Background: Research suggests family-based programs for the prevention and control of childhood obesity can significantly reduce child body mass index and increase healthy behaviors; yet, low parent engagement frequently hinders the implementation of these programs. This dissertation examined factors affecting parent engagement in a family-based childhood obesity prevention and control program conducted in Imperial County, CA.

Methods: This dissertation study was ancillary to a multi-sector, multi-component childhood obesity prevention and control demonstration study named Our Choice, Nuestra Opcion. The ancillary study used a prospective, mixed-methods approach to examine parent engagement in one component of Our Choice, a Family Wellness

Program which included 9 healthy lifestyle workshops and 8 physical activity workshops led by community health workers. Self-report surveys were administered to 128 parents assigned to the Family Wellness program at baseline, or prior to the start of intervention activities. The survey assessed hypothesized predictors of engagement

including readiness to change, perceived relevance of the intervention, and family functioning. Anthropometric data (height and weight) and sociodemographic characteristics of both the parent and child were also collected at baseline. Attendance was recorded throughout the duration of the Family Wellness Program. A sub-set of parents (n=22) were interviewed following the scheduled completion of the Family Wellness program to assess their experiences in the program and to identify factors that influenced their level of engagement.

Results: Results of quantitative analyses indicate parents’ readiness to change their own health behaviors and their weight-related parenting strategies was the strongest predictor of their engagement in the Family Wellness Program. Child behavioral health issues also played a role in parent engagement. Qualitative analysis of interview data showed that parent engagement may also be influenced by the level of support and enthusiasm received from the participating child.

Conclusions: This study elucidated the experiences of parents enrolled in family-based childhood obesity prevention and control programs. Results indicate that engagement may be improved by targeting parents’ readiness to make changes during recruitment and early in the intervention. Also, parent engagement may be improved by implementing strategies to improve the participating child’s attitudes towards the program. Overall, this dissertation has identified several potentially modifiable influences on engagement.

Background: Fertility and family planning are key areas of focus for adolescent and young adult (AYA) cancer survivors. Pregnancy intention is associated with preconception health behaviors in healthy populations of women, but few studies explored the role of intention among AYA cancer survivors. Aims: The aims of this dissertation were to evaluate: 1) if pregnancy intentions are associated with preconception health behavior, 2) if perceptions on post-cancer treatment infertility risk were associated with varying engagement in preconception health behavior, and 3) what factors informed infertility risk perception and are associated with to discordant estimation. Methods: Data for the dissertation came from participants consented to the Reproductive Window in Young Adult Cancer Survivors (Window) study, a longitudinal study to estimate the trajectory of ovarian function among AYA survivors. Participants were followed for 1.5 years encompassing 4 data collection time points from baseline and every 6 months. Study #1 utilized baseline data to evaluate the association between pregnancy intention and preconception behavior with regression analysis. Study #2 utilized data from all 4 time points; associations between changing pregnancy intention and preconception behavior was determined by longitudinal mixed effects. Both Study #1 & #2 evaluated potential effect modification by infertility risk perception. Study #3 utilized baseline surveys, treatment details abstracted from medical charts, and ovarian reserve measured by biomarkers. Multivariable logistic regressions evaluated associations with perceived infertility risk and with discordant risk estimation between perceived and objective infertility risk. Results: Study 1 and 2 found urgent pregnancy intention was associated with higher preconception PA. Study #1 found among survivors with higher pregnancy intention, perception of infertility risk resulted in more PA compared to women who did not perceive reduced infertility. Study 3 found both higher gonadotoxicity of cancer treatment and amenorrhea were associated with higher odds of infertility risk perception. Survivors perceived infertility risk was in poor agreement with objective infertility risks. Conclusions: The dissertation provided insight into the role of pregnancy intention on preconception health behavior and identified factors that may inform perceived infertility risk. The knowledge gained from this dissertation may guide preconception behavioral interventions targeting female AYA survivors and inform infertility risk education needs within survivorship care.

This dissertation research was undertaken to better understand how individuals use photo-based social media to post about diet and weight loss. Understanding this will help public health professionals to develop more appropriate interventions and communication campaigns when using photo-based social media. The following objectives were addressed by this research: Objective 1. To systematically review dietary behavior and social media literature in order to develop a framework for studying dietary behavior on photo-based social media platforms such as Instagram. Objective 2. To collect and analyze a set of dieting for weight loss Instagram posts following the framework developed in Objective 1. Objective 3. To evaluate gender identity and seasonal trends within dieting for weight loss-related Instagram content. For objective one, a systematic review was conducted. For objectives 2 and 3, content analysis methods guided by Ideation Theory and the systematic review were used to evaluate a set of dieting for weight loss Instagram posts and to evaluate seasonal and gender identity trends. Most diet/weight loss-related social media studies focus on either Facebook or Twitter (67%), were non-experimental (41%), and were atheoretical (54%). Over half (55%) of Instagram profiles in our sample belonged to females, and most posts (57%) contained an image of food, with vegetables being the most commonly depicted food (38% of posts). Recipes and motivating language were common in the most popular posts. Females were more likely to be portrayed as thin than males, and males were more likely to be portrayed as muscular than females. Posts mentioning a specific holiday were more likely to describe the holiday as a reason for celebratory eating than a reason to restrict eating. Posts published in spring and summer were more likely to contain red meat and sugar-sweetened beverages than posts published in fall and winter. This dissertation was a preliminary step in investigating the relationship between interaction with photo-based social media and influences on dieting for weight loss. Additional research should rigorously quantify how specifically interaction with dieting/weight loss social media content is related to actual dieting for weight loss behavior.

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