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Racism, sexism, and other forms of oppression are consequential to Black women's mental health. The current research examines the psychological impact of gendered racism, which is oppression on the basis of both gender and race, and the extent to which gendered racial identity may buffer the association between gendered racism and psychological distress (i.e., anxiety and depressive symptoms) among U.S. Black women. The study includes a sample of 150 Black women (at least 18 years of age or older, mean age = 39.11) recruited using Qualtrics panel service. Women were administered measures of gendered racism, gendered racial identity, and mental health (i.e., anxiety and depression). Data was analyzed through a series of bivariate correlations and moderation analyses using PROCESS macro. Results revealed that gendered racial identity did not moderate the association between gendered racism and mental health. This study advances our understanding of the oppression Black women contend with on the basis of their race and gender and offers insight about the factors that may mitigate the psychological impact of this phenomenon on Black women.

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In recent years, there has been increased focus on rural and Appalachian health because of disparate chronic health outcomes when compared to the rest of the US. Appalachia, a subsection of the US, has even worse health outcomes related to chronic diseases. Although Appalachia is its own unique region, there is significant overlap with rural areas in terms of shared cultural characteristics (e.g., strong sense of community, distrust in outsiders, lack of trust in traditional medicine, and strong Christian religious affiliations and faith in God), limited access to healthcare services, and disparate health outcomes. The research presented in this dissertation is significant because it provides insight into and compares healthcare utilization rates in women in Appalachia and surrounding areas. Study 1: In addition to racial discrimination, Black Appalachian women often face other obstacles involving other types of negative interpersonal experiences when seeking healthcare. Despite these known disparities, Black women are frequently underrepresented in Appalachian health research. This study investigated healthcare experiences for sixteen Black Appalachian women using semi-structured interviews to identify and subsequently address ways to eliminate barriers to care. Interview questions utilized the theory of intersectionality and the Social Ecological Model to create a framework to describe the complexity of healthcare utilization and barriers to care while providing context into each participant's background and lived experience. Interview questions explored four topics: 1) barriers to medical care; 2) social support; 3) ideal and actual healthcare experiences; and 4) desired changes to improve quality of care. We used an inductive analysis process to create a robust thematic coding schema, organizing responses into 60 total themes and 141 codes, and reported the most frequent. Our results explore the ways in which one's intersectional identity as a Black Appalachian woman affects interpersonal interactions and experiences when engaging with the healthcare system. Participants frequently reported barriers related to scheduling conflicts and delays, experiences with rushed appointments and inhospitable providers and support staff, and desires for accurate collection of medical information. Participant responses often emphasized difficulties with the organization of the medical system, revealing specific areas for future intervention to improve quality of care for Black Appalachian women. Study 2: Use of the emergency department (ED) for low acuity conditions (e.g., back pain, dental pain, sore throat) and primary care places an additional strain on ED staff and resources, while increasing waiting and treatment times for high acuity patients. Factors such as race, gender, and insurance type have a strong association with the likelihood of a patient using the ED for a low acuity concern. Women are more likely to utilize healthcare services, which also holds true in the context of the ED. Using a sample of adult women from Virginia, West Virginia, Tennessee, North Carolina, and Kentucky, I investigated which demographic factors, age, race, geographic location (metro, nonmetro, rural), employment, and insurance coverage, affect a patient's likelihood to visit the ED for a low acuity condition within a southwestern Virginia hospital system. Log-binomial regression was used to estimate unadjusted and adjusted prevalence ratios of acuity level by race, age, rurality level, employment, and insurance type with corresponding 95% CIs. Our sample included 28,222 female patients who visited the ED between January 1, 2021 and September 30, 2022. Low acuity visits accounted for 15.9% (n=4,485) of visits during the timeframe. In summary, our results suggest that older age and location in non-metro area are the most salient factors contributing to a higher likelihood of low acuity ED visits among women. Race, a primary variable of interest, did not have the relationship to acuity that was expected based on previous literature; Black women patients were less likely to have a low acuity visit than white women patients. During our study period, overall number of visits remained steady, while there was an increase in proportion of low acuity visits. Further research is needed into the underlying causes to more definitively explain this increase. / Doctor of Philosophy / In recent years, there has been increased focus on rural and Appalachian health because of disparate chronic health outcomes when compared to the rest of the US. Appalachia, a subsection of the US, has even worse health outcomes related to chronic diseases. Although Appalachia is its own unique region, there is significant overlap with rural areas in terms of shared cultural characteristics (e.g. strong sense of community, distrust in outsiders, lack of trust in traditional medicine, and strong Christian religious affiliations and faith in God), limited access to healthcare services, and disparate health outcomes. Black/African Americans are another population with higher rates of chronic disease and poorer health outcomes compared to their white and Latinx peers. The combination of poorer health outcomes and higher rates of chronic disease negatively impacts life expectancy and quality of life. One driving factor in these poor health outcomes across all of these groups is low rates of healthcare utilization, whether due to decreased access (as is the case for many rural populations), or other as of yet unidentified challenges. Although literature exists about rural health outcomes, Appalachian health outcomes, and health outcomes focusing on Black women, there is very limited literature that examines the intersectional impact of these characteristics on health. Health disparity research in this region does not currently stratify differences in outcomes by both race and gender, which prevents a detailed analysis of the full extent of the gap in health outcomes. This research presented in this dissertation is significant because it provides insight into and compares healthcare utilization rates in women in Appalachia and surrounding areas across the lifespan. Knowing the contextual factors influencing healthcare seeking behaviors and utilization is the first step to designing effective interventions that improve women's access to care. Interventions need to be intentionally designed to consider, and ultimately, shift medical care and community attitudes to decrease health disparities in Appalachia. To successfully decrease health disparities, it is necessary to consider all of a patient's identities or characteristics. The same contextual factors that affect their healthcare utilization can also impact their care experience.

Black mothers socialize their daughters to embody the strong Black woman (SBW) schema to help them navigate gendered racist oppression. While research indicates that ascribing to the SBW schema offers Black women psychosocial benefits (e.g., increased self-esteem), identifying with the SBW schema has been linked to several negative psychological outcomes (e.g., anxiety, depression, and stress). Considering the evidenced negative implications associated with identifying with the SBW schema on Black women's mental health, the current study had three aims: (1) investigate the socialization messages Black women received about strong Black womanhood, (2) explore the extent to which they identified with these messages, and (3) assess the implications of this socialization on Black women's functioning. To address these aims researchers conducted semi-structured interviews with 11 Black college women (Mage = 20.09; SD = 1.04). For this manuscript, we extracted data pertaining to aim one and analyzed this data using a consensual qualitative research (CQR) data approach. Findings revealed messages Black women were given about strong Black womanhood (i.e., know your worth, depend on yourself, overcome societal barriers, little to no messages about strong Black womanhood, and additional responses) and illuminated behaviors mothers modeled that exemplified strength (i.e., self-sufficient, preserving, caretaking, and additional responses). Findings derived from this study have the potential to inform clinical intervention with Black women and, more specifically, provide insight as to how clinicians may work with Black women to mitigate the impact of the SBW schema on their mental health.

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In 1959, as a reaction to the 1954 Supreme Court's Brown vs Board of Education desegregation decision all public schools in Prince Edward County, Virginia were closed. This dissertation explores one group's response to the schools closings by examining the patterns of resilience that emerged among a group of African American women in Farmville, Prince Edward County, Virginia. Using a multi-disciplinary synthesis of research in education, history, geography, sociology, social movements, personal interviews and questionnaires this dissertation investigated the development of resilience at the grassroots level. African American women are taught early in their socialization process the value of independence, mutual aid, religiosity, community stability, and respect for elders. The school closings didn't just affect the children of Farmville, it changed families and communities, but most particularly it changed the lives of Farmville's women. Much of the research demonstrates that resilience and activism in oppressed communities has a dual nature that surfaces when those communities are under stress. Resilience among this group of African American women emerged both organically and as a result of their religious and community involvements. ii African American women experienced the cultural, educational, contextual, social, behavioral, and political worlds in Farmville, Virginia, from an "outsider within" perspective. When they stepped outside their socially and psychologically constricted lives they developed resilience fortified with both historic and personal commitment. In examining broadly the history of education in Virginia, the historic allegiances of African American women to community, religion, identity, education, and place a fuller understanding of the processes of the development of resilience emerges. This examination moved Black women from the margins to the center of the debate on resilience. The development of personal agency in Farmville was courageous and could have been physically dangerous. However, as the civil rights movement captured the American consciousness, the women of Farmville engaged in a unique social movement that would sustain a campaign for education parity. / Urban Education

The purpose of this research is to explore the processes and strategies through which members of a group or organization use their organizational identity to make salient a normatively dissonant identity. Using both the functionalist perspectives of social identity theory and the existing narrative literature on identity formation in organizations, a conceptual process model of identity formation is created that integrates the identification process with the interaction of multiple identities, including the identity as members of an organization, a normatively dissonant identity, and other salient preexisting identities such as race and gender. This research also examined part of this conceptual model empirically, using members of a national running organization for Black women, Black Girls Run!, using a mixed-methods design including interviews and surveys of participants. Distance running, as a form of physical activity, is not a normative identity for Black women in the United States. Findings from Study 1 showed that members developed a running identity that informed their running behavior. Study 2 highlighted the process through which members used their identity as members of the organization to negotiate through their dissonance and become runners using modeling strategies. Findings from this study contribute to both sport management and organizational literature by empirically demonstrating the effects of and the processes through which an organizational identity might create a pathway for marginalized groups to adapt previously dissonant identities. It highlights the importance of organizational identities in the formation of deeper connections with physical activity, which has been shown to be an essential element of health maintenance and a conduit for sustainable active behaviors. / Tourism and Sport