Digital Commons Network^™

Predicting Poor Mental Health Among Older Syrian Refugees In Lebanon During The Covid-19 Pandemic: A Nested Cross-Sectional Study, Berthe Abi Zeid, Leen Farouki, Tanya El Khoury, Abla M. Sibai, Carlos Mendes F. De Leon, Marwan F. Alawieh, Zeinab Ramadan, Sawsan Abdulrahim, Hala Ghattas Ph.D., Stephen J. Mccall

Faculty Publications

Background: Post-term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High-income countries have responded to this risk by widely adopting labour induction protocols in late-term, but many low- and middle-income countries have not. However, understanding underlying mechanisms linking post-term births to adverse newborn and infant outcomes remains limited.

Objective:To investigate the (a) prevalence of post-term, (b) the risk factors associated with post-term (c) the association between post-term births and the risk of smallfor-gestational-age (SGA) neonates and of infant mortality in middle-income settings.

Methods:We used existing …

Diabetes Health Literacy, Diabetes Numeracy, And Cognitive Function As Predictors Of Type 2 Diabetes Mellitus Self-Management, Twinkle Gupta

Doctoral Dissertations and Projects

The present study assessed older adults (≥ 45 years old) diabetes health literacy, diabetes numeracy, cognitive function, and its association with their Type 2 Diabetes Mellitus (T2DM) self-management outcomes. These factors are of concern as diabetes is a lifelong condition affecting the body’s conversion of food into energy and may lead to complications and comorbidities if this condition is not properly self-managed. Diabetes health literacy refers to having the necessary capabilities in finding and analyzing diabetes-related information to make informed decisions regarding their health. Numeracy in diabetes has to do with being able to compute diabetes-related math such as insulin …

Evaluating The Effectiveness Of A Student-Run Clinic On Reducing Cigarette Smoking In A Homeless Population, Briana Taormina, Bryson Jones, Kiah Gledhill Md, Audrey Darville Phd, Aprn, Cpaha-Tt

ePublications of Emerging Medical Research Scholars

Objective

Cigarette smoking remains a major health crisis in the United States, claiming the lives of hundreds of thousands of tobacco users each year. Access to evidence-based smoking cessation remains a challenge for many people that use tobacco products. Prior research demonstrates that the homeless population is exceedingly vulnerable to cigarette smoking and faces more barriers to quitting than their domiciled counterparts. This study explores the effectiveness of a free Smoking Cessation Clinic (SCC) within a homeless shelter for women and children, run by a nurse practitioner and a clinical nurse specialist trained as Tobacco Treatment Specialists, along with two …

Demographic Correlates Of Weight-Loss Strategies In Us Adults: Cross-Sectional Analysis Of Nhanes Data 2017–2020, Anin Mokari-Yamchi, Richard R. Rosenkranz

Kinesiology and Nutrition Sciences Faculty Research

Objective: To investigate the frequency of various weight loss strategies among adults in the United States and to explore which weight-loss strategies are associated with several demographic factors.

Methods: The study utilized 2017–2020 data from the National Health and Nutrition Examination Survey. Adult participants (N = 3,130) who had tried to lose weight during the past year were included. Pregnant women and individuals under age 20y were excluded. Weight-loss strategies were categorized into 6 groups: consuming more healthy options (e.g., more fruits); consuming less un-healthy options (e.g., junk food); quality of diet changes (e. g., changed eating habits); assisted weight-loss …

Prevalence And Associated Risk Factors Of Current Hepatitis C Infection Among U.S. General Population And Injection Drug Users Aged 20-59 Years: Nhanes 2009-2018, Harun Mazumder, Md Faruk Hossain, Pratibha Shrestha, Sultan Mahmud, Maidul Husain, Rebeka Ahmed

School of Public Health Faculty Publications

INTRODUCTION: The people who inject drugs (PWID) are attributed to high-risk groups for transmission of the Hepatitis C virus (HCV). This study assessed the prevalence and associated factors of current HCV infection (CHI) among U.S. general population and PWID of ages between 20 and 59 years old. METHODS: This study utilized cross-sectional data from the 2009-2018 National Health and Nutrition Examination Survey, conducting separate analyses for the U.S. general population, including PWID and non-PWID, as well as specific analyses focusing solely on PWID. The analytical methods included the estimation of CHI prevalence, Rao-Scott chi-square test to compare CHI-positive and CHI-negative …

Adherence To Mediterranean Diet Principles In Minority College Students, Bridgette Lorraine Barbre

Master's Theses

Every year, millions of young adults attend college. The Centers for Disease Control and Prevention (CDC) lists heart disease and diabetes as the top health concerns for minority Americans. African American and Hispanic/Latino communities could see a reduction in illness risk by promoting physical activity and healthy eating habits such as the Mediterranean Diet. Research indicates that young adults may benefit significantly from taking charge of their eating habits at the crucial point in their transition from high school to college. By determining the dietary patterns of minority college students, as related to the Mediterranean diet principles, this study intends …

Oral Nutritional Supplement Prescription And Adherence Perspectives, Kristyn Bordelon Hood

Master's Theses

Oral nutritional supplements (ONS) are nutrient-dense beverages that aid in meeting the nutrient needs of patients. Recent research has indicated that patient adherence to prescribed nutritional supplements may depend on palatability, tolerance, and taste fatigue. Registered Dietitian Nutritionists (RDNs) are healthcare professionals who may prescribe these supplements directly or make recommendations to the patient’s physician for a prescription, thereby influencing patient adherence. Little research has been documented regarding taste fatigue and the influences of the RDN’s decisions on patient adherence to nutritional supplement adherence. The purpose of this study was to gain an understanding of the perspectives of nutrition professionals …

Accessible Dietary Interventions For The Prevention And Management Of Common Menstrual Disorders: A Systematic Review, Ella R. Motzko

Theses and Graduate Projects

Objective: This systematic review aims to provide healthcare providers with evidence-based dietary recommendations that can be easily implemented by patients across diverse populations to address a critical gap in the management of common menstrual disorders like premenstrual syndrome (PMS) and primary dysmenorrhea (PD).

Methods: A comprehensive search was conducted using UpToDate, American College of Obstetrics and Gynecology (ACOG) Green Journal, Google Scholar, and PubMed electronic databases to identify randomized-controlled trials (RCTs) that investigated the effects of specific essential nutrients or diet-related behavioral or educational interventions on PMS or PD symptoms.

Results: Following the PRISMA guidelines, the identification process began with …

Exploration Of Positive Deviance In Prevention Of Underweight In The Under-Five: A Qualitative Study On Low-Income Urban Families, Irwan Budiono, Lukman Fauzi, Dewi Sari Rochmayani

Kesmas

Children under the age of five (the under-five) from low-income families are more vulnerable to experience underweight. This nutritional vulnerability is evident in the preliminary study, where 35.1% of the under-five experience underweight, and 28.48% are low-income families. This study aimed to explore Positive Deviance (PD) behaviors in preventing underweight among the under-five. The study applied a qualitative approach with a case study design. Data collection took place in July-August 2022, focusing on low-income families in the Gunung Brintik area. Data were collected through two focus group discussions, seven in-depth interviews, and five key informant interviews. Coding, subtheme, and theme …

Risk Factors For Cognitive Impairment In Adult Population Of Coastal Area: A Cross-Sectional Study In Maringkik Island, Indonesia, Herpan Syafii Harahap, Arina Windri Rivarti, Nurhidayati Nurhidayati, Fitriannisa Faradina Zubaidi, Dini Suryani, Legis Ocktaviana Saputri, Yanna Indrayana, Athalita Andhera, Muhammad Hilam, Abiyyu Didar Haq

Kesmas

Cognitive impairment is a medical condition commonly found in elderly populations, which can be due to vascular risk factors in patients. There remains limited data on risk factors for cognitive impairment among coastal region populations. This study aimed to investigate risk factors for cognitive impairment in the adult population of Maringkik Island, West Nusa Tenggara Province, Indonesia. Data collected were age, sex, education level, hypertension, antihypertensive treatment, diabetes mellitus, cigarette smoking, and body mass index status. A total of 114 participants were recruited using a consecutive sampling method. The participants’ cognitive function assessment used the Mini-Cog instrument. The cognitive impairment …

Exploring Informal Caregivers’ Perspectives On Oral Care For Stroke Patients, Haslina Rani, Saidatul Najibah Muhammad Zamzuri, Ezzah Omar, Tuti Ningseh Mohd-Dom, Aznida Firzah Abdul Aziz, Mohd Fairuz Ali

Kesmas

Stroke often results in physical disability and functional impairment, which may severely limit patients' ability to care for personal hygiene, including oral care. This study aimed to identify the challenges faced by informal caregivers in managing the oral health of stroke patients. This study conducted semi-structured individual interviews with eight home-based caregivers of stroke patients recruited from a community-based clinic facility of a public university in Malaysia. The interviews took 30-45 minutes to complete and were transcribed verbatim. Transcripts were analyzed thematically using a phenomenological approach. Relevant themes that emerged were variations in oral hygiene care, caregivers’ concerns in providing …

Perceptions Of Hiv-Related Comorbidities And Usability Of A Virtual Environment For Cardiovascular Disease Prevention Education In Sexual Minority Men With Hiv: Formative Phases Of A Pilot Randomized Controlled Trial, S Raquel Ramos, Harmony Reynolds, Constance Johnson, Gail Melkus, Trace Kershaw, Julian F Thayer, Allison Vorderstrasse

Faculty, Staff and Student Publications

Background: Sexual minority men with HIV are at an increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and clinical trials.

Objective: This study aims to explore perceptions of HIV-related comorbidities and assess the interest in and usability of a virtual environment for CVD prevention education in Black and Latinx sexual minority men with HIV.

Methods: This is a 3-phase pilot behavioral randomized controlled trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with a total of 25 individuals. In phase …

Obese African American Women’S Perceptions Of Transition From College To Workforce, Alea Lycorish

Walden Dissertations and Doctoral Studies

The rate of obesity continues to rise among adults in the United States, and African American (AA) women are at greater risk in comparison with any other group. This matter has become an alarming public health crisis. Obese AA women also face a higher risk of discrimination in the workforce. The purpose of this qualitative, multiple case study was to increase the understanding of the perceptions and experiences of bachelor degree educated, overweight AA women during the postgraduate phase, who entered the workforce within the past 10 years. The theoretical framework used in this study was Crenshaw’s intersectionality theory. The …

Teacher Implementation Profiles: A Response To Top-Down Mandate Of Movement Integration, Zack Beddoes, Jeanne Barcelona, Darla Castelli

International Journal of Physical Activity and Health

This study examined teacher implementation practices to meet a state mandate requiring 135 minutes of student physical activity (PA) weekly. Teachers were required to implement a video-based movement integration (MI) program. Using an embedded mixed-methods design, provider characteristics of 42 teachers and the organizational capacity of six schools were developed from interviews, surveys, observations, and artifacts. Data analysis revealed three teacher profiles (a) Dynamic Experientialists, (b) Coachable Constructivists, and (c) Cautious Behaviorists, and three school profiles (a) Whole Child Approach, (b) Grade Level Champions, and (c) Back to Basics. Findings suggest that school, teacher, …

Socioeconomic Status, Physical Inactivity, And Bmi In Transitional Urban China: Contextualizing The Theory Of Fundamental Causes, Jun Xu, Fang Gong, Wei Zhao

International Journal of Physical Activity and Health

Drawing insights from the theory of fundamental causes of disease, this study examined the relationships between socioeconomic status (SES) and selected risk factors in transitional urban China. Specifically, under China’s distinct institutional and sociocultural environment, we examined how contextualized SES (i.e., party membership, hukou status, housing ownership, and subjective social status) and conventional SES indicators (i.e., education, income, and occupation) were associated with physical inactivity and body mass index (BMI). Utilizing the urban subsample of the 2017 Chinese General Social Survey (CGSS), we found that individuals with higher education, income, Communist Party membership, and urban hukou status had lower risks …

Microvascular Autologous Breast Reconstruction With The Lateral Thigh Perforator Flap, Stefania M.H. Tuinder, Joep A.F. Van Rooij, Robert J. Allen

School of Medicine Faculty Publications

The lateral thigh perforator flap is an excellent alternative to the deep inferior epigastric artery perforator (DIEP) flap for patients with absolute or relative contraindications for a DIEP flap and adequate volume at the lateral thigh. Preoperative physical examination, preoperative markings, and radiological perforator mapping are essential for adequate surgical preparation. The flap is based on septocutaneous perforators of the lateral circumflex femoral artery, located in the posterior septum between the tensor fascia latae and the gluteus medius muscle. Being relatively stiff, septocutaneous perforators are sensitive to kinking and compression, which is important to keep in mind during flap inset. …

Physical Activity Modifies The Risk Of Incident Cardiac Conduction Disorders Upon Inflammation: A Population-Based Cohort Study, Haiyan Zhao, Man Li, Dan Wu, Shuohua Chen, Chenrui Zhu, Yulong Lan, Hongmin Liu, Yuntao Wu, Shouling Wu

Research outputs 2022 to 2026

BACKGROUND: Emerging evidence suggests a central role for inflammation in cardiac conduction disorder (CCD). It is unknown whether habitual physical activity could modulate the inflammation-associated risks of incident CCD in the general population. METHODS AND RESULTS: This population-based cohort was derived from the China Kailuan study, including a total of 97 192 participants without prior CCD. The end points included incident CCD and its subcategories (atrioventricular block and bundlebranch block). Systemic inflammation was indicated by the monocyte-to-lymphocyte ratio (MLR). Over a median 10.91-year follow-up, 3747 cases of CCD occurred, with 1062 cases of atrioventricular block and 2697 cases of bundle-branch …

Occupational Therapy’S Role In Addressing Wellness In Underserved Communities, Kimberlyna Chheang, Amy Lyons-Brown, Anna Saavedra

Summer 2024 OTD Capstone Symposium

This capstone project addresses sociodemographic disparities in community wellness and health services in Kern County, CA, focusing on underserved communities facing trauma and systemic inequalities. In collaboration with the Community Action Partnership of Kern (CAPK) and their East Kern Family Resource Center (EKFRC), it aims to lay the foundation for community-based, tailored interventions using occupational therapy (OT) to enhance community well-being and promote access to critical services to support wellbeing.

Addressing Dermatologic Concerns And Teledermatology In Undomiciled And Sheltered Populations, Kennedy Gallagher, Sahithi Talasila, Anna Bistline, Rebecca Krain, Leena Ramani, Elizabeth Jones

Student Papers, Posters & Projects

Homelessness in the United States is a significant public health issue, with dermatologic disease being the most prevalent health concern among the undomiciled and sheltered populations. Despite a growing need for dermatologic care, the supply of dermatologists remains insufficient, contributing to disparities in healthcare access for this vulnerable group. This review aims to detail the spectrum of dermatologic conditions experienced by homeless individuals, identify barriers to adequate care, and explore teledermatology as a potential solution to bridge these gaps. A comprehensive literature review was conducted, analyzing studies and reports on dermatologic issues prevalent among the homeless population and the efficacy …

The Experience Of Homelessness And Its Effects On Gut Eubiosis, Kamerin Villagomez

University Honors Theses

Microorganisms which populate the human gastrointestinal tract (GIT) have a profound effect on overall human health. The relationship between host health and eubiosis, or balance, of the GIT microbiome is symbiotic and can have reciprocal relationships with quality of sleep, quality of diet, stress and mental health, and the experience of pain. These specific aspects of health are unique in populations experiencing homelessness due to the multi-dimensional and complex nature of their lived experience. Very few studies explore populations experiencing homelessness, with even fewer investigating the intersection between this population and the human GIT microbiome. It is important to do …

Impacts Of Covid-19 And Taliban Takeover On U.S. Afghan Refugee Women’S Mental Health: A Socio-Ecological Approach To Resilience Resources, Atefeh Aghaei

Theses and Dissertations

In response to the escalating global refugee crisis, intensified by ongoing conflicts and environmental changes, this dissertation research focuses on the mental health of Afghan refugee women in the United States (U.S.), particularly in the context of the COVID-19 pandemic and the 2021 Taliban takeover. With over 114 million people displaced globally, Afghan refugees, notably women, encounter heightened mental health risks due to violence, deprivation, systemic persecution, and the challenges of migration. This vulnerability is exacerbated by recent mass traumatic events, including the pandemic and political upheaval in Afghanistan. Our study, conducted through semi-structured interviews with Afghan refugee women and …

Nutrition And Mental Health Related Factors Across Historically Black College And University Students, Nancy Anai Uriegas

Theses and Dissertations

The prevalence of food insecurity across college campus in the United States has been widely explored, with the primary focus placed on large, 4-year, primarily White institutions. Less is known about the prevalence of food insecurity and the impact it may have on health behaviors among minority serving institutions, including Historically Black Colleges and Universities (HBCU). Young adults attending college, and more specifically student-athletes (SAs), are typically in a new place, facing new stressors and high rates of food insecurity, which in turn may play a critical role in their current health status as it pertains to meeting their energy …

Associations Between The Use Of Ssri Medication In Older Adults And Cognitive Decline And Impairment, Paige Jones

Theses and Dissertations

Previous research has indicated that depression is a risk factor for dementia. Since SSRI medication is the most common treatment for depression, it is important to determine if SSRIs are associated with reduced dementia and better cognitive outcomes. Using longitudinal data from the 2004-2014 waves of the Health and Retirement Study merged with the 2005 Prescription Drug Study, we examined potential associations between SSRI and TCA medication and cognitive impairment and cognitive decline. The study population consisted of 1,775 older adults who participated in the PDS in 2005. We found that SSRIs were associated with significantly higher odds of cognitive …

Internalizing Mental Health Symptoms And Nicotine Use Among Adolescents In Canada, England, And The Us From 2020-2022, Emily E. Hackworth

Theses and Dissertations

Background: There is a well-established bi-directional relationship between cigarette smoking and internalizing mental health (IMH) symptoms (e.g., symptoms of depression, symptoms of anxiety). However, it is unclear whether IMH symptoms are associated with using different types of nicotine products among adolescents, as adolescents are using a variety of nicotine products, including combustible products (cigarettes), non-combustible products (e-cigarettes), or combinations of both types of products. This dissertation examines associations between IMH symptoms and current use of various types of nicotine products across three countries from 2020-2022.

Methods: Data come from the 2020-2022 waves of the International Tobacco Control (ITC) Adolescents Tobacco …

Factors Associated With Elevated Sars-Cov-2 Immune Response In Children And Adolescents, Sarah E Messiah, Rhiana Abbas, Emma Bergqvist, Harold W Kohl, Michael D Swartz, Yashar Talebi, Rachit Sabharwal, Haoting Han, Melissa A Valerio-Shewmaker, Stacia M Desantis, Ashraf Yaseen, Henal A Gandhi, Ximena Flandes Amavisca, Jessica A Ross, Lindsay N Padilla, Michael O Gonzalez, Leqing Wu, Mark A Silberman, David Lakey, Jennifer A Shuford, Stephen J Pont, Eric Boerwinkle

Faculty, Staff and Student Publications

BACKGROUND: Understanding the distinct immunologic responses to SARS-CoV-2 infection among pediatric populations is pivotal in navigating the COVID-19 pandemic and informing future public health strategies. This study aimed to identify factors associated with heightened antibody responses in children and adolescents to identify potential unique immune dynamics in this population.

METHODS: Data collected between July and December 2023 from the Texas Coronavirus Antibody REsponse Survey (Texas CARES), a statewide prospective population-based antibody survey among 1-to-19-year-old participants, were analyzed. Each participant had the following data available for analysis: (1) Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for Nucleocapsid protein antibodies (Roche N-test), (2) qualitative and …

Personalized Nutrition: Tailoring Dietary Recommendations Through Genetic Insights, Saiful Singar, Ravinder Nagpal, Bahram H. Arjmandi, Neda S. Akhavan

Kinesiology and Nutrition Sciences Faculty Research

Personalized nutrition (PN) represents a transformative approach in dietary science, where individual genetic profiles guide tailored dietary recommendations, thereby optimizing health outcomes and managing chronic diseases more effectively. This review synthesizes key aspects of PN, emphasizing the genetic basis of dietary responses, contemporary research, and practical applications. We explore how individual genetic differences influence dietary metabolisms, thus underscoring the importance of nutrigenomics in developing personalized dietary guidelines. Current research in PN highlights significant gene–diet interactions that affect various conditions, including obesity and diabetes, suggesting that dietary interventions could be more precise and beneficial if they are customized to genetic profiles. …

The Worry Of Food Insecurity And The Manifestation Of Generalized Anxiety In Relation To Perceived Health Status, Ramona Lynnette Taylor

Walden Dissertations and Doctoral Studies

This study examined the association between the worry of food insecurity and the manifestation of generalized anxiety, and how these factors related to perceived health status among adults aged 18 years and older in the U.S. The study controlled demographic factors such as gender, age, race, and education. Utilizing data from the 2019 National Health Interview Survey (NHIS), a binomial logistic regression analysis was employed. The findings indicated a significant association between those persons who often worry about food insecurity, severe (OR = 7.324, p < .001) and frequent generalized anxiety (OR = 5.185, p < .001) suggesting that individuals who worry about food insecurity have higher odds of experiencing severe and frequent (more than 3 times per week) generalized anxiety. Furthermore, both the worry of food insecurity in persons not sure (OR = 0.120, p = 0.004) and generalized anxiety (OR = 0.623 for severe anxiety, p = 0.009) were found to be significantly associated with lower perceived health status. These results suggest a potential association between worry about food insecurity and negative impacts on mental health and perceived overall well-being. Overall, these findings underscore the significant impact of food insecurity on mental health. Further research, including experimental and longitudinal studies, is necessary to elucidate the causal relationship between food insecurity and the manifestation of generalized anxiety in order to impact positive social change.

Clathrin Light Chains Negatively Regulate Plant Immunity By Hijacking The Autophagy Pathway, Hu-Jiao Lan, Jie Ran, Wen-Xu Wang, Lei Zhang, Ni-Ni Wu, Ya-Ting Zhao, Min-Jun Huang, Min Ni, Fen Liu, Ninghui Cheng, Paul A Nakata, Jianwei Pan, Steven A Whitham, Barbara J Baker, Jian-Zhong Liu

Faculty, Staff and Students Publications

The crosstalk between clathrin-mediated endocytosis (CME) and the autophagy pathway has been reported in mammals; however, the interconnection of CME with autophagy has not been established in plants. Here, we report that the Arabidopsis CLATHRIN LIGHT CHAIN (CLC) subunit 2 and 3 double mutant, clc2-1 clc3-1, phenocopies Arabidopsis AUTOPHAGY-RELATED GENE (ATG) mutants in both autoimmunity and nutrient sensitivity. Accordingly, the autophagy pathway is significantly compromised in the clc2-1 clc3-1 mutant. Interestingly, multiple assays demonstrate that CLC2 directly interacts with ATG8h/ATG8i in a domain-specific manner. As expected, both GFP-ATG8h/GFP-ATG8i and CLC2-GFP are subjected to autophagic degradation, and degradation of GFP-ATG8h is …

Socioeconomic Determinants And Maternal Mortality In Liberia, Monee Sherman

Walden Dissertations and Doctoral Studies

High rates of pregnancies and childbirth contribute to a heightened risk of maternal mortality among women between 15 and 49 in Liberia. Most women are uninformed about their maternal risk behaviors, symptom severity, and delayed care-seeking. The mortality rate for women between 25 and 34 during pregnancy and childbirth is unacceptably high. The highest increase in maternal mortality rates is seen among women between 40 and 44 who choose to delay motherhood. In Liberia, the deaths of 4.5 women a day are caused by complications during pregnancy and childbirth. We examined the influence of participant background characteristics, socioeconomic factors, and …

A Social Media Game To Increase Physical Activity Among Older Adult Women: Protocol Of A Randomized Controlled Trial To Evaluate Challenge, Michael C Robertson, Maria Chang Swartz, Karen M Basen-Engquist, Yisheng Li, Kristofer Jennings, Debbe Thompson, Tom Baranowski, Elena Volpi, Elizabeth J Lyons

Faculty, Staff and Student Publications

BACKGROUND: Older adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits …