Sociodemographic characteristics as predictors of successful smoking cessation among a group of Hispanic Spanish speaking smokers

Few studies have examined predictors of smoking abstinence among Hispanic groups. The purpose of this dissertation was to examine the relations of sociodemographic characteristics and smoking related factors with smoking abstinence among a group of Hispanic Spanish speaking smokers. This study utilized previously collected data from Hispanic Spanish-speaking smokers (N = 246) who participated in a study entitled Smoking Cessation Services for Hispanic Smokers in Texas. ^ The first study examined sociodemographic characteristics and smoking related mechanisms that predicted smoking abstinence among this group. Two of the characteristics were related to smoking abstinence, marital status and acculturation level. Being unmarried increased the likelihood of being abstinent at the 12 week assessment (OR = 1.80). Those in the high acculturation group were twice as likely to be abstinent (OR = 2.24). Of the smoking related mechanisms, those with higher positive reinforcement expectancies were less likely to be abstinent (OR = .86), as were those with a higher level of affiliative attachment (OR = .86), a higher level of craving (OR = .78) and a higher tolerance to the effect of smoking (OR = .74). The second study was to examine the relationship of objective measures of socioeconomic status (SES) (income, education, or employment) with smoking abstinence among this group. This study also compared the relationship of a subjective measure of SES (Social Status Ladder) to smoking abstinence. None of the objective measures of SES were related to smoking abstinence at the 12 week assessment. The subjective measure of SES did predict smoking abstinence (OR = 1.9) indicting that those that rated themselves ≤4 on the SES scale were more likely to be abstinent. ^ Although this group was recruited using various methods across the state of Texas, the fact that they preferred to interact with the counselor in Spanish may limit the study findings. The results of this study highlight the need for research to examine specific subgroups of people and understand the special circumstances that influence their health behaviors. Furthering our knowledge of the relations between sociodemographic characteristics and smoking cessation could lead to interventions that reduce disparities in smoking cessation. ^

Racial/ethnic differences in factors influencing screening and treatment among prostate cancer patients

Background. Racial/ethnic differences have been found in various aspects of cancer care. But a limited number of studies have examined the racial/ethnic differences in predictors of prostate-specific antigen (PSA) screening in a group of prostate cancer patients and have attempted to identify the racial/ethnic differences in treatment discussions, treatment choice and treatment received for organ-confined localized prostate cancer (PCa) among three major racial/ethnic groups of the USA. This study was conducted to redress this lack of information. ^ Methods. This study was conducted on a group of 935 prostate cancer patients representing all three major race/ethnic groups (Whites, African Americans and Hispanics) who were treated at various medical institutes of the Texas Medical Center, Houston between 1996 and 2004 to identify the racial/ethnic differences in predictors of PSA screening. A subset of 640 patients who had organ-confined localized prostate cancer was selected to examine the racial/ethnic differences in treatment discussions, treatment choice and treatment received for their localized prostate cancer. They were interviewed by trained research interviewers of MD Anderson Cancer Center using a validated structured questionnaire. ^ Results. The results showed that African American (54.4%) and Hispanic patients (42.3%) were significantly less likely (p=0.004 and p<.001, respectively) than White patients (63.2%) to report having had PSA screening before their prostate-cancer diagnosis. Among Whites, only education and annual check-ups predicted the use of PSA screening, whereas in African Americans two more additional factors, marital status and bode-mass index (BMI), significantly predicted PSA screening. Among Hispanics, like two other groups, education and annual check-ups also appeared as a significant predictor of PSA screening. ^ Results from multivariable logistic regression showed that African American patients were 15% less likely (OR=0.85, 95% CI=0.61-1.17, p=0.32) and Hispanics patients were 40% less likely (OR=0.60, 95% CI=0.41-0.87, p=0.008) to undergo PSA screening than Whites after adjusting for education and age at diagnosis for African Americans, and for education, annual check-ups and age at diagnosis for Hispanics. ^ This study revealed that health professionals were less likely to discuss surgery (79.9% vs. 93.2%) and watchful waiting (27.9% vs. 43.9%) with Hispanics compared to Whites. African Americans were more likely to choose (35.1% vs. 27.7%) and receive radiation therapy (38.3% vs.31.4%) than Whites. A comparison of concordance between treatment choice and treatment received showed that the highest concordance was found for watchful waiting and radiation therapy among African Americans (100% and 85.9%, respectively) whereas the highest concordance (96.9%) was found for surgery among Hispanics. ^ Conclusions. In this multiethnic study, the rates of PSA screening and its potential predictors varied by racial/ethnic groups. Substantial racial/ethnic variations were also found in treatment discussion, but the differences were not evident for treatment choice and treatment received. Health-education programs and culturally appropriate educational outreach efforts, especially targeted for high-risk groups, are needed to reduce these disparities. In the current climate of uncertainty about the benefits of PSA screening, or the benefit of one treatment over others, men should have access to information and services regardless of race/ethnicity so that they can make informed decisions. Further in-depth studies are needed in other settings to confirm these findings with the goal of developing an intervention to address these concerns. ^

A systematic review of community-based colorectal cancer screening randomized controlled trials with multi-ethnic groups

Background. The CDC estimates that 40% of adults 50 years of age or older do not receive time-appropriate colorectal cancer screening. Sixty percent of colorectal cancer deaths could be prevented by regular screening of adults 50 years of age and older. Yet, in 2000 only 42.5% of adults age 50 or older in the U.S. had received recommended screening. Disparities by health care, nativity status, socioeconomic status, and race/ethnicity are evident. Disparities in minority, underserved populations prevent us from attaining Goal 2 of Healthy People 2010 to “eliminate health disparities.” This review focuses on community-based screening research among underserved populations that includes multiple ethnic groups for appropriate disparities analysis. There is a gap in the colorectal cancer screening literature describing the effectiveness of community-based randomized controlled trials. ^ Objective. To critically review the literature describing community-based colorectal cancer screening strategies that are randomized controlled trials, and that include multiple racial/ethnic groups. ^ Methods. The review includes a preliminary disparities analysis to assess whether interventions were appropriately targeted in communities to those groups experiencing the greatest health disparities. Review articles are from an original search using Ovid Medline and a cross-matching search in Pubmed, both from January 2001 to June 2009. The Ovid Medline literature review is divided into eight exclusionary stages, seven electronic, and the last stage consisting of final manual review. ^ Results. The final studies (n=15) are categorized into four categories: Patient mailings (n=3), Telephone outreach (n=3), Electronic/multimedia (n=4), and Counseling/community education (n=5). Of 15 studies, 11 (73%) demonstrated that screening rates increased for the intervention group compared to controls, including all studies (100%) from the Patient mailings and Telephone outreach groups, 4 of 5 (80%) Counseling/community education studies, and 1 of 4 (25%) Electronic/multimedia interventions. ^ Conclusions. Patient choice and tailoring education and/or messages to individuals have proven to be two important factors in improving colorectal cancer screening adherence rates. Technological strategies have not been overly successful with underserved populations in community-based trials. Based on limited findings to date, future community-based colorectal cancer screening trials should include diverse populations who are experiencing incidence, survival, mortality and screening disparities. ^

Impact of traffic pollution on telomere length and chronic diseases: Results from the multi-ethnic study of atherosclerosis and the Mexican-American cohort study

Exposure to air pollutants in urban locales has been associated with increased risk for chronic diseases including cardiovascular disease (CVD) and pulmonary diseases in epidemiological studies. The exact mechanism explaining how air pollution affects chronic disease is still unknown. However, oxidative stress and inflammatory pathways have been posited as likely mechanisms. ^ Data from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Mexican-American Cohort Study (2003-2009) were used to examine the following aims, respectively: 1) to evaluate the association between long-term exposure to ambient particulate matter (PM) (PM10 and PM2.5) and nitrogen oxides (NO x) and telomere length (TL) among approximately 1,000 participants within MESA; and 2) to evaluate the association between traffic-related air pollution with self-reported asthma, diabetes, and hypertension among Mexican-Americans in Houston, Texas. ^ Our results from MESA were inconsistent regarding associations between long-term exposure to air pollution and shorter telomere length based on whether the participants came from New York (NY) or Los Angeles (LA). Although not statistically significant, we observed a negative association between long-term air pollution exposure and mean telomere length for NY participants, which was consistent with our hypothesis. Positive (statistically insignificant) associations were observed for LA participants. It is possible that our findings were more influenced by both outcome and exposure misclassification than by the absence of a relationship between pollution and TL. Future studies are needed that include longitudinal measures of telomere length as well as focus on effects of specific constituents of PM and other pollutant exposures on changes in telomere length over time. ^ This research provides support that Mexican-American adults who live near a major roadway or in close proximity to a dense street network have a higher prevalence of asthma. There was a non-significant trend towards an increased prevalence of adult asthma with increasing residential traffic exposure especially for residents who lived three or more years at their baseline address. Even though the prevalence of asthma is low in the Mexican-origin population, it is the fastest growing minority group in the U.S. and we would expect a growing number of Mexican-Americans who suffer from asthma in the future. Future studies are needed to better characterize risks for asthma associated with air pollution in this population.^

International images and mass media: The effects of media coverage on Canadians' perceptions of ethnic and race relations in Australia

Recently, there has been much speculation about the impact of international media coverage of Australia's position on Indigenous people, migrants and asylum seekers on other nations' images of Australia. In this experiment we examined whether there was any basis for such concerns by considering the short-term impact of negative TV coverage of Australians on Canadian viewers. A questionnaire provided baseline data on Canadian students' perceptions of Australians and Australian race relations. Four months later, the students were assigned to one of three conditions that varied media contact with Australians. Students viewed one of two television programs (about right-wing political independent, Pauline Hanson, and her emotive criticisms of Aborigines and Asian immigrants or about an ethnically-mixed group of young Australians and their positive sense of cultural identity), or they viewed no program (no contact control). Results indicated that both positive and negative media coverage of Australians affected Canadians' views of Australia in the short-term. In particular, negative coverage (of Hanson) promoted less favourable views of Australians and Australian race relations over time and relative to the positive media and no media control conditions. The media's role in shaping international images is discussed.

Ability of Bioelectrical Impedance to Predict Percentage Fat Mass in Children of Two Different Ethnic Origins

Detailed analysis of body composition in children has helped to understand changes that occur in growth and disease. Bioelectrical impedance analysis (BIA) has gained popularity as a simple, non-invasive and inexpensive tool of body composition assessment. Being an indirect technique, prediction equations have to be used in the assessment of body composition. There are many prediction equations available in the literature for the assessment of body composition from BIA. This study aims to cross-validate some of those prediction equations to determine the suitability of their use on Australian children of white Caucasian and Sri Lankan origins. Height, weight and BIA were measured. Total body water was measured using the isotope dilution method (D2O). Fat-mass (FM) and %FM were estimated from BIA using ten prediction equations described in the literature. Five to 14.99-year-old healthy, 96 white Caucasians and 42 Sri Lankan children were studied. The equation of Schaefer et al was the most suitable prediction equation for this group with the lowest mean bias for %FM assessment in both Caucasian (–1.0±9.6%) and Sri Lankan (1.6±5.2%) children and the fat content of the individuals did not influence the predictions by this equation. Impedance index (height2/impedance) explained for 80% of TBW in white Caucasians and 93% in Sri Lankans and figures were similar for the prediction of FFM. We conclude that BIA can be used effectively in the assessment of body composition in children. However, for the assessment of body composition using BIA, either prediction equations should be derived to suit the local populations or existing equations should be cross-validated to determine their suitability before their application.

The 'Healthy Passport' intervention with older people in an English urban environment:effects of incentives and peer-group organisers in promoting healthy living

This paper reports the evaluation of the effectiveness of incentives (viz. points and prizes) and of peer-group organisers ('older people's champions') in the outcomes of a health-improvement programme for people aged 50 + years in a multi-ethnic district of the West Midlands, England. Health promotion activities Were provided, and adherence, outcome variables and barriers to adherence were assessed over six months, using a `passport' format. Those aged in the fifties and of Asian origin Were under represented, but people of Afro-Caribbean origin were well represented and proportionately most likely to stay in the project. Those of greater age and With more illness were most likely to drop out. There were significant improvements in exercise, diet and the uptake of influenza vaccines and eyesight tests, but slighter improvements in wellbeing. Positive outcomes related to the incentives and to liking the format. The number of reported barriers was associated with lower involvement and lack of change, as was finding activities too difficult, the level of understanding, and transport and mobility problems, but when these were controlled, age did not predict involvement. Enjoying the scheme was related to positive changes, and this was associated with support from the older people's champions.

Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study):a cluster randomised controlled trial

Background - Delivery of high-quality, evidence-based health care to deprived sectors of the community is a major goal for society. We investigated the effectiveness of a culturally sensitive, enhanced care package in UK general practices for improvement of cardiovascular risk factors in patients of south Asian origin with type 2 diabetes. Methods - In this cluster randomised controlled trial, 21 inner-city practices in the UK were assigned by simple randomisation to intervention (enhanced care including additional time with practice nurse and support from a link worker and diabetes-specialist nurse [nine practices; n=868]) or control (standard care [12 practices; n=618]) groups. All adult patients of south Asian origin with type 2 diabetes were eligible. Prescribing algorithms with clearly defined targets were provided for all practices. Primary outcomes were changes in blood pressure, total cholesterol, and glycaemic control (haemoglobin A1c) after 2 years. Analysis was by intention to treat. This trial is registered, number ISRCTN 38297969. Findings - We recorded significant differences between treatment groups in diastolic blood pressure (1·91 [95% CI -2·88 to -0·94] mm?Hg, p=0·0001) and mean arterial pressure (1·36 [-2·49 to -0·23] mm?Hg, p=0·0180), after adjustment for confounders and clustering. We noted no significant differences between groups for total cholesterol (0·03 [-0·04 to 0·11] mmol/L), systolic blood pressure (-0·33 [-2·41 to 1·75] mm?Hg), or HbA1c (-0·15% [-0·33 to 0·03]). Economic analysis suggests that the nurse-led intervention was not cost effective (incremental cost-effectiveness ratio £28?933 per QALY gained). Across the whole study population over the 2 years of the trial, systolic blood pressure, diastolic blood pressure, and cholesterol decreased significantly by 4·9 (95% CI 4·0–5·9) mm?Hg, 3·8 (3·2–4·4) mm?Hg, and 0·45 (0·40–0·51) mmol/L, respectively, and we recorded a small and non-significant increase for haemoglobin A1c (0·04% [-0·04 to 0·13]), p=0·290). Interpretation - We recorded additional, although small, benefits from our culturally tailored care package that were greater than the secular changes achieved in the UK in recent years. Stricter targets in general practice and further measures to motivate patients are needed to achieve best possible health-care outcomes in south Asian patients with diabetes. Funding - Pfizer, Sanofi-Aventis, Servier Laboratories UK, Merck Sharp & Dohme/Schering-Plough, Takeda UK, Roche, Merck Pharma, Daiichi-Sankyo UK, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Bristol-Myers Squibb, Solvay Health Care, and Assurance Medical Society UK.

Comparative risk of microalbuminuria and proteinuria in UK residents of south Asian and white European ethnic background with type 2 diabetes:a report from UKADS

Objective - This study investigated and compared the prevalence of microalbuminuria and overt proteinuria and their determinants in a cohort of UK resident patients of white European or south Asian ethnicity with type 2 diabetes mellitus. Research design and methods - A total of 1978 patients, comprising 1486 of south Asian and 492 of white European ethnicity, in 25 general practices in Coventry and Birmingham inner city areas in England were studied in a cross-sectional study. Demographic and risk factor data were collected and presence of microalbuminuria and overt proteinuria assessed. Main outcome measures - Prevalences of microalbuminuria and overt proteinuria. Results - Urinary albumin:creatinine measurements were available for 1852 (94%) patients. The south Asian group had a lower prevalence of microalbuminuria, 19% vs. 23% and a higher prevalence of overt proteinuria, 8% vs. 3%, X2?=?15.85, 2df, P?=?0.0004. In multiple logistic regression models, adjusted for confounding factors, significantly increased risk for the south Asian vs. white European patients for overt proteinuria was shown; OR (95% CI) 2.17 (1.05, 4.49), P?=?0.0365. For microalbuminuria, an interaction effect for ethnicity and duration of diabetes suggested that risk for south Asian patients was lower in early years following diagnosis; OR for SA vs. WH at durations 0 and 1 year were 0.56 (0.37, 0.86) and 0.59 (0.39, 0.89) respectively. After 20 years’ duration, OR?=?1.40 (0.63, 3.08). Limitations - Comparability of ethnicity defined groups; statistical methods controlled for differences between groups, but residual confounding may remain. Analyses are based on a single measure of albumin:creatinine ratio. Conclusions - There were significant differences between ethnicity groups in risk factor profiles and microalbuminuria and overt proteinuria outcomes. Whilst south Asian patients had no excess risk of microalbuminuria, the risk of overt proteinuria was elevated significantly, which might be explained by faster progression of renal dysfunction in patients of south Asian ethnicity.

A management tool for developing the relationships between large purchasing organisations and small ethnic minority suppliers

Purpose: The purpose of this paper is to scrutinise the characteristics of the relationship between large purchasing organisations (LPOs) and ethnic minority suppliers (EMSs) engaging with supplier diversity programmes and provide an assessment and developmental framework for such organisations. Design/methodology/approach: Having considered an array of purchaser-supplier relationship frameworks in relevant streams of literature, the paper draws on Lamming et al.'s framework to advance a tool for assessing and developing the relationship between LPOs and EMSs. Findings: The submitted relationship assessment and development framework brings in sharp focus the characteristics of the relationship between LPO and EMS, providing a systematic way to examine the inter-organisational context within which EMS development takes place. Research limitations/implications: The framework submitted could signpost future research in this field, which should take a longitudinal, processual approach. This is necessary to provide opportunities to examine the dynamics underlying the development of potent LPO-EMS relationships in a variety of settings, including negative instances. Practical implications: The paper has implications for corporate policy making and practice in this arena. Assessing the potency of LPOs-EMSs relationships by applying the proffered tool can help both parties engage with supplier diversity, to develop fruitful relationships that enhance their competitiveness. Social implications: The latter can have social implications, as EMSs often operate in and employ people from disadvantaged communities. Originality/value: The framework advanced in this article constitutes a novel tool that highlights the areas in which LPOs and EMSs should channel their efforts, in order to develop a potent relationship between them, which underpins the development of EMSs' supply capabilities. © Emerald Group Publishing Limited.

Experimenting with supply chain learning (SCL):supplier diversity and ethnic minority businesses

This paper reports on an innovative UK-based ‘Supply Chain Learning’ (SCL) initiative to encourage the corporate sector to consider supplier diversity in respect of ethnic minority businesses. This follows academic and policy interest in programmes to empower ethnic minority enterprises to achieve breakout to mainstream markets and business growth. The first phase of the initiative, entitled Supplier Development East Midlands (SDEM) is examined. By adopting an inter-organisational action learning approach, some of the key attributes of the programme are delineated, focusing on the recurrent action-reflection cycle taking place in a learning group comprising SDEM, LPOs (Large Purchasing Organisations) and small EMSs (Ethnic Minority Suppliers).

Latin Americans in London:language, integration and ethnic identity

This thesis studies the links between language, migration and integration in the context of the 'new migrant' group of Latin Americans in London. It reviews the many ways in which language impacts the integration processes of migrants by influencing people's access to jobs, services, social contacts and information. By focusing on migrants' experiences this research also investigates the ways in which language and identity articulate, as well as the affective variables that are at play in the acquisition of the local language. With a large sector trapped in a cycle of poor command of English and labour market disadvantage, many Latin Americans experience exclusion and poverty. In reaction to this, a sector of the community is campaigning for ethnic minority recognition. This work reviews the debates for recognition and the strategy of organising around ethnicity, paying special attention to the role language plays in the process. The study is based on over two and half years of qualitative research, which included interviews, surveys, and long-term participant observation within a community organisation and a recognition campaign. Its interdisciplinary perspective allows the recognition of both the intimate links between language and identity, as well as the social and structural forces that influence migrants' linguistic integration. It unveils the practical and symbolic value that the mother tongue has for Latin American migrants and provides a broader account of their experiences. This research calls attention to the need for a more comprehensive approach to the study of language and migration in order to acknowledge the affective and social factors involved in the linguistic practices of migrants. By studying the community's struggles for recognition, this work evidences both the importance of visibility for minority groups in London and the intrinsic methodological limitations of monitoring through ethnic categorisation.

The effect of group counseling on the self-esteem, attendance, and counselor utilization of immigrant Hispanic secondary limited English proficient students

As the population of the United States becomes more diverse and the immigrant Hispanic, limited English proficient (LEP) school age population continues to grow, understanding and addressing the needs of these students becomes a pressing question. The purpose of this study was to investigate the effects of group counseling, by a bilingual counselor, on the self-esteem, attendance and counselor utilization of Hispanic LEP high school students. The design for this study was a quasi-experimental design. The experimental and control groups consisted of one class from each of the four levels of English for Speakers of Other Languages (ESOL), I-IV. The counseling intervention, the independent variable, was delivered by a bilingual counselor once a week, for fifteen weeks.^ A total of 112 immigrant Hispanic LEP students selected from the total ESOL student population participated in the study. The experimental and control groups were administered the Culture Free Self Esteem Inventory (CFSEI) Form AD as a pretest and posttest. The Background Information Questionnaire (BIQ) was utilized to gather information on counselor utilization and demographic data. Attendance data were obtained from the students' computer records. At the conclusion of the study the differences between the experimental and control groups on the three dependent variables were compared.^ Statistical analyses of the data were done using SPSS statistical software. A multivariate analysis of variance (MANOVA) was utilized to determine if there were significant differences in the self-esteem scores, attendance and counselor utilization. Correlational analyses was utilized to determine if there was a relationship between English language proficiency and self-esteem and between acculturation level and self-esteem.^ The study results indicate that there were no significant differences in the self-esteem scores and attendance of the subjects in the experimental group at the completion of the group counseling treatment. Counselor utilization was statistically significant for the targeted population. A relationship was found between English language proficiency level and self-esteem scores for students in ESOL levels II, III and IV. No significant correlation was found between acculturation and self-esteem.^ Research on the dropout rates of LEP coupled with the results of this study show that students at the intermediate and advanced levels of ESOL (III and IV) exhibit more positive self-esteem and achieve higher graduation rates that levels I and II. LEP students at levels I and II, once they became familiar with the role and function of school counselors through group counseling, utilized their services. ^

Rastafarianism and the Nation of Islam as institutions for group-identity formation among blacks in the United States: A case study comparing their approaches

This dissertation explores the Rastafari movement and the Nation of Islam as institutions that provide a group-identity for their adherents. The study seeks to determine the characteristics of the identity that is institutionalized by each movement, and the nature of the institutionalization process. The research was conducted primarily in South Florida where both movements exist. An extensive literature review in conjunction with in-depth field interviews were used as the primary research methodologies. What was of particular interest were the reasons that the members of the movements chose one movement over the other, also the similarities and dissimilarities between the movements in their role as institutions for group-identity formation. The research showed that both movements imbued their members with a sense of pride, high self-esteem and a strong sense of race consciousness. In addition, it showed that there was significant variation in identity orientation within the Rastafari Movement, which contrasted with the Nation of Islam where the identity variations within the movement were negligible. This was due largely to the difference in structure between the movements, the Nation of Islam being a centrally organized movement with one leader while the Rastafari movement is a decentralized polycephalous one. ^ Both movements were found to be millenarian in nature, essentially because of the significant utility of the concept that their members would rise to prominence through God's grace. Additionally, both movements were identified as expressive social movements, since they were determined as being primarily concerned with changing the attitudes of their members rather than effecting structural social change. ^

Ethnic groups and institutions: A study of institutional engineering in four Central and Eastern European countries

The issue of institutional engineering has gained a renewed interest with the democratic transitions of the Central and Eastern European countries, as for some states it has become a matter of state survival. The four countries examined in the study – Macedonia, Slovakia, Romania and Bulgaria – exemplify the difficulty in establishing a stable democratic society in the context of the resurgence of national identity. The success of ethnonational minorities in achieving the desired policies affirming or expanding their rights as a group was conditioned upon the cohesion of the minority as well as the permissiveness of state institutions in terms of participation and representation of minority members. The Hungarian minorities in Slovakia and Romania, the Turkish minority in Bulgaria, and the Albanian minority in Macedonia, formed their political organizations to represent their interests. However, in some cases the divergence of strategies or goals between factions of the minority group seriously impeded its ability to obtain the desired concessions from the majority. The difficulty in the pursuit of policies favoring the expansion of minority rights was further exacerbated in some of the cases by the impermissiveness of political institutions. The political parties representing the interest of ethnonational minorities were allowed to participate in elections, although not without suspicions about their intent and even strong opposition from majority groups, but participation in elections and subsequent representation in legislative bodies did not translate into adoption of the desired policies. The ethnonational minorities' inability to effectively influence the decision-making process was the result of the inadequacy of democratic institutions to process these demands and channel them through the normal political process in the absence of majority desire to accommodate them. Despite the promise of democratic institutions to bring about a major overhaul of the policies of forceful assimilation and disregard for minority rights, the four cases analyzed in the study demonstrate that in effect ethnonational minorities continued to be at the mercy of the majority, especially if the minority was unable to position itself as a balancing actor.