Behavioral & Community Health Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/2802
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Item Diabetes and Periodontal Disease Bi-Directional Relationship: An Examination of Diabetics' Knowledge, Understanding, Social Determinants and Self-Efficacy Impact on Dental Hygiene Practices(2019) Oguntimein, Oluwamurewa Ayodeji; Butler, James; Horowitz, Alice M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Thirty million Americans are living with diabetes; making it the seventh leading cause of death, with 1.3 million Americans dying every year. As such, the total treatment costs of diabetes rose from $245 billion in 2012 to $327 billion in 2017. One factor driving these high costs is diabetes’ comorbidity with other chronic diseases and associated complications – e.g., hypertension, , heart disease, stroke, amputation and blindness. Little attention has focused on periodontal disease- the sixth complication of diabetes awareness, education, and intervention. This research adds to the literature via two studies that assessed diabetics’ knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease. The first study examined gender and self-efficacy differences in knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease among 927 diabetics. Findings suggest diabetics are unaware of their increased risk of periodontal disease based on the low mean 5.79±2.366 scores on the knowledge and understanding scale. After controlling for diabetes duration, smoking status, and other covariates, males had less knowledge and understanding of the bi-directional relationship (p<.0001). Self-efficacy was not significantly associated with participants’ knowledge and understanding of the bi-directional relationship (p= 0.543). The second study assessed health literacy differences in diabetics’ knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease. Education, employment and income were tested as moderators between knowledge and understanding of the bidirectional relationship and dental hygiene practices. After controlling for diabetes duration, dental insurance status, and other covariates, participants with marginal or inadequate health literacy had less knowledge and understanding of the bi-directional relationship compared to participants with adequate health literacy (p<.0001). Education, employment, and income were not moderators. The findings support the need for targeted periodontal disease risk and dental hygiene practice education. These studies are presumably the first to assess diabetics’ knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease. These studies are significant contributions to the limited amount of research and illuminate the need to educate diabetics regarding their increased risk of periodontal disease and the importance of practicing dental hygiene behaviors to prevent diabetes complications.Item THE IMPACT OF DISEASE SEVERITY AND PHENOTYPE ON SMOKING AMONG ADULTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE(2019) Tilert, Timothy; Wang, Min Q; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Chronic Obstructive Pulmonary Disease (COPD) is estimated to be the third leading cause of death in the US. The most significant risk factor for COPD is long-term cigarette smoking. In spite of the myriad benefits of cessation, the proportion of adults with COPD who currently smoke is still nearly 50%. Little is known, however, about the characteristics of, and subsequent differences between, smokers with COPD, particularly at differing lung obstruction severity levels. The goals of this dissertation were to examine and compare the characteristics of smokers with diagnosed COPD as well as to explore the impact of disease severity and disease phenotype on smoking status among persons with COPD. This research utilized secondary data on 10,219 examined adults, aged 40-79 years, from the 2007-2012 National Health and Nutrition Examination Survey. In Study 1, adjusted logistic regression analyses revealed multiple factors that were associated with self-reported COPD diagnosis with those reporting three or more respiratory symptoms having the strongest association (AOR=22.1, 95% CI=12.0-40.5). In Study 2, it was shown that smoking status proportions did not differ by lung obstruction severity among those reporting a COPD diagnosis. In adjusted logistic regression analyses, multiple factors were associated with current smoking status among those with self-reported COPD with the presence of other smokers in the household having the strongest association with being a current smoker (AOR=19.5, 95% CI=10.2-37.5). In Study 3, three distinct phenotypes were found among the COPD population analyzed. In adjusted logistic regression analyses, COPD phenotype was differentially associated with continued smoking, above and beyond other predictors, with the older, heavy-smoking males with emphysema phenotype showing a significant positive association with continued smoking (AOR=3.7, 95% CI=1.3-10.9). Understanding how differences in disease severity and disease phenotypes impact smoking status among persons with diagnosed COPD could help inform more targeted, and effective, interventions to reduce smoking rates in this high-risk population. These findings potentially provide guidance for current smoking cessation interventions aimed at smokers with COPD as well as provide the foundation for further exploration of the association between COPD phenotype and continued smoking.Item INVESTIGATING CARDIOVASCULAR RISK AT THE INTERSECTION OF RACE, GENDER, AND EDUCATION(2019) Taiwo, Omolola Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)As a risk factor of cardiovascular disease (CVD), systemic inflammation is differentially distributed by race, with black populations disproportionately impacted. Additionally, inflammation, as measured by the inflammatory marker C-reactive protein (CRP), is documented to be higher among women when compared to men and varies by educational level. Despite evidence suggesting that various chronic stress domains may contribute to the relationship between race and inflammation, there is limited data exploring the possible mediating role of chronic stress. Furthermore, to date, no study has examined if the potential indirect effect of race on CRP through chronic stress domains are moderated by gender and education. This secondary data analysis stems from the Midlife Development in the United States (MIDUS II) study, and the sample consisted of 193 black and 582 white adults. Study 1: Examined the association between CRP and seven racial/gender/education subgroups. With educated white men as the reference group, findings revealed that educated black and white women had the highest significant risk for elevated CRP. Study 2: Assessed the psychometric properties of a Chronic Stress Scale (CSS) comprised of nine chronic stress subscales. Analyses revealed CSS to be a three-dimensional scale with questionable validity and reliability. Study 3: First, tested for significant correlations between nine chronic stress domains, race, and CRP. Everyday discrimination and financial strain were found to be the only two domains significantly correlated to race and CRP. Second, two mediation analyses assessed the mediating effect of financial strain and discrimination, finding that they both respectively mediated the relationship between race and CRP. Third, two moderated mediation analyses examined if the indirect effect of financial strain and discrimination were moderated by gender and education. Results indicated that the indirect effect of race on CRP through discrimination was significant only among educated black men. Additionally, findings revealed that the indirect effect of race on CRP through financial strain was significant among black men and women regardless of educational attainment. Combined, these studies characterized the social patterning of CRP, illustrated validity and reliability concerns when developing a multidimensional chronic stress scale, and revealed that discrimination and financial strain did have mediating roles and these mediators were moderated by gender and education.Item PRESENCE AND PREDICTORS OF HEALTH PROGRAMMING IN A SAMPLE OF AFRICAN AMERICAN CHURCHES(2019) Woodard, Nathaniel; Fryer, Craig S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Churches have played a central role in African American communities for decades. In addition to religious services, African American churches have increasingly offered a variety of health programs. However, there is a dearth of empirical literature on church-initiated health programming. This study examines quantity and variety of health programs and areas addressed by a convenience sample of African American churches (N = 119), as well as church characteristics that predict these health initiatives. Churches offered a mean of 6.08 (SD = 2.15) health programs targeting 4.66 (SD = 3.63) different health topics within the previous 12 months. Various church characteristics indicating greater availability of programming resources were positively associated with the quantity and variety of health initiatives. It is recommended that practitioners partner with under-resourced churches to support their existing health activities and address gaps in health programming. Future research should seek to evaluate the effectiveness of church-initiated health programs.Item Examining the Food-Insecurity Obesity Paradox among Latino Immigrants(2019) Amador, Maria Aileen; Garza, Mary A; King-Marshall, Evelyn C; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Obesity is linked to chronic illnesses such as type 2 diabetes, cardiovascular disease, and some cancers (breast, kidney, and liver). Food insecurity refers to lack of access to nutritious and safe food. Latinos are a rapidly growing population in the US with higher levels of food insecurity than the national average, and higher obesity rates than non-Latino white adults. The “food insecurity-obesity” is a paradoxical relationship seen in rising obesity and correspondingly high food insecurity rates. We examined demographic factors, acculturation, stress, dietary habits, and food access among Latina immigrants to understand this paradox. This sub-analysis (n=128) found that education level (p=0.03) and marital status (p=0.08) were significantly and marginally significantly associated with food security level. Additionally, this analysis helped to better describe a population that lacks research. A better understanding of the “food insecurity-obesity” paradox and related factors will inform future culturally-tailored interventions to address obesity among Latina immigrants.Item “NOTHING TO BE WORRIED ABOUT YET”: PERCEPTIONS OF COLORECTAL CANCER AMONG INDIVIDUALS BELOW THE AGE OF 50.(2019) Mueller, Nora M.; Curbow, Barbara A; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)National guidelines recommend regular screening for colorectal cancer (CRC) begin at age 50. Recent research however showed rates rising among adults below the age of 50 despite declining overall rates of CRC. Screening guidelines have not been updated to reflect new findings. Younger individuals may not be aware of their CRC risk and providers may be unaware of the need to screen younger patients. An online survey of individuals between the ages of 24 and 45 was conducted in April and May of 2018 using Amazon© Mechanical Turk. Measures collected included perceived CRC risk and susceptibility, screening knowledge, and understanding of screening results. Analysis I examined these variables by generational cohort. Analysis II randomized participants to receive one of two fictional colonoscopy result reports, the first being the standard of care report provided by a medical center in Maryland and the second a modified report containing a “gist” synthesis of findings. Mixed methods examined participants’ interpretations of these reports. Analysis III randomized participants to receive one of two statements describing trends in the rates of colon cancer to examine participants’ ability to discern false and true information. Analysis I found Gen-Xers more likely to report higher perceived risk (general cancer and CRC) and severity (general cancer) and be aware of current CRC screening guidelines. Both groups displayed a lack of awareness of CRC screening methods. Analysis II showed that individuals who received the gist report correctly rated the report as more serious and the importance of follow-up higher than those who received the standard medical report. Analysis III revealed a lack of knowledge among participants to differentiate between correct and incorrect statements regarding colon cancer trends, with participants defaulting to accepting the validity of the statement. Findings revealed gaps in knowledge of recommended screening activity and available screening methods. Providers should be prepared to discuss available screening options and accurate risk information; in addition, providers should discuss with patients which medical information they read online and remind individuals to take a more critical stance. CRC screening reports that contain a synthesis of findings may help patients plan next steps accordingly.Item AN EXPLORATION OF PUBLIC HEALTH WORKER ENGAGEMENT WITH HEALTH-RELATED SOCIAL MOVEMENTS THROUGH AN ANALYSIS OF #BLACKLIVESMATTER(2018) Bickford, Abigail Runa; Gold, Robert S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Social movements fight for social justice by protesting systemic social inequities. The field of public health aims to eliminate these same disparities as they relate to health. Many social movements are not currently viewed as health social movements despite these movements addressing health disparities by challenging existing inequities related to social determinants of health. One example is the Black Lives Matter movement which has gained considerable attention in its efforts to address systemic racism, a known determinant of health. While the Black Lives Matter movement has evoked many academic and popular responses, there has been a lack of focus on this movement by the public health workforce. Therefore this work uses the Black Lives Matter movement as an example of a health-related social movement warranting engagement from the public health workforce. This study utilizes a novel approach to the use of social media data in the public health field. The first part of this work examines tweets containing #BlackLivesMatter and compares the online discourse to the stated mission and principles outlined by the leaders of the Black Lives Matter organization. An analysis of the Twitter data was then presented in a Delphi study conducted with a panel of experts in public health. Delphi participants were tasked with developing ideas on how the public health workforce could best apply the information collected from #BlackLivesMatter Twitter data to aid in addressing the health-related issues highlighted by the Black Lives Matter movement. More broadly, participants also generated ideas about what can be done to encourage the public health workforce to systematically engage with health-related social movements. Finally, one-on-one interviews were conducted with self-identified social activists. These activists were asked about their participation in social movements, their use of social media regarding their advocacy work, and for ideas about how the public health workforce could engage with their causes. Findings from each study are discussed along with recommendations for future work aimed at developing relationships between public health workers and social movements.Item Cyberbullying: an examination of victimization, parent-child communication, collective efficacy and safe behaviors online among young adolescents(2018) McHugh, Meaghan Conte; Gold, Robert S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Each year, approximately 10%-40% of adolescents are the victims of cruel online behaviors such as posting embarrassing photos or videos, purposeful exclusion, harassment, even threats of violence, often referred to as cyberbullying. Cyberbully victimization (CBV) during adolescence, a critical time for physical, mental and emotional development, might lead to adverse short and long-term health impacts and teach the adolescent to mistrust others while suggesting that it is appropriate for peers to intentionally harm each other. Numerous studies have reported the negative health impacts associated with CBV including both internalizing problems (i.e. depression, anxiety, loneliness, and low self-esteem) as well as externalizing problems (i.e. self-harm and drug use). CBV has also been linked to suicide. The current study examined suspected protective factors of CBV from a social ecological model including: demographic and Internet behaviors (individual characteristics), parent-child communication about Internet use (Interpersonal or relationships) and collective efficacy (school community). Data were obtained from a convenience sample of 1,249 young adolescents through a web-based survey administered in multiple public-school classrooms. An important feature of this study was a comparison of a multi-item scale of repeated cyberbully behaviors suggesting that 37% of adolescents were CBV with females (38%) and 8th graders (43%) at greatest risk, compared to a binary item that suggested that only 12% of adolescents were victims (females:13% and 8th graders:15% at greatest risk). Several statistically significant correlates of CBV were identified in this study including safe behaviors online and number of hours on the Internet, quality parent-child communication, and school collective efficacy. For our sample, safe behaviors online partially mediated the association between quality parent-child communication and CBV. Research is needed to understand the mechanism by which parent-child communication might protect against CBV. Suggestions for future prevention and intervention strategies for this complex public health challenge are discussed.Item Exploring Predictors of Military Spouses’ Comfort Seeking Military-Provided Counseling Services(2017) Brown, Christye Yvonne; Beck, Kenneth; Zanjani, Faika; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Over 1.2 million (approximately half) of the service members deployed in support of the Global War on Terror were married at the time of their last deployment (Department of Defense, 2013). Data from the study of military and veteran families suggests that both stress and the process of coping with or overcoming exposure to adversity or stress resonate across the family system (Meredith L. S., et al., 2011), and that the impact of war and its consequences are experienced by partners and families in addition to service members (Lester, Blair, Saltzman, & Klosinski, 2013). The purpose of this study was to determine predictors of spouses' comfort in seeking military-provided counseling services when service members are deployed, by examining spousal coping behaviors, mental health status, and social support and demographics (rank and gender), as reported from the 2012 Active Duty Spouses Survey (ADSS). Analyzing survey data from 10,574 participants, we determined that 82.5% of the participants had spouses who were deployed for more than 30 consecutive days, and 64.3% of the participants felt comfortable using military-provided services for counseling. Statistically significant predictors of comfort-seeking, military-provided counseling services included positive coping behaviors, mental health status, social support, and the rank of the spouse’s partner. Spouses of officers were less likely to feel comfortable using military-provided services for counseling compared to spouses of enlisted service members. The level of psychological stress experienced by the spouses correlated with all predictors of comfort seeking, military-provided services for counseling. The results were consistent with previous studies on the predictors and outcomes of psychological stress among military spouses, and supported the Transactional Model of Stress and Coping. The results have practical significance because they will help planners tailor programs to optimize the uptake of counseling services for military spouses who are in need. We recommend that future research incorporate measures of the service members’ extended deployments in combat zones to determine if extended combat-related deployment predicts spouses’ comfort seeking military-provided services for counseling. Qualitative research may also be useful to provide more insight into why some military spouses feel comfortable using military-provided services for counseling while others do not.Item Feasibility of An Online Survey Examining the Physical Activity Patterns Among South Asian Adults Residing In the United States(2016) Haider, Syeda Rabab Zehra; Butler III, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Physical inactivity is a major risk factor for cardiovascular disease and diabetes among South Asians (SAs) - Bangladeshi, Bhutanese, Indian, Maldivian, Nepali, Pakistani, and Sri Lankan. Methods: An online survey was used to determine the feasibility of examining physical activity (PA) levels of SAs living in the US. The Social Ecological Model was the theoretical basis for identifying individual-level, social environmental, and physical environmental factors that impact PA. Results: Ethnicity, intention, self-efficacy, and perceived health benefits of PA were significantly associated with being physically active. Facilitators to PA included achieving improved health; while barriers were lack of time to exercise, unfamiliarity with PA, and nonexistent gender-specific PA facilities. Conclusions: This study showed that online surveys can be a promising tool for data collection among SAs. Health promotion programs should include education on the benefits of PA, and provide culturally sensitive facilities that support PA, especially for SA women.