Many areas of clinical informatics research rely on accurate and complete race and ethnicity (RE) patient information, such as estimating disease risk, assessing quality and performance metrics, and identifying health disparities. Structured data in the electronic health record (EHR) is an easily accessible source for patient-level information, however RE information is often missing or inaccurate in structured EHR data. Furthermore, current federal standards on RE categories have been acknowledged as inadequate, and in need of more granular realizations. While more difficult to extract data from, clinical notes provide a rich, nuanced and subjective source of information that can be leveraged to increase granularity and/or recover RE information missing in structured data. State-of-the-art clinical natural language processing (NLP) approaches can enable researchers to extract RE information from clinical notes, however, NLP has also been shown to inherit, exacerbate, and create new biased and harmful associations, especially in modern deep learning approaches. This thesis explores the relationships between direct and indirect explicit mentions of RE and RE inferences in clinical text annotated by humans, and leverages an approach to audit deep NLP models for their learned associations. We develop gold-standard annotations for information related to RE (RE indicators) and RE labels. We leverage four RE indicators: country of origin, spoken language, direct race, and direct ethnicity mention. We find high agreement between annotators for RE label assignments, and that sentences assigned RE categories have drastically different distributions of RE indicators. Furthermore, we find high agreement between structured and unstructured sources of RE information, and that unstructured data can be used to recover missing RE information in structured data. Leveraging the gold-standard RE annotations, we train a model to label sentences with RE information and audit the model to examine the alignment between salient features and RE indicators. While our models attain good classification performance, this does not translate into high overlap with RE indicators. We find evidence for learned associations that are benign mistakes, helpful but not strictly correct, and potentially harmful mistakes if not addressed by future work.

The primary objective of this study is to determine the viability of opening a speciality top end, Ethnic cosmetic and toiletry retailer in the Greenacres Mall of Port Elizabeth, in order to meet the cosmetic and toiletry needs of Ethnic consumers, having moved from rural places of work and dwelling, to urban areas of work and dwelling. In order to achieve the above mentioned primary objective, the following secondary objectives will be pursued: • To investigate the current and forecast Ethnic cosmetic and toiletry trends in the United States of America, in order to serve as a benchmark in the development of a top end, speciality Ethnic cosmetic and toiletry retail store model, for the Greenacres Shopping Mall in Port Elizabeth, South Africa; • to identify whether a top end, speciality Ethnic cosmetic and toiletry store model for the Greenacres Shopping Mall in Port Elizabeth, South Africa, would be a viable business venture; • to investigate current and forecast Ethnic cosmetic and toiletry trends in South Africa, in order to reveal the shortfalls of retailers targeting this market segment; and • to identify the best business model for an organisation or individual wanting to grow their business through targeting the Ethnic cosmetic and toiletry consumer

The study examined the correlations between gender, ethnicity, socio-economic status, self-reported mode of exposure to HIV, the types of coping strategies utilized, social support, perceived stress, preventive resources, depression, and disease progression among 79 HIV+ patients, eleven of which were Spanish speaking, seen at a federally and city funded HIV/AIDS clinic. The first aim was to demonstrate that there is a linear relationship between gender, ethnicity, the manner in which one copes with the HIV infection (utilizing problem-focused strategies versus emotion-focused strategies), and the progression of HIV as measured by each participant’s CD4 count. The second aim of the study was to show that the higher the frequency of seeking medical support at the HIV/AIDS clinic, the lower the rate of HIV progression as measured by the CD4 count. The third aim of the study was to demonstrate that there is a significant difference in the types of coping strategies utilized by differing ethnicities to combat the stress related to HIV. Findings indicated that among the 78 participants who completed the surveys, housing status (homeless versus having a home), intravenous drug use (IVDU), Escape-Avoidance behavior, Positive Reappraisal, the perception of having familial support, and the perception of mastery were all significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 3 through 15 months later. Of the 17 of the total 78 participants who did not return to the clinic consistently, housing status was found to be significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 3 through 8 months later. Of the 61 of the 78 participants who did return to the clinic consistently, IVDU, the perception of family as supportive, the perception of having sources of comfort, the perception of the ability to scan the environment as a resource, the perception that one recognizes the opportunity to prevent stress, perceived control, the perception that one has control, the perception that one has efficacy, the perception that one can master tasks, and the perception that one can maintain self-direction were all significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 9 through 15 months later. Therefore, there was a significant difference between those patients who returned for consistent medical treatment at the clinic versus those who attended the clinic infrequently. The issues pertaining to the adherence of medical treatment as well as attempts to buffer the positive coping strategies that facilitate adherence are of critical importance to current prevention measures. In addition, it was found that there were significant differences in the manner in which differing ethnicities coped with the stressors related to HIV. The study revealed that among the 25 black men and women, coping by accepting responsibility, and coping by positively reappraising situations were predictive of ethnicity. Among the 21 Hispanic men and women and the 31 white men and women who participated in the study, none of the coping strategies were predictive of ethnicity. The identification of the differential manners in which each ethnicity copes with the stressors related to HIV has the potential to bolster both HIV treatment and prevention efforts. Further research needs to be conducted in order to further explore these important issues. / text

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.