Tzu-An Chen
Biographic Data
| ID | 133402 |
|---|---|
| NAME | Tzu-An Chen |
| GIVEN NAMES | Tzu-An |
| FAMILY NAME | Chen |
| SIGNATURE | CHEN T |
| AFFILIATIONS | University of Houston |
| ORCID | 0000-0003-4312-7258 |
| VERIFIED | Yes |
| TOTAL WORKS | 52 |
| TOTAL CITATIONS | 51 |
| AUTHOR COUNT | 52 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2012 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 3 |
Tobacco-Related Knowledge Among Employees at Substance Use Treatment and Medical Healthcare Centers Serving Rural and Medically Underserved Patients with Substance Use Disorders in Texas, USA
Findings support the need for routine tobacco training in healthcare centers serving rural and MUAs of Texas. Brief educational sessions may help address provider knowledge gaps and, ultimately, strengthen cessation care and reduce tobacco-related disparities in these settings
Exploring social and environmental predictors of school engagement among first‐ and second‐generation Latino youth
Using a multidimensional, integrative approach this study examined the influence of social position factors (nativity, economic hardship, and language) and environmental contexts (community trauma, geographic location, and discrimination) on three domains of school engagement (cognitive, behavioral, and relational) among a community sample of first‐ and second‐generation Latino adolescents. Findings from this study reveal that both social positio…
Threat and deprivation as distinct predictors of posttraumatic stress and depression symptoms in first and second generation Latinx youth
Recent adverse childhood experiences (ACEs) scholarship emphasizes that differing ACEs affect the onset and course of psychopathology, and that sociopolitical context contributes to ACEs experienced by marginalized youth. Guided by the Immigration-Related Adverse Childhood Experiences Model, we explored the associations between different ACEs-immigration enforcement fear and perceived economic hardship-on posttraumatic stress disorder (PTSD) and …
Negotiating cancer alone
COVID-19 has critically impacted cancer care services including reduced screenings, diagnoses, and surgeries; particularly among Black and Latina/x women who already suffer worse outcomes. This qualitative study explored the care experiences of a diverse sample of breast cancer survivors ( N = 21; 7 Black, 4 Hispanic, 10 White) undergoing treatment during the pandemic via online semi-structured interviews. Grounded theory analysis yielded the cor…
Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients
People with substance-use disorders have elevated rates of tobacco use compared with the general population, yet rarely receive tobacco-dependence treatment within substance-use treatment settings (SUTS). One barrier to delivering evidence-based interventions in SUTS is providers' misconception that treating tobacco use and non-nicotine substance use concurrently jeopardizes clients' substance-use recovery, although research indicates that it enh…
Understanding Mental Health Status of Syrian Refugee and Jordanian Women
(1) Background: War and displacement are well-known predictors of negative mental health outcomes among affected populations. This is especially relevant for refugees of war, particularly women, who often repress their mental health needs due to family responsibilities, social stigma, and/or cultural pressures. In this study, we compared the mental health status of urban Syrian refugee women ( n = 139) with local Jordanian women ( n = 160). (2) M…
Exploring Covid-19 Vaccine Attitudes among Racially and Ethnically Minoritized Communities
COVID-19 has disproportionately affected Black, Indigenous, and People of Color (BIPOC) communities, yet rates of COVID-19 vaccination remain low among these groups. A qualitative study was undertaken to better understand the factors contributing to low vaccine acceptance among these communities. Seventeen focus groups were conducted in English and Spanish from 8/21 to 9/22, with representatives from five critical community sectors: (1) public he…
Changes in Substance Use Treatment Providers’ Delivery of the 5A’s for Non-Cigarette Tobacco Use in the Context of a Comprehensive Tobacco-Free Workplace Program Implementation
Tobacco use treatment is not prioritized in substance use treatment centers (SUTCs), leading to tobacco-related health inequities for patients with substance use disorders (SUDs) and necessitating efforts to enhance providers' care provision. Training providers on how to treat tobacco use increases their intervention on patients' smoking, but limited work addresses its effects on their non-cigarette tobacco use intervention provision. This study …
Educating Substance Use Treatment Center Providers on Tobacco Use Treatments Is Associated with Increased Provision of Counseling and Medication to Patients Who Use Tobacco
Tobacco use is the leading preventable cause of death in America and is elevated among patients with non-tobacco substance use disorders. Substance use treatment centers (SUTCs) do not commonly address their patients' tobacco use. Lack of knowledge on treating tobacco use with counseling and medication may be a barrier that underlies this inaction. A multi-component tobacco-free workplace program implemented in Texas SUTCs educated providers on t…
Guest Support for Outdoor Smoke-Free Policies within a Homeless Shelter
Roughly 70-80% of adults experiencing homelessness smoke cigarettes. Smoke-free living/workplace policies are an empirically-supported tobacco control intervention. However, homeless shelters may be reluctant to implement smoke-free policies due to fears of it discouraging current/potential shelter guests from taking refuge there. The current study was meant to characterize guest support for on-property smoke-free policies within a homeless shelt…
Collaborative Learning
Individuals with behavioral health conditions account for 50% of annual smoking-related deaths, yet rarely receive tobacco dependence treatment within local mental health authorities (LMHAs). As lack of training and knowledge are key barriers to providing tobacco dependence treatment, Taking Texas Tobacco-Free (TTTF) developed an iterative, 4-6-months train-the-trainer program to embed expertise and delivery of sustained education on tobacco-free…
Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women
Black women have a slightly lower breast cancer incidence rate than White women, but breast cancer mortality is approximately 40% higher among Black women than among White women. Early detection by mammography may improve survival outcomes. Outlets providing information on cancer and cancer screening often present data, including mammography recommendations, that are unreliable, accessible, and/or inconsistent. We examined associations between so…
Displacement and Isolation
(1) Background: Syrians are the largest forcibly displaced population in the world. Approximately 20,000 Syrian refugees have resettled in the United States (US) since the civil war in Syria began in 2011, with an estimated 130 families resettling in Houston, Texas. We conducted a pilot study with the objective of examining the physical and mental well-being of the Houston Syrian refugee population. (2) Methods: Online surveys were conducted usin…
Providers’ Non-Cigarette Tobacco Use Intervention Practices in Relation to Beliefs about Patients, Prioritization of and Skills for Intervention, and Referral Knowledge in Texas Healthcare Centers Pro…
Rates of non-cigarette (colloquially, other) tobacco use is elevated among adults with behavioral health conditions. Little is known about whether behavioral health providers are using brief interventions, including the evidence-based 5As (Ask, Advise, Assess, Assist, and Arrange) for other tobacco use, or what provider factors may be associated with use of these interventions. The current study redressed this gap. Overall, 86 providers in Texas …
Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment
Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers' use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined…
Organization-Level Factors Associated with Changes in the Delivery of the Five A’s for Smoking Cessation following the Implementation of a Comprehensive Tobacco-Free Workplace Program within Substance…
Many adults with a substance use disorder smoke cigarettes. However, tobacco use is not commonly addressed in substance use treatment centers. This study examined how provider beliefs about addressing tobacco use during non-nicotine substance use treatment, provider self-efficacy in delivering tobacco use assessments, and perceived barriers to the routine provision of tobacco care were associated with changes in the delivery of the evidence-based…
The Impact of the Covid-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer …
The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients' quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at …
Perspectives of Black/African American and Hispanic Parents and Children Living in Under-Resourced Communities Regarding Factors That Influence Food Choices and Decisions
Families living in under-resourced communities are at risk of obesity and obesity-related chronic diseases. To develop effective interventions, it is important to identify parent and child perspectives of factors that influence food-related choices and decisions. This paper reports qualitative findings from a larger mixed method study investigating this topic. Hybrid thematic analysis was used to code and analyze the interviews. Family-generated …
Discrimination and PTSD among Latinx immigrant youth
These results further provide support for research into discrimination as a potentially traumatic experience linked to PTSD and underscore the importance of including discrimination in assessments of trauma and adverse childhood outcomes among Latinx immigrant youth. Results further suggest the importance of an intersectional approach to understanding how discrimination relates to PTSD among Latinx immigrant youth. (PsycInfo Database Record (c) 2…
Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers
Tobacco use is disproportionately elevated among patients with substance use disorders relative to the general U.S. population. Tobacco interventions are lacking within substance use treatment centers (SUTCs) due to lack of knowledge and training. This study examined knowledge gain and the organizational factors that might moderate knowledge gains following tobacco education training provided to employees (N = 580) within 15 SUTCs that were parti…
Uhand”—A National Cancer Institute Funded Partnership to Advance Cancer Health Equity through Scholar Training
Black and Hispanic adults are disproportionately affected by cancer incidence and mortality, and experience disparities in cancer relative to their White counterparts in the US. These groups, including women, are underrepresented among scientists in the fields of cancer, cancer disparities, and cancer care. The "UHAND" Program is a partnership between institutions (University of Houston and The University of Texas MD Anderson Cancer Center) aimin…
Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness
Psychiatric medication nonadherence continues to be a leading cause of poor health outcomes for individuals experiencing homelessness. Identifying the sociodemographic factors that contribute to medication nonadherence may help guide strategies to care for and support this group. This study examined 200 adults with depression diagnoses and active anti-depressant prescriptions (Mage = 43.98 ± 12.08, 59.4% Caucasian, 58.5% male, 70% uninsured, 89.5…
Addressing Smoking Cessation among Women in Substance Use Treatment
Intersecting socially marginalized identities and unique biopsychosocial factors place women with substance use disorders (SUDs) experiencing myriad disadvantages at higher risk for smoking and stigmatization. Here, based on our work with women receiving care for SUDs in four participating treatment/women-serving centers (N = 6 individual clinics), we: (1) describe the functions of smoking for women with SUDs; and (2) explore participants' experi…
Implementation and Outcomes of a Comprehensive Tobacco Free Workplace Program in Opioid Treatment Centers
Tobacco use is exceedingly high among individuals receiving care for opioid addiction, but not commonly addressed by clinicians in treatment settings. Taking Texas Tobacco Free (TTTF) is a comprehensive tobacco-free workplace (TFW) program that builds treatment centers' capacity to address tobacco use with evidence-based tobacco cessation policies and practices. Here, we examine the process and outcomes of TTTF's implementation within 7 opioid ad…
Implementation and Outcomes of a Train-the-Trainer Program at Behavioral Health Treatment Centers as a Mechanism to Maintain Organizational Capacity to Address Tobacco Use Disorder
Despite prior successful implementation of Taking Texas Tobacco Free (TTTF), an evidence-based tobacco-free workplace program, in local mental health authorities (LMHAs), post-implementation employee attrition necessitated continuing education on tobacco-free policies and tobacco treatment practices. Here, we report on the outcomes of a train-the-trainer program which trained "champions" to deliver tobacco cessation education at their LMHAs. Thre…
Parents’ perceptions of preschool children’s ability to regulate eating. Feeding style differences
Immigration Enforcement Fear and Anxiety in Latinx High School Students
Exploratory factor analysis of The Comprehensive Feeding Practices Questionnaire (CFPQ) in a low-income hispanic sample of preschool aged children
Dimensions of vegetable parenting practices among preschoolers
Impact of a pilot walking school bus intervention on children's pedestrian safety behaviors
Walking school buses (WSB) increased children's physical activity, but impact on pedestrian safety behaviors (PSB) is unknown. We tested the feasibility of a protocol evaluating changes to PSB during a WSB program. Outcomes were school-level street crossing PSB prior to (Time 1) and during weeks 4-5 (Time 2) of the WSB. The protocol collected 1252 observations at Time 1 and 2548 at Time 2. Mixed model analyses yielded: intervention schoolchildren…
Association of Fear and Mistrust with Stress Among Sheltered Homeless Adults and the Moderating Effects of Race and Sex
Confirmatory factor analysis of the Feeding Emotions Scale. A measure of parent emotions in the context of feeding
Impact of a pilot walking school bus intervention on children's pedestrian safety behaviors
Walking school buses (WSB) increased children's physical activity, but impact on pedestrian safety behaviors (PSB) is unknown. We tested the feasibility of a protocol evaluating changes to PSB during a WSB program. Outcomes were school-level street crossing PSB prior to (Time 1) and during weeks 4-5 (Time 2) of the WSB. The protocol collected 1252 observations at Time 1 and 2548 at Time 2. Mixed model analyses yielded: intervention schoolchildren…
Dimensions of vegetable parenting practices among preschoolers
Psychometric validity of the parent’s outcome expectations for children’s television viewing (Poetv) scale
The Positive and Negative POETV scales offer a new tool to better define predictors of screen media parenting practices and child screen media use behaviors
Environmental and cultural correlates of physical activity parenting practices among Latino parents with preschool-aged children
Interventions promoting PA among Latino preschoolers may need to address the social-ecological context in which families live to effectively promote PA parenting, especially parents' perceptions of neighborhoods
Parents’ perceptions of preschool children’s ability to regulate eating. Feeding style differences
Predicting use of effective vegetable parenting practices with the Model of Goal Directed Behavior
Objective To model effective vegetable parenting practices using the Model of Goal Directed Vegetable Parenting Practices construct scales. Design An Internet survey was conducted with parents of pre-school children to assess their agreement with effective vegetable parenting practices and Model of Goal Directed Vegetable Parenting Practices items. Block regression modelling was conducted using the composite score of effective vegetable parenting…
Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior
Objective Increasing a parent’s ability to influence a child’s vegetable intake may require reducing the parent’s use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices. Design A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed …
Confirmatory factor analysis of the Feeding Emotions Scale. A measure of parent emotions in the context of feeding
Vegetable parenting practices scale. Item response modeling analyses
Several effective vegetable parenting practices and ineffective vegetable parenting practices scale items functioned differently on the basis of child's demographic characteristics; therefore, researchers should use these vegetable parenting practices scales with caution. Item response modeling should be incorporated in analyses of parenting practice questionnaires to better assess differences across demographic characteristics
Psychological Correlates of Self-Reported and Objectively Measured Physical Activity among Chinese Children—Psychological Correlates of PA
This study aimed to explore the associations among psychological correlates and physical activity (PA) in Chinese children and to further examine whether these associations varied by different PA measures. PA self-efficacy, motivation, and preference were reported in 449 8-13-year-old Chinese children (252 males). Moderate- to vigorous- intensity PA (MVPA) was measured by the Physical Activity Questionnaire for Older Children (PAQ-C) and with an …
Obesity status trajectory groups among elementary school children
Boys, Hispanic and non-Hispanic Black children were at higher risk of being overweight or obese throughout their elementary school years, supporting the need for obesity treatment. Post kindergarten and post second grade summer months were times when some children transitioned into overweight/obesity. It will be important to identify which behavioral factors (e.g., diet, physical activity, sedentary behaviors, and/or sleep) predisposed children t…
Predicting habits of vegetable parenting practices to facilitate the design of change programmes
Objective Habit has been defined as the automatic performance of a usual behaviour. The present paper reports the relationships of variables from a Model of Goal Directed Behavior to four scales in regard to parents’ habits when feeding their children: habit of (i) actively involving child in selection of vegetables; (ii) maintaining a positive vegetable environment; (iii) positive communications about vegetables; and (iv) controlling vegetable p…
Characterizing Alcohol Use Behaviors among Homeless Men and Women
Objectives: In this study, we characterized alcohol use behaviors by sex among sheltered homeless adults and explored associations with health and readiness to change drinking behaviors. Methods: Participants (N = 581; 63.7% men; M age = 43.6, 29.4% white) self-reported alcohol use and readiness to change drinking behaviors. Sex differences were analyzed via Wilcoxon ranksum, chi-square tests, logistic regression, and ANCOVAs. Results: Overall, 3…
Characterizing Discrimination Experiences by Race among Homeless Adults
Objectives: Among domiciled samples, racial discrimination is a known stressor linked with poorer quality of life. However, homeless adults may be particularly vulnerable to discrimination due to multiple factors beyond race. In this study, we characterized perceived discrimination and its reported impact on quality of life in a sample of adults who were homeless. Methods: Homeless adults recruited from Oklahoma City self-reported their socio-dem…
Exploratory factor analysis of The Comprehensive Feeding Practices Questionnaire (CFPQ) in a low-income hispanic sample of preschool aged children
Association of Problematic Alcohol Use and Food Insecurity among Homeless Men and Women
Food insecurity results from unreliable access to affordable and nutritious food. Homeless adults are particularly vulnerable to both food insecurity and problematic alcohol use. The current study examined the link between problematic alcohol use and food insecurity among homeless adults. Participants (N = 528; 62.7% men; M age = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Problematic alcohol use was measured usin…
Mental Illness and Youth-Onset Homelessness
Financial challenges, social and material instability, familial problems, living conditions, structural issues, and mental health problems have been shown to contribute to youth homelessness. Based on the paucity of literature on mental illness as a reason for youth homelessness, the current study retrospectively evaluated the association between the timing of homelessness onset (youth versus adult) and mental illness as a reason for homelessness…
Clinician Training in the Adaptation of a Comprehensive Tobacco-Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed
Tobacco use is exceedingly high among those who are homeless or at risk of homelessness but not commonly addressed by clinicians. Taking Texas Tobacco Free (TTTF) is a tobacco control program that addresses known clinician barriers to intervention (e.g., low training receipt, limited resources). Here, we examine the process and outcomes of TTTF's adaptation within four agencies that provide housing or other services to individuals who are homeles…
Understanding the Associations between Smoking-Related Risk Perception, Interest in Quitting Smoking, and Interest in Lung Cancer Screening among Homeless Adult Smokers
Individuals experiencing homelessness smoke cigarettes at high rates, suffer a disproportionate incidence of lung cancer, but are unlikely to be screened to enhance early detection. Understanding correlates of lung cancer screening (LCS) interest within this vulnerable group may lend insight into prevention and treatment efforts and reduce their smoking-related morbidity and mortality. This study sought to understand how risk perception and inter…
Adapting and Evaluating Implementation of a Tobacco-Free Workplace Program in Behavioral Health Centers
Objectives: State-administered community behavioral health centers (CBHCs) rarely treat tobacco dependence, despite high client tobacco use. Using a mixed-methods approach we examine the adaptation and implementation of an evidence-based tobacco-free workplace (TFW) program in 2 CBHCs (17 individual clinics). Methods: Varied data collection included pre- and post-implementation leader, clinician, and staff surveys; pre-, mid-, and post-implementa…
Tobacco-free Workplace Program at a Substance Use Treatment Center
Objectives: About 65%-87% of substance use disorder patients smoke cigarettes, compared to 14% of the general adult population. Few substance use treatment centers (SUTCs) have comprehensive tobacco-free workplace (TFW) policies or offer tobacco interventions. Taking Texas Tobacco Free (TTTF) implements an evidence-based TFW program in SUTCs, including at the Billy T. Cattan Recovery Outreach Center (BTC). We present a mixed methods case study of…
Immigration Enforcement Fear and Anxiety in Latinx High School Students
Association of Fear and Mistrust with Stress Among Sheltered Homeless Adults and the Moderating Effects of Race and Sex
The Impact of the Covid-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer …
The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients' quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at …
Perspectives of Black/African American and Hispanic Parents and Children Living in Under-Resourced Communities Regarding Factors That Influence Food Choices and Decisions
Families living in under-resourced communities are at risk of obesity and obesity-related chronic diseases. To develop effective interventions, it is important to identify parent and child perspectives of factors that influence food-related choices and decisions. This paper reports qualitative findings from a larger mixed method study investigating this topic. Hybrid thematic analysis was used to code and analyze the interviews. Family-generated …
Medicine (42 works) · Psychology (33 works) · Environmental health (23 works) · Psychiatry (20 works) · Clinical Psychology (15 works) · Clinical Psychology (14 works) · Smoking Behavior and Cessation (14 works) · Nursing (13 works) · Psychological intervention (13 works) · Family medicine (12 works)