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    The Relationship between Dietary Intakes of Magnesium, Copper, Iron, Omega-3, and Selenium and Depression among College Students Aged 18-24 Years at George Mason University
    Ren, Xinye; Basiri, Raedeh
    Background: Depression is a common illness that leads to serious outcomes ranging from poor functional performance at work, school, and in family roles, to suicide. Young adult (18-29 years old) depression is a serious health problem. Over twenty percent of young adults have reported depression symptoms in the United States1. Around seventeen percent of American college students are depressed2. For college students, mental health is important for their education and quality of life. About sixty percent of people who have committed suicide previously reported mood disorders such as major depression, bipolar disorder, and dysthymia3. According to WHO (2020)1, suicide is the second leading cause of death among the individuals aged 15-29 years, which is the age when people typically attend college. Nutrition is a modifiable factor that plays an essential role in human psychological health4. It could be a sustainable treatment method for depression with low cost and minimal side effects. Nutrients, such as selenium, copper, iron, magnesium, and omega-3, are reported to have an association with depression. However, studies regarding the intakes of these nutrients and depression are inconclusive. Few studies focused on college students. Thus, the overall purpose of this study is to investigate the relationship between dietary nutrient intakes and depression level among college students at George Mason University by 1) evaluating the dietary intakes of selenium, magnesium, copper, iron, and omega-3 among George Mason University college students with different depression levels; and 2) examining whether the extent of dietary intake of these nutrients is related to the severity of depression. Method: This is a cross-sectional study. In total, 205 participants were eligible to be included in this study from the 2019 population of the Mason: Health Starts Here cohort study. The participants were first-year college students aged 18-24 years at George Mason University. Demographic information such as gender, race, BMI, and financial support were collected, and dietary nutrient intake was measured using Dietary History Questionnaire (DHQ-III). Depression level was evaluated by utilizing Patient-Reported Outcomes Measurement Information System (PROMIS). Physical activity level was assessed using International Physical Activity Questionnaire (IPAQ) - short version. SPSS version 28.0 was used to do the statistical analysis. ANOVA was used to compare the differences between the average nutrient intakes and depression levels. Linear regression was to analyze the relationship between dietary nutrient intakes and depression levels. Results: There were no significant differences between depression levels in race, gender, body mass index, physical activity level, and financial support. Compared to the mild and the moderate/severe groups, the none to slight depression group had the highest percentage of the participants (68.1%) with normal BMI. The moderate/severe depression group had the highest percentage of underweight (11.9%) and obese (11.9%) participants. Finally, the mild depression group had the highest percentage of participants being overweight (25%). A greater proportion of participants had low physical activity level as the depression level increased, from 17.6% in the none to slight group to 31.0% in the moderate/severe group. The percentage of participants with high physical activity was higher in the none to slight depressed group (56.3%) compared to the other two groups (mild 40.9% and moderate/severe 50%). Dietary intakes of magnesium, iron, copper, selenium, and omega-3 were not significantly related to depression level. The average intakes of examined nutrients were not significantly different between depression groups. Conclusion: The present study did not find significant between-group differences of the average dietary intakes of magnesium, copper, iron, omega-3, and selenium; nor a significant relationship between dietary intakes of selenium, iron, copper, magnesium, and omega-3 and depression level among freshmen college students aged 18-24 years at George Mason University.
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    Patient-Centered Communication and Provider Interacting eHealth Behaviors: Trends and Associations with Cancer Screening
    (2022) McKeown, Lisa M; Hong, Y. Alicia
    Patient-centered communication (PCC) is a key indicator of healthcare quality and is critical to patient-centered care. Provider interacting eHealth behaviors (PIEB) help facilitate patient-centered care. This dissertation is comprised of three papers centered around PCC and PIEB. The three papers examined PCC and PIEB from three perspectives: (1) trends in PCC, (2) trends in PIEB and the association of PCC with PIEB, and (3) the association of PCC and PIEB with cancer screening. The three studies used nationally representative survey data from the Health Information National Trends Study (HINTS) administered by the National Cancer Institute (NCI). Findings from the three papers indicate PCC has increased over the past decade, is associated with PIEB, higher PCC is associated with increased odds of breast and colon cancer screening adherence, and higher PIEB is associated with increased odds of breast, cervical, and colon cancer screening adherence when controlling for PCC. In addition, disparities in PCC and PIEB continue to exist. PCC is differentially associated with breast and colon cancer screening based on race and ethnicity. PIEB is differentially associated with breast, cervical, and colon cancer screening by race and ethnicity. This research helps to inform the continued need for progress in PCC and PIEB including culturally and linguistically appropriate communication and eHealth tools in healthcare.
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    Examining the Role of Social Isolation on Hospitalizations, Nursing Home Entry, and Mortality among Older Adults
    (2022) Pomeroy, Julia Mary Louise; Gimm, Gilbert
    Social isolation affects a quarter of older adults in the United States, complicating efforts for Americans who wish to age at home or in the community. Social isolation is a key risk factor for adverse health outcomes and high health care costs, and is expected to have increased during COVID-19 due to social distancing efforts. However, little research has examined the impact of social isolation on health care utilization. Literature in this area tends to be conducted internationally, uses short follow-up times, measures social isolation through single-item variables, and usually does not control for both social isolation and loneliness in the same sample. No prior studies have examined the association between social isolation and nursing home entry in a United States-based sample. This dissertation includes three studies that expand knowledge on the associations between social isolation and hospitalization, nursing home entry, and mortality in a nationally-representative sample of community-dwelling Americans ages 65 and older. Data from the Health and Retirement Study were used to construct a multi-domain measure of social isolation while controlling for loneliness. The first study uses a panel data analysis to examine whether social isolation was associated with overnight hospital stays, nursing home entry, and mortality among older adults tracked between 2006 and 2018. The second study uses a time-to-event analysis to examine whether social isolation is associated with earlier time to long-term nursing home placement (residency of 100+ days) and mortality over ten years. The third study provides an exploratory, cross-sectional analysis to examine whether use of senior services moderates the association between social isolation and nursing home entry among respondents interviewed between 2010 and 2012. Results demonstrate that social isolation is significantly associated with increased nursing home entry and early mortality. Research examining the association between social isolation and health care utilization has important implications for the expansion of home and community-based services under Medicaid and billing codes to cover screening, referral, and treatment under Medicare. Future research should evaluate whether initiatives that enhance social connections in home or community-based settings are effective in offsetting nursing home entry, reducing premature mortality, and curbing health care costs for patients and payers.
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    Understanding the Dynamics of Social Determinants in Health Disparity, and Their Impact on Cardiovascular Diseases
    (2022) Parekh, Tarang; Cuellar, Alison E
    Traditional efforts to improve health in the United States have been driven by focusing on the health care system. However, these efforts require broader approaches that also address social, economic, and environmental factors that influence health. Cardiovascular diseases remain the leading cause of death in the United States. Although CVD disparities are shaped by differences in risk factors across racial and ethnic groups, non-traditional risk factors such as housing and food insecurities remain important social determinants of health (SDOH). While the recent trend in CVD mortality has declined, the prevalence of CVD is expected to rise by 10% in 2030. With this current trajectory, chapter 1 of this dissertation is focused on identifying predictors of SDOH by reviewing and summarizing literature that examined the association of housing and food insecurity with cardiovascular disease. Chapter 2 builds on the findings from study-1 through identified literature gap in potential predictors of housing and food insecurities, retrospectively examining how demographics, socioeconomic, and healthcare characteristics differ by available food environment and the likelihood of CVD mortality with poor food environment. Chapter 3 focuses on addressing this unique challenge of capturing SDOH by conducting a natural experiment using the Difference-in-Difference methodology and examining whether the broad-based health delivery system and payment reforms can incentivize social risk factor diagnosis in hospital settings among adults hospitalized with CVD.
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    Effects of State Scope of Practice Laws on Supply of Nurse Practitioners in Rural Communities
    (2022) Jones, Tammie Michele; Maddox, Peggy J
    In 1965, the nurse practitioner profession began in response to a shortage of primary care providers in urban and rural areas. States began recognizing advanced practice nurse providers who completed certificate or post graduate training programs for advanced practice to diagnose and treat health conditions under various levels of physician supervision. Today, over 25 million people live in areas designated as rural primary care health professional shortage areas where it is still difficult to get timely access to health services. The National Governor’s Association, advocates for nurse practitioners, and researchers have suggested that more effective incorporation of nurse practitioner services and easing restrictions to practice could mitigate the growing shortage and/or maldistribution of primary care physicians, reduce geographic disparities, and improve access to primary care services. Over time, some states have amended their nurse practice acts to allow nurse practitioners more independent practice with the intent to increase the supply of primary care providers and improve access to care (especially in rural and underserved areas). Research studies conducted to date provide limited understanding about the relationship between state nurse practice act changes on the growth and distribution in the supply of nurse practitioners as primary care providers. This dissertation employed a difference-in-differences design to exploit variation in timing of changes in state scope of practice laws (from more restrictive to less restrictive) to study the causal effects on the supply of nurse practitioners at the county level. The results of this study found states that authorized nurse practitioners to practice independently saw a 17.5 percent decrease in the number of nurse practitioners at the county level and a 12.5 percent decrease in rural counties. We found the supply of nurse practitioners continued to decline 7 years after adoption of full scope of practice regulation in two states.
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    Disability, Depression, Opioids, and Suicide among Women of Reproductive Age: Four Different Studies of Nationally Representative Samples
    (2022) Booth, Edward J; Kitsantas, Panagiota
    Disability adversely affects a substantial proportion of the United States (US) population and is a recognized major public health challenge. Despite established associations between disability and adverse health conditions, limited information exists regarding its effects among women of reproductive age. This dissertation consists of four different studies that examine depression, opioids, and suicide among US women of reproductive age with disabilities. Using data from the Pregnancy Risk Assessment Monitoring System, the first study in Chapter One examined disability, stressful life events, and postpartum depressive symptoms among women. Descriptive statistics, bivariate, and binary logistic regression analyses were conducted to estimate the effect of stressful life events on postpartum depressive symptoms among women with and without disabilities. Compared to their peers without disabilities, women with disabilities reported a higher number of stressful life events (87% to 67%) and post depressive symptoms (37% to 9%). Women with disabilities experiencing six or more stressful life events were more likely (odds ratio = 3.78, 95% confidence interval = [1.57-9.10]) to report postpartum depressive symptoms, compared to those with no stressful life events. Data from the National Survey on Drug Use and Health (NSDUH) were used in the second, third, and fourth studies. The analyses included descriptive statistics, bivariate analyses, and logistic regression to measure associations. All of the analyses were weighted to account for the complex survey design of NSDUH. The second study in Chapter Two examined disability and prescription opioids among pregnant women. Pregnant women with any type of disability had higher adjusted odds of using (adjusted odds ratio = 1.71, 95% confidence interval = [1.27-2.29]) and misusing (adjusted odds ratio = 2.00, 95% confidence interval = [1.22-3.28]) opioids within the past year compared to their peers without disabilities. The third study in Chapter Three assessed disability and prescription opioids among non-pregnant women of reproductive age. The findings of this study indicate that similarly to the pregnant population, non-pregnant women with disabilities had higher adjusted odds of opioid use (adjusted odds ratio = 1.59, 95% confidence interval = [1.50-1.67]) and misuse (adjusted odds ratio = 2.01, 95% confidence interval = [1.82-2.21]) than their peers without disabilities. The fourth study in Chapter Four examined disability and suicidal behaviors among non-pregnant women of reproductive age. Women with disabilities had greater adjusted odds of past-year suicidal behaviors (adjusted odds ratio = 1.73, 95% confidence interval = [1.60-1.87]) than women without disabilities. Disability adversely affects women of reproductive age in multiple facets of life. Compared to their peers without disabilities, women with disabilities are at an amplified risk for stressful life events, opioid use and misuse, and postpartum depressive symptoms. Early prenatal screenings for disabilities, life stressors, and opioid use or misuse is critical for timely awareness and appropriate treatment to prevent associated adverse health conditions. Further postnatal screening for postpartum depressive symptoms and opioid use or misuse is vital to optimize favorable health outcomes for mothers and their children. Both pregnant and non-pregnant women with disabilities are at increased risk for prescription opioid use and misuse relative to their peers without disabilities. Furthermore, non-pregnant women of reproductive age with disabilities are at increased risk for suicidal behaviors, particularly suicide attempts, compared to their counterparts without disabilities. Effectively mitigating the effects of opioids prior to reproduction will prevent associated adverse consequences for prospective mothers, children, and families. Furthermore, this study’s findings elucidate the complexity of suicidal behaviors among women with disabilities and the influence of specific health determinants on such behaviors. Enhancing our knowledge of suicidal behaviors and associated health determinants among women with disabilities can preserve the wellbeing of future generations via enhanced prevention, detection, and intervention enterprises.
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    The Impact of an Online Movement Training Program for Community-Based Adults and Older Adults on Balance, Physical Activity, Self-Efficacy and Resilience
    (2022) Kestle, Emily; Guccione, Andrew A; Higgins, Rosemary D
    Objective: To examine the effects of a 30-minute, 3 times per week, 24-session at home online movement exercise program on balance, physical activity, self-efficacy, and resilience in community-based adults and older adults. Background: Balance impairment is a commonly reported consequence of the aging process. It may lead to falls, serious injuries, and physical activity avoidance. Moreover, these sequelae may worsen when balance impairments work in concert with the psychological factors of decreased self-efficacy and resilience. Fortunately, existing evidence supports the use of movement training programs to improve balance in older adults. However, there are no known studies that examine the impact of a dual-task online movement training program on balance, physical activity, self-efficacy, and resilience and associations among these factors in community-based independent living older adults. Several critical relationships have been identified among balance, physical activity, self-efficacy, and resilience, which affect balance and physical activity after motor training that warrant further exploration. Methods: Participants between the ages of 55-80 years of age were recruited from the Washington, D.C. metro area, including senior independent living facilities. Eligible participants were asked to complete a total of 24 30-minute training sessions, 2-3 times per week. Outcome Measures: Participants completed pre- and post-test measures of static balance using the 4-stage balance test, physical activity using the International Physical Activity Questionnaire (IPAQ), self-efficacy using the confidence scale of the OPTIMAL instrument (OPTIMAL) and Activities-Specific Balance Confidence Scale (ABC), and resilience using the Connor-Davidson Resilience Scale (CD-RISC). Data Analysis: Statistical analysis was completed using STATA/BE version 17.0 and Microsoft Excel. Comparison of means pre- and post-training was performed using a paired t-test with a significance level of p≤0.05 to determine if there was significant improvement in balance, physical activity, self-efficacy, and resilience. Wilcoxon signedrank tests were used for comparisons of non-parametric data. Effect sizes were also calculated. Additionally, Pearson’s correlations were used to determine the extent to which self-efficacy and resilience were associated with balance and physical activity before and after training. Results: Significant differences between baseline and final measures were found for tandem stance, single leg stance (SLS), and CD-RISC. Moderate effect sizes were found for both tandem and single leg stance measures. Additionally, moderate correlations were found between baseline SLS and IPAQ measures, final ABC and SLS measures, final OPTIMAL and SLS measures, final CD-RISC and IPAQ measures, and final SLS and IPAQ measures. Strength of correlations increased between baseline and final measures for ABC and SLS, OPTIMAL and tandem stance, OPTIMAL and SLS, OPTIMAL and IPAQ, CD-RISC and tandem, CD-RISC and SLS, and CD-RISC and IPAQ. Conclusion: Based on effect sizes, this study provides preliminary support for the efficacy of an at home online movement training program to make modest improvements in balance and physical activity, and small improvements in self-efficacy and resilience. Correlations among some aspects of balance, physical activity, self-efficacy, and resilience before and after training were also evident.
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    The Effects of an Online Movement and Cognitive Dual Task Training Program for Community-Based Adults and Older Adults on Executive Function: A Pilot Study
    (2022) Elsarafy, Lobna; Guccione, Andrew A
    Objective: To examine the effects of a 30-minute, 3x/week, 24-session at home online movement and cognitive exercise program on executive function in community-based adults and older adults. Background: Cognitive performance is known to decline over time. Essential for functional independence through the aging process, cognitive performance can determine whether an individual has the ability to live independently, drive safely, and manage medications and finances. There is a growing body of evidence supporting the use of dual movement and cognitive interventions to improve executive function in the aging population. No known studies have examined the impact of an online dual movement and cognitive training program on attention, visual and auditory spatial working memory and processing speed; three essential contributors to executive function. Methods: This was a prospective pre-experimental pilot study. Participants were recruited from the greater Washington, D.C area, including those who reside in independent living facilities. Twenty-two individuals consented (age: 75.95±3.55; gender: 17F/5M) and completed the Brain and Balance (BAB) program which consisted of 24-online training sessions, spanning approximates 30 minutes each, 2-3 times per week. Outcome Measures: Administered via videoconference, baseline and post intervention measures of cognitive performance included the Deary-Liewald simple (RTS) and choice (RTC) reaction time task, the forward (DS-f) and backwards Digit Span (DS-bk), Letter Number Sequencing (LNS) and the spatial addition (SA) subset of the Wechsler Memory Scale-IV. Data Analysis: Statistical analysis was completed using STATA IC version 16 and Microsoft Excel. Normality was visually confirmed with histogram graphs. A comparison of means pre and post training was completed using a paired t-test with a significance set at level of p≤0.05. Scatter plots were used to depict individual baseline and post treatment scores for each outcome measure, the difference in scores and mean difference (meandiff). Cohen’s d unbiased was used to calculate effect size. Results: Following BAB, improvements in RTS (meandiff = -10.95ms), RTC (meandiff= -37.50ms), DS-f (meandiff = 0.54), DS-bk (meandiff = 0.57), LNS (meandiff = 0.62) were observed. Small effects were observed for DS-f (Cohen’s d (unbiased) = 0.201), DS-bk (Cohen’s d (unbiased)= 0.236), LNS (Cohen’s d (unbiased)= 0.206). RTS and RTC were treated as non-parametric data, there was a small effect for RTC with r=0.210, however RTS effect was unremarkable at r= 0.053. SA data were grouped by baseline performance (low performers ≤ 10, high performers >10). Following BAB, improvements in low performers (meandiff = 0.60) and small effect (Cohen’s d (unbiased) = 0.27) were observed. However, baseline high performers in SA task showed a moderate decline post treatment, likely attributed to a possible regression towards the mean. Conclusion: Participants trended towards improvement in cognitive performance following an online simultaneous movement and cognitive training program. Further research is necessary to determine magnitude of change and functional implications associated with dual movement and cognitive training in this population.
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    Substance Use Disorders and Mental Health Illnesses Among U.S. Veterans: A Multi-Method Study Using Quantitative and Qualitative Research Methods
    (2022) Betancourt, Christian; Kitsantas, Panagiota
    This manuscript-style dissertation presents three studies highlighting some of the biggest challenges that U.S. veterans face after leaving the military, and explores trends related to their challenges. The most pervasive types of veteran’s health care treatment needs are for substance use disorders (SUD), suicidal behaviors (ideation, plan, attempt), and depression. Research evidence shows that among veterans who used the Veterans Health Administration (VHA) health care system, nearly half were diagnosed with at least one SUD. A study on military personnel found that approximately 30% of suicide attempts that resulted in death were preceded by substance use. Veterans who have experienced SUDs and homelessness also have a greater likelihood of struggling with depression and suicidal behaviors. The purpose of the first two studies were (1) to examine risk factors that contribute to SUD relapse upon completion of SUD treatment, (2) to estimate the prevalence of suicidal behaviors and prescription opioid misuse among veterans, and (3) to identify associations between suicidal behaviors and misuse of prescription opioids as well as other sociodemographic and behavioral determinants of health using data from large nationally representative datasets that are not affiliated with the VHA system. The third study used semi-structured interviews to conduct a phenomenological study in exploring the perspectives of homeless veterans living with SUDs and assess how social ecological factors impact their recovery. This multi-method study provides a robust analysis of the veteran population using nationally representative data and veterans’lived experiences through collection of data from semi-structured interviews. All three studies used non-VHA data, thus, producing an alternate assessment of all veterans, not just those who receive care from the VHA. The first study found that approximately 94% of veterans relapsed upon discharge from outpatient or residential SUD treatment. It also showed that veterans with homelessness, unemployment, or arrests upon discharge had a higher likelihood of relapse after SUD treatment completion. The second study revealed that approximately 3.7% of veterans experienced suicidal behaviors and nearly 3.0% reported prescription opioid misuse. This study also determined that 16.3% of veterans who misused prescription opioids also demonstrated suicidal behaviors; these results showed a much higher prevalence of suicidal behaviors than those with prescription opioid use without misuse (4.8%) and those with no prescription opioid use (2.5%) in the last year. The third study established that veteran homelessness and substance use are strongly associated with trauma suffered while on active duty and personal adverse life events. These experiences varied from grieving the death of a family member to being the victims of physical and sexual assault. Our findings suggest that a more focused approach to address substance use and mental health illness, along with permanent housing must be placed on veterans who recently separate from the military.
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    Three Essays on Antipoverty Programs and Reductions in Child Maltreatment
    (2022) McCray, Neil; Anand, Priyanka
    Millions of children are reported maltreated in the United States each year. In addition to the costs imposed on victims, maltreatment also imposes costs on society at large, including short and long-term medical care, reductions in education and workforce productivity, and increased criminality, among other costs. Finding ways to reduce maltreatment risk is a critical concern of public policy. Because poverty is a primary risk factor for child maltreatment risk, researchers have considered whether antipoverty programs might reduce child maltreatment. This dissertation consists of three papers discussing and assessing the effects of antipoverty programs on child maltreatment. The first paper discusses theories that explain the relationship between poverty and child maltreatment generally – primarily family stress and family investment models – and then considers literature on the relationship between child maltreatment and several antipoverty programs and policies including the Earned Income Tax Credit, the Supplemental Nutrition Assistance Program (SNAP), Medicaid, Temporary Assistance for Needy Families (and its predecessor, Aid to Families with Dependent Children), and the minimum wage. Findings from the literature suggest strong theoretical reasons to expect that antipoverty programs should reduce maltreatment risk, that there are correlations between antipoverty program increases and reductions in child maltreatment, and some more recent causal studies demonstrate policies can reduce maltreatment risk. The second and third papers each consider a different antipoverty program (Medicaid and SNAP, respectively) and use variation in policy decisions at the state-level to assess effects on child maltreatment outcomes. Paper two considers Medicaid’s effects on child maltreatment. First, the paper discusses why Medicaid might reduce maltreatment risk, both via the proposed theoretical models relating to socioeconomic status and via changes in health care utilization for both adults and children. Because the Patient Protection and Affordable Care Act’s (ACA) Medicaid expansions, which were originally mandatory, were rendered optional by the U.S. Supreme Court’s decision in National Federation of Independent Business v. Sebelius, state selection to expand or not expand Medicaid functions as a sort of natural quasi-experiment. This paper exploits variations in state selections to expand or not expand Medicaid to identify the causal effect of Medicaid expansion on child maltreatment outcomes. Prior to the ACA, a number of states had state-funded programs expanding Medicaid similar to ACA Medicaid expansions. Some states also chose to expand Medicaid early or to partially expand their programs. Due to these and other variations, precisely defining which policy changes constitute “Medicaid expansion” can be complicated; this paper considers several different definitions of expansion to examine whether inclusion or exclusion of some states affects results. The paper finds that January 2014 Medicaid expansions led to reductions in child neglect, but the robustness of that result is sensitive to which states are included in the sample in terms of when they expanded and the generosity of their prior Medicaid coverage. The third paper considers the relationship between SNAP and child maltreatment. The paper first considers theoretical reasons why SNAP might affect child maltreatment risk, including family stress and family investment models, and then considers additional factors relating specifically to food insecurity. Then the paper turns to empirically assessing whether SNAP leads to reductions in child maltreatment. It exploits variation in state decisions regarding broad-based categorical eligibility (BBCE) in SNAP, a policy which increases the number of people eligible for SNAP and can also simplify application processes. State selection of BBCE leads to reductions in neglect and sexual abuse, and some findings indicate BBCE may also reduce physical abuse and medical neglect, though those findings are sensitive to model specification. This dissertation discusses several theoretical reasons why antipoverty programs should reduce maltreatment risk, assesses literature on several programs, and empirically assesses the causal effect of two programs – Medicaid and SNAP – on child maltreatment outcomes. Findings suggest Medicaid expansions may reduce neglect, though the results are sensitive to how Medicaid expansion is defined, and that SNAP broad-based categorical eligibility reduces neglect and sexual abuse. Results support the proposed theoretical models and more generally support the idea that antipoverty policies and programs may reduce child maltreatment.
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    Investigation of the Correlation between Screen Time, Social Media Status, and BMI Status among Mason College Students
    Alsayegh, Abdulrahman; Alsayegh, Abdulrahman; Batheja, Sapna
    People's lives have become increasingly reliant on technology, especially with the emergence of social media. Research has shown that high technology usage has a detrimental impact on health and is linked to rising rates of overweight individuals and obesity worldwide (Chau et al., 2014; Liu et al., 2021; Melton et al., 2014). There is a surge in the number of college students who use technology. Previous research examined the effect of technology on BMI in children and adolescents (Alotaibi et al., 2020; Rosen et al., 2014; Shen et al., 2021), but to date, there has been limited research conducted on young adults ages between 18 -24. Increased technology usage is one of the main culprits that lead to poor dietary choices and sedentary lifestyles, both of which have been linked to an increase in BMI (Chau et al., 2014; Liu et al., 2021; Melton et al., 2014). This study aims to examine the relationship between screen time usage and an increase in body mass index (BMI) among George Mason University college students. The data was abstracted from the Health Starts Here Study and included 131 first year students from George Mason University. Technology usage, BMI, diet, physical activity, and sleep were obtained through various questionnaires and anthropometric measurements. These variables were analyzed using different statistical tests: Person's correlation, independent t-tests, and stepwise regression analysis. The results showed that there is a non-significant correlation between using social media, BMI, and dietary choices. Person's correlation result revealed that the correlation between social media and BMI was r (129) =.072 p=.416 while the correlation between BMI and diet was r (129) =.09 p=.30. T-test result showed on average low-tech usages (M#.24, SD=5.09) had lower BMI scores than high-tech usage (M$.71, SD=6.81). This study concludes that the amount of time of using social media has no impact on increasing BMI.
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    Measuring Food Preparation Equipment in the Home: Developing and Field Testing an Instrument for Use in a Pediatric Obesity Intervention
    Kogan, Kelly; Kogan, Kelly; LaCharite, Kerri
    Background: Hispanic children are disproportionately affected by obesity in the United States. Interventions targeting the home food environment of obese Hispanic children may contribute to reductions in obesity in both the short term and the long term. One component of the home food environment that has not been studied is food preparation equipment present in the homes of obese Hispanic children. Objectives: To develop and field test an instrument for the collection of data about food preparation equipment present in the homes of obese children of Spanish-speaking Central American immigrants living in the Woodbridge area of Northern Virginia. Method: A multi-stage process was used to develop and field test the instrument: A literature review was conducted to identify any existing instruments that could be used to collect data on the home food preparation equipment of the target population. Since no appropriate instrument was identified from this review, an instrument in the form of a checklist was developed. Face validity of the checklist was assessed using a review by a native Spanish speaker with experience working with the target population. Content validity of the checklist was assessed through its use in field tests that occurred in the homes of two members of the target population. Both quantitative and qualitative data were collected from these reviews and analyzed using descriptive statistics and NVivo software. Results: Face validity assessment revealed the need to include a photographic image of each item next to it on the checklist. With two limited exceptions, the checklist demonstrated good content validity. Descriptive analysis of the data collected with the checklist showed that the homes of both persons participating in the field testing were adequately stocked with the minimum number of items needed to store and prepare foods for home consumption. Qualitative analysis showed that both of these individuals regularly prepared balanced, healthy meals for their families. Both also showed interest in food and the process of cooking, although convenience was an important consideration. The reliance by one individual on the use of social media to obtain information about food and cooking skills suggests that efforts to promote home cooking as part of a family- and home-based obesity intervention must take these new ways of transmitting information into account. Overall, the checklist achieved the purpose for which it was developed. Field testing also suggested that the checklist was adaptable and could be used other populations of interest with some modification as appropriate to reflect their unique foodways.
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    The Influence of an Overground Locomotor Training Program on Walking Gait Propulsive Force in Ambulatory Patients with Parkinson’s Disease
    (2022) Corfman, Thomas A; Corfman, Thomas A; Guccione, Andrew
    OBJECTIVE: To determine the effect of a 12-week overground locomotor training (OLT) program on the anterior-posterior (A-P) ground reaction force in ambulatory subjects with mild to moderate Parkinson’s disease (PD).DESIGN: This is a pre- and post-test design interventional study. SETTING: The study was conducted at the university gait analysis laboratory. METHODS: Participants performed a propulsive force testing procedure before and after the OLT program. PARTICIPANTS: Eleven adults with mild to moderate PD (Hoehn & Yahr stage 1-3, ambulatory). INTERVENTIONS: The intervention was a 12-week OLT program. MAIN OUTCOME MEASURES: Gait parameters: peak anterior ground reaction force (AGRF), rate of rise (ROR) of AGRF, push-off impulse, push-off duration, peak posterior ground reaction force (PGRF), single stance duration, center of mass (COM) to center of pressure (COP) distance at push-off, and walking speed. RESULTS: Paired t-tests indicated significant differences in the ROR between pre and post OLT, the push-off impulse pre OLT and post OLT, and the preferred walking speed pre and post OLT. In addition, a Wilcoxon signed-rank test indicated significant differences in the push-off duration between pre and post OLT, and the single stance duration pre and post OLT. No significant differences were observed in peak AGRF and PGRF between pre and post OLT, and in the COM-COP distance between pre and post OLT. DISCUSSION: Taken together, our results suggest the OLT program was able to improve walking postural and dynamic stability in patients with PD. PD patients were able to spend less time in stance phase, less time in push-off duration, and decrease the rise time of the AGRF (push-off rate increased). This appears to have led to a quicker, more powerful AGRF without changes in peak PGRF, peak AGRF, or push-off posture, and an increase in walking speed in our patients with PD.
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    A Study of Administrative Data Representation for Machine Learning
    (2022) Asadzadehzanjani, Negin; Asadzadehzanjani, Negin; Wojtusiak, Janusz
    Administrative data, including medical claims, are frequently used to train machine learning-based models used for predicting patient outcomes. Despite many efforts in using administrative codes (medical codes) in claims data, little systematic work has been done in understanding how the codes in such data should be represented before model construction. Traditionally, the presence/absence of these codes representing diagnoses or procedures (Binary Representation) over a fixed period (typically one year) is used. More recently, some studies included temporal information into data representation, such as counting, calculating time from diagnosis, and using multiple time windows. However, these methods were not able to comprehensively capture temporal information in data and much of temporal information such as the exact time of the occurrence of an event, and the exact sequence of an event are missed. This dissertation presents the results of development and investigation of two additional methods of administrative data representation (Temporal Min-Max and Trajectory Representation) specific to diagnoses extracted from claims data before applying machine learning algorithms. It then presents a large-scale experimental evaluation of these methods by comparing them with traditional Binary Representation using four classification problems: one-year mortality prediction and high utilization of medical services prediction, prediction of chronic kidney disease and prediction of congestive heart failure. It was shown that the optimal way of representing the data is problem-dependent, thus optimization of representation parameters is required as part of the modeling.
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    The Effects of Performance-Based Overground Locomotor Training on Walking Turns Among Individuals with Parkinson’s Disease
    (2022) Pugh, Randy Jamil; Pugh, Randy Jamil; Guccione, Andrew A; Higgins, Rosemary D
    PURPOSE: Individuals with Parkinson's disease (PD), a progressive neurodegenerative disorder, exhibit compromised postural stability along with impaired gait and balance, contributing to walking limitations, including difficulty performing turns while walking. Previous studies demonstrated that individuals with neurological impairment improve walking capacity following performance-based overground locomotor training (OLT), but the effect of OLT on turning remains unknown. This study aimed to understand the effect of twenty-four sessions of OLT on walking turns among individuals with mild- PD.METHODS: Twelve participants with PD (7 Male / 5 Female; Age: 68.5±6.4 years; H&Y: 1-3) completed twenty-four 60-minute sessions of OLT, twice-weekly. Pre- and Post-assessments included the ten-minute walk test (10MWT) with the primary outcome measures including thoracolumbar rotation change in the vertical axis and peak turn velocity change in frontal (PTVF) and transverse (PTVT) planes. xii RESULTS: Mean thoracolumbar rotation change was not significant following OLT (+0.23 ± 4.24°;95% CI: -4.30, 3.84; p= 0.454;Cohen’s d = 0.05). Mean normalized thoracolumbar rotation change was also not significant (- 0.59 ± 5.52 (unitless);CI:[-12.05, 10.73]; Cohen’s d = 0.10)p = 0.45; Cohen’s d = 0.05). Mean PTVF showed a moderate and significant increase following OLT (1.59 ± 2.18 °/s; 95%CI: 0.20, 2.98; p = 0.014; Cohen’s d = 0.43). The effect of OLT on mean PTVT was small and not significant (0.88 ± 3.18 °/s; 95%CI: -2.90, 1.14; p = 0.179; Cohen’s d = 0.25). CONCLUSION: This study provides preliminary evidence suggesting individuals with mild-PD moderately improved frontal plane dynamic postural stability during walking turns following performance-based overground locomotor training.
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    Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses
    (2021) Kutahyalioglu, Nesibe Sumeyye; Kutahyalioglu, Nesibe Sumeyye; Scafide, Katherine N.
    Background: Family-Centered Care (FCC) is considered to be the gold standard ofNICU patient care. Some of the benefits of FCC practice include greater neurobehavioral development and shorter hospital stay for infants and improvement in staff satisfaction and feelings of reward for nurses. However, barriers to FCC exist in its implementation. Current research has yet to examine how organizational and nursing factors, such as nurse empowerment and compassion fatigue (CF), may be associated with FCC practice in the unique NICU environment. Therefore, the overall purpose of this mixed methods study was to investigate implementation barriers and facilitators of FCC among neonatal nurses. Specific Aims: This mixed-methods study aimed to: a) determine the relationships between nurse empowerment, compassion fatigue, and FCC practices among NICU nurses, while controlling for individual and institutional characteristics; and b) generate a grounded theory that identifies the process by which neonatal nurses engage in FCC practices in the context of the NICU setting. Method: A sequential, convergent mixed-method (quan>QUAL) design was used to address the study aims. The quantitative portion of the study used a cross-sectional, descriptive correlational design. The qualitative component of the study used a grounded theory approach to give a more comprehensive context and explanation of the delivery of FCC. The study was funded by National Association of Neonatal Nurses (NANN) and Sigma Theta Tau International Epsilon Zeta Chapter. Subjects were recruited from social media and NANN membership. A total of 176 bedside NICU nurses with at least 6- month experience were recruited to complete an anonymous, online survey. The following established instruments were included in the survey: The Family-Centered Care Questionnaire-Revised, The Psychological Empowerment Instrument, and the compassion fatigue subscale of Professional Quality of Life Scale. A purposive sample of survey participants was selected from the respondents who agreed to volunteer for an interview. These unstructured, 60 minutes interviews were conducted virtually using web conference software. A total of 20 neonatal nurses were interviewed. Quantitative data analysis consisted of bivariate and multivariate statistical procedures. Hierarchical linear regression analysis was conducted to identify the variables that explain the most variance in FCC. Grounded theory strategies guided the analysis of the qualitative data. Integration of qualitative and quantitative data occurred through a sampling plan, analysis, and discussion. Conclusion: This study contributed to our understanding of the facilitators and barriers to NICU nurses' FCC practices and the role of CF and nurse empowerment. Findings arising from this study were disseminated in several scholarly conferences and the two prepared manuscripts will be disseminated in neonatal science journals. Future studies should examine facilitators and barriers of FCC practices in the NICU from other healthcare providers' perspectives and evaluate interventions.
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    Magnesium Intake and Odds of Migraine Occurrence in Pre- and Peri-Menopausal Women Participating in the Study of Women’s Health Across the Nation (SWAN)
    Djohi, Manisha Khatri; Djohi, Manisha Khatri; Slavin, Margaret
    Background: Migraine is a neurological disorder that causes disabling headaches that can impede day-to-day normal activities. It is three times more prevalent in women than men following puberty. Menstrual migraine, a subtype of migraine that occurs during the perimenstrual period, is typically more difficult to treat than non-menstrual migraine and can be exacerbated during peri-menopause. Magnesium supplementation has shown promising results in reducing the occurrence and intensity of migraine attacks, including menstrual migraines, but information on dietary magnesium intake in pre- and peri-menopausal women in relation to migraine and menstrual migraine is scarce. Objective: The overall aim of the study was to observe the association between dietary magnesium intake and migraine status in pre- and peri-menopausal women. Methods: This analysis included cross-sectional data from 3,022 pre- and peri-menopausal women, aged 42-52 years old participating in the Study of Women’s Health Across the Nation (SWAN). Migraine status was determined from an interview questionnaire, and individuals were classified into four groups: menstrual migraine (n=794), non-menstrual migraine (n=43), history of migraine (n=181), and never migraine (control) (n=2,004). Dietary magnesium intake was determined through the Block Food Frequency Questionnaire. Odds ratios and 95% confidence intervals were calculated using multinomial logistic regression, and p-trends were calculated using median regression. Variables adjusted in different regression models included BMI, race/ethnicity, menstrual status, alcohol consumption, total family income, health insurance, and food group (fruit, vegetable, dairy, grain, and meat) and magnesium intake. Results: Mean dietary intake of magnesium at baseline was below the recommended age-based and gender-based dietary allowance in all migraine status groups. In the unadjusted model, women had higher odds of non-menstrual migraine (ORQ4=2.69 [1.11-6.49], ptrend=0.014) with increasing dietary magnesium intake quartiles as compared to controls. The relationship remained consistent when the model was adjusted for food groups and demographics. For dietary magnesium intake, no statistically significant relationship was observed (ptrend>0.05) in the unadjusted and adjusted models for the menstrual migraine group and the history of migraine group. Except for meat, the mean intake of all other food groups was below the recommended age-based and gender-based food group servings for all the migraine status groups. Conclusions: Dietary magnesium intake and food group intake of pre- and peri-menopausal women with different migraine status are lower than the recommended intake levels. The debilitating nature of migraine might affect the dietary choices of individuals which could lead to inadequate intake of healthy food groups and micronutrients such as magnesium. A statistically significant difference was observed in the non-menstrual migraine group in relation to dietary magnesium. These findings suggest this group may not have been limiting their food choices to avoid triggers or in response to symptoms as they indicated they consumed medication for migraine. However, the results in our study did not show any statistically significant difference in the menstrual migraine group in relation to dietary magnesium intake. Menstrual migraine is harder to treat and does not respond well to migraine medication. This could indicate that diet alone may not prevent menstrual migraine symptoms and may require supplemental treatment(s), which is to be expected given current understanding of migraine pathophysiology. Limited studies that have observed improved symptoms in women with menstrual migraine have made use of supplemental magnesium in high doses. More research is needed on the effect of dietary magnesium intake on features of migraine such as frequency, intensity, and attack duration in this population, particularly in relation to hormonal fluctuations and other pathophysiological mechanisms specific to this population.
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    Dietary Supplement Use in Transmasculine Spectrum Populations
    Kalman-Rome, Eli; Kalman-Rome, Eli; de Jonge, Elisabeth
    Introduction: There are currently no dietary guidelines for the transgender community, and very little is known about the specific nutritional needs of this population. Previous studies suggest that transmasculine spectrum individuals may use dietary supplements in a way different from the general population due to cross-sex hormone therapy, struggles with gender dysphoria, and other elements of transitioning. Objective: To learn how the transmasculine spectrum population differs in its use of dietary supplements by comparing survey reports to the NHANES, 2007-2010 dataset. Methods: Forty-eight participants completed an online survey detailing their dietary supplement use and demographic information so that general trends could be determined. Findings: The rates of supplement use in the sample were significantly higher than the general population and although the participants reported good access to healthcare, the supplements were relied on heavily for overall wellness, specific complaints, and especially mental health. Medical transition status did not mitigate supplement use. There was no relationship between dietary supplement use and BMI or dietary supplement use and income. Conclusion: The transmasculine spectrum population uses dietary supplements in unique ways from the general U.S. population, and further research must be conducted to better understand how to provide proper nutritional guidance to transmasculine spectrum individuals.
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    Dashboard for Machine Learning Models in Health Care
    Bagais, Wejdan H; Bagais, Wejdan H; Wojtusiak, Janusz
    Presentation of machine learning (ML) model results plays an important role in decision makers’ trust and use. Yet, there has been little agreement on how information should be visualized to present models' evaluations. The purpose of this thesis is to formulate an approach to visualize the results of classification model’s evaluation to increase decision makers’ trust. This work proposes a dashboard that visualizes supervised ML model performance in a dashboard which is split into three main sections: statistical measures, feature importance, sensitivity analysis. Three sample dashboards were generated and evaluated using a survey by ten faculty members and students from George Mason University most of which said that the dashboard provides useful information and gives a better understanding of the model behavior than other methods they have experienced. Model evaluation strategies differ based on the prediction problem considered. However, a consistent representation of evaluation results may increase decision makers’ trust in the models. The next step of this project is to visualize the difference between multiple models.
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    The Relationship between Loneliness, Dietary Behaviors, and Physical Activity in College Students
    Jiang, Li; Jiang, Li; de Jonge, Elisabeth
    Background: Loneliness, a common negative emotion, is prevalent in college students. Studies have reported a relationship between loneliness and bodyweight in young adults, but there is a lack of studies examining loneliness, dietary behaviors, and physical activity in college students. The underlying factor in the relationship between loneliness and bodyweight is not fully understood. Purpose: This study aims to fill the gap in current literature by analyzing relationships between loneliness, dietary behaviors, and physical activity to determine whether loneliness is associated with unhealthy dietary and physical behaviors that would potentially influence bodyweight in college students. Methods: Cross-sectional data was retrieved from Mason: Health Starts Here, an ongoing longitudinal cohort study of incoming first-year students at GMU starting in 2019. Dietary intake was assessed using the Diet History Questionnaire III (DHQ-III). Loneliness and physical activity were assessed by surveys. Chi-square, Independent T-Test, and binary logistic regression were used to analyze the relationships between loneliness levels, dietary behaviors, and physical activity. Results: Two hundred and sixty-four students completed the DHQ-III, loneliness, and physical activity surveys. Loneliness score (ranging from a score of 4-12) was categorized into low, medium, and high level groups for chi-squared test and regression analysis. High-level loneliness was a significant predictor of fat intake in obese (p = 0.034) students and also associated with physical inactivity regardless of gender (p = 0.002). Research results also showed a relationship between high level loneliness and increased sugar intake for female students (p = 0.038). Conclusions: High level of loneliness has associations with both fat and added sugar intake and physical inactivity. Additionally, loneliness was potentially associated with saturated fat intake. These unhealthy dietary behaviors and physical inactivity may relate to unhealthy bodyweight in college students. The study results lay a foundation for future studies to examine the relationship between loneliness and dietary behaviors.