While many school districts in the state of Florida have achieved unitary status and are no longer under court jurisdiction, evidence that school districts continue to practice discipline policies that result in the disproportionate suspension of Black students can be found. Despite decades of desegregation, Black students continue to experience the devastating consequences of suspension and expulsion from school. The overrepresentation of Black students in the administration of school discipline is a serious concern for school districts. This study investigated if the attainment of unitary status resulted in equity in school discipline for Black students. Additionally, the study investigated the overrepresentation of Black students in the administration of school discipline as measured by out-of-school suspensions in the secondary schools of the 67 Florida public school districts in 2005-2006. The study compared the representation of Hispanic and Multiracial students to Black students in the administration of school discipline. The study also examined the effects of grade level (6, 7, 8, and 9) on Black, Hispanic, and Multiracial students in the administration of school discipline. Analysis of the data derived from the Florida Department of Education database for school year 2005-2006 led to the following findings: (1) there was overrepresentation of Black students in secondary schools in the state of Florida and that 42 school districts were not in compliance with unitary status guidelines; (2) Black students were overrepresented in school discipline when compared to Hispanic and Multiracial students; (3) the effect of grade (6, 7, 8, and 9) was not significant in the representation of Black students in school discipline; (4) 18 Florida public school districts have attained unitary status, 16 public school districts remained under court jurisdiction, and 33 public school districts were never subject to desegregation litigation; and, (5) Black students were overrepresented in the administration of school discipline in school districts that have attained unitary status.

The goal of this investigation is to explore the relationship of health provider communication techniques and their impact on patient understanding, satisfaction, and self-efficacy. This investigation looked at the two specific communication techniques of concern elicitation and mutual agenda setting which occur during the beginning of a medical visit. Encounters were recorded with patient knowledge and transcribed to be analyzed. Following a coding manual created from both previous research and original input, the transcripts were organized and read through to process data. Focusing on the two communication techniques—concern elicitation and mutual agenda setting—I looked at the beginning of the encounter to note any usage of the techniques. Using a series of independent samples t-tests, I found that patient understanding was significantly correlated with concern elicitation. At the same time, the length of visits that used concern elicitation and mutual agenda setting was not significantly greater than the length of visits in which these techniques were not used. This implies using these communication techniques clinical practice does not risk losing precious time. This investigation can also give support to more in depth research on various other communication techniques and their potential benefits in bridging the disparity in health literacy.

This systematic review examined literature spanning the last 10 years from Canada, the U.K., the U.S.A., Australia, and New Zealand. Findings highlight the significant gap in comparative literature examining (structural) racism as a determinant of South Asian healthcare access, utilization, and outcomes, and identifies areas of future research to address South Asian health equity concerns. / Background: Race, or specifically racism, has been well-established as a critical determinant of health, though current healthcare practices and policies in Western countries do not adequately address these issues. South Asians are the largest minority group in Canada, and they face disproportionate rates of chronic illnesses, mental health conditions, and barriers to care globally. However, their experiences in healthcare settings and the impact of race and racism on their health equity remain unexplored. This systematic review examined whether race affects healthcare access, utilization, and outcomes of South Asians compared to White-majority populations in Western countries. Methods: Embase, PsycInfo, Ageline, and CINAHL, were searched following PRISMA guidelines, as well as Google Scholar. Articles from 2013-2022 were included if they discussed racism, discrimination, or disparities/inequalities in South Asian physical and mental health, healthcare access, and utilization, outcomes compared to White populations in Canada, the U.K., the U.S.A., Australia, and New Zealand. The Mixed Methods Appraisal Tool (MMAT) was used to assess methodological quality. Data was synthesized narratively. Results: The review included 89 studies from Canada (n=19), the U.K. (n=51), the U.S.A. (n=17), and Australia (n=2), with most studies (n=76) utilizing cross-sectional or cohort designs and examining physical health outcomes (n=50). Study samples predominantly included Indians, Pakistanis, and Bangladeshis over other subgroups. Notably, there was no overall increase in comparative studies over the last decade; however, the U.K. observed an 85% increase compared to an 82% and 64% decrease in Canada and the U.S.A., respectively. The review also identified limited research on experiences within healthcare settings and mental health outcomes, sexual/reproductive health, and all health outcomes for children/youth. Few studies directly discussed the impacts of structural or organizational racism or discrimination on outcomes, though some commented on individual racism as well. Instead, studies relied on the social determinants of health as proxies for structural racism, such as education and income. Conclusion: This review highlights the significant lack of comparative research on the impact of structural, organizational, and individual racism on the healthcare access, utilization, and outcomes of South Asians compared to White-majority populations in Western countries. The review emphasizes the need for more primary, comparative research that quantifies and contextualizes South Asian experiences in obtaining healthcare services. Future research must employ rigorous and representative sampling methods, diverse study designs, and quantitative and qualitative measures that capture implicit, covert, and overt racism in healthcare among South Asians. Additionally, studies should measure factors such as religion, housing, language, and racialized institutional policies, in addition to the typically examined social determinants of health. Finally, this review highlights the need to collect and report disaggregated race and ethnicity health data with input from community leaders, and stratify these data by South Asian subgroups to avoid homogenization of distinct cultures and differential experiences in healthcare systems. Overall, acknowledging racism in healthcare and institutional policies is essential to effectively dismantle these issues and ensure health equity for South Asians. / Thesis / Master of Public Health (MPH)

Parkinson’s Disease (PD) is a neurodegenerative disorder affecting multiple domains in patients. Previous studies have illustrated the impact of healthcare disparities in patients with PD, illustrating worsened health outcomes between Black and White patient groups in all steps of the healthcare system such as diagnosis. Furthermore, the current literature has also illustrated the impact of low literacy levels on health-related outcomes in PD patients. While its role specifically in PD patients needs further understanding, language barriers have also affected patients and their interactions with the healthcare system, and its role in PD patients should be considered. In this research study, we aim to address the gaps in the existing literature through a mixed-methods design, using both qualitative and quantitative methods to address patients of Black/African-American, Hispanic/Latinx ethnicities or patients who speak Haitian Creole and Spanish regarding their experiences with diagnosis and treatment of PD.. We also aim to assess providers and their attitudes towards barriers they feel their patients from these populations may face, and to ultimately use the data of this study to develop educational videos for PD patients of these backgrounds. Ultimately, the findings of this research study may be influential not only for PD patients from these backgrounds by potentially improving their healthcare experience, but also other researchers continuing to investigate these disparities in PD and medicine overall.

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