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 "Alexa, do I have an STD?": An Exploration of Young Adult Information Seeking Behaviors When Engaging With Home Assistant Devices About Sexually Transmitted Infections(2023) Siddiqui, Junaed Ahmad; Baur, Cynthia; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)BACKGROUND: Sexually transmitted diseases and infections continue to disproportionately affect young adults in the United States, with half of all new STIs annually occurring in young adults between the ages of 15 and 24. Advances in digital technologies have allowed for the facilitation of fast and discreet information about sexual health but remains understudied in the context of newer technologies. There is limited research on the effectiveness of Home Assistant Devices as channels to facilitate the information seeking process in young adults. To address this gap, this study explored whether Home Assistant Devices can facilitate the sexual health information seeking process in young adults between the ages of 18 and 26 who already use the internet to search for health information. The purpose of this dissertation was to explore the perspectives of young adults to understand the depth of their sexual health information needs and whether a user-centric designed HAD can be a suitable alternative for fulfilling those information needs. METHODS: Informed by the Theory of Motivated Information Management and Technology Acceptance Model, this qualitative study used the Design Thinking framework to understand young adults’ information needs and created a prototype voice skill to address that need. In-depth interviews were conducted virtually on Google Meet or Zoom and were recorded. This qualitative study occurred in three phases: in the first phase, 10 young adults were interviewed about their information seeking needs, current gaps, and how they thought Home Assistant Devices could fill that need. Insights from those interviews were then analyzed and used to create a prototype that would address sexual health information needs. The prototype was then tested with a new group of ten young adults, and their reactions to the prototype was recorded via interviews. In the third phase, the prototype was refined based on feedback from the previous group, and then re-tested with a new group of 10 young adults. In total, in depth interviews were conducted virtually with 30 young adults to understand information needs and create a prototype voice skill that could serve to facilitate the transfer of sexual health information in a convenient and relevant manner. Inductive thematic analysis was conducted to identify emergent themes. RESULTS: Overall, the sample (n=30) was 63% female, 43% White, with 53% having completed a bachelor’s degree, and 47% having owned a Home Assistant Device for over 12 months. The average age of the sample was 24 years old. After analyzing interviews through inductive thematic analysis in NVivo, four themes that were noted in the first phase as it related to Home Assistant Devices and information needs: the use of HADs as a means of convenience, preferring to use screen-based devices for research, tradeoffs between privacy and functionality, and the ability to emergency triage users for medical attention based on symptoms. Three main themes emerged in the second phase after reacting to the first version of the prototype, including anxiety and frustration when experiencing the unknown, pre-existing positive perceptions of Home Assistant Devices, and negative perceptions of Home Assistant Devices. In the third phase, two main themes emerged: a desire to share visuals to build comfort and bridge the information gap, and an ambivalence towards privacy. DISCUSSION: Privacy concerns remain prominent with Home Assistant Devices when engaging with them for information seeking purposes. These concerns are sometimes met with ambivalence by young adults, who were willing to trade some of their privacy for added features or functionality that could improve their user experience. Furthermore, challenges remain with voice search and screen-based devices are perceived to be easier to use. Lastly, the sexual health information seeking process is sensitive, and many young adults in this sample expressed wanting to have a more personalized experience that acknowledged their specific situations. To the author’s knowledge, this is the first study that explored the factors contributing to the sexual health information seeking process using Home Assistant Devices among young adults between the ages of 18 and 26. The results of this study have several implications for public health practice and research, especially as it relates to the Design Thinking approach for public health voice skill development, as well as addressing a new approach to providing sexual health information to young adults that may be more discreet and relevant to them. The findings from this study contribute to the emerging literature base on the use of Home Assistant Devices to address sensitive health information seeking behaviors.Item THE INFLUENCE OF WATERPIPE LOUNGE MENU LABELING ON INTENTION TO QUIT SMOKING AND PERCEIVED HARM, RISK AND ADDICTION AMONG YOUNG ADULT WATERPIPE TOBACCO SMOKERS IN THE UNITED STATES(2020) Kidanu, Azieb; Feldman, Robert H; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In the US, young adults 18 to 24 years of age have experienced the most notable decline in smoking rates from 24.4% in 2005 (Mariolis et al., 2006) to 7.8% in 2018 (Creamer, 2019). However, alternative tobacco products, such as waterpipes (also known as hookahs), are increasingly becoming the first product used by tobacco-naïve young adults and may be a gateway to nicotine addiction (Meier, Tackett, Miller, Grant, & Wagener, 2015). Tobacco surveillance measures show that among young adults in the US, 44.3% reported ever use (lifetime) and 10.7% current use (every day and someday) of waterpipe tobacco (Kasza et al., 2017). Although public health best practices for communicating the harms of tobacco use are well-established in traditional products, such as cigarettes, there is a critical knowledge gap on how to properly communicate the harms of waterpipe tobacco smoking (WTS) to current and potential consumers. In this dissertation, two independent studies were conducted to examine the effect of health-related information on waterpipe lounge menus on intention to quit smoking, as well as perceived relative harm, perceived risk of health consequences and perceived relative addiction.The overall results of Study 1 and Study 2 were consistent with prior research showing that brief health warning messages and nicotine content may increase intention to quit smoking, as well as perceived harm and risk of health consequences (Mays, Tercyak, et al., 2016). In addition, the research expands this evidence by demonstrating that the waterpipe lounge menu is a viable location for delivery of health education messages and product labeling. These findings may be used in future research to design further health communication experiments for WTS, as well as support practice and policy decisions for health warning messages and product labeling specific to waterpipe tobacco.Item Co-occurring Tobacco and Marijuana Use among Young Adults: A Sequential Explanatory Mixed Methods Study(2018) Seaman, Elizabeth Lucy; Fryer, Craig S.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Tobacco use is the greatest cause of preventable death in the United States and an important health behavior to study among young adults. Prior research has suggested that there is an association between tobacco and marijuana use. Studying these two substances together can provide important insight into patterns of young adult tobacco and marijuana initiation and continuation. This dissertation employed a Sequential Explanatory Mixed Methods design to study tobacco and marijuana co-use among young adults 21-30 years old. Quantitative data analyses used National Health and Nutrition Examination Survey (NHANES) data to assess prevalence of cigarette and marijuana co-use (Aim 1), and characteristics of co-users (Aim 2) over a 10-year period (2005-2014). Prevalence of past-month cigarette use decreased from 30.9% in 2005-2006 to 23.7% in 2013-2014 (p = 0.024) while both past-month marijuana use (average 18.0%) and past-month co-use (average 9.8%) remained stable between 2005 and 2014. Prevalence of past-month co-use differed significantly by gender (p < 0.001) and racial and ethnic group (p < 0.001). Education level, marital status, race and ethnicity, ratio of income to the poverty level, depressive symptoms, non-marijuana illicit drug use, alcohol use, and household tobacco exposure differentiated co-users from neither users in a multinomial regression. Results from analyses of NHANES data, prior literature, and theoretical constructs were used to develop a guide for 20 in-depth interviews with young adult co-users living in the state of Maryland (Aim 3). Interviewees reported two modes of co-use: simultaneous and sequential. Participants reporting using tobacco as a replacement for marijuana in situations where they cannot access or use marijuana, suggesting the two products play similar yet distinct roles in co-use. Influences across levels of the Social Ecological Model were salient in young adults’ co-use. Quantitative results and qualitative findings were interpreted together, and five mixed methods meta-inferences emerged as important in understanding co-use. The co-use of tobacco and marijuana is an important behavioral phenomenon to study among young adults. Tobacco and marijuana co-users have unique characteristics compared to tobacco-only and marijuana-only users. Qualitatively, co-users described patterns of product use and replacement that illustrate the complexity of co-use behaviors.Item Longitudinal Effects of Mother-Daughter Relationships on Young Women's Sexual Risk Behaviors(2011) Berger, Amanda Tennyson; Hofferth, Sandra; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Among adolescent and young adult women, sexual risk behaviors represent a critical public health concern. This study used Waves I, II, and III of the National Longitudinal Survey of Adolescent Health to compare two theories of maternal influence on daughters' sexual risk behaviors: parenting style versus social learning theory. Associations between maternal parenting style (based on Wave I warmth and control) and mother-daughter communication about sex (based on Wave I comfort and frequency of communication about sex) and adolescent and young women's sexual risk behaviors (Wave II and III inconsistent condom and contraceptive use and multiple partnerships) were examined. Further, this study examined whether these associations were mediated by socioemotional characteristics (sexual self-efficacy and risk-taking behaviors) or by sexual knowledge (sexual health knowledge and perceived barriers to contraception), respectively. Controlling for covariates, results indicated that in adolescence: 1) authoritarian and permissive parenting were associated with an increased risk of inconsistent condom use, though this association was attenuated by socioemotional and sexual knowledge risk characteristics, whereas infrequent, uncomfortable communication about sex was associated with a decreased likelihood of inconsistent use; and 2) authoritarian parenting was associated with an increased risk of inconsistent contraceptive use, also attenuated by the addition of socioemotional and sexual knowledge risk characteristics to analyses. Results further indicated that in adulthood: 3) parenting style was not associated with inconsistent condom or contraceptive use, but may have an indirect effect on inconsistent condom use, and that uncomfortable communication about sex was associated with a decreased likelihood of inconsistent contraceptive use; and 4) parenting style was not associated with lifetime sex partnerships, but authoritarian and neglectful parenting were associated with higher numbers of past year partners. These findings indicate that both parenting style and mother-daughter communication about sex may serve as predictors of girls' sexual risk-taking in adolescence and young adulthood and should be areas of focus when implementing sexual health prevention and intervention programs. In particular, this study provides support for utilizing parenting styles in understanding how mothers influence daughters' sexual risk-taking behaviors, however future research should examine the ways in which other variables mediate and moderate these effects.