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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    THE INTERGENERATIONAL TRANSMISSION AND IMPACTS OF ADVERSE CHILDHOOD EXPERIENCES
    (2024) McConnell, Krystle; Shenassa, Edmond; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Evidence that adverse childhood experiences (ACEs) are associated with a wide range of adverse health and behavioral outcomes, including poor behavioral outcomes, and increased substance use, has been expanded to demonstrate that ACEs may be a determinant in adverse health and behavioral outcomes across generations as well. To disentangle the intergenerational impacts of ACEs on select health and behavioral outcomes and inform future intergenerational research and practice, three separate studies were conducted as part of this investigation. The first is a systematic review assessing whether ACEs predict earlier age of initiation differently depending on substance, conducted to inform timing of ACE screening and substance use intervention within generations. Given evidence to suggest that maternal ACEs predict related behavioral outcomes, the association between ACEs and earlier age of substance use may extend across generations as well. Informed by the first study, the second study in this investigation assesses the association between maternal ACEs and offspring age of alcohol initiation. Because offspring concordant for higher intergenerational ACE exposure may be most susceptible to the intergenerational impacts of adversity, this study also assesses whether the association between maternal ACEs and offspring age of alcohol initiation is different depending on offspring ACE exposure. The third study of this investigation assesses the association between maternal ACEs and internalizing and externalizing behavior. Importantly, the well-established intergenerational continuity of adversity was considered conceptually and methodologically for the latter two studies. If there is a direct association of maternal ACEs on offspring outcomes independent of offspring ACEs, then ACE screening and intervention efforts should be expanded to include and consider maternal ACEs in addition to offspring ACEs. Therefore, the controlled direct effect of maternal ACEs, not through offspring ACEs, was estimated. Findings from the first study suggest that while ACEs are associated with earlier age of alcohol, nicotine, marijuana, and opioid initiation, often in a dose-dependent manner, ACEs may predict earlier initiation of alcohol and nicotine relative to other substances assessed. Three or more ACEs were associated with initiation of alcohol across multiple studies, with effect sizes (OR) ranging from 1.9 (95% CI: 1.7, 2.1) to 6.2 (95% CI: 4.6, 8.3). Among the youngest samples included in this review (aged 9-10), ACEs were positively associated with use of alcohol at the time of interview OR=1.3 (95% CI: 1.1, 1.5). Studies that assessed the association between ACEs and nicotine used thresholds between 15-17 to define early initiation and reported a range of effect sizes (OR) from 1.6 (95% CI: 1.2, 2.2) after exposure to more than one ACE to 5.2 (95% CI: 2.9, 9.3) after exposure to more than two ACEs. Exposure to two or more ACEs was associated with initiating vaping before age 11 (OR=3.4 (95% CI: 2.2, 5.4). While not rising to statistical significance (p<0.05), findings from the second study suggest there is a small inverse relationship between maternal ACEs and offspring age of alcohol initiation among the full sample. However, among offspring exposed to >2 ACEs themselves, 2 maternal ACEs are associated with =-1.4 (95% CI: -2.7, -0.1) and >2 maternal ACEs are associated with =-2.1 (95% CI: -3.8, -0.5) earlier age of alcohol initiation. These findings suggest that offspring exposed to high levels of intergenerational ACE exposure are at greatest risk for early alcohol initiation. Findings from the third study suggest that maternal ACEs are associated with offspring internalizing and externalizing behavior in a dose-dependent manner, independent of offspring ACE exposure. Specifically, 1, 2, and >2 maternal ACEs were independently associated with a 1.8 (95% CI: 0.9, 2.8), 2.1 (95% CI: 0.7, 3.4), and 2.7 (95% CI: 1.0, 4.4) increase in internalizing score and a 1.8 (95% CI: 0.8, 2.7), 3.1 (95% CI: 1.7, 4.4), and 3.3 (95% CI: 1.4, 5.1) increase in externalizing score, respectively. Taken together, findings from this investigation suggest that universal ACE screening in pediatric settings, particularly prior to onset of puberty, may identify youth for service provision prior to substance initiation and that maternal ACEs should be screened for and considered in addition to offspring ACE exposure to inform interventions related to adolescent substance use and internalizing and externalizing behavior. To that end, the prenatal period may be an opportune time for maternal ACE screening. Conclusions from these investigations may apply to the impact of maternal ACEs on other relevant offspring outcomes across the life course. Future directions for research, including assessment of relevant biological and psychosocial mechanisms, and potential moderators of identified associations are discussed.
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    Social Determinants of Cardiovascular Disease Across the Life Course
    (2023) Ng, Amanda Erin; Dyer, Typhanye; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    According to data from the National Center for Health Statistics, cardiovascular disease is one of the leading causes of death in the United States, contributing to about 697,000 (or 1 in 5) deaths in 2020 alone. Given the public health burden of this disease, it is imperative that research identifies and continues to investigate population factors that may contribute to or alleviate this burden in the United States. The proposed study aimed to analyze such factors across the life course. Study 1 examined associations between an expanded set of Adverse Childhood Experiences (ACEs) and childhood obesity among 10-17 year olds using the National Survey of Children’s Health, as well as sex and age differences within these associations. Study 2 investigated high optimism as a modifier and mediator of the association between childhood socioeconomic disadvantage and CVD in midlife, using the Midlife in the United States Study, a U.S. prospective cohort. Study 3 examined temporal trends in the associations between adult socioeconomic status and CVD mortality using nationally-representative data from the 1997-2018 National Health Interview Survey.
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    Adverse Childhood Experiences (ACEs) in Early Childhood and Their Associations with Middle Childhood Behavior Problems
    (2017) Schroeder, Allison; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Experiences in early childhood lay the foundation for physical and psychological health and wellbeing throughout the life course. A large body of literature demonstrates a graded relationship between adverse childhood experiences (ACEs) and health and social outcomes. Children living in poverty are disproportionately likely to experience multiple adversities, placing them at risk for negative health and developmental outcomes and contributing to widening health disparities. Among the outcomes associated with ACEs are internalizing and externalizing behavior problems, which increase children’s risk of later depression and anxiety, substance use, criminality, low socioeconomic status, and chronic physical health problems. In spite of the substantial knowledge base that has developed around childhood adversity and its association with behavior problems, there are gaps in the literature that warrant further research. Firstly, few studies utilizing prospective longitudinal data have examined the role of timing and duration of exposure to adversities in early childhood, and their relationship with later behaviors. Secondly, researchers have only just begun exploring whether certain patterns or constellations of risk factors are common among different groups of children, and whether these patterns place certain groups at greater risk for behavior problems. A third gap relates to the role of father involvement by unmarried fathers and the potential for these fathers to promote more positive outcomes among children exposed to various levels of early adversity. The three studies in this dissertation analyze data from four waves of the Fragile Families and Child Wellbeing Study to document associations between ACEs experienced at ages 1, 3, and 5, and behavior problems at age 9. Life course theory provides an overarching framework for the dissertation. The first study examines the associations between the accumulation, timing, and duration of ACEs in the first five years of life and odds of behavior problems at age 9. The second study employs latent class analysis to identify patterns of risk exposure and their potential association with age 9 behaviors. The third study investigates whether early father involvement by fathers who were unmarried at the child’s birth moderates the association between early childhood adversity and age 9 behavior problems.