published_or_final_version / Community Medicine / Master / Master of Public Health

Discrimination is not only a human and civil rights offense, but also a detrimental influence on the health outcomes of affected populations. The Muslim population in the United States is a growing religious minority increasingly encountered by health care professionals in the clinical setting. This group has been subject to heightened discrimination since the tragic events of September 11, 2001 and often is misunderstood within the context of American society today. While research has been conducted on discrimination against Muslims in the employment and educational segments of society, more studies are needed which quantify the extent and type of discrimination faced by this group in the health care setting. This inquiry focused on the crossover of anti-Muslim discrimination from society to the health care setting. A newly developed tool to measure anti-Muslim discrimination in health care and an established perceived discrimination scale were used to create the questionnaire employed in this investigation. The items of this newly created tool addressed culturally congruent care practices based on the principles of cultural safety within the nurse-patient relationship and the cultural care beliefs of the Muslim patient/family to ascertain discriminatory occurrences in the health care setting. Ray’s (2010) transcultural caring dynamics in nursing and health care model served as a framework for this quantitative, univariate, descriptive, cross-sectional design. Findings revealed that nearly one-third of Muslim subjects perceived they were discriminated against in the health care setting in the United States. Being excluded or ignored was the most frequently conveyed type of discrimination, followed by problems related to the use of Muslim clothing; offensive or insensitive verbal remarks; and problems related to Islamic holidays, prayer rituals, and physical assault, respectively. Age was positively correlated with perceived anti-Muslim discrimination in society. Education was negatively correlated with perceived discrimination in both society and the health care setting. Findings revealed that three out of five of those surveyed reported that they wear Muslim clothing; the most frequently reported of which was the hijab, the most popular Muslim garment reported to be worn. Participants who wore Muslim clothing, especially females, reported more anti-Muslim discrimination than those who did not. Scores for self-reported perceived anti-Muslim discrimination were found to be higher after the Boston Marathon bombings, April 15, 2013, an act perpetrated by Muslims, which occurred during the time of data collection. The number one Muslim care preference reported was same sex caregiver followed by respect for modesty, prayer rituals, respect for privacy, family involvement in care, and dietary concerns. Implications for practice, policy, education, political science, and recommendations for further research are discussed. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2013.

Bibliography : leaves 375-403. / vi, 403 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the response to a number of outsiders and marginal social groups, such as Jews, Chinese, and Southern and Eastern Europeans predominantly in England and Australia, and considers the role that public health played in arguments for their exclusion and control. Measures the strength of the public health case, arguing that a health threat was generally not a real issue but, more typically, a badge which labelled the outsider as dangerous to the community. / Thesis (Ph.D.)--University of Adelaide, Dept. of Community Medicine, 1993

Sleep has been recognized as a major determinant of physical and mental health. Emerging studies suggested that social and built environments should be considered as important determinants of sleep health, however causal mechanisms between neighborhood factors and sleep health still remain unclear. The proposed dissertation is a connected set of papers including a systematic review and longitudinal studies investigating associations between neighborhood stressors and sleep health as well as potential causal mechanisms via psychological distress and physical activity. The longitudinal studies employed comprehensive measures of neighborhood characteristics and sleep health along with g-estimation and mediation analysis techniques. Neighborhood social and built environments may contribute to poor sleep health, particularly in low-income and racial/ethnic minority neighborhoods, and psychological distress can be a salient pathway linking these neighborhood characteristics and sleep health. Based on our findings, interventions to improve sleep should target modifiable factors and enhance neighborhood environments. These sorts of strategies have the potential to improve not only sleep health but also other health outcomes.

COPD is the third leading cause of death in the United States and is the sixth leading cause of death for low-to middle income countries (Downs & Appel, 2006; GOLD, 2011). COPD is a largely preventable disease due to the lifestyle factors that heavily contribute to disease onset and severity. Although traditionally COPD research has focused on health outcomes related to risk factors, compliance, comorbid psychological and physical conditions, and treatment interventions, a growing body of research suggests religious and spiritual factors may play an equally important role in health outcomes for several medical conditions, including pulmonary disease. However, studies of this kind have not specifically examined COPD nor have they examined the role of religious and spiritual beliefs in COPD management among ethnic minority patients. As such, the current study aimed to examine whether spiritual ethnic minority patients with COPD hold religious fatalistic attitudes and less active religious problem solving . A sample of 35 ethnic minority patients from the Louis. B. Stokes Cleveland VA Medical Center (LSCVAMC) Outpatient Pulmonary Clinic in Cleveland, OH. were recruited to participate in the study. Due to the acknowledgeable limitations of the present study, results are preliminary but convey associations between religious health fatalistic beliefs and religious problem solving approaches. Implications and areas of future study are discussed.

The problem that this study addressed was the lack of a survey tool to adequately assess the impact of practicing capoeira, including for People of Color who are male adults attending undergraduate and graduate universities. Thus, the purpose of the study was to evaluate the value and utility of a new survey designed to enhance research and scholarship on capoeira, while seeking to identify significant predictors of high ratings for having experienced beneficial impacts from capoeira. A small sample permitted only a pilot study that was largely exploratory in nature with suggestive findings. The sample of undergraduate and graduate students was 100% male (N=59) with a mean age of 25; and 47.5% identified as Black, 22% as Asian American, 27.1% as White, and 8.5% identifying as Latinx. Findings showed men reported closest to good physical health and between fair and good mental/emotional health. The mean number of years engaged in capoeira was two years, while playing between three times per month and once per week. Some 78% played capoeira at moderate intensity with 17% reporting high or very high intensity. The sample indicated experiencing a mean of 4 out of the 5 elements of the graduation (batizado) experience. They indicated a moderately high level for experiencing elements of classic capoeira with the highest rated being showcasing trickery without inflicting harm. Common experiences during the capoeira included feelings of transcendence, feeling accepted by others, and encouragement to develop one’s own identity. They indicated a high level of beneficial impacts from capoeira with the top ranked being a more positive attitude and a greater sense of control over one’s life. Noteworthy findings indicated men of color had significantly higher beneficial impacts from capoeira than White men. Both the Pearson correlations and regression found higher beneficial impacts were associated with higher exposure to the basic elements of capoeira, higher exposure during capoeira play to commonly reported experiences, and higher race-related stress due to being a Person of Color. The benefits found for men of color and those experiencing higher race-related stress support university investments, so men of color have access to community-based capoeira.

The primary focus of the current study was to identify health disparities between sexual minority subgroups by examining differences of health indicators in lesbians, gay men, and bisexual individuals, and compare these to their heterosexual counterparts. Data was drawn from the National Health and Nutrition Examination Survey (NHANES), and variables examined in sexual minorities were related to health care access and utilization, risky health behaviors, and overall disease prevalence and outcomes. Findings suggest there are still some current health disparities in terms of insurance coverage, access to medical care, substance use, and prevalence of certain health conditions. However, a trend analysis conducted to examine three NHANES panels, suggests a mild improvement in some of these areas. Further findings, discussion, limitations of the study, current implications, and future directions are addressed.

Diabetes is a chronic disease which affects approximately 5% of all Canadians and contributes to considerable health care costs. At present diabetes can be controlled but not cured. Increased recognition that the provision of diabetes education is essential in diabetes management has led to the development of education programs in many Canadian hospitals. However, participation surveys done in the United States indicate that only 12 to 35% of individuals with diabetes receive education through formal programs. This study seeks to identify factors deterring participation of elderly Sikh Indo-Canadians with NIDDM in education programs. In depth interviews were conducted with the research participants. The Adapted Chain of Response Model was used as the framework to develop questions for the interview guide and to collect, organize and analyze the data. Deterrents identified in previous studies and supported by this study include: older age, low self-confidence, questioning the worth of the program, being on oral medications versus insulin, having one's own ways of self-care, having a family doctor for treating diabetes, financial concerns, time constraints and transportation problems, and an underestimation of the seriousness of NIDDM by doctors. Deterrents unique to the study include: viewing self as healthy, desiring anonymity, reliance on religion, not valuing non-doctors, lacking familial support, perceiving health professionals as lacking cultural sensitivity, lacking awareness of program purpose and existence, and not being referred at time of diagnosis. Family doctors not valuing diabetes education and/or services of health professionals and not encouraging individuals to attend were also identified as deterrents. This study makes recommendations for practice and research which may be useful to diabetes educators, health care organizations and researchers in assisting them to fully understand and address challenges involved in making diabetes education a reality for a greater number of individuals with diabetes.

Diabetes is a chronic disease which affects approximately 5% of all Canadians and contributes to considerable health care costs. At present diabetes can be controlled but not cured. Increased recognition that the provision of diabetes education is essential in diabetes management has led to the development of education programs in many Canadian hospitals. However, participation surveys done in the United States indicate that only 12 to 35% of individuals with diabetes receive education through formal programs. This study seeks to identify factors deterring participation of elderly Sikh Indo-Canadians with NIDDM in education programs. In depth interviews were conducted with the research participants. The Adapted Chain of Response Model was used as the framework to develop questions for the interview guide and to collect, organize and analyze the data. Deterrents identified in previous studies and supported by this study include: older age, low self-confidence, questioning the worth of the program, being on oral medications versus insulin, having one's own ways of self-care, having a family doctor for treating diabetes, financial concerns, time constraints and transportation problems, and an underestimation of the seriousness of NIDDM by doctors. Deterrents unique to the study include: viewing self as healthy, desiring anonymity, reliance on religion, not valuing non-doctors, lacking familial support, perceiving health professionals as lacking cultural sensitivity, lacking awareness of program purpose and existence, and not being referred at time of diagnosis. Family doctors not valuing diabetes education and/or services of health professionals and not encouraging individuals to attend were also identified as deterrents. This study makes recommendations for practice and research which may be useful to diabetes educators, health care organizations and researchers in assisting them to fully understand and address challenges involved in making diabetes education a reality for a greater number of individuals with diabetes. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

Gender and sexual minorities (GSM) experience considerably worse health outcomes than heterosexual and cisgender people, yet no comprehensive understanding of GSM health exists due to a dearth of research. GSM leaders in Dallas expressed need for a community needs assessment of GSM health. In response to this call, the Center for Psychosocial Health Research conducted a needs assessment of gender and sexual minority health in Dallas (35 interviews, 6 focus groups). Competency was one area highlighted and shared across existing research. Thus, the current study explored how competency impacts gender and sexual minorities' experience of health care in Dallas. We utilized a consensual qualitative research approach to analyze competency-related contents. The meaning and implications of emerging core ideas were explored. These findings were also used to develop a survey instrument.