abstract: Native American communities face an ongoing challenge of effectively addressing cancer health disparities, as well as environmental racism issues that may compound these inequities. This dissertation identified the shared cultural knowledge and beliefs about cancer in a southwest American Indian community utilizing a cultural consensus method, an approach that combines qualitative and quantitative data. A community-based participatory research (CBPR) approach was applied at all stages of the study. The three phases of research that were undertaken included: 1) ethnographic interviews - to identifying the themes or the content of the participants' cultural model, 2A) ranking of themes - to provide an understanding of the relative importance of the content of the cultural model, 2B) pile sorts - identify the organization of items within specific domains, and 3) a community survey - access whether the model is shared in the greater community. The cultural consensus method has not been utilized to date in identifying the collective cultural beliefs about cancer prevention, treatment or survivorship in a Native American community. Its use represents a methodological step forward in two areas: 1) the traditional ethnographic inferences used in identifying and defining cultural meaning as it relates to health can be tested more rigorously than in the past, and 2) it addresses the challenge of providing reliable results based on a small number of community informants. This is especially significant when working with smaller tribal/cultural groups where the small sample size has led to questions concerning the reliability and validity of health-related research. Results showed that the key consultants shared strong agreement or consensus on a cultural model regarding the importance of environmental and lifestyle causes of cancer. However, there was no consensus found among the key consultants on the prevention and treatment of cancer. The results of the community survey indicated agreement or consensus in the sub-domains of descriptions of cancer, risk/cause, prevention, treatment, remission/cure and living with cancer. Identifying cultural beliefs and models regarding cancer could contribute to the effective development of culturally responsive cancer prevention education and treatment programs. / Dissertation/Thesis / Ph.D. Anthropology 2011

BACKGROUND: Over recent decades, the nationwide prevalence of chronic disease among children and adolescents has been on the rise. Conditions such as obesity pose a significant risk to the physical and mental health of individuals in youth as well as in adulthood, as these health risks track into later years and increase in severity. Low-income and racial/ethnic minorities are disproportionately affected by chronic conditions. In particular, African American (AA) youth are reported to have a higher prevalence of fair/poor health than their Caucasian peers. Compounding the effects of this racial disparity in health is the disparity AA youth face in SES, as many live in poverty. The individual and environmental influences associated with factors of race and SES contribute to negative health behaviors leading to poor health status among AA youth living in disadvantaged communities. Health disparities have been shown to manifest in the earliest years of life, therefore the monitoring of at-risk populations of children and adolescents is essential to identifying, addressing, and reducing poor health outcomes throughout the course of life. OBJECTIVE: To determine the health status of AA children and adolescents living in a low-income community using multiple health measures, examine the relationships between these health measures in AA youth, as well as to identify barriers to participation in a family-oriented health promotion program. METHODS: A total of 111 AA boys and girls attending a community fine arts program located in a low-income suburb of Chicago participated in the study. Data from anthropometric measurements, the 20-m Shuttle Run Test, and curl-ups were collected and analyzed to assess the health measures of Body Mass Index (BMI) and BMI Percentile, Cardiorespiratory Fitness (CRF), and Muscular Fitness (MF), respectively. Data pertaining to barriers encountered in attending a health promotion program were collected from 13 families who were active members of the community fine arts program and had participated in health promotion program. The cross-sectional survey consisted of questions pertaining to the different components of the intervention program as well as to family demographic information. RESULTS: The prevalence of overweight and obesity in the entire study population was 34.2%, with 31.6% of boys and 34.8% of girls being classified as overweight/obese. 16.2% of youth categorized specifically as obese, with 26.3% of boys and 15.2% of girls being obese. 43.9% of study participants aged 10-18 years needed improvement in CRF, all of whom were girls. All but one boy reached the healthy fitness zone for curl-ups. Significant positive correlations were found between BMI and age as well as curl-ups and age, and significant negative correlation was found between CRF and age as well as BMI and CRF for AA youth. Of reported barriers, scheduling conflicts and time constraints were consistently most listed by survey respondents. CONCLUSION: Within the at-risk population of AA youth studied, despite high levels of MF, a large proportion presented with problematic health as indicated by the high levels of poor CRF and weight status observed, suggesting a need for intervention in order to address these health issues. An intervention program targeting youth within this and similar communities should take into consideration attenuating excessive program-associated expenses as well as offering more scheduling options and information on efficient food preparation and exercise.

This exploratory study examined links between health communication and other constructs affecting health promotion and disease prevention among Haitian mother-daughter dyads living in West Central Florida, and the risk or protective factors for HIV. Risky sexual behaviors can be reduced with accurate and effective information provided through parent-adolescent communication (Coetzee et al, 2014; Ogle, Glasier & Riley, 2008; Hadley et al., 2009). In Haiti, a country that bears a disproportionate burden of HIV/AIDS, women are the most vulnerable (UNAIDS, 2016a); In the United States (U.S.), foreign-born Haitian women in the state of Florida experience health disparities in many areas and bear a disproportionate burden of HIV/AIDS relative to their non-Haitian peers but little is known about (Florida Department of Health [FLDOH], 2017; U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion [ODPHP], 2017). Indeed, the state of Florida recently reported that newly diagnosed cases of HIV increased for foreign-born Haitian women and in 2016, the latter represented 3.64% of all cases (Florida Department of Health, Bureau of Communicable Diseases, HIV/AIDS Section, 2017a). Recognizing that Haitian mothers traditionally bear the primary responsibility for transmitting traditional norms, values, health beliefs and practices, a concept referred to as poto mitan, this qualitative study examined risks and protective factors for HIV that may emerge in health and sexual health communication among Haitian mothers and daughters. This study comprised a two-phase process in which purposive sampling was first used to recruit and interview a focus group of seven health care providers and Haitian-descendant community leaders who engage Haitian-descendant clients in West Central Florida, after which findings from the focus group were used to strengthen a semi-structured interview guide that would be used to interview 10 Haitian mother/daughter dyads in the area. This study addressed a gap in the scientific literature related to health and sexual health promotion and disease prevention communication among Haitian immigrant women in the U.S., particularly surrounding HIV risk. Specifically, it sought to discover what constitutes specific methods that Haitian mothers use to communicate health and sexual health and the contents of such conversations, as well as the intention of daughters to transmit information that they received from their mothers, even here in the U.S. This study applied a constructivist grounded theory approach, in which Symbolic Interactionism (SI) and the Information-Motivation-Behavioral Skills Model (IMB) were triangulated as a framework. ATLAS.ti® 7.0, a software that supports analysis of textual data, was used to analyze transcripts from the focus group and from the interviews. Findings indicate that (a) Haitian mothers intentionally transmit specific and valued traditional knowledge about health and sexual health to their daughters, specifically in the areas of vaginal health, post-partum rituals, and abstinence as the acceptable mode of HIV prevention; (b) Haitian mothers in the study sample lack adequate and accurate knowledge about HIV/AIDS as well as the time to learn more that they can share with daughters; (c) Haitian mothers in the study sample do engage in direct communication about HIV prevention, taking advantage of teachable moments, using popular music and television programs; (d) there is a strong reliance on religious leaders and school systems to address health and sexual health instruction; (e) Haitian mothers in the sample reported and daughters confirmed that there is extremely limited conversation between the mothers and daughters surrounding sex, HIV risk reduction methods outside of abstinence. (f) Symbolic Interactionism is a useful framework for understanding the process of communication between Haitian mothers and daughters in this study; (g) IMB is useful to understand that the information being provided by Haitian mothers in this sample is at times insufficient and inaccurate, thereby limiting the ability of daughters to effectively and intentionally engage in conduct that protects their sexual health and reduces HIV risk. This study has several implications for social work education, research, practice, and policy. First, social work students must be taught to conduct comprehensive assessments of Haitian women in the context of valued Haitian family dynamics, and to engage in life-long learning regarding protective as well as risk factors for Haitian mothers and daughters. Second, Haitian and non-Haitian health providers who serve Haitian clientele could be surveyed regarding knowledge of health beliefs and practices and its potential impact on the health of their constituents. their Haitian patients. Third, researchers may use this study’s findings as a foundation for developing interventions that enhance strategies aimed at establishing rapport with Haitian clients and for assessing potential interactions between hidden health practices and prescribed medications. Fourth, findings suggest the need to develop interventions that empower trusted religious leaders to gain accurate HIV knowledge and to deliver empowering information effectively to their congregants. Fifth, findings suggest a need to develop outreach programs aimed at heightening HIV awareness and increasing HIV testing for Haitian women who are similar to this study’s sample. Sixth, social workers engaging Haitian female clients can make intentional efforts to include Haitian mothers in treatment. Seventh, this study’s findings underscore a need for social workers to advocate on behalf of Haitian immigrants’ efforts to be properly counted in the census, and to be counted as a culturally distinct group in other surveillance data. Social workers can benefit from understanding the strengths of relationships between Haitian mothers and daughters and to enhance their awareness of the heterogeneity among Haitians in general when working with Haitian clients. To work effectively with Haitian immigrant females overall requires cultural humility to mitigate the likelihood of bias towards them based on known or hidden traditional health beliefs and practices and gender roles.

Purpose: Although Asian Americans are the only racial group for whom cancer is the leading cause of death, colorectal cancer screening is consistently lower than that of White Americans. Physicians also recommend colorectal cancer screening to Asian Americans at nearly half the rate as White Americans. This study tests a mechanism that may underlie low recommendation rates. I based my hypothesis on a conceptual model that integrates the literature on information processing and decision making with Asian American stereotypes. Methods: I conducted an online study of primary care physicians and measured their cancer screening referral behavior in response to clinical vignettes. I used the existing Asian Attitude Implicit Association Test (IAT) and developed a new Health Attitude IAT to measure implicit attitudes about Asian American foreignness and health advantages, respectively. Explicit attitudes about these constructs were also assessed through self-report. I used binary logistic regression models to evaluate the association of attitudes about Asian Americans foreignness and health advantage with screening recommendation. Results: My sample included 167 physicians (23% response rate). I found strong implicit bias that Asians are foreign (Cohen’s d = 1.09) and strong implicit bias favoring a white health advantage (Cohen’s d = -0.86). There were weaker explicit biases that Asians are foreign (Cohen’s d = 0.62). Explicit beliefs about health advantage favored Asians (Cohen’s d = 0.73). Physician race, age and gender were significant moderators of bias score. .I found no evidence of a race based screening disparity and no association between implicit or explicit bias scores and making a cancer screening recommendation. Conclusions: Foreign and health advantage biases exist among a sample of physicians, but may not influence cancer screening recommendation behavior. Physicians demonstrated both implicitly and explicitly held attitudes that Asian Americans are perpetual foreigners. Physicians also reported explicit beliefs that Asian Americans have health advantages relative to other races. Implicitly, their attitudes indicated that White Americans are a healthier group. Further research should address whether race-based cancer screening disparities persist in real world settings, both in terms of screening completion, and physician recommendation. If disparities still exist, alternate explanatory mechanisms should be identified.

abstract: In the U.S., breast cancer (BC) incidences among African American (AA) and CA (CA) women are similar, yet AA women have a significantly higher mortality rate. In addition, AA women often present with tumors at a younger age, with a higher tumor grade/stage and are more likely to be diagnosed with the highly aggressive triple-negative breast cancer (TNBC) subtype. Even within the TNBC subtype, AA women have a worse clinical outcome compared to CA. Although multiple socio-economic and lifestyle factors may contribute to these observed health disparities, it is essential that the underlying biological differences between CA and AA TNBC are identified. In this study, gene expression profiling was performed on archived FFPE samples, obtained from CA and AA women diagnosed with early stage TNBC. Initial analysis revealed a pattern of differential expression in the AA cohort compared to CA. Further molecular characterization results showed that the AA cohort segregated into 3-TNBC molecular subtypes; Basal-like (BL2), Immunomodulatory (IM) and Mesenchymal (M). Gene expression analyses resulted in 190 differentially expressed genes between the AA and CA cohorts. Pathway enrichment analysis demonstrated that differentially expressed genes were over-represented in cytoskeletal remodeling, cell adhesion, tight junctions, and immune response in the AA TNBC -cohort. Furthermore, genes in the Wnt/β-catenin pathway were over-expressed. These results were validated using RT-qPCR on an independent cohort of FFPE samples from AA and CA women with early stage TNBC, and identified Caveolin-1 (CAV1) as being significantly expressed in the AA-TNBC cohort. Furthermore, CAV1 was shown to be highly expressed in a cell line panel of TNBC, in particular, those of the mesenchymal and basal-like molecular subtype. Finally, silencing of CAV1 expression by siRNA resulted in a significant decrease in proliferation in each of the TNBC cell lines. These observations suggest that CAV1 expression may contribute to the more aggressive phenotype observed in AA women diagnosed with TNBC. / Dissertation/Thesis / Doctoral Dissertation Molecular and Cellular Biology 2015

abstract: The primary aim of this study was to investigate resilient profiles in low-income Mexican American (MA) mothers. MA mothers are part of an under researched population, the fastest growing ethnic minority group, and have the highest birth rate in the United States, presenting a significant public health concern. The transition to motherhood can be an emotionally and physically complex time for women, particularly in the context of a stressful low-income environment. Although most low-income women navigate this transition well, a significant number of mothers develop moderate to severe depressive symptoms. The proposed research investigated profiles of resilience during the prenatal period using a person-centered approach via latent profile analysis. In alignment with current resilience theories, several domains of resilience were investigated including psychological, social, and cultural adherence (e.g., maintaining specific cultural traditions). Concurrent prenatal depressive symptoms and stress were correlated with the profiles in order to establish validity. Six week postpartum depressive symptoms and physiological processes (e.g., overall cortisol output, heart rate variability, and sleep) were also predicted by the prenatal resilient profiles. The resulting data revealed three separate profiles: low-resource, high-resource Anglo, and high-resource Mexican. These resilience profiles had differential associations with concurrent depressive symptoms and stress, such that women in the high-resource profiles reported less depressive symptoms and stress prenatally. Further, profile differences regarding cortisol output, resting heart rate variability, were also found, but there were no differences in insomnia symptoms. Profile classification also moderated the effects of prenatal economic stress on postpartum depressive symptoms, such that women in the high-resource Mexican profile were at risk for higher postpartum depressive symptoms under high economic stress compared to the high-resource Anglo group, which demonstrated a more resilient response. Overall, the results suggest the presence of multiple clusters of prenatal resilience within a sample of MA mothers facing health disparities, with various effects on perinatal mental health and postpartum physiological processes. The results also highlight the need for multi-dimensional models of resilience and the possible implications for interventions. / Dissertation/Thesis / Doctoral Dissertation Psychology 2014

African Americans (AA) are more susceptible to end-stage renal disease (ESRD) for several reasons. Treatment options for patients with ESRD include dialysis therapy and transplantation, with the latter typically producing better outcomes. AA are less likely to complete the medical evaluation process, which requires patients to consult with doctors and undergo a series of tests and examinations. This study sought to determine the factors that predict completion of the medical evaluation for AA ESRD patients using a mixed methods design. Participants consisted of transplant professionals (N=23) recruited from nine transplant centers in the Mid-Atlantic, Mid-Western and Southeastern parts of the United States, and kidney patients (N=30 patients) recruited from one transplant center in the Mid-Atlantic region. Semi-structured interviews and nominal focus groups were conducted to gather qualitative data; quantitative survey data were also collected. The results revealed factors classified as impacting patients at the individual-level and systemic level, and others classified as health-related and informational/educational. Participants ranked insurances issues, limited income, lack of a personal means of transportation, lack of patient motivation, the number of procedures required to complete the evaluation, scheduling difficulties and time constraints as top barriers to completing the medical evaluation process. Top motivators consisted of informational support, social support, religious beliefs, patients’ desire to get off dialysis, support from the transplant staff, center-based education, patient’s knowledge of the benefits of transplantation and patient navigators. These findings provide valuable information on factors that impact AA renal patients’ completion of the medical evaluation.

Even though the oral health of Americans has improved greatly in the last 50 years, some specific groups of the population have been left behind. Latinos, children and adults, bear a disproportionate burden of oral diseases. Latino children, the fastest growing minority group of children in the US, are affected disproportionately by oral diseases like dental caries compared to other groups. Understanding the difficulties and barriers that these children have to utilize dental care will help us in the future to develop effective programs to reduce health disparities in this segment of the population. The purpose of this study is to identify the factors that determine dental services access and utilization by children in the state of Iowa. Emphasis will be given to differences in utilization of dental services among different racial/ethnic groups. Additionally, the study will describe and compare difficulties in utilization of care among Latino children whose parents answered the survey in English (LE) and those who answered it in Spanish (LS). In order to address these objectives existing data from the Iowa Child and Family Household Health Survey 2005 (HHS) were analyzed. The dependent variable for the study was utilization of dental services. This outcome variable was dichotomized as whether or not the child had a dental visit in the last year. Characteristics of study subjects were first analyzed through descriptive statistics. Bivariate analyses were conducted to assess associations between the dependent variable and independent variables. Multiple logistic regression was used to identify factors associated with utilization of dental services in Iowa's children, and for each different racial and ethnic group. Seven factors were related to the time of the last dental visit for Iowa children: Having a regular source of dental care, dental insurance status, having a dental need in the past 12 months, brushing habits, the age of the children, and family income. The same seven factors were correlated to having a dental visit for white children. For African-American children, having a regular source of dental care, dental insurance status, and having a dental need in the last 12 months were the factors that were found associated to the time of the last dental check-up. For the Latino Spanish children, having a regular source of dental care and the age of the children were factors associated to dental utilization. Finally, for the Latino English children, the only factor associated with having a dental visit was having a regular source of dental care. Information from this research gives policy makers, public health workers, and clinicians an overview of oral health disparities affecting children in the state. For those agencies in Iowa interested in the improvement of access and utilization of dental services for minority children, this project gives important inside about the factors related to the use of services for different racial/ethnic groups in the state.

Background: Oral health is crucial for overall health. Oral health care need is the most prevalent unmet health care need among children and adolescents in the United States. Youth characteristics and socio-demographic factors are known to influence dental health service utilization. While there have been studies listing the factors contributing to the oral health disparities in the Appalachian region, very few studies have inspected the risk behaviours of the youth and their association with dental health care utilization. Methods: A structured questionnaire was administered to high school students in five counties of South-Central Appalachia. The survey included a question on a recent dental visit. The students provided information on socio-demographic characteristics and risk behaviours. Descriptive analysis was performed and the association between recent dental visit as the outcome variable and sociodemographic factors and health risk behaviours as independent variables were analyzed using logistic regression analysis. The analysis was performed using SAS 9.4. Results:80.1% (N= 129) of the adolescents who had admitted to using tobacco products or electronic vapour products reported having visited the dentist in the past 12 months. 87.5% (N= 168) of the females and 80.3% (N=127) of the males reported having visited the dentist in the past 12 months and 81.43% (N=114) of the adolescents who received free or reduced lunch reported having visited the dentist in the past 12 months. Use of tobacco products was the only health risk behaviour significantly associated with dental visit in the past 12 months (p=0.04) after adjusting for covariates with OR=0.5 (95% C I:0.312 -1.01). Conclusion: The findings suggest that health risk behaviours such as using tobacco products may be associated with dental health care utilization and future research should focus on adolescents with health-risk behaviours with the goal of identifying interventions for at-risk populations. Keywords: Oral health, health disparities, youth, health risk behaviours

No description available.