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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Now showing 1 - 7 of 7
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    Predictors of maternal health services utilization by poor, rural women: a comparative study in Indian States of Gujarat and Tamil Nadu
    (Springer Nature, 2015-07-31) Vora, Kranti Suresh; Koblinsky, Sally A.; Koblinsky, Marge A.
    India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world’s largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women’s access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women’s use of maternal health services in Gujarat and Tamil Nadu. Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women’s education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands’ education predicted institutional delivery in Gujarat. Overall, assistance from health financing schemes, good road access to health facilities, and socio-demographic and obstetric factors were associated with differential use of maternity health services by poor, rural women in the two states. Policymakers and practitioners should promote financing schemes to increase access, including consideration of incentives for antenatal care, and address health system and social factors in designing state-level interventions to promote safe motherhood.
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    Tobacco cues in India: An ecological momentary assessment
    (BioMed Central, 2016) Borzekowski, Dina L. G.; Chen, Julia Cen
    Background: Tobacco use in India is a major health concern; however, little is known about the influence of tobacco-related social and environmental cues on tobacco use. This study uses ecological momentary assessment (EMA) to examine real-time tobacco use and exposure to social and environmental cues. Methods: In Hyderabad and Kolkata, participants were recruited, and an EMA application was installed on their mobile phones. Momentary prompts (MP) were randomly used to collect real-time information and end-of-day (EOD) prompts gathered retrospective information on daily basis. Besides personal tobacco use, the surveys asked about exposure to social (e.g., presence of others using tobacco) and environmental cues (e.g., visual and olfactory stimuli). Using the data aggregation approach, bivariate and multivariate analyses were performed to examine the association of tobacco use and cue exposure. Moderating roles of participants’ socio-demographic characteristics were also tested to gain an in-depth understanding of the relationship. Results: Among the 205 participants, around a third (MP, 33.7 %; EOD, 37.6 %) used tobacco at least once during the study period. Tobacco-related social and environmental cues related were commonly reported. In the bivariate models, tobacco use was associated with gender, age, and all the examined social and environmental cues except for seeing restrictions on tobacco use. In the multivariate models, tobacco use was associated with age, gender, seeing others using tobacco, and seeing restrictions on tobacco use. Seeing others in one’s immediate group using tobacco was the strongest predictor of tobacco use in both MP and EOD assessments. Gender and age did not moderate the relationship between cue exposure and tobacco use, although males reported higher tobacco use and cue exposure in general. Conclusions: This research provides data on the ubiquity of social and environmental tobacco cues in India. The EMA approach was feasible and informative. Future cessation interventions and advocacy efforts should address the high prevalence of tobacco use and exposure to pro-tobacco use cues especially among Indian males. Health education campaigns for promoting tobacco use restrictions in private places as well as changing the norms of tobacco use in social settings are recommended.
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    DOMESTIC VIOLENCE EXPOSURE, MATERNAL EDUCATION, AND MATERNAL AUTONOMY AS PREDICTORS OF INDIAN WOMEN'S USE OF MATERNAL HEALTH SERVICES AND INFANT LOW BIRTH WEIGHT
    (2015) Duggal, Mili; Koblinsky, Sally A; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    India contributes disproportionately to the world's maternal mortality ratio and rate of infant low birth weight. Securing adequate antenatal care and delivery in a hospital or health facility are key strategies aimed at improving India's maternal and infant health outcomes. This study utilized the National Family Health Survey-3 (NFHS-3) to investigate predictors of Indian women's use of maternal health care services and delivery of a low birth weight infant. The ecological model of health was used to examine how the individual level factor of maternal education and the relationship level factors of women's domestic violence exposure and maternal autonomy were related to maternal and infant outcomes. Specifically, the study examined the role of physical violence, psychological violence, sexual violence, maternal education, and maternal autonomy in predicting women's receipt of adequate antenatal care, institutional delivery, and likelihood of delivering a low birth weight child. The study utilized NFHS-3 data from 2005-06 with a sample of 4,983 Indian women who gave birth in the previous year. This survey was the first to include a module addressing three different types of domestic violence exposure within the marital relationship. Findings revealed that 19% of women reported experiencing physical violence, 10% reported psychological violence, and 8% reported sexual violence in the previous year. Multivariate logistic regression analyses examined the association between the targeted maternal variables and women's use of maternity health services and infant low birth weight. Domestic violence emerged as a risk factor, with physical violence predicting less adequate antenatal care and higher likelihood of low infant birth weight. Psychological violence predicted lower likelihood of adequate antenatal care and institutional delivery, and sexual violence was associated with a lower likelihood of institutional delivery. In contrast, both maternal education and maternal autonomy emerged as protective factors. Maternal education was predictive of adequate antenatal care, institutional delivery, and lower likelihood of infant low birth weight, while maternal autonomy predicted institutional delivery and lower likelihood of delivering a low birth weight infant. Implications of the findings for policy makers, public health practitioners, and educators seeking to improve maternal and infant outcomes in India are discussed.
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    SECONDARY DATA ANALYSIS INVESTIGATING THE UTILITIES OF ECOLOGICAL MOMENTARY ASSESSMENTS TO UNDERSTAND SMOKING ENVIRONMENTS IN INDIA
    (2014) Strausser, Amanda; Fryer, Craig S; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    In the 21st century, India has become one of the most affected countries by tobacco mortality in the world (Perry, 2009).The aim of this secondary data analysis was to determine the utility of Ecological Momentary Assessments (EMA) to better understand the perceived social and environmental cues that encourage and discourage tobacco use in India. However, published EMA studies have only been conducted in western countries. This thesis was shaped by three research questions: What are individuals' tobacco behaviors and environments in India, does tobacco use and tobacco environments reported at baseline differ from EMA and end of day (EOD) data, and are there differences by age, gender, education or work status in the average number of completed EMA and EOD? Univariate and bivariate analyses were conducted as part of the analysis plan. The analysis from this thesis will help direct future EMA research, particularly in non-western countries.
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    Postcolonial Play: Encounters with Sport and Physical Culture in Contemporary India
    (2012) Maddox, Callie Elizabeth; Andrews, David L; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Drawing upon the idea that India and the West are "tethered geographies" (Reddy, 2006), this dissertation project explores how the ongoing and dialogic relationship between contemporary India and the West is represented, experienced, and contested in and through the realms of sport and physical culture. With escalating rates of economic growth, a rapidly expanding middle class, and increasing international political clout, India is emerging as a global power while simultaneously defining itself as a postcolonial nation against, and in tandem with, the West. Utilizing a fluid theoretical vocabulary (Andrews, 2008) and employing mixed qualitative research methods that include participant observation and interviews, I examine how various sites of physical culture serve as points of meaningful exchange between India and the West. This project presents a necessarily partial and contingent understanding of the chosen sites, tempered by considerable reflexivity and self-awareness, as my own Self is intricately enmeshed in this work. The four distinct, yet related, empirical studies that comprise this project thus focus on the following: 1) the embodiment of gendered nationalism and male power as manifested by the Cheer Queens, a cheerleading squad supporting the Pune Warriors cricket team in the Indian Premier League, and the Great Khali, a professional wrestler from India who performs internationally for World Wrestling Entertainment; 2) the city of Delhi's efforts to (re)create itself as a "world class" metropolis by hosting the 2010 Commonwealth Games that resulted in spatial exclusion and the magnification of social inequalities; 3) changing body ideals amongst the young Indian middle class influenced by Western fitness practices and neoliberal discourses of healthism; 4) perceptions of authenticity held by Western tourists traveling to India to study Ashtanga yoga that reject the syncretic evolution of yoga and contribute to a construction of Otherness that continues to mark India and Indians as exotic, primitive, and poor. Also included is an "interlude" chapter centered on my personal experiences as a white, Western woman navigating the complexities of daily life in India and questioning the place of my own body within a context of fear, harassment, and assault.
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    Analysis of Factors Associated With Tuberculosis Outcomes in District Kullu, India
    (2012) Stone, Heather; Lee, Sunmin; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    India is the country with the largest number of tuberculosis (TB) cases, contributing 20% of the global burden of infection (1) and 2 million cases annually (2). However, few if any studies have examined the epidemiology of TB in the Northern state of Himachal Pradesh. This study is a retrospective review of medical records of all tuberculosis patients (N=1086) seen at the two hospitals in Manali, District Kullu, Himachal Pradesh, India between 2008-2011. The analysis determined that being younger, female, living in a town, and/or a patient at Mission Hospital, were factors significantly associated with having extrapulmonary versus pulmonary tuberculosis (EPTB). Being older was associated with an increased likelihood of previous/complex treatment compared to new patients. Being female, from a town, and/or older were associated with receiving a non-standard regimen. Finally, patients who were previously treated/complex were significantly more likely to receive a non-standard regimen than new patients.
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    Implementation of Janani Suraksha Yojana and other maternal health policies in two Indian states: Predictors of maternal health service utilization among poor rural women
    (2012) Vora, Kranti Suresh; Koblinsky, Sally; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Poor, rural women in India contribute disproportionately to the nation's high maternal mortality ratio. In response to this problem, the Indian government launched a conditional cash transfer scheme, "Janani Suraksha Yojana (JSY)," in 2005 to increase poor women's access to maternal health care. The state of Tamil Nadu reorganized public health system resources and the state of Gujarat contracted with private providers to implement the scheme in rural areas. This study investigated the role of JSY/government assistance, and other health care sector and household factors in predicting poor, rural women's utilization of maternal health services in the two states. Health care sector factors included receipt of JSY payment, availability of a primary health center with round-the-clock services, and connection to a health facility by an all-weather road. Household factors included maternal education, paternal education, age at first birth and parity. Use of four maternal health care services was examined: adequate antenatal care, institutional delivery, private facility delivery and Cesarean section. State findings were compared and contextualized by examining health polices/practices and health infrastructure within each state. The study employed secondary data analyses using District Level Household Survey (DLHS)-3 data, with a sample of 2,267 rural women from the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between identified factors and maternal health care utilization in the two target states. Overall, Tamil women had better access to maternal health care services than Gujarati women. JSY payment predicted use of private facility deliveries in Gujarat, which incentivized use of private providers, but not institutional deliveries in Tamil Nadu where women also received cash regardless of the place of delivery. JSY payment did not predict adequate antenatal care, which was not incentivized. Access to an all-weather road predicted institutional deliveries in both states and adequate antenatal care by Tamil women. Maternal education was a significant predictor of maternal health services utilization in Tamil Nadu, while paternal education predicted such usage in Gujarat. Parity significantly predicted poor, rural women's use of all services. Implications of the findings for strengthening conditional cash transfer schemes and improving maternal health care services are discussed.