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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Item Socioeconomic Position, Gender, and HPV Vaccine Utilization(2018) Rogers, Taylor; Boudreaux, Michel; Thomas, Stephen B; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In 2011-2014, the prevalence of HPV was higher in adult males compared to adult females. HPV and its associated health outcomes can be prevented through the completion of the 3-dose HPV vaccine series. Using the 2010 - 2016 National Immunization Survey - Teen, I examined the association of family income and gender with three HPV vaccine utilization outcomes: (1) receipt of provider recommendation; (2) HPV vaccine initiation; and (3) HPV vaccine completion using logistic regressions. Results suggested that family income was negatively correlated with HPV vaccine outcomes regardless of gender and controlling for other covariates. I also found that males had lower vaccine use compared to females, regardless of income. In the second analysis I investigated if the 2011 ACIP guideline increased vaccine utilization outcomes using a difference-in-differences. This analysis suggested that the new guideline increased recommendations by 24 percentage points for males, relative to females (P<0.01), HPV vaccine initiation improved by 23 percentage points (P<0.01), and vaccine completion improved by 10 percentage points (P<0.01).Item An Investigation of Child and Adolescent Dental Sealant Predictors, NHANES 2011-2012(2016) Roman, Agnieszka Anna; Kleinman, Dushanka; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Objective: To examine sociodemographic and dental factors for associations with dental sealant placement in children and adolescents aged 6-18 years old. Methods: Secondary data analysis of 2011-2012 NHANES data was conducted. Multiple logistic regression models were used to assess relationships between predictor variables and sealant presence. Results: More than a third (37.1%) of children and adolescents have at least one sealant present; 67.9% of children compared with 40.4% of adolescents. Racial/ethnic differences exist, with Non-Hispanic black youth having the lowest odds of having sealants. Sealant placement odds vary by presence of dental home; the magnitude of the odds varies by age group. Those with untreated decay have lower odds of having sealants than those who do not have untreated decay (child OR: 2.6, 95% CI: 1.83-3.72; adolescent OR: 3.9, 95% CI: 2.59-6.07). Conclusion: Disparities exist in odds of sealant prevalence across racial/ethnic groups, income levels, and dental disease and visit characteristics. Further research is necessary to understand the reasons for these differences and to inform future interventions.Item Sentencing in a New Era: Examining the Impact of Judicial Discretion and Contextual Dynamics in Federal Criminal Sentencing after Booker/Fanfan(2015) Betsinger, Sara Linn; Johnson, Brian; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)For nearly twenty years, federal judges were required to strictly adhere to the federal sentencing guidelines (`the Guidelines"), which calculated sentences based on the offender's current offense level and his or her prior offense history, and which tightly controlled which aggravating and mitigating factors could be considered. However, the U.S. Supreme Court effectively altered the course of federal sentencing with its decision in Booker/Fanfan in 2005, which made the Guidelines advisory; although judges are still required to consider the Guidelines and to provide reasons for departing from their recommendations, Booker has minimized the concern for appellate interference and, as such, has presumably opened the door for increased judicial discretion. The current dissertation examines the impact of the Supreme Court's decision and extends prior work by paying particular attention to its effect on drug and immigration offenses and by incorporating unique dynamic measures to examine contextual changes over time. Because Booker provides a natural experiment, a quasi-experimental pre-test post-test design is employed to examine the decision's impact, with separate models estimated for the full study period (2000-2008), the pre- and post-Booker periods, and each quarter in the study period. In addition, the impact of the decision is examined both through individual-level models, which focus on the role of offense and offender characteristics, and multilevel models, which more closely investigate how Booker's impact may be contextualized by district-level factors. The results provide very little evidence of a "Booker effect" during the years examined; instead, they largely suggest that judges continued to sentence according to pre-Booker sentencing patterns. When noticeable differences were found pre- to post-Booker, closer examination of quarterly trends often revealed that shifts occurred prior to Booker, during the PROTECT Act period. However, because there was initially a large amount of federal-level confusion regarding the interpretation of Booker's application - subsequent clarification was provided by the Supreme Court in Kimbrough and Gall - it is possible that the true effects of Booker became evident well after the study period ended. Future research should expand the types of contextual variables included, incorporate qualitative data, and more precisely estimate Booker's causal influence on sentencing outcomes.Item RACIAL AND ETHNIC DIFFERENCES IN ACCESSING TIMELY CANCER SCREENING AND TREATMENT SERVICES: A QUANTITATIVE ANALYSIS(2013) King, Christopher Jerome; Thomas, Stephen B.; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This research is organized into three integrated studies that explored differences in screening and treatment services across the cancer care continuum by race and ethnicity. The Andersen Behavioral Model of Health Services Use and the Five Dimensions of Access were used as conceptual frameworks. In the first study (Chapter 2), data from the Medical Expenditure Panel Survey were used to examine breast and cervical cancer screening rates before and during the Great Recession (2007-2009). The interaction terms of recession and race and ethnicity were controlled to examine whether minorities exhibited different utilization patterns under economic shock compared to Whites. In Chapter 3, data from the National Health Interview Survey (NHIS) from 2006-2010 were used to identify adult cancer survivors and adults without a history of cancer. Multivariate logistic regressions were applied to examine the prevalence of cost, organizational and transportation barriers between survivors and the general population. The likelihood of experiencing barriers was explored by race and ethnicity. In Chapter 4, differences in the likelihood of experiencing access barriers among survivors by race and ethnicity was explored. Data were merged from the 2000-2011 (NHIS) to identify adult cancer survivors who reported cost, organizational and transportation barriers. Logistic regressions were applied to determine the likelihood of reporting each type of barrier, while controlling for demographic and socioeconomic variables. The Fairlie decomposition technique was applied to identify contributing factors that explained differences in accessing care based by race and ethnicity. Overall, results of the investigations demonstrate that: (1) breast and cervical screening rates declined most among White women during the recession period, while rates increased among Hispanic women during the same period; (2) minority cancer survivors were significantly more likely to experience access-to-care barriers than Whites; and (3) insurance, comorbidity, perceived health and nativity were leading factors that contributed to racial and ethnic differences in timely receipt of cancer screening and treatment services. As provisions of the Affordable Care Act take effect, findings provide insight into practices, policies, and future research that will help achieve Healthy People 2020 screening objectives and reduce racial and ethnic disparities in accessing timely cancer care.