Behavioral & Community Health Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/2802
Browse
6 results
Search Results
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 The Health Literacy Process Older Adult Long-Term Smokers Use to Make an Informed Decision about Lung Cancer Screening: A Grounded Theory Study(2019) Platter, Heather N; Feldman, Robert; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Lung cancer is the leading cause of cancer-related death in the United States with 160,000 annual deaths. Recent advances in screening technologies have proven effective in reducing mortality and increasing early stage detection of lung cancer, yet only 3.9% of the 6.8 million eligible Americans were screened in 2015. Potential barriers to lung cancer screening have been examined; however, there is limited research available on the impact of health literacy and the process of informed decision-making about lung cancer screening. To fill this gap, this study explored how health literacy relates to intentions and behaviors to screening for lung cancer among long-term smokers between 55 to 80 years old who have a 30-pack year smoking history, health insurance, and a provider seen in the past two years. The study was guided by the following research question: “How does health literacy relate to intentions and behaviors to screen for lung cancer?” Twelve participants (N=12) were enrolled in the study. Participants were 58.3% female, 83.3% black, 83.3% had screened for any cancer besides lung cancer, and 75% were current smokers with a 41.8 mean pack-year history. The majority of the sample (91.7%) had adequate health literacy based on the Short Test of Functional Health Literacy in Adults. Data were transcribed verbatim and analyzed using constructivist grounded theory methods, proceeding through four stages of coding (open, focused, axial, and theoretical). Analysis produced a Health Literacy Theoretical Model of Informed Decision-Making about Lung Cancer Screening. The theoretical model is underpinned by a core category: Making an Informed Decision about Lung Cancer Screening. This core category is supported by eight categories characterizing how health literacy relates to lung cancer screening among older adult long-term smokers, including Health Information Seeking Behaviors, Trusted Sources, Knowledge, Trusted Provider, Advocacy, Perceived Risk, Patient-Provider Communication, and Shared Decision-Making. This is one of the only known studies that describes the health literacy process of informed decision-making about lung cancer screening. The results of this grounded theory study have several implications for public health practice, research, and policy and have the ability to increase lung cancer early detection and survival.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 CERVIXCHECK: A SPIRITUALLY-BASED SMS TEXT MESSAGING PILOT INTERVENTION TO INCREASE CERVICAL CANCER AWARENESS AND PAP TEST SCREENING INTENTION AMONG AFRICAN AMERICAN WOMEN(2016) Le, Daisy; Holt, Cheryl L.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African American women account for a disproportionate burden of cervical cancer incidence and mortality rate when compared to non-Hispanic White women. Cervical cancer is one of the most preventable types of cancer, and women can be screened for it with a routine Pap test. Given that religion occupies an essential place in African American lives, framing health messages with important spiritual themes and delivering them through a popular communication delivery channel may allow for a more culturally-relevant and accessible technology-based approach to promoting cervical cancer educational content to African American women. Using community-engaged research as a framework, the purpose of this multiple methods study was to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention to increase cervical cancer awareness and Pap test screening intention among African American women. The study recruited church-attending African American women ages 21-65 and was conducted in three phases. Phases 1 and 2 consisted of a series of focus group discussions (n=15), cognitive response interviews (n=8), and initial usability testing that were conducted to inform the intervention development and modifications. Phase 3 utilized a non-experimental one-group pretest-posttest design to pilot test the 16-day text messaging intervention (n=52). Of the individuals enrolled, forty-six completed the posttest (retention rate=88%). Findings provided evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There were significant pre-post increases observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Additionally, results post-intervention revealed that 83% of participants reported being either “satisfied” or “very satisfied” with the program and 85% found the text messages either “useful” or “very useful”. 85% of the participants also indicated that they would “likely” or “very likely” share the information they learned from the intervention with the women around them, with 39% indicating that they had already shared some of the information they received with others they knew. A spiritually-based SMS text messaging intervention could be a culturally appropriate and cost-effective method of promoting cervical cancer early detection information to African American women.Item Substance Abuse Treatment Dropout: Examining the Interacting Effect of Distress Tolerance with Intention and Motivation(2015) Ali, Bina; Green, Kerry M.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Despite the knowledge that residential substance abuse treatment completion is effective in improving outcomes among chronic substance users, a large proportion of African American residential treatment-seeking substance users experience premature treatment dropout. Previous studies have examined the predictors of early substance abuse treatment dropout; however, a deeper understanding of the conditions that influence treatment dropout among urban African American substance users is limited. Taking the perspectives of the Theory of Planned Behavior, the Stages of Change Model, and the Negative Reinforcement Model, this study examined (1) the interacting effect of intention to complete treatment and distress tolerance on treatment dropout, and (2) the interacting effect of motivation to change substance use behavior and distress tolerance on treatment dropout in a sample of urban African American treatment-seeking substance users. Data were collected from 81 African American substance users entering residential substance abuse treatment facility in an urban setting. Participants completed measures assessing intention to complete treatment, motivation to change substance use behavior, and distress tolerance, as well as measures assessing psychiatric comorbidities, impulsivity, previous treatment, treatment barriers, court-mandated treatment, and demographic information. Participants also engaged in a behavioral measure of distress tolerance. Treatment dropout data were obtained using administrative records of the treatment center. Results from logistic regression analyses indicated that only the interaction between motivation and self-reported distress tolerance was significant in predicting the likelihood of treatment dropout after controlling for relevant covariates, including employment, psychiatric comorbidities, and court-mandated treatment status. Probing of this interaction effect showed that higher motivation was significantly associated with decreased likelihood of treatment dropout among substance users with higher distress tolerance, but not in substance users with lower distress tolerance. Findings of the study suggest that higher motivation and higher distress tolerance may be both necessary for reducing the risk of treatment dropout among urban African American treatment-seeking substance users. Interventions to decrease treatment dropout among substance users may benefit by incorporating motivational strategies, such as motivation interviewing, and distress tolerance skills into their programs to reduce treatment dropout.