Objective: Migration to the United States (U.S.) has been associated with food insecurity and detrimental changes in diet quality. How these changes affect women in context of their neighborhood food environment has not been thoroughly explored. This study aimed to assess if food security is associated with diet quality and to explore if perceived food availability moderates this purported association in a sample of Mexican immigrant women.

Methods: Mexican-born women (n=57, 41±7 years) residing in the U.S. for more than 1 year self-reported food security status, monthly fast-food frequency, and their perception of fruit, vegetables, and low-fat product availability within their neighborhood via survey. Diet was assessed using the Southwest Food Frequency Questionnaire to estimate intake of fruit, vegetables, salty snacks, sugar, and healthy eating index (HEI)-2015 score. Bivariate correlations assessed the relationships between study variables. Independent samples t-tests compared dietary outcomes between women classified as food secure (n=41; high or marginal food security) and food insecure (n=16; low or very low food security). A moderation analysis assessed the effect of the perception of the neighborhood food environment on the relationship between food security and HEI-2015 score.

Results: Fifty four percent of participants worked full time and 42% had a monthly household income <$2,000. Time residing in the U.S. was 20±9 years. Relative to women classified as food secure, participants experiencing food insecurity had lower HEI-2015 (61±8 vs. 66±6; p=0.03). Albeit not significantly different, women experiencing food insecurity reported lower intake of fruit (236±178 vs. 294±239 g), vegetables (303±188 vs. 331±199 g), and salty snacks (6±5 vs. 8±10 g), as well as higher intake of sugar (99±55 vs. 96±56 g) and fast food (2.5±2.5 vs. 1.8±1.7 times per month); p>0.05 for all. Among women experiencing food insecurity, there was a trend for a lower perception of neighborhood fruit, vegetable and low-fat product availability being associated with lower HEI-2015 scores (54±6) relative to those who perceived moderate (63±6) or high (65±8) neighborhood availability of those foods (p=0.07).

Conclusions: HEI-2015 scores were associated with participants’ food security status. Findings suggest a need for better understanding of how neighborhood food availability may affect diet quality among Mexican immigrant women experiencing food insecurity.

As a college student, living in an apartment or home with a kitchen, making your own food decisions can be daunting. After spending so much time either living at home and having food cooked for you or living in a dorm where food is provided, it is difficult to suddenly have to put so much thought into something that for so long you didn’t have to think about at all. Not only that, it sometimes feels like the media is screaming from all sides that you need to eat a certain way to be ‘healthy’ or ‘fit’. I hope to be able to make this process a bit easier for you through this guide I have put together from my own experience and education.
‘Healthy’ foods always seem like the best choice, but what does it really mean to be healthy? A ‘healthy diet’ can mean any number of things depending on who you ask and where you look. Media provides an endless sea of tips, tricks, and diets for ‘eating healthy’. Oxford defines health as a state of physical, mental, and social well-being with the absence of disease and infirmity; and healthy as indicative of, conducive to, or promoting good health1. It is easy to get caught up in the excitement of fad diets, but maintaining a healthy eating pattern can be quite simple when put into practice.

Objective: Parents play a critical role in their child's diets, yet there is lack of research in

the US comparing parental perception of their child’s diet with quantitatively assessed diet quality. We examined the association between parent perception of their child’s overall diet and the child’s diet quality, as measured by frequency of consumption of key food categories.

Methods: Secondary analysis was conducted using data from two independent cross- sectional panels of surveys with parents of a 3-18 year old child. Data collection took place in 2009-2010 and 2014, the random sample was drawn from low-income cities. Well-established survey questions assessed parental perception of their child’s diet and frequency of consumption of fruits, vegetables, sugar-sweetened beverages (SSB), fast food and unhealthy snacks. Diet quality scores were calculated for each child, with higher scores reflective of healthier diets (max score= 40). Ordered logistic regressions examined associations between parental perception and consumption of food categories. Multinomial logistic regressions examined associations between levels of concordance in parent perception and diet scores by demographic sub-groups.

Results: Almost half of children were non-Hispanic black (46%) and 40% were Hispanic. Overall 52% of parents strongly agreed, 33% somewhat agreed, 10% somewhat disagreed, and 4% strongly disagreed that their child eats a healthy diet. The mean diet quality score for the sample was 20.58 ± 6.7. Children from our sample with the unhealthiest diet had a mean frequency of fruit intake = 0.8 times/day and SSBs = 2.2 times/day. Children with the healthiest diet had a mean consumption of fruit=1.7/day and

SSBs= 0.4/day. Parental perception of their child’s diet was significantly higher when their child consumed more fruit (p<0.001) and vegetables (p<0.001) and lower when their child consumed more fast food (p<0.001), SSBs (p=0.01) and unhealthy snacks (p=0.02). Over half of parents overestimated the healthfulness of their child’s diet (61%). Parent, child and household demographics did not moderate this association.

Conclusions: Although parental perceptions that their child eats healthy are associated when their child eats more healthy foods and less unhealthy foods, parents’ perceptions still do not align with their child’s diet.

Through three investigations, this dissertation examined properties of the family and early care and education center (ECEC) environments related to preschool-aged children’s cardiovascular fitness (CVF) and gross locomotor skills (GLS). Investigation one used a systematic review and meta-analysis to synthesize the effectiveness of school-based interventions at improving CVF, in preschool-aged children. For investigations two and three product- and process-based measures of GLS were collected from children in ECECs (n=16), using the progressive aerobic cardiovascular endurance run (PACER; n=144) and the CHAMPS motor skill protocol (CMSP; n=91), respectively. Investigation two and three examined family factors and ECEC factors for associations with measures of GLS, respectively.

Investigation one revealed a moderate-to-large effect size for school-based interventions (n=10) increasing CVF (g=0.75; 95%CI [0.40-1.11]). Multi-level interventions (g=.79 [0.34-1.25]) were more effective than interventions focused on the individual (g=0.67 [0.12-1.22]). In investigations two and three children (78.3% Hispanic; mean ± SD age 53.2±4.5 months) completed a mean ± SD 3.7±2.3 PACER laps and 19.0±5.5 CSMP criteria. Individual and family factors associated with PACER laps included child sex (B=-0.96, p=0.03) and age (B=0.17, p<0.01), parents’ promotion of inactivity (B=0.66, p=0.08) and screen time (B=0.65, p=0.05), and parents’ concern for child’s safety during physical activity (B=-0.36, p=0.09). Child age (B=0.47, p<0.01) and parent employment (B=2.29, p=0.07) were associated with CMSP criteria. At the ECEC level, policy environment quality (B=-0.17; p=0.01) was significantly associated with number of PACER laps completed. Outdoor play environment quality (B=0.18; p=0.03), outdoor play equipment total (B=0.32; p<0.01) and screen time environment quality (B=0.60; p=0.02) were significantly associated with CMSP criteria. Researchers, ECEC teachers and policy makers should promote positive environmental changes to preschool-aged children’s family and ECEC environments, as these environments have the potential to improve CVF and GLS more than programs focused on the child alone.

Background In the United States (US), first-year university students typically live on campus and purchase a meal plan. In general, meal plans allow the student a set number of meals per week or semester, or unlimited meals. Understanding how students’ use their meal plan, and barriers and facilitators to meal plan use, may help decrease nutrition-related issues.

Methods First-year students’ meal plan and residence information was provided by a large, public, southwestern university for the 2015-2016 academic year. A subset of students (n=619) self-reported their food security status. Logistic generalized estimating equations (GEEs) were used to determine if meal plan purchase and use were associated with food insecurity. Linear GEEs were used to examine several potential reasons for lower meal plan use. Logistic and Linear GEEs were used to determine similarities in meal plan purchase and use for a total of 599 roommate pairs (n=1186 students), and 557 floormates.

Results Students did not use all of the meals available to them; 7% of students did not use their meal plan for an entire month. After controlling for socioeconomic factors, compared to students on unlimited meal plans, students on the cheapest meal plan were more likely to report food insecurity (OR=2.2, 95% CI=1.2, 4.1). In Fall, 26% of students on unlimited meal plans reported food insecurity. Students on the 180 meals/semester meal plan who used fewer meals were more likely to report food insecurity (OR=0.9, 95% CI=0.8, 1.0); after gender stratification this was only evident for males. Students’ meal plan use was lower if the student worked a job (β=-1.3, 95% CI=-2.3, -0.3) and higher when their roommate used their meal plan frequently (β=0.09, 99% CI=0.04, 0.14). Roommates on the same meal plan (OR=1.56, 99% CI=1.28, 1.89) were more likely to use their meals together.

Discussion This study suggests that determining why students are not using their meal plan may be key to minimizing the prevalence of food insecurity on college campuses, and that strategic roommate assignments may result in students’ using their meal plan more frequently. Students’ meal plan information provides objective insights into students’ university transition.

Arizona Global Health Project is a student organization at Arizona State University whose main purpose is to volunteer in the community, both locally and globally. Through the New Birth Medical Mission Clinic, students from the University are able to volunteer at Medical Clinics in Puerto Peñasco, Mexico, working hands on alongside various providers. It is through these clinics that leaders of the student organization began to wonder about the true needs of the community and how the care provided at the clinics could be tailored to better suit the needs of the patients. A needs assessment survey was designed with components that took into account general nutrition status, as well as demographical questions that was then administered during the Fall 2018 Medical Trip. Data was analyzed and it was found that female health providers as well as general practitioners would be crucial components of the care team, as well as a Dietitian that could address the massive amount of lifestyle related illnesses within the population. The study also showed general satisfaction with the care provided during the medical trips, but during administration of the survey, patients showed great interest in further nutrition education, all of which should be taken into account during planning for future medical trips. Further research will need to be conducted to look at how other environmental factors influence the health of the patients, as well as their nutritional status. With the data found during this study, as well as the continuation of research, Arizona Global Health Project will hopefully be able to provide succinct and tailored care to these patients that lasts between the medical mission trips.

BACKGROUND: The purpose of this study was to gain a better understanding of what food insecurity among college students. Qualitative research regarding food insecurity on college campuses has been growing as we gain a better understanding of how prevalent this issue is and its broad impact on students. However, to our knowledge there are only a handful of studies that examined the student and university staff experience using mixed methods. Qualitative data is needed to gain a deeper understanding of the student experience. OBJECTIVE: To gain deeper insights about students’ food insecurity experiences from students themselves and the university staff members who work with them. This insight is necessary to shift university’s current policies and approach to helping students experiencing food insecurity and removing the stigma of the “starving student” experience. METHODS: Surveys and interviews were used to collect data from students to gain an understanding of their current living situations and understand their personal experiences accessing food. University staff completed surveys focused on understanding staff’s experiences with student food insecurity as well as their attitudes and beliefs about students who experience hunger. RESULTS: The current study found that the financial burden of attending college along with student’s food literacy level can contribute to student’s food insecurity. Students identified barriers to food access, discussed their perceptions of their food experience, and also discussed who they lean on for support when struggling with food. Student’s previous life experiences, food literacy, and social support systems all impact the student food experience. University staff identified similar barriers that they perceive students experience when struggling with hunger and also indicated that they have received little to no training or instruction on how to support students experiencing food insecurity. CONCLUSION: These findings can be used as a building block for developing interventions and the implementation of new resources to help minimize food insecurity on college campuses.

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.

Background: Healthy eating plays critical roles in the prevention of many chronic diseases, but there are many barriers in life that prevent people from adopting and maintaining healthy diets. Thus, identifications of barriers that people perceive they have in trying to eat healthy can guide the strategies for dietary behavior change interventions by taking account of the barriers. Objective: The purpose of this study was to identify and quantify the perceived barriers to healthy eating (PBHE), to investigate the relationship between socioeconomic factors and PBHE, and to explore the associations between PBHE and dietary intake among parents of elementary-school aged children living in South Phoenix, AZ. Methods: Socioeconomic factors and PBHEs were obtained via survey and diet was assessed by two interviewer-assisted 24 h diet recalls. The associations between employment and PBHEs, education and PBHEs, and household monthly income and PBHEs were analyzed by Mann-Whitney Test, Kruskal Wallis Test, and Spearman’s correlation test, respectively. The relationship between PBHEs and dietary intake were analyzed by Spearman’s correlation test. Linear regression was used to assess the associations between total PBHE, and dietary intake (including added sugar, fruit and vegetable), adjusted by covariates (including socioeconomic status, birth country, age and gender). Results: Of 149 participants who completed the survey (mean age = 38.47±7.08 y), 136 completed the 24 h diet recalls. The mean reported total, social support, emotions and daily mechanics PBHE scores were 2.63±0.91, 2.52±1.16, 2.71±1.06, and 2.58±0.95, respectively, out of a 5-point scale. Daily fruit, vegetable, sugar-sweetened beverage, sweetened foods, and added sugar intake were reported as 1.66±1.56 servings, 2.45±1.43 servings, 1.19±1.30 servings, 2.02±2.12 servings and 49.93±31.17 g, respectively. Employment status was significantly associated with total PBHE (Z = -2.28, p=0.023), and support PBHE (Z = -2.623, p=0.009). Education was significantly related to total PBHE (χ2 = -7.987, p=0.046), and daily mechanics PBHE (χ2= 11.735, p=0.008). Household monthly income levels were significantly correlated to daily mechanics PBHE (r = -0.265, p=0.005). Added sugar was positively correlated with total PBHE (r=0.202, p=0.020), emotions PBHE (r=0.239, p=0.006), and daily mechanics PBHE (r=0.179, p=0.040). Sugar sweetened beverage intake was significantly related to emotions PBHE (r=0.183, p=0.035). When adjusting for socioeconomic factors in the regression analysis, there was no significant association between PBHE and diet intake. Conclusion: Overall, results suggest PBHEs listed in this study are mainly associated with socioeconomic factors, but they are not related to diet intake. Future studies will focus on the precise role of overcoming some identified barriers in improving healthy eating behaviors, and the causality between barriers and healthy eating.

Although past literature has examined the prevalence of campus food pantries, most have not examined student satisfaction of campus food pantries the acceptability and feasibility of the campus food pantries in the U.S. This descriptive and quasi-experimental study assessed the acceptability and feasibility of campus food pantry intervention on two campuses (Downtown Phoenix and Tempe) at Arizona State University (ASU). The acceptability measures were composed of 30 survey questions including demographics, satisfaction survey, and food insecurity questionnaires, which were abstracted from the U.S. Adult 10-Item Food Security Survey Module. The food pantry was open once a week at each site. Any ASU students who enrolled in Spring 2017 and visited a food pantry were eligible to participate in the study. A total of 39 ASU students participated in the study during January 2017 and February 2017 (48.1 % female, 42.3 % White). The number of surveys collected at each site was 52. The majority of students were first-year undergraduate students (57.9% Downtown Phoenix, 45.5% Tempe). Based on their answers to the U.S. Adult 10-Item Food Security Survey Module, 21.2% of students (n=11) indicated low food security, while 48.1% of students (n=25) indicated very low food security. Almost 70% of pantry users reported that they have experienced food insecurity. In this study, the majority (90%) of students were satisfied with the service, hours of operation, and location for both the Downtown and Tempe food pantries. Additionally, 85.7% of students reported that they need additional resources such as financial aid (49%), a career center (18.4%), health services (10.2%), and other services (8.2%). The Pitchfork Pantry operated by student, university, and community support. Total donations received between Fall 2016 and Spring 2017 were 4,600 food items. The study found that most students were highly satisfied with the campus food pantries and it was feasible to operate two pantries on the ASU campus. These findings can be used to contribute to future research into campus food pantries, which may be the solution for food insecurity intervention among college populations.