School of Public Health

Permanent URI for this communityhttp://hdl.handle.net/1903/1633

The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

Browse

Search Results

Now showing 1 - 10 of 25
  • Item
    Sport, Race, and Grassroots Activism: A Contextual Analysis of Colin Kaepernick's Know Your Rights Camp as a Sporting Social Movement Organization
    (2024) Wallace, Brandon T.; Andrews, David L.; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    This dissertation engages Know Your Rights Camp for Black Liberation (KYRC) – founded and led by athlete-activist Colin Kaepernick – as a case study for critically analyzing the contemporary intersections of sport, race, and grassroots activism. Among other related initiatives, KYRC hosts “camps” across the U.S. designed to facilitate empowerment, solidarity, and critical education about structural racism for Black and Brown youth in marginalized communities. KYRC is illustrative of the recent resurgence of sporting activism in the 2010s and early 2020s, in conjunction with the broader Black Lives Matter (BLM) social movement. Not only is Kaepernick a symbolic figure of both athletic protest and Black resistance more generally in this era, but KYRC is representative of how contemporary sporting activism has evolved in more radical, coordinated, and grassroots directions. Because these emerging sporting initiatives more closely resemble the character of social movements organizations than traditional sport-for-development or sporting philanthropy initiatives, I propose conceptualizing these grassroots organizations as Sporting Social Movement Organizations (SMOs). Borrowing from social movement frameworks, I examine KYRC as a Sporting SMO, defined as an organization that utilizes its connection to sport or athletes to pursue social, political, or cultural change in a coordinated, strategic, and sustained manner. While scholars within Physical Cultural Studies and related fields have outlined the historical significance of and public reactions to this resurgence in sporting activism, there remains a considerable lack of theoretically and empirically rigorous research into Sporting SMOs, let alone with data collected in collaboration with organizations that can speak to their inner workings and on-the-ground mechanics. This project fills these gaps. The underlying research question is: in what ways, and within what broader sociopolitical contexts, does Know Your Rights Camp conduct grassroots sporting activism? First, based on in-depth interviews with KYRC associates, content analysis of KYRC’s social media, and textual analyses of KYRC’s public-facing pedagogical documents, I conduct a micro- and meso-level sociological analysis of KYRC’s mechanics, logics, strategies, messages, tensions, and challenges of KYRC’s model of grassroots activism. Second, based in the methods of radical contextualism and articulation, I conduct a macro-level cultural studies analysis of the social, political, economic, historical, technological, and ideological contexts within which KYRC is situated. Overall, this dissertation contains a precise sociological analysis of what KYRC is and does, as well as a broader cultural studies analysis of what KYRC tells us about sport, race, and politics in contemporary America. To summarize the key findings, I suggest that KYRC is simultaneously a Black Radical political project, a form of celebrity sporting activism, a team-based Sporting SMO, a grassroots pedagogical project, and an anti-essentialist progressive conjunctural response to racial capitalism/neoliberalism. KYRC’s blueprint of grassroots activism can be characterized as the symbolic mobilization of high-profile celebrity association and the material mobilization of philanthropy/donor contributions for the purposes of youth empowerment, collective community uplift, and critical public pedagogy. KYRC is propelled by the Kaepernick Brand – referring to Kaepernick’s stature as a global commercial symbol of bold and authentic political resistance – which uniquely affords the organization material and symbolic resources that the KYRC team strategically channels into navigating the non-profit sector and serving its communities with critical education and rapid community response. Based on these findings, I argue that KYRC reveals the political and transgressive potentials inherent to the immense economic and cultural expansion of sport, in ways that urge us to reconsider our assumptions about sport’s emancipatory potential and heighten our expectations of Black (celebrity) athletes. More broadly, KYRC demonstrates how the Left can intervene through the terrain of popular culture to resist neoliberalism and the Right’s reactionary authoritarian populism, and instead articulate a vision for America based in abolition, solidarity, and liberation from all forms of oppression.
  • Thumbnail Image
    Item
    A CASE STUDY OF RED BULL’S USE OF SPORTING EVENTS IN THE NEOLIBERAL URBAN ENVIORNMENT
    (2024) Weber, Emilio; Andrews, David L.; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    This project critically examines the ways in which city space and place are mobilized for capital interests through an examination of the global sports and energy drinks brand, Red Bull, and specifically its urban-based event strategies. The events such as the ones Red Bull hosts, alongside other spectacular urban projects have been prominent endeavors in which the lived experience of space has been reformulated by those who wield power and influence in the city. Informed by the contextual forces and logics of neoliberal urbanism, Red Bull strategically deploys the physical and symbolic reformulation of cities as an important aspect of its brand marketing strategy. The company, alongside local entities, impact the physical environment of the urban areas they occupy for the events. In addition, representations of places are presented and altered. These alterations of urban space and place have included an increased focus on spectacular consumption sites and experiences, in addition to the policing and surveillance of such spaces. Furthermore, this thesis offers analytical insight into the ways Red Bull’s urban strategizing is both and product and producer of the normalized neoliberal fabric that has come to envelope the contemporary US city: ultimately reproducing urban spaces which promote private profit and continue or exacerbate the inequalities felt in cities. Drawing from a range of interdisciplinary scholarship, I examine the relationship between, and impact of, sporting events hosted within the context of neoliberal cities. Deploying theoretical frameworks based in urban studies, neoliberalism, and critical geography informs the literature review and my research. This literature includes, but is not restricted to, physical cultural studies, urban studies, the sociology of sport, and event literature. Additionally, I utilize a case study method to examine the nature of the events within the urban and sport context they take place in. Completing field research and participant observation at three Red Bull sporting events, hosted in three distinct locales in June 2023, August 2023, and February 2024, I focus on the composition, meaning, affect, and experience of urban space, as created by the event itself, alongside marketing and promotional strategies of the company and cities in relation to these events. The research findings are divided into two empirical chapters, focused on the material and symbolic impacts upon urban space and place, respectively. I posit these findings as a normalized occupation of urban space, following the logics of neoliberalism and the event/content production of Red Bull. In conforming to neoliberal capitalist ideas focused on commercialized spectacle, these events simultaneously work to normalize this corporate use of urban space.
  • Thumbnail Image
    Item
    CREATING A SOCIALLY JUST KINESIOLOGY: ADDRESSING ANTI-BLACKNESS IN THEORY, RESEARCH, AND PEDAGOGY
    (2024) Justin, Tori Alexis; Jette, Shannon; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Currently, the National Academy of Kinesiology (NAK) is striving to create a socially just kinesiology (DePauw, 2021). The NAK call to action is informed, in part, by emergent scholarship that examines how dominant approaches in kinesiology often discount the importance of developing anti-racist, critical, and equitable pedagogy (e.g., Armstrong, 2022). While this scholarship brings attention to kinesiology’s centering of whiteness and the persistent stereotyping of (in)active Black bodies, what is missing is an examination of how/if anti-Black explanations of corporeality manifest across differing spaces in contemporary kinesiology and, if present, what form(s) they take. My dissertation addresses the above-identified gap by using a three-manuscript model to examine three 'spaces’ of kinesiology: theoretical, research, and pedagogical.In manuscript 1 (Chapter 2), I engage Black feminist theory to critically evaluate the tenets of Physical Cultural Studies (PCS). In doing so, I identify a significant theoretical and empirical oversight in PCS scholarship, namely the tendency to reify white Eurocentric epistemo-logics and disregard Black feminist thought by emphasizing Black masculinity and white feminist imperatives in examinations of race and gender. To disrupt this practice, I propose a Black feminist informed reconceptualization of four principal PCS tenets (pedagogical, political, qualitative, and theoretical). Manuscript 2 (Chapter 3) delves into research spaces by investigating how notions of “race” and “racial difference” are constructed in cardiovascular health (CVH) and cardiorespiratory fitness (CRF) research. I conducted a scoping review to systematically identify original research articles (N=236) that included “race” in their examinations of CRF and CVH and then analyzed the sample to ascertain how each article approached “race” and “racial difference”. Key findings include: the majority (77.5%) of the studies did not define race; more than half of the studies (58.6%) compared Black and white racial groups in their examinations; 45.2% of the studies positioned white research participants as the ‘average’ or ‘normal’ in comparison to other racial groups; and only one article discussed the possible role of racism in relation to their identification of racial difference in an outcome of interest. These findings illustrate the need for CRF and CVH examinations to engage scientific best practice on how to research “race” and “racial differences” in ways that avoid reproducing racialized stereotypes. Manuscript 3 (Chapter 4) considers how Black women doctoral students experience pedagogical spaces of kinesiology departments. By conducting semi-structured open-ended interviews (N=10) with current and former Black women graduate students in kinesiology, I examine participants’ perspectives on how/if anti-Black explanations of corporeality inform kinesiology research practice and curriculum, and how the participants experience these pedagogies. Key themes identified are: kinesiological research tends to employ “colorblind research methods”; these methods contribute to monocultural and ahistorical understandings of (in)active bodies and health; and participants experience resistance to institutionally-backed attempts to disrupt white normativity. For kinesiology to transform into the socially just field that NAK is advocating, kinesiologists must consider how anti-Blackness can inadvertently manifest in their theories, research practices, and pedagogies. I provide practical suggestions throughout the dissertation on how to move toward change in each of these spaces.
  • Thumbnail Image
    Item
    A Healthy Relationship? The Entanglement of State, Corporate, and Labor Interests in Gender-based Violence Sport Policies
    (2023) Drafts-Johnson, Lilah; Jette, Shannon; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Gender-based violence (GBV) within professional sports made headlines in 2014 following the Ray Rice domestic violence incident, prompting a Congressional hearing with the four major men’s sports leagues in the United States. This hearing resulted in the implementation of several sport industry-wide policies addressing off-field conduct for players and employees, including ones specifically focused on interpersonal relationships. Despite the cultural prominence of corporate sport entities such as the National Football League, National Basketball Association, and Major League Baseball, in addition to the fervor for institutional accountability in the wake of the #MeToo movement, there has been limited academic scholarship examining the scope and efficacy of these policies (see Brown, 2016; Augelli & Kuennen, 2018) Drawing upon the findings of a thematic analysis of Senate Hearing 113-725: Addressing Domestic Violence in Professional Sports, this thesis utilized a governmentality analytic to critically analyze the motivations, assumptions, and tensions which underpinned the institutionalization of GBV policies in corporate sport. The findings demonstrate that while the parties present at the hearing problematized sport culture at large as a producer of GBV, their remarks characterized professional male athletes as perpetrators, reifying the idea of the “violent (Black) male athlete” and violence as an inherent trait in professional sport more generally. Instead of critically interrogating the structure of professional sport, legislators instead focused on expanding the governing capacity of sport leagues, and effectively the state, to discipline and punish perpetrators of GBV by encouraging the implementation of new extra-legal policies. I argue that this hearing reinforced the neoliberal entanglement of state, corporate, and non-profit actors in the movement to reduce GBV in society, strengthening the dependency that the state has on corporate social responsibility to solve leading public health issues, and compelling GBV advocates, activists, and scholars to engage with corporations in order to receive critical funding and legitimacy in their work. Meanwhile, suggested legislation to improve economic and workplace conditions for survivors was ignored as labor issues were positioned as oppositional to GBV accountability efforts. Through articulation and radical contextualism, this thesis sheds new insight into the origins and methods of corporate GBV policies in sport as well as the intricacies of contemporary neoliberal governance, and ultimately argues that the state response to GBV must shift from one of punishment and surveillance to one of preventative care through improved economic and labor conditions for all workers.
  • Thumbnail Image
    Item
    THE LONG TAIL OF HISTORY: COMBINING THE 1940 CENSUS, REDLINING MAPS, AND HRS: METHODS FOR ANALYZING THE IMPACT OF REDLINING ON HEALTH, ECONOMIC, AND HEALTHCARE OUTCOMES IN OLDER ADULTS TODAY
    (2023) Huang, Shuo Jim; Sehgal, Neil J; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    ABSTRACTTitle of Dissertation: THE LONG TAIL OF HISTORY: COMBINING THE 1940 CENSUS, REDLINING MAPS, AND HRS: METHODS FOR ANALYZING THE IMPACT OF REDLINING ON HEALTH, ECONOMIC, AND HEALTHCARE OUTCOMES IN OLDER ADULTS TODAY Shuo Huang, Doctor of Philosophy, 2023 Dissertation directed by: Neil Jay Sehgal, PhD, MPH Department of Health Policy Management BackgroundAs part of the New Deal in the 1930s, the Federal government used the Home Owners’ Loan Corporation (HOLC) to draw real estate security maps that were color coded or redlined to discourage lending in majority Black neighborhoods. Redlined areas still have worse health and economic outcomes in the present day. Current literature is focused on present-day residents of redlined areas. Tracking exposures to redlining and conditions of redlining close to the 1930s with present-day health is an unexplored area. Methods We utilize geo-referenced 1930s HOLC maps to locate individuals and map demographic considerations. We use novel algorithmic solutions to geolocate unknown 1940 enumeration districts. Using a 1940 census-linked sample of the Health and Retirement Study to locate individuals in HOLC areas at the time, we conduct survival analysis on HOLC categories’ effect on age at death as well as other analysis on health, economic, and healthcare utilization in the near present. We test for a potential mediator. Results Population density is not associated with either HOLC category or present day life expectancy, and is unlikely to be a mediator. In uncontrolled models, for HRS individuals in the 1940 census HOLC category is associated with greater hazards, worse odds of self-rated health, and worse economic outcomes. With controls, HOLC category is only associated with worse odds of self-rated health. HOLC category is not associated with health insurance or healthcare utilization in this sample. Conclusion Redlining is associated with health and economic outcomes which are attenuated when controlling for likely pathways between redlining and health. Future research should focus on whether individuals stay in redlined areas, and on identifying policy and initial state matrix that can describe what redlining may be a proxy for.
  • Thumbnail Image
    Item
    Wrestling With the Angels: Synthesizing Assemblage Theory and Conjunctural Analysis In Examining the Korean Sport Context
    (2022) Yang , Junbin; Andrews, David; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Given the increase of ambiguities and uncertainties in contemporary society in general—and in sport and physical culture in particular—it is essential to explore diversified elements simultaneously rather than fixate on only a single factor (Anderson, 2014; Horton, 2020; Law et al., 2014; Ryan, 2021). Accordingly, this thesis introduces Manuel DeLanda’s (2006a, 2006b, 2011, 2016) “Deleuzian-inspired” (Andrews, 2021b, p. 72) assemblage theory as a novel approach to understanding our complex society and its continuous transformations as “assemblages of assemblages” (DeLanda, 2016, p. 3). More importantly, just as DeLanda (2006, 2011, 2016) reorganized Deleuze’s notions when he suggested his own unique assemblage theory, I reconceptualize DeLanda’s assemblage theory by adopting certain vital concepts within conjunctural cultural studies, including the notions of conjuncture and articulation, to propose my own conjunctural analysis-based assemblage theory. Additionally, on a basis of my own version of assemblage theory, I then analyze three representative conjunctures that can be found within Korean history—a longstanding period of totalitarian regimes, the national economic crisis, and contemporary Korean society—in order to discern both dominant and overlooked assemblages within them as well as their endless mutations. Considering the conspicuous paucity of theoretical and conceptual discussions concerning an assemblage and assemblage theory despite the growing academic attention paid to these concepts (Dewsbury, 2011; Savage, 2020), my clarification and reinterpretation of DeLanda’s (2006, 2011, 2016) assemblage theory will make another meaningful contribution to the advancement of its theoretical and conceptual clarification. Analyzing three particular conjunctures within Korean history using assemblage theory will also ascertain the methodological and empirical potential of the concept by illuminating certain “more-than-human aspects of the socio-material world” (Müller & Schurr, 2016, p. 217) without adhering to anthropocentrism, thereby effectively bridging the scholarly gap that exists in the field of sport and physical culture, especially between the United States and South Korea (Andrews, 2019; Coakley, 2021; Tian & Wise, 2020). Ultimately, the critical engagement with and extension of DeLanda’s (2006, 2011, 2016) assemblage theory will provide a valuable opportunity to strengthen the architecture of the complex contextual relations that can critically delineate how society has been formed and how it has come into being by offering a fundamental addendum to the contextual cultural studies approach while also investigating the structure and function of contemporary sport as multifaceted assemblages (Andrews, 2019; King, 2005).
  • Thumbnail Image
    Item
    Protection for whom? A critical examination into the governance of women athletes through policies
    (2022) Posbergh, Anna; Jette, Shannon L; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Women’s sport remains a contested realm that frequently features standards and regulations implying women are “lesser than,” “different from,” or “derivative of” men (Cahn, 2015, p. 222). As such, a range of protective policies have been introduced as techniques to ensure the safety and health of women, defend “fair competition” in women’s sport, and/or prevent women from violating social and medical boundaries that identify them as women. However, because protective policies rely on divergent rationales in their creation and justification, they elicit different impacts for individuals who are categorized (or wish to be categorized) as women. Previous scholarship has analyzed the underlying issues of science, race, gender, and nationality in individual protective policies and indicated the potential for specific policies (i.e., female eligibility policies) to elicit dangerous health, social, and mental consequences on black and brown women from the Global South. However, there a paucity of research that investigates protective policies as a broad category to understand their similarities, differences, and nuances. To fill this gap, I examine multiple protective policies to conduct a critical, qualitative inquiry into how protective policies are created in elite women’s sports. I focus on how such policies regulate women’s bodies and how different versions of “woman” are constructed by interpreting and selectively drawing from myriad forms of evidence to determine who is protected (and who is excluded), how “protection” is understood, what evidence is mobilized, and how protective policy consequences are justified.I investigate three policies as case studies: the International Olympic Committee’s (IOC) 2014 consensus statement on relative energy deficiency in sport (RED-S), World Athletics’ 2019 policy on female eligibility, and World Athletics’ 2019 policy on transgender eligibility. These three policies are selected for analysis because they reflect the range of science-supported protective policies. While all seek to protect women, each adopts a different stance on the importance of sex differences, in the process demonstrating the social construction of “sex” and malleability of scientific evidence. Guided by feminist, critical race, and Foucauldian-inspired governmentality studies approaches, I center the relevant discourses, knowledges, and power relations within policy rationales to better understand how protective policies regulate (women’s) bodies and maintain social norms. Each case study analysis consists of two data sets: the actual policy texts and nine semi-structured interviews with policy authors, scientists, and other relevant administrators involved in the creation, drafting, and implementation of the three policies. I analyze the data through thematic analysis followed by Foucauldian discourse analysis, informed by a governmentality studies perspective. Using this two-step analytic framework, I first determine what was said in document texts and by participants, followed by a deeper level of analysis and contextualization of how dominant discourses, knowledges, and power relations were created and mobilized to protect (some) women athletes. My findings are organized into four empirical chapters. In the first empirical chapter, I examine the document texts to provide a broad examination into the contexts surrounding their creation, as well as the unproblematized logics that inform their dominant discourses, ways of knowing, and power hierarchies. Based on my analysis, I bring to light the implications of the logics underpinning the documents, including the use of elite medical discourses, the construction of “suspicious” athletes, biologizations of race and gender, and individual diagnoses that lack attention to broader social, political, and cultural dimensions. In the second empirical chapter, I focus on the interviews, or “expert knowledge,” with those involved with researching, drafting, and implementing the three case studies to understand how they draw from (certain) forms of evidence, interpret and/or circulate dominant discourses and knowledges, and navigate the (often) contentious process of creating protective policies (see Wells, 2020). In the third and fourth empirical chapters, I examine both sets of data (policy and interview). In the first of these two empirical chapters, I provide an overview of the “start-to-finish” process behind creating and implementing protective policies and investigate the “tensions” that emerge at each step in the process: from explaining why protective policies exist, to finding or constructing appropriate forms of evidence, to determining the necessity of a separate women’s category, to methods of governing. In the latter empirical chapter, I more closely parse through these “tensions” behind and within the rationales and strategies of protective policies to reveal the complexity reality of such documents, particularly with consideration to (protected) participation, (controlled) unfairness, and (felt) policy implementation. This dissertation is significant as it elucidates how, if, and when women’s rights and bodies are protected through policies. As sport shapes and is shaped by society, this research illuminates on a societal scale how science and policy shape dominant ways of knowing, particularly regarding gender, sex, race, and human rights. Especially in a time when legal protections of women’s autonomy, bodies, and rights are in question, this project provides insight into how protective policies enact a range of measures to safeguard (some) women’s bodies through regulation, discipline, or even exclusion. By investigating how sociocultural and scientific knowledges intersect to determine who qualifies as “woman,” who is considered in need of “protection,” and how protection is implemented, the findings from this dissertation will hopefully inform organizational and administrative efforts to create more equitable, compassionate, and inclusive policies, both in sport and society.
  • Thumbnail Image
    Item
    Weighing the Body: Olympic Weightlifters' Negotiations of Weight Class & Body Ideals
    (2021) Nelson, Monica; Jette, Shannon; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Despite the demanding physical requirements of the sports in which they compete, the bodily practices of competitive athletes are informed and constrained by the athletic and dominant discourses that they are surrounded by. Gendered discourses of the ideal body may induce female athletes to avoid development of “masculine” muscle (Krane et al., 2004); dominant healthist discourses that demonize body fat can contribute to physiological impairments among athletes participating in lean-sport cultures (Ackerman et al., 2020). Through feminist poststructuralist analysis of semi-structured, in-depth interviews with eight male and eight female competitive Olympic Weightlifters, this thesis examines how male and female strength athletes negotiate multiple discourses about acceptable and “athletically-functional” bodies when choosing their weight classes. This study also observes how athletes manipulate (and are manipulated by) their bodies in order to accommodate and resist dominant discourses, offering a demonstration of the social and biological construction of the athletic body.
  • Thumbnail Image
    Item
    Racial/Ethnic Disparities in Amputation and Revascularization: The Roles of Socioexonomic Reighborhood Stress and Allostatic Load
    (2020) Hughes, Kakra; Sehgal, Neil J; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Blacks are several times more likely to undergo a leg amputation as compared to Whites. This is because while peripheral artery disease (PAD), the most common cause of amputation, is more likely to be treated by revascularization (restoration of blood flow) in Whites, PAD is more likely to be treated by amputation in Blacks. Whereas an ongoing debate argues as to whether this disparity is primarily a sociologic versus a biologic phenomenon, I proposed that there are socioeconomic neighborhood stressors that create more severe PAD and renders individuals less likely to undergo successful revascularization and more likely to undergo amputation. Three specific aims are addressed in this dissertation resulting in three manuscripts. In Study 1, utilizing the Nationwide Inpatient Sample Database (NIS) in a retrospective study design, I determined that among patients admitted to the hospital for severe PAD, low socioeconomic status (SES) correlates positively with the likelihood of amputation, but paradoxically correlates negatively with the severity of PAD. In Study 2, I used the National Health and Nutrition Examination Survey, in a cross-sectional study design, to evaluate if there was a relationship between PAD severity, as determined by the ankle-brachial index (ABI) and the level of allostatic load. I did not identify an association. In Study 3, I employed the Nationwide Readmission Databases to show that low SES positively correlates with readmission for amputation following surgical revascularization. Findings from these three papers indicate that there is a positive correlation between low SES and the likelihood of amputation both upon initial admission as well as during subsequent follow up after surgical revascularization. I was unable to establish a clear relationship between PAD severity and allostatic load. The paradoxical finding that low SES individuals present with less severe manifestation of PAD signifies that there are yet-to-be-established factors involved in this complex disparity. This dissertation underscores the dominant role of social determinants of health and submits that in order to adequately address this amputation-revascularization disparity and avoid unnecessary amputations, major investments need to be made not only in healthcare, but also in America’s social infrastructure.
  • Thumbnail Image
    Item
    INVESTIGATING CARDIOVASCULAR RISK AT THE INTERSECTION OF RACE, GENDER, AND EDUCATION
    (2019) Taiwo, Omolola Tanya; Boekeloo, Bradley O; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    As a risk factor of cardiovascular disease (CVD), systemic inflammation is differentially distributed by race, with black populations disproportionately impacted. Additionally, inflammation, as measured by the inflammatory marker C-reactive protein (CRP), is documented to be higher among women when compared to men and varies by educational level. Despite evidence suggesting that various chronic stress domains may contribute to the relationship between race and inflammation, there is limited data exploring the possible mediating role of chronic stress. Furthermore, to date, no study has examined if the potential indirect effect of race on CRP through chronic stress domains are moderated by gender and education. This secondary data analysis stems from the Midlife Development in the United States (MIDUS II) study, and the sample consisted of 193 black and 582 white adults. Study 1: Examined the association between CRP and seven racial/gender/education subgroups. With educated white men as the reference group, findings revealed that educated black and white women had the highest significant risk for elevated CRP. Study 2: Assessed the psychometric properties of a Chronic Stress Scale (CSS) comprised of nine chronic stress subscales. Analyses revealed CSS to be a three-dimensional scale with questionable validity and reliability. Study 3: First, tested for significant correlations between nine chronic stress domains, race, and CRP. Everyday discrimination and financial strain were found to be the only two domains significantly correlated to race and CRP. Second, two mediation analyses assessed the mediating effect of financial strain and discrimination, finding that they both respectively mediated the relationship between race and CRP. Third, two moderated mediation analyses examined if the indirect effect of financial strain and discrimination were moderated by gender and education. Results indicated that the indirect effect of race on CRP through discrimination was significant only among educated black men. Additionally, findings revealed that the indirect effect of race on CRP through financial strain was significant among black men and women regardless of educational attainment. Combined, these studies characterized the social patterning of CRP, illustrated validity and reliability concerns when developing a multidimensional chronic stress scale, and revealed that discrimination and financial strain did have mediating roles and these mediators were moderated by gender and education.