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EXPLORING HEALTHY LIFESTYLE BEHAVIORS, DEPLOYMENT FACTORS, AND ADJUSTMENT AMONG MILITARY SPOUSES A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAI`I AT MĀNOA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN NURSING AUGUST 2011 By Norma Jean Suarez Dissertation Committee: Victoria Niederhauser, Chairperson Joseph Mobley Debra Mark Mijung Park Sharon Reese Charles Mueller Keywords: Military Spouse, Adjustment, Health Promoting Behaviors UMI Number: 3485490 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent on the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMI 3485490 Copyright 2011 by ProQuest LLC. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 - 1346 ii   DEDICATION This work is dedicated to my husband, Carlos M. Suarez, and to my children, Carlos III, David, and Nicolas. iii   ACKNOWLEDGEMENTS I would like to express my deepest gratitude to my advisor, Dr. Victoria Niederhauser, for taking me under her wings, and providing excellent supervision, encouragement, and support, which enabled me to understand and complete this dissertation. I would like to thank Dr. Joe Mobley, Dr. Debra Mark, Dr. Mijung Park, Dr. Sharon Reese, and Dr. Charles Mueller for guiding my research, for their thoughtful criticisms, and for their time and attention given to this study with special thanks to Dr. Sharon Reese, who genially accepted working with me as the study site principal investigator at Fort Hood, Texas. I would like to thank my friends and colleagues for sharing their enthusiasm for my work. I would like to thank the Fort Hood community and especially the military spouses at Fort Hood who so graciously participated in this study. I would like to thank my husband, Carlos Suarez, for believing in me and for always being there to push me to finish my study, despite all the obstacles placed before me during the past several years. Finally, I would like to thank God for granting me the perseverance and determination to complete this dissertation and for carrying me through it all. iv   ABSTRACT Background Military family separations have increased significantly in the past decade and military readiness has never been so critical. This can have an impact on the adjustment of military spouses. There have been many interventions to promote the well-being of military spouses, but little, if any, has been documented on the engagement of healthy lifestyle behaviors as a tool for adjustment. Objectives The overall aim of this study is twofold: the first aim is to explore the healthy lifestyle behaviors of military spouses of service members stationed at Fort Hood, Texas. The second aim is to investigate whether healthy lifestyle behaviors, deployment factors, and demographic factors are associated with and predict adjustment in these military spouses. Methods After approval by appropriate channels, study surveys were distributed to military spouses at Fort Hood, Texas. The following instruments were used for data collection: demographic questionnaires including deployment questions, the Healthy Lifestyle Profile II, the Psychological General Well-Being Index, and the Depression, Anxiety, and Stress Scale. Analysis was conducted using SPSS 18.0 for Mac. Results A convenience sample of 158 military spouses who met study criteria completed the study survey. Results of the study indicate that most health-promoting behaviors correlate significantly with adjustment while spiritual growth, health responsibility and v   stress management predict adjustment. Unfortunately, only a small percentage of military spouses were actively engaged in health-promoting behaviors. Several demographic and deployment variables also correlate highly with adjustment, but after a multiple regression analysis and a multiple analysis of variance, none of these variables were found to predict adjustment. Conclusion The employment of healthy lifestyle behaviors as a coping strategy was found to predict adjustment in military spouses. Therefore, new efforts are needed to promote opportunities for military spouses to engage more frequently in healthy lifestyle behaviors. vi   TABLE OF CONTENTS ABSTRACT ....................................................................................................................... iv LIST OF TABLES ............................................................................................................ vii CHAPTER 1. INTRODUCTION ...................................................................................... 1 Background .................................................................................................................................. 1 Problem Statement ....................................................................................................................... 4 Study Aims .................................................................................................................................. 4 Significance of the Study/Nursing Implications .......................................................................... 4 CHAPTER 2. REVIEW OF THE LITERATURE ............................................................ 6 The Impact of a Military Deployment ......................................................................................... 6 Reservists ................................................................................................................................... 15 Reunion ...................................................................................................................................... 16 Family Support to Assist with the Impact of Deployment ........................................................ 17 Adjustment ................................................................................................................................. 18 Deployment Factors ................................................................................................................... 24 Healthy Lifestyle Behaviors to Cope and Adjust ...................................................................... 26 Theoretical Framework .............................................................................................................. 31 Gaps in Knowledge ................................................................................................................... 36 CHAPTER 3. RESEARCH METHOD ........................................................................... 38 Purpose of the Study and Research Questions .......................................................................... 38 Study Design .............................................................................................................................. 39 Procedures ................................................................................................................................. 40 Measures .................................................................................................................................... 41 Data Analysis ............................................................................................................................. 45 CHAPTER 4. RESULTS ................................................................................................. 46 Study Participants ...................................................................................................................... 46 Statistical Results ....................................................................................................................... 47 Association between HPLP II scales and adjustment scales ................................................. 51 Association between deployment factors and adjustment scales .......................................... 56 Association between demographic variables and adjustment ............................................... 59 Multiple regression ................................................................................................................ 61 Multiple analysis of variance (MANOVA) ........................................................................... 62 CHAPTER 5. DISCUSSION ........................................................................................... 64 Demographic Variables ............................................................................................................. 69 Deployment Factors ................................................................................................................... 70 Limitations and Recommendations ........................................................................................... 72 Other Recommendations for Future Research ........................................................................... 74 Implications for Nursing ............................................................................................................ 75 Conclusion ................................................................................................................................. 76 Appendix ........................................................................................................................... 77 vii   LIST OF TABLES Table Page 1. DASS Scales Score – 21-Item Version…..………………………………........ 44 2. Descriptive Statistics for HPLP II Subscales and Overall Scale…….....….…. 48 3. Correlations among HPLP II and PGWBI Subscales and Overall Scale…...... 52 4. Correlations among HPLP II and DASS Subscales and Overall Scale…......... 53 5. Correlations among Number of Deployments and PGWBI/DASS Subscales and Overall Scale..…...…….……………………………………….……….... 56 6. Appendix B: Descriptive Statistics for PGWBI Subscales and Overall Scale...….…………………………………………………….……………..... 78 7. Appendix C: Descriptive Statistics for DASS Subscales and Overall Scale.... 79 8. Appendix D. Summary of All Significant Relationships between Demographics and PGWBI Scales…………………………………….…...… 80 9. Appendix E: Summary of All Significant Relationships between Demographics and DASS Scales……………………….…………..………… 81 10. Appendix F: Summary of Final Stage of PGWBI Multiple Regression……… 82 11. Appendix G: Summary of Final Stage of DASS Multiple Regression…......... 83 1     CHAPTER 1. INTRODUCTION Background The September 11th attacks in Washington D.C. and New York City, the continued world war against terrorism, and even the disasters brought about by Mother Nature, such as the 2010 earthquakes in Chili and Haiti have resulted in a summon for the U.S. military back into the forefront. Consequently, military family separations have increased significantly in the past decade due to such combat mission assignments, hazardous training rotations, humanitarian missions and other deployments in various places worldwide. Additionally, the downsizing of military forces has lead to a call upon the forces to fulfill such missions with fewer human resources, creating a situation of increasing readiness for deployment and ultimately separation of military personnel from their family. Geographical separations resulting from deployment are part of the military life and may have an adverse effect on marital relations, children, family unit stabilization, and mental health of the spouse and children left behind (Wexler & McGrath, 1991; Zeff, et al., 1997). The service member may be called upon at any time to deploy for an extended period of time to serve the nation’s defense mission. Deployments are considered the most stressful event the typical military family will endure (Knox & Price, 1995). The effects of military-induced separation on the spouse and children have been well documented (Kelley, 1994; Wexler & McGrath, 1991; Zeff et al., 1997). Spouses were reported to have experienced emotional symptoms of anxiety and loneliness and 2   physiological symptoms of headaches, insomnia, tenseness, and inability to focus (Wexler & McGrath, 1991). Others have found that spouses experienced symptoms of depression, lowered self-esteem, and hopelessness prior to and during a deployment with symptoms lessening during post-deployment (Kelley, 1994). Researchers have found that military-induced separation can have an undesirable effect on children as well. Children exhibited internalized behaviors, such as fear and inhibition and externalized behaviors, such as aggression and antisocial acts during pre- and post-deployments (Kelley, 1994). Common diagnoses for many of the children were depression, attention deficit/hyperactivity disorder, and oppositional defiant disorder (Kelley, 1994). Studies examining the impact that deployment-induced separation has on the service member, the spouse, and children while the service member is deployed are found in the literature review in the following chapter. These brief descriptions of the effect of military separations give clear indications that the military family experience physiological and psychological consequences. It is apparent then, that being deployed and being on a continuum of readiness for deployment can have an impact on the adjustment of military spouses. To address the psychological outcomes, traditional means such as the use of support from families, friends, the military unit and social services, the use of online resources, and seeking medical care have all been mentioned. Little, if any at all, has been documented on addressing psychological outcomes by use of non-traditional means, particularly the adoption of healthy lifestyle behaviors. The concept of lifestyle is centered around the idea that people typically display a familiar pattern of behavior in their daily lives as in regular work routines, leisure time,

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Keywords: Military Spouse, Adjustment, Health Promoting Behaviors deployment variables also correlate highly with adjustment, but after a multiple.
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