Effects of Childhood Adversities on Positive Adult Functioning across Racial Groups, and Examination of School Bonding as a Moderator

Ebasa B. Sarka

Research has established that adverse experiences during childhood increase the risk of complex sets of long term detrimental effects in adulthood, including poor physical and mental health, as well as functions in multiple social domains. There is a need for a broader (discipline wise), yet focused and unified definition of childhood adversity, in order to adequately appreciate its prevalence and long term consequences. There is also a need to consider a growing evidence in studies of resilience that despite harsh childhood experiences, some achieve a healthy and successful life as adults. This study examined three questions with focus on the long term impacts of childhood adversity: (1) Does childhood adversity as measured by abuse and neglect, poor bonding with parents, poor attachment to neighborhood, family conflict, and poverty impact resilient adult functioning at age 27?; (2) Does the effect identified in question 1 vary across races? In other words, does childhood adversity predict positive adult outcomes differently across three racial groups?; and, (3) Do the experience of high/low school bonding in high school moderate the relationship of childhood adversity on resilient adult functioning? The data in use comes from the Seattle Social Development Project (SSDP), a longitudinal study in which 808 children from 18 schools in an urban area in the Pacific Northwest were followed into their adulthood, and regularly interviewed over the last 25 years. This study focuses on the experiences of African Americans (n=192), Asian Americans (n=171), and European Americans (n=374).


The structural equation modeling (SEM), and Multiple Groups SEM (MGSEM) technique was used to examine questions in this dissertation. Results of the full sample indicate that adverse childhood experience has a negative impact on resilient adult functioning at age 27. In particular, child maltreatment, poor bonding with parents, and eligibility for free lunch (a proxy for poverty) showed significantly negative impacts. Identifying as Asian American was also found to positively predict positive adult functioning. Tests of invariance in the regression paths of childhood adversity on positive adult functioning suggests an overall difference in how childhood adversity predicts adult functioning across racial groups. The differences are tied to how two predictors, specifically child abuse and neglect and poor bonding to parents more strongly predict adult functioning for European Americans. Poor bonding with parents also strongly predicted negative adult functioning for the Asian American group. However, this model did not predict any significant relationships between childhood adversity and positive adult functioning for the African American group.

Examining the moderating effect of high versus low levels of school bonding indicates a non-invariant measurement, which indicates that the measurements are not similar across high and low groups. Results of this analysis suggests that there is not much evidence that bonding to school moderates the relationship between childhood adversities and positive adult functioning as measured in this study.

Experiences of Belonging and Wellbeing

Kimberly Dree Hudson

Community borderlands are spaces that are shifting, polyvocal, and multidimensional; they embody, transform, and resist systems and cultures of oppression, impacting the material realities and lived lives of their occupants and visitors alike. In this dissertation, I applied a borderlands framework to learn about lived experiences in relationship to three central concepts within social work: community, belonging, and wellbeing. This project integrates elements of transnational feminism, postcolonial studies, and borderland epistemology within a queer framework, employing theoretical pluralism to interpret stories of lived lives, material realities, and perceived wellbeing. Using critical narrative and feminist methodologies, I interviewed 12 adults in the Seattle area who identified in flexible, critical, or ambiguous ways across race, gender, and sexuality; most study participants self-identified as mixed and queer. I explored articulations and intimations of liminality and belonging used by participants to make meaning of being in community and being well. Emerging from this analysis is a conceptual framework to understand belongingness in community borderlands and corresponding, contradictory experiences that enhance and detract from participants’ perceived wellbeing. Wellbeing itself, from a borderland perspective, is understood through participant positions on reclaiming “healthy bodies,” priority-setting within their communities, and critical self-reflection regarding the intentional creation of spaces and the unintentional replication of oppressive practices and discourses. This dissertation challenges the monolithic assumption that having liminal status is a source of chronic stress and social disconnection that deteriorates wellbeing. Instead, I demonstrate that borderland experiences of community may provide a sense of connectedness that actually enhances perceived and actual wellbeing through increased resources, sense of safety, and belonging. However, I also highlight the complexity, ambiguity, and discontinuities of these relationships. This study suggests the application of a borderlands framework in social work scholarship, pedagogy, and practice, namely by informing existing and potential collaborative community efforts to address disparities and promote wellbeing.

Impact on Pathways to Adulthood and Adult Criminal Outcomes

JoAnn S. Lee

In today’s social and economic context in the U.S., many individuals experience an extended transition to adulthood period during which they are able to delay adopting adult social roles and responsibilities, such as initiating careers, making long-term commitments to a romantic partner, and starting a family. However, many individuals do not have the resources or supports that would enable them to delay adopting one or more of those roles, experiencing an accelerated transition to adulthood.  An accelerated transition can pose more challenges in the form of economic or housing hardships and may hinder the ability of individuals to accumulate additional and necessary human capital. This dissertation applies an institutional lens to the study of the transition to adulthood in order to help illuminate the role of social structures in shaping individual lives during childhood, adolescence, and the transition to adulthood, and consists of three analyses. Chapter 2 examines the experiences of a general sample of diverse, urban youth, and chapters 3 and 4 focus on foster youth aging out of care. Chapter 2 considers whether the normative socializing institutions of family and school play a role in shaping the transition to adulthood, whether extended or accelerated, and whether the individual’s bond to these institutions mediates the relationship.  Although the findings indicate that the prosocial socialization process operating in the family and school does not play a role in explaining differences in who experiences an extended or accelerated adulthood, other characteristics of the family play an important role, such as parent school expectations, a family disruption, and immigrant status. Chapter 3 examines the impact of legal system involvement on foster youth in preparation for the transition to adulthood on criminal activities during the transition to adulthood. The findings indicate that legal system involvement is associated with higher levels of criminal activities at age 21. In addition, legal system involvement initiates a process of social exclusion where youth are less likely to graduate from high school by age 19, and this has an impact on their employment status at age 21. Chapter 4 investigates the impact on arrests of extending foster care support during the transition to adulthood; the findings indicate that extended support in the first year after turning 18 reduces the risk of arrest, but this effect declines after the first year. Together, this dissertation research finds that during childhood and adolescence, as well as during the transition to adulthood, institutions play an important role in shaping the transition to adulthood.

Diasporic Intersectionalities: Exploring South Asian Women's Narratives of Race, Ethnicity, and Gender through a Community-based Performance Project

Gita Rani Mehrotra

Although South Asians constitute one of the largest, fastest growing Asian groups in the country, there is a paucity of U.S.-based social work literature about this community.  Further, professional social work organizations and feminist social work scholars have called for the field to build paradigms and practices that address the intersections of oppressions facing individuals and communities, such as race/ethnicity, gender, sexuality, and class, in a global context. Drawing from intersectionality theorizing, transnational feminisms, diaspora studies, and theories of narrative identity, this study explores how a local group of South Asian women construct their experiences of race/ethnicity, gender, class, and diaspora.  Thirty-one in-depth interviews were conducted with participants of a culturally-specific, community-based performance project,Yoni Ki Baat (Talk of the Vagina).  Thematic analyses, with attention to context and discourse, elucidated important similarities and differences across women’s narratives.

While all participants communicated a high sense of agency in defining themselves in terms of race/ethnicity, first and second generation women’s narratives diverged significantly in the following domains: use of racialized vs. ethnic constructs, nationality, significant life events impacting racial/ethnic identification, and ways women perceive race/ethnicity assigned to them by others. In contrast, despite differences in age, generation, religion, and other life experiences, all participants narrated the centrality of marriage as a “cultural script” that produces ideal, middle-class, South Asian womanhood. Women’s narratives illustrate some everyday ways this cultural script is communicated, enforced, and negotiated within families and communities. 

Overall, this study demonstrates the utility of narratives and cultural scripts for understanding meaning and self-making processes within diverse communities. Research findings herein also challenge traditional social work frameworks that often rely on essentialized representations of social groups, single-oppression analyses of inequality and identity, and/or U.S.-centric approaches to understanding oppression and experience.  Analyses of South Asian women’s narratives point to the need to expand intersectionality theorizing and social work education to incorporate: context; temporality, age, and lifecourse; transnational experiences; concepts of diaspora; and relationships between experiences of privilege and marginalization.  Fostering deeper understandings of intersecting oppressions and processes impacting transnational populations in these ways can contribute to more liberatory social work scholarship and practice.

Overrepresented, Underserved: The Experiences of LGBTQ Youth in Girls Detention Facilities in New York State

Sarah E. Mountz

Among LGBTQ youth, queer women, transgender and gender non-conforming youth have been particularly marginalized in both social science research, social service settings, and in the community, where they are especially vulnerable to violence and significantly more likely to become involved with law enforcement. This is particularly the case for queer young women, transgender and gender non-conforming youth of color and youth or who are low-income. For my dissertation research, I have conducted an oral ethnography with young adults, ages 18-25, who have been incarcerated in girls detention facilities in the Juvenile Justice system in New York State. The study design used the principles of Community Based Participatory Research (CBPR) and was facilitated by a Community Advisory Board composed of practitioners, legal advocates, researchers, activists, and young people. Life History Interviewing was used to gain insight into participants’ experiences in relation to the research questions asked. It was determined to be the most appropriate methodological tool for its capacity to dialogically elicit a narrated panorama of young people’s lives that elucidated pathways prior to and following their involvement with the Juvenile Justice system in order to identify life choices, systemic barriers, experiences of violence and harassment in detention and elsewhere, and childhood and family history and events. Moreover, Life History Interviews allowed participants to delve richly into questions of how they negotiate their sexual orientation, gender, gender identity, and race in relation to various contexts, relationships, and systems, over time. Interviews were analyzed using Carol Gilligan’s Listening Guide. Findings from the study revealed themes related to identity processes, the role of family acceptance and rejection in systems involvement, pipelines and revolving doors between and amidst child welfare, educational, and juvenile justice systems, the prevalence of interpersonal and state sanctioned violence in participants lives, and participants’ tremendous capacity for resiliency and creative modes of collective and community based healing. Findings suggest profound importance of hearing LGBTQ young adults’ own stories about their lives and experiences in the juvenile justice system and beyond, the need to decriminalize young people’s survival strategies, and to challenge the use of detention facilities, and the rampant abuse of power by law enforcement towards LGBTQ young people within and outside them. This dissertation research draws upon my direct practice experience with LGBTQ youth in the child welfare system and as a queer activist.

Sexual Assault Response Teams: Exploring the Discursive Negotiation of Power, Conflict, and Legitimacy in Coordinated Service Delivery Models

Carrie A. Moylan

To improve services for sexual assault victims, many communities have adopted coordinated models of service delivery, often called Sexual Assault Response Teams (SARTs).  Uniting law enforcement officers, rape crisis advocates, and health care professionals, SARTs frequently aim to create a seamless and compassionate experience for victims who engage with formal helping services.  There is some indication that the process of implementing SART is contentious.  Furthermore, replicating in practice the ideals of SART coordination has proved elusive for some communities.  This research explores the challenges of SART implementation, focusing on why there is sometimes a disconnection between the philosophy of integrated services and the realities of front-line service delivery.  Using a qualitative within-case and cross-case method, interviews with 24 SART professionals were analyzed, resulting in three studies of SART functioning.  The first study explored the discursive construction of conflict in SARTs.  Analysis identified how SART professionals discursively positioned one another in terms of authority, expertise and credibility in order to protect their own professional autonomy and to stake a claim on setting the agenda for the team’s work together.  The second study explored strategies that interviewees used to manage conflict in teams.  Four categories were identified including preventative, responsive, unobtrusive, and resignation strategies. All professions were engaged in processes of managing conflict, but advocates talked much more about strategies and were almost exclusively responsible for all discussions of unobtrusive and resignation approaches to managing conflict.  The final study draws on institutional theory to explore how external forces shaped the adoption and operation of SARTs.  The analysis revealed two simultaneous processes.  The first process illustrated how SART was discursively legitimized, starting with the framing of sexual assault service delivery as a moral imperative for communities and continuing with the identification of coordination as a means of meeting the moral imperative.  Concurrently, a process of decoupling is indicated by the continuing resistance both to the moral imperative and the logic of coordination, as well as by the inconsistent and incomplete implementation of SART.   Implications for SART practice and future research are also discussed.

Community Coalitions: Resolving the Gap between Research & Practice for the Prevention of Youth Mental, Emotional, & Behavioral Problems

Valerie B. Shapiro

Tested and effective approaches are available to prevent mental, emotional, and behavioral problems in youth, but they are underutilized. Communities That Care (CTC) is a coalition-based strategy that creates a local infrastructure for prevention service delivery that facilitates the community-wide adoption of a scientific approach to preventing these problems. A community-randomized trial of CTC in 24 communities, matched in pairs and randomly assigned to a control or an intervention condition, has demonstrated that CTC significantly increases the community-wide adoption of a science-based approach to prevention, as reported by community leaders. For this dissertation, I first examined the extent to which the effect of CTC on the adoption of a community-wide scientific approach to prevention varied significantly across matched community pairs. Results indicated significant and substantial variation in the effect of CTC on the adoption of a scientific approach to prevention across the 12 community pairs. Next I explored potential sources of the variation across community pairs in community transformation toward a scientific approach to prevention. These sources included five coalition capacities: member knowledge, member acquisition of new skills, member attitudes, organizational linkages, and influence on organizations.  Findings indicated that CTC coalitions successfully built capacities.  Results also showed that new skill acquisition by coalition members and the engagement of diverse sectors in coalition work, as reported by coalition members, moderated the relationship between CTC and the community-wide adoption of a science-based approach to prevention. Finally, I explored whether the internal coalition functioning of CTC coalitions predicted community-wide adoption of a science-based approach to prevention directly or through a coalition culture that builds capacities necessary for coalitions to achieve system transformation. Findings indicate no direct effect of goal-directedness, efficiency, opportunities for participation, or cohesion on community-wide adoption of a science-based approach to prevention, but suggest the possibility of an indirect pathway through building new member skills and external linkages to diverse sectors. Identification of these malleable coalition processes and capacities, which facilitate the community-wide adoption of a scientific approach to prevention, will be useful for improving the overall effectiveness of community coalitions focused on preventing adolescent mental, emotional, and behavioral problems.

Political Violence, Trauma, and Resilience

Cynthia Sousa

In recent decades, there has been an expanded effort to examine the adverse effects of political violence on the health of civilian populations; substantial evidence now points to the effects of political violence on outcomes like PTSD, anxiety, and a variety of physical health symptoms. Despite the variety of risks inherent within political violence, we know individuals and communities actively cope with the stressors of political violence, exhibiting marked resilience as they function much better than might be expected. Individual and community resilience is generally defined as the successful recovery from or adaptation to stress or adversity through the use of individual or community characteristics, resources, strategies, and processes. While researchers have increasingly focused on political violence in the past few decades, several areas within the field of political violence and global health remain under-explored. To address these areas, this dissertation explores experiences inherent within the political violence, their effects on health and well-being, and processes of resilience within the experience of political violence. Each paper within this dissertation sheds light on one shared question: How does political violence affect people’s health and how do people and communities endure the stress and trauma it poses? The papers within this dissertation employ distinct guiding questions and associated research methods to: (1) provide an interdisciplinary overview of resilience to clarify what we currently know from scholarly literature about how individuals and communities weather the effects of political violence; (2) explore how political violence affects a variety of health outcomes (including general health, PTSD and distress) and examine how these health effects of political violence might differ along various sources of coping, ranging from self-reliance to use of support from one’s family and from religious and political resources; and (3) examine how women describe the specific, particular experiences they endure within political violence and their strategies of resistance within that context.

A Life Course Perspective on the Social Determinants of Multiracial American Health

Karen Tabb Dina

Few studies provide data on the health of self-identified multiracial (two or more races) Americans. Subsequently, we know little about this population and existing health disparities. Three areas relevant to multiracial health include health status, health care service utilization, and health related to racial stability over the life course. Although some investigations report the health service use of children and adolescents, almost no studies report the health service use of multiracial young adults. Most studies on multiracial groups are cross-sectional and thus focus on a single time point, so it is difficult to establish how health indicators change for multiracial groups over time. This dissertation employs epidemiological methods to investigate the health of self-identified multiracial young adults in a series of three linked papers. I used data from the National Longitudinal Study of Adolescent Health (N = 20,774) in-home sample taken during the period 1994-2008 to examine factors related to multiracial health as individuals enter difference phases of life. Using multivariate logistic regression I tested a series of hypotheses for three distinct research questions. In the first paper, I found that there are differences in self-rated health for some multiracial groups.  In the second paper, I found that there are differences in the rates of health care service utilization when comparing specific multiracial groups to the monoracial majority. In the third paper, I found that there are differences in report of self-rated health when comparing monoracial adults with multiracial adults who switch racial categories over time. These findings contribute to the wider understanding of health disparities for vulnerable populations and assist in identifying salient mechanisms of health disparities over the life course. These results also demonstrate the importance of critically examining changes in categories over time and effects when using quantitative data.

Where is “Home?” Interpreting Horn of Africa Youth Discourse and the Politics of “Displaced Youth”

Aster Solomon Tecle

This dissertation is a discursive inquiry into the language Horn of Africa (HOA) youth use as they talk about their experiences. Study participants are 1.5 and second generation HOA youth, mainly from Eritrea, Ethiopia, and Somalia, living in the Pacific Northwest and actively participating in youth programs provided by three agencies serving HOA immigrant populations. Youth in the study participated in three focus groups. Employing postcolonial and poststructuralist frameworks, the study aims to reveal the function of language in representing HOA youth: it assumes language to be a “site of contestation” where youth position and reposition their claims as they characterize themselves and their experiences.
The study’s thematic findings highlight three aspects of HOA youth experience: their strategic use of the language of difference; the hybridity of their experiences and aesthetics; and their use of this inbetweeness as a space of possibility. The study captures the nuances of HOA youth discourse, moving beyond dichotomous frameworks to more fully acknowledge the complexities for immigrant youth of negotiating inbetween spaces. These complexities reveal that HOA youth can and do displace discourses that represent them. Revealing the complexities of HOA youth language also has the potential to dismantle underlying paradigms that take-for- granted the politics of “displaced youth.” The study potentially contributes to social work methodology, theory, and practice, and to youth programming.

The study findings challenge theoretical and conceptual frameworks that assume HOA youth have a stable, rational, and unified identity, and assume related ideas about empowerment and change, which can ultimately victimize youth for not fitting into expected norms. From the perspective of this study, liberation from dominant discourses does not require a stable identity; rather, identities are continuously and complexly produced in and through competing discourses. The research points to the need for youth programs to focus on exploring how cultures and languages represent youth, and their populations, while also questioning what it means to talk across borders, as the youth move beyond conventional discourses of multiculturalism. The study also has the potential to inform host society perceptions of HOA youth in particular and African immigrants in general.

Courts, Child Welfare, and Criteria for Terminating Parental Rights

William Michael Vesneski

Few legal proceedings in the U.S. have more significant consequences for families than the termination of parental rights. Previously described as family law’s “death penalty,” termination leads to the complete severance of the parent-child bond. Yet, despite its profound consequences, termination is infrequently addressed in social work scholarship. This dissertation aims to help fill this gap by examining North Carolina judicial opinions, written in 2010, that resolved disputed actions to terminate parental rights.  A total of 100 opinions were examined using content analysis. All of the cases involved child neglect. The study focused on neglect because of ongoing difficulty in clearly defining this common form of child maltreatment. A large majority (n=86) of the cases resulted in the termination of parental rights. The study yielded a typology of factors appellate courts used to justify their termination decisions. Altogether, 39 factors were identified and organized into 10 different domains: parental conditions, service compliance, home environment, economic conditions, child conditions, bonding, child welfare history, physical abuse, physical presence, and sexual abuse. These factors are more expansive than the termination criteria listed in the federal Adoption and Safe Families Act as well as North Carolina statutes. Just as important, chi-squared analyses revealed that when courts made their termination decision, they looked to different factors depending upon which parents were involved in the cases (mothers, fathers, or both parents).

Two domains were selected for closer examination using discourse analytics: “service compliance” and “economic conditions.” The goal of this examination was to understand the ideology and social values underlying the rulings. The results indicate that the courts placed significant importance on parents’ compliance with case plans when deciding whether to terminate their rights. At the same time, the courts were very concerned with parents’ poverty and their surrounding economic circumstances. Overall, the study underscores the critically important role the courts play in the child welfare system. Not only do courts safeguard parents’ rights during termination proceedings, they are actively involved in creating child welfare policy and setting the parameters of social work practice in the field.

Same-Sex Partnerships and the Health of Lesbian, Gay and Bisexual Older Adults

Mark Edward Williams

While extensive research has examined associations between marriage, cohabitation and the health of heterosexual adults, it remains unclear whether similar patterns of health are associated with the same-sex partnerships for older adults. The following papers examine how having a same-sex partner may be related to general self-reported health, mental health, and satisfaction with life for older adults. Analyzing survey data collected from lesbian, gay, and bisexual (LGB) adults 50 years of age and older, the first paper reports findings that those with same-sex partners have significantly better self-reported health, fewer depressive symptoms, less perceived stress, and greater life satisfaction, controlling for gender, age, education, income, sexuality, and relationship duration. Relationship duration did not significantly impact the association between partnership status and health, nor did gender. The importance of culturally sensitive clinical practice and policies that recognize the role that same-sex partnerships may play in older adult health are discussed along with implications for future research. The second paper further examines how identifying as married is associated with significantly fewer depressive symptoms and greater life satisfaction compared to those identifying as unmarried partners, but not significantly less perceived stress. Social integration, as reflected in increasing access to and identification with marriage by LGB older adults, is an important area for future research to examine in order to study how changing social acceptance of sexual minorities may impact older adult health. The final paper reviews the theoretical frameworks that have been employed to study lesbian, gay, and bisexual older adult health.  Social determinants of health models are contrasted with social constructionist and post-structural critiques of gender, sexuality, age and health.  Future research needs to envision both structural sources of health disparities as well as account for individual agency and the resilient subject as important elements for theorizing the source and meaning of health disparities for lesbian, gay and bisexual older adults.

Heterogeneity among Youth at Risk for Violence:
Implications of a Stress and Coping Framework for Prevention

Patricia Logan-Greene

This dissertation uses a stress and coping resource framework to examine heterogeneity among adolescents and young adults at risk for violence. Three studies are included that build on existing literature concerning risk and protective factors for violence by consideration of etiological differences that bear upon stress exposures and coping capacity. Participants were recruited from high schools on the basis of risk for drop-out and suicide behaviors (Mean age = 16.0), which resulted in an ethnically diverse, gender-balanced sample. Additional surveys were delivered 5 and 7 years later with satisfactory retention. Paper 1: Latent Profile Analysis was used to detect four distinct groups with differential risk and protective factor profiles and concomitant problem behavior outcomes, demonstrating important differences for etiological risk of violent behaviors. Paper 2: The sustained impact of adolescent violence histories was established relative to early adulthood psychosocial functioning, across multiple dimensions of risky behaviors and emotional distress. Paper 3: An assessment of stress and coping resources in early adulthood successfully predicted continuity and discontinuity in violent behaviors from adolescence to young adulthood. Collectively these findings demonstrate the importance of investigating variation among violent youth with respect to stress-related risk, protective factors, and ways in which coping affects development—distinctions that are crucial to insuring interventions are well matched and proportionate to respective risk profiles among youth. Results strongly bolster arguments concerning the value of preventive and early interventions toward curbing the developmental and transgenerational impacts of violence. Major implications include the need to assess for histories of violence among vulnerable youth, as well as attend to traumatic experiences and emotional distress of youth engaging in violence.

Predictors Associated with Late-Life Depressive Symptoms among Older Black Americans

Gillian L. Marshall

With the projected growth of a diverse older adult population in the U.S., their mental health status is of increasing concern.  It is a concern since little is known about what places them at risk and what factors protect them against late-life depression. The primary aim  of this dissertation is to address  this concern by examining the risk and protective factors associated with depressive symptoms between older black Americans.  Data analyzed for all three studies used the National Survey of American Life.  The study sample consisted of older persons age 55 years and older who self identified as either African American (N=837) or Caribbean Black (N=271).  Results indicate that socio-economic status was significant in predicting high depressive symptoms, especially for older African Americans.  Results also highlight the fact that greater depressive symptoms are associated with stress in the form of perceived discrimination which poses a risk for late-life depression among both groups of older Black Americans. In addition, both social support and social connectedness were significant in moderating the effect of stress for both older African Americans and Caribbean blacks.  The findings from this study will contribute to the general body of knowledge on black Americans, and more specifically, to the heterogeneity embedded between and within older African Americans and Caribbean Black populations.

Bark Made Rope, Roots Made Baskets

Ramona Beltran

Background: Over the last several decades space and place have emerged as important concepts and how they are theorized is beginning to shape many policies and practices that impact the health of indigenous peoples. For indigenous peoples, the ultimate location of space and place is embedded in a profound relationship with the earth.  The earth (or land) is both literally and figuratively the first and final teacher for understanding our world, communities, families, selves, and bodies. This dissertation articulates an indigenous framework for triangulating the concepts of space and place, historical trauma, and embodiment as they impact health and wellness of indigenous peoples. Methods: Innovative qualitative methods including narrative analysis of in-depth interviews about traditional and contemporary perceived experiences between land and health from 13 tribal members of a Washington reservation was conducted along with a GPS and photographic survey of food and activity resources on tribal lands. Data points were mapped onto an interactive web-based map and used to illustrate and deepen individual narratives. Poetic narrative was also woven throughout the dissertation to evoke a fourth analytical space referred to as “differential consciousness” which transcends the bounds of academic words and ideas. Results: Qualitative analysis revealed an overall ambivalence including a simultaneous profound love, care, and loss of original tribal land/health relationships. Thematic findings were organized into eight primary categories with more nuanced sub-themes articulated within each category. The over-arching themes for how Tulalip tribal members experience the relationship between land and health include: 1) Simultaneous reverence and loss; 2) Close kinship relationship; 3) Respect and reciprocity; 4) Dissonance of historical trauma and cultural strength; 5) Impact of development and western values; 6) Cultural transitions and losses; 7) Contemporary practices and realities and; 8) Cultural revival and regeneration.  Photographs and map illustrate these themes. Conclusions: Using personal narratives to investigate complex environmental conditions helps describe how relationships to historical and contemporary cultural knowledge impacts the health of indigenous community members.

From Healthy to Unhealthy: Disaggregating the Relationship between Race, Nativity, Perceived Discrimination, and Chronic Health

Shauna K. Carlisle

There is a clear association between race and health outcomes in the United States.  Needed is a systematic examination of the relationship between chronic health and race, ethnicity, nativity, and length of residency. Further, the role of perceived discrimination and health decline must be explored beyond broad racial categories with the inclusion of Caribbean ethnic subgroups. Utilizing the linked data from the Collaborative Psychiatric Epidemiology Surveys (CPES), this dissertation addresses the gap in literature by examining differences in reports of chronic cardiovascular, chronic respiratory, and chronic pain conditions across three samples of Asian American (n=1,628), Latino Americans (n=1,940), and Afro-Caribbean American (n=978) respondents. Chapter 2 examines the ethnic subgroup variation in chronic health by comparing self-reports of chronic conditions across diverse subgroups of Asian American (Vietnamese, Filipino, Chinese), Latino American (Cuban, Portuguese, Mexican), and Afro-Caribbean (Haitian, Jamaican, Trinidadian/Tobagonian) respondents.  Chi square analysis reveals significant differences by race for chronic cardiovascular [c2 (2, n=4969) 16.77, p<.0000], respiratory [c2 (2, n=4975) 10.23, p<.0001], and pain conditions [c2 (2, n=4973) .22, p>.8].  Logistic regression revealed significant differences in reports of chronic conditions across nine ethnic subgroups.  Chapter 3 examines the nativity differences in reports of chronic cardiovascular, respiratory, and pain conditions between foreign-born (n=3,579) and native-born (n=1,409) respondents.  Results reveal that native-born respondents were significantly more likely to report chronic respiratory [c2(1, n=4958) 30.78, p≤.05] and pain [c2(1, n-4958) 3.77, p≤.05] conditions than were their foreign-born counterparts.  Logistic regression models reveal significant associations between chronic conditions, and other demographic factors known to influence immigrant health.  Chapter 4 explores the relationship between chronic conditions, nativity, perceived discrimination, and length of residency among the three racial and nine ethnic subgroups.  Afro-Caribbean subgroups were more likely to report perceived discrimination than Asian and Latino American subgroups were.  However, a significant positive association with perceived discrimination was found only for Latino American respondents (b=.60; P≤.01).  An interaction term called “exposure” was created to estimate the effects of long-term exposure to perceived discrimination among foreign-born respondents in this study. Logistic regression analysis was conducted to determine which groups within the model were more likely to report exposure effects.

Participatory Action Research in a Prison Nursery

Marie-Celeste Condon

Incarcerated mothers and their babies are invisible to most of us.  Little is known about the discourses surrounding women who give birth and begin raising their babies while doing time in prison.  I conducted a two year, exploratory, qualitative study of babies’ experiences in the Residential Parenting Program in Washington Corrections Center for Women, using Participatory Action Research (PAR).  I present just one aspect of our work, namely operationalizing PAR concepts with prisoners, officers, early childhood educators, nurse practitioners, birth attendants, and community members.  These stakeholders hold divergent views about incarcerated women and their newborns.  They rarely if ever come to the same table to talk and learn from one another.  Stereotyped identities, differences in power, privilege and autonomy, and the divergent missions of their organizations present real challenges to linking research and action on behalf of babies.  PAR literature raises questions about the extent to which PAR philosophy can be truly carried out in prisons, when participation is not limited to one or two groups of allied stakeholders.  I explain challenges.  I present evidence supporting and contraindicating PAR in settings that mandate limited autonomy and agency for women.  I present strategies that led to the emergence of a common discourse.  I offer recommendations for future work.

Investigating the Social Context of Immigration-Related Factors and Asian American Health

Aileen A. Duldulao

This dissertation examines the social context of immigration-related factors as they relate to the health of Asian American immigrants and focuses specifically on age at migration and period of migration as potential explanatory contexts for elucidating the strong relationship between immigration and health.  In the first paper, an historical, social, political and theoretical framework is outlined that argues for the use of expanded contexts when empirically examining Asian American health.  This paper provides recommendations as to how such contexts can be brought to bear on Asian American health, such as using model specification techniques used in research on racial health disparities.  The second paper is an empirical test of historical context as a way to frame the relationship between Asian American self-rated mental health, age at migration and the historical period of migration.  Specifically, this paper tests the applicability of age at migration as a predictor for self-rated mental health between pre- and post-1965 immigrations using model specific path analyses.    The third paper also builds on analytical recommendations set forth in the first paper and provides an empirical test of the relationship between suicidal ideation, ethnic density and historical period of migration using multilevel modeling techniques.   In its entirety, this dissertation argues for and provides a more holistic, nuanced approach to examining and explaining the relationship between immigration-related factors and Asian American health.

Maltreated, Displaced, and Under-Served Foster Youth: Predictors of Developmental Outcomes among Racially Diverse Foster Care Alumni

Antonio R. Garcia

Child welfare practitioners and researchers’ are faced with the daunting challenge of ensuring children in foster care successfully transition into adulthood. In fact, for many of the youth who experienced prior history of chronic abuse and placement instability, the likelihood of experiencing negative mental health, employment, and education outcomes increase. Due to the fact that research focusing on the experiences of foster care alumni of color is limited, existing interventions to address their negative developmental outcomes may not be effective. The Latino Child Welfare Research and Practice (LCWRP) Model (Garcia, 2009) provided a conceptual framework to aid in identifying areas that warrant further attention for this study. Incorporating the individual/social and institutional domains of the model and utilizing data from the Casey National Foster Care Alumni study, this study addressed the following primary questions: 1) Does chronicity of child maltreatment and cumulative familial risk factors impact foster care alumni’s mental health outcomes, and if so, are they moderated by race/ethnicity? 2) Do positive coping mechanisms (high self-esteem and ethnic identity) mediate the relationship between individual stressors during childhood (chronic abuse, cumulative risk factors, and placement instability) and being diagnosed with a mental health disorder during adulthood? 3) Controlling for placement instability, does access to services and agency preparation for leaving foster care uniquely predict developmental outcomes among Latino, Caucasian, and African American foster care alumni? Finally, this dissertation study, from the perspective of front line caseworkers, also examined barriers and challenges Latino children and families experience in the child welfare system. Relying on mixed methods (logistic regression, multiple group structural equation modeling, and grounded theory) to address these questions, this dissertation study offers valuable contributions by: 1) examining unique predictors of developmental outcomes among foster care alumni of color, 2) highlighting strengths and areas where improvement in child welfare practice is needed to ensure foster care children and adolescents receive evidence based, culturally sensitive services to thrive as adults, and 3) exploring factors that may mitigate negative developmental outcomes and contribute to timely permanency and reunification among Latinos in the child welfare system.

Impediments to Facility Delivery among HIV Positive Women in a Kenyan Setting: Insights from Women’s Accounts and the Service Delivery Context

Peris W. Kibera

In sub-Saharan Africa, where over 85% of pregnancies among HIV positive women occur, many countries report low rates of uptake of the widely available and virtually free services to prevent mother-to-child transmission of HIV (PMTCT), such as facility delivery and infant prophylactic antiretroviral drugs. A small but growing body of scholarship that has examined the reasons why women might fail to take advantage of PMTCT services has primarily documented structural and resource factors such as long distance or inability to pay for transportation to a health care facility as key barriers to service uptake. The influence of service delivery dynamics (for example, the nature of provider-patient interactions and the quality of counseling) demonstrated in other health literatures to be salient in service utilization is a perspective that is largely ignored in the assessment of PMTCT service use.

Thus, to understand the influence of service delivery dynamics on women’s uptake of PMTCT services, this study utilized ethnographic methods to examine how i) the bureaucratic organization of services, ii) patients? experience of the care environment, iii) patient-provider relations, and iv) providers’ experience of their work affected facility delivery among HIV-positive women attending Mathare North Health Center, a community health facility in Nairobi, Kenya.

Findings revealed that guarding against inadvertent disclosure of HIV positive status to a partner or relations accompanying a woman to the facility during childbirth was an important motivation for participants’ non-delivery at Mathare or other public sector health care facilities. In understanding how the inadvertent disclosure of a woman’s HIV status could occur during childbirth at Mathare, Michael Lipsky’s (1980) theory of street-level bureaucracy provided an analytical point of departure. Specifically, several patterns of practice elucidated by Lipsky were mapped out in ANC service delivery with pregnant HIV positive women. Because of the work practices that providers at Mathare adopted to cope with the mismatch between limited resources in the work environment and patients’ needs, women did not receive the care necessary to support childbirth at the health center. Insights from this research offer useful directions for modifying care practices to boost facility delivery among HIV positive women.

Is Knowledge Power? A Comparative Textual, Historical, and Practical Study of "Sex Ed" Policy and "Teen Pregnancy" in Canada and the U.S.A.

Morna E. McEachern

In modern welfare states, teen pregnancy, a social phenomenon that is inextricably linked with poverty, inequality, and race, is considered an indicator of social wellbeing. The teen pregnancy rate in the U.S.A. is the highest of modern welfare states, more than twice that of Canada, its culturally similar neighbor. There is evidence that comparative studies of culturally similar countries can reveal factors that are useful in informing policy reform. Sexual activity is a precursor of teen pregnancy, and public schools are a dominant site for sexual health education in both countries.  Yet no studies have compared the “sex ed” policy approaches of these two countries. Addressing this gap, this study compares sexual health education policy exemplars from Canada and the U.S.A., focusing on the language in which these policies are framed with three research questions: 1) What does the political symbolism in the language of two policy exemplars reflect, implicitly and explicitly, about Canadian and U.S. approaches to  “sex ed”? 2) How do Canadian and U.S. “sex ed” policies and discourses about “teen pregnancy” converge and diverge over time? 3) How do Canadian and U.S. high school principals, as front-line policy implementers, describe “teen pregnancy” and its relationship to “sex ed”?  What does the political symbolism of their discourse reveal about Canadian and U.S. “sex ed” policy practices? In order to support pregnant and parenting teens, this dissertation addresses these questions through a critical feminist epistemology and a comparative, historical, qualitative and interpretive methodology. The contributions of the study fall in three areas: 1) it breaks new ground in comparing sexual health education policies in the U.S.A. and Canada; 2) it shifts the focus from individual outcomes of teen pregnancy to policy and policy frames related to preventing unintended teen pregnancy; 3) in so doing, it potentially sheds light on factors that differentially influence the discourse about “sex ed” and “teen pregnancy” in the two countries.

Queering Queer Space

Jennifer M. Self

Lesbian, gay, bisexual, transgender, and queer (lgbtq) college centers emerged in the early 1970s in response to student, faculty, and staff activism and demands for safe and protective spaces from heterosexism and homophobia.  Despite 40 years of practice, however, little research has been conducted about these spaces.  Recognizing the importance of lgbtq campus centers and the political and identity struggles within the movement that created them; this dissertation addressed this gap in research knowledge.  Specifically, the study aimed to: 1) interrogate the power and influence of the leadership of lgbtq centers (directors and other primary leaders) via the exploration of the ways in which dominance in the form of “homonormative whiteness” is interrupted, disrupted, resisted, and (re)produced discursively and spatially through lgbtq campus-based centers; and 2) examine tensions that arised as directors and programs operationalize social transformation praxis models while maintaining their core purpose of safety and respite from heterosexism and homophobia.  To explore these issues, I undertook a modified extended case study of six campus centers.  The case study data included in-depth interviews with directors and center leaders, researcher observations, photographs, and hand-drawn maps produced by center leaders. The methodological approach was broadly critical and interpretive: specific analytic strategies included critical discourse analysis (spatial and dialogic). By examining the role of lgbtq center leadership discourse and center space in the (re)production and resistance of homonormative whiteness, this study contributes to several bodies of literature:  1) center development and practice; 2) intersectionality and praxis within student and community centers; and 3) social justice within higher education.

Examining the Process of Critical Youth Participation in Promoting Health and Wellness:  A Case Study of a Rural Community Program for Asian Pacific Islander Young Adults

Alma M.O. Trinidad

Despite research on health disparities among low-income young adults of color, few studies critically examine how grass-roots, community-based youth programs affect their individual and collective health and wellness.  In particular, little is known about how they develop a critical awareness of the historical-cultural contexts of marginalization and whether such awareness leads them to become activists in promoting health and wellness.  Furthermore, a gap exist in research on the participation of rural young adults in community life and the role they can play in educating, and promoting empowerment in their communities.  To address these gaps, this dissertation bridges theories of community youth participation, critical pedagogies of place, and community epistemology.  Using a community-based youth program in rural Hawai‘i as a case study with 17 interviews and content analysis of texts about the program, this dissertation consists of three articles.  The first examines the program’s use of adult allies and youth participation in farming, while also helping improve community health and well-being.  Findings suggest that the program utilizes an integrated approach that includes:  1) locating the role of adult allies, 2) perceiving young people as partners and agents of change, 3) aiming for a democratic decision-making process, and 4) promoting a learning community.  The second examines how the program through critical Indigenous pedagogy of place (CIPP) encourages youth to interrogate the inequities in their community, thus assisting in their sociopolitical development.  Findings indicate that the use of CIPP provides opportunities to: 1) identify the disparities in the local community, 2) critically explore the complexity of oppression and systemic inequalities, 3) promote a commitment to serve that community and a sense of place, and 4) participate in a knowledge-action-reflection cycle of critical praxis.  The third article examines how the program utilizes Native Hawaiian epistemology and values.  Findings indicate that the program promotes indigenization through CIPP, which provides opportunities to:  1) learn about the genealogy of a geographic place, 2) reclaim Native Hawaiian values and 3) promote a sense of aloha (love) ethic for the community.  Acknowledging the study’s limitations, specific recommendations and implications on youth community organizing, place, and health are discussed.