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

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

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. ^

The relationship between spirituality, knowledge and tuberculosis (TB) medication adherence among African Americans and Haitians

Tuberculosis (TB) is an infectious disease and nonadherence to medication can lead to new cases, multi-drug resistant TB, or potential death. Additionally, healthcare professionals and individuals with TB’s knowledge of the disease and medication adherence are crucial for successful completion of medication therapy. Patient education is one of the most important aspects of care provided in healthcare settings (CDC, 1994). TB tends to disproportionately affect minority and economically disadvantaged patient populations. The purpose of this mixed method study was to explore the relationship between spirituality, knowledge, and TB medication adherence among African Americans and Haitians. The primary research question was: What is the relationship between spirituality, knowledge and TB medication adherence among African Americans and Haitians? Quantitative data were gathered from 33 questionnaires and analyzed by two ANOVAs and four chi square analyses. The null hypothesis was not rejected; there was not a statistically significant relationship between spirituality and TB medication adherence (p =.208) among the study’s African Americans and Haitians. Qualitative data concerning participants’ knowledge of TB, gathered from 16 individual interviews further informed this analysis. Secondary research questions examined the role of spirituality, knowledge of TB and medication adherence among African Americans and Haitians. Four common themes emerged across both groups to answer the secondary research questions. Interviews revealed the themes: (a) God is in control, (b) stigmatization of TB, (c) lack of knowledge, and (d) fear of death. The theme lack of knowledge about TB was found to contribute to stigmatization of TB patients. However, in this study stigma and lack of knowledge were related to initial denial of symptoms and delayed diagnosis, but not found to be related to TB medication adherence. This study could help adult educators and health educators enhance their educational interventions, develop a better understanding of adult learning, resulting in early diagnosis and treatment ultimately decreasing transmission of TB, drug resistance, and potential death. Educators should be aware that TB patients’ spirituality may be an important part of how they cope with having TB. A larger scale study, conducted at multiple locations should be conducted to extend the findings of this small scale exploratory study. Further studies should be done to better determine what patient, healthcare provider and health care system factors might mediate relationships that may exist between lack of knowledge of TB, stigma and TB medication adherence.

Impact of a comprehensive nutrition and lifestyle education intervention on body weight and health-related outcomes in morbidly-obese Hispanic-Americans following laparoscopic Roux-en-Y gastric bypass

As morbid obesity increasingly affects Hispanic-Americans, the incidence of Roux-en-Y gastric bypass procedures (RYGB) among this population rises. Prospective research on the impact of postoperative educational interventions focused on Hispanic- Americans is needed to prevent premature weight loss plateau, weight regain, nutritional deficiencies, and relapse of obesity-related comorbidities. This randomized-controlled study evaluated the impact of a comprehensive nutrition and lifestyle education intervention (6 biweekly postoperative sessions that incorporated motivational strategies for behavioral change) as compared to a non-comprehensive approach (printed guidelines for healthy lifestyle). The variables to consider are body weight, obesity-related comorbidities (depression, diabetes, dyslipidemia, and others), nutrient status, physical activity, and eating habits in 144 morbidly-obese adult Hispanic-Americans 6 to 12 months following RYGB. Patients were randomly assigned to either the comprehensive intervention (n=72) or the comparison group (n=72). Participants (mean age 44.5 ± 13.5 years) were mainly Cuban-born females (83.3%). Intervention sessions attendance was 64%. At 12 months, both groups lost weight significantly, but those in the comprehensive intervention experienced greater excess weight loss than those in the comparison group (80% vs. 64% from preoperative excess weight, P<.001). Intervention participants were significantly more involved in physical activity (+ 14 min/week vs. – 4 min/week), had decreased depression, joint illness, and required less medication for comorbidities than comparison participants. Additionally, those in the comprehensive intervention had sustained supplement intake experiencing less folate deficiency (P=.014). The non-comprehensive intervention group significantly decreased their protein and supplement intake compared to the intervention group. Patients in the comprehensive intervention had significantly better eating habits reflected by fewer episodes of dumping syndrome, constipation, and night eating, than those in the comparison group who reported greater eating in response to negative emotions (P=.003). These findings support the importance of a comprehensive educational approach to achieve more effective weight reduction and health-related outcomes to prevent relapse of obesity-related comorbidities and nutritional deficiencies in Hispanic-Americans 6 to 12 months following RYGB.

Japanese, U.S Tourists: Hotel Selections

The author reports the results of an exploratory study concerning the importance placed on attributes of hotel selection by Japanese and American guests and cultural differences between these two groups, which represent the largest market for Korean international tourist hotels. The findings suggest that Hofstede's (1960) four dimensions of cultural values can be used to help marketers better understand their guest's hotel selection criteria.

The discursive construction of Japanese identity and its haunting others

This dissertation examined the formation of Japanese identity politics after World War II. Since World War II, Japan has had to deal with a contradictory image of its national self. On the one hand, as a nation responsible for colonizing fellow Asian countries in the 1930s and 1940s, Japan has struggled with an image/identity as a regional aggressor. On the other hand, having faced the harsh realities of defeat after the war, Japan has seen itself depicted as a victim. By employing the technique of discourse analysis as a way to study identity formation through official foreign policy documents and news media narratives, this study reconceptualized Japanese foreign policy as a set of discursive practices that attempt to produce renewed images of Japan's national self. The dissertation employed case studies to analyze two key sites of Japanese postwar identity formation: (1) the case of Okinawa, an island/territory integral to postwar relations between Japan and the United States and marked by a series of US military rapes of native Okinawan girls; and (2) the case of comfort women in Japan and East Asia, which has led to Japan being blamed for its wartime sexual enslavement of Asian women. These case studies found that it was through coping with the haunting ghost of its wartime past that Japan sought to produce "postwar Japan" as an identity distinct from "wartime imperial Japan" or from "defeated, emasculated Japan" and, thus, hoped to emerge as a "reborn" moral and pacifist nation. The research showed that Japan struggled to invent a new self in a way that mobilized gendered dichotomies and, furthermore, created "others" who were not just spatially located (the United States, Asian neighboring nations) but also temporally marked ("old Japan"). The dissertation concluded that Japanese foreign policy is an ongoing struggle to define the Japanese national self vis-à-vis both spatial and historical "others," and that, consequently, postwar Japan has always been haunted by its past self, no matter how much Japan's foreign policy discourses were trying to make this past self into a distant or forgotten other.

Hypertension, poor glycemic control, and microalbuminuria in Cuban Americans with type 2 diabetes

Purpose: To investigate to what degree the presence of hypertension (HTN) and poor glycemic control (GC) influences the likelihood of having microalbuminuria (MAU) among Cuban Americans with type 2 diabetes (T2D).Methods: A cross-sectional study conducted in Cuban Americans (n = 179) with T2D. Participants were recruited from a randomly generated mailing list purchased from KnowledgeBase Marketing, Inc. Blood pressure (BP) was measured twice and averaged using an adult size cuff. Glycosylated hemoglobin (A1c) levels were measured from whole blood samples with the Roche Tina-quant method. First morning urine samples were collected from each participant to determine MAU by a semiquantitative assay (ImmunoDip).Results: MAU was present in 26% of Cuban Americans with T2D. A significantly higher percentage of subjects with MA had HTN (P = 0.038) and elevated A1C (P = 0.002) than those with normoalbuminuria. Logistic regression analysis showed that after controlling for covariates, subjects with poor GC were 6.76 times more likely to have MAU if they had hypertension compared with those without hypertension (P = 0.004; 95% confidence interval [CI]: 1.83, 23.05). Conclusion: The clinical significance of these findings emphasizes the early detection of MAU in this Hispanic subgroup combined with BP and good GC, which are fundamentals in preventing and treating diabetes complications and improving individuals’ renal and cardiovascular outcomes.

Healthy Eating Index scores associated with symptoms of depression in Cuban-Americans with and without type 2 diabetes: a cross sectional study

Background Low diet quality and depression symptoms are independently associated with poor glycemic control in subjects with type 2 diabetes (T2D); however, the relationship between them is unclear. The aim of this study was to determine the association between diet quality and symptoms of depression among Cuban-Americans with and without T2D living in South Florida. Methods Subjects (n = 356) were recruited from randomly selected mailing list. Diet quality was determined using the Healthy Eating Index-2005 (HEI-05) score. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Both linear and logistic regression analyses were run to determine whether or not these two variables were related. Symptoms of depression was the dependent variable and independent variables included HEI-05, gender, age, marital status, BMI, education level, A1C, employment status, depression medication, duration of diabetes, and diabetes status. Analysis of covariance was used to test for interactions among variables. Results An interaction between diabetes status, gender and HEI-05 was found (P = 0.011). Among males with a HEI-05 score ≤ 55.6, those with T2D had a higher mean BDI score than those without T2D (11.6 vs. 6.6 respectively, P = 0.028). Among males and females with a HEI-05 score ≤ 55.6, females without T2D had a higher mean BDI score compared to males without T2D (11.0 vs. 6.6 respectively, P = 0.012) Conclusions Differences in symptoms of depression according to diabetes status and gender are found in Cuban-Americans with low diet quality.

Healthy Eating Index and Alternate Healthy Eating Index among Haitian Americans and African Americans with and without Type 2 Diabetes

Ethnicities within Black populations have not been distinguished in most nutrition studies. We sought to examine dietary differences between African Americans (AA) and Haitian Americans (HA) with and without type 2 diabetes using the Healthy Eating Index, 2005 (HEI-05), and the Alternate Healthy Eating Index (AHEI). The design was cross-sectional (225 AA, 246 HA) and recruitment was by community outreach. The eating indices were calculated from data collected with the Harvard food-frequency questionnaire. African Americans had lower HEI-05 scores (−8.67, 13.1); , than HA. Haitian American females and AA males had higher AHEI than AA females and HA males, respectively, () adjusting for age and education. Participants with diabetes had higher adherence to the HEI-05 (1.78, 6.01), , and lower adherence to the AHEI (16.3, −3.19), , , than participants without diabetes. The findings underscore the importance of disaggregating ethnicities and disease state when assessing diet.

Middle -class immigrant identities: Dominican-Americans in South Florida

Identity studies of immigrants are complex because of multiple influences affecting identity reconstruction during immigration and acculturation: nationality, socio-cultural differences, occupations, education, spatial and geographic locations, age, gender, and personal attributes. Most immigrant identity studies deal with lower-income immigrants, who do not have the resources of middle- and upper-middle-class immigrants. South Florida is “home” to many middle-class immigrants, including Dominican-Americans. This dissertation interviewed sixty-six Dominican immigrants in South Florida, in order to determine their reconstructed identities after immigration/resettlement and to discover what influences contributed to these changes in identities. ^ The research design of this dissertation utilized an inductive, qualitative model, with the “grounded theory” method of data collection, categorization, and analysis. Participants were selected by a snowball sampling and interviewed with an informal questionnaire. Results were transcribed, categorized, tabulated, and analyzed for conclusions and theorization on immigrant identity. ^ The dissertation addressed numerous influences relating to identity reconstruction: the differing circumstances of immigration, the unique resources of middle- and higher-class immigrants, the nurturing environment of South Florida for immigrants with education and professional skills, and the boundary protection offered by suburban spaces. The interviewees displayed a wide range of age, length of residence in the United States, reasons for immigration, entry ports, settlement, relocations, occupations, and claimed identities. Identity was cross-tabulated with the various influences, as a means of invalidating certain influences and indicating possible trends. ^ The dissertation concluded that middle-class immigrant identities are diverse and multiple, as are the related influences. None of these immigrants had become totally assimilated, nor have they retained dual, non-overlapping attachments or frames of reference. Instead, many of the immigrants seemed to have developed or negotiated two or more identities, according to need, context, and personal interest. A cosmopolitan community such as South Florida seems to have encouraged such multiplicity of identity. However, rather than forming free-flowing identities, most of these immigrants eventually developed diverse and hybrid identities that have bounded attachments to various networks, groups, and places in South Florida. ^

Comparison of coronary heart disease risk factors in foreign -born and United States-born Afro Caribbean Americans and African Americans in south Florida

In a cross-sectional study design, risk factors for coronary heart disease (CHD) were evaluated in three groups: 66 Afro Caribbeans (FBCA) living in the US for less than 10 years, 62 US-born Afro Caribbean (USBCA) and 61 African American (AA) adults (18–40 years), with equal numbers of males and females in each group. Socio-demographic, dietary, anthropometric and blood pressure data were collected. Fasting blood glucose, blood lipids and high-sensitivity C-reactive protein (hs-CRP) were determined. ^ The USBCA and AA participants compared to the FBCA participants consumed significantly (p < 0.05) more mean total fat (g) (66.3 ± 41.7 and 73.0 ± 47.8 vs. 52.8 ± 32.3), saturated fat (g) (23.1 ± 14.9 and 24.9 ± 15.8 vs. 18.6 ± 11.5), percent energy from fat (%) (33.1 ± 6.5 and 31.4 ± 6.4 vs. 29.3 ± 6.8), fat servings (1.8 ± 1.2 and 1.5 ± 1.0 vs. 1.2 ± 0.9), dietary cholesterol (mg) (220.4 ± 161.9 and 244.1 ± 155.0 vs. 168.8 ± 114.0) and sodium (mg) (2245.2 ± 1238.3 and 2402.6 ± 1359.3 vs. 1838.0 ± 983.4) and less than 2 servings of fruits per day (%) (86.9 and 94.9 vs. 78.5). These differences were more pronounced in males compared to females and remained after correcting for age. Also, the percentages of USBCA and AA participants who were obese (17.1% and 23.0%, respectively) were significantly (p < 0.05) higher compared to FBCA (7.6%) participants. More USBCA and AA than FBCA individuals smoked cigarettes (4.8% and 6.6% vs. 0.0%) and consumed alcoholic beverages (29.0% and 50.8% vs. 24.2%). The mean hs-CRP level of the AA participants (2.2 ± 2.7 mg/L) was significantly (p < 0.01) higher compared to the FBCA (1.1 ± 1.3 mg/L) and USBCA (1.3 ± 1.6 mg/L) participants. ^ The FBCA participants had a better CHD risk profile than the USBCA and AA participants. Focus should be placed on the ethnic and cultural differences in a population to better understand the variations in health indicators among different ethnic groups of the same race. This focus can provide healthcare professionals and policy planners with the opportunity to develop culturally sensitive programs and strategies for the improvement of health outcomes. ^

Political strategy, leadership, and policy entrepreneurship in Japanese defense policy and politics: A comparison of three prime ministerships

Since the end of the Cold War, Japan's defense policy and politics has gone through significant changes. Throughout the post cold war period, US-Japan alliance managers, politicians with differing visions and preferences, scholars, think tanks, and the actions of foreign governments have all played significant roles in influencing these changes. Along with these actors, the Japanese prime minister has played an important, if sometimes subtle, role in the realm of defense policy and politics. Japanese prime ministers, though significantly weaker than many heads of state, nevertheless play an important role in policy by empowering different actors (bureaucratic actors, independent commissions, or civil actors), through personal diplomacy, through agenda-setting, and through symbolic acts of state. The power of the prime minister to influence policy processes, however, has frequently varied by prime minister. My dissertation investigates how different political strategies and entrepreneurial insights by the prime minister have influenced defense policy and politics since the end of the Cold War. In addition, it seeks to explain how the quality of political strategy and entrepreneurial insight employed by different prime ministers was important in the success of different approaches to defense. My dissertation employs a comparative case study approach to examine how different prime ministerial strategies have mattered in the realm of Japanese defense policy and politics. Three prime ministers have been chosen: Prime Minister Hashimoto Ryutaro (1996-1998); Prime Minister Koizumi Junichiro (2001-2006); and Prime Minister Hatoyama Yukio (2009-2010). These prime ministers have been chosen to provide maximum contrast on issues of policy preference, cabinet management, choice of partners, and overall strategy. As my dissertation finds, the quality of political strategy has been an important aspect of Japan's defense transformation. Successful strategies have frequently used the knowledge and accumulated personal networks of bureaucrats, supplemented bureaucratic initiatives with top-down personal diplomacy, and used a revitalized US-Japan strategic relationship as a political resource for a stronger prime ministership. Though alternative approaches, such as those that have looked to displace the influence of bureaucrats and the US in defense policy, have been less successful, this dissertation also finds theoretical evidence that alternatives may exist.

Expression of Bf/C2 Gene(S) in the Japanese Medaka Fish

Complement factor B and C2 are two central serine proteases of the alternative and classical complement pathways, respectively, that serve as the catalytic subunits of the C3 convertase. Research has been completed using a female Japanese medaka fish, (Oryzias latipes), and other teleost and elasmobrach species in order to isolate eDNA clones and perform linkage analysis of the Bf/C2 gene(s). To further analyze the evolution of the complement system in teleosts, different tissues than the ones from previous studies of medaka fish were analyzed for the constitutive gene expression of factor B and C2. Bf/C2 sequences were amplified by reverse transcription-polymerase chain reaction with primers corresponding to the common amino acid sequences shared by mammalian Bf and C2. Agarose gel electrophoresis was used to visualize sample bands and to calculate the concentration of gene expression of the Bf/C2 gene(s) in each tissue. All five tissue types, kidney, liver, muscle, testis, and spleen from a male medaka fish demonstrated Bf/C2 gene(s) expression, confirming that the messages of Bf/C2 gene(s) are distributed throughout the medaka fish. Tissues of the spleen, liver, and kidney contained the highest concentrations of expression of Bf/C2 gene( s ), while tissues of the muscle and testis contained the lowest concentrations. This research also determined that RT-PCR allowed for more sensitive analysis of gene expression than other molecular biology techniques such as Northern blotting analysis.

The Public Health of Cubans and Cuban Americans: A Symposium [Program]

This is the program for "The Public Health of Cubans and Cuban Americans: A Symposium".