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 - 8 of 8
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    COMPARISON OF ACRYLAMIDE EXPOSURE BIOMARKERS IN CHILDREN AND ADOLESCENTS USING NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 2003-04 AND 2015-16
    (2024) Vallejo, Jessica Vasquez; Turner, Paul C; Kadry, Abdel; Maryland Institute for Applied Environmental Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Acrylamide (AA) is an important industrial chemical of occupational concern due to its neurotoxicity and probable carcinogenicity; it is also a tobacco burning product and thus contributes to health concerns in smokers. More recently it was discovered to be thermally generated in the cooking of starch-rich foods, creating a potentially wider public health concern. Children and adolescents are a particularly vulnerable group because they consume more acrylamide-rich foods compared to adults. In addition, they are still going through important developmental stages. This study examines AA and its metabolite glycidamide (GA) using hemoglobin adduct biomarkers (HbAA and HbGA respectively) from the U.S. children (6-11) and adolescents’ (12-19) National Health and Nutrition Examination Survey’s 2003-04 (n=2814) and the 2015-16 (n=697). The study investigated changes in exposure over time and examined the contribution of potential modifiers including smoking status, race/ethnicity, poverty-to-income ratio, sex, and age. All HbAA and HbGA are reported as pmoL adduct per gram Hb (pmol/G Hb).Overall, HbAA biomarkers significantly (p<0.0001) declined from 2003-04, GMs (95% CI) (57.9 [55.7, 60.1] pmol/G Hb) versus (42.8 [41.4, 44.2] pmol/G Hb) in 2015-16 for all ages, with similar reductions observed in the individual children and the adolescent groups. Smokers had a higher burden of HbAA biomarkers than non-smokers, and with a significant reduction in numbers of smokers from 2003-04 to 2015-16, this likely contributes to the reduction in overall exposure. When non-smokers only were examined, a significant (p<0.0001) decrease in HbAA was still observed, from 2003-04 GMs (95% CI) (53.4 [52.0, 54.9] pmol/G Hb) versus (41.2 [40.2, 42.2] pmol/G Hb) in 2015-16, suggesting an additional contribution of changes in AA levels in food or frequency of high-risk food consumption. Similar statistically significant reductions were seen for both children and adolescent groups separately. HbGA is a marker of AA biotransformation to GA, which is a more mutagenic metabolite of AA. The ratio is of HbAA:HbGA is a phenotypic marker of mutagenic risk. In non-smokers, there was a significant (p=0.001) difference in the HbAA:HbGA ratio in children GMs (95% CI) (0.8 [0.8, 0.8] pmol/G Hb) at 2003-04 and (0.9 [0.9, 1.0] pmol/G Hb) at 2015-16 versus adolescents (1.0 [1.0, 1.1] pmol/G Hb) at 2003-04 and (1.1 [1.0, 1.2] pmol/G Hb) at 2015-16, respectively, suggesting children may be at greater risk to the mutational effects of AA exposure compared to adolescents. In multivariate regression analysis of non-smokers only, age and race significantly contributed to the HbAA biomarker levels, with higher HbAA in younger age groups and in non-Hispanic black participants, highlighting a disparity in exposure pattern. Overall, AA exposure seems to have reduced from 2003-04 to 2015-16; the reduction is driven by both changes in smoking but also diet. The young and non-Hispanic black participants remain at highest risk of exposure and potential health effects from exposure to AA.
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    Emotions, Strategies, and Health: Examining the Impact of an Educational Program on Tanzanian Preschool Children
    (MDPI, 2022-05-12) Kauffman, Lauren E.; Dura, Elizabeth A.; Borzekowski, Dina L. G.
    Around the world, well-produced television programming can engage vulnerable, hard-to-reach audiences by offering informal education and enrichment. Akili and Me is an animated children’s educational program available in Sub-Saharan Africa that provides age and culturally appropriate lessons. In 2018, the producers created socio-emotional and health content. This study examines the relationship between children’s exposure to the new Akili and Me content and socio-emotional and health outcomes. Participants included low-income school children (mean age 5.32 years, SD = 0.82) from Arusha, Tanzania. Researchers conducted one-on-one baseline and post-intervention surveys with each participant. Over 12 weeks, the children attended afterschool sessions with screenings of Akili and Me, with distinct content screened on different days. The research team recorded children’s attendance and assessed children’s receptivity to the program through character identification. Using MLM regression models with data from 411 participants from 10 public schools, the analyses showed that a greater exposure and receptivity to Akili and Me predicted improved outcomes scores on the socio-emotional and health outcomes, controlling for sex, age, baseline scores, and general media receptivity (non-Akili and Me characters). Contributing to the literature on educational media, this study shows that exposure to an animated program can teach vulnerable preschool children socio-emotional and health content.
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    Parental Health Literacy, Empowerment, and Advocacy in the Context of Food Allergies Management in Schools
    (2021) Koo, Laura Warnock; Baur, Cynthia E; Horowitz, Alice M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background: Health literacy, empowerment, and advocacy may be important for parents when they communicate with schools related management of their child’s food allergies. Understanding prevention and emergency management of life-threatening food allergies may require high levels of health literacy and may be overwhelming to parents. Yet, parents are often the drivers of school food allergy safety practices. Mixed evidence supports the relationships among communicative health literacy, critical health literacy, and empowerment in chronic disease management. Objective: This cross-sectional study examines the relationships among parental health literacy, particularly communicative and critical health literacy; empowerment; and advocacy in the context of food allergies management in elementary schools. Methods: Parents of children with food allergies were recruited through food allergy organizations to complete an anonymous 20-minute online survey. Measurements of parental health literacy, empowerment, and advocacy were adapted from validated scales or the literature and refined through pre-testing and pilot-testing. Results: Participants (N=313) were predominantly white, college-educated mothers with moderately high food allergy knowledge, health literacy, and empowerment. Their children were allergic to an average of three food allergens and nearly half had asthma. Parents who scored at the highest levels on measures of communicative health literacy, critical health literacy, and empowerment engaged in advocacy behaviors perceived to be more effective than parents who scored at the lowest levels. However, this statistical difference may not represent a clinically significant difference. Communicative and critical health literacy were not more strongly associated with advocacy than functional health literacy. Empowerment and quality of the parents’ relationship with the school were the strongest predictors of the parents’ perceived effectiveness of advocacy efforts. The relationship between parental health literacy and advocacy was mediated by empowerment with a moderate effect size, but reverse causality between health literacy and empowerment could not be completely ruled out. Conclusions: Parental health literacy may impact the effectiveness of advocacy efforts for safe food allergies practices in schools, with parental empowerment possibly mediating the relationship between health literacy and advocacy. Longitudinal studies with diverse samples should verify findings. Health professionals should encourage parents to build good relationships with school personnel and help to empower families when educating them about food allergies management.
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    Variability of organophosphorous pesticide metabolite levels in spot and 24-hr urine samples collected from young children during 1 week.
    (2013-01) Bradman, Asa; Kogut, Katherine; Eisen, Ellen A.; Jewell, Nicholas; Quiros-Alcala, Lesliam; Castorina, Rosemary; Chevrier, Jonathan; Holland, Nina T.; Barr, Dana B.; Kavanagh-Baird, Gerry; Eskenazi, Brenda
    Background: Dialkyl phosphate (DAP) metabolites in spot urine samples are frequently used to characterize children’s exposures to organophosphorous (OP) pesticides. However, variable exposure and short biological half-lives of OP pesticides could result in highly variable measurements, leading to exposure misclassification. Objective: We examined within- and between-child variability in DAP metabolites in urine samples collected during 1 week. Methods: We collected spot urine samples over 7 consecutive days from 25 children (3–6 years of age). On two of the days, we collected 24-hr voids. We assessed the reproducibility of urinary DAP metabolite concentrations and evaluated the sensitivity and specificity of spot urine samples as predictors of high (top 20%) or elevated (top 40%) weekly average DAP metabolite concentrations. Results: Within-child variance exceeded between-child variance by a factor of two to eight, depending on metabolite grouping. Although total DAP concentrations in single spot urine samples were moderately to strongly associated with concentrations in same-day 24-hr samples (r ≈ 0.6–0.8, p < 0.01), concentrations in spot samples collected > 1 day apart and in 24-hr samples collected 3 days apart were weakly correlated (r ≈ –0.21 to 0.38). Single spot samples predicted high (top 20%) and elevated (top 40%) full-week average total DAP excretion with only moderate sensitivity (≈ 0.52 and ≈ 0.67, respectively) but relatively high specificity (≈ 0.88 and ≈ 0.78, respectively). Conclusions: The high variability we observed in children’s DAP metabolite concentrations suggests that single-day urine samples provide only a brief snapshot of exposure. Sensitivity analyses suggest that classification of cumulative OP exposure based on spot samples is prone to type 2 classification errors.
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    What Makes "Fun" Fun? Insights into Children's Participation in Physical Activity
    (2015) Hopple, Christine J.; Andrews, David; Graham, George; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    A rapidly accumulating body of literature points to fun as an important factor in the physical activity participation choices of children. Few studies, however, have conducted systematic, in-depth investigations into what children mean when they say an activity is fun. Scanlan and Lewthwaite’s (1986) Sport Enjoyment Model was used to guide this inquiry into children’s enjoyment of physical activity in the contexts of Physical Education, organized youth, and recreation. This descriptive, mixed-methods study involved a convenience sample of 98 fourth through sixth graders from six classes in three non-traditional public schools in a mid-Atlantic state. Data collection methods included focus group and duo interviews, an activity-related drawing, and a quantitative measure including both Likert and open-ended questions. Qualitative data was inductively analyzed using comparative analysis techniques with triangulation occurring across all data sources. Findings suggest that the reasons children gave for enjoying and not enjoying physical activity were numerous, varied, and compelling in nature. Although many factors were perceived similarly by many children, others were perceived quite differently. Thus, there appears to be an idiomatic tendency of fun – that is, what each individual child will perceive to be either fun or not is particular to that specific child, with some factors being more salient than others. Contextual factors also strongly influence whether a child will find a specific physical activity to be fun or not, to the extent that these appear to have a stronger influence on the enjoyability of an activity than the activity itself. Lastly, data-gathering methods used with children (activity-oriented questions and card-sorting during focus group interviews) were very effective at stimulating discussion amongst children and uncovering what they think in a very non-threatening manner. Taken together, then, results suggest that the reasons as to why any given child will find an activity to be fun or not fun are complex, interwoven, highly individualistic, and dependent upon a number of contextual factors. Results can aid key players in developing policies and programs which hold the potential to increase children’s enjoyment in physical activity while concurrently decreasing their non-enjoyment of activity.
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    The emotional well-being of mothers of transgender and gender non-conforming children
    (2015) Allen, Samuel H.; Leslie, Leigh A; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    In recent years, mental health professionals have reported an upsurge in the number of referrals relating to transgender identities among children. While controversies exist among clinicians over treatment for these children, a growing number of practitioners are encouraging parents to accept their children's gender expressions. This practice, however, may be challenging for parents to embrace for a number of reasons, resulting in a vulnerable mental state. Using a combined theoretical framework of decentering heteronormativity within Meyer's minority stress theory (2003), the present study seeks to determine the association between various factors--gender non conformity, gender role beliefs, and child misbehavior--and the anxiety and depression in mothers of transgender and gender non-conforming children. Data were taken from Wave 1 of a longitudinal study of transgender and gender non-conforming children and their parents. Results indicated that only child misbehavior was significantly associated with maternal anxiety, and social support did not moderate this relationship. Complete findings and their implications are discussed, for both future research and further deconstruction of gender in the social sciences.
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    EXPOSURE OF CHILDREN TO DEET AND OTHER TOPICALLY APPLIED INSECT REPELLENTS
    (2005-05-02) Menon, Kalapurakkal Sunil; Schiraldi, Glenn R; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Use of topical repellents on children is common. Anecdotal reports suggest repellents may be applied inappropriately, but no studies characterizing the actual usage patterns and exposure of children have been reported. In summer 2002, a cross-sectional survey on the use patterns of repellents on children and possible associated effects was conducted in Maryland campgrounds. Information requested included products used, details of applications, post-application practices, and parents' decision-making process. The study yielded 301 respondents. Deet was the most commonly used active ingredient (83.4%); aerosols were the most common formulation (42.5%). Over a third of subjects (38.9%) treated their children's clothing as well as their skin. Over half of the children did not remove the repellent before going to bed. More than a third of parents failed to read or follow label directions. This study provides documentation of practices leading to undesirable exposure. Educational outreach to change parents' usage patterns is required.
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    The Use of Vision in Children's Postural Control
    (2004-07-15) Kim, Stephen June; Clark, Jane E; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The purpose of the current thesis was to characterize age-related changes in postural control with variations in the properties of a dynamic visual stimulus. In the first study, seven 4-year-olds, seven 6-year-olds, and seven adults were presented with a visual stimulus that oscillated at 0.1, 0.3, and 0.5 Hz. Results showed the postural response amplitude and timing depended upon stimulus frequency and a reduction in the amplitude response variability indicated increased response precision with age. In the second study, ten 4-year-olds, ten 6-year-olds, and ten adults were presented with a visual stimulus that oscillated at 0.3 Hz, with amplitudes of 0, 2, 5, and 8 mm. The results characterized the response as a utilization of sensory information for postural control, with increased response precision with age. These findings indicate that the visuomotor coordination needed for postural control shows age-related improvements, consistent with the notion of a response tuning.