Objectives. To determine the association between parental level of acculturation using the Anglo Orientation Subscale (AOS) and the Mexican Orientation Subscale (MOS) derived from the Acculturating Rating Scale for Mexican Americans-II (ARSMA II) and their likelihood of serving green salad, vegetables, fruit, 100% fruit juice, and sugar-sweetened beverages during family meals. Methods. A sample of Hispanic parents of 6th, 7th, or 8th-grade adolescents (n=447; 39.8±6.8 years; 89.7% female) enrolled in a parenting intervention promoting healthy nutrition and substance use prevention. Parents completed baseline surveys to self-report whether they had family meals or not, acculturation-related questions, and the frequency with which they serve green salad, vegetables, fruit, 100% fruit juice, and sugar-sweetened beverages (SSB) during family meals. Associations between parental acculturation level and their likelihood of serving green salad, vegetables, fruit, 100% fruit juice and sugar-sweetened beverages during meal times were assessed with Spearman’s rank correlations. Results. There was a positive correlation between a higher level of acculturation on the Mexican Orientation Subscale (MOS) scale and the frequency of serving SSB during family meals (p=.006). There was a positive correlation between a higher level of acculturation on the Anglo Orientation Subscale (AOS) with the frequency of parents serving green salad (p=<.001), vegetables (p=<.001), and 100% fruit juice (p=.025) during family meals. Conclusion. Findings suggest that a higher Mexican orientation is associated with serving more sugar-sweetened beverages, and a higher Anglo orientation is associated with serving more green salad, vegetables, and 100% fruit juice to adolescents during family meals. Further research is needed to understand how the association of parental acculturation, home food environment, family meals, and socioeconomic status impact what they serve during family meals to their adolescents. A better understanding of what is served would help develop more evidence-based interventions that could help improve adolescents’ diet, which could help curb down obesity prevalence.

Hotline crisis counselors witness trauma in others, leaving them vulnerable to compassion fatigue and burnout. Vicarious resilience can counterbalance the harmful effects of trauma work and help individuals avoid vicarious traumatization. This dissertation examined four research questions constructed to explore the lived experiences of child abuse hotline crisis counselors over thirty-six months, both before and during the COVID-pandemic. Furthermore, the recent implementation of text and chat, in addition to a traditional phone call, has ushered in new issues of abuse and concern brought on by the pandemic (i.e., isolation, fear of sickness and death, employment, housing and childcare insecurities, school closures, remote work, divisive custody issues related to masks and vaccines). Using a phenomenological methodology, this study draws upon three years of focus group data (2019, 2020, & 2021). Six focus groups were conducted with twenty-six hotline counselors over the three years to address the research questions that explore the counselors’ professional experiences before and during the pandemic. Analysis of the focus group transcriptions included a single-year analysis that looked at each year and a cross-year analysis to look at themes generated by analyzing all years together. Themes of resilience, workspace, and healing found that the hotline counselors shared positive experiences and personal growth from their work with implications of advocating for self-care not as an individual issue but as a larger collective issue among counselors. The results of this study will advance the concept of vicarious resilience, trauma-informed practices, and, most importantly, sustaining, and empowering helping professionals in challenging times.

Objectives. To determine how health-related conversations between parents and their adolescent children are associated with mealtime media device use by adolescents. Methods. A sample of Hispanic parents (n=344; 40.4 ± 6.6 years; 89.2% female) of 6th, 7th, or 8th-grade adolescents enrolled in a parenting intervention promoting healthy nutrition and substance use prevention. Parents completed baseline surveys to self-report the frequency with which they had health- or weight-related conversations with their adolescent child, and the frequency with which the adolescent used media devices during mealtimes (television/movie watching, cellphone use/texting, hand-held gaming devices, listening to music with headphones). Associations between health-related conversations and mealtime media devices were assessed with Spearman’s rank correlations. Chi-square tests and crosstabs were used to identify differences in parents setting limits on media use during mealtime depending on adolescent gender. Independent sample t-tests were used to compare the frequency of health- and weight-related conversations and media device use during mealtime based on adolescent gender. Results. Reported conversations about healthy eating, being physically active, and general weight of the adolescent were not associated with reported use of media devices by adolescents during mealtimes. Having conversations related to the adolescent weighing too much was positively and significantly correlated with television/movie watching (r=0.213; p<0.001), talking on a cellphone (r=0.119; p=0.034), using hand-held gaming devices (r=0.131; p=0.022), and listening to music with headphones (r=0.129; p=0.022). Having conversations about exercising to lose weight was also significantly correlated with television/movie watching during mealtimes (r=0.134; p=0.017). Parents reported having more frequent conversations about weighing too much with males when compared to adolescent females (2.45 ± 1.43 vs. 1.93 ± 1.28; t-stat= 3.58; p=0.005). Parents also reported more frequent weight-related conversations overall (weight-related scale) with males when compared to female adolescents (2.73 ± 1.39 vs 2.52 ± 1.26; t-stat=1.51; p=0.024). Conclusion. Findings suggest that higher frequency of weight-related conversation is associated with higher usage of media devices during mealtimes. Whether parenting practices, parental concerns about their children’s weight, and the home mealtime environment play a role on adolescent weight status in Hispanic households warrants further investigation.

Objectives. This study primarily explored the relationship between family meal frequency and youth intake of fruits and vegetables (FV) and added sugar from sugar-sweetened beverages (SSBs) in a population of Latinx parents and their middle school children. The study secondarily explored factors influencing family meal frequency; specifically, whether parent education level, income level, acculturation level, and food insecurity are associated with family meal frequency.

Methods. Latinx parents and their 6th-8th grade children were recruited from eligible middle schools in Maricopa County to participate in a larger intervention study. A sample of parent-youth dyads from the first cohort of the larger study was selected for cross-sectional analysis of baseline data in this study (n=124). Participants completed a survey requesting demographics, family meal habits, and dietary intake. Participants were asked to report annual income, education level, and number of family meals in the home in the past week. They were also asked to complete an Acculturation Rating Scale for Mexican Americans, a 6-item Household Food Security Questionnaire, and a 26-question Dietary Screener Questionnaire. Analyses were run using Spearman’s Rank Correlation test and a Chi Square test of Independence.

Results. Mean daily youth intake of FV was 2.7 ± 1.4 cup equivalents, and daily youth intake of sugars from SSBs was 8.6 ± 4.9 teaspoon equivalents per day. Fifty percent of parents reported 7 or more family meals per week, while 38.7% reported 3-6 family meals per week and 11.3% reported 2 or fewer family meals per week. There was no significant association between family meal frequency and youth FV (r=-0.154; p=0.256) or added sugar from SSBs (r=0.027; p=0.807) intake. Similarly, results from Chi Square analyses suggested there was no association between family meal frequency and parent income level (p=0.392), Mexican-oriented acculturation level (p=0.591), Anglo-oriented acculturation level (p=0.052) and food insecurity (p=0.754). In contrast, a significant association between parent education and family meal frequency was found (p=0.014).

Conclusions. Parent education may play a role in shaping family meal practices in Latinx families. More research is needed to further understand this relationship and the relationship between family meal habits and youth dietary intake.

This study investigated the potential efficacy of HEAL International's prevention education program in inducing health behavior change in HIV/AIDS, malaria, and communicable disease to children in grade levels ranging from primary school to secondary school. The health education program was aimed at changing health behavior by increasing knowledge. This increase in knowledge was analyzed as a modifying factor in the Health Belief Model suggesting that knowledge, along with five other modifying factors, are directly responsible for an individual's health perceptions. These health perceptions ultimately result in an individual's health behavior. As a result, it is argued that an increase in knowledge can lead to health behavior change so long as it is coupled with a strong theoretical framework. Administering pre-evaluations at the beginning of the program, post evaluations at the end of the program, and a second post evaluation again two months later completed the evaluation. It was hypothesized that if there was a significant difference between the percent of correct answers at the pre-evaluation compared the second post-evaluation then there is evidence that HEAL's health education program is, or at least has the potential to, create sustainable health behavior change. A paired samples t-test was completed on the data and showed a statistically significant difference between the percent of correct answers at pre-evaluation and the percent of correct answers at second post-evaluation. These results indicated that the number of students with a comprehensive knowledge of the subjects that HEAL taught during the program had increased. It was concluded that the results of the study indicate evidence that HEAL's program has the potential to deliver sustainable health behavior change but that it will be more quantifiable once HEAL is able to adopt a theoretical framework on which to base future programs.

Background
Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes.
Methods
Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance.
Discussion
The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth.

Background: Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements.

Methods: The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage.

Results: Gender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care.

Conclusions: Use of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system.

The beginning of the large Baby Boomer cohort's retirement, coupled with the increased divorce rate among older adults, means that there will be more single older adults than ever before beginning to consider living arrangements and long-term care needs as they age. Using a cumulative (dis)advantage framework and logistic regression, this research examines whether marital disruption and social support at Wave 1 increase the odds of having a specific chronic disease at Wave 2, diabetes, heart failure, and hypertension. The sample consists of 2,261 adults age 57-85 who participated in the first two waves of the National Social Life, Health, and Aging Project (NSHAP). Being female and having more positive social support reduced the odds of having diabetes at Wave 2. Being older at Wave 1 increased the odds of having congestive heart failure at Wave 2. Being black and having a happy family life in childhood increased the odds of having hypertension at Wave 2. Suggestions for increasing positive social support are discussed, along with implications for long-term care and health education.

This thesis is a qualitative research study that focuses on siblings of children with Autistic Spectrum Disorder (ASD). Even though it is expected that having a child with ASD in the family will influence the whole family including siblings of the child with ASD, the sibling population is rarely included in research related to children with ASD, and there is only limited services available for them. This exploratory study (n=6) is aimed at better understanding the siblings' lives in their family settings in order to identify the siblings' unmet needs and determine how they have been influenced by the child with ASD. This study is also aimed at identifying the most appropriate support for the siblings to help them cope better. The study followed the Resiliency Model of Family Stress, Adjustment, and Adaptation and a narrative theory approach. An in-depth interview with the parents was conducted for the study, so the findings reflect the parents' perception of the siblings. All the themes emerged into two categories: life in the family setting and supports. The findings indicate that the families are striving for balance between the siblings and the children with ASD, but still tend to focus more on the children with ASD. Also, the families tend to have autonomous personal support systems. The parents tend to perceive that these personal support systems are good enough for the siblings; therefore, the parents do not feel that formal support for the siblings was necessary. As a result of the findings, recommendations are made for the organizations that work with individuals with ASD to provide more appropriate services for the families of children with ASD, including siblings. Also, recommendations are made for future studies to clarify more factors related to the siblings due to the limitation of this study; the siblings' lives were reflected vicariously via the parents.