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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Item COVID-19 Vaccine Hesitancy and Uptake in the United States Considered Through the Lens of Health Behavior Theory(2024) Kauffman, Lauren Emily; Nguyen, Quynh; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Given the low COVID-19 vaccine uptake rates in many areas of the United States despite their demonstrated safety and effectiveness, COVID-19 vaccine hesitancy and vaccination barriers continue to be critical areas of research in epidemiology and behavioral health science. This series of studies focuses on COVID-19 vaccine hesitancy and vaccination barriers, as they relate to vaccination intention and vaccine uptake, considered in the context of established health behavior theories. The first study is a systematic review of existing research on COVID-19 vaccine hesitancy using one or more health behavior theories as key components of the design or analysis. This study examined the types of theories that are most often used, how they are used, and where research gaps exist. The remaining two studies use data from the U.S. COVID-19 Trends and Impact Survey, a national cross-sectional survey. The second study investigates the association between recent feelings of anxiety or depression and vaccination intention, as well as between these feelings and identifying with specific vaccine hesitancy reasons. The third study examines vaccine hesitancy and barriers among those with chronic illness or disease, a particularly vulnerable population. Factor analysis was conducted using constructs from the Theory of Planned Behavior as a framework, and the results were used in a regression model to investigate the association between these underlying factors and vaccination intention. This research demonstrated the usefulness of the Theory of Planned Behavior, the Health Belief Model, and the 3 Cs Model in existing and future COVID-19 vaccine hesitancy research, as well as identified Protection Motivation Theory as a promising area for future research. Additionally, psychological states were demonstrated to be significantly associated with vaccine hesitancy, adjusting for demographic, socioeconomic, and time factors. Lastly, the Theory of Planned Behavior was found to be applicable to those unvaccinated and with chronic illness, as the construct factor scores developed were significantly associated with vaccine hesitancy (adjusting for the presence of specific chronic conditions and demographic, socioeconomic, and time factors). These associations were also consistently demonstrated in subgroup analyses of participants with specific chronic conditions.Item The Role of Personal Integrity in Shaping Healthcare Worker Perceptions of Patient Safety Culture in US Hospitals During the Covid-19 Pandemic(2024) Edelstein, Lauren Michelle; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Abstract Overview: The COVID-19 pandemic strained hospitals in unprecedented ways that required healthcare workers to adapt to and endure challenges, testing their ability to do a good job with the human and technological resources available to them. Using a proxy variable for personal self-integrity (PSI), derived from questions on the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS), this dissertation explores the way workers’ capacity to maintain alignment of their actions and morals shifted during the pandemic. Conceptual Framework: The investigations within this study can be understood through the Healthcare Workforce Integrity Model, an innovation based on the Job Demands and Resources Model that accounts for the deeply moral nature of healthcare work. The model holds that intensity of job demands and the strength of supportive job resources shape workers’ abilities to maintain PSI in their work. Over a sustained period, this impacts worker energy and motivation, and ultimately, organizational resilience. Methods: The study uses descriptive statistics and regression modeling based on data from the AHRQ’s HSOPS and data from the Hospital Cost and Utilization Project (HCUP), from timeframes before and during the COVID-19 pandemic, to analyze shifting perceptions about patient safety culture within the hospital workforce. Results: Workers’ capacity to maintain their PSI worsened steadily over the pandemic. When patient mortality was higher, workers’ PSI worsened, with particularly acute effects experienced in ICU settings. When hospital workers perceived teamwork and leadership support negatively, and when they perceived that staff were blamed for patient safety problems, their perceptions of their own personal integrity diminished by statistically significant margins. No significant associations indicate that hospital workers’ perceptions of teamwork, leadership support, or being blamed for safetyproblems were more closely tied with their ability to maintain positive PSI during the pandemic than they were before the pandemic. Conclusions: Organizational solutions are needed to support healthcare workers’ ability to thrive and maintain integrity in non-crisis moments just as much as they are needed during moments of crisis and uncertainty. Achieving this goal can better ensure that healthcare workers feel they can depend on their institutions and its people to do the right thing.Item Using 164 Million Google Street View Images to Derive Built Environment Predictors of COVID-19 Cases(MDPI, 2020-09-01) Nguyen, Quynh C.; Huang, Yuru; Kumar, Abhinav; Duan, Haoshu; Keralis, Jessica M.; Dwivedi, Pallavi; Meng, Hsien-Wen; Brunisholz, Kimberly D.; Jay, Jonathan; Javanmardi, Mehran; Tasdizen, TolgaThe spread of COVID-19 is not evenly distributed. Neighborhood environments may structure risks and resources that produce COVID-19 disparities. Neighborhood built environments that allow greater flow of people into an area or impede social distancing practices may increase residents’ risk for contracting the virus. We leveraged Google Street View (GSV) images and computer vision to detect built environment features (presence of a crosswalk, non-single family home, single-lane roads, dilapidated building and visible wires). We utilized Poisson regression models to determine associations of built environment characteristics with COVID-19 cases. Indicators of mixed land use (non-single family home), walkability (sidewalks), and physical disorder (dilapidated buildings and visible wires) were connected with higher COVID-19 cases. Indicators of lower urban development (single lane roads and green streets) were connected with fewer COVID-19 cases. Percent black and percent with less than a high school education were associated with more COVID-19 cases. Our findings suggest that built environment characteristics can help characterize community-level COVID-19 risk. Sociodemographic disparities also highlight differential COVID-19 risk across groups of people. Computer vision and big data image sources make national studies of built environment effects on COVID-19 risk possible, to inform local area decision-making.Item “People Will Continue to Suffer If the Virus Is Around”: A Qualitative Analysis of Sub-Saharan African Children’s Experiences during the COVID-19 Pandemic(MDPI, 2021-05-25) Kallander, Samantha Watters; Gordon, Rebecca; Borzekowski, Dina L.G.Children are particularly impressionable and at risk during a global public health crisis, making it important to examine their unique perspectives. To hear and understand sub-Saharan African children’s experiences with the COVID-19 pandemic, we conducted an exploratory qualitative analysis based on interviews with 51 children, ages 9 to 13, from Nigeria, Tanzania, and Sierra Leone. Applying the organization of Bronfenbrenner’s ecological systems theory, we reveal how COVID-19 affected children’s daily lives and domestic challenges, schooling and neighborhood issues, media use (and its relationship to knowledge and fear of the disease), perceptions of the country and government response, and thoughts of religion and hope. Children’s responses differed greatly, but patterns emerged across sex, age, household size, religion, and country. This study offers guidance and recommendations for meeting the needs of children, especially in times of crisis.Item Reducing Anxiety with Nature and Gardening (RANG): Evaluating the Impacts of Gardening and Outdoor Activities on Anxiety among U.S. Adults during the COVID-19 Pandemic(MDPI, 2022-04-22) Gerdes, Megan E.; Aistis, Lucy A.; Sachs, Naomi A.; Williams, Marcus; Roberts, Jennifer D.; Rosenberg, Goldstein Rachel E.The COVID-19 pandemic impacted mental health. Growing research has identified the mental health benefits of nature contact, including gardening. We used a cross-sectional survey to investigate the association between gardening and other outdoor activities with anxiety among U.S. adults. The RANG (Reducing Anxiety with Nature and Gardening) survey was distributed online from June–September 2020 through social media (Twitter and Facebook) and a national Master Gardeners listserv. Survey questions captured demographics, COVID-19 experiences, gardening, outdoor activities, and anxiety using the Generalized Anxiety Disorder 7-item scale. Data were analyzed using chi-square, Fisher’s exact, and Kruskal–Wallis tests, as well as logistic regression. Among participants, 46% reported anxiety symptoms. Participants who had gardened ≥ 15 years and those gardening > 8 h over two weeks had lower anxiety scores. Spending more time outdoors on weekdays also decreased anxiety scores. After adjusting for covariates, lower odds of anxiety were identified for 50–69 and 70–89-year-olds vs. 18–29-year-olds; males vs. females; and Texas vs. Maryland residents. These findings confirm increased anxiety during the COVID-19 pandemic and suggest that sustained gardening and other outdoor activities could help reduce anxiety.Item Social Network Analysis on the Mobility of Three Vulnerable Population Subgroups: Domestic Workers, Flight Crews, and Sailors during the COVID-19 Pandemic in Hong Kong(MDPI, 2022-06-21) Yu, Weijun; Alipio, Cheryll; Wan, Jia'an; Mane, Heran; Nguyen, Quynh C.Background: Domestic workers, flight crews, and sailors are three vulnerable population subgroups who were required to travel due to occupational demand in Hong Kong during the COVID-19 pandemic. Objective: The aim of this study was to explore the social networks among three vulnerable population subgroups and capture temporal changes in their probability of being exposed to SARS-CoV-2 via mobility. Methods: We included 652 COVID-19 cases and utilized Exponential Random Graph Models to build six social networks: one for the cross-sectional cohort, and five for the temporal wave cohorts, respectively. Vertices were the three vulnerable population subgroups. Edges were shared scenarios where vertices were exposed to SARS-CoV-2. Results: The probability of being exposed to a COVID-19 case in Hong Kong among the three vulnerable population subgroups increased from 3.38% in early 2020 to 5.78% in early 2022. While domestic workers were less mobile intercontinentally compared to flight crews and sailors, domestic workers were 1.81-times in general more likely to be exposed to SARS-CoV-2. Conclusions: Vulnerable populations with similar ages and occupations, especially younger domestic workers and flight crew members, were more likely to be exposed to SARS-CoV-2. Social network analysis can be used to provide critical information on the health risks of infectious diseases to vulnerable populations.Item Umbrella Review: COVID-19 Public Health Measures and Patient and Public Involvement in Health and Social Care Research(2023-08-10) Fouladi, Negin; Tchangalova, Nedelina; Ajayi, Damilola; Millwee, Elizabeth; Lovett, Corinne; Del Sordi, Alana; Liggett, Samantha; De Silva, Malki; Bonilla, Laura; Nkwonta, Angel; Ramnarine, Leah; Munoz, Allyssa; Frazer, Kate; Kroll, ThiloBackground: - Patient and public involvement (PPI) in health research refers to patients and other members of the public with relevant experience contributing to design, implementation, and dissemination of research. PPI entails research being carried out ‘with’ or ‘by’ members of the public, rather than ‘to’, ‘about’ or ‘for’ them. - Over the past decade, there has been an increased emphasis on the importance of PPI in health and social research as it provides alternative views and insights into the needs of healthcare users to improve the quality and relevance of research. - PPI enhances the efficiency, design, and quality of healthcare initiatives and facilitates decision-making regarding resource allocations and the usability of services by including information about the capabilities, needs, and priorities of local people. - The rapid response to the COVID-19 pandemic resulted in PPI being viewed as non-essential, leading to its minimal inclusion in research and, thereby, minimizing the contribution of patients, the public, and, particularly, minority groups in helping find solutions to the pandemic crisis. - Public health measures (PHM) aim to reduce the transmission, severity of illness, and death and are critical strategies to address pandemic outbreaks, therefore, PPI is crucial in building trust and acceptance in research, greater benefits for the community, new and improved services, valuable changes in practice/partnership leading to positive changes and outcomes.Item COVID-19 public health measures and patient and public involvement in health and social care research: An umbrella review(International Journal of Environmental Research and Public Health, 2023-03-10) Fouladi, Negin; Tchangalova, Nedelina; Ajayi, Damilola; Millwee, Elizabeth; Lovett, Corinne; Del Sordi, Alana; Liggett, Samantha; De Silva, Malki; Bonilla, Laura; Nkwonta, Angel; Ramnarine, Leah; Munoz, Allyssa; Frazer, Kate; Kroll, ThilloAn umbrella review of previously published systematic reviews was conducted to determine the nature and extent of the patient and public involvement (PPI) in COVID-19 health and social care research and identify how PPI has been used to develop public health measures (PHM). In recent years, there has been a growing emphasis on PPI in research as it offers alternative perspectives and insight into the needs of healthcare users to improve the quality and relevance of research. In January 2022, nine databases were searched from 2020–2022, and records were filtered to identify peer-reviewed articles published in English. From a total of 1437 unique records, 54 full-text articles were initially evaluated, and six articles met the inclusion criteria. The included studies suggest that PHM should be attuned to communities within a sociocultural context. Based on the evidence included, it is evident that PPI in COVID-19-related research is varied. The existing evidence includes written feedback, conversations with stakeholders, and working groups/task forces. An inconsistent evidence base exists in the application and use of PPI in PHM. Successful mitigation efforts must be community specific while making PPI an integral component of shared decision-making.Item DEVELOPMENT OF A CORE OUTCOME SET FOR STUDIES INVESTIGATING SAFETY, EFFICACY, AND IMPLEMENTATION OF COVID-19 VACCINES: A COLLABORATION WITH AFRICAN AMERICAN/BLACK COMMUNITIES IN BALTIMORE CITY, MARYLAND(2022) Datar, Reva; Howard, Donna; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Since it was declared a global pandemic in March 2020, Coronavirus Disease 2019 (COVID-19) has claimed over one million lives in the United States. Since COVID-19 vaccine rollout efforts began in Baltimore City, Maryland in December 2020, approximately 63.4% of all residents have been fully vaccinated (i.e., received their first and second doses in a two-dose series or received a single-dose vaccine). Despite efforts to implement equitable vaccine distribution in Baltimore City, prominent disparities in COVID-19 vaccine uptake persist, with poorer, predominantly Black neighborhoods frequently reporting lower levels of vaccine uptake than affluent, predominantly White neighborhoods. Guided by key principles of community-based participatory research, this dissertation explores community experiences with COVID-19 vaccines and develops a core outcome set (COS), inclusive of community-important outcomes, for use in studies evaluating the safety, efficacy, and implementation of COVID-19 vaccines. Methods: In March 2022, semi-structured interviews were held with vaccinated and unvaccinated Black residents of a community in Baltimore City reporting 40% vaccination uptake. Data were analyzed using inductive thematic analysis with subsequent subgroup analyses and thematic network analyses. To assess the extent to which outcomes measured in COVID-19 vaccine studies published between December 2019 and March 2022 aligned with factors of vaccine hesitancy, a systematic literature review (SLR) was conducted. Results from the qualitative analyses and the SLR informed the development of a candidate list of outcomes used in the first round of a Delphi study held in June 2020. After two rounds of Delphi survey distribution, a face-to-face consensus meeting was held with community members and community health workers to prioritize outcomes of interest to all relevant stakeholders and finalize the COS.Results: Thematic analysis yielded four emergent themes relating to COVID-19 vaccine uptake decision making: (I) Safety and efficacy of vaccines, (II) Perceived importance of COVID-19 vaccines in relation to pre-existing community needs, divided into two subthemes, a) Environmental injustice and (b) Personal health concerns, (III) Access to trustworthy, understandable information, and (IV) Physical access to vaccines. Participants acknowledged that physical access to COVID-19 vaccines was not a major barrier to uptake, however finding trustworthy and understandable information about the safety and efficacy of the vaccines were common areas of concern. Of all primary outcomes (N=20) identified in the 56 articles included in the SLR, 85% (n=17) corresponded with factors of vaccine hesitancy. The final COS included 19 outcomes across four “domains:” “Is the vaccine safe?”; “Does the vaccine work in my body?”; “Does the vaccine work in the community?”; and “Outcomes identified during consensus meeting.” Conclusion: The findings from this dissertation suggest that although community-important outcomes related to safety and efficacy of vaccines are often addressed in clinical studies, outcomes measuring institutional trust, economic and health impacts, community acceptance of the vaccines, and trustworthiness of vaccine information are underutilized in studies of vaccine implementation. As these social factors function as barriers to vaccine uptake, particularly among underserved communities, they should be regarded as indicators of equitable access to COVID-19 vaccines. The findings from this dissertation provide a framework with which public health researchers can begin to rethink measures of equity in vaccine rollout efforts.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.