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.

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Subject: search.filters.subject.Behavioral sciences

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Now showing 1 - 10 of 26
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    Exploring Young Bi+ Women's Intersecting Mental Health and Sexual and Reproductive Health Experiences in Context: A Multi-Analytic Method Qualitative Study
    (2023) Robinson, Jennifer Lynn; Aparicio, Elizabeth M; Butler, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Young bi+ women report worse mental health and sexual and reproductive health (SRH) outcomes compared to gay, lesbian, and straight young adults. They experience intersecting threats to their health and well-being due to their sexuality, gender, and stage of development. There is a lack of research on bi+ women’s unique mental health and SRH experiences, and often bi+ women are overlooked due to bi-erasure and biphobia. Regressive policies related to LGBTQ+ and women’s rights, including increased restrictions to reproductive healthcare after the Dobbs v. Jackson Women’s Health Organization decision overturning abortion protections, further threaten bisexual women’s health. This dissertation used a multi-analytic method qualitative approach to explore the intersecting mental health and SRH experiences of young bisexual women in the current socio-political context. Semi-structured in-depth interviews were conducted over Zoom with 16 young bi+ women from across the U.S. A narrative inquiry approach was used to explore young bi+ women’s mental health experiences and coping strategies. In addition, thematic analysis was used to investigate how young bi+ women describe their mental health as intersecting with their SRH in the current socio-political context. The study yielded rich and nuanced information about challenges these young bi+ women experienced throughout their lives that affected their mental health and SRH. Experiencing trauma had far-reaching negative effects on their mental health. Participants discussed the challenges of forming their identity within the social context, particularly as bi+ women in a society that often invalidates bisexual identities and subjugates women. They also discussed the joys along with difficulties of navigating young adulthood. They further described coping with challenges in a variety of adaptive (e.g., therapy, exercise) and maladaptive (e.g., substance use, self-injury) ways. They discussed relying on social support such as partners, friends, family, therapists, and teachers. Participants desired more support with sexuality-related issues, particularly in early adolescence. These bi+ women described their mental health and SRH as intertwined and discussed how bodily autonomy and agency were essential to their well-being. The socio-political context, including social norms, rhetoric, and federal- and state-level policies, influenced participants’ well-being. The current study shows that young bi+ women face unique threats to their mental health and SRH. Practice implications include improving access to affordable and LGBTQ+-affirming healthcare and developing interventions attuned to the needs of young bi+ women. Policies are needed that uphold the choice and agency of young women in their reproductive health decision-making. Future research should continue to explore the needs and experiences of young bi+ women concerning their mental health and SRH including demographic differences along with potential mechanisms resulting in poorer health.
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    "Alexa, do I have an STD?": An Exploration of Young Adult Information Seeking Behaviors When Engaging With Home Assistant Devices About Sexually Transmitted Infections
    (2023) Siddiqui, Junaed Ahmad; Baur, Cynthia; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    BACKGROUND: Sexually transmitted diseases and infections continue to disproportionately affect young adults in the United States, with half of all new STIs annually occurring in young adults between the ages of 15 and 24. Advances in digital technologies have allowed for the facilitation of fast and discreet information about sexual health but remains understudied in the context of newer technologies. There is limited research on the effectiveness of Home Assistant Devices as channels to facilitate the information seeking process in young adults. To address this gap, this study explored whether Home Assistant Devices can facilitate the sexual health information seeking process in young adults between the ages of 18 and 26 who already use the internet to search for health information. The purpose of this dissertation was to explore the perspectives of young adults to understand the depth of their sexual health information needs and whether a user-centric designed HAD can be a suitable alternative for fulfilling those information needs. METHODS: Informed by the Theory of Motivated Information Management and Technology Acceptance Model, this qualitative study used the Design Thinking framework to understand young adults’ information needs and created a prototype voice skill to address that need. In-depth interviews were conducted virtually on Google Meet or Zoom and were recorded. This qualitative study occurred in three phases: in the first phase, 10 young adults were interviewed about their information seeking needs, current gaps, and how they thought Home Assistant Devices could fill that need. Insights from those interviews were then analyzed and used to create a prototype that would address sexual health information needs. The prototype was then tested with a new group of ten young adults, and their reactions to the prototype was recorded via interviews. In the third phase, the prototype was refined based on feedback from the previous group, and then re-tested with a new group of 10 young adults. In total, in depth interviews were conducted virtually with 30 young adults to understand information needs and create a prototype voice skill that could serve to facilitate the transfer of sexual health information in a convenient and relevant manner. Inductive thematic analysis was conducted to identify emergent themes. RESULTS: Overall, the sample (n=30) was 63% female, 43% White, with 53% having completed a bachelor’s degree, and 47% having owned a Home Assistant Device for over 12 months. The average age of the sample was 24 years old. After analyzing interviews through inductive thematic analysis in NVivo, four themes that were noted in the first phase as it related to Home Assistant Devices and information needs: the use of HADs as a means of convenience, preferring to use screen-based devices for research, tradeoffs between privacy and functionality, and the ability to emergency triage users for medical attention based on symptoms. Three main themes emerged in the second phase after reacting to the first version of the prototype, including anxiety and frustration when experiencing the unknown, pre-existing positive perceptions of Home Assistant Devices, and negative perceptions of Home Assistant Devices. In the third phase, two main themes emerged: a desire to share visuals to build comfort and bridge the information gap, and an ambivalence towards privacy. DISCUSSION: Privacy concerns remain prominent with Home Assistant Devices when engaging with them for information seeking purposes. These concerns are sometimes met with ambivalence by young adults, who were willing to trade some of their privacy for added features or functionality that could improve their user experience. Furthermore, challenges remain with voice search and screen-based devices are perceived to be easier to use. Lastly, the sexual health information seeking process is sensitive, and many young adults in this sample expressed wanting to have a more personalized experience that acknowledged their specific situations. To the author’s knowledge, this is the first study that explored the factors contributing to the sexual health information seeking process using Home Assistant Devices among young adults between the ages of 18 and 26. The results of this study have several implications for public health practice and research, especially as it relates to the Design Thinking approach for public health voice skill development, as well as addressing a new approach to providing sexual health information to young adults that may be more discreet and relevant to them. The findings from this study contribute to the emerging literature base on the use of Home Assistant Devices to address sensitive health information seeking behaviors.
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    ASSESSING UNDERGRADUATE STUDENTS’ JUDGEMENT OF SEXUAL ACTIVITY CONSENT SEEKING AND COERCIVE BEHAVIORS, AND ATTITUDE TOWARD ESTABLISHING SEXUAL CONSENT
    (2022) Abebe, Israel; Howard, Donna; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Sexual violence continues to be a serious public health problem, particularly among the college student population. This dissertation developed and implemented a web-based factorial vignette experiment to investigate vignette- and respondent-level factors that can explain undergraduate students’ evaluation of consent-seeking and verbal coercion in hypothetical vignette scenarios (N=420; Study 1). The vignettes embedded three factors with two levels each: level of intoxication (2 levels – sober/drunk), type of sexual relationship (2 levels – casual/committed), and, place of sexual encounter (2 levels – sexual initiator’s/partner’s residence). The respondent-level factors included gender identity, history of sexual victimization, attitude toward establishing consent, and endorsement of alcohol-involved consent scripts. Mixed models were used to assess the effects of vignette-level and respondent-level factors on students’ evaluations of consent-seeking and verbally coercive behaviors. The results showed significant differences in students’ evaluation of whether consent was sought based on level of intoxication, type of relationship, vignette scenarios, gender, consent attitude and endorsement of consent scripts. In addition, the study found significant differences in evaluations of coercive behaviors based on the vignette scenarios, consent attitude and acceptance of consent scripts. The dissertation also assessed the relationship between students’ endorsement of alcohol-involved sexual consent scripts and attitude toward establishing sexual consent, after accounting for covariates (Study 2). Hierarchical regression was used for this purpose. The study demonstrated that there is an inverse relationship between endorsement of consent scripts and consent attitude, after controlling for gender identity, relationship status, and campus athletic participation. There were also significant differences in consent attitude based on gender and relationship status. The findings from this dissertation emphasize the importance unpacking the elements of sexual consent definitions provided in many campus policies and understanding the cognitive and contextual factors that influence students’ interpretations of those elements. In addition, the findings support that there are broader issues such as acceptance of scripts that influence students’ consent attitudes. The implications include the need to target contextually relevant predictors of consent understanding and consent attitude in campus sexual violence prevention efforts.
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    Understanding the informal help-seeking process of Korean emerging adults living in the U.S.: Influence of the family context
    (2022) Yoo, Jee Hun; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Korean Americans are a major Asian subgroup in the U.S., and epidemiological data demonstrate that rates of mental health symptoms are higher among Korean American emerging adults compared to other Asian American counterparts. Seeking and receiving appropriate support are important ways to cope with mental health burden, but there is a dearth of literature on how Asian Americans seek help from friends and family members. Available studies suggest that various sociocultural factors influence the informal help-seeking process among Asian Americans. As family context has a significant impact on children’s sociocultural development, examining such contextual factors can help understand some of the mechanisms and correlates of informal help-seeking. In this dissertation study, I explored the characteristics and associations among family communication patterns, relevant sociocultural factors (i.e., perceived parental support, emotional self-control, relational concerns, face loss concerns), and informal help-seeking intentions using a sample of 201 Korean American emerging adults (ages 18 – 29) drawn from an online survey. In paper 1, factor analysis showed that different help sources can be grouped into three domains (i.e., formal sources, family members, and partner and friends), with intention to seek help being the highest towards partner and friends, followed by family members and formal sources. Characteristics of higher acculturation were positively associated with help-seeking intention towards partner and friends. In paper 2, mediation analyses revealed that participants with parents fostering unrestrained communications perceived receiving more informational support from parents, which in turn was associated with higher intention to seek parental support. Participants with parents emphasizing conformity in beliefs and values perceived receiving less emotional and implicit support from parents, which in turn was associated with lower intention to seek parental support. The negative association between conformity orientation and perceived emotional support was only significant among participants identifying as American or bi-cultural. In paper 3, bivariate analyses showed that conversation orientation was positively associated with informal help-seeking intention, while conformity orientation, emotional self-control, relational concerns, and face loss concerns were negatively associated. Mediation analyses indicated that participants with parents stressing conformity in beliefs and values were more likely to endorse suppression of emotional expression and be concerned with potential loss of face from help-seeking, which in turn were associated with lower intention to seek help from family and friends. Findings from this dissertation study point to the utility of examining family contextual factors to better understand the informal help-seeking process among Korean American emerging adults. More studies on Asian Americans’ informal help-seeking are needed to find more culturally appropriate ways to address the mental health needs of this population.
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    YO SOY PAZ (I AM PEACE): PILOT STUDY OF A TRAUMA-INFORMED, COMMUNITY AND MINDFULNESS-BASED PROGRAM FOR LATINO IMMIGRANTS IN MARYLAND.
    (2022) Munoz, Juliana; Green, Kerry M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background: One in three Latinos in the US is an immigrant. Immigrants face particular stressors that are heightened by previous traumatic experiences before, during, and after migration. Latino populations report the highest level of stress of all racial/ethnic groups in the US and the second-highest prevalence of mental health illness. Mindfulness-Based Interventions (MBIs) have shown to be successful at reducing stress and strengthening mental health in diverse populations, yet little is known about the effects of these interventions on this particular population.Methods: The pilot study tested the Yo Soy Paz (I am Peace) online synchronous program, an evidence and trauma-informed mindfulness-based intervention that was adapted for immigrant Latina mothers and the community staff members that work with them in a community setting. The eight session pilot intervention was delivered to three cohorts for a total of 41 participants, including staff and parents of youth receiving services at a local community-based organization that serves Latino immigrants. The study used the Consolidated Framework for Implementation Research (CFIR) to examine the feasibility, acceptability, appropriateness, and fidelity of the Yo Soy Paz online program. The study also examined the initial effects of the program on stress, mindfulness, mind-body connection, and subjective well-being. Qualitative and quantitative data were collected through self-reported pre-post questionnaire, fidelity checklists, and focus groups with parents and staff. Results: Acceptability, feasibility, fidelity and appropriateness scored high on the quantitative measures. Inner compatibility with the organization’s mission and vision, clients’ needs and the organization’s receptivity to implement the intervention scored in the medium range. Mothers’ and promotoras’ self-reported mean scores for subjective wellbeing and perceived physical and mental health increased significantly from baseline- to post-test. No significant changes were observed in surveys completed by the staff, even though focus group participants reported meaningful improvement. Discussion: Overall the pilot feasibility study was well received and relevant for the organization and the population they serve. MBIs for Latino immigrants and the staff that works with them have the potential to improve well-being and overall mental and physical health. The study’s findings provide guidance to others in implementing online mindfulness practices with Latino immigrants and the staff that works with them.
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    Understanding the Process of Sexual Health Communication Between African American Fathers and Their Daughters: A Multi Analytic Method Qualitative Study
    (2021) Kachingwe, Olivia; Aparicio, Elizabeth M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    African American youth and young adults living in the United States are disproportionately burdened by HIV/AIDS, and when compared to women of other races and ethnicities, African American women have the highest rate of chlamydia, gonorrhea, and syphilis. Although sexual health communication is a well-established protective factor against unprotected sexual intercourse, African American fathers and their daughters are a largely under-studied dyad in comparison to sexual health communication between intimate partners or mother-child dyads.The current dissertation study focused on sexual health communication between African American fathers aged 52-60 (M=56.7) years and daughters aged 19-21 (M=20.3) years recruited in Maryland and the District of Columbia. Of the 19 participants, 7 father-daughter dyads were interviewed, and each participant individually completed a semi-structured interview. This dissertation study encompasses three separate analyses, each presented as separate articles. Article One and Two used thematic analysis, and Article Three used constructivist grounded theory analysis. In Article One, thematic analysis revealed five themes among the topics fathers and daughters perceive to be the most challenging or easy to discuss with one another, and which topics, when discussed, have the greatest impact on daughters’ sexual behaviors. Each theme had two to six sub-themes. Although there were several topics fathers and daughters found easy or challenging to discuss with one another, there were also several topics that were neither definitively easy nor challenging but rather varied across dyads. In Article Two, thematic analysis produced five themes, with two to three sub-themes each, that characterize the family dynamics surrounding the perceived impact of father-daughter sexual health communication on daughters’ sexual health behavior. Family structure, communication skills, parenting style and relationship quality all proved important. In Article Three, Constructivist grounded theory was used to develop a theory describing the process of sexual health communication between African American fathers and their daughters. Analysis revealed the core category fathers and daughters communicating about sexual health was related to three supporting categories: navigating social, cultural and familial contexts, valuing open communication, and avoiding the topic. Taken together, study findings elucidate the unique contribution of African American fathers towards their daughters’ sexual development and the many factors preventing increased and effective father-daughter sexual health communication. Study findings can be used to inform future interventions as we strive to take steps towards mitigating racial sexual health disparities.
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    DISPARITIES IN PRE-EXPOSURE PROPHYLAXIS AWARENESS AMONG WOMEN: A SYSTEMATIC REVIEW OF THE LITERATURE AND LATENT CLASS ANALYSIS OF SYNDEMIC RISK FACTORS
    (2020) Stubbs, Leandra Nicole; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    While rates of HIV infection have declined among women in recent years, women still account for 19% of all new infections each year in the United States (US). Sociodemographic disparities remain with much of the burden falling on Black adult women aged 25-44. Ongoing transmission of HIV in this population has mostly resulted from heterosexual contact and prior studies have identified interpersonal and sociocultural factors that impede a woman’s choice to engage in safe sex and prevent HIV acquisition. With the debut of pre-exposure prophylaxis (PrEP), an FDA-approved once-daily pill to prevent HIV transmission, researchers believed that this user-controlled method would be an innovative method in reducing HIV in this subpopulation. However, since its release in 2012, there has been insufficient knowledge of PrEP among women in the U.S, resulting in slow and disproportionate uptake of PrEP in this population. While we know the clinical efficacy of PrEP, more understanding of the behavioral, social, and structural factors that impede PrEP awareness among women is important in the dissemination of PrEP-related information and subsequent use.In this dissertation, I took an exploratory approach to: a) identify awareness, knowledge, barriers and facilitators of PrEP use among US-based women through a systematic review; b) identify factors associated with PrEP awareness among female participants in the 2018 Community Health Survey; and c) explore how the presence of multiple deleterious factors can create distinct subgroups of women and further exacerbate disparities in PrEP awareness. In Paper 1, the systematic review of PrEP knowledge among Black/African American women identified 12 articles with findings disaggregated by both race and gender. Primary findings included gaps in PrEP knowledge; acceptability and willingness to use once informed of PrEP; perceived disadvantages as a result of exclusion in clinical trials and early dissemination; and social, structural, and institutional barriers to engagement in the PrEP care continuum. Papers 2 and 3 leveraged data from the 2018 Community Health Survey, a cross-sectional telephone survey of randomly selected adults aged 18 and older from all five boroughs of New York City. In Paper 2, 36% of a female subsample (N=2,295) were aware of PrEP at time of survey. As a result of multinomial linear regression, nine variables were significantly associated with PrEP awareness: nativity, education level, recent HIV test, number of sex partners, IPV, age, race/ethnicity, general health, and prior incarceration. In Paper 3, latent class analysis was used to identify distinct classes of women with varied responses to behavioral and structural variables. The adjusted item-response probabilities resulted in three distinct profiles of women: high resource and low risk group (39%), low resource and moderate risk group (33%), and moderate resource and high-risk group (28%). Key differences between groups include PrEP awareness, perceived health, count of sexual partners, and neighborhood poverty level. These findings have key implications for the way in which PrEP is marketed to women. Future studies should consider the importance of intersectionality and the social and structural context through which women engage with HIV prevention materials and promotional campaigns.
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    COLORECTAL CANCER SCREENING IN INDIVIDUALS UNDER AGE 50: USING A SHARED-DECISION-MAKING FRAMEWORK TO EXPLORE KNOWLEDGE, PREFERENCES, AND DESIRED ROLE
    (2020) Hyams, Travis; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The rates for colon and rectal cancer (CRC) are increasing at an alarming rate in individuals under the age of 50. Because of this, The American Cancer Society gave a qualified recommendation for average risk adults to initiate colorectal cancer screening at age 45. This recommendation challenges the long-standing guidelines to begin screening at age 50. If adopted, this would add approximately 19 million Americans to the eligible screening pool. This shift in thinking is controversial and researchers and guideline recommending organizations have responded with caution. While a large body of literature on CRC screening exists, very few studies have focused on individuals under the age of 50 due to the previous, relative consensus on guidelines. Because the uncertainty and relative equality of screening strategies and outcomes, patients under 50 and clinicians making decisions about screening should consider a shared decision-making framework. In this dissertation, I explored differences in several constructs of the shared decision-making framework by age (<50 & ≥50) using a sample of 579 participants drawn from MTurk, a global crowdsourcing workforce that is often utilized for research studies. In paper 1, I evaluated knowledge of CRC risk factors and symptoms and found that age moderated the relationships between several independent variables including perceived likelihood of getting cancer and numeracy with total knowledge scores. In paper 2, I explored preferences for colorectal cancer screening strategies using a multicriteria decision analysis technique called the Analytic Hierarchy Process and found that participants <50 preferred colonoscopy more often than those ≥50. In paper 3 I used multinomial logistic regression and found that participants <50 preferred the shared and passive role compared to the active role for deciding whether to get screened and deciding which strategy to use more often than participants ≥50. These findings will act as a foundation for future work if it becomes necessary to incorporate younger people into colorectal cancer screening programs.
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    THE INFLUENCE OF WATERPIPE LOUNGE MENU LABELING ON INTENTION TO QUIT SMOKING AND PERCEIVED HARM, RISK AND ADDICTION AMONG YOUNG ADULT WATERPIPE TOBACCO SMOKERS IN THE UNITED STATES
    (2020) Kidanu, Azieb; Feldman, Robert H; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    In the US, young adults 18 to 24 years of age have experienced the most notable decline in smoking rates from 24.4% in 2005 (Mariolis et al., 2006) to 7.8% in 2018 (Creamer, 2019). However, alternative tobacco products, such as waterpipes (also known as hookahs), are increasingly becoming the first product used by tobacco-naïve young adults and may be a gateway to nicotine addiction (Meier, Tackett, Miller, Grant, & Wagener, 2015). Tobacco surveillance measures show that among young adults in the US, 44.3% reported ever use (lifetime) and 10.7% current use (every day and someday) of waterpipe tobacco (Kasza et al., 2017). Although public health best practices for communicating the harms of tobacco use are well-established in traditional products, such as cigarettes, there is a critical knowledge gap on how to properly communicate the harms of waterpipe tobacco smoking (WTS) to current and potential consumers. In this dissertation, two independent studies were conducted to examine the effect of health-related information on waterpipe lounge menus on intention to quit smoking, as well as perceived relative harm, perceived risk of health consequences and perceived relative addiction.The overall results of Study 1 and Study 2 were consistent with prior research showing that brief health warning messages and nicotine content may increase intention to quit smoking, as well as perceived harm and risk of health consequences (Mays, Tercyak, et al., 2016). In addition, the research expands this evidence by demonstrating that the waterpipe lounge menu is a viable location for delivery of health education messages and product labeling. These findings may be used in future research to design further health communication experiments for WTS, as well as support practice and policy decisions for health warning messages and product labeling specific to waterpipe tobacco.
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    IDENTIFYING BARRIERS AND FACILITATORS OF LEISURE TIME PHYSICAL ACTIVITY THROUGH THE EXPERIENCES OF 16-18 YEAR OLD AFRICAN AMERICAN/BLACK GIRLS: A GROUNDED THEORY STUDY
    (2020) Zeeger, Tracy; Gold, Robert S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Among older adolescent African American/Black girls, obesity rates continue to rise between the ninth and 12th grades, whereas among white females, rates decline. Contributing to these high rates is the lack of leisure-time physical activity (LTPA) among youth. Nationwide, 95% of older adolescents (ages 16-18) are not meeting federal guidelines for physical activity. Older adolescent African American/Black girls are less likely to report LTPA when compared to their peers. Current approaches are not adequately addressing reduced LTPA among African American/Black older adolescent girls, requiring a return to the population affected to better understand this problem. To address this need, the current grounded theory dissertation study aimed to develop a grounded theory model of barriers and facilitators to LTPA among older adolescent African American/Black girls. Enrolled in the study were 16 African American/Black girls (N=16) aged 16-18 (M=16.7) years. Nine participants were classified as exercisers and seven as non-exercisers. All participants attended high school in Prince George’s County, Maryland. Each participant took part in an in-depth individual qualitative interview, conducted at a private, quiet location of their choice. Using constructivist grounded theory methods (CGT), analysis of the interview data occurred across four phases: open, focused, axial, and theoretical coding. CGT analysis resulted in a behavioral process theory explaining barriers and facilitators of LTPA among African American/Black older adolescent girls, grounded in youths’ own experiences. The theory, anchored by the core category of Choosing to Engage in LTPA, has five related categories: Being Autonomously Motivated, Perceiving Control Over Time, Knowing About Exercise, Experiencing the Influence of Others, and Receiving Messages About One’s Body. Each theoretical category includes multiple properties and dimensions, such as understanding the benefits of LTPA outside of weight loss, believing exercise is fun, and having confidence in the ability to exercise. Multiple influences across family, community, and societal systems shaped participants’ attitudes and beliefs. The results of this study contribute to a growing body of research on physical activity among older adolescents. These findings can inform the development and testing of feasibility in an afterschool LTPA intervention, as well as school physical education curriculum and policy.