Having accurate measurements of sedentary behaviors is important to understand relationships between sedentary behaviors and health outcomes and to evaluate changes in interventions and health promotion programs designed to reduce sedentary behaviors. This dissertation included three projects that examined measurement properties of wearable monitors used to measure sedentary behaviors. Project one examined the validity of three monitors: the ActiGraph GT3X+, activPAL™, and SenseWear 2. None of the monitors were equivalent with the criterion measure of oxygen uptake to estimate the energy cost of sedentary and light-intensity activities. The ActivPAL™ had the best accuracy as compared with the other monitors. In project two, the accuracy of ActiGraph GT3X+and GENEActiv cut-points used to assess sedentary behavior were compared with direct observation during free-living conditions. New vector magnitude cut-points also were developed to classify time spent in sedentary- and stationary behaviors during free-living conditions. The cut-points tested had modest overall accuracy to classify sedentary time as compared to direct observation. New ActiGraph 1-minute vector cut-points increased overall accuracy for classifying sedentary time. Project 3 examined the accuracy of the sedentary sphere by testing various arm elevation- and movement-count configurations using GENEActiv and ActiGraph GT3X+ data obtained during free-living conditions. None of the configurations were equivalent to the criterion measure of direct observation. The best configuration of the GENEActiv was: worn on the dominant wrist at 15 degrees below the horizontal plane with a cut-point <489 for each 15-second interval. The best configuration for the ActiGraph was: worn on the non-dominant wrist at 5° below the horizontal plane with a cut-point of <489 counts for each 15-second interval. Collectively, these findings indicate that the wearable monitors and methods examined in this study are limited in their ability to assess sedentary behaviors and light intensity physical activity. Additional research is needed to further understand the scope and limitations of wearable monitors and methods used to assess sedentary behaviors and light intensity physical activity.

ABSTRACT Caregiving studies generally do not focus on the post-caregiving phase of care, or African Americans post-caregivers (AAPCGs). This mixed-methods study guided by the Transitions Theory, explored the experiences of 40 AAPCGs residing in Los Angeles, California and Phoenix, Arizona, whose loved ones died within the last 10 years. Data collection tools included individual interviews, demographic questionnaire, CES-D, Brief Cope, and Social Support. Findings present the specific aims of the study. Aim 1 dealt with the types, patterns and properties of post-caregiving transitions (PCT). Many AAPCGs experienced multiple, simultaneous transitions that continued to impact their lives many years after caregiving ends. Aim 2 dealt with factors that facilitate or inhibit healthy PCT. Facilitators include: Being satisfied with care provided; fulfilling death-bed promises; living out the legacy of the deceased; deep spiritual beliefs in God and support of family, friends and church. Inhibitors include: Experiencing a deep sense of loss, confusion, depression, loneliness, and guilt; physical challenges such as fatigue and exhaustion, breathing problems, dizziness, fainting, cognitive difficulties, pain, headaches, hypertension and insomnia; family conflicts, job or home loss that linger long after PCT. Aim 3 involves process indicators including: connectedness with family, friends, co-workers, church and God; returning to work or school. Coping strategies that helped AAPCGs include: productive ventures, family mementoes, reminiscing, new baby, or visiting cemetery. Appropriate coping led to outcome indicators of mastery such as new environment; making decisions; taking actions; readying oneself for another caregiving role; preparing for one's own life and death; or caring for self. Fluid integrative identities include: Sense of balance, peacefulness and joy, fulfillment, compassion; remembering without pain; or new identity. Implications for practice, policy, education and research include: Care providers and policy makers must ensure that AA caregivers receive adequate EOL and hospice information and support for adequate preparation of loved one's death. Geriatric educators must design and implement curricular programming that includes the post-caregiving phase as a very important phase of caregiving. Researchers should design culturally-congruent assessment tools or improve the checklist developed in this study to appropriately measure PCT; and also develop culturally-relevant interventions to facilitate healthy PCT.