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 RACIAL AND ETHNIC DISPARITIES IN ADL LIMITATIONS AMONG MEDICARE BENEFICIARIES AND THE EXPERIENCE OF TRANSPORTATION BARRIERS IN THE ADL POPULATION(2022) Saint Dic , Venchele; Boudreaux, Dr. Michel; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The study’s aims were to first determine if racial/ethnic disparities in ADL limitations for low-income Medicare beneficiaries. The logistic regression results suggested there is a variance in ADL limitation among Medicare Beneficiaries across race. Then, it tested if low-income elderly Medicare enrollees aged 65 years and older were at a higher risk of experiencing transportation barriers to care. On account of covariates, persons with ADL limitations (OR: 2.47 p<0.001) had higher odds of having transportation barriers compared to those without ADL limitations. Non-Hispanic African Americans had a higher chance of experiencing transportation delays than non-Hispanic Whites (OR 1.76 p<0.001). Finally, the effect size for transportation access barriers did not have a dose-relationship with increasing ADL limitation severity. Though the point estimates suggested that barriers were greatest for those with moderate severity (3-4 ADLs), it failed to find evidence of a statistically significant dose-response relationship between ADL severity and transportation.Item A SEQUENTIAL MIXED METHODS APPROACH TO IDENTIFYING AND UNDERSTANDING MOTIVATIONS FOR LEISURE TIME PHYSICAL ACTIVITY PARTICIPATION AMONG AMPUTEES(2022) Olsen, Sara H; Howard, Donna E; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Physical inactivity contributes to increased risk for hypertension, coronary heart disease, diabetes, various cancers, and depression. Research shows small increases in leisure time physical activity (LTPA) level among the least active populations result in larger improvements in overall health than any increase in LTPA among more active populations. People with disabilities (PwD) are less likely to meet physical activity (PA) guideline recommendations than their counterparts in the general population (39.2% vs 53.8%). People with mobility disabilities, such as those with amputations, are less active than those with other disabilities. Amputees, however, are largely absent from physical activity-related and disability-related research. One step toward improving LTPA participation among amputees is understanding motivations to be active and the experiences influencing those motivations. Using Self-Determination Theory (SDT) as a framework, this dissertation employed a sequential explanatory mixed methods approach to integrate fitness app intervention data with interpretative phenomenological analysis (IPA) findings. The quantitative component evaluated an app-based intervention with a waitlist control experimental design. Outcomes of motivations and PA level (Aim 1) were evaluated using linear mixed effect models. Amotivation, extrinsic motivation, and intrinsic motivation were evaluated as separate outcomes. Changes in amotivation and total activity level were significant during the intervention; there were no significant changes in extrinsic or intrinsic motivation. Amotivation (complete disinterest in LTPA) increased in both groups, but the increase was greater in the waitlist control group, suggesting use of the app staved off amotivation even though it did not contribute to increases in intrinsic motivation. Total activity increased in the waitlist control group only. Moderation was tested using SDT constructs of general causality orientation, a personality trait that represents a person’s belief about behavioral change and reasons to change (Aim 2). Amotivation is moderated by general causality orientation. Results from intervention analyses, including attrition analysis, were used to develop interview guides and participant inclusion criteria for the qualitative phase. In-depth interviews with amputees (Aim 3) explored motivations to be active and embodied PA experiences. IPA resulted in the development of six superordinate themes. Data from both the intervention and interviews were integrated to develop a deeper understanding of amputees’ experiences with motivations to be active (Aim 4). Participants identified barriers and facilitators to PA engagement that were unrelated to and unaffected by motivation to be active. These experiences disrupted the association between motivation and participation which added context to the intervention findings in which changes in intrinsic motivation over time did not parallel changes in PA over the same intervention period. Public health implications and suggestions for future research are discussed.Item Parental Health Literacy, Empowerment, and Advocacy in the Context of Food Allergies Management in Schools(2021) Koo, Laura Warnock; Baur, Cynthia E; Horowitz, Alice M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Health literacy, empowerment, and advocacy may be important for parents when they communicate with schools related management of their child’s food allergies. Understanding prevention and emergency management of life-threatening food allergies may require high levels of health literacy and may be overwhelming to parents. Yet, parents are often the drivers of school food allergy safety practices. Mixed evidence supports the relationships among communicative health literacy, critical health literacy, and empowerment in chronic disease management. Objective: This cross-sectional study examines the relationships among parental health literacy, particularly communicative and critical health literacy; empowerment; and advocacy in the context of food allergies management in elementary schools. Methods: Parents of children with food allergies were recruited through food allergy organizations to complete an anonymous 20-minute online survey. Measurements of parental health literacy, empowerment, and advocacy were adapted from validated scales or the literature and refined through pre-testing and pilot-testing. Results: Participants (N=313) were predominantly white, college-educated mothers with moderately high food allergy knowledge, health literacy, and empowerment. Their children were allergic to an average of three food allergens and nearly half had asthma. Parents who scored at the highest levels on measures of communicative health literacy, critical health literacy, and empowerment engaged in advocacy behaviors perceived to be more effective than parents who scored at the lowest levels. However, this statistical difference may not represent a clinically significant difference. Communicative and critical health literacy were not more strongly associated with advocacy than functional health literacy. Empowerment and quality of the parents’ relationship with the school were the strongest predictors of the parents’ perceived effectiveness of advocacy efforts. The relationship between parental health literacy and advocacy was mediated by empowerment with a moderate effect size, but reverse causality between health literacy and empowerment could not be completely ruled out. Conclusions: Parental health literacy may impact the effectiveness of advocacy efforts for safe food allergies practices in schools, with parental empowerment possibly mediating the relationship between health literacy and advocacy. Longitudinal studies with diverse samples should verify findings. Health professionals should encourage parents to build good relationships with school personnel and help to empower families when educating them about food allergies management.Item Estimating the Prevalence and Timing of Events Along the Pathway to Identification of Autism in the US 2016–2018(2021) Hanley, Allison; Nguyen, Quyhn; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The prevalence of autism spectrum disorder (ASD) has risen rapidly in the past decade. Estimates on factors associated with developmental screening and the timing of events along the diagnostic pathway can inform early identification efforts. This dissertation uses cross-sectional data from the 2016–2018 National Survey of Children’s Health to achieve 3 aims: 1) evaluate individual- and state-level sources of variance between states in developmental screening rates via multilevel models, 2) evaluate characteristics associated with the ages at which children with ASD are first diagnosed, receive an intervention plan, and begin intervention, and 3) evaluate differences in lengths of time between these events by cohort. Aim 1: The national rate of developmental screening for children ages 9 months to 5 years is 34.4% (95% Confidence Interval (CI), [34.3, 34.4]). Rates varied between states by 38%. Individual-level factors explained 6% of the variance, while income inequality and a state’s choice to track developmental screening did not explain any variance between states. Aim 2: Linear regression models adjusted for individual and household characteristics showed that compared to children aged 3–5 years at the time of the survey, children 6–11 were 18 months older at first services (? =1.49, 95% CI, [1.18, 1.81] and children aged 12–17 were 38 months older at first ASD diagnosis (? =3.16, 95% CI, [2.72, 3.60]. Aim 3: Analyses using identical models showed that compared to children aged 3–5 at the time of the survey, the interval between first plan and first services was 4 months longer for children 6–11 (? =0.34, 95% CI, [0.07, 0.61]; and 8 months longer between first ASD diagnosis and first services for children aged 12–17 (? =0.67, 95% CI, [0.28, 1.06]. Today’s children with autism receive their first diagnosis, intervention plans, and developmental services at younger ages than in the past and are moving between events with less delay compared to older children. However, the low rate of developmental screening nationwide represents missed opportunities for even earlier identification. Research is needed to identify the macro-level factors that explain the variance between states on developmental screening rates.