Psychology
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Item Embargo Impact of Health Literacy and Social Support on the Survival of Hispanic Chronic Kidney Disease Patients(East Carolina University, December 2024) Stallings, Taylor LeeABSTRACT Background: Chronic kidney disease (CKD) is a significant public health concern in the United States (U.S.), particularly among Hispanic populations, as its prevalence is rising. Limited health literacy (HL) in CKD patients hinders self-management of the disease and health-related outcomes. Social support (SS) significantly influences CKD patient outcomes, yet its interplay with HL remains unexplored. We investigated HL, perceived SS, and sociodemographic factors among Hispanic CKD patients, assessing their impact on mortality related-risk. Methods: We analyzed data stemming from the Hispanic sub cohort of the Chronic Renal Insufficiency Cohort (CRIC) study, a longitudinal examination of CKD and cardiovascular disease risk factors over 15 years. Measures included HL (Short Test of Functional Health Literacy in Adults), SS (Medical Outcomes Study Social Support Survey), and sociodemographic factors, with marital status as a metric for SS. We conducted linear regressions to examine the relationship between HL, SS, a sociodemographic factor. Additionally, we conducted a series of Cox proportional hazards models to assess the impact of HL, SS, and sociodemographic factors on survival outcomes. Results: While a total of 327 individuals were enrolled in the H-CRIC study, only 140 participants were included in the current study due to having complete data at year 5 (39.8% male, Mage=59.01, SD=11.17). U.S. birthplace, age, and educational attainment significantly predicted HL scores, while SS did not. Cox proportional hazard models were run to assess the impact of HL on mortality of Hispanic CKD patients. HL was predictive of death (HR = .978, p<.05) and lower HL was associated with earlier mortality. In additional models including social support variables, unmarried status was approaching significance, indicating that it is also associated with increased risk of death (HR = .548, p<.05). When controlling for other mortality risk factors, older age (p=<0.05), participant sex (p= <.01), having diabetes (p= <.001), having CVD (p=<.05), and lower eGFR (p=<.05) were predictive of increased mortality risk, and marriage status- approached significance whereas HL in later models became non-significant (p= .707). Conclusion: Our study highlights the significant impact of sociodemographic factors, including birthplace, age, and education on health literacy scores. Notably, participants born in the U.S. exhibited higher HL scores, emphasizing the need for culturally tailored interventions to bridge HL gaps among diverse populations. These findings emphasize the need for regular assessment and continued monitoring of HL and social support in Hispanic patients with chronic kidney disease as it has been shown to increase mortality risk. Future research should aim to create culturally competent tailored interventions to address the gaps in literacy within diverse populations.Item Embargo PERI-IMPLANT ACTIVITY RESTRICTION IN CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE PATIENTS: DOES ACTIVITY RESTRICTION RESULT IN LONG-TERM RATES OF LOW-LEVEL ACTIVITY IN PATIENTS?(East Carolina University, December 2024) Jordan, Elizabeth WilsonCardiovascular implantable electronic devices (CIEDs), specifically implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) are life-saving devices utilized to care for patients at risk for sudden cardiac arrest. ICDs and CRT-Ds have become increasingly used worldwide and within the United States (US), with over 110,000 devices implanted every year in the US (Green et al., 2016). The implantation procedure for the ICD and CRT-D limits patients from engaging in activities that require using their arm or lifting heavy objects from 4-6 weeks post-implant. Physical activity is limited to allow the implanted leads time to become fibrosed. Regardless, cardiac patients need to return to physical activity for both its physical and mental benefits. The resumption of activity following this time is likely variable, but no published information is available to determine the impact or duration of physical activity restriction. Importantly, all modern ICDs and CRT-Ds have an accelerometer in the device that can continuously monitor patient movement and physical activity and store the data. Research has consistently highlighted that physical activity is a predictor of cardiovascular outcomes and patients’ quality of life, specifically in individuals with CIEDs (Rosman et al., 2018). Given that many of these patients already struggle with engagement in physical activity, coupled with the adjustment to a new device and recovery restrictions, it is plausible that this may impact their levels of activity. Additionally, many patients endure an increase in psychological stressors post-implantation, such as a fear of shocks which may also contribute to a reduction in activity consequently impacting their quality of life (Sears et al., 2023). Changes in health status may also impact patients’ activity levels such as new-onset atrial fibrillation, atrial tachycardia, or ICD shock experiences. Lastly, given the high incidence of cardiovascular disease and decreased resources within rural areas, this may result in lower levels of physical activity (Turecamo et al., 2023). The combination of recovery restrictions, psychological factors, rurality, and the onset of symptoms may create a burden on patients that influences their engagement in physical activity in turn, impacting their long-term cardiovascular outcomes. The present study aimed to determine how peri-implant activity restrictions within ICD and CRT-D patients seen in a rural-serving cardiology clinic impact long-term rates of activity engagement for up to 6 months post procedure. 294 patients from ECU Health who have a Biotronik ICD or CRT-D device that were in the archival data set from 2014 to 2023 were included in the study. Descriptive analyses revealed that the mean age of the sample was 61.76 (SD = 12.29) with 67.79% identifying as male and 52.04% identifying their racial/ethnic background as non-Hispanic Black. Pre-existing cardiac and psychological co-morbidities prior to device implantation were common within the sample and the majority of the sample received their device due to heart failure (79.93%). Major findings of the present study included a) plateaued activity levels after two months following device implantation (95.90 minutes per day in month 1 and 116.93 minutes per day in month 2) b) no significant difference in activity levels between patients with device detected atrial arrhythmias vs. patients without arrhythmias and c) no significant difference in activity levels between patients who experienced defibrillator shocks vs. patients who had not. The findings in the present study demonstrated decreased physical activity patterns up to 6 months following implantation in a rural-serving clinic. In the future, device and accelerometer data should be utilized for research and to determine mechanisms of utilization to provide interventions, improve patient care, patient quality of life, and overall health outcomes.Item Embargo Novel GPCR Mechanisms of Phenotypic Control in Vascular Smooth Muscle(East Carolina University, December 2024) Williams, Madison D.Cardiovascular disease (CVD) is a significant global health concern and the number one cause of morbidity and mortality in the US and worldwide. Ischemia and resulting tissue hypoxia and acidosis are important contributors to CVD development and progression. G protein-coupled receptors (GPCRs) are seven transmembrane receptors with established functions in cardiovascular (patho)physiology. Phenotypic switching of vascular smooth muscle (VSM) from a contractile, quiescent state to a noncontractile, proliferative state is a common feature of CVD. Two GPCRs, protease-activated receptor 2 (PAR2) and GPR68, have capacity to control cell proliferation in various tissues, but their role(s) in VSM cell proliferation and phenotypic control remain unclear. The purpose of this project was to determine how PAR2 and GPR68 independently control VSM cell growth and phenotype. Findings revealed that PAR2 controls VSM cell growth in a PKA/MEK1/2 and phenotype-dependent manner, while GPR68 inhibits VSM cell growth through Rap1A. Proteomics analysis revealed wide-ranging effects of GPR68 on VSM phenotype including modulation of extracellular matrix, actin-binding, and contractile proteins. Our findings highlight novel mechanisms of PAR2 and GPR68 in VSM cell growth and phenotypic control and offer evidence that they might be important targets for treatment of deleterious phenotypic switching of VSM in CVD.Item Embargo EXAMINING A CULTURALLY INFORMED MODEL OF MENTAL HEALTH CARE UTILIZATION AMONG LATINX COLLEGE STUDENTS(East Carolina University, July 2025) Ruiz, Michelle IsabelDespite an elevated risk of mental health concerns among Latinx college students due to the unique stressors and challenges Latinx college students may face, including discrimination, cultural isolation, lack of representation, and low educational expectations, Latinx college students tend to underutilize mental health services. The behavioral model of health services utilization (BMHSU) has often been utilized to examine the individual characteristics that predispose individuals to use or not use health services, environmental factors that enable or impede health service use, and one’s need for health services as determined by symptoms, provider’s diagnoses, or other illness indicators. However, the BMHSU has been criticized for failing to consider the influence of specific cultural factors, and as such, may not fully account for disparities in mental health care utilization. The purpose of this study was to develop and examine a cultural adaptation of the BMHSU by including indicators of acculturation and related variables at each level (e.g., predisposing, enabling, and need factors) in hopes of creating a culturally informed model of mental health care utilization more applicable to Latinxs. The total sample was comprised of 126 Latinx undergraduate students, the majority of which were bilingual, second-generation immigrants of Catholic background. Results indicated that the culturally informed model of mental health care utilization more than doubled the predictive power of the BMHSU, accounting for 54% of the variance in utilization, whereas the traditional BMHSU only accounted for 24% of the variance in MHC utilization. Analysis of individual predictors revealed that mental health stigma and familism make help seeking behavior less likely. Meanwhile greater congruence between an individual’s perceived need for mental health care and a professional’s evaluation of need was found to promote help seeking behavior. Historically, cultural factors, including ethnic identity and familism, have been assumed to uniformly promote health and well-being among Latinxs, while acculturative stress and cultural beliefs such as machismo, have been associated with psychopathology. Findings of the current study emphasize the need to further understand the contexts in which cultural factors might be protective or function as a risk factor when tailoring research studies, and interventions that stem from such studies to Latinx populations.Item Embargo Adverse Childhood Experiences, Risk-taking, and Protective Factors(East Carolina University, May 2025) Stickel, DanielResearchers have discovered many detrimental effects of adverse childhood experiences (ACEs). While these outcomes can have far-reaching effects into adulthood, experiencing adversity can also exert proximal impacts on children. An outcome of recent interest in trauma literature is increased risk-taking behavior. I designed the current study to investigate the possible relationship between ACEs and risk-taking in children in the Adolescent Brain Cognitive Development (ABCD) Study funded by the NIH. Additionally, I explored the role of close friends and school protective factors as potential moderators in the hypothesized relationship between adverse experiences and risk-taking. My results indicate that ACEs do not significantly predict risk-taking as it was measured in the ABCD Study using a computerized laboratory task. Furthermore, neither having a close friend nor school protective factors moderated the relationship between ACEs and risk-taking. Parent income, ADHD symptoms, and sex of the participant did significantly predict scores on the risk-taking task. Findings are discussed and recommendations for future research are provided.Item Open Access EVALUATING THE CORE OF CORE SELF-EVALUATION: A REVIEW OF THE CONCEPTUALIZATION OF THE CONSTRUCT(East Carolina University, December 2024) Board, Toby EmanuelThis dissertation examined the conceptualization, measurement, and predictive validity of Core Self-Evaluations (CSE) as a higher-order construct in relation to job and life satisfaction. Through analyses including usefulness analysis, relative weights analysis, and structural equation modeling, the study demonstrated that CSE provides incremental and relative importance over its components—self-esteem, generalized self-efficacy, locus of control, and neuroticism—when predicting satisfaction outcomes. Structural comparisons supported an aggregate, formative model where each component contributes uniquely, challenging traditional reflective approaches and advancing our understanding of personality and self-concept. These findings have important implications for theory and practice, offering a refined framework for assessing and applying CSE to predict satisfaction and well-being. By conceptualizing CSE as an aggregate construct, future research can focus on improving its measurement by expanding item content, addressing compensatory scoring, and ensuring its validity across cultures and diverse settings, such as remote work environments and broader life domains beyond the workplace.Item Open Access Minding the Intergenerational Gap: The Role of Age on Knowledge Hiding and Constructive/Destructive Behaviors(East Carolina University, May 2024) Jones, Seth WayneGiven employee’s increased time in the workforce and average lifespans, intergenerational workplaces are more prevalent, and many benefits of age-diverse workplaces have been substantiated (e.g., increased creativity, Backes-Gellner et al., 2011; increased decision-making capabilities, Wegge et al., 2008). Knowledge management research has considered knowledge sharing within intergenerational teams, suggesting that age may be an important factor to how employees share knowledge (Fasbender et al., 2021), but not explicitly knowledge hiding. There has yet to be a study to consider the relationship between intergenerational contact and knowledge hiding even as age influences many other workplace processes. Survey data collected through Cloud Research’s Connect from 401 working employees were analyzed using path analysis. Older employees were found to engage in more evasive hiding and rationalized hiding. However, when older workers are in environments with intergenerational contact, evasive hiding and rationalized hiding was less likely. Further, employees that engage in rationalized hiding were more likely to consider constructive behaviors like loyalty or considerate voice, while those who play dumb/hide evasively are more likely to utilize destructive behaviors like assertive voice, neglect, and employee exit. Mediations provide further context to how age impacts these behaviors showing how age influences constructive/destructive behaviors through differing facets of knowledge hiding. Theoretically, these relationships could be motivated by lifespan development and social exchange processes, which future research should explore.Item Embargo Relationships among Cumulative Life Stress, Interoception, and Psychiatric Presentations with Somatic Features(East Carolina University, July 2024) Simon, AliaInteroceptive processes involve awareness and insight into one's physiological state, as influenced by the integration of sensations detected and interpreted by the nervous system. Since interoception involves ongoing communication between the brain and the body, research is beginning to investigate if interoceptive processes are influenced by past experiences that may have disrupted mind-body communication. For the current study, we sought to investigate whether one's accumulation of severe stressors across the lifespan may interfere with one's ability to perceive the integration of internal bodily signals accurately and adaptively, contributing to interoceptive dysregulation and bodily distrust. We sought to explore whether this dysregulation would ultimately contribute to adverse mental health outcomes that feature somatization. Research examining relations between cumulative life stress, interoceptive processes, and psychiatric presentations remains in its infancy with limited investigation. The current study sought to bridge the current gap in the literature by investigating interoceptive accuracy and interoceptive awareness as a dual mediator, partially accounting for the assumed relationship between cumulative life stress and symptoms of psychological disorders with somatic features. Given that interoceptive processes are a multidimensional construct, we examined interoceptive awareness (attentional style when interpreting and attending to internal bodily signals) and interoceptive accuracy (appraisal of one’s perceived accuracy when interpreting bodily signals). Key variables of interest were explored within emerging adults, given that this is a salient developmental period marked by identity exploration with a greater propensity for the emergence of psychological presentations. A total of 575 undergraduate students at a large Southeastern university completed an online survey that examined cumulative life stressor severity, interoceptive processes (interoceptive awareness and interoceptive accuracy), and screeners assessing for symptoms of psychological disorders with somatic features (i.e., social anxiety disorder, panic disorder, depression, somatic symptom disorder, post-traumatic stress disorder, eating disorders). To our surprise, interoceptive accuracy did not demonstrate significant relationships with stress or symptoms, failing to account for the relationship between stress and symptoms. In contrast, interoceptive awareness demonstrated a significant inverse relationship with stress and symptoms while also acting as a protective mechanism, reducing the translation of stress to symptoms. Ultimately, our findings support the protective utility of one’s ability to attune to bodily senses with a mindful, non-judgmental mindset as captured by interoceptive awareness. Gaining insight into interoceptive patterns associated with common psychological disorders provides insight for tailoring transdiagnostic psychometric tools and interventions informed by the mind-body connection.Item Open Access Association Between the Behavioral Inhibition System/Behavioral Activation System, Big-5, and Sleep in a College Student Sample: The Moderating Role of Neuroticism(East Carolina University, July 2024) Falletta, GillianCollege students are a unique population due to the challenging transition into the independence of adulthood, as well as the increase in academic rigor and social expectations. As a result, health behaviors such as getting enough sleep can often fall to the wayside and, as such, sleep complaints are highly prevalent in college students. There are a variety of reasons for college students to experience sleep problems or choose to forgo sleep, and there is evidence to suggest that personality characteristics play a role. Jeffrey Gray’s Reinforcement Sensitivity Theory (RST) suggests that the Behavioral Inhibition System (BIS) responds to signals of punishment and non-reward, is responsible for individual differences in anxiety, and inhibits movement toward goals, while the Behavioral Activation System (BAS) responds to signals of reward and non-punishment and stimulates movement toward goals. The BAS scales can be further separated into three BAS factors – Drive, Reward, and Fun Seeking. While there are few studies available that explore the relationship between BIS/BAS and sleep, one study found that college students higher in BIS were more likely to forgo sleep to study while individuals higher in BAS were more likely to forgo sleep due to work, social life, and entertainment. In addition, higher BAS activation was positively correlated with the number of perceived benefits of cutting down on sleep and higher BIS activation was positively correlated with the number of perceived losses. Additionally, there is evidence linking the Five-Factor Model (FFM) of personality with sleep. Specifically, neuroticism is characterized by a tendency toward distress and negative affect and has largely been found to be associated with poor sleep quality. Extraversion is characterized by sociability and positive affect; the literature yields mixed results with some studies indicating that higher extraversion is associated with better sleep quality while other studies have found the opposite effect. Moreover, research suggests that neuroticism has a strong positive relationship with BIS and extraversion is positively related to all BAS scales. While there are many studies linking BIS and BAS to the Big Five personality traits, several studies focusing on the Big Five and sleep, and a few studies focusing on BIS and BAS and sleep, no studies were found that assess the relationship among all three factors. As a result, the present study expanded the literature by providing more insight into how BIS/BAS, the Big Five (i.e., neuroticism and extraversion), and sleep are interrelated in 657 college students. It was hypothesized that BIS would be significantly associated with higher neuroticism, and that BAS would be significantly associated with higher extraversion. It was also hypothesized that BIS and neuroticism would be significantly associated with worse sleep quality, higher levels of insomnia, increased daytime sleepiness, and higher levels of dysfunctional beliefs about sleep. All three BAS factors and extraversion were hypothesized to be significantly associated with sleep quality, levels of insomnia, daytime sleepiness, and dysfunctional beliefs about sleep; these hypotheses were more exploratory. Lastly, it was hypothesized that neuroticism would moderate the relationship between BIS and sleep quality, as well as the relationship between BIS and insomnia severity. The hypotheses were partially supported. The results suggested a significant relationship between BIS and neuroticism, and between all BAS factors and extraversion. Higher levels of BIS and neuroticism were both significantly correlated with worse self-reported sleep quality, increased insomnia severity, more daytime sleepiness, and increase dysfunctional beliefs and attitudes about sleep. Extraversion was not significantly related to the domains of sleep assessed in this study. However, participants higher in BAS- Reward Responsiveness and BAS-Drive reported significantly better sleep quality and individuals higher in BAS- Reward Responsiveness also reported significantly lower levels of insomnia severity. Unexpectedly, the results of this study suggest that neuroticism does not significantly moderate the relationship between BIS and sleep quality nor the relationship between BIS and insomnia severity. These results are discussed in light of post-hoc analyses, and clinical implications with regards to the association between personality characteristics and sleep in college students.Item Embargo Using A Sexual & Gender Minority Health Disparities Framework To Examine Multi-level Influences On Bisexual College Women’s Sexual Health Communication About HIV(East Carolina University, July 2024) Muscari, EmmaPrior studies have consistently revealed that bisexual+ women are at an increased risk for numerous mental and sexual health disparities compared to individuals with differing sexual orientations, in part due to bierasure and binegativity—yet less is known about bisexual+ women’s approaches to obtaining information about partner sexual health and HIV status. My dissertation employed a mixed-methods approach to investigate sexual health communication strategies (i.e., requesting partner sexual health history) as a means of HIV prevention, and the multi-level psychosocial factors that underlie sexual health communication related to HIV. Specifically, I assessed the individual, interpersonal, community, and societal factors—informed by the Sexual & Gender Minority (SGM) Health Disparities Research Framework and the Theory of Planned Behavior (TPB)—that guide sexual health communication in bisexual+ college women. A total of 258 bisexual+ college women completed an online survey that assessed for multi-level factors that affect HIV-related sexual health disparities and HIV prevention behaviors. Across levels of influence in the SGM ecological framework, community level influence in the form of LGBTQ community connectedness predicted bisexual women's individual level experience of sexual identity outness (i.e., more LGBTQ community connectedness predicted more sexual identity outness). Societal level influence in the form of bierasure predicted medical mistrust on the interpersonal level (i.e., less bierasure predicted less medical mistrust). When examining ecological influences on variables associated with the TPB, more LGBTQ community connectedness and less internalized heterosexism predicted more favorable attitudes around having a shared sexual conversation. More LGBTQ community connectedness also predicted more perceived social pressure around having a shared sexual conversation. Examining TPB variables more focally, the TPB intermediate variable of intention was not only influenced by upstream TPB variables (more attitudes, norms, and self-efficacy predicted greater intention) but also predictive of TPB outcome variables of sexual safety strategies and request for partner sexual health history. A qualitative analysis of HIV prevention behavior (request for partner sexual health history) yielded three themes across participants who reported requesting history: 1) Style, 2) Content, and 3) Timing, and one theme across participants who did not request history: 1) Barriers. The Barrier theme had seven subthemes: Discomfort, Unaware, Managing Partner Reactions, Perceived Minimal Risk, Partner Initiated, Social Norms, and Perceived Lack of Relevance. Qualitative responses provided context for upstream TPB variables and elucidated specific attitudes, norms, and efficacy factors that are involved in shared sexual health conversations. Future research should continue to take a multi-level approach in capturing the numerous factors that influence HIV-related sexual health outcomes for bisexual+ women. HIV prevention programs should consider how fostering positive attitudes, favorable social norms, and self-efficacy influences request for partner sexual health history.Item Embargo Use of Modular Therapy to Treat Anxiety for School Age Students with Autism(East Carolina University, July 2024) Glenn, Melissa RegineAutism spectrum disorder (ASD) is a neurological disorder characterized by challenges with social communication, interpersonal skills, sensory stimulation, and restricted and repetitive behaviors. Because of these challenges, the social demands of school can produce anxiety in some children with ASD. Although practitioners use several evidence-based interventions to treat autism, there are few evidence-based treatments to address the anxiety symptoms commonly associated with individuals with ASD. This study aims to determine the extent to which perceived anxiety levels decrease for school-age children with autism who also present with anxiety-related concerns, the extent to which children with ASD rate the usefulness of the intervention, and measure parent and teacher satisfaction with the intervention and perceived behavioral outcomes. The school psychology researcher will use a modified version of the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, and Conduct Disorders (MATCH-ADTC) to include more visuals, schedules, and social stories. In addition, the researcher intends to determine the effectiveness of the intervention by collecting data on the students’ engagement (determined by the practitioner) and feedback on the students’ experience (determined by the student).Item Embargo Feasibility and Acceptability of a Behavioral Intervention Program Among Patients with Atrial Fibrillation to Promote Engagement in Physical Activity(East Carolina University, July 2024) Anthony, Scarlett LeighContemporary AF management includes rate control, rhythm control, anticoagulation, and lifestyle management. Lifestyle management remains aspirational for most clinical settings around the world. Achieving regular physical activity (PA) is daunting for patients and programs such as cardiac rehabilitation are often not available, or not covered as in the USA, leaving few treatment options for patients. This study employed a behavioral PA intervention focused on psychoeducation, aerobic exercise, and problem solving to examine the feasibility and acceptability of a brief PA intervention among patients with AF in a rural-serving clinic. 128 patients were approached in clinic and a total of 24 participated in the study. Accelerometer data revealed an average of 255 minutes of moderate and vigorous PA per week (36.4 min/day) at baseline and 298 minutes of moderate and vigorous PA per week (42.6 min/day) at the end of program. Accelerometer data showed an average of 18.24 hours per day of sedentary time at baseline compared to 17.18 hours per day at the end of the program. Despite increases in PA, overall symptom burden and quality of life scores remained consistent. The average rating of patient satisfaction of the program was 21.8 out of 25 indicating high satisfaction. High attendance rates and patient satisfaction ratings provide preliminary evidence of the feasibility and acceptability of a PA behavioral intervention for patients with AF. Findings suggest that programs have the potential to improve PA levels in rural-serving clinics.Item Embargo Evaluation of a Measure of Everyday Function in Older Adults; Use of a Rural-Serving, Outpatient Neurology Clinic Sample(East Carolina University, July 2024) Sorrell, Anne ElizabethBackground: Understanding a patient’s ability to complete instrumental activities of daily living (IADLs) provides valuable insight into the cognitive and functional decline associated with diseases of aging, such as neurocognitive disorders. Early and accurate evaluation of IADLs permits healthcare professionals to conceptualize level of impairment, track disease progression, and tailor interventions to support patients in preserving quality of life and, in some cases, slow decline for as long as possible. Revised in 2021, the Everyday Cognition scale (ECog-II; Farias et al., 2021) is a measure of IADLs, unique for its evaluation of everyday functioning relative to specific cognitive domains often examined in comprehensive neuropsychological evaluations and for its ability to be used both by patients and their informants. Purpose: The purpose of the present study was to evaluate the clinical utility of the ECog-II Patient- and Informant-Reports in an outpatient neurology clinic that primarily serves rural-living patients in the southeastern United States presenting with comorbid medical and mental health conditions. Methods: A total of 106 patients from an outpatient neurology clinic in Eastern North Carolina who were internally referred for neuropsychological testing were included in the present study. The sample included 52 patients with mild cognitive impairment (MCI), 48 patients with dementia, and six patients without any objective cognitive impairment. Patient reports and informant reports from the ECog-II were administered, which include a total Global factor score and six domain-specific factor scores: Everyday Language, Everyday Memory, Everyday Visual-spatial/perceptual abilities, Executive Functioning (EF): Everyday Planning, EF: Everyday Organization, and EF: Everyday Divided Attention. All patients also completed a neuropsychological test battery as standard of care, and age-normed standard scores were calculated for each measure. The study sought to examine differences between respondent types, evaluate construct and predictive validity, and develop cut-off scores for the global factor. Results: Evidence of convergent validity between ECog-II responses and gold standard neuropsychological measures of similar constructs was demonstrated. Observed trends are highlighted in the manuscript. Predictive validity between diagnostic severity, but not etiology, was established using informant reports. Global cutoff scores for ECog-II informant report data with adequate sensitivity and specificity were established. Data from patient self-reports were less significant overall, and predictive validity was no better than chance. As such, global cutoff scores were unable to be established based on patient-report data. Overall, results from the current study suggest that informant reports of patient IADLs and everyday cognitive functioning map on better to objective neuropsychological measures compared to patient reports. Discussion: Results suggest that when evaluating neurocognitive impairment in rural-living older adults with varying comorbid medical health conditions, objective neuropsychological assessment remains the gold standard as subjective reports are not as predictive of actual cognitive functioning. Patient reports of IADL functioning are encouraged for enhanced understanding of patient awareness and insight. Collateral reports are encouraged for use in clinical decision making to supplement, but not replace, neuropsychological test data. Future studies are encouraged to collect a larger, heterogeneous diagnostic sample to further understand cognitive and functional impairment in a predominantly rural-living, southeastern patient population.Item Embargo Validation of the Nine Item AvoidantRestrictive Food Intake Disorder (ARFID) Screen within a Pediatric Gastroenterology Clinical Setting(East Carolina University, July 2024) Al-Hammori, DeannaARFID is a relatively new psychiatric diagnosis having been introduced in the DSM-5 in 2013. As ARFID is a relatively new diagnosis, there is little research on the etiology, prevalence, outcomes, assessments, and treatments. Of the assessments available, the NIAS is currently the only free, easily accessible, and brief self-report measure of symptoms available. The validity of the NIAS has only been assessed in adult and special populations until recently when the only peer-reviewed validation of the NIAS with a pediatric population was published. This research aimed to validate the NIAS in a pediatric gastroenterology clinic using child self-report. Using a retrospective chart review, 41 participants between the ages of 8 and 17 years old were identified. Participants were split between two groups, those with ARFID and those without. A ROC curve analysis was conducted to assess the sensitivity and specificity of the NIAS. The results of the ROC curve analysis indicate that the NIAS correctly identified ARFID in the patient population beyond chance when they presented with the Picky eating subtype, but not overall.Item Open Access Improving Sleep in Young Children(East Carolina University, July 2024) Rodriguez, MarieABSTRACT Sleep disorders are a serious problem in the United States alone, affecting between 50 and 70 million individuals. Between 20% and 30% of toddlers, infants and preschoolers around the world suffer from problems with falling asleep or staying asleep throughout the night. One of the most common sleep problems in young children is delayed sleep onset (DSO). This occurs when the child has difficulty going to bed within 20 minutes. Night waking episodes, when the child wakes up at least once per night and does not reinitiate sleep independently, are another common problem. DSO and night waking episodes in children can negatively impact caregiver sleep as well. Because these children lack the ability to self-soothe, their caregiver(s) have to wake up and help them fall back to sleep. One evidence-based intervention for DSO is letting the child “cry it out”, also called “extinction”. However, some caregivers are not comfortable with this method. Other interventions include moving the child’s bedtime back by small increments until the child’s desired bedtime is reached, called fading. Fading interventions have been effective when paired with response cost, but this has only been studied in the case of one typically developing child. This pilot study tested a novel fading intervention for typically developing children between the ages of two and six. During the intervention, caregivers moved the child’s bedtime back by 15 minutes every night and woke them at the same time every morning. Sleep was monitored using ActiGraphs to objectively examine frequency of night waking episodes and how well the intervention worked over 3.5 to 6.5 weeks. By implementing this pilot study of sleep, I aimed to determine the feasibility, acceptability, and preliminary effectiveness of a sleep intervention in promoting independent sleep onset (ISO) and less frequent night waking episodes in typically developing preschool aged children with DSO. While the two caregivers who completed this intervention demonstrated that it was feasible for some, it was not feasible for the 12 caregivers who declined to participate in either part or all parts of the study. The two caregivers who completed this intervention found it to be acceptable. The intervention was also effective at reducing night waking episodes in both participants. For one participant, diaries revealed night waking episodes were reduced from five episodes during baseline (an average of one episode per night) to zero at intervention and post-intervention. For the other participant, the sleep diary revealed eight night waking episodes during baseline, three episodes during the intervention, and the caregiver reported qualitatively that night waking episodes had ceased altogether post-intervention (the caregiver did not fill out diaries during post-intervention). The intervention was also effective at promoting ISO, which was found to continue past the post-intervention phase based on a follow up email survey for both participants. Both caregivers reported a decrease in the length of time it took their child to fall asleep independently from 30 minutes at baseline to 15 minutes at post-intervention. Limitations of this study included a small sample size, homogeneity of participants, unforeseen barriers to approval of the study, including difficulties with recruitment due to the COVID-19 pandemic, and multiple barriers to participants completing the study as written in the protocol. Future studies of sleep should include larger, more diverse samples, seek to reduce caregiver barriers to participation, and increase feasibility of sleep interventions for night waking and delayed sleep onset.Item Open Access A FOOD BOX INTERVENTION FOR FAMILIES EXPERIENCING FOOD INSECURITY AND TYPE 2 DIABETES: A PILOT PROJECT(East Carolina University, July 2024) Donelan, JenniferThe negative impacts of type 2 diabetes (T2D) can be exacerbated by food insecurity (FIS), contributing towards overall familial stress, poor health outcomes, and difficulties with diabetes management. Food box interventions may reduce some barriers to healthy eating, including access to fresh produce, transportation, and food cost. The current pilot project was designed to examine the feasibility, acceptability, and satisfaction of a produce food box intervention for families impacted by T2D and FIS, as well as any changes in eating habits and perceived stress. The pilot project was shown to be acceptable to families and participants indicated that they were satisfied with the intervention. Study feasibility was negatively impacted by participant recruitment and retention. Participant eating habits did not change; however, perceived stress was shown to decrease mid-intervention before rebounding post-intervention. Barriers identified throughout the pilot study, as well as via participant response are highlighted.Item Embargo An Evaluation of the Psychometric Properties of the Coping Flexibility Scale-Revised(East Carolina University, July 2024) Vanacore, Sarah MarieCoping flexibility is the ability to alter coping strategies based on situational demands. While it has been conceptualized in multiple ways, the dual-process theory defines coping flexibility as the ability to discontinue ineffective strategies and devise and implement alternative strategies (Kato 2012; 2020). In order to measure the dual-process theory, Kato (2020) developed the Coping Flexibility Scale-Revised (CFS-R), which has been validated only in Japan. As some researchers (e.g., Cheng et al., 2014; Kato, 2012) have suggested that individuals in Western countries do not cope as flexibly as individuals in Eastern countries, it is unclear whether the dual-process theory as measured by the CFS-R is appropriate for a Western population. Therefore, the purpose of this study was to start to examine the factor structure, reliability, and validity of the CFS-R in a sample of U.S. college students. This dissertation took a two-study approach. Study 1 (N = 1246) was a cross-sectional study that took place during the 2021-22 academic year. Study 2 (N = 441) was longitudinal study that took place during three time points during Spring 2023. In both studies, participants were recruited from Introductory Psychology courses, other psychology courses, a sample obtained from the university survey research and oversight committee, student groups, and academic advisors. Study 1 examined the CFS-R’s factor structure and associations with measures of depression, anxiety, and stress. Study 2 assessed the CFS-R’s longitudinal invariance, internal consistency, test-retest reliability, and convergent, discriminant, ecological, and predictive validity. In addition, to evaluate whether individualism/collectivism impacted scores, the CFS-R’s relationship with self-construal was also investigated. Overall, there were mixed findings. Study 1 found a similar factor structure to Kato’s (2020), and Study 2 found configural, weak, and strong invariance of the CFS-R. Good internal consistency (McDonald’s omegas > .70) was also found; however, adequate test-retest reliability was found between Times 1 and 2, but not between Times 1 and 3 or 2 and 3. The CFS-R subscales demonstrated acceptable convergent validity with Goal Re-engagement (Goal Disengagement and Re-engagement Scale [GDRS]), Knowledge of Cognition (Metacognitive Awareness Inventory-19; [MAI-19]), and Regulation of Cognition (MAI-19; rs ranging from .18 to .51); however, CFS-R scores were negatively correlated with Goal Disengagement (GDRS; rs ranging from -.19 to -.01). The CFS-R also demonstrated mixed discriminant validity, with trivial-to-small positive correlations with the Ten-Item Personality Inventory (TIPI; rs ranging from .06 to .26) and small-to-moderate correlations with the Balanced Inventory of Desirable Responding-16 (BIDR-16; rs ranging from .25 to .42). Regarding predictive validity, CFS-R scores at Time 1 did not predict perceived stress or symptoms of anxiety or depression at Times 2 or 3; however, there were negative correlations with symptoms and stress within each time point (rs ranging from -.22 to -.54). In addition, Abandonment and Re-coping scores did not predict the likelihood of engaging in abandonment or re-coping behaviors, but Meta-coping scores did predict the likelihood of engaging in meta-coping. Finally, regarding self-construal, the longitudinal CFA did not demonstrate weak invariance, so only Time 1 data was used to examine the relationship between self-construal and coping flexibility. Higher Independent Self-construal significantly predicted greater coping flexibility, but Interdependent Self-construal did not significantly predict coping flexibility. These studies built upon Kato’s (2012, 2020) research, in which they suggested that coping flexibility may not be an applicable construct to Western populations. These findings indicate that the CFS-R has similar factor structure to Kato’s (2020), good internal consistency, but test-retest reliability and predictive validity could not be established. There were also mixed findings regarding convergent validity, and discriminant validity results suggested that responses may be impacted by socially desirable responding. In addition, ecological validity was not established, and contrary to the hypothesis, higher independent self-construal was related to coping flexibility in Time 1; however, these were exploratory aims. Additional research is needed to continue to establish the test-retest reliability and validity of the CFS-R in Western populations. Such research could aid clinicians in college counseling centers and other professionals in higher education settings in understanding how their students cope flexibly with stress across the semester.Item Open Access A Third-Wave Intervention for Internalized Weight Bias Combined with a Weight Loss Program Using Video Conference Software(East Carolina University, December 2024) Force, CarolineBackground. Obesity is highly prevalent and associated with a plethora of adverse outcomes on health (e.g., heart disease, type II diabetes, certain forms of cancer), suggesting a clear need for effective weight loss strategies. Behavioral weight loss programs (BWLP) can produce weight loss for mild to moderate obesity, with a 5-10% weight loss on average by modifying lifestyle factors. However, complex biological, psychological, social, and environmental factors also contribute to an individual’s weight. Specifically, individuals who are overweight or obese are often frequently subjected to discrimination, prejudice, or stigmatization in a variety of settings. It is possible for individuals to internalize stereotypes about weight, such as the belief that individuals who are obese or overweight are lazy. This internalization, known as internalized weight bias (IWB), has been shown to impact mental (e.g., depression and anxiety) and physical health (e.g., cardiometabolic functioning), as well as weight loss and weight loss associated behaviors (e.g., interference with exercise and healthy eating). These associated behaviors especially pose a risk for weight regain and disruption of healthy weight loss. Therefore, given the association between IWB and weight loss associated behaviors, as well as the psychological and health risks associated with IWB, IWB interventions are also needed independently and in conjunction with BWLPs. Interventions using third-wave strategies (such as acceptance commitment therapy; ACT) have begun to show promise in reducing IWB, but have not yet been conducted in conjunction with a BWLP. Finally, there has also been a growing need for telehealth-based programs and interventions. The COVID19 pandemic demonstrated a clear need for efficacious telehealth programs, and a further benefit is that these programs may reach populations with limited access to resources (i.e., rural populations). Thus, the current study aims to pilot a novel ACT-based IWB intervention paired with a standard BWLP delivered through video conferencing software. Methods. The baseline sample included 54 men, women, and individual identifying as nonbinary, with 28 participants completing some form of post data. The mean age was 45.4 years (SD = 12.2) and the average weight was the average weight was 227.4 lbs (SD = 42.8) and 38.5 for BMI (SD = 6.6), Racial and ethnic breakdown was as follows: Black (N = 13, 24.1%), Hispanic or Latino/a (N = 3, 5.6%), Native American/Native Alaskan (N = 2, 3.7%) or White (N = 34, 63%). Ten 90-minute weekly sessions were offered over video conferencing software, with 60 minutes of weight loss programming and 30 minutes of IWB intervention. The BWLP used was adapted from the Diabetes Prevention Program, while the IWB intervention used ACT-based principles, self-compassion, and the dialectical behavioral therapy skill DEAR MAN. Results. Participants demonstrated a significant reduction in IWB (p = .002), as well as externalized weight bias (p <.001). In addition, participant weight loss was significant, as participants lost an average of 2.16% of their body weight (SD = 2.34%; p = < .001). Participants also demonstrated a decrease in emotional eating (p =.001) and saturated fat intake (p =.016), and an increase in moderate physical activity (p =.005). Participants reported several other benefits including a reduction in depressive symptoms (p =.026), self-judgement (p =.023), and psychological inflexibility (p =.004), and an increase in self-esteem (p =.007), mindfulness (p =.013), and self-compassion (p <.001). Participants reported high treatment acceptability and that the program was helpful. Discussion. While the current study does note limitations (e.g., small sample size, no control group), this is the first intervention combing treatment for IWB using third-wave skills (including ACT, self-compassion, and DEARMAN skill of DBT) in conjunction with a BWLP. In addition, this is the first IWB intervention that has utilized a virtual format. The intervention was successful in reducing IWB (and weight) among a sample of weight loss seeking participants.Item Open Access IMPACT OF A MEDICAL TEAM PROGRAM ON PATIENT EXPERIENCE IN CARDIOLOGY- FEASIBILITY STUDY(East Carolina University, December 2024) Force, ZacharyBackground. Patient-centered care (PCC) is a proposed style of healthcare that succinctly explores aspects of the biopsychosocial model by allowing the opportunity for patients to actively engage in their medical visit, forming a patient-provider relationship (PPR). Research confirmed the importance of the PPR but has not identified consistent means of improving this relationship. Provider self-disclosure (PSD) has varied efficacy on the PPR, depending on clinic setting with patients expressing greater benefit from PSD in the specialty setting of surgery as compared to a primary care setting. Harnessing provider biographies to convey information that patients want to know may be a strategy to standardize and elucidate effective practices of PPR in pursuit of the goals and benefits of PCC. It also remains to be seen whether biographies can provide a quick and simple way to heed the call of directives issued by the American College of Cardiology (2012) and improve PPR and PCC. Purpose. The purpose of the study was to examine the effect of provider biographical information on the perceptions of patient-centered care and the patient-provider relationship in a cardiology practice setting. Methods. The sample included 200 patients who attended their regularly scheduled medical appointment at a cardiology practice. Participants were randomized to receive either a biography about their provider (intervention) or about the medical institution (control). The mean age was 62.74 (SD = 14.04) and the mean Charlson Comorbidity Index was 3.87 (SD = 2.33). Demographics for the sample included individuals who identified as Black (N = 95, 47.5%), White (N = 89, 44.9%), Hispanic or Latino/a (N = 5, 2.5%), Asian (N = 1, 0.5%), middle Eastern (N = 2, 1%), and multiple racial (N = 3, 1.5%). Results. Acceptability of reading a one-page biography was high, with patients from both groups having read the biography. Patients who read biographical information about their providers perceived their providers as engaging in higher levels of patient-centered care behavior (M = 74.54, SD = 11.34; t(195) = 23.05, p = .003) as compared to the control (M = 69.83, SD = 15.28), having higher levels of relationship depth with their providers (M = 26.72, SD = 6.57; t(196) = 2.461, p = .015.) as compared to the control (M = 23.75, SD = 15.28), and were more likely to ask a question during their consult (X2 (1, N = 198) = 6.58, p = 0.01). Qualitative information was collected on what patients would like to know about their providers. Conclusion. Presenting patients with provider biographical information significantly improved perceptions of their provider’s patient-centered care behavior, perceptions of the provider-patient relationship, and were more engaged in their medical visit. This study offers a viable and low-cost method of improving patient-centered care with minimal provider burden that can be implemented at any clinic.Item Embargo THE IMPACT OF IDENTITY ON BMI AND CONTRIBUTING FACTORS: A Comparison of Identity, Sociocultural Attitudes, Maladaptive Eating, Physical Activity, Weight Stigma, and BMI among Bisexual, Lesbian, and Heterosexual Women(East Carolina University, July 2024) Shonrock, Abigail ThorndykeWith the rising rates of obesity and its association with chronic health conditions, there has been an increasing focus on the contributing factors. Also concerning are the numerous disparities observed in the prevalence of obesity within certain marginalized groups. In particular, sexual minority women have higher rates of obesity (as defined by BMI) than heterosexual women. This disparity is concerning due to the correlation between obesity and chronic health conditions, and LGBTQ+ populations have significant health disparities compared to their cisgender and heterosexual counterparts. While research has turned towards examining maladaptive eating, physical activity, internalized and experienced weight stigma, and sociocultural attitudes among LGBTQ+ populations, there is still much work to be done in exploring the connections between these variables. For sexual minority women in particular, research has demonstrated that this population reports higher maladaptive eating than heterosexual women despite comparable levels of experienced weight stigma and internalized weight bias. Some research attempting to examine barriers to physical activity for lesbian and bisexual women has hypothesized that the unique identity of an LGBTQ+ individual may play a significant role in health behavior engagement. Therefore, this dissertation explored the impact of sexual identity on predictors (maladaptive eating, physical activity, internalized and experienced weight stigma, and sociocultural attitudes) of obesity among bisexual and lesbian women, as compared to heterosexual women. Furthermore, the dissertation explored the potential predictive value of identity acceptance, heterosexist experiences, and community connection on BMI outcomes among bisexual and lesbian women. While sexual orientation appeared to moderate the relationship between several predictive variables and BMI, the relationship between these variables and bisexual and lesbian women was not clearly explained by the current models of obesity. Additionally, identity acceptance, community connection, and heterosexist experiences were not predictive of BMI, suggesting they may play more of a distal role in BMI outcomes. Future research should continue to explore the mechanism of obesity for bisexual and lesbian women.