The purpose of this study was to understand the role of Sport for Development (SFD) in addressing health disparities in low-SES communities. This was done using a multiple case study design, in which administrators, staff, and youth participants from five SFD programs were interviewed. A theoretical model, consisting of the theory of fundamental causes (Link & Phelan, 1995), the classification of SFD programs (Coalter, 2007), and the ecological model of health promotion (McLeroy, 1988), was developed to guide this study. Interviews were transcribed and then analyzed using a deductive coding process (Gilgun, 2005). The findings revealed that the SFD programs in this study were driven by goals such as providing access and opportunity to sport, helping youth develop life skills, and promoting health. The programs worked to achieve those goals by providing education, through their use of sport, and by providing resources and services. Finally, the programs in this study promote health at the intrapersonal, interpersonal, organization, environment, and policy levels. These findings hold various practical, scholarly, and policy implications and could shed light on how SFD programs may operate in order to reduce health disparities among low-SES populations.

acase@tulane.edu

Introduction . Non-Hispanic blacks (blacks) are more insulin resistant compared to non-Hispanic whites (whites), increasing their risk for Type 2 diabetes. The role played by ethnic/racial disparities in the response to physical activity in mediating those higher rates of insulin resistance in blacks is unknown. Because the beneficial effects of exercise are transient and require subsequent doses of exercise to maintain the effect; the metabolic and psychosocial responses to single exercise bouts have strong implications for both opposing insulin resistance and raising the probability that an individual will continue to exercise. Purpose . To compare the metabolic and psychosocial responses to individual bouts of exercise, at the intensity and duration corresponding to the current Institute of Medicine guidelines, in blacks and age/gender/BMI-matched whites. Methods . Insulin sensitivity (hyperinsulinemic-euglycemic clamp) and metabolic flexibility (suppression of resting fat oxidation) along with exercise task self-efficacy, mood, and state-anxiety were assessed before and after a bout of exercise in black and white men and women (metabolic n = 21; psychosocial n = 31). Participants walked on a treadmill at 75% of maximum heart rate for 75 minutes. Exercise sessions were repeated on three separate occasions to assess the cumulative change in psychosocial responses to exercise. Results . There were no ethnic/racial differences in baseline measures of whole-body insulin sensitivity (p = 0.95). Black participants demonstrated larger improvements in the insulin sensitivity response to individual bouts of exercise compared to their white counterparts (+18% vs. -1.8%), which was primarily the result of enhanced non-oxidative glucose disposal during the clamp. Additionally, blacks demonstrated a greater capacity to switch from primarily fat oxidation at rest to primarily carbohydrate oxidation during the clamp (p <0.003). There were no ethnic/racial differences in the psychosocial response to individual bouts of exercise; individual bouts of exercise improved exercise task self-efficacy and reduced psychological distress in both black and white participants (p = 0.006). Black participants reported higher positive in-task mood during all three bouts of exercise (p = 0.003) and lower RPE scores (p = 0.04) during the third exercise bout compared to white participants, despite similar heart rates in both groups. Conclusions . These data demonstrate that metabolic and psychosocial responses to individual bouts of exercise do not help to explain the increased insulin resistance and lower adherence rates to exercise programs reported in blacks compared to whites. If these results are confirmed in a larger, more diverse, free-living population, future research should focus on social determinants of insulin resistance and physical inactivity to obtain a better understanding of the root causes of increased risk of Type 2 diabetes in black populations.

Introduction: Domestic research studies focused on the interrelationships between political ideology characteristics inherent in policy decisions and the contributions these political determinants exert over health indicators and outcomes are limited. Given the paucity of research that focuses on political and policy support of health at the county-level, this study sets out to utilize the University of Wisconsin Population Health Institute’s (UWPHI) annual County Health Rankings data and examine them within the context of county-based majority political partisanship and economic measures. Methods: This exploratory ecological study examined differences between independent variables: partisan voting behavior (trichotomized as conservative, moderate, and liberal) and median per capita household income in U.S. dollars (by quartile) on dependent variables related to mortality (years of productive life lost) and morbidity (number of poor mental and physical health days) at the county-level to compare differences in political and ideological underpinnings that may act as influencers on health outcomes. Multiple data sources were combined and matched to all 3,140 counties located in the U.S. Two-way between-subjects ANOVA statistical tests were conducted to determine if there is an effect of partisan voter index category on the three aforementioned dependent variables related to health outcomes, and median per capita income by quartile. Results: There was a statistically significant main interaction between median per capita household income by quartile and partisan voter index category on years of productive life lost, F(6,2789) = 19.3, p < .000, partial η2 = .040. While there were also statistically significant interactions between the independent and dependent variables of poor mental and physical health days, results of those analyses should be interpreted with caution. Pertaining to years of productive life lost, post hoc analyses of significant interactions revealed significant differences at the lower income quartile, but not in the expected direction. The conservative category had statistically significant lower years of productive life lost in comparison to the liberal category (M = -8.21, SE = 1.47, p = .000). Also, there were significant differences detected in the upper quartile suggesting that the liberal category has lower years of productive life lost in comparison to the conservative category (M = 7.06, SE = 1.06, p = .000). Conclusion: Results should be interpreted with caution and suggest more research and methodological refinements are needed, particularly related to categorizing county-level political dynamics.

This study analyses warehoused data collected by Georgia State University and Centers for Disease Control and Prevention (GSU/CDC) researchers after developing an HIV testing message for urban adults with low functional health literacy. It expands previous work by examining data collected when 202 primarily African-American homeless clients of an urban community based organization (CBO) reviewed both the low literacy brochure (Wallace et. al., 2006) and a standard HIV brochure (Georgia Department of Human Resources, 1997). Participants’ health literacy was assessed using 2 measures; the Rapid Estimate of Adult Literacy in Medicine or REALM (Davis, Crouch, Long & Green) and the Test of Functional Health Literacy Assessment or TOFHLA (Nurss, Parker & Baker, 2001). HIV risk was determined using an interview questionnaire developed by the research group (Belcher, Deming, Hunter & Wallace, 2005) which allowed participants to self-report recent alcohol and drug use, sexual behavior, sexually transmitted disease (STD) history and exposure to abuse and sexual coercion. Open-ended response questions regarding readability, understanding, main message, and importance for each brochure provided the qualitative data.This analysis confirms previous work showing accessibility, readability, cultural sensitivity and user-friendly formatting are important when attempting to engage at-risk adults with varying levels of functional health literacy in an HIV testing message. The visual aspects of the brochure can be essential in capturing the reader’s attention and should be relevant to the target audience (Wallace, Deming, Hunter, Belcher & Choi, 2006). Mono-colored graphics may be perceived as dated and irrelevant or worse yet, threatening to some readers. Whenever possible culturally appropriate color photos of people depicting relevant content should replace excess text and difficult medical terms should be eliminated. Wording on the cover and within the brochure should be used to focus the reader on a single main message.This data also shows that many participants considered the quantity of information just as important. For reasons not elucidated here, many respondents equated quantity of information with message quality. Based on these results it is important to further clarify how much information is enough to maintain legitimacy and the reader’s attention while simultaneously avoiding confusing mixed messages.

This study evaluated the associations of individual and neighborhood level risk factors with physical health, mental health, and stress in a diverse urban county. Relatively little research has attempted to disentangle the interactive individual characteristics and neighborhood conditions underlying health outcomes and disparities. To address this, survey data were collected and analyzed from 1,107 residents living in one of the 114 census tracts in DeKalb County, GA. Using multilevel structural equation modeling techniques, this study found that neighborhood level measures of the social and built environment were not associated with the health outcomes under study after controlling for neighborhood level income and education. Alternatively, individual level perceptions of the social and built environment and measures of access to health care were significantly associated with physical health, mental health, and perceived stress. This study also found that the association between low individual income and poor physical health was more pronounced for participants who lived in low-income neighborhoods than participants who lived in high-income neighborhoods. Additionally, this study found that Black residents reported significantly better mental health compared to White residents when they lived in high-income neighborhoods, and Black participants reported significantly more stress compared to White participants when they lived in low-income neighborhoods. Results of this study further scientific understanding of the role of neighborhood processes in health disparities and potentially help inform the development of programs and policies related to neighborhood conditions and health disparities.

Help-seeking has been studied for over 20 years, but much is yet to be known about what variables influence parental help-seeking. In the present studies, participants were recruited from Texas, Mississippi, and Louisiana. Study 1, included 260 caregivers recruited from local school districts and a church. Using confirmatory factor analysis, results supported the hypothesized 3-factor structure of the Parental Attitudes Toward Psychological Services Inventory (PATPSI) and internal consistency ranged from moderate to high. Study 2 conducted subsequent analyses on the data from Study 1. Correlation analyses supported the relationships among parental attitudes, stigma, and help-seeking. Secondly, parents with previous use of child mental health services reported more positive attitudes and less stigma than parents with no previous use. Thirdly, no significant gender differences were found, but there was a trend toward parents reporting higher intentions for boys than girls. Additionally, African Americans reported less positive attitudes and more stigma than the other ethnic groups. Finally, moderation analyses suggested that attitudes are more likely to influence help-seeking for European Americans but not for African Americans, and stigma appeared to influence helpseeking for Hispanic Americans but not for European Americans; no moderation effects were found for child gender. Finally, analyses indicated that only stigma and attitudes were significant independent predictors of help-seeking. Study 3 was a sub-sample from Study 1 (N = 118) who completed additional measures. The purpose was to replicate findings from Study 2 and examine test-retest reliability of the PATPSI. Test-retest reliability for the PATPSI was low in this sample. Overall, results were consistent with Study 2. Results indicated that parents with previous service use reported higher externalizing symptoms (not internalizing) than those with no previous use. Inconsistent with Study 2, Asian Americans reported less positive attitudes, and African Americans reported less stigma than European Americans and Asian Americans. Additionally, stigma tolerance was found to have a stronger influence on European Americans likelihood of future service use than for African Americans. Furthermore, the interaction between problem type and gender was not a significant predictor of likelihood of future use. Finally, only previous service use and attitudes (not stigma) were independent predictors of likelihood of future use. Implications for future research and practice are discussed.

Existing literature provides support for a possible syndemic among adult film actresses. Multiple studies emphasize that a combination of economic, social, and cultural issues work together in tandem to synergistically amplify HIV/STI risk in this vulnerable population. It is critical to acknowledge how the detrimental effects of the high prevalence of substance abuse, psychological distress, intimate partner violence, and childhood sexual abuse work together in a system to heighten HIV/STI risk among adult-film actresses. Additionally, issues including the retrogressive dynamic and unequal power and hegemony in the industry function as facilitators which lower the overall health profile of adult-film actresses. It is therefore important to explore the additive relationship between multiple psychosocial health problems of HIV/STI risk among adult-film actresses. The goals of this study are to explore the tenets of the adult-film actress syndemic and use the ecosocial model to organize the associations between psychosocial health problems and HIV/STI risk. This thesis utilizes a two-phase, transformative explanatory sequential mixed methods design which combines multivariable logistic regression and ethnography to understand HIV/STI risk and how depression, childhood sexual abuse, intimate partner violence, and substance use are embodied in the daily lives of adult-film actresses. The quantitative component of this study utilized data collected from a survey of 134 adult- film actresses from the United States. Statistically significant relationships were seen between the independent variables (psychosocial problems) and the dependent variables (i.e., number of personal sex partners, perception of HIV risk, and participation in other sex work). Other relevant quantitative findings included the statistically significant relationships between the syndemic variable and multiple dependent variables. The second component of this study consisted of an ethnography that addressed the theoretical deficiencies in the quantitative phase. Eight adult-film actresses living in the United States were recruited through a testing agency located in Florida, a non-profit located in California, and social networking sites (You tube, Twitter, Facebook, and MySpace) and were then interviewed by phone. The ethnography provided substantive information on the processes which potentially undergird and fuel the syndemic among adult-film actresses including the link between traumatic childhood experiences, substance use and depression. Additional qualitative findings also included elucidating how components of occupational culture increase HIV/STI risk among adult-film actresses. Prominent qualitative themes included traumatic childhood experiences, tenuous romantic relationships and multiple rapes. The integration of both phases of this study provide information on how the interplay between micro, meso and macro level factors work together in a system to additively augment HIV/STI risk among adult-film actresses. Findings from this study have the potential to influence risk reduction policies that could improve the lives of adult-film actresses.

This dissertation study was designed to examine measurement equivalence of the Center for Epidemiological Studies Depression (CES-D) Scale across White, African American, and Mexican American elders. Specific aims were to identify race/ethnicity-, sociodemographic-, and acculturation and instrument language-related measurement bias in the CES-D. Three studies were conducted in this dissertation to accomplish these aims. Two existing national datasets were used: the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) for the White and African American samples and the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) for the Mexican-American sample. Differential item functioning (DIF) analyses were conducted using both confirmatory factor analysis (CFA) and item response theory (IRT) methods. Study 1 focused on the role of race/ethnicity on the measurement bias in the CES-D. Results from Study 1 showed a lack of measurement equivalence of the CES-D among Mexican Americans in the comparison with both Whites and Blacks. Race/ethnicity-specific items were also identified in Study 1: two interpersonal relation items in Blacks and four positive affect items in Mexican Americans. Study 2 focused on identifying sociodemographic-related measurement bias in responses to the CES-D among diverse racial/ethnic groups. Results from Study 2 showed that gender and educational attainment affected item bias in the CES-D. The interaction between gender and educational level and race/ethnicity was also found in Study 2: Mexican American women and lower educated Blacks had a greater predisposition to endorse the 'crying' item. Focusing on Mexican American elders, Study 3 examined how level of acculturation and language influence responses to the CES-D. In Study 3, acculturation and instrument language-biased items were identified in Mexican American elders. Study 3 also suggested that acculturation-bias was entirely explained by whether the CES-D was administered in the English or the Spanish versions. Possible reasons for item bias on the CES-D are discussed in the context of sociocultural differences in each substudy. Findings from this dissertation provide a broader understanding of sociocultural group differences in depressive symptom measures among racially/ethnically diverse older adults and yield research and practice implications for the use of standard screening tools for depression.

Colorectal cancer (CRC) is the third most common cancer in the United States (U.S.) and is the second leading cause of cancer deaths. Although the incidence of CRC has been decreasing with CRC screenings, disparities of CRC and screening prevalence exist for racial and ethnic groups. The CRC incidence rates have dramatically increased in Korean Americans, however, there is little known about their CRC screening behaviors and the factors that may predict screening behaviors have not been fully investigated. The purposes of this study were to describe CRC screening behaviors and identify the predictors and barriers influencing CRC screening behaviors among Korean Americans. A sample of 254 Korean Americans participated in this study. Correlation, Multiple logistic regression, and Chi-square were used to analyze data. In this study, Korean American had lower rates of CRC screenings compared to the general U.S. population. Only 20% of the sample had ever had a fecal occult blood Test (FOBT), 49% had ever had a colonoscopy, and 19% responded they had ever had a sigmoidoscopy in their lifetime. Korean Americans had low rates of perception of cancer screening (annual physical exam and periodic cancer screening), moderate CRC knowledge, low cancer fatalism, limited CRC literacy, lack of health care access, and a low rate of receiving the physician's recommendation of CRC screenings. The greatest predictors influencing CRC screening were perception of cancer screening for a FOBT, and the physician's recommendation for a colonoscopy and a sigmoidoscopy. There were no significant differences by gender in CRC screening behaviors. However, significant differences were found between the two groups divided by length of U.S. residence. Compared to those who have lived in the U.S.>10 years, new immigrants had lower rates of all three CRC screening, lower perception of cancer screening, higher uninsured, less receiving physician's recommendation, and higher perceived barriers to CRC screening. The findings of this study suggest that improved efforts are needed to increase CRC screenings among Korean Americans. Further research is needed to increase a physician's recommendation for CRC screenings and awareness for the importance of annual checkups and periodic cancer screening among Korean Americans.