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Maternal morbidity and mortality rates in the United States continues to rise, with a wide range of contributing factors such as mental illness, cardiovascular disease and systemic inequality. This metastudy provides a holistic view of the research that has been published on the issue of U.S. maternal healthcare from 2000-2022. The patterns of publications on specific topics over time can tell us what is perceived as a current major cause by physicians, public leaders, researchers, and the public. A deeper dive into systemic inequality as a cause of maternal morbidity and mortality highlights it as a major contributor to these high rates, but that progress is slowly being made through the implementation of detection and prevention tactics, as well as accessible prenatal programs and care.
ContributorsRettig, Lelia (Author) / Amdam, Gro (Thesis director) / Bang, Christofer (Committee member) / Barrett, The Honors College (Contributor) / School of Human Evolution & Social Change (Contributor) / School of Life Sciences (Contributor)
Created2023-05
Description
Longitudinal recursive partitioning (LRP) is a tree-based method for longitudinal data. It takes a sample of individuals that were each measured repeatedly across time, and it splits them based on a set of covariates such that individuals with similar trajectories become grouped together into nodes. LRP does this by fitting a mixed-effects model to each node every time that it becomes partitioned and extracting the deviance, which is the measure of node purity. LRP is implemented using the classification and regression tree algorithm, which suffers from a variable selection bias and does not guarantee reaching a global optimum. Additionally, fitting mixed-effects models to each potential split only to extract the deviance and discard the rest of the information is a computationally intensive procedure. Therefore, in this dissertation, I address the high computational demand, variable selection bias, and local optimum solution. I propose three approximation methods that reduce the computational demand of LRP, and at the same time, allow for a straightforward extension to recursive partitioning algorithms that do not have a variable selection bias and can reach the global optimum solution. In the three proposed approximations, a mixed-effects model is fit to the full data, and the growth curve coefficients for each individual are extracted. Then, (1) a principal component analysis is fit to the set of coefficients and the principal component score is extracted for each individual, (2) a one-factor model is fit to the coefficients and the factor score is extracted, or (3) the coefficients are summed. The three methods result in each individual having a single score that represents the growth curve trajectory. Therefore, now that the outcome is a single score for each individual, any tree-based method may be used for partitioning the data and group the individuals together. Once the individuals are assigned to their final nodes, a mixed-effects model is fit to each terminal node with the individuals belonging to it.
I conduct a simulation study, where I show that the approximation methods achieve the goals proposed while maintaining a similar level of out-of-sample prediction accuracy as LRP. I then illustrate and compare the methods using an applied data.
I conduct a simulation study, where I show that the approximation methods achieve the goals proposed while maintaining a similar level of out-of-sample prediction accuracy as LRP. I then illustrate and compare the methods using an applied data.
ContributorsStegmann, Gabriela (Author) / Grimm, Kevin (Thesis advisor) / Edwards, Michael (Committee member) / MacKinnon, David (Committee member) / McNeish, Daniel (Committee member) / Arizona State University (Publisher)
Created2019
Description
There is a need to reinvent evidence-based interventions (EBIs) for pediatric anxiety problems to better address the demands of real-word service delivery settings and achieve public health impact. The time- and resource-intensive nature of most EBIs for youth anxiety has frequently been noted as a barrier to the utilization of EBIs in community settings, leading to increased attention towards exploring the viability of briefer, more accessible protocols. Principally, this research reports between-group effect sizes from brief-interventions targeting pediatric anxiety and classifies each as well-established, probably efficacious, possibly efficacious, experimental, or questionable. brief interventions yielded an overall mean effect size of 0.19 on pediatric anxiety outcomes from pre to post. Effect sizes varied significantly by level of intervention: Pre to post-intervention effects were strongest for brief-treatments (0.35), followed by brief-targeted prevention (0.22), and weakest for brief-universal prevention (0.09). No participant or other intervention characteristic emerged as significant moderators of effect sizes. In terms of standard of evidence, one brief intervention is well-established, and five are probably efficacious, with most drawing on cognitive and behavioral change procedures and/or family systems models. At this juncture, the minimal intervention needed for clinical change in pediatric anxiety points to in-vivo exposures for specific phobias (~3 hours), cognitive-behavioral therapy (CBT) with social skills training (~3 hours), and CBT based parent training (~6 hours, eight digital modules with clinician support). This research concludes with a discussion on limitations to available brief EBIs, practice guidelines, and future research needed to capitalize on the viability of briefer protocols in enhancing access to, and impact of, evidence-based care in the real-world.
ContributorsStoll, Ryan (Author) / Pina, Armando A. (Thesis advisor) / Gonzales, Nancy (Committee member) / MacKinnon, David (Committee member) / Perez, Marisol (Committee member) / Arizona State University (Publisher)
Created2019
Description
Positive alcohol outcome expectancies (AOEs) are consistent longitudinal predictors of later alcohol use; however, exclusion of solitary drinking contexts in the measurement of AOEs may have resulted in an underestimation of the importance of low arousal positive (LAP) effects. The current study aimed to clarify the literature on the association between AOEs and drinking outcomes by examining the role of drinking context in AOE measurement. Further, exclusion of contextual influences has also limited understanding of the unique effects of AOEs relative to subjective responses (SR) to alcohol. The present study addressed this important question by exploring relations between AOEs and SR when drinking context was held constant across parallel measures of these constructs. Understanding which of these factors drives relations between alcohol effects and drinking behavior has important implications for intervention. After conducting confirmatory factor analysis (CFA) and tests of measurement invariance for the AOE and SR measures, 4 aims collectively examined the role of context in reporting of AOEs (Aims 1 and 2), the extent to which context specific AOEs uniquely relate to drinking outcomes (Aim 3), and the importance of context effects on correspondence between AOEs and SR (Aim 4). Results of Aims 1 and 2 demonstrated that participants are imagining contexts when reporting on measures of AOEs that do not specify the context, and found significant mean differences in high and low arousal positive AOEs across contexts. Contrary to the hypotheses of Aim 3, context-specific AOEs were not significantly associated with drinking behavior. Results of Aim 4 indicated that while LAP AOEs for both unspecified and solitary contexts were associated with LAP SR in a solitary setting, unspecified context AOEs had a stronger relation than the solitary context AOEs. No significant relations between high arousal positive (HAP) AOEs and HAP SR emerged. The findings suggest that further investigation of the relation between context-specific AOEs and drinking outcomes/SR is warranted. Future studies of these hypotheses in samples with a wider range of drinking behavior, or at different stages of alcohol involvement, will elucidate whether mean level differences in context specific AOEs are important in understanding alcohol related outcomes.
ContributorsScott, Caitlin (Author) / Corbin, William (Thesis advisor) / MacKinnon, David (Committee member) / Barrera, Manuel (Committee member) / Chassin, Laurie (Committee member) / Arizona State University (Publisher)
Created2016
Description
Recent advances in hierarchical or multilevel statistical models and causal inference using the potential outcomes framework hold tremendous promise for mock and real jury research. These advances enable researchers to explore how individual jurors can exert a bottom-up effect on the jury’s verdict and how case-level features can exert a top-down effect on a juror’s perception of the parties at trial. This dissertation explains and then applies these technical advances to a pre-existing mock jury dataset to provide worked examples in an effort to spur the adoption of these techniques. In particular, the paper introduces two new cross-level mediated effects and then describes how to conduct ecological validity tests with these mediated effects. The first cross-level mediated effect, the a1b1 mediated effect, is the juror level mediated effect for a jury level manipulation. The second cross-level mediated effect, the a2bc mediated effect, is the unique contextual effect that being in a jury has on the individual the juror. When a mock jury study includes a deliberation versus non-deliberation manipulation, the a1b1 can be compared for the two conditions, enabling a general test of ecological validity. If deliberating in a group generally influences the individual, then the two indirect effects should be significantly different. The a2bc can also be interpreted as a specific test of how much changes in jury level means of this specific mediator effect juror level decision-making.
ContributorsLovis-McMahon, David (Author) / Schweitzer, Nicholas (Thesis advisor) / Saks, Michael (Thesis advisor) / Salerno, Jessica (Committee member) / MacKinnon, David (Committee member) / Arizona State University (Publisher)
Created2015
Description
Variability in subjective response to alcohol has been shown to predict drinking behavior as well as the development of alcohol use disorders. The current study examined the extent to which individual differences in alcohol pharmacokinetics impact subjective response and drinking behavior during a single session alcohol administration paradigm. Participants (N = 98) completed measures of subjective response at two time points following alcohol consumption. Pharmacokinetic properties (rate of absorption and metabolism) were inferred using multiple BAC readings to calculate the area under the curve during the ascending limb for absorption and descending limb for metabolism. Following the completion of the subjective response measures, an ad-libitum taste rating task was implemented in which participants were permitted to consume additional alcoholic beverages. The amount consumed during the taste rating task served as the primary outcome variable. Results of the study indicated that participants who metabolized alcohol more quickly maintained a greater level of subjective stimulation as blood alcohol levels declined and reported greater reductions in subjective sedation. Although metabolism did not have a direct influence on within session alcohol consumption, a faster metabolism did relate to increased ad-libitum consumption indirectly through greater acute tolerance to sedative effects and greater maintenance of stimulant effects. Rate of absorption did not significantly predict subjective response or within session drinking. The results of the study add clarity to theories of subjective response to alcohol, and suggest that those at highest risk for alcohol problems experience a more rapid reduction in sedation following alcohol consumption while simultaneously experiencing heightened levels of stimulation. Variability in pharmacokinetics, namely how quickly one metabolizes alcohol, may be an identifiable biomarker of subjective response and may be used to infer risk for alcohol problems.
ContributorsBoyd, Stephen (Author) / Corbin, William R. (Thesis advisor) / Chassin, Laurie (Committee member) / MacKinnon, David (Committee member) / Olive, Michael Foster (Committee member) / Arizona State University (Publisher)
Created2014
Description
The present study utilized longitudinal data from a high-risk community sample (n=254, 52.8% female, 47.2% children of alcoholics, 74% non-Hispanic Caucasian) to test questions concerning the effects of genetic risk, parental knowledge, and peer substance use on emerging adult substance use disorders (SUDs). Specifically, this study examined whether parental knowledge and peer substance use mediated the effects of parent alcohol use disorder (AUD) and genetic risk for behavioral undercontrol on SUD. The current study also examined whether genetic risk moderated effects of parental knowledge and peer substance use on risk for SUD. Finally, this study examined these questions over and above a genetic "control" which explained a large proportion of variance in the outcome, thereby providing a stricter test of environmental influences.
Analyses were performed in a path analysis framework. To test these research questions, the current study employed two polygenic risk scores. The first, a theory-based score, was formed using single-nucleotide polymorphisms (SNPs) from receptor systems implicated in the amplification of positive effects in the presence of new/exciting stimuli and/or pleasure derived from using substances. The second, an empirically-based score, was formed using a data-driven approach that explained a large amount of variance in SUDs. Together, these scores allowed the present study to test explanations for the relations among parent AUD, parental knowledge, peer substance use, and SUDs.
Results of the current study found that having parents with less knowledge or an AUD conferred greater risk for SUDs, but only for those at higher genetic risk for behavioral undercontrol. The current study replicated research findings suggesting that peer substance use mediated the effect of parental AUD on SUD. However, it adds to this literature by suggesting that some mechanism other than increased behavioral undercontrol explains relations among parental AUD, peer substance use, and emerging adult SUD. Taken together, these findings indicate that children of parents with AUDs comprise a particularly risky group, although likelihood of SUD within this group is not uniform. These findings also suggest that some of the most important environmental risk factors for SUDs exert effects that vary across level of genetic propensity.
Analyses were performed in a path analysis framework. To test these research questions, the current study employed two polygenic risk scores. The first, a theory-based score, was formed using single-nucleotide polymorphisms (SNPs) from receptor systems implicated in the amplification of positive effects in the presence of new/exciting stimuli and/or pleasure derived from using substances. The second, an empirically-based score, was formed using a data-driven approach that explained a large amount of variance in SUDs. Together, these scores allowed the present study to test explanations for the relations among parent AUD, parental knowledge, peer substance use, and SUDs.
Results of the current study found that having parents with less knowledge or an AUD conferred greater risk for SUDs, but only for those at higher genetic risk for behavioral undercontrol. The current study replicated research findings suggesting that peer substance use mediated the effect of parental AUD on SUD. However, it adds to this literature by suggesting that some mechanism other than increased behavioral undercontrol explains relations among parental AUD, peer substance use, and emerging adult SUD. Taken together, these findings indicate that children of parents with AUDs comprise a particularly risky group, although likelihood of SUD within this group is not uniform. These findings also suggest that some of the most important environmental risk factors for SUDs exert effects that vary across level of genetic propensity.
ContributorsBountress, Kaitlin (Author) / Chassin, Laurie (Thesis advisor) / Crnic, Keith (Committee member) / Lemery-Chalfant, Kathryn (Committee member) / MacKinnon, David (Committee member) / Arizona State University (Publisher)
Created2015
Description
Anxiety and depression are among the most prevalent disorders in youth, with prevalence rates ranging from 15% to 25% for anxiety and 5% to 14% for depression. Anxiety and depressive disorders cause significant impairment, fail to spontaneously remit, and have been prospectively linked to problematic substance use and legal problems in adulthood. These disorders often share a high-degree of comorbidity in both clinical and community samples, with anxiety disorders typically preceding the onset of depression. Given the nature and consequences of anxiety and depressive disorders, a plethora of treatment and preventative interventions have been developed and tested with data showing significant pre to post to follow-up reductions in anxiety and depressive symptoms. However, little is known about the mediators by which these interventions achieve their effects. To address this gap in the literature, the present thesis study combined meta-analytic methods and path analysis to evaluate the effects of youth anxiety and depression interventions on outcomes and four theory-driven mediators using data from 55 randomized controlled trials (N = 11,413). The mediators included: (1) information-processing biases, (2) coping strategies, (3) social competence, and (4) physiological hyperarousal. Meta-analytic results showed that treatment and preventative interventions reliably produced moderate effect sizes on outcomes and three of the four mediators (information-processing biases, coping strategies, social competence). Most importantly, findings from the path analysis showed that changes in information-processing biases and coping strategies consistently mediated changes in outcomes for anxiety and depression at both levels of intervention, whereas gains in social competence and reductions in physiological hyperarousal did not emerge as significant mediators. Knowledge of the mediators underlying intervention effects is important because they can refine testable models of treatment and prevention efforts and identify which anxiety and depression components need to be packaged or strengthened to maximize intervention effects. Allocating additional resources to significant mediators has the potential to reduce costs associated with adopting and implementing evidence-based interventions and improve dissemination and sustainability in real-world settings, thus setting the stage to be more readily integrated into clinical and non-clinical settings on a large scale.
ContributorsStoll, Ryan (Author) / Pina, Armando A (Thesis advisor) / MacKinnon, David (Committee member) / Knight, George (Committee member) / Arizona State University (Publisher)
Created2015
Description
Methods to test hypotheses of mediated effects in the pretest-posttest control group design are understudied in the behavioral sciences (MacKinnon, 2008). Because many studies aim to answer questions about mediating processes in the pretest-posttest control group design, there is a need to determine which model is most appropriate to test hypotheses about mediating processes and what happens to estimates of the mediated effect when model assumptions are violated in this design. The goal of this project was to outline estimator characteristics of four longitudinal mediation models and the cross-sectional mediation model. Models were compared on type 1 error rates, statistical power, accuracy of confidence interval coverage, and bias of parameter estimates. Four traditional longitudinal models and the cross-sectional model were assessed. The four longitudinal models were analysis of covariance (ANCOVA) using pretest scores as a covariate, path analysis, difference scores, and residualized change scores. A Monte Carlo simulation study was conducted to evaluate the different models across a wide range of sample sizes and effect sizes. All models performed well in terms of type 1 error rates and the ANCOVA and path analysis models performed best in terms of bias and empirical power. The difference score, residualized change score, and cross-sectional models all performed well given certain conditions held about the pretest measures. These conditions and future directions are discussed.
ContributorsValente, Matthew John (Author) / MacKinnon, David (Thesis advisor) / West, Stephen (Committee member) / Aiken, Leona (Committee member) / Enders, Craig (Committee member) / Arizona State University (Publisher)
Created2015
Description
Neurotoxicology has historically focused on substances that directly damage nervous tissue. Behavioral assays that test sensory, cognitive, or motor function are used to identify neurotoxins. But, the outcomes of behavioral assays may also be influenced by the physiological status of non-neural organs. Therefore, toxin induced damage to non- neural organs may contribute to behavioral modifications. Heavy metals and metalloids are persistent environmental pollutants and induce neurological deficits in multiple organisms. However, in the honey bee, an important insect pollinator, little is known about the sublethal effects of heavy metal and metalloid toxicity though they are exposed to these toxins chronically in some environments. In this thesis I investigate the sublethal effects of copper, cadmium, lead, and selenium on honey bee behavior and identify potential mechanisms mediating the behavioral modifications. I explore the honey bees’ ability to detect these toxins, their sensory perception of sucrose following toxin exposure, and the effects of toxin ingestion on performance during learning and memory tasks. The effects depend on the specific metal. Honey bees detect and reject copper containing solutions, but readily consume those contaminated with cadmium and lead. And, exposure to lead may alter the sensory perception of sucrose. I also demonstrate that acute selenium exposure impairs learning and long-term memory formation or recall. Localizing selenium accumulation following chronic exposure reveals that damage to non-neural organs and peripheral sensory structures is more likely than direct neurotoxicity. Probable mechanisms include gut microbiome alterations, gut lining
damage, immune system activation, impaired protein function, or aberrant DNA methylation. In the case of DNA methylation, I demonstrate that inhibiting DNA methylation dynamics can impair long-term memory formation, while the nurse-to- forager transition is not altered. These experiments could serve as the bases for and reference groups of studies testing the effects of metal or metalloid toxicity on DNA methylation. Each potential mechanism provides an avenue for investigating how neural function is influenced by the physiological status of non-neural organs. And from an ecological perspective, my results highlight the need for environmental policy to consider sublethal effects in determining safe environmental toxin loads for honey bees and other insect pollinators.
damage, immune system activation, impaired protein function, or aberrant DNA methylation. In the case of DNA methylation, I demonstrate that inhibiting DNA methylation dynamics can impair long-term memory formation, while the nurse-to- forager transition is not altered. These experiments could serve as the bases for and reference groups of studies testing the effects of metal or metalloid toxicity on DNA methylation. Each potential mechanism provides an avenue for investigating how neural function is influenced by the physiological status of non-neural organs. And from an ecological perspective, my results highlight the need for environmental policy to consider sublethal effects in determining safe environmental toxin loads for honey bees and other insect pollinators.
ContributorsBurden, Christina Marie (Author) / Amdam, Gro (Thesis advisor) / Smith, Brian H. (Thesis advisor) / Gallitano-Mendel, Amelia (Committee member) / Harrison, Jon (Committee member) / Vu, Eric (Committee member) / Arizona State University (Publisher)
Created2016