White English-speaking Research Articles

Sociodemographic Disparities in Coronary Artery Calcium Screening

ObjectivesThis study aimed to compare the demographic features and socioeconomic status of patients who underwent coronary artery calcium screening to that of their local population. BackgroundCoronary artery calcium scores provide important evidence of subclinical atherosclerosis. However, insurance often does not cover coronary artery calcium testing, which could exclude people of lower socioeconomic status. MethodsDemographic and occupational data were obtained for all patients referred for coronary artery calcium in a metropolitan area between October 2010 and August 2023. Household income and population reference information were taken from US Census Data and matched to zip code and regional metropolitan area. ResultsCoronary artery calcium tests were performed on 627 patients with a median age of 63 years and equal gender representation (52% female, 48% male). Patients were predominately White (77%) and English-speaking (98%), which is incongruent with local demographic data (P < .001). Healthcare workers were the largest workforce (22%), followed by people involved in education (12%), which is higher than the local healthcare workforce of 10% (P < .001). Those with graduate/professional degrees accounted for 32% of patients, significantly more than the local population (P < .001). The average median annual income ($94,116) of patients who underwent CAC testing was greater than that of the metropolitan median income of $81,264 (P < .001). ConclusionThe disproportionate distribution of coronary artery calcium screening favoring educated, affluent, White English speakers indicates that higher-income and healthcare personnel are more likely to receive testing. Disparities in coronary artery calcium testing, especially in minorities and non-English speaking individuals, should be further explored.

Language, 6-mercaptopurine adherence, and relapse in children with acute lymphoblastic leukemia.

Hispanic children with acute lymphoblastic leukemia (ALL) have lower 6-mercaptopurine (6MP) adherence and greater hazard of relapse compared with non-Hispanic White children. We examined the association between Spanish language and 6MP adherence, and hazard of relapse. 6MP adherence was measured electronically over a 6-month period. Participants were grouped by the language of demographic questionnaire completion: Non-Hispanic White-English Speaking (ES, n = 159), Hispanic-Spanish Speaking (Hispanic-SS, n = 59), and Hispanic-ES (n = 109). Hispanic-ES had significantly lower fitted median 6MP adherence compared with non-Hispanic White-ES participants (88.3%, 95% CI = 84.7% to 91.2% vs 95.0%, 95% CI = 93.6% to 96.2%, P < .001). There was no difference in fitted median 6MP adherence between Hispanic-ES and Hispanic-SS participants (88.3%, 95% CI = 84.1% to 91.5% vs 88.3%, 95% CI = 84.7% to 91.2%, P = .9) or adjusted hazard of relapse for Hispanic-SS participants (HR = 0.9, 95%CI = 0.3 to 2.4, P = .8). Spanish language use among Hispanic patients with ALL is not associated with lower 6MP adherence or greater relapse risk. Factors related to Hispanic ethnicity, apart from language, appear to influence adherence.

‘Becoming manly’: white South African defence force veterans negotiating masculinity

ABSTRACT This study examines how white South African men reflect on their experiences of being and becoming army veterans, while negotiating masculinity. In the context of ‘high apartheid’, Afrikaner domination of the socio-political landscape, ethnic and racialised inequalities, the veterans negotiated being white English-speaking men through reflecting on, critiquing and disassociating from military masculinity. An English South African masculinity was upheld by distancing from Afrikaner domination and values, violence and compulsory heterosexuality. These findings suggest that while a military masculinity offered men a powerful template to assert their authority as white men, such power was nuanced by English South Africans’ relative political impotence, the domination of Afrikaans as a language and illustrates the heterogeneity in the experience of white veteran masculinity under apartheid. At the same time, however, white English veterans were complicit in and benefitted from whiteness and the power accrued in the country by virtue of race, class and history of British colonialism. We argue that the experience of being and becoming conscripts and the reflection on military masculinity directs attention to the ways in which broader social and political contexts have effects for the shaping of masculinity reflecting hierarchies of power and fluidity.

Parental attitudes in the pediatric emergency department about the COVID-19 vaccine

BackgroundCOVID-19 vaccinations are now recommended in the United States (U.S.) for children ≥ 6 months old. However, pediatric vaccination rates remain low, particularly in the Hispanic/Latinx population. ObjectiveUsing the 4C vaccine hesitancy framework (calculation, complacency, confidence, convenience), we examined parental attitudes in the emergency department (ED) towards COVID-19 vaccination, identified dimensions of parental vaccine hesitancy, and assessed parental willingness to have their child receive the COVID-19 vaccine. MethodsAs part of a larger multi-methods study examining influenza vaccine hesitancy, we conducted interviews that included questions about COVID-19 vaccine authorization for children. We used directed content analysis to extract qualitative themes from 3 groups of parents in the ED: Hispanic/Latinx Spanish speaking (HS), Hispanic/Latinx English speaking (HE), non-Hispanic/non-Latinx White English speaking (WE). Themes were triangulated with the Parent Attitudes about Childhood Vaccines (PACV) survey, where higher scores indicate increased vaccine hesitancy. ResultsFactors influencing vaccine hesitancy were mapped to the 4C framework from 58 sets of interviews and PACVs. HE and HS parents, compared to WE parents, had less knowledge about COVID-19 and its vaccine, and more beliefs in COVID-19 vaccine myths. However, both HS and HE parent groups were more inclined to endorse COVID-19 vaccine effectiveness as a reason to have their children vaccinated. HS parents felt that COVID-19 increased their fear of illnesses in general and were worried about confusing COVID-19 with other infections. Median PACV scores of HS (Mdn = 20) and HE (Mdn = 20) parent groups were higher than of WE parents (Mdn = 10), but parental willingness to have their child receive COVID-19 vaccination was similar across groups. ConclusionsHigher COVID-19 vaccine hesitancy among HS and HE parents compared to WE parents may be attributed to insufficient knowledge about COVID-19, its vaccine, along with COVID-19 vaccine myths. Efforts to provide targeted vaccine education to different populations is warranted.

Being Non-Anglo Fisheries Consultants in the Pacific

In the pacific islands in recent years the scientific consulting world is a place where underrepresented groups have resided helping more “educated white English-speaking” scientists. Due to language culture gaps, there has been segregation of researchers leading non-English speaking partners not to receive the recognition of the money that they deserve. This is an example of the colonial system affecting the consulting industry. Now it is time to pave the way for the next generation to help decolonize these systems in scientific research so there are more opportunities for underrepresented people of science.

Decolonizing Qualitative Research With Rural People With Disabilities: Lessons From a Cross-Cultural Health Systems Study

Decolonization of research is nowhere more pressing than in post-apartheid South Africa, where cross-cultural encounters characterize every aspect of society. The health system plays a critical role in realizing the rights of marginalized populations, particularly rural communities and people with disabilities. However, cultural divides between service users and health care workers render health care provision unexpectedly complex. Such divides likewise obscure the meanings embedded in qualitative data, rendering research interpretations challenging. A study of the engagement between rural isiXhosa-speaking people with disabilities and primary health care workers was conducted by the first author, a White English-speaking female health care worker, in partnership with the second author, a Xhosa male research implementer. Ethnographic and narrative methods were used to create an embedded case study of 11 households of people with disabilities. Lessons on conducting ethical and culturally congruent research with this population are presented, important limitations in the qualitative paradigm raised, and alternative stances explored.

THE LIMITATIONS AND POSSIBILITIES OF THE SOUTH AFRICAN EDUCATION SYSTEM IN THE INCULCATION OF VALUES

Values form part of a culture and have a direct influence on an individual’s life. Some values are ethnically based, whereas others may emanate from the economic activities in a community. Both official and non-official values have to be taken into account. Traditionally the Afrikaner believed that all aspects of life fell under God’s law and as a result he emphasized principles and had clear guidelines for his life. The values of the contemporary Afrikaner are more secular and he displays hedonistic individualistic characteristics. The white English-speaking South African’s values vary from Christian to pragmatic with economic prosperity playing a major role. Traditional black values were determined by a belief in the ancestral spirits who prevented cultural change and magical powers. Consequently casual explanations were not looked for. Many members of contemporary black community consider themselves Christian, although the belief in ancestral spirits is still strong. In comparing the value systems it is clear that the South African community is heterogeneous. It is typical of such communities to have only vague aims of education. Groups should not be ignored in a future educational dispensation. The structuring of the education system should be such that it is possible for the teacher to convey certain values. The existence of different sets of values should not lead to the forced separation between cultural and other groups. The idea of value articulation’ should be explored. Biblical Studies as an examination subject will disappear, but biblical values will not only remain, but become more important.

Perceptions of Daisy de Melker: Representations of a Sensational Trial

This article discusses the sensational trial of the serial poisoner Daisy de Melker in terms of the reaction of 1930s South Africa to the transgression of white, English-speaking communal ties and values. The discussion focuses on representations of the events by three writers – Harry Morris, Herman Charles Bosman and Sarah Gertrude Millin. Each attended the trial, directly observing the court proceedings, yet each presents a different perspective. Morris, de Melker’s lawyer, provides details of his client’s crimes and personality, while exhibiting a subtle ambivalence towards her; Bosman’s and Millin’s accounts are less direct and factual, harnessing de Melker for their contrasting identifications of social ills. For Bosman, alienated from the white social body by his own former murder trial and conviction, de Melker’s trial emphasised the punitive nature of South African society, providing a platform to discuss the barbarism of the death penalty. For Millin, however, de Melker embodied the abjection relating to the criminal disgrace of a white English-speaking woman. Indeed, de Melker’s trial resulted in conflicting responses that emphasised the ambivalence, fragility and internal contradictions within white South Africa at the time. These responses reveal race and gender as essential components of sensational trials within the colonial South African body politic.

Measurement equivalence of a safety climate measure among Hispanic and White Non-Hispanic construction workers

Research continues to expose ethnic disparities in safety and health outcomes, making comparative studies of work-related factors that may explain these disparities increasingly important. Such studies raise issues about the cross-ethnic validity of the measures used to assess the factors of interest, such as safety climate. The current study is the first to examine the measurement equivalence of a multidimensional safety climate scale. A multi-group confirmatory factor analytic approach was used to assess the equivalence of the measure across White English-speaking, Hispanic English-speaking, and Hispanic Spanish-speaking construction workers. Results indicated that the same pattern of factors and equivalent factor loadings adequately represented the safety climate items across groups. However, other differences in item parameters were identified, including non-equivalence of some error variances and intercepts. This study highlights the importance of establishing measurement equivalence before proceeding with mean comparisons among groups. Future research should continue to investigate why differences in safety-related perceptions across ethnicities might exist.

Discipline and Disorder in the Whiteness of Mock Spanish1

Following Hill's investigation of the “permeability of language” that includes the heteroglossic mixing of Spanish phrases into English, I examine here the “permeability of race,” focusing on racial shifts in and out of whiteness. I begin by arguing that the construction of racial difference hinges on the perception of one's ability to display a disciplined body, and I illustrate how language becomes a critical site for the racial disciplining of bodies. Next, I show how nonwhites can be “racially improved” and assimilate into whiteness through performances of standard English and control over their Spanish. Conversely, I demonstrate how white people who engage in intentional or unavoidable contact with latinos and Spanish speaking risk a loss of whiteness. Finally, I make the claim that white English speakers who embrace Mock Spanish actually “lose whiteness” as they “flirt” with the disorder of nonwhiteness. Here the temporary loss of whiteness that accompanies the display of a lack of linguistic refinement and control is readily exchanged for the positive associations of jovial and relaxed amiability. I thus argue that Mock Spanish helps us better understand the role of language in the moment-by-moment racial shifts speakers make in and out of whiteness. [Mock Spanish, race, whiteness, discipline, the body]

Communication and Coordination: The Keys to Quality

Numerous studies document disparities in cancer care based on race, and many extend this finding to ethnicity and socioeconomic status. Most highlight racial disparities in some aspect of cancer care delivery but fail to specify the mechanisms that lead to this pervasive phenomenon. Although such studies are valuable because they call attention to the magnitude of this problem, without elucidating the specific mechanisms that lead to disparities, they do not suggest interventions to eliminate them. In this issue of the Journal of Clinical Oncology, Ayanian et al describe results from a population-based survey of a multiethnic cohort of 1,067 colorectal cancer patients from Northern California. Patients completed surveys modified from the Picker Institute that reveal their perceptions of the quality of their cancer care. The surveys covered the core domains of access to care, symptom control, psychosocial support, health information, treatment specific information, confidence in providers, and coordination of care. Across all racial, ethnic, and linguistic groups, patients perceived access to information, psychosocial support, and care coordination to be the most deficient aspects of their care. African American, Hispanic, and other non–English-speaking patients reported significantly more problems with the quality of their care than white English speakers, and this was especially pronounced in the domains of communication and coordination of care. Despite the wealth of health information readily available in multiple media formats, these surveys reveal that patients desire better communication with their physicians. The study highlights the extent to which patients value having health information filtered, synthesized, and custom-tailored to their individual circumstances by a trusted physician. Communication refers specifically to information flow from physician to patient, and requires that a physician explain the diagnosis, prognosis, and therapeutic options in a comprehensible manner. Communication involves more than a oneway flow of information from physician to patient because it also requires that the physician listen to and incorporate patient preferences into formulation of a final treatment plan. Coordination of care involves facilitating patients’ access to the full complement of providers whose expertise may improve their outcomes or experience. It means ensuring that these providers have the necessary information available to formulate recommendations and then function as a team to deliver care. Thus, coordination itself focuses on communication and generally requires that one provider—typically the medical oncologist, but sometimes the surgeon—assume primary responsibility for orchestrating and overseeing all aspects of care. For many cancer patients, this requires more than simply a referral, but rather active engagement by the coordinating physician to ensure that other providers’ expertise is indeed obtained and that neither essential information nor the patient him or herself slips through the cracks. The survey by Ayanian et al reveals just how highly patients value physicians’ roles as coordinators. The eight items adapted from the Picker Institute survey ascertained the extent to which patients knew who was responsible for advising them about specific decisions and how often their providers seemed to be familiar with their problems, had communicated with one another, and had access to all necessary information. These issues of coordination are, of course, especially salient for cancer patients, whose care is typically shared by providers from multiple subspecialties often located at disparate practice sites. Given that colorectal cancer patients customarily undergo evaluation by gastroenterology, surgery, medical oncology, and often radiation oncology departments within the first few weeks of diagnosis, it is not surprising that coordination figures so prominently in a survey about quality of care. The finding that there are deficiencies in colorectal cancer care delivery and that there are racial disparities in perceived quality has been well documented previously by Ayanian and others. However, what is novel and especially important JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 23 NUMBER 27 SEPTEMBER 2

Apartheid's festival: contesting South Africa's national pasts

Apartheid's Festival: Contesting South Africa's National Pasts. By Leslie Witz. African Systems of Thought. Bloomington: Indiana University Press, 2003; and Cape Town: David Philip, 2003. Pp. xiv, 324; illustrations. $59.95 cloth, $29.95 paper. In over a decade of teaching South African history American university students, I have often asked them, toward the end of the course, if we should consider South a segregated state from its founding in 1652. Some have answered with considerable subtlety, noting that the Dutch East Indies Company founded a refreshment station, not a colony at Table Bay in 1652, and that the Union of South dated only from 1910. Many, however, have enthusiastically embraced the idea that Europeans systematically oppressed the indigenous peoples who lived in a country called South that is seen have existed since time immemorial (p. 253), from the moment Jan Van Riebeeck stepped ashore, an interpretation now ironically shared by many students in post-apartheid South Africa. Leslie Witz's engaging study is a welcome remedy this misreading of history. In Apartheid's Festival, Witz dismisses the notion that Van Riebeeck founded anything, noting that one of the first things he did was search the coast immediately around Table Bay make sure that there were no Portuguese or English ships whose captains might object the Dutch setting up their provisioning depot. Van Riebeeck was a minor figure in the Company's history-even his famous diaries, it seems, were largely business records transcribed by clerks at the direction of the Company. In 1804, however, the Batavian Republic, having regained control of the Cape from the British (only lose it again in 1806) resurrected him as a symbol of early settlement bolster their claims the small colony at the Cape. In 1910, Van Riebeeck was appropriated again as a symbol of the new Union. In 1952, he became the vehicle through which the Afrikanerdominated National Party and its newly inaugurated apartheid state reached out white English speakers. The 1952 festival commemorating the 300th anniversary of Jan Van Riebeeck's arrival in South is the centerpiece of Apartheid's Festival. The 1948 election had been bitterly contested and the National Party's margin of victory was narrow; achieve the goals of its rigid, segregationist platform, it needed reach out non-Afrikaans-speaking whites, to construct a history and identity of as whites (p. 15). Presenting Van Riebeeck as the purveyor of a shared Western Civilization darkest Africa offered the government its opportunity. …

Acculturation and the health and well-being of U.S. immigrant adolescents

Purpose To examine the association of acculturation, as measured by language spoken at home, with the health, psychosocial, school, and parental risk factors of adolescents of various racial/ethnic groups. Methods Using the U.S. component of the 1997–98 World Health Organization Study of Health Behavior in School Children, bivariate and multiple logistic regression analyses were conducted of records for adolescents in four racial/ethnic groups to explore the relationship between the language spoken at home and outcome variables regarding health status and risks, psychosocial and school risk factors, and parental factors. Data were analyzed using Software for the Statistical Analysis of Correlated Data (SUDAAN). Results Adolescents of all racial and ethnic groups who primarily speak a language other than English at home are at elevated risk for psychosocial risk factors such as alienation from classmates and being bullied, and parental risk factors such as feeling that their parents are not able or willing to help them. Those who speak a combination of languages are also at risk for being bullied and for high parental expectations. Language spoken at home is generally not associated with health and safety measures for adolescents across racial/ethnic groups. Conclusions Adolescents whose primary language at home is not English experience higher psychosocial, school, and parental risks than non-Hispanic white English-speakers. New immigrant youths of all races and ethnic groups would potentially benefit from preventive and risk-reduction services.

POLITICAL CHANGE AND SOCIAL ATTITUDES IN SOUTH AFRICA

This investigation sought to determine the correlates of attitudes towards the new ANC-dominated government in South Africa among two groups of White university students. To a large extent, the research replicates an earlier project conducted in 1986 which investigated the predictors of attitudes towards the ANC at a time when it was banned as were its leaders who were either imprisoned or in exile. Results indicate that conformity to group norms was of importance in the Afrikaans-speaking sample as was patriotism, authoritarian behavior and prejudiced attitudes. Conversely, attitudes in the English-speaking group seemed to be held less strongly and attitudes towards the ANC-led government appeared no longer to be related to such factors as prejudice, authoritarianism, patriotism or self-esteem. Results are understood in terms of long-standing sociopolitical differences between White English-speaking and Afrikaner groups in South Africa.

Crosscultural Comparison of Effects of Instrumental Enrichment on Children in a South African Mining Town

Feuerstein's theory of Structural Cognitive Modifiability, its construct of Mediated Learning Experience, and its vehicle of thinking skills development, Instrumental Enrichment (IE), have been widely discussed and researched. This study assessed the effectiveness of IE for primary school pupils, combined with concurrent provision to their teachers of training in Mediated Learning Experience and of curriculum packages embodying IE concepts. The effectiveness of the programme for groups of African, 'Coloured', and white English-speaking and Afrikaans-speaking fifth grade pupils in the segregated schools of a South African mining town was assessed. The post-intervention improvements for all groups on cognitive measures were significant, with varying results on scholastic, creativity and self-concept measures. For the African group, the improvements were significantly greater than for the others, which was expected in terms of their educational deprivation under apartheid. The value of IE, and of this particular model of implementation, for children of various cultural groups, is discussed.

Drama and Politics in a State of Emergency: Athol Fugard's My Children! My Africa!

Standing ovations are customarily directed toward playwrights and are usually reserved for opening nights. Subsequent standing ovations, if there are any, are typically directed toward the actors. Neither convention accounts for the impassioned standing ovations that nightly accompanied the first South African runs of My Children! My Africa!.(1) In a curious way these ovations were directed toward the audience itself: those applauding enthusiastically were responding to what they saw to be an affirmation of their own social and political positions and values, which had come under increasing pressure through the 1980s. Such ardent responses carried over into other areas of the play's initial reception. Though one or two critics struck discordant notes, South African reviews generally adopted the eulogizing manner evident in the concluding words of Stephen Gray's Introduction to his edition of My Children! My Africa!, where he writes of its being so faithful to the stage in South Africa, powerfully, undefeatably magnificent (13). Such descriptions, and there were many,(2) portray the playwright in heroic guise--embattled, resolute, undaunted. That guise accords with the tenor of Fugard's own famous remark that the play was me and country (Gray Introduction 9). The playwright, the audience, and the reviewers all seemed to share in a ritual celebration of their own intrepid righteousness. In short, the play made them feel good about themselves. Providing that satisfaction for the predominantly white, predominantly middle-class audiences of Johannesburg and Cape Town may not have been foremost in Fugard's mind in composing the play, which found other audiences and other receptions outside South Africa, it is nonetheless worth asking just what sort of social and cultural intervention is involved in a work that is said to be me and country. The description gives the appearance of placing Fugard on one end of a communication process, with the entirety of South Africa on the other: he the sender, they the receiver. On closer inspection that turns out not to be the case. instead, one segment of South Africa is directly addressed in the play, and another is the object of the address. Put another way, what the audience avidly enjoys is the experience of having Fugard tell off one segment of my country on behalf of another--themselves. The reception accorded the play by those who felt Fugard to be speaking on their behalf stemmed from what they perceived to be the stance the play takes regarding issues and conflicts thrown up by the political and social context that had unfolded in the years between just before the temporal setting of the play, 1984, and the year in which it was first performed, 1989. The audience's own social composition obviously had a good deal to do with how they responded to that context and its representation in the play. Fugard's audience was drawn largely from more liberal circles of the English-speaking white segment of the South African middle class. For many years this group through its political and cultural spokespersons and institutions defined the boundaries of legitimate opposition to the South African government. A comparatively homogeneous social bloc, it dominated the English-language press, the historically white English-medium universities, the main opposition parliamentary party, and the principal cultural vehicles engaged in producing and circulating political and cultural work in English. It seems contradictory to speak of a social bloc which functions in opposition to the state as hegemonic; nevertheless, in the peculiar circumstances of South Africa, that is exactly what this group, in relation to the white English-speaking population generally, paradoxically was. Though outside the channels through which state power was directly imposed (which is not the same as saying it was absolved of all responsibility for the apartheid policies adopted by the state), this bloc shaped and delimited for the bulk of the white English-speaking middle class the terms in which opposition to state power could be conducted, determining what were acceptable and what were unacceptable forms of opposition. …