Williams, Christine L.

The pioneering work of Ödegaard (1932) was the first to link migration and
schizophrenia by reporting rates in Norwegian immigrants in Minnesota as twice that of
native Minnesotans and of Norwegians in Norway. However, only in recent decades has
an interest in migration and schizophrenia been rekindled as a result of reports of elevated
rates of schizophrenia in Afro-Caribbean immigrants in the United Kingdom in the mid-
1960s (Hutchinson & Haasen, 2004). Later studies reported elevated rates in secondgeneration
Afro-Caribbean immigrants compared to first-generation (Harrison, Owens,
Holton, Neilson, & Boot, 1988).
In the United States, Blacks were diagnosed with schizophrenia 2.4 times more
often than Whites (Olbert, Nagendra, & Buck, 2018). However, mental health researchers
in the United States generally combine all individuals of African descent as African-
Americans. This practice obscures the nuances of culture and ethnicity within the Black
subgroups as well as the immigrant status of Afro-Caribbeans. This research focused on the Afro-Caribbean immigrants and factors that predict risk for schizophrenia within this
population.
The process of migration is a complex enterprise that produces stressors and
challenges, the effects of which are multifaceted. The social and environmental forces
that parallel the process of migration may predispose individuals to severe psychiatric
disorders such as schizophrenia. Socio-political dynamics in the host country that
marginalize others of different cultural and/or racial persuasions can compound the
negative effects of post-migration. Therefore, migration is considered a social
determinant of health.
Empirical evidence has substantiated that socio-environmental factors such as
urbanicity, discrimination or socio-economic deprivation, social support, and goal
striving stress are potential contributing factors to the development of psychotic disorders
in immigrants. Moreover, evidence has supported that the darker the skin color of the
immigrant the greater the risk (Cantor-Graae, 2007). The findings of this study confirmed
that for Afro-Caribbean immigrants stressors in the post-migration phase such as
discrimination, limited social support, and economic hardship that can be compounded by
the number of dependent children were identified as possible predictors of risk for
schizophrenia. This risk increased with length of residency and continued into the
second-generation.

Aim: This meta-synthesis explores the potential for schizophrenia in at risk Afro-Caribbeans living in the
United States U.S. Background: African Americans are diagnosed with schizophrenia 9 to 32 more than
Caucasians. However, this percentage does not distinguish the percentage of schizophrenia in Afro-
Caribbeans from the Afro-Caribbean population. Extensive studies conducted in the United Kingdom
U.K. reported higher rates of schizophrenia in Caribbean Blacks in Britain when compared to White British citizens. However, there is a paucity of information about schizophrenia in Caribbean Blacks
living in the U.S. Method: A review of literature conducted between 1990 and 2014, using a qualitative
approach, identified four journal articles; the results of which were analyzed with the aid of NVivo
software, using thematic synthesis. Results: The analysis identified six themes; racism and drug use
were themes consistent with those identified in some of the primary studies. However, four new themes
emerged: Effects of migration; disintegration of family; powerlessness and a rush to
diagnose; all were acknowledged as significant factors that may have contributed to the onset of
schizophrenia.Discussion: The themes unveiled by this review exposed a number of complex
sociopolitical and economic factors that can possibly potentiate schizophrenia. However, these studies
were the experiences of Afro-Caribbeans in the U.K. There is a great need for research in the U.S. to
further explore the risk factors for schizophrenia in Afro- Caribbean communities.

Health disparities among rural African Americans include disproportionately higher morbidity and mortality rates associated with cardiovascular disease. Interventions designed to decrease cardiovascular risk can potentially improve health outcomes among rural, underserved communities. The purpose of this study was to test the effect of a cardiovascular health promotion intervention among rural African Americans. An experimental study randomized by church clusters was done in two rural counties in northern Florida. A total of 229 participants, 114 in the intervention group and 115 in the control group, were recruited from twelve rural African American churches. The pretest-posttest design included instruments chosen to measure cardiovascular health habits and knowledge as well as changes in produce consumption, dietary fat intake, and exercise using the major components of the Integrated Model of Behavioral Prediction: intentions, norms, attitudes, and self-efficacy. Linear mixed model was the statistical test used to detect the program effects. Participants who received the intervention had significant increases in scores for the cardiovascular health habits (p < .01) and health knowledge (p < .01) variables compared with the control group. There were also significant group differences regarding intentions to increase produce consumption (p < .01) and reduce dietary fat intake (p < .01). The cardiovascular health program was associated with other statistically significant results including produce consumption attitudes (p = .01) and norms (p < .01), dietary fat attitudes (p = .04) and norms (p < .01), and exercise attitudes (p < .01). There were also significant results found for perceived behavioral control/self-efficacy regarding increasing produce consumption (p < .01), reducing dietary fat intake (p = .03), and increasing exercise (p = .01). Compared to the control group, the cardiovascular health promotion intervention was effective in fostering positive health effects for most of the variables measured. The findings supported the theoretical framework used for guiding the study, the Integrative Model of Behavioral Prediction Nurse-led health promotion interventions within church settings can be effective means for reducing overall cardiovascular risk and health disparities among rural African American populations.

Discrimination is not only a human and civil rights offense, but also a detrimental
influence on the health outcomes of affected populations. The Muslim population in the
United States is a growing religious minority increasingly encountered by health care
professionals in the clinical setting. This group has been subject to heightened
discrimination since the tragic events of September 11, 2001 and often is misunderstood within the context of American society today. While research has been conducted on discrimination against Muslims in the employment and educational segments of society, more studies are needed which quantify the extent and type of discrimination faced by this group in the health care setting. This inquiry focused on the crossover of anti-Muslim discrimination from society to the health care setting. A newly developed tool to measure anti-Muslim discrimination in health care and an established perceived discrimination scale were used to create the questionnaire employed in this investigation. The items of this newly created tool addressed culturally congruent care practices based on the principles of cultural safety within the nurse-patient relationship and the cultural care beliefs of the Muslim patient/family to ascertain discriminatory occurrences in the health care setting. Ray’s (2010) transcultural caring dynamics in nursing and health care model served as a framework for this quantitative, univariate, descriptive, cross-sectional design. Findings revealed that nearly one-third of Muslim subjects perceived they were discriminated against in the health care setting in the United States. Being excluded or ignored was the most frequently conveyed type of discrimination, followed by problems related to the use of Muslim clothing; offensive or insensitive verbal remarks; and problems related to Islamic holidays, prayer rituals, and physical assault, respectively. Age was positively correlated with perceived anti-Muslim discrimination in society. Education was negatively correlated with perceived discrimination in both society and the health care setting. Findings revealed that three out of five of those surveyed reported that they wear Muslim clothing; the most frequently reported of which was the hijab, the most popular Muslim garment reported to be worn. Participants who wore Muslim clothing, especially females, reported more anti-Muslim discrimination than those who did not. Scores for self-reported perceived anti-Muslim discrimination were found to be higher after the Boston Marathon bombings, April 15, 2013, an act perpetrated by Muslims, which occurred during the time of data collection. The number one Muslim care preference reported was same sex caregiver followed by respect for modesty, prayer rituals, respect for privacy, family involvement in care, and dietary concerns. Implications for practice, policy, education, political science, and recommendations for further research are discussed.

Rural West Virginia has a very high percentage of older adults. The age-related
disease of Alzheimer’s threatens the health of older Appalachians, yet research on
Alzheimer’s disease (AD) in this population is scarce. In order to improve screening
rates for cognitive impairment, Appalachians need to understand their vulnerability. The
first step would be to assess their knowledge about AD but a suitable AD knowledge test has not been developed. The purpose of this study was to test the reliability and validity of a new measure of knowledge about AD that is culturally congruent, and to examine factors that may predict AD knowledge in this rural population. A correlational
descriptive study was conducted with 240 participants from four samples of older adults
in south central rural Appalachian West Virginia using surveys and face-to-face
interviews. Results from tests for stability, reliability including Rasch modeling,
discrimination and point biserial indices, and concurrent, divergent, and construct validity were favorable. Findings were that although more diversity in test item difficulty is needed, the test discriminated well between persons with higher and lower levels of
education [F(2, 226) = 170.51, p = .001]. Using multiple regression, the predictors of AD
knowledge included caregiver status, miles from a healthcare provider, gender, and
education; (R2=.05, F(4,187) = 2.65, p =. 04). Only years of education accounted for a
significant proportion of unique variance in predicting the total BKAD score (t = 2.14, p
=. 03). Implications include the need for further tool refinement, testing for health
literacy, coordination with recent statewide efforts to educate the public regarding AD,
and community based participatory research in designing culturally effective education
programs that will ultimately increase screening and detection of Alzheimer’s disease in
rural populations.