The proliferation of social media and other online forums has allowed female patients to share their experiences in the healthcare system. Female patients and women’s health advocates can more easily speak out about instances of gender bias in medicine, which impact women’s access to equitable healthcare and positive healthcare experiences. Although there are some medical studies addressing gender disparities in various aspects of medicine, the impacts of gender bias on healthcare remain understudied and poorly understood. Patient narratives therefore provide an essential insight into the state of gender bias in medicine today. This paper aims to explore these narratives for common themes, to determine whether the current medical literature supports the presence of gender-based disparities, and to highlight the biological, psychological, and sociocultural factors impacting any disparities. Patient narratives frequently cite frustrations with diagnostic errors or delays and inadequate pain management, and the medical literature generally supports women’s accounts of gender disparities in these areas. Several studies of diagnostic disparities show that women more frequently experience delays in diagnosis, missed diagnoses, and incorrect psychiatric diagnoses. Multiple pain management studies have found that women face longer delays in care, lower rates of analgesic administration (particularly opiates), and fewer referrals for nonpharmacologic management strategies. Explanations for these disparities are likely multifactorial, and include provider ignorance of female-specific presentations and diseases, prevalence of understudied diseases in women, misattribution of symptoms to psychogenic causes, communication differences, normalization of female pain, and misconceptions about pain tolerance. / Urban Bioethics

Type 2 Diabetes Mellitus (T2DM) was once a disease process found only in the adult population. However, incidence rates of T2DM in children and adolescents are increasing at alarming rates and becoming a grave public health concern. As many as 5,089 individuals under the age of 20 are newly diagnosed with T2DM each year. The military community is not immune to these national trends and T2DM among military dependents is growing at similar rates to that of the civilian population. The primary aim of this DNP project was to investigate if barriers exist with regard to pediatric military dependents, ages 10-17 years, receiving appropriate diagnosis, and treatment of T2DM. Previously published literature has identified health disparities exist within the Military Health System (MHS), despite beneficiaries having equal access to care. This project also sought to assess providers' use of Evidence Based Practice (EBP) and Clinical Practice Guidelines (CPGs) in the treatment of pediatric patients' ages 10-17 with T2DM, as it has been indicated that use of evidence based guidelines for management of T2DM vary among military treatment facilities. Results of the DNP Project reflected information found in previous evidence based literature. Fifty percent of providers felt there is "probably" a health disparity among Type 2 Diabetic youth who seek care at a Military Treatment Facility (MTF). Diverse responses were received regarding applicable health disparity indicators among MHS beneficiaries, indicating these disparities may be multifactorial. Routine incorporation of EBP and CPGs into clinical practice also appeared to vary among participants. It is evident that further research may positively contribute to current understanding of health disparities among MHS beneficiaries.

In national surveys of adolescents, Latina females have been found to have higher rates of suicidal ideation and attempts when compared to Latino males and to non-Latino White and Black males and females (Centers for Disease Control [CDC], 2014). The reasons for these gender and racial disparities in suicidal behavior have not been definitively established. Prior research indicates that suicidal behavior among adolescents is influenced by both individual-level psychological symptoms and by psychosocial risk factors (Bridge, Goldstein, & Brent, 2006; King & Merchant, 2008; Prinstein, Boergers, Spirito, Little, & Grapentine, 2000). Among Latina adolescents in particular, the interplay between cultural processes and family relationships has been identified as a key influence on suicidal behavior (Zayas, 2011). The purpose of this study was to build upon Zayas’s (2011) model of suicidality among adolescent Latinas by evaluating the relative effects of individual, family, and peer factors on suicidal ideation, plans, and attempts. A latent variable structural equation model (SEM) was developed and tested using a sample that included 946 Latinas aged 13 to 18 who were interviewed for a national psychiatric epidemiological survey, the National Comorbidity Survey – Adolescent Supplement (NCS-A; Kessler, 2013). The SEM model measured the direct and indirect effects of the latent variables of generation status, peer support, negative peer influence, family relationships, and depression on suicidality. Results of the study indicated that higher levels of depression, poorer family relationships, and higher levels of negative peer influence resulted in higher levels of suicidality. The influence of family relationships and negative peer influence on suicidality were partially mediated by depression; however, negative peer influence also had a substantial direct effect on suicidality. Results of this study support a clinical focus on multisystemic interventions for Latina adolescents that address functioning at individual, family, and peer levels, as well as further investigation into the pathways by which negative peer influence impacts suicidality in this population. / text

Class of 2012 Abstract / Specific Aims: To identify and assess cultural competency courses for healthcare professionals that are available to pharmacy students. Methods: A literature review was performed to identify research articles discussing pharmacy courses in health care disparities. Additionally, a systematic review of all curricula for ACPE accredited schools of pharmacy was conducted and these syllabi were subsequently evaluated. Main Results: The search identified XXX articles focusing on specific health disparities curricula in schools of pharmacy and XXX syllabi about specific courses. Out of those articles and syllabi XXX were included in the analysis. Results are pending. Conclusions: Anticipated results will be utilized to design effective health disparities curricula at the University of Arizona College of Pharmacy.

Student achievement gaps between Black and White students, and socioeconomically disadvantaged and advantaged students, have been observed and formally documented since the National Assessment of Educational Progress (NAEP) began in the 1970s. In particular, the mathematics achievement gap between these historically disadvantaged populations has been a phenomenon that, in spite of improvements, has nevertheless remained persistent for decades. This study sought to identify and derive additional information about the mathematics achievement gap between Black students and White students, and socioeconomically disadvantaged and advantaged students, by elementary and middle school level in a Virginia school district over three consecutive school years. Overall student performance on the Virginia Mathematics Standards of Learning (SOL) assessment was examined and achievement gaps were reported. In addition to overall mathematics achievement, this study also sought to detect specific mathematic conceptual areas in which Black and White students, and socioeconomically disadvantaged and advantaged students, were significantly disparate. Factorial Analysis of Covariance (ANCOVA) and Factorial Multivariate Analysis of Covariance (MANCOVA) were used to identify statistically significant differences between the subgroups in assessment scores reflecting overall mathematics achievement, and student achievement in five conceptual “content strands.” Interactions between student race, socioeconomic status, and school level were also examined. Effect sizes were calculated to indicate any practical significance corresponding to statistical significance noted. For overall mathematics performance, results indicated the continued presence of an achievement gap between Black and White students, and socioeconomically disadvantaged and advantaged students, for each year examined. Interaction was noted between race and socioeconomic status, and race and school level. For mathematics performance along the content strands, results indicated the presence of an achievement gap between Black and White students, and socioeconomically disadvantaged and advantaged students, in every conceptual area for each year analyzed. Interaction was indicated between race and socioeconomic status in all but one content strand during one school year. Consistent interaction was also observed between race and school level in two content strands. No significant effect size was indicated for overall or strand-based mathematics achievement differences, demonstrating limited practical significance. Implications for practice, limitations, and suggestions for future research are discussed.

Diabetes is a leading cause of premature death and disability in the United States and vulnerable populations may be at increased risk. Racial residential segregation, population density, and other factors influence the built environment, which in turn affects access to health-related facilities. Using the theory of fundamental causes, this study aims to determine whether neighborhood-level sociodemographic factors, the built environment, and subsequent access to health-related facilities are associated with diabetes prevalence in Georgia’s population. A built environment assessment of all health facilities located in the state of Georgia was conducted using health data from the 2014 Behavioral Risk Factor Surveillance System and demographic data from the 2010 US Census. Geospatial techniques, including hot-spot analyses and the two-step floating catchment area method were used to determine the effect of racial concentration, socioeconomic status, and population density on access to health-related facilities and thus on diabetes prevalence. Linear and spatial regression analyses were conducted to determine the significance of the association between access to facilities and diabetes prevalence. The results of the geospatial and regression analyses show that socioeconomic factors significantly affect the built environment, which in turn significantly influence diabetes prevalence. This interdisciplinary study contributes to the literature by providing a comprehensive analysis of the relationship between sociodemographic factors, the built environment, and diabetes prevalence in a southeastern state. Keywords: Diabetes, Disparities, Access, Racial Segregation, Urban/Rural, Built Environment Diabetes is a leading cause of premature death and disability in the United States and vulnerable populations may be at increased risk. Racial residential segregation, population density, and other factors influence the built environment, which in turn affects access to health-related facilities. Using the theory of fundamental causes, this study aims to determine whether neighborhood-level sociodemographic factors, the built environment, and subsequent access to health-related facilities are associated with diabetes prevalence in Georgia’s population. A built environment assessment of all health facilities located in the state of Georgia was conducted using health data from the 2014 Behavioral Risk Factor Surveillance System and demographic data from the 2010 US Census. Geospatial techniques, including hot-spot analyses and the two-step floating catchment area method were used to determine the effect of racial concentration, socioeconomic status, and population density on access to health-related facilities and thus on diabetes prevalence. Linear and spatial regression analyses were conducted to determine the significance of the association between access to facilities and diabetes prevalence. The results of the geospatial and regression analyses show that socioeconomic factors significantly affect the built environment, which in turn significantly influence diabetes prevalence. This interdisciplinary study contributes to the literature by providing a comprehensive analysis of the relationship between sociodemographic factors, the built environment, and diabetes prevalence in a southeastern state.

Master of Arts / Sociology, Anthropology, and Social Work / Mario V. Cano / Despite the substantial research conducted on racial and ethnic disparities in the criminal justice system, the majority of research focuses on final sentencing decisions. Less attention has been devoted to earlier stages in criminal processing, such as the presentence detention process. In fact, the analyses that did investigate presentence detention status mainly used state-level data, and there is only a handful of studies that have examined race/ethnicity and gender effects on detention and bail in the federal criminal justice system (e.g., Albonetti, 1989; Bak, 1998: Reitler, et. al., 2012; Spohn, 2009). Furthermore, recent analyses have uncovered that extralegal disparities in presentence detention outcomes, particularly racial and ethnic disparities, vary across court jurisdictions (e.g., Levin, 2008; Pinchevski & Steiner, 2013; Eisenstein & Jacob, 1977). Thus, the purpose of this study is to explore the effects of defendants’ race/ethnicity and gender, and social context, on defendants’ pretrial status. This study employs a multilevel modeling strategy and uses criminal sentencing data (N=130,120) from the U.S. Sentencing Commission (USSC) for fiscal years 2008 to 2010, across 89 U.S. District Courts, including supplemental data drawn from the U.S. Census Bureau and the Federal Judicial Center’s Federal Court Management Statistics. The initial findings indicate that Black and Hispanic defendants are less likely than Whites, and females are more likely than males, to be released on bail and rereleased on their own recognizance (ROR). Regarding the district level, ROR is less likely for defendants processed in districts with a higher crime rate and higher socioeconomic disadvantage. On the other hand, bail is more likely for defendants processed in districts with larger courts (more judges). In cross-level interactions increase in percent Black, increase in crime rate, and increase in socioeconomic disadvantage are positively associated with bail for Black defendants, while increase in percent Hispanic and court size are positively associated with bail for Hispanic defendants. Consistent with the courts as communities and focal concerns perspectives, this study found that the presentence process is influenced by local practices, norms, and concerns for organizational efficiency. These distinctive features of court jurisdictions interact with race/ethnicity and affect defendants' presentence status. Future research is needed to better assess the detention process with increased access to federal data. In addition, examination of intersectionality of race/ethnicity, gender and age at the presentence detention stage is required.

Thesis advisor: Janet E. Helms / Black women have been more likely to suffer from negative health conditions in comparison to Black men and White women. The biopsychosocial model might suggest that gendered racism and related stress may contribute to poor health, but the model has not been adapted to address the specific psychological factors that uniquely affect Black women’s health. Therefore, the purpose of this study was to investigate the relationship between gendered racism and eating and exercise practices of Black women in addition to examining racial and gender identity as potential mediators of the effects of gendered racism on health behaviors of Black women. Adult Black women (N= 153) were invited to complete measures that assessed gendered-racism experiences and stressors, racial identity (BRIAS), womanist identity (WIAS), and health behaviors. Multivariate multiple regression analyses revealed that more experiences of gendered racism were related to lower levels of emotional eating, but higher levels of uncontrolled eating and physical activity. WIAS Immersion/Emersion (idealization of women), WIAS Encounter (confusion regarding gender beliefs) and BRIAS Immersion (idealization of Black people) were significant mediators of these relationships. A post hoc canonical correlation analysis indicated that experiencing higher levels of gendered racism was related to greater use of less sophisticated racial and gender identity schemas, which were related to lower levels of emotional eating and higher levels of uncontrolled eating and physical activity. These results suggested that BRIAS and WIAS concepts should be integrated rather than treating them as separate sets of variables when investigating gendered racism. Collectively, the results of the main and post hoc analyses indicated that race and gender constructs were related to health practices, but not in explicable ways. Limitations of existing measures for studying this population are discussed and results are used to speculate about the implications of biological, psychological, and socio-cultural factors on the health engagement practices of Black women. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Thesis advisor: Thomas O'Hare / Depression in adolescence is associated with a number of negative consequences, including low school achievement, substance abuse, increased risk of later major depression, and suicide. Adolescent children of immigrants are arguably at greater risk of depression than their native counterparts, due to greater likelihood of migration-related stress, a minority racial/ethnic background, lower socioeconomic status, and lower proficiency in the host society language. Informed by theories of assimilation and social network theory, this study examines the contribution of assimilation, sociodemographic factors, and social supports to depressive symptoms in immigrant and native United States adolescents. Nationally representative data on United States adolescents from Waves I and II of the National Longitudinal Study of Adolescent Health (N = 4,263) are analyzed. Results demonstrate immigrant adolescents report significantly higher levels of depressive symptoms and more risk factors for depression than their native peers. However, hierarchical regression analysis shows generational status ceases to be a significant correlate of depressive symptoms when age, sex, race/ethnicity, socioeconomic status, and home language are controlled. Mediation analysis shows unique relationships between control variables, social supports, and depressive symptoms. Findings are in accordance with social network theory, but challenge assimilation theories premised on the assumption that immigrants face unique migration related challenges that are overcome through generations. Findings support adolescent children of immigrants and native children share common non-migratory related risk factors of depressive symptoms, and adolescent children of immigrants are at greater likelihood of experiencing these risk factors. Practice and policy implications are discussed. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Underrepresentation of women and minorities in the science, technology, and engineering (STEM) fields is a perennial concern for researchers and policy-makers. Many causes of this problem have been identified. Less is known about what constitutes effective methods for increasing women’s participation in STEM. This study examines the role that identity formation plays in encouraging girls to pursue STEM education and careers utilizing data from a cohort-based, informal science enrichment program that targets middle-school-aged girls. A Mixed-methods design was employed to examine girls’ science interests, efficacy, attitudes, and identity—referred to as affinities. Quantitative data were collected before and after program participation using science affinity scales. Qualitative data included observations, focus groups, and individual interviews. This study builds on past research conducted on the same program. The study is presented in three components: fidelity of implementation, participant affinities, and science identity theory building. Quantitative and qualitative measures reveal that the program was implemented with high fidelity. Participants had high initial affinities for science as compared to a contrast group. Analysis of qualitative data of science affinities revealed several themes in girls’ attitudes, experiences, and intentions toward science. Emergent themes discussed include girls’ preferences and interests in science, gender and science efficacy, attitudes toward science, and elements of science identities. Archetypes of emergent science identities developed in this study (expert, experimenter, and inventor) inform different ways in which girls engage with and envision science study and careers. Implications for best practice in fostering science engagement and identities in middle-school-aged girls include the importance of hands-on science activities, the need for enthusiastic relatable role models, and an emphasis on deep understanding of scientific principles.