Human Development & Family Science Doctoral Work

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Tracking Body Dissatisfaction and Body Ideals of Ethnically Diverse College Women
(North Dakota State University, 2022) Johnson, Emma
Globally, women are exposed to society-created, unachievable body ideals, which change over time and are subject to influence by other, typically Western, societies. Socializing agents such as family members, peers, and media often reinforce these ideals through pressure, which can then lead to body dissatisfaction. Research on body ideals and body dissatisfaction disproportionately focuses on White women within the United States. While this group is important to continue to examine, there is a need to include women from outside of the United States and from Non-Western societies. Thus, this study examined college women’s perceptions of body ideals within and outside of the United States, where they learned these ideals, changes in body dissatisfaction over time, and how pressure to be thin from socializing agents was associated with body dissatisfaction in women from both Western and Non-Western societies. College women born and raised within the United States (domestic) and women from outside of the United States but now living in the United States to attend college (international) completed a series of online surveys. First, open-ended questions were used to gather participant perceptions of body ideals. Results indicated that three main body ideals existed within and outside of the United States, with a thin, with accentuated features ideal being the most prominent within the United States, and a thin-ideal being the most common among Non-Western women. Further, nearly all participants stated that the media was responsible for teaching them about body ideals. Second, validated measures were used to collect data about pressure from socializing agents and body dissatisfaction among Western and Non-Western (specifically Asian) women. Body dissatisfaction at baseline and trajectory of body dissatisfaction did not significantly differ between the two groups. However, while greater pressure all socializing agents were associated with higher body dissatisfaction in the predominantly White Western group, for the Asian group, only pressure from family members was significantly associated with increased body dissatisfaction. The results of this study can be used to inform and create broader, culturally appropriate educational body image programming with the goal of preventing or intervening to reduce body dissatisfaction in college women.
Multiracial Identity as a Factor in Body Image and Disordered Eating
(North Dakota State University, 2022) Leonard, Kerrie
Emerging adulthood is a significant developmental stage where both ethnic-racial identitydevelopment and body dissatisfaction/disordered eating are salient. Past research suggests that there are links between identity development and body image/disordered eating (Palmeroni et al., 2020). Additionally, studies in the body image/disordered eating field have begun to examine differences among ethnic-racial groups (see Bucchianeri et al., 2016). However, there is limited research with Multiracial individuals (i.e., individuals with two or more ethnic-racial backgrounds). It is undetermined how Multiracial identity development influences body image and disordered eating behaviors. Thus, two studies were conducted to explore such connections. Participants included 174 Multiracial emerging adults (M = 21.8 years, SD = 2.08 years) in the U.S. Most participants were women (73.6%). The most common Multiracial identities were Asian-White (36.2%) and Black-White (23.0%). Study 1 was a mixed-method study that tested the racial identity-related factors of ethnic-racial identity achievement (i.e., feeling secure in one’s identity), racial ambiguity, racial incongruity, race esteem, and self-rated impact of identity and their associations with body dissatisfaction, body appreciation, and disordered eating. Furthermore, participants provided their overall thoughts and feelings on the impact of their Multiracial identity on their body image. Study 2 was a qualitative study that further explored Multiracial participants’ lived experiences with exoticization, racial ambiguity, and racial incongruity and how those experiences influenced their feelings towards their bodies. Quantitative results showed that ethnic-racial identity achievement and race esteem were positively associated with body appreciation. The qualitative findings provided mixed evidence, with an array of diverse appraisals and feelings ranging from positive to negative. Together, this research illuminates the ways in which being Multiracial plays a role in body image and disordered eating. The overall findings have implications for medical professionals, families, prevention and intervention programming, and Multiracial individuals themselves. Research with Multiracial participants is particularly important given that the U.S. Multiracial population is growing at a swift pace and that body image/disordered eating issues are prevalent for emerging adults.
Aging Out of Place: Quality of Life and Successful Aging Among Aging Refugee Immigrants in the US
(North Dakota State University, 2021) Owino, Jonix Atieno
As individuals age, they experience physical, cognitive, and socioemotional changes that may impact their well-being. However, little is known about well-being among aging refugees. Thus, the present study explores factors associated with quality of life and perceptions of successful aging among refugees who are aged 50 years and above. This mixed methods dissertation included a quantitative and qualitative study. For the quantitative study, 108 refugee participants (from Bhutan, Burundi, and Somalia) living in the US were surveyed to assess quality of life. Hierarchical regression analyses showed that females, older individuals, individuals with lower education levels, and African refugees reported lower quality of life. When controlling for sociodemographic factors, social integration was positively and loneliness was negatively associated with quality of life. Furthermore, trauma related experiences and post-migration living difficulties did not predict well-being for all participants; however, moderating effects of place of origin, sex, level of education and length of residence were observed. Twenty-one aging, Burundian refugees were recruited for the qualitative study to explore perceptions and experiences of successful aging. Emergent themes showed that some of aging refugees’ perceptions of successful aging were consistent with perceptions among other aging populations, yet in many ways the unique background of aging refugees seemed to impact their aging perceptions, such as perceiving an earlier onset of aging. Cultural factors and the context of being a refugee led to unique experiences of successful aging, and apparent gender differences. In summary, perceptions of aging out of place among aging refugees indicated both protective factors and risk factors. The findings from the two studies of this dissertation suggest important future directions of inquiry and have potential implications for communities on how they can better support aging refugees as well as develop effective interventions to promote well-being.
Does Mom Know Best? The Influence of Baby-led Weaning on Picky Eating and Sweetener Use
(North Dakota State University, 2021) Jellison, Savanna Elizabeth Jean Westrom
Baby-led weaning, the process of an infant feeding themselves at the introduction of solid foods as opposed to being spoon-fed by a caregiver, is an under-researched area of infant development. There is a significant gap in knowledge regarding how baby-led weaning influences aspects of this critical period of development including picky eating and parental use of sweeteners or additives. The purpose of this research was to better understand the influence that feeding method has on optimal infant development. The central hypotheses were (1) that infants who baby-led weaned would have greater food acceptance and be less likely to be labelled a picky eater than parent-led weaned infants, and (2) parents who utilize baby-led weaning will be less likely to utilize sweeteners or additives with their infants compared to parents who choose parent-led weaning. Participants (N = 412) were given a link to a single questionnaire through an online survey software. The survey consisted of a variety of question types including Likert-type scales, yes/no, and short answer. Results of our first study showed that infants in both groups accepted most foods at similar rates at first introduction, indicating that initially infants from the two groups were similar in their food preferences. However, infants who had experienced baby-led weaning were less likely to be considered to be picky eaters by their parents than those who were parent-led weaned. These results support the hypothesis that feeding method may influence rates of picky eating. The results of our second study showed that there were no differences between parents who baby-led weaned and those who parent-led weaned in willingness to give sugar to increase food acceptance. For most of the sweeteners and additives surveyed, parents in both groups did not differ significantly in utilization. The exceptions were ranch dressing and honey. Parents who baby-led weaned were more likely to use both ranch and honey compared to their parent-led counterparts. Together, these studies indicate that baby-led weaned infants differ from parent-led weaned infants in a variety of factors that contribute to the development of healthy eating habits.
Exploring the Concept of Prevescalation Through the Lens of Trauma: The Role of Students and Teachers
(North Dakota State University, 2021) Chinopfukutwa, Vimbayi Sandra
Numerous studies highlight that adolescence is the peak period of risk for trauma and its negative effects on physical and mental health. The current research focused on two studies examining whether training students and teachers in schools on effective strategies such as trauma-informed practices (TIPs) may help those who have experienced trauma build resilience and prevent the negative effects of trauma from progressing to adulthood. Study one examined the degree of trauma exposure, the role that students play in the implementation of TIPs, and the extent to which implementing TIPs impacts their lives. Participants were students (aged 15-18) participating in an elective Social Emotional Learning course in two rural high schools in the Midwest. Descriptive statistics showed that 46.2% of the students in the sample had at least one adverse childhood experience. Interview data also showed that students implemented Social Emotional Learning, Self-Care, and Restorative Circles in their schools. Results also showed that students trained younger students, same-age peers, and their teachers on these practices. Finally, results indicated that implementing TIPs promoted positive behaviors among students and teachers in the schools. Study two examined whether teachers’ professional quality of life and type of training received predicted their implementation of TIPs in schools. Participants were 324 teachers (aged 22-70) from three public school districts in the Midwest (different from the schools in study one). Hierarchical multiple regression analyses showed that compassion satisfaction positively predicted teachers’ implementation of TIPs while compassion fatigue negatively predicted teachers’ implementation of TIPs. In addition, teaching experience significantly moderated relations between compassion fatigue and teachers’ implementation of TIPs. Finally, training on Self-Care and Restorative Circles positively predicted teachers’ implementation of TIPs in schools. Discussion focuses on ways to provide support for students and teachers as they continue to promote the implementation of TIPs in schools.
Exploring the Meaning of a Rural Mind-Body Medicine Group Curriculum from the Perspectives of Community-Based Participants
(North Dakota State University, 2020) Riegert, JoAnne Marie
The challenges and stress that are present in our daily lives can be consuming and are often associated with chronic illnesses and mental health concerns. In rural communities, residents may experience greater exposure to a range of potentially traumatic events at both a personal and community level (Handley et al., 2015). Additionally, in many rural areas, the availability of health services is a significant issue. One emerging approach utilized to treat the increasing numbers of chronic illnesses and trauma-related mental health problems in a rural population is the integration of meditation skills presented in a group setting, to counterbalance the effects. This phenomenological study explores seven individuals' perspectives on the impact of participation in a Mind-Body Medicine Group Curriculum, in a rural community. The findings illuminate etic clusters of the impact of worry, the importance of forgiveness, growth of self-love and self-compassion, the benefits of the therapeutic bond in the group experience, and micro and macro healing. Emic themes of self-actualization and the importance of relational connection were discovered. These outcomes suggest that healing in rural communities is obtained in group settings, as an additional alternative to individual therapy. Implications for integrating mindfulness into psychotherapy practice, the impact of group work in rural areas, as well as applications for counselor educators and graduate training programs, are additionally explored.
Retraining the Brain to Prevent Disordered Eating: Approach Versus Avoidance
(North Dakota State University, 2019) Jones, Maegan Elizabeth
Emerging adult college women are at particular risk for developing unhealthy eating habits. Despite this, methods of intervention in this population are understudied. This study sought to test whether an implicit, cognitive retraining program could alter how women approach foods. Specifically, the researcher wanted to determine if the Behavioral Activation System (BAS), which encourages individuals to approach positive goals, and the Behavioral Inhibition System (BIS), which helps individuals avoid negative outcomes, could be manipulated. Thus, this study examined whether a dot-probe retraining program could significantly alter women’s approaches to healthy foods. Dot-probe programs present two pictures side-by-side; when the pictures disappear, a stimulus, in this case a “+”, appears where one of the pictures was previously located. In this project, participants assigned to an experimental training program would have the “+” located under healthy foods most of the time, in order to encourage BAS activation and approach behaviors. In addition, because it is imperative to understand how women’s families affect their thin ideal internalization (i.e., drive for thinness and restraint) and their approach/avoidance habits, the quality of past and current parent-daughter relationships were examined. Indeed, no known research has examined how the parent-child relationship may affect BAS/BIS usage. Forty emerging adult women were recruited; half were assigned to an experimental training group, while the other half completed a sham training group, in which they equally reacted to all foods. Participants were asked to complete five sessions on their own devices, in their chosen environment. By the final training sessions, those in the experimental group (n = 15) reacted to healthy foods two times faster than those in the sham group (n = 15). In addition, a series of moderation analyses found that, even when participants had high levels of thin ideal internalization, positive parenting characteristics such as a current high-quality mother-daughter relationship and past low paternal control improved participants’ reaction times to healthy foods. These findings suggest that a combination of both a biologically-based method of intervention and a family systems intervention may lead women to have healthier approaches to foods, thereby potentially preventing the development of unhealthy eating habits.
Longitudinal Associations among Personality, Perceived Control, and Health for American and Japanese Aging Adults
(North Dakota State University, 2019) Toyama, Masahiro
Perceived control is associated with health throughout adulthood, yet has also been found to decline with age possibly due to age-related experiences of increasing losses and limitations in life circumstances. Perceived control may also be affected by individual personality characteristics, which also predict health through late adulthood. Although previous studies have addressed these associations, research is lacking in examining nuanced associations among personality, perceived control, and health all together as well as age and gender differences in these associations. Moreover, perceived control may be related to individualistic values (e.g., autonomy, agency) that vary cross-culturally and the implications of perceived control as well as personality for health may differ in distinct cultures. However, cross-cultural research on longitudinal associations of personality, perceived control, and health is further limited. In order to address the gap in the literature, the present dissertation, consisting of three studies, focuses on investigating longitudinal associations among personality, perceived control, and health for American and Japanese middle-aged and older adults. The first two studies address longitudinal associations between personality and perceived control (Study 1) and the potential mediation of perceived control for longitudinal associations between personality and health (Study 2) for 4,611 American adults (aged 40 to 75 at baseline). Study 3 examines associations among personality, perceived control, and health for 827 Japanese adults (aged 40 to 79 at baseline) in contrast to Americans. The findings suggest that neuroticism and conscientiousness are consistent predictors for perceived control over time and that perceived control mediates longitudinal associations of neuroticism and conscientiousness with functional health for American adults. Such mediation was not found for Japanese adults despite overall similar tendencies except for associations between personality and perceived control. No age differences in associations among personality, perceived control, and health were found for both nationalities (who were in their 40s to 70s at baseline) while there were some gender differences in a limited few associations for Americans. The dissertation contributes to the literature by furthering the understanding of longitudinal associations of personality, perceived control, and health and indicating future directions for research including exploring potential avenues to promoting health through perceived control.
Weight-Related Health Behaviors and Body Mass: Associations between Young Adults and their Parents, Moderated by Parenting Styles
(North Dakota State University, 2011) Niemeier, Brandi Shea
The incidence of overweight conditions among children and adolescents is a growing national concern. Although current literature suggests that parental health behaviors could influence health behaviors of children, studies have not explored the actual predictive relationships of parents' and their children's weight statuses and weight-related behaviors. In addition, current studies have not tested the influence of parental authority, family communication, or demographic characteristics on the relationships. This study first examines factors that contribute to overweight conditions among children and adolescents and the associated costs. Studies of interventions that target children's and adolescents' weight-related health are then reviewed and provide evidence that parental involvement contributes to intervention success. The theory of planned behavior, social cognitive theory, social action theory, and systems theory are discussed and support the notion that parental influences contribute to the development of children's weight-related health behaviors. To test the relationships, 151 young adults and their parents were recruited and completed a series of questionnaires to describe their weight statuses, dietary behaviors, and physical activity behaviors. In addition, the young adult participants completed questionnaires to further describe their parents' parental authorities and their family communication environments during childhood and adolescence. Comparisons of body mass index, average daily energy consumption, average weekly energy expenditure, and physical activity enjoyment of young adult participants and their parents were conducted with correlation analyses and paired-samples t-tests. Further, multiple regression analyses were used to explore the influence of parental authority and family communication, and demographic characteristics were also considered. The empirical results of the current study indicate that, overall, parents' weight statuses and dietary behaviors help predict weight statuses and dietary behaviors of their young adult children. Further, parental authority scales interact with the relationships. At high levels of authoritarian and permissive parental authorities, young adults tend to have weight statuses that are opposite to those of their parents; at high levels of authoritarian parenting, young adults also tend to follow opposite dietary consumption patterns. The findings in this study have implications for professional practice, parenting practices, and the design of intervention activities. Recommendations for future research are provided.
The Role of Music Among Healthy Older Performance Musicians
(North Dakota State University, 2016) Hutchison, Barbara
This qualitative study explored the role of music in the lives of 18 healthy older performance musicians (PMs). PMs began music education in early childhood and developed music competencies of advanced, expert, and virtuoso by voice, instruments, and composing music. The phenomenology approach to data consisted of a 7-item demographic questionnaire, and an 18-semi-structured interview questionnaire. From the themes of community music participation, wellness, and happiness emerged 11 subthemes. The role of participating in community music validated PMs’ music identity. First, values and beliefs explained music was life and a livelihood; second, music participation continued for decades because conductors chose complex repertoires that encouraged learning, and showcased music competencies. Third, camaraderie and enduring relationships sustained social connectedness, and fourth worldwide travel was inherent to performance and socialization. The role of music and wellness supported PMs’ healthy aging through the life course. First, emotional wellness explained sense of self to trust and share emotions with others and aligning views of aging to make adaptations to aging processes when needed. Second, intellectual wellness explained the relationship between complex music and brain health. Third, physical wellness explained personal benefits of physical fitness, nutrition, and intellectual energy to performing music. Fourth, sociological wellness explained PMs’ favorite music connected with family, friends, and community. The role of music and happiness clarified motivations to needing and wanting challenging repertoires. First, lifelong learning of music was resultant to happiness, and, second, happiness was resultant to performing repertoires expertly, and third, performing music was exhilarating and fun despite the countless hours of practice to perform expertly. This study found that music was critical to PMs’ health, happiness, and well-being. Future research should include audiology because hearing loss is endemic among musicians. Furthermore, establishment of regional U.S. research teams should gather data on yearly cycles, and longitudinal qualitative studies to help build a base of knowledge on PMs, and bridge the gap in literature to reverse the current empty trend. These efforts will help make seminal contributions for all generations and society.
Qualitative Research as a Creative Teaching Technique: A Phenomenological Study
(North Dakota State University, 2018) Hemming, Lynae Sue
Phenomenological inquiry was utilized to explore masters level counseling students’ experiences completing a qualitative research project as part of a Shame and Shame Resiliency course. Five of seven counseling students who participated in the Shame and Shame Resiliency course and completed the qualitative research project participated in an about their experience completing the assignment and the impact it had on their learning and growth. The qualitative research assignments were also analyzed by the researcher. The researcher identified themes and numerous subthemes using Moustakas (1994) method for data analysis. Four main themes were identified (Process of the Qualitative Research Project; Impact of the Qualitative Research Project; Learning Outcomes of the Qualitative Research Project and the Context of the Qualitative Research Project). Creative pedagogy was used as a framework for understanding student learning. Implications for counselor education and research are discussed.
The Impact of Psychosocial Outcomes in Long-Term Bariatric Patients
(North Dakota State University, 2015) Geraci, Angela Ann
The disease of obesity is a serious and significant public health epidemic affecting more than 78 million Americans. The increase in human life expectancy also increases the chance of reduced quality of life and well-being by those suffering from obesity. Obesity–related factors may mean years of physical and psychosocial discomfort, lack of mobility, and chronic ill health. This study analyzed long-term bariatric patient outcomes, specifically, factors regarding postprocedure weight regain, surgeon follow-up, and psychosocial issues related to quality of life (i.e. self-concept and obesity discrimination). The overarching research design for this study employed survey methods, using a cross-sectional, self-reported questionnaire and enlisted both a combined quantitative and qualitative approach to analyze data. Participants over the age of 18 and at least 18-months post-procedure were recruited either from public bariatric support forums (n = 133) or through a regional weight management center in the Midwest (n = 534), which specializes in bariatric surgery. Results suggests that although some weight regain after surgery is likely, weight regain decreases as a patient continues to maintain adherence to the recommended post-operative diet, as well as the importance of bariatric follow-up and support. Additional results revealed that different aspects regarding the ‘self’ such as body image, the continued struggle to develop alternative coping strategies to eating, and obesity stigma have an impact for a multitude of years post-bariatric surgery, and therefore can overshadow the benefits of surgery. It is recommended that a critical key to success for long-term bariatric patients is having access and care of multidisciplinary teams including a bariatric surgeon, gastro-intestinal specialist, endocrinologist, nutritionist, and psychiatrist at minimum. Finally, there is also a significant need for long-term bariatric research in the future.
Understanding the Social Effects of Water Intervention Implementation in Sub-Saharan Africa: A Qualitative Study in Kitui, Kenya
(North Dakota State University, 2015) Zolnikov, Tara Rava
Global public health interventions focus on creating solutions to unaddressed humanitarian issues in developing countries; priority projects include providing communities with access to water, food, and healthcare. Nearby access to safe drinking water is a primary public health concern and a frequent public health intervention. Intervention success may depend on other factors in addition to health outcomes. However, previous research has focused solely on health effect outcomes and has not reviewed the impact of social effects from implemented water interventions. The purpose of this study was to understand the impacts of an implemented water intervention on social relationships among community members in Sub-Saharan Africa. A qualitative phenomenological approach with 52 semi-structured interviews was used to examine relationship experiences among primary water gatherers and their families after the implementation of water interventions in the community. This study took place throughout the historically semi-arid eastern region in Kitui, Kenya, where community members have been beneficiaries of various water interventions. Prior to the water intervention, family members experienced economic hardships, diminished community rapport, irregular meal times and food availability, infrequent family conversations, irritation with lack of bathing and cleanliness, and general discontent without the availability of one able-bodied family member. Participants’ experiences after implemented water interventions revealed enhanced relationships within household family units and within the community; additional personal time was gained and used to re-build relationships. The newly established relationships encouraged growth through family discussions and in conversations understanding and providing solutions to economic or individual challenges. This research provides evidence of an increased need for access to quality water for communities throughout the world in order to positively impact family relationships, which may ultimately contribute to the acceptance of the intervention. iv Clearly, the findings from this study are important to consider during the development phase of water interventions.
Anticipatory Guidance Provision Related to Driving Safety/Cessation for Older Drivers
(North Dakota State University, 2014) Huseth-Zosel, Andrea Lynn
Increasing numbers of older adults continue to drive. Aging-related physical and cognitive changes can impact driving ability. Health care providers (HCPs) are ideally placed in society to provide mobility counseling to older drivers. This research explored the frequency of HCP mobility counseling provision to older drivers; HCP demographic and practice predictors of mobility counseling provision; and rural-urban differences in HCP mobility counseling provision, HCP perceptions of mobility counseling provision, and HCP barriers to mobility counseling provision. Data were collected by surveying HCPs in several upper Midwest states. Two manuscripts were produced as a result of this research. The first article focuses on rural-urban differences in HCP mobility counseling. It was found that rural HCPs were less likely than urban HCPs to provide mobility counseling to patients aged 75 or older. Additionally, rural HCPs were less likely than urban HCPs to feel there are adequate resources, less likely to refer patients if they had questions related to driving issues, and less likely to know where to refer older drivers for driving fitness assessments. The second article focused on HCP demographic and practice predictors of mobility counseling provision. It was found that HCP predictors of mobility counseling provision differed by patient age. HCPs that had personal experience with a motor vehicle crash more often provided mobility counseling to patients aged 65 to 74. For older patients (aged 75 or older), HCPs who practice in rural areas, older HCPs, and HCPs with greater proportions of patients aged 65 or older were more likely to provide mobility counseling. This study is important in laying the groundwork for future research focusing on mobility counseling and older drivers, and emphasizing the significant role of HCPs in this process.
Childhood Adversity and Successful Aging
(North Dakota State University, 2017) Danielson, Ramona Ann
Extant literature offers consensus regarding the long-term impacts of childhood adversity (CA) but its impact on successful aging is not well understood. The Midlife in the United States (MIDUS) study – a nationally representative sample including 1,017 adults 55-76 (Ryff et al., 2016) – did not include a measure of CA exposure for use in analyses. Two papers were developed for this dissertation. The first paper, An effective measure of childhood adversity for use with older adults, explored whether a cumulative CA measure that is effective for older adults could be developed using existing MIDUS questions. It provided a rationale for operationalization of CA for researchers and for creating a cumulative score of eight CA types. Distributions of individual items and the CA score were consistent with past studies using similar CA measures. The overall factor structure of the scale was consistent with previous research: 1) household dynamics (did not live with both biological parents until age 16, substance abuse in the home, financial distress, moved three or more times) and 2) child abuse and neglect (sexual assault, emotional abuse, physical abuse, emotional neglect). Consistent with the literature, CA score showed a significant negative association with life satisfaction and positive association with number of chronic conditions, and dose-response relationships with cumulative CA. This study demonstrated that CA score, created using existing MIDUS data, was an effective measure for use with older adults. The second paper, The impact of childhood adversity on successful aging for older adults, examined the impact of CA score on successful aging for older adults, operationalized using eight dimensions of wellness. Results showed that CA affected successful aging decades later. Controlling for age and gender, hierarchical multiple regression showed a significant negative association between CA score and emotional, physical, social, financial, environmental, and spiritual wellness as well as the cumulative wellness index, and no significant association with intellectual or occupational wellness. Prevention is the best way to address public health implications of CA. However, the present study provided insight into successful aging and can inform interventions that target adults for whom prevention of CA is not possible.
Graduate Counseling Students' Interest in Gerocounseling A Quantitative Study
(North Dakota State University, 2015) Nielsen, Twyla Ann
A growing population of older persons in the United States will require not only additional counselors but counselors who are trained to work with an aging adult population. Recent trends indicate that counselor education programs have moved away from gerocounseling as an academic track as well as eliminating units on aging from courses currently offered to counselors-in-training. Some graduate counselor education programs offer individual courses in aspects of gerontological counseling. If the counseling profession is to meet the rapidly increasing needs of a growing older population, more attention must be given to training counselors to meet the needs of this population. The purpose of this study was to assess graduate counseling students, from counselor education programs, regarding the students’ willingness to participate in gerocounseling training and identify specific topics of interest that the graduate counseling students would most be interested in counseling aging adults. Forty-four counselor education programs were contacted in the North Central Region of the Association of Counselor and Education Supervision (North Central ACES) and 211 students responded to the electronic survey through Survey Monkey. The results showed that graduate counseling students are very interested in gerocounseling and working with older adults. Students were willing to take additional coursework but not to the extent that it would delay graduation. Students indicated that they felt prepared to counsel older adults; however, none of the graduate counseling students surveyed had completed their field experience which could impact that sense of preparedness. As the aging population increases, so does the need for counselors who can help older adults with life transitions. It is important that counselor education programs have faculty that identify as gerontology specialists, that graduate counseling students have specialized coursework and are performing research specific to counseling older adults.
Structured Life Review and its Impact on Family Interactions
(North Dakota State University, 2013) Dahley, Laurie K.
Communication has been deemed by Nelson, Schrader, and Eidsness (2009) as critical to the ability to provide quality end-of-life care. While past research has focused on communication between healthcare professionals and the patient/family unit, this qualitative study explored the impact of a life review technique on family interactions. Structured life review interviews were conducted with fifteen residents of a skilled nursing facility in the presence of family members. Follow-up interviews were conducted with elders and family members to determine the impact of the intervention on family interactions as well as individual effects. Using qualitative methodology, open-ended questions were employed to enhance our understanding of the participant's experience through the life review process. Themes that emerged included: affirmation of prior knowledge, living legacy, new information, opened communication, enhanced understanding, affirmation of the older adult, testimonials, and bridging distant family relationships. Two articles for publication were produced as a result of the project. The first article defined and reviewed all of the themes identified in the study. Along with the discussion of themes, its potential as a tool to improve communication and family interactions was explored. The second article focused on the psychological impact of the life review process experienced by the individual as well as the family system. In addition, the implications for social work practice with older adults were examined and recommendations for implementation were reviewed. Possible direction of future research was also discussed.
Evaluation of Osteoporosis Educational Interventions on Knowledge, Health Beliefs, Self-Efficacy, Dietary Calcium and Vitamin D Intakes
(North Dakota State University, 2013) Evenson, Alexa
Osteoporosis is a serious public health issue, which is growing in significance because of our aging population. It is estimated that 34 million individuals in the United States are at risk for osteoporosis. Education may be key to increasing preventative behaviors in younger adults to help prevent osteoporosis in later life. One purpose of this study was to determine the validity and reliability of three revised scales, which were revised to include vitamin D related items: Osteoporosis Knowledge Test -D, Osteoporosis Health Belief Scale-D, and the Osteoporosis Self-Efficacy Scale-D. These revised scales were then used to determine the effects of educational interventions (lecture versus hands-on activities) on osteoporosis knowledge, health beliefs, self-efficacy, dietary calcium, and dietary vitamin D intake in a sample of college age adults. A sample of 153 college age men and women completed online pre- and post-questionnaires to assess osteoporosis knowledge, health beliefs, and self-efficacy using the validated revised Osteoporosis Knowledge Test (OKT-D), revised Osteoporosis Health Belief Scale (OHBS-D), and revised Osteoporosis Self-Efficacy Scale (OSES-D) respectively. Pre and post three-day food diaries were used to assess dietary calcium, vitamin D, and kcalorie intake. In general, the college age adults in this sample were low in osteoporosis knowledge. Both intervention styles increased osteoporosis knowledge and health beliefs but not self-efficacy. Dietary calcium intakes at baseline met the recommendations while dietary vitamin D did not. No significant increases were found in dietary calcium or vitamin D intake after the educational interventions. Osteoporosis health beliefs were a significant predictor of dietary calcium intake (p<.044) and vitamin D intake (p<.047) accounting for approximately 11.2% and 10.1% of the variance respectively. Self-efficacy was a significant predictor of vitamin D intake (p<.01) only, accounting for approximately 7.3% of the variance. These findings suggest different types of osteoporosis educational interventions may increase knowledge and health beliefs in college-age adults but may not change behaviors. Perhaps tailored interventions towards specific health beliefs and self-efficacy are needed to warrant behavior change.
Impact of a Wellness Coaching Program on Bariatric Surgery Candidates Following Weight Loss
(North Dakota State University, 2013) Gust, Anita Marie
A lifestyle approach toward weight loss, encompassing behavior modification strategies, education, and new coping skills may be most effective in adoption of the healthy behaviors necessary for achievement and maintenance of successful weight loss. Limited research exists on the effectiveness of pre-surgery wellness programs on post-surgical health behaviors for bariatric surgery candidates. The purpose of this study was to determine the impact of a pre-bariatric surgery wellness coaching program on health behaviors, quality of life (HRQoL), and psychosocial factors.A questionnaire containing measures of weight (self-report), dietary and physical activity (PA) (7-day IPAQ-short) behaviors, exercise motivation (BREQ-2), HRQoL (SF-12v2), and open-ended questions evaluating the wellness program, was sent out to all participants who engaged in a 12-week weight loss wellness coaching program and all bariatric surgery patients from 2009-2012 (n=782). From the 118 returned surveys (15.0%), participants (age = 51.46 years ± 12.98, BMI = 30.31 ± 7.70) were placed in either the wellness-coaching only group (n=16), surgery-only group (n=58), or surgery plus wellness coaching group (n=44) based on whether they participated in, and completed, the 12-week program and/or surgery. The wellness-coaching only group was excluded for the first set of analysis where weight loss, PA, dietary factors, exercise motivation and HRQoL were analyzed between a control (surgery only) group and intervention (surgery + wellness coaching) group. Compared to controls, participants in the wellness-coaching group had significantly more weekly vigorous PA, total minutes of MVPA, and total weekly PA. Significant differences were also found for two measures of exercise motivation and vitality scores. The second set of analysis excluded the surgery only group to analyze the impact of the wellness coaching program. Results indicate favorable results for health behaviors. A qualitative analysis found positive results for several psychosocial factors, motivation, and new skills learned. A comprehensive, wellness approach encompassing evidence based strategies toward weight loss had positive results towards health related behaviors and emotional and social well-being. Additionally, participants reported responses consistent with continued engagement in health behaviors and weight loss maintenance.
Changing Rural Communities: An Exploration of Older Adults' Experiences
(North Dakota State University, 2013) Strommen, Jane M.
This research was designed to better understand the perceptions and experiences of older adults who live in small towns and rural areas. In this qualitative study, 13 individuals were interviewed to gain an in-depth understanding of their experiences related to aging, community change, and well-being. Participants ranged in age from 69 to 90. Two articles report the results of this research in Chapters Three and Four. The first article presents the themes that reflect the participants' perceptions of living in changing communities. Data analysis revealed five themes: elders were saddened by losses in their community but were resigned to accept them; diversity among the rural communities affected views about community; dwindling social networks and opportunities left elders feeling isolated and lonely; attachment to place was strong, and commitment to stay on despite concerns for the future. The second article focuses on the daily life experiences, challenges, and strategies of older adults living in rural communities. Four key themes emerged from participants' responses about their lived experiences in communities that have undergone long-term changes: social interactions were limited; sense of social connectedness had weakened; daily life experiences depended on community and individual characteristics; and elders sought to manage challenges. Overall, there was a strong desire to remain in rural areas in spite of challenging conditions, with attachment to place being a factor contributing to the commitment to age in place. Daily experiences and challenges for participants were influenced by both community and individual characteristics. Person-environment relationships served as environmental comfort, maintenance, or distress for rural elders. Participants expressed disappointment in the deteriorating social interactions and social connections in their communities, resulting in feelings of isolation and loneliness. Future research should include a closer examination of the environmental characteristics that serve as resources or stressors for rural elders and of the personal competencies that help older adults adapt to changing environments and manage their lives effectively. These studies help identify specific environmental and personal characteristics that either promote or hinder well-being for elderly living in rural communities.

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