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 The Self Reported Health of US Women in the First Postpartum Year: NHANES 2007-2018(2021) Fahey, Jenifer Osorno; Shenassa, Edmond; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Most existing information about the health of US postpartum mothers comes from studies of morbidity and mortality. As a result, relatively little is known about the general well-being of postpartum mothers. Self-rated health (SRH), a single-item, 5-level ordinal measure has been widely used as an indicator of general health status in epidemiologic and population health research. There are no US population studies of maternal SRH in the postpartum period. Methods: An analytic sample of 6,266 women ages 20-44 was created from the 2007-2018 waves of the National Health and Nutrition Surveys. The 5-level SRH measure was dichotomized into “good” and “poor” levels and multivariate logistic regression analysis was used to characterize the relationship between postpartum status and SRH and to test whether parity, cigarette smoking, pregnancy, depression, sleep duration, tiredness/fatigue, obesity, history of c-section and breastfeeding status independently predict poor SRH in the sub-population of postpartum women (n=508). Results: There is a significant relationship between postpartum status and SRH that is moderated by pregnancy status. For women who are not pregnant, postpartum status is associated with lower odds of poor SRH (OR 0.52, 95% CI, 0.34-0.79) while for women who are pregnant, postpartum status is associated with increased odds of poor SRH (OR 2.34, 95% CI 0.81-6.78), an association that did not reach statistical significance at a p=0.05 level. Having a high school education (OR 0.35, 95% CI, 0.13-0.95) breastfeeding (OR 0.22, 95% CI 0.10-0.52) were associated with lower odds of poor SRH, while being Hispanic (OR 3.51, 95% CI 1.20-10.27), tired (OR 2.40, 95% CI 1.08-5.57) or obese (OR 2.72, 95% CI, 1.35-5.56) were associated with higher odds of maternal report of poor health. Discussion: Postpartum status is associated with better SRH. This is not the case; however, for women who are pregnant again in the first postpartum year suggesting that a short interpregnancy interval (IPI) is a threat to postpartum maternal well-being. Breastfeeding, on the other hand, is associated with a strong protective effect on maternal postpartum SRH. These results suggest a need for postpartum contraceptive and breastfeeding promotion efforts that focus on immediate impacts on maternal health. Maternal postpartum obesity and maternal tiredness also emerge as priority areas for maternal postpartum health promotion initiatives. Additional research on the postpartum experience of Hispanic mothers is warranted.Item Measuring Allostatic Load in a Nationally Representative Sample of Pregnant Women(2012) Selmer, Stephanie; Shenassa, Edmond; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Allostatic load (AL) is a measure of cumulative "wear and tear" on the body resulting from exposure to chronic stress. Recently, a potential link between AL and poor birth outcomes was proposed, although it is unknown whether AL can be measured in a meaningful way during pregnancy. To determine this, an AL index was created using data from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. The distribution of AL scores were significantly different in pregnant and non-pregnant women (p<0.01). AL scores were associated with race, age, income, and education level in the sample of non-pregnant women, but similar associations were not seen in pregnant women. Overall, the results of this study suggest that AL does not have the same attributes in pregnant women as it does in non-pregnant women. However, the findings suggest directions for future study of AL as a risk factor for poor birth outcomes.Item "Sin Querer Queriendo": Exploring The Factors Associated With Pregnancy Prevention And Pregnancy Intention Among Latino Youth In Montgomery County(2010) Martinez-Garcia, Genevieve; Atkinson, Nancy; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study seeks to determine the factors that influence pregnancy desire and pregnancy prevention behavioral intentions among Latino youth. One out of two Latino girls in the U.S. will become pregnant before they turn 20. A pregnancy significantly hinders a teen's ability to pursue an education and develop professionally, and places an undue economic burden on the family. In order to appropriately address the factors that fuel teen birth rates, it is imperative to study behavioral, social, and cultural dynamics associated with pregnancy prevention and sexual behavior in the local Latino community. This study utilized the Theory of Planned Behavior (TPB) to explore factors associated with pregnancy prevention behaviors, namely abstinence, condom use, and birth control pill use. The study specifically addresses attitudes, subjective norms, and perceived behavioral controls of Latino adolescents/teens regarding three pregnancy prevention behaviors. The Pregnancy Wantedness Scale was designed to specifically measure pregnancy attitudes among youth. The study answered three main questions: 1) What are the characteristics of Latino youth who desire a pregnancy during their adolescent years?; 2) Are pregnancy prevention behavioral intentions associated with pregnancy wantedness?; and 3) Are attitudes, subjective norms and perceived behavioral control associated with pregnancy prevention behavioral intentions? A questionnaire was designed in English and Spanish using input from local community stakeholders. A total of 949 Latino youth were recruited using a central location intercept approach. Univariate and multiple linear regression analyses were used to answer the three research questions. Analyses were conducted separately for males and females with some and no sexual experience. Psychometric studies and factor analysis were conducted to assess the reliability and underlying structure of the scale. This study found that multiple demographic, familial and acculturation factors influenced youth's pregnancy intentions. For most groups, pregnancy wantedness was mostly influenced by youth's religion salience, acculturation level and living with a parent. Only condom use intention was associated with lower pregnancy wantedness for males. Perceived behavioral control and parental norms was positively associated with increased behavioral intentions across all three behaviors for most groups. This study suggests that practitioners should be aware of the gender, sexual experience and acculturation level of Latino youth when designing education interventions. Moreover, the findings of this study suggest that strengthening parental role and communication will protect youth from desiring a pregnancy and motivate them to use contraception effectively.