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.
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Item STATE-LEVEL STRUCTURAL RACISM AND ALCOHOL AND TOBACCO USE BEHAVIORS IN A NATIONAL PROBABILITY SAMPLE OF AFRICAN AMERICANS(2023) Woodard, Nathaniel; Knott, Cheryl L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Structural racism is how society maintains and promotes racial discrimination through established and interconnected systems. Structural racism is a historical driver of health disparities, including those in the area of cancer. One pathway posited for this effect is through the promotion of maladaptive coping behaviors, such as alcohol and tobacco use. This dissertation empirically assessed the association between state-level structural racism and alcohol and tobacco use behaviors among African Americans, including within various subgroups of African Americans based on age, gender, and household income. This project analyzed secondary self-report data collected from a national probability sample of 1,946 African Americans in the Religion and Health in African Americans (RHIAA) Study. Existing measures of state level structural racism were merged into the RHIAA dataset including a composite index of structural racism assessed using five dimensions (i.e., residential segregation, and economic, employment, education, and incarceration disparities). Analyses were performed in SPSS Version 28 using hierarchical linear and logistic regression models. In the first study, two models (Model A and Model B) were constructed for each of four outcomes, frequency of alcohol consumption (measured in days per month), frequency of binge drinking (measured in the number of occurrences per month), smoking status (current smoker or not a current smoker), and smoking frequency (never smoked, former smoker, currently smoke on some days, and currently smoke every day). Model A used the composite structural racism index measure to model the four alcohol and tobacco use measures and Model B analyzed the disaggregated dimensions of structural racism rather than the composite measure. All hierarchical analyses controlled for confounding variables (i.e., participant gender, age, education, income, and employment status). In the second study, analyses using the dimension-level approach in Model B from study one were repeated in subgroups stratified by participant age, gender, and income for the frequency of binge drinking and smoking status behaviors. Statistical comparisons of the slope estimates between corresponding subgroups (e.g., younger and older age) were used to test the moderation effects of age, gender, and income on the association between structural racism and alcohol and tobacco use behaviors. Results from these studies generally indicated a positive association between state level structural racism, especially in the incarceration dimension, and binge drinking and tobacco use behaviors. Stratified analyses generally did not support age, gender, or income as moderating variables of the association between structural racism and binge drinking and tobacco use behaviors. Current findings demonstrate a need for further research on structural racism and health and progress in structural racism measurement, including further emphasis of dimension-level measurement and analysis. Findings from the current dissertation highlight the importance of addressing structural racism, especially in incarceration, to reduce alcohol and tobacco use behaviors among African Americans and help address existing health disparities.Item 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.Item PRESENCE AND PREDICTORS OF HEALTH PROGRAMMING IN A SAMPLE OF AFRICAN AMERICAN CHURCHES(2019) Woodard, Nathaniel; Fryer, Craig S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Churches have played a central role in African American communities for decades. In addition to religious services, African American churches have increasingly offered a variety of health programs. However, there is a dearth of empirical literature on church-initiated health programming. This study examines quantity and variety of health programs and areas addressed by a convenience sample of African American churches (N = 119), as well as church characteristics that predict these health initiatives. Churches offered a mean of 6.08 (SD = 2.15) health programs targeting 4.66 (SD = 3.63) different health topics within the previous 12 months. Various church characteristics indicating greater availability of programming resources were positively associated with the quantity and variety of health initiatives. It is recommended that practitioners partner with under-resourced churches to support their existing health activities and address gaps in health programming. Future research should seek to evaluate the effectiveness of church-initiated health programs.Item Measuring the Single Cigarette Use Phenomenon: Scale Development and Validation(2019) Phan, Lilianna; Butler, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The practice of single cigarette use perpetuates normative smoking beliefs and increases smoking propensity among urban, African American smokers. Despite the 2009 Family Smoking Prevention and Tobacco Control Act’s ban of single cigarettes, there is a paucity of research to inform the public about the harms of single cigarettes and regulatory enforcement of their sales by the Food and Drug Administration. This dissertation utilized a mixed-method, three-phase design with primary data collection to: 1) examine the social context, beliefs, and attitudes of loosie use; and, 2) develop and validate two theoretically-based scales (i.e., social context and Health Belief Model) on the purchasing and use of loosies by urban, African American smokers. In Phase I, 25 semi-structured, in-depth interviews were conducted to understand the social context and underlying intrapersonal factors related to loosie use. Qualitative data, analyzed using the Framework Method, informed the development of potential scale items. During Phase II, three expert reviewers and 24 urban, African American loosie users provided feedback and pilot tested the items via the “Think Aloud” method. In Phase III, psychometric data were collected from 122 urban, African American loosie users from the District of Columbia Housing Authority public housing sites. Rigorous exploratory factor analysis and reliability and validity testing were conducted to determine the most parsimonious models for two scales: The Social Context of Loosies Scale (SCL-11) and the Health Belief Model for Loosies Scale (HBML-20). Both scales and their respective subscales demonstrated internal consistency and divergent and convergent validity. To our knowledge, this dissertation research is the first study to utilize semi- structured interviews (Phase I) to examine individualized patterns of loosie use by urban, African Americans and to develop valid scales designed by, and for, urban, African American loosie users (Phase II and Phase III). Given the strong psychometric properties of the scales, they may be used to identify meaningful targets for individual, social, and environmental intervention to prevent and reduce loosie use among this priority population.Item CERVIXCHECK: A SPIRITUALLY-BASED SMS TEXT MESSAGING PILOT INTERVENTION TO INCREASE CERVICAL CANCER AWARENESS AND PAP TEST SCREENING INTENTION AMONG AFRICAN AMERICAN WOMEN(2016) Le, Daisy; Holt, Cheryl L.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African American women account for a disproportionate burden of cervical cancer incidence and mortality rate when compared to non-Hispanic White women. Cervical cancer is one of the most preventable types of cancer, and women can be screened for it with a routine Pap test. Given that religion occupies an essential place in African American lives, framing health messages with important spiritual themes and delivering them through a popular communication delivery channel may allow for a more culturally-relevant and accessible technology-based approach to promoting cervical cancer educational content to African American women. Using community-engaged research as a framework, the purpose of this multiple methods study was to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention to increase cervical cancer awareness and Pap test screening intention among African American women. The study recruited church-attending African American women ages 21-65 and was conducted in three phases. Phases 1 and 2 consisted of a series of focus group discussions (n=15), cognitive response interviews (n=8), and initial usability testing that were conducted to inform the intervention development and modifications. Phase 3 utilized a non-experimental one-group pretest-posttest design to pilot test the 16-day text messaging intervention (n=52). Of the individuals enrolled, forty-six completed the posttest (retention rate=88%). Findings provided evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There were significant pre-post increases observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Additionally, results post-intervention revealed that 83% of participants reported being either “satisfied” or “very satisfied” with the program and 85% found the text messages either “useful” or “very useful”. 85% of the participants also indicated that they would “likely” or “very likely” share the information they learned from the intervention with the women around them, with 39% indicating that they had already shared some of the information they received with others they knew. A spiritually-based SMS text messaging intervention could be a culturally appropriate and cost-effective method of promoting cervical cancer early detection information to African American women.Item Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches(Implementation Science, 2014-05-31) Holt, Cheryl L.; Tagai, Erin K.; Scheirer, Mary Ann; Santos, Sherie Lou Z.; Bowie, Janice; Haider, Muhiuddin; Slade, Jimmie L.; Wang, Min Qi; Whitehead, Tony; Holt, Cheryl L.Background Community-based approaches have been increasing in the effort to raise awareness and early detection for cancer and other chronic disease. However, many times, such interventions are tested in randomized trials, become evidence-based, and then fail to reach further use in the community. Project HEAL (Health through Early Awareness and Learning) is an implementation trial that aims to compare two strategies of implementing evidence-based cancer communication interventions in African American faith-based organizations. Method This article describes the community-engaged process of transforming three evidence-based cancer communication interventions into a coherent, branded strategy for training community health advisors with two delivery mechanisms. Peer community health advisors receive training through either a traditional classroom approach (with high technical assistance/support) or a web-based training portal (with low technical assistance/support). Results We describe the process, outline the intervention components, report on the pilot test, and conclude with lessons learned from each of these phases. Though the pilot phase showed feasibility, it resulted in modifications to data collection protocols and team and community member roles and expectations. Conclusions Project HEAL offers a promising strategy to implement evidence-based interventions in community settings through the use of technology. There could be wider implications for chronic disease prevention and control.Item The Development of a Non-Physical Dating Violence Risk Assessment Instrument for Urban Black Young Adult Men(2013) Gilchrist, Brian Winston; Sawyer, Robin G; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Young urban African American men may be disproportionately affected by dating violence victimization. To date, there are no known reliable and valid measurement instruments that have been developed to assess the risk of dating violence victimization among this population. Furthermore, there is very little research that has been conducted assessing factors related to dating violence victimization specifically among young urban men. The current study developed a valid and reliable non-physical dating violence victimization risk assessment instrument for urban African American males ages 18-25 years old. Focus groups, survey pre-testing, and expert panel review was used to develop an initial set of items included in the new instrument. The survey administration phase of the study used a non-experimental cross-sectional design to collect primary data from participants for psychometric analysis. A new instrument with a total of 9 new scales (83 items) was developed as a result of this study. Results from the study support evidence of psychometrically sound and reliable measures that can be used in the target population.Item 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.Item The Challenge of Teen Nutrition: An Ecological View of Sociocognitive Influences on Urban, African-American Adolescent Diet Quality(2010) Wrobleski, Margaret Mary; Atkinson, Nancy L.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The routine food choices that adolescents make impact their nutritional status, health, and their risk of developing chronic illnesses such as heart disease, cancer, and osteoporosis in the future. Nutrient requirements during adolescence are comparable to those in early infancy, emphasizing the importance of a high quality diet for healthy growth and development. A myriad of personal, social, and environmental factors influence adolescents in shaping their dietary intake and quality of diet. Low-income, African-American adolescents in Baltimore were identified as having sub-optimal nutritional intake compared to national dietary recommendations. This study explored the dynamic and relative contributions that factors within three environmental levels (personal, social, and community) made as predictors of diet quality in a sample of low-income, urban African-American adolescents using an integrated Social Cognitive Theory (SCT) / ecological theoretical framework. It was hypothesized that 1) the personal, social, and community environmental levels of dietary influences would all significantly contribute to diet quality, with community environment making the largest relative contribution; 2) self-efficacy for healthy eating moderated the relationship between parental beliefs about nutrition and diet quality; and 3) self-efficacy for healthy eating moderated the relationship between peer eating behaviors and diet quality. There have been very few studies using an integrated SCT/ecological model to explore the dietary influences on adolescent nutrition, especially on this demographic. The significant influence the SCT construct of observational learning has on adolescents was evidenced in this study by the positive relationship found between diet quality, parental beliefs about nutrition, and peer eating behavior. Younger participants in early adolescence and females were predominately guided by their parents' beliefs about nutrition, while males in this study appeared to identify more with their peers' nutrition-related behaviors. This study revealed that parents and peers play important roles in African-American adolescents' food choices and subsequent diet quality. Nutrition interventions should focus on parent-teen interactions and on improving the dietary habits of parents so they may be more effective role models for youth. Nutrition promotion research targeting young African-American men may consider using group interactive behavioral interventions with peers that build and reinforce peer modeling of positive nutrition behaviors.Item Predictors of Abstinence, Safer Sex & Higher Risk Sexual Behaviors At A Historically Black College & University(2009) Saunders, Darlene Renee; Desmond, Sharon M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this cross sectional study, purposive sampling was used to examine the sexual behaviors and practices of African American college age students (n=681) attending a Mid-Atlantic HBCU. The majority of participants were women (72%) and sexually attracted to men (69%); the mean age was 20 (SD=1.3). The primary purpose of this research was to explore specific factors that may contribute to African American college students' decisions to practice abstinence, engage in safer sex or higher risk sexual practices. The Theory of Planned Behavior loosely guided the selection of variables, specifically normative beliefs, attitudes and behavioral control constructs were used to examine the sexual behaviors of African American college students. Binge drinking, marijuana use, the number of hours per day students' listened to rap music and viewed rap music videos, and the extent rap music or rap music videos influenced their sexual attitudes were variables examined using backward logistic regression. Additionally, the investigator examined religiosity and students' perceptions of whether peers and parents would approve of their engagement in specific sexual behaviors, using valid and reliable scales developed by other researchers. Demographic variables explored included age, gender and the students' sexual orientation. Results from research question one (predicting whether students would be abstinent or sexually active) indicated age, marijuana use, and binge drinking were the best predictors, accounting for 22% of the variance. Students who reported binge drinking or marijuana use were more liked to report being sexually active than students not engaging in these behaviors. Research question two (distinguishing between sexually active students who engage in safer vs. riskier sexual behaviors) found that sexual orientation was the only significant predictor. The study documented greater sexual risk-taking behaviors among heterosexual women when compared to heterosexual males. This exploratory study helps fill the void in the literature about the sexual behaviors of African American college students.