Undergraduate Research

A New Approach: Investigating the Relationship Between the Pediatric Inactivity Triad and Body Image Perception in Children

Project Mentor: Elizabeth Bailey, lecturer in Exercise Science

Project Abstract
The World Health Organization recommends that children aged 5-17 should acquire 60 minutes of moderate to vigorous physical activity (MVPA) a day, yet studies show that few children actually attain this minimum. The Pediatric Inactivity Triad (PIT), consisting of physical inactivity, pediatric dynapenia, and physical literacy, has been proposed as a way to assess the consequences of insufficient activity in children. To date, the PIT has been largely understudied and the relationship between PIT and body image perception in children has not been examined. Therefore, the purpose of this study was to evaluate the existence of PIT and examine its potential relationship to body image perception in children of Alamance County, NC. Subjects (N=93) were recruited from Elon University programs that target grades 3rd-5th, as well as from local elementary schools. Once parental consent and participant assents were obtained, handgrip strength and standing vertical leap were used to assess pediatric dynapenia. Physical literacy was assessed using the PLAYbasic Physical Literacy Score (PLAYbasic), requiring evaluation of five motor tasks. Physical inactivity was measured using the Evaluation of Activity Surveys in Youth (EASY) questionnaire, and body image perception was evaluated using the Social Physique Anxiety Scale for Children (SPAS-C) (N=32), and the Rosenberg Self-esteem scale (SE). The SPAS-C is a better measure of perceived body image, but local schools would not allow the questionnaire to be administered, limiting its contribution to our analysis to a small subset of participants. Results indicated that 62% of participants showed a deficit in at least 1 category of PIT, with 9% showing deficits in all categories of PIT. No significant correlations were found between the PIT and SE, however, a negative correlation was found (r value = -0.413) between SPAS-C and the composite PLAYbasic score (p-value = 0.023), indicating increased physique anxiety correlating to deficits in physical literacy. The results of this study verify the existence of PIT and its ability to be evaluated in an empirical setting. However, due to constraints applied by the school system, it was difficult to determine a relationship between body image perception and PIT, and thus further research is needed.

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Internationally adopted children with PHIV: A longitudinal qualitative study of adoption narratives and HIV disclosure practices

Project Mentor:Cindy Fair, professor of public health studies and human service studies, Watts/Thompson Professor and chair of the Department of Public Health Studies

Project Abstract
Following the 2010 repeal of the ban regarding immigration of HIV-positive individuals to the United States, an increasing number of families sought to adopt children with perinatally-acquired HIV (PHIV) from other countries. However, little is known about the experiences of these families. The purpose of this longitudinal study is to explore how parents construct the adoption narrative for their child, how they approach disclosure of HIV to their child and the community, and determine if the adoption narrative and disclosure practices change over time. A purposive snowball sample of 24 parents of 27 internationally adopted children with PHIV (IACP) were recruited from two pediatric infectious disease clinics. Parents participated in two semi-structured, audio-recorded interviews, approximately one year apart. The first interview elicited adoption narratives parents shared with their children and their disclosure decisions. The follow-up interview focused on the parents’ and children’s experiences in their families and communities. Interviews were transcribed, coded, and analyzed using principles of constant comparison. All parents identified as white and 22 as Christian. Mean age of the children at enrollment was 9.2 years (range 2-19, 15 females). Both the adoption narrative and disclosure of HIV to the child were dynamic. Factors influencing parental decisions to share or withhold information included the child’s age, maturity level, and cognitive ability, child questioning, and nature of the adoption story. Disclosure of HIV to the child typically began with a discussion about medication and how viruses work in the body before the term “HIV” was introduced. Parents emphasized that medically, “HIV is easy” but “socially difficult”, stating disclosure as one of their most significant challenges. Most families did not openly disclose their child’s status to the community, citing lack of HIV education, stigma, and desire to protect their child as reasons to avoid disclosure. Parents prepared their child for HIV stigma by fostering self-confidence and ownership of their story, normalizing HIV, educating others, and creating a support system. This research emphasizes the role that adoption and disclosure narratives play in the development of IACP as they learn to manage their illness. It underscores the need for support of adoptive families and may help providers develop individualized comprehensive care as this emerging population matures into adolescence.

Deactivation of Parasitic Nematodes for Improved Water, Sanitation, and Hygiene

Project Mentor: Scott Wolter, associate professor of engineering

Project Abstract
Helminth infections, caused by parasitic worms, impact approximately a quarter of the global population according to the World Health Organization (WHO). This global health issue predominantly affects individuals in developing regions of the world, as they are more likely to have insufficient water, sanitation, and hygiene resources. Recent work in our laboratory has reported on deactivation of parasitic worms using high intensity pulsed electric fields to permeabilize cellular and eggshell lipid bilayers. Initial work showed eggshell permeability in Caenorhabditis elegans (C. elegans) nematodes that was determined to be detrimental to the developing embryo. More recent work by our collaborators at Duke University has shown similar efficacy for destruction of Ascaris suum, a helminth parasite of swine. Herein, we report on research to evaluate the impact of varying solution conductivities and C. elegans worm and egg concentrations on the pulsed electric field deactivation efficiency. C. elegans were placed onto nematode growth media plates, which provided nutritive support allowing the worms to thrive and produce eggs. After approximately two days, 0.1X (solution conductivity ~ 2 mS/cm), 0.01X (~ 0.2 mS/cm), and 0.001X (~ 0.02 mS/cm) phosphate buffered saline solutions were pipetted onto separate plates containing worms and newly hatched eggs, then transferred from the plates into cuvettes fitted with opposing electrodes for electric field deactivation. Additionally, varying concentrations of worms and eggs (0.5, 1.0, and 2.0 times standard worm and egg concentrations) were placed into cuvettes of differing solution conductivities to enable a comprehensive parametric study. Results thus far show a strong relationship between pulsed electric field deactivation efficiency to that of solution conductivity and worm and egg concentration in the buffer solution. We will discuss observations during our experimental work and ongoing effort through our work with the Bill & Melinda Gates Foundation ‘Reinvent the Toilet Challenge.’

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Community Outcomes and Responses to the Alamance Doula Program

Project Mentor: Stephanie Baker, assistant professor of public health studies

Project Abstract
The Alamance Volunteer Doula Program has provided women in child labor and birth with doulas since 2017. Doulas are trained to offer physical and mental support measures to expectant mothers before delivery, during labor and birth, and postpartum, and are proven to increase birth outcomes for both the mother and baby (Gruber et al., 2013). The program was created in an effort to reduce infant mortality, maternal mortality, and racial and socioeconomic-driven health disparities within Alamance County by offering a doula to be present at labor and delivery, should the mother desire one. The purpose of this research is to collect and analyze qualitative data from the women who utilize these doulas during their labor and delivery in order to understand birth experiences, outcomes, benefits, and areas of improvement. Mothers with doula-attended births at Alamance Regional Medical Center were asked to complete an open ended, multiple choice, and scaled-response survey to gather data on the birth, baby, and doula. The analysis included multiple choice and scaled-response data from 30 mothers and open-ended responses from 15 mothers who are ages 15-44, 64% White, 18% African American, and 18% Hispanic or another race. Results show overwhelmingly positive outcomes, with 100% of mothers reporting that having a doula was beneficial to their experience. Common sentiments among mothers were feeling empowered, comforted, courageous, reassured, and in control of their birth experience. 33% of respondents reported that their doula was a source of valuable information and support for the mother’s partner and family as well. The aspects of the program identified for improvement are marketing the program more and encouraging mothers to focus on birth goals rather than birth plans, as 47% of mothers felt their birth was not what they envisioned. Overall, these results show a positive effect on the mother’s birth experience as well as identify areas for improvement, and these findings may allow current and future community doulas within Alamance County to better understand, care for, and support their patient population.

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“It’s all about labels”: Caregiving experiences among guardians of adolescents and young adults living with perinatally-acquired HIV

Project Mentor: Cindy Fair, professor of public health studies and human service studies, Watts/Thompson Professor and chair of the Department of Public Health Studies

Project Abstract
Prior to the advent of antiretroviral treatment in the early 1990’s, approximately 30% of children born to HIV-positive mothers were HIV-infected, many of whom did not survive early childhood. Children born with HIV typically experienced upheaval in their daily lives due to parental illness and absence resulting in the need for additional caregivers. Today the risk of mother-to-child transmission in the US has reached a record low and youth with perinatally-acquired HIV (PHIV) are living well into young adulthood. While there has been extensive research related to the social impacts PHIV has on individuals, little recent research has examined their broader family system. Because of their lived experience, caregivers of adolescents and young adults with PHIV have a unique perspective regarding the ways in which the social context of HIV has impacted parenting relationships. This qualitative exploratory project examines themes found in caregiver/child relationships among 18 caregivers (17 females) who cared for adolescents and young adults with PHIV over the age of 14. Participants included ten biological mothers (all HIV-positive), two caregiver relatives (maternal aunt and older sister), four adoptive/foster mothers, one step-mother, and one step-father. Nine identified as African American, five as white, three as African, and one as Hispanic. Mean age of participants was 50.5 years (range 40-75). Transcripts from semi-structured interviews focused on parenting experiences were coded for emergent themes.  Analyses revealed several common themes including a strong sense of pride related to their children’s accomplishments, a sense of hopefulness in the reduction in HIV-related stigma, and the utilization of doctors and social workers as forms of support. However, they also noted continued HIV-related discrimination in the medical field and felt that their children were still judged based upon the labels associated with HIV. Participants explored aspects of parenting an adolescent with PHIV and indicated focus on safe-sex as compared to abstinence-based discussions, fear of HIV transmission to future generations, and challenges in allowing their adolescent to self-manage their illness. Considering these unique challenges felt by caregivers, collaboration among social workers and healthcare professionals to identify support strategies will benefit both caregivers and adolescents and young adults with PHIV.

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Understanding Social Media’s Impact on Breastfeeding Black Millennials

Project Mentor: Stephanie Baker, assistant professor of public health studies

Project Abstract
The World Health Organization recommends six months of exclusive breastfeeding for infants. Race disparities exist, where only 27.9% of black women exclusively breastfeed at 6 months compared to 45.1% of white mothers. Previous research suggests that these disparities are due to a variety of factors including poor paid leave policies, racism, and bias. This mixed-method study aimed to understand the racialized experiences of breastfeeding among black millennials and whether social media is a space that could impact the effects of racism. Social media has a significant influence on black millennials’ lives, yet little research has explored its connection to breastfeeding. The quantitative phase involved a 48-item online survey (N=51) and included questions about demographics, breastfeeding, social media use, and the Major Experiences of Discrimination Scale. Quantitative survey results informed the qualitative phase of the study which included three focus groups (N=15). Participants were recruited through social media sites, emails to breastfeeding/black maternal health organizations, and local partnerships. Inclusion criteria included self-identification as a black/African American woman, born between 1981-1996, and having at least one child five years or younger. Six major themes emerged from the qualitative analysis including: (1) institutional racism & barriers, (2) challenges to motherhood, (3) black experiences, (4) breastfeeding in the millennial age, and (5) social media impact and (6) hopes for the community. Results show that black millennial mothers use social media to support their breastfeeding journey, although not specifically as a strategy to impact racism/bias, though they expressed being treated differently and poorly due to race. Further research should explore differences between online social support and in-person support groups for black millennial mothers, additionally to how social media can become more inclusive for this population.

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“We are not different from others”: A qualitative study of career aspirations, relationships, and childbearing among Hispanic/Latino adolescents with perinatally-acquired HIV

Project Mentor:Cindy Fair, professor of public health studies and human service studies, Watts/Thompson Professor and chair of the Department of Public Health Studies

Project Abstract
Little research has investigated Hispanic/Latino youth with perinatally-acquired HIV (PHIV), that comprise 26% of those living with PHIV and are now surviving into young adulthood. This population faces a myriad of challenges such as stigma from peers and family members, rejection from potential sexual partners, and difficulty navigating the United States healthcare system. Hispanic/Latinos are also disproportionally affected by high rates of poverty and low educational status. This qualitative study examined the lived experiences of 19 Hispanic/Latino adolescents living with PHIV recruited from a pediatric clinic. Mean age of participants was 19.8 years (range 15-25; 13 females and 6 males). Interviews included questions regarding adolescents’ future career aspirations, relationship and childbearing intentions, and narratives of living with PHIV. Interview transcripts were analyzed for emergent themes. Many did not view HIV as a barrier to their career aspirations. Two participants were married and nine were in committed relationships. Of the unmarried participants (n=17), 16 expressed a desire for marriage. While participants frequently tried to minimize how HIV had influenced their romantic relationships, every participant acknowledged that their illness had caused issues related to disclosure along with fears of rejection and transmission. Thus, they stressed the importance of maintaining a suppressed viral load by adhering to treatment. Participants with children (n=9) expressed a strong desire to continue educational and career goals for the benefit of their children. The majority of participants expected to have children in the future and did not consistently use contraceptives or condoms. In addition to living with HIV, participants also frequently discussed adverse childhood experiences including incarceration of a parent, death or suicide of a parent, and physical/verbal/sexual abuse during childhood. While living with a stigmatizing illness certainly influenced their daily lives, the challenges of living in poverty and experiences of loss and trauma also shaped their well-being. Hispanic/Latino adolescents with PHIV may benefit from the provision of trauma-informed and culturally competent care with the goal of supporting educational goals, risk reduction, and managing fear of rejection. Future research needs to assess current interventions with the aim of supporting this vulnerable population in their transition to adulthood.

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“It Makes Me Feel Like I Have Freedom”: Examining the Social-Emotional Effects of a School Garden at a Title I Elementary School

Project Mentor: Scott Morrison, associate professor of education

Project Abstract
Spending time in nature has a multitude of established benefits yet is a diminishing trend among children in the modern world. Due to the positive connection between the natural world and human health, the growing disconnect can be viewed as reason for concern. School gardens, a trend currently on the rise nationwide, pose a potential solution because of the positive effects they have on children’s connection to nature and overall health and well-being. This research study examines a school garden at a Title I school in eastern North Carolina and its social-emotional effects on elementary school students. The effects of the garden experience were examined through analysis of the voices of both students and teachers. Students’ and teachers’ perceptions of the school garden were analyzed along with student written reflections. Data collection included interviews with K-5 teachers (n=8), K-5 students responses to journal prompts (n=46), and semi-structured interviews with students (n=20) about garden experiences, as well as direct observations within the garden. Social-emotional learning (SEL), or the development of social-emotional competence, plays an important role in early childhood development and is the framework used to analyze both teacher and student data from the school garden. Results indicated that school gardens are sites for promoting SEL and student happiness, ultimately fostering positive youth development (PYD). This provides support for school garden programs to be implemented in the future as potential health and development promotion tools.