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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Item EXAMINING RACISM AS A RISK FACTOR FOR UTERINE FIBROIDS AMONG AFRICAN AMERICAN WOMEN(2020) Porter, Shyneice; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Uterine fibroids are a common gynecological condition among women. African American women, however, are particularly susceptible to developing fibroids; in fact, approximately 80-90% of African American women are diagnosed with the condition by age 50. Left untreated, these benign tumors can reduce fertility and increase the risk of pregnancy complications. Despite the high prevalence of uterine fibroids among African American women and the detrimental effects they may have on reproductive health, little is known about the risk factors associated with fibroid development among this demographic. To address this gap in the literature, the proposed study used data collected from 699 African American women in the southern region of the United States. This study was guided by an adapted racism and health framework as well as an expanded ABC-X model that includes elements of the mundane extreme environmental stress theory. Structural equation modeling was used to examine the relationship between perceived and internalized racism, the interaction between the two racism variables, and uterine fibroid diagnosis among African American women. The study also investigated depressive symptomology and body mass index as mediators of the proposed relationships. Results revealed a direct effect between perceived racism and the likelihood of a uterine fibroid diagnosis (β = .172, SE = .05, p < .001, OR = 1.19 [95% CI = 1.08, 1.31]). There was not a direct effect, however, between internalized racism and fibroid diagnosis, or the racism interaction variable and fibroid diagnosis. Perceived racism (β = .214, SE = .03, p < .001), internalized racism (β = .108, SE = .04, p < .01), and the racism interaction term (β = .067, SE = .03, p < .05) were positively and significantly associated with depressive symptomology. There was no evidence of full or partial mediation through the proposed mediators. The present study is among the first to examine two forms of racism as critical psychosocial risk factors for an adverse reproductive health outcome that differentially impacts African American women. The findings have important implications for clinical practice and policy that may aid in the effort to address racial disparities related to uterine fibroid development.Item Life Course Events and Reproductive Function: Examining the Long-Term Influence of Stress on Women's Fertility and Reproductive Health Over the Life Course(2019) Gleason, Jessica L; Thoma, Marie E; Moser Jones, Marian; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Over the last decade, infertility, or the inability to achieve pregnancy after 12 months of trying, has risen to a place of public health prominence, with links being made to cardiovascular disease, diabetes, cancer, and other chronic disease. The mechanisms linking infertility to later-life morbidity are unclear, but are most likely due to shared physiologic pathways, such as chronic perturbation of the stress response axes. This investigation had three primary aims: understanding the current state of the research on psychosocial factors as precipitants of infertility by conducting a systematic scoping literature review; exploring associations between infertility-related conditions, endometriosis and uterine fibroids, and chronic inflammation and telomere attrition; and, examining the temporal influence of early life stress on infertility. For the first aim, few studies were identified that directly explored a temporal association between psychosocial factors and infertility, though these studies support the plausibility of this association. For the second aim, women with endometriosis had higher odds of having elevated levels of the inflammatory biomarker, C-reactive protein, and their telomeres shortened at a rate of 1% for every year of diagnosis of their condition. Black women with endometriosis had 13.6% shorter telomeres than those without endometriosis. For the third aim, the experience of stressful life events (SLEs) was associated with elevated odds of infertility, which increased with each increasing event, such that women reporting three and four or more events had 1.68 (CI: 1.16, 2.42) and 1.88 (CI: 1.38, 2.57) higher odds, respectively. Maternal responsiveness moderated this association, such that those with lower responsiveness had higher increasing odds of infertility with the experience of two, three, or four or more events (OR=1.98, CI: 1.01, 3.93; OR=2.63, CI: 1.18, 5.89; OR=3.07, CI: 1.53, 616). The results of this investigation indicate that there may be a temporal association between stress and infertility. Additionally, given their associations with reproductive function, inflammation and stress may be part of the shared mechanisms linking infertility to poor overall health, as well as future health outcomes.Item Examining the Association Between Infertility, Pregnancy Intention, and Postpartum Depression(2019) Barber, Gabriela Anita; Steinberg, Julia R; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)While much research has studied postpartum depression (PPD), few studies have examined PPD in women who become pregnant through the use of fertility treatments. The process of experiencing infertility and its treatment may alter the risk of developing PPD. We utilized data from The Pregnancy Risk Assessment Monitoring System (PRAMS; unweighted N=145,036) to compare PPD symptomatology between women who had unintended pregnancies (an at-risk group for PPD), women who conceived naturally/intentionally, and women who conceived using fertility services. We show that women who used fertility treatments did not differ from women who conceived naturally in regards to PPD. The women who utilized fertility enhancing drugs in comparison to insemination or assisted reproductive technologies had higher depressive symptoms. Therefore, our results suggest that the type of fertility treatment utilized may be important for clinicians to consider when working with these women as they transition into the postpartum period.