Sickle cell disease: Its signs, symptoms and varied manifestations

Seventy-five sickle cell patients, age 3-36 years from Houston, Texas, participated in the research study to investigate sickle cell manifestations, conducted between November 1989 and August 1990. All the participants were blacks. There were 35 females and 39 males among the participants in this research study. One of the participants did not document the gender.^ The sickle cell history questionnaire was administered to the participants. Data collected from this study were statistically analyzed using frequencies, percentages, crosstabulations and chi-squares.^ Regular source of health care influences the time of diagnosis of sickle cell disease. Early diagnosis of sickle cell disease with proper care and management will reduce the morbidity and mortality rate of the disease.^ Fevers, bacterial infection, pneumoniae, anemiae, pains, ulcers and cardiovascular problems are common causes of hospitalizations. The average length of stay in the hospital on admission were higher among the sickle cell patients than their family members who themselves did not have sickle cell disease. ^

For health's sake: Cervical and breast cancer screening

African-Americans make up twelve percent of the United States population, yet they experience morbidity and mortality at a rate that, in some cases, is disproportionate to their numbers. There are numerous health areas, including cancer, in which disparities exist. There are also numerous reasons which have been suggested to explain the high rates of cancer morbidity and mortality experienced by African-Americans. Among the reasons given to explain these differences are lack of knowledge and lack of access to medical care (1). This study sought to increase the knowledge, attitudes, and behavioral intentions of African-American women attending a Baptist church in Houston with regard to cervical cancer, breast cancer, Pap smear, and mammography. It was hypothesized that a church-based cancer education program would produce the desired change in knowledge, attitudes, and behavioral intentions.^ The quasi-experimental design of the study was untreated control group with pretest and posttest and untreated control group with posttest only. Female members of Mount Ararat Baptist Church took part in an eight-week, cancer education program based on social cognitive theory. Baseline data were collected before the start of the program at Mount Ararat and at Solid Rock Baptist Church, control group one. At the end of the program, the follow-up survey was administered at the program church, control church one, and in a third church, Damascus Missionary Baptist Church, which served as the posttest only group. The data were analyzed by Fisher's exact and paired t-test to determine if the program supported the project's hypotheses.^ Results of data analyses supported the major study hypotheses, the exception being behavioral intention to have Pap smear performed. Although the program appeared to have generally influenced changes in the desired direction, the results are limited due to the quasi-experimental design and small sample size. Longer term studies with larger sample sizes are needed to more fully develop and evaluate programs which impact the health of African-Americans. ^

The illness experiences of African Americans residing in an inner city community, Houston, Texas

This dissertation documents health and illness in the context of daily life circumstances and structural conditions faced by African American families living in Clover Heights (pseudonym), an inner city public housing project in the Third Ward, Houston, Texas. Drawing from Kleinman's (1980) model of culturally defined health care systems and using the holistic-content approach to narrative analysis (Lieblich, Tuval- Mashiach, & Zilber, 1998) the purpose of this research was to explore the ways in which social and health policy, economic mobility, the inner city environment, and cultural beliefs intertwined with African American families' health related ideas, behaviors, and practices. I recruited six families using a convenience sampling method (Schensul, Schensul, & LeCompte, 1999) and followed them for fourteen months (2010–2011). Family was defined as a household unit, or those living in the same residence, short or long-term. Single, African American women ranging in age from 29–80 years headed all families. All but one family included children or grandchildren 18 years of age and younger, or children or other relative 18 years of age and older. I also recruited six residents with who I became acquainted over the course of the project. I collected data using traditional ethnographic methods including participant-observation, archive review, field notes, mapping, free-listing, in-depth interviews, and life history interviews. ^ Doing ethnography afforded the families who participated in this project the freedom to construct their own experiences of health and illness. My role centered on listening to, learning from, and interpreting participants' narratives, exploring similarities and differences within and across families' experiences. As the research progressed, a pattern concerning diagnosis and pharmacotherapy for children's behavioral and emotional problems, particularly attention-deficit hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD), emerged from my formal interactions with participants and my informal interactions with residents. The findings presented in this dissertation document this pattern, focusing on how mothers and families interpreted, organized, and ascribed meaning to their experiences of ADHD and PBD. ^ In the first manuscript presented here, I documented three mothers' narrative constructions of a child's diagnosis with and pharmacotherapy for ADHD or PBD. Using Gergen's (1997) relational perspective I argued that mothers' knowledge and experiences of ADHD and PBD were not individually constructed, but were linguistically and discursively constituted through various social interactions and relationships, including family, spirituality and faith, community norms, and expert systems of knowledge. Mothers' narratives revealed the complexity of children's behavioral and emotional problems, the daily trials of living through these problems, how they coped with adversity and developed survival strategies, and how they interacted with various institutional authorities involved in evaluating, diagnosing, and encouraging pharmaceutical intervention for children's behavior. The findings highlight the ways in which mothers' social interactions and relationships introduced a scientific language and discourse for explaining children's behavior as mental illness, the discordances between expert systems of knowledge and mothers' understandings, and how discordances reflected mothers' ‘microsources of power’ for producing their own stories and experiences. ^ In the second manuscript presented here, I documented the ways in which structural factors, including gender, race/ethnicity, and socioeconomic status, coupled with a unique cultural and social standpoint (Collins, 1990/2009) influenced the strategies this group of African American mothers employed to understand and respond to ADHD or PBD. The most salient themes related to mother-child relationships coalesced around mothers' beliefs about the etiology of ADHD and PBD, ‘conceptualizing responsibility,’ and ‘protection-survival.’ The findings suggest that even though mothers' strategies varied, they were in pursuit of a common goal. Mothers' challenged the status quo, addressing children's behavioral and emotional problems in the ways that made the most sense to them, specifically protecting their children from further marginalization in society more so than believing these were the best options for their children.^

Sudden Infant Death disparities: A systematic review on health education and policy recommendations for decreasing Sudden Infant Death in the African-American community

Objective: To perform a systematic review of the literature on SIDS and SUID deaths concentrated in the African-American community, describe health education and policy recommendations and recommend a new approach that may aid in decreasing the disparity of infant mortality in the African-American community. ^ Methods: The PubMed database was systematically searched to identify relevant articles for final review and analysis. Using the CASP 2006 system to critique literature, twelve articles were found that met inclusion and exclusion criteria. ^ Results: Evidence in the literature confirmed there was a current disparity among African Americans' infant mortality rates in comparison to other US ethnic groups. The underlying reasons for these disparities included the following maternal and infant characteristics: mothers younger than eighteen, having more than one live infant, having a high school education or less, never been married, and have infants born preterm or with low birth weight. Maternal smoking, substance abuse, and breastfeeding did not have a significant impact on infant sleep environments among African Americans. ^ Conclusion: Tailored health education programs at the community level, better access to pre-pregnancy and prenatal care, and increased maternal perception of risk that is relevant to the infants sleeping environment are all possible solutions that may decrease African American infant mortality rates.^

Social and economically influenced factors associated with breast cancer treatment among blacks and whites. A qualitative study

Background: Despite the fact breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. A part of these disparities may be due to either inadequately following guideline recommended treatment or treatment delays. Although racial/ethnic disparities in breast cancer treatment and mortality have been extensively documented, the mechanisms by which these disparities occur remain largely unknown. Social and economically influenced factors such as choice of providers, distance of treatment facility, transportation, health insurance, and job related factors may also contribute to racial differences in breast cancer treatment; however, these have not been explored sufficiently in previous research. ^ Aim: The purpose of this study was to evaluate the role of social and economically influenced factors that may contribute to racial disparities in the receipt of guideline recommended treatment using the Health Disparities Model. ^ Methods: In this qualitative comparative case study, data from medical records, structured telephone interviews, and in-depth patient interviews explored the relationship between social and economically influenced factors and breast cancer treatment. Transcripts were analyzed using standard iterative process followed by immersion/crystallization approach. Participants were identified through rapid ascertainment from the New Jersey Cancer Registry and this study included 8 African-American and 8 white women aged 20-85 years old diagnosed with early stage breast cancer between 2003-2007, matched on age, race, and physician recommended treatment. ^ Results: We did not identify differences by race in factors that influenced the receipt of breast cancer treatment among the individual matched pairs. Four prominent themes emerged among women from both groups who experienced similar difficulties influenced by socioeconomic factors. Choice of providers, distance of facility, health insurance, and job related factors all contributed to breast cancer treatment experience among these women. Conclusions: We identified common issues influenced by socioeconomic factors and its relation with the receipt of breast cancer treatment, regardless of race. However, more research is needed to study the additional factors conveying racial differences affecting breast cancer treatment. ^

Orientations in Time: Music and the Construction of Historical Narrative in 20th and 21st Century African-American Literature

Thesis (Ph.D.)--University of Washington, 2016-06

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

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

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. ^

Academic achievement orientation of West Indian American parents and adolescents

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

Coronary heart disease risk factors among tri-ethnic students at Florida International University

The present study identified and compared Coronary Heart Disease (CHD) risk factors quantified as “CHD risk point standards” (CHDRPS) among tri-ethnic (White non-Hispanic [WNH], Hispanic [H], and Black non-Hispanic [BNH]) college students. All 300 tri-ethnic subjects completed the Cardiovascular Risk Assessment Instruments and had blood pressure readings recorded on three occasions. The Bioelectrical Impedance Analysis (BIA) was used to measure body composition. Students' knowledge of CHD risk factors was also measured. In addition, a 15 ml fasting blood sample was collected from 180 subjects and blood lipids and Homocysteine (tHcy) levels were measured. Data were analyzed by gender and ethnicity using one-way Analysis of Variance (ANOVA) with Bonferroni's pairwise mean comparison procedure, Pearson correlation, and Chi-square test with follow-up Bonferroni's Chi-square tests. ^ The mean score of CHDRPS for all subjects was 19.15 ± 6.79. Assigned to the CHD risk category, college students were below-average risk of developing CHD. Males scored significantly (p < 0.013) higher for CHD risk than females, and BNHs scored significantly (p < 0.033) higher than WNHs. High consumption of dietary fat saturated fat and cholesterol resulted in a high CHDRPS among H males and females and WNH females. High alcohol consumption resulted in a high CHDRPS among all subjects. Mean tHcy ± SD of all subjects was 6.33 ± 3. 15 μmol/L. Males had significantly (p < 0.001) higher tHcy than females. Black non-Hispanic females and H females had significantly (p < 0.003) lower tHcy than WNH females. Positive associations were found between tHcy levels and CHDRPS among females (p < 0.001), Hs (p < 0.001), H males (p < 0.049), H females (p < 0.009), and BNH females (p < 0.005). Significant positive correlations were found between BMI levels and CHDRPS in males (p < 0.001), females (p < 0.001), WNHs (p < 0.008), Hs (p < 0.001), WNH males (p < 0.024), H males (p < 0.004) and H females (p < 0.001). The mean knowledge of CHD questions of all subjects was 71.70 ± 7.92 out of 100. The mean knowledge of CHD was significantly higher for WNH males (p < 0.039) than BNH males. A significant inverse correlation (r = 0.392, p < 0.032) was found between the CHD knowledge and CHDRPS in WNH females. The researcher's findings indicate strong gender and ethnic differences in CHD risk factors among the college-age population. ^

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

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

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

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

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

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

Women of African descent: Persistence in completing doctorates

This study examines the educational persistence of women of African descent (WOAD) in pursuit of a doctorate degree at universities in the southeastern United States. WOAD are women of African ancestry born outside the African continent. These women are heirs to an inner dogged determination and spirit to survive despite all odds (Pulliam, 2003, p. 337).This study used Ellis’s (1997) Three Stages for Graduate Student Development as the conceptual framework to examine the persistent strategies used by these women to persist to the completion of their studies. Semi-structured interviews were conducted, transcribed, and analyzed for the 10 study participants. The study examined their beliefs, roles, and support systems utilized during their studies to help propel them to succeed. Interview data were analyzed using cross-case analysis to discover emerging themes and patterns. A comparative analysis was used to analyze the participants’ experiences and discover themes and patterns to review against the historical data. The findings showed that WOAD experienced feelings of isolation, neglect and racial prejudice as doctoral students. Their ability to formulate supportive relationships among each other and in their communities outside the university was key to their persistence to graduation. There still remains a need to create a more engaging and inclusive environment for nontraditional students, particularly those who are WOAD. The study concludes with six strategies of success used by these WOAD to persist to completion. Those six strategies include 1. Keeping the goal of earning a doctorate and graduating foremost on your mind. 2. Set a class and study schedule that allows you to balance family, work and study. 3. Take care of yourself, physically, mentally and emotionally. 4. Keep a goal chart to track your strides toward completion/graduation. 5. Establish a strong support system among your family, friends, colleagues and community; and 6. Do not let the “isms” (racism, sexism, and ageism) deter you.

Negotiating identities, striving for state recognition: Blacks in Córdoba, Argentina 1776–1853

Race in Argentina played a significant role as a highly durable construct by identifying and advancing subjects (1776–1810) and citizens (1811–1853). My dissertation explores the intricacies of power relations by focusing on the ways in which race informed the legal process during the transition from a colonial to national State. It argues that the State’s development in both the colonial and national periods depended upon defining and classifying African descendants. In response, people of African descendent used the State’s assigned definitions and classifications to advance their legal identities. It employs race and culture as operative concepts, and law as a representation of the sometimes, tense relationship between social practices and the State’s concern for social peace. This dissertation examines the dynamic nature of the court. It utilizes the theoretical concepts multicentric legal orders that are analyzed through weak and strong legal pluralisms, and jurisdictional politics, from the late eighteenth to early nineteenth centuries. This dissertation juxtaposes various levels of jurisdiction (canon/state law and colonial/national law) to illuminate how people of color used the legal system to ameliorate their social condition. In each chapter the primary source materials are state generated documents which include criminal, ecclesiastical, civil, and marriage dissent court cases along with notarial and census records. Though it would appear that these documents would provide a superficial understanding of people of color, my analysis provides both a top-down and bottom-up approach that reflects a continuous negotiation for African descendants’ goal for State recognition. These approaches allow for implicit or explicit negotiation of a legal identity that transformed slaves and free African descendants into active agents of their own destinies.