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 Food insecurity among African Americans in the United States: A scoping review(2022-09-12) Dennard, Elizabeth; Kristjansson, Elizabeth; Tchangalova, Nedelina; Totton, Sarah; Winham, Donna; O’Connor, AnnetteIn 2019, the estimated prevalence of food insecurity for Black non-Hispanic households was higher than the national average due to health disparities exacerbated by forms of racial discrimination. During the COVID-19 pandemic, Black households have experienced higher rates of food insecurity when compared to other populations in the United States. The primary objectives of this review were to identify which risk factors have been investigated for an association with food insecurity, describe how food insecurity is measured across studies that have evaluated this outcome among African Americans, and determine which dimensions of food security (food accessibility, availability, and utilization) are captured by risk factors studied by authors. Food insecurity related studies were identified through a search of Google Scholar, PubMed, CINAHL Plus, MEDLINE®, PsycINFO, Health Source: Nursing/Academic Edition, and Web of Science™ (Clarivate), on May 20, 2021. Eligible studies were primary research studies, with a concurrent comparison group, published in English between 1995 and 2021. Ninety-eight relevant studies were included for data charting with 37 unique measurement tools, 115 risk factors, and 93 possible consequences of food insecurity identified. Few studies examined factors linked to racial discrimination, behaviour, or risk factors that mapped to the food availability dimension of food security. Infrequently studied factors, such as lifetime racial discrimination, socioeconomic status (SES), and income insecurity need further investigation while frequently studied factors such as age, education, race/ethnicity, and gender need to be summarized using a systematic review approach so that risk factor impact can be better assessed. Risk factors linked to racial discrimination and food insecurity need to be better understood in order to minimize health disparities among African American adults during the COVID-19 pandemic and beyond.Item Racial Socialization, Observed Maternal Conflict Behaviors, and Externalizing Problems in Black Mother- Adolescent Dyads(2021) Shan, Salwa; Smith-Bynum, Mia; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African Americans living in the United States face unique stressors as a result of being part of a marginalized group that has been consistently at the bottom of the social structure system. We see the impact of systemic racism when we look at the racial disparities associated with various economic, political, and civil rights in our society. The emphasis on rules and strict parenting in African American families is related to the need that many African American parents feel to protect and inform their children of the many forms of racial discrimination they will face in American society. In order to raise children who are less likely to be engaged in risk behaviors and better prepared for the environment they are living in, African American parents enforce stricter rules and discipline for their children and utilize racial socialization as a unique parenting strategy. Adolescents who struggle for behavioral autonomy in areas where parents try to emphasize their control, often engage in deviant behavior and are more at risk of struggling to be compliant with rules and adjusting as they grow and develop. Some research has indicated that parent-child conflict has increased when there has been a focus on rules due to adolescents’ desire for autonomy. The role of maternal conflict as a contextual factor when delivering racial socialization messages has not been studied and may have significant impacts on the transmission and reception of such messages. This study aims to address the gap in research and connect the contextual factors of parent-child relationship quality in influencing the transmission and reception of racial socialization messages as seen by the impact on externalizing behaviors in adolescents.Item Role of life events in the presence of colon polyps among African Americans(Springer Nature, 2013-06-12) Ashktorab, Hassan; Namin, Hassan Hassanzadeh; Taylor, Teletia; Williams, Carla; Brim, Hassan; Mellman, Thomas; Shokrani, Babak; Holt, Cheryl L; Laiyemo, Adeyinka O; Nouraie, MehdiAfrican Americans have disproportionately higher incidence and death rates of colorectal cancer among all ethnic groups in the United States. Several lifestyle factors (e.g. diet, physical activity and alcohol intake) have been suggested as risk factors for colorectal cancer. Stressful life events have also been identified as risk factors for colorectal cancer. The association between stressful life events and colon polyps, which are precursors of colorectal cancer, has yet to be determined. We aimed to evaluate the relationship between stressful life events and the presence of colon polyps and adenomas in African American men and women. In this cross-sectional study, 110 participants were recruited from a colon cancer screening program at Howard University Hospital. Participants completed an 82-item Life Events Questionnaire (Norbeck 1984), assessing major events that have occurred in the participants’ life within the past 12 months. Participants also reported whether the event had a positive or negative impact. Three scores were derived (total, positive, and negative). Total life events scores were higher (Median [M] = 29 and Interquartile range [IQR] = 18-43) in patients with one or more polyps compared to patients without polyps (M, IQR = 21,13-38; P = 0.029). Total, positive or negative Life Events scores did not differ significantly between normal and adenoma patients. Total, negative and positive Life Events scores did not differ between patients who underwent diagnostic colonoscopy (symptomatic) and patients who underwent colonoscopy for colon cancer screening (asymptomatic) and patients for surveillance colonoscopies due to a personal history of colon polyps. Linear regression analysis indicated that male gender is associated with 9.0 unit lower total Life Events score (P = 0.025). This study suggests that patients who experienced total life events may be at higher risk of having colon polyps and adenomas which indicates an association between stress and the development of colorectal polyps.Item EXAMINING RACISM AS A RISK FACTOR FOR UTERINE FIBROIDS AMONG AFRICAN AMERICAN WOMEN(2020) Porter, Shyneice; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Uterine fibroids are a common gynecological condition among women. African American women, however, are particularly susceptible to developing fibroids; in fact, approximately 80-90% of African American women are diagnosed with the condition by age 50. Left untreated, these benign tumors can reduce fertility and increase the risk of pregnancy complications. Despite the high prevalence of uterine fibroids among African American women and the detrimental effects they may have on reproductive health, little is known about the risk factors associated with fibroid development among this demographic. To address this gap in the literature, the proposed study used data collected from 699 African American women in the southern region of the United States. This study was guided by an adapted racism and health framework as well as an expanded ABC-X model that includes elements of the mundane extreme environmental stress theory. Structural equation modeling was used to examine the relationship between perceived and internalized racism, the interaction between the two racism variables, and uterine fibroid diagnosis among African American women. The study also investigated depressive symptomology and body mass index as mediators of the proposed relationships. Results revealed a direct effect between perceived racism and the likelihood of a uterine fibroid diagnosis (β = .172, SE = .05, p < .001, OR = 1.19 [95% CI = 1.08, 1.31]). There was not a direct effect, however, between internalized racism and fibroid diagnosis, or the racism interaction variable and fibroid diagnosis. Perceived racism (β = .214, SE = .03, p < .001), internalized racism (β = .108, SE = .04, p < .01), and the racism interaction term (β = .067, SE = .03, p < .05) were positively and significantly associated with depressive symptomology. There was no evidence of full or partial mediation through the proposed mediators. The present study is among the first to examine two forms of racism as critical psychosocial risk factors for an adverse reproductive health outcome that differentially impacts African American women. The findings have important implications for clinical practice and policy that may aid in the effort to address racial disparities related to uterine fibroid development.Item Assessing Changes in Access to Health care and Utilization of Preventive Services among Immigrants of African Descent Before and After Implementation of the Affordable Care Act(2020) Williams-Parry, Kester F; Chen, Jie; Thomas, Stephen B.; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In the U.S., African Americans experience a disproportionate burden of health disparities. The African American population includes 4.3 million people who are foreign-born. Yet, a paucity of empirical data exists on the health of immigrants of African descent. The lack of data disaggregation by subpopulations of African Americans, disregards the unique characterization of the African American diaspora and the influence of different cultural, linguistic, political, social, economic, environmental, and historical experience on the overall health of the population. Access to health care including lack of health insurance coverage has been a longstanding contributor to poor health outcomes among African Americans. The passage of the Affordable Care Act aimed to improve access to care including health insurance coverage and utilization of preventive services with no cost-sharing. Studies have shown significant reductions in the uninsured rate among African Americans and uptake in some preventive services, but the impact of the ACA on immigrants of African descent is not well understood. This dissertation research examined changes in access to health care, and utilization of preventive screenings for cancer, high blood pressure, diabetes, and high cholesterol among immigrants of African descent and U.S.-born African Americans before and after implementation of the ACA. This research integrated three studies to understand changes in access and utilization of health care using t-test for descriptive analyses and multivariable logistic regressions to assess any differences post-ACA. Results showed lower odds of being uninsured (OR=0.52, p=0.000), delaying care (OR=0.72, p=0.000), and forgoing care (OR=0.71, p=0.000) post-ACA, for all groups. There were higher odds of having cholesterol (OR=1.33, p=0.000) and hypertension screenings (OR=1.32, p=0.000) after the ACA. Cancer screening results found slightly higher odds of obtaining a mammogram (OR=1.07, p=0.069) after the ACA, but lower odds of having a pap smear (OR=0.89, p=0.002) or colorectal cancer (OR=0.91, p=0.021) screening. Citizenship was a significant factor that influenced screening rates with non-citizen immigrants having the lowest screenings for all groups.Item 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.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 relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans(2016) Tagai, Erin Kelly; Holt, Cheryl L; Garza, Mary A; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.Item THE ROLE OF DENIAL AND PERCEIVED HIV STIGMA AS BARRIERS TO ENGAGING IN HIV MEDICAL CARE AMONG HIV POSITIVE AFRICAN AMERICANS IN THE WASHINGTON, DC AREA(2015) Geiger, Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)HIV is a potentially fatal and highly stigmatized disease such that diagnosis with the disease is often met with high anxiety. Many people who test positive for HIV may not receive sufficient linkage to HIV care or do not remain engaged in continuous HIV medical care once they have entered care. While a considerable amount of research exists on referral, access, personal characteristics, and mental illness barriers associated with engagement in HIV medical care, far less attention has been given to psychosocial factors, specifically denial and perceived HIV stigma as important barriers to engaging in HIV medical care. The purpose of this study was to determine whether denial and/or perceived HIV stigma are associated with engagement in HIV medical care for African-American people living with HIV/AIDS (PLWHA). Data were collected as part of a peer-based community health worker program (CHW), based in Washington DC, designed to link PLWHA to HIV medical care and services. Logistic regression analyses were performed to determine whether the psychosocial variables were predictors of engagement in HIV medical care.Results indicated that disclosure is a major issue for this population, as 46% of the participants had not disclosed their HIV status to others. Separate analyses were conducted for the total sample (n=262) and with the disclosed sample (n=120). Results in the total sample revealed that disclosure of HIV status was associated with engagement in HIV status. PLWHA who disclosed HIV status to others were 2.2 times more likely to engage in HIV medical care than persons who had not disclosed HIV status. In the disclosed sample, gender, educational level and employment status were also associated with engagement in HIV medical care. Women and persons with low educational level and unemployed were less likely to engage in HIV medical care. Denial and perceived HIV stigma were not found to be independent predictors of engagement in HIV medical care when other covariates were included in the model. Disclosure of HIV status, gender and educational level were predictors of engagement in HIV medical care for this population. These obstacles to care may be amenable to disclosure and gender-specific interventions; and, therefore, warrant better understanding to improve outreach interventions to PLWHA who are not engaged in HIV medical care.Item Associations and Pathways between Substance Involvement and Risky Sexual Behavior over the Life Course of Urban African Americans(2015) Zebrak, Katarzyna A.; Green, Kerry M.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African Americans are disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs) relative to other racial/ethnic groups. Substance involvement has been linked to risky sexual behavior, an important risk factor for HIV/STI transmission, relatively early in the life course; yet such associations have not been found consistently among African Americans. Understanding of how substance involvement relates to risky sexual behavior among men and women over time and into midlife remains limited. The goal of this study was to examine the associations and pathways between substance involvement and risky sexual behavior over the life course in a community-based urban African American cohort (n=1242) followed prospectively from age 6 to 42 years. Using a combination of structural equation modeling and mediation testing, the study examined (1) prospective associations (from adolescence through adulthood) and within-life stage associations (in adolescence, young adulthood, and midlife) between substance involvement and risky sexual behavior, (2) the role of young adult social bonds as potential pathways linking substance use and risky sexual behavior over time, and (3) gender differences in the associations and pathways. The results revealed statistically significant positive associations between earlier substance involvement and subsequent risky sexual behavior over the life course among men and women. Greater adolescent substance use predicted greater midlife risky sexual behavior, partly through greater young adult substance problems and risky sexual behavior for both genders. Substance involvement was also positively correlated with sexual/risky sexual behavior in adolescence, young adulthood, and midlife among men and women. Although greater adolescent substance use predicted fewer young adult social bonds for both men and women, the latter was associated with decreased involvement in midlife risky sexual behavior among women only. Considered individually, young adult social bonds were not significant mediators of the adolescent substance use–midlife risky sexual behavior association for either gender. Given the complex pattern of associations and pathways between substance involvement and risky sexual behavior over time, public health interventions to address substance involvement among urban African Americans at any life stage, starting with adolescence, may have immediate and long-term effects, and direct and indirect effects on decreasing sex-related HIV/STI risk.