Barriers to Accessing Medical Care for Hispanic Individuals With Craniofacial Conditions.

In the United States, having limited access to health care has been an ongoing concern that could cause detrimental effects for minority populations, specifically the Hispanic population. Numerous barriers to accessing health care were identified for both pediatric and adult Hispanic patients who were born with craniofacial conditions. Barriers that were determined to impact Hispanic patients with craniofacial conditions from receiving medical and health services included language and communication, patient-health care provider relationships, socioeconomic status and finances, insurance status, timely access to appointments, citizenship and immigration status, and lack of family and social support. Interventions for these barriers were also proposed to increase support for Hispanic patients. Lamentably, there is scant research that investigates how these barriers affect this special population, despite the limitations that they have in their ability to access health care. In addition, these barriers to treatment have dire consequences for individuals with craniofacial conditions. The findings and proposed interventions discussed in this review article provide measures to minimize these barriers and define ways to benefit Hispanic patients with craniofacial conditions.

The Role of Mothers' Child-Based Worth in Their Affective Responses to Children's Performance.

This research examined whether American and Chinese mothers' tendencies to base their worth on children's performance contributes to their affective responses to children's performance. Study 1 used daily interviews to assess mothers' warmth (vs. hostility) and children's school performance (N = 197; Mage  = 12.81 years). In Study 2, such affect was observed in the laboratory following children's manipulated performance on cognitive problems (N = 128; Mage  = 10.21 years). The more mothers based their worth on children's performance, the more their warmth (vs. hostility) decreased when children failed in Study 1. This pattern was evident only among Chinese mothers in Study 2. In both studies, child-based worth did not contribute to mothers' affective responses to children's success.

Coping With Racism: Moderators of the Discrimination-Adjustment Link Among Mexican-Origin Adolescents.

What strategies help ethnic minority adolescents to cope with racism? The present study addressed this question by testing the role of ethnic identity, social support, and anger expression and suppression as moderators of the discrimination-adjustment link among 269 Mexican-origin adolescents (Mage  = 14.1 years), 12-17 years old from the Midwestern U.S. Results from multilevel moderation analyses indicated that ethnic identity, social support, and anger suppression, respectively, significantly attenuated the relations between discrimination and adjustment problems, whereas outward anger expression exacerbated these relations. Moderation effects differed according to the level of analysis. By identifying effective coping strategies in the discrimination-adjustment link at specific levels of analysis, the present findings can guide future intervention efforts for Latino youth.

Physical activity, benefits, and barriers across the aging continuum.

BACKGROUND: A growing body of evidence indicates the importance of physical activity during midlife period linked to the likelihood of healthy aging, while the likelihood of an individual engaging in physical activity depends largely on their perceived benefits and barriers to being physically active. AIM: This study was to examine physical activity levels of midlife Korean American adults and their perceived benefits and barriers to physical activity compared with young and older adults. METHODS: We conducted a secondary analysis of data collected for a larger descriptive, cross-sectional study that was conducted with a sample of 517 Korean American adults in a Midwestern city. Data were collected using a survey questionnaire. RESULTS: A little more than half of the sample were women (57.1%), with a mean age of 41.6 (±â€¯13.4). The study sample met the current guidelines for physical activity far less than the general U.S. population (30.4% -34.6 vs. 51.7%). Less midlife adults met the guidelines for moderate-intensity physical activity than older adults (34.2% vs. 57.4%), while less midlife adults met the guidelines for vigorous-intensity physical activity than young adults (24.8% vs. 40.6%). Midlife adults perceived fewer benefits than did young and older adults. CONCLUSION: The findings indicate that midlife adults are less likely to engage in physical activity and probably more at risk for unhealthy ageing than young and older adults. Understanding benefits and barriers of target population is the first step in developing culturally and age-appropriate intervention to promote physical activity.

Peer Influence on Ethnic-Racial Identity Development: A Multi-Site Investigation.

The peer context features prominently in theory, and increasingly in empirical research, about ethnic-racial identity (ERI) development, but no studies have assessed peer influence on ERI using methods designed to properly assess peer influence. We examined peer influence on ERI centrality, private, and public regard using longitudinal social network analysis. Data were drawn from two sites: a predominantly Latina/o Southwestern (SW) school (N = 1034; Mage = 12.10) and a diverse Midwestern (MW) school (N = 513; Mage = 11.99). Findings showed that peers influenced each other's public regard over time at both sites. However, peer influence on centrality was evident in the SW site, whereas peer influence on private regard was evident in the MW site. Importantly, peer influence was evident after controlling for selection effects. Our integration of developmental, contextual, and social network perspectives offers a fruitful approach to explicate how ERI content may shift in early adolescence as a function of peer influence.

Ethnic-Racial Identity and Friendships in Early Adolescence.

The current study examined how adolescents' ethnic-racial identity (ERI) informed the demographic diversity of their friendship network (Goal 1) and the extent of similarity between adolescents' and their friends' ERI (Goal 2). Participants were sixth and seventh grade students (N = 353; Mage  = 11.88, SD = .73; 50% girls; 29% African American, 31% White, 13% Latino) in the Midwestern U.S. Results from longitudinal cross-lagged models (Goal 1) indicated that having more diverse friendships at T2 was associated with greater T3 ERI exploration among all youth. In addition, boys who reported higher ERI resolution at T1 had more diverse friendships at T2. Furthermore, findings from longitudinal social network analyses (SNA; Goal 2) suggested that influence drove similarity between adolescents and their friends in ERI exploration and resolution.

Predicting the Onset of Alcohol Use and the Development of Alcohol Use Disorder Among Indigenous Adolescents.

Empirical efforts to identify the predictors of drinking behavior among North American Indigenous adolescents are relatively limited. Using longitudinal data, this study considers perceived discrimination, positive drinker prototypes, and peer drinking behavior as risk factors for the onset of alcohol use and development of an alcohol use disorder among 674 Indigenous adolescents as they progressed from early to late adolescence (M age at baseline = 11.11, SD = 0.83). Results showed that positive drinker prototypes and associations with peers who drink increased the risk for the onset of drinking, while perceived discrimination and associations with peers who drink increased the risk for the development of an alcohol use disorder. The theoretical and practical implications of our results are discussed.

Ethnic differences in medicinal plant use among University students: a cross-sectional survey of self-reported medicinal plant use at two Midwest Universities.

BACKGROUND: Numerous surveys of medicinal plant use among college students abound, but none compare use between students enrolled in two different Universities with significantly different ethnic compositions. The objective of this study is to compare medicinal plant use between two different ethnic college populations and explore differences between student medicinal plant users and non-users for comparison with previous research. METHODS: Students (n = 721) at a large research university (n = 498) and a Pan-Tribal University for Native Americans (n = 233) completed surveys in October 2011 to assess past year medicinal plant use. The Mann-Whitney U test, Chi Square test, and General Linear Model were used to compare demographics and self-reported use of medicinal plants among students at both Universities and between past year users and non-users. RESULTS: Over 23% of university students surveyed reported past year medicinal plant use. Users were more likely to use commercial tobacco products and to report poorer health than non-users. While Native American student medicinal plant users reported significantly higher rates of commercial tobacco use, lower self-assessment of health, and less use of prescription medicine than non-Native users, no significant differences in prevalence of medicinal plant use were found between University student populations. CONCLUSIONS: Results are consistent with preexisting data showing higher rates of medicinal plant use among college students compared to the larger US population of adults and demonstrate previously documented health disparities in Native American populations compared to non-Native Americans.

Psychometric evaluations of the efficacy expectations and Outcome Expectations for Exercise Scales in African American women.

This secondary analysis tested the reliability and validity of the Self-Efficacy for Exercise (SEE) and the Outcome Expectations for Exercise (OEE) scales in 126 community dwelling, middle aged African American women. Social Cognitive Theory postulates self-efficacy is behavior age, gender and culture specific. Therefore, it is important to determine ifself-efficacy scales developed and tested in older Caucasian female adults are reliable and valid in middle aged, minority women. Cronbach's alpha and construct validity using hypothesis testing and confirmatory factor analysis supported the reliability and validity of the SEE and OEE scales in community dwelling, middle aged African American women.

Moyamoya disease in a primarily white, midwestern US population: increased prevalence of autoimmune disease.

BACKGROUND AND PURPOSE: Moyamoya disease is an uncommon, cerebrovascular occlusive disease of unknown pathogenesis. Previously described Moyamoya cohorts include predominantly Asian populations or ethnically diverse North American cohorts. To gain further insight into the pathogenesis of moyamoya, we examined clinical characteristics of a primarily white, Midwestern US population METHODS: Retrospective analysis of patients with angiographically confirmed moyamoya disease evaluated at our institution was performed. Prevalence of comorbidities, cerebrovascular risk factors, and autoimmune diseases were compared with the general population. RESULTS: Ninety-four patients with moyamoya were evaluated; 72.3% were female. Ethnic composition was primarily white (85%). A significantly higher prevalence of autoimmune disease was seen, particularly type 1 diabetes mellitus (8.5% versus 0.4% in the general population) and thyroid disease (17.0% versus 8.0% in the institutional general patient population). Hyperlipidemia was also increased (27.7% versus 16.3% in the general population). CONCLUSIONS: This study of a unique, primarily white, Midwestern population of moyamoya patients demonstrates a significantly higher prevalence of autoimmune disease than in the general population. This supports a possible autoimmune component to the pathogenesis of moyamoya disease.

The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketing.

OBJECTIVES: Exposure to tobacco marketing has been associated with an increased likelihood that youth start smoking and may interfere with tobacco cessation. We aimed to describe the prevalence, placement, and features of tobacco advertising at the point of sale by race, ethnicity, and other neighborhood demographics, as well as by store type. DESIGN: A cross-sectional assessment of the advertising environment in establishments that held tobacco licenses in our study region (a metropolitan area in the Midwest USA) was conducted in 2007. Stores were geocoded and linked with block group demographic data taken from the Year 2000 US census. We calculated associations between our hypothesized predictors, race, ethnicity, and other neighborhood demographics, and two types of outcomes (1) amount and (2) characteristics of the advertising. RESULTS: Tobacco advertising at the point of sale was most common in gas stations/convenience stores, liquor stores, and tobacco stores. A 10% difference in a block group's African-American/Black population was associated with 9% (95% confidence interval [CI]=3%, 16%) more ads as well as a greater likelihood that ads would be close to the ground (prevalence ratio [PR]=1.15 [95% CI=1.04, 1.28]). Block groups with greater African-American/Black, Asian, people on public assistance or below 150% of the poverty threshold, or people under the age of 18 years had more ads for menthol brands. Block groups with greater proportions of Whites were more likely to have ads that used health words, such as 'light' or 'natural' (PR for 10% difference in White population=1.41 [95% CI=1.17-1.70]). Chain stores were more likely to have greater amounts of advertising, ads close to the ground, ads for price deals, or ads that use words that imply health. CONCLUSION: Tobacco advertising targets communities with various racial and ethnic profiles in different ways. Now that US Food and Drug Administration has the authority to regulate the marketing and sale of tobacco products, there is new opportunity to reduce the harmful impact of tobacco advertising.

Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system.

PURPOSE: The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system. METHODS: We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately. FINDINGS: Patients in rural clinics vs. urban clinics had worse health status [χ2 = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits. CONCLUSIONS: Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.

More than a photo: Germans from Russia remember their familial relationships.

Most narrators of the Dakota Memories Oral History Project (DMOHP), the children and grandchildren of ethnic German immigrants from Russia, reminisce a great deal about their family relationships -- grandparent-grandchild relationships, parent-child relationships, and sibling-sibling relationships. They share memories of their grandmothers baking them delicious dough dishes, of their fathers making them labor endlessly in the fields, and of their siblings coaxing them into mischief. Through these relationships, Germans from Russia not only learned about their ethnic group's identity, but they also reshaped it into a new identity, blending their past with their present. Within the context of family relationships, these German Russian descendants forged a new identity rooted in their ethnic heritage and history, but serviceable to new, American-born generations.

Wave of mutilation: the cattle mutilation phenomenon of the 1970s.

During the 1970s many small-scale cattle ranchers across the Midwest reported finding their cattle mutilated. The episode, often dismissed as mass hysteria or sensationalized reporting, demonstrates the growing dissatisfaction of many ranchers concerning government intrusiveness and restrictive policies. These frustrations found a release in response to the mutilation phenomenon during which ranchers vented their anger by taking direct aim at the federal government. The turbulent economic conditions of the period paired with government interference in the cattle industry helped sustain the mutilation phenomenon as ranchers projected their fears and insecurities through the bizarre episode. The hostility ranchers showed toward the federal government during the mutilation scare presaged and helped provide the impetus for events such as the Sagebrush Rebellion. The mutilation phenomenon also underscores the pronounced effects of the libertarian movement of the 1960s that gave rise to the New Right and gained adherents across the West and Midwest.

"We were all trespassers": George Edward Lemmon, Anglo-American cattle ranching, and the Great Sioux Reservation.

With the opening of the Black Hills to white settlement in the mid-1870s, thousands of fortune-seekers made their way into Dakota Territory. George Edward Lemmon, a man later renowned as one of the world's most accomplished cowboys, was among them. During the 1880s his employer, the Sheidley Cattle Company, grazed thousands of cattle in western Dakota Territory, many of them on Sioux Indian land. Indeed, the company owed a great deal of its success to illegal grazing on the Great Sioux Reservation. Opportunists such as Lemmon supported Indian reservations because they could use those lands to make a profit. The interaction between large-scale white ranchers and the Indians of the Great Sioux Reservation provides insight into the development of the range cattle industry in the northern Great Plains and illuminates the motivations that led many ranchers to support, rather than oppose, the reservation system.

Fields of dreams: negotiating an ethanol agenda in the Midwest United States.

Corn ethanol production is central in the United States' agrofuels initiatives. In this paper I discuss corn ethanol production in Iowa, USA and examine several dynamics: farmers' positions in agrofuel supply chains; struggles around the construction and operation of agrofuel refineries; the politics of ethanol production and regulation; and the ecological consequences of increased corn production. I argue that current US agrofuels production and politics reinforce longstanding and unequal political economic relationships in industrial agriculture. I also argue that the politics of US agrofuels, focused on carbon accounting for greenhouse gas reduction and energy security, privilege urban and other actors' social and ecological interests over those of rural places of production.

Parenting profiles of academic and racial socialization: Associations with academic engagement and academic self-beliefs of African American adolescents.

In addition to being involved and encouraging their youth academically, many African American caregivers also employ socialization practices that prepare their adolescents for entering into a school system where they will be an ethnic minority or be taught by predominantly non-minority educators. The purpose of the current investigation was to fill existing gaps in the literature by examining two dimensions of parental socialization practices: academic socialization (parent school involvement and academic encouragement) and racial socialization (cultural pride, preparation for bias, and egalitarian messages). Additionally, this study examined how the identified profiles are associated with African American adolescents' academic outcomes (academic engagement and academic self-beliefs). A latent profile analysis was utilized to analyze data on 140 African American adolescent participants (M = 12.4; SD = 1.13; 56% female). Profiles that were identified included (a) academic socializers, (b) low race salient socializers, (c) preparation for bias socializers, (d) unengaged socializers, (e) multifaceted socializers, and (f) race salient socializers. Although there was no demographic (age, gender, SES) variation in profile membership, there were some differences in academic engagement and adolescents' academic-self beliefs. Findings highlight the importance of examining how academic and racial socialization work together and their association with adolescents' academic outcomes. Implications are discussed for school psychologists and educators.

Ethnic and geographical differences in HLA associations with the outcome of hepatitis C virus infection.

BACKGROUND: The association of human leukocyte antigen (HLA) genes with the outcome of hepatitis C virus (HCV) infection may be modified by ethnic and geographical differences. RESULTS: HLA-A, -C, -DRB1 and -DQB1 genotyping were performed in a Midwestern American cohort of 105 HCV infected subjects among which 49 cleared HCV infection and 56 had persistent viral infection. A new protective association of HLA-Cw*05 to HCV infection of all ethnic populations was identified (OR = 0.12, 95% CI = 0.01-0.97, P = 0.03). It was surprising that HLA-A*02 (P for interaction = 0.02) and HLA-DRB1*12 (P for interaction = 0.05) showed statistical interaction with race indicating opposite associations in Caucasians (OR = 2.74 for A*02 and 2.15 for DRB1*12) and non-Caucasians (OR = 0.41 for A*02 and 0.15 for DRB1*12). In addition, HLA-DRB1*01 (OR = 0.26), DQB1*05 (OR = 0.23) and the haplotype DRB1*01-DQB1*05 (OR = 0.19) showed strong associations with viral clearance in Caucasians. The protective associations of A*03 (OR = 0.20) and DQB1*03 (OR = 0.20) were exclusive to non-Caucasians. In contrast, DQB1*02 (OR = 2.56, 95% CI = 1.15-7.71, P = 0.02) and the haplotype DRB1*07-DQB1*02 (OR = 5.25, 95% CI = 1.04-26.6, P = 0.03) were risk markers in Caucasians. CONCLUSION: The associations of HLA-A*02 and HLA-DRB1*12 with HCV infection are opposite with different races. HLA-A*03, Cw*05, DRB1*01, DQB1*03 and DQB1*05 are associated with viral clearance while HLA-DRB1*07 and DQB1*02 are risk markers for viral persistence of HCV infection in Midwestern Americans. These results reveal ethnically and geographically different distribution of HLA-genes which are associated with the outcome of HCV infection.

An unremembered diversity: mixed husbandry and the American grasslands.

The Green Revolution of the 1960s brought about a dramatic rise in global crop yields. But, as most observers acknowledge, this has come at a considerable cost to biodiversity. Plant breeding, synthetic fertilizers, and mechanization steadily narrowed the number of crop varieties commercially available to farmers and promoted fencerow-to-fencerow monocultures. Many historians trace the origins of this style of industrialized agriculture to the last great plow-up of the Great Plains in the 1920s. In the literature, farms in the plains are often described metaphorically as wheat factories, degrading successive landscapes. While in many ways these farms were a departure from earlier forms of husbandry in the American experience, monocultures were quite rare during the early transformation of the plains. Analysis of a large representative sample, based on manuscript agricultural censuses and involving twenty-five townships across the state of Kansas, demonstrates that diverse production reached even the most challenging of plains landscapes.

The intellectual legacy of Mary Neth's work on farm women and rural communities.

Mary Neth's 1995 book, "Preserving the Family Farm: Women, Community, and the Foundations of Agribusiness in the Midwest, 1900-1940," made a major contribution to the analysis of the connections between gender and the political economy that shaped farm women's lives and fueled farmers' resistance to the transformation of rural life wrought by agribusiness. Focusing on the processes of negotiation between women and men in farming families and rural communities, Neth illuminated the relationship between women's work and their power. Tracing the dense networks that connected farm families, she also showed how cooperation in work generated and sustained radical farm movements.