In recent years, literature in the area of web-based interventions for health-related concerns has burgeoned due to the increasing popularity and accessibility of the World Wide Web. Researchers have investigated the success of web-based programs to facilitate improved health behaviors, weight loss, and social support. However, due to the relatively recent application of web-based health-behavior programs, little research has studied whether these interventions are effective with overweight older adolescents. The purpose of this study was to test the application of health behavior theory in an on-line intervention designed to address health behaviors such as exercise and nutrition in a sample of overweight older adolescents. Using a pre-test, post-test, randomized, control group design, participants (n=71) were randomly assigned to either the comparison (Information) group, or the treatment (Information plus Discussion) group. Specific aims of the study were: 1) To test a new health behavior theory, the Model of Influence of Social Support on Health Behavior (MISSHRB), in a group of older adolescents; 2) To determine the feasibility and clinical utility of an internet intervention for social support for overweight older adolescents, and 3) To examine the impact of that intervention on the MISSHB variables. Results provided partial support for the MISSHRB, with social support correlating significantly with expectancies, attitudes, and perceived behavioral control. Results also provided support for the hypotheses that family general support, family specific support, attitudes, and engagement in health behaviors would improve over time. Results supported the feasibility of using an internet intervention with overweight older adolescents, with participants easily engaging in the study, fulfilling study requirements and reporting improved perceptions of the utility of online groups for providing social support. Additionally, results approached significance for medical outcomes, with trends representing Body Mass Index decrease over time, and suggesting that the Information plus Discussion group lost more weight than the Information group. These data suggest that internet information and discussion groups have promise as a means of social support for older overweight adolescents who are interested in improving their health behaviors. These results also provide information about the usefulness of web-based programs in facilitating overweight older adolescents’ engagement in health-related behaviors and the utilization of internet support groups for other marginalized or socially stigmatized groups.

Immigration transition may be an opportunity for physical, psychological, and social improvement, but the health of transitioning individuals may actually be at an increased risk for decline. In order to overcome negative influencing factors on the health of immigrants trying to integrate into a new society, examining the impact of transitioning immigration on the health of immigrants is important. Transition has complex and multidimensional patterns based on an individual’s social and cultural background. Korean immigrants in transitioning to the U.S. have experienced a specific and unique situation. Thus, the primary purpose of this study was to identify the impact of immigration transition, which is defined in the middle-range theory of transition, on the health-promoting behaviors and mental well-being of Korean immigrants in the U.S. A cross-sectional, descriptive correlational comparative design was used for examining a total of 192 Koreans: 105 in the U.S. and 87 in S. Korea, which were selected through matched age and gender controls with Korean immigrant participants in the U.S. The average ages were 46.8 (Median = 47, SD = 12.5) of Korean immigrants in the U.S and 46.2 (Median = 46, SD = 12.7) of 87 native S. Koreans. Korean immigrants had a low level of acculturation and limited English proficiency. The level of health-promoting behaviors of Korean immigrants was higher than that of S. Koreans, especially in subscales of health promotion, nutrition, and safety. Social resourcefulness was a key predictor of health-promoting behaviors and mental well-being among Korean immigrants. Also, self-control was a dominant mediator on the relationship between behavioral acculturation and mental well-being. Increasing acculturation and English ability for Korean immigrants, as well as increasing self-control, family functioning, and social resourcefulness were found to be important to improve integrating Korean immigrants into the U.S. These findings provide essential information that all health care professionals can use to increase their awareness of the importance of appropriately treating individuals with different cultural perspectives as well as diverse populations coming from varied countries. / text

In this collection of essays I study individuals' health related decision-making and the consequences of those decisions for health and labor market productivity.

The primary aim of this study is to better understand the link between supportive and influential communication among individuals in romantic relationships and health behavior changes in their partners. Interdependence theory (Thibaut & Kelley, 1959) posits that individuals in relationships may interact in ways that emphasize their interconnected relationship by making behavioral transformations to align their own behavior with their partner (Kelley, 1979). In general, research suggests that behavioral transformations are associated with rewarding relationship outcomes (Rusbult & Van Lange, 2003), yet little is known about the communication climate within relationships and why individuals may engage in healthy or unhealthy behaviors for the sake of their relational partners. The present study examines how individuals make health-related transformations and how these transformations- both healthy and unhealthy- are associated with relationship quality, social support, and positive and negative social influence. Using the Actor-Partner Interdependence Model (Kenny, Kashy & Cook, 2006) and cross-sectional dyadic data from 169 couples, results indicate that individuals in relationships engage in healthy and unhealthy transformations for their partners and that interdependence theory assumptions can be applied to an interpersonal health communication context. Specifically, being in a supportive relationship was positively associated with health, relationship quality, and healthy behavior transformations. Social influence results were mixed. Positive social influence was associated with an individual's own health, relationship satisfaction, and their partner's health behavior transformations; negative social influence was associated with lower relationship satisfaction and commitment and more frequent unhealthy behavior transformations. Individuals who reported making healthy behavior changes for their partners experienced better relationship quality. Taken together, the results of this study highlight the importance of investigating health behaviors and communication as interdependent components of interpersonal relationships.

Individuals diagnosed with schizophrenia commonly experience problems with accurately assessing their health status due to cognitive deficits including impaired working memory, amotivation, and communication difficulties. Little is known about whether these deficiencies influence health behavior decision-making among individuals with schizophrenia. Individuals with schizophrenia die an average of 25 years earlier than those without a mental illness. Approximately 60% of premature deaths in this population are from medical comorbidities; mortality rates due to cardiovascular and pulmonary diseases are two to three times higher than the general population. In order to reduce morbidity and mortality, it is important to find effective ways to assist these individuals in modification of risky behaviors (e.g., smoking, poor dietary habits, and sedentary lifestyles) and to incorporate daily health promoting behaviors (e.g., balanced diet and regular exercise). This qualitative descriptive study was conducted to describe the decision-making processes used by adults with schizophrenia when making health behavior decisions, identify what it means to be healthy from the perspectives of adults with schizophrenia, and identify the perceived barriers and facilitators that affect health behavior decisions. Ten adults diagnosed with schizophrenia were interviewed for this study. Fifty-percent of participants were female, ages 28 to 59 years, and received treatment in a community mental health centers. Data were analyzed using content analysis. Methods included the use of field notes, open and axial coding, and development of a visual model. Trustworthiness of the findings was established through the qualifications and experience of the investigator, peer scrutiny, and member checks. Three phases of health behavior decision making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. The main category that described health behavior decision making was “Tracking Health Behaviors,” which resulted in the ability to maintain physical and mental health. Within each phase, specific actions associated with achieving and maintaining physical and mental health were identified and were displayed in a visual model. These findings provide a guide to clinicians in identifying health behavior decision making processes and may lead to the design of clinical interventions that improve the health status of adults with schizophrenia.

The present study aimed to analyze and describe the health behaviors or practices that of students in their first years of study at a private university in Lima. One hundred fifty five students participated with an average age of 18 years. A measure of health behaviors was administered anonymously. The results indicate that most students engage in healthy behaviors, but there are significant percentages of students who are presenting some risk behaviors, such little or no physical activity and exercise (especially in the group of womenand older students), little or no preventive health care, low consumption of water, fruits and vegetables, excessive alcohol consumption and excess use of tobacco. This study highlights the presence of symptomatic problems in sleep and leisure time in a large group of students. Intervention programs should be implemented in the university population to educate, motivate and change their adverse behaviors. / La presente investigación tuvo como objetivo analizar y describir las prácticas o conductas de salud que presentan un grupo de estudiantes en sus primeros años de estudio de una universidad privada de Lima. Participaron 155 estudiantes con promedio de edad de 18 años. Se les aplicó en forma anónima un cuestionario sobre conductas de salud. Los resultados indican que la mayoría de los alumnos presentan conductas saludables respecto a las áreas investigadas pero que paralelamente existen porcentajes significativos de alumnos que están presentando algunas conductas de riesgo, como la poca o ninguna realización de actividad y ejercicio físico (especialmente en el grupo de mujeres y los mayores), escaso o nulo cuidado preventivo de su salud, poco consumo de agua, frutas y verduras, consumo excesivo de alcohol y consumo de tabaco. Resalta la presencia, en un grupo considerable de alumnos, de problemas sintomáticos en el hábito del sueño y del descanso. Se recomienda la realización de programas de intervención en los estudiantes con el fin de informar, motivar y modificar sus conductas adversas. / A presente pesquisa tem como objetivo analisar e descrever as práticas ou comportamentos relacionados à saúde que apresentam um grupo de estudantes em seus primeiros anos de estudo em uma universidade privada em Lima. Participaram 155 estudantes; a idade média foi de 18 anos. De forma anónima realizaram um teste sobre sua conduta em relação à saúde. Os resultados indicam que a maioria dos alunos apresentam condutas saudáveis em relaçãoàs áreas pesquisadas, mas, paralelamente, existem percentagens significativas de alunos que estão apresentando algumas condutas de risco, como pouca ou nenhuma realização de atividades ou exercícios físicos, (especialmente no grupo de mulheres e maiores), assim como pouco ou nenhum cuidado preventivo com sua saúde, pouco consumo de água, frutas e verduras, e consumo excessivo de álcool e consumo de tabaco. É importante destacar a presença, em um número considerável de alunos, de problemas sintomáticos no hábito do sono e do descanso. É recomendável a realização de programas de intervenção nos estudantes, com o fim de informar, motivar e modificar suas condutas adversas.

Background: Mothers with HIV often face personal and environmental risks for poor maternal health behaviors and infant neglect, even when HIV transmission to the infant was prevented. Maternal-fetal attachment (MFA), the pre-birth relationship of a woman with her fetus, may be the precursor to maternal caregiving. Using the strengths perspective in social work, which embeds MFA within a socio-ecological conceptual framework, it is hypothesized that high levels of maternal-fetal attachment may protect mothers and infants against poor maternal health behaviors. Objective: To assess whether MFA together with history of substance use, living marital status, planned pregnancy status, and timing of HIV diagnosis predict three desirable maternal health behaviors (pregnancy care, adherence to prenatal antiretroviral therapy–ART, and infant’s screening clinic care) among pregnant women with HIV/AIDS. Method: Prospective observation and hypothesis-testing multivariate analyses. Over 17 consecutive months, all eligible English- or Spanish-speaking pregnant women with HIV ( n = 110) were approached in the principal obstetric and screening clinics in Miami-Dade County, Florida at 24 weeks’ gestation; 82 agreed to enroll. During three data collection periods from enrollment until 16 weeks after childbirth (range: 16 to 32 weeks), participants reported on socio-demographic and predictor variables, MFA, and pregnancy care. Measures of adherence to ART and infant care were extracted from medical records. Findings: Sociodemographic, pregnancy, and HIV disease characteristics in this sample suggest changes in the makeup of HIV-infected pregnant women parallel to the evolution of the HIV epidemic in the USA over the past two decades. The MFA model predicted maternal health behaviors for pregnancy care (R2 = .37), with MFA, marital living status, and planned pregnancy status independently contributing ( = .50, = .28, = .23, respectively). It did not predict adherence to ART medication or infant care. Relevance: These findings provide the first focused evidence of the protective role of MFA against poor maternal health behaviors among pregnant women with HIV, in the presence of adverse life circumstances. Social desirability biases in some self-report measures may limit the findings. Suggestions are made for orienting future inquiry on maternal health behaviors during childbirth toward relationship and protection.

Thesis advisor: Summer S. Hawkins / Thesis advisor: Mireya . Vilar-Compte / Child malnutrition, including overweight and stunting, is a public health concern that affects millions of families worldwide causing short- and long-term health, social and economic inequalities. The global prevalence of child overweight has increased over the past decades in countries across the economic spectrum. In contrast, the prevalence of child stunting has decreased globally yet remains the most prevalent form of child malnutrition commonly affecting children in the most vulnerable conditions in low- and middle-income countries (LMICs). Global initiatives have been adopted in response to the high burden of child malnutrition. In order to support these initiatives, researchers have focused on informing evidence-based, affordable and effective policies and interventions to prevent child malnutrition mostly within the programmatic timeframe of the first 1,000 days, conception through the first 2 years of life, and beyond. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child malnutrition. However, the protective effect of breastfeeding on child malnutrition has been discrepant across findings from LMICs and high-income countries (HICs). These inconsistencies may be due to differential contextual factors in LMICs and HICs. Theoretically grounded in the World Health Organization (WHO) conceptual models on social determinants of health and childhood stunting, as well as in the Dahlgren and Whitehead model, and cultural perspectives, the goal of this 3-paper dissertation was to assess the effect of breastfeeding duration and individual, household and area factors on child malnutrition among Mexican children aged 0 to 35 months living in México (a LMIC) and in the US (a HIC). Paper 1, hereon referred to as chapter 2, assessed the association between breastfeeding duration and child overweight while sequentially controlling for individual, household and area factors in Mexican children, and also assessed a 2-level mixed-effects logistic model accounting for households clustered within areas. We curated a subset from the 2012 Mexican National Health and Nutrition Survey (ENSANUT). We found evidence for an association between breastfeeding duration and child overweight, and maternal obesity and offspring high birthweight were consistent risk factors for child overweight across models, suggesting genetic and shared environment influences. Paper 2, hereon referred to as chapter 3, used the same subset but incorporated relevant risk factors for child stunting while using the same analytical approach. We found no evidence for an association between breastfeeding duration and child stunting. However, children who were never breastfed were at higher odds for stunting compared to those breastfed <6 months. Consistent risk factors for child stunting across models were increased child age, being male, child low birthweight, maternal ethnicity (self-identifying as indigenous), maternal short stature, higher count of children aged <5 years per household, and household moderate to severe food insecurity. These findings support the intergenerational effect of early stunting and the burden of food insecurity, perpetuating the cycle of inequalities. Paper 3, hereon referred to as chapter 4, incorporated a binational approach examining the effects of breastfeeding duration and individual and household factors on child malnutrition in Mexican-American children, and then compared results with Mexican children by running separate and pooled analyses. Besides using the ENSANUT 2012 subset, we curated a new dataset using 4 waves of the 2007-2014 National Health and Nutrition Examination Survey (NHANES) which provided data for Mexican-American children aged 0 to 35 months. ENSANUT variables were recoded to match NHANES subset. We found a protective effect of breastfeeding duration on child overweight among Mexicans and in the pooled dataset. The only consistent risk factor for child overweight among Mexican and Mexican-Americans was high birthweight. Regarding child stunting, we found no evidence for an association with breastfeeding duration but low birthweight was a risk factor across both populations, while being male and living in moderate to severe food insecure households were risk factors only for Mexican children. In general, findings from this chapter coincide with previously described patterns meaning that child stunting was mostly prevalent in LMICs such as México, and that country of residence and cultural perspectives were relevant when examining child malnutrition among Mexican immigrants. Altogether, results advance the knowledge base by providing a comparison of Mexicans sharing a nurturing system while living in 2 different sustaining systems, a LMIC- and HIC-context. Findings provide evidence for shared risk factors for child malnutrition across Mexicans in both countries as well as identifying country-specific factors. While we acknowledge that the cross-sectional design of both surveys, from which we curated our subsets, limit our ability to infer causality, these results have pertinent policy and intervention implications. Pre- and post-natal culturally-sensitive components in policies and interventions need to be aimed towards preventing proximal and distal risk factors for child malnutrition within the first 1,000 days and beyond, including the promotion and support of positive maternal health behaviors such as breastfeeding. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

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The world is experiencing a rapid rise in chronic health problems, which places an enormous burden on health care services. Modifiable health behaviors such as physical inactivity are largely responsible for this high prevalence and incidence of chronic diseases. Message tailoring is a well-established approach for constructing health communication and has been shown to increase the persuasiveness of messages in the promotion of healthy behaviors. Message framing is an effective strategy that has been well-studied in psychology over the past 20-plus years across a breadth of health-related behaviors but has received little attention in the nursing research literature. Based on prospect theory, temporal construal theory, and motivational orientation theories, the present study examined how two individual differences factors - consideration of future consequences (CFC) and motivational orientation - combine to moderate temporal proximity and valence framing effects on intentions to increase physical activity. A mail survey was conducted using Dillman's Tailored Design Method. Two hundred and eighteen adults with type 2 diabetes were randomly assigned to receive one of four versions of a health message aimed to increase regular physical activity. Messages were framed using a 2 (immediate- vs. distal-framed) x 2 (gain- vs. loss-framed) design. After reading the message, participants rated their intention to increase physical activity. They also completed a measure of CFC and two measures of motivational orientation. Participants who read a message with a temporal proximity or valence frame congruent with their CFC or motivational orientation, respectively, did not show greater intentions to increase physical activity when compared to those who read a health message that was incongruent with these individual differences. Plausible explanations for these negative results are considered. Several interesting findings emerged from supplemental analyses. For instance, participants who perceived the health message as more believable tended to have greater intentions to increase physical activity. Suggestions for future research applying message congruence to promote complex health behaviors in at-risk populations are given. Implications of message framing and other message tailoring strategies for nursing research, education, and practice are discussed.