Background. Emerging evidence suggests that youth with attention deficit/hyperactivity disorder (ADHD) may engage in sub-optimal health behaviors including high levels of screen time, low physical activity participation, and consumption of poor diets. These are independent risk factors for adverse health outcomes, and health-related behavior patterns established in childhood can track into adulthood. Thus, identifying and addressing dietary and physical activity habits in sub-populations of youth have important implications for health over the lifespan. The specific aims of this dissertation were to: (1) compare screen time between youth with and without ADHD and to assess its relationship to ADHD symptomatology; (2) compare participation in physical activity (PA) between adolescents with and without ADHD and to assess the relationship of PA participation to ADHD symptomatology; and (3) evaluate the association of diet quality and dietary patterns to ADHD symptomatology among youth ages 8-15 years. Methods. The aforementioned outcomes of interest were analyzed using data from the continuous National Health and Nutrition Examination Survey (NHANES) 2001-2004. These waves of NHANES included a structured DSM-IV-based interview administered to parents that identified youth with ADHD and also yielded symptom counts for hyperactivity/impulsivity and inattention. Screen time and physical activity data were obtained from questionnaires that queried the amount of time spent watching television, playing videos, or using the computer outside of school time, and also surveyed the types, frequency, and duration of PA in which youth participated. Diet quality and dietary patterns, which included consumption of sugar-sweetened beverages (SSBs), total calorie intake, and eating frequency, were obtained by a 24-hour dietary recall using the Automated Multiple Pass Method of interviewing. Linear and logistic regression models adjusted for sociodemographic factors and anxiety/depression were employed to address the specific aims. Results. The findings suggest that youth with ADHD are at the same, if not higher, risk for engaging in suboptimal health behaviors. Overall, youth participating in NHANES engaged in excessive amounts of screen time, failed to acquire sufficient physical activity, and consumed diets of poor quality. However, our findings suggest that ADHD symptomatology places youth at higher risk for sedentary behavior and poor diet quality. Relative to screen time, youth with ADHD showed a trend toward increased screen time, as did youth who took medication. ADHD symptoms were also associated with over two hours of daily TV viewing and overall increased screen time, and this was particularly true for children ages 8-11 years. Relative to physical activity, the outcomes did not differ between youth with and without ADHD, but the majority of youth did not meet the recommended guidelines of 60 minutes or more of moderate-to-vigorous PA each day. Diet quality was poor across the population of youth who participated in NHANES, and hyperactive/impulsive symptoms were associated with an even greater decrease in diet quality in both children and adolescents. In males, the presence of hyperactive/impulsive symptoms was associated with a decrease in diet quality, whereas in females, inattentive symptoms accounted for a decrease in diet quality. No differences in the other dietary patterns (i.e., SSB consumption, total energy intake, and eating frequency) were observed. Conclusions. The diagnosis of ADHD and/or its symptoms are associated with less-than-recommended levels of screen time and poor diet quality, though youth in general were found to be engaging in suboptimal sedentary, physical activity, and dietary behaviors. The mechanisms for why youth with ADHD may have increased vulnerability to poorer health behaviors are not yet well understood. The findings from this dissertation support the need for ongoing efforts to address lifestyle factors among the nation’s youth generally, but may also stimulate new hypotheses about the needs of youth with ADHD from both public health and clinical perspectives, and encourage research on the implications of ADHD symptomatology on health-related behaviors and lifestyle factors.

The purpose of this study was to describe diet and/or physical activity-based interventions and their control in cardiometabolic risk factors of diabetes for the South Asian (SA) population. A systematic review was conducted in accordance with the PRISMA guidelines. Seventeen randomized control trials meeting the inclusion criteria were included for analysis. Interventions with type-2 diabetic SA showed significant improvements in HbA1c% (4/5 studies), fasting blood glucose (3/4 studies), and postprandial glucose (2/2 studies). Interventions with at-risk/prediabetic and non-diabetic SA showed a modest change in overall outcomes, with significant change reported for post-prandial insulin (3/4 studies), BMI and weight (2/4 studies), and waist circumference (2/5 studies). These intervention studies showed modest control of risk factors particularly when the interventions included aspects of the culture and the attrition rate was lower. To be effective with South Asians, future studies need to have a culturally specific design, and a focus on both diet and physical activity.

Food borne illnesses continues to be a public health challenge in the United States (U.S.); an estimated 9.4 million incident cases occurred in 2011. In view of this challenge we conducted two food safety studies; 1) related to product formulation (hummus spoilage challenge study) and 2) evaluating the microbial safety of domestic kitchen surfaces in Residential Child Care Institutions (RCCI pilot study). Hummus is of Mediterranean origin but is currently eaten globally. This challenge study evaluates a variety of industrial hummus formulations (four in total, differing in pH and/or addition of a preservative (natamycin). Two batches were setup: batch 1; aseptically inoculated hummus with 100 CFU/g fungal isolates and batch 2; uninoculated hummus. Samples of both hummus batches were stored at both 20oC (10 days accelerated testing) and 4oC (84 days recommended temperature testing). Inoculated samples were analyzed for fungus, whiles both fungi and bacteria (standard plate count (SPC) and Lactococci) counts were done for uninoculated samples. Results indicate that accelerated testing inaccurately predicts fungal growth at 4oC in hummus, also fungal growth inhibition requires a pH ≤ 4.0 ± 0.2 and refrigeration. Limited studies have specifically evaluated the prevalence of pathogenic bacteria in domestic kitchens in the U.S, for this reason we assessed the microbial safety of 6 RCCI locations in MA. Fifteen key food contact surfaces and dish washing sponges, if available at each RCCI facility were assessed for SPC, yeast and molds, total coliform and E. coli, Listeria sp and Salmonella sp. Microbiological assessments were conducted preceding and after a hazard analysis and critical control point (HACCP) food safety training and implementation at each location. Microbial growth varied by surface for each type of microorganism, wet surfaces had higher most probable number (MPN) counts. Compared to dry surfaces, wet surfaces had significantly higher mean total coliform counts. For both E. coli and total coliform, microbial load differed significantly by surfaces sampled (P = 0.0323 and 0.014) respectively. The surface and training interaction effect was highly significant for only E. coli (P = 0.0089). Training overall had no significant effect on reducing the microbial load on kitchen surfaces.

Current research shows moderate alcohol consumption is associated with decreased risk of diabetes and excessive consumption or binge drinking can cause insulin resistance and diabetes. In 2010, diabetes was the seventh leading cause of death in the United Statesand was responsible for significant health complications: blindness, kidney failure, and limb amputations, and is a large national economic burden. Fasting blood glucose (FBG) is a tool used to help diagnose diabetes. Abnormally high FBG, ≥100 mg/dl, is indicative of diabetes and pre-diabetes. Few studies have observed diabetic prevalence among young adults or college students. Studying young adults can help provide added information about early risk factors for diabetes and pre-diabetes, facilitating public health efforts to stem the rising tide of the diabetes epidemic. This study aimed to research the associations between alcohol consumption (numbers of days alcohol consumed in the past month and binge alcohol consumption in the past month) and FBG in a college population as part of the FLASH cohort study. FBG levels were measured in 141 young adult participants and alcohol consumption was determined by self report. Other individual-level characteristics and potential confounding variables were also collected. The association between alcohol consumption and FBG followed a J-shaped curve whereby students who reported drinking 6-8 days within the last 30 days showed significantly lower FBG levels than those who did not drink and those who consumed alcohol on nine or more days (p=0.04). Binge drinking did not have a significant association with FBG (p=0.4). Sex and body mass index were also significantly associated with FBG. In conclusion, moderate frequency of alcohol consumption is found to have an inverse relationship with FBG and excessive drinking can reverse these effects.

<p>  </p> <p>Food insecurity describes the lack of access to foods and affects 10.2% of general U.S. households and 27% of low-income households in 2021. Food insecurity is a pervasive public health concern in the United States and has been linked to poor dietary intake and diet quality, overweight and obesity (especially among women), and risk of other chronic diseases, such as diabetes, hypertension and dyslipidemia. </p> <p>To better understand food security status and address its associated health and dietary outcomes among low-income populations, a conceptualized model was built and served as research framework for the dissertation, including 1) internal factors and motivations, such as traits related to self-efficacy and sufficiency that may influence diet and health; 2) external factors of temporary support, such as financial benefits from assistance programs that low-income populations are eligible for that may influence diet and health; and 3) external factors of potentially long-term support, such as nutrition education programs targeting low-income groups that may foster internalized knowledge that could sustain impact and improvement of diet and health in the long-term. Each chapter of this dissertation addresses a component of the model.</p> <p>Cross-sectional analysis of a sample of rural veterans using food pantries quantified psychological traits related to self-motivation and efficacy including grit and help seeking, at the individual and internal factors level of the conceptualized model, and their links to food security and resource use, and revealed an inverse association between grit score and risk of food insecurity. The findings provided evidence for future interventions targeting food insecurity improvement to include education and resources that address traits related to self-efficacy, such as grit, among low-income populations to improve health outcomes directly or through improving food security or use of resources. </p> <p>Using nationally representative data, the second study investigated relationships between food assistance through the Supplemental Nutrition Assistance Program (SNAP) participation, a type of societal level external support, and dietary outcomes among low-income older U.S. adults. There were no differences in dietary quality, usual nutrient intake or risk of inadequacy between SNAP participants and eligible nonparticipants. Furthermore, results revealed a high prevalence of not meeting the Estimated Average Requirement from dietary sources for several nutrients (vitamins A, C, D, E, calcium, and magnesium) but the prevalence was lower when nutrients from dietary supplements were included. The results highlight a need for continued effort to improve nutrient and dietary intake among low-income older adults.</p> <p>External factors of potentially long-term support (e.g. nutrition education and food assistance) were evaluated for relationships with body mass index. A longitudinal sample of low-income women interested in participating in nutrition education through SNAP-Education (SNAP-Ed) was examined to determine the relationship between nutrition education (SNAP-Ed) and food assistance program participation through (SNAP, WIC), separately and in combination, with long-term changes in body mass index. No differences in changes of weight status over time were observed by nutrition education, food assistance, or combination participation. The prevalence of obesity was high among this sample, calling for targeted obesity prevention interventions and further support of healthy lifestyle promotion among low-income populations. </p> <p>The findings shown in this dissertation further reveal a high health burden among low-income groups. The studies filled several research gaps described in the conceptualized model. The results may be used to inform future tailored interventions to address food insecurity, dietary and health outcomes at individual and societal levels, incorporating internal motivation and external support to mediate health and dietary risks among low-income population.</p>