Recent Dissertation Abstracts

Integrating the Lived Experiences of Mexican Families
in the Delivery of Public Child Welfare Services

Cecilia Ayón
2008

This study aimed to understand Mexican families’ experiences and interactions with the public child welfare system from the perspective of Mexican parents and child welfare workers. Grounded theory, a qualitative method, was used as the focus of this study is on a population that has not been well studied within the context of the child welfare system and because the focus is on the case process. In-depth semi-structured interviews were completed with 19 parents and 14 child welfare workers.
This dissertation is a compilation of three papers which examine the experiences and interactions of Mexican families with the public child welfare system. The first paper examines how Mexican parents and child welfare workers negotiate cultural values and expectations throughout the case process. Child welfare workers efforts to provide culturally congruent services are evident though they are cut short by organizational context and child centered policies. Parents highlight the importance of having a good relationship with their worker and reveal barriers in their engagement with the worker. The next paper examines, from the perspective of the child welfare worker, the paths to mandated services experienced by Mexican families. Child welfare workers express that different barriers to services are experienced based on the families’ documentation status and their language abilities. The final paper aims to understand how parents exercise their voice throughout their case process. Their involvement with the public child welfare system is a fear driven experience (i.e., fear of losing children and/or due to documentation status). Also, power imbalances play a role in their decision to exercise their voice. Often parents are expected to be compliant and not exercise their voice (i.e., to express their dissatisfaction, concerns, or opinions). Implication for child welfare policy, social work practice, and research are discussed.

 

Ideology Made Flesh:
A Study of Political Culture Within the Irish Republican Army

Mick Beyers
2007

The Irish Republican Army (IRA) serves as the case study for this research which links anthropologically informed methods with a social welfare perspective to explore atypical political culture. The person-environment formulation provides a conceptual orientation to ideology and class consciousness that emphasizes the social ecology of revolutionaries with a focus on the interrelations and processes that shape political culture. Ethnographic methods pay attention to language, meanings, and sentiments whereas political-anthropological theory examines the material basis of life and culture. This framework sensitizes the text to the particulars of the subjective everyday experience of individuals situated in community and wider contexts; the role of language, meaning, and emotions in shaping ideology and class experience; and the material determinations of social relations, context, and agency.
To understand more fully the politic and ideology of modern republicanism this analysis relies on two primary sources of data: a bank of political narratives from prominent IRA agents and deeply immersed community ethnography (embeddedness). The research utilizes an integrative, multi-method qualitative approach, combining analysis of oral narratives from prominent IRA volunteers with embedded ethnography to delve into the narrator’s experiential world in order to understand a distinct form of political culture from the viewpoint of the activist
The distinctiveness of the research stems from its attempt to explore ‘atypical’ political culture, utilizing the voices of revolutionary agents, to bring to light the worldview and critical ideology that shape a revolutionary persona. From this ‘indigenous’ perspective republicanism is a community-based response to social injustices informed by the distinct analysis of individuals who self-identify as political activists adept at community organizing and multiple, simultaneous strategies for change. The study privileges this perspective and the actual lived experience of revolutionary agency as a salient source of knowledge.

 

Disciplining Through the Promise of “Freedom”:
The Production of the Battered Immigrant Woman in Public Policy and Domestic Violence Advocacy

Rupaleem Bhuyan
2006

In the context of U.S. public policy, battered immigrant (and associated terms battered alien or battered nonimmigrant) signifies a person who is eligible to suspend or amend the conditions of their status under immigration law if they can demonstrate they have suffered domestic violence. Among community organizers, battered immigrant women refers to a broader range of people for whom legal immigration status plays a role in their experience of domestic violence, including options for safety planning, the potential threat of deportation, and eligibility for public benefits. Battered immigrant woman, is also used within women’s rights discourses to call attention to the social political interests of marginalized women. This dissertation focuses on how the difference in signification has direct social and political consequences, with regard to who is recognized by the state and thus may access the benefits and protection offered by the state with regard to legal rights awarded to battered immigrants.
I analyze the production of the battered immigrant in public policy and legal advocacy through the lens of neoliberal governmentality and intersectionality. I call upon conceptualizations of governmentality, introduced by Foucault and taken up in a broad range of studies, to interrogate how the regulatory modes of government extended beyond the state, through social actors at all levels of society (Sharma 2006). Theories of subjectivity and discourse complete my analytic frame in providing theory to explore how subjectivities are produced through legal discourse. When immigration lawyers and domestic violence advocates take up the legal discourse of the “battered immigrant” in their advocacy, they are at once, inheriting the complex tensions and hierarchies within the existing discourse, while participating in its potential transformation.

 

Multi-Level Factors Related to Deficiencies in Psychosocial Care
in Washington State Skilled Nursing Facilities

Robin P. Bonifas
2007

Persons living in skilled nursing facilities (SNF) have extensive psychosocial needs, yet the services provided to meet those needs appear insufficient. Facility social workers are recognized as the primary providers of psychosocial services in SNFs, but often report barriers interfering with their ability to furnish services to all residents who need them. This study utilizes a three-category quality assessment framework to assess specific factors that either enhance or hinder the provision of effective psychosocial services in Washington State SNFs.
A cross-sectional research design was employed merging two sources of data: an investor-developed questionnaire administered to Social Services Directors (SSDs) in participating SNFs (N = 121) and resident-centered state survey outcomes in psychosocial care-related areas obtained from the Online Survey and Certification Reporting (OSCAR) database. Ordinary least squares regression was utilized to assess the ability of facility structural factors, process factors, and SSD characteristics to predict the frequency of psychosocial services in five diverse service domains: care planning, resource and referral, administration and advocacy, assessment, and intervention. Hierarchical linear regression methods were utilized to assess the ability of structural factors, process factors, and SSD characteristics to predict the scope and severity of survey deficiencies in psychosocial care. Interaction terms were also included in the regression model to determine the potential moderating effect of service delivery on predictive multi-level factors.
Results indicate that structural factors, process factors, and SSD characteristics play only a limited role in predicting service frequency, although the size of the SSD’s caseload is associated with frequency of care planning and intervention services. Four multi-level factors are associated with positive psychosocial care outcomes: low ownership turnover, more years of SSD experience in SNF social services, stronger SSD identification with the helper role, and paradoxically, lower priority attributed to residents’ individualization needs at the facility level. This surprise finding is possibly explained by a stronger focus on assessment services in lieu of intervention services within high individualization priority facilities. An additional finding is that the frequency of assessment services appears to moderate the impact of both ownership turnover and role identification on outcomes in psychosocial care. 

 

Sexual Assault Perpetration among Adolescent and Adult Males:
Ecological Approaches to Conceptualizing the Etiology and Prevention of Rape

Erin Casey
2006

Significant gaps remain in our understanding of the etiology of sexually aggressive behavior among adolescent and young adult men. To speak to these gaps, this dissertation describes results from two analyses of data from the National Longitudinal Study of Adolescent Health, a nationally representative study of U.S. teens. The first analysis examined childhood and adolescent predictors of sexually coercive behavior in early adulthood among males in the sample. A path analysis suggests that experiencing sexual abuse as a child has both a direct effect on sexual aggression in adulthood, and an indirect effect through sexual aggression in mid-adolescence. Perpetration of sexual assault in adolescence, and involvement in delinquent activities are the only two additional significant predictors of later sexually coercive behavior. The second analysis examined social network correlates of sexually aggressive behavior among adolescent boys, and added significant social network factors to the predictors identified in the first analysis. Findings from the full model suggest that having friends who engage in delinquent behavior, perceiving peer pressure to have sex, feeling uncared for by friends, and participating in delinquent conduct are significantly correlated with sexual aggression during adolescence. The final chapter of this document incorporates this evidence of multi-level predictors of sexual aggression with previous research documenting the ecological nature of risk factors for sexual assault perpetration to argue for a renewed focus on using a multi-level approach to conceptualizing and implementing sexual violence prevention programming.  

 

Rhythms of Clinical Process

Andrea Marie Doyle
2008

Social work researchers have focused in recent years disproportionately on outcome studies, not only to legitimate the field but also to demonstrate clinical effectiveness. While this work is important, the investigators have neglected certain methodological domains, specifically, our early interest in process research that might prove useful in advancing the professional knowledge base. This dissertation is a compilation of three papers which address clinical process research in social work and challenge the field to develop better capacities to measure what our theories deem important: dynamic patterns of relationship, context, and change. Developments in both theory and measurement provide a way for the social work profession to move forward in clinical process research. The first paper in this multi-part dissertation begins with a brief account of the history of clinical process research bringing us to the present day where methods from biology offer means to pick up where previous process researchers have left off. The second paper is a review of the relevance and applicability of new advances in nonlinear modeling for elucidating key relational processes at work during the clinical encounter. Previously we have not had theory or effective ways of measuring processes, particularly dynamic ones. Developments in complexity theory and nonlinear methods offer an opportunity to measure process in a rigorous way and provide a possible resolution to the splits in our field. We are at a critical juncture where computer technology, the push for evidence-based practice, and the availability of new methodologies provide the opportunity for the measurement of change processes relevant to the quotidian of social work practice. The final paper is a demonstration of using nonlinear techniques, namely Fourier or spectral analysis and recurrence plots, to model dynamic processes in a clinical case study of a woman who meets criteria for Borderline Personality Disorder (BPD) and substance use disorder (SUD). Nonlinear dynamic analyses may be an optimal way to track client data and elucidate mood processes in BPD. Delineating mood patterns over time may help identify borderline subtypes and thus enable the development of treatment for more targeted intervention reducing expensive treatment costs.

 

Spirituality and Health among Native Americans Living with HIV

Karen Colleen Fieland
2008

The purpose of this dissertation, composed of three studies, is to address unexplored aspects of health, in particular, the role of spirituality, and barriers to and facilitators of appropriate health care among HIV-positive Native Americans. This dissertation advances the body of research on spirituality among HIV-positive persons in three areas: 1) conceptually, examining the pathways between Native-specific spirituality dimensions and health among HIV-positive persons; 2) methodologically, operationalizing spirituality with culturally- and dimension-specific measures; and 3) investigating the role of spirituality among HIV-positive Native Americans—a group with disproportionate numbers living with HIV that has been virtually ignored in this area of research. In study 1, a secondary data analyses of a national community-based sample of 96 urban HIV-positive two-spirits (gay, lesbian, bisexual, transgender Natives) examined the relationship between two spirituality dimensions (i.e. self-compassion, connectedness to ancestors/future generations/natural world) with depressive symptoms and QOL using measures developed among urban two-spirits. Utilizing hierarchical regression to test two hypotheses: spirituality was inversely related to depressive symptoms and positively related to QOL. In study 2, a grounded theory study of 10 HIV-positive Native Americans explored the experience of living with HIV and conditions under which spirituality is considered. Findings revealed that the major task participants were engaged in was the process of ‘keeping their spirits strong’ with the focus on ‘staying alive’. This process, which reflected an indigenous relational worldview, involved four inter-related aspects: ‘staying well’, ‘connecting with supportive others’, ‘thinking positively’, and ‘connecting with the spiritual’. Lastly, study 3, a descriptive mixed-methods study identified the obstacles to and facilitators of appropriate medical care among urban HIV-positive Native Americans. Data was triangulated from secondary data analyses of the national HIV-positive two-spirit sample and qualitative analyses of in-depth interviews with, 10 HIV-positive Native Americans and 3 health care providers. Findings revealed that many HIV-positive Native Americans are challenged by multiple obstacles to engagement in HIV care, and there are particular resources and supports that can serve as facilitators to care. Although many of these obstacles may not be unique to HIV-positive Native Americans, they may be more concentrated among this population than other ethnic/racial groups.

 

Federal Charitable Choice and Faith-Based Initiatives:
Do Faith-Based Organizations Pose a Barrier to Services?

Michelle Dianne Garner
2007

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the 2001 White House Office of Faith-Based and Community Initiatives have allowed any Faith-Based Organization (FBO) to compete alongside secular organizations to offer tax-payer funded social service programs. A dearth of research evaluates FBOs from the client’s perspective. The current study analyzed data from chronic public inebriates who have accepted a secular organization’s housing and service program and determined that 26% (95% CI: 18-34%) of them would not accept the same program if offered by an FBO; subsequent hypotheses about the importance of religiosity/spirituality and majority/minority ethnic and religious identity status as predicting participant’s report of accepting FBO services are partially supported with the current, small data set (n=122). While results derive from a specific, difficult-to-treat population, findings are a milestone in contemplating who might be inhibited from treatment because it is offered through an FBO; study findings have social justice, clinical, pragmatic, and policy implications.

 

Gay Men’s Brief Sexual Connections:
Settings, Processes, Meanings, and Ethics

Darrel Hideyasu Higa
2008

With the increase of HIV cases and emergence of drug resistant STDs among populations of men who have sex with men, there has been an increased emphasis on personal responsibility and demonstrating care for sexual partners in all kinds of sexual encounters, including those that are anonymous. These encounters are commonly believed to be risky for HIV/STDs, impersonal, meaningless, and lacking in care. This dissertation questioned these assumptions by examining the lived experiences of men who engage in anonymous sex to better understand the meanings attributed to these encounters, and if and how care is demonstrated towards anonymous sexual partners.
To counter dominant trends in HIV prevention research, embodiment and strengths theories were employed to centralize the body, highlight context, explore relationality, and focus on resiliencies. Interviews with 17 gay men were transcribed and analyzed using interpretative methods from phenomenology, grounded theory, and narrative analysis. The analyses revealed that gay men’s sexual relationships were fluid involving constellations of steady, casual and anonymous partners. Men made sexual connections in a variety of settings including commercial, public, and technological sex environments. The findings also indicated that meeting anonymous sex partners required learning a complex set of skills to communicate interest and desire. Men engaged in mostly safer sexual activities although a few reported unprotected anal sex and esoteric sex practices.
In addition, anonymous sex encompassed multiple and fluid meanings, but was primarily a way of making connections, experiencing sexual release, and recreating. Moreover, care was sometimes absent in these encounters but when present, was experienced as responsibility, respect, and reciprocity. Hegemonic masculinity might interfere with caring for anonymous sex partners.
Based on study findings, directions for future research and implications for HIV prevention with gay men engaging in brief sexual connections are proposed.

 

Neighborhood Contexts, Mental Health, and Immigration

Seunghye Hong
2009

In the past decade, empirical research examining the association between neighborhoods and health outcomes has been flourishing; however, several research gaps still exist.  First, although many studies have addressed neighborhoods and physical health associations, only a few studies have focused on mental health outcomes.  Second, past studies have primarily focused on blacks and whites: few studies have incorporated immigrant populations, especially Latino and Asian American populations.  Third, although current literature suggests that characteristics of neighborhoods are associated mental health outcomes, we still do not know why.  To fill these gaps, my dissertation research examines neighborhood contexts, immigration, and mental health.  Chapter 1 examined neighborhood contexts and mental health associations, focusing on poverty and racial density of neighborhoods.  It found that higher racial density was associated with poorer mental health among Asian Americans and Latinos before controlling for individual-level covariates—age, gender, marital status, and household income.  This association was significant only for Asian immigrants (not for Asian U.S.-born counterparts), after controlling for neighborhood poverty and individual-level covariates.  Chapter 2 examined whether social cohesion mediates neighborhood poverty, racial density, and mental health for Asian Americans and Latinos and whether its mediating effect differs by race.  Social cohesion fully mediates the association between neighborhood poverty and mental health.  Specifically, high levels of social cohesion appear to buffer the negative effects of living in poor neighborhoods on mental health for Latinos.  Social cohesion partially mediates the association between racial density and mental health for both Asian Americans and Latinos, but in different directions:  Asian density is negatively associated with mental health via social cohesion; whereas Latino density is positively associated with mental health via social cohesion.  Chapter 3 determined identified immigrant subgroups based on immigration-related factors and tested whether these classified immigrant subgroups can be used to examine the association between immigration and mental health outcomes.  It used latent class models and found four latent classes each for Asians and Latinos.  Asian and Latino immigrants showed similar patterns in the identified subgroups, and type of immigrant subgroups was associated with mental health outcomes.

 

Toward Equitable Development:
Theorizing the Tensions that Arise in Redeveloping Urban Neighborhoods

Linda Hurley Ishem
2008

This theory building dissertation aims to develop and empirically test one element of an alternative framework for revitalizing African American inner city neighborhoods. Structured in two parts, the dissertation relies on case study and grounded theory methodologies. As appropriate to the iterative process of theory building, I analyze varied sources including theoretical literature, archival and historical texts, government records and interviews.

Part I of the dissertation examines four domains of literature including equitable development, Comprehensive Community Initiatives, Afrocentric theory and conflict transformation theory. Although diverse, the literature is complementary in identifying ideal goals, contextually appropriate strategies, potentially destructive tensions and tension mitigation techniques. This investigation of the literature led me to propose an alternative revitalization framework which suggests, among other things, that mitigation of intra- and interpersonal tensions is a necessary precondition to successful community change.

Having derived a conceptual framework, Part II of the dissertation focuses on my use of an African American neighborhood, case study, to investigate one element – the tensions – exploring their presence in a historical and a current case study. The historical study consists of an informal thematic analysis of archival records related to the neighborhood’s experience with Model Cities in the late 1960s. Findings confirm the historical roots of tensions in alignment with the theorized constructs and trace their source to differing stakeholder perspectives. The second and more substantial study entails thematic analysis of public comments and interviews with neighborhood stakeholders regarding the planned development of a cultural facility. Although originally designed as an investigation of a planning process for the facility, I use a subset (n=15) of the data to see whether and how the case study manifests the tensions identified in the conceptual framework. Using grounded theory methods, I selectively coded data to the four tension constructs contained in my tentative framework, with additional categories for sources and possible mitigations. Study results affirm the presence of tensions identified in the literature, offer a more complex, nuanced understanding of those tensions than the literature offers and further suggest ways of ameliorating them, including grounding development in a neighborhood's social and spatial history.

 

Investigating Mental Health, Comorbidity, and Intergenerational Caregiving Disruption among Alumni of Foster Care

Lovie Jewell Jackson
2008

A relatively small set of empirical studies address adult functioning among alumni of foster care. Without a closer systematic examination of long-term risks among former foster care recipients, we may not adequately address the service needs of this population. To expand the literature on foster care alumni, the studies comprising this dissertation addressed three research aims. The first study examined the effects of race and gender in predicting individual mental health disorders while controlling for other sociodemographic and early childhood factors, and the moderating influence of foster care experiences (i.e., revictimization during foster care, placement change rate, and placement in kinship care) on these effects. The second study investigated the prevalence of depression comorbidity and Posttraumatic Stress Disorder (PTSD) comorbidity in terms of their co-occurrence and correlation with other mental health diagnoses and physical health disorders. The third study examined a model of intergenerational continuity of foster care placement (caregiving disruption). Specifically, Structural Equation Modeling was used to investigate whether characteristics (mental health, criminality, employment) of the parents of foster care alumni (Generation 1) significantly influenced caregiving disruption between foster care alumni (Generation 2) and their own children (Generation 3), and whether this intergenerational relationship was mediated by alumni psychological distress and social network support. The findings of each study are presented with specific recommendations for prevention and treatment of trauma symptomatology for diverse racial and gender groups, as well as prevention of intergenerational caregiving disruption

 

The Structure of Opportunity:
Child Care Subsides and Employment-Family Balance

Lucy Porter Jordan
2006

Women’s employment following childbirth depends, in part, on the cost and quality of available child care arrangements. High cost and lower perceived quality may depress employment, particularly for lower-income women, who typically spend a larger proportion of their earnings on child care then do women with higher skills and education. One policy tool, child care subsidies, may shorten the time between the birth of a child and the entry to employment and facilitate family-to-employment balance among low-income mothers by (1) reducing the costs of employment relative to earnings and (2) facilitating stable child care arrangements. However, the child care subsidy system operates within a context of limited funding and local policy discretion. States use various strategies to manage scarcity resulting in regional variation, and these tradeoffs in policy choices that may have unintended, or even offsetting consequences, for subsidy program participation.

Capitalizing on regional policy variation, a set of original policy indicators for state and local welfare and child care subsidy programs are combined with micro data from two waves of the Fragile Families and Child Well-Being Study to (1) characterize child care policy strategies in twenty cities across U.S.; (2) examine the effects of these policies on child care subsidy receipt; and (3) evaluate the role of subsidy receipt in maternal employment and employment-family balance following the birth of a new child. Instrumental variable procedures are used to address concerns of endogeneity and sample selection.

The key findings include: (1) characterization of four different types of policy strategies adopted by the study cities; (2) the important contribution of individual characteristics and Temporary Aid to Need Families (TANF) welfare policies to predicting subsidy receipt among low-income mothers in urban centers; and (3) significant effects of predicted subsidy receipt on several employment outcomes including a positive relationship with breakdowns in child care arrangements and a negative relationship with family-to-employment spillover. A discussion of historical and current relationship among the market, the family and the state frames the research study, and in the conclusion suggestions for addressing enduring legacy of gender and class inequities are presented.

 

Immigrant Cultural Citizenship:
Construction of a Multi-ethnic Asian American Community

Hye-Kyung Stella Kang
2006

This dissertation examines the role of cultural citizenship in the construction of immigrant community identity. Immigrant cultural citizenship is the process by which immigrant individuals create a legitimized social space for themselves while contesting and negotiating hegemonic discourses that seek to define and limit their subject positions. This study explores immigrant community identity development by examining discursive constructions of the International District (ID) of Seattle, WA. Applying post-structural and post-colonial theoretical frameworks, this study investigates the particular social, political, and historical contexts within which the discourse of a "multi-ethnic Asian American community" arose through an example that is located in specific geographical and historical positions.
This study traces the intertextual chains through which the subject position of the ID was and is produced, deployed, and changed via a critical discourse analysis of mainstream and community newspapers, in-person interviews with community members, community history archives, and government documents. The data illuminate three major challenges that impact the evolving process of community identity development. The population changes, influenced by immigration policy changes, resulted in the influx of new ethnic groups in the ID. The urban development boom in Seattle which swept through many traditionally ethnic communities changed local geographies. Forces of globalization bring increased transnationalism and may alter the ways that capital is invested in the community and used by its members.
The analysis of data suggests that the ID as a subject is produced and sustained not through a consistent and stable articulation of a singular identity but through multiple, contested, and contingent articulation of history, contribution, and change. Similarly, the ID is not produced through unilateral regulatory control of the government or other regimes of a civil society; nor is it completely produced by the inventions of the community members ‘outside’ those controls. Rather, it is constructed through constant processes of engagement, contestation, and negotiation between the community and the various larger social and political structures, as well as among community members themselves. The discursive changes produced by such processes illuminate the possibility that immigrant communities may be able to change the discourses that produce them.

 

Subjectivation, Historicity, and Liminal Space: Korean American Immigrants and Their Discourses of Positionalities

Hyun-Jun Kim
2009

Uncritical construction of immigrant subjectivities in social work tends to ignore immigrant agency, seldom addresses the complexity and incommensurability of immigrants' lives and subjectivities especially in the context of globalization and transnationalism, and reproduces colonial discourses that reduce immigrant subjects to an inferior and powerless position. This dissertation was designed to suggest a way of exploring immigrants' negotiations of liminal spaces, where immigrants experience contestation and fragmentation and struggle to renegotiate their subjectivities and develop and control their own historicity, through focusing on the life narratives of Korean immigrants. The narratives of eight Korean immigrants who moved to the U.S. around 1965 and were residing in Seattle and Tacoma area were analyzed, utilizing critical ethnography and discourse analysis within a post-structural/post-colonial analytical framework. The liminal spaces of study participants were constructed out of contestation among the imaginaries of the host society, the traditional in combination with the new in their society of origin, and their actual experiences in the host society. The findings also showed that these elements cannot be simply additive. Rather, they trigger contestation, and the informants learn similar and dissimilar strategies for manipulation and negotiation out of this contestation. 

 

Youth Violence Prevention: Social Development Model Approaches to Predicting and Preventing the Progression of Childhood Aggression into Youth Violence

Min Jung Kim
2008

This dissertation seeks to address four gaps in youth violence research: limited assessment on the progression of childhood aggression into adolescence violence, a lack of studies that test theory of the development of youth violence, a dearth of studies identifying protective factors of the progression of childhood aggression into youth violence, and little attention to gender differences in predicting adolescent violent behavior. This dissertation consists of three chapters that describe results from three analyses of data from the Raising Healthy Children project, a longitudinal study of the etiology of adolescent problem behaviors. The first chapter examined how different aggression trajectories during elementary school were associated with trajectories of youth violence and whether the associations varied by gender. Findings suggested that despite overall discontinuity of childhood aggression, early aggression is a significant risk of youth violence and an important target for early identification of violence involvement for boys and girls. In the second chapter, the Social Development Model (SDM) theory was tested to examine whether socialization processes specified by this theory accounted for the association between childhood bullying behavior and later youth violence across genders. Findings indicated that the SDM constructs significantly reduced the continuity from childhood bullying to youth violence for boys and girls. In the third chapter, this dissertation examined whether positive family, peer, and school influences reduced the likelihood of youth violence involvement and whether exposure to these protective social influences during early adolescence moderated the effects of childhood aggression on later adolescent violent behavior. Findings from multinomial logistic regressions indicated that above and beyond effects of childhood aggression and drug use risk, higher family monitoring, interaction with prosocial peers, academic achievement, and commitment to school predicted lower likelihood of being in moderate and high trajectory groups of youth violence relative a low violence trajectory group. In addition, it appeared that strong and positive family monitoring significantly buffered the effect of being in a high trajectory group of childhood aggression on being in a moderate trajectory group of youth violence. Implications of the results for prevention practice and future research are offered in each chapter.

 

Adult Children and Parents in Assisted Living

David Michael Kekano O’Nalei La Fazia
2008

Adults over the ages of 65 are the most rapidly growing segment of the population in the United States, while Assisted-living (AL) is the fastest growing residential care option for older adults. Adult children are often the ones to provide care to an older parent even after a move to AL. There is a paucity of research on family and resident outcomes in AL. The purpose of this study was to examine the relationship of adult child caregivers’ perceptions of care and contact with their parent residing in AL, parent behavioral problems, and staff reaction to these behavioral problems. The current study analyzed data from adult children, their parents residing in AL, and the staff who care for them. Results indicate that adult children were in contact with their AL residing parents, with 91% visiting at least monthly. Adult children were satisfied with the care their parents received (M=5.01, SD=.92, Range=2.24-6.92). Sons visited less in the presence of greater behavioral problems while daughters visited more (ß=-.28, p<.06). Greater staff reaction to behavioral problems was a predictor of lower family satisfaction (ß=-.27, p=.012). These findings indicate the importance of family, resident, and staff interactions for family satisfaction of care. 

 

Women’s Sexual Agency: Implications for HIV Prevention

Tatiana Masters
2009

Positive aspects of young women’s sexuality are seldom the focus of attention, but research that acknowledges sex is more than a risk behavior may contribute to prevention programs that are effective because they work with both the risks and the rewards of sex. Young women, particularly women of color, are at high risk from STIs and HIV in the United States today. Norms limiting female power in heterosexual negotiations may influence negative sexual outcomes including STIs and HIV, but little research has been done on how these norms are enacted or resisted by individual women. Even within a context assigning active sexuality to men, there are some women who, in some situations, are sexually confident and powerful, making sexual choices and striving to enforce them. This positive aspect of women’s sexuality, sexual agency, is the focus of this three-study mixed methods dissertation.

Study one used existing survey data (n = 179) on young heterosexually active women’s sexual beliefs and behavior to construct a preliminary scale of sexual agency, then examined the associations among agency, sexual frequency, and condom use. Sexual agency was positively correlated with sexual frequency but not with condom use. Findings suggest that associations are more complex than greater sexual agency being associated with more condom use; relationships may play a role. Study two used qualitative interview data (n = 18) to model sexual agency in context. Sexual agency appears to involve a combination of desire, intimacy, and personal sexual philosophy. Study three used findings from studies one and two to develop an improved agency measure and administered it to the same group of women. Qualitative agency assessments and scale scores were used together to refine conceptualization of sexual agency and improve its measurement. The new quantitative measure appeared to assess agency accurately among women who were less ambivalent about sex and to be less successful among women in relational transition or whose agency involved reflective aspects of sexual choice-making. This dissertation as a whole reports comprehensively on young women’s sexual agency in relationships with men and the potential role of agency in HIV/STI prevention.

 

Contagious Communication:
The Mediatization, Spatialization, and Commercialization of “HIV”

A. Tyler Perry
2008

Harnessing a queer methodology based in critical language and visual studies, this dissertation critiques contemporary discursive formations of HIV, that is, objects that give the virus life in discourse, in order to intervene at the level of knowledge
production. This dissertation is based on the premise that “HIV” is already in all of us – as HIV is also a matter of discourse, not simply corporeal matter. While advocating for more self-reflexivity in HIV prevention by professionals, the aims of this dissertation are achieved through three scholarly papers:

Paper one presents findings from a textual analysis of contemporary infotainment magazines and web portals that target and construct a “new” lifestyle for queer young people. Illustrated through the analysis is that collaborations between HIV/AIDS and media professionals are a practice that has yet to be fully developed. Infotainment holds potential to be a channel through which to deploy interventions< more appropriate for the lifestyles of young queer consumers. This paper also points to the need for marginalized populations to gain skills in critical language awareness.

Paper two presents findings from a case study of the Little Prick campaign, a recent Seattle HIV prevention effort. This study attempts to illuminate the social distance between HIV professionals and targeted high-risk gay men via a geosemiotic investigation of the marketing collateral emplaced in the material environment. What is found is that a discursive relationship exists among queer, HIV, and prevention, and that the common notion that “prevention fatigue” hampers professional efforts, in fact, is “semiotic fatigue,” or a reproduction of exhausted prevention discourses, unresponsive to the contemporary place and pace of the virus.

Finally, paper three presents findings from the first critical analysis of (RED)TM, an international branding effort. While aestheticizing the pandemic and its consumers, (RED)’s strategic cause marketing appears to support its financial partners more than the recipients in Africa, advertised as deserving. Moreover, the brand appears to assist its consumers in becoming neocolonizers in the post-Fordist political economy. This paper concludes that thinking “semiopublics” would be a productive addition to prevention practices.

 

Living Knowledge: Embodied Health Care Research Practice

Rachel Elizabeth Robinson
2006

The purpose of this dissertation is to re-examine the findings from a research study I conducted in 2001. I examined the recollections of three Somali women—hereafter referred to as F, Z, and S—regarding their experiences of accessing and utilizing prenatal health care services for their most recent live births in the U.S. I used semi-structured in depth interviews to collect and analyze narrative data that yielded valuable information about the participants’ prenatal experiences. However, my analysis led to my discovery of unexpected information that I felt merited further exploration. I re-examined the 2001 study from a critical theoretical perspective within which I used the discourse of multiculturalism as a point of reference. By using multiculturalism in this manner I attended to the range of culturally diverse issues that appear to shape the challenges Somali women experienced within the U.S. perinatal service delivery system. Additionally, using multiculturalism, analyzed in a critical perspective, allowed me to conduct my re-examination keeping in mind that similar challenges continue to be experienced by women from many different cultural backgrounds. My re-examination produced data that led to my discovery that 1) health care representatives often function on the basis of unexamined biomedical assumptions, 2) effective research and clinical practices must include experiential knowledge, and 3) such knowledge comes from an experience of the professional self embodying a critical theoretical stance. My findings do not represent new discoveries in that various scholars have previously discussed similar conclusions in relation to health care issues. However, they are highly relevant to perinatal social work research and practice, and have not been previously applied to widespread efforts to construct and evaluate culturally appropriate perinatal social work and health care practices.  

 

Normalizing Knowledge and Practices: Interrogating the Representation of the Ethnic Other
in Human Behavior and the Social Environment (HBSE) Textbooks

Theresa M. Ronquillo
2008

Over the years, social work professionals have had to pay increasing attention to ethnic and cultural concerns. In this increasingly diverse and multicultural society, it is both inevitable and necessary that social workers conduct their practice or research with ethnic groups and individuals. Many research studies are conducted with different ethnic groups and examine a range of problems including health disparities, mental health issues, problems of child welfare and poverty. Yet despite this vast research and practice realm, little research has been conducted to interrogate the discursive and normalizing power of uncontested ethnic categorizations that pervade social work discourses.
Positioning social work education and curricula as a central influence on research and practice, this dissertation critically examines the representation of ethnic groups in social work foundation texts shaped by curricular guidelines set forth by the Council on Social Work Education (CSWE). More specifically, I concentrate on human behavior and the social environment (HBSE) discourses, which focus on the effects of socially constructed identities such as ethnicity on people and the ways in which social systems promote or deter people in maintaining or achieving health and well-being. The basis of my study is critical discourse analysis of a sample of fifteen foundation HBSE textbooks published in 1998-2005 and widely used in social work schools nationwide. Poststructural and postcolonial theories of discourse and representation provide an analytic framework through which to critically examine how representations and knowledges about ethnic peoples are produced through HBSE textbook discourse and implications for social work education, research, and practice. 

 

Health Care Provider Implicit and Explicit
Racial Bias and Medical Care

Janice Sabin
2006

There is speculation that physician implicit racial bias may contribute to racial/ethnic health care disparities. This dissertation presents three papers that investigate physician implicit and explicit racial bias and the relation of bias to medical care. Paper One presents results from a sample of test takers (n = 21,302) who dropped in to a public web site and took the Race Implicit Association Test (IAT). The data were analyzed by educational attainment, producing a sub sample of MDs. The MD sample (n = 103) showed significant, strong implicit bias favoring White Americans (M = 0.38, SD = 0.44, p = .001, Cohen’s d = 0.88). This result was similar to all other test takers in the sample and is true for a majority of Americans.

Paper two presents findings from an experiment that targeted a physician sample (n = 95) from one department at a large research university. This study aimed to measure pediatricians’ attitudes about race and medical care. Three Implicit Association Tests (IAT) were used; the Race IAT, Race and Patient Behavior IAT and Race and Quality of Care IAT. Sample showed unexpected, weak bias favoring white Americans (M = .18, SD = .44, p = .01) and a moderate association favoring “compliant patient” and white (M = .25, SD = .42, p = .001). The Race and Quality of Medical Care IAT showed an unexpected, association between African Americans and preferred medical care (M = -0.21, SD =0.33,p = .001).

Paper three presents findings from a survey using clinical case vignettes, manipulated by patient race, to assess pediatricians’ treatment recommendations. The relationship between implicit and explicit racial attitudes and treatment was explored. Predicted that if bias exists, would find bias favoring whites and, a relationship between recommendations and implicit and explicit bias. Pediatricians identified optimal treatment recommendation for three of four cases irrespective of patient race. Non-significant differences for optimal recommendations for African American vs. white patients for pain management (56% vs. 39%), management of IV antibiotics (71% vs. 54%) and asthma care (51% vs. 39%). Relationships found between implicit bias scores and medical care.

 

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