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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Item Family Support, Rejection, and Connectedness: Family Context and SGM Youth Mental Health and Substance Use(2021) Tomlinson, Katherine; Fish, Jessica N; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Adolescence is an acutely significant period of development, and sexual and gender minority youth (SGMY) experience unique stressors which contribute to elevated rates of substance use, mood disorders, suicidal ideation and attempts, and other health outcomes when compared with their heterosexual, cisgender peers. Family is often the context in which SGMY navigate these stressors and manage their health. Family rejection and support have each been linked to health outcomes among SGMY, including depression and substance use. More globally, family connectedness is beneficial to adolescent’s health but is an understudied construct within SGMY research. Limited research has examined how these family processes converge to influence SGMY health. In an effort to capture nuance in family process and SGMY health, this study examined the relationship between experiences of family support, rejection, and connection among SGMY and their depressive symptoms and substance use. Findings have implications for research and practice with families.Item The Effects of Marijuana Legalization on Adolescent Alcohol Consumption(2019) Montano, Ashley Nicole; Dugan, Laura; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Among researchers, there has been a long-standing debate on the issue of whether alcohol and marijuana are used as substitutes or complements of one another. In other words, does the increased usage of one decrease the usage of the other (substitution) or does usage of both substances simultaneously increase (complements)? The primary purpose of this study is to identify whether a suggested substitution or complementary effect exists among adolescent drinking patterns following the recent emergences of increased marijuana legalization. To explore these effects, data is used from 38 different states included in the Youth Risk Behavior Surveillance System between the years 1995 and 2017. The primary analysis finds limited support for a substitution effect and no evidence of a complementary effect among adolescents. This study also includes a supplementary analysis providing implications for the direction of future research on the apparent relationship between alcohol and marijuana usage patterns.Item Mediators of the Relationship between Depression and Medication Adherence among HIV Positive Substance Users(2012) Magidson, Jessica F; Lejuez, Carl W; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Medication adherence is of utmost importance in predicting health outcomes across numerous chronic conditions, particularly HIV/AIDS. Highly active antiretroviral therapy (HAART) to treat HIV/AIDS requires high levels of adherence to maintain viral suppression, which is crucial for optimal HIV treatment and prevention. One of the most significant patient-level barriers to medication adherence is depressive symptoms. Even at subclinical levels, depressive symptoms predict nonadherence above and beyond other relevant psychosocial factors. Despite the focus on depressive symptoms as a reliable and powerful predictor of nonadherence, few studies have sought to test potential mechanisms underlying this relationship, which is an important step to advance our understanding of how depression affects adherence to inform intervention efforts. The current study utilized early behavioral theories of depression (Lewinsohn, 1974; Ferster, 1973) to select potential mediators that may be relevant to both depression and adherence. Specifically, we tested the key components of these models, (1) goal-directed activation, (2) positive reinforcement, and (3) punishment in one's environment as potential mediators of the relationship between depressive symptoms and medication adherence among HIV positive individuals in substance abuse treatment (n = 73). We examined adherence to HAART as well as adherence to other daily medications using a combination of self-report assessments (% of doses missed over past four days, frequency of doses missed across common reasons for nonadherence) and viral load. Greater levels of punishment mediated a positive relationship between clinician-rated depressive symptoms and greater frequency of missed doses across common reasons for nonadherence. Activation and positive reinforcement were unrelated to adherence or viral load in this sample. Findings suggest the importance of punishment in explaining the relationship between depression and medication nonadherence. Individuals with elevated depressive symptoms may perceive greater negative consequences related to medications (e.g., side effects, stigma) and may be less likely to overcome barriers necessary for optimal adherence. If findings continue to replicate, this may suggest a need to target punishment in HIV prevention and treatment, for instance in the context of integrated cognitive behavior therapy interventions that target depression and adherence among substance users.Item PSYCHOLINGUISTIC INDICATORS OF MOTIVATION FOR SUBSTANCE USE BEHAVIOR CHANGE AMONG INDIVIDUALS WITH SERIOUS MENTAL ILLNESS(2011) Sargeant, Marsha Nneka; Blanchard, Jack J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The co-occurrence of mental illness and substance use disorders (termed "dual diagnosis") represents a significant public health issue and is associated with significant impairment and negative health consequences, particularly among individuals with serious mental illness. Given the negative consequences associated with dual diagnosis, researchers have sought to identify treatment components that would improve outcomes among individuals with serious mental illness. Therefore, significant efforts have been made to increase motivation for change within severe mental illness populations using Motivational Interviewing, a client-centered therapy. The primary mechanism underlying the effect of Motivational Interviewing on behavior change is hypothesized to be the selective reinforcement of change talk by the therapist with the aim of reducing ambivalence. Change language has been found to predict substance use treatment outcomes; however, it is not clear if change language has similar predictive utility in individuals with serious mental illness. Therefore, the current study sought to validate change language as an indicator of motivation among 45 individuals with serious mental illness and co-occurring substance use disorders. Overall, we found that change language could be reliably coded in this sample. Evidence supported the predictive utility of Ability language (i.e., statements regarding self-efficacy) in prospectively predicting long term substance use treatment outcomes (i.e., six months after the Motivational Interview session) above and beyond negative symptoms, depressive symptoms, and substance use severity. These findings suggest that the investigation of client language during MI represents a promising avenue for understanding motivational processes underlying substance use treatment outcomes among individuals with serious mental illness. Specifically, elicitation of client statements regarding self-efficacy to reduce or stop substance use is particularly important in predicting favorable outcomes in this population. Future studies should evaluate the utility of incorporating treatment components aimed at cultivating self-efficacy for substance use behavior change among individuals with serious mental illness.Item Examining the Effect of the LET'S ACT Behavioral Activation Treatment for Depression on Substance Abuse Treatment Dropout(2009) Magidson, Jessica F; Lejuez, Carl W.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Despite the prevalence of depression among substance users and the negative impact of depressive symptoms on substance abuse treatment outcomes, few interventions targeting depression have been developed to meet the needs of depressed substance users, particularly in low-income urban areas. The current study aimed to replicate and expand upon promising preliminary findings for the use of a brief behavioral activation approach [Life Enhancement Treatment for Substance Use (LET'S ACT; Daughters et al., 2008)] to treat depression in the context of inner-city residential substance abuse treatment. Main extensions to the previous study include a comparison of LET'S ACT to a contact-time matched control treatment, Supportive Counseling (SC), and a more definitive evaluation of the effect of LET'S ACT on substance abuse treatment dropout. Results indicated that compared to SC, participants receiving LET'S ACT evidenced significantly lower rates of substance abuse treatment dropout and depressive symptoms, as evidenced by a significant treatment x time interaction with the change in self-reported and clinician-rated depressive symptoms from baseline to the 2-week follow up, as well as significantly higher rates of behavioral activation, as evidenced by a significant treatment x time interaction with scores on the Behavioral Activation for Depression Scale (BADS) from pre- to post-treatment. This study builds on preliminary evidence for LET'S ACT as a short-term behavioral treatment for depression in residential substance abuse treatment and offers initial support for the effect of LET'S ACT on substance use outcomes.Item Biobehavioral Mechanisms Underlying Emotionality in Antisocial Personality Disorder and the Role of Psychopathic Traits(2008-07-15) Sargeant, Marsha Nneka; Daughters, Stacey B; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)As one possible mechanism for behaviors associated with Antisocial Personality Disorder, the DSM-IV indicates that individuals with ASPD have low tolerance for frustration. A study investigating the relationship between ASPD and distress tolerance (DT) indicated that ASPD was related to low DT, indexed as low persistence on laboratory stressor tasks. The interpretation of this finding is clouded by the co-occurrence of psychopathy and ASPD. We examined whether psychopathic traits are related to higher DT and low biological stress response in the form of cortisol reactivity to a stressor. Results lent support to the relation of ASPD and psychopathic traits to DT; however, cortisol reactivity was not significantly related to ASPD or psychopathic traits. Nevertheless, discrepant patterns of stress reactivity emerged for individuals with ASPD and high levels of psychopathic traits. These findings suggest unique contributions of ASPD and psychopathic traits to emotionality across behavioral and biological domains.Item General Strain Theory and Stability in Offending and Substance Use Over Time: A Dynamic Approach(2007-08-08) Slocum, Lee Ann; Simpson, Sally S.; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)One of the hallmarks of a good theory is that it can explain the known facts. Therefore, it is surprising that little research has examined whether General Strain Theory (Agnew 1992, 2006) can account for the relative continuity in antisocial behavior that individuals generally display over their time. The current study fills this void in the criminological literature by testing the ability of General Strain Theory (GST), in combination with the broader stress literature, to account for stability in offending and substance use from adolescence to adulthood. Four mechanisms that Agnew (1997, 2006) argues lead to behavioral continuity--a direct effect, evocative and active selection, passive selection, and stressor and deviance amplification--are examined using structural equation modeling. Drawing from the broader stress literature and the life-course perspective, two additional pathways--stress proliferation and the moderating effect of past exposure to stressors--are tested. This research is conducted using two unique datasets, the Collaborative Perinatal Project and the Pathways to Adulthood Study, which together provide information on the lives of 1,758 high risk individuals from birth through adulthood. Support for GST explanations of behavioral continuity is mixed, with more support for the dynamic mechanisms that do not rely on negative emotionality and low constraint. Specifically, for both offending and substance use, there is no evidence to suggest that evocative and active selection or passive selection contribute to the stability of criminal behavior, however, stress proliferation and stressor and deviance amplification each explain a small portion of the association between adolescent and adult illegal behavior. In addition, the findings indicate that negative emotionality and low constraint condition the effect of stressors on criminal behavior, as does exposure to stressors in childhood. The findings for offending and substance use diverge only with regard to the direct effects of negative emotionality and low constraint: the direct effect of these variables on criminal behavior accounts for continuity in substance use, but not offending. It is argued that GST's emphasis on individual differences may be misplaced and that more attention should be directed to exploring the social processes through which stressors develop over time.Item Substance use in two generations of Indian Americans as a function of marginalization and perceived discrimination.(2007-08-10) Gholkar, Radha; Smith, Barry D.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Past studies using acculturation to predict substance use in immigrants have yielded mixed findings, suggesting support for both acculturative and assimilation theories of substance use in immigrants. In this investigation, two variables from the cross-cultural literature, Marginalization and Perceived Discrimination, were used to examine the predictions of these theories. First- and second-generation Indian-Americans were recruited and completed questionnaires measuring quantity, frequency, and negative consequences of drug / alcohol use, Perceived Discrimination, and Marginalization. Information on demographics and depressive symptoms were used as covariates. Hierarchical regression and correlation analyses indicated that lower levels of Marginalization significantly predicted higher rates Alcohol Use in the first-generation; conversely, higher levels of Perceived Discrimination were significantly associated with increased Drug Use in the second-generation. It was concluded that both assimilation and acculturative theories may have merit for identifying substance users in an Indian-American sample when generation is considered as a moderator.Item Disentangling Selection from Causation in the Empirical Association between Crime and Adolescent Work(2004-08-05) Apel, Robert; Paternoster, Raymond; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Researchers consistently find that youths who work longer hours during high school tend to have higher rates of crime and substance use. On the basis of this and other research showing the negative developmental impact of an "intensive" work commitment during high school, the National Research Council (1998) recommended that federal lawmakers place limits on the maximum number of hours per week that teenagers are allowed to work during the school year. However, recent empirical research demonstrates the possibility of severe bias due to failure to control for unobserved sources of heterogeneity. I take advantage of two unique characteristics of the National Longitudinal Survey of Youth 1997 to assess the veracity of the claim that longer work hours are causally related to elevated involvement in crime and substance use. First, since the same respondents are followed over a period of five years, I use individual fixed effects to adjust for the omission of relevant time-stable covariates. Second, I exploit state-to-state variation in the restrictiveness of child labor laws governing the number of hours per week allowed during the school year, and the fact that these restrictions are relaxed (and eventually expire) with increasing age. In this modelbased on a fixed-effects instrumental variables (FEIV) estimatoridentification of the "work intensity effect" on problem behavior is predicated on exogenous within-individual variation in school-year work hours attributable to the easing of child labor restrictions as youths age out of their legal status as minors. The attractiveness of the FEIV estimator is its ability to eliminate bias in the estimated "work intensity effect" due to omitted stable and dynamic variables. The model thus provides an especially powerful test of the thesis that intensive employment during the school year causally aggravates involvement in problem behavior. The empirical results demonstrate that longer work hours are associated with a significant decrease in adolescent crime, contrary to virtually all prior research. The results for adolescent substance use are mixed, suggesting the possibility that longer work hours either increase or have no effect on substance use, depending on whether a fixed-effects or first-differences procedure is implemented.