Indiana University-Purdue University Indianapolis (IUPUI) / Prospective epidemiologic evidence indicates that both stressful life events (SLEs) and depression are associated with an increased risk of subclinical atherosclerosis and cardiovascular disease (CVD) events. Even though stressful life events (SLEs) and depression co-occur and may act together to influence cardiovascular disease (CVD) risk, these psychosocial factors have been mainly examined in isolation. For instance, depression may moderate the relationship between SLEs and CVD outcomes. I hypothesized that depressive symptoms would potentiate the deleterious effect of SLEs on subclinical atherosclerosis. This hypothesis is plausible, given that depressed adults exhibit exaggerated and prolonged sympathetic nervous system, hypothalamic-pituitary-adrenal (HPA) axis, and inflammatory responses to stress, which in turn could promote atherosclerosis. As compared to their nondepressed counterparts, depressed individuals may also be more likely to engage in maladaptive methods to cope with SLEs (e.g., increased tobacco use, alcohol use, and consumption of low-nutrient, energy dense foods), which could also promote atherosclerosis. I examined cross-sectional data from 274 to 279 (depending on the outcome measure) older, African American adults (mean age = 66 years, 67% female) with no evidence of clinical CVD or dementia who participated in the St. Louis African American Health-Heart study (2009–2011). Number of SLEs was assessed using the Life Events Calendar, a structured interview. From this interview, a continuous SLEs variable was computed (number of adult SLEs: 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11+). Severity of depression symptoms was measured using the 17-item Hamilton Rating Scale for Depression (HAM-D). Two measures of subclinical atherosclerosis were obtained: carotid intima-media thickness (CIMT; assessed by ultrasonography) and coronary artery calcification (CAC; assessed by multi-detector computerized tomography). I conducted linear (CIMT) and logistic (CAC) regression models, first adjusted for demographics (age, sex, education) and then fully-adjusted (demographics; mean arterial pressure; low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C); hemoglobin A1c; BMI; tobacco use; diabetes diagnosis; and use of antihypertensitve, lipid lowering, antidiabetic, and antidepressant medications). No main effects of SLEs or HAM-D were found for CIMT or CAC. There were also no SLEs by HAM-D interactions for CIMT or CAC. Because the current results are largely inconsistent with prior literature and there is a paucity of studies utilizing African American samples, future research is needed to examine the independent and interactive associations of SLEs and depressive symptoms with measures of subclinical atherosclerosis. If the present results are replicated, it may suggest that SLEs, depressive symptoms, and their interactive effect are not cardiotoxic among African American adults.

This thesis consists of three chapters. The first chapter examines the impact of judicial discretion and left-digit bias on criminal sentencing outcomes. Judicial discretion allows judges to make nuanced decisions, taking into account details of legal cases that are not directly covered by law. However, judicial discretion can also expose behavioral biases and lead to irrational decision-making. I test for the existence of a particular behavioral bias: age-based left-digit bias. Specifically, I use a regression discontinuity design to test for changes in sentencing decisions occurring on an offender's 20th birthday using data on sentencing decisions from the state of Pennsylvania. I find that an offender sentenced just after his/her 20th birthday is 3.5 percentage points more likely to be sentenced to incarceration than an offender sentenced just before his/her 20th birthday. I test for evidence of conscious mechanisms underlying this effect and find no such evidence, leaving an unconscious bias as the best available explanation. Chapter two examines the impact of highly publicized police killings of black individuals on the racial gap in birth outcomes. Police killings of Black Americans are increasingly being met with significant media coverage and public response, including civil unrest. Given the frequency with which these events occur, it is vital to understand both their direct and indirect impacts. Using national birth certificate data and an event study design, I test for the impact of high-profile police-involved killings of Black Americans on racial disparities in maternal stress levels and birth outcomes. I find a large, statistically significant, and persistent increase in gestational hypertension of Black mothers relative to White mothers, strongly indicating an increase in the racial gap in maternal stress following these high-profile killings. I find limited evidence of an accompanying effect on the racial gap in birth outcomes. However, many existing papers similarly find no impacts of maternal stress on birth outcomes while simultaneously finding significant impacts on later-life outcomes, leaving room for additional future work based on these findings. How does the content of public communication by elected representatives change in response to highly salient, politically polarizing events? In Chapter 3, I examine this question using the text of tweets from members of the U.S. House of Representatives and the U.S. Senate, an n-gram text regression model and sentiment analysis alogorithms, and an event study design focused on mass shootings in the U.S. Observable effects on communication are concentrated on the day of and the day following a mass shooting. Republican members of Congress exhibit a reduced tweet frequency relative to Democratic members of Congress in the immediate aftermath of a shooting, while Democratic members of Congress speak with a more clearly differentiated Democratic vocabulary. Members from both parties speak with a more negative vocabulary. With Republicans collectively disengaging and Democrats collectively highlighting their partisan identification, this may suggest that Democrats are taking advantage of an opportunity for a political and/or policy win while Republicans in the same period are choosing to avoid additional political and/or policy losses.

Differences in Mexican American ethnicity, family and friend social support, and importance of diabetes self-management as related to diabetes management in the older adult population were evaluated with the University of Michigan Health and Retirement Study (HRS) 2003 Diabetes Study. Comparisons were made between Mexican Americans with Type II diabetes and similar non-Hispanic Caucasian and African American individuals with Type II diabetes. Neither family/friend social support nor importance of diabetes self-management were significant predictors of HbA1c levels. Results did not support the idea that perception of receiving support from family/friends or placing importance on diabetes self-management covaried with lower HbAlc level (family/friend: beta = -.13, t = -1.47, p = .143; self management: beta = .08, t = .55, p = .584).

The purpose of this study was twofold. First, the study evaluated Loma Linda University Medical Center's (LLUMC) Diabetes Treatment Center's (DTC) effectiveness in providing diabetes education and services to high risk minority populations. Second, the results of the study helped the DTC determine the need for expanding its present efforts in the form of community health prevention services to San Bernardino County residents.

Indiana University-Purdue University Indianapolis (IUPUI) / Shelby County has the fastest growing rate of HIV infection in the State of Tennessee and the majority of the people with HIV/AIDS are African Americans. 2011 CDC report stated Memphis had the fifth highest proportion of new HIV infections. The African American church is a natural and potentially powerful venue to facilitate health awareness. The purpose of this qualitative study was to explore the views of African American faith-based leaders (FBLs) toward offering HIV prevention services in faith-based organizations (FBOs). The theoretical framework for this study was the Consolidated Framework for Implementation Research (CFIR). The fourth domain of CFIR, characteristics of the individuals, is concerned with organizational change which occurs on the individual level. CFIR provided a means to ensure effective implementations, data coding and analysis. Interpretative Descriptive (ID) design, which seeks to discover associations, relationships, and patterns within the described phenomenon, was used. The targeted population was African American Faith-based Leaders from areas known to have high rates of HIV and sexually transmitted infections (STIs). Purposeful sampling was employed to recruit participants. Data was generated through face-to-face, semi-structured interviews. The researchers categorized and analyzed the data to form the concepts and themes identified using a coding scheme which was applied to all data. Faith-based leaders revealed that they had a role in HIV prevention. The themes that emerged were their role to provide education on HIV, minister with compassion, teach Biblical doctrine, maintain a community focus, and partner with expert healthcare professionals. Perceived barrier concepts identified were lack of knowledge, denial, stigma, fear, keeping issues private, and the breakdown of family and community values. Findings suggest that FBLs had some knowledge of the health disparities and ongoing stigma concerning HIV remains a major barrier. The participants interviewed were open to HIV preventions on different levels to address HIV but needed more education.

Indiana University-Purdue University Indianapolis (IUPUI) / Research indicates that negative affective traits (e.g., depression) are predictors and consequences of excess adiposity. Given that racial minorities and positive affective traits have been underrepresented in past investigations, more prospective studies are needed which examine multiple affective traits in relation to obesity in these populations. The objective of the current study was to investigate the prospective, bidirectional associations between multiple affective traits and multiple adiposity indicators in African Americans using data from the African American Health (AAH) study. The AAH study is a prospective cohort study of African Americans aged 49-65 years at baseline (N = 998). The longest follow-up period in the current study was 9 years (N = 579). Self-reported and measured body mass index (BMI; kg/m2) and body fat percent (BF%) were used as adiposity indicators. Depressive symptoms were assessed with the 11-item Center for Epidemiologic Studies-Depression Scale (CES-D), and anxiety was assessed using the Generalized Anxiety Disorder-2 (GAD-2) scale. Positive affective traits were assessed with the Vitality subscale of the Short Form-36 and Positive Affect subscale from the CES-D. Latent variable path analysis, a structural equation modeling technique, was conducted. Although fit statistics indicated that the models fit the data (RMSEA < .06), examination of the structural paths revealed that the CES-D and GAD-2 were not predictors or consequences of self-reported BMI, measured BMI, or BF% (ps > .05). Likewise, Vitality and CES-D Positive Affect were not related to any adiposity indicator (ps > .05). The results of this prospective cohort study suggest that affective traits are not predictors or consequences of adiposity in middle-aged African Americans and that this group may require obesity prevention or intervention programs with little to no emphasis on affective traits. Possible explanations for the current results include ethnic differences in the mechanistic pathways between affective traits and adiposity.

Indiana University-Purdue University Indianapolis (IUPUI) / A significant body of literature has accumulated in the last decade that provides evidence of the growing health care disparities among racial and ethnic groups in the United States. The literature suggests that Black adults share a disproportionate burden in death, disability, and disease. In 2002, the Institute of Medicine report, Unequal Treatment, showed that racial-ethnic disparities in health cannot be entirely attributed to problems of health care access, clinical performance, or patients’ personal characteristics. Many studies have shown that institutional and individual level discrimination that Blacks face in the health care system impacts their health status. This study used secondary data analysis to examine how primary care experience impacts self-reported health status and health care utilization among Black adults. Data were from the Medical Expenditure Panel Survey (MEPS) implemented by the Agency for Healthcare Research and Quality (AHRQ). Specifically, MEPS Panel 10 (2005-2006) and Panel 11 (2006-2007) data were used in the analyses. The final sample comprised of N=15,295 respondents ages 18 and over. Logistic regression analyses were carried out using Stata Statistical Software, version 11. The study results reflect the disparities among Blacks and Whites on self-reported health and health care utilization. Blacks were 15% less likely to report good health status compared to Whites and had 0.11 less expected office-based doctor visits. Respondents who had better primary care experience had 0.05 times higher expected office-based doctor visits than respondents who did not have good primary care experience. Health care Social Workers should advocate for structural changes in health policy that will take into account the historical marginalization and contemporary inequities that continue to encompass the lives of many Black Americans.