A qualitative assessment of multi-level nutrition strategies for reducing racial and ethnic disparities in diabetes

The purpose of this study is to examine the stages of program realization of the interventions that the Bronx Health REACH program initiated at various levels to improve nutrition as a means for reducing racial and ethnic disparities in diabetes. This study was based on secondary analyses of qualitative data collected through the Bronx Health REACH Nutrition Project, a project conducted under the auspices of the Institute on Urban Family Health, with support from the Centers for Disease Control and Prevention (CDC). Local human subjects' review and approval through the Institute on Urban Family Health was required and obtained in order to conduct the Bronx Health REACH Nutrition Project. ^ The study drew from two theoretical models—Glanz and colleagues' nutrition environments model and Shediac-Rizkallah and Bone's sustainability model. The specific study objectives were two-fold: (1) to categorize each nutrition activity to a specific dimension (i.e. consumer, organizational or community nutrition environment); and (2) to evaluate the stage at which the program has been realized (i.e. development, implementation or sustainability). ^ A case study approach was applied and a constant comparative method was used to analyze the data. Triangulation of data based was also conducted. Qualitative data from this study revealed the following principal findings: (1) communities of color are disproportionately experiencing numerous individual and environmental factors contributing to the disparities in diabetes; (2) multi-level strategies that targeted the individual, organizational and community nutrition environments can appropriately address these contributing factors; (3) the nutrition strategies greatly varied in their ability to appropriately meet criteria for the three program stages; and (4) those nutrition strategies most likely to succeed (a) conveyed consistent and culturally relevant messages, (b) had continued involvement from program staff and partners, (c) were able to adapt over time or setting, (d) had a program champion and a training component, (e) were integrated into partnering organizations, and (f) were perceived to be successful by program staff and partners in their efforts to create individual, organizational and community/policy change. As a result of the criteria-based assessment and qualitative findings, an ecological framework elaborating on Glanz and colleagues model was developed. The qualitative findings and the resulting ecological framework developed from this study will help public health professionals and community leaders to develop and implement sustainable multi-level nutrition strategies for addressing racial and ethnic disparities in diabetes. ^

A systematic review of the methods used to assess race and racial disparities in uterine fibroid research

Context: Black women are reported to have a higher prevalence of uterine fibroids, and a threefold higher incidence rate and relative risk for clinical uterine fibroid development as compared to women of other races. Uterine fibroid research has reported that black women experience greater uterine fibroid morbidity and disproportionate uterine fibroid disease burden. With increased interest in understanding uterine fibroid development, and race being a critical component of uterine fibroid assessment, it is imperative that the methods used to determine the race of research participants is defined and the operational definition of the use of race as a variable is reported for methodological guidance, and to enable the research community to compare statistical data and replicate studies. ^ Objectives: To systematically review and evaluate the methods used to assess race and racial disparities in uterine fibroid research. ^ Data Sources: Databases searched for this review include: OVID Medline, NML PubMed, Ebscohost Cumulative Index to Nursing and Allied Health Plus with Full Text, and Elsevier Scopus. ^ Review Methods: Articles published in English were retrieved from data sources between January 2011 and March 2011. Broad search terms, uterine fibroids and race, were employed to retrieve a comprehensive list of citations for review screening. The initial database yield included 947 articles, after duplicate extraction 485 articles remained. In addition, 771 bibliographic citations were reviewed to identify additional articles not found through the primary database search, of which 17 new articles were included. In the first screening, 502 titles and abstracts were screened against eligibility questions to determine citations of exclusion and to retrieve full text articles for review. In the second screening, 197 full texted articles were screened against eligibility questions to determine whether or not they met full inclusion/exclusion criteria. ^ Results: 100 articles met inclusion criteria and were used in the results of this systematic review. The evidence suggested that black women have a higher prevalence of uterine fibroids when compared to white women. None of the 14 studies reporting data on prevalence reported an operational definition or conceptual framework for the use of race. There were a limited number of studies reporting on the prevalence of risk factors among racial subgroups. Of the 3 studies, 2 studies reported prevalence of risk factors lower for black women than other races, which was contrary to hypothesis. And, of the three studies reporting on prevalence of risk factors among racial subgroups, none of them reported a conceptual framework for the use of race. ^ Conclusion: In the 100 uterine fibroid studies included in this review over half, 66%, reported a specific objective to assess and recruit study participants based upon their race and/or ethnicity, but most, 51%, failed to report a method of determining the actual race of the participants, and far fewer, 4% (only four South American studies), reported a conceptual framework and/or operational definition of race as a variable. However, most, 95%, of all studies reported race-based health outcomes. The inadequate methodological guidance on the use of race in uterine fibroid studies, purporting to assess race and racial disparities, may be a primary reason that uterine fibroid research continues to report racial disparities, but fails to understand the high prevalence and increased exposures among African-American women. A standardized method of assessing race throughout uterine fibroid research would appear to be helpful in elucidating what race is actually measuring, and the risk of exposures for that measurement. ^

Historical development of residential segregation and black housing quality in Dade County

This paper examines the relationship between the historical development of residential segregation in Black areas of Dade County and the level of housing quality in those areas. Previous literature studies the effect of hypersegregation on housing quality. Instead, this paper analyzes the nature of each Black community and the social process by which they became segregated in contrast with only hypersegregation being considered. Data were drawn from the 1990 Census of Housing and Population at the block group level for Dade County. Two indicators for housing quality were considered: crowding and rent. Six categories for Black areas in Dade County and one residual category were developed for the analysis. Regression's results show that the effect of each community on housing quality varies. For example, overcrowding goes down in first-ghetto areas when compared to second-ghetto areas, although the percentage of Blacks in both communities is about the same. ^

Responses to racial segregation in a black Miami community

The present study examines the extent to which blacks are segregated in the suburban community of Coconut Grove, Florida. Hypersegregation, or the general tendency for blacks and whites to live apart, was examined in terms of four distinct dimensions: evenness, exposure, clustering, and concentration. Together, these dimensions define the geographic traits of the target area. Alone these indices can not capture the multi-dimensional levels of segregation and, therefore, by themselves underestimate the severity of segregation and isolation in this community. This study takes a contemporary view of segregation in a Dade County community to see if segregation is the catalyst to the sometime cited violent response of blacks. This study yields results that support the information in the literature review and the thesis research questions sections namely, that the blacks within the Grove do respond violently to the negative effects that racial segregation causes. This thesis is unique in two ways. It examines segregation in a suburban environment rather than an urban inner city, and it presents a responsive analysis of the individuals studied, rather than relying only on demographic and statistical data. ^

Mentoring and minority student development

Positive student development is a complex and multidimensional process, and is therefore best understood through interdisciplinary approaches. Recently, researchers studying the optimization of student development have responded to the challenge by using and integrating concepts from both educational and human developmental theories (King & Magdola, 1999). This theoretical confluence holds significant promise for ethnic minority college students due to the particular challenges these students often encounter. This research assesses individuals involved in an undergraduate educational and professional development mentoring intervention designed to optimize student development for ethnic minority students. First, in order to explore how development is fostered for minority college students, three objectives were pursued. The first objective was to assess the goals that students set for themselves and the degree of personal expressiveness they have in relation to their chosen goals. The second objective was to identify the types of challenges and obstacles that minority students perceive during their college years. The third objective was to identify the need for and availability of resources and support in overcoming obstacles to college success. Specifically, it was assessed whether (and in what ways) students involved in the intervention perceive significantly fewer obstacles and limitations to their development and greater availability of support and resources as a result of their involvement with the mentoring intervention. Second, the relationship between intervention involvement and students' perceptions of institutional and mentor nurturance and support was assessed. ^ A survey was conducted with 77 undergraduate students at Florida International University. A comparison-control design was used to compare students who were involved in the intervention (n = 38) and students who were not involved (n = 39) on variables related to their goals, perceived obstacles and supports, and college experiences. Results indicate that students in the intervention and students in the control group differed in goal orientation and perceived obstacles and supports. The two groups did not differ in their perceptions of institutional nurturance and support. Implications for the development and refinement of interventions aimed at fostering professional development for minority students are discussed. ^

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.

Inter-subjective and transnational racial effects: The role of the United States in the formation and evolution of the collective perception and racial relations in Cuba, 1898–1902

Since the arrival of the first African slaves to Cuba in 1524, the issue of race has had a long-lived presence in the Cuban national discourse. However, despite Cuba’s colonial history, it has often been maintained by some historians that race relations in Cuba were congenial with racism and racial discrimination never existing as deep or widespread in Cuba as in the United States (Cannon, 1983, p. 113). In fact, it has been argued that institutionalized racism was introduced into Cuban society with the first U.S. occupation, during 1898–1902 (Cannon, 1983, p. 113). This study of Cuba investigates the influence of the United States on the development of race relations and racial perceptions in post-independent Cuba, specifically from 1898-1902. These years comprise the time period immediately following the final fight for Cuban Independence, culminating with the Cuban-Spanish-American War and the first U.S. occupation of Cuba. By this time, the Cuban population comprised Africans as well as descendants of Africans, White Spanish people, indigenous Cubans, and offspring of the intermixing of the groups. This research studies whether the United States’ own race relations and racial perceptions influenced the initial conflicting race relations and racial perceptions in early and post-U.S. occupation Cuba. This study uses a collective interpretative framework that incorporates a national level of analysis with a race relations and racial perceptions focus. This framework reaches beyond the traditionally utilized perspectives when interpreting the impact of the United States during and following its intervention in Cuba. Attention is given to the role of the existing social, political climate within the United States as a driving influence of the United States’ involvement with Cuba. This study reveals that emphasis on the role of the United States as critical to the development of Cuba’s race relations and racial perceptions is credible given the extensive involvement of the U.S. in the building of the early Cuban Republic and U.S. structures serving as models for reconstruction. U.S. government formation in Cuba aligned with a governing system reflecting the existing governing codes of the U.S. during that time period.

The Complacent Acceptance of Diversity: Human Resource Development in a Culturally Diverse Environment

This paper examines the inability of work organizations to achieve racial balance and use training and development, organization development, and multicultural organizational development principles to manage and enable diversity initiatives. The paper proposes a conceptual framework for a micro and macro model as an approach to diversity initiatives.

A phenomenological exploration of Black male law enforcement officers' perspectives of racial profiling and their law enforcement career exploration and commitment

This phenomenological study explored Black male law enforcement officers' perspectives of how racial profiling shaped their decisions to explore and commit to a law enforcement career. Criterion and snow ball sampling was used to obtain the 17 participants for this study. Super's (1990) archway model was used as the theoretical framework. The archway model "is designed to bring out the segmented but unified and developmental nature of career development, to highlight the segments, and to make their origin clear" (Super, 1990, p. 201). Interview data were analyzed using inductive, deductive, and comparative analyses. Three themes emerged from the inductive analysis of the data: (a) color and/or race does matter, (b) putting on the badge, and (c) too black to be blue and too blue to be black. The deductive analysis used a priori coding that was based on Super's (1990) archway model. The deductive analysis revealed the participants' career exploration was influenced by their knowledge of racial profiling and how others view them. The comparative analysis between the inductive themes and deductive findings found the theme "color and/or race does matter" was present in the relationships between and within all segments of Super's (1990) model. The comparative analysis also revealed an expanded notion of self-concept for Black males – marginalized and/or oppressed individuals. Self-concepts, "such as self-efficacy, self-esteem, and role self-concepts, being combinations of traits ascribed to oneself" (Super, 1990, p. 202) do not completely address the self-concept of marginalized and/or oppressed individuals. The self-concept of marginalized and/or oppressed individuals is self-efficacy, self-esteem, traits ascribed to oneself expanded by their awareness of how others view them. (DuBois, 1995; Freire, 1970; Sheared, 1990; Super, 1990; Young, 1990). Ultimately, self-concept is utilized to make career and life decisions. Current human resource policies and practices do not take into consideration that negative police contact could be the result of racial profiling. Current human resource hiring guidelines penalize individuals who have had negative police contact. Therefore, racial profiling is a discriminatory act that can effectively circumvent U.S. Equal Employment Opportunities Commission laws and serve as a boundary mechanism to employment (Rocco & Gallagher, 2004).

On the developmental continuity /discontinuity of early adolescent patterns of racial identity salience: Relations with later identities and psychosocial adjustment

Given the significant amount of attention placed upon race within our society, racial identity long has been nominated as a meaningful influence upon human development (Cross, 1971; Sellers et al., 1998). Scholars investigating aspects of racial identity have largely pursued one of two lines of research: (a) describing factors and processes that contribute to the development of racial identities, or (b) empirically documenting associations between particular racial identities and key adjustment outcomes. However, few studies have integrated these two approaches to simultaneously evaluate developmental and related adjustment aspects of racial identity among minority youth. Consequently, relations between early racial identity developmental processes and correlated adjustment outcomes remain ambiguous. Even less is known regarding the direction and function of these relationships during adolescence. To address this gap, the present study examined key multivariate associations between (a) distinct profiles of racial identity salience and (b) adjustment outcomes within a community sample of African-American youth. Specifically, a person-centered analytic approach (i.e., cluster analysis) was employed to conduct a secondary analysis of two archived databases containing longitudinal data measuring levels of racial identity salience and indices of psychosocial adjustment among youth at four different measurement occasions.^ Four separate groups of analyses were conducted to investigate (a) the existence of within-group differences in levels of racial identity salience, (b) shifts among distinct racial identity types between contiguous times of measurement, (c) adjustment correlates of racial identity types at each time of measurement, and (d) predictive relations between racial identity clusters and adjustment outcomes, respectively. Results indicated significant heterogeneity in patterns of racial identity salience among these African-American youth as well as significant discontinuity in the patterns of shifts among identity profiles between contiguous measurement occasions. In addition, within developmental stages, levels of racial identity salience were associated with several adjustment outcomes, suggesting the protective value of high levels of endorsement or internalization of racial identity among the sampled youth. Collectively, these results illustrated the significance of racial identity salience as a meaningful developmental construct in the lives of African-American adolescents, the implications of which are discussed for racial identity and practice-related research literatures. ^

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.

In Whose Image: The Emergence, Development, and Challenge of African-American Evangelicalism

The current era of American Christianity marks the transition from a Western, white-dominated U.S. Evangelicalism to an ethnically diverse demographic for evangelicalism. Despite this increasing diversity, U.S. Evangelicalism has demonstrated a stubborn inability to address the entrenched assumption of white supremacy. The 1970s witnessed the rise in prominence of Evangelicalism in the United States. At the same time, the era witnessed a burgeoning movement of African-American evangelicals, who often experienced marginalization from the larger movement. What factors prevented the integration between two seemingly theologically compatible movements? How do these factors impact the challenge of integration and reconciliation in the changing demographic reality of early twenty-first Evangelicalism?

The question is examined through the unpacking of the diseased theological imagination rooted in U.S. Evangelicalism. The theological categories of Creation, Anthropology, Christology, Soteriology, and Ecclesiology are discussed to determine specific deficiencies that lead to assumptions of white supremacy. The larger history of U.S. Evangelicalism and the larger story of the African-American church are explored to provide a context for the unique expression of African-American evangelicalism in the last third of the twentieth century. Through the use of primary sources — personal interviews, archival documents, writings by principals, and private collection documents — the specific history of African-American evangelicals in the 1960s and 1970s is described. The stories of the National Black Evangelical Association, Tom Skinner, John Perkins, and Circle Church provide historical snapshots that illuminate the relationship between the larger U.S. Evangelical movement and African-American evangelicals.

Various attempts at integration and shared leadership were made in the 1970s as African-American evangelicals engaged with white Evangelical institutions. However, the failure of these attempts point to the challenges to diversity for U.S. Evangelicalism and the failure of the Evangelical theological imagination. The diseased theological imagination of U.S. Evangelical Christianity prevented engagement with the needed challenge of African American evangelicalism, resulting in dysfunctional racial dynamics evident in twenty-first century Evangelical Christianity. The historical problem of situating African American evangelicals reveals the theological problem of white supremacy in U.S. Evangelicalism.

Understandings of transnational families in debates on Migration and development

International migration sets in motion a range of significant transnational processes that connect countries and people. How migration interacts with development and how policies might promote and enhance such interactions have, since the turn of the millennium, gained attention on the international agenda. The recognition that transnational practices connect migrants and their families across sending and receiving societies forms part of this debate. The ways in which policy debate employs and understands transnational family ties nevertheless remain underexplored. This article sets out to discern the understandings of the family in two (often intermingled) debates concerned with transnational interactions: The largely state and policydriven discourse on the potential benefits of migration on economic development, and the largely academic transnational family literature focusing on issues of care and the micro-politics of gender and generation. Emphasizing the relation between diverse migration-development dynamics and specific family positions, we ask whether an analytical point of departure in respective transnational motherhood, fatherhood or childhood is linked to emphasizing certain outcomes. We conclude by sketching important strands of inclusions and exclusions of family matters in policy discourse and suggest ways to better integrate a transnational family perspective in global migration-development policy.

Black-White Wage Gap Among Restaurant Servers: A Replication, Extension, and Exploration of Consumer Racial Discrimination in Tipping

There is a rich history of social science research centering on racial inequalities that continue to be observed across various markets (e.g., labor, housing, and credit markets) and social milieus. Existing research on racial discrimination in consumer markets, however, is relatively scarce and that which has been done has disproportionately focused on consumers as the victims of race-based mistreatment. As such, we know relatively little about how consumers contribute to inequalities in their roles as perpetrators of racial discrimination. In response, in this paper we elaborate on a line of research that is only in its’ infancy stages of development and yet is ripe with opportunities to advance the literature on consumer racial discrimination and racial earnings inequities among tip dependent employees in the United States. Specifically, we analyze data derived from a large exit survey of restaurant consumers (n=378) in an attempt to replicate, extend, and further explore the recently documented effect of service providers’ race on restaurant consumers’ tipping decisions. Our results indicate that both White and Black restaurant customers discriminate against Black servers by tipping them less than their White coworkers. Importantly, we find no evidence that this Black tip penalty is the result of interracial differences in service skills possessed by Black and White servers. We conclude by delineating directions for future research in this neglected but salient area study.

RACIAL/ETHNIC VARIABILITY IN THE EFFECT OF RADIATION ON SECOND PRIMARY THYROID CANCER IN CHILDREN: ANALYSIS USING SURVEILLANCE EPIDEMIOLOGY AND END RESULTS DATA

Increases in pediatric thyroid cancer incidence could be partly due to previous clinical intervention. This retrospective cohort study used 1973-2012 data from the Surveillance Epidemiology and End Results program to assess the association between previous radiation therapy exposure in development of second primary thyroid cancer (SPTC) among 0-19-year-old children. Statistical analysis included the calculation of summary statistics and univariable and multivariable logistic regression analysis. Relative to no previous radiation therapy exposure, cases exposed to radiation had 2.46 times the odds of developing SPTC (95% CI: 1.39-4.34). After adjustment for sex and age at diagnosis, Hispanic children who received radiation therapy for a first primary malignancy had 3.51 times the odds of developing SPTC compared to Hispanic children who had not received radiation therapy, [AOR=3.51, 99% CI: 0.69-17.70, p=0.04]. These findings support the development of age-specific guidelines for the use of radiation based interventions among children with and without cancer.