Master of Arts / Sociology, Anthropology, and Social Work / Mario V. Cano / Despite the substantial research conducted on racial and ethnic disparities in the criminal justice system, the majority of research focuses on final sentencing decisions. Less attention has been devoted to earlier stages in criminal processing, such as the presentence detention process. In fact, the analyses that did investigate presentence detention status mainly used state-level data, and there is only a handful of studies that have examined race/ethnicity and gender effects on detention and bail in the federal criminal justice system (e.g., Albonetti, 1989; Bak, 1998: Reitler, et. al., 2012; Spohn, 2009). Furthermore, recent analyses have uncovered that extralegal disparities in presentence detention outcomes, particularly racial and ethnic disparities, vary across court jurisdictions (e.g., Levin, 2008; Pinchevski & Steiner, 2013; Eisenstein & Jacob, 1977). Thus, the purpose of this study is to explore the effects of defendants’ race/ethnicity and gender, and social context, on defendants’ pretrial status. This study employs a multilevel modeling strategy and uses criminal sentencing data (N=130,120) from the U.S. Sentencing Commission (USSC) for fiscal years 2008 to 2010, across 89 U.S. District Courts, including supplemental data drawn from the U.S. Census Bureau and the Federal Judicial Center’s Federal Court Management Statistics. The initial findings indicate that Black and Hispanic defendants are less likely than Whites, and females are more likely than males, to be released on bail and rereleased on their own recognizance (ROR). Regarding the district level, ROR is less likely for defendants processed in districts with a higher crime rate and higher socioeconomic disadvantage. On the other hand, bail is more likely for defendants processed in districts with larger courts (more judges). In cross-level interactions increase in percent Black, increase in crime rate, and increase in socioeconomic disadvantage are positively associated with bail for Black defendants, while increase in percent Hispanic and court size are positively associated with bail for Hispanic defendants. Consistent with the courts as communities and focal concerns perspectives, this study found that the presentence process is influenced by local practices, norms, and concerns for organizational efficiency. These distinctive features of court jurisdictions interact with race/ethnicity and affect defendants' presentence status. Future research is needed to better assess the detention process with increased access to federal data. In addition, examination of intersectionality of race/ethnicity, gender and age at the presentence detention stage is required.

abstract: Identifying modifiable causes of chronic disease is essential to prepare for the needs of an aging population. Cognitive decline is a precursor to the development of Alzheimer's and other dementing diseases, representing some of the most prevalent and least understood sources of morbidity and mortality associated with aging. To contribute to the literature on cognitive aging, this work focuses on the role of vascular and physical health in the development of cognitive trajectories while accounting for the socioeconomic context where health disparities are developed. The Assets and Health Dynamics among the Oldest-Old study provided a nationally-representative sample of non-institutionalized adults age 65 and over in 1998, with biennial follow-up continuing until 2008. Latent growth models with adjustment for non-random missing data were used to assess vascular, physical, and social predictors of cognitive change. A core aim of this project was examining socioeconomic and racial/ethnic variation in vascular predictors of cognitive trajectories. Results indicated that diabetes and heart problems were directly related to an increased rate of memory decline in whites, where these risk factors were only associated with baseline word-recall for blacks when conditioned on gender and household assets. These results support the vascular hypotheses of cognitive aging and attest to the significance of socioeconomic and racial/ethnic variation in vascular influences on cognitive health. The second substantive portion of this dissertation used parallel process latent growth models to examine the co-development of cognitive and functional health. Initial word-recall scores were consistently associated with later functional limitations, but baseline functional limitations were not consistently associated with later word-recall scores. Gender and household income moderated this relationship, and indicators of lifecourse SES were better equipped to explain variation in initial cognitive and functional status than change in these measures over time. Overall, this work suggests that research examining associations between cognitive decline, chronic disease, and disability must account for the social context where individuals and their health develop. Also, these findings advocate that reducing socioeconomic and racial/ethnic disparities in cognitive health among the aging requires interventions early in the lifecourse, as disparities in cognitive trajectories were solidified prior to late old age. / Dissertation/Thesis / Ph.D. Sociology 2011

Introduction: The purpose of this study is to examine how nursing home (NH) characteristics, specifically racial composition of nursing homes residents, influences the use of physical restraints. As the population ages and becomes more diverse, it is essential to mitigate/eliminate racial/ethnic disparities in quality care. Methods: This is cross-sectional study using a 2010 national data set from Brown University Center for Gerontology and Healthcare Research. This study employs Donabedian's Structure-Process-Outcome (SPO) conceptual framework. Statistical analysis includes univariate, bivariate, and a logistic regression model. It is hypothesized that nursing homes with higher proportions of black residents, more Medicaid residents, and for-profit ownership status will be associated with higher prevalence of physical restraint use. Results: Findings show that nursing homes with high proportions of blacks have a lower likelihood of high physical restraint use. Nursing homes with a higher proportion of Medicaid-reliant residents have a higher likelihood of restraint use, as does for-profit nursing homes. Discussion: The findings indicate that there are no racial/ethnic disparities present in the use of physical restraints in nursing homes. There is indication of socio-economic disparities, since nursing homes with higher Medicaid-reliant residents are associated with greater restraint. There are policy implications associated with these findings, including raising Medicaid per diem or implementing a quality performance payment incentive. Further research will be needed to determine ways to reduce racial/ethnic disparities in nursing homes. This research, adds to the nursing home literature focused on socio-economic disparities.

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The objective of the present study is to address some important questions related to prostate cancer treatments and survivorship among White and African American men. It is commonly understood that the risk of developing prostate cancer is higher in African American men than the other races. However, using parametric analysis, this study demonstrates that this perception is a "myth" not a "reality". The study further identifies the existence of racial/ethnic disparities by comparing the average mean tumor size, the median of survival time, and the survival function between White and African American men. These results underline the necessity of understanding the role of racial background in working towards improved clinical targeting, and thereby, improving clinical outcomes. Furthermore, parametric survival analysis was performed to estimate the survivorship of white men undergoing different treatments at each stage of prostate cancer. Additionally, to better understand the risk factors (age, tumor size, the interaction between age and tumor size) associated with survival time, an accelerated failure time model was developed that could accurately predict the rates of survivorship of white men at each stage of prostate cancer in accordance with whatever treatment they had received. Finally, the results of parametric survival analysis and the accelerated failure time model are compared among white men undergoing similar treatment at each stage of the disease.

OBJECTIVE: Substance use disorders (SUD) affect approximately 19.3 million adults in the United States. Of adults with SUDs, only 5% perceive the need for SUD treatment and 10% utilize specialty SUD treatment. The literature evidences racial disparities in utilization of SUD treatment yet presents mixed outcomes regarding race/ethnicity (i.e., White, Latinx, and Black/African-American) and gender (i.e., male, female) differences in perceived need for SUD treatment, specialty SUD treatment utilization, and barriers to SUD treatment. In addition, interaction with healthcare systems for chronic medical conditions like diabetes or hypertension may facilitate connection to SUD treatments for individuals with co-occurring SUD and chronic medical conditions, but little research exists that explores this potential facilitator. This dissertation addresses the following questions, with a focus on race/ethnicity and gender, and their interaction: 1.) What characteristics are associated with perceiving a need for SUD treatment among adults with SUD? 2.) What are the characteristics of adults who do not engage in specialty SUD treatment among those who perceived a need for SUD treatment? What were the most commonly reported barriers to specialty SUD treatment? and 3.) Is receipt of a chronic medical condition diagnosis among individuals with SUD associated with a greater likelihood of specialty SUD treatment utilization? METHODS: This study uses data from the National Survey on Drug Use and Health (NSDUH) from years 2005 through 2017. Simple and multivariate logistic regressions were conducted and interactions were tested using multiplicative terms with race/ethnicity and gender. Analyses adjusted for weights to account for the survey’s complex sampling design. RESULTS: No significant racial/ethnic or gender differences were found in association with perceived need for SUD treatment. Among adults who perceived the need for SUD treatment, less than 20% in any racial/ethnic category utilized specialty SUD treatment services. Black/African-American adults, compared to White, were more likely to utilize specialty SUD treatment and less likely to name stigma as a barrier to treatment. Black/African-American adults with co-occurring chronic medical conditions and SUD were more likely to perceive a need for SUD treatment, but similarly likely to utilize specialty SUD treatment in comparison to White adults. Women and men did not significantly differ on perceived need for SUD treatment, utilization, or barriers. CONCLUSIONS: Differences in SUD treatment utilization patterns exist in association with race/ethnicity, though not with gender. Study findings suggest the presence of specialty SUD treatment utilization disparities, with stigma contributing to lower utilization for Whites compared to Blacks/African-Americans. Higher rates of treatment utilization among Blacks/African-Americans may reflect the presence of strengths uniquely attributed to this group.

The purpose of this dissertation was to examine patterns of antenatal stressful life events (SLEs) experienced by women in the United States (U.S.) and their association with postpartum depression (PPD). It further explored the role of women's state-level socio-economic status (SES) on PPD; the racial/ethnic dispartites in SLE-PPD relationship; and the role of provider communication on perinatal depression. Data from 2009–11 Pregnancy Risk Assessment Monitoring System (PRAMS) and SES indicators published by the Institute of Women’s Policy Research (IWPR) were used. Latent class analysis (LCA) was performed to identify unobserved class membership based on antenatal SLEs. Multilevel generalized linear mixed models examined whether state-level SES moderated the antenatal SLE-PPD relationship. Of 116,595 respondents to the PRAMS 2009-11, the sample size for our analyses ranged from 78% to 99%. The majority (64%) of participants were in low-stress class. The illness/death related-stress class (13%) had a high prevalence of severe illness (77%) and death (63%) of a family member or someone very close to them, while those in the multiple-stress (22%) class endorsed most other SLEs. Eleven percent had PPD; women who experienced all types of stressors, had the highest odds (adjusted odds ratio [aOR]: 5.43; 95% confidence interval [CI]: 5.36, 5.51) of PPD. The odds of PPD decreased with increasing state-level social/economic autonomy index (aOR: 0.75; 95% CI: 0.64, 0.88), with significant cross-level interaction between stressors and state-level SES. Among non-Hispanic blacks and non-Hispanic whites, husband/partner not wanting the pregnancy (aOR: 1.47; 95% CI: 1.14, 1.90) and drug/drinking problems of someone close (aOR: 1.37; 95% CI: 1.21, 1.55) were respectively associated with PPD. Provider communication was protective. That 1 out of every 5 and 1 out of every 8 women were in the high- and emotional-stress classes suggests that SLEs are common among pregnant women. Our results suggest that screening for antenatal SLEs might help identify women at risk for PPD. The finding that the odds of PPD decrease with increasing social/economic autonomy, could have policy implications and motivate efforts to improve these indices. This study also indicates the benefits of antenatal health care provider communication on perinatal depression.