College of Agriculture & Natural Resources

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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

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    DIET, FOOD SECURITY, SOCIAL RELATIONSHIPS AND DEPRESSIVE SYMPTOMS IN HOMEBOUND OLDER ADULTS IN THE UNITED STATES AND THEIR IMPACT ON HEALTHCARE UTILIZATION
    (2020) Ashour, Fayrouz A.; Sahyoun, Nadine R; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Homebound older adults may be at increased risk for malnutrition and social isolation, posing a potential threat to them aging in their communities and increasing healthcare cost. The Nutrition Service Program under Older Americans Act (OAANSP) was established to support older adults aging in place by delivering meals and providing nutrition-related services. Aims: 1) Examine diet quality of home-delivered meal (HDM) recipients; 2) examine direct and indirect associations between social relationships, depressive symptoms, food insecurity (FI) and diet quality; and 3) examine direct and indirect associations between social relationships, FI, diet quality and hospitalization. Methods: Data obtained from OAANSP Outcomes Evaluation study included: 1) client outcomes survey, 2) two 24-hour dietary recalls, and 3) Medicare healthcare utilization data. Dietary recalls examined diet quality by calculating 1) population-level mean HEI scores; and 2) usual vegetable and protein intakes. Diet quantity was compared to Dietary Guidelines for Americans 2010 (DGA), and structural equation modeling was used to examine direct and indirect relationships. Results: HDM recipients and controls have high prevalence of FI, 22.4% and 16.5%, respectively. HDM recipients who did not receive a meal on day of dietary recall (no-meal recipients) had significantly poorer diet quality than HDM recipients who received a meal (meal recipients) that day and control group. Quality of overall diet for meal recipients, no-meal recipients and controls did not meet recommendations for several food groups/nutrients. Compared to DGA, HDM and complementary foods were low in whole grains, dairy, fiber, and surpassed upper limit of consumption for saturated fats, refined grains, sodium and added sugar. High FI was associated with greater depressive symptoms and lower usual vegetable intake in control group. High FI was associated with lower usual protein intake in HDM recipients and controls. Both groups were at high risk for protein insufficiency, which was associated with greater hospitalization in the control group. Conclusions: HDM recipients and controls have high prevalence of FI, poor diet quality, and insufficient protein intake. Increasing funding for OAANSP can allow program expansion and improvement of HDM. Validated tools to examine social relationships and additional contributors to FI are needed
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    Social Preferences Among Clinicians in Tanzania: Evidence from the Lab and the Field
    (2011) Brock, J. Michelle; Leonard, Kenneth L.; Agricultural and Resource Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Health worker effort can have a dramatic influence on patient outcomes. This is especially true in developing countries, where poor overall quality of healthcare systems is the norm. There is evidence, however, that despite low levels of education and experience, clinicians in Tanzania underperform relative to their ability (Leonard and Masatu, 2005). Understanding clinicians' intrinsic motivations may help us identify nonmonetary incentives for improving quality of care. To this end, this dissertation considers how risk, pride and social information impact altruism among Tanzanian clinicians. In Chapter 4, we study how risky environments impact social preferences. With experimental evidence from games with risky outcomes, we establish that social preferences of players who give in standard dictator games are best described by consideration of equating ex ante chances to win rather than of ex post payoffs. The more money decision-makers transfer in the dictator game, the more likely they are to equalize payoff chances under risk. Risk to the recipient does, however, generally decrease the transferred amount. Also, while some people behave generously regardless of the attributes of others, pride and knowledge about the recipient characteristics may also motivate altruistic behavior. In Chapter 5, we explore the role of social information and pride in determining pro-social behavior among clinicians in Tanzania. We find that making someone feel proud increases the number of "fair" allocations (50/50 giving) and that those who do not respond to decreased partner anonymity are less responsive to induced pride. Chapter 6 combines laboratory data on social preferences and field data on clinicians' workplace effort. This study is unique in that we observe the same subjects from the laboratory in a field setting, where pro-social behavior has large welfare impacts. We use modified dictator games to define subjects as fair types, social information responsive types and pride responsive types and test how those characteristics are correlated with effort in the workplace. We find that clinicians responsive to both pride and social information provide higher than average effort in the workplace. These results are suggestive of Ellingsen and Johannesson's (2008) theory of social preferences wherein social identity and esteem interact to motivate altruism.