RISK AND PROTECTIVE FACTORS INFLUENCING .RISK AND PROTECTIVE FACTORS INFLUENCING CHILDREN AT RISK

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  • RISK AND PROTECTIVE FACTORS INFLUENCING CHILDREN AT RISK FOR OVERWEIGHT AND OBESITY IN LOW-INCOME, SINGLE FEMALE, PRIMARY

    CAREGIVER HOUSEHOLDS: AN EXPLORATORY QUALITATIVE STUDY

    By

    Sara N. Lappan

    A DISSERTATION

    Submitted to Michigan State University

    in partial fulfillment of the requirements for the degree of

    Human Development and Family Studies Doctor of Philosophy

    2016

  • ABSTRACT

    RISK AND PROTECTIVE FACTORS INFLUENCING CHILDREN AT RISK FOR OVERWEIGHT AND OBESITY IN LOW-INCOME, SINGLE FEMALE, PRIMARY

    CAREGIVER HOUSEHOLDS: AN EXPLORATORY QUALITATIVE STUDY

    By

    Sara N. Lappan

    Obesity has risen to epidemic levels in the United States (US) and affects individuals from all

    socioeconomic levels and ethnicities. Children of low-income, single female, primary caregiver

    households are at higher risk for being overweight and obese, particularly if they are members of

    ethnic minority populations exposed to permanent contextual adversity. Therefore, the most

    deleterious impacts of the epidemic are experienced by low-income and under-served ethnic

    minority populations. Both adult and childhood overweight/obesity are associated with

    devastating and costly health problems, reduced life expectancy, stigma, and discrimination.

    Although efficacious obesity intervention programs exist, their impact continues to be limited

    among underserved populations. Couple and family therapists can offer a relevant contribution to

    alleviate this health problem due to the professions systemic training and strengths-based

    orientation. This study consisted of an exploratory qualitative design with a thematic analysis

    approach. Data were gathered from 16 low-income, single, female, primary caregivers who were

    predominantly Black/African American (56.25%) of children between 3 and 8 years of age. In-

    depth interviews focused on exploring risk and protective factors associated with healthy eating

    and regular physical activity, two critical components for addressing the disease. Additional

    findings will facilitate obesity-focused interventions, and better inform practice and research.

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    ACKNOWLEDGEMENTS

    I bleed green. I call the third month of the year Izzo. My favorite college basketball

    player of all time is Mateen Cleaves. I followed the Flintstones. I repped Michigan State as my

    first Starter jacket in 5th grade. I was destined to be a Spartan, so when I had the opportunity to

    attend Michigan State for my doctorate, I didnt think twice. I was home.

    From the moment I stepped on campus even before I applied to the program, I was

    welcomed with open arms. Dr. Richard Wampler was so hospitable and it only affirmed that I

    was right where I was supposed to be. Thank you, Richard, for making me feel comfortable and

    important. I have been reaffirmed at every step of my journey at Michigan State that this was the

    school and the program for me. I have a community of people here who support me, encourage

    me, advocate for me, and cheer for me and I would not have gotten through the program sanely

    without you.

    First and foremost, Ruben, on paper my advisor, but in life so much more. Ruben, you

    have been a true blessing in my life not only as an academic, but as a person. I sincerely believe

    that you were brought into my life to help me grow and to pass along all I have learned to help

    others. I cannot sing your praises loudly enough for all you have taught and given me. You

    helped me believe in myself when I was struggling to see my worth, you have advocated for me

    time and again throughout my career at MSU to assure that I was seen and heard, and most of all,

    you have been a truly respectful and empathic mentor and friend. I am so grateful for the

    incredibly important role that you played for me while going through the toughest time of my life

    with the passing of my mother. You were my spiritual guide, my voice of reason, wisdom, and

    strength, you made yourself available and took the time to listen to my pain. You helped me

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    make sense of a time in my life that was filled with chaos and turmoil. For that, I will be forever

    grateful to you.

    Marsha, you have helped me to feel grounded in my decision to pursue health promotion.

    I am so grateful for your knowledge and your guidance in taking an interdisciplinary approach to

    health. I really think your encouragement was crucial to putting me in a fulfilling direction in my

    career. Youve also helped me become a better instructor by watching you do such a wonderful

    job. You always trusted me and took the time to hear my suggestions and implemented my input.

    That has been so instrumental in helping me gain confidence and better understand my own

    philosophies about teaching, therapy, and mentoring. I so appreciate all the time you have taken

    to get to know me beyond my role as a student and helping to guide me outside of the classroom.

    Thank you.

    Yo, Adriaaaaaaan! First, let me thank you for humoring my (probably annoying) Rocky

    impersonations. Thank you so much for your guidance and honest feedback throughout my time

    in the program. Thank you for offering me your tickets to basketball games before you would

    offer them to others (am I allowed to say that?). Thank you for partaking in post-clinic trivia

    nights. Thank you for showing me that its possible to be a successful and productive academic

    while also letting loose and never taking yourself too seriously. I appreciate you!

    Dr. Weatherspoon, thank you so much for imparting your wealth of knowledge of

    nutrition and programming. I have really appreciated your honest and constructive feedback

    throughout my dissertation process and truly look up to you and admire all that you have

    accomplished in your career. Thank you for being a wonderful role model.

    All of my accomplishments mean nothing without people with whom to share them. I

    could not be more grateful to my family, my heart, and my purpose for their love and support.

  • v

    To my mom, my guardian angel. You have given me so much throughout my life, but

    nothing as strong or as formative as your unwavering belief in me. You have been the best role

    model of a strong woman and supporting presence. I could not have asked for anything better

    than for the wonderful privilege of calling you mom. All I wish for is more time with you, but

    youve left me with so many wonderful memories and qualities that I will treasure forever. I love

    and miss you, mom.

    Dad, my rock, my guiding light, the most important and wonderful man I have ever

    known. Youre amazing, dad. I dont tell you enough how great you are and how much you

    mean to me. Quite honestly, if I told you every day, it wouldnt suffice. Thank you so much for

    helping me through tough times, but also allowing me to struggle while providing encouraging

    words. I would not be the woman I am today without your love and support. I love you.

    Lulu, thank you for being silly with me while also being a wonderfully smart woman who

    can talk academics and challenge me to think in a more creative way. I admire your drive, vision,

    and passion for learning and teaching. You truly inspire me to think outside of the box and teach

    my craft in ways that my students will understand. You amaze me with your ability to be such a

    wonderful mother and professional. Thank you for being there for me. Also, thank you for

    bringing my favorite little human into the world! I love you.

    Ollie butt, you are such a light in my life. You help motivate me to be better, not only for

    myself, but also to show you what a strong, successful, confident woman looks like. You are a

    goofy, goofy girl who has brought so much joy into everyones life that you touch. I love you so

    much, Oliviah Grace. Thank you for being you!

    To my cohort, Chris, Jessica, Reham, Karlin, Zain, and Sudha. Thank you so much for all

    of your support throughout our time in the program. I am so grateful to have walked this journey

    with you. You have challenged me, encouraged me, given me shoulders to lean on, and also had

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    fun with me outside of this crazy endeavor of a doctorate. I am so honored to call you my friends

    and colleagues. Heres to changing the world!

    Of course, Id like to thank the wonderful 16 women for allowing me into their homes

    and their lives to share their stories. I am so humbled to be able to do this work and I hope that I

    have done you proud and your stories justice.

    Last, but definitely not least, Jen. I cannot thank you enough for all of your support and

    encouragement during these crazy past three years. Youve been my biggest cheerleader, life

    coach, and punching bag (sorry:/). Thank you for all of the hours of listening to my fears,

    triumphs, doubts, and dreams. I sincerely would not have made it to this point in my academic

    career without you. I am so grateful for you. Youre pretty great!

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    TABLE OF CONTENTS

    LIST OF TABLES xi

    LIST OF FIGURES xii

    CHAPTER 1: INTRODUCTION 1 Purpose 1 Rationale 2 Theoretical Framework 4

    Ecological systems theory 4 Family resilience theory 5

    Summary of Manuscripts 6 CHAPTER 2: STUDY ONE: Challenges and Resilience Related to Childhood Obesity for Low-Incom