Postpartum depression affects approximately 15% of the childbearing population in the United States and has been linked to a number of negative maternal and infant outcomes. Mothers who rate low in areas of confidence and self-efficacy tend to have lower satisfaction and view their infants as having more negative temperaments. Infants of depressed mothers have been found to have delays in social and emotional growth which can impair their health and future developmental outcomes. The purpose of this study was to determine if there is any evidence to support the hypothesis that maternal depression is associated with infant social and emotional development and maternal role satisfaction among low-income women in rural Arizona. This study employed a repeated measures correlational descriptive prospective longitudinal design using chart reviews analyzing existing clinical data. Purposive sampling was used to select charts of women who participated in the Verde Valley Medical Center branch of the Arizona Healthy Families program. Chart reviews were used to identify charts that met the inclusion criteria of mothers and their infants who completed at least 18 months of the Arizona Healthy Families Program. Findings of this study indicated evidence of a relationship between depression, infant social and emotional development, and maternal role satisfaction. Mothers who had infants that scored higher, with higher being indicative of concern, on the Ages & Stages Questionnaire: Social-Emotional Edition 2 (ASQ:SE 2) had lower role satisfaction scores on the Healthy Families Parenting Inventory (HFPI) and mothers who indicated dissatisfaction at 6 months postpartum were more likely to continue to indicate lower maternal satisfaction at 12 and 18 months postpartum when infant ASQ:SE 2 scores were higher. Investigating the role of the visiting service providers, such as Healthy Families, and their impact on young families for risk identification and resource support will provide information to policy and lawmakers to aid in decisions for funding and help support young families with the goal of growing strong, healthy families in healthcare deserts like rural Arizona. Keywords: Postpartum depression, maternal depression, infant social and emotional development, maternal role, maternal role satisfaction

2019 coronavirus disease (COVID-19) remains a pressing health concern, especially with lagging youth vaccination rates despite its evident benefits. Given the significant role of vaccination in safeguarding individual and community health, this dissertation sought to explore how the use of serious games may offer hope for addressing the COVID-19 vaccine coverage gap among youths. This dissertation collected, appraised, and synthesized existing evidence on serious game-based vaccination interventions, finding increased youths’ vaccine knowledge but limited effectiveness in boosting their vaccination intentions and uptake. Using serious game in youth health education considered key attributes including gamification, game mechanics, educational, health-related content, and objective, tailored for youth and adaptability, real life relevance, engagement, interactivity, safe environment, feedback, and assessment. Stemming from technological advances and interdisciplinary collaborations, these games provided experiences that resonated with diverse populations. Outcomes from such educational games have shown improved health knowledge, attitudes, and behaviors, improved self-efficacy and reduced health disparities. The dissertation also presented a pilot study randomization control trial (RCT) on a COVID- 19 game-based intervention (vs. usual care) targeting unvaccinated youth, showing its feasibility, acceptability and positive influence on vaccine knowledge, vaccination intention and uptake. Partnering with key stakeholders and adapting game designs for ongoing relevance could contribute to intervention effectiveness in promoting youth vaccination, catering to diverse needs and preferences.

Team-based care has been linked to key outcomes associated with the Quadruple Aim including improving the health of populations, patient and provider experience and lowering healthcare costs. Less is understood about the connection between team-based care and the patient experience. Emerging evidence connects team-based care with patient activation, a component of the patient experience. Use of the Electronic Health Record (EHR) and machine learning have significant potential to overcome previous barriers in how teams are studied to better understand their impact on critical care delivery outcomes, such as patient activation. This research program included a systematic review of the literature to analyze the relationship between team-based care and patient satisfaction, a proxy for the patient experience. Overall, this review found a positive relationship between team-based care and patient satisfaction, including 57% of studies with improved patient satisfaction with team-based care implementation. Secondary findings included a relationship between team composition and patient satisfaction, with larger teams (three or more disciplines) associated with improved patient satisfaction. A methodological paper was then prepared to describe the process in which primary care teams were identified within EHR data utilizing a common definition for team-based care supported by prominent team theorists. This novel approach provides a roadmap for the health services researcher to leverage EHR data to study the impact teams may have on critical patient outcomes in the real-world practice environment. The final study in this work utilized a large EHR data set (n = 316,542) from an urban health system to examine the relationship between team composition and patient activation. Patient Activation was measured using the Patient Activation Measure (PAM). Results from mixed-level model analysis were compared to machine learning analysis using multinomial logistic regression to calculate propensity scores for the multiple effect of team composition. After controlling for confounding variables in both analyses, more diverse, multidisciplinary teams were associated with improved patient activation scores. Implications for this research program include the feasibility of identifying teams within the EHR and utilize big data analytics with machine learning to measure the impact of teams and real-world patient related outcomes.

Purpose: To develop a valid and feasible short-form corner store audit tool (SCAT) that could be used in-store or over the phone to capture the healthfulness of corner stores.

Design: Nonexperimental.

Setting: Four New Jersey cities.

Subjects: Random selection of 229 and 96 corner stores in rounds 1 and 2, respectively.

Measures: An adapted version of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to conduct in-store audits. The 7-item SCAT was developed and used for round 2 phone audits.

Analysis: Exploratory factor analysis and item response theory were used to develop the SCAT.

Results: The SCAT was highly correlated with the adapted NEMS-CS ( r = .79). Short-form corner store audit tool scores placed stores in the same healthfulness categories as did the adapted NEMS-CS in 88% of the cases. Phone response matches indicated that store owners did not distinguish between 2% and low-fat milk and tended to round up the fruit and vegetable count to 5 if they had fewer varieties.

Conclusion: The SCAT discriminates between higher versus lower healthfulness scores of corner stores and is feasible for use as a phone audit tool.

Relationships between food and physical activity (PA) environments and children's related behaviors are complex.

Latent class analyses derived patterns from proximity to healthy and unhealthy food outlets, PA facilities and parks, and counts of residential dwellings and intersections. Regression analyses examined whether derived classes were related to food consumption, PA, and overweight among 404 low-income children.

Compared to children living in Low PA-Low Food environments, children in High Intersection&Parks-Moderate Density&Food, and High Density-Low Parks-High Food environments, had significantly greater sugar-sweetened beverage consumption (ps<0.01) and overweight/obesity (ps<0.001). Children in the High Density-Low Parks-High Food environments were more likely to walk to destinations (p = 0.01)

Recognizing and leveraging beneficial aspects of neighborhood patterns may be more effective at positively influencing children's eating and PA behaviors compared to isolating individual aspects of the built environment.

Objective: The Social Ecological Model (SEM) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention. The current paper applies the SEM to data collected at multiple levels, representing different layers of the SEM, and examines the unique and relative contribution of each layer to children's weight status.

Design: Cross-sectional survey of randomly selected households with children living in low-income diverse communities.

Setting: A telephone survey conducted in 2009-2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child's residence to food and physical activity outlets.

Subjects: Analysis based on 560 children whose parents participated in the survey and provided measured heights and weights.

Results: Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children's weight status.

Conclusions: The approach used herein supports using the SEM for predicting child weight status and uncovers some of the most promising domains and strategies for childhood obesity prevention that can be used for designing interventions.

In response to lack of access to healthy foods, many low-income communities are instituting local healthy corner store programs. Some stores also participate in the United States Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP). This study used two assessment tools to compare the healthfulness of offerings at stores participating in local healthy store programs (upgraded stores), WIC, and/or SNAP to that of similar non-participating stores.

Based on store audits conducted in 315 New Jersey corner stores in 2014, we calculated healthy food availability scores using subsections of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS-Availability) and a short-form corner store audit tool (SCAT). We used multivariable regression to examine associations between program participation and scores on both instruments.

Adjusting for store and block group characteristics, stores participating in a local healthy store program had significantly higher SCAT scores than did non-participating stores (upgraded: M = 3.18, 95% CI 2.65–3.71; non-upgraded: M = 2.52, 95% CI 2.32–2.73); scores on the NEMS-CS-Availability did not differ (upgraded: M = 12.8, 95% CI 11.6–14.1; non-upgraded: M = 12.5, 95% CI 12.0–13.0). WIC-participating stores had significantly higher scores compared to non-participating stores on both tools. Stores participating in SNAP only (and not in WIC) scored significantly lower on both instruments compared to non-SNAP stores.

WIC-participating and non-SNAP corner stores had higher healthfulness scores on both assessment tools. Upgraded stores had higher healthfulness scores compared to non-upgraded stores on the SCAT.

Background

The transition from the home to college is a phase in which emerging adults shift toward more unhealthy eating and physical activity patterns, higher body mass indices, thus increasing risk of overweight/obesity. Currently, little is understood about how changing friendship networks shape weight gain behaviors. This paper describes the recruitment, data collection, and data analytic protocols for the SPARC (Social impact of Physical Activity and nutRition in College) study, a longitudinal examination of the mechanisms by which friends and friendship networks influence nutrition and physical activity behaviors and weight gain in the transition to college life.

Methods

The SPARC study aims to follow 1450 university freshmen from a large university over an academic year, collecting data on multiple aspects of friends and friendship networks. Integrating multiple types of data related to student lives, ecological momentary assessments (EMAs) are administered via a cell phone application, devilSPARC. EMAs collected in four 1-week periods (a total of 4 EMA waves) are integrated with linked data from web-based surveys and anthropometric measurements conducted at four times points (for a total of eight data collection periods including EMAs, separated by ~1 month). University databases will provide student card data, allowing integration of both time-dated data on food purchasing, use of physical activity venues, and geographical information system (GIS) locations of these activities relative to other students in their social networks.

Discussion

Findings are intended to guide the development of more effective interventions to enhance behaviors among college students that protect against weight gain during college.

Programs such as the Healthy Corner Store Initiative have been widely adopted in recent years to increase the availability of healthy foods in small retail food stores. Valid and reliable measures are necessary to evaluate the effectiveness of these programs. The validated instruments currently available for assessments require in-person evaluations, with surveys taking up to 30 minutes per store to complete. This instrument was developed by researchers at Arizona State University to simplify the process of evaluating the effectiveness of healthy store interventions, and to enable community partners and practitioners to conduct their own evaluations of food access. The SCAT was validated against an adapted version of the Nutrition Environment Measures Survey for Corner Stores, and tested for feasibility of use over the telephone. The SCAT was found to discriminate between corner stores in the top 20% of healthfulness scores from those in the lower 80% with 89% accuracy.

In 2015 a panel of experts was convened by Healthy Eating Research, a program of the Robert Wood Johnson Foundation, to establish a set of minimum guidelines small retail food stores could reach to be classified as meeting basic or preferred stocking levels. Work is currently in progress to assess how the SCAT scores correlate with basic and preferred levels. 

Effective communication plays a major role in the psychological adjustment and quality of the relationship of couples coping with cancer, yet only a few communicative behaviors have been examined in the context of a cancer diagnosis and treatment. This study sought to expand the extant literature by describing a wider range of communicative behaviors (beyond the frequently researched withdraw, disclosure/holding back, and avoidance behaviors) through an observable measure, as previous research has relied heavily on self-report. Couples (134 cancer patients and their caregiving partners) were video-taped discussing a cancer-related concern in the laboratory. Discussions were coded separately for patients and caregivers using the Asymmetrical Behavioral Coding System which captures 22 communicative behaviors. These behaviors contribute to four higher-level scales: positive approach, negative approach, positive avoidance, and negative avoidance. Area under the curve was calculated to describe each factor. The most frequently observed behavior was positive approach, followed by negative avoidance, negative approach, and positive avoidance.

Paired samples t-test analyses examining the factors by moderating variables revealed that women engaged in more positive approach behaviors than did men; men engaged in more avoidant behaviors (both positive and negative) than did women; and caregivers engaged in more avoidant behaviors (both positive and negative) than did patients.

Findings are consistent with prior research in the field and suggest consideration of tailoring possible future interventions. Further investigation is needed to assess possible interactional effects to ultimately help couples better communicate about the challenges associated with cancer treatment and recovery.