Family Science Theses and Dissertations

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    Mental health among black lesbian, gay, and bisexual people: Examining patterns of risk, treatment utilization, and mental health management strategies
    (2023) Williams, Natasha Diamond; Fish, Jessica N; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Empirically, a Black-White “double paradox” exists whereby 1) despite living in a society plagued by anti-Black racism, Black individuals in the United States are no more likely to experience depression than their White counterparts and 2) Black individuals are more likely to report severe psychological distress, a construct that is correlated with depression. Further, intersectional theory suggests that Black lesbian, gay, and bisexual, transgender, and queer (LGBTQ+) young adults may experience elevated risk for mental health issues due to overlapping systems of oppression (i.e., racism, heterosexism). Lastly, Black LGBTQ+ persons’ utilization of professional mental health services (PMHS; e.g. therapy, medication) may be impacted by these same forces, but quantitative research has yet to explore utilization disparities at this intersection. Therefore, Studies 1 & 2 of this investigation documented disparities in major depressive episodes (MDE) and severe psychological distress (SPD), as well as differences in the utilization of outpatient PMHS. Study 3 involved semi-structured interviews with Black LGBTQ+ young adults that explored participants’ (i) experiences of intersectional minority stress; (ii) perceptions of the relationship between these experiences and their mental health; and (iii) strategies for managing their mental health. In Study 1 covariate-adjusted models, compared to White heterosexual individuals, Black LGB males and females evidenced similar or reduced odds of an MDE; there were no statistical differences between these groups for SPD. Compared to their White LGB peers, Black LGB males and females were less likely to report an MDE or SPD. However, compared to their Black heterosexual counterparts, Black LGB males and females had higher odds of an MDE and SPD. Bisexual identity (as opposed to lesbian/gay identity), age, and education were associated with MDE or SPD among the subsample of Black LGB adults. In Study 2 unadjusted models, compared to White heterosexual females, Black LGB females were less likely to use PMHS. This relationship was not significant in models adjusted for covariates. In models that accounted for mental health need, Black LGB females were less likely to use PMHS than White heterosexual females in unadjusted and adjusted models. The association for Black LGB males, relative to White heterosexual males, was not significant in unadjusted or adjusted models, regardless of mental health need. Still, predicted probabilities illustrated disparities among Black LGB adults, with and without accounting for mental health need, in PMHS utilization relative to White LGB adults and Black heterosexual adults. Age, income, and education were also associated with PMHS utilization among Black LGB individuals. Participants in Study 3 generally did not describe their identities or attribute their bias experiences in intersectional terms. Rather, most described themselves as “Black first” and discussed instances of anti-Black or, separately, anti-queer discrimination. Almost all shared periods of poor mental health and discussed myriad strategies for managing their mental health, including seeking PMHS, as well as social supports and self-care strategies. Together, these studies illustrate differences in risk for depression and psychological distress, disparities in utilization of PMHS, and mental health experiences of Black [LGB]TQ+ young people. Based on all three studies, it appears that the experience of being a sexual minority in Black contexts may have different, and potentially more deleterious, mental health consequences than being Black in queer contexts. In aggregate, this investigation’s findings have implications for health policy and mental health practice related to bias/discrimination, barriers to care, and PMHS quality. Directions for future research are also discussed.
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    Exploring Couple and Family Therapist Involvement in Social Justice Praxis
    (2023) Golojuch, Laura; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    As the nation becomes more diverse, multicultural competence and social justice are being increasingly recognized as essential components to effective therapy practice (Hays, 2020; Ratts et al., 2016; Vera & Speight, 2003). While some scholars in the field of Couple and Family Therapy (CFT) have urged the importance of infusing social justice into training and clinical practice for years (see Hardy, 2001; Knudson-Martin et al., 2019; McDowell et al., 2019; McGoldrick, 2007), this topic is understudied and underprioritized by the field at large. Recent CFT scholars also acknowledge the importance of advocacy as an accompaniment to therapy (J. M. Goodman et al., 2018, Jordan & Seponski, 2018a, 2018b). Counseling and social work fields have prioritized social justice advocacy and codified it into mission statements and ethical codes (Ratts et al., 2016; Ratts & Greenleaf, 2018; Toporek & Daniels, 2018). Although CFTs are trained systemically, and may be enacting micro-level advocacy intervention in the therapy room, they do not always view themselves as advocates or enact macro-level advocacy interventions (J. M. Goodman et al., 2018; Holyoak et al., 2020; Jordan & Seponski, 2018b). This study utilized a sequential transformative mixed methods design to assess multicultural competence, social justice commitment and self-efficacy, and advocacy competence in a nationally representative sample of CFTs (n = 101) using survey methods. A subsample of 22 participants were interviewed to further explore their practices as multiculturally competent and socially just clinicians. Three complementary frameworks were utilized to ground the study: The Multicultural and Social Justice Counseling Competencies (MSJCC), critical consciousness, and Public Health Critical Race praxis. Overall, multicultural competence, social justice commitment, and social justice self-efficacy scores were high in this sample, while advocacy competence scores were lower. Results showed that identifying as Black or African American and completing additional training in multicultural competence and social justice were associated with multicultural competence. Results also showed that working in an agency setting vs. other settings was associated with lower levels of multicultural competence. Results showed that identifying as female compared to male, having a higher level of oppression, a higher level of civic engagement, and more additional training in multicultural competence were all associated with social justice commitment. Results showed that being older, completing more additional training, and having a higher level of oppression were all associated with higher levels of social justice self-efficacy. Finally, results showed that identifying as non-binary compared to male, completing more hours of additional training, and experiencing higher levels of oppression were all associated with advocacy competence. Additionally, receiving more post-graduate hours of training in multicultural competence, social justice, and advocacy competence was associated with higher multicultural competence, social justice, and advocacy competence. Qualitative findings revealed ways in which CFTs developed and embodied socially just clinical practice and explored recommendations for training.
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    (2023) Barber, Gabriela A; Thoma, Marie E; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Interpregnancy interval (IPI) is defined as the period of time between a previous birth and a subsequent conception, usually measured in months. While recommendations issued by the World Health Organization and the American College of Obstetricians and Gynecologists provide guidance for ideal birth spacing, many births occur after non-optimal IPIs – either too short (<18 months) or too long (60+ months). These recommendations were motivated by the body of research on a host of adverse infant and maternal health outcomes associated with non-optimal IPIs. To date, the literature has focused heavily on the association between IPI and adverse infant health outcomes, with limited attention in comparison being given to IPI and maternal health. Within the research on IPI and maternal health, there is a narrow focus on physical health outcomes related to pregnancy/delivery complications, with few studies looking at health outcomes in the postpartum and beyond. In order to fill this gap, this research investigated the association between IPI and several postpartum maternal health outcomes/indicators, including 1) postpartum depression (PPD), 2) attendance at a postpartum checkup, and 3) postpartum contraceptive use (any and type). One of the perennial difficulties in studying IPI is parsing out whether IPI has an independent association with a health outcome or behavior or is exerting its effects through pregnancy intention, therefore, for each aim, pregnancy intention was tested as a moderator. For each aim, unique cut-offs for IPI were determined after examination of the association between more detailed IPI categories and the outcome of interest. Categories were collapsed into broader IPI classifications when the associations were similar in order to maximize precision of the estimates and in order to allow us to characterize the most clinically relevant exposure for specific health outcomes. In fully adjusted models, individuals who had IPIs less than 18 months were significantly more likely to experience elevated PPD symptoms (aOR: 1.19, 95% CI: 1.02 – 1.39, p=0.024) when compared to individuals with long IPIs, and individuals who had IPIs less than 12 months were significantly less likely to attend their postpartum checkup (aOR: 0.78, 95% CI: 0.66 – 0.93, p=0.006) when compared to those with long IPIs. Pregnancy intention was not found to significantly moderate either of these associations. For the third aim, pregnancy intention was found to moderate the association between IPI and any use of postpartum contraception. Stratified analyses show that it is among unintended pregnancies that there is an association between short IPI and increased use of any contraception in the postpartum. Among unintended pregnancies, those with IPIs less than 6 months (aOR: 2.31, 95% CI: 1.37 – 3.90, p=0.002) and those with IPIs of 6-11 months (aOR: 2.15, 95% CI: 1.48 – 3.10, p=0.001) were more likely to be using any contraception in the postpartum than those with long IPIs, and the magnitude of this association exceeded that of other IPI intervals and pregnancy intention categories. Among those who were using contraception in the postpartum, individuals with IPIs less than 6 months were more likely to be using highly-effective methods (aOR: 1.59, 95% CI: 1.22 – 2.10, p=0.001) than least-effective methods of contraception. Pregnancy intention did not significantly moderate the association between IPI and type of contraception. Future research should continue to explore the association between IPI and a broader range of maternal health outcomes and work to identify the mechanisms through which IPI may be impacting these outcomes. Recent changes in reproductive policies in the U.S. may also soon change the proportion of individuals who experience short IPIs, therefore making it even more important to understand how this shift may impact a broad range of maternal health behaviors and outcomes. This research highlights how an increase in births occurring after a short IPI would likely increase rates of PPD and increase demand for certain family planning services.
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    ¡Hay que hablar sobre esto! [We need to talk about this]: Exploring the Relationship Between Contraceptive and Consent Knowledge, Sexual Self-efficacy and Psychological Distress Among Latino Adolescents
    (2023) Kerlow, Marina Angelica; Lewin, Amy; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Latino adolescents are a growing population in the US (U.S. Census Bureau, 2020), and they experience disproportionately high rates of unintended teen pregnancy, STIs and HIV (Guilamo-Ramos et al., 2012; Martin et al., 2021). Also, adolescents struggle with high rates of mental health issues (Bitsko et al., 2022; Merikangas et al., 2010). Some studies support that psychological distress plays a role in teens’ sexual behavior and sexual self-efficacy (Lehrer et al., 2006; Seth et al., 2009; Seth et al., 2011). Yet, few studies have looked at the association between aspects of sexual health and psychological distress within Latino teens. This study conducted secondary data analysis using baseline data from a randomized controlled trial to test the effectiveness of El Camino, a comprehensive sexual health education curriculum developed by Child Trends. Participants consisted of 474 Latino adolescents (44.8% male and 53.1% female) and they completed electronic self-report surveys (mean age 16.55 years). 84.2% of the sample was foreign born and 15.8% was US born. Results indicated that there was a significant correlation between sexual self-efficacy and knowledge about contraception and sexual consent (r = .31, p < 0.001). There was a small significant correlation between sexual self-efficacy and psychological distress (r = .12, p < 0.001). Psychological distress did not moderate the relationship between knowledge and sexual self-efficacy. Interestingly, the interaction term between knowledge and gender was statistically significant (β = -0.44, SE = 0.09, p= <.001), indicating that the relationship between knowledge and sexual self-efficacy is stronger for males than for females. The findings support that Latino youth may benefit from interventions that strengthen their knowledge and sexual self-efficacy, despite differences in nativity status and levels of psychological distress. Future studies should consider potentially important cultural, societal, and relational factors that may further explain these results.
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    (2023) Du, Jingshuai; Quinn, Sandra SQ; Mittal, Mona MM; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The current study aimed to investigate the longer-term impact of everyday discrimination and major lifetime discrimination at Time 1 (T1; 2008 and 2010) on couple relationship functioning at Time 3 (T3; 2016 and 2018) across 8 years. It also aimed to explore if psychological (measured by depressive symptoms) and physiological stress responses (measured by allostatic load) at Time 2 (T2; 2012 and 2014) mediated the longitudinal association between discrimination and couple relationship functioning among middle-aged and older-aged adults in the United States (U.S.). To answer the study aims, I conducted a longitudinal mediation path analysis (N = 2,344) in Mplus Version 8 using data from the Health and Retirement Study, an ongoing national survey of the health and aging experience of U.S. adults aged 51 and older residing in the community. The primary longitudinal mediation model with control variables demonstrated good model fit (χ2[4] = 21.78, p < 0.01, CFI = 0.99, RMSEA = 0.04, SRMR = 0.01). The analysis results suggested that depressive symptoms at T2 significantly mediated the longitudinal association between the two types of discrimination and the two types of couple relationships spanning 8 years while controlling for race, age, gender, education, number of reasons for everyday discrimination and T1 assessments of couple support and couple strain. However, allostatic load was not found to be a significant mediator between the two types of discrimination and the two aspects of couple relationship functioning (couple support and couple strain). The direct relationship between discrimination (everyday and major lifetime discrimination) and couple relationship functioning (couple strain and couple support) was not significant either. The results from the multi-group analysis suggested that several structural paths differed significantly across gender, age groups, and number of reasons for everyday discrimination, but none of the paths differed significantly based on race. Overall, the current study did not find evidence supporting the pathway from perceived discrimination to couple relationship functioning through allostatic load. It provided evidence supporting depressive symptoms as a mediating mechanism between perceived discrimination and couple relationship functioning. Future work should develop innovative methods for assessing and measuring allostatic load to test its possible mediation role between perceived discrimination and couple relationship functioning. Moreover, effective and culturally-responsive interventions and programs are needed to decrease all types of discrimination and depression in order to improve couple relationship functioning among middled-aged and older-aged adults in the U.S.
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    Influence of Latinx Fathers' Behaviors, Cognitions, Affect, and Family Congruence on Youth Energy Balance-Related Health Outcomes
    (2022) Rodriguez, Matthew Rene; Roy, Kevin; Hurtado Choque, Ghaffar Ali; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    For decades, researchers have studied and theorized about the ways fathers interact with children and other members of the family. While this research provides important evidence, few father involvement studies have included Latinx fathers. Numerous father involvement conceptual frameworks have helped us understand the ways fathers interact with their families. Much of this research has focused on fathers' behaviors, but research suggests other domains need more investigation, such as fathers' cognitions and affect. Understanding these additional domains of father involvement can provide important evidence for understanding the ways fathers influence the health of children. Fathers influence the health of their children within different cultural and socio-political contexts. When considering Latinx father involvement within a social determinants of health approach, research has encouraged focusing on upstream factors that can contribute to the health of Latinx families. Addressing these upstream factors can shape the health and wellbeing of children. Currently, Latinx youth suffer disproportionately from obesity compared to all other racial and ethnic groups in the U.S. Through investigating Latinx father involvement, I fill an important gap by researching the extent to which Latinx fathers' affect, behaviors, and cognitions shape youth health outcomes. I also investigate theorized moderators that may influence the relationship between fathers' involvement and youth health outcomes. Using a cross sectional study design with a community-based sample of Latinx fathers and youth (ages 10-14) (n=193), I use latent moderation structural analyses to test the theorized causal mechanisms.
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    (2022) Kartashev, Maria; Falconier, Mariana K; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    This qualitative study investigated how African American heterosexual couples’ relationship are affected by racial discrimination and how they cope with stress from racial discrimination (including communicating their own and responding to each other’s stress). The data were analyzed using thematic analysis, and themes were organized based on the areas of inquiry. Themes related to the impact of racial discrimination on the couple relationship included “my partner’s experiences of racial discrimination also affect me,” and “couples feel connected through the similarities in the experience of discrimination.” Themes regarding coping as a couple included “talking about racial discrimination with your partner helps,” “agree to disagree,” “joking together to show solidarity,” and “complementary gender responses to racial discrimination.” Themes were discussed using the systemic-transactional model of dyadic coping (Bodenmann, 1995, 2005). Though further research is needed to understand the impact of racial discrimination on African American couples and their coping, the current study suggests that couples cope with racial discrimination dyadically. This coping is diverse and sometimes gendered. Additionally, creating a safe space of compassion, despite differences in perceptions of racial discrimination, helps couples feel bonded by mutual trust, intimacy, and connectedness. Finally, limitations, clinical and research implications, and issues of reflexivity were discussed.
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    A Qualitative Examination of the Barriers and Facilitators of Pre-Exposure Prophylaxis (PrEP) Uptake Among Heterosexual HIV Serodiscordant Couples
    (2022) Mathews, Ronneal; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    It is estimated that there are 140,000 heterosexual serodiscordant couples in the United States. Given the considerable number of these couples and the high risk of HIV acquisition among non-infected partners, it is important to focus prevention methods on programs and interventions that target transmission of HIV infection among serodiscordant heterosexual couples. Currently, we understand little about factors that influence these couples to use pre-exposure prophylaxis (PrEP). According to the CDC, this population is one of the highest risk groups, therefore, understanding the factors that influence them to use PrEP as a strategy in their HIV prevention regimen is an important step in preventing new HIV cases among this population. This study was a qualitative analysis that explored potential motivators and inhibitors for PrEP among heterosexual HIV serodiscordant couples. Secondary data from 26 qualitative interviews of HIV serodiscordant couples (N = 52 individuals) was examined to determine the factors that influenced the decision to use PrEP. Overall, there were five overarching themes from the Health Belief Model that manifested in all participant interviews. Perceived threat, perceived barriers (concerns about side effects, fear/anxiety about taking medication, indifference about HIV transmission), perceived benefits, cues to action (partner protection, PrEP use as condom replacement, PrEP use due to concerns about condom efficacy), and relational efficacy emerged as the most salient themes that determined whether couples chose to use PrEP as an HIV prevention method. Two constructs from the Theory of Gender and Power, sexual division of power and cathexis also emerged as relevant factors that influenced the decision to use PrEP in these couples. Findings from this study indicate that practitioners need to consider the motivators and barriers to PrEP uptake, and critically examine how power dynamics impact the decision to use PrEP. There is a need for the development of couples-based interventions to encourage PrEP uptake and adherence in mixed status couples.
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    Evaluating immigrant-specific adverse childhood experiences as a social determinant of health among Latino immigrant families
    (2022) Conway, C. Andrew; Lew, Amy; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Research consistently demonstrates the critical role of Adverse Childhood Experiences (ACEs), traditionally defined as exposure to abuse, neglect, and household risk factors, in shaping overall health and well-being throughout life and even across generations. However, our current conceptualization and measurement of ACEs are based on items initially examined in a primarily white, middle-class, highly educated sample. This strategy may provide a limited understanding of childhood adversity within marginalized groups. This study aimed to examine the relationship between ACEs (both traditionally studied ACEs and immigrant-specific ACEs) and the psychological well-being of Latino immigrant adolescents. The relationship between parental experiences of ACEs, child ACEs, and child psychological well-being was also explored. Data comes from a community sample of 338 Latino immigrant adolescents. These youth completed an 11-item measure of traditional ACEs (ACE-T), a novel 13-item measure of immigrant-specific ACEs (ACE-I), the Strengths and Difficulties Questionnaire, and health risk behavior items as part of the intake process for a positive youth development program. Data on parent ACEs was available for a subsample (n¬ = 112). Structural equation modeling was used to examine the relationship between the ACEs measures and the psychological and health risk outcomes. Immigrant youth, on average, reported more adversities on the ACE-I measure than the ACE-T measure (3.6 vs. 1.6). Both ACE-T and ACE-I scores were positively related to increased emotional issues (standardized coefficients were .24 and .25, respectively). Only ACE-T scores were related to increased conduct problems and peer relationship problems. There was no relationship between adolescents' ACE-T or ACE-I scores with prosocial or health risk behaviors. The parent's ACE-T scores were positively related to the child's ACE-T scores (b = .18). These findings suggest that essential early adverse experiences for immigrants, which have not been considered, impact adolescents' psychological well-being. Broadening our conceptualization and measurement of ACEs among immigrant populations could provide valuable insight into social determinants of health and avenues for intervention for immigrant adolescents and families.
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    Racial Socialization, Observed Maternal Conflict Behaviors, and Externalizing Problems in Black Mother- Adolescent Dyads
    (2021) Shan, Salwa; Smith-Bynum, Mia; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    African Americans living in the United States face unique stressors as a result of being part of a marginalized group that has been consistently at the bottom of the social structure system. We see the impact of systemic racism when we look at the racial disparities associated with various economic, political, and civil rights in our society. The emphasis on rules and strict parenting in African American families is related to the need that many African American parents feel to protect and inform their children of the many forms of racial discrimination they will face in American society. In order to raise children who are less likely to be engaged in risk behaviors and better prepared for the environment they are living in, African American parents enforce stricter rules and discipline for their children and utilize racial socialization as a unique parenting strategy. Adolescents who struggle for behavioral autonomy in areas where parents try to emphasize their control, often engage in deviant behavior and are more at risk of struggling to be compliant with rules and adjusting as they grow and develop. Some research has indicated that parent-child conflict has increased when there has been a focus on rules due to adolescents’ desire for autonomy. The role of maternal conflict as a contextual factor when delivering racial socialization messages has not been studied and may have significant impacts on the transmission and reception of such messages. This study aims to address the gap in research and connect the contextual factors of parent-child relationship quality in influencing the transmission and reception of racial socialization messages as seen by the impact on externalizing behaviors in adolescents.
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    (2021) Ramsey, Lauren Meta; Moser Jones, Marian; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Racism permeates all U.S. institutions. The criminal justice system has been identified as a clear form of structural racism. Numerous studies have documented disproportionate criminal justice contact among Black people. Several researchers have used the Black/White differences in incarceration as an indicator of racism. However, there are 4.5 million people under community supervision, in addition to the 2.3 million people incarcerated in the U.S. Despite this large number of the population being under this type of correctional supervision, probation and parole does not receive as much attention in studies of institutional racism and health. Probation and parole are important to consider in any investigation of criminal justice system involvement because they are major drivers of mass incarceration in the United States. Incarceration, parole and probation can have negative effects on individuals, families and communities, with Black people disproportionately impacted by these negative outcomes. This study utilized the indicator of Black/White differences in Correctional Control (defined as populations who are on probation, paroled and incarcerated in jail and state prison) as a proxy for institutional racism on overall population health. This dissertation utilized Pregnancy Risk Assessment Monitoring System (PRAMS), and Bureau of Justice Statistics data to investigate the relationship between institutional racism (i.e. Black/white differences in state level Correctional control) on disparities in rates of preterm birth, postpartum depression and pregnancy hypertension among Black and White women.
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    (2021) Ellick, Kecia Lurie; Lewin, Amy B; Roy, Kevin M; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Rationale: Black women suffer disproportionate rates of stress-related diseases including heart disease, diabetes, cancer, maternal mortality, and depression. Education is promoted as a protective factor against these outcomes. An increasing number of Black women are leveraging advanced degrees to secure leadership positions in education, law, science, and technology. Yet, highly educated, middle-class Black women experience the same deleterious health outcomes, at the same rates, as Black women living in poverty. This suggests that neither education nor its correlates protect Black women from harmful outcomes. It further suggests that, for Black women, the cost of social mobility afforded by advanced education may result in diminishing returns by reproducing and reinforcing social inequalities that inform and exacerbate negative experiences.Purpose: The purpose of this study was to explore the experiences of highly educated Black women during their prime work, partnering, and reproductive years. This study examined the strategies that highly educated Black women employed to cope with stressors perceived while navigating, negotiating, and performing multiple roles, social identities, and responsibilities in their personal and professional lives. Methods: Data was collected from a sample of Black, middle-class women living in Georgia, ages 28 - 49, with doctorate degrees (n = 24, Mage = 40.2) via in-person, semi-structured interviews. Following a constructivist grounded theory approach, a triadic scheme of open, axial, and selective coding will be performed to uncover emergent themes from women’s narratives. Findings: Evaluation of the data revealed three central themes that serve as the main findings of this study and answer the study questions about how highly educated Black women experience and cope with stress: 1) redefining of the strong Black woman, 2) prioritization of self-care practices and, 3) unapologetic authenticity. Discussion: This study explored the heterogeneity of Black women and contributes to the body literature focused on the interactive effects of race, gender, and class. It provides empirical data on the ways in which Black women experience, perceive, and respond to stress and highlights the ways in which Black women take proactive approaches to protect their health and well-being.
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    (2021) Drew, Laura Briggs; Thoma, Marie E; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    20% of women and girls in Nigeria have undergone female genital cutting (FGC). Although FGC may have cultural and religious importance, it is a violation of human rights and is associated with long-term impacts on women’s health. FGC is practiced to ensure marriage eligibility and attenuate sexual desires, but intercourse can be painful for women with FGC, and while there appears to be a relationship between FGC and STIs and infertility, these pathways are not clear. Therefore, this dissertation utilized Nigeria Demographic and Health Survey (NDHS) data to accomplish the following three aims: 1) Examine trends in women’s attitudes and beliefs toward FGC from 2003-2018 in Nigeria, including after criminalization of FGC in 2015, and by region; 2) Assess the association between FGC and sexual behaviors among couples; and 3) Examine the relationship between FGC and delays in pregnancy via time-to-pregnancy (TTP). The first study found women’s attitudes and religious beliefs toward FGC have changed in Nigeria, with support and religious beliefs toward FGC decreasing in the South, but increasing in the North. These variations may reflect concerted efforts to address FGC through state-level policies and anti-FGC programs in the southern regions where it is more commonly practiced, while the northern regions have experienced ongoing conflicts. The second study found women with FGC are less likely to have been recently sexually active, more likely to be sexually active before age 18, their partners are more likely to have had extramarital sexual partners in the past year, and the magnitude of these associations is greater for women with more severe forms of FGC. The third study found more severe forms of FGC may lead to longer TTP among nulliparous women, but the relationship between FGC and increased TTP was not evident among parous women. However, these associations may be complicated by differences in fertility preferences and sexual behaviors. As we move forward in efforts to prioritize the sexual and reproductive health and rights of women and girls across the globe, examining the impact that cultural practices, like FGC, can have on health behaviors is a critical area of research.
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    Family Support, Rejection, and Connectedness: Family Context and SGM Youth Mental Health and Substance Use
    (2021) Tomlinson, Katherine; Fish, Jessica N; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Adolescence is an acutely significant period of development, and sexual and gender minority youth (SGMY) experience unique stressors which contribute to elevated rates of substance use, mood disorders, suicidal ideation and attempts, and other health outcomes when compared with their heterosexual, cisgender peers. Family is often the context in which SGMY navigate these stressors and manage their health. Family rejection and support have each been linked to health outcomes among SGMY, including depression and substance use. More globally, family connectedness is beneficial to adolescent’s health but is an understudied construct within SGMY research. Limited research has examined how these family processes converge to influence SGMY health. In an effort to capture nuance in family process and SGMY health, this study examined the relationship between experiences of family support, rejection, and connection among SGMY and their depressive symptoms and substance use. Findings have implications for research and practice with families.
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    (2020) DeYoung, Kathryn Alyce; Leslie, Leigh A; Shackman, Alexander J; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Graduate students are an essential part of the academic enterprise. Converging lines of evidence suggests that many graduate students experience high levels of emotional distress. Yet the true depth and breadth of this public health “crisis” has remained unclear. The present study used survey data collected from 187,427 American graduate students between 2008 and 2019 as part of the ACHA-NCHA II to demonstrate that moderate-to-severe emotional distress, psychiatric illness, and suicidality are common among graduate students. Remarkably nearly 1 in 3 students were diagnosed with or treated for one or more psychiatric disorders. Notably, every indicator of emotional distress and illness increased over the past decade, in some cases substantially, above and beyond contemporaneous shifts in demographic and institutional characteristics. This study represents the most comprehensive assessment to date, provides crucial information for refining research and policy, and sets the stage for efforts aimed at developing effective intervention strategies.
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    Depression and Perception of Family Cohesion Levels and Social Support from Friends in Emerging Adulthood at a University Mental Health Clinic
    (2020) Roc, Sabrina; Barros, Patricia; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Emerging adulthood is identified as a period of transition and uncertainty that occurs between the stages of adolescence and adulthood, often from ages 18-25. During this period, mental health issues are quite prominent, especially symptoms of depression. Previous research has explored what can ease the stress of depressive symptoms, and social support has had resounding effects. The present study used secondary analysis of data from 372 therapy-seeking individuals at a university-based family clinic to evaluate how perceived levels of familial cohesion and social support from friends are associated with depressive symptoms during emerging adulthood and whether or not age moderated the association. The results of this study show significant associations between familial cohesion as predicted, and social support from friends but in an unexpected direction. Age did not appear to have any significant associations. Potential future research as well as clinical implications are discussed.
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    Maternal postpartum nutrition exposures, breastfeeding, and infant weight
    (2020) Cassar-Uhl, Diana; Steinberg, Julia R; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Objective: This dissertation investigated relationships between postpartum maternal dietary intakes, breastfeeding exclusivity, intensity, and duration, reasons for weaning before 6 months, and infant weight at 6 months. Methods: Three aims examined 8 nutritional exposures: magnesium, added sugar, dairy, energy, glycemic load, and macronutrient distributions (percent of calories from carbohydrate, protein, and fat) among participants in the United States Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC)’s second Infant Feeding Practices Study (IFPS II). The first aim employed logistic regression to examine the association between intakes of dietary factors and exclusive breastfeeding at 3 months, partial breastfeeding at 3 months, and any breastfeeding at 6 months (n = 1099). The second aim used logistic regression to investigate the association between intakes of dietary factors and reasons for early weaning (n = 587). The third aim used multivariable linear regression to examine differences in infant weight and weight-for-age z-scores at 6 months by intakes of dietary exposures (n =186). Unadjusted models and models adjusted for relevant covariates were executed. Results: Those with consumption at or exceeding recommended daily intakes of magnesium, dairy, and energy were more likely to engage in recommended breastfeeding behaviors. Consuming a diet with a low average daily glycemic load was associated with not breastfeeding as recommended. Low average daily glycemic load was associated with a lower likelihood of citing “too much milk” as a reason to wean. No maternal intakes were associated with higher or lower weight or weight-for-age z-scores at 6 months. Conclusion: Findings support existing nutrition guidelines for women of childbearing age, and suggest that a higher daily intake of magnesium may be appropriate for lactating mothers. Average daily glycemic load may also be important, and should be studied further. Implications: This dissertation provides an exploration into specific maternal dietary intakes and important outcomes of infant feeding. It provides a foundation for future inquiries into the roles of magnesium and glycemic load in supporting breastfeeding.
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    Examining Maternal Experiences of Food Insecurity on Birth and Early Childhood Outcomes
    (2020) De Silva, Dane André; Thoma, Marie E; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Food insecurity, or the inadequate access to nutritionally-acceptable food, has been increasingly recognized as a distal determinant of poor health outcomes. While 11.1% of U.S. households suffer from food insecurity, specific populations are disproportionately affected, including pregnant women and single mothers. From a life course perspective, growth trajectories may be influenced by both prenatal exposures and postpartum practices, such as breastfeeding. Since food insecurity is associated with stress and poor nutrition, when occurring during critical periods of development, the fetus may be programmed to have poor future health. Other research on developmental origins have identified patterns that exhibit sex differences, particularly around growth. Therefore, this investigation sought to examine maternal food insecurity on: (i) low birthweight and sex-specific differences; (ii) breastfeeding initiation and exclusive breastfeeding duration; and (iii) obesity at age two and sex-specific differences. In Aim 1, mothers experiencing prenatal food insecurity had a higher odds of delivering a low birthweight infant, though much of the association was explained by sociodemographic factors after adjustment (OR 1.10 [95%CI 0.98, 1.25]), with female infants showing OR 1.21 (95%CI 1.02, 1.43). For Aim 2, food insecurity did not appear to deter women from initiating breastfeeding (OR 1.41 [95%CI 0.58, 3.47]), and minimal differences in exclusive breastfeeding duration between food insecure and food secure women were found (TR 0.89 [95%CI 0.57, 1.39]). Finally, Aim 3 revealed that sociodemographic factors explained much of the association between maternal food insecurity and childhood obesity at 2 years (OR 1.15 [95%CI 0.75, 1.75]), though male offspring showed a stronger magnitude (OR 1.54 [95%CI 0.86, 2.74]). Maternal food insecurity is a multi-faceted exposure that is related to other covariates, which may interact in multiple ways to influence health outcomes through both biologic and behavioral pathways. This preliminary investigation highlights the importance of exploring exposures occurring during critical periods, including food insecurity, on birth and childhood outcomes, and how it may affect the later health of offspring differently by sex. Additional longitudinal data with accurate measures of food insecurity are needed to fully ascertain how it affects the health of mothers and children, and to identify possible mediating pathways.
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    Are We Ready to Serve? Couple and Family Therapists’ Attitudes Toward BDSM and Their Perceived Competence Helping BDSM Practitioners
    (2020) Berman, Zachary Lane; Fish, Jessica N; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Cultural competence is a core component of delivering effective psychotherapy to clients with diverse sexual lifestyles, including BDSM practitioners, who constitute a substantial minority of the population. Couple and Family Therapists (CFTs) are uniquely prepared to explore relationships and power dynamics, but no research has explored CFTs’ psychotherapeutic relationship with BDSM practitioners. This study measures CFTs’ BDSM attitudes, perceived competence, and the relationship between these and related professional factors. Results indicated that CFTs (n = 132) have positive attitudes and moderate perceived competence; attitudes and perceived competence were negatively correlated. Controlling for various professional factors such as AASECT certification, we found that participants with at least three or more hours of BDSM-specific training had significantly more positive attitudes and significantly higher perceived competence. Including these hours in graduate training or continuing education credits could help CFTs to feel more “kink aware” and competent to deliver ethical care for this population.
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    (2020) Lee, Jennifer Grace; Leslie, Leigh A; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Siblings are the longest relationship many people have in their lives, yet are often overlooked in research. Transracial adoptees, who may struggle with forming a sense of racial identity and experiencing low self-esteem, may benefit from the presence of a sibling of color. The research questions posed by this study are 1) What is the independent effect of having a sibling of color for transracial adolescent adoptees' racial identity and self-esteem? 2) Does having a sibling of color moderate the well-established relationship between parental racial socialization and outcomes of racial identity and self-esteem in transracial adoptees? Results of the present study indicated that having a sibling of color was negatively associated with a transracial adolescent adoptees’ self-esteem and having a sibling of color moderated the relationship between racial socialization and self-esteem. Higher racial socialization was associated with lower self-esteem for adoptees with no sibling of color.