Radical prostatectomy is the main surgical treatment for prostate cancer and is associated with various short-term complications. Racial and ethnic minority patients have worse postoperative outcomes than White patients following prostate cancer surgery. One of the factors that may contribute to the racial differences in postoperative outcomes is the differential use of new medical technology of robot-assisted surgery (RAS) across racial and ethnic groups. Patients undergoing robot-assisted radical prostatectomy (RARP) have been shown to have reduced short-term complications, length of stay (LOS), and readmissions and comparable long-term survival compared with patients undergoing open radical prostatectomy (ORP). Previous studies demonstrated that racial and ethnic minority patients with prostate cancer were less likely to receive RARP than White patients. However, critical gaps remain in 1) understanding current evidence on racial and ethnic disparities related to RAS in pelvic cancer surgery thoroughly; 2) determining the impact of RARP on racial and ethnic disparities in postoperative outcomes among prostate cancer patients, and; 3) investigating the role of surgeons on the differential use of RARP across racial and ethnic groups. To address these gaps, this dissertation conducted a systematic review to comprehensively understand racial and ethnic disparities in the use of RAS in four major pelvic cancer treatments (prostate, uterine, bladder, and rectal cancers). Following the systematic review, empirical analyses were performed using linked New York State Cancer Registry and statewide discharge records to determine the contribution of RARP to racial and ethnic disparities in the short-term outcomes after prostate cancer surgery, including determining the presence and pattern of interaction between race/ethnicity and RARP use. Based on a multilevel framework, two important hypotheses were also tested to assess surgeons’ influence on the use of RARP across racial and ethnic groups through access to care and the process of care. The systematic review found consistent evidence that Black and Hispanic patients were less likely to receive RAS than White patients in all four pelvic cancer surgeries. There is a lack of formal assessment to determine the impact of RAS use on racial and ethnic disparities in postoperative outcomes. The systematic review also found that racial and ethnic minorities were less likely to receive treatment at RAS-performing or high-technology centers than White patients. But there is a paucity of research examining physician-level factors that may be related to differential use of RAS across racial and ethnic groups. The first empirical analysis detected a statistical interaction between race/ethnicity and procedure approach that was present on the additive scale but not on the multiplicative scale. Specifically, when undergoing RARP rather than ORP, non-Hispanic Black (NHB) and Hispanic men with prostate cancer, as compared to non-Hispanic White (NHW) men, experienced a greater reduction in the risk of adverse short-term outcomes of major events (NHB vs. NHW: RERI -0.32, 95% CI (-0.70,-0.01); Hispanic vs. NHW: RERI -0.28, 95% CI (-0.74,0.09)) and prolonged LOS (NHB vs. NHW: RERI -0.32, 95% CI (-0.70,-0.01); Hispanic vs. NHW: RERI -0.28, 95% CI(-0.74,0.09)) on the absolute risk (additive) scale. The second empirical analysis confirmed the two hypotheses related to surgeons’ role in the racial and ethnic disparities related to RARP use. First, NHB and Hispanic patients were more likely to be treated by surgeons who were low-RARP users (NHB vs. NHW: OR 1.73, 95% CI 1.58-1.90; Hispanic vs. NHW: OR 2.14, 95% CI 1.90-2.41) or by surgeons at non-RARP facilities (NHB vs. NHW: OR 4.26, 95% CI 3.45-5.27; Hispanic vs. NHW: OR 4.01, 95% CI 3.44-4.67) than NHW patients, supporting racial and ethnic disparities in access to care. Second, when treated by the same surgeon and having similar conditions, NHB and Hispanic patients were less likely to receive RARP than NHW patients (NHB vs. NHW: OR 0.73, 95% CI 0.59-0.91; Hispanic vs. NHW: OR 0.72, 95% CI 0.55-0.96), supporting racial and ethnic disparities in the process of care. In summary, this dissertation identified gaps in current literature and showed that NHB and Hispanic patients with prostate cancer were less likely to receive but benefitted more from RARP than NHW patients. Increasing equitable penetration of robot-assisted technology may help reduce racial disparities in patient outcomes after radical prostatectomy. This dissertation also revealed that NHB and Hispanic patients were less likely to be treated by high-RARP-use surgeons and less likely to receive RAPR when treated for similar conditions by the same surgeons than NHW patients. Addressing structural barriers faced by racial and ethnic minority patients during care-seeking and the process of care can help reduce disparities in RAS use.

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Prostate cancer is the most commonly occurring cancer and the second leading cause of cancer death for men in the United States. Because early prostate cancer is frequently without symptoms and data on how to prevent prostate cancer is lacking, early detection has the greatest potential for decreasing mortality. Studies have shown Hispanics/Latinos to be less likely than whites or African-Americans to utilize prostate cancer screening exams. The purpose of this descriptive study was to design a social marketing plan which could be used as a model to promote Hispanic/Latino participation at prostate cancer screenings. Information obtained through medical and marketing literature review, the author's experiences serving on the promotion committee of a community-sponsored prostate cancer screening project, and interviews with 51 Hispanic/Latino prostate cancer screening participants is described and incorporated into a guide with recommendations for future program planners.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p. 79-82).

Text includes English and Spanish versions of questionaires and consent forms.

The criminal justice system is a primary driver of racial and gender injustice. While research and policy advocacy tends to center the most typical criminalized subjects— black, and more recently Latino, men— unique insights into the dynamics of race, gender, and punishment emerge when we focus on a more unique group: transgender people of color. Nearly half of black transgender people experience incarceration over the course of their lives. The extreme criminalization of transgender people of color highlights the intersectional nature of carceral violence, and the ways state violence operates alongside social exclusion and structural abandonment. The carceral state produces and maintains social divisions. This dissertation investigates how the penal definition and management of racialized gender boundaries produces vulnerability and constrains life chances for transgender and gender-nonconforming people. I also demonstrate how, in the face of state coercion, criminalized gender-nonconforming people navigate and seek to mitigate vulnerability. The empirical context for this work is the California state prison system and the reentry ecosystem of San Francisco. Drawing on extensive archival research, 20 months of ethnographic observation in transgender prisoner advocacy organizations, and 136 interviews with formerly incarcerated transgender people, advocates, policymakers, and former prison staff, this dissertation shows how racialized gender regulation operates, transforms, and is resisted in penal organizations. This study traces racialized gender regulation over time— from 1941 to 2018— and across the carceral continuum, examining the management and navigation of racialized gender boundaries behind prison walls and in reentry organizations upon transgender people’s release. While transgender prisoner discourse foregrounds issues of identity, I find that neither identity nor accounts of race and gender as stable and transportable structures are sufficient to explain the ways racialized gender boundaries operate at the meso-level of penal organizations. Prison administrators and reentry staff articulate and regulate racialized gender boundaries based on historically-specific organizational imperatives (e.g. to distinguish between reformable and incurable prisoners, or to allocate limited reentry resources). Currently and formerly incarcerated transgender people, in turn, engage with classification pragmatically and pursue safety strategies designed to minimize vulnerability to both interpersonal and state violence. I arrive at these findings through three papers that focus on different dimensions of organizational practice and pragmatic survival strategies. In the first paper, I argue that, rather than emphasizing a categorical conflict between an institutionalized gender binary and gender-nonconformity, we should analyze how the nature of prison gender boundaries arises from the historically evolving nature of racialized punishment and the inherently coercive nature of classification in a total institution. Prison gender boundaries reflect an evolving conflict between the prison’s efforts to label, control, and confine bodies, and prisoners’ capacity to resist. Prison administrators make and manage gender boundary violation based on the evolving penal logics and resources at their disposal; from 1941-2018, administrators successively use strategies of segregation, treatment, risk management, and bureaucratic assimilation. Prisoners, in turn, express or repress non-normative gender identifications based on the consequences of classification in changing penal regimes. In the second paper, I extend research that has explained incarcerated transgender women’s high rates of victimization based on the prison’s rigid institutionalization of the gender binary. Employing an intersectional approach, I demonstrate that trans women of color in men's prisons are vulnerable because their restricted mobility, subjection to guard coercion, and material deprivation facilitates sexual assault. In this context, trans women of color use embodied, social, and economic resources to avoid victimization. Lastly, I examine how racialized gender regulation persists in the reentry organizations transgender people encounter upon release. Examining the gender rules and gendered interactions fostered by reentry housing programs, I show how the repudiation and regulation of black trans women’s womanhood leads to their exclusion from reentry resources and heightened reentry hardship. Together, these three papers work to explain how racialized gender regulation in the penal system generates complex, intersectional inequality, while also illuminating the ways criminalized transgender people of color understand, navigate, and resist these conditions.

Latino men, particularly those who have sex with other men, have been disproportionately affected by HIV/AIDS. Scholars have sought for nearly two decades to understand how various social and cultural factors in the Latino community exacerbate HIV risk among these men. Although following the advent of life-sustaining medications in 1996, HIV is often regarded as a manageable chronic illness, as opposed to a death sentence, scant attention has been devoted to how HIV-positive Latino men experience managing the illness. Among studies that have focused on HIV-positive persons' illness management, few Latino men have participated. Using the Appraisal framework from Hallidayan Systemic Functional Linguistics, with Bucholtz and Hall's theory of social identity (2004, 2005), this discourse analysis sought to explore intersubjective relations as reported by five HIV-positive Latino men, three native-born and two immigrants, in semi-structured interviews that attempted to avoid preconceived expectations about salient structures. While structures such as homophobia, machismo, and stigma emerged in each interview, the native-born men's discourse differed from that of the immigrants in that the former did not address financial concerns with regard to HIV medications, whereas the latter represented their agency as having been constrained by low income requirements for obtaining assistance in accessing expensive HIV medications. This finding tentatively suggests that the issue could be more salient for immigrants than native-born Latinos and warrants additional, more focused research on the effects of the structures of benefit programs on HIV-positive Latino immigrants.

Men are frequently left out of the picture in the study of family planning and sexual risk behavior. This approach means few programs and policies address men's family planning and sexual health issues. There is also a lack of understanding of the role fatherhood plays in men's development and in family planning and sexual health. For Mexican immigrant men, the picture is even worse given their disadvantaged position and the unique obstacles they face (e.g., language barriers, acculturation issues) that put them at risk for experiencing unintended pregnancies and contracting Sexually Transmitted Infections (STIs). Grounded in symbolic interactionism and life course theory, I explored how social roles (e.g., partner, father), individual factors (e.g., education, cultural values), and health systems influence the family planning and sexual risk-taking experiences of young Mexican immigrant men paying particular attention to differences and similarities between fathers and nonfathers. To answer the research questions, a qualitative study was conducted using secondary data from the Latino Health Project: Men Only. The sample was comprised of 21 fathers and 25 nonfathers ages 18 to 30 (N = 46), all of whom had lived in the United States for 10 years or fewer, thus being considered recent immigrants. Data for the project were collected using a semi-structured interview guide with open-ended questions followed by directive probes. The analysis process used grounded theory methodology techniques (LaRossa, 2005). Key findings suggest that both fatherhood status and partners play an important role in men's experience with sexual and reproductive health, with partners playing a more influential role. Fatherhood plays a more active role in men's ideas about family planning while partners seem to play an influential role in men's actual behaviors such as engaging in family planning services and using birth control other than condoms. The influence that fatherhood and partners have on men's experiences with family planning and sexual risk-taking was shaped by a unique combination of accurate information, different levels of knowledge, and misinformation. Access to services was shaped by health systems that prevented men from seeking services due to documentation issues and economic barriers. Cultural factors such as machismo, marianismo, and personalismo also influenced some attitudes and behaviors related to birth control use, vasectomies, risk-taking, and services utilization. Findings suggest these men are exposing themselves and their partners to unintended pregnancies and sexually transmitted infections. Beyond these being public health concerns, it is crucial that researchers, policy makers, and service providers remember that current sexual risk behaviors have a direct impact on the fertility and family formation patterns of the fastest growing population in the United States. / Graduation date: 2012 / Access restricted to the OSU Community at author's request from Jan. 9, 2012 - Jan. 9, 2013