Racial Minority Women Research Articles

Inpatient Palliative Care Consultation for Women with Gynecologic Malignancies

Objective: Recommendations to improve end-of-life cancer care include integration of palliative care into standard cancer care. There is limited information regarding palliative care for ethnic and racial minority women with gynecologic malignancies. The purpose of this study was to determine the impact of clinical, socio-demographic, and provider factors on palliative medicineconsultation. Methods: After IRB approval, patients with gynecologic malignancies who received a palliative medicine consultation from January 1, 2008 until June 1, 2010 were identified. Abstracted data included demographics, reason/s for consultation, and outcomes. Results were described and comparison made using Fisher’s Exact Test, Student’s T analysis, and Kaplan-Meier time to event analysis with SPSS software. Results: 84 patients were referred for palliative medicine consultation. Ethnic/racial distribution was Black (37%), White (39%), and Hispanic (16%). The reason/s for consultation included pain (45%), goals of care (46%), and bowel obstruction (4%), dyspnea (4%). Median number of days from the initial consultation until death by Kaplan-Meier time to event analysis, which is a proxy metric for timely consultation was 35 days [Range 0-1005 days].Younger patients (<60) were less likely to be DNR (p=0.03, 60% verses 79.5%) or referred to hospice (p=0.02, 9% versus 33%). “Goals of care” was the consultation reason in 61% of patients of medical sub-specialists vs. 26% of Gynecologic Oncologists (p=0.003). 28% of patients from medical sub-specialists died in the hospital verses 8% of gynecologic oncologist referred patients (p=0.02). Conclusions: These data suggest that there may be barriers to the implementation of palliative medicine for women with gynecologic malignancies. Providers may be influenced by patient age as well as their own specialty background. Reasons for the barriers to access in these women need to be further explored.

Moving with the Women: Tracing Racialization, Migration, and Domestic Workers in the Archive

This article invites readers to embark on a methodological journey to examine the challenges of conducting archival research about the similar yet distinct labor experiences of Irish women and African American women from the US South who worked as domestic servants after migrating to the state of New York between 1880 and 1930. Researching these women’s lives required tracing formations and circulations of racialized ideas of class, gender, ethnicity, and sexuality between England and New York. Yet the sources and the organization of the archive itself initially appeared to have no relevance to the study of race and gender. Drawing from Toni Morrison’s Playing in the Dark: Whiteness and the Literary Imagination, this article discusses how employing innovative and interdisciplinary research methods led to the discovery that the British archive actually offered important yet unforeseen interventions in the analysis of materials housed in the archives in England and New York. The British sources revealed that tracing the processes of gendered racialization within domestic work requires an analysis of how the occupation lent itself to particular racial, class, and gender meanings. Thus, the aim of this article is to offer insights about negotiating the politics of the archive while conducting feminist research about the experiences of racial minority women who performed stigmatized forms of labor.

Abstract P4-13-01: Racial Disparities in the Incidence of Dose-limiting Chemotherapy Induced Peripheral Neuropathy

Abstract Objective: To determine the incidence of and risk factors for dose-limiting chemotherapy induced peripheral neuropathy (CIPN) in non-metastatic breast cancer. Methods: This retrospective cohort study included 488 women with an adjuvant or neoadjuvant treatment plan with docetaxel or paclitaxel from June 1, 2009 to December 31, 2011. Exclusion criteria were: metastatic disease, previous neurotoxic chemotherapy, pre-existing neuropathy, pregnant or within 3 months post-partum, and prosthetic limb. The primary outcome was dose-limiting CIPN, defined as a treatment modification event (dose delay, dose reduction, or treatment discontinuation) attributed to CIPN. The primary risk factor of interest was obesity (BMI≥30). Covariates included race, age, menopausal status, diabetes, and other comorbidities, node status, tumor size, regimen, and oncologist. With 80% power and 0.05 type I error rate, the study could detect a risk ratio of 1.8 in the obese versus non-obese. Results: Fifty (10.2%) women had a treatment modification event attributed to CIPN (TM-CIPN). TM-CIPN incidence differed significantly by agent (docetaxel = 2.4% (N = 5/209), paclitaxel=16.1% (N = 45/279); p &amp;lt; 0.001). In analyses restricted to patients treated with paclitaxel with complete covariate data (N = 273), the odds of TM-CIPN did not differ by obesity, OR = 1.17 (95% CI 0.59–2.35). After adjusting for black race, menopausal status, disease severity, and type II diabetes the TM-CIPN and obesity association was attenuated. The attenuation occurred after adjustment for black race, which was a confounder of the obesity and TM-CIPN relationship, and associated with obesity (OR = 3.78, p = &amp;lt;0.001). Post-menopausal status, disease severity, and type II diabetes were associated with obesity, but were not confounders. Compared to whites, and after controlling for disease severity, menopausal status, and oncologist, blacks and other non-whites had significantly increased odds of CIPN-TM (OR = 2.5, p &amp;lt; 0.02; OR = 4.8, p &amp;lt; 0.01; respectively). Tests of homogeneity indicated the race and TM-CIPN association was not modified by oncologist or disease severity. Conclusion: Obese and non-obese women have a comparable likelihood of having their treatment modified due to CIPN. Women of racial minorities had over 2-to 4-fold increased odds of TM-CIPN compared to white women. Investigations addressing the mechanistic explanations for this association are warranted. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-01.

THE MULTIFACTORIAL ORIGEN OF VASCULAR DISRUPTION DEFECTS IN CALI, COLOMBIA: A CASE CONTROL STUDY

Background: Vascular disruption defects(VDD) refer to birth defects caused by alteration of blood flow and decreased availability of O2 in a tissue/organ during a critical period of fetal formation. Surveillance of birth defects in Cali-Colombia is developed under the ECLAMC. An analysis of the spatial and temporal distribution reported a cluster of VDD in the poorest area of the city. Objective: To evaluate socioeconomic, behavioral and environmental factors potentially associated to VDD in Cali Methods: A case-control study was carried out between 2007 and 2009. Cases were newborns with VDD(mainly gastroschisis, limb reduction) and normal cariotyping. Controls were normal newborns from the same hospital with conception date +/-two weeks of cases. A questionnaire was applied to collect information about: socioeconomic condition(race, education, income level), behavioral (smoking, alcohol, marihuana and cocaine), environmental exposures(activities with high risk)and diet(folic acid, Zn, Fe). Heavy metals(Cd,Pb,Zn) were determined on hair samples of a subgroup of participants(n=50) Results: We included 45 VDD cases and 135 controls. Women of racial minorities(black and indigenous) had an increased risk of VDD(OR:2.34;CI95=0.93-5.74). Also, mothers exposed to secondhand smoke during the first trimester had an increased risk OR:3.02(CI95%=1.34-6.8). Although, in univariate analysis, increased levels of cadmium were not related to VDD(OR:1.18;CI95%=0.24– 4.74), after adjusting for low levels of Zn the risk increased to 5.22(CI95%=0.41 -66.19). In addition, exposure to Misoprostol®, a method used for abortion, was associated with VDD(OR:14.14;CI95%:1.29–703.14) Conclusions: Our results suggest multiple exposures potentially associated to VDD, and increased susceptibility and vulnerability. Environmental and behavioral factors, including the use of recreational drugs, smoking, and periconceptional exposure to sub therapeutic doses of abortion drugs may interact in the etiology of VDD.

'It's easier said than done': perspectives on mammography from women with intellectual disabilities.

Women with intellectual disabilities (or mental retardation) are living longer, receiving primary care in the community, and have equal rates of breast cancer compared with women in the general population, but they have lower rates of mammography. Although several public campaigns have successfully raised the mammography rate for racial and ethnic minority women, they have not penetrated the community of women with intellectual disabilities. No research to date has explored potential barriers to mammography for these women by involving the women themselves as participants. We undertook a qualitative study to explore the perceptions and understanding of mammography for women with intellectual disabilities and some of the potential reasons they would or would not have the test. Twenty-seven intellectually disabled women were recruited through a variety of community groups and interviewed using a semistructured interview guide. Data were analyzed using qualitative techniques from grounded theory. Participants in this study described being poorly prepared for mammography: they did not understand its purpose and were not prepared for the logistics of the experience. The latter was more upsetting to participants and contributed to their negative perceptions of mammography. Participants reported feeling unprepared and singled out for being unprepared, despite their desire to have at least 1 mammogram, as do other women their age. Women with intellectual disabilities perceive mammography differently than do women who do not have intellectual disabilities, and their perception is informed by inadequate knowledge, anxiety, and inadequate preparation. These themes should be considered when planning cancer prevention interventions with this population and when counseling individual women in the clinical setting.

Breast cancer screening and ethnicity in the United States: implications for health disparities research

Ethnic and racial minority women within the U.S. are less likely to use breast cancer screening (BCS) procedures than non-Latina White women, and are more likely to be diagnosed with cancer at later stages of disease. Previous studies examining Latina rates of screening and disease have used aggregated populations for comparison, possibly attenuating important ethnic healthcare disparities and yielding misleading findings. The purpose of this study was to examine if ethnicity matters in understanding current estimates of BCS patterns among U.S. women; to test if healthcare disparities in BCS are present, and if any ethnic/racial groups are primarily affected. The authors used multivariate multinomial regression to examine self-reported mammogram and clinical breast exam in the 2007 full-year U.S. Medical Expenditure Panel Survey. Mexican origin women reported the lowest rates of past-year mammograms and clinical breast examination. Factors enabling healthcare moderated the group's lower likelihood of mammograms and clinical breast examination. Some breast cancer screening parity appears to have been achieved in 2007 for Black and some Latina groups; however, those rates lag behind for the largest Latino ethnic group, Mexican. Factors enabling healthcare access, such as education, income and insurance, attenuated the BCS inequalities found for Mexican origin women. Findings suggest that successful efforts to reduce BCS disparities be strategically redirected to include women of Mexican origin in addition to other underserved populations.

Integrating Tools for Breast Cancer Risk Assessment, Risk Reduction, and Early Detection

Commentary on Graubard et al., [p. 2430][1] In 2010, it is projected that there will be 207,090 diagnoses and 39,840 deaths from breast cancer among women in the United States. Approximately 10,300 will be diagnosed before the age of 40 ([1][2]), the age when the American Cancer Society ([2][3])

Identification of HIV-Infected 12- to 24-Year-Old Men and Women in 15 US Cities Through Venue-Based Testing

To test whether "venue-based testing" could identify human immunodeficiency virus (HIV) infection in US youth, 12 to 24 years of age, who were otherwise not aware of their infection. Racial and ethnic minority women and men who have sex with men (WSM and MSM) compose the majority of new HIV cases among adolescents and young adults. Cross-sectional study. Selected venues in communities surrounding the 15 Adolescent Trials Network for HIV/AIDS Interventions (ATN) clinical sites over a 3-month period. At each venue, ATN sites recruited 20 to 30 English- or Spanish-speaking at-risk youth (12 to 24 years of age), resulting in a total of 1217 study participants, including 611 MSM and 606 WSM. Intervention Venue-based HIV testing with 2 components: an anonymous audio computer-assisted self-administered interview and an anonymous HIV antibody assay. The prevalence of HIV infection in MSM and WSM. The prevalence of HIV infection in MSM and WSM was 15.3% and 0.3%, respectively. Sixty percent of the MSM and 100% of the WSM claimed to not know of their infection. Venue-based testing may be an important strategy to identify HIV-infected younger MSM; however, other strategies are needed for WSM.

German and Swedish procedures as models for the empowerment of racial minority women in rape trials

Drawing on the concept of intersectionality developed by Crenshaw, this article analyses the erasure of racial minority women in rape cases, and assesses the ways in which English adversarialism compounds this erasure. It outlines the contours of a transformative procedure for rape trials that includes racial minority women's experiences of intersectional oppression. Based on a comparative analysis of German and Swedish law, it contends that the introduction of auxiliary prosecutors or victims' lawyers in the U.K. would contribute to the generation of a space for the inclusion of such experiences within adversarial trials. It invokes recent jurisprudence of the European Court of Human Rights, as well as Council of Europe provisions, to argue that auxiliary prosecutors or victims' lawyers would not infringe defendants' right to a fair trial, and concludes that objections to their introduction in the U.K. are not persuasive.

Help-Seeking Behavior for Intimate Partner Violence among Racial Minority Women in Canada

Intimate partner violence (IPV) is experienced by women of all ethnoracial backgrounds. Despite the serious adverse impacts of IPV on women's lives, many abused women do not seek help. The main objective of this paper was to determine whether a woman's racial minority status was a significant predictor of help-seeking for IPV after controlling for other factors associated with help-seeking. Data from a national Canadian, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, the use of social services subsequent to IPV, and barriers to social service use. In the bivariate analyses, rates of disclosure and reporting to police were similar for racial minority and white women, however, racial minority women, compared to white women, were significantly less likely to use social services. After adjustment for age, marital status, household income, number of young children at home, immigration status, household language, and severity of IPV, racial minority status was not a significant predictor of help-seeking in the multivariate analysis. Our findings suggest that further investigation is necessary to understand what aspects of membership in a racial minority group or sytemic factors may be contributing to inequalities in accessing help for IPV.

Elisabeth Schüssler Fiorenza and Postcolonial Studies

Elisabeth Schüssler Fiorenza and Postcolonial Studies Kwok Pui-lan (bio) Elisabeth Schüssler Fiorenza has made distinguished contributions to the fields of feminist biblical hermeneutics and feminist theological and religious studies. The influence of her work is worldwide. On this occasion to celebrate her seventieth birthday, I want to focus on how her work provides insights for postcolonial studies of Christianity. If we compare her earlier classic In Memory of Her (1983) with some of her later publications, we can discern her growing interest in global feminist scholarship. Over the years, her discussants have expanded to include many scholars from the third world. As Schüssler Fiorenza has noted, her critical feminist interpretation for liberation shows affinities to postcolonial criticism because both emphasize the decolonizing task of biblical hermeneutics and the process of conscientization.1 In 1996, at a lecture given at the twenty-fifth meeting of the Korean Association of Christian Studies, which I had the privilege of attending, she discussed the meaning of postcolonialism and the ways the Bible and biblical studies have been associated with Western colonialism.2 Following Françoise Lionnet, she defined postcoloniality as "a condition that exists within, and thus contests and resists the colonial moment itself with its ideology of domination."3 In a later [End Page 191] article, she used the term postcolonial to characterize one of the paradigms of biblical interpretation: the doctrinal literalist paradigm, the "scientific" positivist paradigm, the hermeneutical (post)modern paradigm, and the emancipatory "postcolonial" paradigm.4 In this last paradigm, she said the colonized and subordinated others need to "engage in a political and theoretical process of constituting ourselves as subjects of knowledge and history."5 She engages postcolonial theory in a much more sustained manner in her latest work, The Power of the Word: Scripture and the Rhetoric of Empire.6 Schüssler Fiorenza's exemplary work in the historical reconstruction of women in early Christianity offers methodological clues and insights to postcolonial historiography and subaltern studies. Similar to postcolonial historians like Dipesh Chakrabarty, Schüssler Fiorenza challenges the alleged objectivity of positivism and insists that history is best figured not as an accurate record of the past but as a "perspectival discourse that seeks to articulate a living memory for the present and the future."7 Since male historians tend to leave women out of their historical accounts, Schüssler Fiorenza urges us to look for alternative clues and data, and describes the reconstructive process as much like "quilt-making." For her, the "quilt-maker carefully stitches material fragments and pieces into an overall design that gives meaning to the individual scraps of material."8 By placing women and other marginalized people at the center of her inquiry, Schüssler Fiorenza insists that history is variegated and multilayered, and never monolithic or linear. Her work helps us reimagine early Christianity as radically heterogeneous, shaped by women and men, Jews and Gentiles, and people of diverse classes. She retraces the footsteps of Christian women living under Roman imperial rule, highlights their leadership roles in the household churches, and describes the increasing patriarchalization of the Christian community. Using a critical hermeneutics of suspicion, she challenges established theories and widely accepted assumptions that support or rationalize women's subordination. For example, she criticizes the assumption that Mediterranean society was characterized by a gender-based honor and shame system and points [End Page 192] to how such a theory is based on sociological and anthropological studies that have colluded with colonialism.9 From early on, Schüssler Fiorenza has argued that gender oppression must be placed within the overall matrix of other forms of oppression. She coined the term kyriarchy to name the interlocking and multiplicative systems of domination and submission.10 In doing so, she has remained sensitive to racial minority women and the cries of third-world women that by focusing on gender alone, feminists (predominantly white and Western) have failed to acknowledge their privileged status in other areas. In The Power of the Word, Schüssler Fiorenza differentiates her approach from that of feminist postcolonial critics and criticizes the latter for constructing a dual system of patriarchy and imperialism without attending to the intersectional analysis...

Expanding Access Through Doctoral Education: Perspectives from Two Participants of the Sisters of the Academy Research Boot Camp

Expanding Access Through Doctoral Education:Perspectives from Two Participants of the Sisters of the Academy Research Boot Camp Dannielle Joy Davis (bio) and Joanne Sutherland (bio) When pondering the term boot camp, one often envisions the rigorous physical training soldiers endure prior to military service. Boot camps challenge individuals to exceed limits that may never have been tested and develop physical, mental, and emotional stamina to prepare for future arduous tasks. The Sisters of the Academy (SOTA) Research Boot Camp exemplifies such an environment, featuring strict training for the "academic battlegrounds" of doctoral attainment and the professoriate. It seeks to develop the intellectual muscles of women who have enlisted to pursue the doctorate and academic careers, stretch them beyond their zones of familiarity, and validate commitment to their research interests. Black women have made phenomenal strides in their quests for higher education, but have yet to reach demographic parity in the ivory tower (Evans, 2007). As such, the camp trains its participants for active duty in the academy, from the dissertation writing stage, toward tenure, and beyond. Significance of the Program In their work, Exposing the "Culture of Arrogance" in the Academy: A Blueprint for Increasing Faculty Satisfaction in Higher Education, Thompson and Louque (2005) found that the majority of Blacks in academia have experienced the sting of undermining from colleagues and administration (64% and 58%, respectively), marginalization at department meetings (57%), and professional jealousy (70%). Such hostile climates call for a heightened need of Black women to establish and maintain strong support systems (Gregory, 1999). However, chances of developing such connections on most American campuses are challenging due to the low numbers of the population in these settings. Black, non-Hispanic women comprise only 2.7% of all full-time faculty in the United States, compared to White women who are 31.6% of full-time faculty (U.S. Department of Education, 2005, cited in Holmes, Land, & Hinton-Hudson, 2008). The SOTA Boot Camp addresses occupational stressors and underrepresentation by providing mentorship, a key component in the retention and success of minorities in White spaces (Davis, 2008a & 2008b; Owens, 2004), as well as a structured environment to facilitate writing productivity. By fostering mentorship, the camp works to "replac[e] prevailing interpretations of how we [as Black women] are [End Page 606] supposed to view ourselves with oppositional perspectives that not only redefine notions of marginality but reclaim marginal locations as places of . . . intellectual, political, and ethical strength" (Collins, 1998, p. 5). Preparing for Active Duty: An Overview of the Program SOTA is an organization whose mission centers upon facilitating the success of Black women in higher education. The organization's goals include creating networks for Black women to promote success in teaching, scholarly inquiry, and community service and developing programs and relationships to enhance members' professional development. To address the underrepresentation of African and African American women in doctoral study and the professoriate, SOTA sponsors the Research Boot Camp, a week-long workshop geared towards enhancing the research skills, writing productivity, and professional networks of doctoral candidates and junior faculty members of the group. Senior scholars facilitate workshops designed to assist doctoral students in the conceptualization and design of their dissertations. Each student participant is linked with senior and junior scholar mentors to cultivate mentoring relationships. Participants in the 2007 Boot Camp consisted of both doctoral students and junior scholars. The camp catapulted us to the next level as it transcended every aspect our lives by countering myths related to the capabilities of racial minority women. Dispelling myths was demonstrated by the extraordinary senior scholars who availed themselves as mentors on our journeys toward academic careers in various disciplines. Each participant's assignment of a mentor enabled them to receive personalized attention and address the individual challenges we faced at various stages of doctoral proposal, dissertation, or manuscript completion. Each participant strengthened her resolve to accomplish goals during the camp experience, be it completing a dissertation proposal, book chapter, or journal article. This article provides the perspectives of two participants. One was a student who attended the boot camp and the other served as a junior mentor and faculty participant. Their brief stories are the focus of this article...

“You've Gotta Know the Community”: Minority Women Make Recommendations About Community-Focused Health Research

ABSTRACT Objectives: To determine what ethnic and racial minority women recommend as the best approaches to participatory health research in their communities. To achieve this goal, this study focused on HIV prevention research. Methods: In 2003, Seven African American and seven Latina women (ages 33 to 52), all members of an HIV Prevention Collaborative Board, participated in individual interviews, lasting about 90 minutes each. Participants discussed their involvement in participatory research, and made recommendations as to how health researchers might better engage their communities. Data were coded independently by two coders following standard procedure for content analysis. Results: Women's voices and expertise can help guide health-related research. This study shows that: (1) participatory HIV prevention research should be founded on trust and commitment, leading to social support; (2) research partners ought to come from diverse backgrounds and be knowledgeable about the community and willing to work on common objectives; and (3) collaborative partnerships ought to portray an image of strength and cohesion, and a clear articulation of the mission around a research project. Implications: To develop meaningful health research, researchers need to establish long-term ongoing relationships with community collaborators, including minority women from diverse backgrounds. Researchers ought to take a holistic approach working with communities, and ought to consider their research interests vis-à-vis the community's needs.

Drugs for Cardiovascular Disease Prevention in Women

Lifestyle interventions constitute the initial strategy for the primary and secondary prevention of cardiovascular disease in women. However, pharmacotherapy is often indicated for control of major cardiovascular risk factors, and abundant clinical trial data support the morbidity and mortality benefit of a number of categories of drug therapy following a coronary event. Although women have increasingly been enrolled in clinical trials of pharmacotherapy, under representation of women in most research studies limits the gender-specific assessment of outcomes. Equally importantly, recent randomized clinical trial data have highlighted inappropriate preventive therapies for women (i.e. those lacking effectiveness and potentially imparting harm). Decision-making data for drug therapy for women also derive from a number of clinical trials conducted solely in women. The drug classes reviewed in this article include omega-3 fatty acids, aspirin, ACE inhibitors and angiotensin II receptor antagonists or blockers, beta-adrenoceptor antagonists (beta-blockers), aldosterone antagonists, antioxidants, folic acid and vitamins B(6) and B(12), and menopausal hormone therapy and selective estrogen-receptor modulators. Information is sparse regarding specific cardiovascular pharmacotherapies for elderly women, and women of racial and ethnic minorities. Owing to the under representation of the subset of women in many trials, analysis by age, race and ethnicity is not appropriate. This information gap presents a major challenge for future studies, as these subgroups constitute populations of women at high cardiovascular risk.

Psychiatric comorbidities in a community sample of women with fibromyalgia

Prior studies of careseeking fibromyalgia (FM) patients often report that they have an elevated risk of psychiatric disorders, but biased sampling may distort true risk. The current investigation utilizes state-of-the-art diagnostic procedures for both FM and psychiatric disorders to estimate prevalence rates of FM and the comorbidity of FM and specific psychiatric disorders in a diverse community sample of women. Participants were screened by telephone for FM and MDD, by randomly selecting telephone numbers from a list of households with women in the NY/NJ metropolitan area. Eligible women were invited to complete physical examinations for FM and clinician-administered psychiatric interviews. Data were weighted to adjust for sampling procedures and population demographics. The estimated overall prevalence of FM among women in the NY/NJ metropolitan area was 3.7% (95% CI = 3.2, 4.4), with higher rates among racial minorities. Although risk of current MDD was nearly 3-fold higher in community women with than without FM, the groups had similar risk of lifetime MDD. Risk of lifetime anxiety disorders, particularly obsessive compulsive disorder and post-traumatic stress disorder, was approximately 5-fold higher among women with FM. Overall, this study found a community prevalence for FM among women that replicates prior North American studies, and revealed that FM may be even more prevalent among racial minority women. These community-based data also indicate that the relationship between MDD and FM may be more complicated than previously thought, and call for an increased focus on anxiety disorders in FM.

Gender, Race and Class Dimensions of Nonstandard Work

This review article critically analyzes and synthesizes the academic literature on nonstandard work and its gender, race and class dimensions. We argue that it is important and crucial to understand these dimensions of nonstandard work in order to develop appropriate labour policies. We present our discussion in a conceptual framework of duality within which nonstandard workforms are located. We discuss the role the unions could play in achieving equity in labour markets and conclude the paper with recommended labour policy changes to respond to the needs of women, particularly those racial minority and low economic class women employed in nonstandard jobs.

Psychosocial and behavioral correlates of depression among HIV-infected pregnant women.

This study addressed two aims: (1) to assess the level of depressive symptoms among pregnant, HIV-infected racial and ethnic minority women and (2) to identify potentially modifiable factors associated with prenatal depression in order to foster proactive clinical screening and intervention for these women. Baseline interview data collected from HIV-infected women participating in the Perinatal Guidelines Evaluation Project were analyzed. Participants were from prenatal clinics in four areas representative of the U. S. HIV/AIDS epidemic among women. Of the final sample (n = 307), 280 were minorities (218 blacks [African American and Caribbean], 62 Hispanic). Standardized interviews assessed potential psychosocial factors associated with pregnancy-related depression and psychological distress (life stressors, inadequate social support, and ineffective coping skills) in a population for whom little work has been done. Depressive symptomatology was considerable, despite excluding somatic items in order to avoid confounding from prenatal or HIV-related physical symptoms. The psychosocial factors significantly predicted the level of prenatal depressive symptoms beyond the effects of demographic and health-related factors. Perceived stress, social isolation, and disengagement coping were associated with greater depression, positive partner support with lower depression. These findings demonstrate that psychosocial and behavioral factors amenable to clinical intervention are associated with prenatal depression among women of color with HIV. Routine screening to identify those currently depressed or at risk for depression should be integrated into prenatal HIV-care settings to target issues most needing intervention.

Welfare Reform and Marriage Promotion: The Marital Expectations and Desires of Single and Cohabiting Mothers

Using nationally representative data, this examination of marital expectations, desires, and behaviors of single and cohabiting unmarried mothers suggests that a majority of unmarried women, including disadvantaged single and cohabiting mothers, value marriage as a personal goal. Among disadvantaged women, single mothers, and racial minority women, systematic differences point to subgroups with lower marital expectations. However, our results also indicate that marital desires do not easily translate into marriage. Accordingly, from a public policy perspective, single mothers’ attitudes about marriage need not be changed. The problem lies in identifying and reducing barriers that prevent single women from realizing marital aspirations.

Racial Frontiers: Africans, Chinese, and Mexicans in Western America, 1848-1890

Once neglected, racial minorities are now the focus of intense interest among historians of the American West, who have come to recognise the roles of African American, Chinese, and Mexican people in shaping the frontier. Racial Frontiers is both a highly original work, particularly in its emphasis on racial minority women, and a masterful synthesis of the literature in this young field. De Leon depicts a US West populated by settlers anticipating opportunities for upward mobility, jockeying for position as they adapted to new surroundings, and adjusting to new political and economic systems. Minority groups discarded unworkable political traditions that had followed them from their homelands and sought to participate in a democracy that they trusted would see to their well-being. Many embraced capitalism in preference to the economic systems they had left behind but refused to give up their cultural traditions. The result was a US West of many colours. Known as a skilled writer, De Leon tells countless stories of the lives of men and women to guide the readers through his narrative. Personal histories and revealing quotations illustrate the struggles and victories of the newcomers, enriching our understanding of the settlement of the trans-Mississippi West since the middle of the nineteenth century.

Economic Restructuring and the Retreat from Marriage

Our objective is to link recent U.S. marriage trends to changes in the employment and earnings of the marriage-eligible population, welfare benefit levels, and macroeconomic performance, which are played out differently across states. Specifically, we link pooled cross-sectional data from the 1986–1997 annual demographic supplements of the March Current Population Survey to state-year-specific indicators of economic performance from the Regional Economic Information System. We use these data to estimate reduced-form models of the economic, institutional, and demographic determinants of individual marriage outcomes. We also estimate endogenous switching regression models of marriage which take into account women's expected incomes inside and outside of marriage. Our results provide several conclusions. First, the “retreat from marriage” continued unabated during the economic recovery period of the 1990s. Second, our reduced-form results reveal that the recent economic recovery has, on balance, dampened the downward trend in marriage; the percentage married would be roughly three points lower in 1997 if state employment and earnings had remained at their 1986 levels. Third, the effects of state economic restructuring were highly differentiated, with negative effects on marriage, especially among the younger, less educated, and racial minority women. Fourth, results from our endogenous switching regression models provide only modest evidence for the economic model of marriage and call into question the appropriateness of strictly economic explanations of declining marriage.