Publications by authors named "Elizabeth Reifsnider"

61 Publications

Recruitment and retention of underrepresented and vulnerable populations to research.

Public Health Nurs 2021 Jul 8. Epub 2021 Jul 8.

Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.
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http://dx.doi.org/10.1111/phn.12943DOI Listing
July 2021

Nurses' resilience in the face of coronavirus (COVID-19): An international view.

Nurs Health Sci 2021 Jun 25. Epub 2021 Jun 25.

Arizona State University, Phoenix, Arizona, USA.

The purpose of this cross-sectional study was to examine factors associated with nurses' resilience during the COVID-19 pandemic. Data were collected in the latter half of 2020 from 904 nurses across Japan, Republic of Korea, Republic of Turkey, and the United States. The questionnaire included the Connor-Davidson Resilience Scale 10, plus demographics and 20 questions about practice environment, workplace safety concerning infection control, COVID-related experience, and organizational support. Fear of becoming infected, intention to leave nursing, and having had a positive COVID-19 test were inversely associated with resilience (p < 0.05). Regression analysis indicated that U.S. nurses had significantly greater resilience than nurses in the other countries examined (p < 0.001). Nurses reporting organization support and those who participated in policy and procedure development had higher resilience scores (p < 0.01). Organizational support, involving nurses in policy development, and country of practice were found to be important resilience factors in our research, which aligns with other findings. Further research is recommended to determine the optimal practice environment to support nurse resilience.
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http://dx.doi.org/10.1111/nhs.12863DOI Listing
June 2021

A guide to writing grant proposals for nursing research.

Res Nurs Health 2021 Aug 11;44(4):596-597. Epub 2021 May 11.

College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, USA.

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http://dx.doi.org/10.1002/nur.22137DOI Listing
August 2021

Community development for improved housing, health equity, and education in rural Honduras.

Public Health Nurs 2021 Jul 16;38(4):680-686. Epub 2021 Apr 16.

Orangewood Presbyterian Church, Phoenix, AZ, USA.

This paper describes an international, long-term, population health project in rural Honduras among Mayan villagers, focused on collaboration, community building, partnership formation, and improvement of their living situation. Improved housing, health checks, education for their children, and clean water were chosen by the Honduran residents as the projects they thought were most important to improve their health and living conditions. During the short mission trips, the North Americans (NAs) and the villagers worked side-by-side on house building and participated in village life. The Hondurans organized into communities that mutually decided on which families received homes and together worked on each other's homes with the NAs' assistance. Nurse-led health clinics and scholarships for students were provided by the visitors during their time in the villages. Health has improved from better housing and periodic health checks, and most significantly, sustainable community organizing occurred. Public Health Nurses can work towards health equity and population health improvement by basing efforts on what the community partners request and create outcomes through relationships with those who stand to benefit from the improvement.
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http://dx.doi.org/10.1111/phn.12902DOI Listing
July 2021

Review of Chinese young adults' human papillomavirus knowledge, attitudes, and vaccine acceptability.

Public Health Nurs 2021 Jul 14;38(4):701-714. Epub 2021 Mar 14.

Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.

Objective: The human papillomavirus (HPV) vaccine is effective in reducing HPV-related disease. The 2-, 4-, and 9-valent HPV vaccines have been approved by the Chinese FDA since 2016; however, factors associated with HPV vaccine acceptability and use in Chinese young adults remain unclear.

Design And Sample: We conducted a systematic review to analyze factors affecting HPV vaccine acceptability and use in Chinese young adults. A comprehensive search of databases (e.g., PubMed, CINAHL, and PsycINFO) was conducted, and articles between 2011 and 2020 were included.

Results: Seventeen studies were included in the final review, and eleven were conducted in mainland China and six in Hong Kong. All studies reported low level of HPV-related knowledge. Better knowledge, more concerns about HPV-associated diseases, and being female were found associated with higher vaccine acceptability. The vaccine cost and safety were the major concerns for vaccination.

Conclusions: Findings suggested a low level of HPV-related knowledge and suboptimal vaccination rate in Chinese young adults. Theory-based interventions addressing knowledge and other influencing factors and involving both males and females are urgently needed to increase vaccine acceptability and use in Chinese young adults.
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http://dx.doi.org/10.1111/phn.12893DOI Listing
July 2021

Building a culture of PhD and DNP collaboration: An SNRS position paper.

Res Nurs Health 2021 Feb 25;44(1):9-11. Epub 2020 Dec 25.

College of Nursing, Arizona State University, Phoenix, Arizona, USA.

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http://dx.doi.org/10.1002/nur.22104DOI Listing
February 2021

Importance of global connections.

Res Nurs Health 2020 Dec 5;43(6):556. Epub 2020 Nov 5.

Arizona State University, Phoenix, Arizona, USA.

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http://dx.doi.org/10.1002/nur.22079DOI Listing
December 2020

Sleep-wake patterns in newborns are associated with infant rapid weight gain and incident adiposity in toddlerhood.

Pediatr Obes 2021 03 11;16(3):e12726. Epub 2020 Sep 11.

Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.

Background: Rapid weight gain (RWG) by 6 months of life is a significant risk factor of childhood overweight (OW)/obesity. Infant sleep patterns are associated with incident OW in childhood, but few have examined its relationship with RWG.

Objective: Examine associations between newborn sleep-wake patterns and incident RWG at 6 months of life and OW at 36 months.

Methods: Low-income Mexican/Mexican-American women with OW/obesity and their infants (n = 126) enrolled in a 1-year randomized controlled trial designed to prevent incident, infant RWG and toddlerhood OW/obesity. Sleep pattern metrics at 1 month were extracted from the Brief Infant Sleep Questionnaire-Revised. Outcome measures included RWG (>0.67 positive change in weight-for-age Z-score) from birth to 6 months and incident OW (body mass index percentile ≥85) at 36 months.

Results: By 6 months, 35.7% (n = 45) of infants experienced RWG, and by 36 months 42.3% (n = 41) of toddlers were OW. Napping ≥5x/day at 1-month was significantly associated with decreased odds for RWG compared to napping <5x (OR = 0.11, 95%CI:0.02, 0.63). Each 1-hour increase in nocturnal vs diurnal sleep was associated with greater odds of incident OW at 36 mos (OR = 1.51, 95%CI:1.13, 2.03).

Conclusions: Early-life sleep patterns related to infant nap frequency and nocturnal vs diurnal sleep distribution were associated with obesity outcomes and may be important intervention targets to prevent lasting consequences on infant growth.
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http://dx.doi.org/10.1111/ijpo.12726DOI Listing
March 2021

Applying a Solution-Focused Approach to Life With Diabetes: Insights Gleaned via Twitter.

Diabetes Educ 2020 10 16;46(5):485-494. Epub 2020 Jul 16.

Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona.

Purpose: The purpose of this study was to explore responses of people with diabetes (PWD) when exposed to a solution-focused brief therapy (SFBT) approach. This approach focuses on solutions rather than the problems and what is desired in life rather than what will not occur.

Methods: Ten SFBT questions were presented for discussion during 1 hour of a Twitter chat on November 14, 2018, during a World Diabetes Day multiple-hour chat. Verbatim transcripts of Twitter data were downloaded from Symplur Signals LLC. Thirty-two participants from 4 countries created 358 tweets, 118 retweets, and 1.5 million impressions. A qualitative content analysis was then completed.

Results: Five themes emerged regarding the desired future state: more living life, laughter and humor, self-compassion, resilience, and support. There was an overwhelming sense of burden associated with diabetes yet a global feeling of hope, acceptance, and being "capable" to manage diabetes.

Conclusion: Employing SFBT, asking future-directed questions with a focus on solutions and the desired state, generated impactful insights around life with diabetes. Diabetes care and education specialists can incorporate SFBT as a tool to focus diabetes care, education, and support in partnership with PWD. Use of SFBT in diabetes demonstrates potential to strengthen resilience and confidence needed to manage this challenging condition.
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http://dx.doi.org/10.1177/0145721720941415DOI Listing
October 2020

Chinese Medical Students' Attitudes toward Older Adults and Willingness To Consider a Career in Geriatric Medicine: A Cross-Sectional Survey.

Teach Learn Med 2020 Oct-Dec;32(5):486-493. Epub 2020 Jul 7.

School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

: Ageism is a significant social issue, especially in China. Ageism adversely affects willingness to consider a career in geriatric medicine. However, few studies have examined this topic among Chinese medical students. This study aimed to investigate attitudes toward older people among medical students in China, examine the factors related to these attitudes, and determine the relationships between attitudes and willingness to consider geriatric medicine as a career after graduation. : Responses from 1,022 Chinese medical students were included in the analyses. Students provided demographic information and completed the Fraboni Scale of Ageism (FSA). The data were analyzed using the Statistical Package for Social Sciences, version 24.0 (IBM SPSS Corp). : The mean score of the FSA was 64.42 ± 6.58. Multiple regression analysis showed that the significant predictors of ageism were being male, longer years of training in medical school, and no caregiving experiences with older adults during clinical practice ( = .038,  = 13.520, < .001). Students who had higher FSA scores were more unwilling to consider a career in geriatric medicine after graduation ( = 4.281, < .001, Cohens = .268). : Chinese medical students have fewer positive attitudes toward older adults than what has been reported in other countries. Future studies should examine the determinants of ageism among medical students in various cultures to guide the development, implementation, and assessment of interventions designed to nurture a more positive attitude toward older adults and increase willingness to consider a career in geriatric medicine.
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http://dx.doi.org/10.1080/10401334.2020.1784739DOI Listing
July 2020

Exploring Chinese College Students' HPV Awareness, Knowledge, Attitudes, and Intent of HPV Vaccination: a Qualitative Study.

J Cancer Educ 2020 Apr 20. Epub 2020 Apr 20.

West China School of Nursing, West China Hospital, Sichuan University, Sichuan, China.

Human papillomavirus (HPV) infection is the world's most prevalent sexually transmitted infection and causes cancers. In China, about 47,739 deaths occur annually from HPV-related cervical cancer, and this number continues to increase. HPV vaccines have shown promising results in preventing HPV-associated cancers; however, the vaccination rate in Chinese college students remains extremely low. This qualitative research explored Chinese college students' HPV-related awareness, knowledge, attitudes and beliefs, and their vaccination intention as well as the strategies promoting vaccination in China. We conducted four focus groups with 18 male and 20 female students; prompts were developed based on the health belief model (HBM). Discussions were audiotaped, transcribed, and translated from Chinese to English by three bilingual researchers. Content analysis of the data revealed eight themes addressing HBM. Participants demonstrated high awareness (71% had heard of HPV) with limited knowledge. They perceived very low risks of being infected but expressed high vaccination intention if the cost was covered by the government. Participants identified reasons that facilitate and prevent vaccination and proposed culturally and developmentally congruent strategies to promote vaccination in China. It is essential to address facilitators and barriers at individual, societal, political, and cultural levels to promote HPV vaccination in Chinese college students.
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http://dx.doi.org/10.1007/s13187-020-01750-0DOI Listing
April 2020

Calories, Caffeine and the Onset of Obesity in Young Children.

Acad Pediatr 2020 08 17;20(6):801-808. Epub 2020 Feb 17.

College of Nursing and Health Innovation (L Reyna and E Reifsnider), Arizona State University, Phoenix, Ariz.

Objective: High calorie foods and beverages, which often contain caffeine, contribute to child overweight/obesity. We evaluated the results of an educational intervention to promote healthy growth in very young children. Secondarily, we used detailed diet data to explore the association of nutrient intake with the early development of overweight and obesity.

Methods: Mothers were obese Latina women, enrolled prenatally, and their infants. Specially trained community health workers provided breastfeeding support and nutrition education during 10 home visits, birth to 24 months. At follow-up, age 18 to 36 months, we measured growth and completed detailed diet recalls (1-7 recall days/child).

Results: Of 174 infants randomized, 106 children were followed for 24 to 36 months. The educational intervention did not prevent overweight/obesity. Forty-two percent of children became overweight or obese. Fifty-eight percent of children consumed caffeine on at least 1 recall day. Mean intake was 0.48 mg/kg/day. Caffeine correlated with higher consumption of calories, and added sugar and decreased intake of protein, fiber and dairy. Compared with days without caffeine, on days when caffeine was consumed, children ingested 121 more calories and 3.8 gm less protein. Children frequently consumed less than the recommended daily intake of key nutrients such as fiber, vegetables, whole fruit, and vitamins.

Conclusions: Caffeine was a marker for increased intake of calories and decreased intake of key nutrients. When discussing dietary intake in early childhood, practitioners should screen for nutrient deficiency in young children and recommend limiting the intake of caffeinated foods and beverages.
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http://dx.doi.org/10.1016/j.acap.2020.02.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416448PMC
August 2020

Resting Energy Expenditure Relationship with Macronutrients and Gestational Weight Gain: A Pilot Study.

Nutrients 2020 Feb 11;12(2). Epub 2020 Feb 11.

College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA.

Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG) or maternal diet. The objective of this study was to examine the impact of metabolic tracking on GWG and the association with maternal macronutrients. Pregnant women aged 29.8 ± 4.9 years (78.6% non-Hispanic, White) with gestational age (GA) < 17 week were randomized to Breezing™ ( = 16) or control ( = 12) groups for 13 weeks. REE by Breezing™ indirect calorimetry, anthropometrics and dietary intake were collected every two weeks. Early (14-21 weeks), late (21-28 weeks), and overall (14-28 weeks) changes in macronutrients and GWG were calculated. The Breezing™ group had a significantly greater rate of GWG [F (1,23) = 6.8, = 0.02] in the latter half of the second trimester. Late (-155.3 ± 309.2 vs. 207.1 ± 416.5 kcal, p = 0.01) and overall (-143.8 ± 339.2 vs. 191.8 ± 422.2 kcal, p = 0.03) changes in energy consumption were significantly different between Breezing™ and control groups, respectively. Early changes in REE were positively correlated with overall changes in carbohydrates (r = 0.58, = 0.02). Regular metabolism tracking alone did not have an impact on GWG. Early shifts in REE might impact GWG later in pregnancy. Investigation in a larger population from preconception through postpartum is needed.
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http://dx.doi.org/10.3390/nu12020450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071224PMC
February 2020

A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients.

J Adv Nurs 2020 May 25;76(5):1172-1181. Epub 2020 Feb 25.

West China School of Nursing & Department of Nursing, West China Hospital, Sichuan University, Chengdu, People's Republic of China.

Aims: To examine the effects of a tailored telehealth educational intervention on medication adherence and disease activity in discharged patients with rheumatoid arthritis (RA).

Design: An un-blinded randomized controlled trial.

Methods: A total of 92 eligible patients were recruited from January 2015-December 2015. Participants were randomly assigned to either the intervention (N = 46) or control group (N = 46). The intervention group received four educational sessions delivered through a telephone across a 12-week intervention. The content of the education mainly included: subject's knowledge about disease; treatment goals; the importance of taking medication correctly; side effect management; remembering to take medication. The control group received only standard care including discharge instructions. Outcome measures included medication adherence and disease activity.

Results: The intervention group had significantly higher medication adherence compared with the control group at 12th and 24th week. There was no significant difference between two groups in disease activity at 12th and 24th week.

Conclusions: The telephone-delivered tailored educational intervention effectively improved medication adherence among discharged patients with rheumatoid arthritis. However, no significant benefits of the intervention on disease activity were detected.

Impact: Good medication adherence in rheumatoid arthritis patients contributes to controlling symptom and inflammation, preventing the progressive structural damage. This study demonstrated that the telehealth educational intervention could improve patients' medication adherence but did not have a direct impact on clinical condition in the short-term. The intervention for discharged patients with rheumatoid arthritis can be integrated into the clinical setting by the nursing staff as follow-up care.

Trial Registration Number: ChiCTR-IPR-14005722.
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http://dx.doi.org/10.1111/jan.14319DOI Listing
May 2020

An Ecological Approach to Obesity in Mexican American Children.

J Pediatr Health Care 2020 May - Jun;34(3):212-221. Epub 2019 Dec 6.

Introduction: The objective of this study was to explore the risk factors that contribute to obesity in Mexican American children compared with Mexican American normal weight children. No hypotheses were tested in the study. When risk factors are known, nurses can use evidence to reduce risky behavior.

Method: A cross-sectional descriptive design was used, comparing two groups of children to discern the risk factors for obesity. The setting is a county in South Texas along the border with Mexico. The sample consisted of 55 Mexican American dyads (mother-child). The following measures, based on the Ecological Model of Growth, were used to collect data: anthropometrics, dietary data of children, home environment, perceived stress of mother, and maternal acculturation. Independent sample t tests, chi-square tests, Fisher exact tests, and a hierarchical logistic regression analysis were used to analyze the data.

Results: The findings show children's age and maternal body mass index (BMI) are positively correlated with childhood obesity, as measured by BMI percentile by age/sex. There were significant differences in the host and agent factors of prolonged bottle feeding, amount of outdoor play, and fruit drinks between normal weight and obese children.

Discussion: Engagement and involvement of other family members in outdoor activities, nutrition/feeding, and child care may mitigate the negative effects of host and agent factors on child body size.
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http://dx.doi.org/10.1016/j.pedhc.2019.09.012DOI Listing
June 2021

Community/public health nurses' responsibility to ensure adequate nutrition for hungry families.

Public Health Nurs 2019 09;36(5):587-588

Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.

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http://dx.doi.org/10.1111/phn.12663DOI Listing
September 2019

Knowledge and attitudes towards breastfeeding practices: A cross-sectional survey of postnatal mothers in China.

Midwifery 2019 Jul 18;74:68-75. Epub 2019 Mar 18.

College of Nursing and Health Innovation, Arizona State University, 500N. 3rd Street, Phoenix AZ, 85004, USA. Electronic address:

Objective: To examine the mothers' knowledge and attitudes toward breastfeeding and highlight barriers to exclusive breastfeeding in Chinese postpartum mothers.

Design: Cross sectional survey SETTING: Maternity wards of two large, multi-service teaching hospitals, Wuhan, China.

Participants: 324 postnatal mothers completed a structured questionnaire during their stay at hospital from October 2016 to January 2017.

Measurements And Findings: Descriptive and inferential statistics revealed that most mothers showed neutral attitude on breastfeeding and neutral knowledge level as well. The average score for the total Iowa Infant Feeding Attitude Scale (IIFAS) was 56.55±4.77 M±SD, and 10.83±2.77, M±SD for the knowledge section. The mothers who had poor knowledge were less likely to initiate breastfeeding within an hour after birth.

Conclusions: The results of this study are applicable to nurses and nurse midwives to assist in identification of women who may be at-risk to not initiate breastfeeding. Maternal positive attitude and good knowledge play key roles in the process of breastfeeding. Thus, it is important to provide antenatal and early postpartum education and periodical breastfeeding counselling, especially for new mothers, to improve maternal attitudes and knowledge toward breastfeeding practices.
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http://dx.doi.org/10.1016/j.midw.2019.03.009DOI Listing
July 2019

The Combined Impact of Sleep and Diet on Adiposity in Infants, Toddlers, and Young Children: A Systematic Review.

J Dev Behav Pediatr 2019 04;40(3):224-236

College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.

Objective: Short sleep duration and poor dietary habits may contribute to increased adiposity; however, the impact of the interaction between these variables on adiposity is less understood. To evaluate research investigating the combined effects of sleep and diet on adiposity in infants, toddlers, and young children.

Methods: Systematic searches of electronic databases (PubMed, CINAHL, and Web of Science) from inception through April 2017 were conducted. All studies published in English that had at least 1 sleep (e.g., sleep duration and night awakenings), diet (e.g., 24-hour diet recall and breastfeeding duration), and adiposity (e.g., body mass index z-score and weight-for-length) measure were eligible for inclusion. Abstract and full-text article reviews were conducted by 2 independent reviewers. Data were extracted into a standardized spreadsheet.

Results: Of the 17 full-text articles reviewed, 14 studies were included. Mediation (n = 2) and moderation (n = 2) were seldom used. Investigation of the combined effects of sleep and diet on adiposity demonstrated a substantial lack of evidence. Synthesis of articles suggests that the relationship between sleep and diet may be interactive and their effects additive in their impact when targeted simultaneously within interventions.

Conclusion: Without consideration of interaction effects among variables of interest, a substantial gap in the literature persists. Both diet and sleep need to be assessed simultaneously and repetitively in future longitudinal research.
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http://dx.doi.org/10.1097/DBP.0000000000000636DOI Listing
April 2019

Associations of Diabetes-Related Distress and Depressive Symptoms With Glycemic Control in Korean Americans With Type 2 Diabetes.

Diabetes Educ 2018 12 15;44(6):531-540. Epub 2018 Oct 15.

College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona.

Purpose: The purpose of this study was to investigate the associations of diabetes-related distress and depressive symptoms with glycemic control in Korean Americans (KAs) with type 2 diabetes mellitus (T2DM).

Methods: The cross-sectional, correlational descriptive study explored glycemic control in KA. A total of 119 KA adults with T2DM were recruited from Korean communities in Arizona between July and November 2016. Data were collected by a finger-stick glucose test for A1C, the Diabetes Distress Scale for diabetes-related distress, the Center for Epidemiological Studies Depression for depressive symptoms, and sociodemographics. Height and weight were measured to calculate body mass index. Descriptive statistics, bivariate correlation, and multiple linear regression analyses were performed.

Results: The total score for diabetes-related distress was positively associated with A1C in both unadjusted and adjusted models, while depressive symptoms were not associated with glycemic control regardless of analysis methods. In the further analysis of the 4 subscales of diabetes-related distress, only regimen-related distress was a significant predictor of poor glycemic control after adjusting for covariates. Emotional burden was not associated with glycemic control, even though there was a weak but significant correlation between emotional burden and glycemic control.

Conclusions: Diabetes-related distress and depressive symptoms should be recognized as different psychological aspects in T2DM, and individual-centered approaches should be used for diabetes self-management education and support. In addition, diabetes-focused psychological interventions and culturally tailored diabetes self-management programs should be included in comprehensive education and support for KAs with T2D to achieve good glycemic control.
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http://dx.doi.org/10.1177/0145721718807443DOI Listing
December 2018

Acculturation, Cultural Values, and Breastfeeding in Overweight or Obese, Low-Income, Hispanic Women at 1 Month Postpartum.

J Hum Lact 2018 May 15;34(2):358-364. Epub 2018 Mar 15.

1 College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.

Background: Most Hispanic infants are fed formula during the first 6 weeks, and although 80% of Hispanic women initiate breastfeeding, rates of exclusive breastfeeding are much lower. Research aim: The purpose was to examine the influence of acculturation and cultural values on the breastfeeding practices of pregnant women of Mexican descent participating in the Special Supplemental Nutrition Program for Women, Infants, and Children who were enrolled in a prospective randomized clinical trial that aimed to reduce child obesity. The data were abstracted from a larger randomized clinical trial focused on prevention of child obesity.

Methods: The sample consisted of 150 women of Mexican origin who were enrolled at the time of these analyses from the randomized clinical trial and had a prepregnancy body mass index of ≥ 25 and spoke English and/or Spanish. All breastfeeding data for this report came from data collection at 1 month postpartum.

Results: A higher score on the Anglo orientation scale of the Acculturation Rating Scale for Mexican Americans was associated with less breastfeeding at 1 month postpartum and less exclusive breastfeeding.

Conclusion: Acculturation plays a role in breastfeeding practice. Exploring acculturation associated with breastfeeding can guide us to design culturally relevant interventions to promote breastfeeding exclusivity among immigrant mothers.
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http://dx.doi.org/10.1177/0890334417753942DOI Listing
May 2018

Randomized Controlled Trial to Prevent Infant Overweight in a High-Risk Population.

Acad Pediatr 2018 04 23;18(3):324-333. Epub 2017 Dec 23.

College of Nursing and Health Innovation, Arizona State University, Phoenix, Ariz.

Objectives: Infants are at risk of overweight. Infant overweight predisposes child, adolescent, and adult to obesity. We hypothesized that parent education, initiated prenatally and provided in the home, would reduce the incidence of infant overweight at age 12 months.

Methods: Pregnant obese Latina women were recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and randomized to intervention versus control. Intervention subjects received home visits by trained Spanish-fluent community health workers who provided counseling on infant growth, breastfeeding, nutrition, child development, sleep, physical activity, and safety. Promotoras did not visit the control subjects. A research assistant collected outcome data on all subjects.

Results: Compared to controls, parent education did not reduce infant overweight. Infant overweight developed rapidly and was present in 46% of infants by age 6 months. Infants overweight at 6 months were likely to be overweight at age 12 months (r = 0.60, P < .0001). Overweight was more common in formula-fed infants at ages 6 months (P < .06) and 12 months (P = .005). Breastfeeding was less common in families with employed mothers (P = .02) and unemployed fathers (P < .01), but the father living with the mother at the time of the prenatal visit predicted successful breastfeeding at infant age 2 months (P < .003). Compared to formula feeding, overweight at age 12 months was 2.7 times less likely for infants breastfed for ≥2 months (P = .01).

Conclusions: The lack of success of the intervention may be explained in part by a high cesarean section rate in the intervention group, food and employment insecurity, and confounding by WIC breastfeeding promotion, which was available to all mothers. Breastfeeding was the most important mediator of infant overweight. The study supports efforts by WIC to vigorously promote breastfeeding.
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http://dx.doi.org/10.1016/j.acap.2017.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889724PMC
April 2018

Foreword.

Fam Community Health 2018 Jan/Mar;41(1)

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http://dx.doi.org/10.1097/FCH.0000000000000174DOI Listing
November 2017

Stakeholders' Perceptions of Care Coordination: A Participatory Process.

J Pediatr Health Care 2017 Sep - Oct;31(5):555-559. Epub 2017 Apr 12.

Objective: Children with special health care needs or chronic conditions are more likely to have unmet health needs than other children. The purpose of this study was to use a community engagement research strategy to assess the essential elements of care coordination that can serve as the foundation for a system-wide care coordination model for children with special health care needs.

Study Design: As part of a summit designed to review the status of pediatric care coordination within the state of Arizona and a call to action, a qualitative descriptive study was conducted to solicit anonymous feedback from 104 stakeholders (family, health care provider, or community entity) on the strengths and areas of improvement in the current system that provides care to Arizona children with special health care needs. Data were analyzed using inductive content analysis.

Results: Five essential categories crucial to building an effective and seamless care coordination model were extracted from the data: Communication, Insurance, Health Care Capacity, Provider Knowledge, and Family Education.

Conclusions: The results from this study can serve as the working foundation to build a system-wide model for pediatric care coordination throughout the state. Providing care coordination services involves many activities across a wide range of organizations and locations. Research that is inclusive of community stakeholders can determine essential components for building a foundation for care coordination.
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http://dx.doi.org/10.1016/j.pedhc.2017.01.012DOI Listing
July 2018

Relationship of Sleep Duration and Regularity with Dietary Intake Among Preschool-Aged Children with Obesity from Low-Income Families.

J Dev Behav Pediatr 2017 Feb/Mar;38(2):120-128

*College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; †School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ; ‡School of Nursing, University of Texas Health Science Center at Houston, Houston, TX.

Objective: Diet is a modifiable factor associated with pediatric obesity outcomes, but few studies have evaluated the relationships of sleep duration and regularity on dietary intake of young preschool-aged children. The goal of this study was to evaluate whether short sleep duration and irregular sleep timing were associated with greater calorie, carbohydrate and fat consumption among young children with obesity from low-income families.

Methods: Fifty-one ethnically diverse children aged 2 to 4 years were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics in a southeast Texas county. Sleep behaviors were parent reported using the Child Sleep Assessment tool. Dietary intake data were obtained by 24-hour recall interviews (2 weekdays and 1 weekend day).

Results: Short sleep duration (<11 hr) was highly prevalent among this cohort of preschool-aged children. Short sleep duration was associated with greater fat and decreased carbohydrate consumption. Children with greater variability in sleep duration and timing had greater energy intake from fat and protein sources.

Conclusion: Allowing for the opportunity to educate parents on the importance of maintaining regular, adequate sleep and relationships between sleep and dietary intake may decrease the risk of childhood obesity in this high-risk pediatric population.
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http://dx.doi.org/10.1097/DBP.0000000000000369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285397PMC
December 2017

The Role of SNAP in Home Food Availability and Dietary Intake among WIC Participants Facing Unstable Housing.

Public Health Nurs 2017 05 12;34(3):219-228. Epub 2017 Jan 12.

College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona.

Objective: Little nutrition research has been conducted among families with unstable housing. The objective of this study was to examine the role of food stamps (i.e., Supplemental Nutrition Assistance Program; SNAP) in home food availability and dietary intake among WIC families who experienced unstable housing.

Design And Sample: Cross-sectional study among vulnerable families. Low-income, multiethnic families with children participating in WIC (n = 54).

Measures: Dietary intake was assessed with 24-hr recalls. Home food availability was assessed with an adapted home food inventory for low-income, multiethnic families. Validation results from adapted home food inventory for these families are also reported.

Results: SNAP households had more foods than non-SNAP households; few significant associations were observed between food availability and child dietary intake.

Conclusions: With few exceptions, the home food environment was not related to children's dietary intake among these vulnerable families. More research is needed on food access for families facing unstable housing.
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http://dx.doi.org/10.1111/phn.12311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5521212PMC
May 2017

The Relationship Among Breastfeeding, Postpartum Depression, and Postpartum Weight in Mexican American Women.

J Obstet Gynecol Neonatal Nurs 2016 Nov - Dec;45(6):760-771. Epub 2016 Sep 13.

Objective: To determine if symptoms of postpartum depression and postpartum weight varied according to the level of breastfeeding among women of Mexican origin at 1 month and 6 months postpartum.

Design: Secondary quantitative analysis to study the differences in postpartum weight and depression among the mothers in the study who breastfed and those who did not.

Setting: A heavily Hispanic community located in a major Southwestern U.S. city.

Participants: Women of Mexican origin (N = 150) who enrolled during their third trimesters in a local Special Supplemental Nutrition Program for Women, Infants, and Children clinic and were followed for 6 months.

Methods: Weight was measured at 1 month and at 6 months postpartum at home visits with validated digital scales. Breastfeeding was measured according to World Health Organization criteria and recorded after monthly phone calls. Depression was measured at home visits at 1 month and 6 months with the Edinburgh Postnatal Depression Scale.

Results: At 6 months postpartum, participants who did not breastfeed had the highest scores on the Edinburgh Postnatal Depression Scale; participants who breastfed nonexclusively had the lowest scores (p = .067). At both time points, there was a significant difference in weight (p = .017) between women who were doing any breastfeeding and women who were not breastfeeding.

Conclusion: Breastfeeding, even if not exclusive, contributed to lower depression scores and significantly lower postpartum weight among this sample of Mexican American women.
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http://dx.doi.org/10.1016/j.jogn.2016.05.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135013PMC
April 2018

Malnutrition coupled with diarrheal and respiratory infections among children in Asia: A systematic review.

Public Health Nurs 2017 07 29;34(4):401-409. Epub 2016 Jun 29.

School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona.

Objective: The purpose of this systematic literature review was to assess the relationship between malnutrition and respiratory and diarrheal infections among children aged five and under living in Asian countries.

Design And Sample: The design was adapted from the PRISMA method to include case-control, cross-sectional, ecological, and experimental studies. A review of electronic databases identified 144 articles of which 20 met the inclusion criteria. The inclusion criteria were studies of malnourished children under the age of five with respiratory and/or diarrheal infections, admitted to hospitals or residing in villages throughout countries in Asia, and published between 2005 and 2015.

Measures: Infection was defined as the presence of a respiratory or diarrheal illness. Malnutrition was predominantly measured by WHO standards.

Results: Malnutrition is associated with respiratory and diarrheal infections. Children have higher rates of mortality when both malnourished and experiencing a respiratory infection.

Conclusion: Further research needs to examine the synergetic effect of diarrheal and respiratory infections in malnourished children and rates of mortality. Public health nurses (PHNs) play a critical role in the prevention and treatment of malnutrition and infections in community and national systems. Obtaining better data will allow PHNs to provide critical care in the most underserved areas throughout Asia.
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http://dx.doi.org/10.1111/phn.12273DOI Listing
July 2017

How Did They Grow: An Intervention to Reduce Stunted Growth in Low-Income Mexican-American Children.

Res Nurs Health 2016 Apr 24;39(2):105-20. Epub 2016 Feb 24.

Project Coordinator, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.

Growth stunting is a complex phenomenon related to undernutrition that can contribute to developmental delay, cognitive deficits, and small size and obesity in adulthood. Stunted growth, defined as height for age below the 5th percentile, is primarily caused by chronic malnutrition. In this study, a community-based intervention to reduce undernutrition was tested in a quasi-experimental design with 174 low-income, Mexican-American mothers and children recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in a major southwestern city. The intervention was based on the public health nursing practice of collaborating with mothers of young children on appropriate nutrition and parenting, and was tailored by the author and community informants for mothers of children with stunted growth. Data were collected on child height and weight, dietary intake, maternal acculturation, maternal perceived stress as measured by the Perceived Stress Scale (PSS), home environment as measured by the home screening questionnaire (HSQ), and maternal-child interaction as measured by the Nursing Child Assessment Teaching Scale (NCATS). Intervention children had higher growth velocity than the children in the comparison group. These findings were especially prominent for children of women who were older and less acculturated. Results suggest that a nursing intervention delivered in collaboration with WIC can make a significant improvement in growth of low-income children with growth stunting.
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http://dx.doi.org/10.1002/nur.21714DOI Listing
April 2016

Food security, maternal feeding practices and child weight-for-length.

Appl Nurs Res 2016 Feb 26;29:31-6. Epub 2015 Mar 26.

Arizona State University, College of Nursing and Health Innovation, Phoenix, AZ, USA. Electronic address:

Background: Over consumption of energy-dense nutrient-poor foods may contribute to childhood obesity. We hypothesized that greater than recommended servings of sugar sweetened beverages and foods, indicators of food security, and a high maternal recumbent weight-for-length are positively associated with high percentages of child overweight/obesity.

Methods: This secondary data analysis consisted of a sample of 240 mother-child dyads. The original studies were designed to examine the effect of a public health nursing intervention on optimal childhood growth for low-income, minority children. Eligibility to participate included: 1) mothers self-identified as Hispanic; 2) children were 12-24 months old; and 3) children were enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); and 4) children were free of any major disease. Multivariate logistic regression examined the association between child weight, weight-for-length, maternal recumbent weight-for-length, child's eating schedule, maternal attitudes on feeding, food security, and consumption of sugar-sweetened beverages, desserts and fatty meats.

Results: Receiving SNAP was positively associated with child weight-for-length (WL). Children whose mothers reported ever having received SNAP were 2.01 times more likely to be overweight compared to children whose mothers did not report ever having received SNAP (95% CI=1.04-3.90). Children who consumed desserts were 2.87 times more likely to be overweight compared to children who did not consume desserts (95% CI=1.19-6.88). Also, child's caloric intake was significantly associated with child WL. Children who consumed more calories were 1.00 times more likely to be overweight compared to children who consumed fewer calories (95% CI=1.00-1.00).

Discussion: Research on food security and children's weight has reported mixed findings. Methodological issues have been identified as contributory to the inconsistent findings. Of paramount importance to these studies is the measurement of low food security.

Conclusion: Children in this sample who were food insecure, as indicated by SNAP recipients, were more likely to have a higher WL measurement. Future studies should focus on the correlation between food security and hunger/satiety cues.
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http://dx.doi.org/10.1016/j.apnr.2015.03.009DOI Listing
February 2016

Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions.

Int Breastfeed J 2015 1;10:21. Epub 2015 Jul 1.

University of Texas Medical Branch at Galveston, School of Nursing, Galveston, TX 77555 USA.

Maternal obesity is associated with significantly lower rates of breastfeeding initiation, duration and exclusivity. Increasing rates of obesity among reproductive-age women has prompted the need to carefully examine factors contributing to lower breastfeeding rates in this population. Recent research has demonstrated a significant impact of breastfeeding to reduce the risk of obesity in both mothers and their children. This article presents a review of research literature from three databases covering the years 1995 to 2014 using the search terms of breastfeeding and maternal obesity. We reviewed the existing research on contributing factors to lower breastfeeding rates among obese women, and our findings can guide the development of promising avenues to increase breastfeeding among a vulnerable population. The key findings concerned factors impacting initiation and early breastfeeding, factors impacting later breastfeeding and exclusivity, interventions to increase breastfeeding in obese women, and clinical considerations. The factors impacting early breastfeeding include mechanical factors and delayed onset of lactogenesis II and we have critically analyzed the potential contributors to these factors. The factors impacting later breastfeeding and exclusivity include hormonal imbalances, psychosocial factors, and mammary hypoplasia. Several recent interventions have sought to increase breastfeeding duration in obese women with varying levels of success and we have presented the strengths and weaknesses of these clinical trials. Clinical considerations include specific techniques that have been found to improve breastfeeding incidence and duration in obese women. Many obese women do not obtain the health benefits of exclusive breastfeeding and their children are more likely to also be overweight or obese if they are not breastfed. Further research is needed into the physiological basis for decreased breastfeeding among obese women along with effective interventions supported by rigorous clinical research to advance the care of obese reproductive age women and their children.
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http://dx.doi.org/10.1186/s13006-015-0046-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488037PMC
July 2015
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