Falls are a public health concern for older adults with or without cognitive impairment, including clinical Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD) dementia. Executive function (EF) is linked to falls and is notably impaired in individuals with MCI and AD dementia. However, it is unclear which EF assessments are associated with falls in older adults with intact cognition, MCI, and AD dementia. Apolipoprotein E4 (ApoE4) increases the risk of MCI and AD dementia, with limited information suggesting decreased EF and gait impairment in ApoE4 carriers. The purpose of this study was to 1) investigate the relationships between EF assessments and falls (fall history and future fall) by cognitive status (intact cognition, MCI, AD dementia) and 2) determine if ApoE4 moderates the relationship between EF and falls across cognitive status. EF assessments included Digit Span (DS), Trail Making Test (ΔTMT), Stroop Interference Test, Controlled Oral Word Association assessments of phonemic and semantic fluency (COWAC), and Clock Drawing Test. Binary logistic regression was used with secondary data to analyze the EF and falls relationship. Results showed a significant association of the ΔTMT with fall history but may not be appropriate for use with people with AD dementia due to a floor effect. Significant interaction effects were shown between AD dementia and DS, ΔTMT, and EF as a latent variable, where individuals with a fall history had better EF performance. The interaction effects are influenced by the lower percentage of reported falls in people with severe AD dementia. In the second aim, a confounding effect exposed a potential four-way interaction where higher EF in ApoE4 non-carriers with AD dementia experienced a future fall without a fall history. Overall, more research is needed to determine which EF assessments are best suited for fall risk assessment and whether ApoE4 plays a role in the relationship between EF and falls. Since the low percentage of reported falls in people with severe AD dementia exposed a differing trend between EF and falls, more research is needed to develop valid and reliable tools for collecting fall data in individuals with severe AD dementia.

Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food, which may include inadequate finances, transportation, skills, and information. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of hunger, nutritional deficiencies, and chronic disease among vulnerable populations. This dissertation tested a novel food insecurity intervention using informational nudges to promote food security through the elimination of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity. The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group. Qualitative findings revealed how the intervention group found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food.

Background: Down syndrome is the leading genetic cause of intellectual disabilities. Executive function is an area that people with Down syndrome have a diminished capacity compared to those in the general population. In recent years it has been determined that acute and chronic exercise has a small but positive effect on measures of executive function in typically developed individuals. The effect has been recorded separately in both aerobic, high-rate passive and resistance exercises in adolescents with DS but has not been compared between exercise types in adults with DS. Methods: A randomized crossover study was utilized to determine the effect of resistance exercise, assisted cycling therapy, and no exercise on executive function and enjoyment in adults with Down syndrome. Resistance Training (RT)- participants completed a total of 16- repetitions of approximately 75% of a 1-RM in the leg press, chest press, seated row, and latissimus pulldown. ACT- participants completed 30-minutes of cycling at 35% above voluntary (e.g., self-selected pace) rate. No-Training (NT)- participants spent 35-minutes playing board games. Cognitive assessments were recorded pre- and post- intervention. The Physical Activity Enjoyment Survey was collected post-intervention. Statistics: The cognitive measures and Physical Activity Self-efficacy scale were analyzed using the delta scores (pre-post) in a Linear mixed models analyais. The main effect of sequence (A, B, C) and intervention (RT, ACT, NT), and visit were assessed. Significance level was set with α=0.05. If any differences were detected, the Bonferroni post-hoc test was used to determine differences. Physical Activity Enjoyment Scale post scores were compared using a General Linear Model. Alpha was set at 0.05 with a Bonferroni post-hoc test to determine differences. A secondary analysis was conducted investigating the effect of participants that completed testing individually compared to those that completed the testing in a group setting. Results: There were no significant difference in the delta score of any of the measures. The secondary analysis also found no significant difference but showed a trend that those tested individually had opposite results than those tested in a group.

The health benefits of sufficient moderate-to-vigorous physical activity (MVPA) and sleep arewell-supported, with established links to decreased cancer risk, cardiometabolic health, all-cause mortality, and psychiatric symptomatology—including stress-related phenomena—for those who engage in 150 min MVPA/week and get at least 7 hours sleep/night. The latter outcome has rapidly become a major public health concern as our nation grapples with the impact of prolonged COVID-19 pandemic stress, which has triggered an onslaught of depression, anxiety, and PTSD throughout the population. Thus, while strategies to decrease stress are desperately needed, many Americans fall short of the very MVPA and sleep recommendations that have been shown to increase their capacity to cope. The purpose of the present study was to explore time-varying associations of MVPA and sleep with momentary perceived stress in adults forced to work from home due to the COVID-19 pandemic. Thirty remote-working adults (86.7% women; mean age 37.5 years, SD = 10.4 years) wore GENEActiv accelerometers on the wrist to capture MVPA and sleep data, and answered four Ecological Momentary Assessments (EMAs) per day regarding perceived stress, for fourteen days straight. Between- and within-person variations in MVPA, sleep quality rating (SQR), total sleep time (TST), and sleep efficiency (SE) were analyzed via multilevel models to determine whether certain changes in these parameters might lead to decreased perceived momentary stress. Between-person models revealed a significant negative effect of SQR on perceived stress levels the next day, beta= -.651, SE= .303, P= .04. Mean MVPA, TST, and SE were not significant inter-individual predictors of momentary stress. However, within persons, higher than normal MVPA (beta= -.005, SE= .002, P= .015), SQR (beta= -.277, SE= .071, P <.001), TST (beta= -.001, SE= .000, P = .004), and SE (beta= -.524, SE= .242, P = .031) were all associated with significant decreases in momentary stress, with individuals experiencing incremental benefits with each additional minute of MVPA and TST. In conclusion, daily fluctuations in MVPA and sleep habits correlate more strongly with momentary stress than do typical levels of these behaviors; this presents an attainable strategy for individuals to enhance their capacity to cope.

The ability to walk while completing a secondary task, dual-task walking (DTW), poses notable challenges for individuals affected by neurological disorders, such as multiple sclerosis (MS), who experience both cognitive and motor problems secondary to their disease. However, DTW is an everyday activity that has putative importance for optimal function. Although some research in the past decade has begun to examine changes in DTW in MS, there is still limited work to understand the predictors of DTW, the factors that might moderate relationships between baseline cognitive and motor function and DTW ability, and its consequences (e.g., for quality of life [QoL] or fall risk). To contribute to the understanding of these phenomena and their intersections, three secondary data analyses of two relatively large data sets in the area were conducted to address five major aims. The first step was to identify of the most relevant of these inherently involved domains (cognitive [aim 1] and motor [aim 2] abilities). Lasso regression for inference was performed to address this question for both cognitive (South Shore Neurologic Associates, PC data) and motor (University of Kansas Medical Center [KUMC] data) domains. Next, evaluations to explore the moderating role of the psychological impacts that are common in MS (e.g., depression and falls self-efficacy) were undertaken to determine whether the relationships between cognitive and motor function and DTW ability are different for individuals with different levels of these factors using regression with factor scores performed with each data set (aim 3). As a final step, relationships between DTW and distal outcomes like QoL (cross-sectionally using both data sets and factor score regression; aim 4) and falls (cross-sectionally and longitudinally using KUMC data and negative binomial regression; aim 5). These studies contribute to the corpus of knowledge about DTW in MS in needed ways.

The promulgation of the thin-ideal is associated with bulimia, dieting, supplement use, negative affect, and body dissatisfaction. “Fitspiration” was created as an “antidote” to the thin-ideal through the promotion of healthy eating and exercise; however, research indicates Fitspiration continues to promote the thin-ideal with similarly detrimental outcomes. Recently, research has shifted from a focus on body disturbance to concepts of positive body image (Halliwell, 2015), often researched through the concept of body appreciation. While the research is limited, a few studies have shown increases in body appreciation and mood after viewing body positive images. Therefore, the purpose of this study was to experimentally examine the impact of exposure to body positive and Fitspiration Instagram images on the body satisfaction, body appreciation, and mood of undergraduate women. Participants were 98 female undergraduate students (18-29 years old) currently attending Arizona State University. Participants were randomly assigned to view Fitspiration, Body Positive, or appearance neutral Instagram images. Dependent variables of state body appreciation, state body dissatisfaction, and state mood were measured using Visual Analogue Scales. Trait thin-ideal internalization, trait social comparison, and body mass index (BMI) were included as covariates. Qualitative short-answer questions were included as an exploratory aim. A one-way analysis of covariance (ANCOVA) was used to examine group differences in post-test scores followed by post-hoc analyses using the Bonferroni correction when significant. After controlling for baseline score, trait thin-ideal internalization, trait social comparison, and BMI, post-test body appreciation scores within Fitspiration condition were significantly lower than the control (MD= 9.818, SE=3.743, p=.031) and Body Positive condition (MD=9.372, SE=3.492, p=0.26). After controlling for baseline score, trait thin-ideal internalization, trait social comparison, and BMI, the Body Positive condition demonstrated significantly higher post-test body satisfaction scores than the control (MD= 11.134, SE=3.093, p=.002) and Fitspiration condition (MD=17.312, SE=3.092, p=<.001). After controlling for baseline scores, mean post-test positive mood scores within the Fitspiration group were significantly lower than the Body Positive condition (MD=-0.378, SE=.135, p=.019). There were no differences in post-test negative mood across conditions. Findings suggest short-term exposure to body positive images may improve body appreciation, Body Positivity, and positive mood among undergraduate females.

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.

Physical inactivity is a continuing public health crisis because of its negative effects on health (e.g. hypertension, cardiovascular disease, type II diabetes). To combat the rising prevalence of these non-communicable diseases, physical activity (PA) promotion is a public health priority. However, current programs seem to be ineffective in the long-term promotion of PA. Resultingly new, effective interventions are needed. Recent studies have established a link between mindfulness and PA engagement. Based on the current literature, the present study sought to investigate the associations between trait mindfulness, behavioral regulation towards exercise, exercise intention, stress, and self-reported PA. This study also examined whether trait mindfulness was independently associated with meeting weekly, leisure-time, moderate-to-vigorous PA [MVPA] recommendations in university undergraduate students after controlling for demographic characteristics, past PA experience, exercise intention, stress, and motivation.

The study used a cross-sectional design and participants consisted of 180 undergraduate university students (aged 18 to 24 years). Participants completed a one-time survey that assessed demographic characteristics, trait mindfulness, behavioral regulation toward exercise, exercise intention, perceived stress and PA. Bivariate associations between the variables were assessed with Pearson or Spearman correlations. A logistic regression analysis was conducted to determine which variables were independently associated with meeting weekly, leisure-time MVPA guidelines. Results of this study found weak positive associations between the mindfulness domain of acceptance and leisure time MVPA ( = .168, p < .05), no associations between mindfulness and transportation PA, and negative associations between mindfulness (MAAS,  = –.238, p < .01; acceptance,  = –.175, p < .05) and sitting time. Results of logistic regression found that only relative autonomy (OR = 1.085, 95% CI [1.008, 1.168], p = .030) and intention (OR = 2.193, 95% CI [1.533, 3.138], p < .0001) were independently associated with meeting weekly, leisure- time MVPA recommendations. The results of this study show that while there is only a weak direct relationship between trait mindfulness and PA, mindfulness may be related with other factors associated with PA. More research is needed in order to better understand the potential mechanisms behind the results found in this, and past, studies.

Background: Hispanic women are at high risk for Type 2 Diabetes (T2D), in part due to their high prevalence of obesity, which may influence the development of insulin resistance and disease onset. Unhealthy eating contributes to T2D risk. Dietary patterns are the combination of total foods and beverages among individual’s over time, but there is limited information regarding its role on T2D risk factors among Hispanic women. Objective: To identify a posteriori dietary patterns and their associations with diabetes risk factors (age, BMI, abdominal obesity, elevated fasting blood glucose, and hemoglobin A1c) among overweight/obese Hispanic women. Design: Cross-sectional dietary data were collected among 191 women with or at risk for T2D using the Southwestern Food Frequency Questionnaire capturing the prior three months of intake. Dietary patterns were derived using exploratory factor analysis. Regression scores were used to explore associations between dietary patterns and diabetes risk factors. Results: The patterns derived were: 1) “sugar and fat-laden”, with high loads of sweets, drinks, pastries, and fats; 2) “plant foods and fish”, with high loads of vegetables, fruits, fish, and beans; 3) “soups and starchy dishes”, with high loads of soups, starchy foods, and mixed dishes; 4) “meats and snacks”, with high loads of red meat, salty snacks, and condiments; 5) “beans and grains”, with high loads of beans and seeds, whole-wheat and refined grain foods, fish, and alcohol; and 6) “eggs and dairy”, with high loads of eggs, dairy, and fats. The “sugar and fat-laden” and “meats and snacks” patterns were negatively associated with age (r= -0.230, p= 0.001 and r= -0.298, p<0.001, respectively). Scores for “plant foods and fish” were associated with fasting blood glucose (r= 0.152, p= 0.037). There were no other statistically significant relationships between the dietary patterns and risk factors for T2D. Conclusions: A variety of patterns with healthy and unhealthy traits among Hispanic women were observed. Being younger may play an important role in adhering to a dietary pattern rich in sugary and high-fat foods and highlights the importance of assessing dietary patterns among young women to early identify dietary traits detrimental for their health.