Racial inequalities in health are well documented in the literature, specifically with respect to Blacks and Whites in the United States (U.S.) These stark racial differences in health may be explained by the weathering hypothesis, whereby Blacks experience earlier deterioration of health resulting from cumulative stress from living in a race-conscious society. Despite the abundance of research on the weathering hypothesis to account for racial disparities, few research studies have attempted to empirically test this theory as it relates to cardio-metabolic disease disparities. Using nationally representative data from the National Survey of American Life (NSAL) and the National Comorbidity Survey Replication (NCS-R), the weathering hypothesis was examined in the context of cardio-metabolic disease disparities among a U.S. sample of Whites, African-Americans and Caribbean Blacks. This dissertation was organized into three main papers: The first paper (“Application of the Weathering Hypothesis: A Systematic Review of the Research”) is a systematic review of the existing literature that empirically tests the weathering hypothesis, which informed the methods in papers 2 and 3 of this dissertation. The second paper (“Cardio-Metabolic Disease Disparities: Comparisons between Caribbean Blacks, African-Americans and Whites to Test the Weathering Hypothesis”) tests the weathering hypothesis as an explanation for health disparities compared with other potential explanations (e.g. minority stress, socioeconomic status, health behaviors and genetics). The third paper (“Racial and Ethnic Disparities in Cardio-metabolic Disease: The Role of Racial Group Identification and Discrimination-Specific Coping”) assesses whether and to what extent racial socialization factors (racial identity and coping strategies) affect racial disparities in cardio-metabolic disease, as well as influence the effect of racial discrimination on cardio-metabolic disease. The systematic review informs future studies of the weathering hypothesis as a comprehensive framework for understanding racial disparities in health outcomes, but highlights the need for additional studies examining the impact of weathering on health outcomes other than birth outcomes. In paper 2, the results showed some support for the weathering hypothesis, but the patterns were not fully consistent with the predictions of this hypothesis. The results in paper 3 revealed racial differences in racial socialization factors (racial identity and coping strategies), but these factors did not explain racial/ethnic disparities in cardio-metabolic disease. Future studies should examine the effect of structural racism on racial disparities in cardio-metabolic disease as another test of the weathering hypothesis.

There is strong evidence supporting the view that beliefs and attitudes influence health behaviour. Furthermore, cultural and social beliefs also have been shown to influence the way health care facilities are used. Although western medicine plays a dominant role in the mass control of disease, traditional or folk medicine continues to play an important role in the health care of black communities. They therefore, possess unique attitudes, values and beliefs about health and illness which integrally influence their health behaviour. This study aims therefore to: understand phenomenologically the urban African’s perception of illness, disease and health; identify attitudes that directly influence health behaviour: identify “trigger factors” that precipitate health action and isolate factors that contribute to “negative” health behaviour. The sample in this study consisted of 3 groups of urban Africans who were 20 years and older. Group 1 comprised first time attenders to a medical outpatients department Group 2 and Group 3 were sample groups drawn from the Umlazi Township and the Kwa Mashu Township respectively. The Health and Illness Battery in the language of the participants were administered by trained interviewers. This study has demonstrated the following: urban Africans have a personal conception of illness, health and disease that influences their manner of help‐seeking; there are certain attitudes and beliefs that directly influence both positive and negative health behaviour;. there are several health beliefs which interact in a complex way and may lead to medical help‐seeking. Health action was found to be influenced by significant individuals in the subject's environment; demographic variables, such as, age, sex, education and urbanisation strongly influence the health and illness beliefs; these results validated some of the fundamental aspects of the common western health and illness models; the use of services and facilities are determined by the location, accessibility and the quality of services; financial costs, time, transport, lack of community supports, negatively affected helpseeking; symptoms have been identified as a “trigger factor” of help‐seeking. Individuals use other forms of treatments independent of medical treatments. A model of help‐seeking for urban Africans is proposed. / Thesis (Ph.D.)-University of Natal, 1993.

M.A. (Psychology) / Please refer to full text to view abstract

D.Litt. et Phil.. (Psychology) / Please refer to full text to view abstract

M.Cur. (Midwifery and Neonatal Nursing) / The infiltration of modern trends into black cultures, has allowed fathers to support mothers during labour. Only a limitednumber of fathers utilise this opportunity. Whether more will do so in future seemed in part to depend on the following: * how do black fathers experience their support to mothers during labour? * what can be done to encourage black fathers to support mothers during labour? The following aims were formulated: to explore and describe the experiences of black fathers concerning support during labour and to establish guidelines to encourage black fathers to support mothers during labour. This study was explored and described within the framework of the Nursing for the Whole Person Theory (ORU 1990; RAU 1992) which functions in an integrated biopsychosocial manner (body, mind, spirit) within the family and or community. The parameters of nursing and beliefs about man, health, illness and nursing are also described. A functional reasoning approach is followed, based on the Botes (1991) model for Nursing Research. The research design entailed an exploratory, descriptive, qualitative study, which is contextual to clinical nursing. Two groups of black fathers were purposively selected for the research study. Group one consisted of fathers who provided support to mother during labour and was selected from a private maternity hospital. Group two, consisted of fathers who did not provide support during labour, and was selected from a provincial hospital. Both hospitals are within the Gauteng province. A phenomenological approach to nursing research was utilized. Unstructured interviews were conducted with ten fathers. They were divided into two groups of five each. After analysis of data, follow-up interviews were conducted with two of the fathers included in the sample. Data was analyzed according to Kerlinger's (1986:476) method of content analysis. A literature control was undertaken in order to explore and describe the conclusions of other researchers and authors. The results from this study indicate that most of the fathers in Group one, experienced negative feelings of frightened, difficulty, helplessness and anxiety due to lack of information concerning childbirth. This is coupled with positive feelings such as excitement, nice, overwhelming and miracle. Most of the fathers in Group two, expressed a feeling of wanting to be there. Lack of information, fear and culture were identified as stumbling blocks. Conclusions were drawn and recommendations concerning nursing practice, nursing education and nursing research were made. Guidelines for encouragement of black fathers concerning support during labour were described.

This commentary is essentially a report on various aspects of assessment of health needs and priorities in a peri-urban black community (mainly African) situated near Pinetown. The study was initially conducted under the auspices of the Pinetown Health Department, and the main findings are as follows (a) The geographical area of Mariannhill II Location includes what the local people call "Impola" and "Tshelimnyama", and sustains a population of 3 000 persons on some 500 hectares. (b) The origins of the population have been found, contrary to popular belief, to be 92% urban and semi-urban, and only 8% rural. (c) Demographic characteristics are those of an established stable community with a high mortality rate and high fertility (135 livebirths per 1 000 women aged 15 - 49 years per annum). The sex ratio is 99.4 males per 100 females, and there are no migratory characteristics. (d) The average number of individuals per household is 9, with a lot of overcrowding per room (not quantified). Of 1 346 adults of working age 43.68% are unemployed. (e) Morbidity and mortality studies conducted both at the level of the community and hospital revealed that children under the age of one year had the most sickness episodes, while the age groups 6.1 to 18 years had the least. (f) The disease profile is that of a typical third world developing country, with predominance of infections, accidents and physical violence. (g) Diarrhea disease constituted about 11% of the profile and was significantly associated with the water source for the household. (h) The most important cause of the 33 deaths reported over a one year period is motor vehicle accidents and physical violence (33.3%). (i) The major health resource is the local St Mary's Hospital with a 55% uptake of sickness episodes from the community. Nearly half of these ended up as in-patients. (j) 60% of children under the age of 6 years were estimated to have been fully immunized, and virtually all of it had been done by the hospital. (k) Community opinion on their problems and needs overwhelmingly pointed at water, clinic and lack of transport facilities as urgent matters. However, careful assessment of community concern pointed to the threat of removal as the most important single community problem, with implications for housing and all the other perceived problems. The majority of the people looked up to the Catholic Mission as a possible source of help to resolve the problem of availability of water. (l) As the study was initiated with a view to interventive strategies, the main findings are discussed against a background of information distilled from several literary sources, and recommendations for action are advanced. (m) Lastly, the most important problem in data collection has been that of inaccessibility of the Pinetown register of births and deaths to the Pinetown Medical Officer of Health. We regret the difficulty, but we hope to update our study when the problem has been overcome. / Thesis (M.Med.)-University of Natal, 1984.

M.A. (Psychology) / Please refer to full text to view abstract

M.A. (Psychology) / Against the background of increasing costs of treatment of hypertension amongst the South African Black population, a non-pharmacological treatment model in the form of relaxation and aerobic fitness training was developed. The relaxation and aerobic fitness training model was then evaluated in a pretest-post test experimental and control group design. The findings indicated that the relaxation training as well as the aerobic fitness training showed statistical and clinical significant decreases in both systolic and diastolic blood pressure levels...

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-04-18T11:35:02Z No. of bitstreams: 1 Emiliano de Camargo David.pdf: 2824007 bytes, checksum: ddecdcacbe1690e952a713f3ada98203 (MD5) / Made available in DSpace on 2018-04-18T11:35:02Z (GMT). No. of bitstreams: 1 Emiliano de Camargo David.pdf: 2824007 bytes, checksum: ddecdcacbe1690e952a713f3ada98203 (MD5) Previous issue date: 2018-03-13 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / This paper considers the assumption that racism, in relation to power and the attempt to keep privileges, produces subjectivities and might generate psychic suffering, affecting (also) black children and teenagers and their territories. The aim of this research was to discuss the relationship between psychosocial care and racism through the perspective of those who work at a juvenile Psychosocial Care Centre II (CAPSij). In order to do that, an institutional perspective of analysis was favoured, one that sees racism as an institution, as a logic of production and reproduction of social interactions. To achieve the objectives, a review of the literature about psychology and racial interactions was carried out, highlighting the relationship between insanity and the black population, as well as the relationship between racism and health care inequities and the empiric study in a CAPSij. The study used the following procedures: participant observation; reading of medical records; partaking in meetings and staff interviews, with the intention of: characterizing possible psychic sufferings related to racism; using colour/race as an item in the planning of Singular* Therapeutic Projects (STP) for users under care; psychosocial interventions to fight racism. The material collected was organized into two thematic axes: the first, based in two cases brought by professionals, discusses how the team think the relationship between psychic suffering and racism and how they develop their intervention; the second approaches the dimensions of the service organization and of the political-institutional sphere. The ongoing interventions and therapeutic projects at the CAPSij suggest that the ethical-political dimension of the anti-asylum fight already takes into consideration the effects of racism within their commitment with the freedom practices and refusal of exclusion and violence processes. However, they also suggest that seeing the effects of racism as an anti-asylum issue, which is being called a CAPS assembly, might augment the power of actions in health care that contributes to the promotion of racial equity and to the deinstitutionalisation of racism / Este trabalho parte do pressuposto que o racismo, enquanto relação de poder e sustentação de privilégios, produz subjetividades, podendo gerar sofrimento psíquico, afetando (inclusive) crianças e adolescentes negros e seus territórios. O objetivo desta pesquisa foi discutir as relações entre atenção psicossocial e racismo na perspectiva dos profissionais de um Centro de Atenção Psicossocial II Infantojuvenil (CAPSij). Para tanto, foi privilegiada uma perspectiva institucional de análise, a que pensa o racismo como instituição, como lógica de produção e reprodução das relações sociais. Para o alcance dos objetivos, foi realizada revisão de literatura sobre psicologia e relações raciais, com destaque para a relação entre loucura e população negra e a relação entre racismo e iniquidades em saúde, bem como um estudo empírico em um CAPSij. O estudo teve como procedimentos: observação participante; leitura dos prontuários; participação em reuniões e entrevistas com a equipe, com a intenção de: caracterização dos possíveis sofrimentos psíquicos relacionados ao racismo; utilização do quesito cor/raça no planejamento dos Projetos Terapêuticos Singulares (PTS) dos(as) usuários(as) atendidos(as); e identificação das intervenções psicossociais de enfrentamento do racismo. O material colhido foi organizado em dois eixos temáticos: o primeiro, com base na apresentação de dois casos trazidos pelos profissionais, aborda o modo como a equipe pensa as relações entre sofrimento psíquico e racismo, e como desenha sua intervenção; o segundo aborda dimensões da organização do serviço e da esfera político-institucional. As intervenções e os projetos terapêuticos em andamento no CAPSij sugerem que a dimensão ético-política da luta antimanicomial já acolhe os efeitos do racismo na medida dos seus compromissos com as práticas de liberdade e da recusa dos processos de exclusão e de violência. No entanto, sugerem também que a tomada dos efeitos do racismo como uma questão antimanicomial, o que se chamou de uma aquilombação dos CAPS, pode ampliar a potência de um agir em saúde que contribua para a promoção da equidade racial e para a desinstitucionalização do racismo

D.Litt. et Phil. / A problematic aspect of the latter half of the twentieth century in the South African health context, has been the change of the incidence of hypertension amongst black South Africans from being barely. endemic to being a virtual epidemic. This change in hypertension has had several negative components, notably the development of malignant hypertension wherein a markedly accelerated rate of development in hypertension has led to severely high incidences of morbidity and mortality amongst black South Africans notably in urban areas. Many researchers have cited the rapid process of urbaniztion as being the major cause, of this rapid rise in the relative incidence of hypertension amongst black South Africans. Whereas previously, the rapid rise of hypertension in urbanizing black South Africans has been attributed to the social readjustment, associated with urbanization, recent research have suggested that it is not only stressrelated, but also related to a change in basic lifestyle. Basic lifestyle changes have been found to include a change in work ethic from being a rural, cooperative work ethic, to being an urbanized firstworld type A, aggressive, competitive workstyle. This has led also to changes in eating habits with the ingestion of more salt, fats and oils, and has led to a hurried, but non exercised lifestyle. Because of the rapid increase of incidence of hypertension amongst black South Africans, the treatment of this condition has become problematic~ While black South Africans do not respond as well to traditional pharmacological interventions in this condition, they also show side-effects which make it very difficult for them to continue taking this medication. The cost aspects have also been noted to be prohibitively high and the availability of medicines because of the cost aspects has been projected to decline in the coming century. For this reason it would be "important to address other adjunctive measures to treat hypertension amongst black South Africans. In addition to standard harmacological interventions , it appears that there has been mention in the Iiterature of. lifestyle changes to be an efficacious intervention method in stabilizing and reducing blood pressure amongst hypertensives. This has however not been investigated individually or systematically amongst black South Africans. It was therefore the purpose of this study to investigate the effectiveness of lifestyle intervention programs, notably an aerobic exercise intervention, a dietary intervention, and an intervention to increase assertiveness and therefore reduce the aggressiveness associated with the competitive working style acquired by black South Africans. In order to test the efficacy of these treatment measures, a large group of black mineworkers were selected on a basis of meeting the diagnostic criteria for essential hypertension. These black mineworkers were then systematically sUbjected to an aerobic exercise intervention, a dietary intervention, and anger management by means of assertiveness training. Various measures were performed on a pretest and posttest basis. All three interventions were shown to have moderate efficacy. It was found that aerobic exercise, the dietary intervention and the anger management to be associated with a decline in both systolic and diastolic blood pressure, and to be associated with a reduction in the taking of hypertensive medication as ordered by the attending physicians. The aerobic exercise intervention also indicated that black South African mineworkers are relatively unfit and a ch~nge in fitness resulted in a decline in systolic and diastolic blood pressure. The dietary intervention proved to be efficient in terms of changing lifestyle eating habits. Of note is the fact that there was a substantial decrease in the taking of medication when compared to a· control group. It would appear from this research that the specific forms of lifestyle change in black hypertensives noted in this study would be an efficient adjunct or even a substitute for present treatment of hypertension amongst black mineworkers.