UMD Theses and Dissertations
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Item Essays on the Economics of Crime, Gender, and Health(2023) Ramirez Pierce, Elena; Goldberg, Jessica; Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this dissertation I study the impacts of large government programs on crime and health outcomes. I also run an online experiment about the use of professional titles to elicit perceptions of experts cited in major news outlets and to test whether these perceptions vary across genders. In the first chapter, I examine the effects of large changes in cash availability on crime. South Africa has a large social safety net comprised of numerous cash transfer programs, called social grants, that are paid on a monthly basis. Prior to late 2018, these social grants were paid mostly in cash at grant disbursement locations called paypoints. Using a differences-in-differences (DiD) strategy, I analyze the effects of the temporary increase in cash availability on crime by comparing crimes on social grant payment dates in small geographical areas, police precincts, between areas with differing numbers of cash disbursement locations. The results suggest a small decrease in crime the day prior to social grant payments, and small increases the day of payments or the day after payments, depending on the empirical specification. These results are consistent with perpetrators potentially delaying their labor supply of crime until the widely publicized cash grant payment days, an anticipation effect, and increasing their labor supply of crime on or after payment days consistent with a loot effect, resulting from increased cash and purchased goods availability. Chapter two investigates whether there exists a credibility penalty for female experts compared to male experts when major news outlets forgo the use of professional titles, such as ``Dr." that serve as an information signal on the level of their training. Given the extensive literature on gender and racial bias in media reporting and professional and academic environments, the practice of abstaining from the use of professional titles may reinforce and even exacerbate these biases. In this co-authored analysis, we test for differential effects by conducting an online experiment that presented survey respondents with news articles holding constant content, but varying the gender and title of the cited experts and asked them to rate the expert's credibility. Our design enables between-subject and within-subject analysis. While we are able to detect a positive credibility effect of using professional titles, we are unable to distinguish a differential credibility impact across gender. Finally, in chapter three I estimate the effects of a large-scale national physician provision program in Brazil on birth outcomes. Given the risk to mothers of injury and disease associated with childbirth that may affect the health of the newborn, as well as the myriad of complications that may arise that could threaten the health of the fetus, increasing access to and quality of medical care may have substantial effects on birth outcomes. The Mais Medicos Program (PMM) focused on equalizing physicians per capita as well as generally increasing the number of physicians across the country. Beginning in late 2013 and an executive branch initiative, the program placed almost 20,000 physicians by 2016, predominantly from Cuba, throughout the country. Using vital statistics data of the universe of births in Brazil from 2006 to 2017, I estimate the effect of increasing the supply of primary care physicians on birth weight using both a differences-in-differences and an instrumental variables approach. I find that PMM resulted in higher average birth weight for children throughout Brazil. However, I find no improvement on the incidence of low birth weight or any weight effects for those living in rural parts of the country. Hence, these results imply PMM did not affect the most vulnerable pregnancies.Item Overcoming Opioid Stigma through Communication: An Extension of the Model of Stigma Communication(2022) Ledford, Victoria Ann; Nan, Xiaoli; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study examines how stigmatizing messages about opioids influence beliefs, emotions, attitudes, and behaviors. Uniting the model of stigma communication (MSC) and intergroup emotions theory (IET) along with persuasion and stigma research, this study proposed a new identity-based model of stigma message effects: the integrative model of identity-based stigma communication (I-MISC). The experimental study among 1,444 U.S. MTurk participants tests the proposed mediators and moderators put forth in the I-MISC and offers theoretical and practical implications related to stigma communication theory and opioids stigma communication. The I-MISC argues that stigma messages can lead to stigma-related outcomes through dual affective and cognitive pathways. In other words, stigma messages can cause harm because those messages trigger negative emotional reactions or belief-based perceptions. More specifically, the I-MISC situates stigma beliefs and negative affect or emotions as these dual mediators that can operate in tandem or separately to influence stigma outcomes. Affective mediators explored in this study include negative affect, anger, frustration, fear, disgust, anxiety, sadness, and sympathy. Cognitive mediators explored in this study include stigmatizing beliefs about opioids related to beliefs about dangerousness, immorality, and responsibility. In addition, experience with Opioid Use Disorders (OUDs) was explored as a moderator of the relationship between stigma messages and emotional responses. Five outcomes of the stigma process were considered: attitudes, social distance, behavioral regulation, support for opioid-related policies, and stigma message sharing. Results of a 4 (stigma message feature: mark, label, responsibility, peril) x 2 (stigma level: high, low) x 3 (opioid context: prescription opioids, fentanyl, heroin) between subjects online experiment offered preliminary support for the I-MISC. Mark and peril messages exerted the strongest effects, with null findings for label and responsibility messages. Mark and peril messages each exerted indirect effects on all five study outcomes, through primarily a combination of cognitive and affective pathways, leading to less positive attitudes, more desired social distance, increased behavioral regulation, less support for helpful opioid-related public policies, and more stigma message sharing. Affective mediation varied based on an individual’s experience with OUDs. This research suggests the importance of removing stigmatizing communication about opioids in health and news media messaging.Item Health, Self-Tracking Technologies, and the Emotional Impacts they have on Older Adults with Memory Concerns(2022) Short, Amelia; Lazar, Amanda; Library & Information Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Most individuals, including older adults, in the United States are not meeting the recommended levels of physical activity for their age group. Research has shown that adopting self-tracking technologies can be one way to motivate users to increase their physical activity levels. Further, tracking progress in terms of health and wellbeing has the potential to support individuals with memory concerns; however, most older adults do not use technology to track progress towards their health-related goals. While traditional qualitative research might aim to uncover the reason behind this lack of adoption, this thesis instead focuses on how the topics of health and self-tracking technologies affect the lives of older adults with memory concerns. Leaning on a style of writing and analysis from anthropologist Kathleen Stewart, this thesis offers the reader a series of resonating stories– stories that have no obvious meaning, classification, or rationalization. Rather, these narratives gather the textures and intensities that participants face in their everyday lives and offer us a brief look into their habitus and interactions with the world around them. By taking this approach, this thesis calls for more detail into participants’ lived experiences that would otherwise be overlooked by traditional qualitative analysis.Item Effects of a Mexican Conditional Cash Transfer Program on Health and Demography(2022) Ryu, Soomin; Parker, Susan W.; Public Policy; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Progresa, a Mexican conditional cash transfer program (CCT), was introduced in 1997 to alleviate poverty. The program provided cash payments to low-income households conditional on the children’s regular attendance at school and household members’ regularly visits to health clinics. Progresa also offered nutritional supplements, principally to young children and pregnant women. This anti-poverty program was one of the oldest and best-known CCT programs, supporting 7 million low-income families. However, in Spring 2019, the Mexican government officially dismantled Progresa. This dissertation evaluated the impacts of implementing and terminating of Progresa on Mexican health and demographic outcomes using nationwide vital statistics. As vital events were frequently under-reported in rural areas of Mexico where Progresa was mainly implemented, the first chapter examined the validity of vital statistics using the Brass method. I found that births and child deaths were under-reported in Mexico, and under-reporting was more severe in poorer areas. However, for births, there was little evidence of under-reporting once late-registered births were taken into account. The second chapter evaluated the effects of Progresa on fertility, child mortality, and maternal health. Using variations in the beneficiaries of Progresa across municipalities and time, I found that Progresa significantly reduced 0.4-0.5 births during a woman’s lifetime, while adolescent pregnancy was decreased by 13-18%. The program reduced child mortality by 19%, but the effect was temporary. Progresa also enhanced maternal health: it significantly increased institutional deliveries and birth attendance by physician, while decreasing childbirth at home and birth attendance by nurse or midwife. The third chapter assessed the effects of the recent sudden termination of Progresa: it immediately increased in infant mortality due to infectious and parasitic diseases, whereas it reduced deliveries at private clinic and marginally increased deliveries with midwives’ attendance. This dissertation makes significant contributions to social policy and public health by estimating the effects of the CCT program on understudied demographic and health outcomes and the effects of its sudden termination on maternal and child health. This research has crucial public health and policy implications, particularly for several middle- and low-income countries where similar CCT programs are implementedItem Promoting Rich and Low-Burden Self-Tracking With Multimodal Data Input(2022) Luo, Yuhan; Choe, Eun Kyoung; Library & Information Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Manual tracking of personal data offers many benefits such as increased engagement and situated awareness. However, existing self-tracking tools often employ touch-based input to support manual tracking, imposing a heavy input burden and limiting the richness of the collected data. Inspired by speech's fast and flexible nature, this dissertation examines how speech input works with traditional touch input to manually capture personal data in different contexts: food practice, productivity, and exercise. As a first step, I conducted co-design workshops with registered dietitians to explore opportunities for customizing food trackers composed of multimodal input. The workshops generated diverse tracker designs to meet dietitians' information needs, with a wide range of tracking items, timing, data format, and input modalities. In the second study, I specifically examined how speech input supports capturing everyday food practice. I created FoodScrap, a speech-based food journaling app, and conducted a data collection study, in which FoodScrap not only collected rich details of meals and food decisions, but was also recognized for encouraging self-reflection. To further integrate touch and speech on mobile phones, I developed NoteWordy, a multimodal system integrating touch and speech input to capture multiple types of data. Through deploying NoteWordy in the context of productivity tracking, I found several input patterns varying by the data type as well as participants' input habits, error tolerance, and social surroundings. Additionally, speech input helped faster entry completion and enhanced the richness of the free-form text. Furthermore, I expanded the research scope by exploring speech input on smart speakers by developing TandemTrack, a multimodal exercise assistant coupling a mobile app and an Alexa skill. In a four-week deployment study, TandemTrack demonstrated the convenience of the hands-free speech input to capture exercise data and acknowledged the importance of visual feedback on the mobile app to help with data exploration. Across these studies, I describe the strengths and limitations of speech as an input modality to capture personal data in various contexts, and discuss opportunities for improving the data capture experience with natural language input. Lastly, I conclude the dissertation with design recommendations toward a low-burden, rich, and reflective self-tracking experience.Item The Impact of International Accreditation on The Quality of Health Services at King Fahd University Hospital, Saudi Arabia: A Mixed Methods Approach(2019) AL Shawan, Deema Saad; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The Joint Commission International Accreditation (JCIA) is perceived worldwide as the symbol of exceptional quality of care. Despite the popularity of international accreditation, evidence of its effectiveness on improving health care quality is inconclusive. This dissertation research utilized a Convergent parallel mixed method framework to evaluate the impact of the JCIA process on quality and to identify the factors that influence the effectiveness of this process at King Fahd Hospital of the University in Khobar, Saudi Arabia. An interrupted time series analysis was conducted to assess the changes in a total of 12 quality outcomes pre and post accreditation. Furthermore, a qualitative approach was used to investigate the attitudes and perceptions of 31 health providers towards this process and the factors that influence its success. The quantitative results suggested that the JCIA had a positive impact on 9 out of 12 outcomes. The improved quality outcomes included: the average length of stay, the percentage of hand hygiene compliance, the rate of nosocomial infections, the percentage of radiology reporting outliers, the rate of pressure ulcers, the percentage of the correct identification of patients prior to medication administration, the percentage of critical lab reporting within 30 minutes, and the bed occupancy rate. The outcomes that did not improve were the rate of patients leaving the ER without being seen, the percentage of OR cancelations on the day of the or and the rate of patient falls. The qualitative analysis suggested that the JCIA was perceived positively by all participants. Some of the perceived advantages of international accreditation included the transformation of the organizational culture to a culture that promotes continuous quality improvement, standardization, and the reduced paperwork in some departments. The participants’ responses also indicated that there were many factors that influence the success of the process. Examples of the factors identified in the study include the increased workload and the providers’ resistance to participate in the JCIA process. In conclusion, international accreditation seemed to have a positive impact on quality outcomes and was received positively by providers. Nevertheless, the factors that hindered the JCIA process need to be addressed by the hospital’s leadership to ensure more efficient quality improvement efforts during future accreditation cycles.Item FAMILY-CENTERED PEDIATRIC CARE: PREDICTORS OF ACCESS AND ASSOCIATIONS WITH CHILD WELL-BEING(2019) Fife, Julie Marie; Lewin, Amy B; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Despite widespread recognition that family-centered care (FCC) is a critical component of quality pediatric health care, not all children receive FCC. This study builds on previous work by: (1) examining the extent to which socioeconomic resources are associated with the receipt of FCC after implementation of the Affordable Care Act, (2) exploring whether healthcare workforce shortages interfere with the delivery of FCC, and (3) extending previous research on the role of FCC in child well-being by measuring well-being across multiple domains and including children without special health care needs. Using data from the 2016 National Survey of Children’s Health (n=50,212), this study found a graded relationship between the odds of receiving FCC and multiple indicators of family-level socioeconomic resources, indicating that socioeconomic resources, beyond health insurance, are important factors in accessing quality pediatric health care. Healthcare workforce shortages may also play a role in the availability of FCC. Results from this study found consistent and significant associations between FCC and positive child well-being among healthy and typically developing children, and these associations were found across all domains of development. Findings indicated that FCC is particularly beneficial for young children (0-5 years), and children in households with low to moderate socioeconomic resources, making it a potentially meaningful tool to help reduce health disparities for children from households with more limited socioeconomic resources. Future research, and policies and practices aimed at increasing the delivery of FCC should include and emphasize the experiences of Hispanic families and families with limited socioecnomic resources.Item THE PHYSICAL CULTURE OF DIVERSITY WORK: A CASE STUDY OF EMBODIED INCLUSION AND EXCLUSION WITHIN THE CONTEMPORARY AMERICAN UNIVERSITY(2019) Cork, Stephanie Joan; Jette, Shannon; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Considering recent incidents of white nationalism and racial violence on college campuses, the efficacy of diversity and inclusion work within this context has garnered increased attention. What received less attention, however, the embodied experiences of university employees, specifically “diversity workers,” who are tasked by their institution to combat equity issues. Previous research has shown that experiences of exclusion and discrimination can negatively impact work, educational, and health outcomes.This study explores how these impacts are experienced by the diversity workers themselves, many of whom inhabit intersectionally marginalized identities. In examining the physicality of the diversity worker, this project merges scholarship from the field of public health and the sociology of work to investigate occupational health and wellness through the lens of critical theory. It builds on a long tradition of studying the working body in the field of kinesiology through the lens of occupational health, and in doing so also fills a gap in the area of Physical Cultural Studies given that bodies at work (outside the sporting context) have received little attention in this subfield.The aims of this study are to explore the social, political, and economic context of the diversity worker in contemporary American post-secondary education, and how this impacts health, wellness, and job performance. This study uses a critical qualitative approach drawing from theories of embodiment, radical contextualism, and intersectionality. Data collection entailed a survey (n = 48) and one-on-one semi-structured interviews with diversity workers (n = 8) at an anonymized site referred to here as “public four-year university.” Using thematic analysis and the radical contextual method of articulation, the data was coded and synthesized to construct the three empirical chapters. Through centering the embodied experiences of diversity workers within the context of the contemporary American university, this study contributes to existing scholarship in a variety of disciplines. Study findings point to how we might better support diversity work and workers through a more supportive and healthier workplace environment.Item Psychological Well-being and Health Gains in the Developing World: Evidence from Peru and Malawi(2018) Dickerson, Sarah; Graham, Carol; Public Policy; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this dissertation, I assess the relationship between psychological well-being and health gains in Peru and Malawi. The first chapter consists of a comprehensive and systematic examination of research that frames the quantitative analyses found in the second and third chapters. It investigates literature on the relationship between maternal well-being and multiple dimensions of health in children and adolescents. It also explains how maternal depression may interact with poverty to worsen offspring’s outcomes. Then, it explores literature on the association between catastrophic health expenditure in Malawi and two of its potential predictors: unexplained happiness and access to antiretroviral therapy (ART), a treatment regimen for people living with HIV/AIDS. The second chapter assesses the impacts of maternal depression and life satisfaction on children in Peru. Using panel data from rounds three (2009-2010) and four (2013-2014) of Young Lives Peru, I find that children’s self-reported life satisfaction and health positively correlate with maternal life satisfaction and negatively associate with maternal depression. Furthermore, maternal life satisfaction predicts whether a female adolescent smokes, while maternal depression predicts smoking behavior and misinformation on pregnancy amongst male adolescents. The third chapter investigates the relationships between household catastrophic health expenditure in Malawi and two predictors, antiretroviral therapy (ART) and unexplained happiness. Using data from round two (2004-2005) and round three (2010-2011) of Malawi’s Integrated Household Survey, I find that proximity to ART-providing clinics and higher levels of psychological well-being associate with reduced likelihood of catastrophic health expenditure.Item The effect of feeding mixed tocopherol oil on body accumulation and immune cell functions in lactating holstein dairy cows(2017) QU, YANG; Moyes, Kasey M; Animal Sciences; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Non-α-tocopherol (i.e. β, γ, and δ-tocopherol) supplements are as important as α-tocopherol with regard to maintaining lactating dairy cow health. However, information on non-α-tocopherol bioaccumulation and its effects on immune cell function is not available. A series of experiments were conducted to investigate the effect of mixed tocopherol oil supplement (Tmix; i.e. α, β, γ, and δ-tocopherol) on body accumulation and immune cell functions of the lactating Holstein dairy cow. Tissue, tissue mitochondria, blood and milk were collected from lactating dairy cows to measure the concentration of all four tocopherol isoforms via Tmix supplementation. In addition, polymorphonuclear leukocyte (PMN) were isolated to investigate the effect of Tmix on its function and immune gene expression. In the first experiment, Tmix increased γ-tocopherol concentrations but did not increase the α-tocopherol concentration in three different types of tissues (i.e. liver, mammary gland and muscle) and liver mitochondria. Within those three different types of tissues, liver showed the highest ability to store tocopherol isoforms (i.e. α- and γ-tocopherol) compared to the other two tissues. Also, amounts of α- and γ-tocopherol were detected in liver mitochondria, but limited amounts were detected in mammary gland mitochondria. In the following experiment, Tmix increased γ-tocopherol concentration in milk and blood as determined via every 8 h and daily measurements. Compared to γ-tocopherol, α-tocopherol showed the highest concentration of the tocopherol isoforms in milk and blood. Limited quantities of β- and δ-tocopherol were detected in milk and blood via Tmix supplementation. In the last experiment, Tmix increased PMN chemotaxis function and did not impair the whole blood respiratory burst response of dairy cows, which might be associated with non-α-tocopherol existing in Tmix. Even though Tmix increased the expression of pro-inflammatory genes in PMN, those are needed during the initial immune activation. Overall, the results of the experiments demonstrated that short-term supplementation with Tmix could compensate γ-tocopherol without altering α-tocopherol in dairy cows. The liver showed the highest capability of accumulating tocopherol isoforms compared to the mammary gland and muscle. In addition, Tmix did not harm immune functions or have any apparent effects on animal health in lactating Holstein dairy cows.