Dietary Micronutrient Levels in Allied Health and Nursing Students

279 Pages·2015·10.22 MB·English

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2015
A Cross-Sectional Study: Dietary Micronutrient
Levels in Allied Health and Nursing Students
Grisseel A. Cruz-Espaillat
Walden University
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Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Grisseel Cruz-Espaillat

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Cassius Lockett, Committee Chairperson, Public Health Faculty
Dr. Aaron Mendelsohn, Committee Member, Public Health Faculty
Dr. German Gonzalez, University Reviewer, Public Health Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2015
Abstract
A Cross-Sectional Study: Dietary Micronutrient Levels in Allied Health
and Nursing Students
by
Grisseel Cruz-Espaillat

MPH, Florida International University, 2000
MD, Universidad Central Del Este, 1986
AA, Miami Dade Community College, 1982

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health Epidemiology

Walden University
March 2015
Abstract
The adequate intake of micronutrients is important to maintain optimal health and prevent
nutritional disorders and chronic disease. Studies have shown that medical students often
reduce self-care behaviors and lack adequate dietary intake, leading to nutritional
deficiencies. In this quantitative cross-sectional study, measurements of micronutrient
levels in a sample of allied health and nursing students were compared to Recommended
Daily Allowance (RDA) values. NutritionQuest Data-on-Demand System was used to
analyze nutrients and food group intake. The postpositivist paradigm was used to
examine how the independent and dependent variables relate to each other. Using a one-
sample t test, a comparison of average micronutrient intake among study participants
with RDA values for those micronutrients showed that average micronutrient intake in
the study population was higher than recommended values. Two sample t-test results
showed no significant difference in average intake of micronutrients among participants
with high and low income levels, or with high and low stress levels. As the normality
assumption was not satisfied by the outcome variables, nonparametric tests were used to
evaluate hypotheses. While this finding does not support the original hypothesis, it could
have implications for the role of allied health and nursing practitioners in the care of both
their patients and members of their medical team. Conversely, an assumption of this
study was that a high level of similarity between the traditional medical student
population and the allied health and nursing population in terms of nutritional habits may
have led to a flaw in the overall research hypothesis. The detection of micronutrient
deficiencies in students can bring awareness to improve nutritional intake and initiate a
change in how public health officials advocate healthy and balanced diets.
A Cross-Sectional Study: Dietary Micronutrient Levels in Allied Health
and Nursing Students
by
Grisseel Cruz-Espaillat

MPH, Florida International University, 2000
MD, Universidad Central Del Este, 1986
AA, Miami Dade Community College, 1982

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Health Epidemiology

Walden University
March 2015
Dedication
I dedicate this dissertation to my mother, Julia Esther Cruz Sanchez, my sons,
Eliseo de Jesus Espaillat, Jr. and Julyan Elishah Espaillat, and my sister, Martizael Lanza.
Thank you for the support, encouragement, and constant love that have sustained me
throughout my life. I also thank my husband, Dr. Eliseo de Jesus Espaillat, for his
support.
Acknowledgments
I would like to thank my committee members, Dr. Cassius Lockett, Dr. Aaron
Mendelsohn, and Dr. German Gonzalez for your assistance and suggestions throughout
my dissertation process. I would like to express my sincere gratitude to my supervisors,
Dr. Gary Markowitz and Dr. Cristy Sibila for their academic, emotional, and
psychological support. I would like to give my deepest appreciation to the faculty, staff,
and students of Keiser University in the Miami campus for allowing me to access data
collection and completion of my study. I cannot forget to acknowledge those who have
crossed my path in the course of this journey to critique my work and provide
encouragement, such as Dr. Tammi L. Fleming-White, Andrea Bowers, Dr. John
Orisasona, Dr. Michelle Witherspoon, Belkis Cabrera, Cyndi White, Eliseo de Jesus
Espaillat, Jr., and Ivette Enriquez.
Table of Contents
List of Tables .......................................................................................................................v
List of Figures ................................................................................................................... vii
Chapter 1: Introduction to the Study ....................................................................................1
Introduction ....................................................................................................................1
Background ....................................................................................................................4
Statement of the Problem ...............................................................................................8
Purpose of the Study ....................................................................................................13
Research Question and Hypotheses .............................................................................15
Theoretical Framework ................................................................................................17
Nature of the Study ......................................................................................................18
Definitions....................................................................................................................19
Assumptions .................................................................................................................20
Scope and Delimitations ..............................................................................................20
Limitations ...................................................................................................................22
Significance of the Study .............................................................................................23
Summary ......................................................................................................................25
Chapter 2: Literature Review .............................................................................................29
Introduction ..................................................................................................................29
Literature Search Strategy............................................................................................29
Micronutrient Background ...........................................................................................30
Micronutrients ........................................................................................................34
Trace Elements.......................................................................................................38
i
Micronutrient Deficiency .............................................................................................39
Epidemiology ...............................................................................................................51
Incidence and Prevalence of Micronutrients..........................................................51
Theoretical Framework ................................................................................................54
Comparative Studies on Micronutrient Deficiency .....................................................55
Micronutrient Sustainment Roles ..........................................................................59
Trace Elements Sustainment Roles ........................................................................67
Risk Factors .................................................................................................................68
Modes of Administration .......................................................................................70
Summary of Research ..................................................................................................73
Chapter 3: Research Methodology.....................................................................................75
Introduction ..................................................................................................................75
Research Design and Rationale ...................................................................................76
Research Hypotheses ...................................................................................................77
Setting and Sample ......................................................................................................81
Sampling and Sampling Procedures ......................................................................82
Procedures for Recruitment, Participation, and Data Collection ...........................84
Data Collection ......................................................................................................87
Study Eligibility .....................................................................................................89
Instrumentation and Materials .....................................................................................90
Block Rapid Food Screeners Questionnaire ..........................................................90
The Perceived Stress Scale ....................................................................................92
Reliability Analysis ................................................................................................93
ii
Income Interpretation .............................................................................................93
Data Analysis ...............................................................................................................94
Threats to Validity .................................................................................................97
Ethical Consideration ...................................................................................................98
Protection of Participants’ Rights ..............................................................................100
Summary ....................................................................................................................101
Chapter 4: Results ............................................................................................................102
Introduction ................................................................................................................102
Data Collection ..........................................................................................................104
Subject Recruitment .............................................................................................104
Prescreening Data/Phase I ....................................................................................105
Phase II Screening................................................................................................106
Results ........................................................................................................................107
Demographic Data ...............................................................................................107
Descriptive Analyses ...........................................................................................110
Mann-Whitney U Analyses..................................................................................119
Perceived Stress Scale..........................................................................................122
Multiple Linear Regression..................................................................................127
Summary ....................................................................................................................134
Chapter 5: Discussion, Conclusions, and Recommendations ..........................................137
Introduction ................................................................................................................137
Interpretation of Findings ..........................................................................................138
Independent Variable (Income) ...........................................................................139
iii