Theses and Dissertations from UMD
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Item COMPARISON OF ACRYLAMIDE EXPOSURE BIOMARKERS IN CHILDREN AND ADOLESCENTS USING NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 2003-04 AND 2015-16(2024) Vallejo, Jessica Vasquez; Turner, Paul C; Kadry, Abdel; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Acrylamide (AA) is an important industrial chemical of occupational concern due to its neurotoxicity and probable carcinogenicity; it is also a tobacco burning product and thus contributes to health concerns in smokers. More recently it was discovered to be thermally generated in the cooking of starch-rich foods, creating a potentially wider public health concern. Children and adolescents are a particularly vulnerable group because they consume more acrylamide-rich foods compared to adults. In addition, they are still going through important developmental stages. This study examines AA and its metabolite glycidamide (GA) using hemoglobin adduct biomarkers (HbAA and HbGA respectively) from the U.S. children (6-11) and adolescents’ (12-19) National Health and Nutrition Examination Survey’s 2003-04 (n=2814) and the 2015-16 (n=697). The study investigated changes in exposure over time and examined the contribution of potential modifiers including smoking status, race/ethnicity, poverty-to-income ratio, sex, and age. All HbAA and HbGA are reported as pmoL adduct per gram Hb (pmol/G Hb).Overall, HbAA biomarkers significantly (p<0.0001) declined from 2003-04, GMs (95% CI) (57.9 [55.7, 60.1] pmol/G Hb) versus (42.8 [41.4, 44.2] pmol/G Hb) in 2015-16 for all ages, with similar reductions observed in the individual children and the adolescent groups. Smokers had a higher burden of HbAA biomarkers than non-smokers, and with a significant reduction in numbers of smokers from 2003-04 to 2015-16, this likely contributes to the reduction in overall exposure. When non-smokers only were examined, a significant (p<0.0001) decrease in HbAA was still observed, from 2003-04 GMs (95% CI) (53.4 [52.0, 54.9] pmol/G Hb) versus (41.2 [40.2, 42.2] pmol/G Hb) in 2015-16, suggesting an additional contribution of changes in AA levels in food or frequency of high-risk food consumption. Similar statistically significant reductions were seen for both children and adolescent groups separately. HbGA is a marker of AA biotransformation to GA, which is a more mutagenic metabolite of AA. The ratio is of HbAA:HbGA is a phenotypic marker of mutagenic risk. In non-smokers, there was a significant (p=0.001) difference in the HbAA:HbGA ratio in children GMs (95% CI) (0.8 [0.8, 0.8] pmol/G Hb) at 2003-04 and (0.9 [0.9, 1.0] pmol/G Hb) at 2015-16 versus adolescents (1.0 [1.0, 1.1] pmol/G Hb) at 2003-04 and (1.1 [1.0, 1.2] pmol/G Hb) at 2015-16, respectively, suggesting children may be at greater risk to the mutational effects of AA exposure compared to adolescents. In multivariate regression analysis of non-smokers only, age and race significantly contributed to the HbAA biomarker levels, with higher HbAA in younger age groups and in non-Hispanic black participants, highlighting a disparity in exposure pattern. Overall, AA exposure seems to have reduced from 2003-04 to 2015-16; the reduction is driven by both changes in smoking but also diet. The young and non-Hispanic black participants remain at highest risk of exposure and potential health effects from exposure to AA.Item Psychological inoculation against vaccine misinformation: why and how it works(2023) Wang, Yuan; Nan, Xiaoli; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Vaccine misinformation has posed a significant threat to public health. Drawing upon inoculation theory, this dissertation investigates whether exposure to an inoculation message – a message that forewarns and refutes potential persuasive attacks – can confer resistance to misinformation about COVID-19 vaccines. Based on two online experiments, this research seeks to answer four overarching questions: Can exposure to an inoculation message reduce susceptibility to misinformation? Through which mechanisms does inoculation message confer resistance to misinformation? Does the effect of inoculation messages vary among initially informed, uninformed, and misinformed individuals? How do partisan source cues (in-group vs. out-group) impact the effectiveness of inoculation messages among politically affiliated individuals? Study 1 investigated the effectiveness, mechanisms, and recipient factors related to inoculation messages. A two-condition (inoculation vs. control) between-subject experiment was conducted (N = 659). Results indicated that exposure to an inoculation message effectively reduced individuals' susceptibility to misinformation. Inoculation message not only counteracted beliefs in misinformation but also protected positive attitudes and intentions toward COVID-19 vaccination. Moreover, perceived ease of counterarguing and anger were identified as significant mediators underlying the persuasive effects of the inoculation message, while counterarguing was not a significant mediator. Furthermore, the effectiveness of inoculation message remained consistent among initially informed, uninformed, or misinformed groups, suggesting that inoculation message offers both prophylactic and therapeutic effects. Study 2 examined how partisan source cues impacted inoculation message effectiveness. A 2 (in-group vs. out-group inoculation) X 2 (in-group vs. out-group misinformation) between-subject online experiment was conducted among politically affiliated individuals (N = 448). Results showed no main or interaction effects of in-group (vs. out-group) inoculation and in-group (vs. out-group) misinformation on persuasive outcomes, suggesting that the efficacy of inoculation messages in conferring resistance to misinformation did not differ based on whether the inoculation or misinformation messages came from an in-group or out-group source. Additionally, party identification strength moderated the impact of in-group (vs. out-group) inoculation on beliefs in COVID-19 vaccine misinformation and COVID-19 vaccination attitudes. Surprisingly, the advantage of in-group inoculation over out-group inoculation was stronger among individuals with lower levels of party identification. Moreover, out-group inoculation appeared to be more persuasive than in-group inoculation among individuals with extremely strong political identification. This dissertation offers several theoretical and practical implications for health communication research and practice. First, this research contributes to inoculation theory by examining two alternative mechanisms – perceived ease of counterarguing and anger – underlying inoculation message effects. The findings underscore the importance of considering cognitive, meta-cognitive, and affective routes that underlie resistance to persuasion. Additionally, this research expands the scope of inoculation theory by demonstrating its effectiveness among initially informed, uninformed, and misinformed individuals. These results suggest that inoculation messages can be useful beyond the traditional scope of cultural truisms, offering both prophylactic and therapeutic effects. Furthermore, the study challenges the conventional assumption that messages from in-group sources are more persuasive than those from out-group sources, indicating that political groups should work together to address vaccine hesitancy. Overall, this dissertation supports the use of inoculation messages as an effective tool in counteracting misinformation and promoting vaccination acceptance.Item USING SOCIAL MEDIA AS A DATA SOURCE IN PUBLIC HEALTH RESEARCH(2022) Sigalo, Nekabari; Frias-Martinez, Vanessa; Library & Information Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Researchers have increasingly looked to social media data as a means of measuring population health and well-being in a less intrusive and more scalable manner compared to traditional public health data sources. In this dissertation, I outline three studies that leverage social media as a data source, to answer research questions related to public health and compare traditional public health data sources to social media data sources. In Study #1, I conduct a study with the aim of developing, from geotagged Twitter data, a predictive model for the identification of food deserts in the United States, using the linguistic constructs found in food-related tweets. The results from this study suggest the food-ingestion language found in tweets, such as census-tract level measures of food sentiment and healthiness, are associated with census tract-level food desert status. Additionally, the results suggest that including food ingestion language derived from tweets in classification models that predict food desert status improves model performance when compared to baseline models that only include socio-economic characteristics. In Study #2, I evaluate whether attitudes towards COVID-19 vaccines collected from the Household Pulse Survey can be predicted using attitudes extracted from Twitter. The results reveal that attitudes toward COVID-19 vaccines found in tweets explain 61-72% of the variability in the percentage of HPS respondents that were vaccine hesitant or compliant. The results also reveal significant statistical relationships between perceptions expressed on Twitter and in the survey. In Study #3, I conduct a study to examine whether supplementing COVID-19 vaccine uptake forecast models with the attitudes found in tweets improves over baseline models that only use historical vaccination data. The results of this study reveal that supplementing baseline forecast models with both historical vaccination data and COVID-19 vaccine attitudes found in tweets reduce RMSE by as much as 9%. The studies outlined in this dissertation suggest there is a valuable signal for public health research in Twitter data.Item A LOOK AT COHOUSING: WHY BABY BOOMERS ARE SELF DEVELOPING ALTERNATIVE HOUSING OPTIONS(2019) Matthews, Georgeanne Nabrit; Howland, Marie; Dawkins, Casey; Urban and Regional Planning and Design; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)An interdependent community with shared amenities and resources, like ‘cohousing’, is one solution to the challenges Baby Boomers face in finding suitable housing options to age in place. Cohousing developments are on the rise in the U.S., more often lead by a committed group of Baby Boomers who seem to be getting around existing public policy hurdles at great emotional and financial costs on the front end of development. This in an indicator that certain barriers exist in the public policy arena that make it difficult to get zoning approval for a cohousing development, and in turn to access traditional financing options to get these projects built. This dissertation looks at why and how Baby Boomers are self-developing their own alternative housing options as they face their retirement years. Over the next 20 years, the Census Bureau anticipates an increased national demand for moderate to middle-income housing posed by the retirement of 80 million Baby Boomers by the year 2031. This paper will highlight: 1) The demographic issue of the rapid growth in the retirement age population; 2) The social considerations that occur with family members living further afield than in previous generations, and therefore leaving the elderly without a built-in network to depend on. In addition, this generation is accustomed to independence and is looking for alternatives that support their ability to remain independent; and 3) The public policy gap highlighting the lack of affordable housing that meets the needs of Baby Boomers, who are ill prepared to shoulder the costs of retirement according to the Social Security Administration. Architects Schreiner and Kephart draw attention to the need for Baby Boomers to have safe, moderately affordable, amenity intensive housing with built-in community and safety nets (2010). The Harvard Journal on Housing (2008) acknowledges the challenge of providing quality housing across a broad income spectrum and points to population shifts indicating a future need for more cost effective, densely clustered housing that is smaller and more sustainable than the typical American dream home. Baby Boomers will be the largest group in this demand shift, accompanied by other groups like single parent headed households, individuals who live alone and Millennials. However, due to the sheer size of the Baby Boomer generation, this group has the potential to be a catalyst for the creation of new housing initiatives. This trend will require changes in land-use zoning for multi-family housing, and the creation of new financial options that support group living. Baby Boomers seem to be investigating various collective living options in order to offset the financial and social challenges that can come with the aging process. The cohousing model will be used as a case study for its claim that it offers luxury amenities, homeownership, community, cultural activities and a built-in social network by design.Item AN EXPLORATION OF PUBLIC HEALTH WORKER ENGAGEMENT WITH HEALTH-RELATED SOCIAL MOVEMENTS THROUGH AN ANALYSIS OF #BLACKLIVESMATTER(2018) Bickford, Abigail Runa; Gold, Robert S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Social movements fight for social justice by protesting systemic social inequities. The field of public health aims to eliminate these same disparities as they relate to health. Many social movements are not currently viewed as health social movements despite these movements addressing health disparities by challenging existing inequities related to social determinants of health. One example is the Black Lives Matter movement which has gained considerable attention in its efforts to address systemic racism, a known determinant of health. While the Black Lives Matter movement has evoked many academic and popular responses, there has been a lack of focus on this movement by the public health workforce. Therefore this work uses the Black Lives Matter movement as an example of a health-related social movement warranting engagement from the public health workforce. This study utilizes a novel approach to the use of social media data in the public health field. The first part of this work examines tweets containing #BlackLivesMatter and compares the online discourse to the stated mission and principles outlined by the leaders of the Black Lives Matter organization. An analysis of the Twitter data was then presented in a Delphi study conducted with a panel of experts in public health. Delphi participants were tasked with developing ideas on how the public health workforce could best apply the information collected from #BlackLivesMatter Twitter data to aid in addressing the health-related issues highlighted by the Black Lives Matter movement. More broadly, participants also generated ideas about what can be done to encourage the public health workforce to systematically engage with health-related social movements. Finally, one-on-one interviews were conducted with self-identified social activists. These activists were asked about their participation in social movements, their use of social media regarding their advocacy work, and for ideas about how the public health workforce could engage with their causes. Findings from each study are discussed along with recommendations for future work aimed at developing relationships between public health workers and social movements.Item IMPROVING CHRONIC ILLNESS MEDICATION ADHERENCE: A COUNTERFACTUAL THINKING-BASED MODEL OF PERSUASIVE COMMUNICATION(2017) Iles, Irina; Nan, Xiaoli; Communication; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The World Health Organization estimates that, by 2020, the number of Americans affected by at least one chronic condition requiring medication therapy will grow to 157 million. Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the U.S. health care system. As with much of health care, drug adherence is primarily about human behavior. Therefore, patients who lack motivation to take their medication as prescribed cannot be forced or simply educated to take their medication; they must be persuaded and motivated to do so. However, existing literature on how persuasion-based behavioral change can be achieved for non-adherent patients is sparse. To help build more evidence on how effective communication can be used to promote drug adherence for patients who have been diagnosed with chronic illness, this research tested the effectiveness of counterfactual thinking as a message design strategy aimed at increasing drug adherence among individuals at risk for nonadherence. Findings from experiments 1 and 2 showed no effect of counterfactual thinking on medication adherence. Findings from experiment 3 showed that, in a sample of 303 patients with type 2 diabetes at risk for nonadherence, messages including upward counterfactual thinking (e.g., “if only I had taken my medication as prescribed, I would not be in the hospital right now!”), compared to messages including downward counterfactual thinking (e.g., “it could have been worse and I could have died!”) or no counterfactual thinking, increased perceptions of medication adherence self- and response efficacy, and behavioral intention to take one’s medications as prescribed. Counterfactual thinking-based messages are a promising and easy to use persuasion strategy for patients who are at risk for nonadherence. Counterfactual thinking can be incorporated in interventions aimed at increasing adherence, and in doctor-patient or pharmacist-patient communications. Future studies should replicate these findings patients who have other chronic illnesses. Furthermore, measuring actual medication adherence behavior as opposed to behavioral intention, would provide a better indicator of the effectiveness of counterfactual thinking in increasing adherence.Item BUREAUCRAT POLITICKING: AN EXAMINATION OF LOCAL HEALTH OFFICIALS AND THEIR LOCAL HEALTH DEPARTMENTS(2014) Elligers, Julia Joh; Morris, Irwin; Government and Politics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Based on a model of bureaucrat politicking, this study investigates how local health officials, as political actors, secure financial resources to ensure their local health departments can meet the needs of their constituents. The model draws from theories of bureaucracies, public administration, and community power and describes administrating, advocating, co-learning, and politicking behaviors bureaucrats employ as leaders of local government agencies. The model of bureaucrat politicking generates a series of hypotheses that describe how bureaucrat behavior can affect elected official budget appropriations. I hypothesize that politicking will result in more resources for bureaucrats than administrating, advocating, or co-learning. Secondarily, I hypothesize that co-learning will result in more resources than advocating or administrating. Co-learning is predicted to have a greater affect than advocating because a bureaucrat will be leveraging electoral pressures via constituent engagement. In addition, administrating behavior will result in the fewest resources of the four behavior types. I examine the behaviors of local health officials to uncover how the model of bureaucrat politicking plays out in practice. Results from in-depth interviews with ten local health officials from around the country illustrate how local bureaucrats demonstrate administrating, advocating, co-learning, and politicking behaviors. Ordinary least square regression analyses using survey data mainly from the National Association of County and City Health Officials' National Profile of Local Health Departments study support my hypotheses.Item Race, Sexuality, and the "Progressive Physician": African American Doctors, Eugenics, and Public Health, 1900-1940(2014) Nuriddin, Ayah; Michel, Sonya A; History/Library & Information Systems; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This thesis will examine how African American doctors interpreted eugenic thought in the early twentieth century. African American doctors embraced eugenics for its potential to improve the health of their race, thus bringing about a kind of "biological racial uplift." African American doctors thus drew on their discipline to pursue a form of eugenic activism that had internal and external ramifications for the race. . Even though African Americans faced medical injustice, they were not simply the victims of eugenics and scientific racism. They were also critics and proponents of eugenics. The first chapter will address how eugenics shaped African American discussions of public health, and how eugenic ideas about sex and sexuality influenced their discourse and understanding of venereal disease. The second chapter will examine how African American doctors discussed birth control, compulsory sterilization, and abortion within the context of racial uplift.Item IMPACT OF RURALITY, BROILER OPERATIONS, AND COMMUNITY SOCIOECONOMIC FACTORS ON THE RISK OF CAMPYLOBACTERIOSIS IN MARYLAND(2013) Zappe Pasturel, Barbara; Sapkota, Amy; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The combined impact of community-level environmental and socioeconomic factors on the risk of campylobacteriosis were evaluated. Campylobacter case data (2002-2010, n=3,694) were obtained from the Maryland Foodborne Diseases Active Surveillance Network. Community-level socioeconomic and environmental data were obtained from the 2000 U.S. Census and the 2007 U.S. Census of Agriculture. Data were linked by zip code. Incidence rate ratios were derived by Poisson regressions. A subset of zip code-level characteristics was mapped. In zip codes that were 100% rural, incidence rates of campylobacteriosis were 6 times (IRR=6.18; 95%CI=3.19-11.97) that of urban zip codes. In zip codes with broiler chicken operations, incidence rates were 1.45 times that of zip codes without broilers (IRR=1.45, 95%CI=1.34-1.58). Higher rates were also observed for zip codes that were predominantly white and had high median incomes. Findings suggest that the risk of campylobacteriosis could be significantly influenced by the community and environment where one lives.Item Neighborhood Level Disadvantage, Race/Ethnicity and Infant Mortality in Washington DC(2010) Amutah, Ndidi N.; Anderson, Elaine A; Hofferth, Sandra L; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study examines the effects of neighborhood level disadvantage and individual level characteristics such as race/ethnicity on infant mortality. Social determinants of health theory and ecological theory were used to construct a neighborhood advantage index for Washington DC. Secondary analyses were conducted using linked birth/death certificate and census data from the DC State Center for Health Statistics. Live births (55,938) and infant deaths (607) occurring in Washington DC from 2001-2007 were examined. Multilevel modeling techniques were utilized to determine the relationship between individual and neighborhood level factors on infant mortality. The research questions were: (a) Do women who are comparable on factors such as maternal education and marital status experience different rates of infant mortality by race? (b) Do women living in areas of high disadvantage experience higher rates of infant mortality than women living in areas of low disadvantage? (c) Does the effect of race/ethnicity on infant mortality change if the mother lives in a place of high disadvantage versus low disadvantage? (d) Does having an infant born preterm or low birth weight increase the risk of infant mortality? Whites have the lowest rates of infant mortality (2.8/1000), followed by Hispanics (7.4/1000), with Blacks having the highest rates (15.2/1000) after adjusting for age, education, and marital status. These findings are consistent with previous research affirming a relationship between race/ethnicity and infant mortality. Infants born in disadvantaged neighborhoods are 1.63 times more likely to die before their first birthday than those born in advantaged neighborhoods. The odds for infant mortality compared to Whites decreases especially for Blacks (5.39 to 3.10; 42% change), living in disadvantaged communities even when race/ethnicity was interacted with the neighborhood disadvantage index. This suggests that disadvantage has different consequences for different race/ethnicity populations living in those neighborhoods. The importance of place (disadvantaged or advantaged neighborhood) in relation to infant mortality at the neighborhood level in addition to improving individual level factors is discussed for program development and policymakers. Implications for health disparities, maternal and child health, social support and future public health research are presented.