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The Baby Friendly Hospital Initiative (BFHI) was created in 1991 with the goal to provide support and education to mothers on breastfeeding in order to increase the rate and duration of breastfeeding across the world. Despite being around for over 20 years, it has only been successfully incorporated into 245

The Baby Friendly Hospital Initiative (BFHI) was created in 1991 with the goal to provide support and education to mothers on breastfeeding in order to increase the rate and duration of breastfeeding across the world. Despite being around for over 20 years, it has only been successfully incorporated into 245 hospitals in the United States as of 2015. Due to the many benefits this initiative brings to mothers, infants, and the hospitals themselves as well as being shown to increase the incidence, duration, and exclusivity of breastfeeding, the goal of this project was to create a mother friendly brochure sharing this. The brochure was created in order to spread the word of the BFHI to expecting mothers so that they are informed and able to use this information to not only improve their own child-birthing experience but also push for implementation in their delivering facilities. The brochure covers additional topics such as breastfeeding benefits and tips, lactation resources, and steps to incorporate into their own hospital stay if outside of a BFHI facility in order to get a few of the benefits that the Baby Friendly Initiative provides. The brochure was tested for clarity, effectiveness, and for overall reactions in a study conducted at a local women's clinic surveying expectant mothers through the use of a short survey. These results were used to make minor improvements to the brochure before moving on to plans of how to disseminate the brochure to more clinics within the Phoenix area. The dissemination of this brochure will share this important information with women of childbearing age and hopefully lead to greater knowledge and progress towards improved maternal and neonatal outcomes.
ContributorsGunnare, Chrystina Jean (Author) / Whisner, Corrie (Thesis director) / Bever, Jennie (Committee member) / Barrett, The Honors College (Contributor) / School of Nutrition and Health Promotion (Contributor)
Created2015-05
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Since 1975, the prevalence of obesity has nearly tripled around the world. In 2016, 39% of adults, or 1.9 billion people, were considered overweight, and 13% of adults, or 650 million people, were considered obese. Furthermore, Cardiovascular disease remains to be the leading cause of death for adults in the

Since 1975, the prevalence of obesity has nearly tripled around the world. In 2016, 39% of adults, or 1.9 billion people, were considered overweight, and 13% of adults, or 650 million people, were considered obese. Furthermore, Cardiovascular disease remains to be the leading cause of death for adults in the United States, with 655,000 people dying from related conditions and consequences each year. Including fiber in one’s dietary regimen has been shown to greatly improve health outcomes in regards to these two areas of health. However, not much literature is available on the effects of corn-based fiber, especially detailing the individual components of the grain itself. The purpose of this preliminary study was to test the differences in influence on both LDL-cholesterol and triglycerides between treatments based on whole-grain corn flour, refined corn flour, and 50% refined corn flour + 50% corn bran derived from whole grain cornmeal (excellent fiber) in healthy overweight (BMI ≥ 25.0 kg/m2) adults (ages 18 - 70) with high LDL cholesterol (LDL ≥ 120mg/dL). 20 participants, ages 18 - 64 (10 males, 10 females) were involved. Data was derived from blood draws taken before and after each of the three treatments as well as before and after each treatment’s wash out periods. A general linear model was used to assess the effect of corn products on circulating concentrations of LDL-cholesterol and triglycerides. From the model, it was found that the whole-grain corn flour and the 50% refined corn flour + 50% corn bran drive from whole grain cornmeal treatments produced a higher, similar benefit in reductions in LDL-cholesterol. However, the whole grain flour, refined flour, and bran-based fiber treatments did not influence the triglyceride levels of the participants throughout this study. Further research is needed to elucidate the effects of these fiber items on cardiometabolic disease markers in the long-term as well as with a larger sample size.

ContributorsLe, Justin (Author) / Whisner, Corrie (Thesis director) / Ortega Santos, Carmen (Committee member) / School of Molecular Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
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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

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
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Immigrants and their U.S.-born children account for 26% of the American population as of 2020. Despite this large proportion, 14% of immigrants live below the federal poverty line compared to 12% of U.S.-born citizens. The immigrant population is vulnerable to food and housing insecurity and limited access to social services

Immigrants and their U.S.-born children account for 26% of the American population as of 2020. Despite this large proportion, 14% of immigrants live below the federal poverty line compared to 12% of U.S.-born citizens. The immigrant population is vulnerable to food and housing insecurity and limited access to social services and medical care, on top of navigating the increasingly convoluted immigration system. Migrant women and children are especially at risk for systemic, poverty-related adversities. Periods of pregnancy and postpartum are particularly financially straining due to employment disruptions and additional expenses. Migrant mothers experience adverse health outcomes due to chronic stress, unstable living situations, integration barriers, and an unfavorable occupational environment during pregnancy. In addition to the postpartum needs of a new mother and her baby, these challenges may be barriers to maintaining breastfeeding. The unanticipated COVID-19 pandemic exasperated many existing systemic inequities and brought additional hardship. This study aims to investigate breastfeeding rates among immigrant mothers compared to U.S.-born mothers and other social disparities that affect health. While this study did not find a statistical difference between breastfeeding adherence and immigrant status during the COVID-19 pandemic, other risk factors relating to maternal-child health were identified. Immigrant families were more likely to experience job or income loss and a higher frequency of food insecurity compared to families with U.S.-born parents. The risks of being impoverished greatly reduce the incidence of breastfeeding, which can offer tremendous health benefits both to mother and baby. Most immigrants migrating to the U.S. are ethnic minorities who face additional societal disparities in culture, employment, economic stability, safety, and healthcare. The burden of social determinants of health that impact this population is not unique to adults. The moment a child is born into an immigrant family, particularly if they are also an ethnic minority, they inherit risk factors that can impact their entire lifespan. Ultimately, the risks associated with pregnancy and infant feeding are issues of social justice and health equity.
ContributorsFahmy, Gabriella (Author) / Whisner, Corrie (Thesis advisor) / Schuster, Roseanne (Thesis advisor) / Mayol-Kreiser, Sandra (Committee member) / Arizona State University (Publisher)
Created2023
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Description
Background: Rapid infant weight gain (RWG) by six months of age has been identified as one of the earliest indicators of childhood obesity. Previous research suggests that exclusive breastfeeding over formula feeding may serve a protective effect from RWG. In addition, the makeup of the infant gut microbiome may influence

Background: Rapid infant weight gain (RWG) by six months of age has been identified as one of the earliest indicators of childhood obesity. Previous research suggests that exclusive breastfeeding over formula feeding may serve a protective effect from RWG. In addition, the makeup of the infant gut microbiome may influence RWG as differences in feeding practices have been shown to alter the bacterial makeup of the gut, potentially impacting energy metabolism. However, little research has been conducted investigating the potential relationships between RWG, infant feeding practices, and the infant gut microbiome.Methods: This study was a pilot study, which included 31 mother-infant dyads who were primarily recruited from Women, Infant, and Children’s Supplemental Nutrition Program (WIC) clinics and by word of mouth in the Southwestern United States. Participants were followed over six months, with study staff conducting home study visits four times (pregnancy, two days postpartum, three weeks and six months). Mothers who participated in this study were majority White (n=40.6%), non-Hispanic or Latino (67.7%), and obtained a graduate degree (n=22.6%). Participants were included in this analysis (n=22) if they provided at least two infant fecal samples, and the study staff were able to collect infant anthropometric data at the three-week and six-month study visits. Microbial DNA from fecal samples was sequenced using the Illumina MiSeq instrument after polymerase chain reaction (PCR) amplification was performed on the V4 region of the 16S rRNA gene sequence. Statistical analysis was performed using the QIIME2 longitudinal plug-in. Results: Results of this study suggested a significant difference in weighted UniFrac between infants who were exclusively breastfed and formula-fed from birth to three weeks of age. Additionally, an exploratory statistical method identified family Prevotellaceae as a potentially volatile microbe; however, this model failed to reach significance for either RWG or mode of feeding. Overall, no additional alpha or beta diversity metrics or differential abundance of microbes by either RWG or feeding practice group was found in this study. Conclusion: Future research is warranted to further explore potential connections between RWG, infant feeding practices, and the infant gut microbiome in a longitudinal study with a larger sample size.
ContributorsToffoli, Samantha (Author) / Whisner, Corrie (Thesis advisor) / Bruening, Meg (Committee member) / Sears, Dorothy (Committee member) / Arizona State University (Publisher)
Created2021