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 Effectiveness of a Brief Behavioral Smoking Cessation Intervention In A Residential Substance Use Treatment Center(2009) White, Thomas James; Smith, Barry D; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Cigarette smoking is the number one preventable cause of death in the United States (American Cancer Society, 2008). Despite decades of awareness on the dangers of cigarette smoking, many smokers have been unable to successfully quit. One population with little access to smoking cessation treatments is inner city drug abusers in residential treatment centers. Smoking rates among polydrug users in treatment approach 100% (Burling & Ziff, 1988), and half of those treated for alcohol or substance abuse will die of smoking-related illnesses (Hurt, et al., 1996). Nonetheless, a recent survey of residential substance abuse treatment centers found that only 31% of centers provided smoking cessation programs (Fuller, et al., 2007). The relative scarcity of smoking cessation programs offered at such centers is alarming. A residential substance-abuse center setting is, theoretically, an ideal location for the implementation of a smoking cessation program, due to the available resources (Bernstein & Stoduto, 1999). Successful completion of a smoking cessation intervention during drug treatment increases illicit drug abstinence rates by 25% at one year (Prochaska, Delucchi, & Hall, 2004). Nonetheless, studies of smoking cessation programs in residential treatment centers have typically showed low rates of success (Friend & Pagano, 2005), although these programs have typically utilized the group modality and not individualized, one-on-one treatment (Currie, Nesbitt, Wood & Lawson, 2003). It is important to measure the effectiveness of smoking cessation programs delivered in a one-on-one modality in residential treatment centers. The smoking cessation intervention employed in the present study was based on prior behavioral interventions. The effectiveness of this intervention on smoking cessation and short-term (one-month) relapse were assessed. Goodness-of-fit analysis revealed significantly greater rates of point-prevalence smoking reduction or cessation in the active treatment condition compared with the placebo condition; however, when smoking cessation rates were examined alone, there was no significant difference in cessation rates across the two conditions. No sex differences were found in smoking cessation or reduction rates across conditions. Hierarchical linear modeling revealed that sex (being male) and nicotine dependence contributed most significantly to CPD following quit day.Item THE IMPACT OF HEALTH INSURANCE ON CANCER PREVENTION: EX ANTE AND EX POST MORAL HAZARDS(2010) Tang, Li; Jin, Zhe; Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The classic model of moral hazard suggests that health insurance may reduce preventive care because the insurer will pay for part of the treatment in case of disease. However, if health insurance covers preventive care as well, the reduced cost of preventive care will encourage the insured to consume more preventive care. These two countervailing effects are referred to as ex ante and ex post moral hazards (Zweifel & Manning 2000). Most studies do not distinguish the two effects, leading to a potentially wrong characterization of moral hazard. Using Medicare coverage as an example, this thesis identifies ex ante and ex post moral hazard effects of health insurance on cancer prevention. As we know, Medicare eligibility rules increase health insurance coverage at age 65. However, some preventive screenings were not covered in Medicare until recently. The different timing of Medicare eligibility and Medicare expansion of preventive care allows me to use a difference-in-differences framework to separate ex ante and ex post moral hazards. I focus on female uptake of breast cancer screening and male uptake of prostate cancer screening, using the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS). In both datasets, I find evidence in support of ex ante and ex post moral hazards. No evidence shows that people try to delay screening until it has been covered by Medicare. Moreover, the level of prevention and responsiveness to insurance changes vary with demographics, with larger effects among whites and the better-educated. Then I take a second look at the moral hazard problem in the health insurance market using the Health and Retirement Study (HRS). Compared with MEPS or NHIS, the panel nature of HRS allows me to control for individual fixed effects and therefore provides a more stringent test. The major findings on breast cancer screening are consistent. I find strong ex ante and ex post moral hazard effects in it, and individual reactions to Medicare enrollment and Medicare's preventive care coverage vary by factors such as race and income. However, moral hazards on prostate cancer screening is not found, mainly due to data limitation.Item Examining the Effect of the LET'S ACT Behavioral Activation Treatment for Depression on Substance Abuse Treatment Dropout(2009) Magidson, Jessica F; Lejuez, Carl W.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Despite the prevalence of depression among substance users and the negative impact of depressive symptoms on substance abuse treatment outcomes, few interventions targeting depression have been developed to meet the needs of depressed substance users, particularly in low-income urban areas. The current study aimed to replicate and expand upon promising preliminary findings for the use of a brief behavioral activation approach [Life Enhancement Treatment for Substance Use (LET'S ACT; Daughters et al., 2008)] to treat depression in the context of inner-city residential substance abuse treatment. Main extensions to the previous study include a comparison of LET'S ACT to a contact-time matched control treatment, Supportive Counseling (SC), and a more definitive evaluation of the effect of LET'S ACT on substance abuse treatment dropout. Results indicated that compared to SC, participants receiving LET'S ACT evidenced significantly lower rates of substance abuse treatment dropout and depressive symptoms, as evidenced by a significant treatment x time interaction with the change in self-reported and clinician-rated depressive symptoms from baseline to the 2-week follow up, as well as significantly higher rates of behavioral activation, as evidenced by a significant treatment x time interaction with scores on the Behavioral Activation for Depression Scale (BADS) from pre- to post-treatment. This study builds on preliminary evidence for LET'S ACT as a short-term behavioral treatment for depression in residential substance abuse treatment and offers initial support for the effect of LET'S ACT on substance use outcomes.Item An Experimental Evaluation of After School Program Participation on Problem Behavior Outcomes: Does Pre-Existing Risk Moderate the Effects of Program Participation?(2009) Cross, Amanda Brown; Gottfredson, Denise C; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Some prevention programs negatively affect participants. Previous research indicates that peers can cause these negative effects. However, little is known about which students may be most vulnerable to negative peer effects in prevention interventions. Purpose: This study tests the effect of participation in an after-school program (ASP) on student outcomes of peer delinquency, problem behavior and antisocial attitudes and beliefs for students of differing pre-test levels of risk for those outcomes. Drawing on social learning theory, this study examines whether low- and moderate- risk students in the intervention are more likely to acquire delinquent behaviors and beliefs in the ASP than their already-delinquent counterparts. Participants: 447 middle school students attending underperforming schools in Baltimore County, Maryland. Intervention: The data are drawn from an experimental evaluation of an after school program which operated in five middle schools in Baltimore County during the 2006-2007 academic year. The overall evaluation of the program found null effects on the wide range of measured outcomes (including academic achievement and delinquency). I explore whether the lack of beneficial program effects is partially attributable to negative effects among low and moderate risk participants who absorbed negative beliefs and behaviors from high-risk peers in the ASP. Research Design: Randomized, controlled field trial. Findings: Results indicate that low- and moderate- risk youth are not more likely to experience negative outcomes than high-risk youths. On the contrary, low-risk participants are less likely to experience negative effects than high-risk participants. Students who began the program with elevated negative peer influences grew in this characteristic if they often participated in the ASP but declined in negative peer influences if they less often attended the program. Implications for universal prevention are discussed.Item CHILD ABUSE HOMICIDE INFLICTED BY A CHILD'S CARETAKER: A POTENTIALLY PREVENTABLE TYPE OF CHILD MURDER(2009) Rezey, Maribeth Lorraine; Simpson, Sally S; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Child abuse inflicted by caretakers has been reported the leading cause of morbidity and mortality in children. Although researchers have attempted to estimate the rate of child abuse homicide nationwide, its true scope is unknown. Quantifying child abuse homicide is important since this type of homicide is arguably preventable. This study utilizes the National Violent Death Reporting System (NVDRS) to analyze child abuse homicides inflicted by the child's caretaker across 17 U.S. states during the years they participated from 2003 to 2005. The NVDRS reports violent death data from multiple official sources, providing this analysis with a more accurate number of child abuse homicides than previously available. In this thesis, I established if the NVDRS ascertains more abuse or non-abuse homicides than death certificates. I reviewed ascertained and misclassified deaths to assess whether a common set of victim or incident characteristics exist across these homicides. A logistic regression was also conducted to examine the probability of child abuse homicide given these characteristics.Item Residential Segregation: Hurting or Helping U.S. Hispanic Health?(2009) Nelson, Kyle Anne; Iceland, John; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)U.S. Hispanics experience health disparities that are in part socially determined. My dissertation explores the connections between health and residential segregation for Hispanics and key Hispanic subgroups in metropolitan America. I conduct a multivariate analysis combining individual-level health survey data on Hispanics from the 1997-2002 Urban Institute National Survey of America's Families with metropolitan area-level residential segregation scores from Census 2000. My primary research question is: What is the role of residential segregation in shaping the health disparities of U.S. Hispanics? I compare the link between segregation and health for U.S. Hispanics with African Americans, and evaluate differences among Hispanics by nativity and country of origin. My outcome measures are self-rated health, insurance status, and having a usual source of health care. I find a significant negative effect on health status of residential segregation from whites for U.S. Hispanics even after accounting for compositional factors such as poverty status and education. Consistent with spatial assimilation theory, however, much of the observed negative effects of segregation on health are overshadowed by individual-level socioeconomic characteristics. In support of place stratification theory which emphasizes the relative disadvantage of African Americans as racial minorities in the U.S., I find that African Americans experience modestly greater health disparities associated with segregation than Hispanics. Despite my prediction that health outcomes for foreign-born Hispanics may actually improve with higher segregation, nativity does not significantly alter the link between health and segregation among U.S. Hispanics. I do find a significant interaction between nativity and segregation for Mexicans in the prediction of being uninsured and for Cubans in the prediction of self-rated health. For foreign-born Mexicans, segregation is more of a disadvantage in the prediction of being uninsured. The only evidence I find of any positive or protective link between segregation and health is for Cuban-origin Hispanics whose odds of reporting good self-rated health increase with higher levels of segregation. While segregation has a positive association with health status for both U.S.-born and foreign-born Cubans, the effect is substantially stronger for the foreign born. This research highlights the importance of examining residential segregation as a social determinant of health, and reveals important nuances in the link between health and segregation for nativity and country-of-origin subgroups of U.S. Hispanics.Item Biomedical Innovation and the Politics of Scientific Knowledge: A case study of Gardasil(2008) Clark, Aleia Yvonne; Mamo, Laura; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Vaccine development represents a special case where historically, public health priorities are central. Trends of privatization have increased the role played by pharmaceutical and biotech companies in developing new biomedical technologies. As the innovative science behind new medical technologies moves into pharmaceutical laboratories and biotech companies, the "logics of action" that pattern knowledge production shift. This project explores how different logics of action based on commercial investment and public good shaped the development of Gardasil, a new vaccine to prevent cervical cancer. The study found that both the logics of public good and commercial profit significantly shaped the final product. The study also found that variations in the definition of public good allowed for the settlement of tensions between good and profit. The findings have implications for the future of vaccine development, as well as for the analysis of biomedical innovation in our contemporary political economy.Item The Impact of Medical Malpractice Reforms on Hospital-Based Obstetric Services(2005-07-27) Zhao, Lan; Evans, William N; Economics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Policy-makers and public health researchers are concerned that rapidly rising medical malpractice insurance premiums and reduced supply of malpractice insurance coverage have discouraged health-care providers from providing some key but high-risk services in certain geographic regions. Obstetricians/gynecologists and family practitioners who also provide obstetric services appear to be particularly vulnerable to pressure from malpractice litigations. They are frequently sued and face large damages when they lose. To mitigate perceived adverse effects of malpractice litigation on physician behaviors, states have introduced a variety of tort reforms such as caps on malpractice damage awards since the mid-1970s. This thesis examines the effect of direct tort reforms - those reforms that are expected to have a direct and significant impact on the size of malpractice damages -- on access to hospital-based obstetric services. Using data from the American Hospital Association's annual survey of hospitals, we document a significant decline in the availability of hospital-based obstetric services in a county, particularly in rural communities, from the mid-1980s to the early 2000s. By combining hospital data with novel data on the introduction and repeal of tort reforms at the state level, we are able to measure the effects of different types of reforms on the likelihood that a county has hospital-based obstetric services available. Applying a difference-in-difference approach to data from 1985, 1990, 1995, and 2000, we find some evidence that caps on total damages and the mandatory offset of compensation from collateral sources in total damages improve the availability of hospital-based obstetric services at the county level. Caps on non-economic damages have smaller effects while caps on punitive damages or allowing periodic payment of damages do not appear to have an impact on the likelihood that a county has hospital-based obstetric services available. The mandatory offset of collateral source rule is found to have a larger impact in rural counties. However, our estimates were not statistically significant at conventional levels and thus no firm conclusions concerning the impact of direct tort reforms on the provision of hospital-based obstetric services can be drawn.Item The Private Life of Public Health: Managing Chronic Disease in an Era of Neoliberal Governmentality(2005-04-11) Glasgow, Sara Mae; Pirages, Dennis C.; Government and Politics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Noncommunicable diseases (NCDs) such as heart disease and cancer account for over half of the global mortality burden, and are the leading cause of death in every region of the world except Sub-Saharan Africa. Despite this, they remain off the analytical radarscope in political science. This silence has been coupled with the tendency of public health researchers to frame NCDs as apolitical--largely a product of an individual's risk behaviors. Such an accounting depoliticizes NCDs, as well as public health approaches to their analysis and prevention. This project's central aim is to introduce a political analysis of chronic disease, demonstrating that public health approaches to NCDs exhibit political rationality. To that end, I explore several questions. How are NCDs accounted in behavioral terms, and how are their risks constructed as apolitical in the public health discourse? Additionally, if public health is presented as a domain of neutral science, how is it that its practices increasingly display market values, including a limited role for the state, a preoccupation with cost efficiency and choice, and the cultivation of the entrepreneurial self who sees her health as a site of investment? To answer these, I employ a discursive approach, specifically Foucault's framework of government rationality, or "governmentality." It is through the deployment of neoliberal governmentality in three spheres - knowledge, power, and subjectivity - that public health reveals itself not a neutral science, but rather one brimming with the values and logic of the private sector. I develop this argument through a critique of the discipline and practices of public health in three cases: the United States, United Kingdom, and Sweden. Despite exhibiting historically different approaches to health and social welfare, all three show a marked manifestation of neoliberal rationality in public health approaches to chronic disease. The consistency of these findings, in addition to the more general features of the public health discourse, thus allow a conclusion that public health approaches to NCDs are not value-neutral, and are indeed a political phenomenon.Item Moderate Shocks to Wealth and Health: Estimates of Their Impact on the Mortality of Elderly(2004-05-03) Snyder, Stephen Edward; Evans, William N; EconomicsIn Chapter One, we examine evidence for a causal connection between income and mortality. There is widespread and longstanding agreement that life expectancy and income are positively correlated. However, it has proven much more difficult to establish a causal relationship since income and health are jointly determined. We use a major change in the Social Security law as exogenous variation in income to examine the impact of income on mortality in an elderly population. We compare mortality rates after age 65 for males born in the second half of 1916 and the first half of 1917. Data from restricted-use versions of the National Mortality Detail File combined with Census data allows us to count all deaths among elderly Americans between 1979 and 1993. We find that the higher income group has a higher mortality rate, contradicting the previous literature. We also found that the younger cohort responded to lower incomes by increasing post-retirement work effort. These results suggest that moderate employment has beneficial health effects for the elderly. In Chapter Two, we examine another potential determinant of mortality among the elderly, pre-natal shocks to the mother's health. D.J.P. Barker has presented epidemiologic evidence that maternal health status affects the later-life mortality of children. We use the 1918 influenza epidemic as a health shock which is orthogonal to chronic health status. Our findings are that the influenza-exposed cohorts do not experience significantly higher mortality. This allows us to bound any Barker effect of the epidemic as raising mortality less than ten percent.