This dissertation examines the relationship between race and bodily health in the British West Indies and the Carolina/Georgia Lowcountry from the late seventeenth through the early nineteenth century. In the eighteenth century, planters often justified African slavery by claiming that Africans, unlike Europeans, had bodies particularly suited to labor in warm climates. Historians have tended to take these claims as evidence of a growing sense of biological race in plantation societies. Much of this work, though, relies on published sources. This dissertation examines these public sources, including medical manuals, natural histories, and political pamphlets, alongside private sources, particularly the personal correspondence of planters and slaveholders to uncover a different story of race and slavery. These two source types reveal significant discrepancies between planters’ public rhetoric and private beliefs about health, race, and the environment in plantation societies. First, correspondence between the Greater Caribbean and Britain demonstrates that health and disease did not contribute to the development of racial slavery in the Atlantic. Second, these sources show how and why planters manipulated public conceptions of climate and health to justify and maintain a system of racial slavery. Planters insisted on climate-based arguments for slavery in spite of their experiences in the Americas, rather than because of them. Slaveholders contributed to the construction of a biological concept of race by making arguments about health differences between Africans and Europeans that they neither experienced nor believed. Nevertheless, their arguments entered the public record and consciousness, and the resultant development of racial thinking had profound consequences that continue to the present day. This dissertation demonstrates the critical importance of the environment to the history of race.

Backgroud: Drinking to a level that causes harm to oneself or others is characterized by several terms in the alcohol literature. These include: alcohol abuse, alcoholism, excessive drinking, heavy drinking, and problem drinking. The latter is the term used throughout the dissertation. Findings across various alcohol measures and across time show that Blacks have lower prevalence rates of problem drinking than Whites. These results appear paradoxical. First Blacks have poorer health status than Whites for many health outcomes such as diabetes, hypertension, and cirrhosis of the liver--a chronic condition attributed to heavy alcohol use. Blacks lower problem drinking than Whites seem contrary to the way social determinants and tension-reduction theories are thought to influence health. According those theories and frameworks, exposure to poor economic and social circumstances are considered socioeconomic status-related stressors, which are risk factors for problem drinking. Blacks therefore would be expected to have higher prevalence rates of problem drinking because they are exposed to a greater number and frequency of poor socioeconomic status conditions, and greater frequency of stressors relative to Whites. Quite often, the typical investigation of Black-White differences in health aims to understand why Blacks have poorer health than Whites. I investigated problem drinking for my dissertation because I thought it was equally important to understand health and behavioral outcomes for which Blacks do better than Whites and to learn about what contributes to that better health. Levels of religious involvement, the salience of religion among groups, and the potential strength of religion to regulate the lives of individuals differ across social statuses such as race/ethnicity and socioeconomic status. That rationale is discussed through historical evolution of religion among Blacks, beginning slavery, through theories attributed to Max Weber and Karl Marx, and through analysis of a passage within the Holy Bible. Given that measures of religion differ across social status, it is plausible then that religion's protective effect on health too is expected to be different across social statuses. My second hypothesis is that the protective benefits of religion on problem drinking will be stronger among Blacks than Whites. My third hypothesis is that lower socioeconomic status is associated with higher levels of religious involvement. My fourth hypothesis is that the protective benefits of religion on problem drinking are stronger among persons with low compared to high socioeconomic status. Finally, I argue that the dual social location of low socioeconomic status and Black race creates an opportunity where the protective effects of religious involvement on problem drinking become compounded. My fifth hypothesis is that the protective effects of religious involvement on problem drinking among Black low socioeconomic status would explain their lower prevalence rates of drinking compared to Whites. Methods: A secondary data analysis was conducted using Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) among a sample of Non-Hispanic Blacks (n=6, 587) and Non-Hispanic Whites (n=20,161). The main dependent variable was DSM-IV alcohol abuse. A second variable, heavy drinking, which was used for sensitivity analyses, was derived from two variables (1) frequency of consuming 5+ drinks in a single day and (2) largest number of drinks in a single day. The exposure variables were four measures of religious involvement: (1) currently attending religious services, (2) frequency of religious service attendance, (3) count of the number of religious members one interacted with on a social basis, and (4) importance of spirituality in one's daily life. Education and income were the socioeconomic status (SES) variables. Race/ethnicity was a binary variable indicating Non-Hispanic Blacks versus Non-Hispanic Whites. Results: Detailed results of this analysis are presented in this dissertation. Conclusions: Overall, religion measures had a protective effect on problem drinking, but service attendance had the most robust association. It appears that religion and socioeconomic status are not competing factors that potentially explain race-differences, in fact, they work together. There appears to be some support for the perspective that Black-White differences are explained, or at least better understood, when socioeconomic status and religion operate in an interaction model framework. The lack of finding of Black-White differences across all combinations of religion and socioeconomic status, and those differences being dependent on the type of problem drinking measure used limits the ability to generalize to an overall hypothesis. There are some noteworthy contributions this dissertation that advances the state of knowledge on this topic. It appears that the effect of religion on DSM-IV alcohol abuse for Blacks operates under different model assumptions than for Whites. Therefore, statistical comparisons may not tell the full story of Black-White differences and I recommend a renewed focus on race-specific analyses. Two main theoretical contributions emerge from this study. First, these findings suggest that individual religiosity plays an important protective role on problem drinking for equally for Blacks and Whites. The study adds more evidence as to which dimensions of religiosity most salient for protecting against problem are drinking, which is lacking in the research literature. Second, sensitivity analyses showed that the type of alcohol measure one uses to characterize problem drinking has potential implications racial disparities in alcohol research.

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.

Abstract not available

Thesis (M.S.)--Oregon State University, 2008. / Includes bibliographical references (leaves 72-76). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.S.)--University of Toledo, 2009. / Typescript. "Submitted as partial fulfillment of the requirements for The Master of Science in Pharmaceutical Sciences degree, Administrative Pharmacy option." "A thesis entitled"--at head of title. Bibliography: leaves 66-70.

Socioeconomic status (SES) is inversely related to health status. Disparities in health status among races and ethnic groups are partly attributable to differences in SES, but the indirect pathways by which SES may influence health status are not widely studied. Using the Health and Retirement Study (HRS) data, this dissertation examined the pathways by which SES, via social, psychological, and behavioral factors predicted physical impairment and overnight hospitalization, and asked whether these indirect relationships differed by race/ethnicity. The HRS is a nationally representative multistage area probability sample administered biennially to respondents over the age of 51 and their spouses. Data collected between 2002 and 2010, covering five waves of the original HRS cohort born between the years 1931 and 1941, were used. Two analysis approaches, Structural Equation Modeling (SEM) and Reconstructability Analysis (RA), were used. Adjustments for the complex survey design were made in the SEM analysis, whereas, data were matched for the RA method using propensity scores. Results of the SEM analyses supported most of the hypothesized indirect relationships between SES variables and physical impairment via social and psychological factors, but the indirect effect of SES on physical impairment via behavioral factors was weak. Multiple group analyses of path equality using nested chi-square tests indicated that the indirect effect of SES on physical impairment status did not vary by race/ethnicity. Social, psychological and behavioral factors were weakly related to overnight hospitalization, and SES was not indirectly related to overnight hospitalization. While these results supported several hypothesized indirect relationships between SES variables and physical health status, the indirect effect sizes were small. However, because this study examined predictive paths across groups rather than compare mean differences, and because indirect effects are products of individual path coefficients, small effect sizes are not uncommon in mediation analysis. Moreover, over a lifetime, small effects may gradually add up increasing group differences in health status with greater benefits accruing to higher SES individuals via social and psychological factors, as observed in this study. The RA results showed that indirect relationships between SES and physical impairment were similar across races/ethnicities for identical variables with a few exceptions. In several cases, however, selected SES variables related to social and psychological variables were different for different groups. Cross-sectional indirect relationships were stronger than longitudinal indirect relationships. As in the SEM study, SES was not related to physical impairment via behavioral factors; and, across groups, SES was also not related to overnight hospitalization either directly or via social, psychological or behavioral factors. Variables predicting physical impairment exhibited differences across groups; these differences were detected because RA, unlike SEM, used disaggregated social, psychological and behavioral factors. Where predictive variables overlapped, the effects of identical independent variable (IV) states on physical impairment were similar across groups with a few exceptions. In summary, both the SEM and RA results indicated that SES was indirectly related to physical impairment via social and psychological factors, and results from both methods also showed that SES was not indirectly related to overnight hospitalization via these factors. SEM did not find that these indirect effects varied by race/ethnicity; RA found a few differences.

Racial, ethnic, and linguistic minority workers suffer higher rates of work-related injuries and illnesses in the United States compared to their White counterparts. Explanations for these higher rates include potential socioeconomic causes (education, income, and wealth) and occupational segregation into more dangerous occupations. What is less studied are the post-injury sequelae for minority workers, which is their experiences in the workers' compensation system, as well as their health and return to paid employment. What is known comes primarily from qualitative literature, which includes themes of racial discrimination (from employers, health care providers, and workers' compensation employees), a lack of information on how to navigate the workers' compensation system, and linguistically inappropriate communication with those whose first language is not the majority language. In addition, qualitative studies have found differences in the treatment of minority workers, delays in receiving partial wage payments, and worse health outcomes. Most studies examining minority workers in the workers' compensation system have not provided a theoretical framework from which to test hypotheses as to why differences exist in a social insurance system based on race, ethnicity, and language. The purpose of this dissertation was to test the role of racial discrimination in creating worse post-injury workers' compensation outcomes for minorities, compared to English speaking Whites. This dissertation utilized fundamental cause theory to frame the hypotheses and analyses in a cross-sectional investigation of differences in workers' compensation system outcomes, using both administrative data from the workers' compensation agency, as well as survey responses from a sample of 488 injured workers in Washington State. The survey, conducted by Washington State University Social and Economic Science Research Center (SESRC), provided many variables not available in the WC administrative data including measures of perceived racial discrimination to test the hypotheses that racial discrimination is a fundamental cause of worse workers' compensation outcomes for minorities. Fundamental cause theory suggests that there are basic or fundamental reasons for health disparities that are not caused by mechanisms linking the fundamental cause with a health outcome; in fact, these mechanisms can and do change, but the relationship between the primary cause and the health disparity outcome will remain. In addition, a fundamental cause affects multiple outcomes via multiple mechanisms. Access to resources such as income, wealth, prestige, knowledge, and beneficial social connections can reduce the impact of a disease once it occurs. The analytic chapters in this dissertation are organized first, to address racial discrimination in health care provider outcomes; second, to address racial discrimination in workers' compensation agency outcomes; and third, to address the role of pre-injury racial discrimination in post-injury return to work outcomes. Racial discrimination was tested in this dissertation as the fundamental cause of health-care provider disparities in timeliness of follow-up care, adequacy of care, and patient satisfaction. Racial discrimination was tested in the workers' compensation agency as the fundamental cause of administrative delays and difficulties: delays in diagnostic approval and wage replacement payments, as well as language appropriate communication, and higher counts of independent medical exams. Racial discrimination was also tested as the fundamental cause of poor return-to-work outcomes (feeling a worker returned to work too early and overall general health). Workplace support, as a possible resource (social connection), was tested as a mediator in the relationship between racial discrimination and workplace outcomes. Due to the survey nature of the study design, replicate weights were calculated based upon information available in both the surveyed and not-surveyed population to account for non-response bias, and all analyses were bootstrapped using Stata survey software. The results support the role of racial discrimination as a fundamental cause of outcomes for hypotheses in the workers' compensation agency with clear differences in delays for diagnostic services, a higher number of independent medical exams, as well as linguistically inappropriate communication for language minorities. Racial discrimination (prior to injury) was found to be significant in overall general health for minority workers, and for feeling they had returned to work too early. Workplace support (a potential social resource), was found to mitigate the role of racial discrimination in the workplace return-to-work outcomes. This study is an initial effort to examine racial discrimination as a fundamental cause of disparities in occupational health after an injury. As the majority of adults will spend one-fifth to one-third of their lives in paid employment, the ability to heal and return to full and active employment after a work-related injury is critical to ones' self-worth, as well as to the economic stability of individuals, families, and societies. If racial, ethnic, and language minorities suffer worse outcomes in their post-injury sequelae, these results will have long-lasting implications in any quest for a more equitable society.

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 118-130).

Blacks are more affected by Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) than any other race or ethnicity in the United States. The purpose of this dissertation was to investigate potential race-based differences in cardiovascular disease (CVD)-related hospitalizations and use of opportunistic infection (OI) prophylaxis between Blacks and Whites with HIV/AIDS. This dissertation includes two systematic literature reviews that identified knowledge gaps in the areas of CVD diagnosis and OI prophylaxis use between Blacks and Whites with HIV/AIDS, as well as two independent studies that addressed some of the gaps identified in the literature. The first study evaluated the association between race and CVD-related hospitalization in Blacks and Whites with HIV/AIDS. Data were retrieved from the 1996-2008 National Hospital Discharge Surveys (NHDS). Approximately 1.5 million hospital discharges were identified. After controlling for confounders, the odds of CVD-related hospitalization were 45% higher for Blacks than Whites (OR=1.45, 95% CI, 1.39-1.51). There was a statistically significant difference in the proportions of CVD-related hospitalization type and race (x2=479.77; df=3; p<0.001). Compared to Whites with HIV/AIDS, Blacks with HIV/AIDS had greater proportions of heart failure and hypertension, but lower proportions of stroke and coronary heart disease. These results suggest that there is an influence of race on both the occurrence and type of CVD-related hospitalizations in patients with HIV/AIDS. The second study assessed if race was associated with the use of OI prophylaxis (Pneumocystis jiroveci pneumonia [PCP] and Mycobacterium avium complex [MAC]). Data for this study were retrieved from the 1996-2008 National Hospital Ambulatory Medical Care Surveys (NHAMCS). Approximately 9.1 million hospital ambulatory visits were identified. After controlling for confounders, the odds of PCP prophylaxis use were 16% higher for Blacks than for Whites (OR=1.16, 95% CI, 1.15-1.17). In a separate regression analysis, the odds of MAC prophylaxis use were 12% higher for Blacks than for Whites (OR=1.12, 95% CI, 1.10-1.13). These findings suggest that Blacks with HIV/AIDS may have increased odds for OI prophylaxis. Based on this work, there is a need for further research to confirm these findings and to identify the causes of these race-based disparities. / text