Digital Commons Network^™

Effects Of Cumulative Risk On Asthma Outcomes In Urban Children And Adolescents, Samantha A. Miadich

Theses and Dissertations

Pediatric asthma disproportionately affects racial/ethnic minority children and children living in low-income, urban areas. Many families living in low-income, urban areas experience a number of stressors that can place children/adolescents at risk for worse asthma outcomes. This study examined the impact of a cumulative risk model of stressors (e.g., ED visits, quick-relief medication use, lung function, asthma control, QOL) in urban children (7-12 years) with persistent asthma. This study further aimed to examine both the original cumulative risk model and an adolescent-specific cumulative risk model as predictors of asthma outcomes in a sample of 60 adolescents (13-17 years). Asthma-related caregiver …

Implementing Integrated Care In Family Medicine: Description And Outcomes In An Underserved Population, Zach Radcliff

Theses and Dissertations

Introduction: Family physicians provide access to medical and behavioral healthcare for many underserved populations. Integrating behavioral health clinicians into primary care practices has been proposed as one of the most effective ways to increase access to necessary behavioral health services for many Americans. Integrated behavioral healthcare (IBHC) has begun to be implemented in family medicine practices but there is limited research examining the impact for patients and clinic staff. This study begins to fill this gap in the literature by examining the effects of implementing integrated behavioral healthcare in an urban family medicine clinic in a medically underserved area.

Objective: …

Examining Health Behaviors In College Students With And Without Chronic Conditions, Duc-Thi J. Barsell

Theses and Dissertations

Many college students are in a developmental period in which they are transitioning from pediatric to adult health care. This time period can be challenging for all college students and especially for students with a chronic condition. The current study investigated the association between various health-related factors (health locus of control [HLOC], health literacy, health self-efficacy, and health-related quality of life [HRQOL]) and health behaviors in college students, as well as the moderating effect of having a chronic condition on those associations. These health behaviors were further operationalized as healthy lifestyle behaviors (preventative and wellness behaviors, dietary behaviors, physical activity) …

Exploring The Role Of Motivational Interviewing In Adolescent Patient-Provider Communication About Type 1 Diabetes, Laura J. Caccavale

Theses and Dissertations

Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control.

Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% …

Sustainable Adapted Treatments For Eating Disorders: The Role Of Cultural Adaptation In Prevention, Sarah J. Javier

Theses and Dissertations

Despite demonstrating eating disorder rates equivalent to White women, African American and Asian American women are less likely to seek treatment and are more likely to terminate treatment prematurely. One of the most successful programs for eating disorder prevention has only focused on surface-level cultural adaptations. Prevention literature maintains that deep-structure cultural adaptation (e.g., integrating cultural values and beliefs) can enhance outcomes for ethnic minorities. This dissertation examined the feasibility of Sustainable Adapted Treatments for Eating Disorders (SATED), a pilot intervention that included a culturally- targeted pre-treatment to an eating disorder dissonance-based intervention. A sample of 72 women (ages 18-30) …

The Role Of Afrocentric Features In Mental Healthcare Utilization And Counselor Preferences In Black College Students, Randl B. Dent

Theses and Dissertations

Though mental health issues are prevalent in Black young adults, they underutilize mental healthcare services. This research examined the role of feature-based discrimination in mental healthcare (under)utilization. Study 1, a secondary analysis of the National Longitudinal Study of Adolescent to Adult Health, provided no evidence supporting a link between skin tone and mental healthcare utilization, when controlling for depression diagnosis. However, when controlling for depression symptoms, there was a trend such that Black young adults with darker, as opposed to lighter, skin tone utilized healthcare less. Study 2, an experimental study with 33 Black college students, showed 73% of the …

Mechanisms Of Motivational Interviewing In A Parent-Focused Pediatric Obesity Intervention, Nadia Islam

Theses and Dissertations

Pediatric obesity is a major public health epidemic with serious physical and psychological consequences. Difficulty engaging families in treatment is a significant obstacle in addressing pediatric obesity, especially among underserved populations. Motivational interviewing (MI) is a collaborative, person-centered communication style that has been shown to reduce attrition, increase attendance, and improve patient treatment adherence; however, little is known about the process of MI and how it improves treatment engagement. This study examined clinician and parent language in a pre-treatment MI session that increased initial engagement in a parent- focused pediatric obesity intervention (N= 81). Results showed that increased parent change …

An Integrated Behavioral Model Of Healthcare Utilization Among Transgender And Gender-Nonconforming Adults, Megan Elizabeth Sutter

Theses and Dissertations

Transgender and gender-nonconforming (TGNC) individuals in the United States experience significant marginalization due to stigma enacted at the structural, interpersonal, and individual levels. As a result, this population has reported increased behavioral and physical health needs, as well as unique barriers to healthcare. Moreover, TGNC individuals have reported greater experiences of childhood abuse compared to cisgender individuals. The cumulative experiences of stigma-related stressors and adverse childhood experiences put this population at risk for the development of mental and physical health problems, increasing need for health services. However, TGNC individuals have reported being denied medical care and postponing seeking care due …

A Hierarchical Linear Modeling Approach To Predicting Trajectories Of Posttraumatic Growth In Veterans Following Acquired Physical Disability, Lisa Goldberg Looney

Theses and Dissertations

The purpose of this study was to examine potential predictors of PTG across time in Veterans with acquired physical disabilities. Specifically, this study aimed to understand how various demographic and injury characteristics, coping styles, appraisals of injury, and social support might predict trajectories of PTG from discharge from inpatient rehabilitation through 12 months after baseline. Initial curvature analyses suggested that a cubic polynomial trend best fit the movement of PTG over time, generally conforming to an initial increase, decrease, and then plateau or slight increase. Four HLMs were run to examine whether demographic and injury characteristics, coping styles, appraisals of …

Protective Factors In The Association Between Child Sexual Abuse And Telomere Length In Adults, David Sosnowski

Theses and Dissertations

The purpose of the present study was to examine if childhood sexual abuse (CSA) was associated with decreases in mean telomere length (TL), and if social support and/or optimism moderated this association. The study included 99 Caucasian female monozygotic twins, ranging in age from 19-48 (M_age = 30.5, SD = 7.8) at Time 1. Linear mixed effects models were employed to test study hypotheses. Analyses with all participants did not detect an effect of CSA exposure or severity on mean TL, nor were there effects with optimism. However, in analyses that only included women exposed to abuse, increases …

Non-Medical Use Of Prescription Drugs, Stress, Cultural Orientation, Utilization Of Healthcare, And Protective Factors Among College Students In China, Cheuk Chi Tam

Theses and Dissertations

Background: Non-medical use of prescription drugs (NMUPD) refers to the use of prescription drugs which are traditionally utilized to manage pain or treat psychiatric problems but without a doctor’s prescription. In 2010, an investigation by the Substance Use and Mental Health Services Administration (SAMHSA) revealed that 5.3% of young adults (18 to 25-year-olds) in the United States reported past-month NMUPD. NMUPD has become a growing concern owing to associations with consequences such as college dropout, poor academic achievement, and health jeopardizing behaviors. College students' NMUPD has been well documented in the United States. Limited studies, however, have been conducted among …