Purpose Physical activity is recognized as a complementary therapy to improve physical and physiological functions among prostate cancer survivors. Little is known about communication between health providers and African-American prostate cancer patients, a high risk population, regarding the health benefits of regular physical activity on their prognosis and recovery. This study explores African-American prostate cancer survivors’ experiences with physical activity prescription from their physicians. Methods Three focus group interviews were conducted with 12 African-American prostate cancer survivors in May 2014 in St. Louis, MO. Participants’ ages ranged from 49 to 79 years, had completed radical prostatectomy, and their time out of surgery varied from 7 to 31 months. Results Emerged themes included physician role on prescribing physical activity, patients’ perceived barriers to engaging in physical activity, perception of normalcy following surgery, and specific resources survivors’ sought during treatment. Of the 12 men who participated, 8 men (67%) expressed that their physicians did not recommend physical activity for them. Although some participants revealed they were aware of the importance of sustained physical activity on their prognosis and recovery, some expressed concerns that urinary dysfunction, incontinence, and family commitments prevented them from engaging in active lifestyles. Conclusions Transitioning from post radical prostatectomy treatment to normal life was an important concern to survivors. These findings highlight the importance of physical activity communication and prescription for prostate cancer patients.

The overarching goal of this dissertation was to elucidate the psychosocial and behavioral determinants of medication nonadherence among African Americans with hypertension. One in three Americans in the United States has hypertension, and the prevalence of hypertension among African Americans is among the highest in the world. In addition to healthy behaviors such as following a low-salt and low-fat diet, getting regular exercise, and reducing stress, patients with hypertension must also adhere to antihypertensive medications. Poor medication adherence may be driven by psychosocial and behavioral factors; however, the impact of these factors on medication adherence is unclear especially within the African American community. To date, a paucity of research has examined the relationship between psychosocial and behavioral factors such as reported racial discrimination, John Henryism (a measure of active coping and an unhealthy response to stress) and home remedies with medication nonadherence. However, each of these factors has individually been linked with poorer health outcomes among African Americans. Using data from the TRUST study (2006-2008) the association between these constructs and medication adherence was assessed within our sample of 788 African Americans and a comparison group of 137 White participants with hypertension. Ordinal logistic regression was used to assess the association between racial discrimination, John Henryism, home remedies, and medication adherence. The findings from this research indicated more reported racial discrimination, higher John Henryism scores, and greater use of home remedies were associated with lower medication adherence. These findings yield new knowledge about medication adherence and provide practical insights about the psychosocial and behavioral determinants of medication adherence.

An emerging framework, the Identity Pathology (IP) model, partially addresses persistent uncertainties about the primary causes of disparities in cardiovascular health (CVH) between black and white women and men through outlining how identity beliefs associated with social group membership lead to predictable differences in the health-damaging effects of discrimination exposure. Using data from the CARDIA cohort, this doctoral thesis seeks to: 1) propose a novel psychosocial characteristic, identity pathology, that drives the distribution of reported race and gender discrimination in health-relevant ways, 2) assess whether there are group differences in the effects of multiple versus single forms of discrimination on future CVH, and 3) assess variation between these groups in the relationships of reported racial and gender discrimination in a variety of daily life settings with future CVH. The IP framework suggests that beliefs about identity unique to each gendered race group influence the perception of discrimination and whether reported exposure will be associated with CVH. Simultaneous reports of racial and gender discrimination in multiple settings (compared with no discrimination) were negatively associated with future CVH only among white men. Further, the setting in which discrimination was reported appeared to be a significant indicator of whether experiencing multiple forms of discrimination negatively impacted CVH in each group. Our findings contribute to the literature through introducing a novel framework for assessing the effects of interpersonal discrimination. This work also provides preliminary evidence that compounded experiences of interpersonal racial and gender discrimination may not substantially contribute to poorer CVH among black women.

Background Acute coronary syndromes (ACS) are a major cause of mortality and morbidity in the developed world. By 2020, ACS will be the leading cause of morbidity and mortality worldwide, largely due to substantial increases in ACS burden in developing countries. The developing world has been under-represented in international ACS registries. The Arabian Gulf area is a part of the developing world where little is known about the epidemiology of ACS. The first aim of the dissertation is to compare ACS patient characteristics, current practice patterns, and in-hospital outcomes in the Arabian Gulf area to a large multinational sample. Patients with an ACS suffer numerous clinical complications that worsen their prognosis. Cardiogenic shock (CS) is the most serious complication of ACS and the leading cause of in-hospital death. Despite advances in therapies; CS hospital mortality rates continue to exceed 50%. The second aim of the dissertation is to describe the characteristics of patients presenting with ACS complicated by cardiogenic shock, their management, and outcomes in a large multinational sample. In recent years, ACS has been increasingly affecting younger patients. While marked age-related differences have been observed in the risk of developing as well as the prognosis of ACS, few studies however examined time trends in the epidemiology of ACS in young adult patients. The third aim of the dissertation is to examine trends in frequency rates, patient characteristics, treatment practices, and outcomes in young adults hospitalized with an ACS. Methods Data from two large multinational registries of patients hospitalized with an ACS were used for this investigation. Nearly 65,000 patients were enrolled in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007, while 6,700 patients participated in the Gulf Registry of Acute Coronary Events (Gulf RACE) in 2007. Results Aim1: Patients in Gulf RACE were significantly younger and were more likely to be male, diabetic, and smoke Compared to GRACE. Patients in Gulf RACE were less likely to receive evidence based therapies. Short-term mortality rates were comparable between the two patient cohorts. Aim2: Compared to patients with no CS, patients with CS were more likely to be older, female, have a history of diabetes, and heart failure. Patients with CS were less likely to receive effective cardiac catheterization and adjunctive cardiac medications. In-hospital case-fatality rate of patients with CS were 59.4%. While in-hospital mortality declines over the study period, incidence rates only showed minor declines. Aim2: Baseline characteristics of patients < 55 years of age did not significantly change, while the use of evidence based therapies increased significantly during the years under study. Rates of short-term adverse outcomes and mortality significantly declined over time. Conclusions We observed marked regional differences in the risk profile, clinical management, and outcomes of patients with an ACS internationally compared to the Arab Middle East. Despite the encouraging trends in the use of evidence based therapies which have likely contributed to the improving trends in the prognosis of ACS, rates of development of ACS, as well as mortality due to ACS complications, remain high.

This paper examines the relationship between Track I Diplomacy and Civil Society in Cyprus. Cyprus has been a divided island for over 45 years despite numerous attempts at reconciliation on the societal level and ongoing negotiations on the diplomatic level. It was the aim of this study to examine the ways in which both civil societies and their leaders do or have worked together, if at all, to negotiate a political solution or reconciliation between the two communities. Interviews were conducted on both sides of the cultural divide and within both political and civil society sectors. Those interviews were coded, categorized, and then thematically analyzed. Findings explicate three themes that challenge the relationship and cooperation between Track I and Track II; Structural Elements, Nationalism, and International Support. Furthermore, it is proposed that the leaders must lead and support their citizens in reconciliation and peacebuilding efforts while continuing to negotiate a solution to the Cyprus problem as civil society organizations continue to support negotiation efforts.

Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning. Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion. Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan. I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values.

Cross-race mentoring relationships are of interest to the theory and practice of mentoring and they also speak to a longstanding problem in the sociological study of prejudice. The mentoring literature reveals some disagreement regarding the advisability of cross-race matching for young protégés. Some researchers stress same-race matching, while others emphasize the problem this creates for minority's facing a dearth of mentors. Sociologists and psychologists, on the other hand, have amassed evidence showing support for a contact hypothesis, which states frequent intergroup contact between equal-status members can lead to improved perceptions of the Other. However, to date, the contact hypothesis has not been explored in the context of mentoring relationships between white adults and minority youth. This Thesis hopes to fill these gaps in the literature. The purpose of this Thesis is to better understand the perceptions and understandings mentors and protégés attach to their cross-race mentoring relationship. It is primarily concerned with identifying the conditions that lead to successful outcomes of interracial mentoring experiences. Specifically, this study explores the perceptions of white adult mentors and black and Latino protégés of their activities, interactions, and their views on the advantages and drawbacks of their cross-race mentoring relationship. This study explores mentors and protégés in cross-race mentoring relationships to grasp a better idea of the meanings each mentoring partner attaches to their mentoring experience. Respondents are sampled from one formal mentoring program at a four-year university. Nine mentors and eleven protégés are interviewed following a semi-structured format. From this sample of twenty participants, six complete pairs participated. The remaining seven respondents make up the supplemental data group, as their mentoring partner did not participate in this study. This study suggests that the intergroup contact theory is useful in explaining the outcomes of these cross-race mentoring relationships. Not only does this Thesis support the intergroup contact theory, it also broadens our understanding by painting a more complete picture of how the optimal conditions emerge and work to strengthen and reinforce one another. Additionally, this research highlights how important understanding both the in-group and out-group member's perceptions are when exploring cross-race mentoring relationships and the intergroup contact theory. Finally, this study supports the notion that a mentoring program's structure is an important feature that can greatly enhance or inhibit mentoring bonds between mentors and protégés.

This thesis explores patterns of environmental inequality in Portland, Oregon; both the existence of spatial environmental inequalities and the structural and local forces which contribute to them. Research on environmental inequality, or inequitable exposure to toxins, has shown that minority and low-income populations experience the bulk of the exposure to environmental hazards. Although Portland is often cited as the archetype of a sustainable city, environmental inequality is a pervasive issue. This thesis examines the health inequalities that characterize underserved communities in Portland. Utilizing a mixed methods approach, the researcher uses 1) logistic regression to statistically assess the relationship between race, poverty, and Superfund site locations, and 2) in-depth interviews with members of Oregon's environmental justice movement to help understand the historical, social, political, and economic conditions of Portland and their subsequent influence on environmental inequalities. Quantitative data is pooled from 2000 census and 2011 Environmental Protection Agency (EPA) sources. The quantitative findings demonstrate that environmental inequality is present in Portland, with African Americans being particularly overrepresented in tracts with Superfund sites. The quantitative analyses ultimately suggest that minimally populated, highly impoverished tracts with approximately 11% African American residents are most likely to house a Superfund site. The qualitative findings show that a variety of structural and local forces play prominent roles in the formation of Portland's environmental inequalities. The qualitative analyses reveal this to be a multifaceted and complex process that is indicative of Portland's history of racial inequality, contemporary free market and business forces, and governmental interests which culminate in trends of inequitable development.

This research effort is based on the life and development process which the author has experienced and is currently experiencing. This effort for all intents and purposes, is an individual self-study. "Critical Incidents" have been utilized to develop a sense of understanding for the reader. In reading this paper, one can see that at times negative social and cultural situations would cause the author an unusually high level of inner stress, which was not always apparent to the outside world.

It is important to consider the effects of past conflicts on the current perceptions of the people of Cyprus and of the future generations. This thesis contends that the ongoing division of Cyprus along with the many unresolved issues regarding past conflicts have had a profound effect on how the people of Cyprus perceive new information in regard to their future. The inquiry will explore the historical background of Cyprus and the affects of nationalism. The need for enemies, large group identity, divided societies and the need for dialogue will also be examined in relation to perception and new information. In light of the interviews and the lived experiences in Cyprus questions arise in regard to how the Cypriots will move forward to a solution that is agreeable to both Greek Cypriots and Turkish Cypriots. With each person's perception being influenced by the past conflicts, pain and suffering how will they move forward? How has protracted conflict and nationalism influenced the Turkish Cypriot and Greek Cypriot perceptions to new information including a possible solution in Cyprus?