Health beliefs and health care options of disparate black communities in the United States

According to the 1999 U.S. Census, there were approximately thirty-three million African Americans and approximately 1.8 million non-Hispanic black immigrants in the United States. The 1997 U.S. Census estimated that there were as many as 554,000 foreign-born Haitians and 505,000 foreign-born Jamaicans living in the United States, mainly residing in Florida and New York. The U.S. Census claims that blacks are one of the largest emerging ethnic groups in America constituting at least twelve percent of this country's population. Because of this increase, their specific health beliefs and health care options are increasingly nationally significant. ^ In the present intra-black and inter-ethnic study, two hundred seventy African Americans, Haitian immigrants, and Jamaican immigrants residing in South Florida were quantitatively and qualitatively surveyed in order to investigate their health beliefs and health care options. According to the reviewed literature, the three black ethnic groups researched in this study have not been compared or contrasted before in relation to these beliefs and health care choices. ^ As was discovered by the present research, differing health beliefs and health care options were the cultural products of the ethnic differences of the researched communities. It was expected that differing health beliefs among the researched black groups might indicate disparate patterns of health care utilization of either western or non-western models. Additionally, it was projected that by investigating the health beliefs and the health care options of these emerging black ethnic groups, western health care providers in the United States could become better versed in medically servicing growing ethnically-disparate black populations. The study yielded results about the researched groups that supported major findings in the reviewed literature. The data were reported and examined, and theoretical generalizations from the data were discussed. The most important of these findings was that, within a race, health beliefs and health care options were determined by specific ethno-cultural variables dependent on national origins. ^

Knowledge and perceptions about HIV/AIDS and safer sex practices among Korean-Americans in Dade County, Florida

This study was conducted to identify Korean-Americans' knowledge, perceptions, and efficacy (both self and response) relating to HIV/AIDS, as well as safer sex practices. Age, gender, education, Confucianism, religion, and acculturation were also examined for potential relationships with the main variables. A total of 200 Korean-Americans in Dade County, Florida, participated in the study. The mean age of the participants was 32.6 years (range 19-55). The AIDS Risk Assessment Questionnaire (ARA-Q) derived from the AIDS Risk Measurement Study Questionnaire (ARMS-Q) and the Risk Behavior Assessment (RBA) were used for data collection. The overall mean score of HIV/AIDS knowledge was 12.3 (77%) out of a possible 16. Knowledge, and perceptions about HIV/AIDS were not related to safer sex practices. Significant correlations between attitudes toward condoms and the frequency of condom use during oral intercourse were evident. Male subjects reported more sexual partners in their lifetime and more frequent condom use during vaginal intercourse during the last year than female subjects. The number of sexual partners in the last year was not related to perceived HIV/AIDS susceptibility and response-efficacy among men or women, but response-efficacy positively correlated to frequency of condom use among both genders. Acculturation scores were positively correlated with the number of sexual partners and the frequency of condom use during vaginal intercourse for men and women. Further research is needed to determine factors that may increase the cultural relevance of AIDS prevention strategies to the Korean-American community. The findings of this study may be used as a basis for designing culturally-sensitive HIV/AIDS education programs to reach various segments of this ethnic community. ^

Risk factors of coronary heart disease and correlates of type 2 diabetes among Cuban Americans

Cuban Americans, a minority Hispanic subgroup, have a high prevalence of type 2 diabetes. Persons with diabetes experience a higher rate of coronary heart disease (CHD) compared to those without diabetes. The objectives of the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) are to investigate the risk factors of CHD and the etiology of diabetes among diabetics of minority ethnic populations. No information is available on the etiology of CHD risks for Cuban Americans. ^ This cross-sectional study compared Cuban Americans with (N = 79) and without (N = 80) type 2 diabetes residing in South Florida. Data on risk factors of CHD and type 2 diabetes were collected using sociodemographics, smoking habit, Rose Angina, Modifiable Activity, and Willet's food frequency questionnaires. Anthropometrics and blood pressure (BP) were recorded. Glucose, glycated hemoglobin, lipid profile, homocysteine, and C-reactive protein were assessed in fasting blood. ^ Diabetics reported a significantly higher rate of angina symptoms than non-diabetics (P = 0.008). After adjusting for age and gender, diabetics had significantly (P < 0.001) larger waist circumference and higher systolic BP than non-diabetics. There was no significant difference in major nutrient intakes between the groups. One quarter of subjects, both diabetics and non-diabetics, exceeded the intake of percent calories from total fat and almost 60% had cholesterol intake >200 mg/d and more than 60% had fiber intake <20 gm/d. The pattern of physical activity did not differ between groups though, it was much below the recommended level. After adjusting for age and gender, diabetics had significantly (P < 0.001) higher levels of blood glucose, glycated hemoglobin, triglycerides, and homocysteine than non-diabetics. In contrast, diabetics had significantly (P < 0.01) lower levels of high-density lipoprotein cholesterol (HDL-C). ^ Multivariate logistic regression analyses showed that increasing age, male gender, large waist circumference, lack of acculturation, and high levels of triglycerides were independent risk factors of type 2 diabetes. In contrast, moderate alcohol consumption conferred protection against diabetes. ^ The study identified several risk factors of CHD and diabetes among Cuban Americans. Health care providers are encouraged to practice ethno-specific preventive measures to lower the burden of CHD and diabetes in Cuban Americans. ^

Ethnic and American identity development: A developmental systems approach

Given the role ethnic identity has as a protective factor against the effects of marginalization and discrimination (Umaña-Taylor, 2011), research longitudinally examining ethnic identity has become of increased importance. However, successful identity development must incorporate elements from both one's ethnic group and from the United States (Berry, 1980). Despite this, relatively few studies have jointly evaluated ethnic and American identity (Schwartz et al., 2012). The current dissertation, guided by three objectives, sought to address this and several other gaps in the literature. First, psychometric properties of the Multigroup Ethnic Identity Measure (MEIM) and the American Identity Measure (AIM) were evaluated. Secondly, the dissertation examined growth trends in recently immigrated Hispanic adolescents' and their caregivers' ethnic and American identity. Lastly, the relationship between adolescents' and caregivers' ethnic and American identity was evaluated. The study used an archival sample consisting of 301 recently immigrated Hispanic families collected from Miami (N = 151) and Los Angeles (N = 150). Consistent with previous research, results in Study 1 indicated a two-factor model reliably provided better fit than a one-factor model and established longitudinal invariance for the MEIM and the AIM. Results from Study 2 found significant growth in adolescents' American identity. While some differences were found across site and nationality, evidence suggested recently immigrated Hispanic adolescents were becoming more bicultural. Counterintuitively, results found a significant decline in caregivers' ethnic identity which future studies should further examine. Finally, results from Study 3, found several significant positive relationships between adolescents' and their caregivers' ethnic and American identity. Findings provided preliminary evidence for the importance of examining identity development within a systemic lens. Despite several limitations, these three studies represented a step forward in addressing the current gaps in the cultural identity literature. Implications for future investigation are discussed.

The impact of the Miami Cuban exile's political culture on the 1996 fiscal crisis of the city of Miami

The purpose of this study was to determine if the political culture of the Miami Cuban exile community was a significant factor in creating the environment that led to the 1996 fiscal crisis of the City of Miami. The study performed an ethnographic case study that utilized a triangulation strategy which included both qualitative and quantitative methods. Focus groups were conducted to ascertain qualitative and quantitative data as to differences among ethnic and generational groups regarding notions of governance, public administration practices, and overall political values and core beliefs. Quantitative data was obtained through a five year and seven month review of newspaper articles from two periodicals based in Miami-Dade County. A review was also conducted of secondary data in audit and management reports, blue ribbon commission studies, Certified Public Manager (CPM) enrollment, and legal case decisions to examine the administrative practices of the City of Miami leading up to and subsequent to its fiscal crisis. The study found that a political subculture of caudillismo was present in Cuban exile core areas of Miami that appears to have had an influence on the administrative practices and notions of governance that led to the fiscal crisis. The author concludes that an imported foreign political culture has imposed itself as a subculture in core areas of the exile community and that the operationalization of this subculture has manifested itself in non-mainstream notions of governance and public administration practices. ^

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.^

Safety habits promoted by Hispanic parents for school-aged and adolescent children

Accidents are the leading cause of death among children. Compliance with safety measures have been shown to reduce morbidity and mortality in children. However, Hispanic parents and children have not been adequately studied in the literature in regard to trauma and safety habits utilized. In this exploratory-descriptive study, a convenience sample of 48 Hispanic parents were questioned about their child's activities. The purpose was to determine what safety equipment was used during these activities and how often they were used. Responses to an English/Spanish questionnaire were summarized by frequencies and percentages. Findings suggested that these Hispanic children were at risk for injury due to a low percentage of children wearing the necessary protective equipment. Therefore, education must stress consistent use of safety equipment if injuries are to be prevented. ^

Clash of identities in South Florida: An examination of the complexity of racial and national identity and their impact on ethnic solidarity between black Americans and Jamaicans

Immigrants from the West Indies and other nations challenge the simple United States dichotomy of blacks versus whites. Many apparently black Caribbean immigrants proclaim that they did not know they were “black” until they arrived in the U.S. They seek to maintain their national identity and resist identity and solidarity with Black Americans. In response, many Black Americans respond that the immigrants are simply being naive, that U.S. society demands simple racial identity. Regardless of one's self-identity and personal history, in the U.S., if you look black, you are black, was their thinking. ^ This study examines the contemporary struggle of identity and solidarity among and between Black Americans and Jamaicans living in South Florida (Broward and Miami-Dade counties). Even though the primary focus of this study is to examine the relationship between Black Americans and Jamaicans, other West Indian nationals will be addressed more generally. The primary research problem of this study is to determine why the existence of common ancestry and physical traits are insufficient for an assumption of ethnic solidarity between Black Americans and Jamaicans. ^ In examining this problem, I felt that depth rather than breadth would provide insight into the current state of polarization between Black Americans and Jamaicans. To this end, a qualitative study was designed. A non-random snowball sample consisting of forty-seven informants was selected for this study. Realizing that such a technique presents problems with generalizations beyond the sample, this approach was, nonetheless, the most suitable for the current research problem. One of the initial challenges of this research was the use of the label “black” in discussing Caribbean immigrants. Unlike America, where distinctions based on skin color were at the bedrock of America's formation, this was not the case in the Caribbean. In the Caribbean skin color was an important marker as an indicator of class, rather than of race. Therefore, I refrained from using the label, “black Jamaicans,” but rather used Jamaicans throughout. ^

Black churchgoers, environmental activism, and the preservation of nature in Miami, Florida

The goal of this project was to explore activism, attitudes, and imagery connecting Black churchgoers in Miami, Florida and the natural environment. The research approach was qualitative, began as exploratory research, and used the techniques of snowball sampling, participant observation, and semi-structured interviews. Three case studies representing various socio-economic levels, denominations, participant education levels, and environmental facets were chosen for in-depth ethnographic research. There are three major findings in the research. First, there is a link between the preservation of Black history and the preservation of the environment among Black churchgoers, who feel strong connections to a sense of place, rural life, and the past. However their work is strongly directed to bring about benefits for people and the environment in the present and the future. Second, public access to public lands is a basic and important right espoused by these Black churchgoing activists. Third, the vocabulary used by Black churchgoing activists regarding the natural environment differs from today's “mainstream” environmentalists. The concept of “beauty” is pivotal to Black appreciation of and activism toward the environment and is reminiscent of the early environmental protection movement in the United States and conservationists such as John Muir. These findings concerning how Black spirituality relates to the environment adds to the sparse literature on the subject, and provides for potential linkages between Blacks and “mainstream” environmental groups to benefit both parties. An understanding of the connections between Black spirituality and perceptions of the environment should facilitate the development of better programs to improve and protect the environment. Environmental projects may also address the social and economic needs of Black communities, churches, and congregations, as well as the ecosystem. ^

The career development of Black female chief nurse executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.

A study of the differences among African -American, Hispanic, and Anglo women on the perceived barriers and strategies to career advancement in public school administration

Women have been traditionally excluded from the ranks of principals and district administrators in public school systems throughout the country. Traditionally, Anglo women have been more successful than African American and Hispanic women in breaking down the barriers that impede their ascension to the top. The purpose of this study was to ascertain how African American, Hispanic, and Anglo higher-level female administrators perceive the barriers that hinder their progress, the effects of the barriers, and the strategies to overcome the barriers. ^ Two hundred, sixty female administrators employed with Miami-Dade County Public Schools and serving in the role of principal or higher were mailed a questionnaire consisting of 49 questions centering on personal and professional characteristics, perceptions of barriers, perceived effects of barriers, and strategies to overcome the barriers. One hundred, seventy-five questionnaires were returned. To analyze the respondents' personal and professional characteristics, cross tabulations were conducted on the demographic information and on the strategies. ANOVA was conducted on the barriers and the effects of the barriers by ethnic groups. Tukey's test for post-hoc comparisons was utilized to identify groups with means significantly divergent from those of other ethnicities. ^ The data revealed that Hispanic female higher-level administrators who returned the questionnaire were more likely to be married and have children as compared to Anglo and African American female administrators. When addressing the barriers to career success, African American females had a higher mean score on 14 of the 17 barriers to career success as compared to the other ethnic groups. Hispanic female administrators proved to be more successful in utilizing the strategies to overcome career barriers. The strategy, forming a “New Girl Network,” was the least utilized with 79 of the respondents reporting that they had never used it. ^ It is concluded that there is strong need for female administrators to network, mentor, and support one another. Also, it is imperative that the success of particular groups in certain areas is shared with others. ^

Ethnic identity, self-esteem and academic factors in second -generation post-1970 Jamaican immigrants

Immigrants from Jamaica represent the largest number of migrants to the United States from the English speaking Caribbean. Research indicates that of all Caribbean immigrants they are most likely to retain the ethnic identity of their home country for the longest period of time. This dissertation explored the nature of ethnic identity and sought to determine its impact upon the additional variables of self-esteem and academic factors. A secondary analysis was carried out using data collected in the Spring of 1992 by Portes and Rumbaut on the children of immigrants attending the eighth and ninth grades in local schools in San Diego and southern Florida. A sample of 151 second-generation Jamaican immigrants was selected from the data set. ^ Six hypotheses yielded mixed results. Both parents who have a Jamaican ethnic identity present in the household are the best predictor Jamaican youth who retain a Jamaican ethnic identity. It was expected that ethnic identity would be a predictor of positive academic factors. The study showed that ethnic identity was not associated with one of the academic factors which were examined: help given with homework. ^ Neither family economic status nor parents' level of education played a significant role in the retention of Jamaican identity. Other findings were that there was no mean difference in the self-esteem scores of respondents who had similar ethnic identities to their parents and those who did not. There was also no difference found in the academic factors of either group. The study also showed that there was a small correlation between parent-child conflict and self-esteem. Specifically, the study found that the higher the conflict between youth and their parents, the lower the self-esteem of the youth. Finally it found that time lived in the U.S. was the best predictor of a higher GPA and it was also related to lower self-esteem. ^ Surprisingly, the study found that the relationship between ethnic identity and SES was the opposite of what was expected in that it found that SES was higher when there was no Jamaican identity. ^

A study of the relationship between parental self-efficacy and indicators of school involvement exhibited by Hispanic parents of elementary school children

The purpose of this study was to examine the relationship between Hispanic parents' sense of self-efficacy at various degrees of acculturation to the United States and specific indicators of school involvement in their elementary school children's education. It assessed the effects of acculturation on the level of parental self-efficacy and their degree of school involvement. The theoretical framework guiding this investigation was Bandura's theory of self-efficacy which advocates that the amount of effort a person devotes to the accomplishment of a specific outcome is related to a person's beliefs in their capabilities regardless of actual competencies.^ The research method involved a correlational design measuring levels of parental self-efficacy, acculturation, degree of school involvement and related demographic characteristics. Multiple regression analysis was performed to determine the degree of relationships existing between the predictor variables of self-efficacy and level of acculturation, and level of school involvement. The data was subjected to a path analysis to test the validity of the causal model advanced in this study specifying a positive relationship between the constructs of acculturation, parental self-efficacy and level of school involvement.^ A total of 109 Hispanic parents of students enrolled in five elementary public schools in Dade County, Florida, were selected for participation in the study. Results revealed a significant positive correlation r =.23, p $<$.05 between level of parental self-efficacy and number of hours parents spent helping their children with homework. A statistically significant positive correlation was found between acculturation and level of self-efficacy r =.21, p $<$.05. Statistically significant positive correlations were also found between acculturation and such indicators of parental school involvement as participation in parent-teacher conferences r =.20, p $<$.05, volunteering at school, r =.22, p $<$.05, attendance at school sponsored sports activities r =.26, p $<$.01, and volunteering in field-trips r =.28, p $<$.01.^ The multiple regression analysis equation predicting level of homework assistance provided by parents and self-efficacy was statistically significant, F(2,106) = 3.59, p $<$.03. The beta weights revealed that self-efficacy contributed the most to the prediction of homework assistance by parents, B =.258, p $<$.009. In turn, the variable of acculturation was the most significant predictor of number of school based parent involvement activities, B =.281, p $<$.05 level. The path analysis confirmed the results obtained in the multiple regression analyses, establishing self-efficacy as having a direct effect on the level of homework assistance provided by parents. Conversely, the variable of acculturation had a direct effect on the number of school based parent involvement activities. ^

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. ^

A study of dual cultures in dyadic relations

Elderly caregiving, a fact of life for millions of Americans, has gained significance with the increase in the elderly population. Over 25 million family caregivers in the US, most of whom are women rearing their own children, care for severely ill or disabled family members. The increased flow of women into the labor force has caused this traditional role to be entrusted to hired caregivers, mainly home health aides. ^ This case study describes and explains the dyadic experiences of elderly Jewish clients and their Jamaican home health aides in a mixed-culture environment. The inquiry was conducted with a purposive sample of four dyads, their case manager, and the placement officer, all of whom were selected through a home care agency in Fort Lauderdale, Florida. Strategies of data collection including non-participant observation, interviews, document analysis, and researcher's journals. Data from verbatim transcription of interviews and field notes were coded, sorted into emic categories, and reduced as linkages were identified via cross-case comparison. Three major themes—mixed-culture experiences, relationship building and maintenance, and agency role perceptions—emerged from the interpretative analysis of the data. ^ Assertions from these findings include that dyads have established a range of relationships to meet their personal needs, expectations, and desires in these goal-driven relationships. Relationally, they have reached interactional synchrony with some achieving the ideal family-type bond. Cultural difference is but one of the many contextual variables in the home care environment, which has its own cultural norms and expectations. Conflicts transcend cultural difference and seemed more a factor of individual relational disposition. ^