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.

Browse

Subject: search.filters.subject.race

Search Results

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    The Critical Race Framework Study: Standardizing Critical Evaluation for Research Studies That Use Racial Taxonomy
    (2024) Williams, Christopher M.; Fryer, Craig S.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Introduction: Race is one of the most common variables in public health surveillance and research. Yet, studies involving racial measures show poor conceptual clarity and inconsistent operational definitions. There does not exist a bias tool in the public health literature for structured qualitative evaluation in critical areas of critical appraisal – reliability, validity, internal validity, and external validity – for studies that use racial taxonomy. This study developed the Critical Race (CR) Framework to address a major gap in the literature. Methods: The study involved three iterative phases to answer five research questions (RQs). Phase I was a pilot study of the CR Framework among public health faculty and doctoral students to assess measures of fit (RQ1) and to identify areas of improvement in training, instrumentation, and study design (RQ2). Study participants received training and performed a single article evaluation. Phase II was a national cross-sectional study of public health experts to assess perceptions of the revised training and tool to assess measures of fit (RQ1), to determine the influence of demographic and research factors on perceptions (RQ3), and to gather validity evidence on constructs (RQ4). In Phase III, three raters performed article evaluations to support reliability evidence (RQ4) and to determine the quality of health disparities and behavioral health research studies against the CR Framework (RQ5). Analysis: We assessed the reliability of study results and the CR Framework using non-differentiation analysis, thematic analysis, missingness analysis, user data, measures of internal consistency for adopted instruments, interrater agreement, and interrater reliability. Validity was assessed using content validity (CVI and k*), construct validity, and exploratory factor analyses (EFA). Results: The study recruited 30 highly skilled public health experts across its three phases as part of the final analytic sample. Phase I had poor reliability in which the results could not be confidently interpreted (RQ1) and indicated needed improvement in study design, training, and instrumentation (RQ2). Based on Phase II results, we met or exceeded acceptable thresholds for measures of fit – acceptability, appropriateness, feasibility, and satisfaction (RQ1). Demographic or research factors were not associated with responses (RQ3). Interrater agreement was moderate to high among rater pairs (RQ4). Due to lack of confidence in significance testing, interrater reliability results were inconclusive. Overall data results showed excellent content validity. Based on EFA results, construct validity for reliability and validity items was poor to fair (RQ4). Data results were inconclusive on internal validity and external validity. The twenty studies used in critical appraisal showed low quality or no discussion when the Critical Race Framework was used (RQ5). Discussion: The CR Framework study developed a tool and training with quality evidence for implementation effectiveness, content validity, and interrater reliability to fill a major gap in the public health literature. It contributed an innovative theory-based tool and training to the literature. Future research should seek to study individual perceptions and practices that influence outcomes of CR Framework application and to reduce barriers to ensure that minimum sample sizes can be met for additional testing.
  • Thumbnail Image
    Item
    Racial and Sex Differences between Urinary Phthalates and Metabolic Syndrome among U.S. Adults: NHANES 2005–2014
    (MDPI, 2021-06-26) Ghosh, Rajrupa; Haque, Mefruz; Turner, Paul C.; Cruz-Cano, Raul; Dallal, Cher M.
    Phthalates, plasticizers ubiquitous in household and personal care products, have been associated with metabolic disturbances. Despite the noted racial differences in phthalate exposure and the prevalence of metabolic syndrome (MetS), it remains unclear whether associations between phthalate metabolites and MetS vary by race and sex. A cross-sectional analysis was conducted among 10,017 adults from the National Health and Nutritional Examination Survey (2005–2014). Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were estimated for the association between 11 urinary phthalate metabolites and MetS using weighted sex and race stratified multivariable logistic regression. Higher MCOP levels were significantly associated with increased odds of MetS among women but not men, and only remained significant among White women (POR Q4 vs. Q1 = 1.68, 95% CI: 1.24, 2.29; p-trend = 0.001). Similarly, the inverse association observed with MEHP among women, persisted among White women only (POR Q4 vs. Q1 = 0.53, 95% CI: 0.35, 0.80; p-trend = 0.003). However, ΣDEHP metabolites were associated with increased odds of MetS only among men, and this finding was limited to White men (POR Q4 vs. Q1 = 1.54, 95% CI: 1.01, 2.35; p-trend = 0.06). Among Black men, an inverse association was observed with higher MEP levels (POR Q4 vs. Q1 = 0.43, 95% CI: 0.24, 0.77; p-trend = 0.01). The findings suggest differential associations between phthalate metabolites and MetS by sex and race/ethnicity.
  • Thumbnail Image
    Item
    Home Hemodialysis Utilization and Health Outcomes among Racial and Ethnic Minority Populations
    (2023) Zhu, Ying; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background: Home hemodialysis (HHD) offers end-stage renal disease (ESRD) patients greater flexibility and advantages in terms of health outcomes over in-center hemodialysis. There is limited research on the differences between home and center hemodialysis (CHD) and preferences among racial/ethnic minorities, despite ESRD disproportionately affecting these groups. Methods: This project aims to explore the usage and health outcomes of HHD vs. CHD with a focus on racial/ethnic differences using a systematic review of the global main academic database from 2004 to 2022 (study 1), logistic regression and negative binomial analysis of the U.S. Renal Disease System (USRDS) cumulative core data since 2010 merged with 2016-2019 Medicare clinical claims (study 2), and qualitative research using semi-structured interviews with 18 nephrologists and 5 other hemodialysis providers in 8 states of the U.S. (study 3). Results: Study 1: from 3,114 unique studies, six studies met the inclusion criteria and all of them were comparative cohort studies; five out of six studies with a total of 3,172 White patients (68%) and 1,477 minority patients (32%) reported the utilization of HHD; in four of the six studies, the adjusted odds ratio for HHD treatment was shown to be significantly lower for patients of racial or ethnic minorities than for White patients; three out of six studies examined racial/ethnic differences in mortality and other outcomes indicating a lower risk of death for minorities in home hemodialysis. Study 2: minorities were significantly less likely to use HHD than Whites; most minority patients were younger and had fewer comorbidities than Whites, and all minority groups displayed significantly lower mortality and hospitalization incidences than the White group with adjustment on multiple covariates; in the overall and main racial/ethnic cohorts, HHD showed a significantly lower risk of death than CHD after confounding for major risk factors. Study 3: the majority of the interviewees felt that HHD was a viable, safe, and most cost-effective treatment for those with kidney failure, it offered many advantages over traditional CHD but there is a need for additional training and support for the patient, family, provider; minorities and White patients differed in their attitude toward dialysis care, social norms on HHD, and perceived control of personal health. Conclusion: There were major obstacles and considerable racial/ethnic variations in HHD utilization and health outcomes in the US. This study showed that the promotion of HHD will probably require a systematic overhaul in kidney disease management and education.
  • Thumbnail Image
    Item
    Differential associations of homelessness with emergencydepartment visits and hospitalizations by race, ethnicity, andgender
    (Wiley, 2022-05-20) Yue, Dahai; Pourat, Nadereh; Essien, Elsie A.; Chen, Xiao; Zhou, Weihao; O'Masta, Brenna
    Objective To investigate the differential associations of homelessness with emergency department (ED) visits and hospitalizations by race, ethnicity, and gender. Data Sources California Medicaid enrollment and claims. Study Design We identified beneficiaries experiencing homelessness (BEH) and those who did not (NBEH) using diagnosis and place of service codes and residential addresses. Outcomes include four ED visit measures and four hospitalization measures. We compared the use of these services by BEH to NBEH overall and by race, ethnicity, and gender groups in regression models controlling for covariates. Data Collection We used a sample of Medicaid beneficiaries who met eligibility criteria for a California Medicaid demonstration program in 2017 and 2018 but were not enrolled in the program. We identified 473,069 BEH, and the rest (1,948,422) were considered NBEH. We used the 2018 data for utilization analyses and most covariates. We constructed lagged measures of health conditions using 2017 data. Principal Findings We found that homelessness was significantly associated with 0.34 more ED visits (p < 0.01) and a higher likelihood of frequent ED visits (2.77 percentage points [pp], p < 0.01), any ED visits due to mental health conditions (0.79 pp, p < 0.01), and any ED visits due to substance use disorders (1.47 pp, p < 0.01). Experiencing homelessness was also significantly associated with 0.03 more hospitalizations (p < 0.01), a higher likelihood of frequent hospitalizations (0.68 pp, p < 0.01) and high frequent hospitalizations (0.28 pp, p < 0.01), and a longer length of stay (0.53 days, p < 0.01). We found a larger association for American Indian and Alaska Native, Black, Native Hawaii or Pacific Islander, and White populations than that for Asian and Hispanic populations. The associations are larger for males than females. Conclusions Our findings identified distinct utilization patterns by race, ethnicity, and gender. They indicated the need for developing race, ethnicity, and gender-specific strategies to reduce ED visits and hospitalizations of BEH.
  • Thumbnail Image
    Item
    Racial and Sex Differences between Urinary Phthalates and Metabolic Syndrome among U.S. Adults: NHANES 2005–2014
    (MDPI, 2021-06-26) Ghosh, Rajrupa; Haque, Mefruz; Turner, Paul C.; Cruz-Cano, Raul; Dallal, Cher M.
    Phthalates, plasticizers ubiquitous in household and personal care products, have been associated with metabolic disturbances. Despite the noted racial differences in phthalate exposure and the prevalence of metabolic syndrome (MetS), it remains unclear whether associations between phthalate metabolites and MetS vary by race and sex. A cross-sectional analysis was conducted among 10,017 adults from the National Health and Nutritional Examination Survey (2005–2014). Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were estimated for the association between 11 urinary phthalate metabolites and MetS using weighted sex and race stratified multivariable logistic regression. Higher MCOP levels were significantly associated with increased odds of MetS among women but not men, and only remained significant among White women (POR Q4 vs. Q1 = 1.68, 95% CI: 1.24, 2.29; p-trend = 0.001). Similarly, the inverse association observed with MEHP among women, persisted among White women only (POR Q4 vs. Q1 = 0.53, 95% CI: 0.35, 0.80; p-trend = 0.003). However, SDEHP metabolites were associated with increased odds of MetS only among men, and this finding was limited to White men (POR Q4 vs. Q1 = 1.54, 95% CI: 1.01, 2.35; p-trend = 0.06). Among Black men, an inverse association was observed with higher MEP levels (POR Q4 vs. Q1 = 0.43, 95% CI: 0.24, 0.77; p-trend = 0.01). The findings suggest differential associations between phthalate metabolites and MetS by sex and race/ethnicity.
  • Thumbnail Image
    Item
    RACE AND IMMIGRATION STATUS AS MODERATORS OF THE RELATIONSHIP BETWEEN FAMILY ACCEPTANCE/FAMILY REJECTION AND DEPRESSIVE SYMPTOMS FOR LGBTQ+ YOUTH
    (2019) Levin, Emma R; Leslie, Leigh; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Research consistently demonstrates that LGBTQ+ youth, when compared to non-LGBTQ+ youth, are at significantly greater risk for depression, anxiety, substance use, and suicidality as a result of stressors related to belonging to a minority group (Russell & Fish, 2016). Family acceptance is an important protective factor against these negative mental health outcomes, and family rejection has been demonstrated as an important risk factor. Research on LGBTQ+ youth has been criticized for regarding all LGBTQ+ youth as the same and not accounting for the intersection and interaction with other identities such as race or immigrant status. The research questions posed by this study are 1) to what extent do race and immigrant status, separately and combined, moderate the established relationship between family acceptance and depressive symptoms?, and 2) to what extent do race and immigrant status, separately and combined, moderate the established relationship between family rejection and depressive symptoms? Results of the present study show that race significantly moderated the relationship between family acceptance and depression for LGBTQ+ youth, but did not moderate the relationship between family rejection and depression. Immigrant status moderated neither relationship. Three-way interactions with race and immigrant status moderated both the association among family acceptance, family rejection, and depression. Clinical implications and implications for future research are discussed.
  • Thumbnail Image
    Item
    Understanding Bulimia: A Qualitative Exploration of the Roles of Race, Culture, and Family
    (2008-07-21) Southard, Ashley Larsen; Leslie, Leigh A.; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The eating disorder, bulimia nervosa, is a serious physical and mental illness destroying the lives of millions of men, women, and their families. It is characterized by recurrent binge eating and compensatory behaviors (e.g., self-induced vomiting), and afflicts 1-5% of the general U.S. population. Unlike other eating disorders that appear to affect specific racial groups, bulimia more equally affects people of all races. Yet, very little attention has been given to learning about the ways in which women from diverse racial/cultural backgrounds experience bulimia. Thus, the present qualitative study explored the question: How do young African American, Latina, and Caucasian women describe their experiences with bulimia within their racial, cultural, and familial contexts? Open-ended, in-person interviews were conducted with 33 young adult women (ages 18-30) who self-identified as African American, Latina, or Caucasian and who experienced bulimia while living with a parent. Questions were based on sensitizing concepts taken from feminist and family systems theories, and encouraged women to explore their perceptions of how their racial, cultural, and familial contexts influenced their experiences with bulimia. A modified grounded theory approach was used to interpret the data, and findings were organized at sociocultural, familial, and individual levels. Common experiences for many of the women, regardless of race, included sociocultural pressure to be thin; unhealthy family environments that included poor communication, strained relationships, and emphasis on members' appearances; and individual management of comorbid psychological disorders and emotions. Unique processes related to African American women's and Latinas' experiences with bulimia included living in a bicultural context with cultural and familial stigmas surrounding mental health. Additionally, African American women reported overall healthier family environments, in which they had supportive relationships and more open communication. Based on these findings, the theoretical framework was enhanced with race- and culture-specific models. Implications for research related to diverse families' experiences with eating disorders, policies designed to help people of all backgrounds affected by eating disorders, as well as the development of culturally sensitive therapy interventions for families affected by bulimia are discussed.