School of Public Health

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

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

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A Critical Review of an Authentic and Transformative Environmental Justice and Health Community — University Partnership
(MDPI, 2014-12-11) Wilson, Sacoby; Campbell, Dayna; Dalemarre, Laura; Fraser-Rahim, Herb; Williams, Edith
Distressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case study examines the process of building and sustaining a successful transformative and authentic community-university partnership. We apply the framework established by Community-Campus Partnerships for Health (CCPH), focusing on four of the nine principles of Good Practice of Community Campus Partnerships.
Acculturation and BMI among Chinese, Korean and Vietnamese Adults in Maryland
(2011) Chen, Lu; Lee, Sunmin; Carter-Pokras, Olivia D; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Objective: To examine the relationship between acculturation and BMI among Asian Americans. Methods: Data of 847 Chinese, Korean and Vietnamese recruited for a health education program in Maryland were included. Acculturation was measured by the short version of Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA) and its individual components. Height and weight were measured by trained staff. Multiple linear regression was used to estimate the parameters of acculturation variables. Results: After adjusting for confounders, SL-ASIA (β=0.71, 95% CI: 0.15, 1.26), having education in the U.S (β=0.56, 95% CI: 0.01, 1.11), younger age of arrival (0-5 years: β=3.32, 95% CI: 1.84, 4.80, 6-10 years: β=1.55, 95% CI: 0.02, 3.07) and equal preference of Asian/American food in restaurants (β=0.92, 95% CI 0.38, 1.46) were associated with BMI. The association between acculturation and BMI was stronger among men than women, and weakest among Vietnamese. Conclusion: Acculturation is moderately associated with BMI among Asian Americans.
Activation of the endoplasmic reticulum stress response in skeletal muscle of G93A*SOD1 amyotrophic lateral sclerosis mice
(Frontiers, 2015-05-18) Chen, Dapeng; Wang, Yan; Chin, Eva R.
Acts of Livelihood: Bodies and Nature in International Garden City Movement Planning, 1898-1937
(2018) Clevenger, Samuel Martin; Andrews, David L; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Urban planning and reform scholars and policymakers continue to cite the “garden city” community model as a potential blueprint for planning environmentally sustainable, economically equitable, humane built environments. Articulated by the British social reformer Sir Ebenezer Howard and his 1898 book To-Morrow: A Peaceful Path to Real Reform, the model represented a method for uniting the benefits of town and country through a singular, pre-planned, “healthy” community, balancing spaces of “countryside” and “nature” with affordable, well-built housing and plentiful cultural attractions associated with city life. The book catalyzed an early twentieth-century international movement for the promotion and construction of garden cities. Howard’s garden city remains a highly influential context in the history of town planning and urban public health reform, as well as more recent environmentally-friendly urban design movements. To date, while historians have long examined the garden city as an agent of social and spatial reform, little analysis has been devoted to the role of prescribed embodiment and deemed “healthy” physical cultural forms and practices in the promotion and construction of garden cities as planned communities for “healthy living.” Informed by recent scholarship in Physical Cultural Studies (PCS), embodied environmental history, cultural materialism, and theories of modern biopower, this dissertation studies the cultural history of international garden city movement planning in early twentieth century Britain and the United States. Studying archival materials related to some of the prominent planners and resultant communities of the movement, I focus on the biopolitical dimensions of the planners’ contextual designs for “nature,” “health,” and “healthy” physical culture as they devised material garden city community layouts. I argue that the intentional British and American garden cities created during the movement were planned as spatialized strategies for the regeneration of laboring bodies through organized, bourgeois physical cultural practices and access to nostalgic spaces of “naturally healthy environments and outdoor recreation.
Acute cycling exercise and hippocampal subfield function and microstructure in healthy older adults
(Wiley, 2023-08-01) Callow, Daniel D.; Kommula, Yash; Stark, Craig E.L.; Smith, J. Carson
Aging is associated with deterioration in dentate gyrus (DG) and CA3, both crucial hippocampal subfields for age susceptible memory processes such as mnemonic discrimination (MD). Meanwhile, a single aerobic exercise session alters DG/CA3 function and neural activity in both rats and younger adults and can elicit short-term microstructural alterations in the hippocampus of older adults. However, our understanding of the effects of acute exercise on hippocampal subfield integrity via function and microstructure in older adults is limited. Thus, a within subject-design was employed to determine if 20-min of moderate to vigorous aerobic exercise alters bilateral hippocampal subfield function and microstructure using high-resolution functional magnetic resonance imaging (fMRI) during an MD task (n = 35) and high angular resolution multi-shell diffusion imaging (n = 31), in healthy older adults, compared to seated rest. Following the exercise condition, participants exhibited poorer MD performance, particularly when their perception of effort was higher. Exercise was also related to lower MD-related activity within the DG/CA3 but not CA1 subfield. Finally, after controlling for whole brain gray matter diffusion, exercise was associated with lower neurite density index (NDI) within the DG/CA3. However, exercise-related differences in DG/CA3 activity and NDI were not associated with differences in MD performance. Our results suggest moderate to vigorous aerobic exercise may temporarily inhibit MD performance, and suppress DG/CA3 MD-related activity and NDI, potentially through neuroinflammatory/glial processes. However, additional studies are needed to confirm whether these short-term changes in behavior and hippocampal subfield neurophysiology are beneficial and how they might relate to long-term exercise habits.
ADAPTING A BREAST CANCER CONTROL INTERVENTION FOR AFRICAN AMERICAN WOMEN BELOW SCREENING AGE: A CO-DESIGN APPROACH
(2023) Huq, Maisha R; Knott, Cheryl L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Background: Despite African American women below screening age facing greater mortality from early onset breast cancer relative to similar aged peers of other races/ethnicities and African American women of screening age, little attention is given to this group of younger women. Evidence-based breast cancer educational interventions do not exist for this group of younger women. The purpose of the current work was to address the gap of evidence-based breast cancer educational interventions for African American women below screening age. Aims: The current study had two aims. Aim 1 was to adapt an evidence-based breast cancer educational intervention for African American women of screening age, to be targeted to younger African American women (i.e. those below screening age) using a systematic process guided by the seven-step adaptation framework by Card and colleagues, documented using an established implementation science model, the Framework for Reporting Adaptations and Modifications Enhanced Model (FRAME), and using a virtual co-design approach. Aim 2 was to assess the appropriateness of the adapted intervention for African American women below screening age through online surveys administered at the conclusion of Community Chat sessions. Methods: The adaptation process was guided by Card and colleagues’ seven-step framework. Five virtual co-design sessions with n=15 potential users and key stakeholders were conducted in step 7. Observational notes and FRAME Form data were collected from the co-design sessions and analyzed using five-step thematic and descriptive statistics analyses, respectively. Appropriateness data was collected through an online survey; quantitative data were analyzed using descriptive statistics and open-text survey responses were analyzed using five-step thematic analysis. Results: Application of Card and colleagues’ seven step framework was described. Six themes emerged from observing virtual co-design sessions: technological tools can encourage equal participation; personal relationships and stories enhance design; participants introduced content to promote equity; context of original intervention critical to adapt; challenges to virtual designing; and need for facilitator during co-design. Documentation of the adaptation process guided by FRAME found 14 adaptations led to “Black and Breasted (B&B)”, an Instagram and beauty brand partnership-based breast health education tool prototype. Motivations for adaptations were to promote fit (100%), reach (71%), and equity (29%). Adaptations were content (63%) and context-related (37%). All participants rated B&B as highly appropriate—selecting an average of 4.5 (SD=1.4) and 1.2 (SD=.75) reasons, respectively, B&B would and would not be a good fit. Thematic analysis of open-text responses on how to further enhance B&B identified four themes: increase strategies to improve health equity, use multiple social media, consider non-beauty brands, revise visuals/messages. Conclusions & Implications: While usage of the implementation science models led to a highly appropriate adapted intervention, initial testing identified the need for further strategies to improve equity of health outcomes through the intervention. Findings indicate implementation science frameworks may benefit from centering equity more. Co-design may also be an apt approach to promote health equity in public health interventions.
Adaptive Coping in African American Adolescents: The Role of Mother-Adolescent Relationship Quality, Parental Monitoring, and Racial Socialization
(2018) Greene, Diamond; Smith-Bynum, Mia A; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Adolescence can be a stressful stage of development for adolescents and their families; however, it is particularly stressful for African American adolescents who also have to deal with additional stressors such as racial discrimination, which can be detrimental to one’s mental health. The purpose of this study is to examine how: (a) adolescents’ perception of mother-adolescent relationship quality, (b) adolescents’ perception of parental monitoring from their parents, and (c) adolescents’ perception of racial socialization (e.g., cultural coping with antagonism) messages, predicts adaptive coping strategies. The sample included 111 African American adolescents (55% female), ranging from ages 14 to 17 (mean age = 15.50), residing in the Washington, DC metropolitan area between 2010 and 2011. The median household income for this sample is $60,000-69,999. Results showed that adolescents’ perception of positive mother-adolescent relationship quality and receiving racial socialization messages, specifically cultural coping with antagonism messages, were significant predictors of adaptive coping.
Addressing refugee health through evidence-based policies: A case study
(Elsevier, 2018-06) Thiel de Bocanegra, Heike; Carter-Pokras, Olivia; Ingleby, J. David; Pottie, Kevin; Tchangalova, Nedelina; Allen, Sophia I.; Smith-Gagen, Julie; Hidalgo, Bertha
The cumulative total of persons forced to leave their country for fear of persecution or organized violence reached an unprecedented 24.5 million by the end of 2015. Providing equitable access to appropriate health services for these highly diverse newcomers poses challenges for receiving countries. In this case study, we illustrate the importance of translating epidemiology into policy to address the health needs of refugees by highlighting examples of what works as well as identifying important policy-relevant gaps in knowledge. First, we formed an international working group of epidemiologists and health services researchers to identify available literature on the intersection of epidemiology, policy, and refugee health. Second, we created a synopsis of findings to inform a recommendation for integration of policy and epidemiology to support refugee health in the United States and other high-income receiving countries. Third, we identified eight key areas to guide the involvement of epidemiologists in addressing refugee health concerns. The complexity and uniqueness of refugee health issues, and the need to develop sustainable management information systems, require epidemiologists to expand their repertoire of skills to identify health patterns among arriving refugees, monitor access to appropriately designed health services, address inequities, and communicate with policy makers and multidisciplinary teams.
Addressing Unsubmitted Sexual Assault Kits and Reforming Processes Going Forward: Burnout and Vicarious Trauma Among Staff Working the Cases
(2019) Meadows, Kristi; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Burnout and vicarious trauma continue to be high priority topics in healthcare and law enforcement research, but there is a sizeable deficit within the literature among professions working directly with sexual assault cases. Generally, burnout and vicarious trauma among specific professions within the justice system including attorneys, victim advocates, and sexual assault nurse examiners (SANE) have been significantly understudied. Additionally, reforms are currently underway to address the problem of unsubmitted sexual assault kits stored in warehouses across the United States. However, implications for the employees have not been studied by researchers to understand potential consequences in working with these cases nor the added stress of reforms. Secondary qualitative analysis was conducted using data from a sample of interviews with key informants (n=135) who are victim-facing and involved in processes to address both unsubmitted sexual assault kits and current cases of sexual assault. Informants were more likely to focus on facilitators and challenges in their daily work than to discuss the outcomes of burnout and vicarious trauma. Insufficient access to resources and increased workloads were the most significant challenges discussed among key informants, although, emotional labor and other difficult aspects of the job were also a common theme throughout this population. Social support including support across agencies, as well as supervisory support, were the most discussed potential protective factors of burnout. This study contributes information regarding key challenges faced by individuals working on sexual assault cases and has direct implications for employees in the field as well as those undergoing reform on sexual assault kit processing. These findings should be used to understand potential contributors to burnout and vicarious trauma in order to better mitigate negative outcomes associated with this work.
Adoption, reach, and implementation of a cancer education intervention in African American churches
(Springer Nature, 2017-03-14) Santos, Sherie Lou Zara; Tagai, Erin K.; Scheirer, Mary Ann; Bowie, Janice; Haider, Muhiuddin; Slade, Jimmie; Wang, Min Qi; Holt, Cheryl L.
Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)—a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system. Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom (“Traditional”; n = 16 CHAs in 8 churches) or web-based (“Technology”; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance. The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL—226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05). Overall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.
ADVANCING THE HEALTH OF UNDERSERVED COMMUNITIES ACROSS THE UNITED STATES: OPPORTUNITIES TO IMPROVE HEALTH CENTER QUALITY OF CARE AND PATIENT EXPERIENCE
(2017) Nair, Suma; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
1 in 13 people in the United States receives care at a community health center. As health center services become an increasing percentage of all primary care services delivered in the United States, their success is vital to national efforts to advance health and manage costs. This dissertation presents three studies, addressing critical gaps in our understanding of health center quality and quality improvement opportunities. The first study examined the association between ambulatory care accreditation and 14 clinical quality measures in 1,198 health centers. Results demonstrated that accredited centers achieved higher performance on adult weight screening and follow up, tobacco cessation intervention, and use of lipid-lowering therapy. Universal accreditation could lead to an additional 552,087 patients receiving weight screening and follow up, 157,434 receiving tobacco cessation interventions, and 25,289 receiving lipid-lowering therapy. Findings suggest universal accreditation could contribute to quality gains and facilitate health disparity reduction. The second study used the first nationally representative dataset of health center PEC, to investigate the association between five measures of PEC (access to care, provider communication, office staff interactions, follow up on results and overall provider rating) and patient and health center characteristics. Results demonstrated that PEC ratings varied significantly by race/ethnicity, health and mental health status, education and income levels, and language. Findings highlight PEC improvement opportunities as well as the importance of patient-mix adjustment of PEC ratings in value-based payment. The third study evaluated the association between PEC and health center quality of care. Quality of care metrics included receipt of care, health behaviors, patient activation, and clinical outcomes in health center patients. Results showed that PEC ratings were associated with receipt of care, as well as patient adherence and activation. The findings support the importance of measuring PEC as a key determinant of quality, as well improving PEC as a driver for improvement for other aspects of care quality. All three studies were the first to our knowledge to use nationally representative health center data to examine these dimensions of quality and provide significant contributions towards our understanding of health center quality and related quality improvement and policy implications.
Adverse Childhood Experiences (ACEs) in Early Childhood and Their Associations with Middle Childhood Behavior Problems
(2017) Schroeder, Allison; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Experiences in early childhood lay the foundation for physical and psychological health and wellbeing throughout the life course. A large body of literature demonstrates a graded relationship between adverse childhood experiences (ACEs) and health and social outcomes. Children living in poverty are disproportionately likely to experience multiple adversities, placing them at risk for negative health and developmental outcomes and contributing to widening health disparities. Among the outcomes associated with ACEs are internalizing and externalizing behavior problems, which increase children’s risk of later depression and anxiety, substance use, criminality, low socioeconomic status, and chronic physical health problems. In spite of the substantial knowledge base that has developed around childhood adversity and its association with behavior problems, there are gaps in the literature that warrant further research. Firstly, few studies utilizing prospective longitudinal data have examined the role of timing and duration of exposure to adversities in early childhood, and their relationship with later behaviors. Secondly, researchers have only just begun exploring whether certain patterns or constellations of risk factors are common among different groups of children, and whether these patterns place certain groups at greater risk for behavior problems. A third gap relates to the role of father involvement by unmarried fathers and the potential for these fathers to promote more positive outcomes among children exposed to various levels of early adversity. The three studies in this dissertation analyze data from four waves of the Fragile Families and Child Wellbeing Study to document associations between ACEs experienced at ages 1, 3, and 5, and behavior problems at age 9. Life course theory provides an overarching framework for the dissertation. The first study examines the associations between the accumulation, timing, and duration of ACEs in the first five years of life and odds of behavior problems at age 9. The second study employs latent class analysis to identify patterns of risk exposure and their potential association with age 9 behaviors. The third study investigates whether early father involvement by fathers who were unmarried at the child’s birth moderates the association between early childhood adversity and age 9 behavior problems.
Adverse Childhood Experiences and Preterm Birth: A Systematic Review
(2019) Wiggan, Morgan Lynn; Franzin, Luisa; Shenassa, Edmond; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Adverse childhood Experiences (ACEs) elevate one’s risk for poor health outcomes later in life such as psychiatric disorders, cardiovascular disease, depression, anxiety, obesity, diabetes, poor fetal health, and liver disease (Poulton et al., 2002, Anda et al., 2007, Jimenez et al., 2017, Talbot et al., 2009. While the association between ACEs and negative health outcomes is well established in the literature, only ten studies examine the effect of ACEs on one’s risk for preterm birth (Benedict et al. 1999; Bublitz et al., 2014; Cammack et al., 2019; Christiaens et al. 2015; Jacobs 1998; Gillespie et al. 2017; Grimstad et al. 1998; Leeners et al. 2010; Margerison-Zilko et al., 2016; Noll et al. 2007). Preterm birth accounts for 60% of neonatal deaths and elevates an infant’s risk for poor health outcomes later in life ranging from behavioral issues to heart disease (WHO, 2018) and the rate of preterm birth in the United States has steadily risen since 2015, reaching about 10% in 2018 (CDC, 2018). This systematic review seeks to critically assess and synthesize these ten studies and identify proposed mediators and identify gaps in the literature for future research.
Aerobic Fitness and Prevalence of the Metabolic Syndrome in African Americans and non-African Americans in PREMIER: a randomized controlled trial
(2008-08-11) Levin, Laura A; Young, Deborah R; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
Background: The Metabolic Syndrome is the clustering of several cardiovascular risk factors for coronary heart disease and Type 2 Diabetes Mellitus. This syndrome is of public health importance due to its high prevalence and high correlation to all-cause, CHD, and CVD mortality. The purpose of the current study was to determine if a change in aerobic fitness in the treatment group significantly decreased the odds of Metabolic Syndrome at 6 and 18 months. Methods: There were 810 adult participants in this trial with above-optimal blood pressure and up to stage I hypertension. Participants were part of an advice-only control group or a treatment group where physical activity increases were the main component. Results: A change in aerobic fitness, independent of treatment status, was significantly associated with a decrease in prevalent Metabolic Syndrome at both 6 and 18 months (OR: 0.96, CI: 0.94 - 0.98 & OR: 0.96; CI: 0.94 - 0.98, respectively).
African American Couples' Provider Role Attitudes as a Function of Income, Relative Income, Education, and Age
(2018) Walton, Tariiq Omari; Epstein, Norman B.; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
This study investigated characteristics that are associated with the provider role attitudes of African Americans being seen for couple therapy at a university-based family therapy clinic in a major metropolitan region, the Center for Healthy Families at the University of Maryland, College Park. It was predicted that income, relative income, education, age, and gender would be associated with the degree of traditional provider role attitudes of members of African American couples being treated at the CHF between 2000 and 2015. Contrary to the predictions, no relationship between education, age, and relative income and the provider role attitudes of the study’s participants was found. However, the results did show a significant relationship between gender and income and provider role attitudes. The implications for future research and clinical applications are discussed.
African American Girls' Ideal Dating Relationship Now and In the Future and Factors that Shape These Perceptions
(2012) Debnam, Katrina Joy; Howard, Donna E; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
The quality of dating relationships in adolescence can have long lasting effects on identity development, self esteem, interpersonal skills, and shape values and behaviors related to intimate relationships and risk behaviors. However, little is understood about how adolescents view their ideal partner and what implications these perceptions may have for romantic relationships. In fact, research suggests that over 400,000 adolescents have been victims of serious dating violence at some point in their lives. Among African American adolescents, religion may be particularly salient in romantic relationships. Religious organizations not only provide a place for seeking spiritual guidance and social interactions, but also provide unifying morals, beliefs, and practices for African American families. In this dissertation, three studies where conducted. In Study 1 participants' self- identified, defined and vividly described 8 major characteristics, good communication, honesty, trust, respect, compromise, understanding, individuality, and self-confidence, of a healthy relationship. In Study 2 several themes emerged in comparing girls' perceptions of an ideal dating relationship in high school with their perceptions of the ideal future relationship: (1) having a partner who shared similar education and career plans, (2) `best friend' qualities such as respect, trust, and honesty, (3) importance of family in identifying an ideal relationship, and (4) temporariness of high school relationships. Study 3 findings suggest that the influence of religion in the lives of adolescents can be found in several domains. These included whether to become sexually active, choosing a partner based on religious affiliation and issues of sexual orientation. Interestingly, girls also felt that, despite the sanctity of marriage, women should not stay in unhealthy or harmful relationships. Dating violence prevention curricula focus on helping girls identify unhealthy or abusive relationships and provide strategies to help them leave these relationships. More programs are needed to instill in girls the values and characteristics of healthy relationships. Early education and modeling of healthy teen dating relationships will help educators, practitioners and advocates empower girls so they are more likely to develop healthy dating relationships and less likely to experience harm in their dating relationships.
AFRICAN AMERICAN HETEROSEXUAL COUPLES COPING WITH RACIAL DISCRIMINATION
(2022) Kartashev, Maria; Falconier, Mariana K; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
This qualitative study investigated how African American heterosexual couples’ relationship are affected by racial discrimination and how they cope with stress from racial discrimination (including communicating their own and responding to each other’s stress). The data were analyzed using thematic analysis, and themes were organized based on the areas of inquiry. Themes related to the impact of racial discrimination on the couple relationship included “my partner’s experiences of racial discrimination also affect me,” and “couples feel connected through the similarities in the experience of discrimination.” Themes regarding coping as a couple included “talking about racial discrimination with your partner helps,” “agree to disagree,” “joking together to show solidarity,” and “complementary gender responses to racial discrimination.” Themes were discussed using the systemic-transactional model of dyadic coping (Bodenmann, 1995, 2005). Though further research is needed to understand the impact of racial discrimination on African American couples and their coping, the current study suggests that couples cope with racial discrimination dyadically. This coping is diverse and sometimes gendered. Additionally, creating a safe space of compassion, despite differences in perceptions of racial discrimination, helps couples feel bonded by mutual trust, intimacy, and connectedness. Finally, limitations, clinical and research implications, and issues of reflexivity were discussed.
African American Patient Perceptions Regarding Pre- and Post-Dialysis Education and Treatment
(2003-12-10) Greene, Revenda Ann; Desmond, Sharon; Public and Community Health
Kidney disease is common in the United States. It occurs with more frequency and more complications among African Americans than in the general population. Patients with end stage renal disease (ESRD) are at that point in the progression of kidney disease where death is imminent if treatment is not performed to replace the limited kidney function. Hemodialysis is a replacement treatment for ESRD. This study used ecological theory to examine pre-and post-dialysis education and treatment in a convenience sample of African American ESRD patients. A pilot study of 29 patients and a final sample of 98 patients were used. Patient age, income, education and length of time on dialysis were the independent variables examined. Dependent variables included knowledge, satisfaction, treatment intervention, and quality of life. Oneway analyses of variance (ANOVA) were used to analyze the data. The following research questions were examined: 1) Are African American ESRD patient adequately educated about the disease, its causes, possible complications and range of treatments available? 2) Will African American ESRD patient with higher income and education levels score higher on the knowledge and pre-dialysis education subscale, when compared to patient with lower income and education levels? 3) Is the degree of satisfaction with pre-dialysis information and education positively related to age, level of education and income of African American ESRD patients? 4) Do African American ESRD patients with disparate income and education levels receive different treatment interventions? 5) What are the perceptions of African American dialysis patients regarding their quality of life? When the data were analyzed, the research hypotheses related to questions one and three were not supported (p > .05). While the hypotheses for questions two and four were supported (p < .05). A significant relationship was found between patient satisfaction with pre-dialysis education and treatment and level of education. Other significant relationships were also found when examining the quality of life subscales with income and education.
Against the Odds: A Structural Equation Analysis of Family Resilience Processes during Paternal Incarceration
(MDPI, 2021-11-04) Morgan, Amy A.; Arditti, Joyce A.; Dennison, Susan; Frederiksen, Signe
On any given day, approximately 2.1 million children in Europe have an incarcerated parent. Although research indicates that material hardship is associated with parental incarceration, and particularly paternal incarceration, little is known about family processes that may mitigate the harmful effects of such hardship on children with an incarcerated parent. Guided by a resilience framework, this study examined how family processes mediate the effects of material hardship on youth academic adjustment within the context of paternal incarceration. Using Danish data that assessed key family constructs, structural equation modeling was used to perform a mediational within-group analysis of primary caregivers (n = 727) to children with an incarcerated father. Results indicate that although social support and parenting skills did not yield mediating effects, caregiver mental health strongly mediated the effects of material hardship on youth academic adjustment during paternal incarceration. Findings suggest that economic conditions, as well as caregiver mental health symptoms, are important areas of intervention that may promote family-level resilience for youth of an imprisoned father. We conclude with research and practice recommendations to advance our understanding of resilience among families with an incarcerated parent.
Against the Odds: A Structural Equation Analysis of Family Resilience Processes during Paternal Incarceration
(MDPI, 2021-11-04) Morgan, Amy A.; Arditti, Joyce A.; Dennison, Susan; Frederiksen, Signe
On any given day, approximately 2.1 million children in Europe have an incarcerated parent. Although research indicates that material hardship is associated with parental incarceration, and particularly paternal incarceration, little is known about family processes that may mitigate the harmful effects of such hardship on children with an incarcerated parent. Guided by a resilience framework, this study examined how family processes mediate the effects of material hardship on youth academic adjustment within the context of paternal incarceration. Using Danish data that assessed key family constructs, structural equation modeling was used to perform a mediational within-group analysis of primary caregivers (n = 727) to children with an incarcerated father. Results indicate that although social support and parenting skills did not yield mediating effects, caregiver mental health strongly mediated the effects of material hardship on youth academic adjustment during paternal incarceration. Findings suggest that economic conditions, as well as caregiver mental health symptoms, are important areas of intervention that may promote family-level resilience for youth of an imprisoned father. We conclude with research and practice recommendations to advance our understanding of resilience among families with an incarcerated parent.