Theses and Dissertations from UMD
Permanent URI for this communityhttp://hdl.handle.net/1903/2
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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Item Experiences of substance use and medication for opioid use disorder stigmas in an underserved, rural community(2024) Anvari, Morgan; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Overdose rates related to opioid and stimulant use have been steadily increasing in underserved, rural areas of the U.S. for over 10 years. Access to and retention in medication for opioid use disorder (MOUD) care are persistent challenges nationally and in underserved rural communities. Stigma around substance use (SU) and MOUD specifically are barriers to engagement in opioid use disorder and MOUD care. However, little is known regarding how SU and MOUD stigmas manifest and affect patients in rural settings. Given their shared lived experiences, peer recovery specialists (PRSs), individuals with lived substance use and recovery experience who are formally trained to support others’ recovery, may be unique resources to shifting stigma barriers. Yet, few studies have examined if and how PRS engagement shifts stigma, particularly in underserved, rural communities. This qualitative study sought to understand: 1) how substance use and MOUD stigmas manifest in a low-resource, rural community; 2) how these stigmas influence patients’ treatment experiences and preferences; 3) if and how PRS-delivered intervention may shift these stigmas and improve MOUD outcomes. Patients (n = 25) and staff (n = 5) at a telemedicine-mobile treatment unit (MTU) in an underserved, rural community completed semi-structured qualitative interviews. Transcripts were analyzed using thematic analysis, guided by the interview guide and Stigma Mechanisms Framework. Study findings demonstrated the pervasive role of multiple forms of stigma in a rural community, negatively impacting substance use treatment outcomes. Experiences of these stigmas were found to be uniquely influenced by rural living conditions. Additionally, results revealed that PRS-delivered interventions have potential in shifting these stigmas and improving MOUD outcomes by leveraging PRSs’ shared lived experiences. Identifying and understanding patient experiences of substance use and MOUD stigmas are vital in developing innovative solutions to target stigma reduction and support recovery. Future research may continue to develop and evaluate how PRS interventions can reduce stigma and support positive recovery outcomes.Item “It’s more than just the act of not using. It's a feeling of finally completing something.”: Patient-centered definitions of successful treatment outcomes in methadone treatment in Baltimore City(2024) Bradley, Valerie Diane; Magidson, Jessica F.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background. Successful outcomes in substance use disorder treatment are often narrowly defined as retention in care, substance use cessation, and the prevention of recurrent substance use. These widely utilized benchmarks may overlook key patient-centered indicators of success. Few studies have sought patient perspectives to establish a representative definition of successful treatment outcomes for opioid use disorder (OUD), with historically marginalized individuals facing the least representation and the largest inequities in care. With overdose-related deaths increasing to over 112,000 in the 12 months preceding May 2023 and a disproportionate impact on racially minoritized populations, understanding comprehensive patient-centered definitions of successful treatment in minoritized populations is an imperative endeavor for research, treatment planning, and policy. This study aimed to understand how patients and providers at an outpatient methadone treatment program in Baltimore City describe patient-centered successful treatment outcomes.Methods. We conducted qualitative interviews and focus groups with 32 patients, staff, and peer recovery specialists (PRSs) at a Baltimore-based outpatient methadone treatment program predominantly serving low-income, racially minoritized individuals with OUD. Semi-structured interview guides prompted patients (n=20) to describe success in methadone treatment and staff and PRSs (n=12) to describe their observations of patients' success in treatment. Qualitative data were transcribed, coded, and analyzed using thematic analysis. We utilized the Health Equity Implementation Framework to contextualize findings across multiple domains and explore potential influences on equitable outcomes of treatment success. Results. Five key themes emerged to demonstrate how patients and their providers define patient-centered successful methadone treatment outcomes, including (1) improvements in general health, (2) productivity and accomplishment, (3) social improvements, (4) substance use changes, and (5) treatment engagement. Patients and providers were generally in agreement on these five overarching themes. Conclusion: Findings suggest patient-centered definitions of success in methadone treatment span psychosocial, environmental, behavioral, health-related, and other factors beyond the traditionally measured outcomes of treatment retention and substance use abstinence. Working toward a more representative definition of methadone treatment success—integrating patient perspectives, particularly minoritized individuals who often face the greatest obstacles in care—may have significant clinical, research, and policy implications for improving the patient experience and outcomes in methadone treatment.Item Sleep, Alcohol, and Cannabis Use in College Student Drinkers with and without ADHD(2022) Marsh, Nicholas Patrick; Chronis-Tuscano, Andrea; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Heavy drinking college students are at risk for experiencing poor sleep and negative alcohol-and cannabis-related consequences. College students with attention-deficit/hyperactivity disorder (ADHD) are uniquely vulnerable to both poor sleep and negative consequences from alcohol and cannabis use. Thus, it is critical to consider relations between ADHD, sleep and alcohol-related negative consequences together in a single study. In the present study, we examined: (1) the associations among ADHD status, sleep and alcohol- and cannabis-related consequences; (2) the independent and interactive effects of sleep and ADHD on negative alcohol-related consequences. Finally, we explored the independent and interactive effects of sleep and ADHD on negative cannabis-related consequences. Method: College student drinkers with (n=51) and without (n=50) ADHD completed a 2-hour assessment that included measures of sleep quality, alcohol and cannabis use, and alcohol/cannabis-related negative consequences. Analyses utilized a series of hierarchical linear regression models to examine study aims. Results: College student drinkers with ADHD reported significantly worse sleep quality relative to non-ADHD student drinkers. Students with ADHD also experienced more negative alcohol-related consequences, relative to student drinkers without ADHD. When ADHD and sleep quality were included in the model together, ADHD—but not sleep quality—was independently associated with negative alcohol consequences, but not negative cannabis consequences. There were no moderating effects of ADHD on the associations among sleep and negative consequences resulting from either alcohol or cannabis use. Conclusion: This is the first study to examine sleep quality in college students with and without ADHD engaging in heavy drinking, as well as the first to examine the independent and interactive effects of sleep and ADHD on alcohol- and cannabis-related consequences. Results demonstrated that college drinkers with ADHD are particularly vulnerable to experiencing poor sleep and negative consequences from their alcohol and cannabis use, compared to their heavy drinking peers without ADHD. Future, larger scale studies should consider longitudinal effects as well as underlying mechanisms of risk.Item OPIOID ABUSE AMONG ADOLESCENTS WHO OFFEND: RISK FACTORS AND THE ROLE OF GENDER(2018) Hickman, Shelby Nichole; Gottfredson, Denise; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this paper, I explore risk factors for opioid use and abuse among juvenile justice system-involved adolescents convicted of a serious offense; a group known to experience high rates of substance abuse and dependence. Using the Pathways to Desistance dataset, I assess whether risk factors for substance use that includes opioids are distinct from the risk factors for other illicit substance use that does not including opioids (non-opioid substance use). I also explore how, if at all, the motives and patterns of opioid use are distinct for male and female adolescent offenders. I identify older age, white race, and clinically significant mental illness as significant risk factors for substance use including opioids relative to non-opioid substance use. I do not find any distinct risk factors for adolescent females’ opioid use relative to their male peers.Item Graduate school burnout and attrition: Examining associations with substance use, mental health problems, and academic support(2018) Allen, Hannah Katherine; Arria, Amelia; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)There is a well-established connection between health and academic achievement among high school and undergraduate students. Despite the high prevalence of substance use and mental health problems during young adulthood, few studies have examined these relationships among graduate students. Two distinct but interrelated studies were conducted to examine substance use and mental health problems as potential contributors to graduate student burnout and attrition, both individually and in conjunction with academic support factors including advisor satisfaction, departmental support, and program climate. The selection of these variables was determined by an overarching socio-ecological framework, whereby academic success is driven by multiple spheres of influence. The first study utilized secondary data to understand the associations between patterns in alcohol consumption, marijuana use, and mental health during the undergraduate college years and graduate degree completion. The lack of association found between behavioral health during college and graduate degree completion might be due to a decrease in mental health and substance use problems during the post-college years, as well as a possible selection effect where those with mental health and substance use problems are less likely to enroll in graduate school. The second study involved primary data collection to examine the correlates of substance use, mental health problems, and academic support among a sample of graduate students, as well as evaluate the associations between these variables and three dimensions of burnout (exhaustion, cynicism, and inefficacy). Findings showed graduate student subgroups that might be at increased risk for behavioral health problems, particularly professional doctoral students and students enrolled in programs in the humanities and social sciences. High-risk alcohol use, stress, and depression symptoms were all associated with increased levels of burnout, but high levels of departmental and advisor support appeared to buffer this effect. This research is a first step in extending knowledge on the relationship between potentially modifiable health-related risk factors and graduate student burnout and attrition. This line of research has implications for graduate students, faculty, and administrators who are committed to improving student success and well-being.Item The Relation between Substance Use and Medication Adherence among HIV Positive Substance Users in Residential Treatment(2015) Hoffman, Elana Michelle; MacPherson, Laura; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Poor medication adherence is problematic among HIV positive, low-income African-American substance users. Substance use has been shown to be associated with poor medication adherence, though we do not know the mechanism that underlies this relationship. Lack of positive environmental rewards and the propensity to discount delayed rewards may be possible mechanisms to explain this relationship. Using baseline data from a randomized controlled trial, we examined the relationships between substance use and medication adherence, testing both environmental rewards and delay discounting as independent mediators. There was a main effect of substance use on adherence, such that high frequency of substance use predicted poor adherence. There was also a main effect of environmental rewards on adherence, such that a lack of environmental reinforcement predicted poor adherence. This study shed light on the processes that contribute to low adherence, namely substance use and lack of environmental contingencies, and suggests important targets for intervention.Item Associations and Pathways between Substance Involvement and Risky Sexual Behavior over the Life Course of Urban African Americans(2015) Zebrak, Katarzyna A.; Green, Kerry M.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African Americans are disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs) relative to other racial/ethnic groups. Substance involvement has been linked to risky sexual behavior, an important risk factor for HIV/STI transmission, relatively early in the life course; yet such associations have not been found consistently among African Americans. Understanding of how substance involvement relates to risky sexual behavior among men and women over time and into midlife remains limited. The goal of this study was to examine the associations and pathways between substance involvement and risky sexual behavior over the life course in a community-based urban African American cohort (n=1242) followed prospectively from age 6 to 42 years. Using a combination of structural equation modeling and mediation testing, the study examined (1) prospective associations (from adolescence through adulthood) and within-life stage associations (in adolescence, young adulthood, and midlife) between substance involvement and risky sexual behavior, (2) the role of young adult social bonds as potential pathways linking substance use and risky sexual behavior over time, and (3) gender differences in the associations and pathways. The results revealed statistically significant positive associations between earlier substance involvement and subsequent risky sexual behavior over the life course among men and women. Greater adolescent substance use predicted greater midlife risky sexual behavior, partly through greater young adult substance problems and risky sexual behavior for both genders. Substance involvement was also positively correlated with sexual/risky sexual behavior in adolescence, young adulthood, and midlife among men and women. Although greater adolescent substance use predicted fewer young adult social bonds for both men and women, the latter was associated with decreased involvement in midlife risky sexual behavior among women only. Considered individually, young adult social bonds were not significant mediators of the adolescent substance use–midlife risky sexual behavior association for either gender. Given the complex pattern of associations and pathways between substance involvement and risky sexual behavior over time, public health interventions to address substance involvement among urban African Americans at any life stage, starting with adolescence, may have immediate and long-term effects, and direct and indirect effects on decreasing sex-related HIV/STI risk.