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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    YO SOY PAZ (I AM PEACE): PILOT STUDY OF A TRAUMA-INFORMED, COMMUNITY AND MINDFULNESS-BASED PROGRAM FOR LATINO IMMIGRANTS IN MARYLAND.
    (2022) Munoz, Juliana; Green, Kerry M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background: One in three Latinos in the US is an immigrant. Immigrants face particular stressors that are heightened by previous traumatic experiences before, during, and after migration. Latino populations report the highest level of stress of all racial/ethnic groups in the US and the second-highest prevalence of mental health illness. Mindfulness-Based Interventions (MBIs) have shown to be successful at reducing stress and strengthening mental health in diverse populations, yet little is known about the effects of these interventions on this particular population.Methods: The pilot study tested the Yo Soy Paz (I am Peace) online synchronous program, an evidence and trauma-informed mindfulness-based intervention that was adapted for immigrant Latina mothers and the community staff members that work with them in a community setting. The eight session pilot intervention was delivered to three cohorts for a total of 41 participants, including staff and parents of youth receiving services at a local community-based organization that serves Latino immigrants. The study used the Consolidated Framework for Implementation Research (CFIR) to examine the feasibility, acceptability, appropriateness, and fidelity of the Yo Soy Paz online program. The study also examined the initial effects of the program on stress, mindfulness, mind-body connection, and subjective well-being. Qualitative and quantitative data were collected through self-reported pre-post questionnaire, fidelity checklists, and focus groups with parents and staff. Results: Acceptability, feasibility, fidelity and appropriateness scored high on the quantitative measures. Inner compatibility with the organization’s mission and vision, clients’ needs and the organization’s receptivity to implement the intervention scored in the medium range. Mothers’ and promotoras’ self-reported mean scores for subjective wellbeing and perceived physical and mental health increased significantly from baseline- to post-test. No significant changes were observed in surveys completed by the staff, even though focus group participants reported meaningful improvement. Discussion: Overall the pilot feasibility study was well received and relevant for the organization and the population they serve. MBIs for Latino immigrants and the staff that works with them have the potential to improve well-being and overall mental and physical health. The study’s findings provide guidance to others in implementing online mindfulness practices with Latino immigrants and the staff that works with them.
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    Role of life events in the presence of colon polyps among African Americans
    (Springer Nature, 2013-06-12) Ashktorab, Hassan; Namin, Hassan Hassanzadeh; Taylor, Teletia; Williams, Carla; Brim, Hassan; Mellman, Thomas; Shokrani, Babak; Holt, Cheryl L; Laiyemo, Adeyinka O; Nouraie, Mehdi
    African Americans have disproportionately higher incidence and death rates of colorectal cancer among all ethnic groups in the United States. Several lifestyle factors (e.g. diet, physical activity and alcohol intake) have been suggested as risk factors for colorectal cancer. Stressful life events have also been identified as risk factors for colorectal cancer. The association between stressful life events and colon polyps, which are precursors of colorectal cancer, has yet to be determined. We aimed to evaluate the relationship between stressful life events and the presence of colon polyps and adenomas in African American men and women. In this cross-sectional study, 110 participants were recruited from a colon cancer screening program at Howard University Hospital. Participants completed an 82-item Life Events Questionnaire (Norbeck 1984), assessing major events that have occurred in the participants’ life within the past 12 months. Participants also reported whether the event had a positive or negative impact. Three scores were derived (total, positive, and negative). Total life events scores were higher (Median [M] = 29 and Interquartile range [IQR] = 18-43) in patients with one or more polyps compared to patients without polyps (M, IQR = 21,13-38; P = 0.029). Total, positive or negative Life Events scores did not differ significantly between normal and adenoma patients. Total, negative and positive Life Events scores did not differ between patients who underwent diagnostic colonoscopy (symptomatic) and patients who underwent colonoscopy for colon cancer screening (asymptomatic) and patients for surveillance colonoscopies due to a personal history of colon polyps. Linear regression analysis indicated that male gender is associated with 9.0 unit lower total Life Events score (P = 0.025). This study suggests that patients who experienced total life events may be at higher risk of having colon polyps and adenomas which indicates an association between stress and the development of colorectal polyps.
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    Allostatic load amplifies the effect of blood lead levels on elevated blood pressure among middle-aged U.S. adults: a cross-sectional study
    (Springer Nature, 2013-08-16) Zota, Ami R; Shenassa, Edmond D; Morello-Frosch, Rachel
    Scientists and regulators have sought to understand whether and how physiologic dysregulation due to chronic stress exposure may enhance vulnerability to the adverse health effects of toxicant exposures. We conducted a cross-sectional study to determine whether allostatic load (AL), a composite measure of physiologic response to chronic exposure to stress, amplifies the effect of lead exposure on blood pressure among middle-aged adults. We analyzed associations between blood lead levels and blood pressure in a nationally representative sample of 8,194 U.S. adults (aged 40-65 years) participating in the National Health and Nutritional Examination Survey, 1999--2008. Outcomes were elevated systolic (≥ 140 mm Hg) and diastolic (≥ 90 mm Hg) blood pressure. AL was defined as the aggregate score of seven components, reflecting dysregulation of the cardiovascular, inflammatory, and endocrine systems. Logistic regression models showed a linear dose-response relationship for quintiles of blood lead and elevated systolic blood pressure in the high AL group (p = 0.03) but not the low AL group (p = 0.24). Similarly, the relationship between lead exposure and elevated diastolic blood pressure was stronger among the high AL group than the low AL group. Within the high AL group, the fourth and fifth quintiles had significantly elevated odds of elevated blood pressure compared to lowest quintile [OR = 1.92, (95% CI, 1.07, 3.47) and OR =2.28 (95% CI, 1.33, 3.91), respectively]. In the low AL group, none of the quintile effects were significantly different than the referent group although there was evidence of a linear trend (p =0.03). The lead by AL interaction term was not statistically significant for either systolic or diastolic blood pressure models. Results suggest that higher AL may amplify the adverse effects of lead on blood pressure. Future research should assess the implications of cumulative exposures to environmental and social stressors for regulatory decision-making.
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    Joint effects of ethnic enclave residence and ambient volatile organic compounds exposure on risk of gestational diabetes mellitus among Asian/Pacific Islander women in the United States
    (Springer Nature, 2021-05-08) Williams, Andrew D.; Ha, Sandie; Shenassa, Edmond; Messer, Lynne C.; Kanner, Jenna; Mendola, Pauline
    Asian/Pacific Islander (API) communities in the United States often reside in metropolitan areas with distinct social and environmental attributes. Residence in an ethnic enclave, a socially distinct area, is associated with lower gestational diabetes mellitus (GDM) risk, yet exposure to high levels of air pollution, including volatile organic compounds (VOCS), is associated with increased GDM risk. We examined the joint effects of ethnic enclaves and VOCs to better understand GDM risk among API women, the group with the highest prevalence of GDM. We examined 9069 API births in the Consortium on Safe Labor (19 hospitals, 2002–2008). API ethnic enclaves were defined as areas ≥66th percentile for percent API residents, dissimilarity (geographic dispersal of API and White residents), and isolation (degree that API individuals interact with another API individual). High levels of 14 volatile organic compounds (VOC) were defined as ≥75th percentile. Four joint categories were created for each VOC: Low VOC/Enclave (reference group), Low VOC/No Enclave, High VOC/Enclave, High VOC/No Enclave. GDM was reported in medical records. Hierarchical logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) between joint exposures and GDM, adjusted for maternal factors and area-level poverty. Risk was estimated for 3-months preconception and first trimester exposures. Enclave residence was associated with lower GDM risk regardless of VOC exposure. Preconception benzene exposure was associated with increased risk when women resided outside enclaves [High VOC/No Enclave (OR:3.45, 95%CI:1.77,6.72)], and the effect was somewhat mitigated within enclaves, [High VOC/Enclave (OR:2.07, 95%:1.09,3.94)]. Risks were similar for 12 of 14 VOCs during preconception and 10 of 14 during the first trimester. API residence in non-enclave areas is associated with higher GDM risk, regardless of VOC level. Ethnic enclave residence may mitigate effects of VOC exposure, perhaps due to lower stress levels. The potential benefit of ethnic enclaves warrants further study.
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    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.
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    The Health Implications of Stress among Asian Americans in the US and Chinese In China: the Effects of Perceived Stress and Caregiving Stress on Cardiovascular Risk Factors
    (2018) Lu, Xiaoxiao; Lee, Sunmin; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Prior research suggests that stress plays a role in the etiology and progression of cardiovascular disease (CVD). To lend a more accurate depiction of the associations between stress and CVD risk factors, this dissertation used a comprehensive approach to conceptualizing stress by assessing two dimensions of stress: perceived stress and caregiving stress. The objective of this dissertation was to investigate the associations between multiple dimensions of stress and the risk factors of CVD. This dissertation also explored the potential mechanisms that underlie the relationships between stress and CVD risk factors. In Paper 1 (Chapter 3), we assessed the associations between perceived stress and hypertension across varying levels of social support and social network among 530 Chinese, Korean and Vietnamese Americans. Results indicated that individuals with high perceived stress were 61% more likely to have hypertension compared to those with low levels of perceived stress (Odds Ratio (OR): 1.61, 95% Confidence interval (CI): 1.15, 2.46). Social support had a direct beneficial effect on hypertension, irrespective of whether individuals were under stress. In Paper 2 (Chapter 4), we used five waves of longitudinal data from the China Health and Nutrition Survey to examine the association between parental caregiving and blood pressure among 2,586 Chinese women. We found that parental caregivers were associated with higher systolic (β-coefficient (β) = 1.16; p ≤ 0.01) and diastolic blood pressure (β = 0.75; p ≤ 0.01) compared with non-caregivers across multiple waves. In Paper 3 (Chapter 5), we investigated the relationship between caregiving trajectory and Metabolic Syndrome (MetS) among 1,636 Chinese women. Three caregiving trajectories were identified by using group-based trajectory analysis. Results showed that ‘rising to high-intense’ caregivers (OR = 1.90; 95% CI: 0.90, 4.00) and ‘stable low-intense’ caregivers (OR = 1.56; 95% CI: 1.06, 2.29) were associated with higher risk of MetS compared with non-caregivers. This dissertation is innovative in its examining the associations of multiple dimensions of stress with CVD risk factors among Asian subgroups. Findings from the proposed study will be used to develop future stress management interventions, and incorporating culturally and linguistically appropriate strategies into community outreach and education to decrease cardiovascular disease risk within the Asian population.
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    Parenting Style as a Moderator between Maternal Trauma Symptoms and Child Psychological Distress
    (2010) Cook, Emily; Leslie, Leigh A; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Current research suggests parents who experience symptoms of trauma transfer distress to their children. The purpose of this study was to understand the possible moderating effect of mothers' parenting style on this relationship. The level of maternal trauma, use of parenting styles, and child psychological distress was examined for a clinical sample (n=113) of mother and child dyads. Results indicated that mothers who experience high levels of trauma symptoms are more likely to parent using authoritarian or permissive behaviors. Mothers experiencing high levels of trauma symptoms who parent with a high use of authoritarian behaviors have children who experience more depression than those whose mothers use fewer authoritarian behaviors. However, mothers experiencing high levels of trauma symptoms who parent with a high use of permissive behaviors have children who experience less depression than those whose mothers use fewer permissive behaviors. The empirical and clinical implications of these findings are discussed.