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 UNDERSTANDING THE IMPACT OF LONG-TERM CARE NEED AMONG MEDICARE-ONLY BENEFICIARIES(2024) Albaroudi, Asmaa; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The population of adults 65 years of age and older is growing tremendously, and the majority of this population will have some level of long-term services and supports (LTSS) needs. Most older adults will qualify for Medicare insurance, which does not provide coverage for LTSS. The high costs associated with receiving LTSS, which includes supports for activities of daily living, places a financial burden on Medicare-only beneficiaries with limited resources, increasing their likelihood of becoming eligible for Medicaid coverage (i.e., dual-eligible). Given that Medicaid is the primary payer for LTSS, much of the literature on long-term care (LTC) is focused on a Medicaid eligible population. This dissertation explores the experience of Medicare-only beneficiaries with an LTSS need, who are responsible for the costs of their LTSS and may ultimately qualify for Medicaid. The Health and Retirement Study data are used to explore my dissertation objectives. My dissertation examines three areas: (1) the financial burden of Medicare-only beneficiaries with high functional impairment by assessing out-of-pocket costs; (2) spend down to dual-eligible status for Medicare-only beneficiaries with and without a LTC need; and (3) spend down by race and ethnicity with and without a LTC need.Item THE LONGER-TERM IMPACT OF PERCEIVED DISCRIMINATION ON COUPLE RELATIONSHIP FUNCTIONING: EXAMINING PSYCHOLOGICAL AND PHYSIOLOGICAL PATHWAYS AMONG MIDDLE-AGED AND OLDER-AGED ADULTS IN THE UNITED STATES(2023) Du, Jingshuai; Quinn, Sandra SQ; Mittal, Mona MM; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The current study aimed to investigate the longer-term impact of everyday discrimination and major lifetime discrimination at Time 1 (T1; 2008 and 2010) on couple relationship functioning at Time 3 (T3; 2016 and 2018) across 8 years. It also aimed to explore if psychological (measured by depressive symptoms) and physiological stress responses (measured by allostatic load) at Time 2 (T2; 2012 and 2014) mediated the longitudinal association between discrimination and couple relationship functioning among middle-aged and older-aged adults in the United States (U.S.). To answer the study aims, I conducted a longitudinal mediation path analysis (N = 2,344) in Mplus Version 8 using data from the Health and Retirement Study, an ongoing national survey of the health and aging experience of U.S. adults aged 51 and older residing in the community. The primary longitudinal mediation model with control variables demonstrated good model fit (χ2[4] = 21.78, p < 0.01, CFI = 0.99, RMSEA = 0.04, SRMR = 0.01). The analysis results suggested that depressive symptoms at T2 significantly mediated the longitudinal association between the two types of discrimination and the two types of couple relationships spanning 8 years while controlling for race, age, gender, education, number of reasons for everyday discrimination and T1 assessments of couple support and couple strain. However, allostatic load was not found to be a significant mediator between the two types of discrimination and the two aspects of couple relationship functioning (couple support and couple strain). The direct relationship between discrimination (everyday and major lifetime discrimination) and couple relationship functioning (couple strain and couple support) was not significant either. The results from the multi-group analysis suggested that several structural paths differed significantly across gender, age groups, and number of reasons for everyday discrimination, but none of the paths differed significantly based on race. Overall, the current study did not find evidence supporting the pathway from perceived discrimination to couple relationship functioning through allostatic load. It provided evidence supporting depressive symptoms as a mediating mechanism between perceived discrimination and couple relationship functioning. Future work should develop innovative methods for assessing and measuring allostatic load to test its possible mediation role between perceived discrimination and couple relationship functioning. Moreover, effective and culturally-responsive interventions and programs are needed to decrease all types of discrimination and depression in order to improve couple relationship functioning among middled-aged and older-aged adults in the U.S.Item Community Living and Health Services Utilization among the Aging Services Network Population(2017) Gaeta, Raphael; Simon-Rusinowitz, Lori; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)By 2050, the number of older adults will increase from 67 million to 111 million, or roughly 28 percent of the total U.S. population. Age is a principal predictor of physical health status as well as functional and cognitive limitation. As the aging population grows, so too will the demand for long-term services and supports (LTSS) and healthcare services. Despite this intersection, LTSS and healthcare systems are highly disconnected. The Aging Services Network, authorized and partially financed by the Older Americans Act (OAA), may play an important role in an emerging trend toward integrating services. Yet, OAA research is lacking. Existing OAA research faces several obstacles, including handling program variation resulting from a decentralized Aging Services Network, identifying non-user comparison groups for OAA study samples, and limited utility of national datasets. Studies often rely on highly descriptive methods, indirect comparisons to the general population of older adults, or state-restricted analysis. This dissertation addresses several gaps in the research. The first study aims to identify factors associated with community tenure and participation among low-income elderly living in subsidized housing. The research is grounded in conceptual frameworks from the World Health Organization. In-depth interviews and focus groups are used to explore these associations among elderly HUD building residents in Prince George's County, Maryland. The second study aims to identify multilevel predictors of OAA Title III services participation. This study develops a conceptual framework based on the Andersen Behavioral Model of Health Services Use, and uses a merged data set from the nationally representative Health and Retirement Study with geographic data and relevant state policies. The third study further examines the relationship between OAA Title III services participation and patterns of healthcare utilization. This dissertation research provides evidence for the importance of OAA Title III services, including for elderly HUD beneficiaries. Findings from multivariate regression analyses provide evidence for (1) county level targeting criteria used to measure LTSS need and direct OAA Title III funding, (2) substantial influence of Medicaid on access to OAA Title III services, and (3) changes in mix of health care services use among OAA Title III services participants over time.Item Examining Healthcare Expenditures: Mechanical Ventilation & An Evaluation of Long-Term (Acute) Care Hospitals(2013) Frank, Jared; Lee, Sunmin; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study analyzed demographic and clinical characteristics, actual hospital/facility costs, and Medicare charges/payments among beneficiaries discharged to, and from, long-term (acute) care hospitals (LTCHs), skilled nursing facilities (SNFs), or inpatient rehabilitation facilities (IRFs) following an acute inpatient hospitalization under Medicare-severity diagnosis-related group (MS-DRG) 207, "respiratory system diagnosis with ventilator support for greater than 96 hours." We also examined the likelihood of discharge by provider type to determine criteria informing patient discharge to a LTCH, SNF, or IRF for treatment. Concerning discharges to LTCHs, patients were not significantly older, did not have the highest length of stay, and had comparable diagnoses and diagnosis counts to those discharged elsewhere. Discharges from LTCHs had significantly higher diagnosis counts and lengths of stay. Costs, charges, and payments were significantly higher among discharges to, and from, LTCHs. Multinomial logistic regression analyses indicated numerous associations between certain variables and discharge location.Item The influence of ECE-1 gene polymorphism and exercise training on plasma and urinary endothelin-1 levels in pre- and stage 1 hypertensives(2007-08-09) Attipoe, Selasi; Hagberg, James; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Endothelin-1 (ET-1) is a peptide that mediates blood pressure. ECE-1b-C-338A is a polymorphism in the ECE-1 gene that alters ET-1 synthesis. Thus, the goal of this study was to investigate the influence of the ECE-1b-C-338A polymorphism on plasma and urinary ET-1 levels, as well as on aerobic exercise training (AEX)-induced changes in these variables. Outcome variables were assessed before and after 24 weeks of AEX in hypertensive adults. Separate ANCOVAs were used to compare differences in outcome variables. Only AA homozygote men had higher plasma ET-1 levels. After AEX, there were no significant changes in the main outcome variables. Neither were these changes significantly different between genotype groups. Results suggest that this polymorphism is associated with plasma ET-1 levels in men but not with urinary ET-1 levels. Additionally, this polymorphism does not affect AEX-induced changes in plasma and urinary ET-1 levels.Item Relationship between physical activity and telomere maintenance in peripheral blood mononucleocytes(2007-07-24) Ludlow, Andrew Todd; Roth, Stephen M; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this study was to examine the relationship between exercise energy expenditure (EEE) and telomere length, telomerase activity, and hTERT genotype. Sixty-nine male (n = 34) and female (n = 35) participants 50-70 yr. were assessed for weekly EEE level using the Yale Physical Activity Survey. Subjects were grouped according to EEE. Telomere length and telomerase activity were measured in peripheral blood mononuclear cells (PBMCs). Relative telomere length was significantly higher in the Middle EEE group compared to both the low and high EEE groups (p<0.05). Telomerase activity was not different among the three EEE groups. The TT hTERT genotype had significantly greater telomerase enzyme activity than both the CT and CC genotypes (P = 0.013). In conclusion, moderate exercise energy expenditure levels may provide a protective effect on PBMC telomere length compared to both low and high EEE levels. hTERT genotype was associated with telomerase activity.Item The Effects of Strength Training on Regional Body Composition in Older Adults: Sex and Race Comparisons(2007-05-22) Walts, Cory; Hurley, Ben F; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Purpose: To examine the influence of sex and race on the effects of strength training (ST) on thigh muscle volume (MV), mid-thigh subcutaneous fat (SCF) and intermuscular fat (IMF). Methods: One hundred and eighty-one previously inactive healthy Caucasian (N=117), African-American (N=54), and other (N=10) men (N=82) and women (N=99), aged 50-85 yrs, underwent ~10 weeks of unilateral knee extension ST. Results: Training-induced increases in absolute MV were significantly greater (P < 0.01) in men than in women. There were significant increases in MV within each race (P < 0.001); but no significant differences between races. There were no significant changes in SCF and IMF whether sex and racial groups were separated or combined. In addition, there was no sex by race interaction for changes in MV, SCF, or IMF with ST. Conclusion: Ten weeks of unilateral strength training does not alter subcutaneous or intermuscular fat regardless of sex or racial differences. Although men exhibit a greater muscle hypertrophic response to strength training compared to women, the difference is small. Race does not influence this response.Item The Dynamics of Multi-sensory Re-weighting in Healthy and Fall-prone Older Adults(2006-08-04) Allison, Leslie K.; Jeka, John J.; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Multi-sensory re-weighting (MSR) is an adaptive process that prioritizes the visual, vestibular and somatosensory inputs that provide the most reliable information when environmental conditions change. This process is thought to degrade with increasing age, and to be particularly deficient in fall-prone versus healthy older adults. This dissertation presents three studies designed to investigate age- and fall-related changes in MSR. The first study examined the assumption of impaired MSR in healthy and fall-prone older adults using a two-frequency touch/vision experimental design with stimuli at varying amplitudes. Both healthy and fall-prone older adults demonstrated the same pattern of adaptive gain changes as healthy young adults. No group differences in the overall levels of vision and touch gain were found. These results suggest that, for small amplitude vision and touch stimuli, the central sensory re-weighting adaptation process remains intact in healthy and fall-prone older adults. In the second study the effects of a sensory-challenge balance exercise program on laboratory measures of MSR and clinical measures of balance were investigated. Following the intervention the normal adaptive pattern of gain change was unaltered, while declines in overall vision and touch gains that reflect down-weighting of the sensory stimuli were seen. Improvements in four clinical balance measures were observed. These findings indicate that MSR processes in fall-prone older adults are modifiable, that sensory challenge balance exercises may facilitate the ability to down-weight unstable sensory inputs, and that these effects may generalize to other components of balance. A third study explored the dynamics of sensory re-weighting in healthy and fall-prone older adults. Absolute levels of gain, and the rate of adaptive gain change, were examined before and after large changes in visual motion stimulus amplitude. Compared to young adults, gains in both older adult groups were higher when the stimulus amplitude was high, and gains in the fall-prone elderly were higher than both other groups when the stimulus amplitude was low. Both older groups demonstrated slowed sensory re-weighting over prolonged time periods when the stimulus amplitude was high. These results reflect age- and fall-related changes in the extent and rate of down-weighting unstable visual inputs.Item Social Network and Dietary Intake in Community Dwelling Elderly Women: A Secondary Analysis of theThird National Health and Nutrition Examination Survey(2006-07-18) Phillips, Regina Miecznikoski; Simon-Rusinowitz , Lori; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Over the last three decades, more emphasis has been placed on describing and explaining the specific nature of social interactions and the effects of these interactions on health. The elderly population, defined in this study as those individuals 60 years of age or older, has been of particular interest because of their increased risk for illness and disability with advancing age. Elderly women are considered particularly vulnerable to the effects of illness and disability. Research from a variety of disciplines suggests that the social network (i.e. the structure of individuals with a specific, designated relationship to the individual in need), and its inherent social support, is an important factor for maintaining physical, mental and social health in all older adults (Cohen, Teresi & Holmes, 1986; Kaufman, 1990; Shumaker & Hill, 1991). Dietary intake is an indicator of overall health; understanding factors that affect dietary intake provides clinicians with the opportunity to promote positive health outcomes and a positive quality of life for the older adult. Few studies examine the specific relationship between the social network and dietary intake and nutrition in any population. This study examined the relationship between the social network including household size, frequency of non household contact with family/friends and frequency of organizational contact and dietary intake in community-dwelling older women using the third National Health and Nutrition Examination Survey (NHANES III). Dietary intake was measured by total food energy intake, body mass index, total dietary intake of selected vitamins/food components and self reported assessment of food security. Although several significant associations emerged, the study's hypotheses were not supported. For example, frequency of neighbor visits was inversely related to total food energy intake (TFEI) as well as calcium intake. Church attendance was positively associated with TFEI, fiber intake and the odds of having a BMI classified as overweight. This study will heighten the awareness of clinicians, health educators and policy makers to the potential impact of the social network on dietary intake. It emphasizes the need for research that addresses the frequency and quality of the social interactions and more diversity within the sample.Item Effects of Practical Needs and Familism Values on Living Arrangements Among Korean-Born Immigrant Widows in the U.S.: Living Alone vs. Living with Adult Children(2006-01-26) Cho, Ji-Young; Wallen, Jacqueline; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The general understanding of living arrangements of Korean-born immigrant elders is based on the popular American myth that immigrants from Asian culture tend to live together because they value living together. However, this study focuses on the importance of practical needs of elderly widows and their adult children in determining of residential status of elderly widows. The purpose of this study is to examine the relationship between elderly widows' needs, adult children's needs, familism values as a traditional value, and living arrangements among Korean-born immigrant elderly widows in the U.S. Structured interviews of 103 Korean-born immigrant elderly widows were conducted. This study included only elderly widows; therefore, the assessment of adult children's familism values and needs was based on their elderly mothers' perceptions. From environmental press theory, need contingent exchange theory, and previous studies, daycare needs of adult children, economic needs and health needs of elderly parents, and social-emotional needs of both were identified. The relationship between age of elderly widows and co-residence was linear in this sample, showing that as elderly parents became older, the percentage of co-residence within each age group decreased. It was found that adult children's total needs had interacted significantly with age of elderly widows in influencing living arrangements while elderly widows' total needs did not have a significant interaction effect with age of elderly widows. While higher elderly widows' total needs were associated with higher rates of co-residence irrespective of elderly parent's age, higher adult children's total needs were associated with higher rates of co-residence among the young-old (age 60-69) and old-old (70-79) groups than the oldest-old (80 and above) group. Lastly, familism values of elderly widows and adult children as perceived by elderly parents were not related to the likelihood of co-residence when needs variables were controlled. Overall, the results showed that the greater elderly widows' total needs, and the greater adult children's total needs, the more likely elderly widows were to co-reside rather than to live alone. As a result, the findings of this study supported environmental press theory and need contingent theory rather than a cultural preference explanation of co-residence rates.