Theses and Dissertations from UMD
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Item DISPARITIES IN ADOLESCENT MENTAL HEALTH SERVICES UTILIZATION AND HELP-SEEKING(2024) Truong, Michelle L; Sehgal, Neil J; Boudreaux, Michel; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Inequities in access to and utilization of mental and behavioral health care for adolescents have persisted for numerous decades. Adolescents from racial and ethnic minority backgrounds, as well as those in underserved geographic regions, are disproportionately impacted. As the youth mental health crisis escalates, it is critical to study the mechanisms driving these disparities to inform effective and targeted interventions and policies. Divided into three studies, this dissertation explored the influence of individual, cultural, and contextual factors on adolescent help-seeking behaviors using data from the 2009 and 2011 to 2019 California Health Interview Survey (CHIS).The first study employed mediation analyses to assess the extent to which having a subjective or perceived need for mental health care, conditional on objective need, contributes to racial and ethnic disparities in mental health services utilization. I found significant racial and ethnic differences in subjective needs for mental health services and that these differences partially explain the racial and ethnic disparities in service utilization. The second study explored differences in mental health service utilization among subgroups of non-Hispanic (NH) Asian and Latino/Hispanic adolescents compared to NH white adolescents. I found that Vietnamese and Mexican adolescents were significantly less likely to utilize mental health services relative to their NH white counterparts. The third study merged the adolescent data with provider data from the National Plan and Provider Enumeration System (NPPES), facility data from the National Substance Use and Mental Health Services Survey (N-SUMHSS), and population data from the US Decennial Census Redistricting Data Summary Files to assess the moderating effects of distance to the nearest pediatric mental health facility and provider-to-population densities on the relationship between subjective mental health care needs and service utilization. I discovered that provider density and subjective needs interact, resulting in a diminished effect of subjective needs on service utilization among adolescents residing in areas with lower primary care provider density. I did not find that distance to the nearest pediatric mental health facility had a significant impact on service utilization. This dissertation examined racial, ethnic, and geographic mental health care disparities among a diverse adolescent population in California. Findings from this work contribute to the understanding of adolescent help-seeking behaviors and provide insights for targeted interventions and policies to advance mental health care equity.Item “THIS WILL NOT KILL US:” A REFLECTIVE EXPLORATION OF HOW BLACK WOMEN DOCTORAL STUDENTS AND ALUMNAE STRIVED FOR HOLISTIC MENTAL HEALTH AND WELLNESS(2024) Stone, Joakina; Kelly, Bridget T; Counseling and Personnel Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this qualitative research study was to develop a better understanding of the factors that influenced the holistic mental health and wellness of Black women doctoral students and recent alumnae during their doctoral journey. Although research is emerging on the wellness of graduate students, there is limited literature on Black women doctoral students’ wellness. From 2020 to 2023 there were national events involving Black women that underscored the necessity to understand and prioritize the holistic wellness of Black women doctoral students (e.g. Black women in higher education leaving their high-ranking positions and Naomi Osaka and Simone Biles taking a break from their respective sports and citing mental health as a factor). Using narrative inquiry as a methodological approach, and a conceptual framework comprised of Black feminist thought (Collins, 1986, 1989) and Hettler’s (1980, 1984) six dimensions of wellness, the experiences of nine Black women doctoral students and recent alumnae (who were no more than six-months post-graduation) were explored. This research sought to understand the strategies Black women doctoral students and recent alumnae used to manage and maintain their holistic mental health and wellness. The specific research questions that guided this study are: (1) How do Black women doctoral students and recent alumnae at Research 1 (R1) or Research 2 (R2) institutions in the mid-Atlantic region describe their mental health and wellness while pursuing their doctoral degree? (2) What contributed to and interfered with the holistic mental health and wellness of Black women doctoral students and recent alumnae during their doctoral programs?Co-narrators (participants of the study) participated in two semi-structured interviews, each ranging from 60 to 90 minutes in length. Data collection also included co-narrators submitting memes or gifs that represented their mental health and wellness during their doctoral journey. There were several themes that emerged from the data. First, the visual data revealed that co-narrators experienced exhaustion, anguish, fluctuation between joy and stress, and the need to keep moving forward despite what was happening around them. The images submitted served as a visual representation for the overall experiences of the women in the study and enhanced the understanding of the factors that contributed to or interfered with the holistic mental health and wellness of Black women doctoral students (i.e., Research Question 2). The additional findings that emerged from study are as follows: (a) “Wellness for Your Whole Body:” Co-Narrators Definitions of Holistic Mental Health and Wellness; (b) Factors that Contributed to Holistic Wellness, including the subthemes “They Needed the Sisterhood:” The Importance of Community with Other Black Women, and “Finding Those Pockets:” Intentionally Choosing Wellness in the PhD Journey; (c) Positive and Negative Contributing Factors to Holistic Mental Health and Wellness, which included the subthemes “All Skin Folk Ain’t Kinfolk:” Interactions with Challenging Black Faculty and Administrators, and “My Advisor . . . Was Super Supportive:” How Relationships with Black Faculty and Non-Black Faculty and Administrators of Color Can Influence Wellness; (e) Detractors From Holistic Mental Health and Wellness, which included the subthemes “The PhD Program Is Good About . . .Letting You Know You Don’t Belong:” Impostorism and Lack of Belonging in the Academy and “What Is the Benefit of . . . Being Productive, If You’re Literally Killing Yourself?”: Negotiating Wellness to Finish the PhD. The study concluded with implications for practice and research, followed by a letter from the author directly addressing Black women doctoral students.Item THE WORST OF TIMES? AGING WITH LIMITED FAMILY TIES IN THE UNITED STATES(2024) Liu, Jingwen; Caudillo, Mónica L.; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The drastic demographic and family transitions since the 1970s have raised ongoing discussions about whether older adults fare well socially and psychologically when they are increasingly likely to age alone in the U.S. Based on the social convoy model, the three studies of this dissertation answer this question by extending the focus from the proximal kinship ties to nonkin networks and broader social participation. Particular attention is paid to gender and racial/ethnic differences as demographic and family transitions are experienced unevenly by different social groups. The first study examines how family instability and the deviation from “normative” family trajectories are associated with older adults’ mental health. It found different levels of importance of the structure and instability of family for men and women of different racial/ethnic groups. Moving beyond family and households, the second study explores the substitution effect of extended family, friends, and neighborhoods in the absence of proximal relations. It reveals the “double plight” of Black and Hispanic older adults who may suffer from both a disproportionate exposure to the declining marriage and a lack of supportive distant relations serving as buffer zones in the absence of core kinship ties. The third study disentangles the population-level age and cohort trends of social connectedness, a more comprehensive indicator of individuals’ social wellbeing. It finds distinct intercohort changes in both the overall level of social connectedness and intracohort gender and racial/ethnic disparities. These trends can be partially explained by cohort differences in socioeconomic resources and health. However, societal changes that emphasize the significance of intergenerational solidarity, friendship ties, digital communication, non-religious social participation, and volunteering may play a more significant role. Taken together, this dissertation depicts a mixed picture of different populations who demonstrate varying levels of vulnerability and resilience against the quickly developing society. Therefore, it calls for both the enhancement of social welfare regimes and more positive narratives about unique resilience and strengths for women, racial/ethnic minorities, and socioeconomically disadvantaged older adults.Item Distress and Deaths of Despair in the U.S. Healthcare Delivery System: Understanding Patterns in Healthcare among Distressed Americans(2024) Spencer, Merianne Rose Tiglao; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The United States has experienced rising mortality rates for the past several decades. Drug poisonings have increased nearly five-fold, suicide rates by nearly 40%, and by nearly 30% percent for alcohol-induced deaths between 1999 and 2021. This collection of drug-, alcohol- and suicide deaths are oftentimes referred to as “deaths of despair”, first coined by economists Anne Case and Angus Deaton who cited health and socioeconomic disparities driving Americans into mental distress, depression, and anxiety. The impact on the mental health of Americans was further exacerbated by the COVID-19 pandemic; this exposed vulnerabilities in the mental healthcare system as well as the various stressors that negatively impacted individuals across the globe. Using nationally representative data, this dissertation delves into the deaths of despair phenomenon using a multidisciplinary health services research lens. Access, utilization, and risk from deaths of despair are examined by using psychological distress (which is treated as a proxy for despair in the first two aims). Using the Kessler-6 scale, a well-accepted and clinically valid tool for non-specific mental distress, this dissertation explores patterns of healthcare spending among those with varying severity levels of psychological distress over a two-decade period; delves into patterns of healthcare utilization among young adults aged 18-30 (a population disproportionately impacted by stressors during the COVID-19 pandemic) by psychological distress; and quantifies the risk of death among those with varying severity levels of psychological distress.Item LGBTQ+ Youth Therapeutic Engagement and Experiences: Associations with LGBTQ+ Family Environment(2024) Zheng, Azure; Fish, Jessica N,; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)LGBTQ+ youth experience unique stressors that increase the risk for poor mental health. LGBTQ+ youth’s family environment, often measured as parental acceptance and rejection of youth’s LGBTQ+ status, is associated with youth mental health; less often studied is how the family environment may be linked to LGBTQ+ youth’s access to therapy and, more importantly, experiences with LGBTQ+ affirmative and competent providers. Using a contemporary non-probability national sample of LGBTQ+ youth ages 13-17, our study examined the association among LGBTQ+ youth’s reports of caregiver supportive and rejection behaviors related to their LGBTQ+ identity and youth’s engagement and experiences in therapy. Using a step-wise logistic regression method, results tell a clear story. There is a consistent positive association between parent’s LGBTQ+ support behaviors and (1) youth access to therapy and (2) their therapists' LGBTQ+ competency. In the absence of controls, we found that parents’ rejecting behaviors were also positively associated with the youth’s access to therapy, but this relationship was mediated by the youth’s depression and anxiety symptoms. For youth who did not access therapy in the last year, those who reported more parental support were inversely related, and parental rejection positively related to wanting therapy but not receiving it. Youth who reported more rejecting behaviors from parents were less likely to perceive their therapists as LGBTQ+ competent. Findings point to varied pathways and experiences in therapy engagement for LGBTQ+ youth based on parents' support of their LGBTQ+ identity.Item 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.Item TOWARDS EXTENDING ACOUSTIC-TO-ARTICULATORY SPEECH INVERSION AND LEARNING ARTICULATORY REPRESENTATIONS(2023) H P Elapatha Rajapaksha Siriwardena, Yashish Maduwantha; Espy-Wilson, Carol; Electrical Engineering; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Acoustic-to-articulatory speech inversion involves the challenging task of deducing the kinematic state of various constriction synergies, including the lips, tongue tip, tongue body, velum, and glottis, based on their respective constriction degree and location coordinates. These coordinates are referred to as vocal tract variables (TVs). Developing Speech Inversion (SI) systems have gained attention over the recent years mainly due to its potential in a wide range of speech applications like Automatic Speech Recognition (ASR), speech synthesis, speech therapy, and mental health assessments. Over the past few years, deep neural network (DNN) based models have propelled the development of SI systems to new heights. However, the current SI systems still struggle with the lack of sufficiently larger articulatory datasets, speaker dependence, poor performance with noisy speech, and the lack of generalizability across different articulatory datasets. Moreover, one of the major drawbacks of the existing articulatory datasets is the lack of ground-truth data capturing velar and glottal activity of speech. With this work, we try to address some of the aforementioned challenges pertaining to the development of effective SI systems. Our experiments are based on two publicly available articulatory datasets; the University of Wisconsin X-ray microbeam (XRMB) dataset, and the HPRC dataset. We show that the use of appropriate audio augmentation techniques to synthetically create data can further improve the performance of SI systems both on clean and noisy speech data. We also show that the use of multi-task learning frameworks to carry out an auxiliary, but a related task can also improve the TV prediction. A key improvement came about when the SI systems were forced to learn source features (aperiodicity, periodicity, and pitch) as additional targets. Moreover, the use of self-supervised speech representations (HuBERT) and fine tuning them to the downstream task of speech inversion resulted in improved performance. With the aim of extending the current SI systems to estimate velar and glottal activity, data from an ongoing data collection was used to derive and validate two parameters; nasalance to capture velar constriction degree and electroglottography (EGG) envelope to capture voicing. A separate speaker-independent SI system was subsequently trained to estimate the derived parameters and is one of the first systems to achieve the feat. This SI system along with the conventional SI systems (trained to estimate lip and tongue TVs), provide a framework to estimate a complete articulatory representation of speech in speaker-interdependent fashion. While improving and extending the current SI frameworks, we also explored an unsupervised learning algorithm inspired by sensorimotor interactions in the human brain to perform audio and speech inversion. The proposed “MirrorNet”, a constrained autoencoder architecture is first used to learn, in an unsupervised manner, the controls of an off-the-shelf audio synthesizer (DIVA) to produce melodies only from their auditory spectrograms. The results demonstrate how the MirrorNet discovers the synthesizer parameters to generate the melodies that closely resemble the original and those of unseen melodies, and even determine the best set of parameters to approximate renditions of complex piano melodies generated by a different synthesizer. To extend the same idea of learning to vocal tract controls for speech, we developed a DNN based articulatory synthesizer (articulatory-to-acoustic forward mapping) to be incorporated as the motor plant of the MirrorNet. The MirrorNet with this motor plant, once initialized with a minimal amount of ground-truth data (~ 30 mins of speech), can learn the articulatory representations (6 TVs + source features) with significantly better accuracy. Overall, this highlights the effectiveness and power of the MirrorNet’s learning algorithm in enabling to solve the conventional acoustic-to-articulatory speech inversion problem with minimal use of ground-truth articulatory data. In order to assess the practical utility of articulatory representations in real-world scenarios, we employed articulatory coordination features derived from TVs to detect and analyze articulatory-level alterations in the speech of individuals with schizophrenia. We show that the schizophrenia subjects with strong positive symptoms (e.g. hallucinations and delusions), and who are markedly ill, pose a more complex articulatory coordination pattern in facial and speech gestures compared to healthy controls. This distinction in speech coordination pattern is used to train a multimodal convolutional neural network (CNN) which uses video and audio data to distinguish schizophrenia subjects from healthy controls. Furthermore, we used TVs estimated by the best performing SI system to detect mispronunciation of \ɹ\, a common speech sound disorder in children. The classification model trained with TVs performed better compared to the state-of-the-art hand-crafted age-and-sex normalized formants. In essence, the work in this dissertation presents steps taken towards developing effective acoustic-to-articulatory speech inversion frameworks, and highlights the importance of utilizing articulatory representations in real-world applications.Item Exploring Young Bi+ Women's Intersecting Mental Health and Sexual and Reproductive Health Experiences in Context: A Multi-Analytic Method Qualitative Study(2023) Robinson, Jennifer Lynn; Aparicio, Elizabeth M; Butler, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Young bi+ women report worse mental health and sexual and reproductive health (SRH) outcomes compared to gay, lesbian, and straight young adults. They experience intersecting threats to their health and well-being due to their sexuality, gender, and stage of development. There is a lack of research on bi+ women’s unique mental health and SRH experiences, and often bi+ women are overlooked due to bi-erasure and biphobia. Regressive policies related to LGBTQ+ and women’s rights, including increased restrictions to reproductive healthcare after the Dobbs v. Jackson Women’s Health Organization decision overturning abortion protections, further threaten bisexual women’s health. This dissertation used a multi-analytic method qualitative approach to explore the intersecting mental health and SRH experiences of young bisexual women in the current socio-political context. Semi-structured in-depth interviews were conducted over Zoom with 16 young bi+ women from across the U.S. A narrative inquiry approach was used to explore young bi+ women’s mental health experiences and coping strategies. In addition, thematic analysis was used to investigate how young bi+ women describe their mental health as intersecting with their SRH in the current socio-political context. The study yielded rich and nuanced information about challenges these young bi+ women experienced throughout their lives that affected their mental health and SRH. Experiencing trauma had far-reaching negative effects on their mental health. Participants discussed the challenges of forming their identity within the social context, particularly as bi+ women in a society that often invalidates bisexual identities and subjugates women. They also discussed the joys along with difficulties of navigating young adulthood. They further described coping with challenges in a variety of adaptive (e.g., therapy, exercise) and maladaptive (e.g., substance use, self-injury) ways. They discussed relying on social support such as partners, friends, family, therapists, and teachers. Participants desired more support with sexuality-related issues, particularly in early adolescence. These bi+ women described their mental health and SRH as intertwined and discussed how bodily autonomy and agency were essential to their well-being. The socio-political context, including social norms, rhetoric, and federal- and state-level policies, influenced participants’ well-being. The current study shows that young bi+ women face unique threats to their mental health and SRH. Practice implications include improving access to affordable and LGBTQ+-affirming healthcare and developing interventions attuned to the needs of young bi+ women. Policies are needed that uphold the choice and agency of young women in their reproductive health decision-making. Future research should continue to explore the needs and experiences of young bi+ women concerning their mental health and SRH including demographic differences along with potential mechanisms resulting in poorer health.Item Associations between Classical Music, Physical Activity and Symptoms of Depression in Older Adults during the COVID-19 Pandemic(2023) Arnold-Nedimala, Naomi A; Smith, J Carson; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: The initial lockdown in March 2020 due to COVID-19 rattled the residents of North America as normalcy came to a standstill, freedom was stripped away, and people were forced to adapt to new restrictions and regulations, simply to survive. The elderly population was greatly affected by the lockdown as it prohibited those living in assisted living facilities to physically interact with family and friends highlighting the need to identify protective behaviors against mental health and depression. The neurological benefits of listening to classical music is an emerging area of research. A few studies suggest the positive outcomes of listening to classical music in reducing symptoms of depression. Additionally, while the cardiovascular benefits of exercise are well known, the impact of exercise on affect continues to be an emerging area of research. Purpose: The purpose of this study is to understand the efficacy of listening to classical music in attenuating symptoms of depression in older adults (50 – 90+) utilizing data collected from 3 separate time points during the COVID-19 pandemic, and to determine if physical activity is associated with providing additional benefit to lowering symptoms of depression Methods: A survey including the Geriatric Depression Scale (GDS), the Physical Activity Scale for the Elderly (PASE), and questions about listening to music (classical, Broadway, Christian music), and the frequency of listening to music was generated and distributed to people living in the United States and Canada immediately following the initial COVID-19 lockdown in April 2020. Informed consent was obtained prior to completing the survey, and participants who were interested in receiving a follow-up survey were asked to provide their email addresses. The follow-up surveys were generated 4-months (August 2020) and one year (April 2021) after the initial survey. Results: At the initial onset of the COVID-19 lockdown in April 2020, significant associations were observed between classical music listening (CML) and lower symptoms of depression, physical activity (PA) and lower symptoms of depression, music listening frequency, and lower symptoms of depression. In August 2020 and April 2021, significant associations were found between physical activity and lower symptoms of depression. However, no associations were observed between classical music listening and lower symptoms of depression, and music listening frequency and lower symptoms Additionally, significant associations were observed between age and lower symptoms of depression, sex, and lower symptoms of depression at all three time points. Conclusion: The results from our study suggest that there is an association between classical music listening and symptoms of depression, physical activity and symptoms of depression, music listening frequency and symptoms of depression in older adults (50+) during the early stages of the COVID-19 pandemic (April 2020). Additionally, the association between physical activity and symptoms of depression was maintained throughout the first year of the pandemic as supported by the data collected in August 2020 (4 months) and April 2021 (12-months).Item EXAMINING THE ASSOCIATION BETWEEN INTERPREGNANCY INTERVAL AND MATERNAL HEALTH IN THE POSTPARTUM PERIOD(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.