Background: Given the obesity epidemic across communities and countries worldwide, being overweight and obesity among adolescents has become a critical public health concern. Overweight and obesity in adolescence are known to negatively affect on an individual’s physical, psychological, and social status. It is imperative to identify not only individual-level factors but also social-environmental factors that influence physical activity, dietary intake, and body weight in order to reduce disparities in obesity.

Objectives: Using a social-ecological framework, the aims of this dissertation were: 1) to assess the contribution of social-ecological factors to regular physical activity; 2) to explore determinants associated with dietary patterns; 3) to estimate prevalence of overweight or obese, and to identify gender-specific risk factors for obesity among California adolescents.

Methods: The data was drawn from the California Health Interview Survey (CHIS). The first and third study included a total of 2,799 adolescents in the CHIS 2011-2012 data, and the second study included 4,000 adolescents from the CHIS 2011-2012, and 2013 datasets. Data examined included the individual-level (e.g., socio-demographics, body mass index percentile) and the neighborhood-level (e.g., availability of activity resources, food environment, safety) characteristics associated with physical activity, diet, and obesity.

Results: The first study found that those of the male sex, older teenagers, and having a higher household income were significant predictors for engaging in regular physical activity. The second study revealed that unhealthy dietary patterns (low consumption of fruits and vegetables, but high consumption of fast foods and sugary drinks) were found among adolescents from Hispanic or ethnic minorities, lower socioeconomic status, second or third generation immigrants, and in rural areas. The third research study demonstrated the gender-specific factors associated with a risk of overweight or obesity among adolescents. For girls, age, race/ethnicity, income, bitrhplace, physical activity, and neighborhood safety were significantly associated with being overweight or obese. In contrary, only age and race/ethnicity remain significant for boys.

Conclusion: The findings extends our understanding by identifying different features both at the individual and neighborhood level that are hypothesized to influence physical activity, diet, and obesity risk among adolescents. The findings of the dissertation suggest that a multilevel approach from a social-ecological perspective is crucial to implementing interventions/policies to effectively manage the obesity epidemic and to identify root causes of obesity disparities among adolescents.

Obesity, defined by BMI, is an escalating health concern. Selenium is an essential trace mineral involved in many metabolic activities, including the production of antioxidant enzymes, fat accumulation, and the conversion of inactive thyroid- T4 to the active form- T3, all of which impact BMI. However, little is known about the relationship between selenium and BMI. Furthermore, the impact of menopause, T3, and physical activity on this relationship has not been evaluated. This study aimed to 1) map the currently available evidence on the selenium level and BMI using Arksey and O’Malley’s scoping review framework, 2) investigate the relationship between serum selenium, BMI, and the menopausal status in 2,130 women who participated in the National Health and Nutrition Examination Survey (NHANES 2011-2012), and 3) analyze mediating effects of T3 and physical activity in the selenium and BMI relationship in 1,341 NHANES (2011-2012) adult participants. This cross-sectional study applied descriptive statistics, t-test, multiple linear regression models, and multilevel structural equation modeling for analysis. The scoping review identified conflicting findings, ranging from an inverse association between selenium to BMI to the positive association of low selenium with overweight and obesity. Adjusted for demographic factors, no statistically significant relationship between selenium and BMI, menopause, T3, or physical activity was found in our analysis. Postmenopausal women in our study had a significantly higher prevalence of obesity than premenopausal women while consuming significantly fewer calories per day. Men in our study had lower BMI, higher selenium and T3 levels, higheriv daily caloric intake, and lower activity levels than women participants. Future studies need to 1) identify and evaluate other metabolically important factors as potential mediating variables, 2) employ a longitudinal study design to capture changes in selenium, T3, and PA over time, and 3) include populations with selenium deficiency and selenium-replete participants to capture a broader range of serum levels and their effects on BMI values.

Background: Suicide presents a critical global issue, especially for youth and young adults aged15 - 29. In adolescents aged 14 to 18 years, suicide ranks as the third leading cause of death at a rate of 9.0 per 100,000, which poses significant prevention challenges. Research highlights suicidal ideation (SI) as a key predictor of future suicide attempts and completions in this age group. Inadequate sleep duration has recently emerged as a potential modifiable risk factor for both suicide and SI. Objectives: To study various factors related to SI, including sleep, individual characteristics, and family dynamics, and how they interconnect to affect SI among adolescents. To examine the associations between sleep as a primary predictor for SI. To evaluate the role of sleep, individual and family factors as protective or risk factors for SI. Methods: A systematic review was used to synthesize existing literature on the relationship between sleep duration, quality, satisfaction, and SI among adolescents. Additionally, the study utilized data from the California Health Interview Survey (CHIS 2017 and 2018) to investigate the intricate connections between suicidal ideation (SI), sleep duration, various demographic and psychological variables of individuals, and the impact of family dynamics on adolescents aged 12 to 17 years. Results: The systematic review found that there was a significant correlation between insufficient sleep duration, low sleep quality, and low sleep satisfaction and an increased risk of SI. Additionally, younger age and being female were individual factors that contributed to an increased risk of SI. Furthermore, socio-economic status, family structure, and family function were family variables that also elevated the risk of SI. The results from the CHIS secondary analysis demonstrated that sleeping <8 hours per weekday night significantly increased the risk of SI in this sample. Individual psychological factors, such as depression and hopelessness, were identified as major risk factors for SI. The factor adult belief in an adolescent’s potential for success in the future emerged as a protective factor against SI. Conclusions: This study highlights the multifaceted nature of factors influencing SI among adolescents, emphasizing the importance of sleep, individual psychological health, and family environment. The findings advocate for a holistic approach to adolescent mental health care, underscoring the need for interventions that concurrently address sleep patterns, psychological distress, and familial support. These insights provide valuable guidance for clinicians and policymakers in developing effective strategies to mitigate SI risks in adolescents.

The need and demand for kidney transplantation has a significant impact on the quality and quantity of life of Asian Americans who suffer from end-stage renal disease. However, little is known about the attitudes and knowledge regarding organ donation and transplantation among Asian American adolescents. A cross-sectional study design was used to examine the attitudes and knowledge regarding organ donation and transplantation among Asian American adolescents and factors related to willingness to donate and family discussion. A total sample of 121 Asian American adolescents, 16 and 17 years old who identified themselves as having Asian descent of Japanese, Filipino, Korean or Chinese, was recruited from three high schools on the Big Island of Hawaii. Adolescents completed basic demographic information, the Organ Donation Attitude Survey Modified (M-ODAS), the newly developed Organ Donation and Transplantation Knowledge Survey (ODTK), and the Suinn-Lew Asian Self -Identity Acculturation Scale (SL-ASIA). The adolescent's parent or guardian also completed basic demographic information. Linear regression was performed to examine the association between attitudes and knowledge about organ donation and transplantation with willingness to donate and family discussion about organ donation. Stepwise multiple linear regressions were performed on those variables of statistical significance obtained from study constructs. Findings revealed Asian American adolescents have positive attitudes about organ donation are knowledgeable about organ donation issues, are willing to donate, and engaged in family discussion. Results indicate that positive knowledge related to general aspects about organ donation and cultural limitations in receiving an organ transplant, a high level of acculturation, and a low level of negative attitudes are associated with and predict willingness to donate (R2= .402, F=18.86, p=<.005). Asian American adolescents with approving or positive attitudes will engage in family discussion about organ donation (R2=.195, F= 13.85, p=<.005). Significant findings from this study suggest the incorporation of organ donation education in high schools is necessary to reinforce and maintain high knowledge and awareness. Asian American adolescents have the influence to raise organ donation awareness with their parents and families.

Abstract

Arab/Middle Eastern immigrants are a fast-growing population in the United States. Research on their physical and mental health is very limited. This descriptive cross-sectional study sought to explore the trends of serious psychological distress and self-rated health of Arab/Middle Eastern immigrants compared to US-born non-Hispanic White population in the past 15 years, and to examine the effect of factors including socioeconomic conditions, acculturation, and family and health related factors. A systematic review of the literature was conducted on SRH of Arab and Middle Eastern immigrants, and data from the National Health Interview Survey (2001-2015) were examined. This study found that greater risk of serious psychological distress among first-generation Middle Eastern immigrants is significantly associated with gender, BMI, and contacting mental healthcare services, and a higher risk of fair/poor SRH in this population is significantly associated with serious psychological distress, aging, alcohol drinking, and presence of a family member with disability. These findings suggest the need for improved immigrants’ healthcare policies that support specific healthcare services among immigrant populations. Some of these healthcare plans should focus on cultural and gender-related barriers.

ABSTRACT

The purpose of this descriptive cross-sectional study is to examine the factors that contribute to overweight, decreased physical activity and body dissatisfaction in the 12 to 17 year old, ethnically diverse California adolescent and to determine if there are differences among gender and race. Data from the 2005 California Health Interview Survey (CHIS) for adolescents self-identified as Latino, Asian, or White were reviewed. Adolescents reported weight, height, gender, ethnicity, parent education attainment, household income, physical activity, sedentary activity, breakfast consumption, family meals and body satisfaction. Parent information was also used in exploring factors contributing to decreased physical activity and these variables included parent physical activity, acculturation level and BMI. The main findings in this study were that gender and ethnic variations exist in factors contributing to overweight, decreased physical activity and body dissatisfaction in California adolescents. The key factors associated with both overweight and PA included age, gender, ethnicity, SES, screen time, and parent education attainment. The key risk factors that overlapped for body dissatisfaction and PA included general health status and BMI. A higher percentage of Latino adolescents (38%) compared to 25% of whites and 16% of Asians were overweight. Females are 1.5 times as likely to report decreased levels of physical activity compared with males. Asians were the least active and also reported the highest levels of sedentary activity. Across gender and ethnicity reports of poor/fair general health status and overweight were associated with body dissatisfaction. Latina females and Asian males were the least satisfied with their bodies. Overall, there seems to be a relationship between overweight, decreased physical activity and body dissatisfaction in California adolescents. The findings in this study support the need for development of culturally sensitive and gender specific interventions to improve the health behaviors in the adolescent population.

Type 1 diabetes (T1D) is one of the most common pediatric chronic conditions, where the risk of developing future complications is closely related to the tight surveillance of daily glycemic control. The majority of adolescents with T1D are still unable to meet the target glycemic outcomes. In this cross-sectional study, adolescents with T1D and one caregiver were recruited from telehealth visits at a tertiary, multidisciplinary pediatric diabetes center to complete a self-report survey. Factors included diabetes self-management, diabetes technology use, diabetes distress, parenting stress, and family functioning from the individual and family domains. Age, gender, BMI, insurance type, daily insulin dose, insulin regimen, and A1C were collected by medical chart review. CGM data were collected from device software. Univariate and multivariable regression models were conducted for association with outcomes of interest. The relationship between the diabetes self-management, and individual and family factors with glycemic outcomes are a complex one. Our finding suggests the variables in the family domain, particularly the parent diabetes-related distress, is a crucial, modifiable factor associated with the adolescent’s glycemic outcome. There is also an association between parent diabetes-related distress and the adolescent’s diabetes technology satisfaction. Lastly, there exist a gap between families who adapt to the use diabetes technology when compared to those who do not likely related to socioeconomic status, and future studies are needed to bridge this gap.

The proliferating influx of Arab immigrants into the United States unveils several transitional challenges and stressors that can create and exacerbate mental health issues, including depression and emotional distress. Despite the noteworthy impact of Arab mental well-being on the host country, research on addressing emotional distress and accompanying feelings of depression within Arab populations remains notably scant within the realm of mental health studies. Therefore, the first three goals of this dissertation were to: 1) synthesize the available evidence on the psychosocial and demographic factors associated with depression, anxiety, PTSD, and PD among Arab individuals in the U.S.; 2) explore the levels and risk factors associated with depression feelings and emotional distress for Arab immigrants; and 3) evaluate the potential mediation roles of social cohesion and family life impairment on the association between depressive feelings and emotional distress. We conducted a systematic review of the literature on seventeen distinct studies and examined data from the CHIS survey (2013–2022). This study found that the overall prevalence of depression was 23.54%, while that of emotional distress was 4.43%. We found no significant difference in the prevalence rates of depression or emotional distress between first-generation Arab immigrants and second-generation Arab Americans. The review identified key determinants of mental health symptoms among Arab individuals in the United States, including being female, old age, refugee status, and perceived discrimination. Our analysis of 9-year CHIS data further reveals that being less well-educated, being unemployed, or having lived in the U.S. for more than 15 years was associated with an increased risk for depression and emotional distress feelings. We also uncovered statistically significant partial mediations for both social cohesion and family life impairment in the association between depression feelings in the past 12 months and emotional distress in the past 30 days. The findings of our analysis present compelling evidence of the necessity of implementing policy changes and enhancing service delivery methods targeting high-risk groups of Arab immigrants, with the ultimate goal of enhancing the psychological well-being of individuals of Arab descent.