Behavioral & Community Health Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/2802
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Item Meditation, Flow, and Heavy Social Alcohol Use among College Students(1992) Francis, Timothy Lewis; Iso-Ahola, Seppo; Recreation; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)The basis for this study was an experiment designed to explore the effectiveness of various meditation practices and choice and combination of such, regardless of focus, in achieving more drug-free flow experiences, longer periods of meditation adherence, and decreases in heavy social alcohol use among college students. The study also examined the hypothesis that higher frequencies of reported flow in meditation were associated with lower levels of reported alcohol use and higher frequencies of post-training meditation practice, regardless of meditation focus. The interaction of several critical intervening variables not comprehensively addressed in previous studies on meditation and substance abuse, including experimental expectancy and demand, previous alcohol use, hypnotic susceptibility, and personality was checked and controlled for in this experiment. After receiving basic meditation training, 53 subjects with drinking rates typical of heavy social alcohol users were randomly assigned to one of four meditation groups or to a control group. Three groups practiced only one of three foci--object focused, visualization, or mindfulness. The fourth group chose their meditation foci each day from any of the above three types. The fifth (control) group practiced an attention Placebo activity. Four weeks of daily diaries following meditation were used to determine the level of the dependent variables--frequency of flow and amount of alcohol use. Subjects then reported post-required meditation frequency and alcohol use through four weekly phone interviews. MANOVA, ANOVA, and zero-order correlations were employed to analyze the relationships between the variables. No one specific meditation focus nor having choice and combination of foci, was indicated to result in significantly more flow, less alcohol use, or longer mediation adherence. There was a slight indication that higher frequencies of flow were related to higher frequencies of meditation practice, but no indication that more flow was related to less alcohol use. These results should be interpreted with caution for several reasons, including the short meditation training and practice period, low reliability and validity of subject reports, and problems associated with large variations in drinking rates. Future research on these issues should refine training and testing methods so that better treatment methods can be found.Item Resting Metabolic Rates in Child-Onset and Adult Obese Women(1989) Summerfield, Liane M.; Gold, Robert; Health Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)This study investigated differences in resting metabolic rate (RMR) between obese nonobese females and between females with adult and childhood onset of obesity. Subjects were 18 healthy, Caucasian women, ages 20-38 (M=28.16), 6 from each of 3 groups: nonobese with no history of obesity (M-18.53% fat), child-onset obese (COO) (M=41.00% fat), and adult-onset obese (AOO) (M=37.8% fat). Subjects were nonsmokers, weight-stable for at least 3 months prior to the study, and not following a low-calorie diet. All obese subjects had lower-body obesity (waist/hip girth ratio < .80). Subjects underwent three measures: RMR by indirect calorimetry, residual lung volume, and hydrostatic weighing. In addition, a questionnaire elicited information about weight history, educational level, occupation, frequency of exercise, and activity level. When data from the 12 obese subjects were combined, RMR per kg body weight (RMR/BW) was significantly lower in the obese (18.47 kcal/kg/day) than the nonobese (22.94 kcal/kg/day). The obese subjects also had significantly lower RMR per kg fat mass (RMR/FM) than the nonobese. When data from COO and AOO subjects were analyzed separately, COO were found to have significantly lower RMR/FM than the nonobese. COO and AOO subjects did not differ statistically in absolute RMR, RMR/BW, RMR/FM, or RMR/FFM, although COO had lower values on all measures. Multiple regression analysis indicated that, in all groups, more of the variance in RMR was explained when the variables, FM and FFM. However, the effect of activity and exercise on explained variance in RMR was much smaller in COO women.Item Mature Humor or Immature Wit?: The Interaction Effects of Laughter Humor Production, Humor Aprreciation, and Defensive Coping Strategies on Emotional and Physical Stress Symptoms(1993) Carey, Coral Sue; Beck, Kenneth; Health Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)The purpose of this study was to investigate the use of humor and mirth in stress management by an adult population with the potential for high occupational stress. The primary objective was to test the efficacy of each of the humor components (laughter, humor appreciation, and humor production) in mediating the stress response while controlling for other coping strategies. Two new instruments were developed for use in this study; (1) the Emotional Coping Scale to assess laughter and humor production, (2) the Stress Mediators Inventory to measure mature coping and immature defense strategies. Over 2,000 employees of the University of Maryland College Park campus were surveyed, using random probability sampling, stratifying by the 9 EEO occupational categories, such as administration and professionals. Questionnaires were dispersed through inter-campus mail. Results from the 754 returned questionnaires were analyzed with the appropriate multivariate techniques. Males, minorities, faculty skilled crafts, service maintenance, and fellowship students were under-represented. With these limitations in mind, results suggest: (1) men scored significantly higher than women on all three components of humor, as measured by this study; (2) humor appreciation and laughter, but not humor production were significantly related to emotional stress, while only laughter was related to physical stress symptoms, such that those with higher humor scores showed lower stress scores; (3) the type of humor response (self directed, other directed, or neutral) as related to stress symptoms; (4) the interaction effect between humor variables and immature defense strategies for coping with stress did not significantly predict stress; (5) there appears to be a stress and coping profile that is significantly different for many of the 9 occupational groups, such that those with high demand and low control jobs show higher stress scores.Item Psychometric Assessment of Two New Self-Rating Depression Scales: The Correa-Barrick Depression Scale(1994) Barrick, Christina Barrett; Clearwater, Harvey E.; Health Education; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)Depression is a prevalent condition that is responsive to treatment. Efforts to screen and educate the public on depression are beneficial. The purpose of this investigation was to assess the psychometric properties of two new self-rating depression scales, the Schiraldi Depression Check-up (DC) and the Correa-Barrick Depression Scale (CBDS), based upon classical test theory and comparisons to published scales: the Beck Depression Inventory (BDI) and the Inventory for Depressive Symptomatology, Self-Report (IDS-SR). The study was conducted on a total of 387 participants. There were two convenience samples used. Sample I was composed of 337 faculty and staff from a metropolitan comprehensive university. A subset of Sample I was composed of 203 faculty and staff. Sample II included 50 outpatients diagnosed with depression under the treatment of a board certified psychiatrist. Correlation coefficients for the DC and CBDS with the BDI were r = . 75 and r = . 71, respectively. Cronbach alpha coefficients for the DC and CBDS in the patient sample were r = .95 and r = .96, respectively. Correlation coefficients for the IDS-SR with the DC and the CBDS in the patient sample were r = .85 and r = .81, respectively. Two-week test-retest correlation coefficients in the university sample for the DC and CBDS were r = .81 and r = . 70, respectively. Factor analysis for the DC revealed a threefactor structure: "Cognitive-Emotional Disturbance," " Psychophysiological Symptoms," and "Physiological Symptoms." Factor analyses for the CBDS revealed a four-factor structure: "Cognitive-Emotional Disturbance," "General Outlook," "Physiological Symptoms," and "Sensory/Perceptual Disturbance." Discriminant analysis did not support the Depression Check-up or the Correa-Barrick Depression Scale in discriminating between the university and patient samples. There were several conclusions from this study. Findings provided preliminary evidence for the validity and reliability of the Depression Check-up and the Correa-Barrick Depression Scale in measuring depression in an adult population. The findings that sensory-perceptual disturbance may be an additional variable in depression and that a single-factor structure emerged for "emotional-cognitive disturbance" was discussed as well as implications for health education theory, practice, and research.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 Addressing Unsubmitted Sexual Assault Kits and Reforming Processes Going Forward: Burnout and Vicarious Trauma Among Staff Working the Cases(2019) Meadows, Kristi; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Burnout and vicarious trauma continue to be high priority topics in healthcare and law enforcement research, but there is a sizeable deficit within the literature among professions working directly with sexual assault cases. Generally, burnout and vicarious trauma among specific professions within the justice system including attorneys, victim advocates, and sexual assault nurse examiners (SANE) have been significantly understudied. Additionally, reforms are currently underway to address the problem of unsubmitted sexual assault kits stored in warehouses across the United States. However, implications for the employees have not been studied by researchers to understand potential consequences in working with these cases nor the added stress of reforms. Secondary qualitative analysis was conducted using data from a sample of interviews with key informants (n=135) who are victim-facing and involved in processes to address both unsubmitted sexual assault kits and current cases of sexual assault. Informants were more likely to focus on facilitators and challenges in their daily work than to discuss the outcomes of burnout and vicarious trauma. Insufficient access to resources and increased workloads were the most significant challenges discussed among key informants, although, emotional labor and other difficult aspects of the job were also a common theme throughout this population. Social support including support across agencies, as well as supervisory support, were the most discussed potential protective factors of burnout. This study contributes information regarding key challenges faced by individuals working on sexual assault cases and has direct implications for employees in the field as well as those undergoing reform on sexual assault kit processing. These findings should be used to understand potential contributors to burnout and vicarious trauma in order to better mitigate negative outcomes associated with this work.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 A Confirmatory Study on the Motivational Orientations of Older Adults Involved in Formal Education at the University of Maryland(1988) McMahon, Megan Catherine; Riddick, Carol Cutler; Behavioral & Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)The purpose of this study was two-fold. One objective was to confirm Pritchard's (1978) typology of older adults' motives for education participation. Another purpose was to examine the influence that selected demographic variables (age, gender, socioeconomic status, and marital status) had on motivations of older students to participate in the "Golden Identification" (Golden I.D.) Program at the University of Maryland, College Park, Maryland. The sample consisted of 160 participants from the Golden I.D. Program who were selected through a systematic probability sampling procedure. A mailed questionnaire comprised of three instruments was used for conducting this research. The first part of the questionnaire measured motivational orientations for participation in education by older adults and consisted of the Education Participation Scale for Older Adults and the Older Learner Participation Scale. The third instrument measured demographic characteristics of the study participants. The results revealed that the motivation of the Golden I.D. students to participate in education can be divided into the following six factors (in decreasing order of importance): "cognitive interest," "self actualization," "adaptation/self-understanding," "social contact," "social contribution," and "escape/stimulation . " Furthermore, significant relationships emerged between the socioeconomic status of the participant, and the motives "social contribution," "escape/stimulation," and "self actualization." The implications of these findings and recommendations for further research are discussed.Item AIDS AND THE COLLEGE STUDENT: KNOWLEDGE, BELIEFS, AND INFORMATION SEEKING(1989) Shelnutt, Emily Houston; Beck, Kenneth H.; Behavioral & Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)A questionnaire on knowledge, beliefs, and information-seeking behavior about Acquired Immune Deficiency Syndrome (AIDS) was administered to a total of 1,300 university students, and 1,001 were completed and returned. The aim of the study was to investigate the relationship between college students' knowledge and beliefs about AIDS and their information-seeking behavior about AIDS. Students were found to be knowledgeable about the disease, but the majority (50.5%) were not worried about contracting AIDS. The findings revealed that students who are more knowledgeable about AIDS seek more information than those less knowledgeable about AIDS. It was also found that students who feel more highly susceptible to AIDS are more likely to seek information about the disease. The primary sources of student information on AIDS were television, newspapers, magazines, and radio; however, doctors and health-care professionals were considered the most trust-worthy sources of AIDS information. The data suggest that medically supported information on AIDS should be provided to college students by health educators via the popular media sources.