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

More information is available at Theses and Dissertations at University of Maryland Libraries.

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Now showing 1 - 10 of 22
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    Data Analytics and Mathematical Models to Facilitate Disease Prevention in the U.S.
    (2020) Apergi, Lida Anna; Baras, John; Golden, Bruce; Business and Management: Decision & Information Technologies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The U.S. is leading in healthcare expenditures worldwide, but health outcomes in the U.S. are not reflective of the level of spending. Prevention plays a crucial role in improving the health of individuals in the U.S., since it helps people live longer and healthier lives. Preventive services include actions that prevent diseases from ever occurring, detect diseases at an early stage, and manage diseases that have already been diagnosed. In this dissertation, we use data analytics and mathematical modeling techniques to better understand factors that influence disease prevention and help provide efficient solutions. In the first part of this dissertation, we study two problems of disease prevention at the public health level. First, we investigate the impact of state-level vaccination exemption policy and of the highly publicized Disneyland measles outbreak on MMR vaccination rates of young children. At the same time, we highlight the impact that the choice of socioeconomic factors can have on measurement results. We estimate the impact of these policies using multiple linear regression. Furthermore, we study the sensitivity of the results by examining a number of different approaches for the selection of socioeconomic control variables. Second, we utilize big data to estimate the additive cost of chronic diseases and study their cost patterns. We model the cost based on a cost hierarchy; that is, the cost of each condition is modeled as a function of the number of other more expensive chronic conditions the individual has. Using large scale claims data, we identify members that suffer from one or more chronic conditions and estimate their healthcare expenditures. Through our analysis, we categorize the chronic conditions into different expenditure groups based on the characteristics of their cost profiles. In the second part of this dissertation, we study two problems of disease prevention at the healthcare provider level, focusing in the area of cardiology. First, we study the adoption of conversational agent technology by patients with heart failure. Conversational agents can help patients with heart failure to manage their condition and provide frequent feedback to their healthcare providers. We analyze data from two studies, with each study focusing on a different type of conversational agent. We compare the two types of conversational agent technologies in terms of patient engagement, and investigate which patient characteristics are important in determining the patient engagement. Second, we tackle the problem of outpatient scheduling in the cardiology department of a large medical center. The outpatients have to go through a number of diagnostic tests and treatments before they can complete the final procedure. We develop an integer programming model to schedule appointments that are convenient for the outpatients by minimizing the number of visits that the patients have to make to the hospital and the time they spend waiting in the hospital. Furthermore, we investigate whether scheduling outpatients in groups can lead to better schedules for the patients.
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    The Distribution of Care: A Modular Facility for the Treatment of Disease-Stricken Communities in Africa
    (2020) Winters, Kelsey; Gabrielli, Julie; Architecture; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Africa experiences a disproportionate amount of the global disease burden, and existing health care centers struggle to meet everyday patient needs. During a disease epidemic, this inability to accommodate communities is exacerbated by a lack of resources to diagnose and treat infectious disease as well as a physical separation from the location of outbreaks. This thesis investigates how patients of disease outbreaks in Africa can be better accommodated through the exploration of a modular health facility capable of treating communities no matter when and where an outbreak occurs. Outbreaks unexpectedly affect vulnerable populations, and immediate action is crucial to contain the disease. The current Ebola outbreak in the Democratic Republic of Congo is utilized as a case study in this thesis, considering its relevance as an ongoing epidemic. Due to the abrupt and destructive nature of disease, a modular and flexible health facility is needed to handle any outbreak in any location.
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    SOCIAL AND ENVIRONMENTAL BARRIERS TO HEALTHCARE ACCESS AND UTILIZATION FOR LESBIAN, GAY, AND BISEXUAL PEOPLE IN CALIFORNIA.
    (2020) Akre, Ellesse-Roselee; Roby, Dylan H; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Sexual minorities, lesbian, gay and bisexual people, are exposed to chronic stigmatization and heteronormativity in their daily lives and when they access health care. There are no genetic differences between sexual minorities and their heterosexual counterparts; the literature demonstrates that chronic stress related to being a minority, experiences associated with accessing care in a system that assumes one is heterosexual, exposure to negative attitudes from others, and internalized negative attitudes regarding one’s sexuality impact health outcomes and healthcare access and utilization. While there are known barriers to healthcare access the literature does not examine how multiple social identities influence healthcare access in sexual minorities. Intersectionality posits that the interconnected nature of social identities creates an overlapping and interdependent system of disadvantage. This study had three aims: 1) To examine differences in healthcare access at the intersections of urbanicity, race/ethnicity, and sexual identity; 2) examine differences in healthcare access at the intersections of sexual identity, gender, and income; and 3) determine whether non-identifying sexual minorities have disparate access to healthcare compared to identifying sexual minorities. Using 2014-2017 California Health Interview Survey data combined with the supplemental sexual orientation special use research file, I examined the relationship between healthcare access and utilization outcomes and the intersections between sexual identity, urbanicity, gender, income, and sexual identity disclosures. Using known evidence of barriers to healthcare access as dependent variables I used predictive modeling to estimate odds ratios of experiencing barriers to healthcare access using adjusted logistic regressions. The results of my dissertation produced evidence that for sexual minorities in California, sexual identity is associated with varying levels of healthcare access when examined within the context of other social identities. That is, there are differences in access and utilization amongst sexual minorities based on income and gender, and within subgroups of sexual minorities, especially in female and bisexual subgroups. Urban and rural environment did not determine healthcare access in sexual minorities and there was not enough data to confidently estimate differences in access between urban and rural sexual minorities of color. Study findings demonstrate that the female gender has more disadvantages to healthcare access that advantages regardless of income and sexual identity. They also demonstrated that income does not fully mitigate access barriers in sexual minority women. Lastly, findings from the study demonstrate that the non-identifying sexual minority identity is associated with less access to healthcare, specifically in men. Findings from this dissertation contributes to the knowledge of how disparities in healthcare access and utilization continue to persist in the sexual minority population despite increased access to healthcare coverage. This dissertation suggests that other factors uniquely related to being female and bisexual are salient for accessing healthcare for sexual minorities. It is essential that researchers, policy makers, and healthcare providers and staff provide more data on sexual minorities, create curated policy to support the most vulnerable sexual minorities, and engage in culturally sensitive training to eliminate barriers to healthcare access for sexual minorities to eliminate healthcare access disparities.
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    Modeling Syndromic Surveillance and Outbreaks in Subpopulations
    (2020) Pettie, Christa; Herrmann, Jeffrey; Reliability Engineering; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    This research is motivated by the need to assist resource limited communities by enhancing the use of syndromic surveillance (SyS) systems and data. Public health agencies and academic researchers have developed and implemented SyS systems as a pattern recognition tool to detect a potential disease outbreak using pre-diagnostic data. SyS systems collect data from multiple types of sources: absenteeism records, over the counter medicine sales, chief complaints, web queries, and more. It could be expensive, however, to gather data from every available source; subsequently, gathering information about only some subpopulations may be a desirable option. This raises questions about the differences between subpopulation behavior and which subpopulations’ data would give the earliest, most accurate warning of a disease outbreak. To investigate the feasibility of using subpopulation data, this research will gather and organize SyS data by subpopulation (separated by population characteristics such as age or location) and identify how well the SyS data correlates to the real world disease progression. This research will study SyS how reports of Influenza-like-illness (ILI) in subpopulations represent the disease behavior. The first step of the research process is to understand how SyS is used in environments with varying levels of resources and what gaps are present in SyS modeling techniques. Various modeling techniques and applications are assessed, specifically the Susceptible Infected Recovered “SIR” model and associated modifications of that model. Through data analysis, well correlated subpopulations will be identified and compared to actual disease behavior and SyS data sets. A model referred to as ModSySIR will be presented that uses real world community data ideal for ease of use and implementation in a resource limited community. The highest level research objective is to provide a potential data analysis method and modeling approach to inform decision making for health departments using SyS systems that rely on fewer resources.
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    Moving Milk: Public Health, Milk Transportation, and Modal Choices in Baltimore, 1840-1940
    (2018) McDonald, James Dixon; Zeller, Thomas; History; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    This thesis studies the factors leading to the modal shift from rail to road in Baltimore’s farm to city milk transportation in the 1920s. It draws on histories of transportation, public health, food, and business to maintain that progressive public health regulation, driven by calls for reform of the milk supply, created an oligopoly for which trucks better suited vertical integration goals. This research highlights the relevance of public health policy to the study of transportation regulation and modal competition. Secondarily, this thesis establishes railroads as a primary actor in the 19th century rise in urban milk consumption.
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    Forum Theatre as Theatre for Development in East Africa
    (2017) Warheit, Emily Jane; Frederik, Laurie; Theatre; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Theatre for development (TfD) includes a variety of performance practices that aim to communicate or foster dialogue in a development context. Forum Theatre, developed by Brazilian Director Augusto Boal as part of his Theatre of the Oppressed movement has become one of the most widely used forms in TfD. This dissertation looks at the use of Forum Theatre specifically in public health-focused programs funded by the United States Agency for International Development (USAID) in Uganda and Kenya. The appeal of Forum Theatre for addressing development issues stems from its participatory nature, particularly as it aligns with current trends towards community involvement in development. However, power imbalances inherent in foreign-funded projects, public health communication theories modeled after advertising, and the realities of life- and livelihood-threatening conditions on the ground all work against the liberatory potential of the form. The focus of Forum Theatre is on identifying and combatting oppression; in developing communities, what oppressions can theatre projects initiated from the top down by USAID actually address in practice? This study is a multi-sited exploration of the organizations and individuals involved in the funding, planning, and executing of two forum theatre projects promoting global public health goals. Through interviews of stakeholders and organization publications including training manuals and project reports, I examine how the organizations involved implement, evaluate, and justify the effectiveness of the use of theatre in their work. Despite the popularity of theatre for development in Sub-Saharan Africa, many development professionals, particularly in the US, have limited knowledge of how to use theatre in their programs. This study has the potential to improve the understanding of the use of Forum Theatre for both development professionals and theatre artists, allowing for more effective application. It will also place theatre for development in its context in the complicated web of the development industry, illuminating how TfD projects are planned and funded for an audience of theatre scholars and practitioners.
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    Health, Multiculturalism and Social Integration
    (2013) Na, Ling; Hample, Dale; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    This project was inspired by Durkheim's (1897, 1951) pioneering theory of social integration and its health benefits, as well as relatively more contemporary work on contact hypothesis by Allport (1951) and intercultural communication theory by Kim (2001). Durkheim proposed that the underlying cause of suicide was lack of social integration. More recent research also suggested that social integration had health benefits, such as reduced mortality and morbidity, better mental health and wellbeing. What is often missing from this picture is the role of network homophily and possible psychological pathways in the relationship between social integration and health. This study explored social integration, health outcomes, and psychological wellbeing of different groups in Canada using the Canadian General Social Survey 2008, tested the potential predictors of ethnic homophily with multilevel modeling and regression analysis based on Allport's contact hypothesis, examined how ethnic homophily and racial diversity in the neighborhood affected individuals psychologically, and how social integration affected health outcomes (physical health, mental health, and psychological wellbeing) via psychological pathways (personal control, sense of belonging and generalized trust) for each group of Canadians using structural equation modeling. The study found that visible minority immigrants were least socially integrated, and their health outcomes remained at a comparable level as the native-born whites. The Aboriginal Peoples reported poorest physical health, mental health, and psychological wellbeing and lowest level of income and education achievement. They were however integrated at a comparable level as the native-born Whites. Compared to visible minorities, whether they were immigrants or not, Aboriginal Peoples had more ethnically and linguistically homophilous social networks. Living in diverse neighborhoods decreased the sense of belonging felt by the native-born Whites, whereas having less homophilous networks increased the generalized trust of white immigrant and increased the sense of belonging felt by visible minority immigrants. The study also showed social integration had positive impacts on health outcomes across five groups, even though not all effects were significant. When a total effect of a social integration variable on a health outcome variable was significant, it was very likely to be mediated by a psychological pathway. Limitations of the study were discussed as well as its theoretical and policy implications.
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    PREDICTORS OF RESILIENCE AMONG COMMISSIONED OFFICERS IN THE UNITED STATES PUBLIC HEALTH SERVICE
    (2012) Peat, Raquel Antonia; Desmond, Sharon M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The purpose of this cross-sectional study was to examine the predictors of resilience and mental health among United States Public Health Service (USPHS) commissioned officers who have deployed. The study employed the Transactional Model of Stress and Coping (Antonovsky and Kats, 1967; Cohen, 1984; Lazarus and Cohen, 1977) to aid in evaluation of the above factors. Relatively few research studies have examined the concept of resilience, and to date, no study has systematically examined risk, social support, mental health and resilience in USPHS commissioned officers. A pilot study (N = 11) was conducted to determine acceptability of the survey items and assess time needed to complete the questionnaire. The final 94-item on-line survey was completed over a two month time period by a convenience sample of 534 USPHS commissioned officers. Univariate analyses demonstrated that when entered individually, team support, post-deployment social support and mental health (protective factors) and the covariates, gender and relationship status were significantly (p<0.05) associated with resilience, while predeployment affectivity (risk factor) was not. When all risk and protective factors were entered into the multivariate logistic regression model, team support, post-deployment social support, mental health, gender and being divorced as compared to being separated, widowed or living with a partner were found to be significantly associated with resilience (p<0.05). Also, both team support and resilience were negatively associated with mental illness measured using depression, anxiety and post-traumatic stress disorder subscales (p<0.05). Those USPHS commissioned officers who reported mental illness were less likely to be resilient. This study provides new data that may help improve our understanding of the resilience and mental health of USPHS commissioned officers, before and after deployment. Findings can be used to inform education and training programs for USPHS commissioned officers (e.g. coping skills training techniques) to help increase their ability to thrive despite adversity before and after deployment.
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    The Effect of Medicaid Disease Management Programs on Medicaid Expenditures
    (2011) Kranker, Keith; Duggan, Mark; Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Disease Management (DM) programs for Medicaid patients with chronic diseases have become very popular, with a majority of states having introduced some type of DM program in the last decade. These programs provide interventions designed to assist patients and their health care providers appropriately manage their chronic health condition(s) according to established clinical guidelines. Cost-containment has been a key justification for the creation of DM programs, despite mixed evidence that DM actually saves money for the Medicaid program or for society as a whole. While most studies on the impact of DM focus on estimating the impact of a single DM program, Chapter 2 estimates the average, national impact of state Medicaid DM programs by linking a detailed survey of state Medicaid programs to the nationally representative Medical Panel Expenditure Survey. Difference-in-difference models are used to test the hypothesis that medical expenditures change after a DM program is implemented, exploiting variation in the timing at which state Medicaid programs implemented DM programs. DM coverage also varies within states over time due to variation in program eligibility by disease, insurance category, and/or county of residence. Although the models estimate the effect of DM imprecisely, point estimates are stable across multiple specifications and indicate that DM programs for common chronic diseases may decrease total medical expenditures, potentially by 10 percent or more. Chapter 3 evaluates one DM program in the state of Georgia using a proprietary data set. By exploiting a natural experiment that delayed the introduction of high-intensity services for several thousand high and moderate risk patients, the research identifies the causal impacts of the program's interventions on total Medicaid expenditures, categories of health care utilization, and other indicators. These patients are observationally similar to those who received interventions at the beginning of the program. For example, I find the interventions lowered health costs and hospital utilization, after controlling for unobservable individual characteristics. Health expenditures were lowered about 4.4 percent for patients with positive expenditures. Heterogeneous treatment effect analysis indicates that the savings were largest at the most expensive tail of the distribution.
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    THE RELATIONSHIPS AMONG FOOD SECURITY, HEALTH LOCUS OF CONTROL, AND MENTAL HEALTH
    (2011) Munger, Ashley Lauren; Epstein, Norman B.; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Prior research has demonstrated a relationship between food insecurity and poor mental health, but this research has been conducted primarily in samples of females. In addition, the mechanisms through which this relationship operates are not well understood. This study investigated whether a relationship between food security and mental health exists for both males and females, as well as whether health locus of control mediates this relationship. Data were from a convenience sample of 110 female and 40 male Supplemental Nutrition Assistance eligible adults in Maryland. Based on self-reports, the relationship between food security and mental health was significant among males and borderline significant among females. Whereas health locus of control mediated the relationship between food security and mental health for the women, it did not for the men. Findings indicated men and women commonly experience food insecurity and poor mental health concurrently. Understanding this relationship is essential for appropriate intervention.