UMD Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/3
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
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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 PREVALENCE OF MATERNAL SMOKING INTENSITY STATUS IN EARLY AND LATE PREGNANCY AND ITS ASSOCIATION WITH EARLY MORBIDITY IN SINGLETON TERM BIRTHS IN THE UNITED STATES, 2016(2019) Kondracki, Anthony; Moser Jones, Marian; Thoma, Marie; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Relatively little is known about how maternal cigarette smoking influences the health of infants delivered at term. This study was based on the 2016 United States Natality File of live births (N= 3,956,112). The first aim was to examine the prevalence and patterns of smoking in the three months before and during pregnancy and the distribution of smoking intensity in early (1st and 2nd trimester) and late (3rd trimester) pregnancy across race/ethnicity, age, and educational attainment of mothers with all births and with singleton term births (37-41 completed weeks gestation) in the United States in 2016. The second aim was to compare the odds of low birthweight (LBW), low 5-minute Apgar score, and neonatal intensive care unit (NICU) transfer/admission in term singletons with changing maternal smoking status in early and late pregnancy indicating a potential prenatal exposure effect. The third aim was to test and identify the role of low birthweight, as a potential mediator, in the association with maternal smoking status and NICU transfer/admission of a newborn delivered at term. The prevalence of smoking in the three months before pregnancy was 9.42% among all mothers and 9.20% among mothers of term singletons, and high intensity smoking was the highest in the first trimester among non-Hispanic White women, 20-24 years of age, and less educated women for all births and for singleton term births. High intensity smoking in early and late pregnancy was associated with a greater risk of LBW (aOR 3.33; 95% CI: 3.23, 3.44), low 5-min Apgar score (aOR 1.46; 95% CI: 0.88, 2.44), and NICU transfer/admission (aOR 1.62; 95% CI: 1.58, 1.67) in term neonates. The odds ratios of the natural direct and natural indirect effects of NICU transfer/admission were aOR 1.52 (95% CI: 1.47, 1.57) vs. aOR 1.07 (95% CI: 1.07, 1.09) and the proportion mediated through LBW (18.3%) indicated partial mediation. This study has important implications for clinical practice, public health policy and research, and it is particularly timely because of an information gap on the health of infants delivered at term with LBW to mothers who continue smoking at high intensity during pregnancy.Item Menthol Tobacco Sales Restrictions at the Local Level: Community Perceptions, Lessons Learned, and Policy Evaluation(2019) D'Silva, Joanne; Fryer, Craig S.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Menthol cigarettes are a significant public health concern. While sales of regular cigarettes have declined in recent years, menthol cigarette sales are increasing. Known for their minty taste and cooling effects, menthol cigarettes are a starter product for youth. The tobacco industry has a long history of predatory marketing to African Americans, who are more likely to smoke menthol cigarettes, have lower quit rates, and experience higher tobacco-related mortality than white smokers. Because flavored cigarettes are appealing to youth, the 2009 Tobacco Control Act banned the sale of flavored cigarettes; however, menthol was exempted. Due to federal inaction on menthol, localities are enacting restrictions to address this social justice issue. In 2017, Minneapolis, Minnesota was among the first U.S. jurisdictions to restrict menthol sales to tobacco shops and liquor stores. Grounded in the Social Ecological Model, this dissertation utilized multiple methods to increase our understanding of the experience and impact of the Minneapolis menthol policy. Study 1 examined African American adult smoker perceptions and found that many menthol smokers perceived menthol to be as harmful or more harmful than non-menthol cigarettes and emphasized the role of tobacco industry targeting to African American communities and youth. Participants also indicated mixed support for menthol policy restrictions. Study 2 identified key factors that led to policy passage and included an in-depth assessment of critical steps in policy-making from policy formulation through adoption. The active engagement of youth and support of members of communities most impacted by menthol tobacco-related disparities were identified as critical to the policy’s successful adoption. Study 3 evaluated the impact of the menthol policy on the retail environment and found reduced menthol availability and decreased menthol marketing at the point-of-sale two months following policy implementation. Unintended consequences of the policy were also observed; two tobacco shops were added to convenience stores and continued to sell menthol tobacco. Results from these studies provide critical insights from several phases of the policy process. Findings can inform other jurisdictions around the country interested in pursuing menthol restrictions to reduce the burden of tobacco use and advance health equity for priority populations.Item Susceptibility to Smoking and Nicotine Dependence in Schizophrenia(2009) Saperstein, Alice Meredith; Blanchard, Jack J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Evidence suggests that high nicotine dependence observed in schizophrenia is related to its core neuronal deficits such as abnormalities in neural synchronization and sensory gating. Some of these neuronal deficits are shown to mark schizophrenia liability, raising the possibility that the increased nicotine dependence in schizophrenia is related to its etiological factors. This study sought to investigate mechanisms of increased vulnerability to smoking and nicotine dependence in schizophrenia. The individual and interacting effects of familial vulnerability factors, neurophysiological function, and resting cortical oscillatory activity (i.e. resting EEG power) were examined. The study sample was composed of four groups including outpatients with schizophrenia, first-degree relatives of patient index probands, healthy comparison control subjects from the community, and first-degree relatives of control probands. The resulting data demonstrated a pattern of more persistent nicotine use and greater dependence among those with schizophrenia relative to non-psychiatric comparison controls. Persistent smoking was also demonstrated to be highly heritable across groups with no discernable difference in the extent to which smoking is familial in those affected or unaffected by schizophrenia. With respect to resting oscillatory activity, analyses failed to find diagnostic group differences in EEG power for the alpha, beta, and gamma frequency bands and, unlike other substances of abuse, past and present nicotine use did not have a reliable effect on power in the beta frequency band. Rather, power in the gamma frequency band was significantly associated with smoking status. Furthermore, smoking was uniquely related to neurophysiological processes in probands with schizophrenia, suggesting that smoking status should be assessed in any study of information-processing dysfunction in this population. When all putative susceptibility factors were considered together, diagnosis of schizophrenia and family history of smoking best captured what may be characterized as an underlying (i.e. neurobiological) vulnerability to nicotine dependence, rather than circumscribed indices of electrophysiological functioning. Future studies might be implemented to refine the association between smoking and indices of electrophysiological function and, importantly, relate diagnostic or electrophysiological susceptibility factors to mediating processes and observable behaviors associated with aberrant patterns of nicotine use and dependence in persons with schizophrenia.Item A Comprehensive Assessment of Distress Tolerance as a Predictor of Early Smoking Lapse(2008-04-08) Stipelman, Brooke Allison; Lejuez, Carl W; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The CDC estimates that approximately 20.9% of U.S. adults currently smoke. Moreover, cigarette smoking continues to be the leading preventable cause of death and disability in the United States making it is a significant public health problem. Although 70% of smokers express a desire to quit, relapse is quite common, with rates as high as 60-90% depending on the method of quitting used. Moreover, many smokers who attempt to quit, lapse within a few days, and many of these individuals ultimately resume smoking and are not able to recover to achieve abstinence. The initial experience of smoking cessation is stressful and is associated with a number of unpleasant withdrawal symptoms. Therefore, one particular hypothesis suggests that how an individual reacts to and tolerates these uncomfortable feelings may be a key contributing factor of relapse. This threshold for tolerating physical and psychological stress is known as distress tolerance. While early evidence has suggested that distress tolerance is associated with duration of quit attempts, to date, no study has examined the effects of distress tolerance across physical, psychological and biological domains on a number of other relapse predictors (e.g. negative affect, anxiety sensitivity and withdrawal symptoms) in determining smoking outcome. Therefore, the following study looked at the role of these variables in predicting smoking outcome in a group of 58 adult smokers who entered a smoking cessation treatment study. As hypothesized, both measures of physical distress tolerance and one measure of psychological distress tolerance significantly predicted time to smoking lapse above and beyond other smoking related variables. There was no relationship between smoking abstinence and self-report and biological measures of distress tolerance. There were also no significant findings with respect to any affect related smoking variables. Implications and future directions are addressed.Item Smoking and Neurophysiological Markers of Information Processing in Schizophrenia(2007-05-25) Saperstein, Alice Meredith; Blanchard, Jack J.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The primary aim of this study was to compare patterns of nicotine consumption among patients with schizophrenia and a matched community control sample. Assessments included self-report and biological indexes of nicotine use as well as behavioral measures of smoking topography. Secondarily, this study tested the hypothesis that aspects of nicotine consumption are more closely associated with abnormalities in sensory gating and eye tracking performance among smokers with schizophrenia. Results from 50 patient and 10 healthy control smokers provided some evidence to support the primary hypothesis; biological indexes provided the most robust evidence that patients with schizophrenia extract more nicotine from smoking cigarettes than controls. Both groups demonstrated significant relationships between measures of nicotine dependence and neurophysiological functions. Patterns of results suggest that patients are less able to regulate smoking behaviors or efficiently utilize nicotine to enhance information processing. Additional factors likely contribute to smoking phenomena observed among patients with schizophrenia.