This research is an anthology of a series of papers intended to describe the health state, healthcare experiences, healthcare preventive practice, healthcare barriers, and cardiovascular disease (CVD) risk factors of Asian Americans (AA) residing in Arizona (AZ). Asian Americans are known to be vulnerable populations and there is paucity of data on interventions to reduce CVD risk factors. An extensive literature review showed no available disaggregated health data of AA in AZ. The Neuman Systems Model guided this study. Chapter 1 elucidates the importance of conducting the research. It provides an overview of the literature, theory, and methodology of the study. Chapters 2 and 3 describe the results of a cross-sectional descriptive secondary analysis using the 2013, 2015, and 2017 Behavior Risk Factor Surveillance System (BRFSS) datasets. The outcomes demonstrate the disaggregated epidemiological phenomenon of AA. There were variations in their social determinants of health, healthcare barriers, healthcare preventive practice, CVD risk factors, and healthcare experiences based on perceived racism. It highlighted modifiable and non-modifiable predictors of hypertension (HTN) and diabetes. Chapter 4 is an integrative review of interventions implemented to reduce CVD risks tailored for Filipino Americans. Chapter 5 summarizes the research findings. The results may provide the community of practicing nurses, researchers, and clinicians the evidence to plan, prioritize, and implement comprehensive, theoretically guided, and culturally tailored community-led primary and secondary prevention programs to improve their health outcomes. The data may serve as a tool for stakeholders and policy makers to advocate for public health policies that will elevate population health of AA or communities of color in AZ to be in line with non-Hispanic White counterparts.

No studies have evaluated the impact of tracking resting energy expenditure (REE) and modifiable health behaviors on gestational weight gain (GWG). In this controlled trial, pregnant women aged >18 years (X=29.8±4.9 years) with a gestational age (GA) <17 weeks were randomized to Breezing™ (N=16) or control (N=12) for 13 weeks. The Breezing™ group used a real-time metabolism tracker to obtain REE. Anthropometrics, diet, and sleep data were collected every 2 weeks. Rate of GWG was calculated as weight gain divided by total duration. Early (GA weeks 14-21), late (GA weeks 21-28), and overall (GA week 14-28) changes in macronutrients, sleep, and GWG were calculated. Mediation models were constructed using SPSS PROCESS macro using a bootstrap estimation approach with 10,000 samples. The majority of women were non-Hispanic Caucasian (78.6%). A total of 35.7% (n=10), 35.7% (n=10), and 28.6% (n=8) were normal weight, overweight, and obese, respectively, with 83.3% (n=10) and 87.5% (n=14) of the Control and Breezing™ groups gaining above IOM GWG recommendations. At baseline, macronutrient consumption did not differ. Overall (Breezing™ vs. Control; M diff=-349.08±150.77, 95% CI: -660.26 to -37.90, p=0.029) and late (M diff=-379.90±143.89, 95% CI:-676.87 to -82.93, p=0.014) changes in energy consumption significantly differed between the groups. Overall (M diff=-22.45±11.03, 95% CI: -45.20 to 0.31, p=0.053), late (M diff=-23.16±11.23, 95% CI: -46.33 to 0.01, p=0.05), and early (M diff=20.3±10.19, 95% CI: -0.74 to 41.34, p=0.058) changes in protein differed by group. Nocturnal total sleep time differed by study group (Breezing vs. Control; M diff=-32.75, 95% CI: -68.34 to 2.84, p=0.069). There was a 11.5% increase in total REE throughout the study. Early changes in REE (72±211 kcals) were relatively small while late changes (128±294 kcals) nearly doubled. Interestingly, early changes in REE demonstrated a moderate, positive correlation with rates of GWG later in pregnancy (r=0.528, p=0.052), suggesting that REE assessment early in pregnancy may help predict changes in GWG. Changes in macronutrients did not mediate the relationship between the intervention and GWG, nor did sleep mediate relationships between dietary intake and GWG. Future research evaluating REE and dietary composition throughout pregnancy may provide insight for appropriate GWG recommendations.

Type 2 diabetes mellitus (T2DM) is a chronic disease affecting more than ten percent of the U.S. adults. Approximately 50 percent of people with diabetes fail to achieve glycemic targets of A1C levels below seven percent. Poor glycemic control disproportionately affects minority populations such as Korean Americans (KAs). Successful diabetes self-management requires a comprehensive approach that takes into account depression, sleep, and acculturation to achieve good glycemic control. Therefore, the purposes of this study were to: 1) describe the levels of glycemic control, depressive symptoms, sleep quality and duration, and acculturation; 2) examine an association of depressive symptoms with glycemic control; 3) identify mediational roles of sleep quality and sleep duration of less than 6 hours between depressive symptoms and glycemic control; and 4) explore a moderation role of acculturation between depressive symptoms and glycemic control in KAs with T2DM. This is a cross-sectional, descriptive correlational study. A total of 119 first generation KAs with T2DM were recruited from Korean communities in Arizona. A1C levels, the Center for Epidemiological Studies Depression Scale, the Pittsburgh Sleep Quality Index, the Suinn-Lew Asian Self-Identity Acculturation scale, the International Physical Activity Questionnaire, and the Berlin Questionnaire were measured. Descriptive statistics, multiple regression analyses, path analyses, and the Sobel tests were conducted for data analyses of this study. Poor glycemic control (A1C ≥ 7 %), high depressive symptoms (CES-D ≥ 16), poor sleep quality (PSQI > 5), and short sleep duration (< 6 hours) were prevalent among KAs with T2DM. The mean score of acculturation (2.18) indicated low acculturation to Western culture. Depressive symptoms were revealed as a significant independent predictor of glycemic control. Physical activity was negatively associated with glycemic control, while cultural identity was positively related to glycemic control. Sleep quality and sleep duration of less than 6 hours did not mediate the relationship between depressive symptoms and glycemic control. Acculturation did not moderate the association between depressive symptoms and glycemic control. Diabetes self-management interventions of a comprehensive approach that considers depressive symptoms, sleep problems, and cultural differences in minority populations with T2DM are needed.

Scientific evidence strongly indicates that there are significant health benefits of breastfeeding. Lower breastfeeding initiation, duration, and exclusivity rates are found in vulnerable populations particularly among women of low socioeconomic status, and racial minorities such as immigrant, racial, and minority cultural groups. Breastfeeding disparities can contribute to negative health outcomes for the mothers, and their infants, and families.

Muslim Arab immigrants are a fast-growing, under-studied, and underserved minority population in the United States. Little is known about breastfeeding practices and challenges facing this vulnerable population. Immigrant Muslim Arab mothers encounter breastfeeding challenges related to religion, language, different cultural beliefs, levels of acculturation, difficulties understanding health care information, and navigating the health care system.

A cross-sectional descriptive study was used to describe infant feeding practices, and identify contributors and barriers to adequate breastfeeding using the social ecological model of health promotion. A convenience sample of 116 immigrant Muslim Arab women with at least one child, 5 years or younger was recruited from a large metropolitan area in the Southwestern United States. The results indicated that immigrant Muslim Arab mothers demonstrate high breastfeeding initiation rates (99.2%), and lengthy breastfeeding duration (M=11.86), but low rates of exclusive breastfeeding at 6 months (21.6%). Facilitators to breastfeeding within the sample were high intentions to breastfeed, positive breastfeeding knowledge and beliefs related to the benefits of breastfeeding, religious teachings promoting breastfeeding, and encouragement to breastfeed from the mothers’ social support system. Several barriers to successful breastfeeding were related to lacking the specific knowledge of the benefits of breastfeeding, and discomfort with breastfeeding in public, and in front of strangers. High income and religious teachings encouraging breastfeeding were significantly associated with exclusive breastfeeding at six months. Greater maternal age and comfort with breastfeeding in public were associated with longer breastfeeding durations.

The socio-cultural context for support of breastfeeding is an important consideration by healthcare providers caring for Muslim Arab women. An ecological perspective needs to be applied to interventions targeting breastfeeding promotion to facilitate effectiveness in this population. Culturally tailored intervention to the specific breastfeeding concerns and needs of Muslim immigrant women could promote optimal breastfeeding in this population.

Exclusivity and duration of breastfeeding and the provision of human milk in the United States is suboptimal. In the absence of adequate banked donor human milk for distribution to all infants in need, many families choose to engage in the practice of Private Arrangement Milk Sharing (PAMS), partially facilitated through social media, to procure human milk for their infants. Evidence regarding the participant and infant characteristics and risk abatement practices is incomplete. This dissertation describes and explores the characteristics of recipient participants and infants, family constellation, donor screening practices, and related risk abatement strategies. Data was collected via on-line survey as a sub-group of a larger data set including donor participants and international participants. Binary logistic regression modeling of factors that contribute to consistent screening and risk abatement practices and important antecedents to engaging in PAMS was conducted. Results are contextualized within a tailored socioecological framework of factors affecting infant feeding practices. Tailoring was accomplished via qualitative descriptive analysis of participant responses applied to an existing breastfeeding framework. Participants in this sample were predominantly white, married, with a mean age of 32.9 years, with at least some college education and above median income. Risk abatement and screening practices were influenced by support of a healthcare provider during decision-making, college education, infant age and health status, having lactation support, birth type and birth attendant, and the duration and sources sought for learning about milk sharing.

ABSTRACT

The purpose of this study was to investigate physical activity (PA) program characteristics preferred by low-income childbearing age Latinas and the relationship with the participants’ personal characteristics, cultural values, and acculturation. This was an exploratory study guided by the Preferences and Health Behavior Model (PaHBM), developed by this investigator. Recruitment occurred at three sites; two sites were located in Phoenix, AZ and one site was located in Houston, TX. Non pregnant Latinas between 18 to 35 years old were included (N=275). Latinas were excluded if they were pregnant, incarcerated, physically or mentally disabled, or had chronic diseases (e.g. cardiovascular disease). Quantitative data were collected using the Predictors and Preferences of Physical Activity Research Intervention Participation in an Underserved Latina Community Questionnaire, developed by this author, along with the Brief Acculturation Rating Scale for Mexican Americans, and the Mexican American Cultural Values Scale. The hypotheses were tested utilizing Chi-square, Pearson correlation and logistic regression. Annual family income, parity, country of origin, BMI and acculturation were the personal characteristics significantly associated with preferred PA program by this group of Latinas. Latino women were heterogeneous in their preferences. In general, sixty percent endorsed dancing as the type of activity preferred, 20% preferred PA education and 20% preferred walking. Major differences were found between the types of activity the Latino women were currently participating in compared to their preferred type of activity. Of the 124 who reported to be walking/jogging, almost half (49) preferred dancing, 22 preferred PA education and only 12 preferred walking. The study findings add to the existing knowledge by looking at factors that should be considered when developing PA interventions as well as when prescribing or recommending PA to this population. These results demonstrate the need to identify the preferred PA program characteristics of Latinas prior to developing interventions. Failure to know the patient’s preferred PA program characteristics may result in prescribing or recommending an undesired activity and decrease participation in PA interventions.



RESUMEN

El propósito de este estudio fue identificar las características preferidas en un programa de actividad física por una comunidad de mujeres Latinas de bajos recursos económicos y en edad fértil, así como la relación de esas características con sus propias características personales, sus valores culturales y su adaptación a la comunidad Anglosajona. Este fue un estudio exploratorio guiado por el “Modelo Preferencias y Comportamiento Saludables” (PaHBM), por sus siglas en Ingles, desarrollado por esta investigadora. El reclutamiento de las Latinas ocurrió en tres sedes: Una en Houston, TX y dos en Phoenix, AZ. Las mujeres Latinas fueron incluidas si tenían entre 18 y 35 años de edad. Se excluyeron mujeres que estaban embarazadas, estuvieran encarceladas, físicamente o mentalmente incapacitadas o que sufrieran alguna enfermedad crónica. Los datos cuantitativos fueron recolectados a través de una encuesta llamada “Predictores y preferencias de participación en un programa investigativo de actividad física”, desarrollada por la autora de este estudio, además utilizando la escala breve de aculturación para Mejicanos Americanos y la escala de valores culturales en Mejicanos Americanos. Las hipótesis fueron probadas utilizando el Chi-cuadrado, la correlación de Pearson, y la regresión lógica. Las características personales más asociadas con las características del programa preferido fueron el salario anual de la familia, el número de hijos, el país de origen, y el índice de masa corporal. En general, 60% prefirieron bailar, 20% clases de actividad física y 20% caminar. Mayores diferencias se encontraron en el tipo de actividad en las que las mujeres Latinas estaban participando, comparado con lo que ellas preferían. De 124 participantes que estaban caminando o trotando, 49 Latinas (39%) preferían bailar, 22 Latinas (17%) preferían clases de actividad física y solo 12 Latinas (10%) prefirieron caminar. Estos resultados demuestran la necesidad de identificar las características del programa de actividad física antes de crear dicho programa. Estos resultados son una adición a los conocimientos existentes, en los que se identificaron factores que deben ser considerados cuando se planea un programa así como cuando se prescribe o se recomienda actividad física a esta población. Sera un fracaso no conocer las preferencias de una paciente para mantenerse físicamente activa porque puede resultar en la prescripción o recomendación de actividades que la paciente no desea y esto se traducirá en reducción de la participación en programas de actividad física.

Despite the widely recognized health benefits of breastfeeding and its endorsement by leading health organizations, as a preventative public health intervention, inadequate breastfeeding knowledge and lactation management skills among healthcare providers continues to be a major barrier for women who choose to initiate breastfeeding. Breastfeeding competencies are not standardized in healthcare education for any of the health professions. To address this gap, a few continuing education and professional development programs have been implemented, but paucity in research regarding the efficacy of these programs exists. The purpose of this study was to explore the changes in healthcare providers’ learning outcomes related to breastfeeding support and promotion.

A non-experimental pre-posttest self-report survey design was used to assess the feasibility and preliminary efficacy of an online breastfeeding educational intervention for healthcare providers. The Theory of Planned Behavior (TPB) provided the framework for exploring the participants’ psychological and behavioral outcomes. The research questions were: (1) What is the feasibility of an online breastfeeding course for healthcare providers? (2) What are healthcare providers’ psychological and behavioral changes occurring after completion of an online course? (3) How do the post-intervention psychological and behavioral outcomes of the online format compare with those of the previous format (hybrid) of this breastfeeding course?

Although participants’ favorably assessed the feasibility (i.e., acceptability) of the 45-hour course, several factors contributed to participants’ satisfaction level: Previous online learning experience, connectedness with others, and the degree of structural support. Significant positive changes occurring in participants were increases in their knowledge and beliefs about breastfeeding; attitudes toward formula feeding; perceived behavioral control; perceptions about being able to perform breastfeeding supportive behaviors; and intentions to perform actions that are consistent with evidence-based breastfeeding supportive behaviors. Significant changes in the beliefs about formula feeding were not in the expected direction raising conceptual and pedagogical issues. Participants had negative perceptions about being able to implement what they learned in their workplaces or to affect policy. Findings support the use of online breastfeeding education programs for healthcare providers; changes at both individual and institutional levels are necessary to change provider practices.

The purpose of this constructivist grounded theory study was to explore the perceptions of adult female sexual assault victims/survivors about their wellbeing: their definitions and descriptions of wellbeing; the impact of the assault on wellbeing; and barriers and facilitators to achieving wellbeing following assault. Feminist theory provided the sensitizing concepts for this research. Data were collected via semistructured interviews with 22 adult women who had experienced at least one episode of sexual assault at or above the age of 18. Data analysis included first, second, and third level coding techniques, memo writing, and data displays. Participants experienced negative effects to their overall wellbeing as well as to the wellbeing domains of physical, mental, career/economic/financial, relational, and spiritual. The findings of this study support wellbeing as a core category encompassing the five domains listed above, also described in the literature. The participants also confirmed and expounded in depth on the dynamic, interactive, and overlapping nature of each of the domains of wellbeing and their ability to enhance, maintain, or worsen health status and overall wellbeing. In addition, a new construct emerged that cut across all domains, that of safety, and the overarching significance of culture was recognized. Additional research should continue to explore wellbeing in diverse populations of sexual assault victims/survivors. Additional research should also explore the significance and function of safety in sexual assault victims/survivors. Formal and informal supporters of sexual assault victims/survivors should be aware of the complex ways that sexual assault affects women. In addition, they should be aware of helpful resources for sexual assault victims/survivors.

ABSTRACT

Adolescence is a period marked by significant physical, developmental, cognitive, and social changes, all of which contribute to health concerns for teens. A steady rise in life expectancy over the past two centuries is potentially diminishing due to the increase in prevalence, severity, and consequences of obesity in children and adolescents related to unhealthy lifestyle behaviors. Health behaviors are often established during childhood and adolescence that continue into adulthood. The development and integration of healthy lifestyle behaviors are vital through adolescence. Self-determination theory (SDT) offers a theoretical framework for attempting to understand individual differences in motivation and behavior. Recent studies have primarily focused on how adolescents make choices related to eating behaviors, physical activity, and self-care habits, and how the resultant behaviors are measured. Participants in this study were 63 healthy adolescents enrolled in 9th grade health class. All participants provided baseline data at Time 1 and again following the five-week pretest posttest intervention study at Time 2. This study examined the utility of SDT in the development of the Adolescent Intrinsic Motivation, a healthy lifestyle behavior intervention, using the tenets of SDT to explain healthy lifestyle motivational beliefs in adolescents, along with healthy lifestyle behaviors and knowledge. The AIM intervention study introduced basic health recommendations to adolescents in an autonomy-supportive environment, which has been shown to encourage the adolescent to make healthy behavior choices based on their own interest and enjoyment. Preliminary effects of the study indicated that participants receiving the AIM intervention demonstrated significant differences in motivational beliefs, healthy lifestyle knowledge, as well as healthy lifestyle behaviors from Time 1 (baseline) to Time 2 (post-intervention). Results of this study provide support for the use of SDT to address the competence, relatedness, and autonomy of adolescents in the development of health education material. Testing this intervention in a larger, random sampling of schools within the state, or even in more than one state, with a three- or six-month follow-up would be useful in determining the longer-term effects of the intervention.

This study tested the preliminary effectiveness of a health belief and text messaging intervention for parents of five- to eight-year-old children to determine whether health beliefs and influenza vaccine receipt differ when compared to a text messaging control group. Children are almost four times more likely to be infected with influenza than adults (Belshe Piedra, & Block, 2009), shed the greatest quantities of influenza virus, and have been recognized as vectors for spread of disease (Neuzil, Mellen, Wright, Mitchel, Jr., & Griffin, 2002b). The influenza immunization rate for school-age children is less than 56% (Centers for Disease Control and Prevention [CDC], 2014). Reasons for the low vaccination rate include parents’ misperceptions of influenza disease and vaccinations (Bhat-Schelbert et al., 2012; Taylor et al., 2002). There are few theory-based interventions for increasing influenza vaccination rates of school-age children; however, promising results have been found when using the constructs of the health belief model (HBM) (Chen et al., 2011; Coe, Gatewood, Moczygemba, Goode, & Beckner, 2012). Mobile technology using Short Message Service (SMS) text messaging may increase vaccination rates to a greater extent than traditional vaccine reminders (Daley et al., 2002; Grajalva, 2006). Prior to starting this study, only one randomized controlled trial testing text messaging to increase children’s influenza vaccination rates was found (Stockwell et al., 2012). In this study, text messaging was effective in promoting behavioral changes leading to a 4% increase in influenza vaccination (27.1% vs. 22.8%, RR = 1.19, p < .001). This study was a randomized controlled trial using a two-group pre- and posttest experimental design. This study found that a theory-based intervention (SayNo2Flu) guided by the HBM and combined with the use of mobile technology (SMS text messaging) did change parents’ influenza vaccination perceptions. It had an overall increase of 38.1% in Influenza vaccination rates in the intervention group (OR: 4.46, 95% CL, 1.705-11.706, p < .001). These results offer some insight into the use of theory-based preventative interventions for parents of young school-age children.