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- Member of: ASU Electronic Theses and Dissertations
Description
Chronic diseases are the leading causes of death in the United States. Dietary behaviors influence the risk of developing multiple chronic diseases. The U.S. population consumes too few fruits and vegetables and too much sugar sweetened beverages (SSB) and fast food. The Social Ecological Model (SEM) was created as a framework for health promotion interventions. The SEM organizes factors that can influence health into five layers: intrapersonal factors, interpersonal processes, institutional/organizational factors, community factors, and public policy. Each layer can influence dietary behaviors and other layers.
This work aims to understand how the community layer, represented by the food environment, moderates the association of two other layers and dietary behaviors: the interpersonal layer, represented by receiving health care provider’s (HCP) advice to lose weight, and the policy layer, represented by participation in the Supplemental Nutrition Assistance Program (SNAP), and a policy change within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Participant data were obtained from a household telephone survey of 2,211 adults in four cities in New Jersey from two cross-sectional panels in 2009-10 and 2014. Community food data were purchased and classified according to previously established protocol. Interaction and stratified analyses determined the differences in the association between HCP advice, SNAP participation, and time (for WIC participants) and eating behaviors by the food environment.
Interaction and stratified analyses revealed that HCP advice was associated with a decrease in SSB consumption when participants lived near a small grocery store, or far from a supermarket, limited service restaurant (LSR), or convenience store. SNAP participation was associated with a higher SSB consumption when respondents lived close to a small grocery store, supermarket, and LSR. There were no differences in fruit and vegetable consumption between two time points among WIC participants, or by food outlet.
The food environment, part of the community layer of SEM, moderated the relationship between the interpersonal layer and dietary behaviors and the policy layer and dietary behaviors. The association between HCP advice and dietary behaviors and SNAP participation and dietary behaviors were both influenced by the food environment in which participants lived.
This work aims to understand how the community layer, represented by the food environment, moderates the association of two other layers and dietary behaviors: the interpersonal layer, represented by receiving health care provider’s (HCP) advice to lose weight, and the policy layer, represented by participation in the Supplemental Nutrition Assistance Program (SNAP), and a policy change within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Participant data were obtained from a household telephone survey of 2,211 adults in four cities in New Jersey from two cross-sectional panels in 2009-10 and 2014. Community food data were purchased and classified according to previously established protocol. Interaction and stratified analyses determined the differences in the association between HCP advice, SNAP participation, and time (for WIC participants) and eating behaviors by the food environment.
Interaction and stratified analyses revealed that HCP advice was associated with a decrease in SSB consumption when participants lived near a small grocery store, or far from a supermarket, limited service restaurant (LSR), or convenience store. SNAP participation was associated with a higher SSB consumption when respondents lived close to a small grocery store, supermarket, and LSR. There were no differences in fruit and vegetable consumption between two time points among WIC participants, or by food outlet.
The food environment, part of the community layer of SEM, moderated the relationship between the interpersonal layer and dietary behaviors and the policy layer and dietary behaviors. The association between HCP advice and dietary behaviors and SNAP participation and dietary behaviors were both influenced by the food environment in which participants lived.
ContributorsLorts, Cori Elizabeth (Author) / Ohri-Vachaspati, Punam (Thesis advisor) / Adams, Marc (Committee member) / Hooker, Steven (Committee member) / Roberto, Anthony (Committee member) / Tasevska, Natasha (Committee member) / Arizona State University (Publisher)
Created2017
Description
The Internet and climate change are two forces that are poised to both cause and enable changes in how we provide our energy infrastructure. The Internet has catalyzed enormous changes across many sectors by shifting the feedback and organizational structure of systems towards more decentralized users. Today’s energy systems require colossal shifts toward a more sustainable future. However, energy systems face enormous socio-technical lock-in and, thus far, have been largely unaffected by these destabilizing forces. More distributed information offers not only the ability to craft new markets, but to accelerate learning processes that respond to emerging user or prosumer centered design needs. This may include values and needs such as local reliability, transparency and accountability, integration into the built environment, and reduction of local pollution challenges.
The same institutions (rules, norms and strategies) that dominated with the hierarchical infrastructure system of the twentieth century are unlikely to be good fit if a more distributed infrastructure increases in dominance. As information is produced at more distributed points, it is more difficult to coordinate and manage as an interconnected system. This research examines several aspects of these, historically dominant, infrastructure provisioning strategies to understand the implications of managing more distributed information. The first chapter experimentally examines information search and sharing strategies under different information protection rules. The second and third chapters focus on strategies to model and compare distributed energy production effects on shared electricity grid infrastructure. Finally, the fourth chapter dives into the literature of co-production, and explores connections between concepts in co-production and modularity (an engineering approach to information encapsulation) using the distributed energy resource regulations for San Diego, CA. Each of these sections highlights different aspects of how information rules offer a design space to enable a more adaptive, innovative and sustainable energy system that can more easily react to the shocks of the twenty-first century.
The same institutions (rules, norms and strategies) that dominated with the hierarchical infrastructure system of the twentieth century are unlikely to be good fit if a more distributed infrastructure increases in dominance. As information is produced at more distributed points, it is more difficult to coordinate and manage as an interconnected system. This research examines several aspects of these, historically dominant, infrastructure provisioning strategies to understand the implications of managing more distributed information. The first chapter experimentally examines information search and sharing strategies under different information protection rules. The second and third chapters focus on strategies to model and compare distributed energy production effects on shared electricity grid infrastructure. Finally, the fourth chapter dives into the literature of co-production, and explores connections between concepts in co-production and modularity (an engineering approach to information encapsulation) using the distributed energy resource regulations for San Diego, CA. Each of these sections highlights different aspects of how information rules offer a design space to enable a more adaptive, innovative and sustainable energy system that can more easily react to the shocks of the twenty-first century.
ContributorsTyson, Madeline (Author) / Janssen, Marco (Thesis advisor) / Tuttle, John (Committee member) / Allenby, Braden (Committee member) / Potts, Jason (Committee member) / Arizona State University (Publisher)
Created2018
Description
Background: Children’s fruit and vegetable consumption in the United States is lower than recommended. School lunch is an opportunity for students to be exposed to fruits and vegetables and potentially increase their daily intake. The purpose of this study is to examine the relationship between tray color and fruit and vegetable selection, consumption, and waste at lunch.
Methods: Study participants (n=1469) were elementary and middle school students who ate school lunch on the day of data collection. Photographs and weights (to nearest 2 g) were taken of fruits and vegetables on students’ trays before and after lunch. Trained research assistants viewed photographs and sorted trays into variable categories: color of main tray, presence/absence of secondary fruit/vegetable container, and color of secondary fruit/vegetable container. Fruit and vegetable selection, consumption, and waste were calculated using tray weights. Negative binomial regression models adjusted for gender, grade level, race/ethnicity, free/reduced price lunch status, and within-school similarities were used to examine relationships between tray color and fruit and vegetable selection, consumption, and waste.
Results: Findings indicated that students with a light tray selected (IRR= 0.44), consumed (IRR=0.73) and wasted (IRR=0.81) less fruit and vegetables. Students without a secondary fruit/vegetable container selected (IRR=0.66) and consumed (IRR=0.49) less fruit and vegetables compared to those with a secondary container. Light or clear secondary fruit and vegetable containers were related to increased selection (IRR=2.06 light, 2.30 clear) and consumption (IRR=1.95 light, 2.78 clear) compared to dark secondary containers, while light secondary containers were related to decreased waste (IRR= 0.57).
Conclusion: Tray color may influence fruit and vegetable selection, consumption, and waste among students eating school lunch. Further research is needed to determine if there is a cause and effect relationship. If so, adjusting container colors may be a practical intervention for schools hoping to increase fruit and vegetable intake among students.
Methods: Study participants (n=1469) were elementary and middle school students who ate school lunch on the day of data collection. Photographs and weights (to nearest 2 g) were taken of fruits and vegetables on students’ trays before and after lunch. Trained research assistants viewed photographs and sorted trays into variable categories: color of main tray, presence/absence of secondary fruit/vegetable container, and color of secondary fruit/vegetable container. Fruit and vegetable selection, consumption, and waste were calculated using tray weights. Negative binomial regression models adjusted for gender, grade level, race/ethnicity, free/reduced price lunch status, and within-school similarities were used to examine relationships between tray color and fruit and vegetable selection, consumption, and waste.
Results: Findings indicated that students with a light tray selected (IRR= 0.44), consumed (IRR=0.73) and wasted (IRR=0.81) less fruit and vegetables. Students without a secondary fruit/vegetable container selected (IRR=0.66) and consumed (IRR=0.49) less fruit and vegetables compared to those with a secondary container. Light or clear secondary fruit and vegetable containers were related to increased selection (IRR=2.06 light, 2.30 clear) and consumption (IRR=1.95 light, 2.78 clear) compared to dark secondary containers, while light secondary containers were related to decreased waste (IRR= 0.57).
Conclusion: Tray color may influence fruit and vegetable selection, consumption, and waste among students eating school lunch. Further research is needed to determine if there is a cause and effect relationship. If so, adjusting container colors may be a practical intervention for schools hoping to increase fruit and vegetable intake among students.
ContributorsWeight, Raquelle (Author) / Bruening, Meg (Thesis advisor) / Adams, Marc (Committee member) / Martinelli, Sarah (Committee member) / Arizona State University (Publisher)
Created2020
Description
Background: Exercise is Medicine (EIM) is a health promotion strategy for addressing physical inactivity in healthcare. However, it is unknown how to successfully implement the processes.
Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.
Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.
Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.
Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.
Purpose: The purpose of this study was to understand how implementing EIM influenced provider behaviors in a university-based healthcare system, using a process evaluation.
Methods: A multiple baseline, time series design was used. Providers were allocated to three groups. Group 1 (n=11) was exposed to an electronic medical record (EMR) systems change, EIM-related resources, and EIM training session. Group 2 (n=5) received the EMR change and resources but no training. Group 3 (n=6) was only exposed to the systems change. The study was conducted across three phases. Outcomes included asking about patient physical activity (PA) as a vital sign (PAVS), prescribing PA (ExRx), and providing PA resources or referrals. Patient surveys and EMR data were examined. Time series analysis, chi-square, and logistic regression were used.
Results: Patient survey data revealed the systems change increased patient reports of being asked about PA, χ2(4) = 95.47, p < .001 for all groups. There was a significant effect of training and resource dissemination on patients receiving PA advice, χ2(4) = 36.25, p < .001. Patients receiving PA advice was greater during phase 2 (OR = 4.7, 95% CI = 2.0-11.0) and phase 3 (OR = 2.9, 95% CI = 1.2-7.4). Increases were also observed in EMR data for PAVS, χ2(2) = 29.27, p <. 001 during implementation for all groups. Increases in PA advice χ2(2) = 140.90, p < .001 occurred among trained providers only. No statistically significant change was observed for ExRx, PA resources or PA referrals. However, visual analysis showed an upwards trend among trained providers.
Conclusions: An EMR systems change is effective for increasing the collection of the PAVS. Training and resources may influence provider behavior but training alone increased provider documentation. The low levels of documented outcomes for PA advice, ExRx, resources, or referrals may be due to the limitations of the EMR system. This approach was effective for examining the EIM Solution and scaled-up, longer trials may yield more robust results.
ContributorsBirchfield, Natasha R (Author) / Der Ananian, Cheryl (Thesis advisor) / Krasnow, Aaron (Committee member) / Doebbeling, Bradley (Committee member) / Adams, Marc (Committee member) / Swan, Pamela (Committee member) / Arizona State University (Publisher)
Created2019
Description
Background: Studies show that rural schools may be less supportive of student fruit/vegetable (FV) consumption, but few studies have investigated the relationship between school locale and FVs. The aim of this research is to analyze the relationship between school locale (rural vs. urban) and students’ FV selection, consumption, and waste in elementary, middle, and high schools. Methods: A cross-sectional analysis of 37 Arizona schools evaluated differences in the selection, consumption, and waste of fresh FVs from students (n=2525; 45.7% female; 41% non-white; mean age=11.6±3.3; 23.5% rural) using objective plate waste measures. Zero-inflated negative binomial regressions examined differences in FV grams selected, consumed, and wasted by urban vs. rural locale, adjusted for sociodemographics and school.
Results: The percent of students who selected, consumed, and wasted zero grams of FVs were 14%, 21%, 20%, respectively. Among students with some (non-zero amounts), the average selected, consumed, and wasted FVs were 115.0±81.4g, 51.7.5±65.1g, 65.2±66.7g, respectively. Rural students (versus urban) had lower odds of selecting (OR=0.75), consuming (OR=0.78), and wasting (OR=0.71) any FVs, after adjusting for covariates. However, among students with some FVs on their plates, rural students selected (IRR=1.40), consumed (IRR=1.18) and wasted (IRR=1.62) more grams of FVs.
Conclusions: Rural students had reduced odds of selecting and consuming any FVs, but with lower odds of waste, perhaps due to reduced selection. Once some FVs were on the tray, likelihood of consumption and waste by rural students were greater. Results support interventions targeting rural students’ FV intake to reduce waste.
ContributorsJepson, Molly Eilish (Author) / Bruening, Meg (Thesis advisor) / Adams, Marc (Committee member) / Grgich, Traci (Committee member) / Arizona State University (Publisher)
Created2021
Description
Objective: To conduct a content analysis of nutrition marketing in school cafeterias in Arizona to understand how nutrition concepts are currently marketed to students. This is the first study to investigate the content of nutrition marketing in school cafeterias, and also the first to compare content across elementary, middle, and high schools. Methods: Photographs of marketing materials on display in school cafeterias were obtained from a convenient sample of 13 elementary schools, 12 middle schools, and 12 high schools. In total, n=284 examples of nutrition marketing were collected. The photographs were sorted by grade level and then coded quantitatively and qualitatively based on their purpose, visual aspects, marketing strategies used, and language and literacy aspects. Given the multiple comparisons, statistical significance was assessed with a Bonferroni adjustment of p<0.0006.
Results: The average number of nutrition marketing materials within the school cafeterias was 7.7 ± 7.2. The purpose of the marketing materials ranged from promoting selection and consumption of fruits and vegetables, promoting nutrition and physical activity together, food safety, and educating about healthy eating. The sample of nutrition marketing materials emphasized selecting F/Vs over consumption of F/Vs. However, the opposite was found in marketing that exclusively promoted fruits and vegetables. The most common type of marketing in school cafeterias were flyers and most of the materials were small in size. The sample demonstrated a lack of implementation of marketing appeals in half of the sample, but the half that did utilized techniques that are known to be appealing to child and adolescent demographics, such as use of cartoons, humor, and social media/websites. 98.9% of the nutrition marketing with text were written in English and only 1.1% of the materials (n=3) were written in Spanish.
Conclusion: The nutrition marketing sample demonstrated some use of social marketing principles but does not compete with the scale and scope of the child-directed food and beverage marketing that students encounter in their environment. More research is needed to better understand how to best target nutrition marketing to child and adolescent student populations.
ContributorsXavier, Raevyn Francine (Author) / Bruening, Meg (Thesis advisor) / Adams, Marc (Committee member) / Lorts, Cori (Committee member) / Arizona State University (Publisher)
Created2021