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- Genre: Academic theses
Description
The primary aim of this study was to investigate resilient profiles in low-income Mexican American (MA) mothers. MA mothers are part of an under researched population, the fastest growing ethnic minority group, and have the highest birth rate in the United States, presenting a significant public health concern. The transition to motherhood can be an emotionally and physically complex time for women, particularly in the context of a stressful low-income environment. Although most low-income women navigate this transition well, a significant number of mothers develop moderate to severe depressive symptoms. The proposed research investigated profiles of resilience during the prenatal period using a person-centered approach via latent profile analysis. In alignment with current resilience theories, several domains of resilience were investigated including psychological, social, and cultural adherence (e.g., maintaining specific cultural traditions). Concurrent prenatal depressive symptoms and stress were correlated with the profiles in order to establish validity. Six week postpartum depressive symptoms and physiological processes (e.g., overall cortisol output, heart rate variability, and sleep) were also predicted by the prenatal resilient profiles. The resulting data revealed three separate profiles: low-resource, high-resource Anglo, and high-resource Mexican. These resilience profiles had differential associations with concurrent depressive symptoms and stress, such that women in the high-resource profiles reported less depressive symptoms and stress prenatally. Further, profile differences regarding cortisol output, resting heart rate variability, were also found, but there were no differences in insomnia symptoms. Profile classification also moderated the effects of prenatal economic stress on postpartum depressive symptoms, such that women in the high-resource Mexican profile were at risk for higher postpartum depressive symptoms under high economic stress compared to the high-resource Anglo group, which demonstrated a more resilient response. Overall, the results suggest the presence of multiple clusters of prenatal resilience within a sample of MA mothers facing health disparities, with various effects on perinatal mental health and postpartum physiological processes. The results also highlight the need for multi-dimensional models of resilience and the possible implications for interventions.
ContributorsGress Smith, Jenna L (Author) / Luecken, Linda J. (Thesis advisor) / Gonzales, Nancy (Committee member) / Okun, Morris (Committee member) / Zautra, Alex (Committee member) / Arizona State University (Publisher)
Created2014
Description
Native American communities face an ongoing challenge of effectively addressing cancer health disparities, as well as environmental racism issues that may compound these inequities. This dissertation identified the shared cultural knowledge and beliefs about cancer in a southwest American Indian community utilizing a cultural consensus method, an approach that combines qualitative and quantitative data. A community-based participatory research (CBPR) approach was applied at all stages of the study. The three phases of research that were undertaken included: 1) ethnographic interviews - to identifying the themes or the content of the participants' cultural model, 2A) ranking of themes - to provide an understanding of the relative importance of the content of the cultural model, 2B) pile sorts - identify the organization of items within specific domains, and 3) a community survey - access whether the model is shared in the greater community. The cultural consensus method has not been utilized to date in identifying the collective cultural beliefs about cancer prevention, treatment or survivorship in a Native American community. Its use represents a methodological step forward in two areas: 1) the traditional ethnographic inferences used in identifying and defining cultural meaning as it relates to health can be tested more rigorously than in the past, and 2) it addresses the challenge of providing reliable results based on a small number of community informants. This is especially significant when working with smaller tribal/cultural groups where the small sample size has led to questions concerning the reliability and validity of health-related research. Results showed that the key consultants shared strong agreement or consensus on a cultural model regarding the importance of environmental and lifestyle causes of cancer. However, there was no consensus found among the key consultants on the prevention and treatment of cancer. The results of the community survey indicated agreement or consensus in the sub-domains of descriptions of cancer, risk/cause, prevention, treatment, remission/cure and living with cancer. Identifying cultural beliefs and models regarding cancer could contribute to the effective development of culturally responsive cancer prevention education and treatment programs.
ContributorsClaus, Cynthia (Author) / Koss, Joan (Thesis advisor) / Brandt, Elizabeth, (Thesis advisor) / Joe, Jennie (Committee member) / Maupin, Jonathan (Committee member) / Arizona State University (Publisher)
Created2011
Description
Family engagement in child and family service systems can be influenced by the quality of the relationship between service system, provider, and family. Knowledge surrounding how relationships are mechanisms through which family engagement can be enhanced to promote equity in service accessibility remains scant, as such family engagement continues to be studied as a family-centric behavior and attitudinal construct. Thus, limited attention has been given to exploring structural factors influencing family engagement. In response and drawing from the socio-ecological model, this dissertation combines two qualitative studies to discuss the importance of and mechanisms for building relationships in two different contexts. The first study, “Factors Influencing Family Engagement for Immigrant Latina Mothers Participating in Trauma-Informed Child and Family Behavioral Health Services”, explores qualitatively the in-depth experiences of immigrant Latina mothers in trauma-informed services to understand multilevel factors and patterns of interconnection between these factors in the social ecology that impede or foster engagement in such services. Culturally responsive strategies to trauma-informed behavioral health services employed by providers and service agencies that lower immigrant Latina mothers’ barriers are also discussed. The second paper, “Sociocultural Responsive Frameworks to Increase Family Engagement in Child Serving Systems through a Peer-to-Peer Model for Families Experiencing Trauma”, uses multimodal qualitative methodology to comprehensively examine the value of a peer-to-peer support model in the context of trauma-informed and culturally responsive approaches in order to enhance family engagement for communities at higher risk for social exclusion. Together, these studies will shed light on the importance of studying family engagement as a function of intertwined structural factors and capitalizing on meaningful relationships to overcome barriers to community-based service engagement to address health disparities.
ContributorsMelendez Guevara, Ana Maria (Author) / Sarah Johnson, Sarah (Thesis advisor) / White, Rebecca M.B (Committee member) / Lopez, Kristina (Committee member) / Gewirtz, Abigail (Committee member) / Arizona State University (Publisher)
Created2022
Description
Elevated rates of exposure to multi-level chronic stressors (e.g., poverty, discrimination, acculturative stress) place low-income, Mexican-origin individuals in the United States at elevated risk for adverse psychological and physical health across the lifespan. Despite exposure to contextual risk factors, many individuals maintain positive biobehavioral health. In particular, despite greater exposure to sociodemographic risk factors, more recently immigrated Mexican-origin individuals in the U.S. may demonstrate more positive biobehavioral health, warranting consideration of specific cultural values and practices that confer and maintain positive health across generations. Parental cultural socialization is an understudied mechanism in promotive pathways of parent-child processes and child biobehavioral health. Across three generations of Mexican-origin families in the United States – maternal grandmothers, mothers, children – the current study (1) identified a multidimensional measure of child biobehavioral health across psychological and biological indicators, (2) evaluated the intergenerational transmission of grandmother-mother cultural socialization, (3) evaluated the effect of maternal cultural socialization on child-perceived parenting and child biobehavioral health, and (4) evaluated child cultural orientation as a moderator of the effect of maternal cultural socialization on child-perceived parenting and child biobehavioral health. Findings highlight the complex and nuanced relations among parental cultural socialization, individual cultural orientation, child perceptions of parenting, and child biobehavioral health among low-income, Mexican-origin families in the United States.
ContributorsCurci, Sarah Gianna (Author) / Luecken, Linda J (Thesis advisor) / Perez, Marisol (Committee member) / Cruz, Rick (Committee member) / Grimm, Kevin (Committee member) / Arizona State University (Publisher)
Created2024
Description
Every year an alarming number of deaths for the Black community are a result of disparities and inequalities in health outcomes. While literature has largely focused on social determinants of heath (e.g., economic, environmental, biological, and behavioral structures) as contributing factors to disparate health outcomes for Black people, literature on medical mistrust has been on the rise. Medical mistrust is defined as the belief that health care entities and providers act against a patient's best interest and well-being, and is associated with lower rates of service utilization, inadequate management of health conditions, lower levels of involvement in research, and treatment nonadherence. Only recently has patient-centered care been examined as a construct that may reduce the negative effects of medical mistrust. This study examined Black identifying patients (N = 174) across gender and their reported levels of medical mistrust, and if the perception of a patient-centered health care environment would moderate the association. The findings indicated that Black females, compared to Black males, endorsed higher levels of medical mistrust that may be indicative of intersectional influences. While there were significant effects of gender and perceived patient-centered care on medical mistrust, perceived patient-centered care was not found to significantly moderate the relationship between gender identity and medical mistrust. This may be indicative of the varying degrees of medical maladies that may be stronger determinants of perceived patient-centered care, despite gender or other demographic characteristics. Implications for practice and future research on the intersectional influences on medical mistrust and perceived patient-centered care in the Black communities are discussed.
ContributorsMatthews, Tianna (Author) / Warner, Cheryl (Thesis advisor) / Randall, Ashley K (Committee member) / Dillon, Frank (Committee member) / Arizona State University (Publisher)
Created2021
Description
In the U.S., breast cancer (BC) incidences among African American (AA) and CA (CA) women are similar, yet AA women have a significantly higher mortality rate. In addition, AA women often present with tumors at a younger age, with a higher tumor grade/stage and are more likely to be diagnosed with the highly aggressive triple-negative breast cancer (TNBC) subtype. Even within the TNBC subtype, AA women have a worse clinical outcome compared to CA. Although multiple socio-economic and lifestyle factors may contribute to these observed health disparities, it is essential that the underlying biological differences between CA and AA TNBC are identified. In this study, gene expression profiling was performed on archived FFPE samples, obtained from CA and AA women diagnosed with early stage TNBC. Initial analysis revealed a pattern of differential expression in the AA cohort compared to CA. Further molecular characterization results showed that the AA cohort segregated into 3-TNBC molecular subtypes; Basal-like (BL2), Immunomodulatory (IM) and Mesenchymal (M). Gene expression analyses resulted in 190 differentially expressed genes between the AA and CA cohorts. Pathway enrichment analysis demonstrated that differentially expressed genes were over-represented in cytoskeletal remodeling, cell adhesion, tight junctions, and immune response in the AA TNBC -cohort. Furthermore, genes in the Wnt/β-catenin pathway were over-expressed. These results were validated using RT-qPCR on an independent cohort of FFPE samples from AA and CA women with early stage TNBC, and identified Caveolin-1 (CAV1) as being significantly expressed in the AA-TNBC cohort. Furthermore, CAV1 was shown to be highly expressed in a cell line panel of TNBC, in particular, those of the mesenchymal and basal-like molecular subtype. Finally, silencing of CAV1 expression by siRNA resulted in a significant decrease in proliferation in each of the TNBC cell lines. These observations suggest that CAV1 expression may contribute to the more aggressive phenotype observed in AA women diagnosed with TNBC.
ContributorsGetz, Julie (Author) / Baumbach-Reardon, Lisa L (Thesis advisor) / Lake, Douglas F (Thesis advisor) / Bussey, Kimberly (Committee member) / Kusumi, Kenro (Committee member) / Arizona State University (Publisher)
Created2015
Description
This dissertation was guided by the Ecological Model of Physical Activity and Ecological Model of Obesity and sought to determine the relationship between active transportation (AT), physical activity, and cardiometabolic health among adults and ethnic minority women. Chapter 2 presents an investigation into the relationship between walking for AT and cardiometabolic health among adults through systematic review. Chapter 3 presents an exploration of the cross-sectional relationships of AT and moderate-to-vigorous physical activity (MVPA) with cardiometabolic health among African American (AA) and Hispanic/Latina (HL) women from Texas. Chapter 4 presents an investigation into the cross-sectional relationship of AT on cardiometabolic health and physical activity among primarily HL women.
In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.
High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.
In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.
High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.
ContributorsLorenzo, Elizabeth (Author) / Lee, Rebecca E (Thesis advisor) / Todd, Michael (Committee member) / Shin, Cha-Nam (Committee member) / Arizona State University (Publisher)
Created2019