Health Studies
Permanent URI for this collectionhttps://hdl.handle.net/11274/15390
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Item Investigating the effects of rurality on stress, subjective well-being, and weight-related outcomes(Elsevier, 2023) Gold, Joshua M.; Drewnowski, Adam; Andersen, M. Robyn; Rose, Chelsea; Buszkiewicz, James; Mou, Jin; Ko, Linda K.Purpose: Rates of obesity are significantly higher for those living in a rural versus urban setting. High levels of stress and low levels of subjective well-being (SWB) have been linked to poor weight-related behaviors and outcomes, but it is unclear if these relationships differ as a function of rurality. This study investigated the extent to which living in a rural versus urban county ("rurality") moderated associations between stress / subjective wellbeing (predictors) and diet quality, dietary intake of added sugars, physical activity, and BMI (outcomes). Methods: Participants were recruited from urban (n = 355) and rural (n = 347) counties in Washington State and self-reported psychological, demographic, and food frequency questionnaires while physical activity behavior was measured objectively. Findings: After controlling for relevant covariates, levels of stress were positively associated with added sugar intake for those living in the urban county while this relationship was non-significant for those residing in the rural county. Similarly, SWB was negatively associated with added sugar intake, but only for urban residents. County of residence was also found to moderate the relationship between SWB and BMI. Higher SWB was inversely associated with BMI for those living in the urban county while no relationship was observed for rural county residents. Conclusions: These findings support the hypothesis that the relationships between stress / SWB and weight function differentially based on the rurality of the residing county. This work adds to the growing body of literature highlighting the role stress and SWB play in the rural obesity disparity.Item Factors impacting implementation of nutrition and physical activity policies in rural schools(BMC Public Health, 2023-02-10) Ausenhus, Caryn; Gold, Joshua M.; Perry, Cynthia K.; Kozak, Andrea T.; Wang, Monica L.; Jang, Sou Hyun; Leong, Judy; Rodriguez, Edgar; Duggan, Catherine; Ko, Linda K.BACKGROUND: Rural Latino children have higher rates of obesity compared to non-Latino Whites. Schools are in a unique position to address rural childhood obesity through policies. While evidence exists on factors that promote or impede school-based physical activity (PA) and nutrition policies, only a fraction has been in rural communities. This study seeks to understand 1) the knowledge and perceptions of school nutrition and PA policies and 2) barriers and facilitators to their implementation among rural school stakeholders from Washington State. METHODS: We conducted 20 semi-structured, in-depth interviews with school stakeholders (e.g., principals and school nutrition directors) from four K–12 school districts in the Lower Yakima Valley of Eastern Washington State. Thematic analysis was conducted using inductive, constant comparison approach to identify themes around knowledge and perceptions of policies and barriers and facilitators of policy implementation. RESULTS: Three main themes were identified: perceptions and knowledge of school PA and nutrition policies, barriers to policy implementation, and facilitators of policy implementation. The majority of stakeholders were supportive of school-based policies promoting PA and a healthy diet, even when lacking a specific understanding of these policies. Four subthemes were identified as barriers to policy implementation: viewing PA as a low priority, misuse of recess time, funding constraints, and lack of strong leadership. Facilitators of implementation included strong leadership at the district level, creating healthy norms through school-community linkages and pooling community resources to improve nutrition and PA among children. CONCLUSIONS: Schools provide a unique setting to promote healthy diet and PA behaviors among children and their families. Study findings show that while knowledge of specific nutrition and PA policies may vary, support for such policies were high among rural stakeholders. Study findings can inform policy development and support strategies for policy implementation in rural settings. Future studies may want to examine whether implementation of strategies addressing the barriers and enhancing facilitators lead to success in rural school settings.Item Examining the association between acculturation indicators and metabolic syndrome among Hispanic adults(Dewald Academic Enterprises, 2023) Ochoa, Alejandra Quezada; Massey-Stokes, MarilynPurpose: To examine the relationship between acculturation indicators and metabolic syndrome among Hispanic adults living in the Dallas-Fort Worth-Arlington, Texas metropolitan area.Item Examining the association between acculturation indicators and metabolic syndrome among Hispanic adults(11/4/2019) Quezada, Alejandra; Massey-Stokes, MarilynThe purpose of the study was to examine the relationship between acculturation indicators and metabolic syndrome (MetS) among Hispanic adults living in the Dallas-Fort Worth metropolitan area in Texas. MetS is a pressing public health problem, and Hispanics have the highest prevalence among all ethnic groups in the United States (35.4%). MetS is a cluster of five risk factors (blood pressure, waist circumference, high-density lipoprotein cholesterol, fasting blood glucose, and triglycerides) that increase a person’s risk of developing cardiovascular disease and diabetes. Currently, Hispanics are the second-largest ethnic group in the United States, and more than one-third of the U.S. Hispanic population is foreign-born. As immigrants and subsequent generations are exposed to the mainstream U.S. culture, the process of acculturation impacts their lifestyle behaviors and health. Acculturation indicators (nativity, duration in the United States, and scores from the Short Acculturation Scale for Hispanics) and the five MetS markers were assessed among 128 adult participants. Logistic regression modeling was conducted to predict MetS status (present/not present) by acculturation indicators and covariates (sex, age, and education). Additional analyses were conducted to assess the relationship between each individual MetS marker, acculturation indicators, and the identified covariates. For every one-unit increase in a participant’s duration in the United States (measured in years), the likelihood of having abnormal blood pressure increased by 6% and the likelihood of having abnormal blood glucose increased by 5%. Results indicate increasing exposure to the mainstream American culture negatively impacts health risks and status among Hispanics. The primary treatment for MetS is lifestyle modification that includes regular physical activity, healthy eating, and weight loss. Health care providers can aid in reducing MetS prevalence by raising awareness of the condition and associated risk factors among their patients as well as recommending lifestyle modification to reduce their risk. Study results can aid health educators in planning, implementing, and evaluating health communication campaigns and health education/promotion programs to prevent MetS among Hispanics. Further examination of what changes occur in health behaviors that increase risk of MetS would provide further insight into why duration in the United States is associated with elevated blood pressure and elevated fasting blood glucose levels.Item Understanding the interconnection between routine screening behavior, socio-demographics, quality of care, trust, and communication experiences with health-care professionals(Taylor & Francis, 2019) Amuta-Jimenez, Ann Oyare; Ogunyankin, Fadeke; Lo, Celia C.Introduction: Routine screening is an integral aspect of health care. The literature says little about how health-screening behaviors might be predicted based on trust, quality of care and communication within the professional–patient relationship—things that ultimately delimit attitudes towards routine screening. Methods: This study employed data derived from the 2017 Health Information National Trends. Survey (HINTS). Bivariate relationships and two step-hierarchical multiple regression techniques were used to examine associations between routine screening behavior and sociodemographic factors, and to identify any mediating role in such associations played by one or more health-care factors. Results: Native English speakers were significantly more likely than less-fluent nonnative speakers to perceive the quality of care received to be high, [p < .001, d = .45] communication to be better [p = .01, d = .32) and trusted more [p = .02, d = .14). health-care factors trust (b = .105, p = .000) and quality (b = .061, p = .028) were associated significantly with routine screening behavior, while communication (b = .046, p = .192) was not. At Step 2, explained variance increased by 2%, adding health-care factors raised the measure of F-value significantly. Discussion: The small variance implies the need to seek further relevant correlates of routine screening behavior. As health-care systems continue turning toward preventive strategies, grasping the social determinants of preventive screening behavior could prove useful for improving the health of the nation’s residents. Also, cultural understanding by health professionals is pertinent and required to capitalize on immigrant groups’ health-care-seeking behaviors and facilitate competent delivery of care.Item Food label literacy and use among US adults diagnosed with cancer: Results from a national representative study(Springer, 2018-07) Amuta-Jimenez, Ann Oyare; Lo, Celia C.; Talwar, Divya; Khan, Nicole; Barry, AdamFor those diagnosed with cancer, lifestyle factors including diet can be more important than ever. However, lack of nutrition-related knowledge can pose a significant barrier to healthy eating. Food labels guide consumers in selecting appropriate portion sizes—that is, caloric content—and ensuring adequate intake of nutrients. Data from the 2013-2014 HINTS were used to examine (a) differences in food label use and food label literacy between respondents ever had a cancer diagnosis and those never had a diagnosis; (b) sociodemographic correlates and health-related correlates of food label use and literacy, in a context of cancer diagnosis; and (c) potential association between food label use/literacy and each of two dietary choices, eating vegetables and fruits and limiting intake of sugary drinks, again, in a context of cancer diagnosis. Data was analyzed via SPSS version 24.0, and cross tabulations using Pearson's Chi-square test and logistic regressions. Income, gender and non-participation in support groups were associated with food label literacy (p<.05). Confidence to take care of self was associated with food label use (p<.05). Relationships were observed between using food labels and curtailing soda intake (b = -.368, p<.05), eating relatively more fruits (b = .558, p<.05), and eating relatively more vegetables (b = .558, p<.05). The overall models predicting consumption of soda [x2 (2) = 13.70, p = .001, Nagelkerke R-square = .059], of fruits [x2 (2) = 33.87, p < .001, Nagelkerke R-square = .136], and of vegetables [x2 (2) = 36.08, p < .001, Nagelkerke R-square = .144] was statistically significant. Implications for research and practice can be found in results linking food label use to better quality diets. They include the usefulness of nutrition education interventions targeting lower-income men with cancer diagnoses; one lesson should be the use of food labels. **This article was published with the assistance of the Texas Woman's University Libraries Open Access Fund.