UMD Theses and Dissertations
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Item “It's how they found relief and comfort from all the tragedies that life throws at them on a regular basis”: Exploring the association between trauma, opioid use, and opioid use disorder in Washington D.C.(2024) Brown, Imani; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In Washington D.C, African American residents of underserved neighborhoods are disproportionately affected by opioid use (OU), opioid use disorder (OUD), and opioid overdose deaths (OOD), highlighting the need for a more effective intervention to address these issues. Existing literature indicates an association between OUD and trauma, but this relationship is minimally explored in urban, African American communities. This study aimed to qualitatively explore the association between trauma, OU, and OUD from the perspective of community leaders and clinicians (N=78) working in Wards 7&8 of DC, the neighborhoods hardest hit by the problem. Data showed that interpersonal and intergenerational trauma contributed directly to OU and OUD, and that historical trauma and structural violence act synergistically with other traumas to contribute to OU and OUD. Findings suggest a need for early interventions to address the harmful effects of interpersonal and intergenerational trauma and underscore a need for culturally informed political and socio-economic interventions to address structural violence and historical trauma that perpetuate trauma, OU, and OUD.Item 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.Item EXAMINING RACISM AS A RISK FACTOR FOR UTERINE FIBROIDS AMONG AFRICAN AMERICAN WOMEN(2020) Porter, Shyneice; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Uterine fibroids are a common gynecological condition among women. African American women, however, are particularly susceptible to developing fibroids; in fact, approximately 80-90% of African American women are diagnosed with the condition by age 50. Left untreated, these benign tumors can reduce fertility and increase the risk of pregnancy complications. Despite the high prevalence of uterine fibroids among African American women and the detrimental effects they may have on reproductive health, little is known about the risk factors associated with fibroid development among this demographic. To address this gap in the literature, the proposed study used data collected from 699 African American women in the southern region of the United States. This study was guided by an adapted racism and health framework as well as an expanded ABC-X model that includes elements of the mundane extreme environmental stress theory. Structural equation modeling was used to examine the relationship between perceived and internalized racism, the interaction between the two racism variables, and uterine fibroid diagnosis among African American women. The study also investigated depressive symptomology and body mass index as mediators of the proposed relationships. Results revealed a direct effect between perceived racism and the likelihood of a uterine fibroid diagnosis (β = .172, SE = .05, p < .001, OR = 1.19 [95% CI = 1.08, 1.31]). There was not a direct effect, however, between internalized racism and fibroid diagnosis, or the racism interaction variable and fibroid diagnosis. Perceived racism (β = .214, SE = .03, p < .001), internalized racism (β = .108, SE = .04, p < .01), and the racism interaction term (β = .067, SE = .03, p < .05) were positively and significantly associated with depressive symptomology. There was no evidence of full or partial mediation through the proposed mediators. The present study is among the first to examine two forms of racism as critical psychosocial risk factors for an adverse reproductive health outcome that differentially impacts African American women. The findings have important implications for clinical practice and policy that may aid in the effort to address racial disparities related to uterine fibroid development.Item Assessing Changes in Access to Health care and Utilization of Preventive Services among Immigrants of African Descent Before and After Implementation of the Affordable Care Act(2020) Williams-Parry, Kester F; Chen, Jie; Thomas, Stephen B.; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In the U.S., African Americans experience a disproportionate burden of health disparities. The African American population includes 4.3 million people who are foreign-born. Yet, a paucity of empirical data exists on the health of immigrants of African descent. The lack of data disaggregation by subpopulations of African Americans, disregards the unique characterization of the African American diaspora and the influence of different cultural, linguistic, political, social, economic, environmental, and historical experience on the overall health of the population. Access to health care including lack of health insurance coverage has been a longstanding contributor to poor health outcomes among African Americans. The passage of the Affordable Care Act aimed to improve access to care including health insurance coverage and utilization of preventive services with no cost-sharing. Studies have shown significant reductions in the uninsured rate among African Americans and uptake in some preventive services, but the impact of the ACA on immigrants of African descent is not well understood. This dissertation research examined changes in access to health care, and utilization of preventive screenings for cancer, high blood pressure, diabetes, and high cholesterol among immigrants of African descent and U.S.-born African Americans before and after implementation of the ACA. This research integrated three studies to understand changes in access and utilization of health care using t-test for descriptive analyses and multivariable logistic regressions to assess any differences post-ACA. Results showed lower odds of being uninsured (OR=0.52, p=0.000), delaying care (OR=0.72, p=0.000), and forgoing care (OR=0.71, p=0.000) post-ACA, for all groups. There were higher odds of having cholesterol (OR=1.33, p=0.000) and hypertension screenings (OR=1.32, p=0.000) after the ACA. Cancer screening results found slightly higher odds of obtaining a mammogram (OR=1.07, p=0.069) after the ACA, but lower odds of having a pap smear (OR=0.89, p=0.002) or colorectal cancer (OR=0.91, p=0.021) screening. Citizenship was a significant factor that influenced screening rates with non-citizen immigrants having the lowest screenings for all groups.Item African American Couples' Provider Role Attitudes as a Function of Income, Relative Income, Education, and Age(2018) Walton, Tariiq Omari; Epstein, Norman B.; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study investigated characteristics that are associated with the provider role attitudes of African Americans being seen for couple therapy at a university-based family therapy clinic in a major metropolitan region, the Center for Healthy Families at the University of Maryland, College Park. It was predicted that income, relative income, education, age, and gender would be associated with the degree of traditional provider role attitudes of members of African American couples being treated at the CHF between 2000 and 2015. Contrary to the predictions, no relationship between education, age, and relative income and the provider role attitudes of the study’s participants was found. However, the results did show a significant relationship between gender and income and provider role attitudes. The implications for future research and clinical applications are discussed.Item THE IMPACT OF SOCIOECONOMIC STATUS ON SERIOUS MENTAL ILLNESS AND CARDIOVASCULAR DISEASE AMONG AFRICAN AMERICANS(2017) Wilkerson, Thomas G.; Dyer, Typhanye; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Cardiovascular disease (CVD) tends to be more prevalent in individuals older than 18 years of age with serious mental illness (SMI) and CVD is the leading cause of death of African Americans in the United States. Socioeconomic status (SES) is a major confounder that distorts the association of SMI with CVD in the African American population. The goal of this study is to measure the relationship between SMI and CVD in middle and upper income level African Americans. To accomplish this goal the three specific aims are as follows: Aim 1: To measure the prevalence of CVD in the study population. Aim 2: To measure the prevalence of SMI in the study population. Aim 3: To measure the strength of the association between SMI and CVD in the study population. The study is a cross-sectional study using secondary data analysis from four merged 2015 National Health Interview Survey (NHIS) datasets.Item Breaking through the Margins: Pushing Sociopolitical Boundaries Through Historic Preservation(2016) Hopkins, Portia Dene; Williams- Forson, Psyche; American Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)“Breaking through the Margins: Pushing Sociopolitical Boundaries Through Historic Preservation” explores the ways in which contemporary grassroots organizations are adapting historic preservation methods to protect African American heritage in communities that are on the brink of erasure. This project emerges from an eighteen-month longitudinal study of three African American preservation organizations—one in College Park, Maryland and two in Houston, Texas—where gentrification or suburban sprawl has all but decimated the physical landscape of their communities. Grassroots preservationists in Lakeland (College Park, Maryland), St. John Baptist Church (Missouri City, Texas), and Freedmen’s Town (Houston, Texas) are involved in pushing back against preservation practices that do not, or tend not, to take into consideration the narratives of African American communities. I argue, these organizations practice a form of preservation that provides immediate and lasting effects for communities hovering at the margins. This dissertation seeks to outline some of the major methodological approaches taken by Lakeland, St. John, and Freedmen’s Town. The preservation efforts put forth by the grassroots organizations in these communities faithfully work to remind us that history without preservation is lost. In taking on the critical work of pursuing social justice, these grassroots organizations are breaking through the margins of society using historic preservation as their medium.Item BLACK SURVIVAL POLITICS: ORGANIZED MOBILIZATION STRATEGIES IN AFRICAN AMERICAN COMMUNITIES TO END THE HIV/AIDS EPIDEMIC(2016) Beadle Holder, Michelle; Collins, Patricia H; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this study is to examine organizational patterns of African American activism in response the HIV/AIDS epidemic. Given their political, economic, and social disenfranchisement, African Americans have historically developed protest and survival strategies to respond to the devaluation of their lives, health, and well-being. While Black protest strategies are typically regarded as oppositional and transformative, Black survival strategies have generally been conceptualized as accepting inequality. In the case of HIV/AIDS, African American religious and non-religious organizations were less likely to deploy protest strategies to ensure the survival and well-being of groups most at risk for HIV/AIDS—such as African American gay men and substance abusers. This study employs a multiple qualitative case study analysis of four African American organizations that were among the early mobilizers to respond to HIV/AIDS in Washington D.C. These organizations include two secular or community-based organizations and two Black churches or faith-based organizations. Given the association of HIV/AIDS with sexual sin and social deviance, I postulated that Black community-based organizations would be more responsive to the HIV/AIDS-related needs and interests of African Americans than their religious counterparts. More specifically, I expected that Black churches would be more conservative (i.e. maintain paternalistic heteronormative sexual standards) than the community-based organizations. Yet findings indicate that the Black churches in this study were more similar than different than the community-based organizations in their strategic responses to HIV/AIDS. Both the community-based organizations and Black churches drew upon three main strategies in ways that politicalize the struggle for Black survival—or what I regard as Black survival politics. First, Black survival strategies for HIV/AIDS include coalition building at the intersection of multiple systems of inequality, as well as on the levels of identity and community. Second, Black survival politics include altering aspects of religious norms and practices related to sex and sexuality. Third, Black survival politics relies on the resources of the government to provide HIV/AIDS related programs and initiatives that are, in large part, based on the gains made from collective action.Item The relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans(2016) Tagai, Erin Kelly; Holt, Cheryl L; Garza, Mary A; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.Item THE ROLE OF DENIAL AND PERCEIVED HIV STIGMA AS BARRIERS TO ENGAGING IN HIV MEDICAL CARE AMONG HIV POSITIVE AFRICAN AMERICANS IN THE WASHINGTON, DC AREA(2015) Geiger, Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)HIV is a potentially fatal and highly stigmatized disease such that diagnosis with the disease is often met with high anxiety. Many people who test positive for HIV may not receive sufficient linkage to HIV care or do not remain engaged in continuous HIV medical care once they have entered care. While a considerable amount of research exists on referral, access, personal characteristics, and mental illness barriers associated with engagement in HIV medical care, far less attention has been given to psychosocial factors, specifically denial and perceived HIV stigma as important barriers to engaging in HIV medical care. The purpose of this study was to determine whether denial and/or perceived HIV stigma are associated with engagement in HIV medical care for African-American people living with HIV/AIDS (PLWHA). Data were collected as part of a peer-based community health worker program (CHW), based in Washington DC, designed to link PLWHA to HIV medical care and services. Logistic regression analyses were performed to determine whether the psychosocial variables were predictors of engagement in HIV medical care.Results indicated that disclosure is a major issue for this population, as 46% of the participants had not disclosed their HIV status to others. Separate analyses were conducted for the total sample (n=262) and with the disclosed sample (n=120). Results in the total sample revealed that disclosure of HIV status was associated with engagement in HIV status. PLWHA who disclosed HIV status to others were 2.2 times more likely to engage in HIV medical care than persons who had not disclosed HIV status. In the disclosed sample, gender, educational level and employment status were also associated with engagement in HIV medical care. Women and persons with low educational level and unemployed were less likely to engage in HIV medical care. Denial and perceived HIV stigma were not found to be independent predictors of engagement in HIV medical care when other covariates were included in the model. Disclosure of HIV status, gender and educational level were predictors of engagement in HIV medical care for this population. These obstacles to care may be amenable to disclosure and gender-specific interventions; and, therefore, warrant better understanding to improve outreach interventions to PLWHA who are not engaged in HIV medical care.