menu labeling is an effective public policy and that nutrition education campaigns should accompany national menu labeling implementation in order to make the policy more effective across all socio-demographic groups.
ContributorsGreen, Jessie (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Bruening, Meg (Committee member) / Wharton, Christopher (Christopher Mack), 1977- (Committee member) / Arizona State University (Publisher)
Created2014
Description
Research related to food deserts, areas with limited access to healthy and affordable food options, has focused primarily on issues of healthy food access, food quality and pricing, dietary outcomes, and increased risk for chronic diseases among residents. However, upstream challenges that might play a major role in the creation and perpetuation of food deserts, namely problems in the supply chain, have been less considered. In this qualitative study, researchers conducted semi-structured interviews with local produce supply chain representatives to understand their perspectives on the barriers to, and potential solutions for, supplying affordable produce to underserved areas in Phoenix, AZ. Through industry and academic experts, six representatives of the supply chain were identified and recruited to take part in one-hour interviews. Interviews were audio-recorded, transcribed, and coded into categories using a general inductive approach. Using the qualitative analysis software NVIVO to assist in data analysis, themes and subthemes emerged. Results suggested that considerable barriers exist among the representatives for supplying fresh, affordable produce in Phoenix-area food deserts, including minimum delivery requirements beyond the needs of the average small store, a desire to work with high-volume customers due to transportation and production costs, and the higher price point of produce for both store owners and consumers. Conversely, opportunities were identified that could be important in overcoming such barriers, including, tax or economic incentives that would make distribution into food deserts financially viable, infrastructural support for the safe handling and storage of fresh foods at existing retail outlets, and the development of novel distribution mechanisms for producers such as mobile markets and food hubs. Future research is needed to determine if these findings are representative of a larger, more diverse sample of Arizona produce supply chain representatives.
ContributorsLacagnina, Gina (Author) / Wharton, Christopher (Christopher Mack), 1977- (Thesis advisor) / Hughner, Renee (Committee member) / Barroso, Cristina (Committee member) / Arizona State University (Publisher)
Created2015
Description
Food security literature has a heavy emphasis on physical barriers, often employing spatial analysis or market-based approaches, but the human dimensions of food security remain unexplored. This has resulted in a disconnect between the understanding of the problem and proposed interventions, as the contextual factors and lived experiences of residents are not considered. There are many barriers and opportunities for food security that are not spatially fixed (e.g. family relations, social capital) that may be important but are unrepresented in these types of studies. In order to capture these barriers and opportunities, community stakeholders need to play a fundamental role in the problem analysis and visioning stages. This study utilized community-based participatory research methods to engage an important stakeholder in the future food environment, youth, to 1) understand how the youth of Canyon Corridor describe their food environment, and thus capture contextual aspects of food security 2) adapt CBPR methods to engage youth in a visioning session to elicit their ideal community food environment and 3) determine if these applications of CBPR can empower youth of Canyon Corridor to mobilize towards a more secure food environment. I found that while the youth did identify many barriers to food security (i.e. transportation, cost, availability), this community also had significant strengths, particularly social capital, that allowed them to overcome what would be food insecurity. Despite their conclusions on food security, youth did desire many changes for the future food environment and felt increased empowerment after the workshops. Thus this shows the need for incorporating methods that also acknowledge the role of social and individual factors and how they interrelate with the physical environment in relation to food security.
ContributorsSchoon, Briar (Author) / Eakin, Hallie (Thesis advisor) / Wharton, Christopher (Christopher Mack), 1977- (Committee member) / Szkupinski-Quiroga, Seline (Committee member) / Arizona State University (Publisher)
Created2012
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
Most American children consume less than the recommend amount of fruits and vegetables (F&V), 74% and 84%, respectively. Eating too few F&V in childhood is associated with increased risk of cardiovascular disease, hypertension, respiratory symptoms, and some cancers later in life. Adequate F&V consumption favorably impacts antioxidant status, gut flora, mood, and cognitive functioning. Nutrients such as vitamin C and fiber are only naturally occurring in plant foods. For many children, school lunches are an important source of F&V. This pilot study assessed the feasibility of providing condiments to increase children’s consumption of salad bar F&V in an elementary school cafeteria at lunchtime. The trial site was a single Title 1 elementary school in a large, urban district in the greater Phoenix metropolitan area. Taste tests were conducted on three convenience samples of children in grades 3 – 7, aged 8 – 12 years (n=57) to identify the most popular condiment flavors. The five highest rated flavors were made available daily at a “flavor station” in the school’s lunchroom for three consecutive weeks during the Fall 2018 semester. Descriptive and inferential statistics were used to analyze data. A cost analysis was conducted for capital outlays related to the flavor station. School employee perceptions of F&V and the flavor station were assessed via posttest online surveys. Peanut butter was rated the best tasting condiment by children and was the only condiment that increased in popularity throughout the intervention. Overall, daily F&V consumption increased 17 g per child. There was a linear increase in F&V consumption during the study (r=0.986; P=0.014). As a proportion of the total F&V selected, F&V waste decreased by nearly 3%. The average daily cost of providing the flavor station was $0.09 per student. Sixty-five percent of school staff felt that the flavor station should continue at their school. Peanut butter is an affordable, nutrient-dense food that accommodates the USDA Food and Nutrition Service meal patterns and nutrition standards, and thus, is a viable strategy for increasing F&V consumption and decreasing F&V waste. The results herein inform the development of future interventions to improve the palatability of F&V for children.
ContributorsScholtz, Cameron (Author) / Johnston, Carol (Thesis advisor) / Alexon, Christy (Committee member) / Hooker, Steven (Committee member) / Schwake, David (Committee member) / Swan, Pamela (Committee member) / Wharton, Christopher (Christopher Mack), 1977- (Committee member) / Arizona State University (Publisher)
Created2019
Description
By offering increased access to medical care, telemedicine offers significant opportunity for the process of development under Amartya Sen’s definition, that development is freedom, including freedom from illness, early death, and preventable disease. It advances development by freeing people from these burdens. However, like many emerging technologies, organizing information and understanding the field faces significant challenges. This paper applies Bashshur's three-dimensional model of telemedicine to the classification of telemedicine literature found in databases to assess the value of the model as a tool for classification. By standardizing language and creating a repository of research done to date in a centralized location, the field can better understand how it is progressing and where work still needs to be done. This paper aims to see if Bashshur's model serves well for this task.
ContributorsBlum, Alexander (Author) / Parmentier, Mary Jane (Thesis advisor) / Zachary, Gregg (Committee member) / Grossman, Gary (Committee member) / Arizona State University (Publisher)
Created2015
Description
In 1996, President Clinton ordered the formation of the Advisory Committee on Human Radiation Experiments (ACHRE), which undertook to evaluate the morality of a myriad of secret and publicized radiation experiments ranging from 1944 to 1974. The goal of this thesis is to analyze the ways in which that committee formed moral evaluations and the extent to which its strategies related to a broader historical and philosophical discourse. Here I attempt to describe two specific techniques of simplification the committee deploys in order to make a retrospective moral analysis possible. Although the techniques comprise specific problems, frameworks, subjective perspectives, and conceptual links, their unifying principle is the field of choices the techniques produce. In the first technique I outline, I argue that by focusing on the problem of historical relativism, the committee gains a platform through which it would be granted flexibility in making a distinction between moral wrongdoing and blameworthiness. In the second technique of simplification I outline, I argue that the committee's incorporation of a principle to reduce uncertainty as an ethical aim allow it to establish new ways to reconcile scientific aims with moral responsibility. In addition to describing the structure of these techniques, I also demonstrate how they relate to the specific experiments the analysts aim to evaluate, using both the ACHRE experiments as well as the Nuremberg Trial experiments as my examples. My hope is not to show why a given committee made a particular moral evaluation, or to say whether a decision was right or wrong, but rather to illustrate how certain techniques open up a field of choices that allow moral analysts to form retrospective moral judgments.
ContributorsCirjan, Cristian (Author) / Hurlbut, Ben (Thesis director) / Humphrey, Ted (Committee member) / Zachary, Gregg (Committee member) / Barrett, The Honors College (Contributor)
Created2015-05