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 Exploring Young Bi+ Women's Intersecting Mental Health and Sexual and Reproductive Health Experiences in Context: A Multi-Analytic Method Qualitative Study(2023) Robinson, Jennifer Lynn; Aparicio, Elizabeth M; Butler, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Young bi+ women report worse mental health and sexual and reproductive health (SRH) outcomes compared to gay, lesbian, and straight young adults. They experience intersecting threats to their health and well-being due to their sexuality, gender, and stage of development. There is a lack of research on bi+ women’s unique mental health and SRH experiences, and often bi+ women are overlooked due to bi-erasure and biphobia. Regressive policies related to LGBTQ+ and women’s rights, including increased restrictions to reproductive healthcare after the Dobbs v. Jackson Women’s Health Organization decision overturning abortion protections, further threaten bisexual women’s health. This dissertation used a multi-analytic method qualitative approach to explore the intersecting mental health and SRH experiences of young bisexual women in the current socio-political context. Semi-structured in-depth interviews were conducted over Zoom with 16 young bi+ women from across the U.S. A narrative inquiry approach was used to explore young bi+ women’s mental health experiences and coping strategies. In addition, thematic analysis was used to investigate how young bi+ women describe their mental health as intersecting with their SRH in the current socio-political context. The study yielded rich and nuanced information about challenges these young bi+ women experienced throughout their lives that affected their mental health and SRH. Experiencing trauma had far-reaching negative effects on their mental health. Participants discussed the challenges of forming their identity within the social context, particularly as bi+ women in a society that often invalidates bisexual identities and subjugates women. They also discussed the joys along with difficulties of navigating young adulthood. They further described coping with challenges in a variety of adaptive (e.g., therapy, exercise) and maladaptive (e.g., substance use, self-injury) ways. They discussed relying on social support such as partners, friends, family, therapists, and teachers. Participants desired more support with sexuality-related issues, particularly in early adolescence. These bi+ women described their mental health and SRH as intertwined and discussed how bodily autonomy and agency were essential to their well-being. The socio-political context, including social norms, rhetoric, and federal- and state-level policies, influenced participants’ well-being. The current study shows that young bi+ women face unique threats to their mental health and SRH. Practice implications include improving access to affordable and LGBTQ+-affirming healthcare and developing interventions attuned to the needs of young bi+ women. Policies are needed that uphold the choice and agency of young women in their reproductive health decision-making. Future research should continue to explore the needs and experiences of young bi+ women concerning their mental health and SRH including demographic differences along with potential mechanisms resulting in poorer health.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.