Abebe, Israel (UMD SPH Behavioral and Community Health)
Background: Female Genital Mutilation (FGM) is a public health and human rights problem that still exists in certain parts of the world. FGM is uncommon and less known in western countries. Understanding the literature on the intercultural communication dynamics between FGM-exposed immigrant women and western gynecological and obstetric care providers is important.
Goal: To understand the literature on communication behaviors and experiences pertaining to FGM-exposed immigrants and obstetric/gynecological care providers.
Objectives: To explain the patient-provider communication dynamics, and identify relevant intrapersonal, interpersonal and system-level factors that shape the interaction.
Approach: A review of the published literature was conducted in the following databases: PubMed, ScienceDirect and MEDLINE.
Results: Overall, the literature review found patient-provider communication challenges primarily stemming from cultural and linguistic discordances, and differences in personal view points.
Importance to public health: Understanding the intercultural patient-provide communication challenges between FGM-exposed immigrants and gynecological/obstetric care providers could inform the development of effective interventions that not only can improve communication but also care experiences for patients.
Acheampong, Tracy (Georgetown University Human Science)
Barrington, Debbie (Georgetown University Human Science)
Background: Low-income individuals disproportionately suffer from disparities in oral health access. Dental services are an essential health benefit for children, providing them with a robust safety net, but dental care access remains limited for non-elderly adults.
Goal: To describe the racial/ethnic differences in dental insurance and utilization.
Objectives: 1. To describe dental services provided by Medicaid for each state. 2. To describe racial differences in dental insurance and utilization. 3. To describe racial differences in dental insurance and utilization for Medicaid recipients.
Approach: We analyzed 2007-2015 data from the nationally representative Medical Expenditure Panel Survey (MEPS) on approximately 164,000 non-elderly adults aged 18-64 years. Race and ethnicity, health and dental insurance coverage, dental visits, and frequency of dental checkups were self-reported. Chi square tests and associated p-values <0.05 determined statistical significance of racial differences in dental insurance and utilization. Multivariable logistic regression models will be utilized to adjust for socio-demographic factors and describe the independent associations between race/ethnicity and dental insurance and utilization. All statistical analyses were performed in SAS version 9.4.
Results: Descriptive analyses indicate that 64% of Hispanics, 88% of Non-Hispanic Whites, 81% of Non-Hispanic Blacks, and 85% of Non-Hispanic Asians had health insurance (p<0.0001). However, 32% of Hispanics, 53% of Non-Hispanic Whites, 43% of Non-Hispanic Blacks, and 54% of Non-Hispanic Asians had dental insurance (p<0.0001). 25% of Hispanics, 46% of Non-Hispanic Whites, 28% of Non-Hispanic Blacks, and 37% of Non-Hispanic Asians had a dental visit within the previous year (p<0.0001).
Importance to public health: These results indicate that the dental safety net for non-elderly adults needs to be fortified.
Adenaiye, Oluwasanmi (UMD School of Public Health)
des Mesquita, Jacob (UMD School of Public Health)
Milton, Donald (UMD School of Public Health)
Background: There are critical questions and knowledge gaps concerning modes of transmission of acute respiratory infections (ARI) including influenza and the factors that influence transmission risk in communities and illness severity. Illness severity and transmission risk can be affected by host’s socio-behavioral and physical environment, host defense mechanisms and virulence of the infectious agents. Uncertainties remain, however, with respect to the relative importance and role of each of these factors. A thorough understanding of these requires highly enhanced epidemiological surveillance data from a comprehensive study design.
Objectives: 1. To identify cases with a high and low probability of transmission while controlling for variability in CO2 concentration. 2. To identify contacts with high susceptibility and describe their phenotype. 3. To evaluate how much of an influence the environmental conditions have on the above.
Approach: We recruited a cohort of UMD college dormitory students and closely monitored their social and physical environment, gene expression, and microbiome of ARI cases. For each of the identified cases, we recruited up to 4 contacts and closely monitored them to identify secondary transmission events while also monitoring their social, physical, gene expression and microbiome.
Results: Still being computed
Importance to public health: The study design offers a unique method of studying ARI transmission because unlike other transmission studies, it precisely mimics conditions encountered in real life transmission events.
Agha, Crystal (School of Public Health (UMD))
Wilson, Sacoby (UMD School of Public Health)
Background: Brandywine, Maryland, an unincorporated town in Prince George's County, has many locally unwanted land uses (LULUs) such as gas-fired power plants, a Superfund site, a fly ash landfill, a sludge lagoon, 10-12 surface mining operations, a sludge pond, and diesel emissions (3500 diesel truck trips/day). There is scheduled to be five power plants in a 13-mile radius of Brandywine, making this area one of the largest power plant clusters in the United States. The power plants and diesel trucks can emit air pollutants including particulate matter, volatile organic compounds (VOCs), black carbon, and other air toxics that can impact human health.
Goal: The aim of this study is to assess baseline levels of particulate matter (PM2.5) levels at recreational parks, schools, and commercial areas in close proximity to the Keys Energy Center power plant.
Objectives: Our objective is to determine baseline PM2.5 levels in Brandywine prior to the opening of the new facility. We hypothesize there will be higher levels of PM2.5 at locations closer to roadways from commuter and industrial traffic compared to locations farther away. We hypothesize there will be higher PM2.5 levels at local community centers and recreational locations after the power plant is open.
Approach: Air quality monitoring was conducted through the use of the Airbeam, a real-time personal air monitoring sensor that measures PM2.5 (µg/m3), temperature (℉), sound (dB), and humidity (%). Air quality levels were being recorded at 1-second intervals through the AirCasting app. These were conducted in July 2017 during off-peak hours in the morning. Researchers also considered meteorological conditions and traffic counts at sites near roadways.
Results: The PM levels at the five different sites ranged from 2 µg/m3 to 38 µg/m3. The range for the overall averages for the five different sites were from 3 µg/m3 to 5 µg/m3. The highest PM readings were observed at the section of the park closest to the new facility.
Importance to public health: Creating a baseline assessment of air quality near these environmental health hazards will allow us to track changes in air quality and assess exposure-disease associations for at-risk populations.
Amador BS, Maria Aileen (UMD SPH Behavioral and Community Health)
Garza PhD MPH, Mary (UMD SPH Behavioral and Community Health)
Boyle MPH CPH, Meleah (UMD SPH Maryland Institute for Applied Environmental Health)
Merlo, Leyla (UMD SPH Maryland Institute for Applied Environmental Health)
Feldman PhD FAAHB, Robert (UMD SPH Behavioral and Community Health)
Quiros-Alcala PhD MS, Lesliam (UMD SPH Maryland Institute for Applied Environmental Health)
Background: The “food insecurity-obesity” paradox differentially affects individuals in the US based on gender, income, and race/ethnicity. Latinos are a rapidly growing population in the US with high levels of food insecurity and higher obesity prevalence rates compared to non-Latino white adults. Research to reduce these health disparities, especially among Latino populations, is limited with most studies focused on children.
Goal: To address this gap, we examined barriers and facilitators to understand this paradox.
Objectives: Identify barriers and facilitators of the food insecurity-obesity paradox among US Latina Immigrants
Approach: As part of a larger study whose aim is to assess the health needs, lifestyle behaviors and other risk factors linked to chronic diseases among Latino immigrants in Prince Georges County, MD, we conducted a comprehensive survey and collected biospecimens. The survey captured information on demographics, cancer screening behaviors, mental health, nutrition, and food insecurity, using validated measures. Recruitment is ongoing with 123 participants recruited to date.
Results: Our study population is female (87%), obese (67%), and Central America natives (78%) with a mean age of 51 years. Preliminary analyses indicate that participants who reported: “worried about money for food” were more likely to be obese (p<0.04) and “hungry but no money for food” were less likely to graduate high school (p<0.02). Those who reported “cannot afford to eat balanced meals” were more likely to have high school degree (p<0.03), lived less time in US (p<0.02), less income (p<0.03) and be single (p<0.06). Additional analyses are underway.
Importance to public health: Understanding the “food insecurity-obesity” paradox and related factors will inform future culturally-tailored interventions to address obesity among Latina immigrants.
Raab, Constance (UMD SPH Health Services Administration)
Amaize, Aitalohi (UMD SPH Health Services Administration)
Simon-Rusinowitz, Lori (UMD SPH Health Services Administration)
Background: Senate Bill 707 Freestanding Medical Facilities- Certificate of Need, Rates and Definition (SB 707) established the Rural Health Care Workgroup to oversee a study of healthcare delivery in the Middle Shore region and develop recommendations to the legislature to meet the health care needs of the five counties – Caroline, Dorchester, Kent, Queen Anne’s and Talbot. Maryland Health Care Commission (MHCC) contracted with the University of Maryland School of Public Health and the NORC Walsh Center for Rural Health Analysis to conduct a study to develop rural health care delivery and payment options for the five counties. Five focus groups were conducted as part of this study, the results of which were published in November of 2017.
Goal: To gain insight into the health care perceptions and behaviors of consumers and to understand their views, opinions and preferences for a regional health care system. Additionally, to gather direct feedback on the needs, wants, availability and accessibility of health care for Mid-Shore consumers.
Objectives: To gain insight into the health care perceptions and behaviors of consumers and to understand their views, opinions and preferences for a regional health care system. Additionally, to gather direct feedback on the needs, wants, availability and accessibility of health care for Mid-Shore consumers.
Approach: Between March and April of 2017, five focus groups (45 participants total), one in each county, were conducted, audio-recorded, transcribed, and analyzed. Participants addressed assets and challenges related to health care in the region, identified defining characteristics of improved health services, and provided recommendations for the MHCC.
Results: Analysis revealed the following areas of need: • An environment that supports care coordination and case management and includes health care professionals who know their patients and focus on their needs. • Improvements to the health care environment, including reforms in drug pricing, health insurance, reimbursement for care coordination, mental and behavioral health services and non-pharmaceutical interventions. • Increased involvement of patients and families • Enhanced health literacy around specific health conditions, health insurance, and the health care system • Special attention to the needs of vulnerable populations including older people, young people, caregivers, those at the end of life, people with disabilities, low-income individuals, and others.
Importance to public health: By listening to residents’ voices, policymakers, program planners and others can better understand and address the healthcare needs and priorities facing the five Mid-Shore counties.
Amaize, Aitalohi (UMD SPH Health Services Administration)
Barath, Deanna (UMD SPH Health Services Administration)
Bloodworth, Robin (UMD SPH Health Services Administration)
Chen, Jie (UMD SPH Health Services Administration)
Franzini, Luisa (UMD SPH Health Services Administration)
Kleinman, Dushanka (UMD SPH Epidemiology and Biostatistics)
Knudson, Alana (Walsh Center for Rural Health Analysis at NORC)
Oran, Rebecca (Walsh Center for Rural Health Analysis at NORC)
Simon-Rusinowitz, Lori (UMD SPH)
Background: Like many rural communities, the five-county Mid-Shore region of Maryland (comprised of Caroline, Dorchester, Kent, Queen Anne’s and Talbot counties) faces unique health challenges, including higher rates of poverty and people living with chronic diseases. To help better meet regional health care needs and provide recommendations that could be applied to other Maryland rural areas, the Maryland Health Care Commission (MHCC) and the Department of Health established a workgroup (via Senate Bill 707 Freestanding Medical Facilities — Certificate of Need, Rates and Definition effective July 1, 2016) on rural health care delivery to oversee a study, hold public hearings and recommend policy options. At MHCC’s request, the UMD SPH and the Walsh Center for Rural Health Analysis at NORC partnered to conduct the study in parallel with the workgroup. The results of the study were published in November of 2017.
Goal: To highlight our mixed methods approach and present a summary of study findings and recommendations for restructuring and enhancing the health care delivery system on the Mid-Shore.
Objectives: To highlight our mixed methods approach and present a summary of study findings and recommendations for restructuring and enhancing the health care delivery system on the Mid-Shore.
Approach: The study consisted of the following: • 5 focus groups with Mid-Shore residents • Stakeholder interviews with community leaders • Analysis of claims and primary care physician workforce data • Review of literature and national rural health delivery models • Input from the Rural Health Care Delivery Workgroup, its advisory groups, and public hearings
Results: Four high-level recommendations to support better health and well-being of Mid-Shore residents and potentially other rural Maryland communities emerged: 1. Establish a Mid-Shore multi-sector Coalition 2. Create a rural community health demonstration program 3. Invest in fundamental programs that expand the health care workforce, elevate community-based health literacy and enable technology 4. Use strategic programs to position Maryland rural communities to benefit from Maryland’s health care reform initiatives.
Importance to public health: Maryland’s health care system is transforming from a volume-based to a value-based reimbursement and delivery system, and is well-positioned to respond to residents’ needs by focusing on improvement of the health and well-being of communities. Our study findings and past experience working with rural communities, indicate that community-driven solutions have the greatest potential for success.
Background: The local food environment plays a critical role in determining individual and community health. Some communities, defined as food swamps, have an abundance of unhealthy food options, such as convenience stores and fast food restaurants, that are more readily available and accessible than healthy food outlets, such as supermarkets. Lack of access to affordable, healthy food can contribute to community stress and deprivation, and can lead to diet-related chronic diseases such as obesity and diabetes.
Goal: The goal of this project is to compare healthy food availability between three different communities within Prince George’s County, Maryland: Bladensburg, Greenbelt, and Hyattsville.
Objectives: As part of this project, we have the following objectives: 1) Compare and contrast the presence of supermarkets and grocery stores across our study neighborhoods; 2) Compare and contrast the quality of food stores in and across our study neighborhoods; 3) Assess in disparities in the types of food stores and quality of food stores in and across our study neighborhoods in regards to race/ethnicity and socioeconomic status (SES).
Approach: We visited all stores that sell food in Bladensburg, Greenbelt, and Hyattsville. We mapped each store and categorized by type: convenience, grocery store, supermarket, or other. We gave each store a food quality score based on the presence or absence of certain food items such as fresh produce and non-processed foods. In the next phase of the project, we plan to use US EPA’s EJSCREEN tool to assess differences in types of food stores and food quality scores in relation to race/ethnicity and SES at the census block group level.
Results: Based on preliminary results, we believe that: 1) Hyattsville will have more grocery stores and supermarkets than Bladensburg and Greenbelt per person and 2) Hyattsville will have higher rated stores compared to the other study neighborhoods.
Importance to public health: Our results will demonstrate a need for policymakers to address food injustice in Prince George’s County, Maryland. Limited availability and access to salutogenic food infrastructure such as supermarkets and grocery stores is a great challenge for many Americans, especially here in our own community.
Banis, George (UMD)
Beardslee, Luke (UMD)
Stine, Justin (UMD)
Ghodssi, Reza (UMD)
Background: Integrated capsule systems are widely gaining momentum for analysis or drug delivery in gastrointestinal (GI) regions where alternative techniques are expensive, invasive, or inadequate. Depending on the region, there are numerous physiological considerations that must be addressed for fluid sampling with minimal human intervention. Previous passive approaches to GI sampling lack a means of knowing whether a sample has been retrieved in real-time, while active approaches suffer due to cost and complex assembly.
Goal: This project aims to develop a wireless ingestible microsystem with specialized sensors for sampling secretions throughout the GI tract and monitoring enzymes in situ for indicating pathological conditions.
Objectives: In this work, a breadboard-level circuit representative of the electronics toward full integration within the capsule are used to monitor the removal of polymer material from gratings within a 3D printed capsule. The polymers protect sensors within the capsule, only exposing them when the device has reached the GI region of interest. Different Eudragit polymers are used to target different GI regions: E PO, S 100, and L 100 dissolve respectively at the stomach, ileum, and duodenum.
Approach: The circuit setup was first characterized and signal transmission protocols (serial or wireless) were compared. Sensors are inserted into 3D-printed capsules. Once inserted, the capsules are fastened using built-in threads and sealed with epoxy, then dip-coated into a 30 w/v% solution of each polymer in methanol, each for 1-5 coats with removal for 20 min intervals between each coating. Capsule coating thicknesses were analyzed over gratings and non-grating regions for uniformity. Capsules were then immersed in a control solution (pH 3 for S/L100 and pH 7 for E PO formulations) and progressively adjusted at 30 min intervals to different test pH sequences. After coating optimization was performed for each polymer, combined coatings were tested to determine ability to tailor sampling for more complex pH sequences.
Results: Gratings resulted in a slower increase with each coating due to polymer in-fill. We obtain the sensor output and corresponding change in capacitance over the course of pH adjustments for each polymer, indicating the expected length of time for chamber filling and sampling dynamics for each coating thickness. We also obtain representative sequences of L 100 and E PO formulations, as well as a combined coating of both polymers. As expected, the capacitance increase did not occur until the respective polymers dissolved at the appropriate pH, indicative that both single and combined coating strategies can be used to protect the sensing chambers until the characteristic pH-targeted regions are reached.
Importance to public health: This work is the first demonstration of a passive pH-dependent packaging strategy for ingestible capsule technology that offers information on the package integrity at any given time, while simultaneously providing a real-time active microelectronics-based system capable of wireless retrieval of sensor data for use in GI sampling and analysis.
Chen, Jie (UMD SPH Health Services Administration)
Background: Suicide is the leading cause of death among people with substance use disorders (SUDs). Together, 42% of emergency Department suicidal ideation-related visits were associated with SUDs in 2013. Though, numerous studies indicate ED-initiated interventions have been successful in reducing adult suicidal ideation and intentional self-inflicted injury, none are wide-spread; and while other studies recommend interventions outside the ED, none examine the role of local health departments (LHDs) in relation to suicide prevention.
Goal: The goal of this study is to examine whether LHDs’ activities are associated with reductions in the rate of suicidal ideation and intentional self-inflicted injury in the ED settings.
Objectives: The objective of this study is to examine whether LHDs’ active roles of health promotion are associated with reductions in the rate of suicidal ideation and intentional self-inflicted injury in the ED settings.
Approach: Using data sets linked from multiple sources, including 2012-2013 State ED Databases for the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Health Resource File, and U.S. Census data, we first employed multivariable models to examine whether LHDs’ active provisions of preventive care and medical services and LHDs’ health policy advocacy (such as affordable housing, mental health, education, etc.) were associated with the reduction of having suicidal ideation and intentional self-inflicted injuries. We then used an instrumental variables (IV) design to reduce the risk of endogeneity of LHDs’ activity measures.
Results: People with SUDs who committed suicidal ideation and intentional self-inflicted injuries were more likely to be White, had more chronic conditions, and were more likely to live in rural areas. The rate of suicidal ideation and intentional self-inflicted injury was 0.78% overall, but the rate increased to 7.26% of among patients with SUDs. Over 42% of ED suicidal ideation-related visits were associated with SUDs. After adjusting for individual-, hospital-, LHD-, and county-level characteristics, results of the IV approach demonstrated that LHDs’ provision of mental health preventive care and services was associated with 6% (p<0.001) and 7% (p<0.001) reduction of suicidal ideation and intentional self-inflicted injury rate respectively. Association of LHDs’ health policy advocacy was no longer significant after adjusting the endogeneity. These IV models passed the tests for (a) the validity of instruments, (b) over-identifying restrictions and (c) the endogeneity of LHD factors.
Importance to public health: Evidence on interventions that can effectively prevent suicide is extremely lacking. Suicide is the product of multiple causes; its prevention requires broad, interdisciplinary approaches. LHDs, as the center of community-engaged health programs and the major source of health care for vulnerable populations, are expected to design and implement activities that can reflect the community health needs and target specific psychological barriers.
Barath, Deanna (UMD SPH Health Services Administration)
Bloodworth, Robin (UMD SPH Health Services Administration)
Franzini, Luisa (UMD SPH Health Services Administration)
Background: Like many rural communities, the five-county Mid-Shore region of Maryland (comprised of Caroline, Dorchester, Kent, Queen Anne’s and Talbot counties) faces unique health challenges, including higher rates of poverty and people living with chronic diseases
Goal: To understand the demand for health care by Mid-Shore residents in order to plan for a health care system that meets residents’ needs.
Objectives: • Where do residents of the Mid-Shore region go for health care? • Do residents in the region access care in the Mid-Shore region, in state or out of state? • For each county, do county residents access care in the county, the region, in state or out of state?
Approach: We used HSCRC hospital data, All Payer Claims Database, Medicare and Medicaid data to answer the questions above. We identify Mid Shore residents by zip codes, match to utilization databases, and identify visit location by provider zip code using the provider’s National Provider Identifier. All visits were assessed by type of visit: primary care, ER, inpatient.
Results: Mid-Shore residents have higher health care utilization relative to state averages. While most health care was accessed in the county of residence and in region, Medicare and Medicaid residents received more care locally compared to privately insured residents. Queen Anne’s residents are more likely to access care on the Western Shore, due to its proximity. Only about half of inpatient admissions are on the Mid-Shore, with less than 50 percent of privately insured residents staying in region. These patients have the transportation and other resources to access care based on reputation and specialized services offered by out-of-region hospitals.
Importance to public health: The findings reinforce the need to provide high-quality and accessible care on the Mid-Shore given that most residents access care locally for all their needs; and highlight the importance of maintaining and strengthening access to emergency room services on the Mid-Shore. The higher rates of inpatient admissions due to ambulatory sensitive conditions, across the region and particularly in Dorchester and Kent counties, indicate the need to reinforce ambulatory care locally. These results were shared with a Rural Health Workgroup and shared with the Legislature.
Arria, Amelia (UMD SPH Behavioral and Community Health)
Bugbee, Brittany (UMD SPH Behavioral and Community Health)
Soong, Andrea (UMD SPH Behavioral and Community Health)
Barrall, Angelica (UMD SPH Behavioral and Community Health)
Vincent, Kathryn (UMD SPH Behavioral and Community Health)
Background: Excessive drinking and marijuana use are prevalent among college students, and can negatively affect academic success. Research has previously highlighted skipping class as a mechanism linking substance use to poor academic performance.
Goal: The present analysis aimed to confirm prior findings in a multi-site college sample and examine if the strength of the associations differs by institution.
Objectives: 1. Describe the prevalence of skipping class, binge drinking, and marijuana use across the institutions of higher education studied. 2. Evaluate the association between skipping class, alcohol use, and marijuana use. 3. Assess whether or not the association between skipping class and substance use varies across institutions of higher education.
Approach: Data were collected online as part of a multi-year cross-sectional study of undergraduates attending twelve institutions of higher education (IHEs) in a single state. The present analyses were limited to full-time undergraduates ages 18-25 who participated in at least one of two annual surveys (n=5814; response rates 19.0% in 2016 and 17.5% in 2017). Either a census or a random sample was recruited via email. Binge drinking was defined as consuming 4+ drinks (females) or 5+ drinks (males) on one occasion. A single item assessed how often classes were skipped during the past year. Responses were collapsed into “sometimes/often” versus “rarely/never.” Logistic regression models evaluated the associations between past-month binge drinking, past-year marijuana use, and skipping class, adjusting for IHE, survey year, age, and race/ethnicity.
Results: Across all IHEs, 20.5% of students skipped class sometimes or often. The prevalence of binge drinking and marijuana use across IHEs ranged from 21.0%-60.9% and 20.1%-48.8%, respectively. Skipping class was more prevalent among binge drinkers than non-binge drinkers (28.5% vs. 14.8%, p<.001) and among marijuana users than non-users (30.4% vs. 15.0%, p<.001). After adjusting for covariates, the odds of skipping class were nearly two times greater for binge drinkers than non-binge drinkers and marijuana users than non-users. Two interaction terms, school by binge drinking and school by marijuana use, were not statistically significant.
Importance to public health: Results are consistent with previous studies showing that excessive drinking and marijuana use are associated with skipping class. The effect of excessive drinking and marijuana use on skipping is similar regardless of the level of substance use at a school. Because academic achievement and retention are central to the mission of IHEs, these findings provide a compelling argument to bolster substance use prevention activities on college campuses and identify students at risk for substance use problems by levels of academic engagement.
Kaley, Beins (UMD SPH Maryland Institute of Applied Environmental Health)
Milton, Don (UMD SPH Maryland Institute of Applied Environmental Health)
Background: Vasculitis is an umbrella category covering a series of about 20 rare autoimmune disorders. Anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis comprise three diagnostic forms of this autoimmune disorder: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Due to the severity of these disorders, the limited resources available to vasculitis researchers have mostly been targeted towards treatment and relapse prediction with a small amount of research examining genetic and environmental etiologic factors.
Goal: This research aims to develop novel methodology that can be used to examine potential environmental triggers of vasculitis in genetically pre-disposed individuals.
Objectives: In this project the authors: 1) review the existing literature on AAV etiology to identify gaps and promising areas for future research and 2) design a novel matched case-control study on gene-environment interaction in AAV pathogenesis.
Approach: Through collaborations with medical professionals, conversations with patients, and a review of AAV literature, the authors selected specific environmental exposures to be evaluated via a series of previously validated survey questions. These environmental exposures included potential triggers from occupational, travel, and leisure activities.
Results: This research is ongoing, and the authors plan to implement this validated methodology in a full study beginning in August 2018. Currently, two rheumatologists with access to AAV patients have shown interest in supporting the study and assisting with recruitment. Additionally, approximately 200 vasculitis patients have expressed interest in the study via Facebook support group message boards, demonstrating the significance of etiologic information to the vasculitis community.
Importance to public health: Given its chronic and potentially fatal nature, AAV has high social and economic costs; however, as a result of the unknown etiology of AAV, preventative care is often impossible. Studying the environmental etiology of AAV enables physicians to be proactive in identifying risk factors, which leads to increased monitoring and the potential for reducing AAV incidence.
Beins, Kaley (UMD SPH Maryland Institute of Applied Environmental Health)
Yuki, Lama (UMD SPH Family Science)
Jaleh, Montazer (UMD SPH Public Health Science)
Kajal, Parikh (UMD SPH Public Health Science)
Darya, Soltani (UMD SPH Public Health Science)
Kelsey, Talarico (UMD College of Computer)
Ghaffar Ali, Hurtado (UMD SPH Family Science)
Elisabeth, Maring (UMD SPH Family Science)
Background: Worldwide, two thirds of children who are chronically malnourished live in lower- to middle-income countries. A 2017 report from the Pan American Health Organization found that prevalence of hunger has recently increased in six Latin American countries, including in Peru. According to the World Food Programme, 13.1% of Peruvian children are malnourished with child malnutrition reaching as high as 33.4% in rural areas where government programs and funding are less available. The Peruvian Ministry of Health (MINSA) estimates that 43.5% of children aged 6 to 35 months are anemic, with estimates rising to 51.1% in rural areas, concerns about the lasting health effects of malnutrition on children and pregnant women. Although MINSA has created technical guides and interventions to combat these issues, the resources necessary for effective interventions are rarely available in rural areas of Peru. Public Health Without Borders (PHWB) relies on its 5-year relationship with the community of Compone, an agricultural highland community 16 miles west of Cusco, to address public health issues that are relevant to the residents.
Goal: In collaboration with the local health clinic in Compone, the PHWB team modified MINSA’s materials and implemented a culturally-competent, low-cost nutrition intervention.
Objectives: Based on a 2013 technical document from MINSA, this education-based intervention aimed to prevent negative health outcomes associated with malnutrition by targeting children and childbearing age women.
Approach: PHWB led 30-minute workshops (in Spanish) at the clinic and covered information on portion sizes, food groups, and the effects of malnutrition. Each workshop included: 1) a short presentation (charla), 2) a hands-on activity, 3) a child’s activity book about nutrition, and 4) a summary handout for participants to take home.
Results: The workshop was held twice over the course of the week with a total of 17 participants. Participant feedback and discussion helped shape a follow-up nutrition intervention that PHWB will implement in Compone in July 2018.
Importance to public health: This intervention provides a model for the creation of future culturally competent interventions based on community input and materials from the partner country.
Bell, Caryn (UMD)
Background: Poor or predominately African American communities have fewer healthy food resources. Previous studies have not fully addressed important factors such as complex interrelationships between race and higher income and the interplay between “healthy” and “unhealthy” food resources.
Goal: To examine the effects of racial segregation and SES on food environments in Maryland.
Objectives: This study's objective is to determine if racial segregation and SES interact on "healthy" and "unhealthy" food environments in a unique way in Maryland.
Approach: Using data from the Census Bureau and InfoUSA, variations in associations between healthy and unhealthy food environments were assessed by neighborhood racial segregation and income. Associations between segregation and food environment were assessed using spatial regressions to account for neighboring communities using a 3rd order Rook contiguity. Multiplicative interaction terms were used to assess the potential modifying effects of income.
Results: Supermarket and grocery store density were negatively associated with fast food and convenience store density. Supermarkets were negatively associated with fast food and convenience stores among neighborhoods with fewer African American residents. Spatial regression analyses found that income was inversely, and segregation positively, associated with fast food and grocery store density with significant interactions. Spatial lag and error were detected for grocery store density.
Importance to public health: Unhealthy food resources were not negatively associated with healthy food resources in African American neighborhoods suggesting that African Americans are more likely to be simultaneously exposed to both healthy and unhealthy food environments. This has implications for racial disparities in obesity and diet. Moreover, neighborhood SES is implicated in these associations. Policymakers and researchers should examine food environments with specificity rather than broadly.
Benjenk, Ivy (UMD SPH HLSA)
Linman, Shawn (UMD SPH HLSA)
Chen, Jie (UMD SPH HLSA)
Background: Primary care practices are transforming the way that they provide care by increasing their medical home infrastructure. However, previous studies have shown variation in the implementation of these medical home functions across different practices types.
Goal: This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with severe psychological distress (SPD).
Objectives: Early work has also shown that adults with mental illness can significantly benefit from receiving their primary care through a medical home. The objective of this study is to examine the degree to which medical home functions have been implemented by primary care practices that care for adults with severe psychological distress (SPD), a proxy measure of mental illness. We also aim to examine whether adults with SPD are more or less likely to receive primary care from practices that have implemented the medical home functions as compared to adults without SPD.
Approach: Analysis of the 2015 Medical Expenditure Panel Survey (MEPS) Household Component and Medical Organizations Survey (MOS). This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care.
Results: Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with SPD (N=267, representing 3,658,230 Americans) were not any more or less likely to receive care from practices that have implemented the functions of a medical home that adults without SPD, including case management, electronic health records, flexible scheduling, and Patient Centered Medical Home (PCMH) certification. We did however find that adults with SPD were significantly more likely to be cared for in practices that provided individualized quality reports to their physicians (AOR=2.06, 95% CI 1.13-3.77).
Importance to public health: Although we found that adults with SPD receive care from different types of practices than adults without SPD, we did not find much difference between the two groups as related to the medical home functionality of their site of primary care. Due to their complex medical and psychosocial comorbidities, adults with mental illness have significant potential to benefit from primary care that is delivered through a medical home.
DuGoff, Eva H. (UMD SPH HLSA)
Benjenk, Ivy (UMD SPH HLSA)
Cushman, Jeremy T. (University of Rochester)
Jones, Courtney MC (University of Rochester)
Kind, Amy JH (University of Wisconsin)
Lohmeier, Michael (University of Wisconsin)
Shah, Manish N. (University of Wisconsin)
Background: Older adults are estimated to make over 20 million visits to the emergency department (ED) annually. Reducing unnecessary ED use is a priority, and designing appropriate interventions requires a nuanced understanding of what is driving health care utilization. Previous studies have established that sociodemographic and clinical health factors contribute to frequent ED use, but less is known about the importance of enabling resources as defined by the Aday-Andersen Health Behavior Model.
Goal: The purpose of our project is to identify enabling resources among older adult emergency department users.
Objectives: In light of a recent National Academy of Medicine report recommending population segmentation to better understand the specific needs in high-need subgroups, we examine the enabling resources among high-need segments of the ED population.
Approach: This is a retrospective cross-sectional study of patient-survey data collected as part of an on-going randomized trial. We defined high-need segments as individuals reporting one or more functional limitation with an activity of daily living and/or multimorbidity (3+ chronic conditions). For purposes of comparison, we use “relatively healthy” subjects who did not report a functional limitation or multimorbidity. 434 adults 60 and older living in Monroe County, New York or Dane County, Wisconsin who consented to participate in a randomized trial and were enrolled into the control group.
Results: One out of four older adults (24.9%) reported living with multimorbidity and a functional limitation; 32.5% reported living with multimorbidity and no functional limitations; and, 9% reported a functional limitation and fewer than three chronic conditions. Older adults with functional limitations and/or multimorbidity were more likely to report fair/poor health compared to relatively healthy older adults (p<0.001). We also found substantial differences in enabling resources by high-need segment. Older adults reporting a functional limitation with and without multimorbidity were more than three times as likely to report poor health literacy compared to relatively healthy older adults (p=0.015) and more than four times likely to report high levels of social isolation (p<0.001).
Importance to public health: Older adults with high needs have fewer enabling resources. These high-need older adults may require tailored interventions to reduce repeat ED visits, and future unnecessary ED visits.
Bickford, Abigail (UMD SPH Behavioral and Community Health)
Gold, Robert (UMD SPH Behavioral and Community Health)
Background: Originally started as an online forum, the Black Lives Matter organization has grown into a social movement through an extensive social media presence under the hashtag #BlackLivesMatter. While the Black Lives Matter movement has evoked many academic and popular responses, there has been a distinct lack of focus on this movement by the public health discipline. The Black Lives Matter organization has outlined its mission and goals, which includes bringing awareness to the many ways black people face discrimination and oppression today.
Goal: The purpose of this study is to identify the prevalent themes in a sample of tweets containing #BlackLivesMatter to better understand how this online social movement relates to public health.
Objectives: 1. To determine the major themes present in a sample of tweets using #BlackLivesMatter 2. To identify health-related themes in the tweet sample 3. To match tweets with the mission and goals of the official Black Lives Matter organization
Approach: A random sample of 10,000 tweets collected from January 2017 through June 2017 containing #BlackLivesMatter were collected and analyzed. Tweets were coded by two human raters for thematic content based on codes developed from the Black Lives Matter organization's stated mission and goals.
Results: 52% of tweets were found to align with the Black Lives Matter organization's stated mission and goals with the most prevalent themes surrounding protest, death by police, and diversity. 48% of the tweets contained themes unrelated to the movement's mission and goals. The majority of tweets were in favor of the Black Lives Matter movement (57%), while 35% were opposed, and 18% were neutral in nature. 115 different health-related words were discovered in the tweet sample. Tweets also have high clout, suggesting confidence in the statements made, and showed a low emotional tone, indicating the anxiety, hostility, and sadness in the text of the messages.
Importance to public health: It is important for the field of public health to better understand social movements and their relation to health issues. With more social movements organizing through social media, it is important to utilize this form of data when examining health-related social movements.
Boyle, Meleah (UMD SPH MIAEH)
Garza, Mary (UMD SPH Behavioral and Community Health)
Beins, Kaley (UMD SPH MIAEH)
Dokshina, Dasha (UMD SPH MIAEH)
Merlo, Leyla (UMD SPH Public Health Science)
Feldman, Robert (UMD SPH Behavioral and Community Health)
Rous, Jennifer (UMD ESSR)
Quiros-Alcala, Lesliam (UMD SPH MIAEH)
Background: Latinos represent a growing demographic in the U.S., however, they are often overrepresented in lower-paying, higher risk jobs, placing them at an increased risk for work-related illnesses, including respiratory-related outcomes. Additional efforts are needed to identify environmental exposures of concern to inform future epidemiologic studies and interventions, as Latinos are an underrepresented population in environmental and occupational health research.
Goal: The goal of our project was to identify environmental and occupational exposures that may contribute to adverse health outcomes.
Objectives: We sought to examine the association between self-reported respiratory and allergic symptoms and exposure to 16 different products used at work and personal behaviors, including personal care product use.
Approach: Data was obtained from an ongoing study whose aim is to assess the health needs and to identify risk factors potentially linked to chronic diseases among Latino immigrant adults in Prince Georges County, MD. We administered a comprehensive questionnaire, which queried participants on demographic information, environmental exposures at the workplace and home environment, and we also collected biospecimens (i.e., urine, nasal swabs).
Results: Our population consisted of 156 adults most of which were female (87%) and Central American natives (81%). The mean age of participants was 51 years. Preliminary bivariate analyses indicate that using whiteboard cleaner is positively associated with reporting wheeze (p=0.02) and rashes (p=0.03) in the prior year; perfume use was moderately associated with wheeze in the prior year (p=0.06). Additional data and biospecimen analysis is underway.
Importance to public health: Study findings may inform intervention programs designed to reduce respiratory and allergic symptoms and improve overall health in Latino adults.
Buckenmaier, Susan (UMD SPH Epidemiology)
Tullier, Sophie (UMD Stamp Student Union)
Cruz-Cano, Raul (UMD SPH Biostatistics)
Dallal, Cher (UMD SPH Epidemiology)
Background: Nearly two-thirds of recent veterans are classified as overweight or obese. While prior research has examined various biological and psychological explanations for the high proportion of veterans struggling with excess weight, limited studies have assessed overweight and obesity among veterans in a university environment.
Goal: The goal of this project was to gain a better understanding of how past military history is associated with current overweight or obesity among student veterans.
Objectives: This analysis aimed to estimate the prevalence of overweight and obesity among the Veteran Student population at the University of Maryland and to examine whether factors related to military service background are associated with weight status.
Approach: Participants included University of Maryland, College Park veteran students who completed the 2017 Veteran’s Needs Assessment (n=172). The study utilized a convenience sample of male and female student veterans recruited using an email and social media campaign and through announcements made at different events. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence limits (CI) for relationships between military factors (rank, commission status, time in service, and deployment history) and weight status (normal weight and overweight/obesity).
Results: After preliminary analysis, the odds of being overweight/obese were significantly elevated for those that were junior ranking personnel (OR=4.35, 1.41-13.38 95% CI) versus senior ranking, those that deployed (OR=2.50, 1.28-4.91 95% CI) versus those that did not deploy, and individuals who spent 6 or more years in military service (6-10 years: OR=3.94, 1.86-8.34 95% CI, 11-15+ years: OR=2.67, 1.01-7.10 95% CI) compared to those who spent 5 or less. Conversely, earning a commission and being an officer were inversely associated with being overweight/obese (OR=1.58, 0.71-3.51 95% CI).
Importance to public health: This project is the first assessment of weight status among veterans at the University of Maryland. Findings from this analysis can help University of Maryland and other schools better support the health and well-being of the student Veteran population as a means of limiting the long-term impacts of overweight/obesity on health. Moreover, these findings lend support for further evaluation, particularly in larger studies, to combat this health concern.
Bueno de Mesquita, Jacob (UMD SPH Maryland Institute for Applied Environmental Health)
Heidarinejad, Mohammad (Illinois Institute of Technology)
Addo, Kofi (UMD A. James Clark School of Engineering)
Dalgo, Daniel (UMD A. James Clark School of Engineering)
Mattise, Nicholas (UMD A. James Clark School of Engineering)
Srebric, Jelena (UMD A. James Clark School of Engineering)
Background: The purpose of this study is to estimate exposure to infectious, airborne influenza virus in a dormitory room given an infected roommate. To understand a typical quantity of infectious virus in the exhaled breath of campus cases, we take advantage of observed viral shedding from 142 influenza cases at the University of Maryland, described in Yan et al., 2018. We couple this data with newly collected, dormitory room CO2, a marker of exhaled breath exposure, to estimate the dose of inhaled virus following the Rudnick-Milton equation (2003).
Objectives: Given the challenges with effective vaccine match, strategies designed to reduce influenza virus exposure are paramount to protecting population health. Effective exposure reduction draws upon knowledge of transmission via direct contact, large droplet spray, and fine particle aerosols. Contact and large droplet transmission can be mitigated by reducing close contact with infected individuals, washing hands, and sterilizing surfaces, as recommended by CDC. Protecting against airborne exposure poses a greater challenge, however, a household transmission study estimated that about half of influenza is spread by airborne, fine particle aerosols (<5um in aerodynamic diameter), and infection initiated this way may lead to enhanced respiratory symptoms (Cowling et al., 2013). Given the potential for fine particle aerosols to carry infectious virus, and to mix suspended in air, we employed continuous CO2 monitoring of dormitory rooms to estimate the rebreathed air fraction as a proxy for exposure to airborne virus. Transmission risk is inferred given the assumption that a single virus is infectious and follows a Poisson distribution.
Approach: Influenza virus shed into fine particle aerosols was quantified, using a G-II bioaerosol sampler from community acquired influenza cases season (Yan et al., 2018). 30% of cases had culturable virus by focus assay and the geometric mean of positive cases was 37 with geometric standard deviation of 4.4. Per Rudnick and Milton, a rebreathed air fraction is calculated as the difference between indoor and outdoor CO2 concentrations (PPM) divided by the volume fraction of CO2 added to exhaled breath during breathing, assumed to be 0.038. Then average virus concentration in a room was calculated for a triple with 1 case and 2 susceptibles, for an exposure period and later the average number of viruses breathed by a susceptible person, using equation 1, µ ̅=ptN ̅ (1) where p is the pulmonary ventilation rate (l/hr) assumed to be 480, t is the exposure time, assumed to be 8 hours, and N ̅(per l) is the average virus concentration in the room for total exposure time t. There is a poisson distributed probability that a susceptible person remained uninfected, and thus the probability of infection.
Results: The findings show that the rebreathed air fraction for each of the two representative dorm rooms is dramatically different, and the building with improved ventilation (dorm 2) somewhat reduces transmission risk, given the low dose for influenza. From an epidemic prevention standpoint, the critical rebreathed air threshold is 0.0035, which is an order of magnitude smaller than what was observed in dormitory 2. The average CO2 level at night (8am-8pm) for dormitories 1 and 2 were 1.57E+04 and 1.70E+03, respectively. Rebreathed air fractions, based on these CO2 levels were 0.40 and 0.033. Geometric mean for number of inhaled infectious viruses over an eight hour period were 79 and 7 respectively. Assuming infection can be caused by a single infectious particle, as suggested by Alford et al. (1966), the risk of airborne transmission for the 2 susceptibles in both dorms would be 100%. If the number of viruses inhaled by susceptibles were at 1 standard deviations below the geometric means, then that would result in infection risk of 100% and 50% for dormitories 1 and 2, respectively. If the number of viruses inhaled by susceptibles were at 1 standard deviations below the geometric means, then that would result in infection risk of 88% and 16% for dormitories 1 and 2, respectively. These infection risk outcomes warrant validation through additional analyses to account for various exposure conditions and infectious dose estimations.
Importance to public health: Results from this analysis show that there is significant risk of airborne transmission between roommates, given a single shedder. Overall this work suggests that there is room to further reduce aerosolized virus exposure through improved ventilation and/or filtration, and/or inactivation methods such as upper-room germicidal UV.
Burnett, Jenna (UMD SPH Kinesiology)
Kim, Yong Woon (Kyungnam University)
Shim, Jae Kun (UMD SPH Kinesiology)
Background: Human performance is quantified utilizing many variables, with power specifically used to analyze maximal effort in movements such as jumping, which can be a proxy for whole body power. Many jump height calculations use the ground reaction force (GRF) as the basis of calculating the center of mass (CoM) position. However, it is possible that CoM height variables may be influenced by errors in the initial mass estimated from the static portion of the GRF.
Goal: This project investigated how mass errors influenced the CoM position during a countermovement jump.
Objectives: Specifically, this project tested (1) how the static range of the GRF used to calculate the mass changed the CoM position and (2) how incrementing the mass by 0.1 kg up to ±0.5 kg changed the position during a countermovement jump.
Approach: The static portion of 8 GRF trials was divided into 10 static ranges (Tk, k = 1:10), and used to calculate 10 initial masses (Mi, i = 1:10). Each Mi was incremented to simulate 11 masses (Mi,j, j = 1:11) with up to 0.5 kg of error. Using the Mi,j and GRF, the position was calculated as the double integration of acceleration using the cumulative trapezoid method. From the position, the maximum (Hmax) and minimum (Hmin) height, the timing of the maximum (Tmax) and minimum (Tmin), the difference between the initiation (H1) and the landing (H2), the H1 and the final height at the end of the trial (H3), and H3-H2 were calculated.
Results: Preliminary visual results indicate that the Mi,j may significantly influence Hmax, Hmin, H3-H1 and H3-H2, while Tmax and Tmin may not be largely influenced. The Hmax difference between Mi,1 and Mi,11 appeared to be up to ~10 centimeters, a significant change in Hmax. Visual analysis of Tk indicates it may have minimal influence on the variables, assuming the GRF was properly stable.
Importance to public health: These preliminary analyses indicate that researchers may need to proceed with caution if using this method to calculate jump characteristics, as errors may significantly inflate or deflate results, leading to inaccurate conclusions, especially regarding maximal human performance.
Cairns, Christopher (UMD SPH Epidemiology and Biostatistics)
Carter-Pokras, Olivia (UMD SPH Epidemiology and Biostatistics)
Payne-Sturges, Devon (UMD SPH Epidemiology and Biostatistics)
He, Xin (UMD SPH Epidemiology and Biostatistics)
Background: Arthritis and rheumatoid arthritis are highly prevalent among U.S. adults, but, the cause of the disease remains unknown. Identified risk factors for developing arthritis include age, sex, genetics, smoking, history of live births, obesity, and environmental factors. Exposure to mercury and other heavy metals has been associated with autoimmune diseases, but the association between mercury and arthritis is underexplored.
Goal: Using data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), this project will determine if adults with arthritis have higher levels of blood methyl mercury compared to healthy adults.
Objectives: • Determine the odds that an adult with arthritis will have higher levels of blood methyl mercury compared to adults without arthritis. • Determine the odds that an adult with rheumatoid arthritis will have higher levels of blood methyl mercury compared to adults without rheumatoid arthritis. • Establish whether gender, age, race, or BMI are confounding variables.
Approach: A secondary data analysis of the NHANES 2013-2014 was performed for adult participants who were at least 20 years of age, and had arthritis and blood methyl mercury data (n=2695). Weighted multiple logistic regression models were used to explore the association between arthritis/rheumatoid arthritis and blood methyl mercury levels while considering potential confounders.
Results: The weighted geometric mean blood methyl mercury levels for healthy adults, all adults with arthritis, and adults with rheumatoid arthritis are 0.91, 0.86, and 0.76 ug/l, respectively. After adjusting for age and obesity, the odds of adults reporting arthritis increased by 44% for every unit increase in log methyl mercury (95% CI = 1.13-1.84). The odds of adults reporting rheumatoid arthritis increased by 126% for every unit increase in log methyl mercury (95% CI = 1.29-3.95) after adjusting for age.
Importance to public health: Based on this cross-sectional analysis, exposure to methyl mercury was found to be positively associated with arthritis and rheumatoid arthritis. Future studies should consider a different study design to establish temporality.
Callow, Daniel (Kinesiology)
Won, Jun (Kinesiology)
Weiss, Lauren (Neuroscience and Cognitive Science)
Alfini, Alfonso (Kinesiology)
Smith, J. Carson (Kinesiology and Neuroscience and Cognitive Science)
Background: Dementia is a decline in cognitive ability severe enough to affect daily life and which affects approximately 5-7% of the world’s population over 60. Throughout our lives, the brain undergoes structural and functional changes to maintain cognitive performance in response to continuous neurodegenerative insults. Semantic memory task activation, measured via the famous name recognition task (FNRT), acts as a measure of neural efficiency and a predictor of future cognitive decline. Exercise has shown promise as a means for attenuating age and disease-related cognitive decline, however, there is a gap in our understanding of the mechanisms by which exercise affords these benefits.
Goal: The purpose of our study is to compare the effects of an acute bout of low versus high-intensity cycling exercise on functional magnetic resonance imaging activation during a semantic memory task in younger adults.
Objectives: We hypothesized that after both high and low-intensity exercise, subjects would exhibit greater semantic memory task activation compared to baseline pre-intervention measures. We also hypothesized that the intensity of the cycling condition would have an interactive effect on semantic memory task activation changes.
Approach: In a completely within-subject design, 12 participants (8 Male, 6 Female, Age = 24.1 (±4.1) Yrs.), on two separate days and in counterbalanced order, performed the FNRT while undergoing functional magnetic resonance imaging both before and after a 30-minute bout of high and low-intensity exercise.
Results: The extent of semantic memory task activation was significantly lower in the Left Middle Frontal Gyrus following exercise and no significant effect of exercise intensity was found. Mean semantic memory task activation within the Left Middle Frontal Gyrus was significantly lower following exercise, independent of exercise intensity (p<.001). These results indicate that a single bout of acute exercise may be beneficial for cognition via improvements in neural efficiency, independent of exercise intensity.
Importance to public health: These findings suggest participation in aerobic exercise may provide short-term benefits to neural efficiency. These short-term benefits may culminate over time, reducing strain on neural networks throughout the lifespan, therefore, providing protection from age-related cognitive decline and contributing to the healthy aging of the brain.
Caminita, Mia (UMD SPH Kinesiology)
Shim, Jae Kun (UMD SPH Kinesiology)
Background: Various types of sensory manipulation influence human motor performance. Most studies examining sensory manipulation have focused on the sensory effects on fine motor skills. However, gross whole-body movements are also important to many tasks of daily living requiring larger motor output for movement, yet little is known about the effects of sensory manipulation on these movements.
Goal: The goal of the current study is to examine one type of sensory manipulation, cooling, and the effect this may have on motor performance of a vertical jumping task.
Objectives: We hypothesize that sensory cooling of the soles of the feet will lead to decreased performance on a gross motor task of maximal vertical squat jump (MVSJ).
Approach: Participants are first instructed on proper technique for performing a MVSJ. Following practice trials and a brief rest period, the participant performs baseline vertical jumping trials. The soles of the participants’ feet are then submerged in an ice-water bath for 15 minutes to induce sensory cooling. Immediately following the cooling procedure participants perform subsequent trials of the MVSJ. The feet are then allowed to warm naturally for 15-minutes and subsequent MVSJ trials are performed. Immediately prior to the completion of the jumping trials for each condition, temperature measurements of the soles of the feet are recorded and following jumping trials, a standardized evaluation of tactile perception is completed. Joint angles, joint power, and jump height at key points during the jump sequence are calculated.
Results: Preliminary results suggest that sensory manipulation in the form of cooling the soles of the feet reduces MVSJ height as compared to the baseline condition. Additionally, given a re-warming phase following the cooling procedure maximum jump height increases towards that of the baseline condition.
Importance to public health: Diseases such as diabetes can lead to a condition known as peripheral neuropathy which diminish patients’ ability to correctly perceive tactile and temperature stimuli, especially in the feet. By understanding the change in performance with induced sensory loss in the feet, we can begin to understand the necessary rehabilitation considerations to improve quality of life for clinical populations suffering from the loss of peripheral sensation.
Choi, Yoon Sun (UMD SPH Health Services Administration)
Boudreaux, Michel (UMD SPH Health Services Administration)
Background: Racial and ethnic minorities in the U.S. are more likely to be uninsured than non-Hispanic Whites. The Affordable Care Act (ACA) reduced these disparities; however, previous work has focused on broad racial-ethnic categories that inadequately address the heterogeneity existing within minority communities.
Goal: This study investigates the interplay between socio-demographic factors and ethnicity for six major Asian-American subgroups related to continued post-ACA disparities.
Objectives: 1. Describe the socio-demographic variations between Asian-American ethnic subgroups related to health insurance status. 2. Assess existing disparities in health insurance coverage within the Asian-American population after the implementation of the Affordable Care Act.
Approach: Using the American Community Survey, we examined relative changes in health insurance coverage rates for non-elderly non-Hispanic Whites compared to Chinese, Japanese, Filipino, Indian, Korean, and Vietnamese Americans between 2012-2016 (before and after major provisions of the ACA were implemented). We then used a regression framework to examine the contribution of demographics (e.g. age, family structure), socioeconomic status (e.g. education, income), and community characteristics (e.g. concentration of local ethnic populations) on coverage disparities in the post ACA period (2014-2016).
Results: We observed n=5,275,791 non-elderly individuals in our analytic sample. Overall, between 2012-2016, there was a substantial decline in the absolute percentage-point disparity in uninsurance for Chinese, Vietnamese, and Koreans. In 2014-2016, Vietnamese and Koreans still had 2.3-5.6 percentage-points higher uninsured rates (p<0.05) than non-Hispanic Whites. The disparities for Vietnamese, but not for Koreans, were explained by their socio-demographic characteristics. Further results are upcoming.
Importance to public health: Results suggest the ACA reduced uninsured rates for major Asian-American subgroups, yet Koreans continue to experience disparities in insurance status. This highlights the need to use disaggregated data for further investigations into the impact of health policies across diverse racial and ethnic groups.
Chopyk, Jessica (UMD SPH Maryland Institute for Applied Environmental Health)
Allard, Sarah (UMD SPH Maryland Institute for Applied Environmental Health)
Nasko, Daniel (UMD Center for Bioinformatics and Computational Biology)
Bui, Anthony (UMD SPH Maryland Institute for Applied Environmental Health)
Mongodin, Emmanuel (Institute for Genome Sciences and Department of Microbiology and Immunology)
Sapkota, Amy (UMD SPH Maryland Institute for Applied Environmental Health)
Background: Agricultural ponds have a great potential as a means of capture and storage of water for irrigation. However, pond topography (small size, shallow depth) leaves them susceptible to environmental, agricultural, and anthropogenic exposures that may influence microbial dynamics.
Goal: The aim of this project was to characterize the bacterial and viral communities of pond water in the Mid-Atlantic United States with a focus on the late season (October-December), where decreasing temperature and nutrient levels can affect the composition of microbial communities.
Objectives: (i) survey the bacterial consortium utilizing different filter pore sizes (1 μm and 0.2 μm); (ii) characterize the diversity and abundance of the bacteriophage within the viral community; and (iii) compare the phylogeny of pond viromes across time using the phylogenetically relevant, and biologically meaningful, Pol I protein.
Approach: Ten liters of freshwater from an agricultural pond were sampled monthly, and filtered sequentially through 1 μm and 0.2 μm filter membranes. Total DNA was then extracted from each filter, and the bacterial communities were characterized using 16S rRNA gene sequencing. The remaining filtrate was chemically concentrated for viruses, DNA-extracted, and shotgun sequenced.
Results: Bacterial community profiling showed significant shifts over time, corresponding to changes in the condition of the pond freshwater (e.g. pH, nutrient load). In addition, there were significant differences in the alpha-diversity and core bacterial operational taxonomic units (OTUs) between water fractions filtered through different pore sizes. The viral fraction was dominated by tailed bacteriophage of the order Caudovirales, largely those of the Siphoviridae family. Moreover, while present, genes involved in virulence/antimicrobial resistance were not enriched within the viral fraction during the study period. Instead, the viral functional profile was dominated by phage associated proteins, as well as those related to nucleotide production.
Importance to public health: Overall, these data suggest that farm pond water harbors a diverse core of interacting microbial species whose abundance is influenced by environmental variables and, therefore, may require water treatment technologies to assure its safety for use in irrigation.
Coates, Erica (UMD SPH Family Science)
Tran, Quynh (USF CAS Psychology)
Phares, Vicky (USF CAS Psychology)
Background: The majority of Black youth live in a single-mother household (SMH) at some point during childhood (The Annie E. Casey Foundation, 2015). Children who spend part of their childhood living in SMHs are at greater risk for adverse psychosocial outcomes compared to those who live continuously in two-parent households (Langton & Berger, 2011). Although the majority of resilience studies have investigated the protective roles of maternal positive parenting, maternal well-being, mother-child relationships, and coparent relationship quality, a burgeoning literature suggests the positive influence that noncustodial father attributes and father-child relationships have on children’s psychosocial outcomes (e.g., Harper & Fine, 2006).
Goal: Guided by the Coparenting Framework for African American Single-Mother Families (Jones et al., 2007), we examined the protective role of nonresidential fathers in the psychosocial adjustment of Black adolescents from SMHs.
Objectives: We expected 1) higher paternal warmth, lower depressive symptoms, and better father-child relationship quality would be uniquely related to adolescents’ lower externalizing and internalizing behaviors above and beyond maternal warmth, depressive symptoms, and mother-child relationship quality, and 2) coparenting relationship quality would mediate the relation between father factors and adolescent psychosocial functioning in that fathers who have lower depressive symptoms, higher warmth, and better father-child relationships would in turn have better coparenting relationships that would be related to more favorable youth outcomes.
Approach: Participants included 107 noncohabiting Black parental dyads aged 27 to 68 years with children aged 12 to 18 years. Participants completed a telephone survey including demographic questions and measures of positive parenting, parent-child relationship quality, depressive symptoms, coparenting relationship quality, and adolescents’ emotional and behavioral functioning.
Results: Results of hierarchical multiple regressions controlling for father-child contact, economic hardships, and maternal factors, found that father factors contributed unique variance to father-reported adolescent internalizing problems, Fchange(3, 98)=7.28, p<.001, ∆R2=.17 and father-reported adolescent externalizing problems, Fchange(3, 98)=5.63, p=.001, ∆R2=.13. Path analysis showed that coparenting relationship quality mediated the relation between father-child relationship quality and mother-reported adolescent externalizing behaviors (β=-.30, p=.009; 95% CI [0.129–0.595]).
Importance to public health: This study highlights the unique contributions of nonresidential Black father factors to adolescent mental health outcomes.
McClure, Erin (SPH)
Stephanie, Cork (SPH)
Background: Lactation/feeding spaces on university campuses are a necessary facility to support the health and wellness of the community. To assess the accessibility of current facilities as well as need and usage patterns at the University of Maryland we have created a survey that will be disseminated Spring 2018. The findings of this survey will direct a current project that looks to assess and improve current facilities at on campus and promote the three pillars of public health: preventing disease and injury, promoting health and wellness, with the goal of prolonging life with the highest of qualities.
Goal: Using data collection via survey to assess need/awareness, obtain feedback on existing facilities that support nursing parents, and increase awareness so that current designated lactation/feeding spaces can be improved and opportunities for new facilities and educational programming can be identified and implemented via supported by a grant to the President’s Commission on Women’s Issues (PCWI) in collaboration with the UMD School of Public Health (SPH).
Objectives: 1). Assessing Facilities to assess need/awareness of lactation feeding spaces. 2). Improving Facilities to promote healthy feeding behaviors on campus (this includes accessibility to disabled and LGBTQ+ populations) 3). Educating Campus & Increasing Awareness about the current facilities and working with parent(s) to offer spaces conducive to comfortable and safe feeding practices and lactation facilities.
Approach: -Survey to entire campus disseminated through the University’s Human Resource Office (UHR) to assess the current need/awareness of lactation/feeding space. -Assessment of current physical spaces in collaboration with the PCWI and SPH and in partnership with the University Health Center, the Business School and Facilities Management. -Improvement of current UMD lactation/feeding spaces. Construction of new lactation/feeding spaces, so there are more “lactation friendly” facilities for all community members across campus.
Importance to public health: Providing a “lactation friendly” campus with designated environmentally friendly lactation/feeding spaces for students, staff, faculty, alumni and visitors and providing designated healthy lactation/feeding spaces decreases barriers to expressing milk/breastfeeding and increases health benefits, both short and long-term, to infants and feeding parent(s). The American Public Health Association recognizes breastfeeding as a public health issue and an important preventive health measure.
Covington, Lauren (UMB SON)
Rogers, Valerie (UMB SON)
Background: Sleep plays an important role in children’s physical growth, behavior and emotional development. The National Sleep Foundation recommends that toddlers get between 11-14 hours of sleep per 24 hours, and go to bed no later than 9 pm. Given the important role sleep plays in toddler development, it is imperative that sleep assessment is accurate.
Goal: The purpose of this study was to explore toddler sleep in an urban, low-income, minority population using sleep diaries and actigraphy (watch size device that measures movement and light), and to compare these measures.
Objectives: We hypothesized that this sample would not meet the National Sleep Foundation Recommendations and that there would be limited agreement between sleep diaries and actigraphy.
Approach: A convenience sample of mother-toddler dyads were recruited and an actigraph was placed on the toddler’s ankle and worn consecutively for 3 days. A sleep diary was completed simultaneously. Bedtime, nighttime sleep duration, number of naps, nap duration and 24-hour sleep duration were collected.
Results: Twenty toddlers were included in sleep analyses. Nearly all (95%) mothers/toddlers identified as African American, and 95% had public or no health insurance. Mothers were a mean age of 25.8 years (SD=5.0), 89.5% were not married and over half (52%) had a high school education or less. Per actigraphy data, only one toddler went to bed before 9 pm on all 3 nights. Six participants received at least 11 hours of sleep in a 24-hour period, for one of the 3 study days, but when sleep was averaged across the study, none achieved this goal. Compared to actigraphy, toddler bedtimes recorded in sleep diaries underestimated bedtime by an hour, overestimated nighttime sleep duration by 2.5 hours, and overestimated 24-hour sleep duration by 2.25 hours, on average for all 3 nights.
Importance to public health: The majority of toddlers had inconsistent bed times and inadequate sleep duration. These findings are concerning given the important role that sleep plays in child health and development.
Kelbick, Hillary (UMD - MIAEH)
Sapkota, Amy (UMD - MIAEH)
Lipchin, Clive (Arava Institute for Environmental Studies)
Background: The reuse of wastewater for agricultural irrigation is emerging in water scarce regions around the world, including the West Bank, Palestinian Authority. However, to our knowledge, no long-term testing of this water has been undertaken.
Goal: The purpose of this study is to 1) investigate the safety of agricultural irrigation water produced by small-scale, off-grid greywater treatment systems and 2) investigate the efficacy of these systems in reducing contaminants.
Objectives: 1) To investigate and compare the bacterial counts of two types of fecal bacteria, Escherichia coli and total Coliforms, in the influent and effluent over time; and 2) To investigate and compare basic chemical water quality parameters in the influent and effluent over time.
Approach: Water samples (n= 88) will be collected over eight months from three off-grid greywater systems. Bacterial levels will be tested using membrane filtration. Hach probes will be used to test pH and Electrical Conductivity. Turbidity will be tested for with a Lutron meter.
Results: Two out of three systems were within quality standards for pH and salinity. Turbidity values were highly variable over time and among the systems. Regarding bacterial levels, however, the data suggests that these systems are not effective at reducing bacterial levels to acceptable levels. 100% of samples violated quality standards for bacteria.
Importance to public health: Access to safe, abundant irrigation water sources is critical to public health. Safe irrigation water reduces the potential for diarrheal disease and foodborne disease outbreaks, while abundant irrigation water improves nutrition through increased access to fruits and vegetables.
Do, Kieu Anh (UMD)
Ross, Ana-Sophia (UMD)
Wang, Cixin (UMD)
Frese, Kristen (UMD)
Barlis, Julia (UMD)
Sullivan, Kate (UMD)
Background: Mental disorders are prevalent during adolescence; however, adolescents from immigrant families tend to underutilize mental health services in both the community setting and at school, which negatively impacts their development. Parents and teachers are important gatekeepers of mental health services for adolescents; however, few studies have examined their perspectives concerning mental health.
Goal: The current study explored teachers’ and immigrant parents’ perception and identification of contributing factors of mental illnesses.
Objectives: The objective of the current study was to identify the contributing factors of eating disorders, depression, and anxiety as described by teachers and immigrant parents.
Approach: In-depth interviews were conducted with 34 secondary-school teachers/ staff (70% White) and 23 Latino and Asian immigrant parents (91.3% mothers, mean age = 43.8 years, SD = 6.3).
Results: Both teachers and parents described various contributing factors ranging from the micro- to the macro-system. For example, they discussed parental pressure, adolescents’ identity struggles, media influence, as well as beliefs and values relating to femininity and masculinity, and ethnic/ cultural expectations. Parents discussed additional factors, such as genetic and immigration experiences contributing to mental disorders, specifically discordant family relationships between parents and their adolescents. Findings showed that teachers and parents have a general understanding of the contributing factors of three common mental disorders, however, parents also reported many barriers preventing teens from seeking help such as lack of communication between parents and adolescents.
Importance to public health: The findings from this study could inform the development of effective public health education and promotion, particularly with immigrant families. Specifically, more work is needed to increase communication and collaboration between teachers and parents to monitor and to address adolescent mental health needs.
Drew, Laura (UMD SPH Family Science)
Grantz, Katherine (National Institute of Child Health and Human Development)
Thoma, Marie (UMD SPH Family Science)
Background: Little research has considered the association between macrosomia and neonatal morbidities at the national level and how maternal diabetes may alter this relationship. Using revised U.S. birth certificate data, we examined the association between macrosomia and neonatal morbidities overall and by diabetes status.
Goal: To identify the association between macrosomia and neonatal morbidities overall and by mother's diabetes status using near national level data.
Objectives: Identify the relationship between macrosomia (birthweight of 4000 grams or more) and the following neonatal morbidities: Apgar score < 7, NICU admission, and immediate assisted ventilation, using US birth certificate data. Assess whether or not these relationships vary by mother's diabetes status (none, pre-pregnancy, or gestational).
Approach: We used 2014-2016 U.S. birth certificate data restricted to singleton, first-born, full/post-term (> 39 weeks gestation) infants with birthweights >= 2500g. We compared macrosomia (4000-4499g; 4500-4999g; and >= 5000g) to normosomic (2500-3999g) birthweight categories by the following outcomes: Apgar <7, NICU admission, and immediate assisted ventilation following delivery. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for gestational age, infant sex, as well as maternal demographic and health characteristics. Models were then stratified by diabetes status during pregnancy (none, pre-pregnancy, and gestational).
Results: After adjustment, increasing categories of macrosomia were significantly associated with increased odds of Apgar <7, NICU admission, and immediate assisted ventilation compared to normosomic births. Odds ratios for infants >= 5000g were 1.53 (CI: 1.21-1.94), 2.56 (CI: 2.28-2.88), and 1.33 (CI: 1.10-1.60), respectively. The magnitude of the association between birthweight >= 5000g and NICU admission differed for mothers with pre-pregnancy (OR: 4.96) or gestational diabetes (OR: 2.77) compared to without (OR: 2.40).
Importance to public health: The odds of neonatal morbidities increased with increasing levels of macrosomia and among women with pre- or gestational diabetes, suggesting diabetes may alter this relationship. Future research should explore potentially modifiable risk factors for excessive birthweight to prevent these related neonatal morbidities.
Bara, Samuel (UMD SPH)
Woldu, Root (UMD SPH)
Wilson, Sacoby (UMD SPH Community Engagement)
Driver, Aubree (UMD SPH Maryland Institute for Applied Environmental Health)
Background: A wealth of research has shown that communities of color and low-income populations have been disproportionately burdened by environmental hazards and locally unwanted land uses (LULUs) including incinerators, power plants, landfills, and other pollution-intensive facilities. Unfortunately, the state of Maryland has made little progress in constructing tools to assess and address environmental injustice and related health issues. The National Center for Smart Growth has begun developing a new mapping tool for the state of Maryland known as Maryland EJSCREEN that highlights the prevalence and frequency of environmental hazards and LULUs and health risks for nearby populations.
Goal: The long-term goal is to use this tool to highlight areas with environmental justice issues, areas that need additional investments, and be used in permitted, regulations, zoning, and development decisions.
Objectives: The objectives of this project: 1) Collect information on environmental, social, economic, exposure, and health indicators that should be included in the Maryland EJSCREEN tool; 2) Obtain feedback on from various stakeholder groups on indicators that should be included in the tool and prioritized; and 3) demonstrate the utility of the EJSCREEN tool.
Approach: In collaboration with the Partnership in Active Learning in Sustainability (PALS), we performed a literature review of economic, social, environmental, exposure, and health indicators identified as important by several Prince George’s County community members and stakeholders through a series of demonstration workshops. Stakeholders included residents from the Port Towns, Environmental Action Council members, the Environmental Justice legislative team, and the Commission on Environmental Justice and Sustainable Communities. Flashcards, posters, and surveys were distributed to community members and stakeholders in order to gather valued feedback regarding which indicators were deemed necessary and acceptable to be highlighted in the Maryland EJSCREEN tool.
Results: We found that the demonstration workshops were quite effective in soliciting feedback from residents, advocates, health practitioners, policymakers, and other stakeholder groups.
Importance to public health: The tool can be used by local residents to advocate for new policies, better enforcement, and public health improvements. The tool can be used by government officials to build healthier, greener, more equitable, and more sustainable communities.
D'Silva, Joanne (UMD SPH Behavioral and Community Health)
Rose, Shyanika (Truth Initiative)
Mayo, Ashley (Truth Initiative)
Ganz, Ollie (Truth Initiative)
Perreras, Lexie (Battelle Memorial Institute)
Cohn, Amy (Battelle Memorial Institute)
Background: Perceived discrimination leads to adverse health outcomes and higher risk of tobacco use among various racial/ethnic minority groups. Menthol cigarette use is more prevalent in racial/ethnic minority groups as well as among young adults. Yet, the relationship of discrimination in menthol cigarette use has been understudied.
Goal: The purpose of this exploratory study was to determine whether perceived experiences of discrimination are related to past 30-day menthol smoking status among young adults.
Objectives: We hypothesized that perceived experiences of discrimination are related to past 30-day menthol smoking status, after controlling for race/ethnicity and other demographic characteristics.
Approach: A multi-ethnic convenience sample of young adults (n=599, aged 18-24) were surveyed online via Amazon Mechanical Turk. Analyses included a subset of participants (n=177) who reported cigarette use in the past 30-days (current smokers). Participants were asked whether they typically used menthol or non-menthol-flavored cigarettes. Exposure to lifetime discrimination was assessed using the Brief Perceived Ethnic Discrimination Questionnaire-Community Version scale. Differences in experiences of racial/ethnic discrimination were assessed between menthol and non-menthol smokers in bi-variate analyses and adjusted models controlling for demographics, perceived stress, and smoking-related correlates.
Results: Preliminary results suggest that non-Hispanic Black and female smokers were more likely to report current use of menthol cigarettes than non-Hispanic White and male smokers, respectively. Discrimination scores for menthol compared to non-menthol smokers were significantly higher (1.19 vs. 0.71, p<.001; mean total sample 0.99, SD=0.88). In adjusted logistic regression analyses, the odds of being a menthol smoker were 2.2 greater for every unit increase in perceived discrimination, after controlling for race/ethnicity, gender, education, and perceived stress (p=.001).
Importance to public health: This study is suggestive that vulnerability characteristics, such as discrimination, may influence menthol cigarette use over and above demographics associated with increased use and race/ethnicity. Additional research can determine how experiences of discrimination may influence communication of policy efforts around menthol for young adults who may be most at-risk of tobacco use.
Ekwunife, Odera (UMB SOP Pharmaceutical Health Services Research)
Onukwugha, Eberechukwu (UMB SOP Pharmaceutical Health Services Research)
Botwe, Theophilus (UMD Upper Chesapeake Medical Center)
Background: Continuity of care post-discharge allows for a seamless transition between the inpatient care that was received and any post-discharge care such as filling prescriptions and visiting a primary care physician. The literature to date on continuity of care has not focused on foreign-born populations who can be at risk of poor transitions following an inpatient stay. There is limited information regarding the factors that represent barriers to a successful transition from hospital to home.
Goal: The objective of this pilot project is to explore perspectives on the barriers to adequate post-discharge transitional care among foreign-born patients and identify ways to improve the quality of the transition from hospital to home.
Objectives: 1. To explore perspectives on the barriers to adequate post-discharge transitional care among foreign-born patients 2. To identify ways to improve the quality of transitions of care from hospital to home
Approach: We recruited physicians who provided care in a suburban hospital that serves a significant foreign-born population. We conducted in-depth key informant interviews (KIIs) with providers who self-identified as knowledgeable about inpatient and post-discharge care for foreign-born individuals. We explored barriers to adequate post-discharge, identified reasons for hospital readmission, and asked about approaches to improve the quality of the transition from hospital to home among FB patients. We conducted a preliminary coding of the interview data and report results to date.
Results: The KIIs included 4 physicians. The distribution according to specialty: 2 hospitalists, 1 family medicine physician, 1 emergency room physician. The distribution according to gender: 1 woman and 3 men. Three of the physicians were African immigrants. The following factors were common across the interviews: language barriers, limited transportation, lack of trust, poor mental health, and unreliable community support leading to inadequate post-discharge care and hospital readmissions. The health care providers identified the following options for improving the transition from hospital to home: increase access to community health programs, provide education at discharge in a foreign language, provide access to health care providers from similar ethnic groups, and familial support interventions.
Importance to public health: Health care providers with specific foreign-born patient populations equipped with an understanding of the factors presented in this project will undoubtedly be in a better position to provide quality healthcare and advance our community's public health. The findings from this study ultimately identify areas for further exploration in qualitative and quantitative inclusive public health research for patients and healthcare providers.
Hatfield, Bradley (UMD SPH Kinesiology)
Ginsberg, Andrew (UMD SPH Kinesiology)
Lu, Calvin (UMD SPH Kinesiology)
Bah, Mohammed (Howard University Biology)
Background: Psyching refers to a type of mental preparation that involves using self-directed cognitive strategies to enhance arousal, focus, and confidence to improve psychomotor performance. The project was conducted as a result of the practice of psyching being incorporated into sports. However, it was not concrete as to whether this practice was truly effective.
Goal: The goal of the project was to determine if mental preparation, or psyching, will contribute to higher muscular performance and heightened cortico-cortical communication when compared to distracting conditions. (Mental Arithmetic, Reading Comprehension.)
Objectives: - mental preparation would produce increased average torque when compared to other conditions. - there would be higher overall communication or coherence within different parts of brain during psyching
Approach: Healthy adults (N=15) between the ages 19-30 were included in this experiment. This study consisted of two visits: the first consisting mainly of reviewing the consent form, along with taking measurements and familiarization with leg extension machine. The second visit involved the participants engaging in the three conditions: PSY, MA, and RC. Each condition consisted of three trials in which participants performed 20 second task periods prior to the voluntary movement of a maximal leg extension, beginning with the instructed “You may now begin” command. Following the end of the 20 second task period, the maximal leg extension was performed at the “Move” command. This all occurred while being hooked up to an EEG in order to record brain waves. Torque production was measured by the Biodex Quick Set Isokinetic Dynamometer, and EEG data was gathered via Brain Vision EEG Cap.
Results: Average torque production for participants within the PSY, MA, and RC condition were 144.80 N*m, 122.05 N*m, and 125.19 N*m respectively. A significant difference was found between PSY and MA (0.008), and PSY and RC (0.005). No significant difference existed between RC and MA distractions. Coherence (High Alpha Bandwidth) averages for participants within PSY, MA, and RC, were 0.474, 0.420, and 0.419 respectively. A significant difference was found between PSY and RC (0.028).
Importance to public health: With its effects very apparent, we can test to see if there is also increased muscle recruitment as a result of the increased communication. Thus psyching can be applied to multiple areas of performance such as: rehab, sports, activities, etc.
Ezeugoh, Rosemary (UMD SPH Maryland Institute of Environmental Health)
Wilson, Sacoby (UMD SPH Maryland Institute of Environmental Health)
Background: Ambient air pollution from stationary sources, industrial traffic, and commuter traffic can negatively impact air quality and human health including emissions of particulate matter and volatile organic compounds (VOCs). Ernest Maier, a concrete block plant located in Bladensburg, Maryland wants to expand to include a concrete batching plant on the same property. This expansion could further degrade air quality and impact the health of vulnerable residents.
Goal: The purpose of this study is to provide information on particulate matter (PM) and volatile organic compounds (VOCs) levels near residential areas in close proximity to commuter traffic and industrial activity associated with the concrete plant.
Objectives: 1. To determine human exposure to PM and VOCs in Bladensburg, Maryland. Hypothesis 1: Areas close to the concrete block plant will have higher exposure levels of PM and VOCs than areas farther away from the plant. 2. To assess variation in human exposure to PM and VOCs at different locations during different times of the day in Bladensburg, Maryland. Hypothesis 2: Individuals walking on highly trafficked roads will have higher exposure levels of PM and VOCs during on-peak periods than individuals walking on low trafficked roads during on-peak hours.
Approach: Air quality monitoring will be conducted in the community at six personal sites using the Airbeam, a real-time sensor that can measure PM2.5. The Atmotube is a real-time sensor that can be worn to measure VOCs via Air Quality Score Android app. Also, traffic counts will be conducted at the six personal monitoring locations. PurpleAir sensors will be installed at the fixed monitoring locations to measure PM10, PM2.5, and PM1 in real-time at locations near the concrete facility and local roadways.
Results: Based on preliminary results, we will see: 1) higher PM levels and possibly VOC levels at the fixed monitoring site closest to the concrete factory and 2) higher PM and VOC levels at locations closer to roadways and during rush hour traffic.
Importance to public health: This study will provide valuable information on human exposure to PM and VOCs that may be contributing to poor health outcomes in the community such as asthma.
Fernando, Nimasha (UMB SOM Epidemiology and Public Health)
Peprah, Yolanda (UMB SOP Pharmaceutical Health Services Research)
Chapin, Bambi (UMBC Sociology)
Onukwugha, Eberechukwu (UMB SOP Pharmaceutical Health Services Research)
Camelo Castillo, Wendy (UMB SOP Pharmaceutical Health Services Research)
Background: Federally Qualified Health Centers (FQHCs) are a valuable resource among individuals from underserved communities who face challenges accessing the health system. The vulnerability of these individuals is heightened if they have a chronic condition and experience multiple hospital-to-home transitions in care while attempting to continually manage their condition.
Goal: To investigate how health providers and community advocates from public service sites view FQHCs as possible resources for members of the Hispanic community with chronic conditions.
Objectives: Qualitative study. Six semi-structured audio-recorded interviews were conducted with providers (n=4) and patient advocates (n=2) regarding their perspectives of resources for individuals with chronic conditions from a Hispanic community in the Baltimore area during hospital-to-home transitions. Providers included a physician, nurse, interpreter, and community health program director. Interviews were recorded, transcribed, and translated verbatim (from Spanish, n=2).
Approach: Transcripts were systematically analyzed with Dedoose software to identify all responses where participants referred to an FQHC such as by describing a free clinic for the uninsured. Since participants were not directly asked about FQHCs, they were free to discuss these sites in any context they felt was relevant.
Results: All providers discussed FQHCs, but some described FQHCs as one resource to be utilized for a specific service or episode of care, while others only identified these centers as actors within the broader health system but not as resources for patients to utilize. No provider discussed FQHCs’ abilities to provide continuous chronic disease care. Although other elements of patients’ health networks and the health system were described as interconnected, FQHCs were referred to in isolation with no comment about their connection to the broader health system.
Importance to public health: Viewing FQHCs as disconnected from the larger health system may lead to providers and advocates missing opportunities to provide coordinated care for underserved patients with chronic conditions. By establishing partnerships and facilitating collaboration between FQHCs and other actors within patients’ health networks, the overall health system can be strengthened thereby improving access to continual care for underserved populations who may similarly utilize multiple health resources and sites for care.
Kittner, Steven (UMB SOM Neurology)
Background: Although the incidence of ischemic stroke in individuals under age 50 has increased in recent years, risk factors affecting this population remain poorly understood. Poverty has been identified as an independent risk factor for stroke, but the extent to which poverty impacts risk for younger adults is not known.
Goal: This project aimed to evaluate the role of age, race, and poverty in determining the risk for young-onset ischemic stroke.
Objectives: 1. To determine whether age modifies the risk for ischemic stroke associated with poverty 2. To determine whether this age-poverty-stroke relationship differs according to race.
Approach: The data source for this project is the Stroke Prevention in Young Adults Study, a case control study that enrolled patients (n=1200) aged 15-49 with first-ever ischemic stroke, along with age-matched controls (n=1154). First, the odds ratio for stroke associated with poverty was estimated in unadjusted and adjusted models, and then in age- and race-based strata. A logistic regression model including other known risk factors was then applied separately to white and black populations.
Results: Poverty was a significant risk factor for ischemic stroke (OR 2.16, p<.0001) even after adjustment for other risk factors (OR 1.72, p = .001). Among black participants under 40, the odds ratio associated with poverty was 4.43 (95% CI 2.38-8.23), where in those over 40, the odds ratio was only 1.29 (0.78-2.11). In comparison, odds ratios for white participants under and over 40 were 2.85 and 2.80, respectively. In the regression analysis, an interaction term between age and poverty was statistically significant in the black population (p=0.0067), but not in the white population (p=0.36).
Importance to public health: These findings demonstrate that younger black individuals living in poverty are at a uniquely high risk for stroke, suggesting that the underlying mechanisms linking poverty and ischemic stroke are more complex than a simple accumulation of social and biological stresses across the lifecourse. These results indicate a role for public health interventions targeting the development of resiliency to cope with stressors like poverty in high-risk communities in order to decrease the risk of stroke.
Fukunaga, Ami (UMD SPH Epidemiology and Biostatistics)
Liu, Hongjie (UMD SPH Epidemiology and Biostatistics)
Cruz-Cano, Raul (UMD SPH Epidemiology and Biostatistics)
Background: Female sex workers are less likely to seek for HIV prevention measures because of occupational stigma or sex work related stigma against them. The level of occupational stigma against female sex workers may be higher in China because interdependent group perspectives in Chinese collectivist culture emphasize negative attitudes towards sex work in China. Collectivist culture is most likely to be a major barrier to combat HIV in Chinese populations
Goal: To understand the impacts of collectivist culture on occupational stigma and HIV protective measure/condom use among middle-aged female sex workers in China.
Objectives: (1) Determining whether higher levels of collectivist culture are associated with higher perceived occupational stigma among middle-aged female sex workers in China. (2) Determining whether higher levels of collectivist culture are associated with inconsistent condom use.
Approach: A secondary data analysis was conducted with data from a multisite cross-sectional study among middle-aged (≥35 years) female sex workers from Nanning, Hefei, and Qingdao in China in 2014. To investigate the impacts of collectivist culture on occupational stigma and HIV protective measure/condom use, items reflecting these variables from the questionnaire “Survey of Social Network and HIV Risk Behavior” were selected. Multiple linear regressions were employed to assess the associations, adjusting socio-demographic variables as confounders such as age, education, city, residency, and marital status.
Results: A sample of 1245 middle-aged female sex workers were recruited at the three study sites (418 in Nanning, 407 in Hefei, and 420 in Qingdao). Across all study sites, the majority of participants were 35-40 years old (60.5%), received a middle school (46.3%) or primary or no school education (43.9%), were from rural (69.5%), and were married (49.0%) or divorced /widowed (41.7%). The mean occupational stigma score was 2.05 out of 3 (SD=0.36), the mean collectivist culture score was 1.87 out of 4 (SD=0.55), and the mean score of condom use with clients was 3.29 out of 4 (SD=0.48). After adjusting for age, education, residency (urban/rural), city, and marital status, middle-aged female sex workers who had higher levels of collectivist culture were more likely to perceive occupational stigma (β=0.06, p=0.002). Female sex workers who had higher levels of collectivist culture and perceived occupational stigma were less likely to use condom with their clients (β=−0.09, p=0.01).
Importance to public health: In order to promote safer sex among middle-aged female sex workers in China, the department of HIV intervention should take the collectivist culture and sex work related stigma into consideration.
Gaskins, Christopher (UMD SPH Kinesiology Neuroscience and Cognitive Science)
Kontson, Kimberly (Food and Drug Administration)
Shaw, Emma (UMD SPH Kinesiology Neuroscience and Cognitive Science)
Shuggi, Isabelle (UMD SPH Kinesiology Neuroscience and Cognitive Science)
Ayoub, Maria (UMD SPH Kinesiology)
Rietschel, Jeremy (Department of Veteran's Affairs)
Miller, Matthew (Auburn University)
Gentili, Rodolphe (UMD SPH Kinesiology)
Background: Mental workload has been widely examined during cognitive-motor tasks performed by individuals without physical injuries, but a more restricted effort has studied this notion in the context of motor rehabilitation. This pilot study was conducted to better understand how varying levels of mental workload affect simulated upper limb prosthetic performance.
Goal: To examine changes in mental workload under various levels of motor and cognitive demands during simulated upper-limb prosthetic performance
Objectives: 1. We predict that for both conditions, upper-limb performance would be negatively related to changes in cognitive-motor demands. 2. We predict that for both conditions, mental workload would be positively related to changes in cognitive-motor demands. 3. We predict that for a given level of task difficulty, upper-limb performance would be higher and mental workload would be lower for the unbraced condition compared to the braced condition.
Approach: Ten right handed participants (average age 27.5 ± 3.47 years) with no upper limb disabilities or injuries were selected for this study. Participants were required to place colored blocks in identically colored target spaces in a two-minute period. The task was executed under unbraced and braced (participants’ wrists and fingers were restrained to simulate a prosthetic hook grasp) conditions and under two levels (easy, hard) of cognitive (one or two block colors) and motor (large, small targets) demands. The NASA Task Load Index(NASA-TLX) was employed to assess mental workload. Additionally, the total number of blocks transported as an indicator of motor performance and the percentage of blocks transported without a block placement error as an indicator of attention was recorded.
Results: The preliminary findings revealed increases in motor and/or cognitive demand led to elevated mental workload and a decreased performance in both normal and braced conditions although greater frustration and effort was reported for the braced condition.
Importance to public health: A better understanding of the changes in mental workload can not only elucidate underlying attentional mechanisms engaged during adaptive motor performance but also inform the development of metrics to assess mental workload during upper limb prosthetic performance with the use of different prosthetic devices.
Gayfield, Asiah (UMD)
Cohen, Philip (UMD)
Background: Although, the overall rate of infant mortality in the United States has declined for all races in the past ten years, Black mothers are still more likely than White mothers to experience the death of an infant. Past research has found that Black mothers initiate and continue prenatal care at lower rates than their White counterparts, however there exists very little research examining how prenatal care usage varies by socioeconomic status within racial groups and how this variation effects the relationship between maternal race and infant mortality.
Goal: This paper investigates variation in prenatal care utilization within racial groups and across socioeconomic statuses, and the effect that prenatal care has on the relationship between race, SES, and infant mortality.
Objectives: This study has three specific aims: 1. Determining if there is a difference between the prenatal care initiation and continuation rates of black women of different socioeconomic statuses. 2. Comparing the prenatal care initiation and continuation behavior of black women to white and Hispanic women of similar socioeconomic statuses. 3. Examining the moderating effect that receiving prenatal care may have on the relationship between race, socioeconomic status, and birth outcomes.
Approach: This study used the Linked Birth/Infant Death Public Use File from the Centers for Disease Control and Prevention (CDC), to model the effect that maternal education and prenatal care has on the relationship between maternal race and infant mortality.
Results: Results indicate that the probability of infant death decreases as maternal education and prenatal care increases, but the effect is not as strong for Black mothers as it is for White and Hispanic mothers.
Importance to public health: This study fills a necessary gap in knowledge regarding prenatal care utilization habits of women who exist at different intersections of race and socioeconomic status.
Ginsberg, Drew (UMD)
Hatfield, Bradley (UMD)
Objectives: To determine if mental preparation i.e. psyching (PSY), will contribute to higher muscular performance (maximal knee extension) and heightened cortico-cortical networking when compared to distracting conditions mental arithmetic (MA), reading comprehension (RC).
Approach: Fifteen healthy participants (19-30 years of age), were recruited and required to have a minimum of one year weight training experience. Eleven of the participant data for analysis. Electroencephalography (EEG) and torque production (Isokinetic) were measured. The study consisted of two visits. Visit one consisted of informed consent, a background questionnaire and isokinetic practice trials for familiarization. EEG collection was conducted on visit two, included the same warm-up and exposure to three different conditions (PSY, RC, and MA). Conditions consisted of three trials (total of nine) with a rest interval between each trial. During each trial, a 20- second task period was provided (PSY, RC, MA). For each trial, EEG data was collected and participants determined their rate of perceived exertion by using the Borg RPE scale.
Importance to public health:
Gleason, Jessica (University of Maryland School of Public Health)
Shenassa, Edmond (University of Maryland School of Public Health)
Thoma, Marie (University of Maryland School of Public Health)
Background: Infertility is increasingly a public health issue, with emerging links to health conditions including cancer, diabetes, and cardiovascular disease. Existing literature on infertility primarily focuses on known causes, such as polycystic ovarian syndrome and endometriosis, which likely excludes a substantial number of women, for whom there is no known cause or formal diagnosis.
Goal: The goal of this project was to explore potential associations between infertility and both cardiovascular dysfunction and metabolic syndrome, a long-term predictor of cardiovascular disease.
Objectives: Using a nationally-representative sample, compare the prevalence of metabolic syndrome and cardiovascular dysfunction between women who report ever experiencing infertility, and those who do not.
Approach: We examined the association between self-reported infertility (i.e., ever experiencing inability to conceive after 12 months of trying to become pregnant) and metabolic syndrome and cardiovascular events among US women, aged 20-59, (National Health and Nutrition Examination Survey 2013-2014). Odds ratios were calculated using multivariate logistic regression, adjusting for demographic, behavioral, and lifestyle factors in separate models.
Results: Compared to women who have never experienced infertility, women who reported infertility were 1.52 (99% CI 1.52, 1.52) times more likely to report symptoms of metabolic syndrome and 1.69 (99% CI 1.68, 1.70) times more likely to have experienced a cardiovascular event (i.e., congestive heart failure, coronary heart disease, heart attack, or stroke). Furthermore, women with self-reported infertility were 50% more likely to report a cardiovascular event after controlling for metabolic syndrome (99% CI 1.49, 1.50).
Importance to public health: Our results indicate that the experience of infertility at any point in a woman’s reproductive window is associated with subclinical and clinical cardiovascular dysfunction in the general population.
Golojuch, Laura (UMD SPH Family Science)
Roy, Kevin (UMD SPH Family Science)
Background: Adverse childhood experiences (ACEs) have been linked to negative outcomes in adulthood such as depression, obesity, and even early death (CDC, 2010; Dube et al., 2003; Felitti, 1998). However, much of this research does not focus on the experiences of Black and Latino young men, who face disproportional exposure to violence and are much more likely to be incarcerated or killed than their white counterparts (Rich, 2009; The Sentencing Project, 2015; CDC, 2017).
Goal: The current study examines the processes by which young men of color make sense of and cope with exposures to ACEs within their families and communities
Objectives: 1) To examine the frequency of exposure to adverse childhood experiences (ACEs) in this sample 2) To explore how context shapes exposure to and processing of trauma and ACEs 3) To explore how young men of color cope with exposures to trauma and ACEs during the transition to adulthood
Approach: This study employed a qualitative methodology, utilizing a semi structured life history interview protocol with 36 African American/ Latino young men ages 17-24. Two comparison sites were used to examine difference across neighborhood context. A modified grounded theory approach was used to analyze the data in three phases.
Results: More frequent exposure to ACEs was found among the Baltimore cohort, with two thirds of the sample experiencing four or more ACEs. Coping mechanisms to deal with exposure to adversity included keeping emotions in, substance use, and fighting. The importance of family and neighborhood context was noted- those who were embedded in family, peer, or institutional networks tended to cope better than those doing so in isolation.
Importance to public health: ACEs are increasingly being understood as a critical public health concern. It is necessary to contextualize ACEs through qualitative research and expand research to diverse populations.
Griffioen, Mina (UMD SPH Public Health Science)
Briggs, Joseph (UMD CMNS Cell Biology and Genetics)
Jones, John (UMD CMNS Cell Biology and Genetics)
Dinman, Jonathan (UMD CMNS Cell Biology and Genetics)
Background: Translation of the genetic code is traditionally thought to be static. However, specific signals have been discovered in certain mRNAs that can dynamically adjust the coding capacity of the genome. Programmed ribosomal frameshifting (PRF) is a mechanism by which mRNAs can produce several polypeptides. Ribosomes may slip a base then they encounter a PRF structural element resulting in translation of a unique polypeptide. This mechanism is well described in viruses but few examples exist in higher eukaryotes (1).
Goal: Previously, a dual luciferase reporter system was used to quantify PRF in cells. However, we identified several problems with this system prompting us to develop a new generation of dual reporter plasmids. Using modified dual luciferase and dual fluorescent reporters, we cross-validated previously published +1 and -1 PRF signals in HeLa and HEK293T cells (2).
Objectives: These include signals for mammalian ornithine decarboxylase antizyme (OAZ1), as well as tumor related genes MA3 and PEG10 (3).
Approach: Using the dual fluorescent approach, coupled with live-cell imaging, we were able to answer the question of cell-to-cell heterogeneity for PRF.
Results: The results indicated that individual cells have different rates of frameshifting but the median fluorescence of the cell population was in good agreement with our whole cell lysis approach in both reporter systems.
Importance to public health: Taken together, we have established a new generation of reporters to understand translational control of genes that may play a role in cancer and other diseases.
Hauge, Theresa (UMD SPH Kinesiology)
Gentili, Rodolphe (UMD SPH Kinesiology)
Reggia, James (UMD CMNS Computer Science)
Background: Limited investigation has explored the neurocognitive processes underlying the performance of complex, goal-directed action sequences. Specifically, the dynamics of motor planning processes, resulting from practice (i.e., changes in mental workload), and the interaction with critical psychological constructs (i.e., self-efficacy) have not been examined for their influence on the structure of high-level motor plans during execution of complex action sequences. A major contribution of this effort includes: i) the deployment of a computational technique imported from the field of DNA sequencing to examine the generation of high-level motor plan underlying complex action sequences and ii) the joint consideration of key variables from motor performance and psychological domains to better understand high-level planning mechanisms during practice of complex action sequence.
Goal: This study presents the performance of a new computational approach to assess complex action sequence that will be employed to examine the high-level motor plans underlying performance throughout practice of complex action sequences along with the concomitant changes in mental workload and self-efficacy.
Objectives: The first aim is to assess to what extent the computational approach can provide specific markers of action sequence performance under unconstrained conditions. The second aim is to deploy this computational approach to examine during a more controlled situation throughout practice the changes of structures of high-level plan underlying action sequence. In particular, as a whole we predict that this novel computational approach will reveal the changes of high-level plan translating into gradual performance improvement while the level of mental workload and self-efficacy will progressively decrease and increase, respectively.
Approach: The novel computational approach is based on Levenshtein edit distance, which has been previously employed in DNA sequencing and linguistic analysis. Such an approach was applied to complex action sequences with limited constraints and flexible success criteria to estimate the distance between two action sequences and the number of insertions of extraneous actions, deletions and substitutions of actions in the sequence. Then, this computational approach is deployed in motor practice settings where participants perform a complex action sequence through completion of the Tower of Hanoi (ToH) puzzle task, which is constrained by three rules and the goal to move the tower from one peg to another in the minimum number of moves and as quickly as possible.
Results: The computational approach was able to provide specific markers of performance in order to differentiate the action sequence having a minimum of steps (optimal) and those that were successful although suboptimal. The changes of high-level motor plan during practice are currently under processing by employing the proposed computational approach.
Importance to public health: This work has implications for understanding the cognitive-motor mechanisms underlying human performance as well as to inform human-robotic interactions in the context of collaborative task completion and problem-solving tasks. This effort can also inform the assessment and rehabilitation of patients with impairment of cognitive functions involved in the generation of high-level plans through retraining and rehabilitative technology.
Pan, He (Department of Geographical Science)
Feng, Kuishuang (Department of Geographical Science)
Baiocchi, Giovanni (Department of Geographical Science)
Hubacek, Klaus (Department of Geographical Science)
Background: Dietary patterns rich in animal foods, fat, and added sugar in the developed countries such as the United States are not only contributing significantly to multiple environmental issues, but also imposing a considerable burden of diseases by causing obesity, diabetes, heart diseases, stroke, etc. As a growing body of literature investigates whether there is an opportunity to improve the nutritional quality and reduce the environmental impacts of food are associated through the dietary patterns simultaneously, the heterogeneity of such food-health-environment nexus due to income inequality is however under-explored.
Goal: In this research, we examine whether the poor have dietary environmental impacts and the nutritional quality that are quite different from those of the rich, and provide policy implications in addressing the food-health-environment nexus with a consideration of equality.
Objectives: We estimate the greenhouse gas (GHG) emissions, water consumption, land appropriation, and energy consumption of the dietary patterns of various income groups using individual-level National Health and Nutrition Examination Survey; meanwhile, we assess the nutritional quality of these dietary patterns.
Approach: The environmental impacts are evaluated using an environmentally extended input-output analysis; the nutritional quality is evaluated using a score of Healthy Eating Index developed by United States Department of Agriculture.
Results: The results show that higher income is correlated with healthier, more nutrient-dense diets but also larger environmental impacts. With limited spendings on foods, individuals from low-income groups tend to purchase empty calories that are of both lower price and smaller environmental impacts.
Importance to public health: Our results call for a focus on social justice in eradicating malnutrition and improving the sustainability of the food system. We further provide implications for policymakers to consider the income inequality when addressing the food-health-environment nexus in the United States as well as other countries with similar socio-economic context.
Hegland, Thomas (UMD BSOS Economics)
Background: Medicaid is the primary payer for nursing home care in the United States and often struggles with ensuring its enrollees receive high quality nursing home care. Partially in an effort to address this quality problem, nearly half of state Medicaid programs have at some point between the 1990s and present offered payroll subsidies to nursing homes as part of their Medicaid payments. These subsidies can be very costly but also have the potential to efficiently induce increases in nursing home staffing levels, and so merit careful evaluation.
Goal: The goal of this project is to assess the efficacy of state Medicaid programs' nursing home payroll subsidies for improving nursing home staffing and care quality.
Objectives: 1. Estimate the causal effect of state Medicaid programs' nursing home payroll subsidies on nursing home staffing levels and care quality. 2. Determine the extent to which the effectiveness of subsidies varies across different subsidy designs and by nursing home market structure.
Approach: This research produces causal estimates of the effect of nursing home payroll subsidies on nursing home level outcomes by exploiting both variation in subsidy rates faced by individual nursing homes within subsidy states as well as variation across states which do and do not offer subsidies. In particular, difference-in-differences and synthetic control methods are employed. The data on nursing home staffing levels and resident outcomes used for these analyses is drawn from annual censuses of nursing homes conducted by state Medicaid agencies from 1996 through 2015. The information on state Medicaid programs’ nursing home reimbursement policies throughout this time period was collected by the researcher.
Results: Preliminary results drawing upon, in particular, evidence from the relatively unique subsidy regimes adopted by the states of Maine, Florida, and Texas point to substantially greater subsidy effects than previously reported in the literature, but with precise effects varying substantially by subsidy design.
Importance to public health: Better information about the relative efficacy of different Medicaid nursing home policies has the potential to improve both nursing home resident outcomes and Medicaid programs' cost efficiency, both important given the pressure created by the aging population’s increasing demand for nursing home care.
Holder, Sharifah (UMD SPH Behavioral and Community Health)
Sifat, Munjireen (UMD SPH Behavioral and Community Health)
Green, Kerry (UMD SPH Behavioral and Community Health)
Background: Anxiety disorders are the most common psychiatric disorder among adolescents, and African American youth are at greater risk for elevated anxiety compared to white youth. High levels of anxiety are associated with many negative life outcomes including incarceration, low educational attainment, and increased risk of other mental health disorders. However, some youth with elevated anxiety have positive life outcomes including increased educational attainment, lower exposure to community violence, and no interaction with the criminal justice system.
Goal: The overarching goal of this project is to examine those factors that protect anxious youth from low educational attainment. Specifically, we will investigate the potential moderators that affect adolescent anxiety's role as a risk factor for low educational attainment among African Americans.
Objectives: 1. Adolescents who experience high levels of anxious mood are less likely to have completed high school than their peers with fewer symptoms of anxious mood. 2. Gender, mother's rating of educational hope and expectations, being read to as a child, school performance, achievement scores, and absenteeism are moderators that impact the direction of the relationship between anxious mood and incarceration and educational attainment.
Approach: This secondary analysis utilizes data from the Woodlawn Study, a longitudinal study of an urban, African-American cohort that has been followed since 1966 when they were in the first grade (N=1242). We will run logistic regression models for the dependent variable high school completion along with the independent variable adolescent anxious mood and test for potential moderation.
Importance to public health: Understanding the modifiable factors that protect those with anxious mood from low educational attainment will improve development of interventions aimed at reducing health outcome disparities that exist for African American men and women. Specifically, understanding anxiety's role as a protective factor for African American children can provide a new research avenue to better understand the positive behaviors associated with elevated anxiety that attenuate negative health outcomes while still helping children manage and reduce their anxiety.
Holmes, Katelyn (UMD SPH Public Health Sceince)
Aparicio, Elizabeth (UMD SPH Behavioral and Community Health)
Boekeloo, Bradley (UMD SPH Behavioral and Community Health)
Kachingwe, Olivia (UMD SPH Behavioral and Community Health)
Salerno, John (UMD SPH Behavioral and Community Health)
Cherubet, Nicole (UMD SPH Behavioral and Community Health)
Background: Compared to their peers, foster youth have an earlier age of sexual initiation, more sexual partners, and become pregnant at two to three times the rate of the general population. Foster youth may have had inconsistent sexual hygiene and sexual health education and support due to multiple placements and schools. Further, foster parents report struggling with discussing sexual health with the youth in their care and, more broadly, addressing their sexual health needs.
Goal: To address the sexual health and hygiene needs of older youth in foster care.
Objectives: Use a community-based participatory action research approach in partnership with local foster care agency Hearts and Homes for Youth to 1) assess the sexual health and hygiene needs of foster youth and 2) design an intervention geared towards the needs and desires of foster youth.
Approach: All study procedures were approved by the UMD Institutional Review Board. We conducted two focus groups (N=2; one for boys and one for girls in group homes) with 10 youth in care using a semi-structured interview guide to explore perceptions of sexual health needs among foster youth and how those needs could best be met through education and other support. Youth were aged 16-18 years (M=16.6), majority female (n=6; male, n=4), and majority African American (n=6; Latinx, n=2; White, n=2). Audio files were transcribed verbatim and analyzed using Template Analysis (a type of Thematic Analysis), using line-by-line coding with a group codebook and to populate key themes and subthemes. Below we report our preliminary findings.
Results: Study participants identified foster youth as having sexual health needs primarily in the areas of safety and privacy, unhealthy relationships, protection, and STI’s. As one young woman shared, “Foster youth…may not know how to get out of an unhealthy relationship or they don’t care they’re in one...” One of the young men stated, “Some kids don’t know how to put a condom on.” Youth expressed having few people with whom to discuss these concerns, though said they would be willing to talk about their sexual health needs with particular adults.
Importance to public health: Successful determination of both the needs of foster youth and how they would like to see these issues addressed may lead to development of an effective, highly attuned intervention program that can be widely disseminated.
Horowitz, Alice (UMD)
Maybury, Catherine (UMD)
Wang, Min Qi (UMD)
Battani, Katy (MDH)
Background: Women, infant and Children (WIC) personnel see the majority of pregnant women in the US. Low-income women have poorer oral health compared with privately insured counterparts and they do not know that poor oral health affects their overall health, the health of their baby and they can transmit dental caries causing bacteria (tooth decay) to their child.
Goal: Improve the oral health of low-income pregnant women and their children
Objectives: 1. Understand Maryland WIC personnel's perspectives on factors that support or prevent low income pregnant women receiving prenatal dental care. 2. Assess WIC personnel's knowledge and understanding of preventing dental caries.
Approach: We sent an email to all Maryland WIC program directors (n=18) requesting they forward it to their staff members. The email described the purpose of the survey and contained an anonymous link to the survey. Fourteen program directors responded and 13 forwarded the survey to their staff (n=173). Of the 187 potential respondents, 130 completed the survey.
Results: The response rate was 69.5%. A majority of respondents had either a college degree (56.7%) or a graduate degree (12.7%). Almost three-quarters (73.9%) had been in their position for more than 3 years. The primary barriers to prenatal dental care were: cost (81.8%); transportation (61.4%); client didn't think their problem was serious enough (58.6%); and lack of dentists who are available/accept Medicaid (51.5%). Ninety-nine percent of respondents reported they had heard of fluoride and 82% knew fluoride prevents caries. Although 71.6% reported teaching clients about drinking fluoridated tap water, only 2.3% recognized the best way to prevent tooth decay is consuming fluoridated tap water. Almost all responded they were very (64.3%) or somewhat concerned (33.3%) about pregnant women in their program getting dental treatment.
Importance to public health: WIC personnel see the majority of pregnant women in the US; they can be extremely influential in educating their clients about the importance and safety of dental care during pregnancy and how to rear cavity free children. Thus, WIC personnel must have accurate knowledge and understanding about caries prevention.
Huang, Shuo (Jim) (UMD SPH Health Services Administration)
Background: In the 1930's, Home Owners Loan Corporations (HOLC) categorized neighborhoods by investment risk, a process known as redlining. These maps were often racially discriminatory, especially against black people. Aaronson et al (2017) found associations of categories and current impacts on racial segregation. Analysis of current health impacts have not used these maps before.
Goal: To determine if historical redlining is associated with health impacts today.
Objectives: Hypothesis 0. There is no association between neighborhood categorization by the HOLC and current health outcomes in Baltimore. Hypothesis 1. Neighborhoods categorized by HOLC as red or yellow in 1937 have lower life expectancy than neighborhoods categorized as green or blue in 2013 in Baltimore.
Approach: HOLC map from 1937 for the Baltimore area and neighborhood health and vital statistics maps from 2013 for 54 Baltimore neighborhoods were superimposed using QGIS 2.18.13. An intersection was taken, and the 54 neighborhoods were assigned red, yellow, green, and blue HOLC categories by predominance. Categories were dichotimized as red/yellow vs. blue/green. Neighborhood life expectancy (LE) was regressed against dichotimized categories, while controlling for TANF and % African American using Stata/IC 15.0 for Mac.
Results: 33 neighborhoods were categorized as red/yellow, 21 as green/blue. Red/yellow categorized neighborhoods are associated with a 4.91 year reduction in life expectancy (95% CI: 2.94, 6.88) compared with green/blue categorized neighborhoods while controlling for TANF uptake and proportion of African American residents.
Importance to public health: Results support the hypothesis that historical redlining impacts health today nearly a century later. It lends weight to proposed policy fixes to health disparities that are reparative and structural in nature.
Huang, Dina (UMD SPH Epidemiology and Biostatistics)
Nguyen, Quynh (UMD SPH Epidemiology and Biostatistics)
Background: Residential mobility is related to a person’s neighborhood environment and social environment and could have impact on an individual’s health outcomes. Mobility studies have focused on the experience of mobility and its association with health behaviors, obesity and mental health outcomes in children and adolescents. Little is known about the effects of mobility on body mass index(BMI) and obesity in adults.
Goal: In this study, we leveraged individual level data from the Utah Population Database (UPDB) and Utah driver licenses to assess the association between residential mobility and obesity for adults in Utah.
Objectives: We hypothesized that greater mobility is associated with higher BMI and higher prevalence of obesity.
Approach: The study population is 1.69 million adults aged 20 years or older in 2015 living in Utah. BMI records calculated from self-reported height and weight extracted from Utah driver license were corrected using BMI regression estimates from NHANES 2007-2014 that compared self-reported-height and weight with exam-measured height and weight. We used the most recent record of BMI for each participant as the outcome and calculated 10 year’s residential changes and life long residential changes as exposures. Generalized linear regression was used for the model using BMI as the outcome and possion regression was used to estimate the prevalence ratio of obesity.
Results: Individuals with the greatest percentage of mobility in the recent 10 years were associated with increase in BMI and higher prevalence of obesity, accounting for individual age, sex, race, education and zip code population characteristics. Associations were robust and even stronger in models using lifelong residential changes as the exposure.
Importance to public health: Understanding mobility and the factors associated with mobility could provide new perspectives in obesity prevention.
Huiszoon, Ryan (UMD)
Ramiah Rajasekaran, Pradeep (UMD)
Bentley, William (UMD)
Ghodssi, Reza (UMD)
Background: Bacterial biofilms present a significant challenge in healthcare, forming on a range of hydrated surfaces, particularly inserted and implanted medical devices where they serve as a source of recurring infection. Biofilms consist of bacteria encased primarily in polysaccharides and extracellular DNA, and this film affords the bacteria increased tolerance to antibiotics, rendering many treatments ineffective. Furthermore, these communities exacerbate the spread of antibiotic resistance by allowing horizontal gene transfer within the film. There are a lack of techniques to detect and eliminate these films on the geometrically complex surfaces where they form.
Goal: This work strives to develop a device-based approach to address the challenge of detecting and treating bacterial biofilms on complex device surfaces without reliance on excessive antibiotic use.
Objectives: In this work we explored the ability of a microfabricated electrode-based platform to function as an impedance sensor for biofilm detection and as a tool to apply the bioelectric effect for biofilm removal. By utilizing a flexible substrate, these functions can be achieved while the device conforms seamlessly with the 3D geometry of the vulnerable surface.
Approach: The device consisted of a flexible polyimide substrate with microfabricated electrodes arranged in an interdigitated pattern. The device is inserted into a cylindrical silicone tube, representative of urinary catheter’s geometry. Biofilms are grown over 24 hours and the change in the system impedance serves to detect the formation. After 24 hours of growth, the mature biofilms are treated with the bioelectric effect (BE). BE consists of the electric field induced by the impedance sensor and a low concentration dose of antibiotics. The electric field increases the susceptibility of the biofilm to antibiotics. After treatment, crystal violet staining will be used to correlate the change in biomass with the impedance sensing results and confirm the efficacy of the BE treatment.
Results: A 30% decrease in impedance corresponded to biofilm growth over 24 hours, along with a statistically significant increase in biomass. BE treatment led to a 12% increase in impedance, due to the removal of biofilm. The BE treatment also led to significant or nearly significant decreases in biomass compared to untreated, antibiotic only treated, or electric field only treated samples.
Importance to public health: Bacterial biofilms are significant public health issue, colonizing medical devices and surfaces, causing infections, and spreading antibiotic resistance. In addition, biofilms colonize water systems and food processing plants, introducing bacterial contaminants into food and drinking water.
Hunter, Jessica (UMD SPH Kinesiology)
Garcia, Gina (UMD SPH Kinesiology)
Shim, Jae (UMD SPH Kinesiology)
Miller, Ross (UMD SPH Kinesiology)
Background: Runners with history of tibial stress fracture show higher per-step vertical average loading rate and absolute free moment than previously uninjured runners. Per-step knee loads increased but cumulative loads were similar between walking and running. At faster speeds, longer step lengths mean fewer steps are required to travel a distance, and may not necessarily lead to increases in accumulated load. The question of how speed distribution within a training program affects cumulative load is important because speed distribution is an easily modifiable factor of training.
Goal: The purpose of this study was to compare the accumulated vertical average loading rate (accumulated LR), accumulated peak absolute tibial free moment (accumulated FM), and accumulated peak compressive tibial load (accumulated TL) between two distributions of speeds: i) all mileage at normal speed (N) and ii) a combination of slow and fast speeds with the same average speed as normal (ASN).
Objectives: We hypothesized that accumulated loads would be greater for ASN than N program due to a larger proportion of fast running.
Approach: Subjects wore 33 reflective markers on the pelvis and lower limb. They ran around a 50-m indoor track for three laps each at three speeds: self-selected slow, normal, and fast paces. For each self-selected speed, velocity (VEL), step length (SL), steps per kilometer (SPK), loading rate (LR), peak absolute free moment (FM), and peak tibial compressive load (TL) was calculated. Per-kilometer accumulated load was calculated for N and ASN by multiplying the respective SPK by the per step load for LR, TL, and FM. Because subjects’ speeds were self-selected, within-subjects repeated measures ANOVA was performed to compare the VEL, SL, SPK, LR, TL, and FM to ensure differences. A paired-samples Wilcoxon test was performed to compare accumulated LR, accumulated FM, and accumulated TL between N and ASN speed distributions.
Results: Each variable increased with speed (p < 0.01) except FM, which was similar between slow-normal. The comparisons of accumulated LR, accumulated TL, and accumulated FM showed no differences between the two speed distributions.
Importance to public health: Development of osteoarthritis is, in part, attributed to how loads are applied to the body. How physical activity affects these loads is important to understand the etiology of this disease and other musculoskeletal disorders.
Hurtado Choque, Ghaffar (School of Public Health - Family Science)
Ezel, Patsy (University of Maryland Extension)
Brown, Virginia (University of Maryland Extension)
Morris, Jamie (University of Maryland Extension)
Background: The University of Maryland Extension is working along with 14 Universities nationwide, Robert Wood Johnson Foundation, and 4-H National Foundation in the initiative titled: 'Well-Connected Communities', towards building a culture of health in our nation.
Goal: To demonstrate a participative process of addressing a health issue through health coalitions in urban and rural Maryland.
Objectives: In Maryland, we are implementing the Well-Connected Communities initiative, with national and local collaborators, in 3 communities (all are at different stages of implementation): 1. Innovator community – Garret County, 2. Implementer community – Cecil County & 3. Planner community – Baltimore City (Highland town area). In the next year and a half, we will be developing/strengthening existing health coalitions to address a relevant health issue and engage youth and adult volunteers as key components of the process.
Approach: The 'Well-Connected Communities' is a national initiative implemented by 15 National Universities. Each University is collaborating with local partners to identify and address a relevant health issue in a participative way. In Maryland, we are focusing on learning about the collaborative process and the factors associated quality collaboration. In addition, we are using a project-specific dashboard developed by RWJF connected to the county health rankings.
Results: At this point, we do not have results to share. This presentation will focus on the unique approach to address community health issues in a participative way (through coalitions) and youth-&-adult volunteers.
Importance to public health: This project is relevant to Public Health because it addresses a health priority (based on the county health rankings) in urban and rural Maryland. This project uses a collaborative (participatory action research) process in the design and implementation.
Hurwitz, Natasha (UMD)
Crowley, Kenyon (UMD)
Background: A digital health disease management company partnered with the Center for Health Information and Decision Systems to gain insights into their patient population and the success of their program.
Goal: The goal of this project is to identify patient characteristics and program features that contribute to patient success.
Objectives: 1. Combine all data at the patient level to prepare for machine learning analysis. 2. Identify measures of patient success. 3. Identify trends in patient characteristics that point toward patient success. 4. Identify program characteristics that lead to patient success.
Approach: Data is coming into the company's system from many different sources. We combined and mined data on insurance claims, initial patient health survey (similar to PHQ-9), device reading data streaming into the system several times per day, notes on health coaching sessions, notes on outreaches triggered by the device reading system and demographic data. We continue to work on preparing the data for time series analysis.
Results: Right now, we are building the dataset and running some analytics. We do not have conclusive results at this time, but we are hoping the time series analysis will help us. Also, the company is enrolling more patients and we hope a larger dataset can run through our scripts and point to patient indicators.
Importance to public health: The patients are Medicaid patients and if programs like this can help Medicaid patients manage their disease conditions, the hope is that they can be applied to other patients as well.
Wang, Min Q. (UMD)
Ighani, Mehrnaz (UMD)
Background: Primary care physicians (PCPs) serve as the patients’ first point of entry into the health care system and the demand for them continues to grow which challenges the long-term viability of health care in rural areas. We provide an analysis of the active physician workforce in the five counties of the Maryland Mid-Shore region with a focus on PCPs and an overview of select demographic and practice characteristics.
Goal: To investigate the necessity and shortage of primary care physicians in 5 counties of Mid-Shore Maryland
Objectives: We provide an analysis of the active physician workforce in the five counties of the Maryland Mid-Shore region with a focus on PCPs and an overview of select demographic and practice characteristics.
Approach: Active primary care physicians (n=110) chosen were ˂75 years of age, held a specialty board in family medicine, general practice, internal medicine, pediatrics or OB/GYN general, had an active medical license, designated a practice in one of the counties, and provided patient care for ≥20 hours per week in 2014-2015. We excluded physicians working for the federal government and military.
Results: Of 110 PCPs available for 171,166 residents, 49 (45%) were family practitioners, 36 (33%) internists, 16 (15%) pediatricians, and 9 (8%) OB/GYNs. 20% were in solo practice, 27% practiced in a single specialty group practice, and 7% practiced as hospital staff as their primary practice. Slightly over half of the PCPs practiced in private non-proﬁt offices and slightly smaller than 1/3 practiced in private proﬁt offices. Ninety-five percent of PCPs participated in private insurance networks, while 86% participated in the Maryland Medical Assistance Program and 86% participated in the Medicare Program. The distribution of PCPs illustrated that Talbot, Kent, and Dorchester counties showed higher density of PCPs than Caroline and Queen Anne’s counties.
Importance to public health: The Mid-Shore region of Maryland suffers from primary care physician shortage and an uneven geographic distribution of PCPs. Policy decisions that increase the size of the primary care workforce without addressing distribution may not solve the PCP shortage issue.
Wang, Min Q. (UMD)
Ighani, Mehrnaz (UMD)
Background: Telehealth technology has been noticed as the use of electronic communication and information technologies to provide long distance clinical health care and health administration. In rural areas telehealth services increase patient access to services such as emergency department care, home health, specialty care, medication adherence, and intensive care monitoring.
Goal: To report an analysis of the telehealth and Electronic Health Records (EHR) adoption by primary care physicians in the 5 counties of Mid-Shore, Maryland.
Objectives: To report an analysis of the telehealth and Electronic Health Records (EHR) adoption by primary care physicians in the 5 counties of Mid-Shore, Maryland.
Approach: Active primary care physicians (n=110) chosen were ˂75 years of age, held a specialty board in family medicine, general practice, internal medicine, pediatrics or OB/GYN general, had an active medical license, and designated a practice in one of the counties, and provided patient care for ≥20 per week in 2014-2015. We excluded physicians working for the federal government and military.
Results: More than 2/3 (73%) used electronic prescriptions more than seventy-five percent of the time. Talbot County has more PCPs than other counties, but has the lowest percent (62%) using electronic prescriptions. More than 2/3 (74%) used electronic medical records in the region and Kent county had the lowest percent (50%) using electronic medical records. Most physicians (93%) used computers to obtain information about treatment alternatives and 83% used them to send prescriptions electronically to pharmacies. About two-thirds (66%) used computers to generate reminders about preventive services needed for patients and most (92%) used computers to access patient notes, medication lists, or diagnoses. About two thirds (67%) used computer for clinical data and image exchanges with other physicians while more PCPs (87%) used computer for clinical data and image exchanges with hospitals and laboratories. About half of PCPs (51%) used computers to communicate about clinical issues with patients by email and (91%) of PCPs use computers to obtain information on potential drug interactions.
Importance to public health: Telehealth technology and EHR play a role in helping rural communities increase access to care for isolated rural residents.
Wang, Min Q. (UMD)
Ighani, Mehrnaz (UMD)
Background: Primary care accessibility is an important component in improving quality of care and reducing health care costs which can be affected by rurality, travel distance, and sociodemographic factors. Transportation is a necessity for obtaining primary care services, particularly for those with chronic diseases. Inadequacy of transportation can lead to lack of convenient medical treatment and unmet health care demands.
Goal: To analyze the importance of geography and spatial behavior as enabling factors in rural health care utilization and controlling for demographic and health status factors by providing a technical report of assessment of travel to access primary care services.
Objectives: To analyze the importance of geography and spatial behavior as enabling factors in rural health care utilization and controlling for demographic and health status factors by providing a technical report of assessment of travel to access primary care services.
Approach: Network analysis (Google Maps API Directions Service) was used to identify the shortest driving distance and driving time by calculating the central point from each of the 60 zip code areas to the nearest primary care physician (PCP) within Kent, Queen Anne’s, Caroline, Talbot, and Dorchester counties. For this report, active primary care physicians (n=110) chosen were ˂75 years of age, held a specialty board in family medicine, general practice, internal medicine, pediatrics or OB/GYN general, had an active medical license, and designated a practice in one of the counties, and provided patient care for ≥20 per week in 2014-2015. We excluded physicians working for the federal government and military.
Results: The average travel distance was 9.6 miles (SD=6.8, median=8.05 miles) in the region while and average travel time was 14.9 minutes (SD=9.5, median 13.0 minutes) from the centroid of the zip code area to the nearest PCP. Based on Maryland’s standard of maximum travel distance (30 miles) and maximum travel time (30 minutes) for accessing the nearest PCP, 98% of the residents travel under 15 miles and 92% of the residents travel under 30 minutes to the nearest PCP. It is also noted that the longest travel distance and time are all in the southern areas of Dorchester County.
Importance to public health: Our results illustrate the importance of spatial behavior factors in rural health care utilization and consideration of the relationship between transportation barriers and health in addressing health care services in vulnerable environments.
Cruz-Cano, Raul ((UMD SPH Biostatistics))
Background: Prescription drug abuse is the fastest growing drug problem in the United States and has been deemed a public health epidemic by the Centers for Disease Control. Since 2002, 26 million people have initiated the nonmedical abuse of prescription painkillers, costing health insurers $72.5 billion annually. While there is research indicating that only 22.1% of individuals obtain their nonmedical painkillers from one doctor, the relationship between health insurance and nonmedical Prescription Painkiller, Sedative, and Tranquilizer (NPPST) use is limited in the literature.
Goal: To identify the relationship between health insurance status and the likelihood of initiating and continuing the use of nonmedical prescription painkillers, sedatives, and tranquilizers.
Objectives: 1. Indicate the frequency of continued and newly initiated NPPST use between wave 1 and wave 2 of the PATH study and identify differences based on insurance status 2. Identify demographic characteristics that are related to initiating the use of NPPSTs
Approach: This research analyzed data from waves 1 and 2 of the Population Assessment of Tobacco and Health study (PATH, 2013-2015) adult datasets. 28,369 individuals were included in the analysis. Survey weights were used to compute nationally representative population estimates and compare weighted frequencies of NPPST use and health insurance status across wave 1 and wave 2. Individuals who used NPPSTs in both wave 1 and wave 2 were considered continuous users while users who started NPPST use in wave 2 were considered newly initiated users. Chi-squared analysis was conducted to test significance of newly initiated and continuous NPPST use with health insurance status and other variables (age, income, gender, education, average pain the last 7 days, and emergency room and urgent care visit in the last year).
Results: 2.96% of individuals in this study were found to be continuous users and 4.57% of individuals were found to be newly initiated users (P<.0001). Among individuals who had used NPPSTs before wave 1, there was no significant relationship between health insurance status and NPPST use (P<0.0593). Among individuals who had not used NPPSTs before wave 1, there was a significant relationship between health insurance status and NPPST use (P<0.0002). Individuals with some private insurance were most likely to become newly initiated users.
Importance to public health: The results indicate that health insurance status influences nonmedical prescription painkiller, sedative and tranquilizer use in newly initiated users but not in continuous users. These findings can inform intervention strategies aimed at preventing the initiation of NPPST use in at-risk demographics.
Jindal, Gagan (UMD College of Information Studies)
Liao, Yuting (UMD College of Information Studies)
Background: Online health information seeking through social media has become increasingly prevalent as individuals become more willing to share their experiences around managing their health conditions online with others. Video blogging (vlogging) on YouTube, in particular, has become a growing source of health information for individuals who have Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS).
Goal: Our study investigates the types of information video bloggers (vloggers) on YouTube choose to share around their experiences managing HIV/AIDS.
Objectives: We examined YouTube videos created by vloggers diagnosed with HIV/AIDS in order to enhance our understanding of how individuals share information on their chronic health conditions through social media and the potential benefits and challenges of this form of information provision.
Approach: We conducted a content analysis of 17 different vloggers most viewed vlogs on YouTube in order to assess their narratives around coping with HIV/AIDS.
Results: The results of our study preliminarily indicate that vloggers tend to interweave both informational and emotional support for viewers into their vlogs, which detail their diagnoses and their experiences around the effects of HIV/AIDS on their health, relationships, and other aspects of their lives. The advantages of this type of information provision include instrumental support for viewers in terms of information on managing diagnoses, symptoms, treatments, healthcare providers, other relevant factors. Reducing the stigmatization around HIV/AIDS also may be a major benefit of vlogging. However, the spread of misinformation on HIV/AIDS may be a hurdle as vlogging becomes a more popular form of health communication.
Importance to public health: The results from our study seem to indicate that vlogs may be a highly useful method for educating viewers on HIV/AIDS in a more contextual and experiential manner, but viewers will also need to learn how to assess the credibility and accuracy of the health content from these types of vlogs.
Kachingwe, Olivia (UMD SPH Behavioral and Community Health)
Aparicio, Elizabeth (Assistant Professor UMD SPH Behavioral and Community Health)
Anderson, Kent (Waikiki Health)
Houser, Carla (Waikiki Health)
Fleishman, Jamie (UMD SPH Behavioral and Community Health)
Novick, Julia (UMD SPH Behavioral and Community Health)
Phillips, Danielle (University of Hawaii at Manoa)
Background: Homeless youth are vulnerable to unintended pregnancies: nearly 50% get pregnant at least once during adolescence. Yet, little is known about homeless youths’ experiences of accessing and selecting birth control, which is critical to informing attuned unintended pregnancy prevention.
Goal: The current study addresses this gap, by assessing how homeless youth and youth at risk of homelessness experience accessing and selecting birth control?
Objectives: Identify factors that homeless youth and youth at risk of homelessness connect with their experience of accessing and selecting birth control.
Approach: Twelve girls aged 14-19 (M=16.5) years participated in two focus groups following a holistic sexual health program at a youth drop-in center. Data were naturalistically transcribed, then analyzed using Interpretive Phenomenological Analysis (IPA), a qualitative approach that focuses on the contextual interpretation and meaning of a particular phenomenon of interest (in this case, “accessing and selecting birth control”), often to a particular group of people (in this case, homeless female youth).
Results: Analysis revealed four final themes that characterize how homeless youth experience accessing and selecting birth control: Getting Acclimated, Becoming Close and Building Trust, Addressing Fear, and Making the Choice. Homeless youth were first engaged through basic needs services and receiving a program incentive. Sustained engagement resulted from building trust with staff and other homeless youth. After building trust, youth began to explore accessing birth control, which was partly influenced by their fear of being sexually assaulted or trafficked. When deciding which birth control to select, youth emphasized the importance of how it would be delivered. Youth ultimately committed to adopting a method of birth control in the context of the medical provider giving detailed information and unwavering support by program staff. When LARC (long acting reversible contraception) was selected, it was due to its low burden in comparison to other methods.
Importance to public health: Findings suggest providers working with homeless youth need to consider basic needs first and build in time for development of trust before delivering birth control-related content and supporting youth to make the best birth control choice for themselves. The unique context within which homeless youth are making sexual health decisions needs to be considered.
Kaplow, Katya (UMD SPH Behavioral and Community Health)
Talarico, Kelsey (UMD CMNS Biology)
Montazer, Jaleh (UMD SPH Pubic Health Science)
Soltani, Darya (UMD SPH Public Health Science)
Lama, Yuki (UMD SPH Family Science)
Background: Stress in rural agricultural communities differs from stress among urban populations. In rural areas, farmers cope with unpredictable climate, social isolation, long work hours, and reduced access to resources . In addition, farms are often connected or close to homes, making it difficult to separate work stress from home life. These factors increase rural farmers’ risk of developing symptoms associated with chronic stress such as insomnia, hypertension, muscular aches, and anxiety. Public Health Without Borders (PHWB) conducted a health needs and strengths assessment in Compone, Peru in 2017 and found chronic stress to be a concern among both community members and health leaders.
Goal: The primary goal of the intervention was to introduce yoga as a simple and convenient way to both exercise and de-stress for Compone community members.
Objectives: To develop and implement a stress relief workshop utilizing elements of yoga and meditation. Yoga is a low impact exercise that reduces stress and relieves muscular tensions by promoting a positive affect and self-compassion .
Approach: The UMD PHWB team designed and implemented five thirty-minute yoga sessions that included beginner and chair poses suited for all ages and physical capabilities, with intent to provide stress relief. PHWB created a booklet for each participant to take home with pictures and descriptions of yoga poses, chair poses, and breathing exercises written in Spanish.
Results: Community member participation increased throughout the week, with groups ranging from 7-20 people. Limited literacy and language barriers prevented valid and reliable evaluations. Improving evaluation tools is an important consideration for future trips.
Importance to public health: PHWB yoga workshops aim to promote healthy coping techniques among a chronically stressed rural-agricultural community and improve overall well-being in Compone, Peru. Reducing stress contributes to improved well-being, which aligns with Sustainable Development Goals of ensuring healthy lives and promoting well-being across the lifespan.
Shim, Jae Kun
Background: Estimation of gait force asymmetry has valuable applications in clinical assessments. However, the gold standard for it (i.e. force platforms) are relatively expensive and limited to laboratory settings. The aim of this project was to investigate the feasibility of using an accelerometer mounted on the lower back for assessing gait asymmetry during gait.
Goal: Development of an accessible, cost-effective system for evaluation of gait force asymmetry under free-living conditions using accelerometers.
Objectives: The region near the L3 vertebrae was chosen for sensor placement of the sensor. We hypothesized that there will be a positive strong correlation between the asymmetry index measured from force platforms and the accelerometer.
Approach: A total of 25 young healthy participants completed three trials of walking and running under six conditions: normal walking as well as simulated asymmetry conditions. Their speed was controlled for by keeping them at +/-5% of their preferred walking/running trial as measured by speed gaits. Ground reaction forces and acceleration were measured simultaneously at 1000Hz. Left-right asymmetry was quantified using the peak magnitude of each signal during the corresponding stance leg. Pearson correlation coefficient was used to investigate the relationship between the two indices.
Results: The results showed a strong positive correlation between the force asymmetry index and the accelerometer index in running and walking ( r = 0.91 vs. r = 0.70, respectively).
Importance to public health: Estimation of force asymmetry in gait under free-living conditions can provide valuable clinical information about the effectiveness of rehabilitation or surgery procedures.
Kelly, McKayla E. (UMD CMNS Physiology and Neurobiology)
Shaw, Emma P. (UMD)
Lu, Yingzhi (UMD)
Shuggi, Isabelle M. (UMD)
Gaskins, P. Christopher (UMD)
Gentili, Rodolphe J. (UMD)
Background: Although a large amount of work on sensorimotor adaptation exists, relatively few investigations have evaluated cognitive workload during sensorimotor adaptation.
Goal: The goal of this study was to examine changes in cognitive workload via an evaluation of attentional reserve over the course of adaptation under two levels of cognitive-motor challenge.
Objectives: We hypothesized that when individuals first encounter a sensorimotor perturbation taking the form of a visual distortion, this would result in an increased cognitive workload, as reflected by a decreased attentional reserve. However, the manner in which the sensorimotor perturbation was delivered was predicted to influence attentional resource allocation throughout adaptation. Specifically, it was hypothesized that as individuals adapt to a visual sudden and gradual distortion the attentional reserve would progressively increase and decrease, respectively
Approach: : EEG and movement kinematics were simultaneously recorded as ten participants performed a visuomotor task involving center-out reaching movements using their right hand on a digitizing tablet displayed in real-time on a computer monitor. Participants were assigned to one of two groups (sudden or gradual distortion) which differed by the level of cognitive-motor challenge imposed on the individuals. Specifically, participants assigned to the sudden group (n = 5) completed the task as their observed movement trajectories were rotated 60˚ counter-clockwise, whereas participants assigned to the gradual group (n = 5) completed the task as their observed movement trajectories were gradually rotated incrementally by 5˚ up to 60˚. Additionally, both groups performed a baseline task in which no visual distortion was applied. Attentional reserve was assessed by evaluating the novelty-P3 component of the event-related potential elicited by task-irrelevant novel auditory stimuli that were intermittently played as participants performed the visuomotor task.
Results: The preliminary findings revealed that both groups exhibited a reduced attentional reserve (i.e., an attenuated novelty-P3 component amplitude) when first encountering the visual distortion, suggesting there was an increased cognitive workload during the early phase of learning. The findings also suggest attentional resource allocation throughout the course of adaptation may differ based on the manner in which the distortion is implemented, which mirrored participant’s movement time. However, additional data analysis is needed to further examine these findings.
Importance to public health: This work can inform the underlying physiological principles of adaptive cognitive-motor performance in humans, which may benefit the assessment and rehabilitation of patients who suffer from cognitive-motor disabilities
Khan, Razeen (UMD School fo Public Health)
Lynch, Jason (UMD Biological Sciences)
Bueno de Mesquita, Jacob (UMD School of Public Health MIEH)
Milton, Donald (UMD School of Public Health MIEH)
Koutsoukos, Stefanos (UMD Chemistry and Biochemistry)
German, Jennifer (UMD School of Public Health MIEH)
Background: A college campus presents a unique environment to study transmission of respiratory illness as well the clinical progression of certain infections. The group sought out to determine if there was a differentiation in symptom presentation between bacterial and viral infection in addition to looking at the impact of certain lifestyle conditions on illness severity.
Goal: The goal of this research project is to determine significance differences between populations of students infected with both viral and bacterial targets.
Objectives: Based on the similarity of immunological responce similar symptom scores are expected. Also, negative confounding lifestyle factors are predicted to increase the risk of symptom onset by infection.
Approach: Clinical samples were collected from individuals with suspected acute respiratory infections from a cohort of living and learning program undergraduates during the Spring 2017 semester.
Results: Significant differences in the symptom presentation were found between viral and bacterial infection.
Importance to public health: A stronger association of symptom presentation with the normalization of confounding factors could eventually lead to a probabilistic correlation model of which could be used to better diagnose and treat infectious disease in the future.
Lama, Yuki (UMD SPH Family Science)
Thoma, Marie (UMD SPH Family Science)
Background: Interconception care is a critical opportunity for health promotion efforts to reduce maternal health risks. Short interpregnancy intervals (IPI) have been associated with adverse infant health outcomes in several studies.
Goal: Our goal was to expand on the limited research on IPI's relationship to maternal health outcomes, including health-promoting behaviors such as early initiation of prenatal care (PNC).
Objectives: Therefore, the objective of this study was to examine the association between IPI and delayed PNC initiation.
Approach: Data are based on births from reporting areas that implemented the 2003 revised U.S. birth certificate in 2015 (97% of all resident births). Our sample consisted of singleton, second-born or higher births (n=2,180,755). Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of IPI and delayed PNC initiation (i.e., 2nd or 3rd trimester or no prenatal care), adjusting for relevant sociodemographic and health characteristics.
Results: Shorter IPIs were associated with delayed PNC initiation, which decreased monotonically with increasing IPI length. Approximately 28% of singleton, second-born or higher births were conceived < 18 months from the previous live birth. Our adjusted model showed a decrease in the odds of delayed PNC with increasing time between pregnancies: < 6 months [OR: 1.92, 95% CI: 1.89-1.95]; 6-11 months [OR: 1.51, 95% CI: 1.49-1.52]; 12-17 months [OR: 1.25, 95% CI: 1.23-1.26] compared 18-59 months.
Importance to public health: Further research is needed to address whether interconception health promotion to optimize birth spacing, such as postpartum contraception and counseling, could translate to earlier PNC initiation and other maternal health-promoting behaviors for subsequent births.
Kaplow, Katya (UMD SPH Behavioral and Community Health)
Talarico, Kelsey (UMD CMNS Biology)
Montazer, Jaleh (UMD SPH Public Health Science)
Soltani, Darya (UMD SPH Public Health Science)
Ahmad, Mishal (UMD CMNS Biology)
Lama, Yuki (UMD SPH Family Science)
Maring, Elisabeth (UMD SPH Family Science)
Background: Road traffic incidents rank ninth as a leading cause of death internationally, many of which could have been prevented by proper road safety practices. Annually, road trauma is the third leading cause of premature death and over 4,000 road traffic deaths are reported in Peru (WHO, 2015).
Goal: To address road safety in rural Peru, a multi-pronged approach was developed and implemented in August 2017 by Public Health Without Borders (PHWB), in collaboration with Engineers Without Borders (EWB), both student-run organizations at the University of Maryland.
Objectives: In a multi-year commitment, the student groups have worked extensively with the rural community of Compone, which is situated along a major highway frequented by commercial trucks that lacks sidewalks for pedestrians, to address the importance of road safety.
Approach: PHWB conducted road safety education workshops for community members, including distribution of culturally and linguistically appropriate road safety educational materials and addressing questions related to bridge construction. Children’s workbooks were composed of simple word and picture games aimed at promoting road safety practices: looking both ways and listening for traffic, wearing bright clothes at night, and walking across the road with a companion.
Results: PHWB utilized frameworks and tools such as cultural competency, community engagement, and health literacy to create a sustainable working relationship with community leaders in Compone. Challenges and lessons learned include language barrier, limited literacy and low health literacy, communication channels, and political considerations.
Importance to public health: Promoting road safety is a preeminent global public health priority as demonstrated by the Sustainable Development Goal to reduce the number of international deaths and injuries from road traffic accidents in half by 2020. Increased incidence of road traffic incidents continues to threaten public health and further research is pivotal in developing concerted, tailored health education efforts to enhance road safety practices within this community.
Levy, Lauren (UMD SPH Behavioral and Community Health Horowitz Center for Health Literacy)
Kaplow, Katya (UMD SPH Behavioral and Community Health Horowitz Center for Health Literacy)
Platter, Heather (UMD SPH Behavioral and Community Health Horowitz Center for Health Literacy)
Background: Limited data on the use of health literacy techniques in the state of Maryland is a barrier to a systems-approach to health literacy progress. It is unknown how nonprofit organizations, local and state government, hospitals, and other agencies incorporate health literacy tactics in their work to improve individual, community, and system-level health literacy.
Goal: The purpose of this project was to gather county-level data on the assets, gaps, and opportunities for health literacy best practices in Maryland.
Objectives: The project included an environmental scan and qualitative interviews with key stakeholders to obtain a diverse and practice-based understanding of the health literacy best practices in Maryland’s 24 counties.
Approach: A team from the Horowitz Center for Health Literacy conducted background research to examine community resources, health indicators, economic factors, social determinants of health, and population demographics for each Maryland county. Relevant organizational, governmental, and community health leaders were contacted to do a semi-structured interview. Data and responses were compiled to assess themes, as well as assets, gaps, and opportunities for health literacy.
Results: More than 30 interviews with state and county-level organizations were conducted with key stakeholders from 22 counties. The types of organizations included local health coalitions, hospitals, nonprofit organizations, health departments, and government agencies. Emerging themes included the desire to empower communities to control their health; the need to evaluate the effectiveness of programs and materials; need for a process to develop health materials; importance of community needs assessments; and difficulty of communicating with hard-to-reach populations. On a scale of 1 (very inadequate) to 5 (highly adequate), most interviewees ranked their organization’s use of health literacy techniques and best practices a 3.
Importance to public health: The 2003 National Assessment of Adult Literacy found that only 12 percent of U.S. adults have proficient health literacy. It is necessary to understand how Maryland public health organizations use health literacy techniques to improve individual and community-level health outcomes. Through learning each county’s assets, gaps, and opportunities, a state framework for health literacy can be created to support the implementation and training of community health leaders to make Maryland the first health literate state.
Li, Weizhe (UMD SPH EPIDEMIOLOGY AND BIOSTATISTICS)
Zhang, Jing (UMD SPH EPIDEMIOLOGY AND BIOSTATISTICS)
Background: The spatial organization of cells is critical for normal organ physiology and function. For immune cells, position influences such key events as intercellular contacts, activation and effector activity. Our understanding of these relationships has been historically derived from imaging of immune-labeled tissue sections. However, section-based sample preparation discards all three-dimensional information and limits the ability to study rare events in structurally complex organs. Based on our new clearing method, Clearing-enhanced 3D (Ce3D), which generates excellent tissue transparency, preserves cellular morphology, maintains reporter protein fluorescence, while also retaining epitopes for antibody-based labeling, we are able to analyze the spatial distribution of immune cells in lymph nodes and their relations in three dimensions.
Goal: To characterize the spatial distribution of immune cells inside lymph nodes.
Objectives: 1. To test if distribution of immune cells is completely spatial random. 2. To test any cluster formation among immune cells. 3. To test the relations among the distribution of immune cells.
Approach: The three-dimension (3D) dots were reconstructed after image stacks were segmented. The 3D dots can be treated stationary point process. Then point pattern was characterized by K, G (nearest-neighbour distance distribution function), F (empty-space function), J functions with incremental modeling. The deviation of immune cells from complete spatial randomness was evaluated, and their possibility of clustering was estimated with depletion of the cofounding from intensity. Distance decay function was then adopted to describe the intensity relations of immune cells.
Results: Still being computed
Importance to public health: The 3D spatial analysis of immune cells in lymph node is novel and fundamental for the diagnosis and characterization of immune diseases.
Li, Andrew (UMD SPH)
Li, Alice (UMD SPH)
Shukla, Malavika (UMD SPH)
Cunningham, Laura (UMD SPH)
Background: Contrary to popular belief, researchers at the University of Maryland have found strong evidence that flu can be transmitted through breathing, and not just through coughing and sneezing. Breathing infectious aerosol particles which can stay suspended in air and transmit disease raises a concern regarding building ventilation. CO2 concentrations are used to estimate the ventilation rate in a room; high CO2 concentrations indicate poor ventilation.
Goal: We studied how factors such as ventilation, humidity, and temperature affected the CO2 concentration to analyze if buildings should change ventilation to decrease the prevalence of potential infectious aerosol particles.
Objectives: We examined data from six CO2 monitors collected over 17 days - five in poorly ventilated rooms in the School of Public Health and one mounted outside. Our objective was to compare the differences in humidity, temperature and ventilation in order to come up with a recommendation if buildings should be renovated so ideal factors are reached. We hypothesized that: Poor ventilation will cause high CO2 concentration Higher humidity will cause high CO2 concentration Higher temperature will cause high CO2 concentration
Approach: In order to study the effect of the aforementioned building factors, relevant data was collected using HOBO sensors. These sensors were mounted in rooms 301, 302, 303, 305, and 307 to measure each room’s average temperature, relative humidity, dew point, and carbon dioxide concentration, with data points taken every five minutes. In addition, a sensor was mounted outside of the School of Public Health to serve as a baseline comparison for outdoor air quality. At the end of the 17 day collection period, the data for each room was subsequently downloaded in a list format using the HOBO mobile app and converted to Excel files. Upon acquiring the data, we analyzed and compared the relationship between time and each of the ventilation variables for each room.
Importance to public health: Old buildings generally have poor ventilation, which can negatively affect the health of its residents and visitors. As the University of Maryland research shows, breathing can expel infectious aerosols that can remain suspended in the air. We believe that having even one sick person in a room with poor ventilation can greatly impact the chances of others in the room getting sick. Therefore, our study is designed to come up with an initial conclusion and recommendation for potential changes in ventilation in old buildings.
Lu, Calvin (UMD)
Hatfield, Bradley (UMD)
Background: Attentional focus refers to the mental capacity an individual has when performing a motor task. How an individual can focus their mental efforts will have a strong effect on their performance. Often in sports, poor performance is due to an error of attention or inability of athletes to focus on the task at hand. How an athlete responds to the change in environment or challenge can dictate their ability to be successful on the field.
Goal: To index how an individual’s psychophysiological biomarkers (EEG and HRV) would change as task difficulty increases.
Objectives: As task difficulty increases 1) Increase in Theta activity 2) Decrease in Alpha activity 3) Decrease in high-frequency HRV 4) Increase in low-frequency HRV
Approach: Thirty-one (n = 31) Performed a Snake® game with two levels of challenge (Easy vs Hard), EEG and HRV measured through BrainVision.
Results: EEG data analysis was calculated using a 2 x 2 x 5 (Condition x Hemisphere x Region) ANOVA. The results of the experiment revealed that with increased task difficulty, an elevation in neural effort as indexed by regional theta band cerebral cortical activation (F (1,30) = 27.15; p < 0.005). HRV data analysis was calculated using a repeated measure ANOVA. The results found an increase in sympathetic dominance and a withdrawal of parasympathetic dominance when task difficulty increased high frequency HRV (F (1,30) = 9.074; p = 0.005)), low frequency HRV (F (1,30) = 9.074; p = 0.005), and low frequency high frequency ratio (F (1,30) = 5.185; p = 0.03).
Importance to public health: The results of this experiment support the validity of EEG and HRV as objective measures of attention demand, this can then help create a framework for characteristics of a cognitive loaded brain. This framework can then be used as a diagnostic tool for people who are under high stress or over worked.
Luo, Yuhan (University of Maryland)
Lee, Bongshin (Microsoft Research)
Wohn, Donghee (New Jersey Institute of Technology)
Rebar, Amanda (Central Queensland University)
Conroy, David (The Pennsylvania State University)
Choe, Eun Kyoung (University of Maryland)
Background: Uninterrupted sedentary behavior (SB) is detrimental to long-term health, and is hard to break due to its strong habitual nature. Information workers, who spent most of their days sitting with computers, are particularly vulnerable to the health risks caused by prolonged SB.
Goal: This work aims to understand information workers’ intentions & practices around standing or moving breaks in workplaces.
Objectives: We examined the contexts affecting participants' receptiveness to standing or moving breaks, with the following research questions: (1) What are information workers’ intended work & break duration and their actual practices? (2) What are reasons and contexts around information workers’ break-taking intentions and practices?
Approach: We developed Time for Break, a desktop-based break prompting system that collects people's situated responses on their desired work duration, willingness to take a moving break, intended & actual break duration and reasons for not taking a break. We conducted an exploratory field study (N = 25) with Time for Break for three weeks, along with health-related measures, and followed by semi-structured interviews.
Results: T4B sent out 1599 prompts in total, with 642 (40%) "yes" responses, 542 (34%) "no" responses, and 415 (26%) prompts ignored. We found that in general, participants had consistent work duration, and when they set longer work duration, they tended to respond "yes" more often. Participants with stronger habit strength in taking moving breaks tended to respond "yes", and participants who set more consistent break duration increased their habit strength more. Common reasons for not taking a break included busy working, close to finishing something, heading to other places soon and engaged in a conversation, etc. Besides, participants took longer breaks than they intended, and their self-regulation in taking breaks increased after the study. From the interviews, we also learned that most breaks were driven by psychological needs. Interestingly, participants showed an increased self-awareness and accountability in taking breaks.
Importance to public health: By providing an empirical understanding of information workers’ intentions & practices to take moving breaks, this work informs public health researchers to design effective interventions that aim to break prolonged SB in workplaces.
Maietta, Justin (UMD BSOS Sociology)
Background: Type 1 diabetes (T1D) and type 2 diabetes and (T2D) are both chronic health conditions that call for consistent monitoring of behaviors in relation to how they might affect blood glucose levels. While research has been conducted on forming diabetic identities, research on how diabetes-related behaviors and care interact with maintenance of established identities is still needed.
Goal: The goal of this research is to understand how chronic health conditions like T1D and T2D influence identity processes, or how individuals may modify their behaviors or concepts of self based on feedback from others they interact with.
Objectives: Objectives include: (1) understanding how people living with T1D or T2D manage their identities in the face of their conditions, and (2) gaining a broad understanding of how management of chronic health conditions like T1D and T2D influence our conception of identity processes.
Approach: 18 open-ended, semi-structured interviews were conducted with people living with T1D (n=11) and people living with T2D (n=7). Interviews occurred either in-person or via the telephone. Subjects were recruited by contacting diabetes support group facilitators, distributing fliers at a health fair, posting recruitment messages on online forums for diabetes discussion, and posting recruitment messages on Facebook. The interview questionnaire was informed by findings and themes that emerged from 5 pilot interviews conducted in 2016, as well as relevant literature. Interviews were coded inductively using ATLAS.ti.
Results: This research finds that those who are living with T1D and T2D carry out identity processes in a different way than what has previously been identified in literature about identity processes. Typically, individuals will either modify behavior, modify the identity standard, or adopt an entirely new identity when others do not verify the individual's identity. However, these findings call for consideration of the body as separate from the self and requiring its own maintenance within identity processes.
Importance to public health: This research adds to the significance of access to proper nutrition, medications, and health technology for those who are living with chronic health conditions. These populations not only require these resources for proper care, but also for the maintenance of self-concept, self-esteem, and acceptance within their social settings.
Marthey, Daniel (UMD SPH Health Services Administration)
Background: In children 6 to 19 years old dental caries are the most common chronic disease and four times more prevalent than asthma in teens (Centers for Disease Control and Prevention, 2016). Under the ACA, Children's dental services are required for Medicaid and CHIP but in the marketplaces dental coverage is not a required purchase.
Goal: The goal of this project was to understand how recent dental coverage policies impact children accessing dental services through each of the insurance types (Medicaid, CHIP, Private On/Off-Exchange).
Objectives: 1. Is there a difference in utilization rates of pediatric dental services between children accessing benefits via plan types including: Medicaid, CHIP, and private insurance on and off-exchange? 2. Between these plan types is there a difference in the rates of financial barriers to dental services experienced by children? We compare utilization and financial barriers to dental services between children (1-20 years) with dental coverage through Medicaid, CHIP and those with private coverage on and off-exchange using a nationally representative sample.
Approach: We use the National Health Interview Survey (NHIS) (2014-2016) to compare the odds of dental utilization and the odds of experiencing a financial barrier to dental services between children and adolescents aged 1-20 years by insurance type (Medicaid, CHIP, private on-exchange, private off-exchange). Using two logistic regression models we calculated differences between groups controlling for sex, race/ethnicity, household income, and health status and region.
Results: Findings suggest there is a significant difference in use of dental services between kids on Medicaid and exchange-based dental coverage (OR: .58, P: 0.00). Further we find that children in the CHIP program are much more likely to experience a dental visit compared with children on Medicaid (OR: 1.69, P: 0.00). Compared with the Medicaid cohort, children with private dental coverage off-exchange are less likely to experience a financial barrier (OR: .75, P: 0.00) and children with private insurance on-exchange are much more likely to experience a financial barrier (OR: 2.4, P: 0.00).
Importance to public health: These findings imply that children's dental health may be at risk if children are shifted from private off-exchange or Medicaid and CHIP programs into marketplace coverage.
Importance to public health:
Wilson, Sacoby (UMD SPH Applied Environmental Health)
Gugssa, Wengiel (UMD SPH Public Health Science)
Mullen, Haley (UMD Environmental Science & Policy)
Background: Research as shown that low-income groups, communities of color, and marginalized populations have been differentially burdened by environmental hazards and locally unwanted land uses (LULUs) across the country. In Prince George’s County, there are a number of vulnerable populations impacted by health disparities that may be related to: 1) differential permitting of LULUs and 2) inequities in planning, zoning, and community development. To address these concerns, the County needs to develop and implement an environmental justice (EJ) plan.
Goal: The goal of this presentation is to discuss elements of the Prince George’s County Environmental Justice 2025 (EJ2025) plan, a blueprint for the County to advance environmental justice, improve public health, and achieve health equity.
Objectives: EJ2025 plan includes an assessment of EJ issues in Prince George’s County. The plan aims to mitigate the differential burden of environmental hazards and health risks on certain populations in the County. EJ2025 offers multiple strategies detailing how to incorporate environmental justice into the local development and policies in Prince George’s County.
Approach: The Prince George’s County Environmental Justice 2025 Plan began as a student project in MIEH730 and has expanded to include other UMD students. The plan includes goals, strategies, recommendations, and metrics related to five themes: lead, water quality, air quality, food security, and equitable development/zoning.
Results: The plan recommends that the County should incorporate: 1) the use of the Maryland EJSCREEN tool to assess areas that may have environmental justice risks, 2) meaningful involvement of impacted stakeholders in local environmental decision-making by establishing a county-wide Commission on Environmental Justice, 3) a moratorium on all permitting, zoning, and development activities in the County until all agencies are in compliance with Title VI of the Civil Rights Act; and 4) decisions that are evidence-based using sound, scientific practices.
Importance to public health: The plan if fully implemented can lead to improvements in health, community sustainability, and quality of life for overburdened and underserved residents in Prince George’s County.
Wilson, Sacoby (UMD SPH Maryland Institute for Applied Environmental Health)
Sapkota, Amy (UMD SPH Maryland Institute for Applied Environmental Health)
Background: Campylobacter is a leading cause of foodborne illness in the United States. Campylobacter infections have been associated with risk factors, such as the consumption of poultry and raw milk. Recent studies, including one in Maryland, have indicated that beyond food-related risk factors there are socioeconomic, agricultural and environmental risk factors for campylobacteriosis, including living in close contact with livestock and consumption of contaminated water. However, no previous studies have evaluated the association between consumption of water from a private well and campylobacteriosis rates in Maryland. Given that the Safe Drinking Water Act does not regulate the water quality of private wells, these could be an important non-foodborne transmission pathway for Campylobacter.
Goal: To evaluate the impact of consumption of water from a private well on the risk of campylobacteriosis in Maryland.
Objectives: The objective is to determine whether consumption of water from a private well is associated with the risk of campylobacteriosis in Maryland.
Approach: Campylobacteriosis case data was obtained from the Maryland FoodNet, which conducts active surveillance on confirmed cases of Campylobacter as well as 9 other pathogens. Only culture-confirmed cases of Campylobacter infection occurring in Maryland between 2007 and 2016 were considered. The Maryland homeowner well permits registry was obtained from the Maryland Department of the Environment. Data from all sources were linked by zip code and campylobacteriosis rates were calculated by zip code. A multivariate, zero-inflated Poisson regression model will be performed to determine the zip code-level association between the number of households in Maryland that rely on drinking water from private wells and the incidence of campylobacteriosis.
Results: A positive association is expected between consumption of water from private wells and the incidence of campylobacteriosis.
Importance to public health: This project will significantly increase our understanding of private wells as a risk factor for campylobacteriosis in Maryland. Results of this study can also be used to inform policies around private well regulations and to educate homeowners on proper well maintenance.
Newton, Shaunna (UMD SPH Behavioral and Community Health)
Boekeloo, Bradley (UMD SPH Behavioral and Community Health)
King-Marshall, Evelyn (UMD SPH Behavioral and Community Health)
Salerno, John (UMD SPH Behavioral and Community Health)
Background: Pre-Exposure Prophylaxis (PrEP) is a fairly new and extremely effective drug that proactively prevents transmission of HIV amongst those at risk. Despite its demonstrated effectiveness, however, PrEP uptake is still particularly low. One potential reason for the low uptake of PrEP is lack of knowledge about its existence, how it works, or availability of the drug.
Goal: This project set out to better understand the sexual risk behaviors, PrEP knowledge and PrEP use of clients participating in the SHIR (Sexual Health in Recovery) Program.
Objectives: This study specifically explored factors associated with PrEP use among substance abuse recovery program participants.
Approach: This sample consisted of clients (N=29) currently attending a substance abuse recovery program in the Maryland area. Participant self-selected into the SHIR substance use treatment program. They were mostly male (69%), White (69%), 41% had at least HS diploma or GED, and came from diverse employment statuses. Frequency analyses were used to illustrate numbers of clients who had used PrEP and who had engaged in sexual risk behaviors. Pearson’s correlations and chi-squares were used to measure associations between sexual risk behaviors and PrEP knowledge, while logistic regression tested whether sexual risk behaviors predicted knowledge about PrEP.
Results: Results drawn from this analysis showed that very few respondents were currently using PrEP (3.4%), were interested in using PrEP (14%) or had even heard of PrEP (N=6, 20%). Analyses also revealed that many respondents cited having had unprotected sex (75.9%), had sex under the influence of a substance (38% within the past 3 months and 62.1% longer than 3 months ago), or reported having other potentially risky sex. Bivariate analyses and regression tests examining the associations of PrEP knowledge and sexual risk behaviors in addition to examinations on whether sexual risk predicts PrEP knowledge are pending.
Importance to public health: These analyses indicate that populations that could possibly benefit the most from PrEP (i.e. those that engage in known risky sexual behaviors) aren’t aware of PrEP. This signifies a gap in awareness of very useful and effective HIV prevention methods.
Newton, Shaunna (UMD SPH Behavioral and Community Health)
Boekeloo, Bradley (UMD SPH Behavioral and Community Health)
King-Marshall, Evelyn (UMD SPH Behavioral and Community Health)
Salerno, John (UMD SPH Behavioral and Community Health)
Background: Literature has gestured to an apparent link between substance use and sexual risk behaviors. Such relationships have potentially important ramifications for both sexual health and recovery from substance abuse. Better understanding of this link is imperative for both sexual health and substance abuse interventions.
Goal: This project set out to better understand the presence and nature of the relationship between sex and substance use among substance abuse treatment clients.
Objectives: The objective of this study was to understand recovery clients' substance abuse in relation to their sexual encounters.
Approach: This pilot-testing sample comprised of clients (N=29) currently attending a substance abuse recovery program in the Maryland area. Participant self-selected into the SHIR substance use treatment program. They were mostly male (69%), White (69%), 41% had at least HS diploma or GED, and came from diverse employment statuses. Frequency analyses were used to illustrate numbers of clients who had engaged in sex and drug-linked behaviors, and quantified reasons why they had engaged in those behaviors. About 1/3 (38%) engaged in sex under the influence in the last three months and 17% (n=5 ) strongly and somewhat agree that the sex while sober has been and disappoint compared to sex while high.
Results: Results showed that a large percentage of people in the substance abuse recovery program reported using drugs during their sexual encounters (38% within the past 3 months and 62.1% longer than 3 months ago). Results showed that they did so for a variety of reasons. Drugs reportedly used most frequently include Alcohol (24.1%), heroin (34.4%) and cocaine or crack cocaine (30.9%). Reasons for usage of said drugs included easier conversation (37.9%), to increase desire to have sex (27.5%), and to improve sexual performance (27.6%).
Importance to public health: These findings indicate that drug and sex-linked activity are strongly connected. This demonstrates a need for continued investigation and intervention to reduce substance abuse and reduce risky behavior that can lead to high HIV and STI rates.
Ngo, Kelly (UMD)
Ajayi, Lola (UMD)
Lau, Gilbert (UMD)
Background: Respiratory illness is a common occurrence in campuses where large student body populations are at risk of developing certain types, especially in close quarters such as dormitorities. This projected was conducted in order to study the transmission rates of these pathogens.
Goal: The overall goal of the project is to make communities healthier by finding out what contributes to someone getting sick, identifying possible modes of transmission, and preparing preventive interventions.
Objectives: Specifically, the study looks at the spread of respiratory illness in specific dorms on the campus of the University of Maryland, College Park.
Approach: A cohort group of students living in specific dorms is assembled and asked to give samples when they are healthy, sick, and if they are listed as a contact of a sick person, samples as well then. The samples will then be collected based on the type of visit in which they are classified into. PCR techniques are used to analyze the samples and identify the identity of the virus.
Results: Among the data analyzed, influenza and coronavirus are the most prevalence in the dormitories on campus.
Importance to public health: The C.A.T.C.H. (Characterizing and Tracking College Health) Study is a respiratory illness study that seeks to understand what makes an infected person contagious.
Novak, Priscilla (UMD SPH Health Services Administration)
Chen, Jie (UMD SPH Health Services Administration)
Background: Care coordination has been identified as a critical component in improving quality of care and patient experience within the health care system. Such care coordination has been conceptualized around domains such as the use of in-patient case managers, medication reconciliation at transitions of care, predictive analytics to identify high-volume, high-cost patients, home visits, and the use of innovative care delivery models such as Accountable Care Organizations and Patient Centered Medical Homes.
Goal: The goal of this poster is to assess general hospitals' linkages to behavioral health services and use of care coordination practices.
Objectives: Using data from the American Hospital Association Survey of Care Systems and Payment for 2015, we examine the Care Coordination Index of hospitals that provided linkages to behavioral health care, whether directly through ownership, through contracts, or who responded that they did not link to behavioral health care.
Approach: A summary Care Coordination Index (CCI) score of for care coordination provision was calculated based upon the 12 categories established by the American Hospital Association. The maximum possible score was 60, meaning an extremely high level of care coordination was provided by the hospital and the minimum was 1, meaning only one type of care coordination was provided and that this occurred only infrequently. There was a total of 1,355 general hospitals in the sample that reported on their care coordination activities. The mean CCI score for general hospitals was 35.95 (range 1-60, standard deviation, 9.91). Hospitals were divided into 2 groups, those with 100 or more beds, or those with 99 or fewer beds. Among hospitals with 100 or more beds, the mean CCI was 38.31. Among hospitals with 99 or fewer beds, the CCI was 32.32.
Results: A total of 729 hospitals owned or provided behavioral health care through their system. Another 270 provided behavioral healthcare through their networks or through a formal contractual arrangement/joint venture. A total of 341 general hospitals did not link to behavioral health care. We tested the relationship between hospital bedsize and owning or contracting for behavioral health care, finding that larger bedsize hospitals were more likely to own behavioral health practices; smaller bedsize hospitals were more likely to not link to, contract for, or own outpatient behavioral health services (p for trend <0.001). Most general hospitals have some business arrangement to provide behavioral health services. Smaller bedsize hospitals offered fewer care coordination activities and were less likely to link to behavioral care.
Importance to public health: Hospital bed size appears to have an important relationship with care coordination provision and linkages to behavioral health. More research is needed to determine how smaller hospitals can effectively link to behavioral health care and coordinate patient care.
Pantaleao, Ashley (UMD SPH Family Science)
Young, Jennifer (UMD SPH Family Science)
Background: Li-Fraumeni Syndrome (LFS) is a hereditary cancer predisposition syndrome mostly caused by germline TP53 mutations. Individuals with LFS have a 90% lifetime risk of developing cancer and a 50% chance of a second, independent primary cancer. Onset of cancer risk is in childhood, creating unique psychosocial challenges for parents and their affected children compared with adult-onset inherited cancer syndromes.
Goal: This work sought to explore how families create and communicate meaning about living with and managing LFS-related cancer risk.
Objectives: How do family members seek methods to cope with cancer and their mutation status based on the meaning and threat they associate with it?
Approach: Semi-structured interviews were conducted with 26 families enrolled in the National Cancer Institute’s LFS Study. Families consisted of parents and their children with at least one family member being a TP53 mutation carrier. Using grounded theory methods, three independent investigators completed independent coding of the transcribed interview data.
Results: The sample consisted primarily of mothers interviewed with one child. Family members discussed shared experiences, and characteristics of self and family that were shaped by their history and risk of LFS-associated cancer. Parents and children discussed daily practices used to cope with LFS, and emphasized family networks as a major emotional support system. They reported that illness-related family coping styles may be prioritized over individual wishes. Parents described the importance of maintaining typical day-to-day routines while also addressing LFS screening and management.
Importance to public health: These findings provide insight into the coping processes families utilize collectively or individually to manage their varying levels of LFS-related distress. Healthcare providers attuned to family dynamics and coping strategies may be better able to meet their patients’ needs based on how LFS can impact the whole family’s psychosocial functioning.
Arria, Amelia (UMD SPH Behavioral and Community Health)
Parisi, Christina (UMD SPH Behavioral and Community Health)
Bugbee, Brittany (UMD SPH Behavioral and Community Health)
Barrall, Angelica (UMD SPH Behavioral and Community Health)
Vincent, Kathryn (UMD SPH Behavioral and Community Health)
Background: Both college student-athletes and fraternity/sorority members are at high risk for excessive alcohol use and related consequences. One related consequence of excessive alcohol use is alcohol-related injury, which can be particularly negative for college student-athletes who will be unable to partake in their sport if injured.
Goal: The present analysis aimed to describe alcohol use patterns and risk for alcohol-related injury among a large sample of student-athletes, and to examine whether risk for injury differed between student-athletes who are and are not members of fraternities/sororities.
Objectives: -Describe the alcohol use patterns and prevalence of alcohol-related injury among a sample of college student-athletes. -Examine the difference between the alcohol use patterns and alcohol-related injury risk among college student-athletes who are and are not members of Greek life.
Approach: Data were collected online as part of a multi-year cross-sectional study of full-time undergraduates ages 18 to 25 at fourteen institutions of higher education. Depending on the number of students at each IHE, either a random sample or a census of all eligible students were recruited via email (response rates 17.5%-23.0% annually). The present analyses were limited to student-athletes who participated in at least one of the four annual waves of data collection (n=1,221). Seventeen percent were also members of Greek life.
Results: About 90.2% of student-athletes drank during the past year, 58.5% of student-athletes engaged in binge drinking during the past month, and 22.6% of student-athletes engaged in high-intensity drinking during the past month. Greek-affiliated student-athletes were significantly more likely than non-Greek student-athletes to have engaged in binge drinking (72.6% vs. 56.6%, p<.001) and high intensity drinking (37.3% vs. 20.1%, p<.001) during the past month. Twenty percent of student-athletes experienced an alcohol-related injury during the past year. Injuries were most common among frequent binge drinkers. The prevalence of alcohol-related injury was not significantly different among Greek-affiliated athletes and non-Greek athletes (20.5% and 21.9%, respectively, p=.767).
Importance to public health: Our data support that student-athletes and Greek-affiliated student-athletes have high rates of excessive drinking and alcohol-related injury. These findings can inform and support future prevention and intervention efforts in this at-risk demographic.
Patterson, Rebecca (UMD SPH Maryland Institute for Applied Environmental Health)
Solaiman, Sultana (UMD AGNR Plant Science and Landscape Architecture)
Payne-Sturges, Devon (UMD SPH Maryland Institute for Applied Environmental Health)
Micallef, Shirley (UMD AGNR Plant Science and Landscape Architecture)
Background: The increasing demand for agricultural water requires identification and safety assessment of alternative water sources, as pathogenic bacteria in the water could cause health risks if transferred to growing produce. Some species of Enterococcus, an opportunistic pathogen and water quality indicator, exhibit antimicrobial resistance and can transfer resistance traits to other bacterial taxa, including human pathogens. Thus, it is important to consider antimicrobial resistance when assessing the safety of irrigation water for food crops.
Goal: The goal of this project is to evaluate the distribution and antimicrobial resistance of Enterococcus faecalis and E. faecium in surface and recycled wastewaters in the Mid-Atlantic region of the U.S.
Objectives: 1) Identify E. faecalis and E. faecium in enterococci isolate collection, recovered from surface and recycled wastewater samples from a variety of sites in the Mid-Atlantic. 2) Evaluate susceptibilities of E. faecalis and E. faecium isolates to a suite of antimicrobials. 3) Assess whether antimicrobial resistance in E. faecalis and E. faecium is associated with season, water type, temperature, pH and salinity.
Approach: Enterococcus species isolated from surface and recycled water samples collected between October 2016 and September 2017 have been archived in -80°C storage. To identify E. faecalis and E. faecium in the collection, PCR amplification targeting the species-specific ddl (D-Ala:D-Ala ligase) gene of two Enterococcus species, E. faecalis and E. faecium is being conducted on these isolates. Once the E. faecalis and E. faecium isolates are identified, antimicrobial susceptibility testing will be conducted to evaluate their susceptibility to a suite of antimicrobials, including ampicillin, ceftriaxone, ciprofloxacin, clindamycin, daptomycin, erythromycin, gatifloxacin, gentamicin, levofloxacin, linezolid, oxacillin + 2% NaCl, penicillin, quinupristin/dalfopristin, rifampicin, streptomycin, tetracycline, trimethoprim/sulfamethoxazole, and vancomycin, using the microbroth dilution method.
Results: A total of 447 enterococci isolates from four water sources (reclaimed wastewater, non-tidal river, tidal river, pond) will be identified by species (E. faecalis, E. faecium, or other). Logistic regression will be used to evaluate correlation of antimicrobial resistance with season, water type, temperature, pH, and salinity.
Importance to public health: Understanding antimicrobial resistance in irrigation water and reducing risk to public health is critical in light of the shrinking treatment options for infectious diseases caused by antimicrobial resistant pathogens.
Lindsey, Katie (UMD SPH Public Health Science)
Pekosz, Maddy (UMD SPH Family Science)
Maring, Elisabeth (UMD SPH Family Science)
Borzekowski, Dina (UMD SPH Behavioral and Community Health)
Background: Public Health Without Borders is a student-led organization at the University of Maryland that provides health education to communities both locally and abroad. PHWB Sierra Leone works closely with the Abigail D. Butscher Primary School and the surrounding Calaba Town community. Previously, the PHWB Sierra Leone Project conducted health workshops that focused on handwashing, first aid, and malaria education, and based on feedback from the community in 2016, the 2017 travel team provided additional health education on typhoid and cholera prevention as well as oral rehydration therapy.
Goal: The main objective of Public Health Without Borders Sierra Leone is to educate communities on the values of health practices such as hand washing, first aid, and communicable disease-prevention.
Objectives: 1. Teach health workshops to students and community members regarding disease prevention 2. Conduct needs assessments for future trips and interventions 3. Conduct health behavior interviews to better understand the community's needs 4. Conduct a school evaluation to understand the impact of education on students
Approach: Health workshops were developed over the semesters prior to traveling to Sierra Leone. Undergraduate and graduate students, as well as faculty members, collaborated on the workshops before they were finalized. Needs assessments and health behavior interviews were developed to address the community. A travel team of undergraduates, graduate students, and a faculty member travelled to Calaba Town, Sierra Leone, and implemented these workshops and conducted interviews with primary school students and community members.
Results: Preliminary reviews of the needs assessments from 2017 reveal unmet health needs persist in the community, including education on chronic disease prevention, nutrition, and methods to improve sanitation and access to clean drinking water.
Importance to public health: Children's health and education shapes the future. Increasing access to quality education, as well as increasing education regarding disease prevention, improves outcomes for children. Addressing disparities in education is an essential part of public health.
Porter, Shy (UMD SPH Family Science)
Pantaleao, Ashley (UMD SPH Family Science)
Background: Upwardly mobile African American women seek spouses of similar backgrounds in terms of race and education. The significant sex-ratio imbalance between African American men and women is exacerbated as education and income increase. Consequently, as African American women accrue accomplishments in their educational pursuits and careers, they are faced with drastically fewer comparably educated and gainfully employed African American male relationship prospects.
Goal: This study aimed to determine how many factors are present in an original measured (the Porter Likelihood of Marriage Scale; PLOM) designed to elucidate the attitudinal and affective experiences of African American women as they search for desirable African American male partners.
Objectives: Determine if there are two primary factors in the scale: one that reflects negative attitudes and another that reflects negative emotions about the likelihood of marriage.
Approach: Principal axis factoring (PAF) was the primary analytical technique. The analytical sample consisted of 386 heterosexual, unmarried, college-educated women who identified as African American and completed the survey in its entirety.
Results: Two factors labeled "negative attitudes" (factor 1) and "negative emotions" (factor 2) were extracted. All of the moderate-to-strong factor loadings for factor 1 were positive, indicating that women have negative attitudes about the likelihood of marriage. In contrast, all of the moderate-to-strong factor loadings for factor 2 were negative, indicating that women have positive emotions about the likelihood of marriage. Since two factors emerged in exploratory data analysis, it is feasible to administer the PLOM Scale as one comprehensive measure or to use one or both subscales (i.e., negative attitudes and emotions).
Importance to public health: The development of this measure has important implications for African American women's overall health and well-being. The presence of negative attitudes and positive emotions might be indicative of high levels of cognitive dissonance for African American women. In conjunction, they may be risk factors for poor mental health and might portend the advent of various psychological disorders (e.g., depression, anxiety). This scale is the first of its kind and is one step forward in the effort to elucidate the psychological and emotional needs of upwardly mobile African American women who seek comparable African American mates.
Porter, Shy (UMD SPH Family Science)
Mittal, Mona (UMD SPH Family Science)
Background: Female survivors of intimate partner violence (IPV) are more likely to engage in sexual risk behaviors that place them at increased risk of adverse sexual health outcomes, including acquisition of HIV. Although consistent condom use is an effective method that protects against HIV, it is a behavior strategy that is often, in large part, reliant upon women's condom use self-efficacy and their ability to negotiate consistent condom use with their sexual partners.
Goal: This study explores predictors of condom use self-efficacy in a sample of racially/ethnically diverse women (MAge = 36) who were recruited from diverse community-based agencies.
Objectives: We hypothesized that all of the independent variables-- age, race education, experiences of abuse, partner dependence, HIV knowledge, and frequency of alcohol consumption--would be statistically significantly associated with condom use self-efficacy in a sample of abused women (n=177).
Approach: Participants (n=177) were recruited from community-based agencies in the northeastern region of the U.S. One-way ANOVA and bivariate correlations were used to determine which demographic, relationship-level, and individual-level predictors were significantly associated with condom use self-efficacy. All hypothesized predictors were entered into a linear regression model.
Results: In the final model, African American race (B = .92, p < .05, 95% CI [0.20, 1.65]), high levels of abuse (B = -.87, p<.05, 95% CI [-1.67, -.07]), partner dependence (B = -.55, p<.01, 95% CI [-.80, -.29]), HIV knowledge (B = 1.7, p<.05, 95% CI [.05, 3.30]), and frequency of alcohol consumption (B = -.24, p<.05, 95% CI [-.46, -.02]) were statistically significantly associated with condom use self-efficacy. The full model explained 25% of the variance in condom use self-efficacy among abused women, F(3,161) = 10.46, p<.001.
Importance to public health: Results indicate that both individual- and relationship-level factors may contribute to HIV risk among abused women. These findings point to a number of important implications for integrated HIV-IPV interventions that aim to reduce HIV-related risk factors for abused women.
Background: The U.S. National Cancer Institute (NCI) has been conducting the Health Information National Trends Survey (HINTS) since 2003. This data collection program was created to monitor changes in the rapidly evolving field of health communication, to understand the use of different communication channels and to create more effective communication strategies. The dataset used for this project consisted of about 425 variables or fields, each of which represent a question on the survey, and 3285 observations. We focus on a subgroup of the whole population, the low income and less educated. In practice, this group of people are vulnerable to cancer and thus their survey results worth being shed more light on. We investigated their likelihood of getting cancer, beliefs towards cancer and cancer information search behaviors.
Goal: Increasing Cancer Awareness in Low Income Population
Objectives: Our findings include: 1) People suffering with depression are more likely to get cancer 2) Marital status was found to have a higher correlation with cancer 3) People that have used e-cigarettes have higher chances of getting cancer 4) We also found a moderate level effect of diabetes on cancer 5) Age had a very high correlation with the chances of getting cancer 6) these people are inclined to connect cancer to fatality and be pessimistic in lowering the chances for getting cancer; 7) they avoid to accept any possibility of getting cancer and even choose to ignore their chances of getting cancer; 8) they don’t actively engage in cancer information searching but are unconfident for finding the information if they need.
Approach: It is obvious that the gap between high probability of getting cancer and low awareness of cancer within group is overwhelming. So we suggest design an effective tool to facilitate positive perspectives and cancer literacy in this population, based on their beliefs and search behaviors. The use of Internet and mobile devices are fascinating since this is one popular source outputting easy-to-understand health information. However, given the barrier that people in this group don’t have access to smartphones or Internet, we design a cancer information kiosk set up in the underprivileged neighborhoods.
Results: Based on our findings, we put forward the kiosk idea designed for the low income and less educated user group. Since they don’t have access to mobile phones or laptops in their daily life, the public kiosk around their living area could bridge the gap and arouse their awareness on the cancer issues. The main features of the kiosk are cancer trivia game, doctor tips, credit system and new cancer information. When users start to use the kiosk, they could participant in cancer trivia game, which are some key findings from the HINTS dataset. For instance, how likely you get cancer if you use the cigarette. If the participant choose the right answer, they could get some points. If not, the kiosk will present the right answer with explanations. After answering the questions, the system automatically sum up all the points and users could use the points to exchange some prize. Also, users are able to walk through some key cancer findings or prevention tips for cancer on the kiosk with the guidance of a virtual clinician. In the end, the kiosk will encourage users to download the app or leave phone number, which could build long-term connection with the target users.
Importance to public health:
Background: About 440,000 patients are expected to die this year according to the National Patient Safety Foundation. The number of deaths has been increasing for the last 20 years. The causes and solutions are covered from the presenter's book "Safer Hospital Care" based on his research as medical writer.
Goal: Hospitals lack the knowledge of proactive risk prevention and they need this knowledge immediately.
Objectives: The objectives for preventing deaths are: . Understand that failure in healthcare is not an option. . Learn proactive tools to prevent 440,000 deaths . It has significant public health benefits. Deaths from mistakes is the third largest cause of population deaths . Learn to prevent mistakes and collect return on investment at least 100,000% . Learn from paradigm pioneers such as Johns Hopkins, Allegheny General and Geissinger Health
Approach: This presentation on the proposal to a new project.
Results: The results are unknown since this is a project proposal.
Importance to public health: It has significant public health benefits. Deaths from mistakes is the third largest cause of population deaths. Hospitals need to use proactive risk prevention tools.
Wilson, Sacoby (UMD SPH Applied Environmental Health)
Ravichandran, Vivek (UMD SPH)
Merlo, Leyla (UMD SPH)
Background: Emissions from industrial traffic and commuter traffic can impact air quality. Individuals who live near or go to school near heavily trafficked roadways can be exposed to traffic-related air pollution (TRAP) including particulate matter which can lead to negative health effects such as asthma, stroke, and heart disease. Langley Park, a predominately low-income Hispanic community within the Capital Beltway, has a network of heavily trafficked roadways. This could lead to disparities in exposure to air pollution for individuals who live in the area.
Goal: Given that PM2.5 is often perceived as the best indicator of combustion-related health impacts, we aim to address gaps in knowledge about pollution levels in neighborhoods near heavily trafficked areas in Langley Park.
Objectives: We had several research objectives including: 1) Explore the use of real-time sensors to measure particulate matter and noise levels in a community with heavily trafficked roadways; 2) Assess traffic related disparities through the use of US EPA’s EJSCREEN; and 3) Examine differences in particulate matter and noise levels during rush hour and non-rush hour time periods.
Approach: We used the Airbeam and the Aircasting system to perform real-time measurements of PM2.5 (µg/m3), temperature (℉), humidity (%), and sound levels (db) during July 2017. These values were recorded at 5-min intervals for a total of 30 minutes during the morning rush, afternoon off-peak, and evening rush time periods, respectively. Traffic counts were conducted in a similar manner to identify areas with a dense number of vehicles as a proxy for high exposure. We also used the USEPA’s EJSCREEN tool to map traffic-related hazards in the community and assess any traffic-related disparities compared to the rest of the state, region, and the US.
Results: The data revealed mean values ranging from 0.125 to 46 µg/m3 of particulate matter. Some mean values were above the daily standard of 35 µg/m3. Levels were the highest at commercial areas including the Takoma/Langley Crossroads Transit Center and University Blvd.
Importance to public health: This research provides a foundation to further explore the link between exposure to TRAP and health disparities in Langley Park, Maryland.
Regmi, Rachana (MPH)
Importance to public health:
Remigio, Richard (UMD SPH Maryland Institute for Applied Environmental Health)
Topping, Alice (Renal Research Institute)
Rainmann, Jochen (Renal Research Institute)
Kotanko, Peter (Icahn School of Medicine)
Maddux, Frank (Renal Research Institute)
Sapkota, Amir (UMD SPH Maryland Institute for Applied Environmental Health)
Kinney, Patrick (BU SPH)
Background: Many studies on extreme heat and health have shown associations with morbidity and mortality within the general population around the world. There has been less focused work on heat vulnerability among individuals living with chronic diseases, particularly for end-stage renal disease treated with hemodialysis (HD).
Goal: We aimed to evaluate the associations between heat wave events and clinical parameters in urban HD populations in three northeastern cities.
Objectives: Hypothesis 1: Extreme heat events will be associated with physiological changes using clinical measures such as weight gain and blood pressure among HD patients. Hypothesis 2: Extreme heat events will be associated with increased mortality and hospitalization risks among hemodialysis patients.
Approach: We obtained data on physical and clinical measures collected during HD visits (EHR) between 2001 to 2012 in three cities: Boston, MA; New York City, NY, and Philadelphia, PA. We extracted meteorological data through the Local Climatological Database (LCD) from National Oceanic and Atmospheric Agency (NOAA) and generated extreme heat event exposure metrics based on single day upper percentile (95th, 97.5th, 99th) exceedances of air temperature and heat index for each location. We analyzed heat effects on inter-dialytic weight gain (IDWG), predialysis systolic and diastolic blood pressure (pre-SBP, pre-DBP), and mortality and hospitalization. Repeated measures regression models controlled for temporal-based confounders: seasonality, long-term trends, and day of the week.
Results: IDWG, pre-SBP, and pre-DBP exhibited highly significant (p<0.005) mean decreases in association with same-day and one-day lag heat events in all three cities. We observed increased mortality among patients residing in Boston during specific extreme heat events suggesting location-specific variation in responses. Hospitalization risks were not evident during extreme heat events. Clinical measures responded to outdoor temperature suggesting more proximate physiological stress.
Importance to public health: These results suggest that patients with ESRD may be especially vulnerable to extreme heat, exposures to which are likely to increase with climate change. Preliminary work has implications for developing location-specific heat adaptation strategy plans for ESRD patients.
Remigio, Richard (UMD SPH Maryland Institute for Applied Environmental Health)
Rainmann, Jochen (Renal Research Institute)
Maddux, Frank (Renal Research Institute)
Sapkota, Amir (UMD SPH Maryland Institute for Applied Environmental Health)
He, Xin (UMD SPH Epidemiology and Biostatistics)
Kotanko, Peter (Icahn School of Medicine)
Background: Access to health care services and treatment due to weather disturbances are among several challenges that medically fragile populations face. As such, end-stage renal disease (ESRD) patients who receive outpatient dialysis are vulnerable to increased morbidity and mortality due to missing critical treatments. There have been few studies that have characterized the role of severe weather events on hemodialysis (HD) treatment adherence using longitudinal-based patient data across multiple regions.
Goal: The overall goal is to characterize the effects of weather conditions such as precipitation, snowfall, snow depth, and wind on HD missed appointments in selected United States (US) urban northeastern cities: Boston, MA (BOS); New York City, NY (NYC), and Philadelphia, PA (PHL) from 2010 to 2012.
Objectives: We tested a series of hypotheses using varying weather types and exposure metrics (e.g., continuous, occurred/not occurred, and inclement/no inclement) in treatment adherence among patients residing in BOS, NYC, and PHL.
Approach: Daily meteorological data on total precipitation, total snowfall, total snow depth, fastest 2-minute wind speed (WSF2), and fastest 5-second wind speed (WSF5) were extracted through the Global Historical Climatology Network (GHCN). We joined location-specific weather data to HD patient databases with respect to their clinic ZIP codes. Marginal logistic regression models were specified to determine averaged population-level effects for each location. All models were adjusted for age, sex, and pre-existing co-morbidities.
Results: Inclement snowfall days exhibited statistically significant (p<0.05) increased averaged odds for missed appointments in BOS (363%), NYC (70%), and PHL (70%). Inclement rainfall days also exhibited a significant response in PHL (81%), and inclement snow depth days demonstrated significant effects in NYC (91%) and PHL (81%). Patients residing in BOS and PHL demonstrated significant responses to sustained windy conditions (WSF2), whereas only PHL exhibited a significant response to missed appointments from storm-driven gusty winds (WSF5).
Importance to public health: Inclement weather conditions demonstrated a potential role in discouraging treatment adherence among hemodialysis patients. As such, dialysis centers and local health services could consider using weather forecasting to anticipate location-specific missed appointments and trigger appropriate preparedness to help shuttle HD patients and manage possible overflow following the weather event.
Holt, Cheryl (University of Maryland)
Santos, Sherie Lou (University of Maryland)
Liu, Hongjie (University of Maryland)
Jones, Laundette (University of Maryland)
Slade, Jimmie (Community Ministry of Prince Georges County)
Background: Institutionalization of evidence-based practices into an organization’s standard behavior is believed to improve the likelihood of sustainability. Project HEAL 2.0 (Health through Early Awareness and Learning) is an implementation trial aiming to institutionalize (integrate) evidence-based cancer health education activities into African American churches. We train lay peer community health advisors (CHAs) to conduct cancer educational workshops and encourage them to work with church leadership to develop sustainable cancer and health education activities. This is done through use of a memorandum of understanding (MOU) individualized for each church. This presentation will report on pilot phase data from HEAL 2.0 with a focus on the integration strategies that the churches selected and implemented during the pilot period.
Goal: Project HEAL 2.0 (Health through Early Awareness and Learning) is an implementation trial aiming to institutionalize (integrate) evidence-based cancer health education activities into African American churches.
Objectives: We train lay peer community health advisors (CHAs) to conduct cancer educational workshops and encourage them to work with church leadership to develop sustainable cancer and health education activities. This is done through use of a memorandum of understanding (MOU) individualized for each church.
Approach: Using the MOU, pastors and CHAs from three churches identified which from a menu of integration strategies (e.g., forming a health team; developing written church health policy; dedicate staff/space for health promotion) they perceived they would be able to complete within a 3, 6, 12-, or 24-month period. Churches were asked to identify at least two strategies. We report on the number and type of strategies the churches selected, time frames in which they planned to implement them, as well as which strategies were actually implemented within the 6-month pilot period.
Results: Pastors and CHAs found the MOU easy to use. The three churches each selected between 2 and 9 implementation strategies (M = 6). In total, half of the strategies were targeted for implementation within three months while the remainder were distributed over the next 24 months. Strategies varied (e.g., including health in Pastor sermons and social media; allocating space for health activities; designating a person to be in charge) with multiple churches intending to provide training and conduct fundraising for health promotion. We also report on strategies that the churches were actually able to implement in the initial 6-month pilot period.
Importance to public health: Project HEAL 2.0 is an illustration of institutionalizing health promotion in organizations whose primary mission is not health-related. This menu-based approach to integration may be helpful for community organizations of varying capacity for planning health activities.
Rudy, Jonathan (UMD SPH Health Services Administration)
Hager, Erin (UMB SOM Pediatrics)
Saksvig, Brit (UMD SPH Epidemiology and Biostatistics)
Background: Modes of Active Transportation (AT, including walking and biking) are often under-utilized and could further integrate physical activity into regular life. For some school-aged children, AT is used in commuting to and from school. For children who live close enough to school to consider AT, school-level barriers may exist, including absence of crossing guards, designated safe routes to school, and safe bike storage facilities, or lack of provision of safe walking and biking education.
Goal: Understand disparities in school-level AT practices among Maryland schools
Objectives: Assess disparities in school-level AT practices by student body race/ethnicity (predominantly African American or Hispanic student body), income (% eligible for free/reduced price meals (FARMS), proxy for low-income] and by the school’s geographic location (urban, suburban, rural).
Approach: Data from the Maryland Wellness Policies and Practices Project (MWPPP) for the 2016-17 school year in conjunction with school demographic data obtained from public sources was used for the analysis. Knowledgeable administrators from each of the Maryland schools completed the survey. Four questions concerning AT practices were included: (1) providing secure storage facilities for bicycles or helmets; (2) providing instruction on walking/bicycling safety; (3) designating safe or preferred routes to school; and (4) using crossing guards. An analysis was completed using bivariate chi-square tests and multi-level regression modeling.
Results: Among the XXXX schools that received the survey, 950 responded to the survey (response rate=XX%) and 908 completed the AT survey and had school demographic data. Schools were 67.0% elementary, 19.1% middle, and 14.0 high. Rural schools were less likely to endorse each of the AT practices (compared to suburban and urban schools; ps<0.05). Schools with a predominantly African American/Hispanic student body were less likely to have storage facilities (2=26.9, p<0.001). Low income schools were less likely to have storage facilities and more likely to have crossing guards (2=12.9, p<0.005 and 2=19.5, p<0.001, respectively).
Importance to public health: By understanding the barriers to AT that schools face in Maryland, schools can more effectively implement programs to increase childhood physical activity and reduce childhood obesity.
Saboori, Zahra (UMD SPH Behavioral and Community Health)
Boekeloo, Bradley (UMD SPH Behavioral and Community Health)
Quinton, Sylvia (UMD Eastern Shore)
Background: Although more prevalent among White college students, binge drinking among African American/Black college students is linked to greater academic, mental health, and social problems. Despite previous literature indicating a strong relationship between peer bingeing, and a weaker relationship between stress-related alcohol use, with predominantly White college campus student bingeing; these relationships have not been well examined among Historically Black College (HBC) students.
Goal: This cross-sectional study sought to determine whether having more binge drinkers within one's social network and using alcohol to reduce tension were associated with personal binge drinking among a sample of first-year HBC students.
Objectives: 1) Among first-year HBC students, having binge drinkers in one's social network and using alcohol to reduce tension are both associated with personal binge drinking.
Approach: A self-report questionnaire was administered to a convenience sample (n=213) of students in first-year dormitories at a rural mid-Atlantic HBC. Study variables included: the number of binge drinkers in one's social network, 30-day binge drinking, 30-day alcohol use to reduce tension, and other demographics.
Results: The sample consisted of mostly African Americans (93.4%) with a mean age of 19.43+ 2.47. Around a third of participants reported using alcohol to reduce tension (31%), personal binge drinking (29.4%) and having no binge drinkers within their social networks (36.5%). Adjusted regression analyses indicated that using alcohol to reduce tension (OR= 2.82, 95% CI= 1.24, 6.39) and having many binge drinkers in one's social network (OR= 9.36 95% CI= 2.808, 31.203) were both significantly associated with increased odds of binge drinking.
Importance to public health: Our results suggest that while peer network and stress-related alcohol use are both associated with binge drinking, peer network may have a stronger association in HBC students. These findings elaborate the need for culturally appropriate alcohol risk reduction strategies targeted towards both peer and personal correlates of binge drinking among HBC students.
Sandhu, Avinaash Kaur (UMD CMNS Cell Biology and Molecular Genetics)
Background: Although many studies have documented the pollution in the Yamuna, few have studied the extent of the pollution in groundwater sources. The potential presence of groundwater pollution poses an imminent public health risk because many socio-economically lower families depend on it as a source of potable water, and often consume it without considering the potentially serious health hazards.
Goal: This research project aimed to clarify the degree of groundwater pollution present in two areas of North Delhi (India): Daulat Ram College and Majnu Ka Tila, by using zebrafish embryos as biosensors.
Objectives: The goal of this study was to observe any developmental defects present in the zebrafish embryos after exposure to sample water. According to previous research performed on pollution in the Yamuna, and the various developmental defects associated with it, the hypothesis was as stated: "Owing to the widespread pollution in the Yamuna, and the fact that these groundwater sources contain water originating from the river, there is a strong possibility of percolated pollution present in groundwater. This pollution would have detectable impacts on organisms exposed to it that may be observed with microscopes and/or other technology."
Approach: Zebrafish embryos were exposed to the sample water for a period of 12 days post fertilization (dpf) (with embryos exposed to System Water functioning as a control group) and were examined for deformities found previously in research studies studying populations living near the Yamuna. A 6 well plate was used with 3 samples -- System water (control), Majnu Ka Tila water, Daulat Ram College water, and a replicate for each sample. Embryos were examined on a daily basis and were photographed for documentation and comparison. Embryos were fed with paramecium after 6 dpf to account for the depletion of the yolk. To document any and all deformities, embryos were photographed under an EVOS microscope from 5 dpf to 12 dpf. These were then compared to photographs of control embryos for analysis.
Results: Although this was a purely phenotypic analysis, significant evidence of deformities was found in the zebrafish exposed to the sample water; the results indicated a significant degree of groundwater pollution in these two sources, implying that other groundwater may also be seriously polluted as well. This research will be followed up on this summer, where chemical analysis of the water will be conducted, and further plans will be developed to build on the conclusion from the initial study.
Importance to public health: Due to advertising and "purity" associated with groundwater, populations in poverty-ridden areas consume this water without any safety precautions. As previous research has not been able to correlate the possibility of developmental defects to groundwater pollution, the water authorities have not made any changes to their current routine and/or publicized the issues connected to groundwater. This research aims to provide the evidence needed to enact that policy change.
Satinsky, Emily (UMD Psychology)
Myers, Bronwyn (University of Cape Town)
Andersen, Lena (University of Cape Town)
Joska, John (University of Cape Town)
Regenauer, Kristen (MGH)
O'Cleirigh, Conall (MGH)
Safren, Steven (University of Miami)
Magidson, Jessica (UMD Psychology)
Background: South Africa is home to the world's largest HIV/AIDS epidemic and has one of the highest global rates of alcohol consumption. Alcohol use can negatively influence ARV adherence and increase the likelihood of HIV transmission. Previous research has shown that patients living with HIV commonly believe mixing alcohol and ARV therapy is toxic and forego medication on days they drink alcohol.
Goal: The goal of this study was to compare and contrast patients' and providers' beliefs around mixing ARV medication with alcohol.
Objectives: The objective was to apply patients' and providers' responses during interviews to inform the adaptation of a cognitive behavioral therapy (CBT) intervention in this setting.
Approach: This study was part of a hybrid-effectiveness implementation trial aimed at adapting a peer-delivered intervention for substance use and ARV adherence in Cape Town. Patient participants were HIV positive and reported moderate to severe substance use (WHO-ASSIST≥4). Provider participants were eligible if they were involved in HIV or substance use care. Semi-structured interviews included questions on barriers to ARV adherence and perceptions around mixing ARV medication and alcohol. Interviews were transcribed from isiXhosa to English and analyzed with thematic analysis using NVivo v.11.
Results: 54% of patients and 82% of providers were female, and all patients (n=19) and 76% of providers were Black African. Patient WHO-ASSIST scores were in the moderate range for alcohol (M=15.8; SD=8.0). Providers (n=11) included nurses, physicians, community health workers (CHWs), and addiction and adherence counselors. Providers and patients reflected conflicting messages around mixing ARV medication and alcohol. Specialized HIV providers informed patients that they should continue medication when using alcohol, while lower level providers gave inaccurate information. While patients reflected providers’ message to continue ARV treatment when drinking, some patients misinterpreted this message under the belief that providers were dismissing alcohol’s harmful effects.
Importance to public health: This research is important to public health as it points to several areas of intervention. These interventions may consider supporting providers in taking harm reduction approaches, providing psychoeducation for patients that includes accurate messaging around mixing alcohol and ARV medication, and introducing cognitive-behavioral strategies to help patients minimize the impact of unhealthy alcohol use on HIV treatment and disease progression.
Shah, Veeraj (UMD SPH Family Science)
Ghodasra, Mitsu (UMD SPH Family Science)
Obasiolu, Camilla (UMD SPH Family Science)
Lewis, Jonathan (UMD SPH Family Science)
Mulloor, Anjali (UMD SPH Family Science)
Vahanan, Manasvinee (UMD SPH Family Science)
Rahman, Tanjila (UMD SPH Family Science)
Sathiya, Vandu (UMD SPH Family Science)
Maring, Elizabeth (UMD SPH Family Science)
Ahmed, Naheed (UMD SPH Family Science)
Background: Varanasi, India is a city of 1.2 million people built on the bank of the Ganges river and is the holiest city in Hinduism. According to a 2014 study conducted by Rai, 78% of the population in Varanasi are cognizant of the health care services provided yet only 25% are content with the options present for primary care.
Goal: The goal of this study was to investigate health needs among community members in Varanasi through a needs assessment in a school and university setting.
Objectives: The objectives of this study were to conduct a focus group, interviews, and observations in order to build rapport and better understand the health needs in Varanasi, India.
Approach: A team of six individuals from Public Health without Borders (PHWB) at the University of Maryland traveled to Varanasi, India in January 2018. Participants consisted of students and staff at a private school with rural and urban campuses, and staff at a public university. The school provides primary and secondary education. The first student cohort (7 students) was from the rural campus and the second (10 students) was from the urban campus. Students participated in focus group discussions and notes were taken of their responses. Interviews with school and university staff were audio recorded, transcribed, and analyzed for common themes.
Results: After analysis of the interview data, several observations were noted. One prominent health barrier was stigma regarding mental health, and variation in how children and adults define mental health. Many students cited standardized exams and homework assignments as a significant source of stress. With regard to environmental issues impacting families, participants obtain water from neighborhood pumps or household filters and taps. However, very few boiled the water before consumption. Many of the children interviewed cited that they would like to learn more about nutrition and physical exercise.
Importance to public health: This initial PHWB travel team conducted a rapid community needs assessment, which involved formal and informal meetings with city residents on pressing health concerns. The needs assessment provided a broad overview of general health needs within Varanasi based on a small set of interviews, which will inform future interventions in Varanasi.
Shaw, Emma (Department of Kinesiology)
Rietschel, Jeremy (Veteran's Health Administration)
Shuggi, Isabelle (Department of Kinesiology)
Xing, Yishi (Department of Electrical and Computer Engineering)
Hendershot, Brad (Department of Rehabilitation)
Pruziner, Alison (Department of Rehabilitation)
Chen, Shuo (Department of Epidemiology and Public Health)
Miller, Matthew (School of Kinesiology)
Hatfield, Bradley (Department of Kinesiology)
Gentili, Rodolphe (Department of Kinesiology)
Background: Prior work has examined cognitive workload by assessing the magnitude of cerebral cortical networking during upper-extremity performance, yet no such examination has been conducted during locomotion.
Goal: The goal of this study was to examine whether changes in the magnitude of cerebral cortical networking could serve as an index of cognitive workload during dual-task walking.
Objectives: We hypothesized that an increase in cognitive-motor demand would result in an elevated cognitive workload, as reflected by an increased magnitude of cortical networking to the motor planning region.
Approach: EEG was collected from fourteen uninjured participants as they performed a task of low and high cognitive demand, both while seated and walking on a treadmill in a Computer Assisted Rehabilitation Environment. Cortical networking was assessed via the weighted phase lag index with a scalp montage centered over the motor planning region (electrode Fz), due to its common use in cognitive-motor studies. Although walking involves cognitive-motor processes, it is often considered automatic and may require limited motor planning compared to upper-extremity performance. Therefore, advanced algorithms able to better capture more detailed patterns of cortical connectivity over the entire scalp was also employed.
Results: While the more exhaustive method revealed additional networks not captured using the traditional montage, both revealed a modulation of cortical networking in the theta and alpha bands for the performance condition (seat vs. walk) and cognitive task difficulty (low vs. high demand), respectively. Overall, the connectivity modulation suggests i) larger engagement of neural network functions (e.g., working memory, attentional control, sensory integration) during elevated cognitive-motor demands and ii) that this approach can index the level of cognitive workload during dual-task walking.
Importance to public health: The present study provides support for the utility of EEG connectivity analyses as an objective real-time assessment of cognitive workload during dual-task walking within an ecologically valid environment. This work can inform cognitive workload assessment in patient populations with gait deficiencies for future applications. This work was funded by the CRSR (awards HU0001-11-1-0004 and HU0001-15-2-0003) and the DoD-VA EACE. Views expressed are those of the authors and do not reflect the official policy or position of the U.S. Government.
Shenassa, Edmond (University of Maryland)
Paradis, Angela (Brown University)
Rogrers, Michelle (Brown University)
Buka, Stephen (Brown University)
Background: Prior studies investigating the association between maternal smoking during pregnancy (MSP) and risk of major depressive disorders (MDD) among adult offspring have produced conflicting results. These studies have differed in their control for potential familial confounding factors and have not accounted for the possibility of confounding by offspring’s history of regular smoking.
Goal: We report findings from a longitudinal study of MSP, MDD, and regular smoking utilizing a family design.
Objectives: Our primary aim was to conduct the first study utilizing a family design to examine the association between MSP and offspring’s lifetime risk of major depressive disorder (MDD) using a biologically-validated, prospectively collected measure of MSP. Our secondary aim was to examine the role of the offspring’s smoking history in the association between MSP and MDD.
Approach: Study participants were adult offspring of members of the Providence and Boston cohorts of the Collaborative Perinatal Project (1959–1966). Approximately 10% of these adult offspring were enrolled in the New England Family Study (n = 1,783), a follow-up study that oversampled families with multiple siblings. Logistic regression models were fit using models that allowed between-mother effects (ORB) of MSP to differ from within-mother effects (ORw).
Results: In models including gender and gravida MSP predicted risk of MDD among the offspring (ORw=2.35, CI=1.05, 5.26 and ORB=1.15, CI=0.96, 1.37). Inclusion of smoking history yielded a slightly larger within-mother effect (ORw=2.48, CI=1.11, 5.52) and had no practical effect on between-mother effect (ORB=1.13, CI=0.95, 1.35). Current regular smoking was an independent risk factor for lifetime MDD (OR=1.80, CI=1.37, 2.35).
Importance to public health: This study explores the lifecourse perspective and provides a clear overview of overlapping pathways linking maternal smoking during pregnancy with risk of depression among the offspring.
Shuggi, Isabelle (UMD)
Shaw, Emma (UMD)
Wu, Helena (UMD)
Moreno, Arianna (UMD)
Oh, Hyuk (UMD)
Shewokis, Patricia (Drexel)
Gentili, Rodolphe (UMD)
Background: While numerous studies have assessed mental workload to understand the allocation of attentional resources throughout performance of a cognitive-motor task, only a limited number of studies have investigated mental workload in the context of longitudinal training. Although the examination of mental workload during motor learning is critical to understanding the underpinnings of cognitive-motor mechanisms, psychological factors such as the notion of self-efficacy are also fundamental to consider.
Goal: This work aimed to examine the changes in performance, mental workload, and self-efficacy throughout practice of a novel reaching task.
Objectives: It was hypothesized that throughout training there would be improved performance, a decrease in mental workload, and an increase in self-efficacy.
Approach: By employing limited head movements and a human-machine interface, participants learned to control a virtual robotic arm within a two dimensional workspace. Participants could move their heads in eight directions (i.e., up, down, left, right, and diagonally) to reach the targets, which appeared randomly throughout the workspace. Kinematic performance, mental workload, and self-efficacy were assessed on each of the eight training days.
Results: Overall, as individuals progressed through the training, the results revealed that: i) motor performance and self-efficacy improved while mental workload decreased and ii) the dynamics of motor performance, mental workload, and self-efficacy tended to differ throughout training. Specifically, although additional analyses are needed to further examine these dynamics throughout training, performance improved faster than the decrease in mental workload, while self-efficacy seemed to be the slowest to exhibit improvement.
Importance to public health: This work contributes to inform cognitive-motor mechanisms as well as the design and training of assistive technologies and prostheses.
Green, Kerry (UMD SPH Behavioral and Community Health)
Holder, Sharifa (UMD SPH Behavioral and Community Health)
Background: This study will examine the interrelationship between suicidal behavior, violent behavior, and substance use over the life course, in a cohort of urban African Americans followed prospectively from childhood to midlife.
Goal: This study will examine the interrelationship between suicidal behavior, violent behavior, and substance use over the life course, in a cohort of urban African Americans followed prospectively from childhood to midlife.
Objectives: To examine if substance use will be associated with suicidal, aggression, and violent behavior.
Approach: This study uses data collected from the Woodlawn study, a longitudinal study, which followed an African American cohort in Chicago from first grade to age 42 (N=1242). It models the relationship between the constructs within a developmental period as well as across developmental periods. Four items assess suicidal behaviors include suicidal thoughts, plans, and attempts. Substance use in adolescence is based on frequency of use, and in adulthood it is based on DSM criteria for abuse and dependence. Violence is based on 8 self-reported items in adolescence and 9 items in young and mid-adulthood, assessing XX.
Results: This study utilizes structural equation modeling to examine the pathways across each data collection period (childhood, adolescence, young adulthood, middle adulthood) for substance use, suicidal behavior, and violent behavior using both latent and measured variables. We examine continuity over time, for example, how suicidal thoughts in adolescence relate to suicidal thoughts in young adulthood, and cross-lag relationships, for example how substance use in adolescence predicts violent behavior in young adulthood. We correlate variables within a developmental period. For example, we correlated adolescent violent behavior with adolescent substance use frequency.
Importance to public health: The identification of the interrelationship between substance use, violence, and suicide from across the life course can be used to begin to identify those at higher risk for these adverse outcomes and developmental times and targets for prevention and intervention programs.
Singh, Usha (UMD/Westat)
Osafo-Darko, Benedicta (Westat)
Samson, Viola (Westat)
Jones, Chandria (Westat)
Brenda, Leath (Westat)
Background: Social determinants such as employment, housing, food and nutrition, education, transportation, recreation, and quality health care affect health. Imbalances in social determinants manifest as disparities and inequities in health. Discussants of a Westat Center on Health Disparities & Health Equity Research roundtable event highlighted innovative solutions and their applications for addressing health disparities. This roundtable highlighted creative approaches for sharing knowledge, applying technology innovations, and implementing sociological interventions as critical elements for promoting health equity.
Goal: The goal of this research is to use data from a Health Equity Roundtable discussion to identify and describe the benefits of recent technological and sociological interventions to improve health and wellness towards the goal of achieving health equity.
Objectives: • Identify innovations and interventions used to address population health needs to achieve health equity • Describe the importance of research and data in health policy and practice to address health disparities and promote health equity • Discuss how narrative inquiry, media, and information technology can be used in community-based participatory approach to explore health disparities
Approach: A Health Equity Roundtable featuring multidisciplinary professionals who engaged in an interactive dialogue about strategies for eliminating disparities and achieving health equity was held in November 2016. Content analysis was performed on the video recording of the roundtable discussion. The video was reviewed and data from the video was organized and coded, to identify key themes and strategies for achieving health equity.
Results: The Health Equity Roundtable participants discussed various strategies and interventions used to address population health needs to improve health equity. Interventions identified included the use of wearable technology to provide early identification of diseases, the application of telemedicine for addressing service needs across settings and geographic boundaries, and the use of video as an educational tool for addressing health disparities and promoting health equity. Additionally, participants emphasized the development of legislative and policy agendas to address prevention, health insurance coverage and workforce development.
Importance to public health: Emerging technological innovations and sociological interventions provide effective means for disease prevention, increase accessibility to quality healthcare, and develop healthcare policy that will address health disparities and promote health equity.
Smith-Bynum, Mia (UMD SPH Family Science)
Hart, John (UMD SPH Family Science)
Davis, BreAnna (UMD SPH Family Science)
Allen, Samuel (UMD SPH Family Science)
Francois, Tiffany (UMD SPH Family Science)
Wilkerson, (Wesleyan University)
Griffith, Leiana-Mejoi (Spelman)
Background: Media reports about shootings of unarmed African American men and boys by the police, and the Black Lives Matter movement underscore the reality of the potentially fatal consequences of racial discrimination and unconscious racial bias for African American males in the US, and also, the ongoing need for racial socialization. Yet, only a few studies to date have delved deeply into the “gendered” experiences of racial discrimination and racial socialization. The present research assessed gendered experiences of race, racism, and racial socialization among African American young adult males through use of qualitative methods.
Goal: Using life course theory, the goal of the research is to highlight the specific ways that being black and male in the U.S. impacts individuals' daily lives and to articulate how families help young African American males navigate these realities (e.g., racial socialization).
Objectives: Since this was a qualitative study, no a priori hypotheses were proposed. We did apply a ground theory analytic approach in conducting the analyses (LaRossa, 2005).
Approach: Trained African American facilitators conducted 7 2-hour focus groups with 29 African American males (ages = 18-24) enrolled in a large public university in the Mid-Atlantic region. The focus group protocol targeted participants’ receipt of messages about race from families, campus, the communities of their youth, and their young adulthood. Focus group transcripts have been analyzed via a thematic analysis of the data with a grounded theory approach. Participants received $15 for their participation. A team of four coders reviewed all of the final coding output with the goal of triangulating the data (Jick, 1979). Over two 2.5 hour sessions, the coders reviewed and organized the content into two broad cohesive themes, under which several subthemes emerged.
Results: Several themes emerged in preliminary analyses. A major superordinate theme in the analysis is communication from families about how to navigate life as an African American male at different stages of the life course. The subthemes addressed parents’ explicit messages about: (1) importance of education for life success; (2) staying on track developmentally (e.g., meeting educational goals, avoiding unplanned pregnancy); (3) the importance of families and role of men and males in families; (4) strategies for managing impressions others form of them in speech and dress and consequences for dressing in a ways that are consistent with negative stereotypes of black males (e.g., lazy, dangerous). Other emergent themes reflected participants’ accounts of their life strategies for navigating life as young black men. Participants described a wide array of challenges in navigating settings during childhood in college that varied substantially in composition by race, ethnicity, and class. The sample’s upward mobility did not shield them from harmful racial stereotypes about young black males that permeate American society. Participants spoke on the following themes: (1) deflecting racial stereotypes about black males within and across settings that vary by racial composition through conscious behavioral choices to appear worthy of membership in those spaces; (2) the experience and emotional impact of racial isolation and racial spotlighting (e.g., being the spokesperson for “black issues” in class); (3) challenges of carving out a positive black male identity while connecting with others through multicultural friendships; and (4) scanning social environments for direct and indirect racial cues to help adjust and adapt to those environments (e.g., schools, campus life). The experience of being black and male shaped the types of racial socialization they received and also, the way participants are received by the social spaces they enter. These results indicate that young black men need a complex array of skill sets to navigate emerging adulthood in the U.S. successfully. The implications of the results for the health and development of black males will be discussed.
Importance to public health: Racial discrimination undermines the health of young African American men. Families strategies for coping with racial discrimination (e.g., racial socialization) can help ameliorate its effects.
Tai, Sheldon (Maryland Institute of Applied Environmental Health)
German, Jennifer (Maryland Institute of Applied Environmental Health)
Milton, Don (Maryland Institute of Applied Environmental Health)
Background: C.A.T.C.H. (Characterizing and Tracking College Health) investigates infectious respiratory diseases and what makes an individual contagious. C.A.T.C.H. looks at how several factors, such as contacts, the infectious agent, and the environment, impact susceptibility.
Goal: The goal of this substudy is to quantify pathogenic copies of respiratory viruses in participants.
Objectives: In particular, the research objective is to create standard curves for specific pathogens.
Approach: To successfully do so, a serial dilution is used to create different concentrations of viral pathogen samples. The dilutions are analyzed using RT-qPCR, which multiplies the number of sample copies. The RT-qPCR creates the standards curves with Ct values that are then used to quantify virus copies.
Results: It is expected that the respiratory viruses analyzed will result in standard curves to retroactively quantify viruses from participants of the C.A.T.C.H. study.
Importance to public health: By better understanding the concentrations of viruses, the standard curves developed can not only be applied for more efficient sample processing in the future, but also provide context about the relationship between factors like BMI, gender, and past vaccinations to viral shedding.
Milton, Donald (UMD SPH Maryland Institute for Applied Environmental Health)
Tai, Sheldon (UMD SPH Maryland Institute for Applied Environmental Health)
Background: C.A.T.C.H. (Characterizing and Tracking College Health) is designed to seek biomarkers of contagiousness in those who have been exposed to Acute Respiratory Infection (ARI). C.A.T.C.H. looks at several factors, which includes direct contacts, indirect contacts (fomites), and living conditions (shared air space), to find out what drives transmission of ARI.
Goal: The goal is to create a standard curve that can be made to quantify viral shedding from a participant, which will be used to assess the social and physical environmental influences, health behavior, and influence of co-infection for ARI contagion.
Objectives: The research objective of this study is to clone the PCR fragments from the viral assays of the Taqman array card, which will be used to create a standard curve that will quantify viral shedding in the C.A.T.C.H study samples.
Approach: The PCR fragment was ligated with the vector pGEM-T Easy and transformed into bacteria by heat shock. Next, the plasmid DNA was isolated from bacterial culture through minipreparation and verified by restriction digestion and sequencing.
Results: PCR amplicons from Coronavirus (COV OC43, COV NL63, COV 229E, and COV HKU1), Respiratory Syncytial Virus (RSV A and RSV B), Influenza A H3N2, and Adenovirus were successfully cloned, verified, and used for establishing the standard curve.
Importance to public health: The results, quantity of viral shedding from a participant of the C.A.T.C.H. study, will help us understand the shedding and transmission of respiratory viruses, which will help identify biomarkers of contagiousness to a certain disease. This will reduce the spread of respiratory diseases and pandemic risk.
Taiwo, Omolola (Department of Behavioral and Community Health)
Wang, Min Qi (Department of Behavioral and Community Health)
Supple, Matt (Department of Fraternity and Sorority Life)
Background: To understand the impact of attending multiple sexual assault prevention programs has on reducing rape myth acceptance
Goal: To improve sexual assault education and awareness
Objectives: Hypothesis: That attending two or more sexual assault prevention programs will reduce rape myth acceptance scores more than only attending one sexual assault prevention program.
Approach: This is a cross-sectional study assessing the rape myth acceptance scores of (n=579) sorority undergraduate women and (n=340) fraternity undergraduate men.
Results: One way ANOVA revealed that there was a significant gender difference in rape myth acceptance scores, F (1,784) = 91.202, p<.001. Females were more likely to have lower rape myth acceptance (M= 31.58, SD= 8.57) when compared to men (M= 34.30, SD = 11.12). Multiple regression analysis revealed that gender, attending a sorority or fraternity chapter's SAP program, and attending a sexual assault prevention (SAP) program open to all undergraduate students (F(3,782) = 34.902, p <.001) significantly predicted lower rape myth acceptance scores; and explained 11.5% of the variance (Adjusted R2=.115).
Importance to public health: The study revealed that gender had the biggest contribution to lowering rape myth acceptance scores, followed by attending a campus-wide SAP program, and attending a chapter specific SAP program. This study suggests that college campuses should consider offering multiple sexual assault prevention programs to Greek affiliated members.
Titus-Glover, Doris (UMB SOP Pharmaceutical Health Services Research)
Shaya, Fadia (UMB SOP Pharmaceutical Health Services Research)
Background: Medication-Assisted Treatment (MAT), is recommended for pregnant women with opioid use disorder (OUD). Without treatment, OUD impacts maternal and neonatal outcomes, yet not all pregnant women receive MAT. Multiple delivery models complicate treatment and there is little evidence of effective delivery strategies, underscoring the significance of seeking input from patients with lived experiences.
Goal: The goal of this qualitative pilot study is to explore the experience of MAT among pregnant and postpartum women with OUD to better understand the critical facilitators and barriers to effective treatment.
Objectives: To identify factors that are relevant to MAT delivery among pregnant and postpartum women with OUD.
Approach: Between September and February 2017, focus groups and telephone interviews were conducted among pregnant and postpartum women diagnosed with OUD (n=12), age 18 or older, recruited from a prenatal clinic and outpatient addictions program in Baltimore. Informed consents were obtained from University of Maryland Internal Review Board. Focus groups/interviews lasted 60-90 minutes, and discussions centered on perceptions, access to care, delivery and support.
Results: Preliminary results of this pilot study identified several facilitators and barriers that include access to care, lack of providers, adherence and support. All women reported a scarcity of MAT-waivered providers outside Baltimore City and expressed concerns about service fragmentation. Buprenorphine was instrumental in reducing cravings, drug-seeking behaviors and adherence to recommendations. Concern and care for children replaced self-seeking behaviors and women feared relapse without the medication. Women also reported stigma as a barrier to treatment.
Importance to public health: We identified patient-reported addiction-specific outcomes such as, adherence, fear of relapse and stigma, and health services outcomes that include, access, MAT continuation and support. Patient-reported outcomes from this study will inform and guide future research and practices in delivering effective care to pregnant and postpartum women on MAT.
Pinto, Nelson (UMD CMNS Biochemistry)
Gold, Louie (UMD SPH Public Health Science)
Sukhavasi, Roohali (UMD SPH Public Health Science)
Shi, Christine (UMD SPH Public Health Science)
German, Jennifer (UMD SPH)
Background: Based on previous focus assays, identifying whether or not a virus was in a cell was unclear. By conducting this project, we can identify better immunofluorescent dyes to differentiate between infected cells and uninfected cells.
Goal: The purpose of the project is to perfect the focus assay.
Objectives: By using immunofluorescent dyes and using different cell staining work on MDCK (Madin-Darby Canine Kidney) cells, we will be able to determine the best staining for future focus assays.
Approach: Students conducted focus assays using MDCK (Madin-Darby Canine Kidney) cells, which were cultivated for several weeks, to study antibody response to influenza A. MDCK cells were selected for their unique susceptibility to influenza virus and the relative inexpensive nature of these cells. Due to this increased susceptibility to influenza virus and ease of cultivation, differentiating the MDCK cells from the sample cells is more efficient.
Results: We are currently testing the dilutions of E-cadherin and cross reacting anitbodies.
Importance to public health: Further developing focus assays, will allows us to better analyze and isolate infectious virus from breath samples.
Toussaint, Ebony (UMD SPH Health Services Administration)
Simon Rusinowitz, Lori (UMD SPH Health Services Administration)
Background: Every second in the United States an older adult falls, making falls the number one cause of injuries and deaths from injury among older Americans. In 2014, older Americans experienced 29 million falls causing seven million injuries and costing an estimated $31 billion in annual Medicare costs. With more than 10,000 older Americans turning 65 each day, the number of fall-related injuries and deaths is expected to surge, resulting in cost increases.
Goal: The primary goal of our study is to facilitate better health policy and public health practice targeted at reducing falls and ultimately lowering the associated costs.
Objectives: (1) Identify strong predictors of falls among older Americans (2) Identify changes in daily activities among older Americans due to falls.
Approach: In this study, we created a subsample population of older Americans ages 65 years and older using data from the National Health Interview Survey (NHIS). We created a logistic regression model for data analysis where the response variable (fall) is equal to 1 if the respondent answered yes to the question “In the past year, have you fallen at least one time?”
Results: We identified predictors including chronic disease diagnosis (diabetes, heart problem, arthritis), prescription drug use, marital status, work status, and substance use (alcohol). Older Americans reported changes in daily activities such as driving or taking public transportation, completing household chores, engaging in social activities outside the home, exercising or walking down a flight of stairs, and changing the frequency or manner of bathroom visits.
Importance to public health: Medications increase the risk of falls among older Americans. The majority (~65%) of older Americans suffer from comorbidity, so they are likely to use prescription medication. Pharmacists can be trained to identify older Americans at risk of falling and provide counseling (e.g. recommend tai chi and vision exam). Additionally, policy changes should support older Americans having a home inspection conducted by certified Community Health Workers to identify fall hazards. This policy change supports the recommendation by the U.S. Preventive Services Task Force for older Americans to “make changes at home to decrease the chances of a fall.”
Trivedi, Neha (UMD SPH Behavioral and Community Health)
Beck, Kenneth (UMD SPH Behavioral and Community Health)
Background: Texting while driving is prevalent among college-aged students despite distracted driving laws. Social Norms Theory suggests that individual behaviors are influenced often times by perceptions of how their social groups act. Proximal sources of social influence, such as significant others (S.O.) may be more likely to effect college-aged students.
Goal: The purpose of this study was to examine whether different social normative relationships (proximal or distal) mediate the pathway between perceptions of risk associated with texting while driving and reported texting and driving, among a sample of college drivers.
Objectives: We hypothesized that individuals who saw their S.O. (proximal sources) texting while driving would be more likely to mediate this relationship than their friends (distal sources). We were also interested in understanding whether mediational differences occurred across driver status as well as gender.
Approach: Our analysis included 835 undergraduates, who were licensed drivers and usually drove a car or other motor vehicle. We examined the influence of perceived risk of texting while driving on texting while driving in the past month, and whether seeing ones S.O. texting while driving mediated this effect. The sample was analyzed in two groups: low-risk drivers and high-risk drivers. Low-risk drivers never received a traffic citation nor got into a crash. High-risk drivers had ever received traffic citation or got into a crash. A series of logistic regressions were conducted to test the mediation effect, adjusting for gender and race/ethnicity. Sobel Tests were conducted to evaluate the indirect effect.
Results: Results showed that the influence of S.O. partially mediated the effect of perceived risk of texting while driving on past month texting while driving. Sobel tests for participants who were low-risk drivers showed that the effect of texting while driving in the past month was mediated by the influence of S.O. (t=2.24, p<0.05). Participants who were high-risk drivers were also partially mediated by perceived influence of their S.O. (t=2.03, p<0.05).
Importance to public health: These findings bolster the limited research on the importance of proximal sources of social influence. These findings suggest prevention efforts focus on proximal social networks of college-aged students as opposed to distal social influences when targeting young adults distracted driving behaviors, and intervention strategies be tailored towards texting while driving.
Ward, Alicia (UMD SPH Epidemiology)
Saksvig, Brit (UMD SPH Epidemiology)
Dallal, Cher (UMD SPH Epidemiology)
Background: The prevalence of physical activity related chronic conditions remains the highest for African American women than any other racial/ethnic group. However, only approximately 30% of African American women report meeting the recommended guidelines for physical activity. Previous studies have suggested that social support facilitates physical activity; however, limited studies have examined associations between social capital, the connections and relationships between individuals and their community, and physical activity among African American women.
Goal: This project examines the association between social capital and physical activity
Objectives: To conduct a cross-sectional analysis examining measures of neighborhood social capital in relation to physical activity among African American women.
Approach: The Sisters Healthy and Empowered Study (SHAPE) recruited African American women (n=200) from a total of six barbershops and beauty salons in two counties in Maryland during the period of March 2014 to March 2015. Participants completed a self-administered questionnaire that focused on beliefs about physical activity such as barriers, benefits, and their social and built environment. Neighborhood social capital was assessed using an index of 9 scored measures which were summed and categorized based on their tertile distribution. Physical activity was dichotomized as having met physical activity guidelines for moderate and vigorous. Logistic regression will be used to estimate odds ratios and 95% confidence intervals for the association between social capital and meeting moderate and vigorous physical activity guidelines.
Results: Across the age groups, approximately 27-35% and 25–32% of women met moderate or vigorous physical activity guidelines, respectively. In addition, among those classified as obese, 39.2% of women met moderate physical activity guidelines while 36.5% met the vigorous physical activity guidelines. Approximately 30% of women with reported high social capital met moderate or vigorous physical activity guidelines (34.2% and 32.4%, respectively). Logistic regression models of social capital in relation to physical activity outcomes are currently underway.
Importance to public health: The results of this project will inform future social supportive, culturally appropriate interventions aimed towards increasing physical activity in African American women
Weisman, Hannah (UMD SPH Maryland Institute of Applied Environmental Health)
Background: Acute Respiratory Infections (ARI) have been detrimental to society for centuries. While research has come a long way, the annual influenza epidemic persists indicating our poor understanding of ARI transmission. The Characterizing and Tracking College Health Study (C.A.T.C.H. Study) will help aid scientists to a better understanding of ARI contagiousness.
Goal: The goal of the C.A.T.C.H. Study is to identify biomarkers that can indicate which individuals are likely to become contagious and spread ARI to others and to ultimately improve our understanding of ARI transmission.
Objectives: 1. To collect samples from sick participants to determine the pathogen causing their illness and identify biomarkers of infection. 2. To follow the case’s close contacts for up to seven days and track their biomarkers of infection to see if they contract the same infection from their case.
Approach: The C.A.T.C.H. Study took participants from two cohorts: 1) The Index Cohort including freshmen living in the Cambridge Community who are in the Life Sciences (LS), Global Public Health (GPH), and Science Technology and Society (STS) Scholars programs and those students’ roommates. 2) The Main Cohort - the remainder of students living in the Cambridge Community and the freshmen who are in LS, GPH, and STS but live outside the Cambridge Community. Participants were taken as sick cases or close contacts and were tested accordingly.
Results: We have conducted 41 case visits with 18 cases positive for one of the four ARI of interest (Influenza, Adenovirus, Coronavirus, and Respiratory Syncytial Virus (RSV)). From those 18 cases, 10 were infected with Coronavirus, 4 with Flu-A, 2 with Flu-B, and 3 with RSV-B. One case had both Flu-A and RSV-B concurrently. We followed 40 close contacts of the 18 individuals with positive ARI tests. 7 of those contacts became sick with the same virus as their case. Further analysis of samples and biomarkers will help us understand more on the transmission of ARI.
Importance to public health: With an improved understanding of what contributes to and impacts contagiousness, we may better prepare for and even prevent future epidemics and pandemics of influenza or other ARI.
Weiss, Lauren (UMD SPH Kinesiology)
Alfini, Alfonso (Johns Hopkins University School of Public Health)
Won, Jun (UMD SPH Kinesiology)
Smith, J. Carson (UMD SPH Kinesiology)
Background: Aerobic exercise training has potent neuroprotective effects on the aging brain; exercise increases neurogenesis and blood perfusion, improves the communication of functionally associated brain regions, and confers benefits across several cognitive domains. These effects are particularly robust in the hippocampus, a structure associated with learning and memory that is vulnerable to atrophy in primary and pathological aging processes. While the effects of exercise training are well studied, it is unknown how short-term cessation of exercise training impacts these biomarkers of brain health.
Goal: The purpose of this study was to determine the effects of short-term exercise cessation on correlated [de]activation, or “functional activity” of the hippocampus in healthy and highly endurance-trained older adults.
Objectives: We hypothesized that exercise cessation would decrease functional connectivity of the hippocampus, indicating attenuated communication of this region with the rest of the brain.
Approach: This study utilized a within-subjects design. Functional connectivity was assessed using resting-state functional magnetic resonance imaging (fMRI), whereby blood oxygen level-dependent fMRI data were acquired from ten master athletes before and after ten days of complete abstention from exercise. We utilized a seed-based correlation analysis using the bilateral anterior and bilateral posterior hippocampi as a priori seed regions of interest in separate analyses. Here, the average signal time series were extracted from each seed region, and a correlation analysis quantified the extent of functionally coherent activity in remaining brain areas. Paired t-tests were used to assess changes in anterior and posterior hippocampal connectivity from pre- to post-exercise cessation.
Results: Pairwise comparisons revealed decreased connectivity of the anterior hippocampi with left medial frontal gyrus and medial prefrontal cortex; decreased connectivity was detected between posterior hippocampi and the right precentral gyrus and left insula. However, none of these decreases were statistically significant after controlling for family-wise error rate.
Importance to public health: Regular exercise is necessary for the maintenance of cardiovascular fitness and other training adaptations. These preliminary findings suggest that functional connectivity of the hippocampus may not be significantly affected by short-term exercise cessation, and that exercise-induced benefits on the aging brain might persist in the face of abrupt exercise training interruptions.
Smith, J. Carson (UMD SPH Kinesiology)
Faroqi-Shah, Yasmeen (UMD Hearing and Speech Sciences)
Ozturk, Zuleyha (Undergraduate)
Mirzazadeh, Tina (Undergraduate)
Nielson, Kristy (Marquette University)
Background: Previous reports have found that exercise training (ET) in older adults diagnosed with mild cognitive impairment (MCI) is associated with increased functional connectivity of the default mode network, increased cortical thickness, decreased cortical activation during semantic memory retrieval and increased episodic memory performance, but no change in verbal fluency. Also, it is not known whether ET influences the total score or complexity of words produced. This project allows us to explore these relationships and determine whether physical activity influences verbal fluency in older adults and mild cognitive impairment.
Goal: The purpose of this study was to examine the effects of a 12-week walking ET intervention on the frequency and complexity of words produced during a phonemic fluency task.
Objectives: Verbal fluency refers to producing words from a specific category (e.g., starts with F), involves selecting words by inhibiting competing alternatives (e.g., phone). Our objective was to determine if a 12-week walking exercise training intervention would significantly influence the frequency and complexity of words produced during this phonemic fluency task. We hypothesized that there would be a significant difference due to the exercise training intervention.
Approach: MCI participants and 18 cognitively intact controls completed a 12-week ET intervention consisting of supervised treadmill walking at a moderate intensity. Before and after ET, participants completed a phonemic verbal fluency task as part of a larger neuropsychological battery. Total word count and complexity of responses, measured by word frequencies and syllable length, were examined.
Results: There was no change in total word count. However, both groups produced words with greater frequency after ET (p = .016, partial eta-squared = .163). In addition, participants diagnosed with MCI produced words with fewer syllables after ET, an effect not observed in healthy controls (interaction p = .034, partial eta-squared = .129). These findings suggest 12-weeks of walking exercise training may modify lexical retrieval strategies, with a greater reliance on more frequently appearing words, and in the case of MCI, words that have fewer syllables.
Importance to public health: It is plausible ET is related to enhanced cognitive control by inhibiting competing words and facilitating a search for easier words to speak. This is significant because exercise training may be used to help improve cognition in older adults with mild cognitive impairment.
Won, Junyeon (Department of Kinesiology)
Alfini, Alfonso (Department of Mental Health)
Weiss, Lauren (Department of Kinesiology)
Michelson, Corey (Department of Kinesiology)
Smith, J. Carson (Depart)
Background: A growing body of research indicates that acute exercise in older adults is associated with enhanced executive function, including inhibitory control and working memory. However, most studies have measured cognition shortly after the exercise session, and whether or not acute exercise has longer lasting cognitive benefits in older adults has not been established.
Goal: To investigate executive function performance 1.5 hours after a single session of exercise, compared to rest, in healthy older adults; and to secondarily determine if sleep moderates these effects.
Objectives: We hypothesized that acute exercise would enhance executive function up to 1.5 hours. Longer sleepers may demonstrate better executive function performance compared to short sleepers. Acute exercise and sleep time may not show interactive effects, because only healthy participants with normal sleep will be recruited.
Approach: 30 healthy older adults (65.8±8.1 years) completed two experimental sessions on different days that entailed 30-min of seated rest or moderate intensity exercise on a Monark cycle ergometer. Ninety minutes after exercise and rest, participants performed the Stoop Color and Word Task (Stroop) to measure inhibitory control and the Symbol Digit Modalities Test (SDMT) to for working memory. To examine sleep, participants wore an actigraphy watch for at least three days prior to the first experimental session.
Results: Written SDMT performance following acute exercise (59.6±7.9) was significantly better compared to rest (57.6±9.4) [p < 0.001, n² = 0.519]. Moreover, oral SDMT performance was significantly better after exercise (58.7±9.4) compared to rest (57.9±9.0) [p < .001, n² = 0.607]. Incongruent accuracy during Stroop task was significantly greater after exercise [p = 0.047, n² = 0.138]. Long sleeper performed significantly faster Congruent [p = 0.007, n² = 0.237] and Incongruent response time [p = 0.004, n² = 0.268], higher Incongruent accuracy [p = 0.004, n² = 0.264] during Stroop task compared to short sleepers. Also, longer sleepers performed significantly better in SDMT written [p = 0.003, n² = 0.277] and SDMT oral [p = 0.006, n² = 0.250] relative to short sleepers.
Importance to public health: These findings suggest that working memory performance is enhanced up to 1.5 hours after acute exercise in older adults. Sleep time may affect executive function performance and longer sleep time was associated with better executive function performance. No interaction between acute exercise and sleep time on executive function was found.
XU, YIXI (UMD SPH Epidemiology and Biostatistics)
Carter-Pokras, Olivia (UMD SPH Epidemiology and Biostatistics)
Background: Human Papillomavirus (HPV) vaccine has been shown to prevent cervical cancer. While factors associated with initiation of HPV vaccine haven been well characterized, little is known about factors associated with completion of HPV vaccine.
Goal: This study aims to examine factors associated with completion of the HPV vaccine series among Hispanic/Latino and non-Hispanic/Latino White teen girls who initiated HPV series.
Objectives: We hypothesized that Hispanics girls ages 13 to 17 would have higher rates of risk factors (poverty status, mother’s education level, access to healthcare services et.al.) associated with completion of HPV series when compared with non-Hispanic Whites.
Approach: We performed a secondary data analysis on 1,043 Hispanic/Latino and 3,426 non-Hispanic/Latino White girls aged 13 to 17 years who initiated the series from the 2016 National Immunization Survey-Teen. We used weighted logistic regression models to examine the independent effects of race/ethnicity on HPV vaccine series completion and performed chi-square tests to look for significant results.
Results: While 74.60% of the non-Hispanic/Latino White girls who initiated the HPV vaccine series in this sample completed the series, 69.15% of Hispanic/Latino girls who had initiated the series achieved completion (p=.11). There were significant socio-demographic differences between there two groups of girls. Compared to non-Hispanic/Latino White girls, Hispanic/Latino girls were less likely to have seen a doctor visit in the previous year, more likely to be raised by a single mother, or mother with lower educational level, live in households with 4 or more children, live in poverty, live in rental homes, and be younger at the time of initiation of the HPV vaccine series.
Importance to public health: As HPV vaccination rates in the United States remain below the Healthy People 2020 goal, messages may need to be targeted based on maternal education, age appropriate series initiation and provider recommendation.
Zambrana, Jordan (UMD SPH Maryland Institute for Applied Environmental Health)
Blythe, David (Prevention and Health Promotion Administration)
Mitchell, Clifford (Prevention and Health Promotion Administration)
Sapkota, Amy (UMD SPH Maryland Institute for Applied Environmental Health)
Sapkota, Amir (UMD SPH Maryland Institute for Applied Environmental Health)
Background: Salmonella infections cause 19,000 hospitalizations and 380 deaths on a yearly basis in the United States. Previous studies have linked higher temperature, including extreme heat events with greater risk of foodborne illness. However, there is a paucity of data regarding how extreme weather events impact risk of Salmonella infection across the United States, and how these risk is modified by large scale weather phenomenon such as El Nino Southern Oscillations (ENSO).
Goal: To understand the critical role extreme heat and precipitation events associated with climate change in concert with increased vulnerability of persons of lower socioeconomic status play in the rate of foodborne illness.
Objectives: 1.To investigate the association between exposure to extreme weather events and risk of Salmonella infection across the 10 Food Net states. 2.Explore how this risk varied across Salmonella serotypes and socio-demographic characteristics
Approach: We merged the Foodborne Diseases Active Surveillance Network data (2002-2012) from 10 states, with extreme weather event data for the same period computed using 1960-1989 as the baseline. We used negative binomial generalized estimating equations to investigate the association between exposure to extreme weather events and risk of Salmonella infection across the 10 states, and explored how this risk varied across socio-demographic characteristics. We further stratified the analysis by phases of ENSO (El Nino, La Nina and ENSO neutral).
Results: Our results show that extreme heat events are associated with an increased risk of Salmonella infection, however the risk vary considerably across the 10 Food Net states. Across all states, the risk of Salmonella infection was higher during El Nino and La Nina compared to ENSO neutral periods. When we stratified the analysis by serotype (enteritdis, javiana, newport and typhimurium), we observed considerable variability in extreme event related risks across different serotypes. We further observed that coastal states were at increased risk compared to non-coastal states.
Importance to public health: Our results show that extreme weather events are associated with salmonellosis in the United States and that the risk varies across geographic region, demographic characteristics and phases of ENSO. Location specific adaptation strategies incorporating such variability in risk are needed to minimize the future burden of food and waterborne illnesses associated with extreme weather events.
Zhang, Shannon (CHIDS)
Zappas, Anne (CHIDS)
Dugas, Michelle (CHIDS)
Gao, Gordon (CHIDS)
Background: Many chronic diseases today can be prevented with better lifestyle choices, but efforts to establish and maintain healthy habits often fail. Part of this could be attributed to a need for continuous care that is not provided in traditional models of health care (Block 2013; CAPP 2015). Treatment delivered via mobile technology (mHealth) may be able to help fill that gap, but there is inconsistency in the effectiveness of such interventions (Free et al. 2013).
Goal: The goal of this review is to summarize the various behavior change techniques (BCTs) used in randomized controlled trials of mHealth interventions to understand the variability in existing approaches and highlight areas for improvement.
Objectives: The first main objective of our literature review was to identify the top impact journals in the medical and medical informatics field and articles within these journals that test the effectiveness of mHealth interventions randomized controlled trial designs. Following this, our final objective is to summarize BCTs employed in intervention and comparator study arms.
Approach: In our mobile health literature review, we selected articles published in 2007-2017 in which the primary component of the intervention under evaluation involved a mobile technology component. Each study tested the effectiveness of mHealth interventions for improving health behavior or outcomes. We then coded the BCTs used in the mHealth intervention and comparator arms with a validated and well-established taxonomy (Michie, 2013).
Results: We identified 22 articles for the systematic literature review, 10 of which used text messaging interventions and 12 that used smartphone application interventions. A wide range of outcomes were studied from weight loss to medication adherence. A portion of the articles have already been coded for the behavioral change technique, but some are still being finalized.
Importance to public health: Our findings will help unpack the diversity in current approaches to mHealth, highlighting areas for standardization, refinement, and improvement of interventions. Evidence that BCTs are highly variable in their effectiveness would suggest that policymakers should be cautious when generalizing from one mHealth approach to another. Finally, greater precision in linking specific BCTs and effectiveness of mHealth will contribute to ensuring that people have access to the most effective treatment possible.