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ABSTRACT Despite significant advancements in drug therapy, cardiovascular disease (CVD) is still the leading cause of death in the United States. Given this, research has begun to seek out alternative approaches to reduce CVD risk. One of these alternative approaches is Vitamin D supplementation. Current research has shown a link

ABSTRACT Despite significant advancements in drug therapy, cardiovascular disease (CVD) is still the leading cause of death in the United States. Given this, research has begun to seek out alternative approaches to reduce CVD risk. One of these alternative approaches is Vitamin D supplementation. Current research has shown a link between Vitamin D status and CVD risk in both healthy and diseased populations. Among the possible mechanisms is a positive effect of Vitamin D on vascular endothelial function, which can be measured with noninvasive techniques such as flow-mediated dilation (FMD) of conduit vessels using high-resolution ultrasound. This dissertation is comprised of two studies. The first examines whether Vitamin D supplementation can improve FMD in older adults within a time period (two weeks) associated with peak increases in plasma Vitamin D concentrations after a single-dose supplementation. The second examines the effect of Vitamin D supplementation in people with Rheumatoid Arthritis (RA). The reason for looking at an RA population is that CVD is the leading cause of early mortality in people with RA. In the first study 29 Post-Menopausal Women received either 100,000 IU of Vitamin D3 or a Placebo. Their FMD was measured at baseline and 2 weeks after supplementation. After 2 weeks there was a significant increase in FMD in the Vitamin D group (6.19 + 4.87 % to 10.69 + 5.18 %) as compared to the Placebo group (p=.03). In the second study, 11 older adults with RA were given 100,000 IU of Vitamin D or a Placebo. At baseline and one month later their FMD was examined as well as plasma concentrations of Vitamin D and tumor necrosis factor-alpha; (TNF-alpha;). They also filled out a Quality of Life Questionnaire and underwent a submaximal exercise test on the treadmill for estimation of maximum oxygen uptake (VO2max). There was no significant change in FMD in Vitamin D group as compared to the Placebo group (p=.721). Additionally, there was no significant improvement in either plasma Vitamin D or TNF-alpha; in the Vitamin D group. There was however a significant improvement in predicted VO2max from the submaximal exercise test in the group receiving Vitamin D (p=.003). The results of these studies suggest that a single 100,000 IU dose of Vitamin D can enhance FMD within two week in older adults, but that a similar dose may not be sufficient to increase FMD or plasma Vitamin D levels in older adults with RA. A more aggressive supplementation regimen may be required in this patient population.
ContributorsRyan, Dana Meredith (Author) / Gaesser, Glenn A (Thesis advisor) / Rizzo, Warren (Committee member) / Martin, Keith (Committee member) / Larkey, Linda (Committee member) / Chisum, Jack (Committee member) / Arizona State University (Publisher)
Created2012
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Excessive gestational weight gain (GWG) during pregnancy is a major public health concern. Studies have reported more than 70% of pregnant women gain excessive weight which may pose increased maternal and fetal risks. Little is known about the relationships of GWG to behavioral factors (i.e., physical activity, sleep, social support)

Excessive gestational weight gain (GWG) during pregnancy is a major public health concern. Studies have reported more than 70% of pregnant women gain excessive weight which may pose increased maternal and fetal risks. Little is known about the relationships of GWG to behavioral factors (i.e., physical activity, sleep, social support) and maternal mental health (i.e., stress, anxiety, depression) during pregnancy. This descriptive, cross-sectional study explored the relationships of GWG to behavioral factors and maternal mental health during pregnancy. Secondarily, this study described the preferences, uses of, and interests in alternative approaches as well as the mental health differences between users and non-users of alternative approaches during pregnancy. A national survey was administered to women ≥8 weeks pregnant, ≥18 years old, and residing in the United States (N=968). Bivariate correlations were used to determine relationships between GWG and variables of interest. Independent t-tests were used to observe mental health differences between users and non-users of alternative approaches. Data were analyzed throughout pregnancy and by trimester. Throughout pregnancy, significant relationships were found in GWG to stressful events (r=-.112, p<.01), depression (r=.066, p<.05), mindfulness (r=-.067, p<.05), and sleep (r=.089, p<.01). When GWG was assessed by trimester, stressful events were significant in the second (r=-.216, p<.01) and third trimesters (r=-.085, p<.05). Depression remained positively related to GWG in the first (r=.409, p<.01) and second trimesters (r=.162, p<.01). A positive relationship emerged between GWG and anxiety in the first trimester (r=.340, p<.01) and physical activity became significant in the second (r=-.136; p<.05) and third trimesters (r=-.100; p<.05). Mindfulness was the only variable significantly related to GWG throughout all time points. Mean anxiety (d=.236; p=.001) and depression (d=.265; p<.001) scores were significantly lower in users compared to non-users of alternative approaches throughout pregnancy and when assessed by trimester anxiety (d=.424; p=.001) and depression (d=.526; p<.001) were significant in the second trimester. This study provides a framework for future analyses in GWG and maternal mental health. The information presented here may inform future interventions to test the effectiveness of alternative approaches to simultaneously manage maternal mental health and GWG due to the integrative nature of alternative approaches.
ContributorsMatthews, Jennifer L. (Author) / Huberty, Jennifer L (Thesis advisor) / Leiferman, Jenn (Committee member) / Larkey, Linda (Committee member) / McClain, Darya (Committee member) / Arizona State University (Publisher)
Created2015
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College students experience a considerable amount of stress. Unmanaged stress is associated with poor academic performance, health risk behaviors (i.e., inadequate sleep and physical activity, alcohol consumption, poor dietary behaviors), and poor mental health. Coping with stress has become a priority among universities. The most tested stress-related programs to date

College students experience a considerable amount of stress. Unmanaged stress is associated with poor academic performance, health risk behaviors (i.e., inadequate sleep and physical activity, alcohol consumption, poor dietary behaviors), and poor mental health. Coping with stress has become a priority among universities. The most tested stress-related programs to date have been mindfulness-based and face-to-face. These programs demonstrated significant improvements in stress, mindfulness, and self-compassion among college students. However, they may be burdensome to students as studies report low attendance and low compliance due to class conflicts or not enough time. Few interventions have used more advanced technologies (i.e., mobile apps) as a mode of delivery. The purpose of this study is to report adherence to a consumer-based mindfulness meditation mobile application (i.e., Calm) and test its effects on stress, mindfulness, and self-compassion in college students. We will also explore what the relationship is between mindfulness and health behaviors.

College students were recruited using fliers on college campus and social media. Eligible participants were randomized to one of two groups: (1) Intervention - meditate using Calm, 10 min/day for eight weeks and (2) Control – no participation in mindfulness practices (received the Calm application after 12-weeks). Stress, mindfulness, and self-compassion and health behaviors (i.e., sleep disturbance, alcohol consumption, physical activity, fruit and vegetable consumption) were measured using self-report. Outcomes were measured at baseline and week eight.

Of the 109 students that enrolled in the study, 41 intervention and 47 control participants were included in analysis. Weekly meditation participation averaged 38 minutes with 54% of participants completing at least half (i.e., 30 minutes) of meditations. Significant changes between groups were found in stress, mindfulness, and self-compassion (all P<0.001) in favor of the intervention group. A significant negative association (p<.001) was found between total mindfulness and sleep disturbance.

An eight-week consumer-based mindfulness meditation mobile application (i.e., Calm) was effective in reducing stress, improving mindfulness and self-compassion among undergraduate college students. Mobile applications may be a feasible, effective, and less burdensome way to reduce stress in college students.
ContributorsGlissmann, Christine (Author) / Huberty, Jennifer (Thesis advisor) / Sebren, Ann (Committee member) / Larkey, Linda (Committee member) / Lee, Chong (Committee member) / Arizona State University (Publisher)
Created2018
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The purpose of this thesis project was to examine the trajectories of physical activity among newly-diagnosed Obstructive Sleep Apnea (OSA) patients within the UC+WS group of the SleepWell24 study across the first 60 days of CPAP use, alone and based on Apnea-Hypopnea Index (AHI), Body Mass Index (BMI), sex, and

The purpose of this thesis project was to examine the trajectories of physical activity among newly-diagnosed Obstructive Sleep Apnea (OSA) patients within the UC+WS group of the SleepWell24 study across the first 60 days of CPAP use, alone and based on Apnea-Hypopnea Index (AHI), Body Mass Index (BMI), sex, and age. The study utilizes objective data from the SleepWell24 randomized controlled trial conducted by a collaborative research team at Arizona State University and Mayo Clinic Arizona and Rochester. Participants use wearable sensors to track activity behaviors, such as sleep, sedentary behavior, light-intensity physical activity (LPA), and moderate-vigorous physical activity (MVPA). The primary aim of the study was to examine the physical activity trajectories among newly-diagnosed OSA patients over the first 8 weeks of CPAP use, utilizing the physical activity data from wearable sensors. The secondary aim was to assess the trajectories of physical activity between categories of AHI, BMI, sex, and age. Multilevel modeling was used to account for clustering within participants considering between and within subject variations, and week was used as a level 1 predictor in the model for LPA, and MVPA, and total activity (sum of LPA and MVPA), while between subject factors of BMI, sex, age, and AHI were also included in the model. It was found that there were no statistically significant trajectories of LPA, MVPA or total activity over the first 8 weeks of CPAP use within the sample of 30 participants. However, a few notable differences in physical activity were seen between categories of age, sex, and BMI. Also, there was a significant interaction found between BMI and each week that influenced the trajectory of physical activity within obese patients, as compared to participants considered overweight or with a lower BMI. Ultimately, this study provides insight into patterns of physical activity seen in a clinical population of OSA patients over the initial period of CPAP use.
ContributorsDavis, Kiley Lynn (Author) / Buman, Matthew P. (Thesis director) / Petrov, Megan (Committee member) / Dean, W.P. Carey School of Business (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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There has been a rise in the prevalence of mental health disorders among western industrialized populations.1 By 2020, depression will be second to heart disease in its contribution to the global burden of disease as measured by disability-adjusted life years.2 Anxiety disorders are the most common mental illness in the

There has been a rise in the prevalence of mental health disorders among western industrialized populations.1 By 2020, depression will be second to heart disease in its contribution to the global burden of disease as measured by disability-adjusted life years.2 Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States ages 18 and older, or 18.1% of the U.S population every year.3
Mental disorders are prevalent in young adults and frequently present between 12-24 years of age.4 The top five sources of stress reported by college students were changes in sleeping routines, changes in eating habits, increased amount of work, new responsibilities, and breaks/vacations.5 Overall, a total of 73% of college students report occasional difficulties sleeping, and 48% of students suffer from sleep deprivation, as self-reported.6,7
Lifestyle factors such as diet, exercise and sleep may influence symptoms related to stress and depression.8 Symptoms of depression include but are not limited to, persistent anxious or sad moods, feeling guilty or helpless, loss of interest in hobbies, irritability, and other behaviors that may interrupt daily living.9 Inadequate intake of folic acid from fruits and vegetables, and essential fatty acids in fish, may increase symptoms of depression.10 Unhealthy eating habits may be associated with increases in depression-like symptoms in women, supporting the notion that healthier eating habits may decrease major depression.11 Diet is only one component of how lifestyle may influence depression and stress in adults. Exercise may be another important component in decreasing depression-related symptoms due to the release of endorphins.12 It has been found that participating in regular physical activity may decrease tension levels, increase and stabilize mood, improve self-esteem, and lead to better sleeping patterns.13 It has been concluded that individuals who consume a healthy diet are less likely to experience depression whereas people eating unhealthy and processed diets are more likely to be depressed.14
Poor sleep quality as well as unstable sleeping patterns may lead to poor psychological and physical health.15 Poor sleep includes longer duration of sleep onset latency, which is defined as the amount of time it takes to fall asleep, waking up multiple times throughout the night, and not getting a restful sleep because of tossing and turning.16 In healthy adults, the short-term consequences of sleep disruption consist of somatic pain, emotional destress and mood disorders, reduced quality of life, and increased stress responsivity.17 Irregular sleep-wake patterns, defined as taking numerous naps within a 24 hour span and not having a main nighttime sleep experience, are present at alarming levels (more than a quarter) among college students.18 A study done with 2,000 college students concluded that more than a quarter of the students were at risk of a sleeping disorder.19 Therefore, college students who were classified as poor-quality sleepers, reported experiencing more psychological and physical health problems compared to their healthy counterparts. Perceived stress was also found to be a factor in lower sleep quality of young adults.20
The link between depression-like symptoms and sleep remains poorly understood. It is mentioned that there are risk factors of poor sleep, depression and anxiety among college students but this topic has not yet been heavily studied within this population.
ContributorsBosnino, Jasmine (Co-author, Co-author) / Whisner, Corrie (Thesis director) / Petrov, Megan (Committee member) / Mahmood, Tara (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
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A cost analysis was done on the participant recruitment for an ongoing research project to promote colon cancer screening in Phoenix, Arizona. The aim of the 5-year project is to navigate people, who do not regularly see primary care physicians, from the community to a nearby clinic to be screened,

A cost analysis was done on the participant recruitment for an ongoing research project to promote colon cancer screening in Phoenix, Arizona. The aim of the 5-year project is to navigate people, who do not regularly see primary care physicians, from the community to a nearby clinic to be screened, using an intervention strategy called tailored navigation. Through tailored navigation, participants' barriers to being screened are addressed by Community Health Navigators, who call the participant over the span of 8 weeks following an initial class at a community site and give them information on how to overcome his or her specific barrier. The objective of this cost analysis is to explore the costs of recruiting a participant from the community to the initial class to a potential program manager. The process of recruitment involved recruitment of a community site, project introduction, the sign-up of interested participants, eligibility, baseline, and consent tests, and the class itself. A Community Site Liaison recruits sites and schedules class times. The Community Health Navigator conducts eligibility, baseline, and consent surveys and teaches the class, a sixty minute presentation on colon cancer screening. The cost of recruitment per community site was $541.23, and the cost per participant attending class was estimated to be $1,594.41 per participant with variation between $1,379.97 and $1,770.71 in optimistic and conservative scenarios, respectively.
ContributorsMishra, Shovna (Author) / Koretz, Lora (Thesis director) / Larkey, Linda (Committee member) / Herman, Patricia M. (Committee member) / Barrett, The Honors College (Contributor) / W. P. Carey School of Business (Contributor) / Department of Management (Contributor)
Created2014-05
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Objectives: The goal of this study was to compare older adults (ages 60 to 80) with a fixed sleep schedule compared to a restricted sleep schedule. The purpose was to determine if reducing one's sleep by an hour each night for 12 weeks, led to worse cognition and mood over

Objectives: The goal of this study was to compare older adults (ages 60 to 80) with a fixed sleep schedule compared to a restricted sleep schedule. The purpose was to determine if reducing one's sleep by an hour each night for 12 weeks, led to worse cognition and mood over time. Study Design: The study contained two groups: older adults with their sleep restricted and older adults with their sleep un-restricted. Participants were recruited by researchers at Arizona State University and The University of Arizona by advertising in newspapers, on flyers in senior centers, and on radio stations. After rigorous screening for health conditions, current sleep patterns and depression, individuals entered the study. Participants completed the Geriatric Depression Scale after two weeks of baseline, and again after treatment week 14 of the study. Likewise, males and females performed three cognitive tests after two weeks of baseline, and again after treatment week 14 of the study. These cognitive tests included Stroop Color and Word Test, Trail making and PVT. Results: The depression scale and three cognitive tests showed that there was no significant difference with cognition and mood over 14 weeks between individuals with a fixed sleep schedule compared to a restricted sleep schedule. Conclusions: Reducing older adult's sleep duration by an hour each night for 14 weeks does not produce negative effects, and does not provoke signs of depression or weakened cognition.
Created2017-05
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Purpose: The purpose of this study was to determine the efficacy of a yoga intervention for adolescents suffering from depression. Secondary results regarding the viability of yoga as an intervention for increasing self-esteem and decreasing anxiety were also explored.

Methods: Using PubMed, Medline, and CINAHL the search terms adolescents, depression,

Purpose: The purpose of this study was to determine the efficacy of a yoga intervention for adolescents suffering from depression. Secondary results regarding the viability of yoga as an intervention for increasing self-esteem and decreasing anxiety were also explored.

Methods: Using PubMed, Medline, and CINAHL the search terms adolescents, depression, and yoga were searched for related articles. Articles were then excluded or included based on certain criteria. Focus was placed on articles written within the last 10 years as well as studies done on children within 10-19 years of age. Final articles underwent extraction for relevant information and comparisons were drawn between the studies.

Results: Final exclusion lead to a total of 5 suitable studies. Studies varied in styles of yoga performed and measurement scales used to assess depression. Populations of adolescents varied significantly as well. The majority of these studies showed significant improvement in depression symptoms when measuring from pre to post intervention. Similar improvements were also noted in anxiety symptoms and low self-esteem.

Conclusion: Data gathered indicated that yoga serves a suitable intervention for decreasing depression symptoms in adolescents. Additionally, there seems to be promising results regarding the viability of yoga as an intervention for decreasing symptoms of anxiety and increasing self-esteem. Despite, current promising results, there is need for more research to affirm the findings found in these articles to determine the long term effects of yoga interventions.
ContributorsMenon, Pranav (Co-author) / Giedraitis, Frances (Co-author) / Larkey, Linda (Thesis director) / Calvin, Samantha (Committee member) / W.P. Carey School of Business (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
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Human trafficking is not only a social injustice, but also a major global health problem, that our communities cannot ignore. Despite the common misconception that trafficking is only seen in foreign countries or is only related to immigrants, the U.S. is known to be a major trafficking market and destination,

Human trafficking is not only a social injustice, but also a major global health problem, that our communities cannot ignore. Despite the common misconception that trafficking is only seen in foreign countries or is only related to immigrants, the U.S. is known to be a major trafficking market and destination, with trafficking reported in all 50 states (Bladwin et al., 2011; Shandro et al., 2016; Dovydaitis, 2010). Although trafficking victims are unlikely to have appropriate access to health care, as much as 80% of sex trafficking victims have reported that they encountered a medical professional while under their traffickers' control and went unidentified at the time (Baldwin et al., 2011; Shandro et al., 2016). This exemplifies a serious missed opportunity for intervention. Health care providers should be prepared to identify and care for victims of trafficking as part of their routine clinical practice. This thesis aims to describe trafficking victims' encounters in U.S. health care settings, to assess health care professionals' and students' awareness, knowledge, and beliefs on trafficking, to examine the impact of an educational intervention on this populations' knowledge/belief changes, and to ultimately spread education about this issue to a wide array of communities.
ContributorsFelix, Kaitlyn Nicole (Author) / Larkey, Linda (Thesis director) / Calvin, Samantha (Committee member) / School of Nutrition and Health Promotion (Contributor) / School of International Letters and Cultures (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
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Sleep is imperative for health and wellness with direct impacts on brain function, physiology, emotional well-being, performance and safety when compromised. Adolescents and young adults are increasingly affected by factors affecting the maintenance of regular sleep schedules. College and university students are a potentially vulnerable population to sleep deprivation and

Sleep is imperative for health and wellness with direct impacts on brain function, physiology, emotional well-being, performance and safety when compromised. Adolescents and young adults are increasingly affected by factors affecting the maintenance of regular sleep schedules. College and university students are a potentially vulnerable population to sleep deprivation and sleep insufficiency. Possible factors that could contribute to poor sleep hygiene include, but are not limited to, academic pressures, social activities, and increased screen time. Arguably, students are still experiencing bone mineralization, until the age of 30 or even 40 years old, which makes it more important to understand the effects that altered sleep patterns could have on continued development of bone health. It is our understanding that to date, studies assessing the risk of sleep insufficiency on bone mineral density in college students have not been conducted. We hypothesized that college-aged students, between the ages of 18-25 years, with shorter sleep durations, greater sleep schedule variability, and poorer sleep environments will have significantly lower bone mineral density. ActiGraph monitoring, via a wrist ActiWatch was used to quantitatively measure sleep habits for up to 7 consecutive days. During the week-long study participants also captured their self-reported sleep data through the use of a sleep diary. Participants were measured one time within the study for bone mineral density of the lumbar spine and total hip through a dual energy x-ray absorptiometry. This was a preliminary analysis of a larger cross-sectional analysis looked at 17 participants, of which there were 14 females and 3 males, (n=5, 1 and 11 Hispanic, Black and White, respectively). The mean age of participants was 20.8±1.7 y with an average BMI of 22.9±3.2 kg/m2. ActiWatch measurement data showed a mean daily sleep duration of participants to be 437.5 ± 43.1 (372.5 – 509.4) minutes. Mean sleep efficiency (minutes of sleep divided by minutes of time in bed) and mean number of awakenings were 87.4±4.3 (75.4-93.4) minutes and 32.1±6.4 (22.3-42.7) awakenings, respectively. The median time for wake after sleep onset (WASO) was 34.5±10.5 (18.3-67.4) minutes. The mean bone mineral density (BMD) for the hips was 1.06±0.14 (0.81-1.28) g/cm2 with a mean BMD of the lumbar spine being 1.24±0.12 (0.92-1.43) g/cm2. Age-matched Z-scores of the hips was 0.31±0.96 (-1.6-2.1) and lumbar spine was 0.53 (IQR: 0.13, 0.98; -2.25-1.55). Neither sleep duration nor sleep efficiency was significantly correlated to BMD of either locations. While WASO was positively associated with hip and spine BMD, this value was not statistically significant in this population. Overall, associations between sleep and BMD of the femur and spine were not seen in this cohort. Further work utilizing a larger cohort will allow for control of covariates while looking for potential associations between bone health, sleep duration and efficiency.

ContributorsEsch, Patricia Rose (Author) / Whisner, Corrie (Thesis director) / Petrov, Megan (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05