Behavioral & Community Health

Permanent URI for this communityhttp://hdl.handle.net/1903/2271

Prior to January 24, 2011, this unit was named the Department of Public & Community Health.

Browse

Now showing 1 - 20 of 216

ADAPTING A BREAST CANCER CONTROL INTERVENTION FOR AFRICAN AMERICAN WOMEN BELOW SCREENING AGE: A CO-DESIGN APPROACH
(2023) Huq, Maisha R; Knott, Cheryl L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Background: Despite African American women below screening age facing greater mortality from early onset breast cancer relative to similar aged peers of other races/ethnicities and African American women of screening age, little attention is given to this group of younger women. Evidence-based breast cancer educational interventions do not exist for this group of younger women. The purpose of the current work was to address the gap of evidence-based breast cancer educational interventions for African American women below screening age. Aims: The current study had two aims. Aim 1 was to adapt an evidence-based breast cancer educational intervention for African American women of screening age, to be targeted to younger African American women (i.e. those below screening age) using a systematic process guided by the seven-step adaptation framework by Card and colleagues, documented using an established implementation science model, the Framework for Reporting Adaptations and Modifications Enhanced Model (FRAME), and using a virtual co-design approach. Aim 2 was to assess the appropriateness of the adapted intervention for African American women below screening age through online surveys administered at the conclusion of Community Chat sessions. Methods: The adaptation process was guided by Card and colleagues’ seven-step framework. Five virtual co-design sessions with n=15 potential users and key stakeholders were conducted in step 7. Observational notes and FRAME Form data were collected from the co-design sessions and analyzed using five-step thematic and descriptive statistics analyses, respectively. Appropriateness data was collected through an online survey; quantitative data were analyzed using descriptive statistics and open-text survey responses were analyzed using five-step thematic analysis. Results: Application of Card and colleagues’ seven step framework was described. Six themes emerged from observing virtual co-design sessions: technological tools can encourage equal participation; personal relationships and stories enhance design; participants introduced content to promote equity; context of original intervention critical to adapt; challenges to virtual designing; and need for facilitator during co-design. Documentation of the adaptation process guided by FRAME found 14 adaptations led to “Black and Breasted (B&B)”, an Instagram and beauty brand partnership-based breast health education tool prototype. Motivations for adaptations were to promote fit (100%), reach (71%), and equity (29%). Adaptations were content (63%) and context-related (37%). All participants rated B&B as highly appropriate—selecting an average of 4.5 (SD=1.4) and 1.2 (SD=.75) reasons, respectively, B&B would and would not be a good fit. Thematic analysis of open-text responses on how to further enhance B&B identified four themes: increase strategies to improve health equity, use multiple social media, consider non-beauty brands, revise visuals/messages. Conclusions & Implications: While usage of the implementation science models led to a highly appropriate adapted intervention, initial testing identified the need for further strategies to improve equity of health outcomes through the intervention. Findings indicate implementation science frameworks may benefit from centering equity more. Co-design may also be an apt approach to promote health equity in public health interventions.
Addressing Unsubmitted Sexual Assault Kits and Reforming Processes Going Forward: Burnout and Vicarious Trauma Among Staff Working the Cases
(2019) Meadows, Kristi; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Burnout and vicarious trauma continue to be high priority topics in healthcare and law enforcement research, but there is a sizeable deficit within the literature among professions working directly with sexual assault cases. Generally, burnout and vicarious trauma among specific professions within the justice system including attorneys, victim advocates, and sexual assault nurse examiners (SANE) have been significantly understudied. Additionally, reforms are currently underway to address the problem of unsubmitted sexual assault kits stored in warehouses across the United States. However, implications for the employees have not been studied by researchers to understand potential consequences in working with these cases nor the added stress of reforms. Secondary qualitative analysis was conducted using data from a sample of interviews with key informants (n=135) who are victim-facing and involved in processes to address both unsubmitted sexual assault kits and current cases of sexual assault. Informants were more likely to focus on facilitators and challenges in their daily work than to discuss the outcomes of burnout and vicarious trauma. Insufficient access to resources and increased workloads were the most significant challenges discussed among key informants, although, emotional labor and other difficult aspects of the job were also a common theme throughout this population. Social support including support across agencies, as well as supervisory support, were the most discussed potential protective factors of burnout. This study contributes information regarding key challenges faced by individuals working on sexual assault cases and has direct implications for employees in the field as well as those undergoing reform on sexual assault kit processing. These findings should be used to understand potential contributors to burnout and vicarious trauma in order to better mitigate negative outcomes associated with this work.
Adoption, reach, and implementation of a cancer education intervention in African American churches
(Springer Nature, 2017-03-14) Santos, Sherie Lou Zara; Tagai, Erin K.; Scheirer, Mary Ann; Bowie, Janice; Haider, Muhiuddin; Slade, Jimmie; Wang, Min Qi; Holt, Cheryl L.
Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)—a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system. Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom (“Traditional”; n = 16 CHAs in 8 churches) or web-based (“Technology”; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance. The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL—226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05). Overall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.
African American Girls' Ideal Dating Relationship Now and In the Future and Factors that Shape These Perceptions
(2012) Debnam, Katrina Joy; Howard, Donna E; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
The quality of dating relationships in adolescence can have long lasting effects on identity development, self esteem, interpersonal skills, and shape values and behaviors related to intimate relationships and risk behaviors. However, little is understood about how adolescents view their ideal partner and what implications these perceptions may have for romantic relationships. In fact, research suggests that over 400,000 adolescents have been victims of serious dating violence at some point in their lives. Among African American adolescents, religion may be particularly salient in romantic relationships. Religious organizations not only provide a place for seeking spiritual guidance and social interactions, but also provide unifying morals, beliefs, and practices for African American families. In this dissertation, three studies where conducted. In Study 1 participants' self- identified, defined and vividly described 8 major characteristics, good communication, honesty, trust, respect, compromise, understanding, individuality, and self-confidence, of a healthy relationship. In Study 2 several themes emerged in comparing girls' perceptions of an ideal dating relationship in high school with their perceptions of the ideal future relationship: (1) having a partner who shared similar education and career plans, (2) `best friend' qualities such as respect, trust, and honesty, (3) importance of family in identifying an ideal relationship, and (4) temporariness of high school relationships. Study 3 findings suggest that the influence of religion in the lives of adolescents can be found in several domains. These included whether to become sexually active, choosing a partner based on religious affiliation and issues of sexual orientation. Interestingly, girls also felt that, despite the sanctity of marriage, women should not stay in unhealthy or harmful relationships. Dating violence prevention curricula focus on helping girls identify unhealthy or abusive relationships and provide strategies to help them leave these relationships. More programs are needed to instill in girls the values and characteristics of healthy relationships. Early education and modeling of healthy teen dating relationships will help educators, practitioners and advocates empower girls so they are more likely to develop healthy dating relationships and less likely to experience harm in their dating relationships.
African American Patient Perceptions Regarding Pre- and Post-Dialysis Education and Treatment
(2003-12-10) Greene, Revenda Ann; Desmond, Sharon; Public and Community Health
Kidney disease is common in the United States. It occurs with more frequency and more complications among African Americans than in the general population. Patients with end stage renal disease (ESRD) are at that point in the progression of kidney disease where death is imminent if treatment is not performed to replace the limited kidney function. Hemodialysis is a replacement treatment for ESRD. This study used ecological theory to examine pre-and post-dialysis education and treatment in a convenience sample of African American ESRD patients. A pilot study of 29 patients and a final sample of 98 patients were used. Patient age, income, education and length of time on dialysis were the independent variables examined. Dependent variables included knowledge, satisfaction, treatment intervention, and quality of life. Oneway analyses of variance (ANOVA) were used to analyze the data. The following research questions were examined: 1) Are African American ESRD patient adequately educated about the disease, its causes, possible complications and range of treatments available? 2) Will African American ESRD patient with higher income and education levels score higher on the knowledge and pre-dialysis education subscale, when compared to patient with lower income and education levels? 3) Is the degree of satisfaction with pre-dialysis information and education positively related to age, level of education and income of African American ESRD patients? 4) Do African American ESRD patients with disparate income and education levels receive different treatment interventions? 5) What are the perceptions of African American dialysis patients regarding their quality of life? When the data were analyzed, the research hypotheses related to questions one and three were not supported (p > .05). While the hypotheses for questions two and four were supported (p < .05). A significant relationship was found between patient satisfaction with pre-dialysis education and treatment and level of education. Other significant relationships were also found when examining the quality of life subscales with income and education.
Aggression and Perceptions of Parenting among Urban Public Middle School Students
(2008-02-28) Murray, Kantahyanee Whitt; Murray, Kantahyanee W; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Adolescent aggressive behavior is a major social problem in the United States and is linked to violence and violence-related injury. Understanding the relationship between parenting and early adolescent aggression provides important insights for developing prevention interventions. This study explored the relationship between parenting and early adolescent aggression in an urban low-income, predominately African American sample. The first aim was to examine whether aggression-specific parenting practices and parenting style predicted subsequent early adolescent aggression. The second aim was to examine the extent to which parenting style moderated the relationship between aggression-specific parenting practices and subsequent early adolescent aggression. The third aim was to explore the bidirectional relationship between parenting (parenting style and aggression-specific parenting practices) and early adolescent aggression. A total of 209 sixth grade early adolescents attending two Baltimore City middle schools completed questionnaires about their overt and relational aggressive behaviors at two time points. Early adolescents also reported on their perceptions of a parent or guardian's parenting style (support/behavioral control and psychological control) and aggression-specific parenting practices (aggression-avoidance parenting practices and aggression-endorsing parenting practices). Adjusted logistic regression results indicated that early adolescents who reported having a parent who supported aggression avoidance strategies were less likely to engage in overt aggression. Study findings also showed that parent support for aggression avoidance strategies ameliorated the tendency toward aggressive behavior when parenting styles were at their least protective levels. A bidirectional relationship between parenting and early adolescent aggression was not found; however, Structural Equation Modeling results indicated significant relationships between early adolescent aggression and subsequent parenting. Early adolescent overt and relational aggression predicted declines in parenting practices and parenting styles associated with buffering early adolescents from aggression. The results of this study suggest that parenting practices and parenting styles may exert a minor influence on early adolescent aggressive behavior in an urban low-income, predominately African American sample. Future research should investigate the role of multiple environmental influences (i.e., parenting, family, peer networks, community violence exposure, school environment) in the prediction of early adolescent aggressive behavior in this population.
Aging African American Women and the Impact of Positive Psychological Factors on Quality of Life
(2006-11-15) Parker, Candace Faye; Desmond, Sharon M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Aging African-American women are disproportionately affected by negative health outcomes and mortality. Life stress has strong associations with these health outcomes. The purpose of this research was to understand how aging African American women manage stress. Specifically, the effects of coping, optimism, resilience, and religiousness as it relates to quality of life were examined. This cross-sectional exploratory study used a self-administered questionnaire and examined quality of life in 182 African-American women who were 65 years of age or older living in senior residential centers in Baltimore using convenience sampling. The age range for these women was 65 to 94 years with a mean of 71.8 years (SD = 5.6). The majority (53.1%) of participants completed high school, with 23 percent (N = 42) obtaining college degrees and 19 percent (N = 35) holding advanced degrees. Nearly 58 percent of participants were widowed and 81 percent were retired. In addition to demographics, the questionnaire included the following reliable and valid survey instruments: The Brief Cope Scale (Carver, Scheier, & Weintraub, 1989), Optimism Questionnaire (Scheier, Carver, & Bridges, 1994), Resilience Survey (Wagnild & Young, 1987), Religiousness Assessment (Koenig, 1997), and Quality of Life Questionnaire (Cummins, 1996). Results revealed that the positive psychological factors examined were positively associated with and significant predictors of quality of life. The bivariate correlations indicated that of the six coping dimensions measured in this study, planning (r=.68) was the most positively associated with quality of life. Optimism (r=.33), resilience (=.48), and religiousness (r=.30) were also significantly correlated with quality of life. In the linear regression model, again the coping dimension of planning was the best predictor of quality of life (beta = .75, p <.001). Optimism (beta = .31, p <.001), resilience (beta = .34, p, .001) and religiousness (beta = .17, p <.01) were also significant predictors of quality of life. It appears as if positive psychology plays an important role in improving quality of life among aging African-American women.
AIDS AND THE COLLEGE STUDENT: KNOWLEDGE, BELIEFS, AND INFORMATION SEEKING
(1989) Shelnutt, Emily Houston; Beck, Kenneth H.; Behavioral & Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md)
A questionnaire on knowledge, beliefs, and information-seeking behavior about Acquired Immune Deficiency Syndrome (AIDS) was administered to a total of 1,300 university students, and 1,001 were completed and returned. The aim of the study was to investigate the relationship between college students' knowledge and beliefs about AIDS and their information-seeking behavior about AIDS. Students were found to be knowledgeable about the disease, but the majority (50.5%) were not worried about contracting AIDS. The findings revealed that students who are more knowledgeable about AIDS seek more information than those less knowledgeable about AIDS. It was also found that students who feel more highly susceptible to AIDS are more likely to seek information about the disease. The primary sources of student information on AIDS were television, newspapers, magazines, and radio; however, doctors and health-care professionals were considered the most trust-worthy sources of AIDS information. The data suggest that medically supported information on AIDS should be provided to college students by health educators via the popular media sources.
"Alexa, do I have an STD?": An Exploration of Young Adult Information Seeking Behaviors When Engaging With Home Assistant Devices About Sexually Transmitted Infections
(2023) Siddiqui, Junaed Ahmad; Baur, Cynthia; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
BACKGROUND: Sexually transmitted diseases and infections continue to disproportionately affect young adults in the United States, with half of all new STIs annually occurring in young adults between the ages of 15 and 24. Advances in digital technologies have allowed for the facilitation of fast and discreet information about sexual health but remains understudied in the context of newer technologies. There is limited research on the effectiveness of Home Assistant Devices as channels to facilitate the information seeking process in young adults. To address this gap, this study explored whether Home Assistant Devices can facilitate the sexual health information seeking process in young adults between the ages of 18 and 26 who already use the internet to search for health information. The purpose of this dissertation was to explore the perspectives of young adults to understand the depth of their sexual health information needs and whether a user-centric designed HAD can be a suitable alternative for fulfilling those information needs. METHODS: Informed by the Theory of Motivated Information Management and Technology Acceptance Model, this qualitative study used the Design Thinking framework to understand young adults’ information needs and created a prototype voice skill to address that need. In-depth interviews were conducted virtually on Google Meet or Zoom and were recorded. This qualitative study occurred in three phases: in the first phase, 10 young adults were interviewed about their information seeking needs, current gaps, and how they thought Home Assistant Devices could fill that need. Insights from those interviews were then analyzed and used to create a prototype that would address sexual health information needs. The prototype was then tested with a new group of ten young adults, and their reactions to the prototype was recorded via interviews. In the third phase, the prototype was refined based on feedback from the previous group, and then re-tested with a new group of 10 young adults. In total, in depth interviews were conducted virtually with 30 young adults to understand information needs and create a prototype voice skill that could serve to facilitate the transfer of sexual health information in a convenient and relevant manner. Inductive thematic analysis was conducted to identify emergent themes. RESULTS: Overall, the sample (n=30) was 63% female, 43% White, with 53% having completed a bachelor’s degree, and 47% having owned a Home Assistant Device for over 12 months. The average age of the sample was 24 years old. After analyzing interviews through inductive thematic analysis in NVivo, four themes that were noted in the first phase as it related to Home Assistant Devices and information needs: the use of HADs as a means of convenience, preferring to use screen-based devices for research, tradeoffs between privacy and functionality, and the ability to emergency triage users for medical attention based on symptoms. Three main themes emerged in the second phase after reacting to the first version of the prototype, including anxiety and frustration when experiencing the unknown, pre-existing positive perceptions of Home Assistant Devices, and negative perceptions of Home Assistant Devices. In the third phase, two main themes emerged: a desire to share visuals to build comfort and bridge the information gap, and an ambivalence towards privacy. DISCUSSION: Privacy concerns remain prominent with Home Assistant Devices when engaging with them for information seeking purposes. These concerns are sometimes met with ambivalence by young adults, who were willing to trade some of their privacy for added features or functionality that could improve their user experience. Furthermore, challenges remain with voice search and screen-based devices are perceived to be easier to use. Lastly, the sexual health information seeking process is sensitive, and many young adults in this sample expressed wanting to have a more personalized experience that acknowledged their specific situations. To the author’s knowledge, this is the first study that explored the factors contributing to the sexual health information seeking process using Home Assistant Devices among young adults between the ages of 18 and 26. The results of this study have several implications for public health practice and research, especially as it relates to the Design Thinking approach for public health voice skill development, as well as addressing a new approach to providing sexual health information to young adults that may be more discreet and relevant to them. The findings from this study contribute to the emerging literature base on the use of Home Assistant Devices to address sensitive health information seeking behaviors.
APPLICATION OF A CULTURALLY RELEVANT HEALTH BELIEF MODEL TO BLACK AND AFRICAN AMERICAN YOUNG ADULTS WITH SICKLE CELL DISEASE DURING TRANSITION TO ADULT HEALTHCARE SERVICES
(2022) Pantaleao, Ashley; Fish, Jessica; Anderson, Elaine A.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Sickle cell disease (SCD) is a hereditary chronic illness hallmarked by pain and functional disability that impacts psychosocial well-being. Within the United States, SCD largely affects Black and African American populations, and general health disparities present in these populations may be further magnified by SCD. Due to the complexity of symptom management, consistent healthcare adherence is imperative and is often scaffolded by family caregivers prior to transition. The transition from the pediatric to adult healthcare facility is a life stage public health concern for young adults with SCD, as it is a time characterized by high mortality and morbidity. Navigating new medical systems and working with new providers are factors contributing to delays in treatment-seeking behavior. Unexplored factors that may impact illness course and outcomes include health-related stigma, racial discrimination, and preparation for bias. This research assessed whether the perceived barriers (e.g., racial discrimination, externalized stigma, and internalized stigma) are linked to SCD-specific self-efficacy and transitioning to the adult healthcare setting, utilizing an adapted Health Belief Model. It additionally explored whether a culturally relevant factor, preparation for bias, contributes to transition readiness. Questionnaires were administered to young adults with SCD who were preparing for transition or actively transitioning to an adult healthcare facility. This work was a first step at exploring the relationships between these variables utilizing a culturally relevant Health Belief Model. Strong positive significant correlations among perceived barrier variables were noted as well as a positive significant correlation between SCD-specific self-efficacy and transition readiness. Results from multivariate models suggest that externalized stigma was significantly positively related to SCD-specific self-efficacy. Counter to expectations, no significant predictors of transition readiness were identified. Additionally, results did not support preparation for bias moderating the relationships between racial discrimination or externalized stigma with SCD-specific self-efficacy or transition readiness. These findings may highlight that our study was underpowered to detect large effects, or that there are additional complex relationships that need to be further explored. A short-term goal of this study was to highlight the value of identifying youth with low self-efficacy or preparation for bias in order to guide educational resources and interventions to increase self-efficacy and readiness to transition for this underserved illness group.
APPLICATION OF DIFFUSION OF INNOVATIONS: A DESCRIPTIVE PILOT STUDY ON THE PERCEPTIONS OF HOME MONITORING SYSTEMS BY ADULTS 45 TO 64 YEARS OF AGE
(2012) Tran, Quynh; Holt, Cheryl L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
BACKGROUND: Improving the function and quality of life of older adults is a key objective identified in Healthy People 2020. Prevention efforts that address the needs of older adults while respecting their desire to remain independent are critical towards meeting this objective. Home monitoring systems (HMS) are a relatively new consumer health technology product that holds promise in enabling independence among seniors in their homes by delaying admittance into institutionalized settings and yet it struggles with low adoption rates in the consumer market. The purpose of this pilot study was to detect and measure the anticipated innovation attributes of HMSs to inform its positioning and promote faster diffusion rates by describing potential adopters among adults 45 to 64 years of age. METHODS: An existing survey was modified to collect perceptions of three anticipated attributes of innovation as they relate to the intention of adopting an HMS as a preventive health behavior. The survey modification was theoretically based on the Diffusion of Innovations (DOI) piloted among residents of Chevy Chase and Bethesda, Maryland (N=71). Logistic regression and Pearson correlation analyses were used to detect evidence to support whether perceived relative advantage, compatibility and complexity and demographic variables were associated with the intention to adopt an HMS in the future. RESULTS: Majority of participants were highly educated, perceived themselves to be in very good health, were or had been caretakers and intended to adopt an HMS in the future. Evidence was found supporting the DOI variables were positively correlated with the intention to adopt an HMS at statistically significant levels (p < .01 and .05). However, high ORs and wide 95% CIs caution the use of these variables as precise predictors of innovativeness and small sample size inhibits the interpretation that a pure statistical relationship exists. Additional findings included the potential of using caretaker status as a predictive variable and purchasing an HMS directly from the manufacturer emerged as an insight into consumer behavior. CONCLUSION: Findings from this study can help us understand how assistive technologies like HMSs are perceived and describe characteristics of early adopters. These preliminary insights can inform future research and improve efforts to encourage faster rates of adoption, particularly in the consumer marketplace where rapid diffusion of promising technologies can have the greatest impact on improving health outcomes for a new aging population.
Assessing Gender Equity in the Workplace: A Case Study
(2015) Wahl, Mary Grace; Garza, Mary A; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Background: Women currently represent 47 percent of the workforce, and these rates have been steadily climbing since the 1970s. The presence of gender discrimination in the workforce has been documented and measured, although not extensively, in the form of qualitative and quantitative studies, court cases, and legislation passed. There has been even less effort focused on its reciprocal, the fostering of gender equity in the workplace. This study examines staff perceptions of gender equity in the workplace, both in the office setting and in the overseas programmatic efforts of the organization. Methods: The organization in the case study, Lutheran World Relief, is a small-scale faith-based international development organization, and the study population is its domestically-based staff located at its headquarters office. This study utilizes a cross-sectional quantitative methods approach by conducting an anonymous survey. Results/Summary: The survey had a 53% staff response rate. This study showed that the organization's staff have overall positive perceptions of its gender equitable workplace culture as well as its programmatic efforts overseas. Main areas of improvement include financial resources allocated for gender integration and improving technical capacity of staff. The study results will guide the organizations' efforts to improve its office culture and programmatic efforts, and this organization sets a strong example of the importance of organization-wide reflection around and prioritizing of gender equity.
ASSESSING HEALTH CARE USE, COSTS, AND QUALITY FOR CENTERS OF EXCELLENCE FOR PEDIATRIC CONGENITAL HEART DISEASE CARE FOR THE MILITARY BENEFICIARY POPULATION
(2022) El-Amin, Amber Jovan; Franzini, Luisa; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Background: For the military beneficiary population with cardiac or congenital anomalies, the Fiscal Year 2019 health care costs were $83 million, including $55 million for newborns who were less than one year of age and $28 million for youth ages 1 to 17 (Kennell and Associates Inc., 2020). The 2019 Military Health System (MHS) costs were approximately $50 billion (Mendez, 2019) and are expected to increase significantly through 2028 (Congressional Budget Office, 2014). In an attempt to close the gap between cost and benefit for its 9.6 million beneficiaries, the MHS has considered targeted inclusion of Centers of Excellence (CoE) for purchased care within TRICARE insurance coverage and MHS policies. In general, a CoE produces consistent outstanding measurable outcomes for a specific medical condition. A Congenital Heart Defect (CHD) is the presence of abnormalities in the heart structure that develop in the uterus during pregnancy. CHDs are the most common types of birth defects and the principal cause of illness and death for birth defect conditions. CHDs are associated with comorbidities and repeat surgical interventions resulting in significant use of health care services during infancy, childhood, and adulthood, making CHDs a great candidate for CoE use.Objective: To compare health care use, costs, and quality of care for pediatric CHD care at CoEs and non-CoEs for the military beneficiary population. Data Sources: Retrospective claims data from the MHS Data Repository for MHS beneficiaries aged 0 to 17 years who received CHD care from 2016 to 2020. Study Design: Using an instrumental variable approach to estimate the impact of CoE use on clinical outcomes (annual admissions, annual emergency room use, and mortality) and health care costs (total costs and hospitalization costs) for pediatric CHD care within the military beneficiary population. Results: A total of 10,865 patients were included, of which 82.9% used a CoE at some point for CHD care. Results suggested that racial disparities in CoE use were not significant for CHD care for the military beneficiary population. There were disparities noted in CoE use by military rank, suggesting that Senior Enlisted and Other ranks were associated with lower odds of CoE use than Junior Enlisted ranks. Results of the IV approach proved that the causal effect of CoE use was a lower probability (-14.1) of emergency room use post one-year CHD diagnosis for the military beneficiary population (p<0.01). The causal effect of CoE use on annual admissions and mortality was insignificant at the .05 significance level but proved that CoE use did not increase annual admissions nor jeopardize patients’ survival post one-year CHD diagnosis for the military beneficiary population. The causal effect of CoE use on CHD related annual costs was a $40,898 decrease in annual costs (p=.059). Although the relationship was not significant at the .05 level, the magnitude of the reduction was approximately 53% of the mean annual cost. When stratified by complexity of CHD diagnosis, the causal effect of CoE use on CHD related annual costs was a statistically significant reduction of $84,852 in annual costs post one-year CHD diagnosis for patients diagnosed with a moderate-complex or single ventricle CHD diagnosis, equating to an approximate 76% reduction in mean annual costs. The causal effect of CoE use on CHD related hospitalization costs was a $33,170 decrease in hospitalization costs (p=.087). Although the relationship was not significant at the .05 level, the magnitude of the reduction was approximately 47% of the mean hospitalization costs. When stratified by CHD diagnosis complexity, the causal effect of CoE use on CHD related hospitalization costs was a statistically significant reduction of $73,084 in hospitalization costs post one-year CHD diagnosis for patients diagnosed with a moderate-complex or single ventricle CHD, equating to an approximate 76% reduction in the mean admission costs. Conclusions: Patients with more severe CHD diagnoses were more likely to use CoEs. After adjusting for selection bias due to disease severity, CoE use improved clinical outcomes, reduced health care resource utilization, and reduced costs for CHD care for the military beneficiary population.
Assessing Knowledge, Attitudes, and Behaviors Toward West Nile Virus Prevention Among Adults ≥ 60 Years Old in Maryland: An Application of the Health Belief Model
(2014) Mitchell, Kimberly C.; Howard, Donna E.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
West Nile Virus (WNV) is a mosquito-borne virus and the leading cause of arboviral (arthropod-borne) disease in the U.S. While most WNV cases are asymptomatic, 20% of infected people develop WNV fever and < 1% develop severe neurologic disease. Individuals over 50 years old are at greatest risk of severe disease and death. Dramatic increases in WNV activity in 2012 underscored its unpredictable nature and highlighted concerns for adverse effects on older adults. It is important to understand factors that influence this population's engagement in WNV prevention. This study analyzed data collected by the Maryland Department of Health and Mental Hygiene (DHMH) via cross-sectional survey to identify barriers to WNV prevention among adults ≥60 years of age. Subjects were recruited via stratified random sample of 1,700 households from counties with ≥ two WNV cases, enrolling 211 Maryland adults ≥ 60 years old. Six constructs of the Health Belief Model (HBM)--perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy--were examined to assess how they predicted attitudes and behaviors toward WNV prevention. Univariate, bivariate and multivariate analyses examined the utility of the HBM for explaining WNV preventive behaviors in Maryland adults. Multivariate logistic regression models tested 36 hypotheses examining associations between HBM constructs and six outcomes: (1) avoiding the outdoors at dusk and dawn, (2) dressing in long-sleeved shirts and long pants when outdoors, (3) using insect repellent on exposed skin, (4) draining standing water from objects around one's property, (5) acceptance of a WNV vaccine, and (6) support for community mosquito control programs. Findings showed high WNV knowledge and awareness but low perceptions of personal risk for WNV infection. Perceived susceptibility to WNV predicted use of insect repellent, draining of standing water from objects around the home, and acceptance of a WNV vaccine; perceived benefits were associated with draining standing water and support for mosquito control programs. Feelings of worry about WNV may inform future WNV interventions and risk communication to older adults. Findings have implications for theory-based research, which could probe applications of the HBM and other theories in understanding WNV attitudes and behaviors.
Assessing the Readiness and Training Needs of Non-urban Physicians in Public Health Emergency and Response
(Harvard School of Public Health, Center for Public Health Preparedness, 2005-10) Hsu, Chiehwen Ed; Soto Mas, Francisco; Jacobson, Holly; Nkhoma, Ella; Zoretic, James
Emergency readiness has become a public health priority for United States communities after the 9/11 attacks. Communities that have a less developed public health infrastructure are challenged to organize preparedness and response efforts and to ensure that health care providers are capable of caring for victims of terrorist acts. A survey was used to assess nonurban physicians’ prior experience with and selfconfidence in treating, and preferred training needs for responding to chemical, biologic, radiologic, nuclear, and explosive (CBRNE) cases. Data were collected through a mailed and Web-based survey. Although the response rate was calculated at 30%, approximately one third of the surveys were not able to be delivered. Most respondents reported never having seen or treated CBRNE-inflicted cases and were not confident in their ability to diagnose or treat CBRNE cases, but many were willing to participate in a state-led response plan. Almost half of the individuals had not participated in any related training but expressed interest in receiving training in small group workshops or through CD-ROM. These results provide potential direction for strategic preparedness planning for non-urban health care providers.
ASSESSING UNDERGRADUATE STUDENTS’ JUDGEMENT OF SEXUAL ACTIVITY CONSENT SEEKING AND COERCIVE BEHAVIORS, AND ATTITUDE TOWARD ESTABLISHING SEXUAL CONSENT
(2022) Abebe, Israel; Howard, Donna; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Sexual violence continues to be a serious public health problem, particularly among the college student population. This dissertation developed and implemented a web-based factorial vignette experiment to investigate vignette- and respondent-level factors that can explain undergraduate students’ evaluation of consent-seeking and verbal coercion in hypothetical vignette scenarios (N=420; Study 1). The vignettes embedded three factors with two levels each: level of intoxication (2 levels – sober/drunk), type of sexual relationship (2 levels – casual/committed), and, place of sexual encounter (2 levels – sexual initiator’s/partner’s residence). The respondent-level factors included gender identity, history of sexual victimization, attitude toward establishing consent, and endorsement of alcohol-involved consent scripts. Mixed models were used to assess the effects of vignette-level and respondent-level factors on students’ evaluations of consent-seeking and verbally coercive behaviors. The results showed significant differences in students’ evaluation of whether consent was sought based on level of intoxication, type of relationship, vignette scenarios, gender, consent attitude and endorsement of consent scripts. In addition, the study found significant differences in evaluations of coercive behaviors based on the vignette scenarios, consent attitude and acceptance of consent scripts. The dissertation also assessed the relationship between students’ endorsement of alcohol-involved sexual consent scripts and attitude toward establishing sexual consent, after accounting for covariates (Study 2). Hierarchical regression was used for this purpose. The study demonstrated that there is an inverse relationship between endorsement of consent scripts and consent attitude, after controlling for gender identity, relationship status, and campus athletic participation. There were also significant differences in consent attitude based on gender and relationship status. The findings from this dissertation emphasize the importance unpacking the elements of sexual consent definitions provided in many campus policies and understanding the cognitive and contextual factors that influence students’ interpretations of those elements. In addition, the findings support that there are broader issues such as acceptance of scripts that influence students’ consent attitudes. The implications include the need to target contextually relevant predictors of consent understanding and consent attitude in campus sexual violence prevention efforts.
Assessment of Nicotine Dependence and its Demographic Correlates among African American Smokers
(2008-05-05) Sharma Acharya, Eva; Howard, Donna E; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Despite scientific evidence that smoking is highly addictive, little information is available on the prevalence of nicotine dependence among African American smokers. The primary objective of this study was to examine the associations between demographic variables, socioeconomic status, self reported smoking history and the level of nicotine dependence among African American smokers. This study was a cross-sectional secondary analysis of data collected during a randomized clinical trial from African American participants (n=206). The results showed that age of smokers, number of years of regular smoking, low education level and negative perception of ability to quit smoking were associated with high nicotine dependence. The multivariate analysis showed that those with negative perception of their ability to quit smoking had greater odds of having high nicotine dependence. The findings suggested that tailored interventions should include components that increase self efficacy among African American smokers depending on the level of nicotine dependence.
The Association Between Electronic Cigarette Use and Cigarette Smoking Behavior Among Young Adults in the United States
(2015) Coleman, Blair N.; Green, Kerry M; Glover, Elbert D; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
The prevalence of electronic cigarette (e-cigarette) use is rapidly increasing in adults and youth; however, little is known about the public health impact of their use. A debate over e-cigarettes has emerged in the literature; one side recognizes the potential benefit of e-cigarettes as a harm reduction tool, while others argue e-cigarette use may delay or deter smoking cessation due to dual use or increase the risk of initiation of conventional cigarettes among previous nonsmokers. Drawing on the Theory of Planned Behavior, this dissertation focused on attitudes, beliefs, and perceived social norms of e-cigarettes, as well as openness to conventional cigarette smoking among young adult users of the product. Using a mixed methods approach, this dissertation analyzed secondary data from the 2012-2013 National Adult Tobacco Survey (NATS) as well as focus group data collected in five cities across the U.S. to better understand the relationship between e-cigarette use and cigarette smoking among young adults. In Study 1, quantitative analyses found non-cigarette smoking young adults who have tried e-cigarettes were more likely to report openness to cigarette smoking in the future compared to those who have not tried e-cigarettes (AOR= 2.4; 95% CI= 1.7-3.3). In Study 2, qualitative findings suggest that young adult exclusive e-cigarette users were less interested in conventional cigarette smoking, and overwhelmingly described negative aspects to cigarette smoking that appeared to become more salient as a result of their e-cigarette use. In Study 3, focus group participants expressed many positive attitudes towards e-cigarettes, and simultaneously reported a lack of information and knowledge about the products. The relationship between e-cigarette use and cigarette smoking is complex and multifaceted, and influenced by a myriad of individual and social factors. Although quantitative findings suggest young adults who have used e-cigarettes compared to those who have not used e-cigarettes were more likely to report openness to future cigarette smoking, qualitative findings did not support the notion that young adult e-cigarette users (who may have prior experience with cigarette smoking) are open to future cigarette smoking. These findings provide a basis for further exploration of the association between e-cigarette use and cigarette smoking.
THE ASSOCIATION BETWEEN NEGATIVE CONFLICT BEHAVIOR AND SUBCLINICAL LEVELS OF PSYCHOPATHOLOGY SYMPTOMS IN CLINIC COUPLES: AN ACTOR-PARTNER INTERDEPENDENCE MODEL APPROACH EXAMINING MEDIATION BY PERCEIVED CRITICISM AND MODERATION BY POSITIVE COMMUNICATION
(2015) White, Anna; Epstein, Norman B; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Past research on family members as psychosocial stressors leading to increased symptom distress has been mostly limited to psychiatric populations and has been problem-focused. The current study used behavioral observations and partner reports to examine the relationship between positive and negative partner behavior and individual symptom distress, mediated by perceived criticism, in 96 clinical couples. Results of structural equation modeling showed that male negative behavior had a positive relationship with female symptom severity mediated by perceived criticism. Female negative behavior had a negative relationship with male symptom severity, not mediated by perceived criticism. Warmth displayed no significant relationship with perceived criticism or symptom severity for either gender. Recommendations for future research include examining the role of power in the relationship between negative partner behavior and symptom severity and assessing the ratio between positive and negative behaviors rather than as separate variables. Replication of these results is warranted.
The association of acculturation, social support, and alcohol use among Mexican American adults
(2008-04-22) McDowell, Margaret Ann; Atkinson, Nancy; Gold, Robert; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Background: The increasing diversity of the U.S. population and the tremendous growth of the elderly population in the U.S. pose a challenge for public health practice. Mexican Americans (MAs) comprise the largest U.S. Hispanic subgroup. Previous research has shown alcohol use among MA adults varies by sex, age, acculturation level, socioeconomic status, and other factors. Purpose: This study explored the association of social, cultural, and demographic factors among MA adults. Berry's acculturation model (1980) and social support theory provided the theoretical underpinnings for this study. Multiple proxy measures of acculturation were used: a 5 item language subscale, generation level, and length of time in the United States. The association of social support and alcohol use among MAs 60 years and older was assessed using NHANES social support interview data. Methods: A secondary data analysis of 1999-2004 National Health and Nutrition Examination Survey data was conducted with a nationally representative sample of 1,682 MAs 40 years of age and older. Psychometric testing was performed with a language use scale and social support index. Descriptive statistics and logistic regression analyses were conducted to examine the predictors of lifetime abstention and current alcohol use. Results: Acculturation was associated with lifetime abstention and current alcohol use among females. Lifetime alcohol abstention rates were higher among less acculturated females, and a majority of female current drinkers were light alcohol users. Among males, lifetime alcohol abstention rates were very low. Light or moderate alcohol use was reported by two-thirds of males. Socioeconomic status and marital status were predictive of heavier alcohol use among males. No association was observed between social support and alcohol use among older adults. Conclusions: The results from this study underscore the complexity of alcohol use behavior among MAs. The strong association of acculturation and alcohol use among MA women suggests that traditional alcohol norms are altered during the acculturation process. Alcohol use among MA men is more common and heavy use was associated with social and economic factors rather than acculturation. The study findings may be used to inform health promotion and alcohol intervention programs for MA adults.