Selecting renal replacement therapies: what do African American and non-African American patients and their families think others should know? A mixed methods study.

BACKGROUND: Little is known regarding the types of information African American and non-African American patients with chronic kidney disease (CKD) and their families need to inform renal replacement therapy (RRT) decisions. METHODS: In 20 structured group interviews, we elicited views of African American and non-African American patients with CKD and their families about factors that should be addressed in educational materials informing patients' RRT selection decisions. We asked participants to select factors from a list and obtained their open-ended feedback. RESULTS: Ten groups of patients (5 African American, 5 non-African American; total 68 individuals) and ten groups of family members (5 African American, 5 non-African American; total 62 individuals) participated. Patients and families had a range (none to extensive) of experiences with various RRTs. Patients identified morbidity or mortality, autonomy, treatment delivery, and symptoms as important factors to address. Family members identified similar factors but also cited the effects of RRT decisions on patients' psychological well-being and finances. Views of African American and non-African American participants were largely similar. CONCLUSIONS: Educational resources addressing the influence of RRT selection on patients' morbidity and mortality, autonomy, treatment delivery, and symptoms could help patients and their families select RRT options closely aligned with their values. Including information about the influence of RRT selection on patients' personal relationships and finances could enhance resources' cultural relevance for African Americans.

Sociocultural and socioeconomic influences on type 2 diabetes risk in overweight/obese African-American and Latino-American children and adolescents.

PURPOSE: It is unclear whether sociocultural and socioeconomic factors are directly linked to type 2 diabetes risk in overweight/obese ethnic minority children and adolescents. This study examines the relationships between sociocultural orientation, household social position, and type 2 diabetes risk in overweight/obese African-American (n = 43) and Latino-American (n = 113) children and adolescents. METHODS: Sociocultural orientation was assessed using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) questionnaire. Household social position was calculated using the Hollingshead Two-Factor Index of Social Position. Insulin sensitivity (SI), acute insulin response (AIRG) and disposition index (DI) were derived from a frequently sampled intravenous glucose tolerance test (FSIGT). The relationships between AHIMSA subscales (i.e., integration, assimilation, separation, and marginalization), household social position and FSIGT parameters were assessed using multiple linear regression. RESULTS: For African-Americans, integration (integrating their family's culture with those of mainstream white-American culture) was positively associated with AIRG (β = 0.27 ± 0.09, r = 0.48, P < 0.01) and DI (β = 0.28 ± 0.09, r = 0.55, P < 0.01). For Latino-Americans, household social position was inversely associated with AIRG (β = -0.010 ± 0.004, r = -0.19, P = 0.02) and DI (β = -20.44 ± 7.50, r = -0.27, P < 0.01). CONCLUSIONS: Sociocultural orientation and household social position play distinct and opposing roles in shaping type 2 diabetes risk in African-American and Latino-American children and adolescents.

The Images of Democracy: Tocqueville and American Exceptionalism

This thesis addresses how Alexis de Tocqueville’s political thought is related to American Exceptionalism. First, I illustrate the multiple meanings of the concept of American Exceptionalism and in what sense it is indebted to Tocqueville. Second, I articulate how the historical background and personal qualities of Tocqueville contribute to the success of his masterpiece Democracy in America. In the main part, by analyzing Tocqueville’s Democracy in America and other writings on America, I argue that he indeed reveals America as exceptional and increasingly recognizes this idea through a process of intellectual development. An elaboration on Tocqueville’s theoretical contribution to the discussion of American Exceptionalism can reveal the different images of modern democracy as he suggests and how they would influence the prospect of human freedom.

The providing resources to enhance African American patients' readiness to make decisions about kidney disease (PREPARED) study: protocol of a randomized controlled trial.

BACKGROUND: Living related kidney transplantation (LRT) is underutilized, particularly among African Americans. The effectiveness of informational and financial interventions to enhance informed decision-making among African Americans with end stage renal disease (ESRD) and improve rates of LRT is unknown. METHODS/DESIGN: We report the protocol of the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED) Study, a two-phase study utilizing qualitative and quantitative research methods to design and test the effectiveness of informational (focused on shared decision-making) and financial interventions to overcome barriers to pursuit of LRT among African American patients and their families. Study Phase I involved the evidence-based development of informational materials as well as a financial intervention to enhance African American patients' and families' proficiency in shared decision-making regarding LRT. In Study Phase 2, we are currently conducting a randomized controlled trial in which patients with new-onset ESRD receive 1) usual dialysis care by their nephrologists, 2) the informational intervention (educational video and handbook), or 3) the informational intervention in addition to the option of participating in a live kidney donor financial assistance program. The primary outcome of the randomized controlled trial will include patients' self-reported rates of consideration of LRT (including family discussions of LRT, patient-physician discussions of LRT, and identification of a LRT donor). DISCUSSION: Results from the PREPARED study will provide needed evidence on ways to enhance the decision to pursue LRT among African American patients with ESRD.

Due to her tender age: Black girls and childhood on trial in South Carolina, 1885-1920

Drawing on local criminal court records in western and central South Carolina, this dissertation follows the legal experiences of black girls in South Carolina courts between 1885 and 1920, a time span that includes the aftermath of Reconstruction and the foundational years of Jim Crow. While scholars continue to debate the degree to which black children were included in evolving conversations about childhood and child protection, this dissertation argues that black girls were critical to turn-of-the century debates about all children's roles in society. Far from invisible in the courts and jails of their time, black girls found themselves in the crosshairs of varying forms of power --including intraracial community surveillance, burgeoning local government, Progressive reform initiatives and military policy -- particularly when it came to matters of sexuality and reproduction. Their presence in South Carolina courts established boundaries between early childhood, adolescence and womanhood and pushed legal stakeholders to consider the legal implication of age, race, and gender in criminal proceedings. Age had a complicated effect on black girls' legal encounters; very young black girls were often able to claim youth and escape harsher punishments, while courts often used judicial discretion to levy heavier sentences to adolescents and violent girl offenders. While courts helped to separate early childhood from the middle years, they also provided a space for African-American children and family to engage a legal system that was moving rapidly toward disenfranchising blacks.

Virgin Territory: Theology, Purity, and the Rise of the Global Sex Trade

Sex sells. A lot. But who exactly is on the market?

What kinds of bodies are calibrated for traffic and consumption, and how exactly do they get there? When it comes to “sex” trafficking—which comprises a minority percentage of human trafficking, yet dominates the moral imagination as an “especially heinous” crime—the rise in predominantly white, evangelical Christian American interest in the trafficked subject galvanizes an ethical outrage that rarely observes critiques of race, ethnicity, sexuality or class as conditions of possibility. Though a nuanced mandate to fight trafficking is all but cemented in the contemporary American political and moral conscience, Virgin Territory accounts for the ways Christian ideas of purity annex both gender and sexuality inside the legacies of racialized colonial encounter, and foreground the market expansion of the global sex trade as it exists today.

In Part I, I argue that the narratives of virginity tied to Mary’s body simultaneously foregrounded the gendered, sexed Other as sparked disdain for the religious Other, for the Jewish body and for Mary’s Jewish identity. Through this analysis I explore the connections of racial identity to the Christian theological elision of Jewish election. I demonstrate how the questions of sexual ethics materialized at the site of the Virgin Mary, and align the moral attachments of sex and purity in the production of whiteness. These machinations, tied to the emerging European identity of empire, irrupt horrifically into the narrative ontology of dark flesh in Africa, Asia, and the Americas.

In Part II, I highlight the function of these narratives inside of the moments of colonial encounter, demonstrating how the logics of purity and virginity were directly applied to manage dark female flesh. I map the visual iconography of the Black Madonna first through a Dutch painting entitled The Rape of the Negress. I read this image through the social theological imagination instantiating the idea of the reprobate body and white imperial gaze. This analysis foregrounds a theological reading of Sarah Baartman, the “Hottentot Venus,” as the center of a complex sex trafficking investigation, outlining the genealogy of race, as well as the ideologies of the racial, ethnic and national Other, as mitigating factors in the conditions of possibility of a global sex trade. By restoring these narratives and their theological undertones, I reiterate the ways Christian thought is imbricated in the global sex trade, and propose theological strategies for rethinking humanitarian responses to sex trafficking.

A THEOLOGICAL NORMATIVE TO THE UNDERSTANDING OF FATHERHOOD IN THE AFRICAN AMERICAN COMMUNITY

ABSTRACT

This thesis examines the theological correlation between the role of the church, the identity and role of the African American male, and the effectiveness of fatherhood. The study begins with an in-depth analysis of how absentee fathers cause a crisis in the family. The absence of fathers from the home causes children to suffer financially, socially and psychologically, and therefore causes a disruption in the community as a whole. Focus on the Family founder and leader, Dr. James Dobson, confirms that “our very survival as a people will depend upon the presence or absence of masculine leadership in millions of homes.” In person interviews of African American Christian males and interpretation of the scriptures are just two of the methods used in this study to explore the theological norm of fatherhood. Collectively, the case studies and statistical data within this study explore attempts to remedy the crisis through governmental policies and networking within the community. The final chapter examines the role of urban churches and clergy in teaching effective fatherhood practices. Within the conclusion, it is made clear that the church is responsible for establishing the theological framework and principles for understanding the intended role of being a father. Another conclusion of this study is the acknowledgement of the African American community’s role in shaping and reforming the identity and role of the African American male as a father in the home. The African American community and the church must continue working in tandem to encourage organic social networks that will promote a model for effective fatherhood practices.

They’re There, Now What?: The Identities, Behaviors, and Perceptions of Black Judges

Prior to the Civil Rights Movement, fewer than 50 Black judges had been elected or appointed to the judiciary. As of August 2015, there are over 1,000 Black state and federal judges. As the number of black judges has increased, one question arises: have American courts been altered purely by this substantial increase? One expectation—and, at times, a prediction—behind the increased descriptive representation of Black judges is that their mere presence would alter the judiciary. It was supposed that these judges would substantively represent Black interests in the decisions they made. In other words, it was suspected, and predicted, that Blacks in the judiciary would enhance equality and justice by being aware of, responsive to, and advocating for African Americans. This theory about the likely role of Black judges derives from theoretical work on political representation and racial group consciousness, and empirical studies of Black elite behavior in other political institutions.

Despite such predictions, there is no corresponding scholarly consensus regarding whether Black judges possess a racial group consciousness and have racially distinctive judicial behavior. Therefore, the theory undergirding the demand for increased diversification, as a means to transform the judiciary, remains unsubstantiated. This is precisely where this project, “They’re There, Now What?: The Identities, Behavior, and Perceptions of Black Judges,” seeks to intervene in and explore, if not settle, the matter of whether black judges possess a racial group consciousness and exhibit racially-distinctive judicial behavior. It addresses a set of interrelated questions relevant to understanding whether we can view Black judges as representatives in ways that are similar to how we view other Black political officials. I examine these questions using a multi-method approach. For my analyses, I draw on diverse materials: the published biographies of every Black judge appointed to the federal bench, a survey experiment with a nationally-representative adult sample, and semi-structured interviews with 30 Black judges.

This research, which engages with scholarship on representation, group consciousness, judicial behavior, and candidate perceptions, offers new insights into the lives, perceptions, and behavior of Black judges, as well as the manifestations of Black substantive representation in the judiciary. My dissertation argues that, despite the general reluctance to use the term “representation” when referring to judges, we can consider Black judges as representatives. Black judges behave as substantive representatives by (1) sharing and understanding the experience, history, and perspectives of Black Americans, (2) challenging language, persons, policies, and laws they feel negatively affect, or violate the rights and liberties of, African Americans, (3) respecting African American litigants, and (4) ensuring the rights of African Americans are protected and the needs of black Americans are being met.

Only through research that considers the perspectives, identities, perceptions, and behavior of Black judges will we arrive at a more comprehensive understanding of the importance of racial diversity in the courts. As this project finds, a link between descriptive representation and substantive representation can, and frequently does exist within the judicial context. Such a link is significant given that Blacks’ liberty and justice through the American legal system continues to be subject to those who exercise judicial power. This dissertation has implications for the discourse surrounding the need for increased descriptive and substantive representation of Blacks in the judiciary, and the factors that affect representation in the justice system.

Examining the Crack Epidemic and Subsequent Drug Policy through Identifying Trends in Outpatient Substance Abuse Treatment for Crack Use/Abuse: 1995-2005

Disparities in the crack/cocaine discourse have changed drastically since its inception over 30 years ago. Since the late 1980s, research examining this particular abuse has become more complex as both nationally and globally crack use/abuse has been examined within various contexts. Crack use has often been framed as an African American problem in part resulting from the high volume of African Americans seeking treatment for illnesses associated with their crack-cocaine use, and more African Americans dying from crack-cocaine overdose. This logical fallacy persists despite evidence showing African Americans have lower substance use/abuse compared to Caucasians. Given the impact of the crack epidemic as well as its related drug policies on African American communities and their families, further examination of crack use/abuse is necessary. This study will discuss the crack epidemic historically and examine crack use among clients of a large sample of outpatient substance abuse treatment units over a decade period between 1995 and 2005.