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 Values in American Hearing Healthcare(2024) Menon, Katherine Noel; Hoover, Eric C; Hearing and Speech Sciences; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The long-term objective of this research is to create a more inclusive, patient-centered hearing healthcare system that aligns with all stakeholders’ diverse values and needs. This dissertation explores the values shaping hearing healthcare through three complementary studies. Chapter 2 analyzes the introduction of over-the-counter (OTC) hearing aids, revealing a values shift from traditional audiology’s focus on accuracy, safety, and subjective benefit to prioritizing access and affordability. Implementing an OTC service delivery model for hearing healthcare promoted values different from those of traditional audiology. Still, the creation of OTC offers affordances that enable us to create more patient-centered hearing healthcare systems to reflect stakeholders’ values. Chapter 3 validates a comprehensive list of values in audiology through a national survey of audiologists, confirming alignment with best-practice guidelines. Previous work developed a codebook of values based on textual documents representing best practices in traditional audiology, and it was essential to validate these findings by directly engaging with audiologists. Chapter 4 develops a codebook based on the values of individuals with hearing difficulties, categorizing their concerns into Material, Social, and Healthcare domains. Results from this study highlight the importance of considering the values of individuals with hearing loss, which encompasses not only the use of hearing aids and affordable hearing healthcare but also concerns regarding the effectiveness, usefulness, and social implications of hearing aids. Together, these studies underscore the balance between efforts to improve accessibility and the need to maintain patient-centered outcomes, suggesting that future research should focus on understanding how values intersect with the daily lives and decision-making processes of all people with difficulty hearing.Item Examining pre-training interpersonal skills as a predictor of post-training competence in mental health care among lay health workers in South Africa(2023) Rose, Alexandra Leah; Magidson, Jessica F.; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)A worldwide shortage of mental health specialists contributes to a substantial global mental health treatment gap. Despite evidence that lay health workers (LHWs), or health workers with little formal training, can effectively deliver mental health care, LHWs vary widely in their abilities to competently deliver mental health care, which undermines the quality of care and patient safety. Prior research from both high-income and low- and middle-income countries suggests this variability may be predicted by LHW interpersonal skills, yet this relationship is little explored to date. The first aim of the current study, which uses an exploratory sequential mixed methods design, was to explore qualitative perspectives through semi-structured individual interviews (n=20, researchers, policymakers, NGO staff, LHWs) in Cape Town, South Africa on interpersonal skills relevant to delivery of mental health interventions by LHWs. The second aim was to quantitatively examine the preliminary effectiveness of pre-training interpersonal skills in predicting post-training competence following a mental health training among LHWs in Cape Town (n=26). Using a standardized LHW assessment measure adapted to the setting, two raters rated ten-minute standardized role plays conducted before and after the training for pre-training interpersonal skills and post-training competence. Qualitative findings highlight the perceived importance of and challenges with assessing interpersonal skills among LHWs being trained in psychological intervention. Quantitative analyses did not identify any interpersonal skills as significant predictors of post-training competence. However, interpersonal skills improved during the training itself, specifically verbal communication, suggesting the potential promise of further research in this area. Recruitment of larger samples with more variable training outcomes would be important in future studies examining predictors of LHW competence. Further research may ultimately help identify areas of intervention to support more LHWs in attaining competence and can help play an important role in increasing access to psychological services globally.Item Tracking the dynamics of the opioid crisis in the United States over space and time(2022) Xia, Zhiyue; Stewart, Kathleen; Geography; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Millions of adolescents and adults in the United States suffer from drug problems such as substance use disorder, referring to clinical impairments including mental illnesses and disabilities caused by drugs. The Substance Abuse and Mental Health Services Administration reported the estimated number of illicit drug users increased to 59.3 million in 2020, or 21.4% of the U.S. population, which made drug misuse one of the most concerning public health issues. Opioids are a category of drugs that can be highly addictive, including heroin and synthetic drugs such as fentanyl. Centers for Disease Control and Prevention (CDC) indicated that about 74.8% of drug overdose deaths involved opioids in 2020. The opioid crisis has hit American cities hard, spreading across the U.S. beginning with the west coast, and then expanding to heavily impact the central, mid-Atlantic, and east coast of the U.S. as well as states in the southeast. In this dissertation, I work on three studies to track the dynamics of the opioid crisis in the U.S. over space and time from a geographic perspective using spatiotemporal data science methods including clustering analysis, time-series models and machine learning approaches. The first study focused on the geospatial patterns of illicit drug-related activities (e.g., possession, delivery, and manufacture of opioids) in a typical U.S. city (Chicago as a case study area). By analyzing more than 52,000 reported drug activities, I built a data-driven machine learning model for predicting opioid hot zones and identifying correlated built environment and sociodemographic factors that drove the opioid crisis in an urban setting. The second study of my dissertation is to analyze the opioid crisis in the context of the global pandemic of SARS-CoV-2 (COVID-19). In 2020, COVID-19 outbroke and affected hundreds of millions of people across the globe. The COVID-19 pandemic is also impacting the community of opioid misusers in the U.S. The major research objective of Study 2 is to understand how the opioid crisis is impacted by the COVID-19 pandemic and to find neighborhood characteristics and economic factors that have driven the variations before and during the pandemic. Study 3 focuses on analyzing the crisis risen by synthetic opioids (including fentanyl) that are more potent and dangerous than other drugs. This study analyzed the geographic patterns of synthetic opioids spreading across the U.S. between 2013 and 2020, a period when synthetic opioids rose to be a major risk factor for public health. The significance of this dissertation is that the three studies investigate the opioid crisis in the U.S. in a comprehensive manner and these studies can facilitate public health stakeholders with effective decision making on healthcare planning relating to drug problems. Tracking the dynamics of the opioid crisis by drug type, including modeling and predicting the geographic patterns of opioid misuse involving particular opioids (e.g, heroin and synthetic opioids), can provide an important basis for applying further treatment services and mitigation efforts, and also be useful for assessing current services and efforts.Item EFFECTS OF INTERSECTING STIGMAS ON HIV AND ALCOHOL-RELATED HEALTH BEHAVIORS(2021) Regenauer, Kristen S; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)South Africa (SA) has a high burden of HIV and problematic alcohol use. However, associations between HIV stigma and alcohol-outcomes, and alcohol stigma and HIV-outcomes are largely unknown. Further, limited research has examined the role of avoidance in these associations. Therefore, as part of a larger clinical trial, we explored these associations among people living with HIV (PLWH) and problem drinking in SA (N=64). Patients had blood drawn for biomarker-verified measures of outcome variables, and completed self-report measures for all variables. A significant interaction was found between internalized HIV stigma and avoidance in predicting self-report problematic alcohol use (b(SE)=.24(.09), p=.01) such that at low levels of avoidance, higher HIV stigma was associated with less problematic alcohol use (b(SE)=-1.92(.85), p=.03). A matching nonsignificant pattern was observed for biomarker-verified alcohol consumption, suggesting that the relationship between internalized HIV stigma and problematic alcohol use may be moderated by avoidance.Item PEOPLE AND PIXELS: INTEGRATING REMOTELY-SENSED AND HOUSEHOLD SURVEY DATA FOR FOOD SECURITY AND NUTRITION(2020) Cooper, Matthew William; Hansen, Matthew C; Geography; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)For several decades now, the study of environmental impacts on human well-being has been informed by what are called "People and Pixels'' methods: the combining of remotely sensed data about environmental conditions with geolocated data from household surveys about health and nutrition. However, much of this work has been conducted at the scale of individual countries and often relies on only one or two survey waves, which creates substantial issues around spatial autocorrelation and endogeneity. Furthermore, much of this work uses simple linear regression as its analysis technique, which is limited in its ability to describe spatial variation as well as non-linearities in the relationship between the environment and human well-being. Thus, this dissertation uses several insights from the emerging field of data science to advance these methods. First, this analysis draws on large, multinational datasets from dozens of surveys, making it possible to better estimate the non-linear effects of climate extremes on human well-being as well as examine spatial heterogeneities in vulnerability. Secondly, this analysis uses techniques at the boundary between traditional econometric regression models and more complex machine learning models, such as using Generalized Additive Models (GAMs) as well as LASSO estimation. This permits the creation of spatially-varying terms as well as nonlinear effects. Applying these techniques, the dissertation has yielded several insights that could be beneficial to policymakers in governments, non-profits, and multinational organizations. The initial chapters analyze the effects of rainfall anomalies on food security and malnutrition, finding that the effect of an anomaly varies considerably depending on the local socioeconomic and environmental contexts, with low-income, poorly-governed, and arid countries, such as Somalia and Yemen, being the most vulnerable. The latter chapters look at the role of ecosystem services in improving human livelihoods, as well as how land cover is associated with dependence on local provisioning ecosystem services.Item The Effects of Marijuana Legalization on Adolescent Alcohol Consumption(2019) Montano, Ashley Nicole; Dugan, Laura; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Among researchers, there has been a long-standing debate on the issue of whether alcohol and marijuana are used as substitutes or complements of one another. In other words, does the increased usage of one decrease the usage of the other (substitution) or does usage of both substances simultaneously increase (complements)? The primary purpose of this study is to identify whether a suggested substitution or complementary effect exists among adolescent drinking patterns following the recent emergences of increased marijuana legalization. To explore these effects, data is used from 38 different states included in the Youth Risk Behavior Surveillance System between the years 1995 and 2017. The primary analysis finds limited support for a substitution effect and no evidence of a complementary effect among adolescents. This study also includes a supplementary analysis providing implications for the direction of future research on the apparent relationship between alcohol and marijuana usage patterns.Item Multi-dimensional measures of geography and the opioid epidemic: place, time and context(2019) Cao, Yanjia; Stewart, Kathleen; Geography; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The opioid crisis has hit the United States hard in recent years. Behavioral patterns and social environments associated with opioid use and misuse vary significantly across communities. It is important to understand the geospatial prevalence of opioid overdoses and other impacts related to the crisis in order to provide a targeted response at different locations. This dissertation contributes a framework for understanding spatial and temporal patterns of drug prevalence, treatment services access and associated socio-environmental factors for opioid use and misuse. This dissertation addresses three main questions related to geography and the opioid epidemic: 1) How did drug poisoning deaths involving heroin evolve over space and time in the U.S. between 2000-2016; 2) How did access to opioid use disorder treatment facilities and emergency medical services vary spatially in New Hampshire during 2015-2016; and 3) What were the relations between socio-environmental factors and numbers of emergency department patients with drug-related health problems over space and time in Maryland during 2016-2018. For the first study, this dissertation developed a spatial and temporal data model to investigate trends of heroin mortality over a 17-year period (2000-2016). The research presented in this dissertation also involved developing a composite index to analyze spatial accessibility to both opioid use disorder treatment facilities and emergency medical services and compared these locations with the locations of deaths involving fentanyl to identify possible gaps in services. In the third study for this dissertation, I utilized socially-sensed data to identify neighborhood characteristics and investigated spatial and temporal relationships with emergency department patients with drug-related health problems admitted to the four hospitals in the western Baltimore area in Maryland during 2016 to 2018, in order to identify the dynamic patterns of the associations in terms of various socio-environmental factors.Item RACIAL DIFFERENCES IN PROTECTIONS AGAINST PREGNANCY: COMPETING GOALS AND DECISIONS(2018) Young Harrison, Eowna; Kahn, Joan; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Racial disparities in unintended pregnancy are largely related to differences in contraceptive practices. Black women are less likely to use an effective contraceptive and more likely to discontinue a method compared to their White counterparts. More concerning is that the Black-White gap in these protections against unintended pregnancy may have widened over time. Reasons for these racial disparities and the pathways to contraceptive practices that leave at-risk women vulnerable to unintended pregnancy are unexplained This project addresses some of the existing gaps in the literature by using a mixed-methods approach to 1) investigate the various factors contributing to Black-White differences in contraceptive practices over time and 2) explore the contraceptive decision-making of women at high risk of unintended pregnancy. Using multinomial logistic regression and a Fairlie decomposition on data from the National Survey of Family Growth 1988 and 2011-2015 survey cycles, I analyze contraceptive use and effective method choice of young adult women. Results reveal that the Black-White gap in contraceptive practices in 2011-2015 are 2-3 times larger than in 1988. Very few factors were statistically significant at explaining the 13% Black-White difference in 2011-2015. Interviews with Black women in Philadelphia were used to improve our understanding of contraceptive practices that are less effective at protecting against pregnancy. Findings highlight criteria for method selection, concern for STDs, and partner trust as key factors guiding contraceptive practices.Item OPIOID ABUSE AMONG ADOLESCENTS WHO OFFEND: RISK FACTORS AND THE ROLE OF GENDER(2018) Hickman, Shelby Nichole; Gottfredson, Denise; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this paper, I explore risk factors for opioid use and abuse among juvenile justice system-involved adolescents convicted of a serious offense; a group known to experience high rates of substance abuse and dependence. Using the Pathways to Desistance dataset, I assess whether risk factors for substance use that includes opioids are distinct from the risk factors for other illicit substance use that does not including opioids (non-opioid substance use). I also explore how, if at all, the motives and patterns of opioid use are distinct for male and female adolescent offenders. I identify older age, white race, and clinically significant mental illness as significant risk factors for substance use including opioids relative to non-opioid substance use. I do not find any distinct risk factors for adolescent females’ opioid use relative to their male peers.Item Intersectional experiences, stigma-related stress, and psychological health among Black LGB communities(2018) Jackson, Skyler; Mohr, Jonathan J; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Contemporary theories of stigma-related stress (Hatzenbuehler, 2009; Krieger, 2014; Meyer, 2003) suggest that marginalized populations face chronic experiences of prejudice and discrimination due to their minority statuses—and that these stressful events undermine psychological health. Research based on this perspective typically (a) focus on one aspect of identity (e.g., sexual orientation) in isolation from other salient aspects of identity (e.g., race), (b) test temporal theories of discrimination and health using cross-sectional study designs, and (c) focus on experiences of stigmatization, overlooking the potential role of positive, identity-supportive experiences in mental health. The present study uses daily diary methods to explore the prevalence and day-to-day correlates of intersectional experiences (IEs) in a sample of 131 Black lesbian, gay, and bisexual (LGB) individuals. Every evening for one week, participants reported both negative and positive IEs from the last 24 hours, and completed measures of identity conflict, rumination, and affect. Across 849 combined study days, participants described 97 negative IEs (11.4% of days) and 263 positive IEs (31.0% of days). Multilevel regression was used to test concurrent and temporal relations between daily IEs and mood—as well as the mediating roles of identity conflict and rumination—at the within-person and between-person levels. Negative IEs were associated with identity conflict and negative affect at both the within- and between-person levels, and negative rumination at the within-person level only. Positive IEs predicted positive rumination and positive affect (but not identity conflict) at the within- and between-person levels. Results indicated that identity conflict mediated the concurrent association between negative IEs and negative affect (but not between positive IEs and positive affect) at both levels of analysis. Negative rumination mediated the concurrent association of negative IEs and negative affect at the within-person level (but not the between-person level). The study also produced a significant indirect path from positive IEs to positive affect, mediated through positive rumination, at both levels of analysis. No direct or indirect lag-effects were demonstrated in which IEs predicted next day outcomes. This microlongitudinal investigation is among the first to quantitatively capture the prevalence and day-to-day correlates of intersectional experiences among LGB people of color.