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 Familial sources of encouragement and breast-feeding practices among women participating in the US Special Supplemental Nutrition Programme for Women, Infants and Children(Cambridge University Press, 2023-04-05) Channell Doig, Amara; Aparicio, Elizabeth M; Gallo, SinaObjective: To explore how sources of familial encouragement are associated with breast-feeding initiation and duration among a national sample participating in the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Design: This study uses the 2013–2015 WIC Infant and Toddler Feeding Practices Study 2 (WIC ITFPS-2) data. Breast-feeding initiation was measured at the first month, while duration was derived from a composite of the first 13 months. The analysis used logistic and linear regression to explore the association between encouragement sources and breast-feeding outcomes. Setting: A nationally representative sample of WIC participants in the USA. Participants: WIC participants who completed the 13-month interview of the WIC ITFPS-2 (n 2807). Results: Encouragement was significantly associated with both initiation and duration. Each source of encouragement was associated with a 3·2 (95 % CI 2·8, 3·8) increase in odds of initiating breast-feeding in the unadjusted model and 3·0 (95 % CI 2·5, 3·6) increased odds, controlling for age, education, nativity, poverty status, race and ethnicity (<0·0001). When predicting log duration, each percent increase in source of encouragement was associated with an increasing duration on average by 0·003 d (95 % CI 0·2, 0·3, <0·0001). When controls were added, it was associated with an increase of an average of 0·002 d (95 % CI 0·2, 0·3) per percent increase in encouragement source (<0·0001). Conclusions: Women who receive encouragement appear to be more likely to breastfeed. Additional work is needed to explore sources of encouragement and how to include them in intervention work.Item SELF-COMPASSION AMONG WOMEN WITH ABUSE EXPERIENCES: THE ROLE OF SOCIAL SUPPORT(2018) LeVine, Naomi; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Intimate partner violence (IPV) is a widespread issue that affects the physical and mental health of its survivors. Because of the severity of the outcomes, it is important that clinicians understand potential risk and protective factors in regard to providing the best outcomes for their clients. Under the framework of the stress-buffering hypothesis, this study explored the association between IPV and a woman’s self-compassion, as well as the role of social support as a variable moderating that association. It was hypothesized that higher levels of IPV victimization would be associated with lower levels of self-compassion among women with experiences of IPV. In addition, social support was hypothesized to weaken the association between IPV and individuals’ self-compassion. Data collected from a sample of women in abusive relationships (n=61) was analyzed using linear regression and a test for moderation. Results indicated that there was no significant association between IPV victimization and self-compassion. However, the interaction between IPV and social support tended toward significance. Contrary to the second hypothesis, among women with higher levels of social support, greater IPV was associated with lower self-compassion. Implications for clinical practice when working with this population are discussed.Item Exploring Predictors of Military Spouses’ Comfort Seeking Military-Provided Counseling Services(2017) Brown, Christye Yvonne; Beck, Kenneth; Zanjani, Faika; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Over 1.2 million (approximately half) of the service members deployed in support of the Global War on Terror were married at the time of their last deployment (Department of Defense, 2013). Data from the study of military and veteran families suggests that both stress and the process of coping with or overcoming exposure to adversity or stress resonate across the family system (Meredith L. S., et al., 2011), and that the impact of war and its consequences are experienced by partners and families in addition to service members (Lester, Blair, Saltzman, & Klosinski, 2013). The purpose of this study was to determine predictors of spouses' comfort in seeking military-provided counseling services when service members are deployed, by examining spousal coping behaviors, mental health status, and social support and demographics (rank and gender), as reported from the 2012 Active Duty Spouses Survey (ADSS). Analyzing survey data from 10,574 participants, we determined that 82.5% of the participants had spouses who were deployed for more than 30 consecutive days, and 64.3% of the participants felt comfortable using military-provided services for counseling. Statistically significant predictors of comfort-seeking, military-provided counseling services included positive coping behaviors, mental health status, social support, and the rank of the spouse’s partner. Spouses of officers were less likely to feel comfortable using military-provided services for counseling compared to spouses of enlisted service members. The level of psychological stress experienced by the spouses correlated with all predictors of comfort seeking, military-provided services for counseling. The results were consistent with previous studies on the predictors and outcomes of psychological stress among military spouses, and supported the Transactional Model of Stress and Coping. The results have practical significance because they will help planners tailor programs to optimize the uptake of counseling services for military spouses who are in need. We recommend that future research incorporate measures of the service members’ extended deployments in combat zones to determine if extended combat-related deployment predicts spouses’ comfort seeking military-provided services for counseling. Qualitative research may also be useful to provide more insight into why some military spouses feel comfortable using military-provided services for counseling while others do not.Item Breast Cancer Narratives of Women without Partners(2013) Ginter, Amanda Christine; Braun, Bonnie; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This qualitative study examined the experiences of female breast cancer patients without partners through the theoretical perspectives of ecological systems and health promotion. Family science literature addresses the importance of social support to quality of life. Women with breast cancer, the second most common cancer among women, often report that their main social support comes from intimate partners. If so, women without intimate partners may experience a health disparity that affects how they cope with their diagnosis and treatment. Although some studies indicate differences in the utilization of detection services between breast cancer patients with and without partners, there is a gap in the literature concerning the lived experience of patients without partners. Qualitative data were collected from 20 participants who did not have partners during diagnosis and treatment. Participants took part in one-time interviews conducted by the researcher. Phenomenology informed the methodology and thematic analysis. Findings included how breast cancer patients without partners adapted supportive networks to cope with the fears and frustrations of diagnosis and treatment; how these women sought health information and interacted with their medical teams; and how they made meaning of their relationship status within the context of their cancer experience. Based on findings from this study, family scientists and public health professionals and oncology care providers may have a better understanding of the specific concerns and experiences of breast cancer patients without partners. Additional implications of these findings for patients, practice, policy, and research will be discussed.Item THE RELATIONSHIP BETWEEN PSYCHOLOGICAL PARTNER AGGRESSION AND DEPRESSION: SOCIAL SUPPORT AS A MODERATING VARIABLE(2012) Rivero, Stephanie Christine; Epstein, Norman B; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The association between psychological aggression within heterosexual couples and the level of depression symptoms was explored in addition to whether or not that association was moderated by the level of perceived social support from friends. Secondary analyses were conducted on assessment data from both males and females in 406 heterosexual couples who sought conjoint therapy at the Center for Healthy Families, a university-based marriage and family therapy clinic. Psychological aggression was assessed using the Multidimensional Measure of Emotional Abuse Scale (MMEA; Murphy and Hoover, 1999); depression was assessed using the Beck Depression Inventory (BDI; Beck, Steer & Brown, 1996); and social support was assessed using the Perceived Social Support Scale (PSS; Procidano & Heller, 1983). Findings support the hypothesis that the more psychological aggression the individual received, the higher their symptoms of depression were; however there was not a significant finding that social support served as a moderator of that association. Furthermore, there were no significant findings for the research questions, which addressed gender-based differences in the degree to which social support moderates the effects of depression and psychological aggression.Item The Impact of Formal Social Support on Outpatient Care Among a Sample of Adults Living with HIV/AIDS in the United States(2007-11-19) Matoff-Stepp, Sabrina A; Boekeloo, Ph.D., Bradley O.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background The HIV Cost and Services Utilization Study and HIV Research Network (HIVRN) clinical studies showed disparities among HIV-positive men and women in outpatient care use in the U.S. Formal social support provided by case managers may help patients access outpatient care. The primary purpose of this study was to determine if having case managers is associated with levels of outpatient care visits among 797 individuals living with HIV/AIDS, and whether this association varies by patient sex. Other aims were to determine if the number of in-person case management visits and the type of formal social support are associated with these same outcomes. Outpatient visit levels were defined as 2-5 (average) or 6+ (high). Based on Andersen's (1995) Behavioral Model of Health Services Use, a conceptual model was developed as a framework for examining the study's hypothesized relationships. Methods The HIVRN is a convenience sample of 17 U.S. clinical sites serving more than 15,000 people living with HIV/AIDS. In 2003, interviews were conducted with a stratified sample of 951 clients at 14 HIVRN sites. The current study sample consisted of 797 adult respondents (543 males and 254 females). Logistic regression was used to identify significant predictors of outpatient care visit levels. Results Patients who had one or two case managers versus no case managers were significantly more likely to have 6+ outpatient visits, while patients who were employed and had higher self-reported perceptions of their health were significantly less likely to have 6+ outpatient visits. These relationships did not vary by patient sex. Level of outpatient visits also did not vary by patient sex. No significant associations were found between the number of in-person case management visits or the type of formal social support and level of outpatient visits. In sub-analyses that separated patients with one case manager from those with two case managers, no new predictors emerged. Conclusion Case management was associated with higher levels of outpatient visits for both male and female patients in this study. This finding suggests that utilization of HIV-related outpatient care may be increased among both men and women with case management.Item Incarceration and Partner Relationships: A Qualitative Analysis of Men's Perceptions of Social Support(2007-05-07) McDowell, April; Roy, Kevin; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Incarceration impacts families in a number of different ways ranging from emotional distress, economic challenges, and social stigma. The purpose of this analysis was to explore how men's perceptions of support from their partners during incarceration and community reentry shape intimate partnerships. Using secondary data content analysis, a sample of 20 fathers from the Fathers and Families Resource and Research Center study dataset has been examined (Roy, 2002-2004). Using family stress theory and symbolic interactionism, qualitative methods were used to examine life history interviews. Interviews were coded for themes related to past incarceration, intimate partnerships, and social support. Overall, men reported feeling supported in their roles as partners across their relationship trajectories and support shifted occurred from their roles as romantic partners to their roles as co-parents. Community reentry was an especially significant time that support mattered due to the recommitments that many made to fatherhood during this process.Item The Association of Socio-Economic Resources and Perceived Social Support with the Occurence of Physical and Psychological Aggression in Heterosexual Clinical Couples(2006-07-24) Alexander, Rachel Erin; Epstein, Norman B; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)This study examined the interaction between relative socio-economic resources, such as income and level of education, and level of perceived social support on couples' levels of physical and psychological abuse. It was hypothesized that individuals with fewer resources than their partner would utilize more aggression, individuals with higher perceived social support would exhibit less aggression, and perceived social support would moderate the relationship between personal resource discrepancy and aggressive behavior. The findings of the current study suggest that the impact of partner resource discrepancies and perceived social support depend on the gender of the perpetrator and the type of abuse considered. The findings also have clinical implications for the importance of gathering information about couples' resources and social support. Implications for future research include analyzing the effects of different types of social support on coping in a sample that includes wider ranges of personal resources and severity of abuse.Item Parents' Stress and Coping with Their Children's Attention Deficit Hyperactivity Disorder(2006-06-28) Mitchell, Mary Moser; Beck, Kenneth H; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In a previous study, the National Institute of Mental Health enrolled 579 children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in a randomized controlled trial to test the efficacy of a stimulant medication. ADHD affects 3-5% of children before age 7 and is characterized by difficulties in controlling impulsive and hyperactive behaviors and/or paying attention. Studies of children with ADHD indicate that the disorder can be extremely disruptive to family functioning. While the original NIMH study examined the children's outcomes, this investigation explored quality of life among the parents of these children. Quality of life was considered in terms of emotional well-being and social functioning. Various studies within the health psychology discipline have suggested that coping strategies, social support, and stress appraisal significantly influence and predict quality of life. It was hypothesized that stress appraisal, social support, coping skills, and symptom severity would predict quality of life indicators (i.e. spouse relationship, parent/child relationship, and psychological/emotional functioning) for parents. This main effects hypothesis was tested using baseline data and using longitudinal data, while controlling for baseline measures. The second set of hypotheses proposed that social support and coping skills would moderate the relationship between stress appraisal and quality of life. These relationships were tested using the baseline data as well as the longitudinal data, while controlling for baseline measures and a variety of covariates (i.e. demographic variables). In addition, the relationship between objective stressors and stress appraisal was tested, as well as the direct effects of objective stressors on the quality of life outcomes. A combination of structural equation modeling and multiple regression analyses were used to analyze the data. Stress appraisal was the most consistent and strongest predictor of quality of life outcomes for parents. Social support, coping, and symptom severity played significant, yet modest roles in prediction. Objective stressors significantly predicted stress appraisal as well as the quality of life indicators. These results indicated support for both the main effects and moderating hypotheses. Recommendations for health educators seeking to develop intervention programs for this population of parents were offered.Item Role of Maternal Social Support and Church Attendance in Moderating the Relationship Between Maternal Depression and African American Preschoolers' Behavior Problems(2004-11-30) Tyler, Crystal Michelle; Koblinsky, Sally A; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Policymakers, educators, researchers and practitioners are devoting increasing attention to the challenges faced by low-income families in urban communities. Research indicates that poor women with young children are particularly susceptible to experiencing depression. Maternal depression has been associated with numerous negative outcomes for both mothers and their children. In view of the high prevalence of maternal depression and the myriad stressors faced by poor families in high crime neighborhoods, there is an urgent need to identify factors that may attenuate the negative impact of mother's depression on preschoolers' socioemotional development. Thus, the major purpose of this study was to examine the potential of social support and church attendance to moderate the relationship between maternal depression and children's behavior problems. The present study utilized secondary data from a larger, three-year study funded by the U.S. Department of Education. The sample for this study consisted of low-income African American mothers in violent neighborhoods in Washington, DC and Prince George's County, Maryland. All mothers had a three-to-five year old child enrolled in Head Start. Data were obtained through face-to-face interviews utilizing culturally-sensitive measures. Multiple regression analyses were used to examine the main and interaction effects for predictor (maternal depressive symptoms), moderator (social support, church attendance), and criterion variables (child internalizing and externalizing behavior problems). Results revealed that maternal depressive symptomology significantly predicted children's internalizing and externalizing behavior problems. Findings further revealed that social support moderated the relationship between maternal depressive symptoms and children's externalizing behavior problems. When the level of social support increased for mothers who did not exhibit extreme depressive symptomology, children had fewer externalizing behavior problems. In contrast, when social support increased for mothers with very severe depressive symptoms, children had greater externalizing problems. Maternal social support did not buffer preschoolers' internalizing problems. Maternal church attendance likewise failed to buffer the relationship between maternal depressive symptoms and internalizing or externalizing problems. Findings suggest a need for culturally-sensitive strategies to increase the support networks of low-income, urban, African American mothers of preschoolers. Such efforts may help educators and family practitioners to reduce the impact of maternal depression on preschoolers' externalizing behavior problems.