Theses and Dissertations from UMD
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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 give thesis/dissertation in DRUM
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Item The Health Implications of Stress among Asian Americans in the US and Chinese In China: the Effects of Perceived Stress and Caregiving Stress on Cardiovascular Risk Factors(2018) Lu, Xiaoxiao; Lee, Sunmin; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Prior research suggests that stress plays a role in the etiology and progression of cardiovascular disease (CVD). To lend a more accurate depiction of the associations between stress and CVD risk factors, this dissertation used a comprehensive approach to conceptualizing stress by assessing two dimensions of stress: perceived stress and caregiving stress. The objective of this dissertation was to investigate the associations between multiple dimensions of stress and the risk factors of CVD. This dissertation also explored the potential mechanisms that underlie the relationships between stress and CVD risk factors. In Paper 1 (Chapter 3), we assessed the associations between perceived stress and hypertension across varying levels of social support and social network among 530 Chinese, Korean and Vietnamese Americans. Results indicated that individuals with high perceived stress were 61% more likely to have hypertension compared to those with low levels of perceived stress (Odds Ratio (OR): 1.61, 95% Confidence interval (CI): 1.15, 2.46). Social support had a direct beneficial effect on hypertension, irrespective of whether individuals were under stress. In Paper 2 (Chapter 4), we used five waves of longitudinal data from the China Health and Nutrition Survey to examine the association between parental caregiving and blood pressure among 2,586 Chinese women. We found that parental caregivers were associated with higher systolic (β-coefficient (β) = 1.16; p ≤ 0.01) and diastolic blood pressure (β = 0.75; p ≤ 0.01) compared with non-caregivers across multiple waves. In Paper 3 (Chapter 5), we investigated the relationship between caregiving trajectory and Metabolic Syndrome (MetS) among 1,636 Chinese women. Three caregiving trajectories were identified by using group-based trajectory analysis. Results showed that ‘rising to high-intense’ caregivers (OR = 1.90; 95% CI: 0.90, 4.00) and ‘stable low-intense’ caregivers (OR = 1.56; 95% CI: 1.06, 2.29) were associated with higher risk of MetS compared with non-caregivers. This dissertation is innovative in its examining the associations of multiple dimensions of stress with CVD risk factors among Asian subgroups. Findings from the proposed study will be used to develop future stress management interventions, and incorporating culturally and linguistically appropriate strategies into community outreach and education to decrease cardiovascular disease risk within the Asian population.Item Dietary and Acculturation Factors Influencing Metabolic Syndrome among South Asian Americans In Two Community Health Centers in Maryland(2014) Khan, Saira; Jackson, Robert; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)South Asian's (SA) have been observed to have higher insulin resistance followed by an altered state of metabolism; however, few studies have attempted to explore the acculturation process and dietary practices of immigrant SA's in the U.S. 1401 South Asian Americans living in Maryland from India, Pakistan, Bangladesh, Sri Lanka, Nepal, Iran, and Afghanistan were selected from two community health clinics to determine the prevalence of metabolic syndrome (MetS) in this study group and its indicators. The prevalence of MetS (51%) in adults was higher than African Americans, European Americans, and Mexican Americans. Overall, Indians had the highest percent of MetS 54% compared to Bengali 51%, Pakistani 49%, or Other SA 44%. The results suggest the high prevalence of MetS among SA may be due to a lack of acculturation in this survey group where 80% were classified as Asian low acculturated. Results from a logistic regression analysis showed that the likelihood of developing MetS was high, but future investigations are needed to confirm the role of acculturation from a more representative sample of SA's. We also examined the role of acculturation, diet and exercise in South Asians who acquire MetS. We also examined the diet quality using the 2010 guidelines. The low acculturated South Asians had a greater prevalence of MetS and the overall diet quality of the low income South Asians in Maryland needed improvement. The SA male and female mean scores for the healthy eating index-2010 were 71.9 ± 1.9 and 67.9 ± 1.2, respectively. Males were more acculturated, consumed healthier foods, and had a lower percent of MetS compared to females.Item IS THE CURRENT DEFINITION OF THE METABOLIC SYNDROME A USEFUL TOOL FOR THE DETECTION OF CARDIOVASCULAR DISEASE IN NON-HISPANIC BLACKS?(2010) Rodriguez, Omayra Isabel; Song, Jiuzhou; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Blacks in the country suffer from higher prevalences of obesity, diabetes, hypertension and cardiovascular disease compared to whites. Paradoxically, they have the lowest prevalence of the Metabolic Syndrome (MS) compared to whites and Mexican Americans. This is likely due to the fact that blacks tend to have lower triglycerides (TG) and higher high density cholesterol (HDL) levels. We challenged the current lipid criteria established by the Adult Treatment Panel III for the detection of the MS and set out to find more appropriate TG and HDL cutoffs to detect the MS in blacks. Using data from the National Health and Nutrition Examination Survey from 1999-2006, we identified that a more appropriate TG cutoff for blacks to detect the MS is 110 mg/dL but were not able to identify more suitable HDL cutoffs. Our results confirm that race/ethnic-specific criteria should be established for the detection of the MS across racial/ethnic groups.Item Assessment of Metabolic Syndrome in a sample of Central and South Americans living in the Washington, D.C. area(2010) Gill, Regina Marie; Jackson, Robert T.; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The Central/South American population is growing rapidly in the U.S., but little is known about the health status. The purpose of this study was 1) to estimate the prevalence of MS and its individual components, 2) compare risk factors among Hispanic sub-groups, and 3) examine how metabolic syndrome (MS) prevalence estimates have changed from 1993–1994 to 2008–2009 in a sample of Central/South Americans living in the D.C. area. In this cross-sectional, medical record extraction survey, data from 1993–1994 were compared with data from 2008–2009 on 1,042 male and female adults collected by questionnaire. 28% of our subjects had MS. The most prevalent MS components were low HDL (43.2% men; 50.7% women), elevated triglycerides (37%), and high BMI ≥ 25 kg/m2 (75.6%). Among Central/South Americans, Salvadorans had the highest prevalence of MS (30.7%). MS prevalence was significantly greater for the 2008–2009 subjects (27.9%) compared with 1993–1994 subjects (19.7%) (p ≤ 0.05).Item Appropriate Waist Circumference Cutoff Values for the Diagnosis of Metabolic Syndrome in Mexican American Adults(2009) Sarafrazi, Neda; Jackson, Robert T; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Metabolic syndrome increases the risk of cardiovascular disease and diabetes. The International Diabetes Federation (IDF) recently proposed new criteria for the diagnosis of metabolic syndrome, which requires the presence of central obesity as measured by ethnic specific waist circumference (WC) cutoff values. Currently, no specific WC thresholds for diagnosis of central obesity in Hispanics are available. The objectives were to determine the appropriate gender specific WC thresholds for diagnosis of central obesity in Mexican American adults and to estimate the prevalence of metabolic syndrome using IDF definition with and without the modified WC in this population. Data from 3265 Mexican American adults aged 20-80 years who participated in the National Health and Nutrition Examination Survey 1999-2006 were used. The prevalence of metabolic syndrome was compared using IDF criteria with and without the modified waist circumference. Receiver operating characteristic curve analysis suggested that yielding at least 80% sensitivity, the WC value of 90 cm in both genders was more appropriate in predicting the presence of two or more metabolic syndrome risk factors in this population. Based on this cutoff, there was 34% reduction in the prevalence of central obesity in women (82.5% to 54.2%). The age adjusted prevalence of metabolic syndrome decreased from 58.4 to 48.2%. The metabolic syndrome was more common among Mexican American men than women (55.8% in men versus 37.8% in women, P =0.0003). Our findings provided a practical guidance in the assessment and screening of central obesity and metabolic syndrome in Mexican Americans.Item The Politics of Metabolism: The Metabolic Syndrome and the Reproduction of Race and Racism(2009) Hatch, Anthony Ryan; Collins, Patricia H; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Biomedical researchers, government agencies, and the pharmaceutical industry increasingly use the term metabolic syndrome to define the observed co-occurrence of the major biological risk markers for heart disease, type II diabetes, and stroke. The metabolic syndrome is a new feature in what I call the politics of metabolism, or the discourses, social processes, and institutional relationships that governs the metabolism of individuals and groups. The emergence of the metabolic syndrome reflects a growing network of scientific, state, and corporate actors and institutions that are invested in studying, regulating, and profiting from control over metabolism. Drawing on insights from critical race theory, science and technology studies, and Foucauldian studies of biopower, I analyze the metabolic syndrome as a new discourse about metabolism that continually draws upon racial meanings to construct individual and group differences in different kinds of metabolic risk. The metabolic syndrome not only constitutes a new way of constructing, studying, and treating metabolic health problems, it also constitutes an emerging site for the production of racial meanings. Researchers use race in metabolic syndrome research and to study, prescribe, and label prescription drugs that may be related to the metabolic syndrome. I investigate the use of race and the metabolic syndrome in biomedical research on prescription drugs and African Americans. I develop the metaphor of killer applications to examine how prescription drugs operate in the politics of metabolism. A killer application is a superior technology that combines human and non-human elements that structure bodily practices in a wide range of social, commercial, and scientific contexts--prescription drugs have become the new killer applications in biomedicine. I argue that the search for killer applications has transformed the ways that pharmaceutical corporations study prescription drugs, metabolism, and race. I compare how drug researchers use race and the metabolic syndrome to study antipsychotics and statins in African Americans, how physicians' race-based diagnoses of schizophrenia and high cholesterol structure the prescribing patterns of antipsychotics and statins, and how scientists' assumptions about the genetic basis of racial differences in drug metabolism structure the debate about racebased drug therapies.Item Aerobic Fitness and Prevalence of the Metabolic Syndrome in African Americans and non-African Americans in PREMIER: a randomized controlled trial(2008-08-11) Levin, Laura A; Young, Deborah R; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: The Metabolic Syndrome is the clustering of several cardiovascular risk factors for coronary heart disease and Type 2 Diabetes Mellitus. This syndrome is of public health importance due to its high prevalence and high correlation to all-cause, CHD, and CVD mortality. The purpose of the current study was to determine if a change in aerobic fitness in the treatment group significantly decreased the odds of Metabolic Syndrome at 6 and 18 months. Methods: There were 810 adult participants in this trial with above-optimal blood pressure and up to stage I hypertension. Participants were part of an advice-only control group or a treatment group where physical activity increases were the main component. Results: A change in aerobic fitness, independent of treatment status, was significantly associated with a decrease in prevalent Metabolic Syndrome at both 6 and 18 months (OR: 0.96, CI: 0.94 - 0.98 & OR: 0.96; CI: 0.94 - 0.98, respectively).