Epidemiology & Biostatistics
Permanent URI for this communityhttp://hdl.handle.net/1903/7125
Browse
42 results
Search Results
Item Self-reported discrimination among Asian Americans: An examination of its measurement and relationship with health-related quality of life(2019) Jung, Mary; Lee, Sunmin; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Labeled as a “model minority,” Asian Americans have often been excluded from the dialogue on discrimination. Previous studies frequently used discrimination measures that were initially developed for African Americans and lack items related to language and nativity. Although discrimination adversely affects mental and physical health, its relationship to health-related quality of life (HRQOL) has been understudied in this population. This dissertation evaluated self-reported discrimination among Asian Americans by examining its measurement and relationship with HRQOL. Manuscript 1 assessed the psychometric properties of everyday (ERDS) and major racial discrimination scales (MRDS) that were developed for Asian Americans. In a sample of 569 Asian American immigrant adults, reliability was excellent for ERDS but moderate for MRDS (Cronbach’s α=0.94 and 0.60). The latter is likely low given that MRDS is an inventory of events. For construct validity, weak positive linear correlations with perceived stress and depressive symptoms were observed (r=0.22 and 0.28 for ERDS and r=0.11 and 0.14 for MRDS; p<0.001). Factor analysis confirmed the unidimensionality of both measures. Manuscript 2 cross-sectionally examined the association between the racial discrimination measures from Manuscript 1 and HRQOL among 524 foreign-born Asian American adults. Multivariable logistic regression and negative binomial regression were performed to examine self-rated health (poor vs. good) and days of poor physical health, mental health, and activity limitation. ERDS (IRR range: 1.04-1.08) and MRDS scores (IRR range: 1.19-1.61) were significantly and positively associated with worse HRQOL for all measures, except for self-rated health. Manuscript 3 examined discrimination trajectories and assessed their relationship with self-rated health in a longitudinal, multi-ethnic sample of 2,004 middle-aged women in the Study of Women’s Health Across the Nation (SWAN). Group-based trajectory analysis identified three distinct discrimination groups. The “high and decreasing” but not “moderate and decreasing” group was significantly associated with poor self-rated health compared to the “low and decreasing” group (OR=1.61; 95% CI: 1.12-2.31). This dissertation provides insight into discrimination measures and their relationships with HRQOL among Asian Americans. Proper measurement and health impact assessment of discrimination in this population can contribute to better monitoring and provide improved accountability and support for interventions and public policies.Item DOES PATIENT-CENTERED COMMUNICATION AND TRUST IN PHYSICIAN INFORMATION VARY BY CANCER SURVIVORSHIP STATUS? AN ANALYSIS OF THE HEALTH INFORMATION NATIONAL TRENDS SURVEY (HINTS) 2017(2019) Al-Nassir, Marwa Fawzi; Dallal, Cher M; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Trust is the foundation of the patient-physician relationship. Patients’ trust in a physician has been associated with patient satisfaction, adherence to treatment, continuity of care, and improved health outcomes. Trust in a physician is especially important for health-vulnerable populations, such as cancer survivors, as they tend to endure complex emotional needs related to re-acclimating to the new normal post cancer diagnosis. The patient-physician relationship also relies heavily on effective patient-centered communication (PCC), however, associations between PCC and trust in physician information overall and by cancer survivorship status is not well understood. Using nationally representative data (N = 2604) ascertained from Cycle 1 of the fifth iteration of the 2017 Health Information National Trends Survey (HINTS), a cross-sectional analysis was conducted to examine PCC in relation to trust in physician information. PCC was assessed on a 4-point Likert scale using responses from seven sub-questions that address the main functions of PCC: 1) fostering healing relationships, 2) exchanging clinical information, 3) responding to emotional needs, 4) managing uncertainty, 5) facilitating shared decision-making, and 6) enabling patient self-management. Trust in physician information was analyzed dichotomously (high versus low) based on responses from a single item question. PCC was analyzed as individual components (optimal versus sub-optimal) and as an overall score. Confounders included age, sex, race/ethnicity, education, and household annual income. Odds ratios (OR) and 95% confidence intervals (CI) for the relationship between PCC and trust in physician information were estimated using multivariable logistic regression. Analyses of cancer survivorship status (cancer survivor versus never had cancer) as an effect modifier of the relationship between PCC and trust in physician information was also conducted using an interaction term. Results from the weighted multivariable models revealed that for every one-unit increase in the overall PCC score (range 1 to 100), the odds of having high trust in physician information increased by 4% (adj OR = 1.04, 95% CI = 1.03–1.05). The odds of reporting high level of trust in physician information were significantly associated with each individual component of PCC when comparing those who felt their communication component was optimal versus sub-optimal (PCC components: exchanging clinical information (adj OR = 2.57, 95% CI = 1.82–3.62), responding to emotional needs (adj OR = 2.34, 95% CI = 1.65–3.30), facilitating in shared decision-making (adj OR = 2.35, 95% CI = 1.70–3.26), enabling patient self-management (adj OR = 2.88, 95% CI = 2.11–3.92), managing uncertainty (adj OR = 2.45, 95% CI = 1.74–3.44), fostering healing relationships (adj OR = 2.79, 95% CI = 2.18–3.57), and spending enough time with you (adj OR = 2.09, 95% CI = 1.49–2.93)). When examining relationships by cancer survivorship status, estimates among cancer survivors were of greater magnitude compared to persons who reported never having cancer, however, no significant interactions were observed in the weighted multivariable models (all p-interaction>0.05). These findings provide insight on how optimal experiences of PCC influence trust in physician information and can help inform the development of PCC strategies to ultimately improve health outcomes and reduce consequences related to poor patient-physician trust overall and among cancer survivors.Item TOOTH RESORPTION AND RISK FOR ANESTHETIC COMPLICATION DURING ANESTHETIZED DENTAL PROCEDURES IN DOMESTIC FELINES(2019) Jenkins, Emily J; Slopen, Natalie B; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Tooth resorption (TR) in felines may present an increased risk for complications during dental procedures, and it is currently unknown whether oral examination is a valid diagnostic method for type 1 TR. Using existing data from 1,530 felines from a large veterinary hospital in Washington, D.C., I examined the association between type 1 TR and complication under anesthesia during a dental procedure, and the validity of oral examination as a diagnostic tool. Controlling for breed, weight, age, sex, hematocrit, total protein, technician, veterinarian, and presence of oral and systemic disease, type 1 TR was associated with a complication under anesthesia during a dental procedure (p<0.0001). Sensitivity (93.1%) and specificity (97.6%) support the reliability of oral examination for diagnosing type 1 TR. Veterinarians can proactively anticipate lower blood pressures when anesthetizing felines with type 1 TR. There are similarities between TR in humans and felines, and further research is needed on the pathophysiology and health implications of TR in both species.Item Using the Index of Concentration at the Extremes to Examine the Impact of Air Pollution Exposure on Infant Mortality in the United States(2019) Ammons, Samantha; Nguyen, Quynh; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: The concentration of privilege in a geographic area can determine how vital resources are distributed among certain groups in that area, thus influencing a community’s health. High air pollutant exposure is often concentrated in deprived neighborhoods with lack of vital resources. Objective: Determine whether states with a high concentration of air pollution exposure have higher infant mortality rates (IMR) than states with lower concentrations of air pollution exposure. Methods: The Index of Concentration of the Extreme was utilized to measure the concentration of air pollution exposure for each state. Incidence Rate Ratios and 95% Confidence Intervals for state infant mortality rate were computed using Poisson regression in Statistical Analysis Software. Results: States with high concentrations of air pollution exposure had 19% lower IMR than states with low air pollution exposure (95%CI:0.70 – 0.94). Conclusions: These findings can enable researchers to conduct census-tract research on adverse health outcomes and societal distributions.Item Relationships of social and physical environmental factors with cardiometabolic outcomes(2019) Huang, Dina; Puett, Robin; Nguyen, Quynh C; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The social and physical environmental factors impact health in general and have been linked with increased risks of cardiometabolic outcomes including obesity, diabetes, hypertension and cardiometabolic biomarkers. The dissertation added to important knowledge on this topic in two ways: 1) by leveraging innovative Twitter-derived characteristics to study the potential influence of social environment on cardiometabolic outcomes, 2) investigating the effects of air pollution exposures on cardiometabolic outcomes in youth living with type I diabetes. The first study investigated the associations between Twitter-derived area-level predictors (happiness, diet, physical activity) with cardiometabolic outcomes (obesity, diabetes, hypertension) using a nationally representative sample from National Health and Nutrition Examination Survey (NHANES). People living in neighborhoods with higher happiness, healthier diet and more physical activity had lower prevalence of obesity and hypertension but not diabetes. Twitter-derived social neighborhood characteristics can be used to identify communities with higher risk of cardiometabolic outcomes. We obtained data from SEARCH for Diabetes in Youth (SEARCH) study for the second and the third study. The second study examined the associations between chronic exposure to air pollution and glucose hemostasis (HbA1c) in youth living with type I diabetes. Particulate matter with aerodynamic diameter <2.5 (PM2.5), proximity to heavily trafficked roads and annual average daily traffic count were associated with higher HbA1c in study site South Carolina, Colorado and Washington, but not in study site Ohio and California. Differences in particulate matter compositions may explain the inconsistent results. The third study assessed the effect of acute exposure to air pollution on subclinical CVD markers including pulse wave velocity (PWV), augmentation index (AIx) and brachial distensibility (BrachD) using a repeated measures design. Reduction in PM2.5 on the day prior to assessment was associated with lower AIx, but not associated with either PWV or BrachD. In summary, exposure to air pollution may be associated with cardiometabolic outcomes and reducing air pollution may have implications in early prevention of cardiovascular complications for youth living with type I diabetes. Overall, reducing social stressors and reducing hazardous physical environmental factors may decrease the risk of cardiometabolic outcomes, providing possible directions for CVD prevention for public health practitioners.Item THE EFFECTS OF FEMALE SEX HORMONES ON THE RELATIONSHIP BETWEEN PARA-OCCUPATIONAL EXPOSURE TO AGRICULTURAL WORK AND URINARY BLADDER CANCER AMONG EGYPTIAN WOMEN(2018) James, India C; Carter-Pokras, Olivia; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Well-established risk factors such as tobacco smoke, occupational exposure, and Schistosoma haematobium infections do not fully explain the lower risk of bladder cancer for women compared to men. Recently, an association was reported between women who were married to agricultural workers and bladder cancer risk. We investigated whether proxies of estrogen exposure (age at first childbirth, number of babies delivered, and age at menopause) act as effect modifiers on the association of para-occupational exposure to agricultural work and bladder cancer among Egyptian women. Data from a multi-center Egyptian case-control study of 222 cases and 471 controls were used to examine the association. No evidence of effect modification was observed for these proxies. Later age at first childbirth may be an independent risk factor for this malignancy (AOR= 1.63; 95% CI 1.17, 2.27). Future studies can help identify sensitive sub-populations of Egyptian women who are more likely to develop bladder cancer.Item THE SYNDEMIC EFFECT OF PSYCHOSOCIAL AND STRUCTURAL FACTORS ON HIV TESTING AMONG BLACK MEN AND THE MODERATING EFFECT OF SEXUAL IDENTITY(2018) Turpin, Rodman Emory; Dyer, Typhanye; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Black populations experience the highest incidence and prevalence of HIV in the United States. It has been posited that numerous structural and psychosocial factors contribute to HIV disparities among Black populations, these factors can have an adverse effect on healthcare utilization, including HIV testing. Given the burden of HIV rates among Black men, especially Black gay and bisexual men, it is important to consider possible barriers to HIV testing in this population. Syndemic theory posits a mutually reinforcement of social and structural conditions that cumulatively affects disease outcomes. While syndemic theory has been applied to HIV acquisition, this framework has not been utilized for HIV testing. We tested for a syndemic of depression, poverty, and a lack of healthcare access impacting HIV testing and tested sexual identity as a moderator of healthcare access in a nationally representative sample of Black men. Participants with 2 or 3 syndemic factors were significantly more likely to have never been HIV tested compared to those with 0 or 1 (49.2% to 31.7%). Having 3 syndemic factors was associated with greater prevalence of never having been HIV tested (aPR=1.46, 95% CI 1.09, 1.95). Gay/bisexual identity moderated the association between health insurance and ever having been HIV tested in adjusted models (aPR=4.36; 95% CI 1.40, 13.62), with not having health insurance being associated with HIV testing among gay/bisexual participants only (aPR=4.84, 95% CI 1.19, 19.70). Using latent class analysis, four syndemic classes were identified as significant predictors of having never been HIV tested. In adjusted log-binomial models, compared to the class with the lowest proportion of syndemic factors, the highest prevalence of never having been HIV tested was among the class with the highest proportions of syndemic component factors (aPR=2.27, 95% CI 1.83, 2.82). Overall, there is evidence of a syndemic of depression, poverty, and a lack of healthcare access that negatively affects HIV testing among Black men, with a lack of healthcare access being a significantly greater barrier to HIV testing among gay/bisexual men compared to heterosexual men.Item THE IMPACT OF SOCIOECONOMIC STATUS ON SERIOUS MENTAL ILLNESS AND CARDIOVASCULAR DISEASE AMONG AFRICAN AMERICANS(2017) Wilkerson, Thomas G.; Dyer, Typhanye; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Cardiovascular disease (CVD) tends to be more prevalent in individuals older than 18 years of age with serious mental illness (SMI) and CVD is the leading cause of death of African Americans in the United States. Socioeconomic status (SES) is a major confounder that distorts the association of SMI with CVD in the African American population. The goal of this study is to measure the relationship between SMI and CVD in middle and upper income level African Americans. To accomplish this goal the three specific aims are as follows: Aim 1: To measure the prevalence of CVD in the study population. Aim 2: To measure the prevalence of SMI in the study population. Aim 3: To measure the strength of the association between SMI and CVD in the study population. The study is a cross-sectional study using secondary data analysis from four merged 2015 National Health Interview Survey (NHIS) datasets.Item The Health Implications of Stress among Asian Americans in the US and Chinese In China: the Effects of Perceived Stress and Caregiving Stress on Cardiovascular Risk Factors(2018) Lu, Xiaoxiao; Lee, Sunmin; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Prior research suggests that stress plays a role in the etiology and progression of cardiovascular disease (CVD). To lend a more accurate depiction of the associations between stress and CVD risk factors, this dissertation used a comprehensive approach to conceptualizing stress by assessing two dimensions of stress: perceived stress and caregiving stress. The objective of this dissertation was to investigate the associations between multiple dimensions of stress and the risk factors of CVD. This dissertation also explored the potential mechanisms that underlie the relationships between stress and CVD risk factors. In Paper 1 (Chapter 3), we assessed the associations between perceived stress and hypertension across varying levels of social support and social network among 530 Chinese, Korean and Vietnamese Americans. Results indicated that individuals with high perceived stress were 61% more likely to have hypertension compared to those with low levels of perceived stress (Odds Ratio (OR): 1.61, 95% Confidence interval (CI): 1.15, 2.46). Social support had a direct beneficial effect on hypertension, irrespective of whether individuals were under stress. In Paper 2 (Chapter 4), we used five waves of longitudinal data from the China Health and Nutrition Survey to examine the association between parental caregiving and blood pressure among 2,586 Chinese women. We found that parental caregivers were associated with higher systolic (β-coefficient (β) = 1.16; p ≤ 0.01) and diastolic blood pressure (β = 0.75; p ≤ 0.01) compared with non-caregivers across multiple waves. In Paper 3 (Chapter 5), we investigated the relationship between caregiving trajectory and Metabolic Syndrome (MetS) among 1,636 Chinese women. Three caregiving trajectories were identified by using group-based trajectory analysis. Results showed that ‘rising to high-intense’ caregivers (OR = 1.90; 95% CI: 0.90, 4.00) and ‘stable low-intense’ caregivers (OR = 1.56; 95% CI: 1.06, 2.29) were associated with higher risk of MetS compared with non-caregivers. This dissertation is innovative in its examining the associations of multiple dimensions of stress with CVD risk factors among Asian subgroups. Findings from the proposed study will be used to develop future stress management interventions, and incorporating culturally and linguistically appropriate strategies into community outreach and education to decrease cardiovascular disease risk within the Asian population.Item MODE OF BIRTH AND VAGINAL MICROBIOTA IN REPRODUCTIVE-AGE WOMEN(2017) Stennett, Christina; Dyerà!o, Typhanye; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)It is well documented that women with robust, Lactobacillus-dominated vaginal microbiotas are less likely to develop a range of adverse reproductive health outcomes. The birthing process is thought to be a critical event in the initial seeding, or colonization, of the human microbiome, and the transfer of microbiota from mother to baby during delivery is associated with long-term health. We recruited 88 adult women to a cross-sectional study to evaluate the relationship between their vaginal microbiota and the mode of their birth (self-reported as vaginal delivery or Cesarean section (C-section)). In a multivariable analysis, women who had a less protective, low-Lactobacillus community state type had 3-fold increased odds of having been born via C-section, indicating that C-section is related to vaginal dysbiosis in adulthood (adjusted OR: 3.73, p=0.01, 95% CI: 1.08-12.77). Although the cross-sectional analysis does not account for fluctuations in microbial composition, the significant point estimate suggests that birth mode may play a role in vaginal seeding and colonization outcomes in adult women.