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 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 "Promoting Responsible Action in Medical Emergencies": Determining the Impact of a New University of Maryland Alcohol Protocol(2010) Hammamy, Ranwa Diaa; Clark, Pamela; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this investigation was to determine the impact of the University of Maryland's "Responsible Action Protocol." Judicial records were evaluated to determine if calls for medical assistance increased after the protocol. Descriptive summaries indicated that the number of calls in the semester following the RAP was double the average of the previous six semesters. While there was no variation in calls prior to the RAP (χ2 = 4.346, p = .501, df = 5), the post-RAP Fall 2009 semester added significant variation (χ22 = 25.069, p < .001, df = 6). Student focus groups were used to evaluate student reaction to the protocol. Students seemed unaware of the RAP's provisions, and stated its language prevented them from trusting the protocol. Students further indicated the university alcohol education was not relevant and did not provide information regarding alcohol poisoning. The findings suggest that the RAP and the university's alcohol education programming will need revisions to increase their impact.Item Factors Related to Listeriosis Prevention in Pregnant Women: A Mixed Methods Exploratory Study(2010) Saperstein, Sandra Lynn; Gold, Robert S; Atkinson, Nancy L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This research examined factors related to listeriosis prevention in pregnant women, with the aim of improving messages designed for pregnant women. Pregnant women are twenty times more likely than other adults to become infected by Listeria monocytogenes. Listeriosis can lead to miscarriage, stillbirth, or illness in the newborn. Current FDA guidelines for pregnant women advise avoiding foods that pose high risk of L monocytogenes contamination: hot dogs or luncheon meats without reheating, soft cheeses made with unpasteurized milk, refrigerated pâtés, refrigerated smoked seafood, and unpasteurized milk. These were updated in 2003 as our understanding of L. monocytogenes contamination in foods has changed. Previous research found that pregnant women were unaware of the guidelines, defensive when made aware, and consuming high-risk foods. The impact of changing guidelines has not been examined. A sequential explanatory mixed methods study was conducted. First, data collected in the second Infant Feeding Practices Study was analyzed to determine whether demographic and health-related factors were related to awareness of L. monocytogenes and the consumption of high-risk foods. Next, six focus groups with pregnant women were used to triangulate secondary data analysis findings, examine underlying beliefs related to listeriosis, and explore the impact of changing listeriosis prevention messages. The Extended Parallel Process Model was used as a theoretical framework to guide the groups. The results showed that awareness has increased, with 37% of IFPS II participants aware of L. monocytogenes. However, almost 75% reported eating unheated cold cuts. Subgroup differences were identified and fell along income and educational lines. Those with less education and lower incomes were less aware and more likely to consume high-risk foods. Focus group findings suggest that risk and efficacy beliefs affected adoption of the guidelines, consistent with the EPPM. Participants felt that too much emphasis on the potential of advice to change weakens response efficacy. The findings suggest that listeriosis prevention messages should heighten risk perceptions, enhance efficacy perceptions, and suggest, but not belabor, the notion of changing messages.Item Sexuality Education, Sexual Communication, Rape Myth Acceptance, and Sexual Assault Experience among Deaf and Hard of Hearing College Students(2009) Francavillo, Gwendolyn Suzanne Roberts; Sawyer, Robin G; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Deaf and Hard of Hearing college students are at an increased risk of sexual assault in comparison to their hearing peers. Previous studies demonstrate that although sexual assault rates among college students are high, among the Deaf community, these rates are nearly double. Data suggest that between 50% and 83% of Deaf and Hard of Hearing individuals will experience sexual assault in their lifetime, with Deaf and Hard of Hearing women more likely to experience sexual assault than Deaf and Hard of Hearing men. There exists only a small amount of published research regarding Deaf and Hard of Hearing individuals and sexuality, and an even smaller amount of research has been conducted with Deaf and Hard of Hearing individuals on the subject of sexual assault. The high sexual assault rates among Deaf and Hard of Hearing students may be partially attributed to their limited sexuality education and knowledge, most often as a result of communication, language, and cultural barriers. The purpose of this study was to 1) examine a possible relationship between levels of sexuality education, sexual communication, rape myth acceptance, and sexual assault experience, along with demographic variables, among Deaf and Hard of Hearing college students; and 2) examine differences between students previously educated in schools for the Deaf versus mainstream schools, with regard to their levels of sexuality education, sexual communication, rape myth acceptance, and sexual assault experience. The instrument was developed incorporating the Sexual Communication Survey (SCS), Rape Myth Acceptance Scale (RMAS), Sexual Experiences Survey (SES), sexuality education and sexual activity components. Two sets of hypotheses were examined via linear regression to ascertain significant relationships among the variables, with Social Cognitive Theory (SCT) constructs being used as the theoretical foundation of the study. Seven analyses were found to be statistically significant, with sexual communication, gender, and consensual sexual activity predictor variables explaining the outcome variable, sexual assault experience, at high percentages. The findings from this research have provided a greater baseline of data for future studies to investigate the factors influencing sexual assault among Deaf and Hard of Hearing college students.Item Cross-Sectional Evaluation of Potential Volatile Organic Compound Exposures Around U.S. Schools(2009) Perodin, Joanne; Sapkota, Amir; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Volatile Organic Compounds (VOCs), characterized by high vapor pressure and low water solubility, exist in gaseous phase at room temperature. Previous studies have suggested exposure to VOCs may be associated with adverse health effects such as asthma exacerbation and in some cases cancer. The major sources of outdoor VOCs include traffic and industrial emissions. Ambient VOCs can react with Nitrogen Oxides (NOx) in the presence of sunlight to form ground level ozone, one of the U.S. Environmental Protection Agency (EPA) Criteria Air Pollutants. This thesis was designed to investigate the potential VOCs exposure among U.S. schoolchildren. Moreover, the influence of various neighborhood factors (urban vs. rural areas, distance from highways, presence/absence of industries) on VOCs concentrations around U.S. Schools was investigated. The findings of this thesis suggest that schools in urban areas, near industries and traffic activity have higher concentrations of VOCs compared to those not possessing such characteristics.Item ISOLATION, IDENTIFICATION, AND ANTIMICROBIAL SUSCEPTIBILITY ANALYSIS OF ENTEROCOCCCUS SPP. AND SALMONELLA SPP. FROM CONVENTIONAL POULTRY FARMS TRANSITIONING TO ORGANIC FARMING PRACTICES(2009) Kinney, Erinna Lea; Sapkota, Amy R.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This baseline study evaluated prevalence and antibiotic resistance of food-borne bacteria as conventional poultry facilities transition to organic practices. Poultry litter, feed, soil, water samples and poultry questionnaire responses were collected from 10 conventional and 10 organic-transitioning poultry houses from March to June 2008. Enterococcus spp. (n=260) and Salmonella spp. (n=100) isolates were identified to species level and antimicrobial susceptibility testing was performed using the Sensititre® system. Statistical analyses were performed using STATA 10. Prevalence of Enterococcus spp. on organic-transitioning and conventional poultry farms was 100%; and prevalence of Salmonella spp. was 100% and 40%, respectively. Enterococcus isolates from conventional poultry houses displayed significantly higher percentages of resistance for 9 antibiotic agents compared to organic-transitioning isolates. Conversely, Salmonella spp. isolated from both conventional and organic-transitioning poultry houses exhibited similar antibiotic resistance patterns. Baseline findings suggest importance of poultry production practice in prevalence and antibiotic resistance patterns of food-borne bacteria.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.Item Environmental influences on physical activity and obesity in African American adolescents-a multilevel perspective(2009) Yan, Fang Alice; Beck, Kenneth; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Prevalence of obesity among adolescents is increasing at an alarming rate. Currently, 34% of all 12-19 year olds are either at risk for overweight or are overweight. Without a comprehensive understanding of the myriad of environmental factors that influence physical activity, we cannot effectively curb the rising rates. Methods: The objective of this study is to evaluate the direct and indirect effects of individual, built, and psychosocial environmental factors on the body mass index (BMI) of African American adolescents, and to assess how the relationships may be mediated by physical activity (PA) levels in an urban setting. A cross-sectional sample of 350 Students (grades 9-12) was drawn from two urban magnet high schools in Baltimore City. The outcome measurements cover a broad array of variables, including BMI, walking behavior, and overall PA. The independent variables are measures of three environments and individual socio-demographic status. The hierarchical linear model analysis was employed. In addition, the mediation analysis was conducted to examine the mediating effect of PA levels. Results: The majority of the sample was African American (69%) and female (58%) with 40% at risk of overweight or overweight. After adjustment for individual socio-demographic factors, living in more hazardous neighborhoods was positively associated with moderate-to-vigorous physical activity (MVPA) and walking for transportation but not with BMI. Densities and proximities of destinations were not associated with BMI. Access to school and museums within 0.25 mile, and grocery stores, retail and shopping, post offices and mix of destinations within 0.5 mile and beyond was positively associated with participation in walking. In addition, densities of fast food restaurants, parks and recreation within 1 mile and 1.5 mile were associated with increased walking. Closer proximity to schools and museums increased both student's MVPA level and their walking trips. Green space coverage within 0.25 mile distance was associated with decreased BMI. In addition, the percentage of green space coverage around homes was not associated with physical activity. Physical activity did not mediate either the destination densities and proximity or the greenness on BMI. Conclusion: The findings support the importance of focusing on places rather than the individuals who live in those places. Increasing the diversity of walkable destinations may contribute to adolescents doing more transport-related walking and achieving recommended levels of physical activity. In general, ecologic approaches to obesity prevention need to focus on urban design and food availability.Item Scale Development and Dimensionality Analysis of a Protective Behavioral Strategies Multi-item Scale for Use with College Student Drinkers(2008-06-17) Griffin, Melinda; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Protective behavioral strategies (PBS) have been defined as self-control behaviors individuals practice prior to, during, and/or after drinking to limit consumption and/or the negative consequences. Although a multi-item PBS measurement scale has been used in the research literature, the psychometrics, reliability, and validity of the PBS scale needed further examination. This study examined the 1) dimensionality of the PBS scale for self-identified college student drinkers as well as for gender and race/ethnicity subgroups, 2) internal consistency and test-retest reliability of the PBS sub-scales, and 3) construct validity of the PBS sub-scales. College students who self-reported as recent alcohol users (n=320) on a web-based survey administered during fall semester of the 2006 academic school year comprised the study sample. Factor analysis was utilized to determine the underlying factor structure of 22 item PBS scale. Additionally, congruence of the factor structure among gender and racial sub-groups was examined by rotating the sub-groups' matrices via the Procrustes orthogonal method. Reliability analysis was utilized to determine the internal consistency of the PBS sub-scales. Separate multiple linear regressions were performed to determine the construct validity based on relationships between the PBS sub-scales and potential motivations (refusal self-efficacy, protection self-efficacy, drunkenness avoidance self-efficacy, alcohol abstinence expectations) and potential alcohol-related outcomes (multiple alcohol use items, negative consequences) while controlling for gender and race. Examination of the output from repeated factor analyses, Procrustes rotation, and reliability analyses resulted in a 2-factor solution with 17 items. Both PBS sub-scales (Planning and Execution) had acceptable internal consistency across all samples and acceptable test-retest reliability. Construct validity of the Execution PBS was fully supported whereas the Planning PBS was partially supported. Specifically, the Planning PBS sub-scale was highly correlated with protection and drunkenness avoidance self-efficacy as projected but not alcohol-related outcomes. The Execution PBS sub-scale was highly correlated as projected with refusal, protection and drunkenness self-efficacy, alcohol use, and negative alcohol effects. Special attention was given in this study to PBS construct validity considering potential PBS motivations and PBS scale dimensionality across gender and race subgroups. This study contributes to parallel research attempting to identify a definitive, standardized measure of PBS.Item Trajectories of Freshmen Alcohol Consumption: Examining the Influence of Drinking Refusal Self-Efficacy(2008-06-12) Watson, Keisha; Boekeloo, Bradley; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The misuse of alcohol is a major social and health issue for college students in the United States. Specifically, first-year students are at a higher risk of consuming alcohol than the rest of the college population. Considerable data suggest heterogeneity in how alcohol use changes during adolescence. New statistical procedures, such as latent class growth analysis (LCGA), are now available that are better suited to study behavior change than earlier applied traditional methods such as regression analysis and structural equation modeling. This study aimed to reveal alcohol consumption patterns of college freshmen using secondary data and LCGA. A second aim of this study was to examine the influence of drinking refusal self-efficacy (DRSE) on potential trajectories of alcohol use among college freshmen. Data used for this study was collected by a federally funded NIH grant entitled "Peers as Family: Preventing Problem Drinking" and includes longitudinal self-reported data of freshmen alcohol use and DRSE. Results revealed four distinct types of drinking trajectories among college freshmen. Growth patterns identified had the following characteristics: 1) "Light-stable" drinkers reported drinking very little or no alcohol use across time assessments; 2) "Escalating" drinkers gradually increased alcohol consumption across time assessments; 3) "Moderate increase-decrease" drinkers increased alcohol use between first and second time points and decreased consumption between second and third time assessments; and 4) "Heavy increase-decrease" drinkers shared an identical pattern of consumption as the moderate increase-decrease group only levels of alcohol use were significantly higher at each time assessment. DRSE was found to significantly (p < .0006) predict membership in all trajectories described above. The light-stable trajectory reported higher levels of DRSE than all other growth patterns, while the heavy increase-decrease trajectory reported the lowest levels of DRSE when compared to all other growth patterns. Study results illustrated that DRSE plays a significant role in explaining why some college freshmen abstain from alcohol use, while others escalate use or drink at high levels over time. Ultimately, this knowledge may facilitate the development of more tailored and consequently effective interventions designed to reduce alcohol consumption on college campuses.