Behavioral & Community Health Theses and Dissertations

Permanent URI for this collectionhttp://hdl.handle.net/1903/2802

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End date: 2019Subject: search.filters.subject.Epidemiology

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    THE PREVALENCE OF MATERNAL SMOKING INTENSITY STATUS IN EARLY AND LATE PREGNANCY AND ITS ASSOCIATION WITH EARLY MORBIDITY IN SINGLETON TERM BIRTHS IN THE UNITED STATES, 2016
    (2019) Kondracki, Anthony; Moser Jones, Marian; Thoma, Marie; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Relatively little is known about how maternal cigarette smoking influences the health of infants delivered at term. This study was based on the 2016 United States Natality File of live births (N= 3,956,112). The first aim was to examine the prevalence and patterns of smoking in the three months before and during pregnancy and the distribution of smoking intensity in early (1st and 2nd trimester) and late (3rd trimester) pregnancy across race/ethnicity, age, and educational attainment of mothers with all births and with singleton term births (37-41 completed weeks gestation) in the United States in 2016. The second aim was to compare the odds of low birthweight (LBW), low 5-minute Apgar score, and neonatal intensive care unit (NICU) transfer/admission in term singletons with changing maternal smoking status in early and late pregnancy indicating a potential prenatal exposure effect. The third aim was to test and identify the role of low birthweight, as a potential mediator, in the association with maternal smoking status and NICU transfer/admission of a newborn delivered at term. The prevalence of smoking in the three months before pregnancy was 9.42% among all mothers and 9.20% among mothers of term singletons, and high intensity smoking was the highest in the first trimester among non-Hispanic White women, 20-24 years of age, and less educated women for all births and for singleton term births. High intensity smoking in early and late pregnancy was associated with a greater risk of LBW (aOR 3.33; 95% CI: 3.23, 3.44), low 5-min Apgar score (aOR 1.46; 95% CI: 0.88, 2.44), and NICU transfer/admission (aOR 1.62; 95% CI: 1.58, 1.67) in term neonates. The odds ratios of the natural direct and natural indirect effects of NICU transfer/admission were aOR 1.52 (95% CI: 1.47, 1.57) vs. aOR 1.07 (95% CI: 1.07, 1.09) and the proportion mediated through LBW (18.3%) indicated partial mediation. This study has important implications for clinical practice, public health policy and research, and it is particularly timely because of an information gap on the health of infants delivered at term with LBW to mothers who continue smoking at high intensity during pregnancy.
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    TRACKING ACUTE RESPIRATORY INFEECTIONS IN A COLLEGE RESIDENT COMMUNITY
    (2018) Adenaiye, Oluwasanmi; Milton, Donald K; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Influenza and other acute respiratory infections (ARIs) contribute significantly to human morbidity and mortality globally. Animal experiments and human challenge studies have not provided an adequate explanation about the relative importance of social, behavioral and physical environment in the transmission of ARIs and are limited due to uncertainty about the generalizability of their findings to a natural infection. Also, household transmission studies seldom characterize all potential transmission covariates e.g. environmental conditions, leaving a gap in the knowledge of transmission mechanisms. Here, we describe the design and preliminary results of an extensive college dormitory ARI transmission study that has the potential to characterize several important ARI transmission covariates; we critically appraise the design and show how the findings from such design can be applied to answer most of the vital questions that exist about the transmission of ARIs.
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    RISK FACTORS FOR NONMEDICAL PRESCRIPTION ANALGESIC USE AMONG COLLEGE STUDENTS: RESULTS OF A PROSPECTIVE STUDY
    (2016) Morioka, Christine Kempsell; Howard, Donna; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Purpose—Nonmedical Prescription Analgesic (NPA) use is a serious public health concern and studies on risk factors for NPA use are lacking. This investigation used preexisting data from a landmark longitudinal, prospective study of college students, the College Life Study (CLS), to examine the longitudinal relationship between four suspected risk factors—affective dysregulation, conduct problems, depressive symptoms, and general psychological health—and NPA use. Methods—The sample was comprised of 1,253 young adults originally recruited as first-year college students from a large, mid-Atlantic university. Results—10.5% (n=103) of the participants during year 3 of the study reported past year NPA use, of which 55.3% (n=57) were male and 81.6% (n=84) were white. Affective dysregulation and conduct problems were found to be significantly and longitudinally (baseline to year 3) associated with incident NPA use after controlling for gender, parents’ education, and race/ethnicity. Conclusions—Affective dysregulation and conduct disorder are longitudinally associated with NPA use among college students. These findings might aid in prevention efforts to reduce NPA use among college students.
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    An Investigation of Child and Adolescent Dental Sealant Predictors, NHANES 2011-2012
    (2016) Roman, Agnieszka Anna; Kleinman, Dushanka; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Objective: To examine sociodemographic and dental factors for associations with dental sealant placement in children and adolescents aged 6-18 years old. Methods: Secondary data analysis of 2011-2012 NHANES data was conducted. Multiple logistic regression models were used to assess relationships between predictor variables and sealant presence. Results: More than a third (37.1%) of children and adolescents have at least one sealant present; 67.9% of children compared with 40.4% of adolescents. Racial/ethnic differences exist, with Non-Hispanic black youth having the lowest odds of having sealants. Sealant placement odds vary by presence of dental home; the magnitude of the odds varies by age group. Those with untreated decay have lower odds of having sealants than those who do not have untreated decay (child OR: 2.6, 95% CI: 1.83-3.72; adolescent OR: 3.9, 95% CI: 2.59-6.07). Conclusion: Disparities exist in odds of sealant prevalence across racial/ethnic groups, income levels, and dental disease and visit characteristics. Further research is necessary to understand the reasons for these differences and to inform future interventions.
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    The Association Between Electronic Cigarette Use and Cigarette Smoking Behavior Among Young Adults in the United States
    (2015) Coleman, Blair N.; Green, Kerry M; Glover, Elbert D; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The prevalence of electronic cigarette (e-cigarette) use is rapidly increasing in adults and youth; however, little is known about the public health impact of their use. A debate over e-cigarettes has emerged in the literature; one side recognizes the potential benefit of e-cigarettes as a harm reduction tool, while others argue e-cigarette use may delay or deter smoking cessation due to dual use or increase the risk of initiation of conventional cigarettes among previous nonsmokers. Drawing on the Theory of Planned Behavior, this dissertation focused on attitudes, beliefs, and perceived social norms of e-cigarettes, as well as openness to conventional cigarette smoking among young adult users of the product. Using a mixed methods approach, this dissertation analyzed secondary data from the 2012-2013 National Adult Tobacco Survey (NATS) as well as focus group data collected in five cities across the U.S. to better understand the relationship between e-cigarette use and cigarette smoking among young adults. In Study 1, quantitative analyses found non-cigarette smoking young adults who have tried e-cigarettes were more likely to report openness to cigarette smoking in the future compared to those who have not tried e-cigarettes (AOR= 2.4; 95% CI= 1.7-3.3). In Study 2, qualitative findings suggest that young adult exclusive e-cigarette users were less interested in conventional cigarette smoking, and overwhelmingly described negative aspects to cigarette smoking that appeared to become more salient as a result of their e-cigarette use. In Study 3, focus group participants expressed many positive attitudes towards e-cigarettes, and simultaneously reported a lack of information and knowledge about the products. The relationship between e-cigarette use and cigarette smoking is complex and multifaceted, and influenced by a myriad of individual and social factors. Although quantitative findings suggest young adults who have used e-cigarettes compared to those who have not used e-cigarettes were more likely to report openness to future cigarette smoking, qualitative findings did not support the notion that young adult e-cigarette users (who may have prior experience with cigarette smoking) are open to future cigarette smoking. These findings provide a basis for further exploration of the association between e-cigarette use and cigarette smoking.
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    Associations and Pathways between Substance Involvement and Risky Sexual Behavior over the Life Course of Urban African Americans
    (2015) Zebrak, Katarzyna A.; Green, Kerry M.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    African Americans are disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs) relative to other racial/ethnic groups. Substance involvement has been linked to risky sexual behavior, an important risk factor for HIV/STI transmission, relatively early in the life course; yet such associations have not been found consistently among African Americans. Understanding of how substance involvement relates to risky sexual behavior among men and women over time and into midlife remains limited. The goal of this study was to examine the associations and pathways between substance involvement and risky sexual behavior over the life course in a community-based urban African American cohort (n=1242) followed prospectively from age 6 to 42 years. Using a combination of structural equation modeling and mediation testing, the study examined (1) prospective associations (from adolescence through adulthood) and within-life stage associations (in adolescence, young adulthood, and midlife) between substance involvement and risky sexual behavior, (2) the role of young adult social bonds as potential pathways linking substance use and risky sexual behavior over time, and (3) gender differences in the associations and pathways. The results revealed statistically significant positive associations between earlier substance involvement and subsequent risky sexual behavior over the life course among men and women. Greater adolescent substance use predicted greater midlife risky sexual behavior, partly through greater young adult substance problems and risky sexual behavior for both genders. Substance involvement was also positively correlated with sexual/risky sexual behavior in adolescence, young adulthood, and midlife among men and women. Although greater adolescent substance use predicted fewer young adult social bonds for both men and women, the latter was associated with decreased involvement in midlife risky sexual behavior among women only. Considered individually, young adult social bonds were not significant mediators of the adolescent substance use–midlife risky sexual behavior association for either gender. Given the complex pattern of associations and pathways between substance involvement and risky sexual behavior over time, public health interventions to address substance involvement among urban African Americans at any life stage, starting with adolescence, may have immediate and long-term effects, and direct and indirect effects on decreasing sex-related HIV/STI risk.
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    Assessing Knowledge, Attitudes, and Behaviors Toward West Nile Virus Prevention Among Adults ≥ 60 Years Old in Maryland: An Application of the Health Belief Model
    (2014) Mitchell, Kimberly C.; Howard, Donna E.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    West Nile Virus (WNV) is a mosquito-borne virus and the leading cause of arboviral (arthropod-borne) disease in the U.S. While most WNV cases are asymptomatic, 20% of infected people develop WNV fever and < 1% develop severe neurologic disease. Individuals over 50 years old are at greatest risk of severe disease and death. Dramatic increases in WNV activity in 2012 underscored its unpredictable nature and highlighted concerns for adverse effects on older adults. It is important to understand factors that influence this population's engagement in WNV prevention. This study analyzed data collected by the Maryland Department of Health and Mental Hygiene (DHMH) via cross-sectional survey to identify barriers to WNV prevention among adults ≥60 years of age. Subjects were recruited via stratified random sample of 1,700 households from counties with ≥ two WNV cases, enrolling 211 Maryland adults ≥ 60 years old. Six constructs of the Health Belief Model (HBM)--perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy--were examined to assess how they predicted attitudes and behaviors toward WNV prevention. Univariate, bivariate and multivariate analyses examined the utility of the HBM for explaining WNV preventive behaviors in Maryland adults. Multivariate logistic regression models tested 36 hypotheses examining associations between HBM constructs and six outcomes: (1) avoiding the outdoors at dusk and dawn, (2) dressing in long-sleeved shirts and long pants when outdoors, (3) using insect repellent on exposed skin, (4) draining standing water from objects around one's property, (5) acceptance of a WNV vaccine, and (6) support for community mosquito control programs. Findings showed high WNV knowledge and awareness but low perceptions of personal risk for WNV infection. Perceived susceptibility to WNV predicted use of insect repellent, draining of standing water from objects around the home, and acceptance of a WNV vaccine; perceived benefits were associated with draining standing water and support for mosquito control programs. Feelings of worry about WNV may inform future WNV interventions and risk communication to older adults. Findings have implications for theory-based research, which could probe applications of the HBM and other theories in understanding WNV attitudes and behaviors.