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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Item STATE-LEVEL STRUCTURAL RACISM AND ALCOHOL AND TOBACCO USE BEHAVIORS IN A NATIONAL PROBABILITY SAMPLE OF AFRICAN AMERICANS(2023) Woodard, Nathaniel; Knott, Cheryl L; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Structural racism is how society maintains and promotes racial discrimination through established and interconnected systems. Structural racism is a historical driver of health disparities, including those in the area of cancer. One pathway posited for this effect is through the promotion of maladaptive coping behaviors, such as alcohol and tobacco use. This dissertation empirically assessed the association between state-level structural racism and alcohol and tobacco use behaviors among African Americans, including within various subgroups of African Americans based on age, gender, and household income. This project analyzed secondary self-report data collected from a national probability sample of 1,946 African Americans in the Religion and Health in African Americans (RHIAA) Study. Existing measures of state level structural racism were merged into the RHIAA dataset including a composite index of structural racism assessed using five dimensions (i.e., residential segregation, and economic, employment, education, and incarceration disparities). Analyses were performed in SPSS Version 28 using hierarchical linear and logistic regression models. In the first study, two models (Model A and Model B) were constructed for each of four outcomes, frequency of alcohol consumption (measured in days per month), frequency of binge drinking (measured in the number of occurrences per month), smoking status (current smoker or not a current smoker), and smoking frequency (never smoked, former smoker, currently smoke on some days, and currently smoke every day). Model A used the composite structural racism index measure to model the four alcohol and tobacco use measures and Model B analyzed the disaggregated dimensions of structural racism rather than the composite measure. All hierarchical analyses controlled for confounding variables (i.e., participant gender, age, education, income, and employment status). In the second study, analyses using the dimension-level approach in Model B from study one were repeated in subgroups stratified by participant age, gender, and income for the frequency of binge drinking and smoking status behaviors. Statistical comparisons of the slope estimates between corresponding subgroups (e.g., younger and older age) were used to test the moderation effects of age, gender, and income on the association between structural racism and alcohol and tobacco use behaviors. Results from these studies generally indicated a positive association between state level structural racism, especially in the incarceration dimension, and binge drinking and tobacco use behaviors. Stratified analyses generally did not support age, gender, or income as moderating variables of the association between structural racism and binge drinking and tobacco use behaviors. Current findings demonstrate a need for further research on structural racism and health and progress in structural racism measurement, including further emphasis of dimension-level measurement and analysis. Findings from the current dissertation highlight the importance of addressing structural racism, especially in incarceration, to reduce alcohol and tobacco use behaviors among African Americans and help address existing health disparities.Item APPLICATION OF A CULTURALLY RELEVANT HEALTH BELIEF MODEL TO BLACK AND AFRICAN AMERICAN YOUNG ADULTS WITH SICKLE CELL DISEASE DURING TRANSITION TO ADULT HEALTHCARE SERVICES(2022) Pantaleao, Ashley; Fish, Jessica; Anderson, Elaine A.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Sickle cell disease (SCD) is a hereditary chronic illness hallmarked by pain and functional disability that impacts psychosocial well-being. Within the United States, SCD largely affects Black and African American populations, and general health disparities present in these populations may be further magnified by SCD. Due to the complexity of symptom management, consistent healthcare adherence is imperative and is often scaffolded by family caregivers prior to transition. The transition from the pediatric to adult healthcare facility is a life stage public health concern for young adults with SCD, as it is a time characterized by high mortality and morbidity. Navigating new medical systems and working with new providers are factors contributing to delays in treatment-seeking behavior. Unexplored factors that may impact illness course and outcomes include health-related stigma, racial discrimination, and preparation for bias. This research assessed whether the perceived barriers (e.g., racial discrimination, externalized stigma, and internalized stigma) are linked to SCD-specific self-efficacy and transitioning to the adult healthcare setting, utilizing an adapted Health Belief Model. It additionally explored whether a culturally relevant factor, preparation for bias, contributes to transition readiness. Questionnaires were administered to young adults with SCD who were preparing for transition or actively transitioning to an adult healthcare facility. This work was a first step at exploring the relationships between these variables utilizing a culturally relevant Health Belief Model. Strong positive significant correlations among perceived barrier variables were noted as well as a positive significant correlation between SCD-specific self-efficacy and transition readiness. Results from multivariate models suggest that externalized stigma was significantly positively related to SCD-specific self-efficacy. Counter to expectations, no significant predictors of transition readiness were identified. Additionally, results did not support preparation for bias moderating the relationships between racial discrimination or externalized stigma with SCD-specific self-efficacy or transition readiness. These findings may highlight that our study was underpowered to detect large effects, or that there are additional complex relationships that need to be further explored. A short-term goal of this study was to highlight the value of identifying youth with low self-efficacy or preparation for bias in order to guide educational resources and interventions to increase self-efficacy and readiness to transition for this underserved illness group.Item PRESENCE AND PREDICTORS OF HEALTH PROGRAMMING IN A SAMPLE OF AFRICAN AMERICAN CHURCHES(2019) Woodard, Nathaniel; Fryer, Craig S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Churches have played a central role in African American communities for decades. In addition to religious services, African American churches have increasingly offered a variety of health programs. However, there is a dearth of empirical literature on church-initiated health programming. This study examines quantity and variety of health programs and areas addressed by a convenience sample of African American churches (N = 119), as well as church characteristics that predict these health initiatives. Churches offered a mean of 6.08 (SD = 2.15) health programs targeting 4.66 (SD = 3.63) different health topics within the previous 12 months. Various church characteristics indicating greater availability of programming resources were positively associated with the quantity and variety of health initiatives. It is recommended that practitioners partner with under-resourced churches to support their existing health activities and address gaps in health programming. Future research should seek to evaluate the effectiveness of church-initiated health programs.Item Measuring the Single Cigarette Use Phenomenon: Scale Development and Validation(2019) Phan, Lilianna; Butler, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The practice of single cigarette use perpetuates normative smoking beliefs and increases smoking propensity among urban, African American smokers. Despite the 2009 Family Smoking Prevention and Tobacco Control Act’s ban of single cigarettes, there is a paucity of research to inform the public about the harms of single cigarettes and regulatory enforcement of their sales by the Food and Drug Administration. This dissertation utilized a mixed-method, three-phase design with primary data collection to: 1) examine the social context, beliefs, and attitudes of loosie use; and, 2) develop and validate two theoretically-based scales (i.e., social context and Health Belief Model) on the purchasing and use of loosies by urban, African American smokers. In Phase I, 25 semi-structured, in-depth interviews were conducted to understand the social context and underlying intrapersonal factors related to loosie use. Qualitative data, analyzed using the Framework Method, informed the development of potential scale items. During Phase II, three expert reviewers and 24 urban, African American loosie users provided feedback and pilot tested the items via the “Think Aloud” method. In Phase III, psychometric data were collected from 122 urban, African American loosie users from the District of Columbia Housing Authority public housing sites. Rigorous exploratory factor analysis and reliability and validity testing were conducted to determine the most parsimonious models for two scales: The Social Context of Loosies Scale (SCL-11) and the Health Belief Model for Loosies Scale (HBML-20). Both scales and their respective subscales demonstrated internal consistency and divergent and convergent validity. To our knowledge, this dissertation research is the first study to utilize semi- structured interviews (Phase I) to examine individualized patterns of loosie use by urban, African Americans and to develop valid scales designed by, and for, urban, African American loosie users (Phase II and Phase III). Given the strong psychometric properties of the scales, they may be used to identify meaningful targets for individual, social, and environmental intervention to prevent and reduce loosie use among this priority population.Item 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.Item CERVIXCHECK: A SPIRITUALLY-BASED SMS TEXT MESSAGING PILOT INTERVENTION TO INCREASE CERVICAL CANCER AWARENESS AND PAP TEST SCREENING INTENTION AMONG AFRICAN AMERICAN WOMEN(2016) Le, Daisy; Holt, Cheryl L.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African American women account for a disproportionate burden of cervical cancer incidence and mortality rate when compared to non-Hispanic White women. Cervical cancer is one of the most preventable types of cancer, and women can be screened for it with a routine Pap test. Given that religion occupies an essential place in African American lives, framing health messages with important spiritual themes and delivering them through a popular communication delivery channel may allow for a more culturally-relevant and accessible technology-based approach to promoting cervical cancer educational content to African American women. Using community-engaged research as a framework, the purpose of this multiple methods study was to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention to increase cervical cancer awareness and Pap test screening intention among African American women. The study recruited church-attending African American women ages 21-65 and was conducted in three phases. Phases 1 and 2 consisted of a series of focus group discussions (n=15), cognitive response interviews (n=8), and initial usability testing that were conducted to inform the intervention development and modifications. Phase 3 utilized a non-experimental one-group pretest-posttest design to pilot test the 16-day text messaging intervention (n=52). Of the individuals enrolled, forty-six completed the posttest (retention rate=88%). Findings provided evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There were significant pre-post increases observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Additionally, results post-intervention revealed that 83% of participants reported being either “satisfied” or “very satisfied” with the program and 85% found the text messages either “useful” or “very useful”. 85% of the participants also indicated that they would “likely” or “very likely” share the information they learned from the intervention with the women around them, with 39% indicating that they had already shared some of the information they received with others they knew. A spiritually-based SMS text messaging intervention could be a culturally appropriate and cost-effective method of promoting cervical cancer early detection information to African American women.Item 'Being on Top of It:' A Qualitative Examination of the Processes and Contexts Shaping Pediatric Caregiving among Low-Income, Young, African-American Fathers.(2015) Waters, Damian M.; Roy, Kevin M; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Several studies have noted the positive relationship between father involvement and children's health outcomes (Stewart & Menning, 2009; Bronke-Tinkew, Horowitz, Scott, 2009; Yogman, Kidlon, & Earls, 1995; Lamb, 1997; Dubowitz, Black, & Cox, 2001; Chenning 2008). Recent years have also seen a growing interest in the impact of adolescent fathers' characteristics and involvement on children's outcomes (Black, Dubowitz, & Starr, 1999; Fletcher & Wolfe, 2011). Few studies of public health or pediatric outcomes, however, have examined how fathers provide and shape healthcare for their children. Through semi-structured interviews (n = 29), this study explored how low-income, minority young men care for their children's health. Participants were recruited from two programs that provide integrative medical care, mental health services, and case management support for adolescent and young adult parents in the Washington, DC metropolitan area. Interviews were digitally recorded, transcribed, and entered into Atlas.ti (Friese, 2014). Informed by grounded theory, data were analyzed over three phases of coding. This study explored how the contexts in which young men fathered facilitated and complicated fathers' involvement in pediatric caregiving. These contexts included young men's relationships with the mothers of their children, family and kin-relationships, socioeconomic circumstances, community contexts, as well as proximity and distance from their children. This study found that young men developed their approaches to pediatric caregiving from their general health knowledge, prior caregiving experiences, personal health histories as well as their intimate familiarity with their children. Taken together, the findings suggested a tripartite framework for describing fathers' involvement in pediatric caregiving. This framework also highlights common processes--constructing self as caregiver and a father, navigating coparent relationships, and engaging in medical visits--that young men used to engage in preventative, acute, and chronic caregiving. These common processes helped men negotiate contexts that often challenged their involvement in pediatric caregiving.Item "I've Got to Help as Best I Can:" The Experiences of Predominately Low-Income African American Parents and Caregivers Involved with the Mental Health Care System and Their Responses to Adolescents' Depressive Disorder Diagnoses(2015) Messina, Lauren A.; Anderson, Elaine A.; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Many mental health disorders are often diagnosed in adolescence, suggesting the well-being of adolescent mental health should be a public health priority. The prevalence of adolescent mental health issues has led researchers to investigate treatment utilization and effectiveness. Findings suggest there is a vast underutilization of care for adolescents and an even greater deficit in family involvement in adolescent mental health care. Yet, existing research neither offers a sound understanding of how parents interpret and understand their child's mental health diagnosis, nor how the parent-child relationship and parental involvement in treatment is experienced. A qualitative approach examined parents' and caregivers' perceptions of their adolescents' mental health disorder and how parents made decisions about their involvement in their adolescent's treatment in a sample of families already engaged with the mental health care system. Semi-structured interviews with 33 predominately low-income African American parents and caregivers who had parented a teenager diagnosed and/or treated for a depressive disorder when the family was the recipient of Medicaid were conducted. The Ecological Risk and Resilience Framework facilitated an understanding of the dynamics shaping parental involvement in adolescent mental health care. Grounded theory was used to analyze the data. Findings suggest parents' involvement in the diagnosis process may be initiated after a build-up of problematic events, often identified from sources outside the family. Parental responses to the teens' diagnoses included feeling relief but also confusion, while advocating for the needs of their teenager. The parent-child relationship post-diagnosis reflected four actions: parents being protective, showing patience and empathy, increasing communication with their teen, and teaching the teen accountability. Parents reported they had agency in making decisions about the teen's treatment. They wanted active involvement and saw their involvement as having mutual benefits for both themselves and their teen. Three encouraging components enhanced parental involvement: positive mental health care provider and parent interactions, the parents' own mental health and exposure to mental health care, and spirituality. The availability of insurance also positively supported more involvement. Care barriers included family or teen resistance and lack of resources. Race/ethnicity shaped the expectations parents had of the mental health care system but did not shape parental involvement in treatment. Strategies for forging greater parental connections with mental health treatment and the role mental health care professionals play in this partnership are discussed.Item Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches(Implementation Science, 2014-05-31) Holt, Cheryl L.; Tagai, Erin K.; Scheirer, Mary Ann; Santos, Sherie Lou Z.; Bowie, Janice; Haider, Muhiuddin; Slade, Jimmie L.; Wang, Min Qi; Whitehead, Tony; Holt, Cheryl L.Background Community-based approaches have been increasing in the effort to raise awareness and early detection for cancer and other chronic disease. However, many times, such interventions are tested in randomized trials, become evidence-based, and then fail to reach further use in the community. Project HEAL (Health through Early Awareness and Learning) is an implementation trial that aims to compare two strategies of implementing evidence-based cancer communication interventions in African American faith-based organizations. Method This article describes the community-engaged process of transforming three evidence-based cancer communication interventions into a coherent, branded strategy for training community health advisors with two delivery mechanisms. Peer community health advisors receive training through either a traditional classroom approach (with high technical assistance/support) or a web-based training portal (with low technical assistance/support). Results We describe the process, outline the intervention components, report on the pilot test, and conclude with lessons learned from each of these phases. Though the pilot phase showed feasibility, it resulted in modifications to data collection protocols and team and community member roles and expectations. Conclusions Project HEAL offers a promising strategy to implement evidence-based interventions in community settings through the use of technology. There could be wider implications for chronic disease prevention and control.Item The Development of a Non-Physical Dating Violence Risk Assessment Instrument for Urban Black Young Adult Men(2013) Gilchrist, Brian Winston; Sawyer, Robin G; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Young urban African American men may be disproportionately affected by dating violence victimization. To date, there are no known reliable and valid measurement instruments that have been developed to assess the risk of dating violence victimization among this population. Furthermore, there is very little research that has been conducted assessing factors related to dating violence victimization specifically among young urban men. The current study developed a valid and reliable non-physical dating violence victimization risk assessment instrument for urban African American males ages 18-25 years old. Focus groups, survey pre-testing, and expert panel review was used to develop an initial set of items included in the new instrument. The survey administration phase of the study used a non-experimental cross-sectional design to collect primary data from participants for psychometric analysis. A new instrument with a total of 9 new scales (83 items) was developed as a result of this study. Results from the study support evidence of psychometrically sound and reliable measures that can be used in the target population.