<p dir="ltr">This dissertation includes two independent chapters which investigated the relations between upward social mobility (USM) and mental health in the United States. Chapter 1 was a systematized review which identified, cataloged, and synthesized the existing literature on the relations between USM and mental health in the United States. Four electronic databases were searched (i.e., PsycINFO, PubMed, Scopus, and Web of Science) and, through an exhaustive screening and data extraction process, a sample of 15 studies were reviewed. Chapter 1 used narrative synthesis (i.e., tabulation and thematic analysis) to describe and synthesize patterns across the existing literature. Notably, review findings revealed great variability in both research methodology used by studies as well as study findings. Moreover, review findings suggested that the variability observed among study findings was likely influenced by a lack of consistent operationalization of social mobility. Finally, recommendations for future research were provided.</p><p dir="ltr">Chapter 2 was an empirical study that examined moderators and mediators of the relations between USM and mental health. Based on the status-based identity framework (SBI; Destin et al., 2017), I hypothesized that USM would relate to poorer mental health, that belonging would mediate the relations between USM and mental health, and that internalized classism, interpersonal classism, and social class centrality would moderate the mediation. Data from a sample of 331 U.S. adults were collected via Prolific. While study results supported the first two hypotheses, only interpersonal classism was found to moderate the mediation. Specifically, the conditional indirect effect showed that those who experienced high and moderate levels of interpersonal classism had a negative relation between USM and belonging. Finally, study limitations and implications for research and clinical practice are discussed.</p>

The Hispanic population in the United States has increased to 62.1 million, significantly shaping the country's demographic landscape, with Hispanic women exhibiting the highest fertility rates. Concurrent with the population's growing trend is an increased prevalence rate of postpartum depression, with Latinas facing heightened risk factors. The inadequate representation of Latinas in postpartum depression research and healthcare guidelines exacerbates their vulnerability. The prevalence of postpartum depression among Latina women makes this condition a serious public health concern. Due to insufficient research on marginalized groups, emphasis is needed on culturally competent healthcare. This literature review aims to explore the underlying factors contributing to higher rates of postpartum depression among Latina women, analyzing existing research and any gaps or limitations in the existing body of knowledge. By examining common themes, it seeks to disclose intervention strategies that address the unique needs of this demographic. A literature review from 2020-2023 analyzed research on postpartum depression in U.S. Latina women, utilizing online databases, focusing on factors, interventions, and healthcare disparities. Identified were ten studies focusing on postpartum depression among Latina women, revealing themes such as unique risk factors, including discrimination, domestic violence, traumatic births, and healthcare access; disparities in access to treatment exacerbated by stigmatization and healthcare coverage gaps; and the effectiveness of community health worker in screening and treatment interventions. In conclusion, various risk factors and disparities were identified, with community health workers' involvement presenting a promising approach to addressing the unique experience of postpartum depression among Latina women.

African Americans (AA) are twice as likely as White Americans (WA) to experience diabetes-related foot amputation due to foot ulcers. Foot ulcers are often caused by high plantar pressure, and several factors can impact plantar loading. Thus, there is a need to determine if race is a significant predictor of plantar loading. Additionally, with the current state of racial health disparities there is a need to determine racial differences in research engagement and mistrust between AA and WA. Data was collected from 107 participants, aged 18-30, in this Institutional Review Board approved study. An EMED pressure-measurement system (Novel Electronics, St. Paul, MN, USA) was used to collect plantar loading data. Additional measurements collected from each participant included arch height index (AHI), standing height, gait speed, and weight. Participants also completed two surveys focused on research engagement and research mistrust. A multiple linear regression was used to test if race and other factors significantly predicted plantar loading. Non-parametric tests were used to test if there were significant differences in research engagement and mistrust between AA and WA. The analysis determined that race was a significant predictor for plantar loading, along with age, AHI, gait speed, sex, and body mass index (BMI). Additionally, it was found that research engagement practices and feelings of research mistrust differed significantly between AA and WA young adults. These findings could improve our understanding as to why AA are more likely to have diabetic foot ulcers than WA, and why AA are less likely to participate in research than WA. / M.S. / African Americans (AA) are twice as likely than White Americans (WA) to experience diabetes-related foot amputation due to foot ulcers. Foot ulcers are often caused by high plantar pressure, and several factors can alter plantar loading. Thus, there is a need to determine if race is a significant predictor of plantar loading. Additionally, with the current state of racial health disparities, there is a need to determine racial differences in research engagement and mistrust between AA and WA. Data was collected from 107 participants, aged 18-30. A pressure-measurement system was used to collect plantar loading data in seven regions of the foot during self-selected speed walking. The measurements collected from each participant, included arch height, standing height, gait speed, and weight. Participants were also asked to complete two surveys focused on research engagement and research mistrust. We used this data to evaluate if race and other factors predicted plantar loading and to compare survey responses between AA and WA. It was found that race, age, arch height, gait speed, sex, and BMI were considered significant predictor variables for plantar loading measures. Additionally, research engagement practices and feelings of research mistrust differed significantly between this younger sample of AA and WA. These findings help to improve our understanding of why AA are more likely to have diabetic foot ulcers than WA, and why AA are less likely to participate in research than WA, even as young adults.

As defined by the US Department of Health and Human Services, health disparities are "a particular type of health differences that are closely linked with social or economic disadvantages." These disadvantages include, but are not limited to, unequal access to quality health care and health information. Health disparities adversely affect groups of people based on racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion. To address the root cause of health disparities there has been a call for more comprehensive frameworks for detecting, understanding, and designing interventions that will reduce or eliminate health disparities. One such framework is a Community-Based Participatory Research (CBPR) approach. CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of co-learning, mutual benefits, and long term commitment. CBPR also focuses on aspects of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities. The overall goal of this dissertation is to build capacity and address health disparities among youth and adults in the Dan River Region. This region is federally designated as a medically under-served area/population and is located in the health disparate region of south central Virginia and north central North Carolina. This research draws on two CBPR projects, including an 8-week community garden program lead by the Dan River Partnership for a Healthy Community (DRPHC) and a 3-month childhood obesity treatment program, iChoose, led by the Partnering for Obesity Planning and Sustainability (POPS) Community Advisory Board (CAB). Since one of the primary aims for CBPR is to increase community capacity, this approach is the ideal process for engaging communities that suffer from health disparities. Thus, engaging community members as collaborators, our studies reported on the relevance and application of CBPR while simultaneously addressing health and capacity outcomes in the health disparate Dan River Region. / Ph. D.

As restorative justice gained popularity in schools as a potential strategy for helping to reverse the deleterious effects of zero-tolerance policies, numerous misunderstandings and misapplications have emerged. This study focused on the experiences of school-based restorative justice practitioners and sought to foreground their voices and perspectives to highlight what is necessary for restorative justice work in schools to be effective. Critical narratives were used to elucidate participants’ perspectives and to allow their voices to serve as the focal point for the study. Findings were as follows: (a) the depth and ongoing nature of preparation practitioners undertake to sustain restorative justice work must be emphasized; (b) rather than a program or set of steps, restorative justice must be experienced as a set of principles or a philosophy grounded in genuine care and concern for individual people; (c) a cultural, political, and social shift is required for restorative justice to be implemented with integrity; and (d) restorative justice is a project of humanization and re-establishing democratic ideals. As such, educators in the field are encouraged to embrace the depth and complexity of the philosophical underpinnings of restorative justice and to acknowledge the personal, internal work that must be undertaken to serve a transformative function in school communities.

Around 46.2 million Americans living in rural areas are disproportionately burdened by health disparities. Likewise, obesity and obesity-associated diseases (e.g., diabetes, cardiovascular disease) are much higher for rural residents when compared to their urban counterparts. There is a high need to understand and address the nutritional determinants of these health inequities among adults and adolescents. One area of concern in rural dietary habits pertains to added sugars and more specifically, sugar-sweetened beverages (SSB). Excessive added sugars and SSB intake have been strongly linked to many of the nutrition and chronic disease disparities impacting rural residents. Moreover, studies conducted in rural populations have found high consumptions of these in both adults and adolescents. There is an opportunity to better understand added sugars and SSB patterns in rural populations to inform the development of culturally relevant, multi-level interventions that address high consumption. Study #1 is a cross-sectional study that explores top food and beverage sources of added sugars in the diet of adults (n = 301) living in rural areas of Southwest Virginia. Study #2 uses a nationally representative sample of adolescents (n = 1,560) from the Family Life, Activity, Sun, Health and Eating (FLASHE) study sponsored by the National Cancer Institute, to explore factors across the levels of the socioecological model associated with adolescent SSB intake. Study #3 utilizes focus groups and a pilot trial to understand language preferences, acceptability and use of SMS aimed at caregivers to reduce SSB intake in both caregivers and adolescents living in rural areas of Southwest Virginia (n = 33). Collectively, these three studies offer recommendations and culturally relevant strategies for future large-scale trials aimed at reducing SSB intake among adolescents and caregivers in rural communities and ultimately reducing rural health disparities. / Doctor of Philosophy / Rural populations in the United States are at higher risk for being diagnosed with and dying from preventable and obesity-associated diseases like heart disease and cancer. Excessive added sugars and sugary drink (i.e. sodas, sweet tea/coffee, energy drinks, sweetened fruit drinks, sports drinks) intake have been strongly linked to many of the chronic diseases afflicting rural residents. Moreover, studies conducted in rural populations have found high consumptions of these, in both adults and adolescents. There is a great need to better understand added sugars and sugary drink patterns in rural populations so that we can develop programs to reduce consumption that are also culturally well received. Study #1 in this dissertation explores top food and beverage sources of added sugars in the diet of 301 adults living in rural areas of Southwest Virginia. Study #2 uses a nationally representative sample of 1,560 adolescents to explain why adolescent SSB intake might be higher. Study #3 aims to understand language preferences, acceptability and use of a text message program to reduce sugary drink intake in both caregivers and adolescents living in rural areas of Southwest Virginia. Collectively, these three studies offer recommendations and culturally relevant strategies for future large scale trials aimed at reducing sugary drink intake among adolescents and caregivers in rural communities and ultimately improving rural health.

Diabetes mellitus affects 7.8% of the American population. National health statistic data and other research shows that racial/ethnic disparities exist in terms of prevalence and treatment outcomes. The present study investigated the role of patient health beliefs (i.e., locus of control, self-efficacy) and the doctor-patient relationship (e.g., satisfaction and collaboration with health care provider), as relative predictors of diabetic control (i.e., HbA1c levels) and overall satisfaction with diabetes care, in older adult participants with diabetes. Demographic, psychosocial, and diabetes-related data from the Health and Retirement Study (HRS) 2003 Diabetes Study were analyzed to compare treatment outcomes among non-Hispanic White, non-Hispanic Black, and Hispanic individuals with various types of diabetes. Non-Hispanic White individuals exhibited better diabetic control than their minority counterparts (F(2, 592) = 7.60, p < .001); however, no significant group differences were noted in terms of psychosocial factors. Diabetic control was best predicted by time since diagnosis (&#946; = -.21, p < .001), satisfaction with diabetes self-care (&#946; = .19, p < .001) and age (&#946; = .12, p < .01). In addition, satisfaction with provider care was best predicted by perceived collaboration with provider (&#946; = .44, p < .001), satisfaction with diabetes self-care (&#946; = .22, p < .001) and diabetes self-efficacy (&#946; = .08, p < .05). Recommendations for future research were discussed.

This study explored healthcare utilization among the Transgender and Gender Non-Binary (TGNB) population of Florida using Geographic Information Systems (GIS) to visualize and analyze the spatial distribution of unmet healthcare needs. The aim was to provide a clear comparison of unmet healthcare needs across various regions, highlight areas with the highest and lowest levels of unmet needs, and understand the demographic factors influencing these disparities. Utilizing survey data from the NIH-funded U=CARE study, which involved TGNB participants aged 18-26 from diverse racial/ethnic and socioeconomic backgrounds, the data were cleaned, geocoded, and analyzed within ArcGIS. Geocoded survey responses were linked to Florida Department of Transportation (FDOT) district boundaries. Choropleth maps were created to represent the percentage of respondents in each geographic unit reporting unmet healthcare needs, with color gradation indicating the intensity of these needs. Regional variations were found, with Northeast Florida and Northwest Florida showing the highest levels of unmet healthcare needs despite having the lowest participant counts, while Central Florida, which had the highest number of participants, also reported a substantial percentage of unmet healthcare needs. A demographic analysis indicated that younger participants, those with lower education levels, and individuals from diverse racial and ethnic backgrounds were more likely to report unmet healthcare needs. Districts with lower socioeconomic status (SES) showed higher levels of unmet needs, underscoring the critical role of socioeconomic factors in healthcare access. This study identifies specific regions and demographic groups with significant unmet healthcare needs, informing targeted healthcare interventions and policies. By integrating spatial and demographic analysis, it provides a comprehensive understanding of healthcare disparities among TGNB young adults in Florida, contributing valuable insights for improving health outcomes across diverse populations and addressing the specific healthcare challenges faced by this community.

Virginia Cooperative Extension's Family Nutrition Program (FNP), which includes EFNEP and SNAP-Ed, works to help limited-resource families across the state make informed food-choices. Virginia Cooperative Extension (VCE) lacks open-access physical activity resources representing individuals with varying weights, races, and ethnicities. In 2015, an integrated research-practice partnership was initiated for the development of an evidence-based physical activity resource for peer educators employed by FNP to use. The video suite, Move More, Virginia!, was created as open-access and includes demographically diverse individuals, representative of FNP clients. Study I determined client perceptions of physical activity and preferences for new resources. Study II identified FNP peer educators' perceptions of physical activity, their resource needs, and intent to use Move More, Virginia! resources. Both studies involved quantitative and qualitative data through surveys and focus groups. Formative data collected in Study I revealed the prominent themes related to clients (n=12) were physical activity facilitators (n= 100 meaning units (MU)) and physical activity barriers (n=77 MU). In Study II, peer educator responses(n=15) led to the emergence of four themes related to physical activity itself: barriers to incorporating physical activity within FNP (n=189 MU), physical activity facilitators (n=106), current delivery of physical activity (n=102 MU), and physical activity barriers (n= 16 MU). When prompted to share video specific feedback, the top theme was positive video feedback (n = 115 MU). Identified themes and subthemes provide deeper understanding of the organizational culture within FNP as thoughts, perceptions, and barriers to incorporating physical activity into FNP curriculum are highlighted. / Master of Science / Faculty and staff in the Virginia Cooperative Extension’s Family Nutrition Program (FNP), which includes EFNEP and SNAP-Ed, work to help limited resource families across the state of Virginia make informed food choices. In addition to nutrition, physical activity is related to health status. However, Virginia Cooperative Extension lacks free physical activity resources representing individuals with varying weights, ethnicities, and fitness levels. In 2015, an integrated research-practice partnership was initiated for the development of a physical activity resource for FNP peer educators to use during programming. The collection of videos, <i>Move More, Virginia!</i>, was created as a free resource and to include individuals that represented the community. Study I determined client perceptions of existing physical activity resources and preferences for new resources. Study II identified perceptions of physical activity and the resource needs of FNP peer educators to deliver physical activity programming. The studies involved concurrent qualitative data through focus group interviews and quantitative data through survey distribution. Results showed common client themes were physical activity facilitators and barriers. The top peer educator theme was barriers to incorporating physical activity within FNP. When prompted to share feedback on the <i>Move More, Virginia!</i> videos themselves, the emergent theme was positive video feedback. Thoughts, perceptions, and barriers to incorporating <i>Move More, Virginia!</i> into FNP curriculum are highlighted. These findings will guide future physical activity integration within FNP programs.

Health-related disparities remain a persistent, serious problem across the nation's more than 60 million rural residents. Rural Populations and Health provides an overview of the critical issues surrounding rural health and offers a strong theoretical and evidence-based rationale for rectifying rural health disparities in the United States. This edited collection includes a comprehensive examination of myriad issues in rural health and rural health care services, as well as a road map for reducing disparities, building capacity and collaboration, and applying prevention research in rural areas. This textbook offers a review of rural health systems in Colorado, Kentucky, Alabama, and Iowa, and features contributions from key leaders in rural public health throughout the United States.