Medical advice and diabetes self-management reported by Mexican-American, Black- and White-non-Hispanic adults across the United States

Background Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results Although medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

Syndemic health disparities and resilience processes related to HIV transmission risk among African American/Black men in south Florida

Rates of HIV infection continue to climb among minority populations and men who have sex with men (MSM), with African American/Black MSM being especially impacted. Numerous studies have found HIV transmission risk to be associated with many health and social disparities resulting from larger environmental and structural forces. Using anthropological and social environment-based theories of resilience that focus on individual agency and larger social and environmental structures, this dissertation employed a mixed methods design to investigate resilience processes among African American/Black MSM.^ Quantitative analyses compared African American/Black (N=108) and Caucasian/White (N=250) MSM who participated in a previously conducted randomized controlled trial (RCT) of sexual and substance use risk reduction interventions. At RCT study entry, using past 90 day recall periods, there were no differences in unprotected sex frequency, however African American/Black MSM reported higher frequencies of days high (P<0.000), and drugs and sex used in combination (P<0.000), and substance dependence (P<0.000) and lower levels of social support (P<0.024) compared to Caucasian/White MSM. At 12- month follow-up, multi-level statistical models found that African American/Black MSM reduced their frequencies of days high and unprotected sex at greater rates than Caucasian/White MSM (P<0.001).^ Qualitative data collected among a sub-sample of African American/Black MSM from the RCT (N=21) described the men's experiences of living with multiple health and social disparities and the importance of RCT study assessments in facilitating reductions in risk behaviors. A cross-case analysis showed different resilience processes undertaken by men who experienced low socioeconomic status, little family support, and homophobia (N=16) compared to those who did not (N=5).^ The dissertation concludes that resilience processes to HIV transmission risk and related health and social disparities among African American/Black MSM varies and are dependent on specific social environmental factors, including social relationships, structural homophobia, and access to social, economic, and cultural capital. Men define for themselves what it means to be resilient within their social environment. These conclusions suggest that both individual and structural-level resilience-based HIV prevention interventions are needed.^

Medical Advice and Diabetes Self-Management Reported by Mexican-American, Black- and White-Non-Hispanic Adults Across the United States

Background: Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods: We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 MexicanAmericans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with ‘undiagnosed diabetes’ [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants’ diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results: Although medical advice to the patient is considered a standard of care for diabetes, approximately onethird of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions: Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

Syndemic Health Disparities and Resilience Processes Related to HIV Transmission Risk among African American/Black Men in South Florida

Rates of HIV infection continue to climb among minority populations and men who have sex with men (MSM), with African American/Black MSM being especially impacted. Numerous studies have found HIV transmission risk to be associated with many health and social disparities resulting from larger environmental and structural forces. Using anthropological and social environment-based theories of resilience that focus on individual agency and larger social and environmental structures, this dissertation employed a mixed methods design to investigate resilience processes among African American/Black MSM. Quantitative analyses compared African American/Black (N=108) and Caucasian/White (N=250) MSM who participated in a previously conducted randomized controlled trial (RCT) of sexual and substance use risk reduction interventions. At RCT study entry, using past 90 day recall periods, there were no differences in unprotected sex frequency, however African American/Black MSM reported higher frequencies of days high (P Qualitative data collected among a sub-sample of African American/Black MSM from the RCT (N=21) described the men’s experiences of living with multiple health and social disparities and the importance of RCT study assessments in facilitating reductions in risk behaviors. A cross-case analysis showed different resilience processes undertaken by men who experienced low socioeconomic status, little family support, and homophobia (N=16) compared to those who did not (N=5). The dissertation concludes that resilience processes to HIV transmission risk and related health and social disparities among African American/Black MSM varies and are dependent on specific social environmental factors, including social relationships, structural homophobia, and access to social, economic, and cultural capital. Men define for themselves what it means to be resilient within their social environment. These conclusions suggest that both individual and structural-level resilience-based HIV prevention interventions are needed.

Representation of people of color in the nineteenth century slavery novel in Cuba and Brazil

This dissertation explores the similarities and differences which characterize the depiction of people of color in certain representative nineteenth century Cuban and Brazilian slavery novels as a function of the authorial approach of each territory's literary tradition toward the issues of slavery, racial prejudice, and people of color. The selected texts, derived from the peak periods in slavery literature of each territory, include Francisco , by Anselmo Snárez y Romero; Sab, by Gertrudis Gómez de Avellaneda; Cecilia Valdés , by Cirilo Villaverde; A escrava Isaura, by Bernardo Guimarães; O mulato, by Aluísio Azevedo; and Bom-Crioulo, by Adolfo Caminha. While the present study explores the enslavement, abuse, and discrimination of people of color as a consequence of a deep-seated discourse of power, privilege and racial superiority, it focuses more extensively on the representation of people of color, particularly in their capacity to constructively appropriate the cultural values of the white dominant group and recognize their identity as ambiguous. ^ Said's theories of Orientalist discourse and geography and formation as well as Dube's perspective on subaltern-oriented studies provide a theoretical framework for exploring the response of slavery writers whose common exposure to slavery but dissimilar socio-political contexts generate some startling findings. Crafted within a period of political repression, fear of black revolt, factional in-fighting as well as strong socioeconomic ties to the slaveholding class, the Cuban texts generally fashioned an approach to slavery as one marked by moderation, reform, and cultural counter discourse and consequently depict people of color with a more passive but culturally authentic outlook. On the other hand, the Brazilian response to the issue of slavery, steeped in an ideological amalgam of liberalism, positivism, republicanism, and abolitionism, is characterized by overt opposition to slavery and a representation of people of color that is less concerned with cross-cultural input but reclaims their humanity as highly educable and socially mobile persons in search of greater freedoms. Ultimately, there is a shared message of higher significance couched in the worthwhile mission of raising slaves to the level of men. ^

A study of intrablack conflict and work attitudes within an African American organization

The present research evidences a field setting studying attitudinal and behavioral results of five Black group contacts. The research was designed, in part, to determine the demographic, cultural, social, and psychological factors associated with intrablack perceptions of conflict and work attitudes in an African American organization. Two organizational groups, African Americans and Caribbean/West Indians totaling 112 participants were studied. The objective of the research was to gain information about attitudinal levels perceived by each of the two groups. Each group rated the other group on items dealing with conflict and work attitudes. One-way analysis of variances (ANOVAs) were employed to test the overall differences on scale means among the groups. The findings in this study buttress some of the major themes in the impressionistic literature on cultural/multicultural diversity in organizations and Caribbean/West Indian literature. The data are reported and examined, and theoretical implications are discussed. ^

Maria W. Stewart: America's first Black feminist

Maria W. Stewart was the first American-born and the first African-American woman known to address a mixed audience, from 1831 to 1833, and publish her essays and speeches. The purpose of this thesis is to examine Maria W. Stewart's acts of defiance--as the first public representation of Black Feminism: demanding that white America end slavery and grant rights to black men and women, re-appropriating the hegemonic, patriarchal codes which have significant social power by exposing their inconsistencies and deconstructing their ideologies, voicing the truth about the status of African-American women in early nineteenth-century America, and challenging Black women to become entrepreneurs and (as she did) acquire an education, establish schools, and take an active role in their community. ^

A comparative study of perceptions about social relations between black Caribbean nationals and African Americans in a black institution

The present study researched how first-generation black national Caribbean groups and native born black Americans perceived each other socially within an African American institution. Each group rated the other group on items dealing with perceived social relations. Two black ethnically-distinct communities totaling 151 participants were studied. Chi-square ($\chi\sp2$) and one-way analyses of variances (ANOVAs) were employed to test the collected data. The study yielded results about the researched groups that supported both the major findings in the review literature and the thesis's hypothesis; namely, that black Caribbean nationals tend to perceive that they relate socially more with their own group than with African Americans even as mutual participants in a monoracial institution. The present study was unique, as it incorporated a multinational Caribbean group and an African American group that the literature has not previously researched together, and especially as it surveyed these two groups in the context of a black-owned institution. ^

Schools and the formation of Black identity during the Civil Rights Movement: Change and resistance in Holly Springs, Mississippi, 1964--1974

Desegregation of social and public spaces was the most visible result of the Civil Rights Movement. After 1960, the integration of schools in Mississippi became a source of conflict. The social change of Civil Rights attacked the social order of White Resistance that supported the state superstructure. The public schools were a place for the discovery of identity for Blacks. The integrated on of the schools caused many Whites to leave rather than be integrated with Blacks. Desegregation of schools was also a slow process because the local and state government could not enforce the decisions of the US Courts, leading Blacks to realize their place in American society could only be secured through individual action. ^ This work explains the role of schooling during the integration of the Holly Springs Separate School System. The process of forging a new identity by local Blacks is examined against the forces of social change and resistance. I addition, this work examines the perils for the Blacks as they faced the uncertainty of change in the crucial Civil Rights years between 1964 and 1974. ^ This work analyzes how the Black community dealt with the problems triggered by the desegregation of the school system in Holly Springs, of a constructed social condition, a psychological state of being, the realities of racism and segregation, and the change and resistance between the individual and the collective. It is based on six months of field work investigation. Although the schools were a crucial aspect of community life for Blacks and Whites, Blacks did form their identity in them. Other institutions, such churches were more crucial. Second, the aspect of politeness and belief in law made the experience in Holly Springs unique to that place, and thus, warrants further study to determine its place within the Civil Rights Movement. Finally, while the political and economic control of Holly Springs remained with Whites, desegregation led to the resegregation of the public schools: as Whites left to private schools. ^

Academic achievement orientation of West Indian American parents and adolescents

Literature addressing academic achievement orientation of Black adolescents in the United States often depicts poor school related attitudes and adaptation patterns, low academic achievement, and deficient family backgrounds. However, some researchers maintained that certain Black immigrant groups possessed positive academic achievement orientations and exemplary academic achievements (Ogbu, 1991; Gibson, 1991; Vernez, & Abrahamse, 1996). In this study, I attempted to combine qualitative data from multiple sources (surveys, interviews, observations, literature, and document analysis), using standard case study methodology and the constant comparative method of analysis to understand the relationship that existed between the academic achievement orientation of a select group of West Indian American parents and adolescents in Broward County, Florida. The sub-sample of 11 families, comprising 15 adolescents and 13 parents, was selected through maximum variation sampling from a pool of 23 families. The findings were presented as a single composite case study. The participants possessed specific, longstanding educational and career goals for the children. The parents were deeply involved and were knowledgeable of their children's schools and academic progress. While mothers were the parents most actively involved in the schools, fathers were strong authoritative figures. Families evidenced a strong moral religious base with set rules of behavior, firm parenting practices, and established chains of authority. Family members emphasized education over material things; reading over audiovisual or social activities; family cohesion over individual wishes; and academics over extracurricular activities. The parents' strong positive academic achievement orientation was communicated to the children and reinforced by relatives, family friends, and others. In turn, the adolescents possessed positive school-related attitudes and attributional styles. While they admitted their parents were somewhat strict, they voluntarily complied with the rules and were highly motivated to succeed because they believed their parents deeply cared for them and that education leads to success and upward mobility. Each adolescent was pursuing an academic track and planning for college and specific profession. The findings support Ogbu's cultural ecological model (1991). I recommend these findings to teachers, counselors, administrators, parents, and others working with West Indian American families. ^

Black middle school students' perceptions of success and their influence on academic performance

The purpose of the study was to investigate the perceptions of success held by Black middle school students in a Miami-Dade County (FL) public school and how these perceptions influence academic performance. The study sought to determine if differences exist among African-American, Haitian-American, and Haitian immigrant subgroups of the Black student population. ^ The study combined qualitative and quantitative methodology in data collection and analysis. The qualitative data consisted of three focus group interviews. Using a semi-structured protocol, questions focused on the student's perceptions of the characteristics of successful people, definitions of success, behaviors associated with achieving success, and peer, family and school support. The quantitative data comprised the responses of 352 Black middle school students to the Inventory of Student Motivation (ISM) developed to measure mastery, performance and social goal orientations. Response similarities and differences were examined using a series of two-way ANOVAs on the success scales by gender and culture. A three-way repeated measures ANOVA was conducted on mastery, performance and social general goal scales by culture and gender. ^ The results of the ISM revealed no statistically significant differences among African-American, Haitian-American, and Haitian students in their mastery, performance or social goal orientations. All three cultural groups scored significantly high on the mastery goal scale. There was a significant effect for gender on the mastery general scale with the females being more concerned with mastery than the males. Qualitative focus group interview results included varying definitions of success. African-American and Haitian-American students defined success in materialistic terms. Haitian students defined success in scholastic achievement terms. All students indicated hard work, persistence and goal setting through completion as important to achieving success. Negative influences included peer pressure, teacher and societal expectations, and classroom environment. Parental reaction to low academic performance varied by culture. ^

Rich and poor, white and black, free and slave: The social history of Cuba's tobacco farmers, 1763--1817

Tobacco was of primary importance to Spain, and its impact on Cuba's economy and society was greater than just the numbers of farms, workers, or production, demonstrated by the Spanish crown's outlay of monies for capital assets, bureaucrats' salaries, and payments to farmers for their crop. This study is a micro- and macro-level study of rural life in colonial Cuba and the interconnected relationships among society, agricultural production, state control, and the island's economic development. ^ By placing Cuba's tobacco farmers at the forefront of this social history, this work revisits and offers alternatives to two prevailing historiographical views of rural Cuba from 1763 (the year Havana returned to Spanish control following the Seven Years' War) to 1817 (the final year of the 100-year royal monopoly on Cuban tobacco). Firstly, it argues against the primacy of sugar over other agricultural crops, a view that has shaped decades of scholarship, and challenges the thesis which maintains the Cuban tobacco farmer was almost exclusively poor, white, and employed free labor, rather than slaves, in the production of their crop. ^ This study establishes the importance of tobacco as an agricultural product, and argues that Cuban tobacco growers were a heterogeneous group, revealing the role that its cultivation may have played in helping some slaves earn their freedom. ^

The effects of using rap music on the fluency skills of 2nd grade African American students

A concern for both educators and policy makers is how to increase the reading achievement of African American students. Studies have shown that rap music, which has its roots in the African American community, can be used as a tool to facilitate this increase, specifically how using rap songs in reading lessons can improve a child's reading motivation, information recall, and vocabulary development. There are also studies on how repeated reading of a text can help improve a child's reading fluency. Yet, there are no studies that combine rap music and repeated reading of a text. This study describes the effects of using a culturally responsive reading strategy on the fluency, decoding, and comprehension skills of African American students. ^ The sample consisted of 105 African American students within eight, second grade classrooms at two different elementary schools. The classes were randomly selected and assigned to the rap group or the control group. Students received eight half-hour sessions using either a rap text or a traditional text in a repeated reading lesson. All of the students were pre-tested and post-tested on the Oral Reading Fluency and the Nonsense Word Fluency portions of the Dynamic Indicators of Basic Literacy Skills Test. Additionally, a researcher constructed comprehension quiz was given to the students at the beginning, middle, and end of the study. Research questions were analyzed using ANOVAs and t tests. ^ The hypotheses were not supported but there was some evidence that rap music in a reading lesson helped improve the fluency skills of African American students at one of the schools. The results also revealed that rap music used in a reading lesson initially improved the comprehension skills of African American students. The rap treatment may not have worked best overall because of the lack of intensity of the treatment. ^ The study has shown some evidence to support using culturally appropriate materials such as rap with students. There needs to be more research on the interaction between teaching methods, materials, and students. ^

Stereotype threat and the standardized testing experiences of African American children at an urban elementary school

Stereotype threat (Steele & Aronson, 1995) refers to the risk of confirming a negative stereotype about one’s group in a particular performance domain. The theory assumes that performance in the stereotyped domain is most negatively affected when individuals are more highly identified with the domain in question. As federal law has increased the importance of standardized testing at the elementary level, it can be reasonably hypothesized that the standardized test performance of African American children will be depressed when they are aware of negative societal stereotypes about the academic competence of African Americans. This sequential mixed-methods study investigated whether the standardized testing experiences of African American children in an urban elementary school are related to their level of stereotype awareness. The quantitative phase utilized data from 198 African American children at an urban elementary school. Both ex-post facto and experimental designs were employed. Experimental conditions were diagnostic and non-diagnostic testing experiences. The qualitative phase utilized data from a series of six focus group interviews conducted with a purposefully selected group of 4 African American children. The interview data were supplemented with data from 30 hours of classroom observations. Quantitative findings indicated that the stereotype threat condition evoked by diagnostic testing depresses the reading test performance of stereotype-aware African American children (F[1, 194] = 2.21, p < .01). This was particularly true of students who are most highly domain-identified with reading (F[1, 91] = 19.18, p < .01). Moreover, findings indicated that only stereotype-aware African American children who were highly domain-identified were more likely to experience anxiety in the diagnostic condition (F[1, 91] = 5.97, p < .025). Qualitative findings revealed 4 themes regarding how African American children perceive and experience the factors related to stereotype threat: (1) a narrow perception of education as strictly test preparation, (2) feelings of stress and anxiety related to the state test, (3) concern with what “others” think (racial salience), and (4) stereotypes. A new conceptual model for stereotype threat is presented, and future directions including implications for practice and policy are discussed.

Swimming against the tide: A study of a youth enrichment program seeking to empower inner-city Black youth

Serious inequities in our K-12 public education system, particularly in regard to the quality of education in predominately Black inner-city schools, are well-documented in the literature (Freeman, 1998; Ross, 1998). Moreover, there is general agreement that the most effective means of ameliorating that situation is through well-thought-out after-school programs and partnership initiatives (Beck, 1993; Gardner et al., 2001). ^ The purpose of this qualitative study was to examine the programmatic interventions of a youth enrichment program for inner-city Black youth currently in place at the Overtown Youth Center (OYC) in Miami, Florida, in order to: (a) discern those factors that support its claim that it is making a difference in students’ lives, (b) explore how any such factors are implemented, and (c) determine whether its interventions have served to equalize the playing field for these youth. ^ Two primary methods of data collection were used for this study. The first was participant observation conducted over the course of two years through a partnership initiative established and led by this author. The second was through in-depth interviews of the Center’s founder, staff, and students. Secondary methods used were the recording of informal conversations and the analysis of written documents. ^ Analysis of the data yielded four features of the Center that are indispensible to the students’ growth. The center provides the youth with (a) physical and psychological safety, (b) supportive relationships, (c) exposure to cultural and educational opportunities, and (d) assistance in building self-esteem. ^ The most significant finding of the study was that OYC has been successful at making a difference in students’ lives and at increasing their aspirations to attend college. By addressing the full spectrum of their needs, the Center has given them many of the necessary tools with which to compete and thereby helped equalize their opportunities to succeed in school and in life. ^ The study also noted a number of challenges for the Center to examine. The main issues that need to be addressed more seriously are staff turnover, staff indifference, nepotism, inconsistent student attendance, and insufficient focus on racial issues and African-American-centered education. Meeting those challenges would engender even greater positive outcomes.^