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 Exploring Young Bi+ Women's Intersecting Mental Health and Sexual and Reproductive Health Experiences in Context: A Multi-Analytic Method Qualitative Study(2023) Robinson, Jennifer Lynn; Aparicio, Elizabeth M; Butler, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Young bi+ women report worse mental health and sexual and reproductive health (SRH) outcomes compared to gay, lesbian, and straight young adults. They experience intersecting threats to their health and well-being due to their sexuality, gender, and stage of development. There is a lack of research on bi+ women’s unique mental health and SRH experiences, and often bi+ women are overlooked due to bi-erasure and biphobia. Regressive policies related to LGBTQ+ and women’s rights, including increased restrictions to reproductive healthcare after the Dobbs v. Jackson Women’s Health Organization decision overturning abortion protections, further threaten bisexual women’s health. This dissertation used a multi-analytic method qualitative approach to explore the intersecting mental health and SRH experiences of young bisexual women in the current socio-political context. Semi-structured in-depth interviews were conducted over Zoom with 16 young bi+ women from across the U.S. A narrative inquiry approach was used to explore young bi+ women’s mental health experiences and coping strategies. In addition, thematic analysis was used to investigate how young bi+ women describe their mental health as intersecting with their SRH in the current socio-political context. The study yielded rich and nuanced information about challenges these young bi+ women experienced throughout their lives that affected their mental health and SRH. Experiencing trauma had far-reaching negative effects on their mental health. Participants discussed the challenges of forming their identity within the social context, particularly as bi+ women in a society that often invalidates bisexual identities and subjugates women. They also discussed the joys along with difficulties of navigating young adulthood. They further described coping with challenges in a variety of adaptive (e.g., therapy, exercise) and maladaptive (e.g., substance use, self-injury) ways. They discussed relying on social support such as partners, friends, family, therapists, and teachers. Participants desired more support with sexuality-related issues, particularly in early adolescence. These bi+ women described their mental health and SRH as intertwined and discussed how bodily autonomy and agency were essential to their well-being. The socio-political context, including social norms, rhetoric, and federal- and state-level policies, influenced participants’ well-being. The current study shows that young bi+ women face unique threats to their mental health and SRH. Practice implications include improving access to affordable and LGBTQ+-affirming healthcare and developing interventions attuned to the needs of young bi+ women. Policies are needed that uphold the choice and agency of young women in their reproductive health decision-making. Future research should continue to explore the needs and experiences of young bi+ women concerning their mental health and SRH including demographic differences along with potential mechanisms resulting in poorer health.Item "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.Item DISPARITIES IN PRE-EXPOSURE PROPHYLAXIS AWARENESS AMONG WOMEN: A SYSTEMATIC REVIEW OF THE LITERATURE AND LATENT CLASS ANALYSIS OF SYNDEMIC RISK FACTORS(2020) Stubbs, Leandra Nicole; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)While rates of HIV infection have declined among women in recent years, women still account for 19% of all new infections each year in the United States (US). Sociodemographic disparities remain with much of the burden falling on Black adult women aged 25-44. Ongoing transmission of HIV in this population has mostly resulted from heterosexual contact and prior studies have identified interpersonal and sociocultural factors that impede a woman’s choice to engage in safe sex and prevent HIV acquisition. With the debut of pre-exposure prophylaxis (PrEP), an FDA-approved once-daily pill to prevent HIV transmission, researchers believed that this user-controlled method would be an innovative method in reducing HIV in this subpopulation. However, since its release in 2012, there has been insufficient knowledge of PrEP among women in the U.S, resulting in slow and disproportionate uptake of PrEP in this population. While we know the clinical efficacy of PrEP, more understanding of the behavioral, social, and structural factors that impede PrEP awareness among women is important in the dissemination of PrEP-related information and subsequent use.In this dissertation, I took an exploratory approach to: a) identify awareness, knowledge, barriers and facilitators of PrEP use among US-based women through a systematic review; b) identify factors associated with PrEP awareness among female participants in the 2018 Community Health Survey; and c) explore how the presence of multiple deleterious factors can create distinct subgroups of women and further exacerbate disparities in PrEP awareness. In Paper 1, the systematic review of PrEP knowledge among Black/African American women identified 12 articles with findings disaggregated by both race and gender. Primary findings included gaps in PrEP knowledge; acceptability and willingness to use once informed of PrEP; perceived disadvantages as a result of exclusion in clinical trials and early dissemination; and social, structural, and institutional barriers to engagement in the PrEP care continuum. Papers 2 and 3 leveraged data from the 2018 Community Health Survey, a cross-sectional telephone survey of randomly selected adults aged 18 and older from all five boroughs of New York City. In Paper 2, 36% of a female subsample (N=2,295) were aware of PrEP at time of survey. As a result of multinomial linear regression, nine variables were significantly associated with PrEP awareness: nativity, education level, recent HIV test, number of sex partners, IPV, age, race/ethnicity, general health, and prior incarceration. In Paper 3, latent class analysis was used to identify distinct classes of women with varied responses to behavioral and structural variables. The adjusted item-response probabilities resulted in three distinct profiles of women: high resource and low risk group (39%), low resource and moderate risk group (33%), and moderate resource and high-risk group (28%). Key differences between groups include PrEP awareness, perceived health, count of sexual partners, and neighborhood poverty level. These findings have key implications for the way in which PrEP is marketed to women. Future studies should consider the importance of intersectionality and the social and structural context through which women engage with HIV prevention materials and promotional campaigns.Item COLORECTAL CANCER SCREENING IN INDIVIDUALS UNDER AGE 50: USING A SHARED-DECISION-MAKING FRAMEWORK TO EXPLORE KNOWLEDGE, PREFERENCES, AND DESIRED ROLE(2020) Hyams, Travis; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The rates for colon and rectal cancer (CRC) are increasing at an alarming rate in individuals under the age of 50. Because of this, The American Cancer Society gave a qualified recommendation for average risk adults to initiate colorectal cancer screening at age 45. This recommendation challenges the long-standing guidelines to begin screening at age 50. If adopted, this would add approximately 19 million Americans to the eligible screening pool. This shift in thinking is controversial and researchers and guideline recommending organizations have responded with caution. While a large body of literature on CRC screening exists, very few studies have focused on individuals under the age of 50 due to the previous, relative consensus on guidelines. Because the uncertainty and relative equality of screening strategies and outcomes, patients under 50 and clinicians making decisions about screening should consider a shared decision-making framework. In this dissertation, I explored differences in several constructs of the shared decision-making framework by age (<50 & ≥50) using a sample of 579 participants drawn from MTurk, a global crowdsourcing workforce that is often utilized for research studies. In paper 1, I evaluated knowledge of CRC risk factors and symptoms and found that age moderated the relationships between several independent variables including perceived likelihood of getting cancer and numeracy with total knowledge scores. In paper 2, I explored preferences for colorectal cancer screening strategies using a multicriteria decision analysis technique called the Analytic Hierarchy Process and found that participants <50 preferred colonoscopy more often than those ≥50. In paper 3 I used multinomial logistic regression and found that participants <50 preferred the shared and passive role compared to the active role for deciding whether to get screened and deciding which strategy to use more often than participants ≥50. These findings will act as a foundation for future work if it becomes necessary to incorporate younger people into colorectal cancer screening programs.Item IDENTIFYING BARRIERS AND FACILITATORS OF LEISURE TIME PHYSICAL ACTIVITY THROUGH THE EXPERIENCES OF 16-18 YEAR OLD AFRICAN AMERICAN/BLACK GIRLS: A GROUNDED THEORY STUDY(2020) Zeeger, Tracy; Gold, Robert S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Among older adolescent African American/Black girls, obesity rates continue to rise between the ninth and 12th grades, whereas among white females, rates decline. Contributing to these high rates is the lack of leisure-time physical activity (LTPA) among youth. Nationwide, 95% of older adolescents (ages 16-18) are not meeting federal guidelines for physical activity. Older adolescent African American/Black girls are less likely to report LTPA when compared to their peers. Current approaches are not adequately addressing reduced LTPA among African American/Black older adolescent girls, requiring a return to the population affected to better understand this problem. To address this need, the current grounded theory dissertation study aimed to develop a grounded theory model of barriers and facilitators to LTPA among older adolescent African American/Black girls. Enrolled in the study were 16 African American/Black girls (N=16) aged 16-18 (M=16.7) years. Nine participants were classified as exercisers and seven as non-exercisers. All participants attended high school in Prince George’s County, Maryland. Each participant took part in an in-depth individual qualitative interview, conducted at a private, quiet location of their choice. Using constructivist grounded theory methods (CGT), analysis of the interview data occurred across four phases: open, focused, axial, and theoretical coding. CGT analysis resulted in a behavioral process theory explaining barriers and facilitators of LTPA among African American/Black older adolescent girls, grounded in youths’ own experiences. The theory, anchored by the core category of Choosing to Engage in LTPA, has five related categories: Being Autonomously Motivated, Perceiving Control Over Time, Knowing About Exercise, Experiencing the Influence of Others, and Receiving Messages About One’s Body. Each theoretical category includes multiple properties and dimensions, such as understanding the benefits of LTPA outside of weight loss, believing exercise is fun, and having confidence in the ability to exercise. Multiple influences across family, community, and societal systems shaped participants’ attitudes and beliefs. The results of this study contribute to a growing body of research on physical activity among older adolescents. These findings can inform the development and testing of feasibility in an afterschool LTPA intervention, as well as school physical education curriculum and policy.Item Diabetes and Periodontal Disease Bi-Directional Relationship: An Examination of Diabetics' Knowledge, Understanding, Social Determinants and Self-Efficacy Impact on Dental Hygiene Practices(2019) Oguntimein, Oluwamurewa Ayodeji; Butler, James; Horowitz, Alice M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Thirty million Americans are living with diabetes; making it the seventh leading cause of death, with 1.3 million Americans dying every year. As such, the total treatment costs of diabetes rose from $245 billion in 2012 to $327 billion in 2017. One factor driving these high costs is diabetes’ comorbidity with other chronic diseases and associated complications – e.g., hypertension, , heart disease, stroke, amputation and blindness. Little attention has focused on periodontal disease- the sixth complication of diabetes awareness, education, and intervention. This research adds to the literature via two studies that assessed diabetics’ knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease. The first study examined gender and self-efficacy differences in knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease among 927 diabetics. Findings suggest diabetics are unaware of their increased risk of periodontal disease based on the low mean 5.79±2.366 scores on the knowledge and understanding scale. After controlling for diabetes duration, smoking status, and other covariates, males had less knowledge and understanding of the bi-directional relationship (p<.0001). Self-efficacy was not significantly associated with participants’ knowledge and understanding of the bi-directional relationship (p= 0.543). The second study assessed health literacy differences in diabetics’ knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease. Education, employment and income were tested as moderators between knowledge and understanding of the bidirectional relationship and dental hygiene practices. After controlling for diabetes duration, dental insurance status, and other covariates, participants with marginal or inadequate health literacy had less knowledge and understanding of the bi-directional relationship compared to participants with adequate health literacy (p<.0001). Education, employment, and income were not moderators. The findings support the need for targeted periodontal disease risk and dental hygiene practice education. These studies are presumably the first to assess diabetics’ knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease. These studies are significant contributions to the limited amount of research and illuminate the need to educate diabetics regarding their increased risk of periodontal disease and the importance of practicing dental hygiene behaviors to prevent diabetes complications.Item THE IMPACT OF DISEASE SEVERITY AND PHENOTYPE ON SMOKING AMONG ADULTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE(2019) Tilert, Timothy; Wang, Min Q; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Chronic Obstructive Pulmonary Disease (COPD) is estimated to be the third leading cause of death in the US. The most significant risk factor for COPD is long-term cigarette smoking. In spite of the myriad benefits of cessation, the proportion of adults with COPD who currently smoke is still nearly 50%. Little is known, however, about the characteristics of, and subsequent differences between, smokers with COPD, particularly at differing lung obstruction severity levels. The goals of this dissertation were to examine and compare the characteristics of smokers with diagnosed COPD as well as to explore the impact of disease severity and disease phenotype on smoking status among persons with COPD. This research utilized secondary data on 10,219 examined adults, aged 40-79 years, from the 2007-2012 National Health and Nutrition Examination Survey. In Study 1, adjusted logistic regression analyses revealed multiple factors that were associated with self-reported COPD diagnosis with those reporting three or more respiratory symptoms having the strongest association (AOR=22.1, 95% CI=12.0-40.5). In Study 2, it was shown that smoking status proportions did not differ by lung obstruction severity among those reporting a COPD diagnosis. In adjusted logistic regression analyses, multiple factors were associated with current smoking status among those with self-reported COPD with the presence of other smokers in the household having the strongest association with being a current smoker (AOR=19.5, 95% CI=10.2-37.5). In Study 3, three distinct phenotypes were found among the COPD population analyzed. In adjusted logistic regression analyses, COPD phenotype was differentially associated with continued smoking, above and beyond other predictors, with the older, heavy-smoking males with emphysema phenotype showing a significant positive association with continued smoking (AOR=3.7, 95% CI=1.3-10.9). Understanding how differences in disease severity and disease phenotypes impact smoking status among persons with diagnosed COPD could help inform more targeted, and effective, interventions to reduce smoking rates in this high-risk population. These findings potentially provide guidance for current smoking cessation interventions aimed at smokers with COPD as well as provide the foundation for further exploration of the association between COPD phenotype and continued smoking.Item INVESTIGATING CARDIOVASCULAR RISK AT THE INTERSECTION OF RACE, GENDER, AND EDUCATION(2019) Taiwo, Omolola Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)As a risk factor of cardiovascular disease (CVD), systemic inflammation is differentially distributed by race, with black populations disproportionately impacted. Additionally, inflammation, as measured by the inflammatory marker C-reactive protein (CRP), is documented to be higher among women when compared to men and varies by educational level. Despite evidence suggesting that various chronic stress domains may contribute to the relationship between race and inflammation, there is limited data exploring the possible mediating role of chronic stress. Furthermore, to date, no study has examined if the potential indirect effect of race on CRP through chronic stress domains are moderated by gender and education. This secondary data analysis stems from the Midlife Development in the United States (MIDUS II) study, and the sample consisted of 193 black and 582 white adults. Study 1: Examined the association between CRP and seven racial/gender/education subgroups. With educated white men as the reference group, findings revealed that educated black and white women had the highest significant risk for elevated CRP. Study 2: Assessed the psychometric properties of a Chronic Stress Scale (CSS) comprised of nine chronic stress subscales. Analyses revealed CSS to be a three-dimensional scale with questionable validity and reliability. Study 3: First, tested for significant correlations between nine chronic stress domains, race, and CRP. Everyday discrimination and financial strain were found to be the only two domains significantly correlated to race and CRP. Second, two mediation analyses assessed the mediating effect of financial strain and discrimination, finding that they both respectively mediated the relationship between race and CRP. Third, two moderated mediation analyses examined if the indirect effect of financial strain and discrimination were moderated by gender and education. Results indicated that the indirect effect of race on CRP through discrimination was significant only among educated black men. Additionally, findings revealed that the indirect effect of race on CRP through financial strain was significant among black men and women regardless of educational attainment. Combined, these studies characterized the social patterning of CRP, illustrated validity and reliability concerns when developing a multidimensional chronic stress scale, and revealed that discrimination and financial strain did have mediating roles and these mediators were moderated by gender and education.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 Examining the Food-Insecurity Obesity Paradox among Latino Immigrants(2019) Amador, Maria Aileen; Garza, Mary A; King-Marshall, Evelyn C; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Obesity is linked to chronic illnesses such as type 2 diabetes, cardiovascular disease, and some cancers (breast, kidney, and liver). Food insecurity refers to lack of access to nutritious and safe food. Latinos are a rapidly growing population in the US with higher levels of food insecurity than the national average, and higher obesity rates than non-Latino white adults. The “food insecurity-obesity” is a paradoxical relationship seen in rising obesity and correspondingly high food insecurity rates. We examined demographic factors, acculturation, stress, dietary habits, and food access among Latina immigrants to understand this paradox. This sub-analysis (n=128) found that education level (p=0.03) and marital status (p=0.08) were significantly and marginally significantly associated with food security level. Additionally, this analysis helped to better describe a population that lacks research. A better understanding of the “food insecurity-obesity” paradox and related factors will inform future culturally-tailored interventions to address obesity among Latina immigrants.