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- Genre: Doctoral Dissertation
- Member of: Theses and Dissertations
- Resource Type: Text
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
There are several visual dimensions of food that can affect food intake, example portion size, color, and variety. This dissertation elucidates the effect of number of pieces of food on preference and amount of food consumed in humans and motivation for food in animals. Chapter 2 Experiment 1 showed that rats preferred and also ran faster for multiple pieces (30, 10 mg pellets) than an equicaloric, single piece of food (300 mg) showing that multiple pieces of food are more rewarding than a single piece. Chapter 2 Experiment 2 showed that rats preferred a 30-pellet food portion clustered together rather than scattered. Preference and motivation for clustered food pieces may be interpreted based on the optimal foraging theory that animals prefer foods that can maximize energy gain and minimize the risk of predation. Chapter 3 Experiment 1 showed that college students preferred and ate less of a multiple-piece than a single-piece portion and also ate less in a test meal following the multiple-piece than single-piece portion. Chapter 3 Experiment 2 replicated the results in Experiment 1 and used a bagel instead of chicken. Chapter 4 showed that college students given a five-piece chicken portion scattered on a plate ate less in a meal and in a subsequent test meal than those given the same portion clustered together. This is consistent with the hypothesis that multiple pieces of food may appear like more food because they take up a larger surface area than a single-piece portion. All together, these studies show that number and surface area occupied by food pieces are important visual cues determining food choice in animals and both food choice and intake in humans.
ContributorsBajaj, Devina (Author) / Phillips, Elizabeth D. (Thesis advisor) / Cohen, Adam (Committee member) / Johnston, Carol (Committee member) / Bimonte-Nelson, Heather A. (Committee member) / Arizona State University (Publisher)
Created2013
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
Description
The unpleasant bitter taste found in many nutritious vegetables may deter their consumption. While bitterness suppression by prototypical tastants is well-studied in the chemical and pharmacological fields, mechanisms to reduce the bitterness of foods such as vegetables remain to be elucidated. Here tastants representing the taste primaries of salty and sweet were investigated as potential bitterness suppressors of three types of Brassicaceae vegetables. The secondary aim of these studies was to determine whether the bitter masking agents were differentially effective for bitter-sensitive and bitter-insensitive individuals. In all experiments, participants rated vegetables plain and with the addition of tastants. In Experiments 1-3, sucrose and NNS suppressed the bitterness of broccoli, Brussels sprouts, and cauliflower, whereas NaCl did not. Varying concentrations of NaCl and sucrose were introduced in Experiment 4 to assess the dose-dependency of the effects. While sucrose was a robust bitterness suppressor, NaCl suppressed bitterness only for participants who perceived the plain Brussels sprouts as highly bitter. Experiment 5, through the implementation of a rigorous control condition, determined that some but not all of this effect can be accounted for by regression to the mean. Individual variability in taste perception as determined by sampling of aqueous bitter, salty, and sweet solutions did not influence the degree of suppression by NaCl or sucrose. Consumption of vegetables is deterred by their bitter taste. Utilizing tastants to mask bitterness, a technique that preserves endogenous nutrients, can circumvent this issue. Sucrose is a robust bitter suppressor whereas the efficacy of NaCl is dependent upon bitterness perception of the plain vegetables.
ContributorsWilkie, Lynn Melissa (Author) / Capaldi Phillips, Elizabeth D (Thesis advisor) / Cohen, Adam (Committee member) / Johnston, Carol (Committee member) / Sanabria, Federico (Committee member) / Arizona State University (Publisher)
Created2014
Description
While obesity rates have plateaued within the last decade,
two-thirds of the United States
population is currently classified as overweight (defined a
s a body mass index [BMI] of
25-29.9 kg/m²) or obese (a BMI greater than 30 kg/m²). Bariatric
surgical interventions
are not only more effective than behavioral treatments
in the short term but are the only
form of obesity intervention with evidence of consisten
t long-term effectiveness.
However, even among bariatric surgery patients, weight
loss often stabilizes and it is
estimated that more than 20% of bariatric surgery patient
s will regain a significant
amount of weight that was initially lost long-term. Li
ttle research to date has been
conducted on physical activity in post bariatric surgery pati
ents. More specifically, there
have been no studies to date examining the effects of Me
ditative Movement (MM)
programs on body composition in bariatric patients. A s
tudy using an 8-week Tai Chi
Easy program was conducted in female gastric bypass patient
s to explore feasibility of
MM in the bariatric population as well as pre- and post-in
tervention changes in weight,
mindfulness, eating behaviors, body awareness, physical a
ctivity patterns, dietary quality
and mood. Data analysis revealed that there were no s
ignificant changes in weight or
physical activity patterns; however, significant changes w
ere observed in anxiety, overall
body awareness and cognitive restraint in eating. Addit
ionally, a significant decrease in
processed meat consumption and a weak trend towards increa
sed consumption of fruits
may suggest an overall improvement in dietary quality.
two-thirds of the United States
population is currently classified as overweight (defined a
s a body mass index [BMI] of
25-29.9 kg/m²) or obese (a BMI greater than 30 kg/m²). Bariatric
surgical interventions
are not only more effective than behavioral treatments
in the short term but are the only
form of obesity intervention with evidence of consisten
t long-term effectiveness.
However, even among bariatric surgery patients, weight
loss often stabilizes and it is
estimated that more than 20% of bariatric surgery patient
s will regain a significant
amount of weight that was initially lost long-term. Li
ttle research to date has been
conducted on physical activity in post bariatric surgery pati
ents. More specifically, there
have been no studies to date examining the effects of Me
ditative Movement (MM)
programs on body composition in bariatric patients. A s
tudy using an 8-week Tai Chi
Easy program was conducted in female gastric bypass patient
s to explore feasibility of
MM in the bariatric population as well as pre- and post-in
tervention changes in weight,
mindfulness, eating behaviors, body awareness, physical a
ctivity patterns, dietary quality
and mood. Data analysis revealed that there were no s
ignificant changes in weight or
physical activity patterns; however, significant changes w
ere observed in anxiety, overall
body awareness and cognitive restraint in eating. Addit
ionally, a significant decrease in
processed meat consumption and a weak trend towards increa
sed consumption of fruits
may suggest an overall improvement in dietary quality.
ContributorsSmith, Lisa L. (Author) / Larkey, Linda K (Thesis advisor) / Ainsworth, Barbara (Committee member) / Chisum, Jack (Committee member) / Ohri-Vachaspati, Punam (Committee member) / McClain, Darya (Committee member) / Arizona State University (Publisher)
Created2014
Description
Fruit and vegetable consumption among school children falls short of current recommendations. The development of Public-Private Partnerships (PPP), which combine the resources of government entities with the resources of private entities, such as businesses or not-for-profit agencies, has been suggested as an effective approach to address a number of public health concerns, including inadequate fruit and vegetable consumption. The United States Department of Agriculture's (USDA) Fresh Fruit and Vegetable Program (FFVP) provides fruits and vegetables as snacks at least twice per week in low-income elementary schools. In addition to increasing fruit and vegetable consumption behaviors at school, children participating in the FFVP have been found to make more requests for fruits and vegetables in grocery stores and at home, suggesting the impact of the program extends beyond school settings. The purpose of this multicase study was to describe key stakeholders' perceptions about creating PPPs between schools and nearby retailers to cross-promote fruits and vegetables in low-income communities, using the FFVP. Semi-structured interviews were conducted with participants from three cases groups: grocery store/produce managers (n=10), district FFVP personnel (n=5) and school FFVP personnel (n=12). Data were analyzed using a directed content analysis approach using constructs from the Health Belief Model, including benefits, barriers, strategies, and motivation. While findings varied by case group, key benefits of creating a PPP included the potential to increase store sales, to enhance public relations with the community, and to extend the impact of the FFVP to settings outside of schools. Barriers included offering expensive produce through the FFVP, time/labor-associated costs, and needing approval from authorities and supervisors. Strategies for developing a PPP included using seasonal produce and having clear instructions for teachers and staff. Stakeholders reported being motivated to create a PPP by the potential to improve health outcomes in children and by wanting to help the community. Both objective and subjective measures were suggested to measure the success of such a partnership. Finally, the educational component of the USDA's Supplemental Nutrition Assistance Program (SNAP-Ed) has the potential to serve as a catalyst for organizing a PPP between FFVP-participating schools and nearby grocery stores.
ContributorsGruner, Jessie (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Evans, Browynne (Committee member) / Bruening, Meg (Committee member) / Tasevska, Natasha (Committee member) / Hekler, Eric (Committee member) / Arizona State University (Publisher)
Created2017
Description
Features of the built environment (BE) are related to a wide range of health factors, including leisure-time physical activity (PA) and active forms of transportation. For working adults, worksite neighborhood is likely an important BE to better understand the impact of various factors on PA patterns. Compared to home neighborhood walkability research, worksite walkability has received relatively less attention. The objective of this project was to identify if worksite walkability was significantly associated with PA behavior.
Aims: to evaluate 1) the PA variation explained by work walkability, 2) the moderating effects of person-level characteristics to the relationship between PA and work walkability, and 3) the differences in the rate of change in PA over time by worksite walkability.
Methods: self-report and accelerometer measured PA at baseline (aim 1, 2); longitudinal accelerometer PA during the initial 56 days of a behavioral intervention (aim 3). Adults were generally healthy and reported part- or full-time employment with a geocodeable address outside the home. Geographic Information Systems (GIS) measured walkability followed established techniques (i.e., residential, intersection, and transit densities, and land-use-mix).
Results: On average, worksite walkability did not show direct relationships with PA (aim 1); yet certain person-level characteristics moderated the relationships: sex, race, and not having young children in the household (aim 2). During 56 days of intervention, the PA rate of change over time showed no evidence of a moderating effect by worksite walkability.
Discussion: Worksite walkability was generally not shown to relate to the overall PA. However, specific subgroups (women, those without young children) appeared more responsive to their worksite neighborhood walkability. Prior literature shows certain demographics respond differently with various BE exposures, and this study adds a potentially novel moderator of interest regarding young children at home. Understanding who benefits from access to walkable BE may inform targeted interventions and policy to improve PA levels and foster health equity.
Aims: to evaluate 1) the PA variation explained by work walkability, 2) the moderating effects of person-level characteristics to the relationship between PA and work walkability, and 3) the differences in the rate of change in PA over time by worksite walkability.
Methods: self-report and accelerometer measured PA at baseline (aim 1, 2); longitudinal accelerometer PA during the initial 56 days of a behavioral intervention (aim 3). Adults were generally healthy and reported part- or full-time employment with a geocodeable address outside the home. Geographic Information Systems (GIS) measured walkability followed established techniques (i.e., residential, intersection, and transit densities, and land-use-mix).
Results: On average, worksite walkability did not show direct relationships with PA (aim 1); yet certain person-level characteristics moderated the relationships: sex, race, and not having young children in the household (aim 2). During 56 days of intervention, the PA rate of change over time showed no evidence of a moderating effect by worksite walkability.
Discussion: Worksite walkability was generally not shown to relate to the overall PA. However, specific subgroups (women, those without young children) appeared more responsive to their worksite neighborhood walkability. Prior literature shows certain demographics respond differently with various BE exposures, and this study adds a potentially novel moderator of interest regarding young children at home. Understanding who benefits from access to walkable BE may inform targeted interventions and policy to improve PA levels and foster health equity.
ContributorsHurley, Jane Cathleen (Author) / Adams, Marc A (Thesis advisor) / Todd, Mike (Committee member) / Hooker, Steven P (Committee member) / Ohri-Vachaspati, Punam (Committee member) / Ainsworth, Barbara (Committee member) / Arizona State University (Publisher)
Created2019
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
Individuals in urban low-income areas often do not have easy access to large grocery stores and supermarkets, and regularly shop at nearby small/corner stores. These stores stock an abundance of processed, energy-dense, nutrient poor foods, combined with few nutrient-dense products. A high concentration of small/corner stores is associated with poor diets by nearby residents. Interventions that target small food stores for increasing the availability and sale of healthy foods have been launched in many communities, and validated survey instruments have been developed to evaluate the effectiveness of the interventions. However, in-store surveys can take up to thirty minutes to conduct and require individual visits from investigators. Many projects assess the food environment in a large number of stores spread across broad geographical areas, making in-person evaluations infeasible and resource-prohibitive. The purpose of this study was to develop a valid and feasible short survey that could be used in-store or over the phone to capture the healthfulness of corner stores. An adapted version of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to conduct store audits of 230 corner stores in four New Jersey cities. Audit results were used in exploratory factor analysis and item response theory to develop a seven-item survey. The short survey was highly correlated with the full survey (r=0.79), and the short survey's classification of stores as healthy (top 20% of scores) versus unhealthy (bottom 80% of stores) matched NEMS-CS categorizations in 88% of cases. A second round of audits was conducted in 100 corner stores to confirm the validity of the seven-item survey and to test its feasibility as a phone audit tool. Complete phone responses were obtained from 86% of stores. Response matches indicated that store owners did not distinguish between 2% and low-fat milk, and tended to round up the fruit and vegetable count to five if they had fewer varieties. The seven-item short survey discriminates between healthy and unhealthy stores and is feasible for use as a phone audit tool.
ContributorsDeWeese, Robin (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Todd, Mike (Committee member) / Karpyn, Allison (Committee member) / Bruening, Meg (Committee member) / Wharton, Chris (Committee member) / Arizona State University (Publisher)
Created2015
Description
Vitamin B12, found only in animal products, is a water-soluble vitamin important for DNA methylation, purine and pyrimidine synthesis, and the myelination of nerves. Symptoms of vitamin B12 deficiency include anemia, gait disturbances, altered vibration proprioception, impaired vision, psychosis, depression, dementia-like illness, and ultimately death. Because vegetarians and vegans consume fewer animal products in their diet than omnivores, they are inherently more at risk for developing these symptoms of vitamin B12 deficiency. Thus, the purpose of this study is to examine the correlation between nervous system markers (balance, dexterity, and vibration sensitivity) and markers of vitamin B12 nutriture (serum B12 and serum holo-transcobalamin II) in a cross-sectional study (n=38). In addition, the impact of daily oral vitamin B12 supplementation on these markers in an 8-week randomized controlled trial was also examined (n=18). The results of the cross-sectional study revealed a moderate correlation (R=-0.351, p=0.031) between serum B12 and left-hand functional dexterity. The results of the intervention study revealed no significant time*group interactions for markers of nervous system functions and biochemical values (after the removal of outliers). In addition, the time*group interaction appeared to be larger for those individuals with a baseline serum B12 of less than 303 pmol/L. These results suggest that vitamin B12 supplementation may have a more pronounced effect on those individuals who are in a state of vitamin B12 depletion (<303 pmol/L serum concentration). In addition, the results also suggest that 8 weeks of oral supplementation is not a long enough period to create significant clinical change, and it is likely that improvements in neurological measures would require long-term supplementation.
ContributorsArnold, Taylor (Author) / Johnston, Carol (Thesis advisor) / Whisner, Corrie (Committee member) / Ohri-Vachaspati, Punam (Committee member) / Lee, Chong (Committee member) / Aleck, Kyrieckos (Committee member) / Arizona State University (Publisher)
Created2016