Trends in Racial, Ethnic, and Gender Diversity in Orthopedic Surgery Spine Fellowships From 2007 to 2021

STUDY DESIGN

Descriptive.

OBJECTIVE

The objective of this study is to analyze trends in racial, ethnic, and gender diversity in orthopedic spine surgery fellowship trainees.

SUMMARY OF BACKGROUND DATA

Orthopedic surgery has consistently been labeled as one of the least diverse fields in Medicine. Although some effort has been made to combat this in recent years at the residency level, it is uncertain whether spine fellowships have had any changes in fellow demographics.

MATERIALS AND METHODS

Fellowship demographic data were collected through the Accreditation Council for Graduate Medical Education. Data collected included gender (male, female, and not reported) and race (White, Asian, Black, Hispanic, Native Hawaiians, American Indian or Alaskan Native, other, and unknown). Percentage equivalents were calculated for each group from 2007 to 2008 to 2020 to 2021. A χ 2 test for trend (Cochran-Armitage test) was done to determine whether there was a significant change in percentages of each race and gender during the study period. The results were considered statistically significant at P <0.05.

RESULTS

White, Non-Hispanic males represent the largest proportion of orthopedic spine fellowship positions each year. From 2007 to 2021, there were no significant changes in the representation of any race or gender of orthopedic spine fellows. Males ranged from 81% to 95%, Whites from 28% to 66%, Asians from 9% to 28%, Blacks from 3% to 16%, and Hispanics from 0% to 10%. Native Hawaiians and American Indians remained at 0% for all years included in the study. Females and all races, excluding Whites, continue to be under-represented in orthopedic spine fellowship.

CONCLUSIONS

Orthopedic spine surgery fellowship programs have not made substantial progress in diversifying its population. More attention is needed to increase diversity in residency programs through pipeline programs, increased mentorship and sponsorship, and early exposure to the field.

LEVEL OF EVIDENCE

1.

US Postgraduate Trainee Racial, Ethnic, and Gender Representation and Faculty Compensation By Specialty

This study compares postgraduate trainee racial, ethnic, and gender representation and faculty compensation for 21 clinical specialties using 2015-2022 data.

How Education Shapes Women's Work and Family Lives Across Race and Ethnicity

Drawing on life course and intersectional approaches, this study examines how education shapes the intertwined domains of work and family across race and ethnicity. By applying multichannel sequence analysis and cluster analysis to the National Longitudinal Survey of Youth 1979, we identify a typology of life course trajectories of work and family and test for the interactive associations of race and ethnicity with college education for different trajectory types. While our results show statistically significant and often sizable education effects across racial and ethnic groups for most of the work‒family clusters, they also suggest that the size and direction of the education effect vary widely across groups. Educational attainment plays an outsize role in shaping Black women's work‒family lives, increasing their access to steady work and partnerships, while educational attainment primarily works to increase White women's participation in part-time work. In contrast, Latina women's work‒family trajectories are less responsive to their educational attainment. In combination, the racialized role of education and persistent racial and ethnic gaps across the education distribution yield unequal patterns in work‒family strategies among Black, Latina, and White women.

Admissions Is Not Enough: The Racial Achievement Gap in Medical Education

The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.

Naming racism in the public health classroom

OBJECTIVE

The discussion of racism within undergraduate public health classrooms can be highly influenced by local and national conversations about race. We explored the impact of local and national events on students' ability to name racism on a public health exam highlighting the impact of racism on maternal and infant health disparities for Black mothers.

METHODS

We undertook this research within the context of an undergraduate introductory public health course at a primarily white institution in the Northeastern part of the United States. A qualitative content analysis of undergraduate student responses to a final exam question soliciting the importance of racism to health outcomes among Black mothers in the United States was undertaken. ANOVA tests were run to assess differences on naming racism, using semantic alternatives, and providing alternative explanations during three main time periods: prior to the election of the 45th president of the United States (pre-Trump), after the election (post-Trump), and after a nationally recognized racist campus incident.

RESULTS

Between the pre- and post-Trump periods we see no differences in naming racism or providing alternative explanations. We do see a reduction in the proportion of students providing semantic alternatives for racism in the post-Trump period (32.2 vs. 25.2%, p = 0.034). After the racist campus incident, we see increases in the proportion of students naming race (53.6 vs. 73.8%, p = 0.021) and decreases in the proportion providing an alternative explanation (43.1 vs. 12.9%, p = 0.004), but no differences in the proportion of students who used semantic alternatives.

DISCUSSION

This work lends itself to our understanding of how local climate affects public health teaching and may also influence students' learning about important social and structural determinants of health. National and local climate should frame and guide public health teaching.

Association Between Parental Educational Attainment and Youth Outcomes and Role of Race/Ethnicity

IMPORTANCE

The concept of minorities' diminished returns refers to the smaller protective effects of educational attainment for racial and ethnic minority groups compared with those for majority groups.

OBJECTIVE

To explore racial and ethnic differences in the associations between parental educational attainment and youth outcomes among US adolescents.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study was performed of 10 619 youth aged 12 to 17 years who were participants at wave 1 of the Population Assessment of Tobacco and Health (PATH) study, a nationally representative survey, in 2013. Data analysis was performed from August to October 2019.

MAIN OUTCOMES AND MEASURES

The dependent variables were youth tobacco dependence, aggression, school performance, psychological distress, and chronic medical conditions. The independent variable was parental educational attainment. Age and sex of the adolescents and marital status of the parents were the covariates. Race and ethnicity were the moderating variables. Logistic regression was used for data analysis.

RESULTS

Among the participants, 5412 (51.0%) were aged 12 to 15 years, and 5207 (49.0%) were aged 16 to 17 years; 5480 (51.7%) were male. For non-Hispanic white youth, as parental educational attainment increased, there were stepwise reductions in the prevalence of tobacco dependence (13.2% vs 6.9% vs 2.7%), aggression (37.9% vs 34.8% vs 26.1%), low grade point average (84.2% vs 75.6% vs 53.3%), and chronic medical conditions (51.7% vs 50.8% vs 43.9%), but there was not such a trend for psychological distress (43.7% vs 48.6% vs 41.0%). Interactions were significant between Hispanic ethnicity and parental education on tobacco dependence (OR, 3.37 [95% CI, 2.00-5.69] for high school graduation; OR, 5.40 [95% CI, 2.52-11.56] for college graduation; P < .001 for both), aggression (OR, 1.41 [95% CI, 1.09-1.81]; P = .008 for high school graduation; OR, 1.59 [95% CI, 1.14-2.21]; P = .006 for college graduation), and psychological distress (OR, 1.50 [95% CI, 1.05-2.13]; P = .03). Black race showed an interaction with college graduation on poor school performance (OR, 2.00 [95% CI, 1.26-3.17]; P = .003) and chronic medical conditions (OR, 1.56 [95% CI, 1.14-2.14]; P = .005). All these findings suggest that the protective associations between high parental educational attainment and youth development might be systemically smaller for Hispanic and black youth than for non-Hispanic youth.

CONCLUSIONS AND RELEVANCE

Although high parental educational attainment is associated with better outcomes for youth, this association is systemically less significant for Hispanic and black than non-Hispanic white youth. The result is an increased health risk in youth from middle class black and Hispanic families. Given the systemic pattern for outcomes across domains, the diminishing returns of parental educational attainment may be due to upstream social processes that hinder ethnic minority families from translating their capital and human resources into health outcomes.

Testing intersectionality of race/ethnicity × gender in a social-cognitive career theory model with science identity

Using social-cognitive career theory, we identified the experiential sources of learning that contribute to research self-efficacy beliefs, outcome expectations, and science identity for culturally diverse undergraduate students in science, technology, engineering, and math (i.e., STEM) majors. We examined group differences by race/ethnicity and gender to investigate potential cultural variations in a model to explain students' research career intentions. Using a sample of 688 undergraduate students, we ran a series of path models testing the relationships between the experiential sources, research self-efficacy beliefs, outcome expectations, and science identity to research career intentions. Findings were largely consistent with our hypotheses in that research self-efficacy and outcome expectancies were directly and positively associated with research career intentions and the associations of the experiential sources to intentions were mediated via self-efficacy. Science identity contributed significant though modest variance to research career intentions indirectly via its positive association with outcome expectations. Science identity also partially mediated the efficacy-outcome expectancies path. The experiential sources of learning were associated in expected directions to research self-efficacy with 3 of the sources emerging as significantly correlated with science identity. An unexpected direct relationship from vicarious learning to intentions was observed. In testing for group differences by race/ethnicity and gender in subsamples of Black/African American and Latino/a students, we found that the hypothesized model incorporating science identity was supported, and most paths did not vary significantly across four Race/Ethnicity × Gender groups, except for 3 paths. Research and practice implications of the findings for supporting research career intentions of culturally diverse undergraduate students are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The challenges of becoming better sex educators for young people and the resources needed to get there: findings from focus groups with economically disadvantaged ethnic/racial minority parents

The benefits of positive parent-adolescent relationships and effective communication on sexual risk have been demonstrated among minority parents and teenagers. However, there is need for illuminating how structural inequalities, such as economic disadvantage and being an ethnic/racial minority, shape parents' approaches to adolescent sexuality. Schalet's cultural framework describes White middle-income Dutch parents' 'normalization' (i.e. support for self-regulated sexuality, healthy relationships and normalization of teenage sexuality) versus White middle-income American parents' 'dramatization' (i.e. emphasis on raging hormones, battle between the sexes and pushing sex outside the home) of teenage sexuality, approaches which she argues contribute to differences in sexual health outcomes in the two countries. We adopt Schalet's framework to explore the approaches of 182 economically disadvantaged ethnic/racial minority parents attending 1 of 15 focus groups across New York State. The results revealed parents' dramatization of teenage sexuality, and how fears about their children's health and safety combined with a lack of resources and educational tools heightened this dramatization process. Yet parents identified communication skills and community resources to help them normalize teenage sexuality. The findings have the potential to inform policy makers and practitioners working to develop programs and policies to bolster parents' role as effective sex educators for adolescents.

Underrepresentation by race-ethnicity across stages of U.S. science and engineering education

Blacks, Hispanics, and American Indians/Alaskan Natives are underrepresented in science and engineering fields. A comparison of race-ethnic differences at key transition points was undertaken to better inform education policy. National data on high school graduation, college enrollment, choice of major, college graduation, graduate school enrollment, and doctoral degrees were used to quantify the degree of underrepresentation at each level of education and the rate of transition to the next stage. Disparities are found at every level, and their impact is cumulative. For the most part, differences in graduation rates, rather than differential matriculation rates, make the largest contribution to the underrepresentation. The size, scope, and persistence of the disparities suggest that small-scale, narrowly targeted remediation will be insufficient.

Ethnic disparities in undergraduate pre-clinical and clinical performance

CONTEXT

Research from numerous medical schools has shown that students from ethnic minorities underperform compared with those from the ethnic majority. However, little is known about why this underperformance occurs and whether there are performance differences among ethnic minority groups.

OBJECTIVES

This study aimed to investigate underperformance across ethnic minority groups in undergraduate pre-clinical and clinical training.

METHODS

A longitudinal prospective cohort study of progress on a 6-year undergraduate medical course was conducted in a Dutch medical school. Participants included 1661 Dutch and 696 non-Dutch students who entered the course over a consecutive 6-year period (2002-2007). Main outcome measures were performance in Year 1 and in the pre-clinical and clinical courses. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by logistic regression analysis for ethnic subgroups (Surinamese/Antillean, Turkish/Moroccan/African, Asian, Western) compared with Dutch students, adjusted for age, gender, pre-university grade point average (pu-GPA), additional socio-demographic variables (first-generation immigrant, urban background, first-generation university student, first language, medical doctor as parent) and previous performance at medical school.

RESULTS

Compared with Dutch students, Surinamese and Antillean students specifically underperformed in the Year 1 course (pass rate: 37% versus 64%; adjusted OR 0.40, 95% CI 0.27-0.60) and the pre-clinical course (pass rate: 19% versus 41%; adjusted OR 0.57, 95% CI 0.35-0.93). On the clinical course all non-Dutch subgroups were less likely than Dutch students to receive a grade of ≥ 8.0 (at least three of five grades: 54-77% versus 88%; adjusted ORs: 0.17-0.45).

CONCLUSIONS

Strong ethnic disparities exist in medical school performance even after adjusting for age, gender, pu-GPA and socio-demographic variables. More subjective grading cannot be ruled out as a cause of lower grades in clinical training, but other possible explanations should be studied further to mitigate the disparities.

Food porn

Since the term first appeared, food porn has typically referred to watching others cook on television or gazing at unattainable dishes in glossy magazines without actually cooking oneself. This forum seeks to revisit this notion of food porn that is mostly taken for granted in both popular and scholarly literature. It offers a brief perspective of the appearance and use of the term food porn to examine how it came to be a term used mostly by commentators rather than by people actively engaged in the world of cooking. Practitioners (chefs and a food television producer) and academics address whether or not food porn exists, what shape it might take, what purpose it might serve, and/or what usefulness it might have, showing that these contentious issues are more complex than the ease with which the term is used might let on.

Slumdog cities: rethinking subaltern urbanism

This article is an intervention in the epistemologies and methodologies of urban studies. It seeks to understand and transform the ways in which the cities of the global South are studied and represented in urban research, and to some extent in popular discourse. As such, the article is primarily concerned with a formation of ideas - "subaltern urbanism" - which undertakes the theorization of the megacity and its subaltern spaces and subaltern classes. Of these, the ubiquitous ‘slum’ is the most prominent. Writing against apocalyptic and dystopian narratives of the slum, subaltern urbanism provides accounts of the slum as a terrain of habitation, livelihood, self-organization and politics. This is a vital and even radical challenge to dominant narratives of the megacity. However, this article is concerned with the limits of and alternatives to subaltern urbanism. It thus highlights emergent analytical strategies, utilizing theoretical categories that transcend the familiar metonyms of underdevelopment such as the megacity, the slum, mass politics and the habitus of the dispossessed. Instead, four categories are discussed — peripheries, urban informality, zones of exception and gray spaces. Informed by the urbanism of the global South, these categories break with ontological and topological understandings of subaltern subjects and subaltern spaces.

Party control, policy reforms, and the impact on health insurance coverage in the U.S. states

Objectives. One of the major policy concerns at the federal and state level is the rising number of individuals without health insurance. The purpose of this article is to investigate whether party control of government and various state reforms impact the percentage of the state population without health insurance.Methods. Using data from 1987–2007, I empirically examine whether party control and five state policy reforms reduce the uninsured population.Results. The results show that Republicans are more effective than Democrats at the state level at reducing insurance gaps and that three of five policy reforms explored appear to significantly expand insurance coverage.Conclusions. The results provide valuable insight into which components of health-care reform at the national level may help address the health insurance problem.

Being Yoruba in nineteenth-century Rio de Janeiro

Through the experiences of two West Africans shipped to Bahia as slaves, probably in the 1840s, then sold south to Rio de Janeiro where they met, became lovers, bought their freedom, married, and divorced, I comment on an ongoing debate over the refashioning or transfer of African ethnic identities in American slave societies. The sources in this Brazilian case suggest that previous identities were not suddenly erased, but rather, new layers of understanding and ways of responding were added. Whatever the dynamic of cultural formation, it was memory that crucially bridged the distance between the past they carried with them and the present into which they were thrust; and so it becomes illuminating to reconstruct the plausibly remembered African pasts on which this couple drew to make sense of an unfamiliar Brazilian present.

D'Eichthal and Urbain's "Lettres sur la race noire et la race blanche": race, gender, and reconciliation after slave emancipation

This article is a close reading of Gustave D'Eichthal and Ishmayl Urbain's Lettres sur la race noire et la race blanche (1839), written during the decade prior to the "second" French emancipation in 1848. The article argues that the hierarchical gendering of race described in the letters is reflective of metropolitan concerns about potential for social disorder accompanying slave emancipation in the French colonies. In arguing for social reconciliation through interracial marriage and its offspring, the symbolically charged figure of the mulatto, the authors deployed gendered and familial language to describe a stable post-emancipation society.

The two worlds of race: a historical view

Franklin's essay traces the practices, policies, and laws that, from colonial times through the mid-1960s moment when he composed his essay, created and sustained the two worlds of race in America. He outlines the history of efforts from that period to alleviate racial distinctions and to foster a "world of equality and complete human fellowship." Franklin cautions, however, that even certain well-intentioned efforts to extend services, opportunities, and rights to African Americans sometimes reinforced segregation and discrimination. He considers how key historical, legal, political, and social developments from the twentieth century -- World War II, the growth of labor unions, the Great Migration, America's ascendancy as a world power, among others -- advanced racial equality in America while often intensifying the backlash from opponents to such equality. Still, Franklin concludes optimistically that however strident those opponents may be, they "have been significantly weakened by the very force of the numbers and elements now seeking to eliminate the two worlds of race."

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

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

White on black: can white parents teach black adoptive children how to understand and cope with racism?

In this article, the authors examine White parents’ endeavors toward the racial enculturation and inculcation of their transracially adopted Black children. Drawing on in-depth interviews, the authors identify and analyze themes across the specific race socialization strategies and practices White adoptive parents used to help their adopted Black children to develop a positive racial identity and learn how to effectively cope with issues of race and racism. The central aim of this article is to examine how these lessons about race help to connect family members to U.S. society’s existing racial hierarchy and how these associations position individuals to help perpetuate or challenge the deeply embedded and historical structures of White supremacy. The authors use the notion of White racial framing to move outside of the traditional arguments for or against transracial adoption to instead explore how a close analysis of the adoptive parents’ racial instructions may serve as a learning tool to foster more democratic and inclusive forms of family and community.

"A man's game": cricket, war and masculinity, South Africa, 1899-1902

As practitioners of the imperial sport of the Victorian age, cricketers rallied whenever war descended upon England and its colonies. The South African War of 1899-1902 was no different. Adding to existing work on cricket's imperial development within South Africa, this study marks a significant contribution to research on the link between masculinity, war and sport during the Victorian era. A concept emerging from the English public schools of the mid- to late nineteenth century, the masculine ethos of sport and military honour had reached colonial South Africa by the outbreak of war in 1899. In its analysis of cricket and masculinity, this essay examines the events surrounding the war in South Africa and provides an example of the distinct relationship that existed between the military and the masculinity of sport and its organisation during this era.

Bad blood: poverty, psychopathy and the politics of transgression in Kenya Colony, 1939-59

This article examines the inter-relationship between psychiatry and sex, both fertile fields within the recent historiography of colonialism and empire. Using a series of case files pertaining to European patients admitted to the Mathari Mental Hospital in Nairobi during the 1940s and 1950s, this article shows how sexual transgression among colonial Europeans precipitated, and was combined with, mental distress. Considering psychiatric treatment as a form of social control, the article investigates a number of cases in which a European patient had been perceived to have transgressed the normative sexual behaviour codes of settler society in Kenya. What these files suggest is that transgressive sexuality in Kenya was itself framed by indices, as insistent as they were uncertain, of gender, race and class. While psychiatry as social control has some degree of purchase here, more valuable is an attempt to discern the particular ways in which certain forms of sexual behaviour were understood in diagnostic terms. Men who had sex with Africans, we see, tended to be diagnosed as 'depressed' on arrival at the hospital but were judged to be mentally normal consequently. Women, by contrast, were liable to be diagnosed as psychopathic, a diagnosis, I argue, that helped to explain the uniquely transgressive status of impoverished European women living alone in the margins of white society. Unlike white men, moreover, women did not have to have sex with non-Europeans to transgress sexual codes: this is because female poverty was a sexual problem in a way that male poverty decidedly was not. Poor white women were marked by uncertainty over their sexual behaviour—and dubious racial identity in its turn—and the problem of social contamination was described by reference both to the polluted racial ancestry of an individual and to the prospective contamination of healthy racial stocks. This article aims to address current historical debates around sex and empire, 'white subalternity' and the social history of psychiatry and mental health. All names have been changed to protect patient anonymity.

Isaac Louverture's mémoires: a nineteenth-century representation of black masculinity in the name of the father

Isaac Louverture’s 1818 memoir, when read in tandem with the memoir (1802) of his father, Toussaint Louverture, offers a nuanced representation of black masculine subjectivity and agency—one that elegizes his father’s legacy while simultaneously rewriting an episode from his father’s narrative. Within the context of the events in Saint-Domingue prior to independence, the son’s memoir suggests the possibility of a different dynamic between black and white men in part by calling into question his father’s account of the latter’s relationship to Napoleon and Saint-Domingue’s relation to France.

Cultural patterns of trauma among 19th-century-born males in cadaver collections

Comprehending violence among bioarchaeological and historical groups is a topic of recent interest among biological anthropologists. This research examines trauma among African American and Euro-American males of low socioeconomic status born between 1825 and 1877. A total of 651 male skeletons from the Cobb, Terry, and Hamann-Todd anatomical collections were macroscopically evaluated for skeletal trauma, based on the presence of fractures and weapon-related wounds, and statistically analyzed according to ancestry, birth (Antebellum, Civil War, Reconstruction), combined ancestry - birth, and collection cohorts. Results indicated that African Americans and Euro-Americans expressed ethnic differences in regard to interpersonal violence. To interpret these disparities, documentary data were used to reconstruct the socioeconomic and cultural environment of these individuals. This research emphasizes the importance of evaluating skeletal data within the context of class, culture, and environment so that behavioral patterns observed in the skeleton can be better understood.

Perspective: are we teaching racial profiling? The dangers of subjective determinations of race and ethnicity in case presentations

Physicians make subjective visual assessments concerning the race and/or ethnicity of their patients and document these assessments in patient histories every day. Medical students learn this practice through textbooks and the example set by their educators. Although physicians may believe that they are helping their patients, the practice of using visual clues concerning race and/or ethnicity to determine whether a patient is at risk of certain diseases lacks scientific rigor and may put the patient at significant risk of receiving substandard medical care. The authors argue that if the patient's race or ethnicity is of critical importance, the data should be collected through more objective, scientifically rigorous means, such as genetic testing. In this article, the authors call for the widespread transformation of the way medical schools teach tomorrow's physicians about the role of race and ethnicity in taking medical histories, and they challenge physicians to change their current practices.

Two accounts of the colonised "other" in South Asia re-exploring alterity

Taking examples from South Asia, this article shows how British colonial knowledge about the non-European "other" hinged substantially on the participation of sections of that other, especially in the context of liminal groups, for whom no ready standardised formula of identification was available. Development of a colonial episteme often involved active intervention from the colonised body, thereby dispelling any strict notion of coloniser-colonised alterity and mere top-down governance. This process of identity construction took place in several arenas and also involved negotiations in courts of law, where rival sections of the amorphous colonised body fought for competing ideals of selfhood. Complementing this legal construction were ethnographic formulations, internally diverse, and often relating to broader politico-intellectual concerns and debates of the Empire, at different planes in different ways. The article explicates their theoretical bases and practical modalities.

Stem families and joint families in comparative historical perspective

This note revisits the author's June 2009 PDR article, "Reconsidering the Northwest European family system." Using an array of contemporary and historical census microdata from around the world with simple controls for agricultural employment and demographic structure, I detected no significant differences in complex family structure between nineteenth-century Western Europe and North America and twentieth-century developing countries. This article adds two new measures designed to detect stem families and joint families. The results suggest that Western Europeans and North Americans have had a long-standing aversion to joint family living arrangements, and that this pattern cannot be easily ascribed to demographic and economic conditions.

Pressed flowers: notions of indigenous and alien vegetation in South Africa's Western Cape, c. 1902-1945

In the early twentieth century, botanists in South Africa's Western Cape sought urgently to popularise and protect the region's unique indigenous Fynbos flora. Plants imported from the 1840s, some of which proved invasive, became a physical and symbolic focus for their advocacy. The botanists' efforts resonated with political attempts to forge a common white South African national identity that drew on notions of landscape and the indigenous flora for symbolism and that consciously exploited the politically integrative potential of the new science of ecology. Introduced by overseas-trained experts, ecological theory was, however, inappropriate for the local flora, and had unfortunate consequences for the scientifically-informed research and management particularly of the fire-maintained Fynbos. While botanists and conservationists were united in defending the local flora against invasive introduced plants, they drew distinctions between what was 'indigenous' and what was 'natural' that further complicated their attitudes to the local flora. These historical debates illuminate agendas and policies on introduced ('alien') and indigenous flora in the region today.

Australia: a continuing genocide?

Debates about genocide in Australia have for the most part focussed on past frontier killings and child removal practices. This article, however, focuses on contemporary culturally destructive policies, and the colonial structures that produce them, through the analytical lens of the concept of genocide. The article begins with a discussion of the meaning of cultural genocide, locating the idea firmly in Lemkin's work before moving on to engage with the debates around Lemkin's distinction between genocide and cultural 'diffusion.' In contrast to those scholars who prefer the word 'ethnocide,' the underlying conceptual contention is that the term 'cultural genocide' simply describes a key method of genocide and should be viewed, without the need for qualification, as genocide. While direct physical killing and genocidal child removal practices may have ceased in Australia, some indigenous activists persuasively contend that genocide is a continuing process in an Australia that has failed to decolonise. Concurring with these views the article argues that the contemporary expression of continuing genocidal relations in Australia can be seen principally, and perversely, in the colonial state's official reconciliation process, native title land rights regime and the recent interventionist 'solutions' to indigenous 'problems' in the Northern Territory.

Alcohol use, abuse, and treatment in people of African descent

The use and abuse of alcohol is prevalent in many nations across the globe, but few studies have examined within-group differences found in people of African descent in the United States, in Africa, and in the Caribbean. A review of current research about alcohol use, abuse, and treatment in people of African descent is presented, including information about risk factors and contributors to alcohol use. Examples of education and prevention interventions are also described. Finally, conclusions based on the review of the research literature as well as recommendations for future research are explained.

Housing supply and residential segregation in Ireland

The article examines the role of housing supply in ethnic diversity and the residential segregation of Asian, African and eastern European immigrants from Irish nationals in Ireland. Housing supply is defined as the proportions of new housing, private rental accommodation and social housing among all housing units in an electoral district. Multivariate regressions reveal that, among all three housing supply variables, the proportion of private rentals had the largest effect on ethnic diversity and immigrant— Irish segregation. Areas with higher proportions of private rental units were more ethnically diverse, had greater presences of Africans, Asians and eastern Europeans (as opposed to high concentrations of Irish nationals) and exhibited greater integration between each of the three immigrant groups and Irish nationals. The article concludes with a discussion of immigrant assimilation and questions whether the patterns of residential integration observed would further facilitate other forms of social inclusion for immigrants in Irish society.

"Must not their languages be savage and barbarous like them?" Philology, Indian removal, and race science

This article highlights the federal government's role as a collector and arbiter of scientific knowledge of "the Indian," in projects directed by Lewis Cass, Albert Gallatin, and Henry R. Schoolcraft; examines the linguistic precursor to biological essentialism; demonstrates white philologists' reliance on Native tutors, some of whom also entered scientific and policy debates; and suggests why the federal government began moving toward English-only instruction even as biological notions of race gained ascendance. During the removal debates, Indian languages focused the attention of men of letters, statesmen, and the broader public. Peter S. Du Ponceau and Cass argued over the grammatical character of the "American languages," with the former praising them and the latter attacking those tongues and the "philanthropic" philology. At stake was the future of Indian affairs and inquirers explored Native languages for evidence of Indians' intellectual and moral capacity to be assimilated into U.S. society. In denying that language corresponded to social condition, Du Ponceau suggested that all Indians spoke according to a uniform, unchanging, and unique "plan of ideas." He and other participants in the debate, such as Wilhelm von Humboldt and Schoolcraft, began to define, linguistically, a distinct and fixed "Indian mind." Scholars of the early republic and antebellum era who wish to study scientific definitions of race must come to terms with linguistic ideas, which requires confronting the intercultural encounters, intellectual exchanges, and institutions through which they emerged.

A total extinction confidently hoped for: the destruction of Cape San society under Dutch colonial rule, 1700-1795

San (Bushman) society in the Cape Colony was almost completely annihilated during the eighteenth and nineteenth centuries as a result of land confiscation, massacre, forced labour and cultural suppression that accompanied colonial rule. Whereas similar obliterations of indigenous peoples in other parts of the world have resulted in major public controversies and heated debate amongst academics about the genocidal nature of these episodes, in South Africa the issue has effectively been ignored aside from passing, often polemical, references to it as genocide. Even recent studies that have approached the mass killing of the Cape San with sensitivity and insight do not address it as a case of genocide. This article sets out to redress this imbalance in part by analysing the dynamic of frontier conflict between San and settler under Dutch colonial rule as genocide. It demonstrates both the exterminatory intent underlying settler violence as well as the complicity of a weak colonial state in these depredations, including its sanctioning of the root-and-branch eradication of the San.

Skindeep Ulysses

This essay is about Joyce as an epidermist and Joyce as a chronicler and cataloguer of the "skindeep" surfaces of Dublin in Ulysses. The book is crowded with skins: tanned skins, blushing skins, skins enhanced by makeup and creams, skins marked by race or religion, skins legible and visible, skins imagined and inaccessible and associated with both authenticity and disguise. Skin in Joyce becomes, in Steven Connor's terms, in The Book of Skin, "a place of minglings; a mingling of places," a space where medical, cultural, and aesthetic meanings jostle and intersect and are inscribed and projected on the surface that both expresses and conceals the subject. A skin-deep analysis of Ulysses can reveal to us the entanglement of surface and depth that characterizes Joyce's novel.

Optimizing environmental health training outcomes: a case study of tribal and nontribal trainees

Approximately 80 percent of the public health workforce lacks formal public health education, thus necessitating ongoing professional development training programs to ensure the delivery of essential environmental public health services. Unfortunately, there is a paucity of literature describing changes in workplace performance directly related to training program attendance. The purpose of the study reported here, which was conducted in the spirit of Essential Public Health Service 8 ("assure a competent workforce"), was to examine training style efficacy and changes in performance among Native Americans and non-Native Americans related to attendance at a two-day professional development course in March 2006. Pre- and post-training knowledge, skills, and abilities (KSA) surveys were administered to a subset of training program attendees. The pre-training survey mapped demographic information and assessed prior knowledge and practices associated with environmental health communications. The post-survey was administered three months after the program to measure changes in these key factors, as well as responses to workshop teaching styles. Data analysis suggests teaching styles did not have a significant impact on the transfer and retention of knowledge among Native Americans and non-Native Americans; however, Native Americans preferred a conversational approach, while non-Native Americans articulated a preference for visual, content-rich presentations. Non-native Americans reported using skills and techniques learned in the workshop more frequently than did their Native-American counterparts.

Racial disparities in acute outcomes of life-threatening injury

PURPOSE

To critically analyze racial and ethnic disparities in acute outcomes of life-threatening injury in the United States (US).

DESIGN

Integrative review of literature.

METHODS

A search of Medline (1966-2005) and CINAHL (Cumulative Index to Nursing and Allied Health Literature; 1982-2002) scientific literature databases was undertaken to identify research aimed at correlating minority race and ethnicity to acute outcomes of life-threatening injury in the US.

RESULTS

Although injury is the leading cause of death for adults 15 to 44 years of age, racial and ethnic health disparities in acute outcomes of life-threatening injury have been relatively unexplored: only seven of 352 (2%) studies. The findings from these studies were mixed. Four studies indicated significant relationships between race or ethnicity to acute outcomes in injury morbidity and mortality, but three studies showed no significant relationships between these variables. Other variables associated with health disparities, such as income and education, were rarely (income) or not (education) addressed.

CONCLUSIONS

These inconclusive results indicate the need for more research aimed at investigating racial and ethnic disparities in acute outcomes of life-threatening injury.

Emergency contraception: Knowledge and perceptions in a university population

PURPOSE

The purpose of this study was to examine knowledge, attitudes, and behaviors regarding emergency contraception (EC) in university men and women aged 18-21.

DATA SOURCES

Data sources included responses to a 25-item questionnaire and an 8-item demographic survey completed anonymously at a public site on campus. Ninety-seven university students participated in the study. Participants were asked to respond to questions relating to knowledge, attitudes, and behaviors regarding EC, perceived worthiness, objections, sources of information about EC, preferred birth-control method and usage, and perceptions of their personal risk of unintended pregnancy.

CONCLUSIONS

Many respondents considered unintended pregnancy to be a major problem and considered EC a worthy option in the event of method failure or unprotected intercourse. While most participants were aware that there was a postcoital method of contraception, confusion existed between EC and RU-486 (the abortion pill). Almost half (49.5%) believed that EC was the same as RU-486. There was an association between advanced prescription for EC and its likelihood of use. Most women would be significantly more likely to use EC if they had a prescription on hand. Of the women who were less likely to choose EC, 100% indicated they would feel embarrassed or judged when asking for it. Only 34% of those women who have had a gynecological exam in the past 12 months had discussed EC with their provider.

IMPLICATIONS FOR PRACTICE

Advanced practice nurses need to incorporate EC into preventive health counseling for both men and women. Providing women with an advanced prescription increases the likelihood that women will use EC.

Entertainment education for informed breast cancer treatment decisions in low-literate women: development and initial evaluation of a patient decision aid

BACKGROUND

We report on the development and initial evaluation of a novel computerized decision support system (CDSS) that utilizes concepts from entertainment education (edutainment) to assist low-literate, multiethnic women in making initial surgical treatment decisions.

METHOD

We randomly assigned 51 patients diagnosed with early stage breast cancer to use the decision aid.

RESULTS

Patients who viewed the CDSS improved their knowledge of breast cancer treatment; found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment.

CONCLUSION

The system clearly reached its intended objectives to create a usable decision aid for low-literate, novice computer users.

Allostatic load: a mechanism of socioeconomic health disparities?

Although research on health disparities has been prioritized by the National Institutes of Health, the Institute of Medicine, and Healthy People 2010, little has been published that examines the biology underlying health disparities. Allostatic load is a multisystem construct theorized to quantify stress-induced biological risk. Differences in allostatic load may reflect differences in stress exposure and thus provide a mechanistic link to understanding health disparities. The purpose of this systematic review is to examine the construct of allostatic load and the published studies that employ it in an effort to understand whether the construct can be useful in quantifying health disparities. The published literature demonstrates that allostatic load is elevated in those of low socioeconomic status (SES) as compared to those of high SES. The reviewed articles vary in the justification for inclusion of variables. Recommendations for future research are made in the contexts of measurement, methodology, and racial composition of participants.

Who was who? Race and Jews in turn-of-the-century Britain

Race—as a category—has commonly been understood as a response to difference. In the first instance, race offered a means of ordering unfamiliar peoples, whether encountered in the empire or at home. In the European historiography, the notion of “biological” race, defined by an inherited set of characteristics passed through the blood, possesses a particular genealogy: its roots can be found in the eighteenth century, its fullest articulation came in the late nineteenth century, and its twentieth-century decline was hastened by the Holocaust.

This article sets out a different, if not completely incompatible, thesis. It takes the case of British Jews to argue that racial categories could arise as a response to the apparent similarities, as well as the perceived differences, between Jews and other Britons. Put differently, in the late nineteenth century, Jews came increasingly to be identified as a race precisely because they were difficult to differentiate from their fellow citizens. Class proved a critical determinant. Jews became ever more invisible as they scaled the social ladder. “East End” Jews—poor and newly immigrated—might be readily detectable, but their middle- and upper-middle-class “West End” counterparts confounded observers. Notions of race, I will argue, emerged in part as a consequence of assimilation, delimiting difference in a nation where formal legal barriers to Jewish integration had been eliminated and social obstacles largely overcome.

Race was a staple term of the late nineteenth century. It proliferated throughout the language of the time.