College of Behavioral & Social Sciences
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The collections in this community comprise faculty research works, as well as graduate theses and dissertations..
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Item EPIDEMIOLOGICAL TRANSITION AND SHIFTING MORTALITY INEQUALITY: AN EXTENSION OF FUNDAMENTAL CAUSE THEORY(2023) Ruan, Hangqing; Kahn, Joan JK; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The dissertation addresses two "public health puzzles" in US mortality inequality trends: (1) SES inequalities in mortality have been growing wider despite declines in overall mortality levels and the expansion of social welfare policies; (2) mortality inequalities present diverging trends across age groups, with declines at younger ages but growth at older ages. These puzzles challenge existing theories in explaining the complex dynamics of mortality disparities. The study aims to bridge this gap by proposing an alternative theoretical framework that combines Fundamental Cause Theory with the concept of epidemiological transition.Previous research has focused primarily on socioeconomic factors as the main drivers of widening mortality disparities. However, this dissertation argues that mortality inequalities can evolve independently of socioeconomic factors due to shifts in disease patterns towards non-communicable diseases and advancements in health-beneficial innovations. By analyzing county-level US mortality rates from 1968 to 2020, this study reveals that mortality inequality related to infectious diseases declined in the early 1970s and remained stable over time. On the other hand, mortality inequality related to non-communicable diseases remained at a low level during the 1970s but saw a significant increase since the 1980s. Further, this study found that mortality inequality from non-communicable diseases is more pronounced in middle-aged and older adults, and the age distribution of mortality inequality progressively shifts towards older ages. This study contributes to the existing literature with a new theoretical perspective to understand the developments of mortality inequalities over time. This framework sheds light on the two "public health puzzles” and emphasizes the crucial role of disease patterns prevailing during specific historical periods in understanding the developments of mortality inequality. Furthermore, the study underlines the interplay of disease patterns, prevention/treatment innovations, and social and economic inequalities in collectively shaping the future of mortality and health disparities. It also sheds light on the social-political circumstances of medical innovation as well as behavioral factors over the life course in determining future population health and health inequalities.Item THE SPATIAL ANALYSIS OF OPIOID-RELATED HEALTH OUTCOMES AND EXPOSURES IN THE UNITED STATES OPIOID OVERDOSE CRISIS(2022) Sauer, Jeffery Charles; Stewart, Kathleen; Geography; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The United States continues to endure the Opioid Overdose Crisis. Yet the burden of the crisis is not experienced uniformly across the United States. The discipline of geography offers a framework and spatial analysis methodology that are direct ways to investigate placed-based differences in opioid-related outcomes, exposures, and proxy measures. This dissertation combines the contemporary frameworks of health geography and geographic information science to provide novel studies on both the geographic patterns in opioid-related health measures at different scales across the United States as well as the actual spatial analytic methods that provide evidence on the Opioid Overdose Crisis. Three main research objectives are addressed over the course of the dissertation: 1) Model the space-time risk of heroin-, methadone-, and cocaine-involved emergency department visits in the greater Baltimore metropolitan area from January 2016 to December 2019 at the Zip Code Tabulation Area-level; 2) Estimate the local and neighboring relationship between prescription opioid volume and treatment admissions involving a prescription opioid across the United States from 2006 to 2014 at the county-level; and 3) Investigate and provide a framework as to how geographic information science has been used to provide knowledge over the duration of the crisis from 1999 to 2021. The first study demonstrates how a recently proposed spatio-temporal Bayesian model can produce disease risk surfaces for opioid-related health outcomes in data constrained scenarios. The second study executes spatial lag of X models on a nationwide prescription opioid distribution dataset, allowing for estimates on the relationship between neighboring prescription opioid volume and nonfatal treatment admissions involving a prescription opioid at the county-level. The third and final study of the dissertation developed and implemented a scoping review methodology, ultimately analyzing the study design and geographical elements of 231 peer-reviewed publications using geographic information science on research questions related to the crisis. Examination of the geographical components of these studies reveals a lack of evidence available at sub-state scales and in the Midwest, north Rocky Mountains, and non-continental United States. Several important future research directions - such as geographic meta-analyses and geographical machine learning - are identified. Taken as a whole, the dissertation provides a contemporary geographical framework to understand the ongoing United States Opioid Overdose Crisis.Item Socio-demographic Variables as Risk Factors for Neurologic Disease due to Infection by West Nile Virus(2009) Pugh, Lashale D.; Kearney, Michael; Geography; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The primary question asked by this research was "Can socio-demographic characteristics be considered risk factors for neurological disease due to West Nile Virus?" Based on the results of this research, the answer is yes. Socio-demographic characteristics identified as risk factors are related to educational attainment, income, age of housing and poverty. Socio-economic variables were useful in discriminating between high moderate and low infection rates and showed modest capabilities of estimating actual rates. One of the most important findings of the research was the public health officials own ideas about the greatest obstacle to preventing the spread of WNV in their jurisdictions. General consensus is that more resources be made available to properly combat this pathogen. More staff and funds to pay workers and provide support for every aspect of surveillance, prevention and control are deemed necessary. Specifically, there is a great need for personnel with specialized training. The support and encouragement of public health organizations is needed to attract individuals into academic fields that will prepare them for infectious disease epidemiology which is crucial to the field. Local level response may have been dictated by resource availability as opposed to the perceived threat. Surprisingly, length of time in the current position was more closely related to lower infection rates than length of surveillance. This suggests that more experienced public health workers likely have some knowledge or experience which was not made known through the survey. Policy implications suggest increased education for public health officials, especially encouragement of more experienced workers to share their knowledge and experiences with less experienced workers.Item The Causality and Characterization of the Widowhood Effect(2006-08-04) Espinosa, Javier; Evans, William; Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Researchers from a variety of fields have noted a sharp rise in mortality for widows soon after the death of their spouse, a relationship that has often been called the widowhood effect. Because of assortative mating, married couples tend to share many of the same lifestyle characteristics, so this result may reflect correlation rather than a causal relationship. In this dissertation, I attempt to decipher whether the widowhood effect reflects a causal relationship. The key innovation in the dissertation turns on the notion that some causes of death reveal more information about the surviving spouse than others. In the extreme, if a cause of death was randomly assigned, then these types of deaths could be used to identify the death of a spouse does in fact raise mortality of the surviving spouse. In practice, we cannot specify what causes of death are randomly assigned, but instead, we can identify those that are uncorrelated with observed characteristics. Specifically, I use data from the National Longitudinal Mortality Survey and the National Health Interview Survey Multiple Cause of Death supplement to create longitudinal datasets of married couples, aged 50 to 70. I initially use this sample to identify those causes of death that are predicted by socio-economic status (income, occupation and education) and those that are not. I refer to these two types of deaths as informative and uninformative causes of death, respectively. If the heightened mortality of surviving spouses is subject to an omitted variables bias, in single-equation models, I should find a greater excess mortality for informative deaths than for uninformative ones. If omitted variable bias is not a serious concern, I should see little difference between the two types of widows. In Cox proportional hazard models, I find for men the death of a spouse from an uninformative cause has only a slightly smaller impact on mortality than a death from an informative cause. The findings suggest a 30 percent increase in male mortality as a direct result of becoming a widow. I do not find similar evidence for women; in fact, the results show no marriage protection effect.