Elaine Wethington | Cornell University (original) (raw)

Papers by Elaine Wethington

Journal of Nutrition Education and Behavior, Sep 1, 2009

Setting-Northeastern U.S. city Participants-Black, white, Hispanic employed mothers (25) and fath... more Setting-Northeastern U.S. city Participants-Black, white, Hispanic employed mothers (25) and fathers (25) randomly recruited from low/moderate income zip codes; 78% of reached and eligible Variables Measure(s)-Socio-demographic characteristics; work conditions (hours, shift, schedule, job security, satisfaction, food access); food choice coping strategies (22 behavioral items for managing food in response to work and family demands (i.e.: food prepared at/away from home, missing meals, individualizing meals, speeding up, planning)) Analysis-Two-tailed chi-square and Fisher's exact tests (p=<.05, unless noted) Results-Half or more of respondents often/sometimes used 12 of 22 food choice coping strategies. Long hours and non-standard hours and schedules were positively associated among fathers with take-out meals, missed family meals, prepared entrees, and eating while working; and among mothers with restaurant meals, missed breakfast, and prepared entrees. Job security, satisfaction and food access were also associated with gender-specific strategies. Conclusions and Implications-Structural work conditions among parents such as job hours, schedule, satisfaction, and food access are associated with food choice coping strategies with importance for dietary quality. Findings have implications for worksite interventions but need examination in a larger sample.

To better support the self-management of chronic pain, this paper investigates how those living w... more To better support the self-management of chronic pain, this paper investigates how those living with the condition prefer to self-assess their pain levels using smartphones. Our work consists of three stages: design ideation and review, an in-lab user study with 10 participants resulting in nine candidate interfaces, and a 3 week field trial of two further honed measures with 12 participants. This research firstly yields a better understanding of participants' strong and sometimes contrasting preferences regarding their self-assessment of pain intensity. We additionally contribute two novel interfaces that support accurate, quick, and repeated use along with other participant-valued interactions (e.g., familiar, relatable, and highly usable). In particular, we focus on designing tailored measures that both enhance respondent motivation as well as minimize the difficulty of meaningful self-assessment by supporting the cog-nitive effort in translating a subjective experience into a single numerical value.

Breastfeeding Medicine, 2016

Background: Breastfeeding rates in the United States are suboptimal. Health professionals (HPs) h... more Background: Breastfeeding rates in the United States are suboptimal. Health professionals (HPs) have a unique opportunity to support breastfeeding because of the frequency and timing of their visits with mothers and infants as well as their call by professional organizations to do so. The objective of this study was to understand HPs' perceived roles and experiences with providing breastfeeding-related care. Materials and Methods: In-depth qualitative interviews were conducted with 34 HPs (obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. Interviews were audio-recorded, transcribed, and verified for accuracy; content analysis was used to identify themes using a grounded theory approach. Results: The overarching theme was discontinuity in breastfeeding care across the continuum. Most HPs relied on other HPs to provide breastfeeding care, which resulted from and contributed to problematic gaps in care that were reported. A minority of HPs attempted to bridge gaps in breastfeeding care or improve continuity. Contributing to the discontinuity were a lack of time, lack of skills, inconsistent messages, and low communication across stages of care. HPs were unsure whether their help was effective and whether required follow-up was completed. Conclusions: Despite HPs' recognition of breastfeeding as the best choice for infant feeding, breastfeeding care may be disjointed and a barrier to achieving breastfeeding recommendations. These problems should be investigated and systemically addressed in future research so that maternal-infant dyad breastfeeding care can be improved.

Food Quality and Preference, Jun 1, 2019

Background: Prior research has reported that plate size may influence an individual's perceptions... more Background: Prior research has reported that plate size may influence an individual's perceptions and recall of food and meal size. Therefore, manipulating plate size could influence projected meal quantities and portion size among community dwelling adults. The present study interviewed 281 adult parents in their own homes in a medium-sized city in the United States. Participants were asked to accurately draw and label the foods they expected to eat for dinner that night, drawing on either a 23 cm or 28 cm paper plate. The respondents were then asked to label each food drawn in order to ensure proper recording of meals. Results: Results showed clear differences in drawn food sizes between plate sizes as well as between sexes. Larger plates had about 24% more food drawn on them than small plates. Men drew their meals on 28 cm plates to be 37% larger than men who received 23 cm plates, while women with 28 cm plates drew their meals to be about 17% larger than women given 23 cm plates. Most (60%) of the overall differences in food size between plates came from the biggest

Care Management Journals, Jun 1, 2010

A number of questions were asked of the recipients of the Meals-on-Wheels program in New York Cit... more A number of questions were asked of the recipients of the Meals-on-Wheels program in New York City to ascertain their food preparation methods and their nutrition so that we could better understand the context in which they were receiving the Meals-on-Wheels foods. Included were questions about ownership of food preparation facilities; their comfort with using these facilities; their consumption of fruit, vegetables, and milk per day; the number of non-Meals-on-Wheels meals they consume; and whether they shopped for and prepared non Meals-on-Wheels foods themselves or with assistance from others. Furthermore, recipients were asked to describe their financial situation as it related to food. Recipients' nutrition and ability to prepare food can be described through their use of the meals, use of non-Meals-on-Wheels food, and their food insecurity.

Gerontologist, Oct 26, 2012

The management of chronic noncancer pain (CNCP) involves trade-offs between immediate and delayed... more The management of chronic noncancer pain (CNCP) involves trade-offs between immediate and delayed consequences of various treatments. Temporal trade-offs may be particularly salient for older adults because of age-related differences in prognosis and perceptions of future time. This study examined how perceptions of time influence the management of CNCP among patients and providers with particular emphasis on age differences. Design and Methods: Focus groups were conducted with 28 CNCP patients (5 groups), 21 physicians (4 groups), and 23 physical therapists (3 groups). Audiotapes were transcribed and analyzed using standard qualitative methods. Results: Analyses identified multiple aspects of time perceptions that are relevant to the management of CNCP: the long-term prognosis, the time horizon used for concrete treatment planning, and concerns about future side effects. Although there was some overlap, these aspects showed divergent patterns across age groups and between patients and providers. Patients and providers agreed that pain is more stable and chronic in older adults. Time horizons in treatment planning differed between patients who were present-focused and providers who were focused on longer term effects, but treatment horizons did not differ by patient age. Finally, although providers were more concerned about future side effects in older people, patients' concerns did not differ by age. Implications: Time horizons have practical implications for the quality of the patient-provider relationship and self-management of CNCP. A better understanding of the underlying mechanisms could inform interventions to reduce age disparities in pain care.

Journal of The American Dietetic Association, Mar 1, 2011

Employed parents' work and family conditions provide behavioral contexts for their food choices. ... more Employed parents' work and family conditions provide behavioral contexts for their food choices. Relationships between employed parents' food-choice coping strategies, behavioral contexts, and dietary quality were evaluated. Data on work and family conditions, sociodemographic characteristics, eating behavior, and dietary intake from two 24-hour dietary recalls were collected in a random sample cross-sectional pilot telephone survey in the fall of 2006. Black, white, and Latino employed mothers (n=25) and fathers (n=25) were recruited from a low/moderate income urban area in upstate New York. Hierarchical cluster analysis (Ward's method) identified three clusters of parents differing in use of food-choice coping strategies (ie, Individualized Eating, Missing Meals, and Home Cooking). Cluster sociodemographic, work, and family characteristics were compared using χ 2 and Fisher's exact tests. Cluster differences in dietary quality (Healthy Eating Index 2005) were analyzed using analysis of variance. Clusters differed significantly (P≤0.05) on food-choice coping strategies, dietary quality, and behavioral contexts (ie, work schedule, marital status, partner's employment, and number of children). Individualized Eating and Missing Meals clusters were characterized by nonstandard work hours, having a working partner, single parenthood and with family meals away from home, grabbing quick food instead of a meal, using convenience entrées at home, and missing meals or individualized eating. The Home Cooking cluster included considerably more married fathers with nonemployed spouses and more home-cooked family meals. Food-choice coping strategies affecting dietary quality reflect parents' work and family conditions. Nutritional guidance and family policy needs to consider these important behavioral contexts for family nutrition and health. Employed parents use food-choice coping strategies to integrate the multiple demands of work and family roles as they feed themselves and their families (1,2). Parents' food choices reflect individual agency as well as the behavioral contexts for those choices (3,4). Individual agency represents people's personal choices as they respond to their life circumstances . Behavioral contexts reflect parents' key personal and social characteristics, such as social class, race/ethnicity, sex, and social roles, such as marriage, parenthood, and employment (7-11). Social class determines exposure to social advantages and disadvantages (12), including food availability, access, and cost (13-15). Race/ethnicity affect food access and availability (15-20), but also reflect food ideals, identities, and roles

Pain Medicine, May 1, 2008

Self-management strategies for pain hold substantial promise as a means of reducing pain and impr... more Self-management strategies for pain hold substantial promise as a means of reducing pain and improving function among older adults with chronic pain, but their use in this age group has not been well defined. Objective. To review the evidence regarding self-management interventions for pain due to musculoskeletal disorders among older adults. Design. We searched the Medline and Cumulative Index to Nursing and Allied Health Literature databases to identify relevant articles for review and analyzed English-language articles that presented outcome data on pain, function, and/or other relevant endpoints and evaluated programs/ strategies that could be feasibly implemented in the community. Abstracted information included study sample characteristics, estimates of treatment effect, and other relevant outcomes when present. Results. Retained articles (N = 27) included those that evaluated programs sponsored by the Arthritis Foundation and other programs/strategies including yoga, massage therapy, Tai Chi, and music therapy. Positive outcomes were found in 96% of the studies. Proportionate change in pain scores ranged from an increase of 18% to a reduction of 85% (median = 23% reduction), whereas change in disability scores ranged from an increase of 2% to a reduction of 70% (median = 19% reduction). Generalizability issues identified included limited enrollment of ethnic minority elders, as well as non-ethnic elders aged 80 and above. Conclusions. Our results suggest that a broad range of self-management programs may provide benefits for older adults with chronic pain. Research is needed to establish the efficacy of the programs in diverse age and ethnic groups of older adults and identify strategies that maximize program reach, retention, and methods to ensure continued use of the strategies over time.

Social Science & Medicine, Nov 1, 2006

Integrating their work and family lives is an everyday challenge for employed parents. Competing ... more Integrating their work and family lives is an everyday challenge for employed parents. Competing demands for parents' time and energy may contribute to fewer meals prepared or eaten at home and poorer nutritional quality of meals. Thus, work-family spillover (feelings, attitudes, and behaviors carried over from one role to another) is a phenomenon with implications for nutrition and health. The aim of this theory-guided constructivist research was to understand how low-wage employed parents' experiences of work-family spillover affected their food choice coping strategies. Participants were 69 black, white and Latino mothers and fathers in a Northeastern U.S. city. We explored participants' understandings of family and work roles, spillover, and food choice strategies using open-ended qualitative interviews. Data analysis was based on the constant comparative method. These parents described affective, evaluative, and behavioral instances of work-family spillover and role overload as normative parts of everyday life and dominant influences on their food choices. They used food choice coping strategies to: 1) manage feelings of stress and fatigue, 2) reduce the time and effort for meals, 3) redefine meanings and reduce expectations for food and eating, and 4) set priorities and trade off food and eating against other family needs. Only a few parents used adaptive strategies that changed work or family conditions to reduce the experience of conflict. Most coping strategies were aimed at managing feelings and redefining meanings, and were inadequate for reducing the everyday hardships from spillover and role overload. Some coping strategies exacerbated feelings of stress. These findings have implications for family nutrition, food expenditures, nutritional self-efficacy, social connections, food assistance policy, and work place strategies.

Gerontology, Nov 6, 2015

Increasing evidence suggests that perceived social isolation or loneliness is a major risk factor... more Increasing evidence suggests that perceived social isolation or loneliness is a major risk factor for physical and mental illness in later life. This review assesses the status of research on loneliness and health in older adults. Key concepts and definitions of loneliness are identified, and the prevalence, correlates, and health effects of loneliness in older individuals are reviewed. Theoretical mechanisms that underlie the association between loneliness and health are also described, and illustrative studies examining these mechanisms are summarized. Intervention approaches to reduce loneliness in old age are highlighted, and priority recommendations for future research are presented.

Background: Fibromyalgia syndrome (FMS) is a leading cause of functional limitations and disabili... more Background: Fibromyalgia syndrome (FMS) is a leading cause of functional limitations and disability for which there is no cure. Positive psychological interventions for improving health have received increasing attention, but evidence of the feasibility, acceptability, and impact of such interventions in adult populations with FMS is limited. Objectives: To describe the rationale and design of a 5-week, online positive affect skills intervention, LARKSPUR: Lessons in Affect Regulation to Keep Stress and Pain UndeR control. Methods: FMS participants (N = 90) will be randomized to one of two conditions: (1) LARKSPUR or (2) emotion reporting/attention control. LARKSPUR is an online multicomponent intervention that targets eight skills to help foster positive affect: (1) noticing positive events, (2) savoring positive events, (3) identifying personal strengths, (4) behavioral activation to set and work toward attainable goals, (5) mindfulness, (6) positive reappraisal, (7) gratitude, and (8) acts of kindness. The primary outcomes include feasibility (i.e., recruitment, retention, adherence) and acceptability (i.e., helpfulness, usability, satisfaction). Secondary outcomes include pain intensity and pain interference. Significance: If feasibility and acceptability metrics are met and reductions in pain outcomes are achieved, we will undertake future efficacy and effectiveness trials of LARKSPUR among older adults with FMS.

JAMA Network Open

ImportanceDirect-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection is highly... more ImportanceDirect-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection is highly effective but remains underused. Understanding disparities in the delivery of DAAs is important for HCV elimination planning and designing interventions to promote equitable treatment.ObjectiveTo examine variations in the receipt of DAA in the 6 months following a new HCV diagnosis.Design, Setting, and ParticipantsThis retrospective cohort study used national Medicaid claims from 2017 to 2019 from 50 states, Washington DC, and Puerto Rico. Individuals aged 18 to 64 years with a new diagnosis of HCV in 2018 were included. A new diagnosis was defined as a claim for an HCV RNA test followed by an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis code, after a 1-year lookback period.Main Outcomes and MeasuresOutcome was receipt of a DAA prescription within 6 months of diagnosis. Logistic regression was used to examine demogra...

Innovation in Aging, 2021

Active coping strategies (e.g., exercise and pharmacological treatments) typically do not leave c... more Active coping strategies (e.g., exercise and pharmacological treatments) typically do not leave chronic pain patients completely pain-free. Therefore, individuals turn to emotion-focused strategies to cope with associated impairment and psychosocial consequences. General coping strategy use has been shown to differ by age. This scoping review explored age differences in the use and effectiveness of emotion-focused strategies in adults experiencing chronic pain. Studies were located via advanced searches in PubMed, PsycINFO, CINAHL, Embase, Web of Science, and Proquest Dissertations and Theses Global and referral. Two reviewers independently conducted abstract screenings and full-text extractions. Conflicts were discussed and resolved by the PI. We identified 15 studies that met our inclusion criteria, of which 14 met criteria for high methodologic quality. The majority of studies utilized the Coping Strategies Questionnaire to assess differential use of pain-coping strategies. The r...

Advances in Group Processes

ABSTRACT The purpose of this paper is to address recent theoretical and methodological developmen... more ABSTRACT The purpose of this paper is to address recent theoretical and methodological developments relating to social and organizational aspects of stress. Further advances are dependent on a more thorough exploration of stress contagion processes. Contagion is defined as a cascade of demands and consequent emotional arousal from one area of life into another, between closely related individuals, and across the life course. Stress originates in the daily course of life as a consequence of social interaction in dyads and groups, opportunities and challenges shaped by social structure, and constraints and demands channeled by organizations and institutions. The paper focuses on three types of stress contagion as social aspects of the stress process, spillover, crossover, and stress trajectories. The review raises new questions to address in this area, and reviews data and methodological work that sheds light on the three types of contagion. In the view of the author, the most fruitful path for advancing research on stress contagion is to combine the insights of more qualitative research with data derived from empirically rigorous quantitative designs and analytic strategies. Researchers should combine careful theoretical analysis of stress processes with measurement technologies capable of distinguishing individual personality factors from situational, socially created factors. The paper also examines the relative strengths and shortcomings of several different research design strategies to advance theory and measurement: (1) life event measurement techniques more sensitive to stress contagion, (2) life history data collection, measuring stress contagion over time, (3) longitudinal prospective studies of stress contagion, (4) paired-informant and group-level designs, (5) daily diary techniques, and (6) experience sampling.

Annals of Behavioral Medicine, 2009

Background The life course perspective (LCP) has emerged as a powerful organizing framework for t... more Background The life course perspective (LCP) has emerged as a powerful organizing framework for the study of health, illness, and mortality. LCP represents a "whole life" analysis perspective which originated in the field of sociology. Methods Its concepts are increasingly applied to understanding the development of chronic disease over long periods of time in the human life span. A missing link, however, in the adaptation of the LCP to health research, is the insight the LCP may offer into understanding the societal, social network, and family contexts that frame stability and change in dietary behavior. Results This paper reviews key concepts that comprise the LCP but primarily focuses on applications that have relevance to food decision making in social context. A case study of chronic work-family stress and perceived time scarcity as barriers to dietary improvement is included. Conclusion Illustrative findings are presented on dietary behavior in a diverse sample of lower-income working parents. This paper also offers ideas on increasing the contributions of the LCP to nutritional research.

Appetite, Jun 1, 2009

This study aimed to understand parents' evaluations of the way they integrated work-family demand... more This study aimed to understand parents' evaluations of the way they integrated work-family demands to manage food and eating. Employed, low/moderate-income, urban, U.S., Black, White, and Latino mothers (35) and fathers (34) participated in qualitative interviews exploring work and family conditions and spillover, food roles, and food-choice coping and family-adaptive strategies. Parents expressed a range of evaluations from overall satisfaction to overall dissatisfaction as well as dissatisfaction limited to work, family life, or daily schedule. Evaluation criteria differed by gender. Mothers evaluated satisfaction on their ability to balance work and family demands through flexible home and work conditions, while striving to provide healthy meals for their families. Fathers evaluated satisfaction on their ability to achieve schedule stability and participate in family meals, while meeting expectations to contribute to food preparation. Household, and especially work structural conditions, often served as sizeable barriers to parents fulfilling valued family food roles. These relationships highlight the critical need to consider the intersecting influences of gender and social structure as influences on adults' food choices and dietary intake and to address the challenges of work and family integration among low income employed parents as a way to promote family nutrition in a vulnerable population.

Innovation in Aging, Jul 13, 2023

Contemporary Clinical Trials, Mar 1, 2015

Background-Obesity is a major health problem that disproportionately affects Black and Hispanic a... more Background-Obesity is a major health problem that disproportionately affects Black and Hispanic adults. This paper presents the rationale and innovative design of a small change eating and physical activity intervention (SC) combined with a positive affect and self-affirmation (PA/SA) intervention versus the SC intervention alone for weight loss. Methods-Using a mixed methods translational model (EVOLVE), we designed and tested a SC approach intervention in overweight and/ or obese African American and Hispanic adults. In Phase I, we explored participant's values and beliefs about the small change approach. In Phase II, we tested and refined the intervention and then, in Phase III we conducted a RCT. Participants This manuscript version is made available under the CC BY-NC-ND 4.0 license.

Journal of Traumatic Stress, 2007

The authors examined the effects of lifetime trauma exposure on salivary cortisol and mood in a s... more The authors examined the effects of lifetime trauma exposure on salivary cortisol and mood in a sample of women (N = 37) over 25 days before and after a stressful event. The sample excluded posttraumatic stress disorder (PTSD) and major depression and was divided into three groups: (a) no trauma, (b) prior trauma with no peritraumatic symptoms of acute distress, and (c) prior trauma with peritraumatic symptoms. Because results indicated no significant differences between groups one and two, they were combined for analysis. Women reporting prior trauma with symptoms had lower afternoon cortisol levels across time, with sustained negative mood relative to the comparison group. These data suggest the presence of long-term psychophysiological effects of trauma exposure in healthy women. The consequences of exposure to psychological trauma have been understudied in the nonclinical human population (McFarlane, 1997), although epidemiological evidence suggests that more than half of the population experiences at least one trauma in their lifetime, and a quarter experiences two or more (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Trauma exposure is a predictor of anxiety and depression (Brown, 1993; Kendler, Hettema, Butera, Gardner, & Prescott, 2003), and a predisposing factor for further incidence of PTSD if there is a subsequent trauma (Bremner, Southwick, Johnson, Yehuda, & Charney, 1993; Breslau, Chilcoat, Kessler, & Davis, 1999). This suggests that there may be lasting psychophysiological consequences of trauma exposure, even in those who do not have a current clinical disorder. There is a small body of research on the biological effects of trauma exposure in adult samples known to be free of clinical disorder, including two recent neuroimaging studies examining the neural correlates of exposure to the terrorist attacks of September 11, 2001 (Ganzel, Casey, Voss, Glover,&Temple, in press; Sharot, Martorella, Delgado, & Phelps, in press). Using different paradigms, both studies found that increased proximity to the disaster predicted increased amygdala reactivity in healthy adults more than 3 years after the attacks. Consistent with these results, heightened cardiovascular reactivity to reminders of the Oklahoma City bombing has been observed in survivors of that event more than 6 years afterwards (Tucker et al., 2007). On the other hand, very limited evidence for

Obesity, Apr 5, 2017

Objective-To evaluate the efficacy of a small change behavioral weight loss intervention with or ... more Objective-To evaluate the efficacy of a small change behavioral weight loss intervention with or without a positive affect/self-affirmation (PA/SA) component on weight loss at 12 months. Methods-Black and Hispanic adults (N=405) with body mass index 25-50 kg/m 2 selected one of 10 small change eating strategies and a physical activity goal, randomly with/without positive affect/self-affirmation. Participants were followed by community health workers (CHW's) at set intervals (weekly months 1-3; biweekly months 4-9; once monthly months 10-12). Results-There was no difference in weight loss at 12 months between participants in the small change approach alone (1.1%) vs. the small change PA/SA intervention (1.2%). During treatment, 9% of participants lost at least 7% of their initial body weight. Participants who reported more interval life events had a lower likelihood of losing weight (p <.0001). However, those randomized to the small change PA/SA intervention gained less weight (+0.3% vs. 2.3% gain; P value <.0001). Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: