Counseling Psychology and Human Services Theses and Dissertations

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Open Access
Examining Daily Associations of Nature Exposure, Body Appreciation, and Physical Activity Among Adolescents
(University of Oregon, 2024-08-07) Castro, Esmeralda; Budd, Elizabeth
Substantial evidence supports engaging in moderate-to-vigorous intensity physical activity (MVPA) for myriad health benefits, yet most adolescents are not active enough to maximize the benefits. Especially among girls, adolescence is marked by reductions in MVPA and body appreciation, both linked to poor physical and mental and health outcomes. There are mixed findings on how nature exposure (NE) is related to MVPA and body appreciation. Most of these NE studies were conducted among adults and all have measured NE by self-report or objective proxies (e.g., quantity of vegetation in an area), which are vulnerable to bias and inaccuracy. Objectives of the current study among adolescents were to determine 1) the daily associations among MVPA, body appreciation, and NE using an innovative mobile application that measures objective individual-level indicators of time spent in nature, 2) whether and how gender moderates these associations, and 3) if body appreciation indirectly affects the relationship between NE and MVPA. In summer 2023, a community sample of Oregon adolescents participated in a prospective 7-day study. Participants wore ActiGraph GT3X+ accelerometers to measure MVPA, enabled the phone application “NatureDose™” to measure NE, and answered the short form 3-item Body Appreciation Scale-2 daily. Adjusting for covariates, multilevel linear regressions and moderation analyses, and indirect pathway analyses were conducted. Participants (N = 209; M = 14.39 y/o ± 1.66; 50.23% cisgender girls; 80.19% White) were highly active (M = 281.9 ± 18.54 MVPA min/day), exposed to nature (M = 95.2 ± 66.6 min/day), and reported moderately high body appreciation (M = 3.99 ± 0.06 per day). Daily NE, not body appreciation, was significantly and positively associated with daily MVPA (γ10 = 10.26, p < .001). Gender did not moderate the daily associations. Body appreciation did not indirectly affect the relationship between NE and MVPA. This is the first study among adolescents to use an objective, individual-level measure of NE and confirm the previously identified positive link between NE and MVPA in this age group. Replication in more diverse adolescent samples is a next step. Findings support interventions that integrate nature and MVPA to promote adolescent health.
Open Access
Effects of the Family Check-Up Intervention on Child Outcomes: A Systematic Review and Meta-Analysis
(University of Oregon, 2024-08-07) Metcalfe, Robyn; Stormshak, Elizabeth
The Family Check-Up (FCU) is a brief, three-session parenting assessment and intervention designed to address child behavioral and emotional concerns by enhancing effective parenting behavior and parent motivation to change. In order to assess the impact on child outcomes, a systematic review and meta-analysis was conducted on randomized controlled trials of the FCU across all age groups to assess overall impacts on child behavior. Additionally, several variables, including both demographic factors (child age, percent of the study sample that is White, and percent of the study sample that is low-socioeconomic status) and implementation factors (sample screening, intervention dosage, the presence of implementation or fidelity concerns, percentage of the intervention group who received the intervention, study retention), were used examined as potential moderators of intervention effects on child outcomes. Fourteen studies (reporting findings in 98 reports) were included in the final analyses, a sample that represents 4598 families. Using intent-to-treat analyses, parents who were randomly assigned to the FCU had children with lower rates of alcohol use (ḡ = 0.15), lower rates of cannabis use (ḡ = 0.14), lower levels of short-term externalizing behavior (ḡ = 0.19; i.e., a one-year follow-up), lower levels of long-term externalizing behavior (ḡ = 0.15; i.e., a two-year follow-up), higher levels of self-regulation skills (ḡ = 0.16), lower levels of peer concerns, (ḡ = 0.13), better health outcomes (ḡ = 0.26), and lower body mass index (ḡ = 0.11) relative to comparison groups that were not assigned to receive the FCU. Very weak evidence was found for the impact of the intervention on internalizing behavior in the short term (ḡ = 0.22) and there was no evidence of an effect of the intervention on tobacco use, long-term internalizing behavior, or school outcomes. These results may under-represent the true intervention effects given the low percentage of families assigned to the FCU who received the intervention in some samples. Moderator analyses were conducted on internalizing and externalizing outcomes. Studies where a higher percentage of the intervention group actually received the FCU had stronger effects on internalizing outcomes. There was evidence of possible publication bias for the analysis examining long-term externalizing behavior (z = 2.23, p = 0.03, b = -.10, 95% CI [-.31, .11]), but a trim and fill analysis suggested that this potential bias was minimal and unlikely to affect the conclusion of beneficial intervention effects. Children of Asian/Pacific Islander, Indigenous American, and Latino/a/e/x descent were underrepresented in the sample, as were fathers and transgender and gender non-conforming parents. This analysis suggests beneficial impacts of the FCU across a range of domains, with additional research needed addressing long-term outcomes, diverse populations, and participant-level moderators of outcomes.
Open Access
Examining the Inclusive Skill-Building Learning Approach (ISLA) and Its Effectiveness in Reducing Exclusionary Discipline Disparities
(University of Oregon, 2024-08-07) Mannan, Irin; Kjellstrand, Jean
Background: Exclusionary disciplinary practices such as office disciplinary referrals (ODR), in-school suspensions (ISS), and out-of-school suspensions (OSS) are used across grades K–12 despite their negative impact on students, schools, and society. These forms of punishments are used for behavior management even though research has indicated their ineffectiveness. Studies have also found that exclusionary discipline is administered at disproportionate rates to students of color, males, and students with disabilities. The Inclusive Skill Building Learning Approach (ISLA) is an alternative that aims to reduce exclusionary discipline practices while providing instructional support when students are removed from the learning environment for practical behavior change. The purpose of this study is to examine ISLA’s effectiveness in reducing discipline disparities for students of color, males, and students with disabilities. Methods: This cohort study focuses on Oregon middle school students and examines ISS and OSS frequencies for 2021–2022 academic year. Sample participants (N = 891) include students from six schools, three ISLA schools and three non-ISLA. Negative binomial regression modeling was used to examine frequencies of ISS and OSS while controlling for school level variables. ISLA’s effects on ISS and OSS outcomes were also examined as moderated by student race/ethnicity, gender, and disability status. Results: Gender was a significant predictor for the ISS regression model and student disability status was a significant predictor for OSS whereby being male predicted 7% higher incidences of ISS and being a student with a disability predicted 92% higher incidences of OSS. Four of the six interactions modeled were also statistically significant, and results indicated that White students, males, and students with disabilities who attended ISLA schools had lower frequencies of ISS compared to students in the non-ISLA schools. Only White students who attended ISLA schools had lower frequencies of OSS compared to students in the non-ISLA schools. Conclusions: Findings indicate that ISLA is a promising intervention for reducing exclusionary discipline especially in terms of decreasing the frequency of in school suspension for specific populations such as males and students with disabilities. However, it is important to note that ISLA was not associated with fewer suspensions for Nonwhite students, who are often at the highest risk for exclusion. Implications, limitations, and future research are discussed.
Open Access
“Tienes Suficiente…?” Ability to Meet Basic Needs and Behaviors During the COVID-19 Pandemic
(University of Oregon, 2024-08-07) Garcia, Yahaira; McWhirter, Ellen
The COVID-19 pandemic had a profound impact on communities around the globe, with older adults, members of minoritized racial and ethnic groups, and residents of urban areas being more susceptible to the SARS-CoV-2 virus, hospitalization, and death (Centers for Disease Control and Prevention, 2020). However, the pandemic presented threats beyond adverse physical outcomes of the disease; efforts to mitigate the pandemic such as closure of workplaces also threatened the ability to meet basic needs, such as healthcare, housing, food security, and transportation for people across different ages. Using existing participant data from the Oregon Saludable: Juntos Podemos project, this study investigated whether COVID-19 risk and protective behaviors vary as a function of age, race/ethnicity, language, and rural/urban residence. Understanding these relationships is important to the development of targeted strategies that decrease health disparities and increase health promoting behaviors. This study also investigated whether challenges in meeting basic needs moderated relationships between specific risk factors (age, race/ethnicity, language, and rural/urban residence) and COVID-19 risk and protective behaviors. Linear mixed effects regressions were used to examine associations between the sociocultural factors (age, ethnicity, language, urban/rural residence) and self-reported COVID-19 protective and risk behaviors. Findings indicate that older adults self-reported engaging in fewer risky behaviors than younger adults, whereas both Latinx and Spanish speaking individuals reported engaging in fewer risky behaviors and engaging in more protective behaviors than their respective counterparts. COVID-19 waves were also significant predictors of engagement in risk and protective behaviors. Specifically, individuals engaged in both fewer risky and fewer protective behaviors in subsequent COVID-19 waves (i.e., Delta, Omicron, and Omicron BVAR) in comparison to individuals who were surveyed during the Alpha Wave. Lastly, basic needs moderated the relationship between BIPOC individuals and individuals surveyed during the Omicron Bivalent Wave, and their engagement in both risky behaviors and protective behaviors for the former, and protective behaviors for the latter. Implications for future research, policy, and practice are presented.
Open Access
Influence of Parental Hostility and Socioeconomic Stress on Children’s Internalizing Symptom Trajectories from Childhood to Adolescence
(University of Oregon, 2024-08-07) Williams, Lue; Leve, Leslie
Children and adolescents with elevated internalizing symptoms are at increased risk for depression, anxiety, and other psychopathology later in life. Bioecological theory provides a framework for understanding multi-level influences on the development of internalizing symptoms during childhood and adolescence. The present study investigated predictive links between two bioecological factors (parental hostility and socioeconomic stress) and internalizing symptoms from childhood to adolescence. Hostile parenting has been associated with child and adolescent internalizing symptoms and was examined as an interpersonal factor predictive of longitudinal patterns of internalizing symptoms. Socioeconomic status, which includes parental educational attainment and household income, was examined as a structural stress factor. The study used data from two cohorts in the NIH Environmental influences on Child Health Outcomes (ECHO) program: Early Growth and Development Study (EGDS) and Family Life Project (FLP). The EGDS sample (n = 561) included adopted children across the U.S. FLP participants (n = 1,292) comprised a statistically representative stratified prenatal sample from six targeted rural communities in the eastern U.S. The study employed latent class growth mixture modeling (Jung & Wickrama, 2008) and multinomial regression mediation analysis to test four hypotheses. Analyses identified three distinct heterogenous internalizing symptom classes characterized by relative symptom levels, including low (41%), moderate (39%), and higher (20%). When regressing child sex assigned at birth onto the latent class outcome without controlling for children’s externalizing symptoms, females were more likely than males to belong to the higher internalizing symptom class, as compared with the low and moderate classes, as anticipated. However, these results reversed when children’s externalizing symptoms were included in the model as a covariate; females were more likely than males to belong to the group characterized by low symptom levels in comparison to the higher symptom group. Findings also indicated that increasing levels of parental hostility and socioeconomic stress each predicted membership in the higher symptom class, as compared with the low and moderate symptom classes. A trending indirect effect suggested that parental hostility partially mediated the predictive effect of socioeconomic stress on membership likelihood in the higher symptom class versus the low symptom class. These results are supported by the extant literature and suggest that 1) attention to co-occurring externalizing symptoms is important to how the development of children’s internalizing symptoms is understood and addressed; and 2) intervening on modifiable bioecological stressors may provide important protective influences on children’s internalizing symptom trajectories.
Open Access
Working-Class Gay Dads: Queer Stories About Family and Work
(University of Oregon, 2024-01-10) Mather, Nathan; McWhirter, Ellen
Context: Recent cultural and legal changes support gay men becoming fathers. Existing research with gay dads has focused almost exclusively on those in the upper middle-class. However, national estimates suggest that working-class gay dads represent a notable proportion of LGBT+ parents. Given the financial barriers to gay fatherhood and that parenting and working experiences often differ based on class—especially during the COVID-19 pandemic—research with working-class gay dads holds promise to broaden understanding of gay-fathered families in the current socioeconomic context. Using the Psychology of Working theory (PWT) as a framework, the present study explored work and family experiences with working-class gay dads living on the West Coast of the United States.Methods: The primary research question guiding the study was: How do working- class gay dads’ family-work stories challenge the grand career narrative and provide new ways of thinking about parenting and decent work? I collected and analyzed data using a narrative inquiry methodology, which involved a three-stage interview process, co-construction of narratives with participants, and generation of study themes and structural recommendations. Results: I organized participant stories into four narrative parts: History, Becoming Dads, Work-Family Interface, and Identity. With participant feedback, I highlighted seven study themes that emerged from the dads’ stories (e.g., Importance of Both Structural Economic Support and Structural LGBTQ+ Support, Many Valid Ways to Form Families). Situating these findings within the PWT model, I demonstrated how economic constraints and marginalization shaped these dads’ experiences of decent paid (and unpaid) work, and how their adaptability and volition buffered these impacts and offered pathways to meaningful roles as workers and fathers. Conclusions: The stories of working-class gay dads expand thinking about parenting and work and extend the research on gay fathering. These stories and related themes provide helpful guidance for structural recommendations that attend not only to LGBTQ+ inclusion, but also policy improvement and economic justice. In so doing, the study sends a message of hopefulness to prospective queer parents while advocating to expand protections and support for all families.
Open Access
Inhibitory Control and Energy Intake in Rural Oregon Youth: The Potential Moderating Effect of Children’s Perceived Food Reward and Parental Restrictive Feeding Practices
(University of Oregon, 2024-01-09) Guidinger, Claire; Kelly, Nichole
Extant data suggest that rural children are more likely to consume a surplus of calories and energy-dense foods (e.g., candy, soft drinks, and vending machine snacks) compared to their urban peers. Eating behaviors established in childhood often persist throughout the lifespan, and longitudinal data implicate a host of medical concerns associated with a childhood diet high in calories, fat, and sugar. Executive function, specifically inhibitory control, or the ability to withhold a preplanned response, may be especially relevant to eating self-regulation in children living in rural communities. Children who already find food to be particularly rewarding may experience exceptional difficulties inhibiting their eating behaviors. Parental restrictive feeding may further complicate the relationship between inhibitory control and eating behaviors because it prevents a child from developing eating self-regulation. The current dissertation investigated the link between inhibitory control and energy intake in rural Oregon children. Children’s perceived food reward and parental restrictive feeding practices were examined as potential moderators. It was hypothesized that lower inhibitory control would be linked to greater energy intake and that children’s perceived food reward and restrictive parental feeding would exacerbate this association. Rural Oregon children (N = 92, 8-10 years, mean age = 9.05, 50% female, 74.5% white/Caucasian) participated in the current study. Children completed neuropsychological assessments of general and food-specific inhibitory control, and total caloric intake was measured via a laboratory test meal. Validated self-reported measures were used to assess children’s perceived food reward and restrictive parental feeding. In this study, neither general (ps = 0.52-0.53) nor food-specific inhibitory control (p = 0.66) was significantly associated with total caloric intake. Neither children’s perceived food reward (ps = 0.53-0.93) nor restrictive parental feeding (ps = 0.39-0.64) functioned as moderators in any models. Our findings suggest that, in 8-10-year-olds, inhibitory control may not be linked to greater caloric intake. Non-significant findings may also be an artifact of limited variability in the constructs of interest among children within the narrow age range of this smaller sample. Future studies should seek to examine these associations in more heterogeneous samples of rural and urban youth.
Open Access
CORRESPONDENCE OF GLOBAL AND MOMENTARY REPORTS OF EMOTION-RELATED SOCIALIZATION BEHAVIORS AMONG CAREGIVERS OF YOUNG CHILDREN
(University of Oregon, 2024-01-09) Wright, Joanna; Giuliani, Nicole
Parents and other primary caregivers support their children's social and emotional development through emotion-related socialization behaviors, which include assistance with emotion regulation strategies. Most research in this area relies on global caregiver self-report measures, but no studies have measured caregiver assistance with child emotion regulation strategies in naturalistic settings or examined correspondence between global and momentary reports. This warrants attention because information captured by global reports may not fully reflect emotion-related socialization behaviors as they occur in dynamic contexts of daily life. To address this gap, the present study employed ecological momentary assessment methods to investigate correspondence between global and momentary reports of caregiver assistance with child use of four emotion regulation strategies: acceptance; distraction; cognitive reappraisal; and expressive suppression. The present study also evaluated whether caregiver stress and household socioeconomic status moderated the correspondence between global and momentary measures. A United States sample of 174 primary caregivers with children ages 1.5-5 years completed virtual check-ins up to three times per day for seven days. Caregivers reported their child’s emotion and the emotion regulation strategies they helped their child use. Caregivers also completed a global measure of assistance with child emotion regulation strategies, a global measure of stress, and demographics. Correlation and regression analyses showed evidence of correspondence between global and momentary reports for acceptance and expressive suppression but not for distraction or cognitive reappraisal. Caregiver stress and socioeconomic status did not significantly moderate associations between global and momentary reports. Results caution against assumptions that global measures of caregiver support for child emotion regulation accurately index individual differences in these behaviors in daily life. Correspondence between global and momentary reports differed across strategies, showing stronger alignment for acceptance and expressive suppression, but weaker alignment for more complex, multifaceted cognitive reappraisal and distraction strategies. Future research can build on this work by investigating potential drivers of the varied correspondence patterns observed here, drawing on more diverse samples, and using validated momentary measures designed to align closely with their global counterpart.
Open Access
Ecological Momentary Assessment of State Affect Prior to and Following Loss of Control
(University of Oregon, 2024-01-09) Williamson, Gina; Kelly, Nichole
Loss of control eating (LOC) is a disordered eating behavior that is prevalent but understudied among young men. Affect regulation models propose that LOC eating functions as a maladaptive effort to escape from distressing affective states. As such, negative affect is thought to increase in the hours and minutes before LOC eating, and decrease afterwards. However, examinations specific to young men are lacking and it remains unclear which discrete types of affect are most implicated in young men’s LOC eating. The current study examined the temporal roles of affect in LOC eating in a sample of 42 young men (18-35 years; Mage = 25.31±5.38y; 46.3% White; 22% Black/African American; 9.8% Black but not African American) who engage in frequent LOC eating. Participants completed a 14-day ecological momentary assessment protocol and recorded all eating episodes and their state affect five times per day. Generalized linear mixed models (GLMMs) were conducted to examine the trajectories of global negative affect, global positive affect, and each discrete type of affect pre- and post-LOC eating episodes. Results did not support study hypotheses; rather, negative affect did not change significantly before or after LOC eating (ps<.05). Positive affect did not change significantly before LOC eating (ps<.05). Global positive affect, excitement, and happiness decreased significantly after LOC eating (ps≤.001, R2s=-.03). Study findings contradict extant theory and empirical data largely from female samples. Negative affect did not increase risk for LOC eating, nor did LOC eating function to improve participant’s moods; rather, positive mood slightly decreased after LOC eating. Results from this pilot study can inform future research on LOC eating in young men who engage in subthreshold disordered eating behaviors. Further investigation around the observed decline in positive affect after LOC eating will clarify if this is a relevant intervention point in this population.
Open Access
Developing and Assessing the Acceptability and Appropriateness of Brief Alcohol Intervention Modules Among Trans and Gender Diverse College Students
(University of Oregon, 2024-01-09) Ehlinger, Peter; Cronce, Jessica
TGD individuals experience elevated levels of stress due to discrimination and oppression and, as a result, many TGD people drink alcohol to cope, resulting in elevated levels of high-risk alcohol use and disproportionate experiences of alcohol-related consequences compared to cisgender peers. TGD college students may be more likely to engage in alcohol use by virtue of typical age-related trajectories for alcohol use and risk factors associated with the college environment, including marginalization. However, there is an absence of extant brief alcohol interventions that serve TGD college students in an affirming way. One type of brief alcohol intervention, a personalized feedback intervention, may be best suited to meeting the needs of TGD college students because they reduce barriers associated with fearing negative interactions with healthcare or counseling personnel. Personalized feedback interventions utilize modules that gather and present different data about a student’s alcohol use and related risk factors, as well as presenting psychoeducation to support use of skills to reduce the likelihood of experiencing alcohol-related harms. To increase the likelihood that new intervention materials will be utilized by TGD college students, it is critical to seek feedback from stakeholders on the acceptability and appropriateness of these materials during the development process. This dissertation utilized a community-based research approach to first develop three novel PFI modules addressing marginalization stress, drinking alcohol to cope, and fostering resilience, and then assess the relative acceptability and appropriateness of the modules from the perspective of TGD college students. Acceptability and appropriateness were assessed first through focus group and interview discussions with TGD college student stakeholder consultants and next through an online survey of TGD college students from across the United States. A framework analysis of participants’ qualitative responses yielded three main themes: relevance of the material in each module (e.g., topics that were most useful to participants), affirming aspects of the material in each module (e.g., the use of correct pronouns and gender-neutral language), and requests for improvements in the material in each module (e.g., edits to module conciseness and organization). Overall, TGD stakeholders supported the preliminary acceptability and appropriateness of the novel modules, setting the stage for a possible feasibility pilot of the modules as part of a larger, integrated personalized feedback intervention.
Open Access
Expressing Disempowering Realities Through the Body: An Embodiment Approach to Disordered Eating in Black and African American Women
(University of Oregon, 2024-01-09) Osa, Maggie; Kelly, Nichole
Disordered eating (DE) among Black women in the United States (U.S.) has increased over the past decade. Although theories of DE have predominantly focused on the drive for thinness, these frameworks fail to demonstrate the same predictive validity among Black women. Embodiment, which reflects the experience of living in one’s body, offers a novel framework for examining DE among Black women by considering the roles of disempowering social experiences (e.g., discrimination) in shaping how one connects to and cares for their body. The current study examined the associations among food insecurity, exposure to traumatic events, discrimination distress, embodiment, and DE (i.e., global symptoms, binge eating, and unhealthy weight control practices). It was hypothesized that food insecurity, traumatic events, and discrimination distress would be collectively significantly associated with both embodiment and DE. It was also hypothesized that embodiment would be significantly negatively associated with DE after adjusting for food insecurity, traumatic events, and discrimination distress. Black women 18 to 40 years old in the U.S. (N = 99; Mage= 27.77  5.17 years) completed an online survey comprising measures of food insecurity, traumatic events, discrimination distress, embodiment, and DE. Multiple regression models revealed that food insecurity, traumatic events, and discrimination distress were collectively significantly associated with embodiment (p < .001) and global DE (p < .001). Zero-inflated negative binomial models demonstrated improved model fit compared to the intercept-only models for binge eating (BF = 1.63) and unhealthy weight control practices (BF = 146 x 104). Considering individual variable contributions, exposure to traumatic events was significantly positively associated with global DE and likelihood of binge eating; food insecurity was significantly negatively associated with global DE; and discrimination distress was not significantly related to any DE constructs (ps = .137-.620). After adjusting for food insecurity, traumatic events, and discrimination distress, embodiment was significantly negatively associated with global DE (p < .001), the likelihood of binge eating (p =.01), and unhealthy weight control practices (p =.03). Results suggest that disempowering social experiences are relevant to Black women’s DE, and embodiment may provide a valuable theoretical perspective for understanding DE in Black women.
Open Access
Institutional Betrayal among LGBTQ Youth: Examining the Association with Suicidality
(University of Oregon, 2024-01-09) Gallo, Mavis; Seeley, John
Suicide is a national public health issue that effects communities, individuals, and society as a whole. Suicidality among youth in the United States in on the rise. Some groups of youth are unequally burdened by suicidality, particularly lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. There has been a good amount of research establishing the elevated risk for suicidality among LGBTQ youth. Extant literature has attempted to identify risk and protective factors for suicidality among all youth, but there is a lack of understanding about the impact of identity-based risk factors that impact LGBTQ youth. This study examines previously identified risk and protective factors: identity-based school violence, having a Gender/Sexuality Alliance in schools, and having identity-based antibullying policies in schools. Another challenge of this work is the lack of theoretical foundation. Though such an integrated theoretical framework has not yet been established, the present study utilizes components from two often utilized models and introduces a case for including interpersonal trauma-focused theory (institutional betrayal) in order to inform a more comprehensive approach to understanding suicidality among LGBTQ youth. Including institutional betrayal in the study of suicidality among LGBTQ individuals, particularly youth, is relevant, as they report multidimensional discrimination from various institutions, including schools. A potential explanation for the disproportionate rates of suicidality are due to the high rates of institutional betrayal these youth experience. This retrospective study found that institutional betrayal was an important contributor to suicidality among participants in grades 5 through 12. The results of this study provide compelling evidence for the impact of schools on the mental health of LGBTQ youth. Throughout each iteration of the analyses, institutional betrayal remained robustly associated with suicidality. The results of this study have important implications for field of suicidology, especially in light of unsupported hypotheses. Limitations of the study, implications, and future directions are discussed.
Open Access
The Implementation of an Online Educational Program for Nurses: Increasing Knowledge about Dysphagia and Dysphagia Dietary Recommendations
(University of Oregon, 2024-01-09) Nagshabandi, Bedoor; Shune, Samantha
Diet modification has become a fundamental clinical tool for speech-language pathologists (SLPs) within dysphagia management, particularly for acutely ill patients. However, for dietary modifications to meet intervention goals of increased intake and prevention of negative health consequences, adherence is needed across healthcare professionals, including nurses. Previous literature has highlighted education as a key contributor to increased adherence. Further, the increased flexibility of online education may help mitigate barriers experienced by healthcare professionals to completing these trainings. The purpose of this study was to develop and pilot an online educational program about dysphagia and diet modification for inpatient nurses caring for patients experiencing dysphagia. The study also aimed to examine the feasibility of program implementation and participants’ overall perceptions of program impact. A total of four participants completed the program and subsequent surveys with three also participating in semi-structured interviews about their experience. Results showed a large effect in knowledge level change between baseline and directly after completing the program and between baseline and one month after completion. Additionally, most of the participants rated the educational program as “good” using the System Usability Scale. Four themes were generated based on the semi-structured interviews. First, participants described the positive benefits of the educational program on their knowledge and clinical practices. The second and third themes encompassed dysphagia-related training received in educational and work settings and what barriers exist to additional training. The fourth theme included insight into the relationships between nurses and SLPs and the positive effects of a strong relationship. Taken together, the quantitative and qualitative analyses supported improvement in participants’ knowledge levels, preliminarily supporting the program’s effectiveness. Results also showed good levels of acceptability and feasibility of the online program as a mode for training. By increasing knowledge about dysphagia management, implementing such a program in nursing training or continuing education may increase adherence to dietary recommendations. In doing so, such a program can lead to earlier identification and appropriate management of dysphagia, resulting in better treatment outcomes, including a reduction in the negative consequence of dysphagia, increased patient satisfaction, and improved quality of life.
Open Access
Longitudinal Associations Between Early Parenting and Adolescent Allostatic Load: Examining the Mediating and Moderating Role of Child Delay of Gratification
(University of Oregon, 2024-01-09) Leonard, Heather; Khurana, Atika
Allostatic load (AL) is a representation of chronic wear and tear on the body due to prolonged exposure to stress. AL measures (e.g., blood pressure, cortisol) capture stress-related dysregulation across multiple physiological systems, which in turn contributes to future disease outcomes. Early contextual influences, such as parenting behaviors, can have a significant impact on the body’s regulatory systems during younger years, with downstream effects on health outcomes later in development, making AL an important outcome to examine in relation to early parenting behaviors. This study utilized longitudinal data (N = 1,364) from the Study of Early Child Care and Youth Development (SECCYD) to examine the relationships between three early childhood parenting behaviors (i.e., supportive presence, respect for autonomy, and hostility) assessed at child age 24 and 36 months and adolescent AL, assessed at age 15. Further, given that early parenting behaviors can influence child self-regulation, and individual differences in self-regulation are linked to AL indicators, this study examined the role of delay of gratification, a behavioral measure of child self-regulation, as a mediator and moderator of the association between early parenting and adolescent AL. Analyses revealed that two early childhood parenting behaviors (i.e., supportive presence and hostility) were directly associated with adolescent AL, and all three parenting behaviors were associated with childhood delay of gratification. However, there was no significant association between childhood delay of gratification and adolescent AL, and childhood delay of gratification was not a significant mediator or moderator of the associations between early parenting behaviors and adolescent AL. Future research should further examine the role of self-regulation using more comprehensive assessments, repeated over time from early childhood to adolescence. Other potential mediators and moderators (e.g., lifestyle factors) should also be examined to understand the mechanisms by which early parenting impacts AL in later years, and identify individuals who may be most at-risk for high AL.
Embargo
Race and Ethnicity as a Moderator of the Association between Stereotype Threat and Alcohol Use
(University of Oregon, 2024-01-09) Jones, Matthew; Cronce, Jessica
Drinking is common among college students but has different social meanings and consequences for students of color. Using data from first-time U.S. resident students gathered pre-matriculation, end-of-first-year, and fall second-year, I examined the association between expectations for stereotype threat (using an identity and stereotype nonspecific measure) over the first year (N = 260) and the relationship between anticipated stereotype threat and alcohol outcomes (total drinks per week and total consequences over the past 3 months) as a main effect and as moderated by Asian and Latinx racial and ethnic identities (Ns = 221-257). Pre-matriculation and end-of-first-year stereotype threat scores were correlated (r = .34, p < .001), supporting use of pre-matriculation (anticipated) stereotype threat scores for other planned analyses. No significant associations were detected between anticipated stereotype threat and either alcohol outcome, either as a main or moderated effect. Recommendations for future studies and lessons drawn from the present study are discussed.
Open Access
The Effects of Suicide Prevention Gatekeeper Training on Behavioral Intention and Intervention Behavior: A Systematic Review and Meta-Analysis
(University of Oregon, 2023-07-06) Spafford, Sarah; Seeley, John
Suicide is a major public health concern worldwide and the tenth leading cause of death for all ages in the United States. As suicidal ideation and suicide behaviors have continued to grow in the U.S., this has encouraged national and statewide efforts to implement comprehensive suicide prevention plans. A critical component of a comprehensive plan is ensuring individuals experiencing suicidal ideation receive mental health treatment. Suicide prevention gatekeeper trainings, which aim to improve knowledge regarding suicide risk as well as increase gatekeepers’ intentions to ask about suicidality and make referrals to appropriate mental health treatment, are a frequently implemented program to increase mental health help-seeking behaviors, despite the lack of evidence around effective implementation. To understand the current state of research regarding suicide prevention gatekeeper training, a systematic review and meta-analysis were conducted that synthesized evidence on the effects of suicide prevention gatekeeper training on behavioral intention to intervene and suicide intervention behaviors and whether these changes are maintained over time. A secondary aim of this meta-analysis was to examine implementation setting, training modality, and training level as moderators for the effectiveness of suicide prevention gatekeeper training on behavioral intention, and suicide intervention behaviors. Results from 43 studies revealed that suicide prevention gatekeeper training had an overall positive effect on behavioral intention and intervention behaviors. Furthermore, subgroup analyses for training level and training modality were unable to be conducted due to the lack of studies examining advanced or online trainings. Results from the implementation setting subgroup analysis revealed no significant differences in behavioral intention or intervention behavior based on the implementation setting. However, these results must be considered with caution as there were significant methodological concerns of the included studies and limited studies that conducted long-term follow-up. Although this meta-analysis reveals an overall positive effect for suicide prevention gatekeeper training on behavioral outcomes, the low methodological quality of the current available evidence limits the ability to draw conclusions from the synthesis. To inform policymakers and interventionists on best practices for suicide prevention gatekeeper training, additional rigorous research is needed.
Open Access
Examining the Impact of Parent-Child Interaction Therapy on Intimate Partner Violence
(University of Oregon, 2022-10-26) Woodlee, Kyndl; Chronister, Krista
Rates of Intimate Partner Violence (IPV) and Child Maltreatment (CM) co-occur in 30-60% of all households, and yet there are few interventions that account for and address the family contextual factors that contribute to both (Appel & Holden, 1998; Dixon et al., 2007; Edleson, 1999; Foley, 2011). Parent-Child Interaction Therapy (PCIT) is one of the most empirically validated interventions shown to reduce CM (Skowron & Funderbunk, 2021), especially for high-risk families. PCIT targets two factors that impact CM and IPV risk: self-regulation and communication skills. The aims of this current dissertation study, therefore, were to explore the effects of PCIT on IPV frequency for families with a history of CM. It was hypothesized that caregivers assigned to PCIT would have a lower frequency of IPV behaviors in comparison to a services-as-usual (SAU) control group. Existing data were collected from caregivers (N = 204) and their children as part of a longitudinal randomized controlled trial called the Coaching Alternative Parenting Strategies Project (CAPS; Skowron, 2019, R01 DA036533). Zero-inflated negative binomial (ZINB) regression analyses showed that (a) assignment to PCIT did not significantly reduce IPV perpetration or victimization regardless of past IPV history compared with SAU and (b) caregiver age and income did not significantly impact IPV perpetration or victimization regardless of treatment group or past IPV history. This was just the second study to examine the effect of PCIT on IPV and the first to do so with a sample this size and with families receiving individual PCIT treatment that could be modified for their needs, as opposed to a standardized group treatment. Limitations include that the sample did not have enough gender diversity to explore outcomes by gender identity and use of verbal self-report to collect IPV data.
Open Access
Examining Parental Knowledge and Involvement as Predictors of Adolescent Impulsivity and Alcohol Use Intentions and Frequency
(University of Oregon, 2022-10-26) O'Brien, Kaitlin; Khurana, Atika
Prior work has shown that parental knowledge and involvement can have protective effects on adolescent alcohol use; however, less is known about how different dimensions of impulsivity might mediate this association. Guided by the self-control theory and more recent brain network-based models of impulse control development, the present study analyzed data from 345 middle-schoolers to examine the direct effects of parental knowledge and parental involvement on adolescent alcohol use intentions and frequency, as well as their indirect effects through acting without thinking (AWT), delay discounting (DD), and attention control difficulties (AD). Consistent with prior evidence, results revealed direct protective effects of parental knowledge on adolescent alcohol use intentions and frequency as well as direct protective effects of parental involvement on adolescent alcohol use frequency. Of the three impulsivity dimensions, only AWT mediated the association between parental knowledge and adolescent alcohol use frequency. Accounting for the effect of AWT, DD and AD were not significantly associated with alcohol use intentions or frequency, and did not operate as significant mediators of parental effects. The present study advances our understanding of how parenting behaviors can impact adolescent alcohol use both directly as well as indirectly through associations with adolescent impulsivity, specifically AWT. Given that AWT may be sensitive to environmental inputs, such as parenting, findings from the current study provide support for parenting interventions that target AWT as an avenue for preventing adolescent alcohol use, in addition to existing approaches that focus on parental rule setting and supervision. Future research should further examine the mediating role of impulsivity with larger samples using longitudinal designs.
Open Access
The Longitudinal Impact of Discrimination on Attention Problems in Latinx Immigrant Youth: Examining the Roles of Somatic Symptoms and Social Support
(University of Oregon, 2022-10-26) Kuperman, Kelsey; McWhirter, Benedict
Youth with attention problems are at significantly higher risk of a wide range of negative outcomes, including academic underachievement, occupational challenges, and socioeconomic disadvantage. Exposure to early adversity, including racial/ethnic discrimination, has been identified as an important risk factor of cognitive impairment, including the development of attention problems. Though significantly understudied, Latinx immigrant youth may be at elevated risk of these negative consequences given their disproportionately higher levels of exposure to discrimination through the immigration and acculturation process. However, a dearth of research has examined the relationship between discrimination and attention problems in this population, and even less is known about potential mediators, such as the manifestation of emotional distress as somatic symptoms, that may help to explain the link between discrimination and attention problems in Latinx immigrant youth. Research is also needed to examine potential moderating factors, such as social support, that may help to protect against the deleterious effects of discrimination on somatic symptoms and attention problems. Using an existing dataset gathered in the Adolescent Latino Acculturation Study (ALAS), the present study address these gaps in the literature by applying a race-based traumatic stress theory and stress and coping model to examine: (a) the direct relationship between perceived discrimination and attention problems, (b) whether somatic symptoms partially mediate the link between perceived discrimination and attention problems, (c) the possible moderating effect of social support on these relationships, and (d) secondary exploratory analyses investigating the influence of time in U.S. residency on the theorized link between discrimination and attention problems in a sample of 218 Latinx immigrant youth living in Oregon.
Open Access
Identifying Physically and Interpersonally Adaptive Strategies for Intrinsic and Extrinsic Emotion Regulation in the Parent-Child Relationship
(University of Oregon, 2022-10-26) Mintz, Brianna; Cronce, Jessica
The ability to effectively regulate emotions is fundamental to interpersonal and physical functioning. Emotion regulation strategies are not equal, however, with some positively and others negatively impacting physical health. Specifically, previous literature has demonstrated that distinct intrinsic emotion regulation strategies differentially predict chronic inflammation, as measured by C-Reactive Protein (CRP), but little is known about the association between extrinsic emotion regulation strategies and chronic inflammation. Furthermore, the extrinsic emotion regulation strategies employed by parents are facilitative of the developing emotion regulation skills of children, and inflammation has been identified as a key biological factor that could impact the intergenerational transmission of emotion dysregulation, either by explaining it or by modifying the strength of the intergenerational association. This study seeks to replicate previous findings demonstrating a link between intrinsic emotion regulation strategies and chronic inflammation in a community sample of mothers with preschool-aged children. Additionally, this study aims to extend those findings and interrogate the association between extrinsic emotion regulation strategies and chronic inflammation. Last, this study proposes to examine the associations between intrinsic and extrinsic emotion regulation strategies in mothers and the socioemotional health of their preschool-aged children, predicting that the relationships between maternal intrinsic and extrinsic emotion regulation strategies and child socioemotional health will be significantly impacted by maternal chronic inflammation. Both moderation and mediation models will be evaluated.