The epidemiology of uterine cervical cancer among Anglo and Hispanic women in Texas

This study describes the incidence and mortality of uterine cervical cancer among Texas Anglo and Hispanic women, compares these data with respective data from the U.S. SEER Program, and determines factors which explain observed differences between the Texas ethnic groups and between Texas and SEER women. A total of 1,052 invasive and 1,852 in situ cervical cancer cases diagnosed during 1976-1985 among Texas residents were identified from the Texas Cancer Registry for study.^ The effect of ethnicity on the incidence of cervical cancer was found to be strongly modified by age. Texas Hispanic women 35 years and older were found to be at significantly greater risk (two- to four-fold) of invasive cervical cancer than Texas Anglos, and the risk was greatest among women 55-69 years. Compared with SEER females, both Texas ethnic groups exhibited excess risks of invasive cancer, but the magnitude varied with age. In contrast, Texas females were diagnosed less frequently with in situ cervical cancer than SEER females, and Hispanics had the largest differentials.^ As an indicator of differences in screening utilization between Texas and SEER ethnic groups, comparisons of in situ with invasive rates revealed both Texas ethnic groups in all age groups to have lower ratios than respective SEER females. Texas Hispanics had the lowest ratios. A larger percentage of squamous cell tumors were diagnosed among SEER females compared with Texas females, also supporting the finding of less screening. Texas invasive cases did not differ by ethnic group in the distribution of cell types. Hispanics 35-54 years had higher rates than Texas Anglos and SEER Hispanics for all four cell types.^ Declines in the incidence of invasive tumors over time were seen among Texas Anglos 35-54 years and Hispanics 55+ years. The mortality of cervical cancer also declined among Texas Anglo and Hispanic females 55+ years, but the rates still remained highest among these groups.^ In summary, these data indicate increased risks of invasive cervical cancer and less screening among subgroups of Texas females. Prevention efforts should be directed toward these Texas women at high risk of invasive cervical tumors. ^

Cross-culture perspectives on fear of HIV disease and AIDS in health care workers

Health care workers have been known to carry into the workplace a variety of judgmental and negative attitudes towards their patients. In no other area of patient care has this issue been more pronounced as in the management of patients with AIDS. Health care workers have refused to treat or manage patients with AIDS and have often treated them more harshly than identically described leukemia patients. Some health care institutions have simply refused to admit patients with AIDS and even recent applicants to medical colleges and schools of nursing have indicated a preference for schools in areas with low prevalence of HIV disease. Since the attitudes of health care workers do have significant consequences on patient management, this study was carried out to determine the differences in clinical practice in Nigeria and the United States of America as it relates to knowledge of a patient's HIV status, determine HIV prevalence and culture in each of the study sites and how they impact on infection control practices, determine the relationship between infection control practices and fear of AIDS, and also determine the predictors of safe infection control practices in each of the study sites.^ The study utilized the 38-item fear of AIDS scale and the measure of infection control questionnaire for its data. Questionnaires were administered to health care workers at the university teaching hospital sites of Houston, Texas and Calabar in Nigeria. Data was analyzed using a chi-square test, and where appropriate, a student t-tests to establish the demographic variables for each country. Factor analysis was done using principal components analysis followed by varimax rotation to simple structure. The subscale scores for each study site were compared using t-tests (separate variance estimates) and utilizing Bonferroni adjustments for number of tests. Finally, correlations were carried out between infection control procedures and fear of AIDS in each study site using Pearson-product moment correlation coefficients.^ The study revealed that there were five dimensions of the fear of AIDS in health care workers, namely fear of loss of control, fear of sex, fear of HIV infection through blood and illness, fear of death and medical interventions and fear of contact with out-groups. Fear of loss of control was the primary area of concern in the Nigerian health care workers whereas fear of HIV infection through blood and illness was the most important area of AIDS related feats in United States health care workers. The study also revealed that infection control precautions and practices in Nigeria were based more on normative and social pressures whereas it was based on knowledge of disease transmission, supervision and employee discipline in the United States, and thus stresses the need for focused educational programs in health care settings that emphasize universal precautions at all times and that are sensitive to the cultural nuances of that particular environment. ^

The effects of ethnicity and ethnic composition of schools on physical activity and nutrition behaviors of 8th and 11th graders in Texas

With rates of obesity and overweight continuing to increase in the US, the attention of public health researchers has focused on nutrition and physical activity behaviors. However, attempts to explain the disparate rates of obesity and overweight between whites and Hispanics have often proven inadequate. Indeed, the nebulous term ‘ethnicity’ provides little important detail in addressing potential biological, behavioral, and environmental factors that may affect rates of obesity and overweight. In response to this, the present research seeks to test the explanatory powers of ethnicity by situating the nutrition and physical activity behaviors of whites and Hispanic into their broader social contexts. It is hypothesized that a student's gender and grade level, as well as the socioeconomic status and ethnic composition of their school, will have more predictive power for these behaviors than will self-reported ethnicity. ^ Analyses revealed that while ethnicity did not seem to impact nutrition behaviors among the wealthier schools and those with fewer Hispanics, ethnicity was relevant in explaining these behaviors in the poorest tertile of schools and those with the highest number of Hispanics. With respect to physical activity behaviors, the results were mixed. The variables representing regular physical activity, participation in extracurricular physical activities, and performance of strengthening and toning exercises were more likely to be determined by SES and ethnic composition than ethnicity, especially among 8th grade males. However, school sports team and physical education participation continued to vary by ethnicity, even after controlling for SES and ethnic composition of schools. In conclusion then, it is important to understand the intersecting demographic and social variables that define and surround the individual in order to understand nutrition and physical activity behaviors and thus overweight and obesity.^

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. ^

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. ^

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. ^

Social and cultural influences in the formation of identity: A cross-national/cultural study

This multi-site, multi-ethnic/cultural study examined the effects of variation between ethnic/cultural groups and the effects of institutional variation within ethnic/cultural groups on identity formation. The participants were 892 late adolescent college students from six sites in 5 countries (Brazil, China, Costa Rica, US, and Sweden) representing different linguistic and ethnic/cultural traditions living in the context of varied social conditions. As hypothesized, there were significant differences in the proportion of identity statuses between sites in the Personal domain, $\chi\sp2$(20, N = 858) = 164.78, $p<.001,$ the Interpersonal domain, $\chi\sp2$(20, N = 858) = 145.69, $p<.001,$ and the World View domain, $\chi\sp2$(20, N = 858) = 120.89, $p<.001,$ but the distribution of the differences was more complex than expected. In addition, there were significant differences in Identity Satisfaction among sites, F(15, 2325) = 12.65, $p<.001.$ Further univariate analyses revealed that differences among sites were found on Identity Satisfaction in the personal, interpersonal and world view domain. The direction of the differences, however, were more complex than hypothesized.^ The second hypothesis was confirmed but only with the world view identity status and not for each of the six sites. Stepwise discriminant analyses showed that Identity status in the world view domain was predicted by Institutional Support in Nebraska, gender and Institutional Change in Brazil, and Institutional Access in China. Lastly and as hypothesized, some Institutional Attributes significantly predicted Overall Identity Satisfaction in all sites as revealed by multivariate regression analyses, except in Sweden, F (5, 79) =.660, p =.65. These findings extend the literature on identity formation not only by having investigated how culture influences the process of identity formation with samples representing different ethnic/cultural and linguistically different populations but also by empirically testing the role that social processes play in identity formation at the cross-cultural level. ^

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

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

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

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

The academic orientation of first and second generation Nicaraguan immigrant adolescents

The rise in diversity and numbers of U.S. immigrants since 1965 has spawned a number of studies about the education of these immigrants and their children. Most of this research finds that school-age immigrants arriving in the last 20 years have the highest drop-out rates, lowest test scores, and are less likely than their native born peers to go to college. This dissertation examines the experiences of Nicaraguan immigrant youth living in Miami and the factors that make some of these adolescents feel positive about education, while others have negative attitudes about education. The method for this study combined structured and unstructured interviews, participant observation, focus groups, and data collected from a larger data set to understand the academic orientation of 25 Nicaraguan youths over a 4-year period. One of the independent variables is length of time in the United States. During the time of my initial contact with the subjects, 6 had been living in the United States for less than 3 years, 14 had been living in the United States between 6 and 12 years, and 6 had been living in the in the United States most or all of their lives (either they were born in the United States or had resided here for over 12 years). ^ Results are based on the students' particular experiences, which influence the dependent variable, academic orientation. Besides length of time, the independent variables also include ethnic self-identity, perceived discrimination, social capital in Miami, and peer influence. The study finds that those who are very recent arrivals have a “dual frame of reference,” that is, they directly compare their educational opportunities here in the United States, with their prior, often less favorable, situation in their homeland. Many of those who were born in Nicaragua, but have been residing in Miami most of their lives, have a less favorable view of education based on a higher degree of perceived discrimination. However, those who are second generation Nicaraguans deliberately take advantage of the strength inherent in their co-ethnic community unique to Miami. Recognition of this ethnic community prompts them to perceive education as worthwhile. ^

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. ^

Boundary maintenance in Qatar: Interpretation of domination, segregation and subordination

This study explores the interaction of expatriates in Qatar and their perception of their subordination. The study design included participant observation in an all female University and University housing as well as interviews with Qatari government agencies and ministries, expatriate embassies and expatriates. Semi-structured interviews were conducted across seven expatriate groups: domestic workers, unskilled laborers, semiskilled, professionals, housewives, second-generation expatriates with host country other than Qatar, second-generation expatriates with host country Qatar, and Gulf Cooperation Council citizens. Forty-two subjects completed the interview schedule while 87 interviews were incomplete. ^ Physical control of expatriates occurs through the Gulf practice of sponsorship (The Kafeel System), and local cultural and Islamic related controls intertwined with the Arab Code of honor. Interviews and observations revealed rankings of Arabs and foreigners which emphasize Qatari superiority such as tribal identity, moral ranking of female groups by dress, legal protection and power, sexual consideration and desexualization and salaries and job opportunities based on nationality and ethnicity. Individuals who desire to transcend boundaries into the Qatari realm through citizenship or marriage view Qataris as possessing the “image of the unlimited good” and have acquired Qatari social and cultural capital. Members from all expatriate groups engaged in various forms of resistance to labor and gender domination which ranged from forms of “exit,” expressing a hidden transcript in the privacy of their own group, disguised resistance in public, and occasionally, direct confrontation with the Qatari. Although the legal arena created the appearance that worker's needs were being addressed, laborers engaged in forms of “exit” to escape their oppression. Omani students in the hostel disguised their resistance by spreading gossip, nick-naming homosexual Qatari students at the University, acting out a skit depicting their exclusion from Qatari privilege, spreading rumors of impending freedom, and singing songs of despair in the courtyard. Other sites of resistance were expatriate embassies, the road, the newspaper and technology. This study emphasizes that blaming oppression of the expatriate worker on globalization is a simplistic view of oppression in the Gulf, and ignores complex issues within Qatari society and other Gulf States. Sponsorship, servitude, and gender segregation intersect in Qatar to create a system of segregation and domination of expatriates. ^

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

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

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

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

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

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