School of Public Health
Permanent URI for this communityhttp://hdl.handle.net/1903/1633
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.
Browse
138 results
Search Results
Item Diabetes and Periodontal Disease Bi-Directional Relationship: An Examination of Diabetics' Knowledge, Understanding, Social Determinants and Self-Efficacy Impact on Dental Hygiene Practices(2019) Oguntimein, Oluwamurewa Ayodeji; Butler, James; Horowitz, Alice M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Thirty million Americans are living with diabetes; making it the seventh leading cause of death, with 1.3 million Americans dying every year. As such, the total treatment costs of diabetes rose from $245 billion in 2012 to $327 billion in 2017. One factor driving these high costs is diabetes’ comorbidity with other chronic diseases and associated complications – e.g., hypertension, , heart disease, stroke, amputation and blindness. Little attention has focused on periodontal disease- the sixth complication of diabetes awareness, education, and intervention. This research adds to the literature via two studies that assessed diabetics’ knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease. The first study examined gender and self-efficacy differences in knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease among 927 diabetics. Findings suggest diabetics are unaware of their increased risk of periodontal disease based on the low mean 5.79±2.366 scores on the knowledge and understanding scale. After controlling for diabetes duration, smoking status, and other covariates, males had less knowledge and understanding of the bi-directional relationship (p<.0001). Self-efficacy was not significantly associated with participants’ knowledge and understanding of the bi-directional relationship (p= 0.543). The second study assessed health literacy differences in diabetics’ knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease. Education, employment and income were tested as moderators between knowledge and understanding of the bidirectional relationship and dental hygiene practices. After controlling for diabetes duration, dental insurance status, and other covariates, participants with marginal or inadequate health literacy had less knowledge and understanding of the bi-directional relationship compared to participants with adequate health literacy (p<.0001). Education, employment, and income were not moderators. The findings support the need for targeted periodontal disease risk and dental hygiene practice education. These studies are presumably the first to assess diabetics’ knowledge and understanding of the bi-directional relationship between diabetes and periodontal disease. These studies are significant contributions to the limited amount of research and illuminate the need to educate diabetics regarding their increased risk of periodontal disease and the importance of practicing dental hygiene behaviors to prevent diabetes complications.Item 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.Item 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.Item The Impact of International Accreditation on The Quality of Health Services at King Fahd University Hospital, Saudi Arabia: A Mixed Methods Approach(2019) AL Shawan, Deema Saad; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The Joint Commission International Accreditation (JCIA) is perceived worldwide as the symbol of exceptional quality of care. Despite the popularity of international accreditation, evidence of its effectiveness on improving health care quality is inconclusive. This dissertation research utilized a Convergent parallel mixed method framework to evaluate the impact of the JCIA process on quality and to identify the factors that influence the effectiveness of this process at King Fahd Hospital of the University in Khobar, Saudi Arabia. An interrupted time series analysis was conducted to assess the changes in a total of 12 quality outcomes pre and post accreditation. Furthermore, a qualitative approach was used to investigate the attitudes and perceptions of 31 health providers towards this process and the factors that influence its success. The quantitative results suggested that the JCIA had a positive impact on 9 out of 12 outcomes. The improved quality outcomes included: the average length of stay, the percentage of hand hygiene compliance, the rate of nosocomial infections, the percentage of radiology reporting outliers, the rate of pressure ulcers, the percentage of the correct identification of patients prior to medication administration, the percentage of critical lab reporting within 30 minutes, and the bed occupancy rate. The outcomes that did not improve were the rate of patients leaving the ER without being seen, the percentage of OR cancelations on the day of the or and the rate of patient falls. The qualitative analysis suggested that the JCIA was perceived positively by all participants. Some of the perceived advantages of international accreditation included the transformation of the organizational culture to a culture that promotes continuous quality improvement, standardization, and the reduced paperwork in some departments. The participants’ responses also indicated that there were many factors that influence the success of the process. Examples of the factors identified in the study include the increased workload and the providers’ resistance to participate in the JCIA process. In conclusion, international accreditation seemed to have a positive impact on quality outcomes and was received positively by providers. Nevertheless, the factors that hindered the JCIA process need to be addressed by the hospital’s leadership to ensure more efficient quality improvement efforts during future accreditation cycles.Item THE IMPACT OF DISEASE SEVERITY AND PHENOTYPE ON SMOKING AMONG ADULTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE(2019) Tilert, Timothy; Wang, Min Q; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Chronic Obstructive Pulmonary Disease (COPD) is estimated to be the third leading cause of death in the US. The most significant risk factor for COPD is long-term cigarette smoking. In spite of the myriad benefits of cessation, the proportion of adults with COPD who currently smoke is still nearly 50%. Little is known, however, about the characteristics of, and subsequent differences between, smokers with COPD, particularly at differing lung obstruction severity levels. The goals of this dissertation were to examine and compare the characteristics of smokers with diagnosed COPD as well as to explore the impact of disease severity and disease phenotype on smoking status among persons with COPD. This research utilized secondary data on 10,219 examined adults, aged 40-79 years, from the 2007-2012 National Health and Nutrition Examination Survey. In Study 1, adjusted logistic regression analyses revealed multiple factors that were associated with self-reported COPD diagnosis with those reporting three or more respiratory symptoms having the strongest association (AOR=22.1, 95% CI=12.0-40.5). In Study 2, it was shown that smoking status proportions did not differ by lung obstruction severity among those reporting a COPD diagnosis. In adjusted logistic regression analyses, multiple factors were associated with current smoking status among those with self-reported COPD with the presence of other smokers in the household having the strongest association with being a current smoker (AOR=19.5, 95% CI=10.2-37.5). In Study 3, three distinct phenotypes were found among the COPD population analyzed. In adjusted logistic regression analyses, COPD phenotype was differentially associated with continued smoking, above and beyond other predictors, with the older, heavy-smoking males with emphysema phenotype showing a significant positive association with continued smoking (AOR=3.7, 95% CI=1.3-10.9). Understanding how differences in disease severity and disease phenotypes impact smoking status among persons with diagnosed COPD could help inform more targeted, and effective, interventions to reduce smoking rates in this high-risk population. These findings potentially provide guidance for current smoking cessation interventions aimed at smokers with COPD as well as provide the foundation for further exploration of the association between COPD phenotype and continued smoking.Item RACE AND IMMIGRATION STATUS AS MODERATORS OF THE RELATIONSHIP BETWEEN FAMILY ACCEPTANCE/FAMILY REJECTION AND DEPRESSIVE SYMPTOMS FOR LGBTQ+ YOUTH(2019) Levin, Emma R; Leslie, Leigh; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Research consistently demonstrates that LGBTQ+ youth, when compared to non-LGBTQ+ youth, are at significantly greater risk for depression, anxiety, substance use, and suicidality as a result of stressors related to belonging to a minority group (Russell & Fish, 2016). Family acceptance is an important protective factor against these negative mental health outcomes, and family rejection has been demonstrated as an important risk factor. Research on LGBTQ+ youth has been criticized for regarding all LGBTQ+ youth as the same and not accounting for the intersection and interaction with other identities such as race or immigrant status. The research questions posed by this study are 1) to what extent do race and immigrant status, separately and combined, moderate the established relationship between family acceptance and depressive symptoms?, and 2) to what extent do race and immigrant status, separately and combined, moderate the established relationship between family rejection and depressive symptoms? Results of the present study show that race significantly moderated the relationship between family acceptance and depression for LGBTQ+ youth, but did not moderate the relationship between family rejection and depression. Immigrant status moderated neither relationship. Three-way interactions with race and immigrant status moderated both the association among family acceptance, family rejection, and depression. Clinical implications and implications for future research are discussed.Item INVESTIGATING CARDIOVASCULAR RISK AT THE INTERSECTION OF RACE, GENDER, AND EDUCATION(2019) Taiwo, Omolola Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)As a risk factor of cardiovascular disease (CVD), systemic inflammation is differentially distributed by race, with black populations disproportionately impacted. Additionally, inflammation, as measured by the inflammatory marker C-reactive protein (CRP), is documented to be higher among women when compared to men and varies by educational level. Despite evidence suggesting that various chronic stress domains may contribute to the relationship between race and inflammation, there is limited data exploring the possible mediating role of chronic stress. Furthermore, to date, no study has examined if the potential indirect effect of race on CRP through chronic stress domains are moderated by gender and education. This secondary data analysis stems from the Midlife Development in the United States (MIDUS II) study, and the sample consisted of 193 black and 582 white adults. Study 1: Examined the association between CRP and seven racial/gender/education subgroups. With educated white men as the reference group, findings revealed that educated black and white women had the highest significant risk for elevated CRP. Study 2: Assessed the psychometric properties of a Chronic Stress Scale (CSS) comprised of nine chronic stress subscales. Analyses revealed CSS to be a three-dimensional scale with questionable validity and reliability. Study 3: First, tested for significant correlations between nine chronic stress domains, race, and CRP. Everyday discrimination and financial strain were found to be the only two domains significantly correlated to race and CRP. Second, two mediation analyses assessed the mediating effect of financial strain and discrimination, finding that they both respectively mediated the relationship between race and CRP. Third, two moderated mediation analyses examined if the indirect effect of financial strain and discrimination were moderated by gender and education. Results indicated that the indirect effect of race on CRP through discrimination was significant only among educated black men. Additionally, findings revealed that the indirect effect of race on CRP through financial strain was significant among black men and women regardless of educational attainment. Combined, these studies characterized the social patterning of CRP, illustrated validity and reliability concerns when developing a multidimensional chronic stress scale, and revealed that discrimination and financial strain did have mediating roles and these mediators were moderated by gender and education.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 "That Chart Ain't For Us": An Examination of Black Women's Understandings of BMI, Health, and Physical Activity(2019) Thompson, Tori; Jette, Shannon; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Significantly, black women have the highest rates of being overweight or obese compared to other groups in the United States, with 60% being classified as obese per the BMI (CDC, 2017). However, there is currently a lack of scholarship which examines black women’s perceptions of the BMI, and how/if those perceptions influence their attitudes toward health and physical activity. In this project, I take a Foucauldian approach to analyze data collected from eight semi-structured interviews with black women who self- identify as obese and who are physically active. Findings suggest that black women find the BMI to be irrelevant to their health and well-being, and do not attribute their engagement in physical activity to their BMI. Instead, their reasons for partaking in physical activity are due to their individual experiences understandings of health and black female identity. These results have the potential to inform healthcare policies, physician practice, and public health interventions that target communities of color.Item ESTIMATING RISK OF AIRBORNE INFLUENZA TRANSMISSION IN A CONTROLLED ENVIRONMENT(2019) Bueno de Mesquita, Paul Jacob; Milton, Donald K.; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Pandemic preparedness is weakened by uncertainty about the relative importance of influenza transmission modes, particularly airborne droplet nuclei (aerosols). A human-challenge transmission trial in a controlled environment was conducted to address this uncertainty. Healthy, seronegative volunteer ‘Donors’ (N=52) were randomly selected for intranasal challenge with influenza A/Wisconsin/67/2005 (H3N2) and exposed to seronegative ‘Recipients’ randomized to intervention (N=40) or control (N=35) groups. Intervention recipients wore face shields and hand sanitized frequently to limit large droplet and contact transmission. A transmitted infection, confirmed by serology in a control recipient, yielded a 1.3% SAR overall. This was significantly less than the expected 16% SAR (p <0.001) based on a proof-of-concept study that used half as many Donors and exposure days. The main difference between these studies was mechanical building ventilation in the follow-on study, suggesting a possible role for aerosols. The extent to which Donor viral shedding was similar to that of mild, natural infections and may be useful for studying transmission was investigated. The only available aerosol shedding comparison data comes from a population of adults with influenza A H3 infection enrolled on the basis of febrile illness plus cough or sore throat, or positive Quidel QuickVue rapid test (N=83). Systematic differences in case selection compared with Donors yielded more severe cases and introduced bias. To account for differences in illness severity, propensity score matching, stratification, and inverse weighting ultimately demonstrated that the experimental and naturally infected groups were too different to compare without bias. While acknowledging the uncertainty in the generalizability of the current challenge model, observed aerosol shedding and CO2 were used in the rebreathed-air version of the Wells-Riley equation to compute average quantum generation rates (95% CI) 0.029 (0.027, 0.03) and 0.11 (0.088, 0.12) per hour for infected Donors and fine aerosol shedding Donors, respectively. Donors shed 1.4E+5 (1.0E+5, 1.8E+5) airborne viral RNA copies per quantum (ID63). This dissertation provides evidence for airborne transmission, presents a methodology for estimating an airborne dose, and suggests a role for building ventilation in reducing risk and the need for future observational studies to evaluate transmission modes in non-experimental settings with greater generalizability.