Handbook of Diversity in Feminist Psychology

Handbook of Diversity in Feminist Psychology Hope Landrine, PhD, is a clinical and health psychologist, and Director ...

Author: Hope Landrine PhD | Nancy Felipe Russo PhD

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Handbook of Diversity in Feminist Psychology

Hope Landrine, PhD, is a clinical and health psychologist, and Director of Multicultural Health Behavior Research at the American Cancer Society. She received her PhD in Clinical Psychology at the University of Rhode Island, postdoctoral training in Social Psychology at Stanford University, and postdoctoral training in Cancer Prevention and Control as a National Cancer Institute Fellow at the University of Southern California Medical School. Her research focuses on the role of social, environmental, and cultural variables in health behavior, and in health and cancer disparities among ethnic minorities, women, and the poor. She has received more than $11 million in research grants, and is nationally known as a leading scholar on minority health. She is a former Associate Editor of Psychology of Women Quarterly, has published numerous articles and books, and has received several awards for her research, including Fellow status in APA Divisions 9, 35, 38, and 45, the Association for Women in Psychology Distinguished Publication Award (1996), and the APA-MFP Dalmas Taylor Award for Distinguished, Lifetime Contributions to Research on Ethnic-Minorities (2005). Her best-known books are Bringing Cultural Diversity to Feminist Psychology (APA, 1995), Discrimination against Women: Prevalence, Consequences, Remedies (Sage, 1997), and African-American Acculturation: Deconstructing “Race” and Reviving Culture (Sage, 1996). Nancy Felipe Russo, PhD, is Regents Professor of Psychology and Women’s Studies at Arizona State University, where she served as Director of the Women’s Studies program (1985–93). Founding Director of the Women’s Programs Office of the American Psychological Association (APA) (1977–1985), Russo is a Fellow of the New York Academy of Sciences, the American Psychological Association (Divisions 1, 9, 26, 34, 35, 35, 38, 45, 52), and the American Psychological Society. She is author or editor of more than 200 publications related to the psychology of women and women’s issues; current editor of the American Journal of Orthopsychiatry; and a former editor of the Psychology of Women Quarterly. Her honors include a Carolyn Wood Sherif Award and a Heritage Award for Contributions to Public Policy from the APA’s Division of the Psychology of Women. She received a Distinguished Career Award from the Association for Women in Psychology, and was recognized by APA’s Board of Ethnic Minority Affairs for contributions to ethnic minority issues. Russo is the recipient of the APA’s 1995 Award for Distinguished Contributions to Psychology in the Public Interest. She is a former member of the Board of Directors of the Hispanic Women’s Corporation and of the American Orthopsychiatric Association.


Hope Landrine, PhD ■ Nancy Felipe Russo, PhD Editors

Copyright © 2010 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Sheri W. Sussman Project Manager: Molly Morrison Cover design: Steve Pisano Composition: Newgen Ebook ISBN: 978-0-8261-1706-9 09 10 11 12/ 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this publication and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Handbook of diversity in feminist psychology / Hope Landrine and Nancy Felipe Russo, editors.—1st ed. p. cm. ISBN 978-0-8261-1705-2 1. Feminist psychology. 2. Multiculturalism—Psychological aspects. 3. Feminist therapy. 4. Sexism. I. Landrine, Hope, 1954– II. Russo, Nancy Felipe, 1943– BF201.4.H36 2010 150.82—dc22 2009034383 Printed in the United States of America by Hamilton Printing

Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Foreword by Florence L. Denmark . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxi Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii

Section I: Theory and Methodology Chapter 1

Overview: Diversity in Feminist Psychology . . . . . . . . . . . . . . 3 Nancy Felipe Russo and Hope Landrine Struggles and Accomplishments . . . . . . . . . Envisioning Difference, Understanding Gender Theory and Method . . . . . . . . . . . . . . . . The Nature and Meaning of Gender . . . . . . . Health: Physical and Mental . . . . . . . . . . . Violence and Harassment . . . . . . . . . . . . . Politics, Policy, Advocacy . . . . . . . . . . . . . Acknowledgments . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . .

Chapter 2

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Multiple Lenses: Multicultural Feminist Theory . . . . . . . . . . . 29 Aída Hurtado The Origins of Multicultural Feminist Theory . . . . . . . . Core Concepts in Multicultural Feminist Theory . . . . . . . Emerging Strands in Multicultural Feminist Theory . . . . Bringing Other Constituencies Into the Fold: Toward a Developmental Multicultural Feminist Theory . Recent Innovations in Multicultural Feminist Theory Production . . . . . . . . . . . . . . . . . . . . . . . . . . . Future Directions in Multicultural Feminist Theory Production . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Theoretical and Methodological Challenges in Participatory Community-Based Research . . . . . . . . . . . . . . 55 M. Brinton Lykes, Erzulie Coquillon, and Kelly L. Rabenstein Feminism and Feminist Psychology: A Brief Introduction . . . . . . . . . . . . . . . . . . . . . . Community Psychology: Historical Roots and Current Possibilities . . . . . . . . . . . . . . . . . . . . . . Community Psychology Research Methodologies . . . . . . Community Psychology Through a Feminist Lens: Principles of Work at the Interface . . . . . . . . . . . . . Participatory and Action Research as a Bridge From Feminist and Community-Based Research in Psychology to Transformational Praxis . . . . . . . . . . . Photovoice in Chajul, Guatemala: Work at the Interface . . . . . . . . . . . . . . . . . . . . . . . . . . Looking Forward: The Complex and Sometimes Contradictory Influence of Globalization on and in Local Participatory and Action Research . . . . . . . . . . . . . Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 4

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Methodological and Statistical Issues in Research With Diverse Samples: The Problem of Measurement Equivalence . . . . . . . . . . . . . . . . . . . . . . . . 83 Irma Corral and Hope Landrine Sample Equivalence . Method Equivalence . Scalar Equivalence. . Item Equivalence. . . Conclusions . . . . . . Acknowledgment. . . References . . . . . .

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Section II: The Nature and Meaning of Gender Chapter 5

Sexism Reloaded: Worldwide Evidence for Its Endorsement, Expression, and Emergence in Multiple Contexts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Janet K. Swim, Julia C. Becker, Elizabeth Lee, and Eden-Reneé Pruitt Sexist Beliefs Around the World . . . . . . . . . . . . . . . . . . . . . 138 Implications of Intersectionality for the Treatment of Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152

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Intersections Between Sexist Beliefs and Other Beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Chapter 6

Women’s Experiences of Sexist Discrimination: Review of Research and Directions for Centralizing Race, Ethnicity, and Culture . . . . . . . . . . . . . . 173 Bonnie Moradi and Cirleen DeBlaere Conceptual Definitions of Sexist Discrimination . . . . . . . Measures of Perceived Sexist Discrimination Experiences . Descriptive Data and Prevalence of Perceived Sexist Events . . . . . . . . . . . . . . . . . . . . . . . . . . Responses to Sexist Discrimination Incidents . . . . . . . . Outcomes of Responses . . . . . . . . . . . . . . . . . . . . . Psychological and Physical Health Correlates of Sexist Discrimination . . . . . . . . . . . . . . . . . . . . . Sexist Discrimination and Identity . . . . . . . . . . . . . . Sexist Discrimination and Psychological Distress . . . . . . Sexist Discrimination and Physical Health . . . . . . . . . . Recommendations and Future Directions. . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 7

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Sanctioning Sexuality Within Cultural Contexts: Same-Sex Relationships for Women of Color . . . . . . . . . . . . 211 Ruth E. Fassinger and Tania Israel Sexual Minority Women of Color: Deconstructing the Discourse . Toward Re-vision . . . . . . . . . Conclusion . . . . . . . . . . . . . References . . . . . . . . . . . . .

Chapter 8

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Psychological Perspectives on Older Women . . . . . . . . . . . . 233 Toni C. Antonucci, Rosemary Blieszner, and Florence L. Denmark Demographics . . . . . . . . . . . . . Stereotypes . . . . . . . . . . . . . . . Age and Physical Health . . . . . . . Age and Cognitive Functioning . . . Cultural Influences . . . . . . . . . . Older Women’s Social Relationships . Later-Life Transitions . . . . . . . . . Spirituality . . . . . . . . . . . . . . . Psychology of Older Women From an International Perspective . . . . . . Summary . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . .

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Section III: Health and Therapy Chapter 9

Diversity and Women’s Mental Health . . . . . . . . . . . . . . . . 261 Nancy Felipe Russo Gender and Its Relation to Mental Health . . . . . . . . . . . . The Epidemiological Picture . . . . . . . . . . . . . . . . . . . Service Delivery, Diagnosis, and Treatment . . . . . . . . . . Stress and Coping Perspectives: Considering Mental Health Outcome in Context . . . . . . . . . . . . . . . . . . . . . . . Stigma, Prejudice, and Discrimination . . . . . . . . . . . . . Violence and Trauma . . . . . . . . . . . . . . . . . . . . . . . Diversity and Women’s Mental Health: Current Status, Future Prospects . . . . . . . . . . . . . . . . . . . . . . . . Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 10

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Breast and Cervical Cancer Among Diverse Women . . . . . . . . .311 Ulrike Boehmer and Deborah J. Bowen Prevalence of Breast and Cervical Cancer and Mortality Causes and Risk Factors. . . . . . . . . . . . . . . . . . . Primary Prevention and Surveillance . . . . . . . . . . . Behavioral Interventions to Change Women’s Risk and Screening Behaviors . . . . . . . . . . . . . . . . . . . Diagnosis and Treatment . . . . . . . . . . . . . . . . . . Interventions to Improve the Experience of Diagnosis and Treatment . . . . . . . . . . . . . . . . . After Diagnosis: Cancer Survivorship . . . . . . . . . . . Psychosocial Programs to Improve Survivorship . . . . Physical and Lifestyle Issues of Cancer Survivorship . . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 12

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Ethnicity, Disordered Eating, and Body Image . . . . . . . . . . . 285 Faith-Anne Dohm, Melanie Brown, Fary M. Cachelin, and Ruth H. Striegel-Moore Sociocultural Factors . . . . . . . Ethnicity and Body Image . . . . Ethnicity and Disordered Eating . Conclusion . . . . . . . . . . . . . References . . . . . . . . . . . . .

Chapter 11

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HIV/AIDS Among Women of Color and Sexual Minority Women . . . . . . . . . . . . . . . . . . . . . . . . . 335 Jane M. Simoni, Teresa Evans-Campbell, Michele P. Andrasik, Keren Lehavot, Dellanira Valencia-Garcia, and Karina L. Walters African American Women . . . . . . . . . . . . . . . . . . . . . . . . 336 Poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 Latin Women (Latinas) . . . . . . . . . . . . . . . . . . . . . . . . . . 343

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American Indian and Alaska Native Women . Sexual Minority Women . . . . . . . . . . . . Conclusion . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . .

Chapter 13

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Multicultural Feminist Therapy . . . . . . . . . . . . . . . . . . . . 367 Carolyn Zerbe Enns and Angela M. Byars-Winston Basic Assumptions: Multiplicity, Intersectionality, and Power Shared Principles of Multicultural Feminist Therapy . . . . . General Principles for Multicultural Feminist Practice . . . . Concluding Thoughts . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Section IV: Violence and Harassment Chapter 14

Sexual Assault Among Diverse Populations of Women: Common Ground, Distinctive Features, and Unanswered Questions . . . . . . . . . . . . . . . . . . . . . . . . . 391 Antonia D. Abbey, Angela J. Jacques-Tiura, and Michele R. Parkhill Characteristics of Sexual Assault in General Population Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview of Chapter . . . . . . . . . . . . . . . . . . . . . . Women of Color . . . . . . . . . . . . . . . . . . . . . . . . African Americans . . . . . . . . . . . . . . . . . . . . . . . American Indians and Alaskan Natives . . . . . . . . . . . Latinas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Asian Americans and Pacific Islanders . . . . . . . . . . . Women Living in Poverty . . . . . . . . . . . . . . . . . . . Women With Disabilities . . . . . . . . . . . . . . . . . . . Lesbian and Bisexual Women . . . . . . . . . . . . . . . . Conclusions and Recommendations for Future Research . Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 15

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Intimate Partner Violence: Perspectives From Racial/Ethnic Groups in the United States . . . . . . . . . . . . . . 427 Irene Hanson Frieze and Karen Y. Chen Types of Violence in Relationships . . . . . . . Intimate Partner Violence in Different Groups of Women . . . . . . . . . . . . . . . . . . . . . Summary and Conclusions . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . .

Chapter 16

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NiCole T. Buchanan and Carolyn M. West Definitions of Sexual Harassment . . . . . . . . . . . . . . . . . . . . 450 The Role of Race in Sexual Harassment . . . . . . . . . . . . . . . . . 451 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464

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Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469

Section V: Politics, Policy, and Advocacy Chapter 17

“Making Room at the Table”: Gender, Ethnic, and Class Inequities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479 Heather E. Bullock, Bernice Lott, and Karen Fraser Wyche Women and Poverty: Who Are the Poor? . . . . . . . . . . Structured Inequality and Survival: Employment and Family Challenges for Low-Income Women . . . . . . . Employment . . . . . . . . . . . . . . . . . . . . . . . . . . Hurricane Katrina: A Case Study of Inequity . . . . . . . . Where Do We Go From Here? Toward a Class-Conscious Multicultural Psychology . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 18

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Feminism and Disability: Synchronous Agendas in Conflict . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 Margaret A. Nosek Disability: The Context . . . . . . . . . . . . . Disability and the Feminist Agenda . . . . . . Issues of Concern to Women With Disabilities Call to Action . . . . . . . . . . . . . . . . . . . Acknowledgment. . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . .

Chapter 19

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The Experience of Immigrant and Refugee Women: Psychological Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 Oksana Yakushko and Oliva M. Espín Psychological Effects of Legal Status . . . . . . . . . . . . . Migration and Stress. . . . . . . . . . . . . . . . . . . . . . . Acculturation . . . . . . . . . . . . . . . . . . . . . . . . . . . Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . Migration and Developmental Stage . . . . . . . . . . . . . . The Impact of Nuclear and Extended Families . . . . . . . . Gendered Power Differentials and Migration . . . . . . . . Language Issues in Clinical Work With Immigrant Women Race and Migration . . . . . . . . . . . . . . . . . . . . . . . Resilience and Sources of Strength . . . . . . . . . . . . . . Some Concluding Thoughts . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 20

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Women in the Workplace: Acknowledging Difference in Experience and Policy . . . . . . . . . . . . . . . . . . . . . . . . 559 Susan Clayton, Amber L. Garcia, and Faye J. Crosby Why Work? Women’s Job Satisfaction . . . . . . . . . . . . . . . . . . 560 Work as a Part of Life: Combining Work and Family. . . . . . . . . . 562

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Work and Status: Women as Leaders . . . . . . . . . The Persistent Problem: Gender Discrimination and Its Effects . . . . . . . . . . . . . . . . . . . . . . . . Toward Solutions: Affirmative Action . . . . . . . . . Conclusion: Directions for Policy and Research . . . References . . . . . . . . . . . . . . . . . . . . . . . .

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Section VI: Conclusion Chapter 21

Afterword: Looking Toward the Future . . . . . . . . . . . . . . . 585 Hope Landrine and Nancy Felipe Russo References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589

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Contributors

Antonia D. Abbey, PhD, Professor of Psychology at Wayne State University, College of Liberal Arts and Science, Detroit, Michigan Michele P. Andrasik, PhD, Clinical Health Psychologist and acting Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, Washington Toni C. Antonucci, PhD, Elizabeth M. Douvan Collegiate Professor of Psychology and Research Professor in the Life Course Development Program of the Institute for Social Research, University of Michigan, Ann Arbor, Michigan Julia C. Becker, PhD, Lecturer of Social Psychology at the University of Marburg, Germany Rosemary Blieszner, PhD, Alumni Distinguished Professor, Professor of Adult Development and Aging in the Department of Human Development and Associate Director of the Center for Gerontology at Virginia Polytechnic Institute and State University, Blacksburg, Virginia Ulrike Boehmer, PhD, Assistant Professor of Social and Behavioral Sciences, Boston University School of Public Health, Boston, Massachusetts Deborah J. Bowen, PhD, Full Professor and Chair in the Department of Social and Behavioral Sciences, School of Public Health at Boston University, Boston, Massachusetts Melanie Brown, MA, Applied Psychology, Silver Hill Hospital, specializing in treatment of psychiatric illnesses and substance use disorders, New Canaan, Connecticut NiCole T. Buchanan, PhD, Assistant Professor, Department of Psychology, Michigan State University (MSU) and core faculty affiliate in MSU’s Center for Multicultural Psychology Research, Center for Gender in Global Context, and the Violence Against Women Research and Outreach Initiative, East Lansing, Michigan Heather E. Bullock, PhD, Associate Professor of Psychology and Director of the Center for Justice, Tolerance, and Community at the University of California, Santa Cruz, California Angela M. Byars-Winston, PhD, Scholar, Institute for Clinical and Translational Research, UW Center for Women’s Health Research, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin

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Fary M. Cachelin, PhD, Professor of Psychology and Department Chairperson of Psychology at California State University, Los Angeles, California Karen Y. Chen, PhD, U.S. Department of State in the Bureau of Democracy, Human Rights and Labor, Silver Spring, Maryland Susan Clayton, PhD, Whitmore-Williams Professor of Psychology and Chair of Environmental Studies at the College of Wooster, Wooster, Ohio Erzulie Coquillon, MA, in Counseling Psychology and JD candidate at Boston College Law School, Boston, Massachusetts Irma Corral, MPH, MS (clinical psych), PhD Candidate, Clinical Psychology/ Behavioral Medicine. Currently a Psychology Intern in Behavioral Medicine at the VA Palo Alto Healthcare System in Palo Alto, California Faye Crosby, PhD, LLD (Hon.), Professor of Psychology at University of California, Santa Cruz, California Cirleen DeBlaere, MA, Assistant Professor of Counseling Psychology at Lehigh University in the Department of Education and Human Services, Bethlehem, Pennsylvania Florence L. Denmark, PhD, Robert Scott Pace Distinguished Research Professor of Psychology at Pace University, New York, New York Faith-Anne Dohm, PhD, Professor of Psychology and Interim Associate Dean of the Graduate School of Education and Allied Professions at Fairfield University, Fairfield, Connecticut Carolyn Zerbe Enns, PhD, Professor of Psychology at Cornell College, Mount Vernon, Iowa Oliva M. Espín, PhD, Professor Emerita in the Department of Women’s Studies at San Diego State University and the California School of Professional Psychology of Alliant International University, San Diego, California Teresa (Tessa) Evans-Campbell, PhD, Associate Professor in the School of Social Work and Director of the Center for Indigenous Child Welfare Research at the University of Washington, Seattle, Washington Ruth E. Fassinger, PhD, Dean of the College of Education at California State University, Stanislaus, California Irene Hanson Frieze, PhD, Professor of Psychology and Women’s Studies at the University of Pittsburgh, Pittsburgh, Pennsylvania Amber L. Garcia, PhD, Assistant Professor of Psychology at the College of Wooster, Wooster, Ohio Aída Hurtado, PhD, Professor of Psychology at the University of California, Santa Cruz, California Tania Israel, PhD, Associate Professor in the Department of Counseling, Clinical, and School Psychology at the University of California, Santa Barbara, California

Contributors

Angela J. Jacques-Tiura, social psychology doctoral student at Wayne State University, Detroit, Michigan Elizabeth Lee, MS, graduate student in social psychology, Pennsylvania State University, University Park, Pennsylvania, and Director of Public Relations for Inquisitive Mind online magazine Keren Lehavot, MS, graduate student, Clinical Psychology program at the University of Washington, Seattle, Washington Bernice Lott, PhD, Professor Emerita of Psychology and Women’s Studies, University of Rhode Island and former Dean of University College, Kingston, Rhode Island M. Brinton Lykes, PhD, Professor of Community-Cultural Psychology, Associate Director of the Center for Human Rights and International Justice, and Chair of the Department of Counseling and Applied Developmental and Educational Psychology, Boston College, Boston, Massachusetts Bonnie Moradi, PhD, Associate Professor of Psychology and a member of the Counseling Psychology program at the University of Florida, Gainesville, Florida Margaret A. Nosek, PhD, Professor, Baylor College of Medicine, Department of PM&R and founder and Executive Director of the Center for Research on Women with Disabilities at Baylor College of Medicine, Houston, Texas Michele R. Parkhill, PhD, Research Scientist, Alcohol and Drug Abuse Institute at the University of Washington, Seattle, Washington Eden-Reneé Pruitt, PhD, Lecturer in Psychology, Pennsylvania State University, University Park, Pennsylvania Kelly L. Rabenstein, MS, Assistant to the Director of Riverlife Task Force for outreach activities, Pittsburgh, Pennsylvania Jane M. Simoni, PhD, Clinical Health Psychologist, and Professor in the Department of Psychology and Adjunct Professor, Departments of Women’s Studies and Global Health, University of Washington, Seattle, Washington Ruth Striegel-Moore, PhD, Professor of Social Sciences at Walter A. Crowell University and Department Chairperson of Psychology at Wesleyan University, Middletown, Connecticut Janet K. Swim, PhD, Professor of Psychology, Pennsylvania State University, University Park, Pennsylvania Dellanira Valencia-Garcia, MA, advanced doctoral student in the Clinical Psychology Program, University of Washington, Seattle, Washington Karina L. Walters, MSW, PhD, Associate Professor and William P. and Ruth Gerberding Endowed Professor in the School of Social Work at the University of Washington, Seattle, Washington Carolyn M. West, PhD, Associate Professor of Psychology (Family Violence and Human Sexuality course), University of Washington, Seattle, Washington

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Karen Fraser Wyche, MSW, PhD, Clinical Psychologist and Professor, Department of Psychiatry and Behavioral Sciences, University of Oklahoma College Of Medicine, Oklahoma City, Oklahoma Oksana Yakushko, PhD, Department of Educational Psychology, University of Nebraska–Lincoln, Nebraska

Foreword

In reading over the chapters for this handbook, I am reminded of how far the field has evolved and the many innovations and developments that were envisioned that have subsequently come to fruition over the years. When the field of feminism and feminist psychology first developed, I was privy to its conception and witnessed, as well as participated in, research aimed at dispelling myths regarding gender and women’s roles in multiple arenas such as the workplace, home, and educational system, as well as in the overall development of feminist theories. At the time, these were new and important innovations that paved the way for current research and thought to grow and develop. In reading this handbook, I am struck and also impressed by the advancements that we have made and the multilayered analysis of feminist psychology and its place in the field since that time. No longer is it a narrow (but critical) discussion of how women and men must be considered equally and yet also how gender can be a distinguishing factor in development and the construction of social roles. Feminist analysis today, as is demonstrated by the examination of feminist thought presented in this book, is a much larger and more vast undertaking. In short, as stated in the book’s title, the field is now truly diverse. Feminist psychology has expanded from a discussion of gender to its current implication and presence in every facet of human life. In fact, this handbook is an indication of the many ways that feminist thought has developed and infiltrated multiple layers of society. The sections of the book testify to this fact and cover the staples of feminist discourse: theory, gender, health, violence, and politics; in so doing, this text is a prime example of the presence of feminist thought in virtually all aspects of life and in psychology in general. Additionally, this text gains credibility not only in the breadth of its topics but in the depth of the analysis in individual chapters as well. This book is significant in that it gathers together many feminist scholars, all of whom are experts in their respective areas of research. Each chapter represents quality research that could stand alone, but the benefit of this text is that it unites exceptional feminist researchers in one compilation. It is a useful book not only in psychology classes, but also in women’s studies classes and sociology classes on diversity; it is an important addition to any professional library. In a word, this book actualizes diversity. Although diversity is the direction in which the field is moving, few publications truly embody what this means. This handbook is an exception; each chapter pertains to diversity as well as

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adding to the entire range of variance that the handbook covers. This is the first time that both of these topics are wedded in such a comprehensive manner. This handbook covers topics related to age, multiculturalism, research design, health concerns, class, politics, sexual harassment, and immigrant women, to name a few. Issues such as race, class, and age are at the forefront of research and are inextricably entwined in this discussion. For instance, Chapter 4 covers research implications and considerations in using diverse samples, and Chapter 7 discusses same-sex relationships. Chapter 12 talks about HIV/AIDS and Chapter 16 talks about sexual harassment. Additionally, one of the chapters talks about older women, thus covering women in virtually all aspects of the life span. All of these chapters, although different in context, are similar in that they are proponents of a discussion of diversity, regardless of the specific manner in which both unite. Why is diversity so important? The world is changing daily. Not only is the world’s population shifting in that populations are rising due to improvements in health care and medicine, but the world is also becoming older. The proportion of older persons is expected to double between 2000 and 2050, from 10 to 21 percent, whereas the proportion of children is projected to drop by one-third, from 30 to 21 percent (Second World Assembly on Ageing, 2002). Additionally, more of these older persons are women, making gender important to discuss and analyze in this age group. Development and social constructs of gays and lesbians are more openly discussed and need to be analyzed and studied further. Women are more likely to be aware of sexism, disordered eating, and abuse in the world and should be informed of the ramifications of these issues and how to combat them. Technological advances have changed the way people communicate, relate to each other, and have heightened the contact that we have with people of different cultures and races, thus increasing the need for cultural competence. Women are advocating for themselves and their needs with increasing frequency and need accurate, scholarly information to inform them. Therefore, psychologists, social workers, professors, and students need to be informed of all of these issues and how they interconnect to be able not only to help others but also to combat prejudices and stereotypes that hinder. All of these topics are not only discussed, but are also analyzed in this book. Chisholm and Greene (2008) state: “Diversity is a socially constructed concept indicating the mere presence of differences. However, we are challenged to understand the meaning of the difference, not simply acknowledge its presence” (p. 43). It is not enough to state that there is diversity in the field of feminist psychology. One must go further and strive to comprehend its significance in every aspect possible. It is inspiring and wonderful to realize how far we have come—from basic feminist research once considered revolutionary, to many different facets of feminist thought, which strike me as just as innovative. This book represents the enthusiasm and general dedication to feminist scholarship that is both rewarding and inspiring. In addition, it is a text that is critical for all who are in the field of psychology to own, refer to, and use. No longer are diversity and gender issues considered to be on the periphery as they once were; now one would be remiss in not considering these factors in psychology. The field has truly grown and developed into a diverse and vibrant area of research,

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and this reality and the qualities thereof are reflected in this important and timely publication. It is helping to advance the field by expanding the borders of feminism to include diverse and relevant topics. —Florence L. Denmark, PhD

References Chisholm, J., & Greene, B. (2008). Women of color. In F. Denmark & M. Paludi (Eds.), Psychology of women (pp. 40–69). Westport, CT: Praeger. Second World Assembly on Ageing. (2002). Madrid International Plan of Action on Ageing: In brief (64346–4M). New York: United Nations Department of Economic and Social Affairs


Preface

Editing this book has been a time-consuming labor of love. This handbook differs from previous work by not only seeking to bring a multilevel, multicultural understanding of diversity to feminist psychology, but also to “give multicultural feminist psychology away” to a host of audiences within and beyond the discipline and outside of the academy. Written by leading experts and active researchers in the field, this book provides a single text that can serve as a resource for achieving these goals. In addition to describing key concepts and findings that enrich understanding of women’s diversity, the authors have provided concrete illustrations of research and applications that can be used to teach others how to conduct their work from a multicultural feminist perspective. The chapters differ significantly from each other in length, focus, perspective, writing style, and the kind of information presented. This diversity reflects not only differences in the data available on specific topics but also cultural (positional) differences among authors, who come from diverse ethnic, geographical, and cultural backgrounds, as well as different generations. Each author brings her own cultural perspective, values, and concerns to her chapter and focuses on issues that she chose as most relevant to address. Our respect for this variation in author approach reflects our belief that it is time for reviewers and editors to “accept the differences in perspectives among women of different cultures and allow views to be heard without editing the ‘baby out with the bath water.’ Women of color [and other marginalized groups] complain . . . about the cultural biases of reviewers and editors who transform what they never understood into something the author never wrote, thereby excluding the diversity we ostensibly seek to achieve” (Landrine, 1995, p. xxiii). This is perhaps the most fundamental level at which cultural diversity in feminist psychology needs to be maintained. The book is organized into six sections. In the first section, we present an overview that provides a context for the knowledge that follows. After outlining the historical context for the emergence of a multicultural perspective on diversity in feminist psychology, we show how the knowledge presented in Sections I through V (Theory and Methodology; Nature and Meaning of Gender; Health and Therapy; Violence and Harassment; Politics, Policy, and Advocacy) illustrates feminist principles and priorities in action. Given that multicultural feminist psychology is so broad that it is impossible to include indepth chapters on every relevant topic, the overview also provides an opportunity to include references to work on some other relevant topics not able to be

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covered in this volume (e.g., developmental issues, gender role socialization, sexualization and sexual abuse of girls, personal and social identities, depression and anxiety, reproductive issues, education and achievement). In Section VI (Conclusion), we present an afterword, where we articulate our visions and hopes for the future development of a multicultural feminist psychology.

Reference Landrine, H. (1995). Preface. In H. Landrine (Ed.), Bringing cultural diversity to feminist psychology (pp. xxi–xxiv). Washington, DC: American Psychological Association.

Acknowledgments

We have been truly fortunate to have engaged a group of outstanding authors to participate in this project and are inspired by the insights and creativity represented in the chapters of this volume. We thank the chapter authors for their time, hard work, and commitment to producing this book. We are grateful to our mentors, students, colleagues, and department chairs for their support of our work on this volume. In addition, we are grateful to the reviewers who provided invaluable feedback on the initial chapter drafts: Alisha Ali, Kristine Ajrouch, Angela Pattatucci Aragon, Jen Ayala, Deborah Belle, Meg Bond, Lisa Bowleg, Melissa Clark, Lilia Cortina, Marjorie Crago, Lillian Comas Diaz, Darlene Defour, Michelle Fine, Patricia Frazier, Peter Glick, Lisa Goodman, Ruth Hall, Sherry Hamby, Ram Mahalingham, Jeanne Marrazzo, Geraldine Moane, Anne Mulvey, Bonnie O’Day, Michelle Paludi, Mary Kay Rizzolo, Scott Roesch, Esther Rothblum, Kate Slevin, Janice Steil, Janet Swim, Maria Testa, Terri Vescio, Carolyn West, Jan Yoder, and Rebecca Young. Special thanks go to Allen Meyer for help in assembling the contributor bios and overall support and encouragement throughout this process. We also want to express our gratitude to Sheri Sussman, Deborah Gissinger, and the other members of the Springer team for their thoughtful feedback, enduring patience, and concerted efforts to keep the book on schedule. Finally, we want to recognize the feminist pioneers across the disciplines who have led the struggle for women’s equality in all their diversity and continue to inspire future generations.

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I Theory and Methodology


Overview: Diversity in Feminist Psychology

1 Nancy Felipe Russo and Hope Landrine

Historical analysis of feminist psychology in the United States has traced its roots to the inception of the discipline. However, it was in the 1970s that feminist psychology emerged as a vital force in the discipline and the psychology of women became recognized as an “official” subfield (Chrisler & Smith, 2004; Russo & Denmark, 1987). This “new” psychology of women has challenged psychological theories, methods, and applications, arguing for more attention to situational and cultural contexts (Denmark & Paludi, 2008; Landrine, 1995a; Paludi, 2004; Rabinowitz & Martin, 2001; Unger, 2001) and for the development of new methods for studying them (McHugh & Cosgrove, 2004). It has both reflected and shaped the larger cultural context, and is explicitly feminist in perspective (Worell & Johnson, 1997), and international in scope (Safir & Hill, 2008). From the beginning, women of diverse ethnicity and sexual orientation made important scientific, professional, and leadership contributions to this emerging area (Russo & Denmark, 1987; Russo & Dabul, 1994). Indeed, the first research conference in the field, which was cosponsored by the American Psychological Association and the National Institute of Mental Health in 1975,

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included a chapter devoted to “Employment and Sex Role Ideology in Black Women” (Gump, 1978); another chapter also pointed out that “white middleclass sexist bias limits the advancement of knowledge at every level, from sampling strategy to theory construction, in both the sociological and psychological literatures … concerned with adult development” (Russo, 1978, p. 105). Recognition of gendered racist and classist bias was not immediately translated into new theories, findings, and applications congruent with the interests and priorities of members of neglected populations, however. Even within feminist psychology, work related to diversity has sometimes been marginalized. For example, the suggestion that there be a presentation on ethnic women’s issues at the first APA-Division 35 jointly-sponsored conference on women and psychotherapy in 1979 was rejected by the conference organizers, and it was only after that conference when questions were raised that a chapter on ethnic women was added to the book that came out of the conference (Brodsky & Hare-Mustin, 1980)—a chapter written by a sociologist (Wilkinson, 1980). Interest in the diversity of women’s experiences was given a boost by President’s Commission on Mental Health (PCMH), established under President Carter. The PCMH report officially recognized inadequacies in mental health services for women and expressed concern about “the failure of mental health practitioners to recognize, understand, and empathize with the feelings of powerlessness, alienation, and frustration expressed by many women” (PCMH, 1978, p. 7). The PCMH Subpanel on the Mental Health of Women emphasized that “the mental health implications of the pervasive sexism that impacts … women of all ages, socioeconomic, and racial/ethnic groups in our society must receive priority attention in policy formation and program implementation” (p. 1025). In 1984, an APA-sponsored interdisciplinary conference in which diverse women were well-represented developed a Women’s Mental Health Agenda that emphasized the need to recognize the interactive effects of differences and consider variation in the needs of diverse populations of women, including ethnic women, older women, lesbians, and chronically mentally ill women, among others (Russo, 1985). Research on and by ethnic women exploded during the decade of the 1980s, accompanied by a growing recognition of the need to integrate findings related to race, class, and cultural differences into mainstream theory, research, and practice (Anthias & Yuval-Davis, 1983; Brodsky, 1982; Cole, 1986; Fine, 1985; Kahn & Jean, 1983; Lott, 1981; Mays & Comás-Díaz, 1988; Reid & Comas-Díaz, 1990). Feminist research on specific groups of women of color began yielding new findings and theory on Hispanic women/Latinas (e.g., Amaro & Russo, 1987; Comas-Díaz, 1991; Mirande & Enriquez, 1979), Native American women (e.g., Blackwood, 1984; Greene, 1980, Medicine, 1978), Asian American women (e.g., Fujitomi & Wong, 1981; Lott & Prian, 1979), and African American women (e.g., Matson, 1983; Murray & Scott, 1981; Smith & Stewart, 1983), as well as on poor women (e.g., Belle, 1990; Reid, 1994) and older women (Rodeheaver & Datan, 1988). Theorists across the disciplines undertook critical analysis of racism and class oppression that influenced the thinking of feminist psychologists and stimulated coalitions across lines of gender, race, and class (e.g., Collins, 1990; hooks, 1981; Lorde, 1982; Moraga & Anzaldúa, 1983, among others). All of the chapters in this book make reference to aspects of this early work, but in particular see those by Hurtado; Lykes, Coquillon, and Rabenstein; and Moradi and DeBlaere.

Chapter 1


Also, during the decade of the 1980s, ethnic minority women in psychology began to build formal support structures in professional organizations. The Section on Black Women was established in APA Division of the Psychology of Women in 1984, with its stated goals including “to increase the scientific understanding of those aspects of culture and class which pertain to the psychology of Black women, and to increase the quality of education and training in the psychology of Black women” (By-laws, Section I). Subsequently, sections on the Concerns of Hispanic Women/Latinas and on Lesbian and Bisexual Women’s Issues were approved in 2003, and a Section for Asian Pacific American Women’s Concerns in 2008. The Division also has Committees on Lesbian Issues (established in 2006) and Native American Women (established in 2001). Unfortunately, despite burgeoning research findings and calls for their integration into the mainstream of feminist psychology, textbooks on the psychology of women and subject matter covered in feminist psychological journals during this period continued to reflect a White, middle-class focus (Brown, Goodwin, Hall, & Jackson-Lowman, 1985; Thomas & Miles, 1995). Thus, the diversity of the population of the United States was not reflected in the issues and priorities of the knowledge base being disseminated to future generations of psychologists, and knowledge about the lives of women of color continued to receive a perfunctory treatment that perpetuated its marginal status in feminist psychology. To begin to address this situation, in 1990 APA Division 35 President Bernice Lott highlighted the need for more attention to cultural diversity in feminist psychology and established a Division 35 Task Force on Cultural Diversity in Feminist Psychology (1990–1992). Hope Landrine served as the Task Force chair. The charge of the Task Force was to begin the process of bringing cultural diversity into the mainstream of feminist psychological research, theory, practice, and advocacy. Among the many outcomes of the Task Force work was adoption of new procedures for recruiting minority women into Division 35, and changing the publication policies of Psychology of Women Quarterly to more strongly emphasize a commitment to diversity and explicitly encourage submission of cultural and cross-cultural manuscripts. A second, equally important charge of the Task Force was to produce the first textbook devoted to cultural diversity in feminist psychology. The resulting book, Bringing Cultural Diversity to Feminist Psychology: Theory, Research, and Practice, was written during 1990–1992 and published in 1995 as the first book in the new APA Division 35 Book Series. Edited by Hope Landrine and published by APA, Bringing Cultural Diversity to Feminist Psychology quickly became a resource widely-cited and adopted by scholars, practitioners, and students in feminist psychology and women’s studies. In that book, Landrine (1995b) argued that if feminist psychologists were to take contextualism seriously, studies of ethnic populations would not be marginalized, and all cultures would be subjected to a similar analysis. Given that feminist psychology emerged in the context of the U.S. feminist movement, the field was the product of European American culture, and should be self-reflexively examined as such. She emphasized that Bringing Cultural Diversity challenged researchers to understand “that European American culture is the structure and content of feminist psychology and is the only thing that is discovered and revealed in feminist data, constructs, therapies, and

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theories of gender” (Landrine, 1995b, p. 17). This challenge helped stimulate the spread of a multicultural feminist perspective that encourages the analysis of cultural contexts through multiple lenses. From these new multicultural feminist perspectives, diversity is defined as encompassing the intersections of culturally-defined categories of social difference, with gender only one of multiple social constructs to be considered in dynamic interaction. At this writing, Bringing Cultural Diversity remains the best-selling of all books in the Division 35 Book Series, and is regarded as a classic by scholars in feminist psychology. It signaled a sea-change in efforts to take seriously the task of integrating diversity into the field. Other evidence of a sea-change in the position of diversity in feminist psychology is found in the discussions and outcomes of the fi rst National Conference on Education and Training in Feminist Practice held in Boston, Massachusetts, in 1993 (the Boston Conference). The goals of the conference were “to explore, integrate, and create a cohesive agenda for training in educating in feminist practice the next decade” (Worell & Johnson, 1997, p. xi). Feminist practice was defi ned as all activities in which psychologists participate, including research, teaching, clinical practice and supervision, scholarly writing, and leadership. The conference planners, a committee of nine members of the APA Division of the Psychology of Women, began by defi ning a framework of feminist process that had “structure for diversity” as its fi rst principle (Worell & Johnson, 1997, p. 6). In addition to including a specific working group on diversity, the planners asked all of the other groups to apply the principles they developed to the “various layers of identity that are represented in diverse populations of women” (Worell & Johnson, 1997, p. 7). The conference planning paid off—the reports of the working groups reflect deep thought and meaningful discussions about integrating diverse perspectives into their area of consideration, and the recognition of valuing of diversity was voted to be included as a primary theme in the conference plenary session. Related themes included addressing differential power, privilege, and oppression as well as promoting empowerment and individual women’s voices (see Common Themes—Final Plenary Session, below). The process of achieving consensus on common themes did not come without tension relating to diversity issues, however. In particular, the statement “Gender is a significant locus of oppression, but it is not primary for all women” (p. 249) was found to be disturbing by some participants, and consensus on including it as a common theme of the conference could not be obtained. A more detailed discussion of tensions and concerns can be found in the report of the diversity working group (Greene & Sanchez-Hucles, 1997). Thus, although there was consensus on the importance of diversity and a commitment to incorporating diversity into feminist analyses, consensus on how gender should be incorporated into that analysis was not achieved, perhaps because conceptualization of the constructs of diversity, gender, and the other dimensions of social difference as dynamic cultural constructs had not been fully apprehended. Today, it is more widely recognized that interrelationships among gender and other dimensions of diversity change with the particular dimensions becoming more or less salient and relevant to a particular

Chapter 1


Exhibit 1.1 Common Themes of the Final Plenary Session, First National Conference on Education and Training in Feminist Practice, July 8–11, 1993 Feminist Practice Includes therapy/intervention, teaching, political action, consultation, writing, scholarship, research, supervision, assessment and diagnosis, administration, and public service. Promotes transformation and social change. Assumes that the personal is political. Embraces diversity is a requirement and foundation for practice. Includes an analysis of power and the multiple ways in which people can be oppressed and oppressing. Promotes empowerment and the individual woman’s voice. Promotes collaboration. Promotes the value of diverse methodologies. Promotes self-reflection on the personal, discipline, and other levels as a life-long process. Promotes continued evaluation and reflection of our values, ethics, and process, which is an active and reflective feminist process. Asserts that the misogyny and other inequalities are damaging. Encourages the demystification of theory and practice. Views theory and practice as evolving and emerging. The process of feminist practice is a part of the content of feminist practice. The contextual framework that looks at the psychological and political is important. Learning integrates thoughts, knowledge, feelings, and experience. Source: From Worell & Johnson, 1997, p. 249,

analysis depending on the cultural or situational context (see Enns & ByarsWinston, Chapter 13 for a more in-depth discussion). The report of the Boston Diversity Working Group inspired Russo and Vaz (2001) to develop the concept of “diversity-mindfulness” to represent the perceiving and processing of the multiplicity of differences among individuals, their social contexts, and their cultures. They specified the qualities of feminist diversity-mindfulness as ■ ■ ■ ■

openness to differences among and between people; the cultivation, appreciation, and nurturance of different perspectives; receptiveness to and respect for others; valuing difference; and [recognition that] . . . we are all subject and object. (p. 185)

They emphasized that diversity mindfulness in research does not mean that every dimension of diversity must always be considered. However, diversitymindfulness does require the consistent recognition of the potential limitations

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of one’s approach and humility about generalizations drawn from one’s work. It also requires conscious attention to the multiplicity of approaches in the field as a whole, as well as active support for developing policies and funding programs that maintain a balance among diverse perspectives regardless of personal interest in exploring all of them. The existence of such tensions among feminists and multicultural feminists should not be surprising, given that historically there have been few occasions for the “difficult dialogues” around race and gender to take place, and if they did not create tension they would not be difficult (Sue, Lin, Torino, Capodilupo, & Rivera, 2009). Recognition of the importance of dialogue as a means to foster mutual understanding and empathy is reflected in the “difficult dialogue” programs that have been instituted in professional conferences, including the biannual National Multicultural Conference and Summit which was first held in 1999, “to convene students, practitioners, and scholars in psychology and related fields to inform and inspire multicultural research and practice” (see http://www.multiculturalsummit.org/). Its definition of multiculturalism encompasses experiences related to ethnicity/race, sexual orientation, gender, physical ability, social class, age, and other social identities. The establishment of this biannual event provided a legitimized and visible venue for intellectual and social exchange on the part of multicultural feminist theorists and practitioners. Such exchange plays a key role in the development and dissemination of new ideas and contributes to rapid advances in a field.

Struggles and Accomplishments There continues to be healthy disagreement and debate about priorities, theories, methods, and applications in feminist psychology. “Feminism” and “feminist” are very big words. Nonetheless, the Boston Conference deliberations provided explicit legitimacy and authority for integrating diversity into feminist psychology; further it provided helpful knowledge and guidance on strategies for how to do so. The work has only just begun, however, and the field’s greatest challenge continues to be conceptualizing and understanding the dynamics of difference. The great strides that have been made in response to that challenge are reflected in the body of work presented in this book. The approach taken in this handbook reflects the development of new social and theoretical models and understandings of diversity. Thus, we envision diversity as a dynamic, ever-changing, multilevel cultural construct that encompasses ethnicity/race, sexual orientation, gender, physical ability, social class, age, and other socially-constructed social status and identity differences among women. “Feminist psychology” refers to feminist theory, research models and methods, and psychotherapy and other forms of practice and advocacy that are based on the consensus principles articulated at the Boston Conference. “Multicultural feminist psychology” reflects a perspective that is based on the consensus principles of the Boston Conference, but views dimensions of difference represented by diversity as themselves as social constructions. Because diversity is a dynamic construct, the elements that are most salient in a particular context at a particular moment will vary.

Chapter 1


Envisioning Difference, Understanding Gender There is a continuing struggle to theorize and study intersections of difference. The number of research articles and books addressing diversity issues has multiplied, with intersections among gender, race/ethnicity and class, sexual orientation, age, and disability receiving primary attention (Andersen & Hysock, 2008; Chan, 1997; Chisholm & Greene, 2008; Denmark & Paludi, 2008; DeSouza, Baldwin, Koller, & Narvaz, 2004; Diamond, 2007; Fassinger & Arseneau, 2008; Healey, 1993; Kitzinger, 2001; LaFont, 2003; Olkin, 2006; Reid, Cooper, & Banks, 2008; Wyche, 2001). Questions of how best to articulate multiple sources of oppression have posed challenges to theory and method, and the struggle to answer them has produced new concepts that require new methods of assessment. For example, “diversity mindfulness” represents the effortful perceiving and processing of the multiplicity of differences among individuals, their social contexts, and their cultures. The terms “ethgender” and “gendered racism” reflect efforts to represent ethnic minority women’s lived experiences of oppression and discrimination. The concepts of “double jeopardy” and “multiplicative jeopardy” and “cross-categorization effects” represent efforts to conceptualize the conjoint effects of multiple group membership. Sections I and II in this book consider the development and interplay among concepts and method as feminist psychologists have responded to the challenge and sought to theorize and examine the conjoint effects of the multiple sources of oppression and discrimination experienced by women.

Theory and Method Incorporating diversity into feminist theory has mandated the conceptualization of gender as a cultural construct rather than a personal attribute and stimulated a large and influential body of work. Conceptualizing gender and other dimensions of difference as dynamic, multilevel social constructs requires conducting research that examines the functioning of the constructs on and across multiple levels of analysis. Methods that can illuminate how gender affects women’s lived, subjective experiences may differ from those that are can illuminate interpersonal processes. The three chapters in Section I of this book consider interrelationships among theory and method, advances in understanding those relationships, and the challenges that need to be met if multicultural feminist knowledge is to progress. In chapter 2 of this book, Aída Hurtado considers how multicultural feminism has called for feminist psychologists to think in “complex, relational, and contextual ways” (p. 48). She focuses on three essential principles– intersectionality, self-reflexivity, and accountability—that have influenced the thinking of multicultural feminist scholars and are reflected in this book. Hurtado’s multilevel discussion of intersectionality, which considers intersectionality in relation to multiple identities, the law, the social structure, and borderlands theory, serves as a model and stimulus for ways to approach the conceptualization of interacting dimensions of difference. Her discussion of self-reflexivity, including its impact on the development of new methodologies, is an exciting portrait of the intellectual benefits and enrichment that

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have resulted from the quest to fi nd methods that can represent human experiences in all of their diversity. Hurtado’s gift for reframing constructs from diverse points of view is seen in her discussion of accountability. In contrast to the view that an investigator’s responsibility to be accountable and give voice to community stakeholders is burdensome, Hurtado articulates the benefits of accountability. For researchers who identify their personal identities with their communities, accountability becomes essential to one’s well-being. Thus, accountability becomes a “compelling reason for academic production and social existence” (p. 36). Another benefit of the multicultural feminist emphasis on accountability to the community is that it forces grounding of feminist theorizing in women’s real world experiences. Hurtado’s rich description of the activities and accomplishments of multicultural feminism ends with a call for a developmental perspective that would guide the development and dissemination of a “living curriculum” and program for social action informed by research knowledge. Her discussion and illustration of methodological issues provides a solid stepping-off point for Chapter 3, where Brinton Lykes, Erzulie Coquillon, and Kelly L. Rabenstein discuss the challenging interplay between theory and method in communitybased participatory and action research (PAR). By “participatory and action research,” Lykes et al. refer to a range of research methodologies that are informed by a combination of systems theory, humanistic values, democratic participation, and action for change (see also Lykes & Coquillon, 2007). These methodologies are designed to understand women’s lived experiences and are also congruent with the consensus of the Boston Conference that feminist practice “promotes transformation and social change” (see the exhibit on Common Themes in this chapter). In keeping with principles of multicultural feminism articulated by Hurtado, Lykes et al. articulate a collaborative role for the stakeholders (including the research participants themselves and members of the community) of knowledge production and highlight the benefits of such collaboration. They offer a view of PAR as both an epistemology and methodology reflected in their discussions of principles and practices at the interface between feminist and community psychology. They provide a compelling case for their argument that simplistic accounts of human experience provide an “impoverished analysis of the complex and often contradictory social and cultural lived realities of women and men, many of whom are also engaged collaboratively with them as co-researchers” (p. 57). The work of Lykes and her colleagues is groundbreaking in that it goes beyond theorizing, critiquing, and calling for more complex approaches in research. In Chapter 3, they explain and concretely illustrate with case examples, how to conduct research that will yield an enriched view of women’s lives at the same time that it has a transformative effect on their consciousness. In so doing, they bridge the gap between feminist ideals and actualities with regard to contextualizing diverse women’s experiences. Of all the methodologies considered in this book, PAR stands out as the one that is most true to the activist roots of the feminist movement. The chapter’s cogent analysis of the relation between feminist and community psychology also makes it an exemplar for individuals who wish to “give multicultural feminist psychology away”—in this case to researchers in community psychology.

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In Chapter 4, Corral and Landrine also consider the relation between theory and method, but take the discussion beyond design and procedure to consider issues of equivalence in sampling, measures, and statistical methods used in research that makes group comparisons. In doing so, they illuminate “the problems and the politics of normative methodologies, measures, and statistical analyses” (p. 84), including the “use of inappropriate, group-differences statistics to compare nonequivalent samples, obtained via non-equivalent methodologies, on non-equivalent scaling attached to non-equivalent items” (p. 120). The idea that the bulk of psychological studies that compare status groups may be based on nonequivalent samples, methods, and measures has profound implications for the interpretation of current research findings. If measures used to identify differences between members of comparison groups are not comparable, the validity of the findings is questionable. Thus, equivalence in meaning, interpretation, and impact of study methods and measures has become a serious concern and challenge to researchers who seek to foster multicultural research and psychology. As the authors observe, not only is work based on nonequivalent comparisons scientifically flawed, it serves to reproduce the status quo. Using research on health disparities as an example, they show how the normative practice of attributing ethnic differences in health to culture/ethnicity serves only to reproduce the social order; they highlight the paucity of research on the correlates of ethnicity that render ethnic samples nonequivalent (e.g., segregation, discrimination and social exclusion), and argue that these correlates, rather than culture/ethnicity, account for ethnic health disparities. In sum, failure to recognize the inextricable connections between knowledge and methods of knowledge production has been an important theme in the feminist critique of psychological science, but a full analysis of the complexity and implications of those connections for differing types of research questions in differing research contexts has yet to be accomplished. As a body of work, the three chapters in this section provide a foundation for beginning that analysis. They, in combination with the work reviewed in later chapters, provide a complex portrait of the diversity of ways that concepts, methods, measures, and statistical analyses influence research findings that cannot be separated from the larger context in which they are obtained. Given that knowledge production is occurring in a larger context of intersecting social inequalities, developing new approaches that do not reproduce those inequalities is a continuing challenge, but also an opportunity for creativity and innovation. This section thus provides a foundation for considering how the dimension of gender intersects with other dimensions of diversity, which thus shape the experience of oppression in the lives and circumstances of women, a task undertaken in Section II.

The Nature and Meaning of Gender Psychology has a long history of studying sex differences (Shields, 1975; Maccoby & Jacklin, 1974), with the findings used to justify the status quo based on women’s deficiencies. While research that identifies gender x ethnic differences in beliefs, attitudes, and behaviors among specified populations can

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answer important questions, theoretical explanations for such differences have evolved far beyond traditional “sex difference” models. There continues to be debate about how to theorize gender (see Wilkinson, 2001). From our perspective, and as the chapters in this section reveal, gender can be theorized as a multifaceted, multilevel cultural construct that dynamically interacts with other dimensions of difference (which are themselves cultural constructs) in complex ways over the life cycle. As a complex multilevel construct, gender can be viewed as a dynamic system of interconnected elements that function on psychological, interpersonal, and structural levels, and change and evolve within and across cultures and over time. These elements include gendered traits, beliefs, attitudes, values, behaviors, expectations, norms, roles, environments, and institutions. Gender can function as “master” (or a meta-) status that interacts with other dimensions of social diversity to determine the variety of social positions a woman might hold in society (Anderson, 2005; Deaux & Major, 1987; Frable, 1997; Hamilton & Russo, 2006; Reid & Comas-Díaz, 1990; Ridgeway & Smith-Lovin, 1999). As you can well imagine, the methodological challenges this conceptualization creates are daunting. The body of research described in these chapters represents efforts to overcome those challenges, unpack gender, and examine its elements in interaction with other dimensions of difference. In Chapter 5, Janet K. Swim, Julia Becker, Elizabeth Lee, and Eden-Reneé Pruitt describe how women from various countries and cultures experience sexism differently because individuals from their countries and cultures vary in their endorsement of sexist beliefs. Their portrait of the complex variation in patterns of beliefs across countries and over time reinforce a dynamic view of gender and illustrate the importance of considering context when envisioning interrelationships among gender’s many facets. The relation of traditional beliefs to violence and HIV infection rates found in varying cultural contexts underscores that the focus on feminist psychology on power issues is not misplaced, a theme revisited in Section IV. As might be expected, people who live in individualistic and/or wealthier nations show less support for traditional gender roles. However, in such countries sexist beliefs have taken on more subtle forms, stimulating theory and research on “modern sexism” or “neo-“ sexism. This work also informs the struggle to conceptualize the experience of discrimination for women with diverse social identities described by Hurtado in Chapter 2. Do we “add” the effects of racism and sexism independently (double jeopardy perspective)? Or do we “multiply” the effects together in attempts to account for unique experiences that women of color have with discrimination (multiplicative perspective)? These authors also link beliefs to behaviors in an examination of how discrimination is affected by being a member of more than one group that has a devalued status. They show how evaluation bias can be affected by being a member of more than one socially devalued group as well as by being a member of more than one outgroup relative to the person doing the evaluating. Whether or not multiple group memberships enhance or detract from obtaining a positive evaluation depends on the status of the groups. Swim and her colleagues document how ideological belief systems that support hierarchal relationships, dominance structures, and justify the

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maintenance of the status quo affect women’s experiences with sexism. In doing so they shift the focus of the investigator’s lens beyond the multiple types of social groups to which women belong to the ideological belief systems that provide the context for how the intersecting elements of social difference interact. This work provides a model for conceptualizing and studying conjoint effects of intersecting difference in other contexts and resolving differences between double jeopardy, multiplicative jeopardy, and cross-categorization literatures. It may be that experiences with discrimination are domain-specific, with some domains yielding preferences for specific combinations of multiple group membership compared to others. In Chapter 6, Bonnie Moradi and Cirleen DeBlaere bring more complexity to the analysis of the interplay of theory and method in research seeking to understand the effects of multiple sources of oppression. They review concepts, instruments, and findings of research that examine women’s experiences of sexist discrimination, with special attention to intersections with race, ethnicity, and sexual orientation. Perceived sexist discrimination is widespread among women, but findings with regard to racial, ethnic, and cultural group differences are inconsistent. Reasons for this inconsistency have yet to be explained and may be due to methodological differences across studies. The authors show how conceptualizing and assessing the lived experience of conjoint sources of oppression and discrimination require clarity in theory and precision of measurement. Research studies informed by additive and interactionist theoretical perspectives use instruments that assess multiple sources of discrimination separately, while work from ethgender or gendered racism perspectives requires measures of the emergent and unique expressions of discrimination in minority women’s lives. Moradi and DeBlaere’s evaluation of the strengths and weaknesses of methods to assess self-reported experiences of discrimination from multiple sources will be useful for researchers who wish to contribute to this area of investigation, and serves as a model for approaches to other areas as well. This chapter also considers responses and outcomes of discrimination that are revisited in later sections. Moradi and DeBlaere review a growing literature that documents robust associations of sexism, racism, and other sources of discrimination with negative physical and mental health outcomes, including increased risk for anxiety, depression, eating disorders, and cardiovascular problems, providing a foundation for the chapters that focus on health and well-being in Section III. In Western culture, sex and sexuality have played central roles in defining gender categories. These range from the construction and assignment of gender based on the presence or absence of a penis, to the construction of ideals for female beauty around its ability to attract male sexual interest, to stigmatizing sexual orientation and using the accusation of being a lesbian as a weapon of social control (you don’t want to go to bed with me? You must be a lesbian…). The examples are legion. It is not possible to contemplate re-visioning gender as a cultural construct without addressing issues of sexuality. Thus, the discussion of same-sex relationships among women of color by Ruth Fassinger and Tania Israel in Chapter 7 not only provides information about a neglected population—it challenges us to examine how heterosexist biases shape our visions of our own possibilities. They argue that “limiting

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views of women’s intimacy to lesbian identity or to sex between women narrows the imaginative possibilities for women’s myriad ways of relating to one another, renders insignificant very common forms of intimacy between women, and ignores the fluidity and multidimensionality of women’s connections” (p. 227). Labels matter. Their examination of the limiting effects of labeling sexuality of women of color as if it were a static construct when in actuality it is dynamic and fluid can inform understandings and issues for individuals who are managing identities that cross other dimensions of difference. They emphasize moving “beyond both social identity labels and sexual behavior to explore the myriad forms of intimate connections between women, and to articulate a women-centric, culturally-conscious perspective for re-conceptualizing—or re-visioning—the lives of sexual minority women of color in contemporary U.S. society” (p. 220). In discussing women of color who have same-sex relationships, Fassinger and Israel refocus the analytical lens on the conjoint effects of triple oppression. As they observe, “relegation to the margins” is exacerbated for these women of color, whose experiences are largely ignored in both feminist and lesbian/gay/ bisexual/transgender/queer (LGBTQ) literature (p. 211). They point out that the dominant discourses in psychology have placed race in the background in research on White LGBTQ individuals, but have placed race ethnicity at the center of the analysis in research on LGBTQ people of color, thereby creating a literature of “psycolonization” (p. 213). Further, when researchers have studied same-sex relationships, they have largely focused primarily on women of color who identify as lesbian to the neglect of those who identify as bisexual or queer. Women now also identify as transgender, transsexual, genderqueer, androgynous, bigender, or pangender, or even reject gender as a meaningful organizer of their experience. The study of how gender-variant or gender-transgressive sexual minorities acquire and enact their identities is not only of interest in its own right; such categories present a profound challenge to current oversimplified, dichotomous, phallocentric thinking about gender (Fassinger & Arseneau, 2008). As Fassinger and Israel so eloquently observe: “the dominance of European American male perspectives in constructing the current psychological understanding of healthy expressions of same-sex attraction obscures the complexities of female relationships, hides the myriad ways in which women’s intimacy manifests outside the context of a declared lesbian identity, and makes it extraordinarily difficult to embrace alternative forms of women’s intimacy, particularly for women of color” (p. 221). They emphasize that “women” and “sexuality” vary widely, offering a view of sexuality as comprised of multiple experiences (proclivities, desires, behaviors, preferences) that reflect a woman’s context, (e.g., cultural norms and expectations, demographic locations, historical factors, sociopolitical forces). In envisioning alternative women-centric approaches, like Hurtado (Chapter 2) their work points to the usefulness of a developmental and dynamic approach, and provides examples of research that can be used as a model (Diamond, 2007) for others. In keeping with Hurtado’s call for a developmental perspective, the importance of viewing gender as a cultural package with norms and expectations that change over the life cycle is underscored by the work of Toni C. Antonucci,

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Rosemary Blieszner, and Florence L. Denmark in Chapter 8 of this book. These authors consider how the meaning of gender changes with age, picking up the theme of intersections in their introduction of the concepts of “gendered ageism” and “gendered age stereotypes.” They suggest that in the process of resolving issues in claiming their identity and dealing with societal oppression, lesbians may develop competencies and resilience that will enable them to more easily negotiate the process of aging. This underscores the need for research on the extent to which dealing with more than one type of oppression may or may not lead to more effective resistance and resilience, depending on the situational and cultural context. As Antonucci and her colleagues point out, ethnic women may have increased problems as they age compared to White women because they are more likely to be poor and disadvantaged. However, women of color may also experience advantages compared to White women, particularly if their cultural heritage values age and wisdom and they have positive relationships with their family members. Antonucci and her colleagues also foreshadow topics developed in subsequent sections in highlighting the violence and maltreatment experienced by older women, the importance of work and family relationships in coping with life transitions, and in their discussions of disability and immigrant status. In the process of examining women’s experience of aging, they demonstrate the importance of viewing women in context, profi ling how demographic trends are changing the population distribution in the United States and globally in fundamental ways. In their analysis of the social relationships of older women, they describe how these are experienced differently by women and men and shape adaptation and adjustment to late-life transitions. In sum, as a body of work, the chapters in this section present a rich and complex view of the dynamics of gender as a cultural construct that varies across situational contexts and over time. In addition to documenting the need for new concepts of difference in all its multiplicity, the knowledge in these chapters serves as a foundation for interpreting the association of elements of gender to women’s health outcomes discussed in Section III, the power dynamics manifested in violence against women discussed in Section IV, and the application of feminist principles to populations of women in policy and advocacy contexts in Section V.

Health: Physical and Mental Good health is essential to leading a productive and fulfilling life, and the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment. —Platform for action: Fourth World Conference on Women, Beijing, China

These words from in the national platform for action of the United Nation’s Fourth World Conference on Women underscore a stark reality: Walking through doors of opportunity is difficult if women are sick, barefoot, and/or pregnant. Women’s health issues have been a central concern in the women’s movement from its inception, evidenced by the impact of Our Bodies, Ourselves (Boston Women’s Health Collective, first published in 1971, last

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published 2005). Similarly, women’s health—physical and mental—has been a central concern in feminist psychology in particular (Travis, Grassley, & Crumpler, 1991). Feminist psychologists have been leaders in challenging traditional biomedical disease-oriented models and broadening the discussion to encompass psychological, social, and behavioral factors that influence treatment and prevention (Gallant, Keita, Royak-Schaler, 1997; Travis & Meltzer, 2009; Worell & Goodheart, 2006). Health issues have united women across lines of social difference, but even though we share “female bodies” the need to understand the implications of diversity for women’s health is reflected in pervasive health disparities, that is, differences in health outcomes that reflect psychological, social, economic, and political processes. In particular, the health status of women of color continues to be shaped by the intersection of gender, race/ethnicity, and socioeconomic status. As Bayne-Smith (1996) has pointed out, access to type and quantity of resources, as well as the manner in resources are provided, is determined by race/ethnicity, gender, and the Western medical model of health services delivery. The chapters in Section III of this handbook offer but a brief window into the burgeoning literature related to women’s health and health disparities among diverse women (e.g., Goodheart & Worell, 2006). In Chapter 9, Nancy Felipe Russo provides an overview of diversity and mental health issues, with a particular focus on mental health and well-being. She examines how cumulative adversity, including experience of discrimination, exposure to violence, reproductive events, sexualized objectification, and stigma undermine women’s physical and mental health. In Chapter 10, Faith-Anne Dohm, Melanie Brown, Fary M. Cachelin, and Ruth H. Striegel-Moore consider interrelations among ethnicity, disordered eating, body image, and body dissatisfaction in more depth. This chapter provides an important correction to the myth that women of color are “immune” to eating disorders, which have been viewed as problems primarily affecting White women and girls and studied in clinical samples (where women of color are underrepresented). It also provides a concrete example of how research biases shaped by the norms and values of the dominant culture can affect psychological theory and method. Body image concerns are indeed found across cultures and ethnic groups, but the reasons and forms of such concerns vary. For example, if the research lens only focuses on what began as a Western White women’s obsession with being thin, aspects of the body of more central concern to diverse women may be missed. The implication that mental health problems (in this instance, disordered eating) cannot be fully comprehended unless their psychological components are understood in cultural context, has broad application beyond disordered eating. Interrelationships among behavioral, mental, and physical health issues are examined more closely in Chapter 11 and 12. As Ulrike Boehmer and Deborah Bowen point out in Chapter 11, “the cancer burden has long been recognized as unequally distributed among the population” (p. 313). They examine disparities in breast and cervical cancer, focusing on disparities due to race, ethnicity, socioeconomic status, and sexual orientation, but also emphasize that there are many groups of women who are socially disadvantaged with regard to these and these and other health concerns, including women with disabilities, rural women, immigrant women,

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and women not proficient in English. Although the impact of biological factors is recognized, many risk factors are modifiable, including exposure to environmental toxins, and personal health behaviors, including smoking, physical inactivity, and poor nutrition. Unfortunately, there is an unmet need for culturally appropriate psychological interventions and support programs for cancer survivors, and insufficient knowledge to inform such programs. Boehmer and Bowen also emphasize the importance of moving beyond simply documenting the existence of health disparities to understanding and eliminating them. In Chapter 12, Jane Simoni and her colleagues review risk factors for HIV infection at multiple levels—historical, structural, and community—for women of color and sexual minorities. Their rich analysis elucidates why programs aimed at preventing HIV infection among women of color must “be contextualized within the historical and contemporary realities that are rooted in colonialism, racism, and gendered violence” (p. 336). They articulate how cultural norms, power inequities, substance abuse, and victimization increase HIV risk and offer areas of focus for intervention that build on resilience and protective factors among ethnic women. In doing so, they provide a model for contextualizing an analysis of a health problem such that the similarities and differences across groups are illuminated. Gendered inequities in power, privilege, and entitlement have long been a central feminist theme, and Simoni et al. provide a model for the discussion of power dynamics. Their discussion of the profound role that gendered violence plays in creating HIV risk complements and expands on Russo’s discussion of intimate violence and mental health in Chapter 9, and provides a foundation for more in-depth consideration of violence found in Section IV. From its inception, challenging and re-visioning psychotherapy has been a major task for feminist psychology (Gilbert & Osipow, 1991). There is now a substantial body of work related to feminist counseling and therapy with women that is informing the practice of therapy in general (Ballou, Hill, & West, 2008; Brabeck & Brown, 1997; Franks & Burtle, 1974; Wyche & Rice, 1997). In Chapter 13, the final chapter in this section, Carolyn Zerbe Enns and Angela Byars-Winston provide a rich portrait of the goals, principles, and applications of multicultural feminist therapy, while at the same time pointing out potential challenges to the integration of feminism and multiculturalism. In considering the shared principles of multicultural feminist therapy (therapist self-awareness; a coping and strength perspective; and ecological and biopsychosocial perspectives), the chapter describes how therapist selfawareness applies to all therapists regardless of social difference, articulating how the positionalities and sociocultural identities of White women as well as women of color may affect the interactions with colleagues and clients. They also emphasize that knowledge of oppressions experienced by women of color must be combined with a knowledge of their strengths and coping resources. Lacking such knowledge may lead to an inaccurate assessment (underestimating or overestimating) of their ability to deal with life stressors, which should be considered in a multi-level biopsychosocial context. Enns and Byars-Winston also articulate principles related to critical consciousness or consciousness-raising, social identity assessment, empowerment goals, the integration of traditional psychotherapy systems with multicultural feminist principles, and the challenges of working within intercultural dyads.

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Their illustration of concepts with concrete examples of myths and fallacious assumptions make for a rich and powerful description of how oppression may be manifested in ethnic client’s lives. They close with a summary of what multicultural feminist therapy can offer clients—ways to integrate diverse aspects of their identities; identify interconnections between their internal and ethnosociocultural realities; deal with anger related to oppression they experience; and become change agents on their own behalf as well as that of society. In brief, while recognizing potential conflicts among multicultural and feminist perspectives, this chapter illustrates application of feminist principles and of provides a solid foundation for the further development of multicultural feminist therapies. The key role that inequities of power, status, and privilege play in the oppression of women is reflected throughout the chapters in this book. In this section, gender-based violence has been indicted as a major threat to women’s physical and mental health and the ability of women to participate fully in public life. They have also emphasized the fact that developing programs aimed at prevention and intervention requires contextualized knowledge about the lives and circumstances of women (White & Frabutt, 2006).

Violence and Harassment In the Platform for Action of the United Nations World Conference on Women in Beijing (Beijing Conference, 1995), gender-based violence was defined as “any act that results in, or is likely to result in physical, sexual, or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life” (United Nations, 1995, Platform for Action, Section D.113). The Beijing Conference definition represents an international consensus on how to conceptualize the dynamics of gender-based violence. Gender violence takes many forms over the life cycle, including physical and sexual abuse, rape, and intimate partner violence, among others (see Exhibit 1.2 on Gender-Based Violence: From Birth to Death). Unfortunately, space precludes providing specific discussions for all of them. Three interrelated forms of violence are considered: sexual assault, intimate partner violence (IPV), and sexual harassment. In Chapter 14, Antonia Abbey, Angela Jacques-Tiura, and Michele Parkhill present a detailed review of the sexual assault victimization literature among diverse populations of adult women, including women of color, poor women, women with disabilities, and lesbian and bisexual women. In addition to identifying risk factors, they consider treatment issues, gaps in the literature, and recommendations for future research. They show how both unique and distinctive cultural and personal experiences of assault victims shape disclosure, help-seeking, institutional responses, and post-assault recovery. The usefulness of the material is enhanced by supplementing the presentation of unique challenges for assault survivors with summaries of treatment suggestions. They describe the studies judged to make the most significant contributions to knowledge about diverse women in more detail, articulating methodological issues, including sampling strategies, data-gathering techniques and measurement issues that need to be addressed.

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Exhibit 1.2 Gender-Based Violence: From Birth to Death Infancy and Childhood Child physical and sexual and neglect Child prostitution Female infanticide Female genital mutilation Malnutrition Adolescence Forced prostitution Forced early marriage Dating violence Psychological abuse Sex trafficking Peer sexual harassment Rape

Reproductive Years Honor killings Dowry killings Acid attacks Homicide Sex work and trafficking Rape and sexual harassment Stalking Forced abortion and sterilization Marital rape and intimate partner violence Elder Years Elder/widow abuse Homicide

Source: Adapted with permission from Russo, N.F. (2006). Violence against women: A global health issue. In Q. Jing, M. R Rosenzweig, G. d’Ydewalle, H. Zhang, H. Chen, & K. Zhang (Eds.). Progress in Psychological Science Around the World, Vol. 2: Social and Applied Issues (pp. 181–198). New York: Psychology Press.

In Chapter 15, Irene Frieze and Karen Chen focus on intimate partner violence, pointing out that violence may vary from “low” (pushing and shoving) to extreme levels that involve serious injury. As their analysis reveals, the distinction is important because the dynamics of violence at various levels may differ. Severely violent relationships involving a violent man and a battered woman have received substantial attention by researchers as well as the media. Although this is not the most common form of violent relationship, the physical, mental, and social effects of the violence are substantial. Less violent forms of aggressive behavior in married couples as well in same-sex and heterosexual co-habiting couples have begun to receive more attention, as has female violence against male partners (couple violence). It is important to be clear about how violence is operationalized when drawing conclusions from such studies. Overall violence level, violence frequency, and level of injury are all important dimensions to consider when investigating violence dynamics. Couple violence largely consists of “lower” level physical aggression such as hitting, slapping, and shoving. When injuries occur, it is most likely that the female partner has experienced them. The physical, mental, and social effects of this “minor” violence have yet to be fully investigated. Frieze and Chen examine what is known about women’s experience of violence depending on socioeconomic status, race, immigrant status, sexuality, and disability, highlighting similarities and differences. As they point out, few studies have examined intersectionalities of race, social class, and sexual orientation, let alone other dimensions of social difference. Research informed by multicultural feminist theory designed to develop a knowledge base that can inform prevention as treatment services is especially needed.

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In Chapter 16, after reviewing legal, behavioral, and psychological definitions of sexual harassment, NiCole Buchanan and Carolyn West examine research on racial/ethnic differences in the frequency, perceptions, psychological consequences, and coping strategies related to sexual harassment among women of color. Specifically, they focus on African American, Latina, and Asian American women. They distinguish racialized sexual harassment from racial or sexual harassment (e.g., calling someone a “Black whore” [p. 450] or a “hot Latina” [p. 462]). Their analysis points to the need to examine how the perceived meaning and impact of acts may vary across diverse groups and can be affected by the characteristics of the target, the perpetrator, and the harassing behavior, as well as contextual factors specific to the organization. Among the factors that vary across diverse groups include the context and nature of sexualized stereotypes and how such stereotypes have been used to justify sexual violence (e.g., the Jezebel stereotype historically applied to justify violence against Black women). Buchanan and West offer several recommendations for future research, including emphasizing need to assess variations in the frequency and prevalence rates, perceptions and definitions of sexual harassment, and the psychological, physical, and job-related consequences across diverse populations as well as diverse settings. They emphasize the links between harassment and power inequities, eloquently concluding, “for women of color, sexual harassment is often racialized, rooted in a long history of discrimination and sexual violence, and fostered by the current inequities in the workplace and academic settings” (p. 468). Taken as a whole, the chapters in this section identify both distinctive and shared features of violence experienced by diverse women. The forms of violence considered here are clearly not confined to a particular group of women, but are found across social and economic levels. They are interrelated with each other as well as with other forms of violence (e.g., childhood sexual abuse is a consistent predictor of later victimization, including sexual assault and intimate partner violence). The findings reported in this section underscore the need for methodologically rigorous qualitative and quantitative research aimed at filling current knowledge gaps about how the experience of and recovery from various forms of interpersonal violence is shaped by the intersections of gender, ethnicity, sexual orientation, poverty, disabilities, and other dimensions of social diversity. Finally, for services to be used, they must be accessible and culturally appropriate. Service providers need to understand cultural gender norms and modify procedures if needed. In particular, the need to address violence in the lives of poor women, who, when homeless, may have housing issues, is striking. Individual-level intervention will clearly not be sufficient—as Corral and Landrine emphasize in Chapter 4, and as reinforced in these chapters—macro-level solutions are also required if poor women are to relocate from high-risk environments and gain access to social, medical, and mental health services. Violence against women is ubiquitous, manifests in multiple and interrelated forms, and produces a host of negative physical, psychological, social, and societal effects. How “racism and other forms of oppression carve unique contours into an otherwise common experience” (Buchannan & West, Chapter 16, p. 468) has yet to be

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fully ascertained, but must be done if prevention of violence against women in diverse populations is to be achieved. They also remind us that inequalities will not be addressed without addressing the social, structural, and political circumstances that reproduce and maintain them. Thus, the final section of this book considers politics, policy, and advocacy issues.

Politics, Policy, Advocacy Translating a policy problem into a program for change is highly complex. What is effective for some issues will not be effective in others (for a discussion of complexities, functions, and limitations of public policies affecting psychological well-being of girls and women, see Glied and Kofman, 2006). Programs and policies are often targeted towards populations in need of services. In this section, policy issues are discussed in the context of four neglected and overlapping populations: poor women, women with disabilities, workers, and immigrants/refugees. As Pamela Reid (1991) so eloquently expressed, for too long, poor women in psychological research were “shut up and shut out” (p. 133). This situation began to change in the 1990s, however, as concerns about racial and ethnic differences in health disparities began to receive national attention. As documented in chapters previously discussed, poor women have multiple burdens and special needs, but little access to social and economic resources to help meet them. In Chapter 17, Heather Bullock, Bernice Lott, and Karen Wyche examine the correlates and consequences of women’s poverty, particularly in relation to family and employment. They argue for more complex and contextualized conceptions of poverty that go beyond establishing a person’s relation to the federal poverty line and consider the context of underpaid and undervalued low-wage work. In the process, they rebut the assumptions about effects of a “culture of poverty” that are used to rationalize forcing poor women to work as a condition for receiving public assistance. They articulate the structures that underlie women’s poverty, including lack of access to affordable health care that compounds problems caused by economic distress. Women’s poverty and poor health are reflected in lower birth weights and reduced chances for the survival of their children. They also discuss the role of stereotypes in justifying class disparity, and the potential of feminist, multicultural analyses to challenge these inequities. They stress attention to intersections of class with race/ethnicity and gender, emphasizing that privilege and oppression do not operate in isolation, and structural inequality goes hand in hand with social vulnerability. Their analysis of Hurricane Katrina’s impact on the women of New Orleans provides numerous concrete examples that illustrate these points. They provide a stark description of how dealing with an inept and aggravating bureaucracy led to poor women “opting” to move into FEMA trailers, creating de facto segregation for the newly formed poor communities. Their discussion of how race, gender, and class intersect in the “politics of ‘deservingness’ ” that shaped the public’s response in the aftermath of Katrina reminds us that support for progressive social policies depends on an understanding of how the social structure creates and compounds the problems

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of disadvantaged groups. Analyses of media coverage after the hurricane revealed an individualistic, depoliticized portrait of issues combined with negative depictions of the victims, and reminds us of the importance of including media in efforts to eliminate disparities in power and privilege. Although poor women are more likely to experience physical and mental disability, disability can happen to any woman and is not bound by lines of social difference. In Chapter 18, Margaret Nosek examines how gender is manifested in the disparities and discrimination experienced by women with disabilities and articulates policies and advocacy strategies for change. She describes diversity among women with disabilities not only in terms of age, social class, race/ethnicity, and sexual orientation, but also in terms of their disability’s nature and severity. The chapter also demonstrates that the lesson, “labels matter,” applies in program development and policy advocacy. Nosek emphasizes that disability, like gender in general, is a cultural construct that reflects a social judgment about the interaction of a person with her environment. Nosek’s discussion of historical events illuminates how the basis for defining disability has changed over time—from classifying people with disabilities based on their diagnosis (e.g., blindness, deafness) to classifying them based on having a physical or mental impairment that substantially limits one or more of major life activities. This change in classification has both mirrored and shaped strategies for advocacy. For women of all ethnicities, disability is deeply rooted in gender- and disability-based discrimination that affects all aspects of a women’s experience, including identity and self worth, individual autonomy, connectedness and social support, control of one’s body, sexuality, violence and abuse, discrimination, employment and income inequities, and disparities in health and access to health care. Her principles for action, which include organizing, using the power of peers, teaching, and demanding answers, are generalizable beyond disability issues. The complexities generated by intersections of social identity and circumstance are similarly found in the lives of immigrant women whose diversity in national origin, race/ethnicity, and language proficiency have prominence in national discussions where other dimensions of social difference, such as age and sexuality, are neglected. In Chapter 19, Oksana Yakushko and Oliva Espín articulate diversity among immigrant women, explaining how distinctions among legal, refugee, and undocumented (illegal) statuses result in distinct experiences for legal immigrants, refugees, and undocumented migrant workers. They argue for a view of immigrant women that recognizes resilience and resourcefulness in dealing with the forces of oppression and discrimination they encounter. Norms, expectations, and circumstances in which women perform their work and family roles continually present challenges that women must negotiate, negotiations made more complex in the immigration context. Yakushko and Espín discuss how family and work roles and circumstances of immigrant women shape migration stresses as well as the psychological impact of acculturation and identity processes. A critical question in working with immigrant and refugee women is: How are the conflicts and incongruities of “modern” ideas about women’s choices, roles, rights, and obligations to be negotiated with

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the more “traditional” ideas about the roles and status of women? Answering this question, found across societies, becomes more complex as well as “more poignant and dramatic” (p. 552) when applied to acculturation within a new context that itself is also undergoing change with regard to the roles and status of women. Negotiation among role obligations at home and at work have long been identified as being of central concern to the feminist movement, although the specific issues and conflicts to be negotiated have varied with the intersections of dimensions of difference (Crosby & Sabbatini, 2006; Steinberg, True, & Russo, 2006) . The view that breadwinner is a “male” role and that women should stop work when they marry and have children reflects a White middle-class construction of wife and mother—poor Whites and women of color did not have that option. Despite the fact that nearly three-quarters of women between ages 25–54 are in the workforce (USDL, 2006), the world of work has been slow to recognize alternative family forms, including dual-worker couples, singleheaded households, lesbian, gay, and bisexual couples, and other unions involving home life (Steil, 2001; Fassinger, 2000). Difficulties are compounded for families that must resolve work and family conflicts in a context of stigma and discrimination—single-parent families, lesbian, gay, and bisexual couples and families where the wife is the breadwinner (Schultheiss, 2006). Stereotyping and idealization of women’s work and family roles must be replaced with an understanding of women’s diverse realities, and the world of work needs to be realigned to reflect those realities (APA, 2004; Halpern, 2005). But as Clayton, Garcia, and Crosby point out in Chapter 20, such a realignment cannot be accomplished without taking “a complex perspective, one that is mindful of work for all women, not just those who are White, middle-class, and heterosexual” (p. 559). In addition to examining the ways that work and family can interact for women, they address both attitudes and policies. They also focus on what is needed for change, including addressing the underrepresentation of women in leadership positions. They articulate ways that employers who seek to reduce turnover and enhance productivity can create a culture of inclusiveness, foster a positive workplace climate, and counter effects of stereotyping and discrimination. They emphasize that structural changes are needed if the effects of past discrimination are to be overcome, and they discuss the promise and problems of affirmative action as a tool for change. Given that myths about the process and outcomes of affirmative action abound, the information in this chapter will be particularly helpful to policy advocates. The conclusions of Clayton and her colleagues apply across the chapters, and reinforce basic themes: Biased beliefs and attitudes towards toward women are shaped by gender stereotypes and reflected in pervasive cultural norms about appropriate traits, roles, and circumstances for women, norms that vary depending on the intersections of social difference and the developmental and social context. While there has been progress in knowledge about the lives and circumstances of different groups of women, the task now is to understand how multiple identities and other expressions of social differences are negotiated over the life cycle in various contexts, including at home, at work, in school, at church, and in various communities.

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Taken as a whole, the body of work represented in the first five sections of this book represents the study of diversity in feminist psychology past and present. Later, in Section VI, we will consider future challenges for multicultural feminist psychology as well as strategies and opportunities for meeting those challenges. Meanwhile, we hope you find the contributions of the chapter authors enriching and rewarding—as we have.

Acknowledgments We would like to thank Ruth Fassinger, Aída Hurtado, Allen Meyer, Bonnie Moradi, and Janet Swim for their feedback on partial drafts.

References Amaro, H., & Russo, N. F. (Eds.). (1987). Hispanic women and mental health: Contemporary issues in research and practice [Special issue]. Psychology of Women, 11(4). Andersen, M., & Hysock, D. (2008). Thinking About Women: Sociological Perspectives on Sex and Gender (8th ed.). Upper Saddle River, NJ: Pearson Education. Anthias, F., & Yuval-Davis, N. (1983). Contextualizing feminism: Gender, ethnic and class divisions. Feminist Review, 15, 62–75. Bayne-Smith, M. (1996). Health and women of color: A contextual overview. In M. BayneSmith (Ed.), Race, Gender, and Health (pp. 1–42) . Thousand Oaks, CA: Sage Publications, Inc. Beal, F. M. (1970). Double jeopardy: To be Black and Female. In T. Cade (Ed.), The Black woman: An Anthology. New York: Signet. Belle, D. (1990). Poverty and women’s mental health. American Psychologist, 45, 385–389. Blackwood, E. (1984). Sexuality and gender in certain Native American tribes: The case across gender females. Signs, 10, 27–42. Brabeck, M. & Brown, L. (1997). Feminist theory and psychological practice. In J. Worell & N. G. Johnson (Eds.), Shaping the Future of Feminist Psychology: Education, Research, and Practice. Washington, DC: American Psychological Association. Brodsky, A. M., & Hare-Mustin, R. T. (Eds.). (1980). Women and Psychotherapy: An Assessment of Research and Practice (pp. 285–304). New York: Guilford. Brodsky, A. M. (1982). Sex, race, and class issues in psychotherapy research. In J.H. Harvey (Ed.), Psychotherapy Research and Behavior Change, Master lecture series, Vol. 1 (pp. 127–150). Washington, DC: American Psychological Association. Brown, A. Goodwin, B. J., Hall, B. A., & Jackson-Lowman, H. A. (1985). Review of psychology of women textbooks: Focused on the Afro-American woman. Psychology of Women Quarterly, 9, 29–38. Chan, C. S. (1997). Don’t ask, don’t tell, don’t know: The formation of a homosexual identity and sexual expression among Asian American lesbians. In B. Greene (Ed.), Ethnic and Cultural Diversity Among Lesbians and Gay Men. Thousand Oaks, CA: Sage. Chin, J. L., & Russo, N. F. (1997). Feminist curriculum development: Principles & resources. In J. Worell & N. G. Johnson (Eds.), Shaping the Future of Feminist Psychology: Education, Research, and Practice. Washington, DC: American Psychological Association. Chrisler, J. C., & Smith, C. A. (2004). Feminism and psychology. In M. A. Paludi (Ed.), Praeger Guide to the Psychology of Gender. Westport, CT: Praeger. Cole, J. B. (1986). All American Women: Lines That Divide, Ties That Bind. New York: Free Press. Collins, P. H. (1990). Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. Boston: Unwin Hyman. Comas-Díaz, L. (1991). Feminism and diversity in psychology. Psychology of Women Quarterly, 15, 597–609. Crosby, F. J., & Sabattini, L. (2006). Family and work balance. In J. Worell & C. D. Goodheart (Eds.), Handbook of Girls’ and Women’s Psychological Health. New York: Oxford University Press.

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Denmark, F. L., & Paludi, M. A. (Eds.). (2008). Psychology of Women: A Handbook of Issues and Theories (2nd ed.). Westport, CT: Praeger. DeSouza, E. R., Baldwin, J., Koller, S. H., & Narvaz, M. (2004). Latin American perspective on the study of gender. In M. A. Paludi (Ed.), Praeger Guide to the Psychology of Gender. Westport, CT: Praeger Publishers/Greenwood Publishing Group. Diamond, L. M. (2007). A dynamical systems approach to the development and expression of female same-sex sexuality. Perspectives on Psychological Science, 2, 142–160. Fassinger, R. E., & Arseneau, J. R. (2008). Diverse women’s sexualities. In F. L. Denmark & M. A. Paludi (Eds.), Psychology of Women: A Handbook of Issues and Theories (2nd ed.). Westport CT: Praeger. Franks, V., & Burtle, V. (Eds.). (1974). Women in Therapy: New Psychotherapies for a Changing Society. New York: Brunner/Mazel. Fujitomi, I., & Wong, D. (1981). The new Asian-American women. In J. S. Cox (Ed.), Female Psychology: The Emerging Self. New York: St. Martin’s Press. Gilbert, L. A., & Osipow, S. H. (1991). Feminist contributions to counseling psychology. Psychology of Women Quarterly, 15, 537–547. Glied, S., & Kofman, S. (2006). An overview of policies that impact the psychological wellbeing of girls and women. In J. Worell & C. D. Goodheart (Eds.), Handbook of Girls’ and Women’s Psychological Health. New York: Oxford University Press. Goodheart, C. J. (2006). An integrated view of girls’ and women’s health: Psychology, physiology, and society. In J. Worell & C. D. Goodheart (Eds.), Handbook of Girls’ and Women’s Psychological Health. New York: Oxford University Press. Greene, B., & Sanchez-Hucles, J. (1997). Diversity: Advancing an inclusive feminist psychology. In J. Worell & N. Johnson, Shaping the Future of Feminist Psychology: Education, Research, and Practice. Washington, DC: American Psychological Association. Greene, R. (1980). Native American Women. Signs, 6, 248–267. Gump, J. P. (1978). Employment and sex role ideology in black women. In J. Sherman & F. L. Denmark (Eds.), The Psychology of Women: Future Directions of Research. New York: Psychological Dimensions, Inc. Halpern, D. F. (2005). Psychology at the intersection of work and family: Recommendations for employers, working families, and policymakers. American Psychologist, 60, 397–409. Kahn, A., & Jean, P. (1983). Integration and elimination or separation and redefi nition: The future of the psychology of women. Signs, 8, 659–671. Kitzinger, C. (2001). Sexualities. In R. K. Unger (Ed.), Handbook of the Psychology of Women and Gender. New York: John Wiley & Sons. LaFont, S. (2003). Constructing Sexualities: Readings in Sexuality, Gender, and Culture. New York: Prentice Hall. Landrine, H. (Ed.). (1995a). Bringing Cultural Diversity to Feminist Psychology: Theory, Research, and Practice. Washington, DC: American Psychological Association. Landrine, H. (1995b). Introduction: cultural diversity, contextualism, and feminist psychology. In H. Landrine (Ed.), Bringing Cultural Diversity to Feminist Psychology: Theory, Research, and Practice. Washington, DC: American Psychological Association. Lewin, M., & Wild, C. L. (1991). The impact of the feminist critique on tests, assessment, and methodology. Psychology of Women Quarterly, 15(4), 581–596. Lott, B. (1981). Dual natures or learned behavior: The challenge to feminist psychology. In R. Hare-Mustin & J. Marecek (Eds.), Making a Difference. New Haven, CT: Yale University Press. Lott, J. T., & Prian, C. (1979). Beyond Stereotypes and Statistics: Emergence of Asian and Pacific American Women. Washington, DC: Organization of Pan-Asian American Women. Maccoby, E. E., & Jacklin, C. N. (1974). The Psychology of Sex Differences. Stanford, CA: Stanford University Press. Marecek, J., & Hare-Mustin, R. T. (1991). A short history of the future: Feminism and clinical psychology. Psychology of Women Quarterly, 15(4), 521–536. Matson, M. R. (1983). Black women’s sex roles: The social context for a new ideology. Journal of Social Issues, 39, 79–100. Mays, V., & Comas-Díaz, L. (1988). Feminist therapy with ethnic minority populations: A closer look at Blacks and Hispanics. In M. A. Dutton-Douglas & L. E. Walker (Eds.), Feminist Psychotherapies: Integration of Therapeutic and Feminist Systems. Norwood, NJ: Ablex.

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McHugh, M. C., & Cosgrove, L. (2004). Feminist research methods: Studying women and gender. In M. A. Paludi (Ed.), Praeger Guide to the Psychology of Gender. Westport, CT: Praeger. Medicine, B. (1978). The Native American Woman: A Perspective. Las Cruces: New Mexico State University Press. Mirande, A., & Enriquez, E. (1979). La Chicana: The Mexican-American Women. Chicago: University of Chicago press. Moraga, C., & Anzaldúa, G. (1983). This Bridge Called My Back: Writings by Radical Women of Color. Kitchen Table – Women of Color Press. Murray, S. R., & Scott, P. B. (Eds.). (1981). A special issue on black women. Psychology of Women Quarterly, 6(3). Paludi, M. A. (Ed.). (2004). Praeger Guide to the Psychology of Gender. Westport, CT: Praeger. Rabinowitz, V. C., & Martin, D. (2001). Choices and consequences: Methodological issues in the study of gender. In R. K. Unger (Ed.), Handbook of the Psychology of Women and Gender. New York: John Wiley & Sons. Reid, P. T. (1993). Poor women in psychological research: Shut up and shut out. Psychology of Women Quarterly, 17, 133–150. Reid, P. T., & Comas-Diaz, L. (1990). Gender and ethnicity: perspectives on dual status. Sex Roles, 22(7/8), 397–407. Rodeheaver, D., & Datan, N. (1988). The challenge of double jeopardy: Toward a mental health agenda for aging women. American Psychologist, 43, 648–654. Russo, N. F. (1978). Beyond adolescence: Research on the psychology of women in the middle and later years. In F. Denmark & J. Sherman (Eds.), The Psychology of Women: Future Directions in Research. New York: Psychological Dimensions. Russo, N. F., & Dabul, A. (1994). Feminism and psychology: A dynamic interaction. In E. J. Trickett, R. Watts, & D. Birman, Human Diversity: Perspectives on People in Context. San Francisco, CA: Jossey-Bass. Russo, N. F., & Denmark, F. L. (1987). Contributions of women to psychology. Annual Review of Psychology, 38, 279–298. Safir, M., & Hill, K. (2008). International aspects of the development of the psychology of women and gender. In F. L. Denmark & M. A. Paludi, Psychology of Women: A Handbook of Issues and Theories (2nd ed.). Westport, CT: Praeger. Schultheiss, D. E. P. (2006). The interface of work and family life. Professional Psychology: Research and Practice, 37, 334–341. Smith, A., & Stewart, A. J. (1983). Racism and sexism in Black women’s lives. Journal of Social Trends (Special Issue), 39(3). Sue, D. W., Lin, A. I., Torino, G. C., Capodilupo, C. M., & Rivera, D. P. (2009). Racial microaggressions and difficult dialogues on race in the classroom. Cultural Diversity and Ethnic Minority Psychology, 15, 183–190. Travis, C. B., & Meltzer, A. L. (2008). Women’s health: Biological and social systems. In F. L. Denmark & M. A. Paludi (Eds.), Psychology of Women: A Handbook of Issues and Theories (2nd ed.). Westport, CT: Praeger. Travis, C. B., Gressley, D. L., & Crumpler, C. A. (1991). Feminist contributions to health psychology. Psychology of Women Quarterly, 15, 557–566. Unger, R. K. (2001). Women as subjects, actors, and agents in the history of psychology. In R. K. Unger (Ed.), Handbook of the Psychology of Women and Gender. New York: John Wiley & Sons. White, E. C. (1990). The Black Woman’s Health Book: Speaking for Ourselves. Seattle: The Seal Press. Wilkinson, D. (1980). Minority women: Social cultural issues. In A. M. Brodsky & R. T. HareMustin (Eds.), Women and Psychotherapy: An Assessment of Research and Practice. New York: Guilford. Worell, J., & Goodheart, C. J. (Eds.). (2006). Handbook of Girls’ and Women’s Psychological Health. New York: Oxford University Press. Worell, J., & Johnson, N. (1997). Shaping the Future of Feminist Psychology: Education, Research, and Practice. Washington, DC: American Psychological Association. Wyche, K. F. (2001). Sociocultural issues in counseling for women of color. In R. K. Unger (Ed.), Handbook of the Psychology of Women and Gender. New York: John Wiley & Sons.

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Wyche, K. F., & Rice, J. K. (1997). Feminist therapy: From dialogue to tenets. In J. Worell & N. G. Johnson (Eds.), Shaping the Future of Feminist Psychology: Education, Research, and Practice. Washington, DC: American Psychological Association. White, J. W., & Frabutt, J. M. (2006). Violence against girls and women: An integrative developmental perspective. In J. Worell & C. D. Goodheart (Eds.), Handbook of Girls’ and Women’s Psychological Health. New York: Oxford University Press.

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2 Multiple Lenses: Multicultural Feminist Theory

Aída Hurtado

Feminist theories in general and multicultural theory in particular have had an enormous effect on a variety of academic fields since the 1990s (Russo & Vaz, 2001). There is a popular, as well as a scholarly, demand to understand the power and impact of the dynamics of gender. Feminism has a direct bearing on people’s lived experiences because it started from the radical notion that, given women’s positionality, they had something worthwhile to say. Most important, the seminal pioneering feminist theorists assumed that women deserve to be heard and listened to (Littleton, 1989). Over the past several decades, feminist theorists have disputed the knowledge claims at the core of theory building, they have challenged in profound ways the construction of method, and ultimately they have questioned the “why and for what purpose” science is produced and who should benefit from this knowledge production. By asserting that women’s perspectives are valuable, feminist theorists defied the notion that knowledge production is independent of the knowledge producer and that it is objective or free from social influence. Instead, all knowledge is situated within a context and must take into account the positionality of the producer, as well as of the receiver, of knowledge. Within this

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simple relationship, the complexity of objectivity is fully disclosed: impartiality is impossible to attain when it comes to producing knowledge by humans for humans. Individuals, by definition, exist within social relations, embedded in a set of coordinates that are tentative, fluid, changing, subjective, and nondeterminative. It is within this web of social relations that feminist production takes place. Layered on these social coordinates is the practice of norms, values, expectations, motivations, histories, and languages, as filtered through culture, all of which gives multicultural feminisms its unique stake in knowledge production (Comas-Díaz, 2000; Vasquez, 2002). Put more simply, feminist multicultural theory is “theory in the flesh” (Moraga, 1981a) as humans live their existence on this planet. Multicultural feminism is not an ideation, abstraction, or philosophical artifice. The nexus for multicultural feminist theory is tucked within the everyday experiences of human beings who love, live, laugh, cry, and think.

The Origins of Multicultural Feminist Theory During the 1980s, a subgroup of feminist writers raised the critique that the diversity of women’s experiences, both within the United States and internationally, was not being fully addressed within the boundaries of traditional feminism (Russo & Vaz, 2001). Their arguments centered around cultural variations in definitions of gender relations and differences within cultures as determined by class, ethnicities, power, and other socially relevant factors. If the ultimate goal of feminist theorizing and political mobilization was to deconstruct and abolish patriarchy, then the multiple manifestations of patriarchy as they vary across cultures should be addressed in all feminist production (Hurtado, 2003a). In other words, multiple masculinities (Coltrane, 1994; Connell 1987, 1995; Pyke, 1996) and femininities (Pyke & Johnson, 2003) are filtered through different cultural manifestations of patriarchies. Multicultural feminist theory was developed in response to this compelling critique and has become a vibrant and prolific field within the larger field of feminist theorizing.

Core Concepts in Multicultural Feminist Theory Across the diverse landscape of multicultural feminist production, there are some common concepts—such as intersectionality, self-reflexivity (including the questioning of privilege), and accountability—that multicultural feminist scholars propose as the basis for their insights and perspectives (Collins, 2000; Perez, 1999; Williams, 2004). While not exhaustive, this list of concepts is illustrative of what multicultural feminist theorists bring to the table in knowledge production. For instance, through the lens of intersectionality, multicultural feminists study the product of multiple identities; through self-reflexity, the questions of privilege and methodology are addressed; and through accountability, the impetus for social and political change is inspired.

Chapter 2

Multicultural Feminist Theory

Intersectionality and Multiple Identities The understanding that women all over the world are subjected to multiple sources of oppression was fi rst documented by activists who were addressing the practical issues and needs of poor and racialized women as they coped with their disadvantages (Collins, 2006; A. Y. Davis, personal communication, February 3, 2007). Obviously the feminisms developed by such influential figures as Betty Friedan and Gloria Steinem could not be applied without modification to women in Africa, for example, who suffer from starvation as well as rape and other gender-specific oppressions based on cultural practices, political upheavals, and historical circumstances (White, 2007). The same is even true among African American women in the United States whose disadvantages have as much to do with their race as with their gender (Collins, 2000).

Intersectionality and the Law Nowhere is the inadequacy of examining gender oppression solely, without consideration of other sources of subordination, more apparent than in the law. Kimberlé Crenshaw’s (1989, 1995) seminal pioneering work on intersectionality eloquently exposed the inadequacies of the legal system in handling multiple sources of discrimination experienced by African American women. Crenshaw systematically demonstrated that, for example, in the case of employment discrimination African American women were forced to bring suit either as women or as Blacks; the courts would not accept their claims as Black women because that would create yet another protected category, with the potential of cumulative oppressions being endless. As stated by the courts: The legislative history surrounding Title VII does not indicate that the goal of the statute was to create a new classification of ‘black women’ who would have greater standing than, for example, a black male. The prospect of the creation of new classes of protected minorities, governed only by the mathematical principles of permutation and combination, clearly raises the prospect of opening the hackneyed Pandora‘s box (cited in Crenshaw, 1989, p. 142).

Crenshaw applied her incisive analysis of intersectionality to rape, where she found the law’s archaic assumptions of (White) women’s purity led to more punitive punishment toward Black men in the case of interracial rape and to less prosecution in the case of rape of Black women by all men. She also applied the intersectionality framework to domestic violence and found that the excessive punishment handed down by the criminal justice system to Black men led Black women to fear and refrain from reporting physical abuse by men in their communities. In addition to the legal realm, when Crenshaw explored the notion of political intersectionality, she found that Black women are forced to choose between joining political movements to end racism and joining feminist movements to end sexism. They find it difficult to be allied with both movements simultaneously (Crenshaw, 1995). Crenshaw’s work did not explicitly examine other social categories also used to oppress women, such as class and sexuality, but her work in the areas of race and gender sets

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up the conceptual framework for considering multiple sources of oppression within feminist analysis.

Intersectionality and Social Structure While Crenshaw’s analysis focused on the hidden legal injuries of intersectional subordination, Patricia Hill Collins (2000) focused on the non-legal, societal structures that collude to create the same phenomenon. As originally defined by Collins (2000), intersectionality is “an analysis claiming that systems of race, social class, gender, sexuality, ethnicity, nation, and age form mutually constructing features of social organization, which shape Black women’s experiences and, in turn, are shaped by Black women” (p. 299). Central to Collins’ analysis is the premise that societal structures are formed and sustained to exert power over people of color in general and African Americans in particular. From Collins’ perspective (2000): The very notion of the intersections of race, class, and gender as an area worthy of study emerged from the recognition of practitioners of each distinctive theoretical tradition that inequality could not be explained, let alone challenged, via a raceonly, or gender-only framework. No one had all of the answers and no one was going to get all of the answers without attention to two things. First, the notion of interlocking oppressions refers to the macro-level connections linking systems of oppression such as race, class, and gender. This is a model describing the structures that create social positions. Second, the notion of intersectionality describes micro-level processes—namely, how each individual and group occupies a social position within interlocking structures of oppression described by the metaphor of intersectionality. Together they shape oppression (p. 82).

Also central to Collins’ analysis is the notion that the media generate “controlling images” that lead to the objectification and commodification of black bodies, thereby justifying many kinds of oppressions, given that Blacks are not perceived as fully human. These controlling images, which Collins considered much more powerful and complex than simple stereotypes, have their origins in the institution of slavery. Historically, to justify the buying and selling of human beings in the slave trade, a set of images were developed to enforce institutional control and oppression. According to Collins, “the objectification of people of African descent as chattel, the commodification of objectified Black bodies as property, and the exploitation of Black people as property and as workers are all closely linked” (2004, p. 55). Controlling images are genderspecific and often complement each other. For example, the controlling image of the “bitch” is used to defeminize and demonize Black women whereas the controlling images of the Black male criminal and athlete help to substantiate the incarceration of Black men and the devaluation of their intellectual capacities (versus their athletic prowess). Collins also recognized that controlling images do not only apply to Blacks but to all people of color through a racialization process; the darker the individual (regardless of race), the more these controlling images are applied by various societal institutions. Controlling images are particularly relevant to the framework of intersectionality as they serve to disempower specific groups of women in different ways depending on the context.

Chapter 2


Intersectionality and Borderlands Theory Since the late 1980s, Chicana feminist scholars have been working at the forefront of intersectionality in multicultural feminism, exploring the psychological consequences of belonging to multiple derogated social formations (Flores, 2000; Vasquez, 2003). Following W.E.B. DuBois’ ideas on double consciousness, Chicana feminist theorists have posited several concepts theorizing on the experiences of Chicanas growing up “in the borderlands.” Gloria Anzaldúa (1987) proposed the border between Mexico and the United States as a metaphor for all types of crossings between geopolitical boundaries—for sexual transgressions, for social dislocations, and for existing in multiple linguistic and cultural contexts. Living in many liminal spaces (Lugones, 2003) results in the development of a mestiza (hybrid) consciousness that simultaneously embraces and rejects contradictory realities so as not to exclude what is critically assessed (Hurtado, 2003a). Other Chicana feminist writers have called this facultad (ability or gift) a “differential consciousness” (Sandoval, 2000), “multiple realities” (Alarcón, 1990), “multiple subjectivities” (Hurtado, 2003a), and a state of “conscientización” (Castillo, 1994). The notion is that women who are exposed to multiple social worlds, as defined by cultures, languages, social classes, sexualities, nation states, and colonization, develop the agility to navigate and the ability to challenge linear conceptions of social reality. As such, oppressions are not ranked nor are they conceptualized as static; rather they are recognized as fluid systems that take on different forms and nuances depending on the context. The intersectionality framework allows for the expression of multiple oppressions and forms of resistance that are not easily accessible through traditional methods of analysis and measurement. Borderlands Theory has been used in the social sciences (Hurtado, 2003a), literature (Saldívar-Hull, 2000), history (Pérez, 1999), education (Bernal, 1998) and political theory (BarvosaCarter, 2007; Barvosa, 2008), producing rich and unique analyses. Another application of Borderlands Theory is found in the analysis of intersectionality through the concept of social identities. Social identities are broadly defined in a variety of fields as an individual’s sense of belonging to significant social groups that have emotional meaning and social and political consequences (Hurtado & Gurin, 2004). From a social psychological perspective, the focus has been on the social identities that compose master statuses such as race, class, ethnicity, sexuality, and physical ability. Following the logic inherent in Borderlands Theory, these social identities are not additive; they do not result in increased oppression with an increased number of stigmatized group memberships. Instead, individuals’ group memberships are conceptualized as intersecting in a variety of ways depending on the social context (Hurtado & Gurin, 2004). Social identities, together with personal identity, constitute an individual’s sense of self (Tajfel, 1981, 1982). Because personal identity is somewhat independent from social identities, individuals cannot entirely override the negative and oppressive effects of their stigmatized social identities. For example, a poor African American lesbian with a physical disability will be treated in many social contexts according to her visible social identities rather than based on her individual characteristics, which quite possibly may include being a kind, gentle, and intelligent human being. Intersectionality as embodied in

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stigmatized social identities allows for an agile analysis of the different social contexts in which certain stigmatized social identities are more salient and likely to be used for oppression (Hurtado & Cervantez, 2009).

Self-Reflexivity and the Questioning of Privilege Self-reflexivity is considered an integral part of multicultural feminist theory because it acknowledges the researcher’s own multiple social identities and potential concomitant multiple subjectivities. Inherent in this standpoint is the recognition that all knowledge is strategic and partial (Haraway, 1988; Pérez, 1999; Sandoval, 2000). Self-reflexivity recognizes the influence of the individual in the normal course of knowledge production and at the same time, the inherent tension in questioning without rejecting and in critiquing within the “context of hope” (Dillard, 2000). Self-reflexivity also acknowledges the involvement of political power and privilege, however circumscribed, and the influence these advantages may have in knowledge production. As Pérez elaborates: “If I am the world, and I heal myself, then I heal the world.” These are personal private revolutions, each member of the collective taking responsibility for her/his contradictions within the collective, willing to grapple with the question, “Who am I exploiting?” (1991, p. 173).

Self-reflexivity is abundant in multicultural feminist writings (ComasDíaz, 2005; Hurtado, 2005; McIntyre & Lykes, 1998). There are several different levels of disclosure within the process of self-reflexivity. For some writers, self-reflexivity entails examining their significant social identities (such as race, class, and ethnicity) in the process of research and writing (Langhout, 2006). In particular, there is concern that the role of researcher, with its inherent higher social statuses, might lead to objectifying and distorting the individuals and communities under study (Comas-Díaz, Lykes, & Alarcón, 1998). Great care has to be taken to prevent non-conscious ideologies (Bem & Bem, 1997) from fogging the perspective and realities of those under study. Among the solutions advocated for researchers to redress potential biases are to learn the communities’ languages, to understand the context of the individuals and communities under study (e.g., their histories, socioeconomic statuses, power relations between different actors), and to engage in collaborations with those under study by making them co-participants in the research process (ComasDíaz et al., 1998; Torre, Fine, Alexander, & Genao, 2007). All of these safeguards ensure that self-reflexivity is enacted in ways that avert essentializing and oppressing those under study. Another level for implementing self-reflexivity is to include the researchers’ life experiences, thoughts, and personal backgrounds as an integral part of the research process. Feminists of color, especially African American writers, have been at the vanguard of writing from this very personal space (Anzaldúa, 2003; hooks, 2003, 2004, 2007; Moraga, 1981b). These writers use their personal trajectories to illustrate the importance of culture, history, politics, oppression, and language in knowledge production (Hurtado, in press). Self-reflexivity has also led to the study of whiteness (Fine, Weis, Powell Pruitt, & Burns, 2004). In multicultural feminist production, there is recognition

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that White women have race privilege that has consequences for the definitions of feminism (Hurtado, 1996) and for feminist research methods as well (Hurtado & Stewart, 2004). Furthermore, the personal disclosure necessary in self-reflexivity has potentially different political consequences for women of color writers than for White women writers. Whereas for White women the acknowledgement of race privilege can be perceived as a radical act of political commitment (McIntyre & Lykes, 1998), for women of color the disclosure can potentially lead to negative repercussions (Comas-Díaz & Jacobsen, 1995; Dillard, 2000; Hurtado, 2003b). The deconstruction of White privilege within feminist circles is still in progress; further study is needed to fully develop models of disclosure (McIntosh, 1992) and documentation (Vasquez, 2006), and ultimately dismantle the privileges accrued through whiteness (Morrison, 1992).

Changes in Methodology as a Result of Self-Reflexivity Multicultural feminist writers deploy a hybridity of methods and epistemological standpoints to circumvent their own subjectivities and biases in knowledge production (Dillard, 2000; Pérez, 1999; Sandoval, 2000). They also advocate the development of new methodologies, the affirmation of nontraditional methodologies, and the extension of the definition of method itself (Mahalingam & Reid, 2007). Methodologies should reflect the relational nature of knowledge that is subject to multiple perspectives to break down oppositional binaries in knowledge production. As such, multicultural feminist theorists have validated the use of the self to explore issues of oppression, history, resistance, and excavation of subjugated knowledge (Cuádraz, 2006). Among the proposed methods still in the making are autobioethnography (Cantú, 1995), personal narrative as historical analysis (Fregoso, 2003; Hurtado & Gurin, 2004), and the use of case studies to situate and acknowledge the personal nature of conducting research in particular areas (Lott & Bullock, 2007). Broadening the methodological options has led to an even greater number of interdisciplinary approaches that blur the theoretical boundaries between the social sciences, humanities, and, most recently, the natural sciences. The quest is to find innovative tools and discourses able to represent the diversity of human experience without relying on outmoded, linear, and colonizing representations (Morrison, 1992; Smith, 1999). Multicultural feminist theory has freed scholars to explore other writing genres and see how they help elucidate phenomena from different perspectives, further complicating and enriching the analysis—for example, historians writing fiction and feminist theory (Pérez, 1996, 1999), lawyers writing personal essays (Williams, 2004), film critics writing about international human rights (Fregoso, 2007), and psychologists writing about art production (Roberts, 2005). The very act of writing has also been expanded beyond its previous precepts. Traditional academic writing, for the most part, has relied heavily on single authorship. When working in collaboration, the roles of the collaborators must be documented to ensure that the authorship reflects the “actual work” invested in the final product. Of course, these guidelines limit collaborations mostly to academic ones and restrict other creative modes of knowledge generation. Through innovation, new methods of devising authorship have

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been broached. One approach is to establish groups of multidisciplinary scholars and practitioners who meet over long periods of time and produce written products that reflect the shared process of their collaboration (Cantú, 2006; Latina Feminist Group, 2001). Other writers have used their family histories and expanded their individual stories by interviewing family members to verify and review their analyses of family dynamics (Méndez-Negrete, 2006). Still other researchers have used participant action research (PAR) techniques to enlist research participants as coauthors (Pastor et al., 2007). The result of all of this experimentation is a lively, rich, and highly productive area of study that is producing fresh material for reflection and investigation.

Accountability and Social Change While self-reflexivity, to a certain extent, is all about the self, accountability is about the social and political act embedded in the constituencies being served by knowledge production (Collins, 2000). Instead of knowledge production for “management and control,” accountability is supposed to ensure that knowledge production is intended for transformation and achieving social equity (Hurtado, 1996). Accountability assumes that the self is not constituted in the individual; rather it is encased in a body that is socially connected and therefore its subjectivity is constituted through communal relations (Comas-Díaz et al., 1998; Rowe, 2005). Because of the inherent individualist nature of U.S. society and of Western academic production, the communal self is seen as a threat to the laws and social norms in most Western countries (Moraga, 2007; Woo, 2004). Multicultural feminist theorists are at the forefront of theorizing the communal self as an integral part of individuals, not as a special partition of the self (Comas-Díaz, 2005). For example, if one feels whole and happy only through belonging to and identifying with specific communities, then the happiness and well-being of those communities are essential to one’s well-being as well. As such, accountability is not an added burden or restriction, but a compelling reason for academic production and social existence (Hurtado, 2009). Collins (2000) does not connect accountability necessarily to this view of self; she situates accountability primarily as a political act for knowledge production. That is, if knowledge production is to be useful in the everyday lives of the constituencies that the author writes about or hopes to inspire, those constituencies should be the ones determining whether the knowledge produced is worthwhile. The academy, as well as the academic bodies within the university, should not be the only arbiters determining the value and standards of knowledge production (Collins, 2000). Accountability also opens the door to exploring various venues beyond academic outlets for disseminating knowledge production. Popular culture, magazines, trade books, public lectures, and art performance, for instance, are potential sites for publicizing the products of knowledge production (Roberts, 2005; Rose, 2001; Williams, 2004). In order to use these alternative venues, however, researchers also have to expand the research sites beyond what was previously viewed as within the privy of academic research. For example, Tricia Rose’s (1994) landmark study of hip-hop introduced this dance form as a subject worthy of academic examination and as a potential site for

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targeted intervention to engage young people, and thereby expanded the research methods available to theorists. The knowledge gained in the study of hip-hop can be connected to the development of photo voice as a method to engage urban youth with their surroundings, helping them to think critically about their neighborhoods, families, and peer relationships (Youth Advisory Committee, 2008).

Knowledge Production and the Inclusion of Sexuality The examination of sexuality is central to all aspects of multicultural feminism, including knowledge production. The feminist critique of heteronormativity and the developments in queer theory have been fully embraced by multicultural feminist theorists and have been integrated into the recent developments in this area of study. Sexuality is not set apart from multicultural feminist production; it takes center stage in examining feminist issues, with a focus on cultural manifestations in gay and transgendered communities across the globe (Cantú, 2002; Ochoa, 2006; Schaeffer-Grabiel, 2007). One central metaphor examined in multicultural feminism has been the consequences of “border crossings” be they physical, as in between countries; social, as in between groups; economic, as in changes in class status; psychological, as in the effect on subjectivities as a result of social and economic dislocations; and sexual, as when women immigrate because of the unwelcoming climate toward homosexuality in their native countries. Because multicultural feminists question existing paradigms, methods, and areas of study, multicultural feminism is a fertile area for cultivating new studies on sexuality. For example, Oliva Espín (1996a) writes about lesbians who immigrated to the United States from Cuba to avoid the stigmatization and political repression directed at them in their native country. In her work she analyzes two life stories, comparing the process of coming out to the process of emigrating from one country to another. From her perspective, “the process of coming out also demands a rewriting of the life story and, almost always, a migration to another cultural context even though the person may not actually move” (Espín, 1996a, p. 101). Both immigration and the coming-out process can result in stressful outcomes: These feelings include: loneliness due to the absence of people with shared experiences; strain and fatigue from the effort to adapt and cope with cognitive overload; feelings of rejection from the new society which affect self-esteem and may lead to alienation; confusion in terms of role expectations, values, and identity; “shock” resulting from the differences between the two cultures; and a sense of uprootedness and impotence resulting from an inability to function competently in a new culture (Espín, 1996a, p. 101).

Espín (1996a) also sees these feelings of dislocation as the beginning of growth toward a deeper sense of self and freedom. She concludes that all border crossings, be they between countries or sexualities, can lead to a mosaic of conflicting and contradictory identities from which individuals choose, depending on the social, political, economic, and ideological contexts. The examination of queer sexualities (Cantú, 2002; Greene, 2004; Pérez, 1999; Roque Ramirez, 2003, 2007; Trujillo, 1991) from a multicultural feminist

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perspective also opened up the study of heterosexual sexualities (Flores-Ortiz, 2000; Zavella & Castañeda, 2007; Tolman, 2002; Hurtado, 2003a). As illustrated by the work of Zavella and Castañeda (2007) and González-Lopez (2005), the migration process from Mexico and the rest of Latin America also results in heterosexual women and men undergoing transitions in their sexualities. Both studies explore how coming to the United States results in, in some instances, restrictions in enacting sexuality because of the lack of available partners, and in other instances, increases in sexual exploration as local and familial ties are loosened by coming to a new country. In summary, a critical aspect of knowledge production in multicultural feminist theory is to embrace the uncertainty and instability of “knowing” at the same time that something must be done now about social inequality (Moya, 2002). The fluidity of this position can lend itself to waste, detours, chaos, and unsettled feelings, knowing that nothing can be known for certain. In other words, multicultural feminist knowledge production embraces all of the stereotypes often attributed to “feminine nature”; it claims that knowledge production has always been unpredictable but that masculinist narratives stressing order and linearity obscure its true nature (Morawski & Bayer, 1995). Most important, multicultural feminist theory assumes that knowledge produced from this standpoint is not only valid but is likely to come closer to the true nature of all knowledge, especially if we mean to apply our discoveries to making the world a better place (Moya, 2002). It is a tremendously hopeful posture.

Emerging Strands in Multicultural Feminist Theory A continued trend in a particular brand of White feminist scholarly production that has received acceptance and reward within the academy is the endorsement of abstract theory, with very little reference to lived experience. Nussbaum (1999) summarizes this trend as “the virtually complete turning from the material side of life, toward a type of verbal and symbolic politics that makes only the flimsiest of connections with the real situation of real women” (p. 38). In this context, activism and applied work are devalued as naive, provincial, and atheoretical (Moya, 2002). A corollary to this standpoint is a growing disdain among this brand of theorists toward analyzing the local in favor of the transnational (Soto, 2005). Ironically, feminisms in general and feminisms produced by writers of color have always been in solidarity with international progressive political movements (Sandoval, 1991). Whatever limitations the early attempts at internationalization led to (for example, the analysis in Robin Morgan’s anthology Sisterhood is powerful [1970]), the commitment to address women’s position all over the world has always been present and paramount. This is not to say that the ideological commitment has not always succeeded or that the commitment has always been followed by concrete, proactive action (Russo & Vaz, 2001). For many feminists of color, the international commitments are an extension of their ethnic and racial connections and historical rootedness in their ancestors’ origins—for example, the African American feminists’ link to the political struggles in Africa (White, 2007) and the Chicana feminists’ relationship to political struggles in Latin America (Arredondo, Hurtado, Klahn,

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Nájera-Ramirez, & Zavella, 2003; Sandoval, 1991). There is no need to bifurcate multicultural feminist production into U.S.-based versus transnational since there is much fluidity in all feminist writings (Collins, 2006; Soto, 2005). This hierarchical division has regrettably displaced White feminism grounded in application (Nussbaum, 1999) and has significantly silenced the work of many feminists of color who have refused to abandon their activist roots and continue to address the local within their feminist theorizing (Collins, 2006; hooks, 2000; Hurtado, 2003a).

Empirical Work The privileging of theory has also sidetracked the importance (or necessity) of empirical work (Moya, 2002). Empiricism has been equated with “methodism” (Brown, 1997) and, as a result, the initial impetus and approach in the field of feminism (that is, to simply ask women what they think about their lived experiences) have been placed in question. Instead, the intellectual is positioned as the expert to theorize women’s existence (Wiegman, 2005). While feminist theoretical production has gained legitimacy in the academy (e.g., Butler, 1990, 1993, 1997a, 1997b), it has not gained much in terms of its relevance to its original constituency and objective—making women’s lives better in their everyday existence. As stated by Nussbaum (1999), abstract theory alone will not remedy the fact that “hungry women are not fed by this, battered women are not sheltered by it, raped women do not find justice in it, gays and lesbians do not achieve legal protection through it” (p. 45). The move toward theory, and away from empiricism, has not happened without controversy. The debate about the “impossibility” (Brown, 1997) and the “possibility” (Wiegman, 2005) of women’s studies has largely been held among White feminist writers (Nussbaum, 1999). In determining the future of women’s studies, the analysis and input of feminists of color have been mostly ignored (Soto, 2005). This is unfortunate because multicultural feminists could contribute much by broadening the terms of the debate and extending the definitions of self beyond the liberal Western concepts of individual rights (Landrine, 1995; Rowe, 2005; Lugones, 2003; Moya, 2002); widening the Western cannon to include analytic work in ethnic studies and writings from Latin America, Africa, Asia, and other areas of the world (Alvarez, 2000); and expanding the use of method and writing processes (Anzaldúa, 2003; Torre et al., 2007; Latina Feminist Group, 2001). Unlike White “academic feminism” that by “the new century … had gone apocalyptic” (Wiegman, 2005, p. 40), multicultural feminist theory is immensely hopeful, believing that academic production in its various hybrid forms can indeed transform the world—to what exactly is to be determined collectively (Moya, 2002). As Vasquez (2002) states: “Psychologists bear a social responsibility to promote the public interest by sharing relevant research and knowledge to influence court decisions, legislation, and policy” (p. 880). Feminists of color, especially those focusing on U.S. issues, have persisted in bringing issues of poverty, racism, homophobia, and classism to the forefront (Collins, 2000; Comas-Díaz, 2000; Moya, 2002; Saldívar-Hull, 2000). As such, their writings continue to emphasize the concreteness of feminism in the broadest meaning of the term—that is, women’s liberation from poverty, prejudice, discrimination, and the continued persistence of sexism in its subtler, more sophisticated manifestations.

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Feminism and Practitioners While these debates rage in the academy, multicultural feminist theory is being embraced by practitioners in various areas as a useful tool in framing their practice (Comas-Díaz, 2005). Surprisingly, clinical and counseling psychologists have implemented many of the proposals made by multicultural feminist theorists (see Enns in this volume for a comprehensive review; Barrett, Chin, Comas-Díaz, Espín, Greene, & McGoldrick, 2005; Comas-Díaz & Jacobsen, 1995; Espín, 1996b; Russo & Tartaro, 2008). The increasing ethnic and racial diversity in the United States, the enormous volume of immigration from all over the world, and the increasing globalization of the U.S. economy have provided the impetus for infusing multiculturalism into psychological therapies to help individuals, especially women, outside the White mainstream practices on which most therapies in the United States are based (Comas-Díaz, Lykes, & Alarcón, 1998). Organizational psychology is another area that has taken multicultural feminist theory seriously. In particular, organizational psychology has been in charge of developing mechanisms for adapting to the increased participation of women in leadership positions (Bell, Meyerson, Nkomo, & Scully, 2003) and for companies’ transition into a multicultural workforce worldwide (Holvino, 2008). The academy and education in general have not been as quick to take up a multicultural feminist agenda in reworking curricula, pedagogies, or even hiring practices (Hurtado, Cervantez & Eccleston, 2009). The challenge that remains ahead is to increase the visibility of multicultural feminist theory in other areas, including popular media such as television, films, and print. For example, intersectionality can be applied to children’s multicultural television so that derogated social identities, including gender and sexuality, are addressed and made apparent to a large audience. Children are targeted to initiate their socialization into a consciousness about inequalities in the world early in life (Hurtado & Silva, 2008).

Bringing Other Constituencies Into the Fold: Toward a Developmental Multicultural Feminist Theory In 1995, Hope Landrine issued an urgent call to the field of psychology to include the analytic work on the dominant and privileged in framing the feminist agenda: [To] bring cultural diversity to feminist psychology requires not only a focus on the cultures of others but a focus on European American cultures. As long as ‘cultural diversity’ means ‘how those minorities are yet different’ (from whom?), diversity discourse eloquently eludes addressing, yet quietly maintains, existing social arrangements.…Culture will be regarded with dignity and the sociology of knowledge altered only when European American cultures are treated like all others. (p. 16)

Landrine called for a multicultural feminist analysis that is multipositioned to maximize the number of lenses through which various cultural contexts are examined. A group of Chicana feminists proposed the metaphor of a

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glorieta (a roundabout) to describe the analytic process: a central standpoint from which dialogue with multiple constituencies and audiences is engaged, depending on which avenida (avenue) is being addressed (Arredondo, Hurtado, Klahn, Nájera-Ramírez & Zavella, 2003). In the words of the authors: The avenidas that we face in the glorieta allow Chicana feminists to make assessments of power in relation to our varied locations. Like a Mexico City glorieta, the dialogue is fast-paced, fluid, and flexible, at times unnerving, it forces intellectual dexterity. Such agility is foundational to the Chicana feminist project, which intervenes in important ways to raise consciousness and further the struggle for decolonization against multiple oppressions. (pp. 2–3)

This intellectual position echoed Landrine’s (1995) concern to shine the spotlight of analysis not only from the top down; the analysis must be multivalent and gyrational to fully capture the significance of cultural context in influencing all human experience. In addition, Arredondo et al. (2003) proposed that multicultural feminisms address the developmental life cycle of women by including girls and young and older women in its analysis, thereby rectifying an earlier omission in the field of feminism that emphasized the adult years. Many feminists of color have also advocated the inclusion of young men of color in feminist analyses as this constituency increasingly comes under attack by the state as demonstrated by high drop-out rates from educational institutions and increased numbers in the criminal justice system (Collins, 2006; Hurtado & Sinha, 2006). Below I develop some of these ideas as I propose a developmental multicultural feminist theory as one of the important areas for future development.

Enlisting Girls and Young Women in Multicultural Feminist Theory Creation A major concern for the future of feminist theory in general is the integration of a younger generation of writers, practitioners, and innovators. Given the current high school dropout rates, the poor college graduation rates, and the ethnic and racial composition of doctoral programs and academic faculty, the racial and ethnic “integration” of young feminist writings is apparently limited to outliers and is not yet reflective of the populations of color in the United States. The existing writings by young feminists are predominately by White middle-class writers, who cast a nod in the direction of multicultural positions but are limited in integrating such positions into the actual production. Furthermore, recent multicultural feminist production has taken place mostly among academics; even the writings outside the university are produced mostly by writers with university degrees (Anzaldúa & Keating, 2002; Baumgardner & Richards, 2000; Hernández & Rehman, 2002). The continued exclusion of women of color from academic production is the result of the failures of the education pipeline, where statistically women of color in higher education are still a rarity. For example, in 2002, 51.7% of young women (under the age of 21) graduated from high school, the majority of them were White (66.7%), followed by Latinas (13.7%), with most women of color having much lower graduation rates (Black women 12.6%, Asian women 4.7%,

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biracial women 1.7%, and 0.4% unknown). Of the women graduating with bachelor degrees, the majority again were White (73.3%), followed by Black women (10.4%), with most women of color having much lower graduation rates (Latinas 6.7%, Asian women 6.1%, non-resident aliens 2.7%, and American Indian/Alaska natives 0.7%). Similarly, of the total master degrees granted, the majority were earned by White (64.7%) women, followed by non-resident aliens (foreign students, 18.8%), with most women of color having much lower rates of advanced degree attainment (Black women 5.9%, Asian women 5.9%, Latinas 4.9%, and American Indian/Alaska natives 0.5%). The trend continues at the doctoral level where the majority of doctorate degrees were earned by White women (66.4%), followed by non-resident aliens (16.8%), with most women of color having much lower rates of degree attainment (Black women 7.2%, Asian women 5.3%, Latinas 3.8%, and American Indian/Alaska natives 0.6%) (U.S. Department of Education, 2003). In 2003, of the 39.3% of woman professors in 4-year universities in the United States, the majority were White (31.56%), followed by Black (2.7%), with most women of color having much lower rates (Asian women 2.1%, Latinas 1.4%, multiracial 0.4%, American Indian/Alaska natives 0.2%, and nonresident aliens 0.1%) (U.S. Department of Education, 2004). Given these dire statistics in higher education, new creative modes of multicultural feminist production need to be developed and employed to increase the participation of young women in creating the feminisms of the future. Fortunately, there have been some exciting breakthroughs in this area of study in recent years.

Recent Innovations in Multicultural Feminist Theory Production One new approach that increases age diversity in feminist theory is the collaborative research models developed within the academy. Armed with the tools of Participant Action Research (PAR), Michelle Fine and her colleagues have produced collaborative pieces exploring feminist issues that are written for academic outlets, perhaps for the first time, across differences in “generations, colors, classes, and ideologies” (Pastor et al., 2007, p. 75). These innovative projects encourage young participants (middle and high school students) to learn research methods, produce art pieces (like spoken word), perform their work, and collaborate in the writing of the final product for academic publishing. As part of their strategy of inclusion, the researchers use different modes of knowledge production than those usually accepted in formal research projects. For example, Pastor and colleagues (2007) have integrated their young collaborators’ poems that document the structural and personal disadvantages experienced in their homes, schools, and society at large. As poignantly illustrated below, in a poem by the high school student Tanzania Roach, a complicated set of social and economic relationships is revealed. Many young women would have trouble articulating these complicated ideas without the freedom of expression encouraged by the poetry genre. Don’t thrust anymore of your sick ideas into my head1 like a rapist thrusts his body into his screaming victim

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don’t force me to say what you want like a rapist forces his victim to perform debasing sexual acts Don’t leave me crying without a shred of confidence to go on without a shred of dignity to continue living Don’t make me second guess myself when I know I have the right to speak You’ve left me with the hate I never asked for Rapist. Racist. They look almost the same. Rapist. Racist. They are the same.

In her poem Roach, listed as a coauthor of the chapter (Pastor et al., 2007) in which the poem appears, astutely deconstructs the intersection of the systems of subordination imposed on her because of gender, race, sexuality, and class (Collins, 2000). She concludes that although the sources of oppression may be different (rapist versus racist), the negative outcome to her well-being is the same: she cannot develop a confident personhood that allows her to function and control her life. Through collaboration with the academic researchers, this young woman’s voice enters the feminist dialogue and thereby inserts a new perspective rarely seen in academic production. Most important, her voice is not filtered through the researchers’ intellectual lens and research method; Roach is witness to her own experiences and theorizes her position in life. Similarly, Torre, Fine, Alexander, and Genoa (2007), two psychologists and two youth performers, wrote the PAR study documenting the construction and performance of the theater piece Echoes of Brown: Youth Documenting and Performing the Legacy of Brown v. Board of Education. The authors’ goal was to write about the “patterns of naturalized cumulative educational injustice and disrupt taken-for-granted patterns of inequity” (Torre et al., 2007, p. 223). Written collaboratively, the chapter is based on interviews and written data from the young women who participated in the theater production of Echoes, as well as the authors’ experiences in producing and performing the work. In the final written product, the first-person pronoun shifts between “we” and “I” to signal the collective experience and permit each author to distinguish her individual thoughts. Both of these research projects illustrate the guiding assumption of the PAR researchers—that young women are “the best narrators of [their] lives” (Pastor et al., 2007, p. 75). Notwithstanding these innovative approaches that interject young women’s voices in multicultural feminist studies, feminist researchers of middle and upper class origins reporting on White adult women continue to dominate academic production, which is still the primary source for disseminating feminist ideas.

Including Older Women and Nontraditional Families in Multicultural Feminist Analysis The high divorce rates found in all ethnic and racial groups, the increasing participation of women working outside the home, and the higher life expectancy for women compared to men, all pose pressing feminist questions. These demographic trends point to an increased need for diverse living

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arrangements, especially for older women. Some women on reaching retirement age are pooling their resources and creating collective living arrangements. In other instances, they are simply living near one another and sharing semi-communal eating and cleaning agreements. In still other instances, they have actually combined their assets to buy large houses to accommodate their different lifestyles and needs under one roof. Some have sold their previous homes and started from scratch, designing innovative housing that has both private and communal areas, moving beyond the conventional houses designed for nuclear families. Of note, men have not followed suit in creating such innovative living arrangements as they grow older (Gross, 2004). These changes to the family structure made by older women are one part of a much larger trend toward what can be considered the “post-nuclear family” (Hurtado, 2009). Another example of alternative families is seen among gays and lesbians who adopt children in the United States as well as from other countries. Lesbian couples are using donors from sperm banks or male friends and relatives to have biological children. Some lesbian couples are alternating having biological children from the same donor, creating a sibling bond among their offspring, an unprecedented phenomenon. Heterosexual single women are also having biological children through sperm banks and, in some cases, are locating other single mothers with children from the same donor. These women are creating semi-structured families in which the biologically related children have the opportunity to develop familial bonds. Of course, at every step of the decision making, these individuals are making choices about the race and ethnicity of not only their partners but of the donors as well. As such, multicultural families, especially among gay and lesbian couples, are at the forefront of changing the family unit as we know it. Similarly, families of color have never fit the normative composition advocated by White hegemony. The histories of slavery, colonization, and forced and semi-forced migration have affected the composition and functioning (as well as meaning) of these families (Baca Zinn, 2000). However, White feminist theory takes as its central point of departure a heterosexual nuclear family. The families that do not fit the mold, whether they be White or of color, remain undertheorized (Fine & Weis, 1998). The increasing diversification and recognition of these changes in family units poses new and profound questions for multicultural feminist theory. If the impetus for the feminist movement in the 1960s and 1970s was largely based on scrutiny of the nuclear family, the decentering of the nuclear family in favor of more varied family structures, especially as women get older, prompts important questions about conventional patriarchal arrangements. For instance, how do nontraditional families subvert the power of patriarchy and what are the longterm consequences of the erosion of the nuclear family structure? Are the innovative living arrangements made by older women a feminist move? If so, in what ways, and how can this new-found freedom to determine living arrangements independent of heterosexual proscriptions contribute to subverting patriarchy? Furthermore, do these living arrangements among older women, following the theorem of “theory in the flesh,” influence young people, especially young women, who may wish to consider an existence beyond heterosexual arrangements? Do the new families built by gay, lesbian, and single women also subvert patriarchy, which is largely based on a nuclear family system?

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Further still, as economic globalization continues to expand, women all over the world are influencing the economic and, consequently, social fabric of families and communities. The World Bank, as well as other foundations interested in funding economic opportunities, has found women workers to be the most reliable investment for economic development. Small cash infusions in the form of loans for cottage industries in such economies as India and Africa have resulted in exceptional returns, primarily benefiting children in these families. These organizations have found that women pay off loans more reliably than men, invest more productively than men, and are more likely to use the benefits of their economic stability to give their families secure and healthy lives. Will economic independence, however limited, result in changing patriarchal arrangements in these societies? All of these questions are relevant to the future of multicultural feminist theory.

Relating to Oppression: Including Young Men of Color in Multicultural Feminist Analysis In Relating to Privilege: Three Blasphemies on Race and Feminism (Hurtado, 1996), I proposed that White women derive a degree of structural and emotional privileges from their familial relationships to U.S. White patriarchy. As daughters, mothers, sisters, spouses, cousins, and aunts to White men, White women inherit a relational power dynamic that informs their perspective and thus their feminisms. Conversely, women of color cannot biologically provide the pure White offspring necessary for White patriarchy to reproduce itself. This distance from and barred biological access to White patriarchy results in the aperture for a different kind of feminist platform that is at times at odds with White feminisms. For example, the increased incarceration of men of color, especially of boys and young men, has created a new concern among feminists of color. For many, it is not an uncommon experience to have a brother, father, uncle, cousin, or other male relative in the criminal justice system. As such, many feminists of color find themselves relating to the oppression of incarcerated men from their communities. Differences in incarceration rates for men of color, as well as their underachievement in the academy, has made these men’s inclusion into a feminist movement a central issue—one that has not been embraced by White feminists of any age. However, feminists of color do not adhere to the notion of the “plight of the Black [of color] male” (White, 2008); they have instead opened the analysis to focus on patriarchy as the central problematic in the current incarceration trends. The study of masculinities of color is to add “complexity to more traditional approaches to social phenomena that focus only on race, class, or gender, by broadening our understanding of how mechanisms of institutional power mesh with personal expressions of power” (White, 2008, p. 19). Another contribution made in the area of multicultural feminist masculinities is the examination of men of color who are thriving and who call themselves feminists (Hurtado & Sinha, 2008; White, 2008). This positive analysis counteracts the deficit thinking inherent in the social problem approach currently in vogue in the study of men of color. Central in the analysis of the feminisms of men of color is the outlining of “new masculinities” that do not depend

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on the domination of women as central to men’s definition of self (Hurtado & Sinha, 2008; White, 2007). Expansion of the definition of manhood may also contribute to a multicultural developmental feminist theory in which the relationships between young people can achieve and benefit from more equitable arrangements.

Future Directions in Multicultural Feminist Theory Production There is no doubt that multicultural feminist theory has made tremendous inroads in the field of psychology largely due to the efforts of committed psychologists of color (Russo & Vaz, 2001) working in collaboration with their White allies. As Russo and Vaz indicate: Since its emergence as a field in the 1970s, women psychologists of color, albeit few in number, have been active participants in feminist psychology. They have been leaders in advocating more complex perspectives on gender and have shaped an inclusive vision for the field. (p. 280)

One of the biggest challenges remaining is to turn the theoretical insights multicultural feminists have so courageously developed into empirical projects (Shields, 2008). There is, for instance, a pressing need to design studies that do justice to the complexity of intersectionality. Far from conclusive, some promising starts merit our attention.

Contributions to the Empirical Study of Intersectionality Intersectionality is commonly thought of as embodied in individuals’ social identities (Hurtado, 2003a; Shields, 2008). Which particular intersecting categories gain significance at a given time is dependent on social context (Hurtado & Gurin, 2004). Deaux and Perkins (2001) refer to intersectionality as the “kaleidoscopic self”; Arredondo et al. (2003) as a glorieta (a roundabout); and Hurtado and Gurin (2004) as a “multivalent amoeba”—all of these terms are used as metaphors to describe the fact that intersectional identities are best highlighted through the specification of the context and/or through the specification of the identificational intersection under study. In other words, an intersection of social identities can be examined from the perspective of the context (or background) in which it occurs or the intersection can be examined from the perspective of the exact nexus (or foreground) of the particular intersection under study. To illustrate these two ways of examining intersectionality, I refer to two studies. In my study of educationally successful Chicanas (Hurtado, 2003a), I asked the respondents about each of their significant (and potentially stigmatizing) social identities separately—first race, followed by ethnicity, sexuality, gender, and social class. When I inquired about their class background, I asked the open-ended question, “When you were growing up, how would you describe your class background?” In this instance, intersectionality is examined by focusing on the context in which that social identity manifests itself.

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The question specifies the context, the time period “when you were growing up,” which by definition takes into account the ethnic and racial composition of the respondent’s neighborhood, the social class based on the family’s economic resources (however family was defined by the respondent), and a specific developmental stage (prior to leaving home for college). The answers provided by the respondents were complex and richly textured with the social realities many of them negotiated growing up poor or working class. For example, they mentioned growing up in neighborhoods where almost everyone was Mexican and poor; therefore they did not perceive themselves as economically deprived. Furthermore, it allowed the respondents to acknowledge their change in class status (the changing “multivalent amoeba”) as many of them moved from predominantly working class, ethnically and racially segregated neighborhoods to the more middle class institutions of higher education. Many of the respondents who experienced these social disjunctures spoke eloquently about how their perceptions of their class status changed as their basis for social comparison changed (Tajfel, 1981) from the residents in their neighborhoods to their fellow students who came from much more privileged backgrounds. Many of the respondents in this study were the first in their families to attend college (Hurtado, 2003a). The Hurtado and Sinha (2008) study illustrates the second approach to analyzing intersectionality, focusing on a particular identificational intersection rather than the background or context in which the intersection occurs. In this study, we examined the views of working class, young, educated Latino men on manhood by asking the open-ended question, “What does manhood mean to you?” We did not specify a particular context (e.g., in your family, in your culture, in your peer group) or a particular developmental stage in their life (as we did in the sample of Chicanas discussed above). The question asked the Latino men was about their perception of a particular facet of their identity. The question required the respondents to take into account how their gender, race, class, sexuality, race, ethnicity, and social class intersected with their concept of manhood. The respondents spoke eloquently and freely on how their definitions of manhood were influenced by all their social identities: of the 36 respondents, 36 mentioned their race, 32 mentioned their ethnicity, 22 mentioned their social class, and 8 mentioned their sexuality (Hurtado & Sinha, 2008). Furthermore, rather than mentioning each social identity separately, the respondents’ comments on their social identities and definitions of manhood were relational and imbedded in rich, textured narratives (Hurtado & Sinha, 2008). Because of the multiple facets and layers created by intersectionality, researchers of empirical studies often choose qualitative over quantitative methods when applying the framework of intersectionality. McCall (2005), however, proposes that quantitative methods can also be used (albeit not at the expense of qualitative methods) to examine the complexities of intersectionality. McCall asserts that qualitative methods have been “privileged” when examining intersectionality because it is assumed that quantitative methods would simplify the effects of intersecting social categories. Indeed, she agrees that qualitative methods may be necessary to fully disclose the layered and nuanced meanings generated by intersectionality. McCall, however, proposes that quantitative methods can be applied by specifying which categories

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are under study (class, gender, for example) and the conditions under which the specified categories are being examined. Furthermore, a researcher can acknowledge that the social categories specified through quantitative methods are tentative, contingent, and artificially bound for the purpose of study, and that the content of the categories may change with time, method of measurement, and context. In summary, multicultural feminism forces us to think in complex, relational, and contextual ways whenever examining human relations—a very tall order indeed. The push within multicultural feminist theory has been to follow the assessment of these conceptual complexities with concrete empirical studies and without abandoning the centrality of lived experience that has been the bedrock of feminism.

Conclusion In 2000 bell hooks wrote that “feminism is for everybody.” hooks’ assumption was that feminism was a “living theory” (Hurtado, 2003a) that can be useful and applied to everyone’s life. The challenge, however, has been how feminism translates from the academy to everyday life. I would argue that its usefulness is dependent on infusing feminism with a developmental perspective such that core principles discussed in this chapter—intersectionality, selfreflexivity, and accountability—are explicitly taught not only in schools but are made accessible to various constituencies in a variety of venues. The exploration of methods, different venues for publication, inclusion of new voices, and expansion of dissemination of feminist knowledge production can all be used to further explore what feminism means and to enhance, modify, challenge, fight, and survive one’s everyday existence. Consciousness about gender disparities as well as other injustices does not happen through “spontaneous combustion” (Hurtado & Silva, 2008). This is especially the case when many institutions in society are structured to keep individuals from questioning the existing power arrangements. Gender, especially, has become so naturalized that all gender disparities have an easily available biological explanation that is extremely difficult to dispute, even among highly educated people. As such, it takes counter-hegemonic education to gain a feminist consciousness. An integral part of the feminist project, then, requires that consciousness about social injustice be taught as early as possible for feminism to be viable throughout the life cycle (Cole & Stewart, 1996). For example, the children’s TV cartoon “Little Bill” takes on multiple social issues in age-appropriate episodes, teaching children about the disadvantages created by the intersecting, derogated social categories of race, class, gender, physical ability, and ethnicity. Hurtado and Silva (2008) have examined the animated series using an intersectional lens. Unfortunately, sexuality is not addressed in the series. Feminism, then, needs a living curriculum that facilitates a counterhegemonic narrative about injustices and that provides avenues for social change throughout the life cycle. Multicultural feminist writers have set the stage for the next phase of feminism and its usefulness for deconstructing, and ultimately, obliterating existing power arrangements. If we accept the premise

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that multicultural feminisms are central to social action through research and influencing social policy, then what have we accomplished so far? Although multicultural feminism is still a counter-hegemonic movement, many of its proposals have been adopted by the mainstream—laws against sexual harassment, women’s reproductive rights, women’s entry into every sector of higher education, normalizing cohabitation before marriage, same-sex marriage, conceiving and raising children in gay and lesbian families, single-chosen parenthood, among many other revolutionary social rearrangements. Many of these accomplishments are the result of multicultural feminist theorists embracing science as an endeavor, not rejecting it because of its inherent subjectivity; instead they conceive of knowledge production for what it is—a strategic, purposeful, and relational endeavor. As such, multicultural feminist writers are true believers in knowledge production precisely because they acknowledge both its limitations and its immense potential. Knowledge production sensitive to the historical conditions that produced it, as well as the human relations involved, can indeed lead to more comprehensible, consumable, and useful knowledge. The questioning of boundaries and methods has not led to an intellectual cul-de-sac where nothing can be known or altered but to a multiplicity of perspectives where patterns, concerns, goals, applications, and solutions (however partial) can be negotiated in collaboration with a diverse group of others. Multicultural feminist theory has much to offer toward the rearrangement of existing social relations. We have just begun.

Endnotes 1. The poem “Don’t Hurt Me Anymore” (1995) is used with permission from Tanzania Roach, copyright by Ms. Roach. For more information please contact [email protected].

References Alarcón, N. (1990). Chicana feminism: In the tracks of “the” native woman. Cultural Studies, 4(3), 248–256. Alvarez, S. E. (2000). Translating the global: Effects of transnational organizing on local feminist discourses and practices in Latin America. Meridians: Feminism, race, transnationalism, 1(1), 29–67. Anzaldúa, G. (1987). Borderlands/La frontera: The new mestiza. San Francisco: Aunt Lute Books. Anzaldúa, G. (2000). Interviews/entrevistas. New York: Routledge. Anzaldúa, G. (2003). Now let us shift...the path of conocimiento ... inner work, public acts. In G. Anzaldúa & A. Keating (Eds.), This place we call home: Radical visions for transformation (pp. 540–578). New York: Routledge. Anzaldúa, G., & Keating, A. (2003). This bridge we call home: Radical visions for transformation. New York: Routledge. Arredondo, G. F., Hurtado, A., Klahn, N., Nájera-Ramirez, O., & Zavella, P. (Eds.). (2003). Chicana feminisms: A critical reader. Durham, NC: Duke University Press. Baca-Zinn, M. (2000). Feminism and family studies for a new century. The Annals of the American Academy of Political and Social Sciences, 571(1), 42–56.

49

50


Barrett, S. E., Chin, J. L., Comas-Díaz, L., & Espín, O. (2005). Multicultural feminist therapy theory in context. Women and Therapy, 28(3/4), 27–61. Barvosa-Carter, E. (2007). Mestiza autonomy as relational autonomy: Ambivalence and the social character of free will. The Journal of Political Philosophy, 15(1), 1–21. Barvosa, E. (2008). Wealth of selves. Multiple identities mestiza consciousness and the subject of politics. College Station, TX: Texas A&M University Press. Baumgardner, J., & Richards, A. (Eds.). (2000). Manifesta: Young women, feminism, and the future. New York: Farrar, Straus and Giroux. Bell, E. L. J. E., Meyerson, D., Nkomo, S., & Scully, M. (2003). Interpreting silence and voice in the workplace: A conversation about tempered radicalism among Black and White researchers. Journal of Applied Behavioral Science, 39(4), 381–414. Bem, S. L., & Bem, D. L. (1997). Training the woman to know her place: The power of a nonconscious ideology. In T. A. Roberts (Ed.), The Lanahan readings in the psychology of women (pp. 419–428). Baltimore: Lanahan Publishers. Bernal, D. D. (1998). Using Chicana feminist epistemology in educational research. Harvard Educational Review, 68(4), 555–582. Brown, W. (1997). The impossibility of women’s studies. Differences: A Journal of Feminist Cultural Studies, 9(3), 79–101. Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York: Routledge. Butler, J. (1993). Bodies that matter: On the discursive limits of “sex.” New York: Routledge. Butler, J. (1997a). Excitable speech: A politics of the performance. New York: Routledge. Butler, J. (1997b). The psychic life of power: Theories in subjection. Palo Alto, CA: Stanford University Press. Cantú, L. (2002). De ambiente: Queer tourism and the shifting boundaries of Mexican male sexualities. GLQ: A Journal of Lesbian and Gay Studies, 8(1/2), 139–166. Cantú, N. E. (1995). Canícula: Snapshots of a girlhood en la frontera. Albuquerque, NM: University of New Mexico Press. Cantú, N. E. (Ed.). (2006). Flor y ciencia: Chicanas in science, mathematics, and engineering. Washington, DC: American Association for the Advancement of Science. Castillo, A. (1994). Massacre of the dreamers: Essays on Xicanisma. Albuquerque, NM: University of New Mexico Press. Cole, E. R., & Stewart, A. J. (1996). Meanings of political participation among Black and White women: Political identity and social responsibility. Journal of Personality and Social Psychology, 71(1), 130–140. Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd ed.). New York: Routledge. Collins, P. H. (2004). Black sexual politics. African Americans, gender, and the new racism. New York: Routledge. Collins, P. H. (2006). New commodities, new consumers: Selling Blackness in a global marketplace. Ethnicities, 6(3), 297–317. Coltrane, S. (1994). Theorizing masculinities in contemporary social science. In H. Brod & M. Kaufman (Eds.), Theorizing masculinities (pp. 39–60). Thousand Oaks, CA: Sage. Comas-Diaz, L. (2000). An ethnopolitical approach to working with people of color. American Psychologist, 55(11), 1319–1325. Comas-Díaz, L. (2005). Becoming a multicultural psychotherapist: The confluence of culture, ethnicity, and gender. Journal of Clinical Psychology, 61, 973–981. Comas-Díaz, L., & Jacobsen, F. M. (1995). The therapist of color and the white patient dyad. Cultural Diversity and Mental Health, 1, 93–105. Comas-Díaz, L., Lykes, M. B., & Alarcón, R. D. (1998). Ethnic confl ict and the psychology of liberation in Guatemala, Peru, and Puerto Rico. American Psychologist, 53, 778–792. Connell, R. W. (1987). Gender and power. Palo Alto, CA: Stanford University Press. Connell, R. W. (1995). Masculinities. Los Angeles: University of California Press. Crenshaw, K. W. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and anti-racist politics. University of Chicago Legal Forum, 139–167. Crenshaw, K. W. (1995). Mapping the margins: Intersectionality, identity politics, and violence against women of color. In K. W. Crenshaw, N. Gotanda, G. Peller, & K. Thomas

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(Eds.), Critical race theory: The key writings that formed the movement (pp. 357–383). New York: The New Press. Cuádraz, G. H. (2006). Myths and the ‘politics of exceptionality’: Interpreting Chicana/o narratives of achievement. The Oral History Review, 33(1), 83–105. Deaux, K., & Perkins, T. (2001). The kaleidoscopic self. In C. Sedikides & M. B. Brewer (Eds.), Individual self, relational self, collective self (pp. 299–314). Philadelphia: Psychology Press. Dillard, C. B. (2000). The substance of things hoped for, the evidence of things not seen: Examining an endarkened feminist epistemology in educational research and leadership. Qualitative Studies in Education, 13(6), 661–681. Enns, C. (in press). Multicultural feminist therapy. In H. Landrine & N. Russo (Eds.), Bringing diversity to feminist psychology (2nd ed.). New York: Springer Publishers. Espín, O. M. (1996a). Leaving the nation and joining the tribe: Lesbian immigrants crossing geographical and identity borders. Women & Therapy, 19(4), 99–107. Espín, O. M. (1996b). Latina healers: Lives of power and tradition. Encino, CA: Floricanto Press. Fine, M., & Weis, L. (1998). The unknown city: The lives of poor and working class young adults. Boston: Beacon Press. Fine, M., Weis, L., Powell Pruitt, L., & Burns, A. (2004). Off white: Readings on power privilege, and resistance (2nd ed.). New York: Routledge. Flores, M. T. (2000). La familia Latina. In M. T. Flores & G. Carey (Eds.), Family therapy with Hispanics (pp. 3–28). Needham Heights, MA: Allyn & Bacon. Flores-Ortiz, Y. G. (2000). Injustices in Latino families: Considerations for family therapists. In M. T. Flores & G. Carey (Eds.), Family therapy with Hispanics (pp. 251–263). Needham Heights, MA: Allyn & Bacon. Fregoso, R. L. (2003). Mexicana encounters: The making of social identities on the borderlands. Berkeley, CA: University of California Press. González-López, G. (2005). Erotic journeys. Mexican immigrants and their sex lives. Berkeley, CA: University of California Press. Greene, B. (2004). African American lesbians and other culturally diverse people in psychodynamic psychotherapies: Useful paradigms or oxymoron? Journal of Lesbian Studies, 8(1/2), 1089–4160. Gross, J. (2004, February 27). Older women team up to face future together. The New York Times. Retrieved September 15, 2008, from http://query.nytimes.com/gst/fullpage. html?res=9F01E3DF113CF934A15751C0A9629C8B63 Haraway, D. (1988). Situated knowledges: The science question in feminism and the privilege of partial perspective. Feminist Studies, 14(3), 575–599. Hernández, D., & Rehman, B. (Eds.). (2002). Colonize this! Young women of color on today’s feminism. Emeryville, CA: Seal Press. Holvino, E. (2008). Latinos y Latinas in the workplace: How much progress have we made. The Diversity Factor, 16(1), 11–19. Retrieved September 15, 2008, from http://www. diversityfactor.rutgers.edu hooks, b. (2000). Feminism is for everybody: Passionate politics. Cambridge: South End Press. hooks, b. (2003). Teaching community: A pedagogy of hope. New York: Routledge. hooks, b. (2004). The will to change: Men, masculinity, and love. Washington, DC: Washington Press. hooks, b. (2007). When angels speak of love. New York: Atria. Hurtado, A. (1996). The color of privilege: Three blasphemies on race and feminism. Ann Arbor, MI: University of Michigan Press. Hurtado, A. (2003a). Voicing Chicana feminisms: Young women speak out on sexuality and identity. New York: New York University Press. Hurtado, A. (2003b). Theory in the flesh: Toward an endarkened epistemology. International Journal of Qualitative Studies in Education, 16(2), 215–225. Hurtado, A. (2005). The transformative power of Chicana/o Studies: Social justice and education. International Journal of Qualitative Studies in Education, 18(2), 185–197. Hurtado, A. (2009). Lifting as we climb: Educated Chicanas’ social identities and commitment to social action. In R. Gutierrez & P. Zavella (Eds.), with the assistance of D. Segura,

51

52


D. Trevizo, & J. V. Palerm, Mexicans in California: Transformations and challenges (pp. 111–132). Chicago: University of Illinois Press. Hurtado, A. (in press). Making face, rompiendo barreras (breaking barriers): The activist legacy of Gloria E. Anzaldúa. In G. Gonzalez-Lopez & A. Keating (Eds.), Bridging: How and why Gloria Evangelina Anzaldúa’s life and work transformed our own. Academics, activists, and artists share their testimonios. Austin, TX: University of Texas Press. Hurtado, A. (2009). The reproduction of privilege. Manuscript in preparation. Hurtado, A., & Cervantez, K. (2009). A view from within and from without: The development of Latina feminist psychology. In F. A. Villarruel, M. Azmitia, N. Cabrera, G. Carlo, J. Chahin, & J. C. Contreras (Eds.), The handbook of U.S. Latino psychology: Developmental and community based perspectives. Thousand Oaks, CA: Sage Publications. Hurtado, A., Cervantez, K., & Eccleston, M. (in press). Infi nite possibilities, many obstacles: Language, culture, identity and Latino/a educational achievement. In E. G. Murillo, Jr., & E. E. Garcia (Eds.), Handbook of Latinos and education: Theory, research, and practice. New York: Routledge. Hurtado, A., & Gurin, P. (2004). Chicano/a identity in a changing U.S. society ¿Quién soy? ¿Quiénes somos?. Tucson, AZ: University of Arizona Press. Hurtado, A., & Silva, J. M. (2008). Creating new social identities in children through critical multicultural media: The case of ‘ “Little Bill.’ New Directions in Child and Adolescent Development, 120, 17–30. Hurtado, A., & Sinha, M. (2006). Differences and similarities: Latina and Latino doctoral students navigating the gender divide. In J. Castellanos, A. M. Gloria, & M. Kamimura (Eds.), The Latina/o Pathway to the Ph.D.: Abriendo Caminos (pp. 149–168). Sterling, VA: Stylus. Hurtado, A., & Sinha, M. (2008). More than men: Latino feminist masculinities and intersectionality. Sex Roles, 59, 337–349. Hurtado, A., & Stewart, A. J. (2004). Through the looking glass: Implications of studying whiteness for feminist methods. In M. Fine, L. Weis, L. Powell Pruitt, & A. Burns (Eds.), Off white: Readings on power, privilege, and resistance society (2nd ed., pp. 315–330). New York: Routledge. Landrine, H. (1995). Introduction: Cultural diversity, contextualism, and feminist psychology. In H. Landrine (Ed.), Bringing cultural diversity to feminist psychology: Theory, research, and practice (pp. 55–75). Washington, DC: American Psychological Association. Langhout, R. D. (2006). Where am I? Locating myself and its implications for collaborative research. American Journal of Community Psychology, 37, 269–374. Latina Feminist Group. (2001). Telling to live: Latina feminist testimonios. Durham, NC: Duke University Press. Littleton, C. (1989). Feminist jurisprudence: The difference method makes. Stanford Law Review, 41, 751–764. Lott, B., & Bullock, H. E. (2007). Psychology and economic justice: Personal, professional, and political intersections. Washington, DC: American Psychological Association. Lugones, M. (2003). Pilgrimages/Peregrinajes: Theorizing coalition against multiple oppressions. New York: Rowman and Littlefield. Mahalingam, R., & Reid Trotman, P. (2007). Dialogue at the margins: Women’s self-stories and the intersection of identities. Women’s Studies International Forum, 3(3), 254–263. McCall, L. (2005). The complexity of intersectionality. Signs: Journal of Women and Culture in Society, 30(3), 1771–1800. McIntosh, P. (1992). White privilege and male privilege: A personal account of coming to see correspondences through work in women’s studies. In M. L. Andersen & P. H. Collins (Eds.), Race, Class, and Gender (pp. 70–81). Belmont, CA: Wadsworth. McIntyre, A., & Lykes, B. M. (1998). Who’s the boss? Confronting whiteness and power differences within a feminist mentoring relationship in participatory action research. Feminism & Psychology, 8, 427–444. Méndez-Negrete, J. (2006). Las hijas de Juan: Daughters betrayed. Durham, NC: Duke University Press. Moraga, C. (1981a). Preface. In C. Moraga & G. Anzaldúa (Eds.), This bridge called my back; Writings by radical women of color (pp. xiii–xix). Watertown, MA: Persephone Press.

Chapter 2


Moraga, C. (1981b). La güera. In C. Moraga & G. Anzaldúa (Eds.), This bridge called my back: Writings by radical women of color (pp. 29–34). Watertown, MA: Persephone Press. Moraga, C. (2007, April 12). The right to remember: A Xicana codex of changing consciousness. Unpublished manuscript. Morawski, J. G., & Bayer, B. M. (1995). Stirring trouble and making theory. In H. Landrine (Ed.), Bringing cultural diversity to feminist psychology: Theory, research and practice (pp. 113–137). Washington, DC: American Psychological Association. Morgan, R. (1970). Sisterhood is powerful: An anthology of writings from the women’s liberation movement. New York: Random House. Morrison, T. (1992). Playing in the dark: Whiteness and the literary imaginations. Cambridge: Harvard University Press. Moya, P. M. (2002). Learning from experience. Minority identities, multicultural struggles. Berkeley, CA: University of California Press. Nussbaum, M. C. (1999). The professor of parody. The New Republic, 37–45. Ochoa, M. (2006). Queen for a day: Transformistas, misses and mass media in Venezuela (Doctoral dissertation, Stanford University, 2006). Dissertation Abstracts International, 66, 11. Pastor, J., McCormick, J., Fine, M., Andolsen, R., Friedman, N., et al. (2007). Makin’ homes: An urban girl thing. In B. J. Ross Leadbeater & N. Way (Eds.), Urban girls revisited: Building strengths (pp. 75–96). New York: New York University Press. Pérez, E. (1996). Gulf dreams. Berkeley, CA: Third Woman Press. Pérez, E. (1999). The decolonial imaginary: Writing Chicanas into history (theories of representation and difference). Bloomington, IN: Indiana University Press. Pyke, K. D. (1996). Class-based masculinities: The interdependence of gender, class, and interpersonal power. Gender & Society, 10(5), 527–549. Pyke, K. D., & Johnson, D. L. (2003). Asian American women and racialized feminities: ‘Doing’ gender across cultural worlds. Gender & Society, 17(1), 33–53. Roberts, R. A. (2005). Radical movements: Katherine Dunham and Ronald K. Brown teaching toward critical consciousness (Doctoral dissertation, City University of New York, 2005). Dissertation Abstracts International, 65(12-B), 6710. Roque Ramirez, H. N. (2003). That’s my place!: Negotiating racial, sexual, and gender politics in San Francisco’s Gay Latino Alliance (GALA), 1975–1983. Journal of History of Sexuality, 12(3), 224–258. Roque Ramirez, H. N. (2007). Mira, yo soy Boricua y estoy aqui!: Rafa Negron’s pan dulce and the queer sonic Latinaje of San Francisco. CENTRO: Journal for the Center of Puerto Rican Studies, 18(2), 274–313. Rose, T. (2001, September/October). Hip hop at the crossroads. The Crisis. Available online at http://www.thecrisismagazine.com/issues/2001/01_09–10.htm Rose, T. (1996). A style nobody can deal with. Politics, style, and the postindustrial city in hip hop. In A. F. Gordon & C. Newfield (Eds.), Mapping multiculturalism (pp. 424–444). Minneapolis, MN: University of Minnesota Press. Rose, T. (1994). Black noise: Rap music and Black culture in contemporary America. Hanover, NH: University Press of New England. Rowe, A. C. (2005). Longing: Toward a feminist politics of relation. NWSA Journal, 17(2), 15–46. Russo, N. F., & Tartaro, J. (2008). Women and mental health. In F. L. Denmark & M. A. Paludi (Eds.), Psychology of women: A handbook of theories and issues (pp. 440–483). Westport, CT: Praeger Publishers. Russo, N. F., & Vaz, K. (2001). Addressing diversity in the decade of behavior: Focus on women of color. Psychology of Women Quarterly, 25, 280–294. Saldívar-Hull, S. (2000). Feminism on the border: Chicana gender politics and literature. Berkeley, CA: University of California Press. Sandoval, C. (1991). U. S. Third world feminism: The theory and method of oppositional consciousness in the postmodern world. Genders, 10, 1–24. Sandoval, C. (2000). Methodology of the oppressed. Minneapolis, MN: University of Minnesota Press. Schaeffer-Grabiel, F. (2007). Cyberbrides and global imaginaries: Mexican women’s turn from the national to the foreign. In D. A. Segura & P. Zavella (Eds.), Women and migration

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in the U.S.-Mexico borderlands: A reader (pp. 503–520). Durham, NC: Duke University Press. Shields, S. (2008). Gender: An intersectionality perspective [Special issue]. Sex Roles, 59, 301–311. Smith, L. T. (1999). Decolonizing methodologies: Research and indigenous peoples. London: Zed Books. Soto, S. K. (2005). Where in the transnational world are U.S. women of color? In E. L. Kennedy & A. Beins (Eds.), Women’s studies for the future: Foundations, interrogations, politics (pp. 111–124). New Brunswick, NJ: Rutgers University Press. Tajfel, H. (1981). Human groups and social categories: Studies in social psychology. New York: Cambridge University Press. Tajfel, H. (1982). Social identity and intergroup relations. New York: Cambridge University Press. Tolman, D. L. (2002). Dilemmas of desire. Teenage girls talk about sexuality. Cambridge: Harvard University Press. Torre, M. E., Fine, M., Alexander, N., & Genao, E. (2007). Don’t die with your work balled up in your fists: Contesting social injustice through participatory research. In B. J. Ross Leadbeater & N. Way (Eds.), Urban girls revisited: Building strengths (pp. 221–242). New York: New York University Press. Trujillo, C. (Ed.). (1991). Chicana lesbians: The girls our mothers warned us about. Berkeley, CA: Third Woman Press. U.S. Department of Education. (2003). National Center for Education Statistics, Higher Education General Information Survey (HEGIS), Degrees and Other Formal Awards Conferred survey 1976–77 through 1984–85, and Integrated Postsecondary Education Data System (IPEDS), Completions surveys, 1986–87 through 1998–99, and Fall 2000-Fall 2002 surveys (table prepared August 2003). Retrieved August 18, 2007, from http://nces.ed.gov/programs/ digest/d03/tables/dt264.asp U.S. Department of Education. (2004). National Center for Education Statistics, 2003 Integrated Postsecondary Education Data System (IPEDS), Winter 2003–04. Retrieved August 18, 2007, from http://nces.ed.gov/programs/digest/d05/tables/dt05_227.asp Vasquez, M. J. T. (2002). Complexities of the Latina experience: A tribute to Martha Bernal. American Psychologist, 57, 880–888. Vasquez, M. J. T. (2003). Troxel v. Granville. Impact on ethnic minority families. Family Court Review, 41(1), 54–59. Vasquez, M. J. (2006). Counseling men: Perspectives and experiences of a woman of color. In M. Englar-Carlson & M. A. Stevens (Eds.), In the room with men: A casebook of therapeutic change (pp. 241–255). Washington, DC: American Psychological Association. White, A. M. (2007). All the men are fighting for freedom, all the women are mourning their men, but some of us carried guns: A race-gendered analysis of Fanon’s psychological perspectives on war. Signs: Journal of Women in Culture and Society, 32(4), 857–884. White, A. M. (2008). Ain’t I a feminist?: African American men speak out on fatherhood, friendship, forgiveness, and freedom. Albany, NY: State University of New York Press. Wiegman, R. (2005). The possibility of women’s studies. In E. L. Kennedy & A. Beins (Eds.), Women’s studies for the future: Foundations, interrogations, politics (pp. 40–60). New Brunswick, NJ: Rutgers University Press. Williams, P. J. (2004). Open house: Of family, friends, food, piano lessons, and the search for a room of my own. New York: Farrar, Straus and Giroux. Woo, D. (2004). Cultural ‘anomalies’ and cultural defenses: Towards an integrated theory of homicide and suicide. International Journal of the Sociology of Law, 32(4), 279–302. Youth Advisory Committee Photovoice Project. (2008). Johns Hopkins Bloomberg School of Public Health. Abstract retrieved September 10, 2008, from http://www.jhsph.edu/ adolescenthealth/research/researcher_page.html?gf_id=4185 Zavella, P., & Castañeda, X. (2005). Sexuality and risks: Gendered discourses about virginity and disease among young women of Mexican origin. Journal of Latino Studies, 3(2), 226–245.

Theoretical and Methodological Challenges in Participatory CommunityBased Research

3 M. Brinton Lykes, Erzulie Coquillon, and Kelly L. Rabenstein

Although feminist and community-based psychology share many values and goals, these two subdisciplines remain practically divided. As a result, there are gaps that, if addressed, would greatly enhance knowledge and praxis in research psychology rooted in a commitment to power-sharing with marginalized communities and promoting positive social change. In this chapter, we explore participatory and action research as resources for integrating feminist and community-based psychological theory and research in a framework that sustainably interweaves an action–reflection dialectic or praxis to create an activist scholarship for psychology. In so doing, we identify the importance of participatory and action research’s (1) recognition of and collaboration with communities’ local or indigenous resources; and (2) emphasis on bringing forward the voices of participants in both the research endeavor and in broader struggles for related social change. The chapter offers an overview of current literature situated at the confluence of feminist and community psychology wherein strengths of local communities as actors draw from and contribute to knowledge generation with a goal of increasing the access to power of marginalized groups. We suggest

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participatory and action research1 as an epistemology and methodology to facilitate engaged and collaborative research for transformational praxis (see Lykes & Mallona, 2008, for a detailed discussion of participatory and action research, liberation psychology, and transformational praxis). We offer examples of participatory and action research praxis to illustrate the nexus of academic, political, and (for participants) personal constructs (e.g., gender roles within a particular environment, voice, subjectivities) revealed through this work. We begin with a discussion of feminist research in general, and psychology in particular, as well as a discussion of community psychology. We then move into an overview of principles and practices at the interface of feminist and community psychology. From there, we introduce participatory and action research as one possible methodological bridge between these two disciplines, and both toward social activism. Moreover, we discuss the emphasis in participatory and action research on recognizing participants’ indigenous resources and using action–reflection to motivate participants to social activism as the “glue” that can bind together these research approaches. In so doing, we offer the first author’s work with Maya women in rural Guatemala (Women of PhotoVoice/ADMI & Lykes, 2000) as a case example and identify practical challenges often met by researchers and participants who are pursuing the goals of these research methodologies. We close by placing these challenges within the framework of the globalizing world, arguing that the forces of globalization offer conflicting possibilities for the reach of feminist and community-based research in the new millennium. On the one hand, global information networks offer opportunities for broad dissemination and interchange of the stories and lived experiences of communities throughout the globe; on the other, this exchange of ideas has profound effects on local identities and understandings of the relationship between self and society. Moreover, global economic relationships and the realities of global poverty raise challenges to feminist and community-based researchers, both in their approach to the nature of individual suffering and in addressing the importance of linking the research endeavor to social or political activism, as called for within the participatory and action research frameworks. Finally, as Susan Berger (2006) has argued in her discussion of the Guatemalan women’s movement, the opening up of new possibilities for social activism through increased communication, etc. is obviated by the political reforms necessitated by globalization, “reforms that can weaken and displace social movements” (p. 4). We argue that these realities further challenge psychologists seeking to infuse their work with feminist and community-based participatory and action research.

Feminism and Feminist Psychology: A Brief Introduction Feminism is often defined as an awareness of gender issues and the analysis of power imbalances (Angelique & Cully, 2003), but many (including Bertram, Hall, Fine, & Weis, 2000) have argued that not enough “strategic attention” has been focused in feminist scholarship on issues of culture and race (see also Boisnier, 2003; Collins, 1998; Smith, 1977, among many others). Early feminist scholarship and the women’s movement of the 1970s and 1980s were initially

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Participatory Community-Based Research

situated among White, middle-class women in Western societies, and lacked a critical analysis of racism and class oppression (Collins, 2000; Smith & Stewart, 1983). Coalitions formed across those diversities to redress inequalities of power at the interface of gender, race, and social class (see, e.g., Collins, 1998; hooks, 1981; Lorde, 1982, 1984; Moraga & Anzaldúa, 1983, among others). Contributions from feminists living in the Southern Hemisphere, postcolonial theorists of color, and Black and Latina feminists in the United States highlight these sources of inequality and press the field towards a more inclusive critical and transformative stance (hooks, 1984; Walsh, 1998; Trinh, 1989; Williams & Chrisman, 1994; Mohanty, 2003). Feminism grew within and from the women’s and civil rights movements of the 1960s and 1970s (see, among others, Evans, 1979/1980). However, despite these roots, a gap exists between activism and the field of contemporary feminist psychology (Bond & Mulvey, 2000). Participatory and action research, as a resource for articulating a contextualized perspective on research and an explicit eye to promote activism, offers the sort of shared conceptual framework that research in feminist psychology and feminist activism currently lack (Albee, 1992; Grant, Finklestein, & Lyons, 2003). Within the social sciences, contemporary feminist critiques have given rise to rich literature on gender-specific research in varied contexts, that is, expanding feminist analysis from a women-centric view, to examining the impact of gender roles and identities on the lived experiences of all community members (Grant, Finklestein, & Lyons, 2003; Merry, 2001; Nelson, Dickinson, Beetham, & Batsleer, 2000; Reinharz, 1992). McIlwaine and Datta (2003) as well as Merry (2001), for example, discuss the role of gender in the context of community development work, and suggest the important use of an “engendered” approach to development programs, that is, one that explicitly includes men in outreach activities and critically interrogates traditional maleness and femaleness and how these categories are deployed in language and behavior. Others such as Leavitt (2003) argue, “that [many] educators and practitioners still ignore the rich analyses based on the intersection of race, ethnicity, class, gender, age, sexual preference, disability, and so forth, and use one-dimensional, gender-neutral arguments, [which] speak[s] to the need for engendering community development” (p. 225). We argue similarly that oversimplifying human experience, whether on the basis of gender, race, or class, leaves researchers with an impoverished analysis of the complex and often contradictory social and cultural lived realities of women and men, many of whom are also engaged collaboratively with them as coresearchers. We urge instead a continuum of possibilities in which to situate the complex diversities reflected in one individual and community to the next.

Feminist Research Methodologies Early contributions to an emerging field of feminist research methodology in the social sciences include Barbara DuBois (1983), Sherna Gluck and Daphne Patai (1991), Sandra Harding (1986), and the Personal Narratives Group (1989). Shulamith Reinharz (1992) summarized the diversity of feminist research practices in Feminist Methods in Social Research, identifying major themes characteristic of feminist research and emphasizing the importance of the feminist

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perspective in influencing what is and is not considered to be “feminist” research. According to Reinharz, feminist research is not rigid, but draws upon a variety of research methods, all of which are reflected in the major themes she identifies, that is that feminist research is: guided by feminist theory, involves an ongoing criticism of non-feminist scholarship, may be interdisciplinary, aims to create social change, and strives to represent human diversity. Additionally, themes in feminist research include giving voice to women’s experience, contextualized thinking, self-reflection linked to activism, collaborative approaches, and research as a tool for seeking social justice (see Cosgrove & McHugh, 2000). Feminist researchers employ a variety of methods and a broad range of epistemological stances in their work. Thus, fluidity remains within the discipline in regards to drawing upon varied resources in engaging feminist scholarship at the community level. Researchers who position themselves within traditional positivist or post positivist epistemologies may utilize methods that are more typically associated with a constructivist or interpretivist epistemology, such as oral history narratives or ethnographic observation. Constructivist or critical theorist feminists, on the other hand, may distribute surveys or engage other, more positivist, research methods, to gain understanding of or develop a critique of existing power relations, for the purposes of transforming them rather than for the purposes of explanation, prediction, or control (Denzin & Lincoln, 2000). Feminist researchers have an opportunity to create conditions in which a group of individuals who, to date, have had very little inclusion in the writing of history can encounter and record their voices, telling their stories and situating their lives in context from new perspectives. Thus, the work of many feminist researchers emphasizes processes of raising awareness or generating consciousness (primarily that of those with whom they work) about gendered oppression and how it constrains women’s lives. Doing so dictates the centering of memory, voice, and re-presentation using a variety of research methods (see, for example, Bond, Belenky, & Weinstock, 2000, work with poor, rural women in the United States).

Community Psychology: Historical Roots and Current Possibilities In one of the first textbooks on community psychology, Julian Rappaport (1977) struggled to define this emerging subdiscipline within psychology. More recently, Nelson and Prilleltensky (2005) have suggested that community psychology began in the community long before psychology as a field was even solidified, in the social turmoil at the start of the twentieth century. At that time, individuals who sought to make positive social changes began to utilize scientific methods to examine, report on, and suggest improvements to a variety of pressing social issues, particularly the inability of the U.S. government to respond to the influx of immigrants to the United States and the resulting subpar treatment of these individuals on a grand scale (Nelson & Prilleltensky, 2005). Duffy and Wong (1996) summarized decades of theory development and applications, describing community psychology as focusing on “social issues, social institutions, and other settings that influence groups and organizations

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(and therefore the individuals in them). The goal is to optimize the well-being of communities and individuals with innovative and alternate interventions designed in collaboration with affected community members and with other related disciplines inside and outside psychology” (p. 11). The shift from roots in social activism to a field of research or subdiscipline within psychology parallels feminist psychology’s growth from activism to scholarly discipline. Community psychology assumed its current research and applied priorities in the 1970s, when the growth of clinical psychology as a subfield within psychology and of the community mental health movement (Cowen, Gardner, & Zax, 1967), in the context of the social movements of that era (Nelson & Prilleltensky, 2005) as well as the policies of deinstitutionalizing the severely mentally ill and treating them with psychotropic drugs, began to shape its goals and scope (Hersch, 1969; Rappaport & Seidman, 2000). More specifically, the growing but severely underfunded community mental health care system revealed a gap between the need for and the availability of these services. Research revealing correlations between low socioeconomic status and increased risk of mental illness (see Dohrenwend & Dohrenwend, 1969, among others), combined with a lack of access to services, increased awareness of the role of social context and structural inequalities in mental health diagnosis and delivery of programs. These conditions also highlighted the need for a field that would take into account the contextual factors facing the “mentally ill,” including, among others, increasing disparities between rich and poor, White and Black. Thus, community psychology developed as a set of strategies for “creat[ing] knowledge and chang[ing] social conditions” (Nelson & Prilleltensky, 2005, p. 6).

Community Psychology Research Methodologies Research in community psychology is diverse and spans studies that utilize positivist and postpositivist methods to explore hypothesized causal relations through activist scholarship. Some, including many who write from a feminist perspective within community psychology (see e.g., Mulvey, 1988), have suggested that despite its roots in community activism, community engagement and applied scholarship are currently undervalued relative to a more traditional form of research wherein the principal investigator remains distant from research subjects, that is, “objects” of investigation. Recognizing and drawing on this critique, this chapter focuses more directly on a community psychology whose underlying concepts and values are consistent with those discussed by Nelson and Prilleltensky (2005). These include an emphasis on person– environment fit (ecological perspective), support and respect for human diversity and empowerment (individuals do and act for themselves), prevention over treatment, and a focus on strengths and competencies. Additional key markers of this community psychology are interdisciplinary collaborations, community-researcher partnerships, and respect for established community practices including indigenous or local knowledge. As importantly, many of the goals or purposes of community psychology described herein (e.g., community collaboration) are actualized through the inclusion of action research, and a “focus on social change. . . . [through] human resource development, political activity and scientific inquiry . . .” (Nelson & Prilleltensky, 2005, p. 4).

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Community psychology research that embraces these values seeks methods and actions to understand and change social processes, including, for example, how to combat negative experiences of oppression and promote well-being for community collaborators. These methods include the documentation of the social ecology of everyday life as it is experienced by people living and engaging in home, work, school, and neighborhood settings. In line with the goals of community psychology, researchers who work within this framework aspire to including methods that are genuinely empowering, rather than distancing. This requires a focus by the researcher on the process, rather than exclusively on outcomes. This aspect of community psychology in particular benefits directly from, is informed by, and informs participatory and action research. Community psychologists utilize many tools in cultivating the goals discussed above. These tools vary among researchers, but may include participant observation, ethnographic recording of the rituals and performances of everyday life, detailed open-ended interviews, textual discourse analysis, and interpretive methods that privilege the perspective of the participant, rather than the scholar-as-expert vantage point. Moreover, although those who work within this subdiscipline frequently engage with communities as researcher and observer, there are many additional roles that are expected of these community-based researchers. Fulfilling these roles may include acting as reporters of participant observations, or as collaborators, accompaniers, educators, advocates, activists, and creators of opportunities for others to speak. Community psychologists sometimes lend their technical skills and human resources to local communities for their use. These researchers are frequently outsiders, but may also be insiders. In so doing, community psychology researchers actively resist treating the community(ies) as objects, as “others,” that is, working as technicians who enter from the outside to solve a problem; or researching for the sake of constructing knowledge for its own sake. They seek rather to collaborate as coresearchers towards the betterment of the community and its diverse members.

Community Psychology Through a Feminist Lens: Principles of Work at the Interface Research in community psychology infused by feminist understandings of power dynamics and difference reflects a number of overlapping themes, which some have argued signify a “profeminist stance” in the field of community psychology (Angelique & Cully, 2003; Mulvey, 1988). Meg Bond and Anne Mulvey, psychologists working at the interface of feminist and communitybased psychology, identify a number of commonalities between the two subfields: (1) a common history as part of movements of the 1960s aimed at social change in the United States; (2) a critique of victim-blaming; (3) questioning of restrictive standards on health and/or behavior; (3) calls for a move from dichotomous thinking and planning, and, most fundamentally; (4) a basis in respect for difference, distributive justice, and equality (Bond & Mulvey, 2000; Cosgrove & McHugh, 2000). Bond, Hill, Mulvey, and Terenzio (2000) offer the following “foundational threads” for integrating feminism and community psychology: a call for

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redistribution of power; participant empowerment; honor and strengthening of “natural helping systems”; and more specific calls-to-action “… integrating contextualized understandings, paying attention to issues of diversity, speaking from the standpoints of oppressed groups, adopting collaborative approaches, utilizing multilevel, multimethod analyses, adopting reflexive practices, and taking activist orientations” (pp. 588–589). In light of these potential intersections in the theoretical frameworks underlying the two psychologies—feminist and community—we explore below the everyday processes of conducting research at their interface.

Methodologies at the Interface Despite this consensus about a set of parameters and underlying values for working at the interface of feminist and community-based psychology, there are varied articulations of the dialectic between reflection and action as well as of the recommended research strategies that embrace these goals. In her discussion of alternative models for social change, Anne Mulvey (1988) was one of the first to note challenges for those seeking to work at this interface. She identified similarities between feminist and community psychology such as the emphasis on diversity and a critique of social structures as well as a shared lack of multicultural awareness and divergent research methods within each subfield. For those working at the interface seeking to prioritize memory, voice, and re-presentation, for example, data collection techniques such as reflective dialogue, use of tape recorders for transcriptions, use of newsprint for group brainstorming, and folders to retain written or drawn information have been prioritized (Bond, Belenky, & Weinstock, 2000). Psychotherapeutic principles are also used in both feminist and community-based psychological research as a resource through which participants can assert their power and to encourage “storytelling,” by, for example, creating safe spaces for conversation and using restatements among group members in dialogue with one another. Additionally, more grassroots group-based methods embraced by some included relationship-building and community change strategies whereby experts were demystified and peer support models were developed that fostered consensus decision-making, community organizing, local interventions, and political advocacy. Although there has been a mutual embrace of strategies for applied research and action, Mulvey (1988) suggests that one reason that the two subdisciplines, regardless of their many similarities, are not better integrated is a lack of awareness among scholars in these subfields concerning the overlap of mission and values. Despite this lack of integration, as feminist research increasingly emphasizes the importance of a general openness to nontraditional approaches to the research process, such as engaging with participants in community settings like nail and hair salons, child care centers, churches, and bookstores (Campbell, Self, Wasco, & Ahrens, 2004), the work relies more explicitly on insights from community psychology. Campbell et al. (2004), for example, argue for the importance of creating a safe space for coresearchers, over the interests of the research itself, and contend that engaging with participants (in this case, rape survivors) in their own self-determined “safe spaces” will yield the comfort necessary for them to share their stories and thus to meet their own needs as well as those of the researcher in gathering data.

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Significantly, this press to engage in and with participants in their “safe places” reflects a growing recognition within community psychology that community is no longer only or exclusively a geographic locality. Specifically, contemporary life is characterized by a range of communities of association and affiliation through which one defines multiple communities of belonging and action (Duffy & Wong, 1996). This recognition, coupled with the insights of participatory and action research to be discussed, contribute new understandings of place that are reflected in this work.

Benefits to Participants and Communities Feminist and community psychology intersect best in concrete attempts to improve the circumstances of research participants and the communities in which they live and work. This can and has been achieved in multiple research experiences, including, for example, the work of Campbell et al. (2004) with survivors of rape in the United States. They offer an excerpt of a letter written by a participant that illustrates the positive outcomes that may result for participants when feminist and community-based researchers in psychology commit themselves to the principles at the interface of the two subdisciplines: Participating in this study was the most helpful thing I experienced in working through the rape. It wasn’t counseling or therapy, I was always clear it was research, but it was research that was caring and healing. I was listened to. This study gave me a chance to talk about what happened to me in a supportive, caring environment….Your interview helped me talk about the assault and gave me the courage to find the help I needed…Participating in this study made me feel valued as a person, and that helped me value myself again and start taking care of myself again. I am so grateful for all that your work has given me. (p. 259)

Lykes, Blanche, and Hamber (2003) cite other benefits that participants have gained through community-based research endeavors in women’s organizations, such as skills acquisition and changes in understandings of gender dynamics. Moreover, through the participatory and action research endeavors in which they participated, efforts that will be described in more detail below, participants gained awareness of and engaged collectively in broader political processes to redress injustices they faced (Lykes, 1999; 2001). Lykes et al. (2003) note that “[through this work] rural [Guatemalan and South African] women’s voices have entered the scientific and human rights discourse about state-sponsored violence and its effects, transforming the ‘talk’ as well as the lives of those who speak their truths” (pp. 84–85). Another example of work at this interface is the ongoing collaboration of psychologist Anne Brodsky with The Revolutionary Association of the Women of Afghanistan, RAWA (Brodsky, 2003). Drawing on the traditions of community psychology and qualitative feminist research, including but not limited to focus groups, ethnographic observations, and interviewing, Brodsky deploys both traditions to, in her words, “draw our attention to the importance of examining not only the results of research but the research process itself” (2003, p. 8). The women of RAWA embraced the collaboration with Brodsky as they determined that she, as an outsider, “might be seen as a more credible source than

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they themselves and who, also, unlike them, had the time and resources to do so,” that is, to document their story as an organization and movement (Brodsky & Faryal, 2006). Brodsky’s work offers another variation on some of the examples described as she entered her collaboration with RAWA as an activist and then became a researcher and, in the words of the women of RAWA, a resource for them. Each of these examples illustrates the dynamic possibilities as well as some of the concrete outcomes attendant to the engagement of community and feminist psychologies through an action–reflection process. Below we explore the possibilities of participatory and action research as another resource to accomplish work at this interface.

Participatory and Action Research as a Bridge From Feminist and Community-Based Research in Psychology to Transformational Praxis As discussed, feminist and community-based research in psychology have distinctive epistemological assumptions yet share overlapping methodologies as well as similar assumptions and goals. Thus, the researcher interested in enacting positive change through the research process from one or both of these perspectives need not “start from scratch.” However, in bridging the subdisciplines in ways that (1) emphasize the position of participants as experts in their own lives, (2) work with participants to tell their stories of oppression and survival, and (3) leverage those stories as resources for social and political activism, participatory action research offers additional dimensions to these processes that hold this work together (the “glue”) and extend it in a number of critical ways.

Clarifying Potential Contributions of Participatory and Action Research As suggested above, participatory and action research refers to a set of research approaches that expose ideological, political, and social processes underlying systems of inequality through collective knowledge generation and action– reflection processes. Some trace the beginnings of participatory and action research to the work of Kurt Lewin in the 1940s and the experiential learning and inquiry communities of the 1960s (see Adelman, 1993; Greenwood & Levin, 1998; Gustavsen, 2001). Zeichner (2001) identified five major traditions in the English-speaking world and argued that some of these draw on the emancipatory practices developed in Asia, Africa, and Latin America, extending the focus of action research beyond institutions to local communities (see also Brydon-Miller & Greenwood, 2003, for a brief historical overview). The emancipatory perspective articulated in the global South moved beyond Lewin’s work which did not include a critique of the wider society nor did he consider “power bases that define social roles and strongly influence the process of any change …” (Adelman, 1993, p. 10). Those who live and work in Latin America, Africa, and Asia and engage in participatory and action research are thus more likely to trace the origin of

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their praxis to the work of Paulo Freire (1970) or the early participatory action research of Orlando Fals-Borda (1985) and Mohammad Ansiur Rhaman (with Fals-Borda, 1991). In the late 1960s and 1970s in India and Latin America, liberation educators and social change advocates were influenced by Paolo Freire’s understanding of critical consciousness, that is, conscientização [conscientization]. These educators and community activists sought to create participatory processes that tap into and engage local knowledge systems towards emancipatory practices. Despite many differences in context, origin, and specific strategies, the theoretical assumptions underlying most participatory and action research—and those to which we refer in this chapter—include systems theory, humanistic values and the development of human potential, democratic participation and decision-making, and social action for institutional and/or structural change. Group processes generated by researchers and participants in participatory and action research seek both to find solutions to the problems confronted by participants in their daily lives as well as to transform the social inequities implicit therein. Often these action research projects involve collaboration between those directly affected by an issue (usually called participants or coresearchers) and those who bring external resources and technical expertise (usually called researchers, catalysts, and coresearchers). All collaborators understand the issue(s) identified and its impact on lived experiences, the systematic exploration of which is beneficial to all parties involved. Increasingly coparticipants press not only for solutions to local problems but for larger community actions that engage the often deeply entrenched causes of the identified problem, that is, for an activist scholarship (see Hale, 2008, for example). Through the development of “mutually dependent and cooperative relationships” (Martin, 1996, p. 88) in participatory and action research, researchers and participants typically experience both personal transformation and politicization (Khanna, 1996). As in feminist and community-based psychological research, the identification or generation of shared spaces wherein the various knowledge systems and skill levels of all research participants can be valued, shared, and exchanged is critical to the work. These spaces facilitate the development of shared procedures for generating, appraising, and reflecting on the data gathered during the research process, as well as the broader systems of power and privilege that influence them. Harrison (2001) summarizes these central tenants of participatory and action research as “community-based sources of accountability, community-based sources of knowledge, action as a criterion of success, [and the] equal weighing of process and results” (p. 235).

Feminist Participatory and Action Research Participatory and action research’s goals are similar to many of the feminist principles discussed here because participatory and collaborative community based research (a) “has an inclusive method of choosing who will carry out the research; (b) […] has an inclusive method of deciding what is valid knowledge; (c) because the social relations among its researchers are, as much as possible, nonhierarchical; (d) [and] because during the process of carrying out the

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research, some of the personal needs of the team members are attended to and met” (Harrison, 2001, pp. 243–244). An even more distinctly feminist approach to participatory and action research focuses on understanding the status of the women involved in the study (see, e.g., Earth, 1998, and Guruge & Khanlou, 2004) and engages gender as an analytic tool to press for structural change and transformations towards more egalitarian outcomes (see Lykes & Coquillon, 2007, for more details). The work of, for example, Cynthia Cockburn (1998, 2004), Dorothy Smith (1987, 1991), Patricia Maguire (2001), and Brinton Lykes (1999, 2001) draws on critical feminist epistemologies and problematizes women’s work, demonstrating how women’s agency is developed towards activism and social change. These researchers, among many others, use a diverse range of research methods to facilitate processes of knowledge construction, engagement with women and women’s concerns, political activity, and social change. We offer Lykes’s collaboration with women of Chajul, in rural Guatemala, as an exemplar of a culturally sensitive approach to community-based, anti-racist, feminist research in psychology within an action-oriented framework of participatory and action research (Lykes et al., 1999; Women of ADMI & Lykes, 2000).

Photovoice in Chajul, Guatemala: Work at the Interface Oppression against the indigenous population of Guatemala by colonial forces centuries ago instituted a system of racism, economic exploitation, and political violence that has manifested itself in cycles of human rights abuses in the country. The most recent iteration of these cycles of violent structural oppression was a 36-year period of civil war during which more than 600 massacres were perpetrated by the Guatemalan military against the predominantly Mayan communities of the Altiplano (Carmack, 1988; CEH, 1999), contributing to massive displacements as survivors sought refuge inside the country and in México (CEH, 1999; Manz, 1988) and places farther north. The Commission for Historical Clarification (CEH) concluded after extensive research and documentation that the Guatemalan government and military were responsible for acts of genocide against the Maya (CEH, 1999). Between 1992 and 2006 the Guatemalan Foundation of Forensic Anthropology [FAFG-Fundación de Antropología Forense de Guatemala], one of five teams of forensic anthropologists who have been conducting exhumations in Guatemala in recent years, carried out more than 530 investigations of these massacres, including exhumations of over 200 clandestine cemeteries in Guatemala (FAFG, 2007). Importantly, a National Program of Reparation [Programa Nacional de Resarcimiento], established by the government in response to the horrors documented by the CEH, has initiated a process of identifying victims and establishing processes for psychosocial and material reparation. Although a fuller discussion of the root causes of this conflict are beyond the scope of this chapter, key factors that gave rise to armed resistance to the oppressive conditions described briefly above and subsequent state counterterrorism included the grossly unequal distribution of wealth as well as the U.S.-backed overthrow of the democratically elected government that held power in Guatemala between 1944 and 1954 and had begun to redistribute land in an effort to redress some of these structural inequalities (see, e.g.,

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Schlesinger & Kizner, 1999). Despite the protracted armed confl ict and the 1996 Peace Accords, these social inequalities have persisted into the 21st century, made more complex by the U.S.-Central American Free Trade Agreement, commonly known as CAFTA, which was ratified by Guatemala on March 10, 2005, despite widespread protests that shut down many areas of the country for days. CAFTA promised greater economic opportunity for all, but to date has privileged a small number of export farmers while reducing the majority to further marginalization and more extreme poverty. CAFTA has also contributed to the growing numbers of young men and women from rural communities who migrate to the capital and then to México and/or the United States in a second major wave of displacement and migration in Guatemala in less than 50 years. In response to these nearly four decades of atrocities and persistent poverty and marginalization, one local group of women in Chajul, the Association of Maya Ixil Women—New Dawn, sought, among other goals, local strategies for telling stories of war, economic oppression, survival, and resistance, and to do so within a context that not only offered some healing of the multiple wounds from the war, but also created an organizational base from which to establish new programs or projects that would improve their lives and the lives of their children (Lykes, 1999). The women realized that the divisions of war and the grief, loss, and rage, among other emotions that they were experiencing in the wake of massacres, military control, refugee experiences and more, required a new kind of response.

Entering Chajul The first author responded to an invitation to join this group after nearly seven years of collaboration with a rural Guatemalan health organization developing community-based, creative resources for responding to war and its psychosocial effects on children and their families (see Lykes, 1994), and many more years of Central American solidarity work. Contact with the group had come through an Ixil friend and colleague whom I2 had known in México when working with refugee women in the compilation of oral histories (see Lykes, 1989/1994). I was thus introduced to this small group of women through “one of their own” but one who had been out of the country and the community for many years. We traveled to this remote village together and I facilitated a workshop designed to explore the local women’s needs and desires and to share in a process of mutual introductions. For several years, I returned to Chajul to facilitate similar workshops with a growing group of women and to collaborate in the formation of a woman’s organization that provided psychosocial and educational activities for women and children as well as to engage with them in an economic development project (see Lykes et al., 1999, for details). As we worked together on concrete goals articulated by the Ixil and K’che’ women, I became more familiar with their cultural realities, their challenges as rural women with minimal formal education, and the breadth and depth of the horrors many of them and their children had survived over several generations of terror and state violence. Field notes and journaling provided me

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with an opportunity to reflect on these developing relationships and tensions that arose in negotiating my role as advisor and advocate, as well as the challenges of developing “just enough trust” (see Maguire, 2001) for collaborative work. During these years, the women developed a corn mill, a revolving loan fund, explored gender relations within their community, and began to develop psycho-educational projects for the children of Chajul (Lykes et al., 1999). After several years of working together and impressive growth in women’s participation as well as the successful incorporation of their women’s group as a nongovernmental organization, the women of ADMI and I agreed to collaborate in a participatory action research project using photography, life stories, and interviews to document the effects of the war on their community as well as the resources—traditional as well as contemporary—that they were deploying to survive and, in some cases, to transform their lives. Informing those outside of the Ixil triangle about the violence of the civil war in Guatemala, its impact on the community, and the ongoing survival and resistance of the people became an important goal for many of the women, as important as sharing their stories within their community, reflecting their deep desire to prevent the recurrence of the violence they had experienced. In part because most of the women in the group could not read or write, and because the camera enables us to capture experiences and then critically reflect on their multiple meanings, we decided to use photography and storytelling to document images of the community, awakening long silenced voices through the stories that framed the photographs, thus reconfiguring the history of the war through the women’s own memories. This approach provided the opportunity for the retelling that the women sought, while offering the necessary documentation for disseminating the women’s understanding of their experiences, remaining true to their memories. In this way, the women of Chajul engaged in processes of self-reflection and collective knowledge generation within the context of a critical analysis of the political, social, and economic forces that influenced their past and current lives.

Collaborating Across Diversities Twenty Maya Ixil and K’iche’ women of Chajul joined the research team, taking one roll of 24 pictures once a month for approximately 10 months, generating between 3,500 and 4,000 usable photographs. The group identified a different theme each month and each photographer was encouraged to take pictures that reflected the chosen topic as well as of events as they emerged in the community or its neighboring villages. Bimonthly small group meetings provided opportunities for individual storytelling in pairs or small groups whereas group analyses took place in monthly workshops. Pictures were described and their stories retold in each of these contexts. Once those analyses were completed and tape recordings transcribed, the processes of data reduction and reorganization began. Below, I trace the creation of one of the 56 phototexts that are presented in the book, Voces e imágenes: Las mujeres Maya Ixiles de Chajul/Voices and Images: Mayan Ixil women of Chajul (Women of ADMI & Lykes, 2000).

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Discovering global realities in a local postwar context. In a biweekly workshop during September 1998, this story was told by Ana while showing her photograph (see Figure 3.1) to the group: I took a picture of a girl who wanted a chocobanana. She lives with her mother in the village of Agro, one hour from Chajul. There they don’t sell chocobananas. So, she asked her mother if when they were in Chajul she could buy a chocobanana. Her mother did not have any money. She told her that if she wanted a chocobanana she would have to go and sell wood to have enough money. So she gathered the amount of wood that was necessary in order to make her purchase and she carried it to Chajul to sell it. She was offering to sell the wood to me [Ana]. She was 7 or 8 years old. She had to wait to get a chocobanana here [in Chajul]. (Memoria/Group Field Notes, Williams, 1998, Translation from Spanish to English, Lykes)

When the ADMI coresearchers and I gathered as a larger group in November of that year for the first of what would be a series of analysis workshops, this picture was chosen from among a large cluster of over 40 photographs about children and work. The photographer’s initial story about this young barefooted girl was shared with a group of six women photographercoresearchers representing three generations. The initial story, summarized

3.1 Reprinted with permission from Proyecto Foto Voz/ ADMI and M. Brinton Lykes. In Women of Photo Voice/ ADMI & Lykes, M. B. (2000). Voces e imágines: Mujeres Mayas Ixiles de Chajul/Voices and images: Mayan Ixil women of Chajul (p. 61). Guatemala: Magna Terra.

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3.1

A Village Girl

Context

Actors/ People

Actions Feelings

Thoughts Reasons/Causes/ Explanations

In our area there is corn & coffee & this girl child is in the path & along the edge of the path there are cloths hanging on the fence surrounding a corral

a child smiling, without shoes, bright eyes; she does not have a mecapal 3 for carrying wood, she is using a small, old piece of headband/ cloth on her head to carry the wood; it is not well situated

she went to gather wood in the woods

I feel badly seeing a child carrying so much wood

she seems happy but also tired. We think she might be worried, and sad to not have any shoes

She is working because her family does not have sufficient income to support the family. Many children work to help gather firewood for the family but this child has to sell her wood, her labor, and so has entered into the paid labor force and a market economy. Her father uses a mecapal but perhaps he disciplined the daughter so she is using an old headband instead of a mecapal.

Note: Italics added to indicate text developed by the group that was not in the initial story told by the photographer. Memoria/Group Field Notes, Lykes, 1998.

on p. 68, focused on a young girl who desires a chocolate covered banana and describes her need to sell the wood on her back in order to secure money to buy herself a treat. After hearing this story and discussing the picture, the group generated the analysis summarized in Table 3.1. The categories for analysis included above were developed through a series of earlier workshops. They reflect issues that had emerged over several years of collaborative work that sought to critically understand war and extreme poverty, as well as women’s responses to them, through dramatizations, drawing, and storytelling. Based on this work, the six categories (see Table 3.1) as well as others were developed to analyze multiple pictures and to rethread experiences towards storying the photographs that women were taking and re-storying them as the community’s “her-story” (see Lykes, 2001; McIntyre & Lykes, 2004, for more details about this process). In contrast to Ana’s story about the picture that centered on the individual child’s desire for a chocolate covered banana, the group-based analysis presents a differentiated understanding of children’s participation in the labor market. The group suggested that this school-age child was forced to sell wood to bring home cash, representing children who “should be in school” but who have rather entered a cash or market economy. In addition, in the

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taped conversations of this group discussion that were later transcribed and analyzed, the older photographers in the group described their experiences as child-workers that included gathering wood to heat their homes or to cook the family’s food, but not being forced to sell things to generate cash for economic survival. Their commentaries reflected generational changes in child labor and the deepening impoverishment of their local community due to the war, shifting local economies, and pressures to export to global markets. Comments about the child’s torn skirt, lack of shoes, and dirty face were described and analyzed as both indices of parental neglect and of family poverty. Some members of the group were critical of the child’s parents, arguing that they should be taking better care of her—interpreting her lack of shoes, torn skirt, and lack of cleanliness, as a “lack of proper parental care-taking.” Others rejected these personal attributions, suggesting that structural poverty was the primary causal factor. Women who interpreted the photograph in terms of structural poverty calculated the cost of the child’s treat and the money she would get for selling the wood. They concluded that the bulk of the funds she secured would be used to enable the family to buy necessary goods for basic survival. In contrast to Ana, who had assumed that the amount of wood was equal to the value of a chocobanana, other members of the group recognized that the child had gathered wood valued at more than the cost of a chocobanana and interpreted this difference in ways that re-situated the child and her labor. Finally, some suggested that the load of wood was “overly burdensome for a small child” and that the child’s labor “deprived her of access to education.” This particular photo-text was reiterated in March, 1999, by Ana on a U.S. tour in which she and I described our collaborative PhotoVoice project. Among the pictures presented was the “village girl.” Ana told the following story while in Boston: The town where we live is an extremely poor place. As you see, here we see a small girl. She is carrying a load of wood, of 16 logs and this size [about 10 to 12 inches each]. And the little girl has, that is, has walked 2 hours to come to the town, as she lives in a village. She said that there were many needs in her family. She asked her mother for 25 centavos [approximately $.05 US] to buy a chocobanana. But 25 centavos is a lot for a family in Chajul and they told the little girl to gather a load of wood and sell it in the town and she could buy a chocobanana. But she [her mother] told her that she could only spend 25 centavos and she needed to bring the rest of the money to her. So that’s the story of the girl. (Lykes, Caba Mateo & Laynez Caba, 1999. Translation from Spanish to English, Lykes)

Of note is the combined story that Ana now tells about her picture. She sustains her earlier focus on the child’s desire but has added details about the cost of this treat and the surplus funds generated by the sale of the wood. This information clearly came from the group discussion and analysis to which Ana was privy. The story she now tells, re-presenting her community to a U.S. audience, is a combined tale. The emphasis Ana has selected, for the U.S. audience, is to minimize the child’s desire for a chocobanana, emphasizing rather the poverty in which children of Chajul live and the challenges they face. As we will see below, the knowledge she constructs about audience and voice through this experience is threaded into the final narrative.

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The narrative or collective story that appears in the book is a combination of Ana’s two stories and the group analysis: A girl went to gather firewood in the bush. We think that she is worried and also sad since she doesn’t have any shoes. She’s tired from walking so much and her head hurts because she is carrying her load without a mecapal; she uses only a rag. Her parents don’t have enough money and this is the reason why she brought her wood from the village to the town to sell. We hope that the girl can have sandals one day, that she can be neat and clean and that she will not have to work like this because it’s too great a burden for her. There should be work appropriate for children her age and the opportunity for this girl to go to school. (Women of ADMI & Lykes, 2000, p. 61)

The economic conditions in which children labor, both in terms of support for their families and in terms of what is considered an appropriate or inappropriate burden, is emphasized here. Although this story attributes individual emotional concerns to the child, it is notable that the original desire for a chocobanana is no longer included. The photo-text stories this girl-child laborer as burdened by work and as living in a desperately poor family in a rural community. Hope is expressed, as well as the group’s collective demands, that is, the authors’ protest of overly burdensome and age-inappropriate child labor in their community and their moral claim that there will be a better future for children, one that includes schooling and improved material well-being. These claims evidence how these women further situate themselves within a global community, this time, the Universal Declaration of Human Rights, or, more specifically, the Convention on the Rights of the Child. As significantly, they include reference to the mecapal thus reasserting one of the multiple traditions within their Mayan community. Through these multiple iterations we, the authors of this chapter, can trace a developing storyline. The singularity of the photographed child’s desire for a chocobanana, the initial focus in Ana’s individual story, was appropriated by the group who gave voice to the particularities of rural Mayan childhood and poverty and universal claims for children’s rights. The singular desire of a young child was thus transformed into a collective hope for a better future for all children of this community and beyond. Personal desire and singularity have been deconstructed and resituated in the particular challenges of rural Mayan life and a universal discourse of childhood characterized by poverty, human pain, and children’s rights.

The Shared Theme of Shared Space: Voces e imágenes The project in Chajul demonstrates how a participatory action-research project enacted over a number of years and in the context of ongoing relationships between coresearchers (outsiders) and community members (insiders): (1) enhanced community participants’ capabilities to adapt to existing settings and to seek to alter problematic and create alternative settings; (2) reflected the priorities of the community and some of its multiple diversities; (3) prioritized prevention over treatment for the traumas of war and gender-based violence and oppression; (4) incorporated local values, beliefs, and cultural strengths into program design, implementation, and evaluation; (5) was integrated into

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existing community settings and activities; and (6) emphasized capacitybuilding over direct service provision. By speaking from the standpoints of oppressed groups, the women of the group were able to join together to design a collaborative process by which memories were collected, analyzed, and discussed, and action for future prevention was embraced. The decision of what was or was not “valid” knowledge in the research project developed through workshops and small group analysis sessions in which all coresearchers deliberated—often heatedly—over the photos and corresponding information and came to agreement on whether or not to include the images, and what the text accompanying the photos should be. Perhaps most importantly, the women of Chajul collaborated actively with outside scholars in the development of strategies for this process of conciliatory memory production. The experience of sorting out and deliberating through their own methods provided the women an opportunity to gain skills in communication and social and political analysis. As importantly, the capacity of the research team to sustain the multiple diversities reflected in the group and create a classed and ethnically diverse community PhotoVoice reflects the remembering process that Jelin (2003), among others, has argued is critical for enhancing the survivors’ ability to define justice in a postwar context such as Guatemala. Participatory action research methodologies emphasize reflexivity, a cyclical process of action and reflection that encourages one to develop a critical and reflexive sense of self both within the group and as a protagonist as well as “product” of society. Through group sharing processes, the women began to discuss ways to prevent the atrocities of war from recurring and to share a vision for change at both the individual and collective levels. Moreover, through reflexivity the researchers and the women attained a form of personal and political transformation (Williams & Lykes, 2003). Indeed, in an interview with the first and second authors of this chapter five years after the close of the project, one of the women of Chajul noted that the experience of participation in the PhotoVoice project meant many things to her and to the other women, because, she said, “what we learned is to create and sustain a space [for ourselves].” Creating spaces for local women to share their experiences and to respect that knowledge, including their “natural” helping systems, while drawing upon the communities’ Mayan traditions as well as new technologies represented by photography, is a particularly important aspect of the nexus of feminism and community psychology as experienced through this participatory and action research project. This example illustrates how participatory and action research can bridge feminist and community psychology methodologies and epistemologies, transforming local actions of photography and storytelling into opportunities for deepening understanding of the causes of rural poverty and the violence of war. As importantly, it provided spaces in which survivors could reclaim their protagonism through demanding a better future for themselves and their children as they transformed themselves as well as some small but significant dimensions of their local realities through collective actions.

Challenges in the Practice of Participatory and Action Research There is a vast literature that discusses the importance of culturally embedded community-based programs (Campbell, Self, Wasco, & Ahrens, 2004; Gurage & Khanlou, 2004; Moane, 2003), specifically, the concepts of consciousness,

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communal healing, and collective change. However, as McIlwaine and Data (2003) have noted “[w]hile theorizing difference is now an integral cornerstone of contemporary feminism, the challenge remains as to how to reconcile the diverse demands and priorities of different constituencies within feminism in the North and South” (p. 372). Moreover, “[t]hese debates on representation have also reignited discussions on the ethics of fieldwork among Western feminists working with Southern women, especially in relation to positionality and reflexivity” (McIlwaine & Data, 2003, p. 372). Despite these cautions, activist researchers working with existing community groups offer feminist-infused psychology a possibility to tap into the systems that local people have put into place and thus into the issues pertinent to them, as well as the resources and skills that they have to offer (Schuler, 1999). Seeking out these groups may be the first step towards greater collaboration between the researcher and participants on the path to becoming coresearchers. Ethical challenges that may arise in feminist, community-based research within a participatory and action research framework include protecting the identity of coresearchers, honoring participants’ needs, maintaining mutuality of the research relationship, and building strategies for making concrete change in the lives of participants (Paradis, 2000), to name a few. Memory, voice, and re-presentation, constructs discussed above and emergent as descriptors of the photovoice processes in Chajul, are constant challenges during a participatory action research process. There is a careful dance between presenting the experiences of the participants as distorted through the interpretations of the researcher, and developing a truly collaborative presentation of information, that is, a “third voice” that represents the combined efforts of researcher and participant (Lykes, Blanche, & Hamber, 2003). Challenges may arise specifically from the complicated relationship among coresearchers (the university-based outsider and community insiders) due to the intense collaboration inherent in the participatory and action research processes. Anne Brodsky describes some of these she experienced in the embrace of community psychology and feminist qualitative methods as a resource in bridging diversity between herself as an outsider and the insiders of RAWA (Brodsky & Faryal, 2006). She writes about the similarity-difference dynamic in her work and in the personal relationships she developed, highlighting, for example, her Western, social scientific, academic tendency to “discuss everything” which contrasted to the Afghan women’s comfort with silence and ambiguity. She and one of the RAWA women with whom she coauthored a piece about their work, describe these “road bumps” and the processes through which they came to a shared understanding—or not. Minkler (2004) addresses many of these points of cultural confusion or friction within the context of participatory research specifying that it is the vast differences in resources, cultural knowledge, and life experiences between the researcher and community members that may lead to miscommunications or worse. She (2004) also stresses the need to remain vigilant during the action stages of the research process to the consequences, unforeseen by the “outsiders,” which may arise as changes are made within the community. In Chajul, there were multiple occasions where women’s engagement in new experiences through PhotoVoice, for example, when rural women hiked to a village and remained overnight to photograph and interview women and families there, created tensions in their families or, more specifically, with their husbands.

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For outsider or university-based researchers, the personal aspects of entering into a project as coresearchers entails a practice of self-disclosure and relationship-building not often expected of the academic researcher (see Acker, Barry, & Esseveld, 1996). For example, during a research process with middle-class mothers in the United States, Acker, Barry, and Esseveld (1996) discovered that expectation by community members of friendship was an unexpected and unrealizable challenge for the authors. Additionally, one of the unforeseen impacts on the actual data collection was self-editing among the interviewees, resulting from the self-comparison of female interviewees to the researcher, who was a professor and similar in age to the interviewees. Acker et al. (1996), in a retrospective criticism to the original essay on the project, noted “empathy is not always possible, nor is it a defining quality of feminist research” (p 82). They continued, “However, a feminist researcher…still need[s] to recognize the researched as an active subject and to comprehend the effects of the social locations of both the researchers and the researched on the process and the content of the interview” (1996, p. 82). Thus, challenges facing participatory and action researchers can directly stem from the goals of working collaboratively. Moreover, institutional issues can affect participatory and action researchers who are working from within the academy. Indeed, Wahab (2003) notes, “if there is one story, one song, to be told in this inquiry, it is that which rests at the intersections of the participants’ lives, my life, and the academic institution” (p. 636). For example, the topics studied by participatory and action researchers are often not “mainstream” enough for funders. Barriers may also include coresearchers who lack the skills, time, or resources necessary for involvement in research which involves the time consuming process of training collaborators. On the flip side, if the community does become involved, the researcher loses control of the project as in the traditional positivist research model. The process of writing and disseminating information with an eye towards memory, voice, and re-presentation is arduous and difficult and, “…might place [university-based] researchers in a difficult ethical position, forcing us to choose between our professional self-interest and doing research that is truly beneficial and meaningful” (Paradis, 2000, p. 856). Other challenges such as language barriers and conflicts of interest also have an impact on project outcomes. Coresearchers in Chajul encountered many of these in their work together. Most notably, language differences among the “outsiders” as well as the women from other parts of Guatemala sometimes caused consternation and aggravation. Funders who visited the project to evaluate it were, for example, particularly self-conscious when, prior to responding to one of their questions, the Ixil and K’che’ women spoke at great length among themselves and did not offer a translation. Moreover, translation involves complex understandings of how words are situated within and among social relations in a particular material context, and thus a power differential emerged between those who spoke Spanish, Ixil, and K’iche’ or those limited to communicating in only one of the four languages spoken by project participants. In addition, basic differences of time and space associated with the differing cultural backgrounds of the coresearchers posed challenges throughout the project. These differences sometimes led to contrasting rhythms of time and work, contributing to miscommunications and misunderstandings.

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Looking Forward: The Complex and Sometimes Contradictory Influence of Globalization on and in Local Participatory and Action Research Throughout this chapter, we emphasize the importance of analyzing gendered, class-based, and racist constructs and social structures and find that processes of re-presentation can be deployed for both personal survival of individual participants as well as to generate structural changes within wider social systems (Lykes, Blanche, & Hamber, 2003). However, this local work is not isolated from wider sociopolitical contexts that introduce constraints and limitations, including, most notably, the forces of globalization. In their discussion of the gendering of globalization, McIlwaine and Datta (2003) draw on an earlier formulation wherein Walby (2000, p. 27) argued that globalization is “ ‘restructuring social relations on a global scale’ creating both deleterious effects [the feminization of poverty, the spread of HIV/AIDS and human trafficking] and opportunities [transnational organizing] for women and men” (McIlwaine & Datta, 2003, p. 376). These realities of global poverty impact upon workers at the grassroots, and the growing economic gap between rich and poor countries calls for new forms of organizing for structural change (Lykes & Mallona, 2007). Moreover, the increasing interconnectedness of many aspects of daily life has led to the rise of the notion of the global civil society (Smith & Johnson, 2002). Within that context, as Berger (2006) has suggested, Guatemalan women, not unlike many other women of the Southern hemisphere, have been “boxed into development labels and set institutional spaces … within institutional cultures” (p. 104) which impede rather than foster wider efforts for collective change. These larger institutional and systemic realities thus shape discourses and actions of individual women and of their efforts to build movements. The relationship between participatory and action research and the redress of social inequities is historically embedded (Fals Borda, 2001; Freire, 1970; Rahman, 1985/1983; Reason & Bradbury, 2001). Moreover, the manner in which this is articulated has changed over time (see Gaventa & Cornwall, 2001). Thus, the assumption made by participatory and action research that processes of critical reflection on material conditions, local knowledge production, and social change efforts will link to broader social movement-building, may not always be realistic within today’s global realities (Lykes & Mallona, 2007). Yet, globalization offers some positive potentials for participatory and action research that aspires to activism and mass-based organizing. For example, shifting populations, power structures, and relationships between nations and their citizens, create new spaces for advocacy, and rapid communications technologies can link organizers across the globe (Stahler-Sholk, 2001). At the same time these global communication strategies can have varied influences on local dynamics and identities (Marsella, 1998; Jensen, 2002; Smith & Johnson, 2002). A focus on social systems (Cosgrove & McHugh, 2000) may lead to the exploration of issues such as the local adoption of nonlocal concepts (e.g., global feminism or cultural rejuvenation of indigenous people) which may be at direct odds with one another, and deeply influence the ways that communities

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see themselves, complicating the research process (Merry, 2001). For instance, Mayan women’s participation in a research process in Chajul was cause for consideration of gender and race power relations, such as how gendered power relations are produced and enacted through discourses and ideologies about these processes (see also, Lennie, 1999; Cornwall, 2003). Race and power relations are also causes for circumspection, and coresearchers must attend to issues of personal privilege and one group’s dominance over another that may infiltrate the research process (Green & Sonn, 2005). In Chajul, for example, the coresearchers faced challenges in the sustainability of the work begun in the PhotoVoice project due to divisions along religious lines that intensified during and after the life of the project. Gaps grew among women around both issues of leadership and affi liation with, on the one hand, the growing evangelical Christian presence in the town, and, on the other, the sustenance of traditional Catholic and Mayan beliefs and practices. Evangelism is not a new feature of globalization, yet the faith traditions of heightened influence today are changing, and global technologies allow for increased contact among faith traditions from the industrialized North and the global South (Drogus, 1995). Additionally, assumptions that “outsider” or feminist researchers sometimes make about women’s shared identifications or affi liations with one another being based upon gender may not be true to local forms of social organization. Neither the category “woman” nor “community” is singular. Women and communities are characterized by “both solidarity and confl ict, shifting alliances, power and social structures” (Cleaver, 2001, p. 45). Thus in some societies, women’s primary alliances may be with family, and thus with male relatives, rather than with other women of the community, as may be assumed by some feminist researchers (Cornwall, 2003). As significantly, as argued by Butchart & Seedat (1990), in the South African context the discourse of community is now deployed to mask or gloss over underlying structural inequalities, assuming similarity or unity in the post-apartheid (sic) era where class and race based inequalities persist. Global poverty raises a significant and very particular challenge for community-based researchers in psychology who are concerned with social change and power differentials. They must evaluate the usefulness of traditional psychological methods such as individual or small group interventions and therapies that fail to address the clients’ or participants’ lack of adequate housing, education, shelter, etc. (Mulvey, 1988) as well as how local poverty is linked to global power relationships that call for redress of social structural inequalities. These needs must be explicitly articulated and problematized in ways that incorporate them as planned outcomes of a project and lead to enhanced community involvement and, eventually, to systematic social and political change (Bond, Belenky, & Weinstock, 2000).

Conclusions Shifting from a set of ideas presumed to be universal to a more local yet globally infused approach to research that allows the space for commonalities to surface between and among coresearchers and communities in order to effect

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change is a central tenet of a feminist, anti-racist, participatory and action research process (McIlwaine & Datta, 2003, p. 373). We suggest that participatory and action research processes bind community-based and feminist psychology research through recognizing the strengths of communities and deploying gender as a critical analytic tool while actively collaborating through activist scholarship processes to challenge the oppressive structures of power in these communities and beyond. We recognize the challenges facing feminist and community-based researchers in psychology who employ participatory and action research methodologies. The case example from Chajul suggests how, in one participatory and action research process, outsider researchers and local insiders were able to creatively rethread a collective story of war and extreme poverty through combining feminist and community psychology principles and values and developing “just enough trust” to generate knowledge and actions. Some of the limits and possibilities of combining these resources and strategies have been critically discussed above. We urge a continued explanation and debate of these modalities in an effort to provide participants with an ever-widening forum within which to re-present memory and voice. Participatory and action research are not, we have argued, the only approaches with transformational possibilities (see, e.g., liberation psychologies in the Special Issues, American Journal of Community Psychology, 2003, 31 (1/2)). It is the embrace of each of these critical action– reflection processes that shifts our gaze as researchers trained in the academy to the reality of participants, the resources they bring, and the social and political constraints that bear upon their lived experiences, garnering for psychology a depth and vastness of human experience without which we will fail professionally and personally to contest injustice and inequality wherever it occurs.

Endnotes 1. Note that we use the terms “participatory and action research” to refer to a spectrum of research methodologies, including that which identifies itself as action research and as participatory action research, all of which draw upon systems theory, humanistic values, democratic participation, and action or change. (For more on this, and the relationship between these forms of research and psychology and feminism, see Lykes & Coquillon, 2007.) 2. In the description of this work the chapter coauthors have employed the first person singular to reference the first author’s collaborative work in Chajul as this is grammatically more clear as well as more consistent with the values and assumptions of the research process and of my positionality within the research process and as coauthor of this chapter. 3. A head strap of leather or woven twine wrapped across the forehead and extending toward the back, used by Mayan peasants to distribute and balance weight of heavy loads carried on the shoulders and back.

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References Acker, J., Barry, K., & Esseveld, J. (1996). Objectivity and truth: Problems in doing feminist research. In H. Gottfried (Ed.), Feminism and social change: Bridging theory and practice (pp. 60–87). Chicago: University of Illinois Press. Adelman, C. (1993). Kurt Lewin and the origins of action research. Educational Action Research, 1, 7–24. Albee, G. W. (1992). Powerlessness, politics, and prevention: The community mental health approach. In S. Staub & P. Green (Eds.), Psychology and social responsibility: Facing global challenges (pp. 201–220). New York: New York University Press. Angelique, H. L. & Cully, M. R. (2003). Feminism found: An examination of gender consciousness in community psychology. Journal of Community Psychology, 31, 189–209. Berger, S. (2006). Guatemaltecas: The Women’s Movement 1986–2003. Austin, TX: University of Texas Press. Bertram, C., Hall, J., Fine, M., & Weis, L. (2000). Where the girls (and women) are. American Journal of Community Psychology, 28, 731–755. Boisnier, A. D. (2003). Race and women’s identity development: Distinguishing between feminism and womanism among Black and White women. Sex Roles, 49, 211–218. Bond, L. A., Belenky, M. F., & Weinstock, J. S. (2000). The listening partners program: An initiative toward feminist community psychology in action. American Journal of Community Psychology, 28, 697–730. Bond, M. A., Hill, J., Mulvey, A. & Terenzio, M. (2000). Weaving feminism and community psychology: An introduction to a special issue. American Journal of Community Psychology, 28, 585–597. Bond, M. A., & Mulvey, A. (2000). A history of women and feminist perspectives in community psychology. American Journal of Community Psychology, 28, 599–630. Brodsky, A. E. (2003). With all our strength: The revolutionary association of the women of Afghanistan. New York: Routledge. Brodsky, A. E. & Faryal, T. (2006). No matter how hard you try, your feet still get wet: insider and outsider perspectives on bridging diversity. American Journal of Community Psychology, 37, 311–320. Brydon-Miller, M., & Greenwood, D. (2003). Why action research? Action Research, 1, 9–28. Butchart, A. & Seedat, M. (1990). Within and without: Images of community and implications for South African psychology. Social Science & Medicine, 31, 1093–1102. Campbell, R., Self, T., Wasco, S. M., & Ahrens, C. E. (2004). Doing community research without a community: Creating safe space for rape survivors. American Journal of Community Psychology, 33, 253–261. Carmack, R. M. (Ed.). (1988). Harvest of violence: The Maya Indians and the Guatemalan crisis. Norman, OK: University of Oklahoma Press. Cleaver, F. (2001). Institutions, agency and the limitations of participatory approaches to development. In B. Cooke & U. Kothari (Eds.), Participation: The new tyranny? (pp. 36–55). London: Zed Books. Cockburn, C. (1998). The space between us: Negotiating gender and national identities in conflict. London: Zed Books. Cockburn, C. (2004). The line. London: Zed Books. Collins, P. H. (1998). Fighting words: Black women and the search for justice. Minneapolis, MN: University of Minnesota Press. Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd ed.) New York: Routledge. Commission for Historical Clarification (CEH) (1999). Guatemala Memory of Silence (Tz’inil na’tab’al): Report of the Commission for Historical Clarification, Conclusions and Recommendations. Guatemala. Cornwall, A. (2003). Whose voices? Whose choices? Reflections on gender and participatory development. World Development, 31, 1325–1342. Cosgrove, L., & McHugh, M. C. (2000). Speaking for ourselves: Feminist methods and community psychology. American Journal of Community Psychology, 28, 815–838. Cowen, E. L., Gardner, E. A., & Zax, M. (Eds.). (1967) Emergent approaches to mental health problems. New York: Appleton-Century-Crofts.

Chapter 3


Denzin, N. K., & Lincoln, Y. S. (Eds.). (2000). Handbook of qualitative research (2nd ed.). Thousand Oaks, CA: Sage. Drogus, C. A. (1995). The rise and decline of liberation theology: Churches, faith, and political change in Latin America. Comparative Politics, 27, 465–477. Dohrenwend, B. P. & Dohrenwend, B. S. (1969). Social status and psychological disorder: A causal inquiry. New York: Wiley-Interscience. Du Bois, B. (1983). Passionate scholarship: Notes on value, knowing, and method in feminist social science. In G. Bowles & R. D. Klein (Eds.), Theories of women’s studies (pp. 105–116). London: Routledge & Kegan Paul. Duffy, K. G., & Wong, F. Y. (1996). Community psychology. Boston: Allyn and Bacon. Earth, B. (1998). Participatory research: Gender and health in rural Tanzania. Convergence, 31, 59–67. Evans, S. M. (1979). Personal politics: The roots of women’s liberation in the civil rights movement and the new left. New York: Vintage Books. Fals-Borda, O. (1985). Knowledge and people’s power: Lessons with peasants in Nicaragua, Mexico, and Colombia. New Delhi: Indian Social Institute. Fals-Borda, O. R., & Ansiur Rhaman, M. (Eds.). (1991). Action and knowledge: Breaking the monopoly with participatory action research. New York: Apex Press and Intermediate Technology Publications. Fals Borda, O. (2001). Participatory (action) research in social theory: Origins and challenges. In P. Reason & H. Bradbury (Eds.), Handbook of action research: Participative inquiry and practice (pp. 27–38). Thousand Oaks, CA: Sage Publications. Fine, M. (1994). Dis-stance and other stances: Negotiation of power inside feminist research. In A. Gitlin (Ed.), Power and method: Political activism and educational research (pp. 13–35). New York: Routledge. Freire, P. (1970). Pedagogy of the oppressed. New York: Seabury Press. Fundación de Antropología Forense de Guatemala [Guatemalan Foundation of Forensic Anthropology] (FAFG). (2007). Retrieved April 22, 2007, from http://www.fafg.org/ Gaventa, J., & Cornwall, A. (2001). Power and knowledge. In P. Reason & H. Bradbury (Eds.), Handbook of action research: Participative inquiry and practice (pp. 70–80). Thousand Oaks, CA: Sage Publications. Gluck, S. & Patai, D. (1991). Women’s words: The feminist practice of oral history. New York: Routledge. Grant, K. E., Finkelstein, J. S., & Lyons, A. L. (2003). Integrating psychological research on girls with feminist activism: A model for building a liberation psychology in the United States. American Journal of Community Psychology, 31, 143–155. Green, M. J., & Sonn, C. C. (2005). Examining discourses of whiteness and the potential for reconciliation. Journal of Community & Applied Social Psychology, 15, 478–492. Greenwood, D. & Levin, M. (1998). Introduction to action research: Social research for social change. Thousand Oaks, CA: Sage Publications. Guruge, S. & Khanlou, N. (2004). Intersectionalities of influence: Researching the health of immigrant and refugee women. Canadian Journal of Nursing Research, 36, 32–47. Gustavsen, B. (2001). Theory and practice: The mediating discourse. In P. Reason & H. Bradbury (Eds.), Handbook of action research: Participative inquiry and practice (pp. 17–26). Thousand Oaks, CA: Sage Publications. Hale, C. R. (2008). Engaging contradictions: Theory, politics, and methods of activist scholarship. Berkeley, CA: University of California Press. Harding, S. (1986). The science question in feminism. Ithaca, NY: Cornell University Press. Harrison, D. (2001). Can research, activism, and feminism converge? Some notes on collaborative action-oriented inquiry. An International Challenge to Feminist Theory, 5, 233–245. Hersch, C. (1969). From mental health to social action: Clinical psychology in historical perspective. American Psychologist, 24, 906–916. hooks, b. (1981). Ain’t I a woman: Black women and feminism. Boston: South End Press. hooks, b. (1984). Black women: Shaping feminist theory. In Feminist theory: From margin to center (pp. 1–15). Boston: South End Press. Jelin, E. (2003). State repression and the labors of memory. Minneapolis, MN: University of Minnesota Press. Jensen, J. (2002). The psychology of globalization. American Psychologist, 57, 774–783.

79

80


Khanna, R. (1996). Participatory action research (PAR) in women’s health: SARTHI, India. In K. de Koning & M. Martin (Eds.) Participatory research in health: Issues and experiences (pp. 62–71). Johannesburg, South Africa: Zed Books Ltd. Leavitt, J. (2003). Where’s the gender in community development? Journal of Women in Culture and Society, 29, 207–231. Lennie, J. (1999). Deconstructing gendered power relations in participatory planning: Towards an empowering feminist framework of participation and action. Women’s Studies International Forum, 22, 97–112. Lorde, A. (1982). Zami: A new spelling of my name. Berkeley, CA: Crossing Press Feminist Series. Lorde, A. (1984). Sister outsider: Essays and speeches. Berkeley, CA: Crossing Press Feminist Series. Lykes, M. B. (1989). Dialogue with Guatemalan Indian women: Critical perspectives on constructing collaborative research. In R. Unger (Ed.), Representations: Social constructions of gender (pp. 167–185). Amityville, NY: Baywood. [Reprinted in Gergen, M., & Davis, S. (Eds.). (1996). Toward a new psychology of gender: A reader. NewYork: Routledge.] Lykes, M. B. (1994). Terror, silencing, and children: International multidisciplinary collaboration with Guatemalan Maya communities. Social Science and Medicine, 38, 543–552. Lykes, M. B. (August & November, 1998; June, 1999). Memoria/Group Field Notes. Chajul, Guatemala. Unpublished documents. Lykes, M. B., Caba Mateo, A., & Laynez Caba, I. (March, 1999). Participatory action research and community photography: Cross border collaborations for a better future among Maya Ixil Women (Lykes, M. B., Trans.). Video taped presentation, Boston College, Boston. Lykes, M. B. (with Caba Mateo, A., Chávez Anay, I., Laynez Caba, A., & Williams, J. W.). (1999). Telling stories—rethreading life: Community education, women’s development and social change among the Maya Ixil. International Journal of Leadership in Education: Theory and Practice, 2(3), 207–227. Lykes, M. B. (2001). Creative arts and photography in participatory action research in Guatemala. In P. Reason & H. Bradbury (Eds.), Handbook of action research (pp. 363–371). Thousand Oaks, CA: Sage. Lykes, M. B., & Coquillon, E. (2007). Participatory and action research and feminism: Towards transformative praxis. In S. Hesse-Biber (Ed.), Handbook of feminist research: Theory and praxis (pp. 297–326). Thousand Oaks, CA: Sage. Lykes, M. B., & Mallona, A. (2007). Towards transformational liberation: Participatory action research and activist praxis. In P. Reason & H. Bradbury (Eds.), The Sage handbook of action research II (pp. 260–292). London: Sage. Lykes, M. B., Blanche, M., & Hamber, B. (2003). Narrating survival and change in Guatemala and South Africa: The politics of representation and a liberatory community psychology. American Journal of Community Psychology, 31, 79–90. Maguire, P. (2001). Uneven ground: Feminism and action research (Version Spring 2002). Thousand Oaks, CA: Sage. Manz, B. (1988). Refugees of a Hidden War: The Aftermath of Counterinsurgency. Albany, NY: State University of New York Press. Marsella, A. (1998). Toward a ‘globalization psychology’: Meeting the needs of a changing world. American Psychologist, 53, 1282–1291. Martin, M. (1996). Issues of power in the participatory research process. In K. de Koning & M. Martin (Eds.), Participatory research in health: Issues and experiences (pp. 82–93). London: Zed Books. McIlwaine, C. & Datta, K. (2003). From feminizing to engendering development. Gender, Place and Culture, 10, 369–382. McIntyre, A. (1997). Making meaning of whiteness: Exploring racial identity with white teachers. Albany, NY: SUNY Press. McIntyre, A. & Lykes, M. B. (2004). Weaving words and pictures in/through feminist participatory action research. In M. Brydon-Miller, P. Maguire, & A. McIntyre (Eds.), Traveling companions: Feminism, teaching, and action research (pp. 82–111). Santa Barbara, CA: Praeger. Merry, S. E. (2001). Rights, religion, and community: Approaches to violence against women in the context of globalization. Law & Society Review, 35, 39–88.

Chapter 3


Minkler, M. (2004). Ethical challenges for the ‘outside’ researcher in community-based participatory research. Health Education & Behavior, 31, 684–697. Mitchell, C. & Reid-Walsh, J. (2002). Researching children’s popular culture: The cultural spaces of childhood. New York: Routledge. Moane, G. (2003). Bridging the personal and the political: Practices for a liberation psychology. American Journal of Community Psychology, 31, 91–101. Mohanty, C. T. (2003). Feminism without borders: Decolonizing theory, practicing solidarity. Durham, NC: Duke University Press. Moraga, C. & Anzaldua, G. (1983). This bridge called my back: Writings by radical women of color. New York: Kitchen Table, Women of Color Press. Mulvey, A. (1988). Community psychology and feminism: Tensions and commonalities. Journal of Community Psychology, 16, 70–83. Nelson, C., Dickinson, S., Beetham, M., & Batsleer, J. (2000). Border crossings/translations: Resources of hope in community work with women in Greater Manchester. Community, Work and Family, 3, 349–362. Nelson, G., & Prilleltensky, I. (2005). Community psychology: In pursuit of liberation and wellbeing. New York: Palgrave Macmillan. Paradis, E. K. (2000). Feminist and community psychology ethics in research with homeless women. American Journal of Community Psychology, 28, 839–858. Personal Narratives Group. (1989). Interpreting women’s lives: Feminist theory and personal narratives. Bloomington, IN: Indiana University Press. Rahman, M. A. (1985). The theory and practice of participatory action research. In O. Fals Borda (Ed.), The challenge of social change (pp. 107–132). London: Sage Publications. Published previously in The theory and practice of participatory research (WEP 10/WP. 29), 1983. Geneva: International Labour Office. Rappaport, J. (1977). Community psychology: Values, research, and action. New York: Holt, Rinehart & Winston. Rappaport, J., & Seidman, E. (Eds.). (2000). Handbook of community psychology. New York: Springer. Reason, P. & Bradbury, H. (Eds.). (2001). Handbook of action research: Participative inquiry and practice. Thousand Oaks, CA: Sage Publications. Reinharz, S. (1992). Feminist methods in social research. New York: Oxford University Press. Schlesinger, S. E., & Kinzer, S. (1999). Bitter fruit: The story of the American coup in Guatemala. Cambridge, MA: Harvard University Press. Schuler, S. R. (1999). Gender and community participation in reproductive health projects: Contrasting models from Peru and Ghana. Reproductive Health Matters, 7(14), 144–157. Smith, A., & Stewart, A. (1983). Approaches to studying racism and sexism in Black women’s lives. Journal of Social Issues, 39, 1–15. Smith, D. E. (1977). Toward a black feminist criticism. New York: Out & Out Books. Smith, D. E. (1987). The everyday world as problematic: A feminist sociology. Boston: Northeastern University Press. Smith, D. E. (1991). The conceptual practices of power: A feminist sociology of knowledge. Boston: Northeastern University Press. Smith, J., & Johnston, H. (2002). Globalization and resistance: an introduction. In J. Smith & H. Johnston (Eds.) Globalization and resistance: Transnational dimensions of social movements (pp. 1–10). Oxford: Rowman and Littlefield Publishers, Inc. Stahler-Sholk, R. (2001). Globalization and social movement resistance: The zapatista rebellion in Chiapas, Mexico. New Political Science, 23, 493–516. Suyemoto, K. L., & Fox Tree, C. A. (2006). Building bridges across differences to meet social action goals: Being and creating allies among people of color. Journal of Community Psychology, 37, 237–246. Trinh, T. Minh-Ha (1989). Woman, native, other: Writing postcoloniality and feminism. Bloomington, IN: Indiana University Press. Wahab, S. (2003). Creating knowledge collaboratively with female sex workers: Insights from a qualitative, feminist, and participatory study. Qualitative Inquiry, 9, 625–642. Walsh, M. (1998). Mind the gap: Where feminist theory failed to meet development practice— A missed opportunity in Bosnia and Herzegovina. The European Journal of Women’s Studies, 5, 329–343.

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Watts, R. J., & Serrano-Garcia, I. (2003). The quest for a liberating community psychology: An overview. American Journal of Community Psychology, 31, 73–78. Williams, P., & Chrisman, L. (Eds.). (1994). Colonial Discourse/Political Theory. New York: Columbia University Press. Williams, J. W., & Lykes, M. B. (2003). Bridging theory and practice: Using reflexive cycles in feminist PAR. Feminism and Psychology, 13, 287–294. Women of PhotoVoice/ADMI & Lykes, M. B. (2000). Voces e imágenes: Mujeres Mayas Ixiles de Chajul/Voices and images: Mayan Ixil women of Chajul. Guatemala: Magna Terra. Texts in Spanish and English, with a methodology chapter by Lykes. Zeichner, K. (2001). Educational action research. In P. Reason & H. Bradbury (Eds.), Handbook of action research: Participative inquiry and practice (pp. 273–284). Thousand Oaks, CA: Sage.

Methodological and Statistical Issues in Research With Diverse Samples: The Problem of Measurement Equivalence

4 Irma Corral and Hope Landrine

Irrespective of their area of specialization, researchers desire to generalize their findings beyond the specific samples in their studies. Such generalization necessitates diverse samples that are representative of the diverse U.S. population (Sue, 1999), and hence, researchers seek to include numerous status groups—for example, racial/ethnic groups, gays/lesbians, various age, and socioeconomic (SES) groups—in their studies. Each increase in the diversity of the sample is a potentially similar increase in the breadth of permissible population inferences (Abelson, 1995). A diverse sample, however, raises questions about the internal validity of the study—namely, the extent to which the samples of various groups are equivalent, and the extent to which the methodology and measures used, as well as the relationships among the measures, are equivalent across those groups (Sue, 1999). These issues of measurement equivalence are critical because researchers inevitably compare the groups (Helms, 1992; Helms, Jernigan, & Maryam, 2005), and such comparisons require cross-group equivalence in the meaning, interpretation, and impact of the methodology and measures (Byrne & Watkins, 2003; Harkness, van de Vijver, & Mohler, 2003).

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Group comparisons raise additional issues such as whether using groupdifferences statistics to compare status groups violates the underlying assumptions of those statistics (Campbell & Stanley, 1966; Cook & Campbell, 1979), and whether any group differences found can be attributed to group membership vs. correlated but unmeasured social and contextual variables (Betancourt & Lopez, 1993; Helms et al., 1995; Matsumoto & Yoo, 2006). Likewise, comparing diverse groups raises issues of external validity—that is, the extent to which each group sample is representative of its population, and the extent to which the latent constructs beneath the measures, as well as the relationships among those constructs, are equivalent for each group in the population, outside of the study (Sue, 1999). Thus, the empirical and epistemological challenges entailed in conducting research with diverse samples are complex, and are fundamental insofar as they highlight the problems and the politics of normative methodologies, measures, and statistical analyses. This chapter focuses on largely neglected problems of sample and measurement equivalence in research with diverse groups, and provides strategies for addressing those to improve cross-group validity. Discussion of the 13 to 15 types of equivalence (e.g., see Byrne & Watkins, 2003; Harachi, Choi, Abbott et al., 2006), however, is beyond the scope of this chapter. Thus, of the many types summarized in Table 4.1 (as questions to consider), we limit this chapter to Sample, Method, Scalar, and Item equivalence. We detail these four equivalence-issues for racial/ethnic groups, but emphasize that the problems in studies of diverse ethnic groups apply to studies of other status groups as well, for example, social class and age groups. Indeed, the questions on equivalence, addressed here, are critical to consider in studies of diverse groups of women.

Sample Equivalence Studies that include diverse racial/ethnic groups invariably compare these groups to Whites, and likewise invariably attribute differences found to ethnic-group membership (Betancourt & Lopez, 1993; Helms et al., 2005; Lehman, Chiu, & Schaller, 2004; Matsumoto & Yoo, 2006). The problem inherent in this normative practice is that racial/ethnic groups differ from Whites in a multitude of ways, only a few of which are cultural/ethnic (Helms et al., 2005; Matsumoto & Yoo, 2006). For example, ethnic minority status groups differ from Whites on social variables such as socioeconomic status (SES), ethnic discrimination, social exclusion, stigmatization, and residential segregation that are not only processes and products of ethnic stratification, but also produce and maintain ethnic disparities in SES (e.g., Iceland, Weinberg, & Steinmetz, 2002; Johnson, Poulsen & Forrest, 2007; Massey, 2001, 2004; Massey & Gross, 1994; Massey & Denton, 1993). Ethnic differences are routinely attributed to ethnic-group membership in the absence of empirical evidence that ethnicgroup membership, rather than the many social contextual variables correlated with it, accounts for the differences found. This attribution is problematically circular insofar it explains ethnic differences in terms of differences in ethnic group (Helms et al., 2005; Smedley & Smedley, 2005). Likewise, this normative practice entails what Matsumoto and Yoo (2006) refer to as the cultural attribution error, namely, the tendency to conclude that ethnic differences “have a cultural source, when in fact the mere

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Methodological and Statistical Issues

4.1

Types of Equivalence

Method. Does the method used to acquire the sample and the data have the same meaning and impact on all groups? Do all groups respond similarly to the methodology? Does the methodology exclude significantly more members of one group than of another? Are data from some groups an artifact of the methodology? Does the method yield a biased vs. representative sample of any group? Are all groups equally comfortable in and familiar with the setting in which the research occurs? Sample. Are the samples of various groups equal on all potentially relevant social variables? How many social variables were measured and controlled? Do the groups differ on social variables to such an extent that results may be a function of those variables rather than of membership in the groups of interest? Task. Is the research task/material novel for any group? Are the groups equally familiar with the task/materials? Does the frequency of engaging in similar tasks or using similar materials outside of the study correlate with group membership? Are results an artifact of group differences in familiarity with similar tasks/materials? Does the task elicit stereotype threat in some groups but not others? Are group-differences a function of differentially-elicited stereotype threat? Construct. Does the etic (i.e., White, American, middle-class, heterosexual) construct under investigation match the emic (group-specific) meaning of the construct for all groups? Do participants of all groups share the same understanding of the construct? Does the construct exist for all groups? Item. Do the items operationalize the construct under investigation in only one manner? Are results a function of the specific operationalization employed? Are participants of different groups perceiving and interpreting the items similarly? What level of literacy and of fluency in English do the items require? Are items presented in English only? What social, educational, developmental, sexual, life-history, and cultural experiences do the items presume? Do such experiences vary with group membership? Do the items elicit stereotype threat in some groups but not others? Are groupdifferences on items on function of differentially-elicited stereotype threat? Scalar. Do the response categories (e.g., Likert scale, multiple-choice) have the same meaning for all groups? Are groups equally familiar with the response categories? Do the categories control for group differences in response-styles? Do the response categories adequately represent the range and nature of experiences and the views of all groups, or, are the categories insufficient for or frankly irrelevant to some groups? Purpose. Do/will all groups understand the purpose of the task and its proper solution in a similar manner? Do groups differ in beliefs about the study, about what they are to do, or about what the researcher expects and desires from them? Ecological. Do the research setting, materials, items, and task reflect the real world sufficiently enough that behavior within the study generalizes to behavior outside of it? Does the ecological validity of the tasks, items, materials or setting differ by group such that findings for one group generalize outside of research whereas those for another group do not? Continued

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Types of Equivalence (continued)

Attrition. Do response or drop-out rates vary by group? If so, what is it about the study that might cause these differences? Are the data an artifact of differential response/attrition insofar as responders may differ from non-responders, and such differences may vary by group? Impact (demoralization). Do the research setting, tasks, items, or materials have different emotional impacts on different groups? Do the setting, task, items, or materials differentially demoralize (insult, offend, anger, embarrass) members of any group? Is this sufficient to render the responses of some groups little more than resentful demoralization? Evaluation apprehension. Do the items/tasks elicit fear of exposing information about one’s group that potentially could be used to harm that group? Is this evaluation apprehension (i.e., fear of the sociopolitical ends to which the data can be put, stereotype threat) equal across groups? What steps are taken to assure groups that data will not be used in harmful ways? If some groups are distrustful of research because of past abuse of their group, what additional steps are taken to reassure them? Researcher. Does the researcher’s actual or presumed gender, age, ethnicity, or social class have a differential, nonrandom impact on different groups? Was this measured? Controlled? Translation. If the items will be translated, what translation procedures will be used? What steps are taken to assure translation equivalence? Do the English-(source) language words have exact or near-exact counterparts in the alternative (target) language? Will items be translated literally or for meaning? What specific dialect of the target languages will be used?

documentation of between-group differences does not justify such interpretation” (Matsumoto & Yoo, 2006, p. 235). Such circular reasoning is not limited to ethnic comparisons, however, and instead appears in research with any group for whom group-membership is socially assigned and constructed rather than carefully measured—for example, explaining age differences as a function of differences in age. Thus, an issue is not a cultural attribution error, but rather, the Fundamental Attribution Error—the error of attributing behavior and outcomes to people by underestimating or simply ignoring their social contexts (Gilbert & Malone, 1995; Ross & Nisbett, 1991). Clearly, researchers must measure and control the social contextual correlates of membership in ethnic (and other status) groups before attributing differences to group membership. That researchers rarely measure and control such variables—for example, harassment, discrimination, and segregation—is merely the tip of the troublesome iceberg of normative research practices. More problematic is that the plethora of potentially relevant, social contextual correlates of ethnic (and other status) group membership cannot be known a priori, and are unlikely to occur to researchers—for example, ethnic and SES differences in having a landline, home-telephone, discussed later here. Consequently, the social contextual correlates that researchers control cannot be demonstrated to be sufficient, and hence, attributing ethnic differences to ethnic-group membership (with any certainty) cannot be empirically justified.

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The presence of unmeasured and unknown but relevant social contextual correlates of ethnic-group membership means that ethnic-group samples are by definition nonequivalent: Such samples are not equal (matched) on all relevant independent variables except ethnic-group, and hence, differences on dependent variables cannot be known to be a function of the ethnic-group independent variable. Moreover, the social contextual correlates of ethnic-group membership that researchers often do indeed measure and control (e.g., SES) are nonequivalent across ethnic (and other) groups. Thus, controlling for such independent variables does not eliminate their effects. The two examples below illustrate these issues. The fi rst, SES, is an obvious contextual correlate of ethnic-group membership that many control, but is nonequivalent across diverse groups. The second is a less obvious social contextual correlate—namely, residential segregation—that may be more powerful than SES and equivalent across groups, but rarely measured in studies that compare ethnic groups or compare ethnically diverse groups of women.

An Obvious but Nonequivalent Social Contextual Correlate: SES Socioeconomic status (SES) is strongly related to membership in ethnic, gender, and ethnicity X gender groups, and accounts for some or much of the behavioral and health differences between these groups, depending on the outcome investigated (Centers for Disease Control [CDC] 2004a, 2004b; Krieger, Williams, & Moss, 1997; National Institutes of Health [NIH], 1998). Consequently, researchers often control for SES in studies that compare people of color to Whites (CDC, 2004a, 2004b; Williams, 2002). In such analyses, SES is usually assessed as individual income and/or education (Krieger et al., 1997). These normative SES measures are nonequivalent—they have different meanings—for women of different groups. For example, among women (Table 4.2, top), individual income differences at each education level are small and statistically nonsignificant until the highest (professional degree) level where differences are striking. When individual income is used as the measure of SES, there are almost no differences among women of different ethnic groups—individual income is an insensitive SES measure for women. This is because women of different ethnic groups differ significantly in marital status (Williams, 2002), as shown in Table 4.3 (bottom). Significantly, more White women than women of color are married, meaning that the number of adults contributing to the income of a household differs by ethnicity. Using household (instead of individual) income as an alternative measure of SES reveals statistically significant ethnic differences in women’s SES at every educational level (Table 4.2, bottom). For example, Black high school– graduate women’s households earned 64 cents, and Black college-graduate women’s households earned 74 cents for every dollar earned by White women’s households (Table 4.2). SES inequality among women of different ethnic groups is masked by individual measures but highlighted by household measures; hence many have suggested using the latter to reveal the context of physical and mental health differences among women (e.g., Krieger et al., 1999;

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4.2

Individual vs. Household Income (in US Dollars) of White, Black, and Hispanic Women, 1996 Individual incomea

Education level

White women

Black women

Hispanic women

8,056 10,666 15,701 18,183 21,727 26,703 46,307

9,694 10,369 15,050 19,640 22,020 27,534 27,323

9,392 10,360 14,146 16,386 20,515 26,454 38,602

< 9 years 9–11 years High school graduate Some college Associate degree Bachelor’s degree Professional degree

Household incomeb < High school High school graduate Some college/associate degree Bachelor’s

a b

18,471 37,000 45,510 64,007

13,100 23,556 33,162 47,100

19,310 32,000 38,000 56,765

From US Census Bureau (1996). From National Center for Health Statistics (1998).

Moss, 2002). For example, significantly more working-class women have poor health when using (gender-neutral) household vs. personal income to categorize women as working-class (Krieger et al., 1999). Although controlling for household income is generally superior to controlling for individual income in research on women (Krieger et al., 1997, 1999), doing so does not resolve the problem of the nonequivalence of SES measures across diverse groups. This is because ethnic differences in wealth (based primarily on property ownership) are significantly larger than differences in household income, such that household income similarly underestimates SES inequity. Less than half of Black and Hispanic households own their homes, compared to more than 70% of White households (Krieger et al., 1997; Williams, 2002), with home ownership (vs. renting) a predictor of other social (independent) variables (e.g., a landline telephone) that are strongly related to behavior and to physical and mental health. Moreover, even controlling for household income, home ownership and marital status does not render income measures equivalent across groups, for two reasons. First, the cost of housing (renting or owning) is significantly higher for ethnic minorities, women, and ethnic minority women as a result of widespread housing discrimination (U.S. Department of Housing and Urban Development [HUD], 2002). HUD (2002) estimates that 2 to 10 million cases of housing discrimination occur each year, such that African-, Asian-, Hispanic-, and Native-American households are twice as likely as White ones

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4.3

Age, Marital Status, and Gender Differences Among Ethnic Group Samples in the 2000 Behavioral Risk Factor Surveillance Survey (BRFSS)a Whites (n = 85,543)

Blacks (n = 11,308)

Latinos (n = 9,080)

American Indians (n = 1,211)

47.36

42.77 − 4.59 years t = 27.077*

38.89 − 8.47 years t = 45.45*

42.35 −5.01 years t =10.11*

Marital status % Married, % single ␹2 vs. Whites

76.5, 23.5

48.5, 51.5 ␹2 = 2617.02*

67.5, 32.5 ␹2 = 263.798*

65.3, 34.7 ␹2 = 57.474*

Gender % Men, % women ␹2 vs. Whites

40.9, 59.1

34.0, 66.0 ␹2 = 197.595*

41.1, 58.9 ␹2 = 0.106

42.6, 57.4 ␹2 = 1.430

Women only

Whites

Blacks

Latinas

American Indian*

Age mean Difference from Whites t-test vs. Whites

48.21

43.04 − 5.17 years t = 24.179*

39.28 − 8.93 years t = 36.135*

42.22 − 5.99 years t = 9.048*

78.9, 21.2

43.8, 56.2 ␹2 = 2286.73*

68.6, 31.4 ␹2 = 190.165*

65.8, 34.2 ␹2 = 46.98*

Women and men Age mean Difference from Whites t-test vs. Whites

Marital status % Married, % single ␹2 vs. Whites *P < .0005. a CDC (2004c).

to spend ≥50% of their incomes on housing alone (HUD, 2002; Krieger et al., 1997; Williams, 2002). This means that people of color usually have less money available for food and other essentials than Whites of matched individual and household income (Krieger et al., 1997). Consequently, people of color, women, and (especially) women of color are more likely to experience stressful, economic hardships (i.e., lack of sufficient money for essentials) than men and Whites even after controlling for individual and household income, education, number of children, and marital status (Krieger et al., 1997; Williams, 2002). Such hardships (and lack thereof) are perhaps the core, experiential meaning of social class, and remain when using normative SES measures. Secondly, as a result of gender and ethnic discrimination, people of color and women pay significantly more for goods and services (e.g., cars, dry cleaning, repairs, haircuts) than their White and male counterparts, such that

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“the same” income is not equivalent by gender, ethnicity, or gender X ethnicity (Krieger et al., 1997; Williams, 2002). Likewise, the poor pay significantly more than the middle-class for food in their respective neighborhoods (e.g., Chung & Meyers, 1999). Thus, a dollar for a White middle-class man goes significantly further than the same dollar for ethnic minorities, women, the poor, and minority women—all of whom have fewer dollars to spend (Krieger et al., 1997; Williams, 2002). These examples underscore the nonequivalence of income measures across groups, and highlight the politics of the normative procedure of matching groups on, or controlling for, SES so measured. Income measures of SES present other difficulties as well. For example, income can be unreliable and inaccurate because it fluctuates during the year. More than 50% of the population experiences a significant change—an increase of ≥ 50% or decrease of ≥ 30%—in income during a year, with such changes more likely for low-SES, women, and minority groups (Krieger et al., 1997). Such fluctuation means that income can differ significantly from month to month (this itself a source of considerable stress), and hence can reflect the moment of measurement only (Krieger et al., 1997). Likewise, nonresponse rates to personal and household income questions are notoriously high, and vary by income and ethnicity, with low-income and minority groups likely to be nonresponders, and income consequently often imputed for substantial percentages of these groups—with significant inaccuracy and threats to study validity (Kim, Egerter, Cubbin, et al., 2007).

Strategies for Improving Measurement of SES Recent studies by Nancy Krieger and her colleagues indicate that measures of SES at the area (neighborhood) level are superior to measures at the individual level (e.g., Krieger et al., 1997). Area-based measures are not subject to nonresponse and other reporting biases or marital-status effects; likewise, they are equivalent across groups because they reflect rather than ignore the ethnic and gender discrimination that relegate people of the same incomes to neighborhoods that differ significantly in hazards, resources, amenities, and safety. Area-based SES can be measured at a variety of area-levels, ranging from census tracts (CT) to zip codes and counties. Krieger’s group has demonstrated that measures at the census-tract (CT) level are more robust than those at the zip code and larger levels (e.g., Krieger et al., 1997; Krieger, Chen, Waterman, et al., 2002, 2003a, 2003b, 2003c, 2005). This is because, unlike zip codes (Mean N = 30, 000), CTS are relatively small geographic areas (Mean N = 4,000) that are largely homogenous in ethnicity, living conditions (e.g., amenities, environmental exposures, property values), life circumstances (e.g., owning vs. renting) and hence quality of life. Moreover, CTS are nonoverlapping, basically permanent subdivisions of a county based on population and ecologicalniche characteristics. Alternatively, zip codes (created by the Postal Service for mail delivery) are not permanent, overlap, range in size from one building to an area that cuts across state lines, and are constantly added, deleted, and (their boundaries) changed in response to letter-carrier needs. Hence, areaSES is usually measured at the CT-level, with this level most sensitive to SES inequity (Krieger et al., 1997, 2002).

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With CT selected as the best area-level, CT-level SES then can be measured in a variety of ways (e.g., median home value, median household income, Townsend Index etc.). Of 18 area-based measures, studies reveal that the percentage of CT residents below the federal poverty (% BPL) is the most robust area measure of SES for diverse ethnic groups, women, and older populations (Krieger et al., 1997, 2002). For example, after controlling for individual/ household income, CT % BPL remains a strong predictor of SES differences, and of SES-related ethnic and gender differences, in weapons-related injuries (Krieger et al., 2003b); smoking (Chuang, Cubbin, Ahn, et al., 2005; Datta, Subramanian, Colditz, et al., 2006); women’s reproductive health and birthoutcomes (O’Campo, Burke, Culhane, et al., 2008; Pearl, Braveman, & Abrams, 2001); breast and cervical cancer screening (Couglin, Leadbetter, Richards, et al., 2008); and many other behaviors, and physical and mental health outcomes (e.g., Cohen, Mason, Bedimo, et al., 2003; Krieger et al., 2005; Lee & Cubbin, 2002; Macintyre & Ellaway, 2003).

The Robustness of Area-Based Measures On the whole, SES measured at the CT-level is a stronger predictor of physical and mental health and of behaviors than SES measured at the individual level (e.g., Krieger, et al., 1997, 2002). Hence, many researchers now use CT % BPL as the preferred measure of SES, with these categories: 0% to 4.9%, 5% to 9.9%, 10% to 19.9%, and ≥20%, where CT % BPL ≥20% is the federal definition of a poverty area. For example, the National Cancer Institute reanalyzed its 1975–1999 data using CT % BPL and found that it better highlights SES, gender X SES, and ethnicity X SES disparities in cancer incidence, mortality, treatment, and survival (Singh, Miller, Hankey, & Edwards, 2003). Such robustness stems from the fact that area-level measures provide data on the neighborhoods in which people reside, that is, on the daily, lived meaning of social class. For example, although people who reside in a CT where 20% of residents are below the poverty line vary significantly in their individual and household incomes (Krieger et al., 1997, 2002), all equally experience life in their low-SES neighborhood. Such neighborhoods often are characterized by substandard housing entailing high indoor exposure to nitrogen dioxide (from old stoves), carbon monoxide (from old heating systems), organic pollutants (emitted by particle board and polyvinyl chloride flooring), polycyclic aromatic hydrocarbons (from old carpets), molds, and lead paint (e.g., Evans, Hydman, et al., 2000; Jacobs, Kelly, & Sobolewski, 2007; Jacobs, Clinkner, et al., 2002; Kingsley, 2003). Such exposures contribute causally to diabetes (Burton, 2007; Schootman, Andersen, Wolinsky, et al., 2007), asthma (Institute of Medicine, 2000), cardiovascular disease (e.g., Ha, Lee, & Jacobs, 2007), and hypertension (e.g., Cozier, Palmer, Horton, et al., 2007; Huang, Lessner, & Carpenter, 2006) among lowSES groups. Indeed, exposure to lead paint has long been known to contribute causally to cognitive-behavioral deficits among children (Jacobs et al., 2007). Less well-known is that it similarly contributes to hypertension among women and Blacks in particular (Nash et al., 2003; Vupputuri et al., 2003). Likewise, low-SES neighborhoods often are characterized by garbage-filled vacant lots, abandoned and boarded buildings, graffiti, noise, wild dogs, air pollution, absence of sidewalks, trees and adequate street-lights, and absence of

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grocery stores and recreational facilities (e.g., Accordino & Gary, 2000; Cohen, Spear, Scribner, et al., 2000; Giles-Corti & Donovan, 2002; Moore & Diez Roux, 2006; Moore, Diez Roux, Evenson, et al., 2008). Living in such neighborhoods can be extremely stressful, and is related to poor physical (Cohen, Farley, & Mason, 2003; Gordon-Larsen, Nelson, Page, et al., 2006) and mental health (e.g., depression) among low-SES groups, women and older adults in particular (e.g., Balfour & Kaplan, 2003; Elliott, 2000; Siefert, Finlayson, Williams, et al., 2007; Steptoe & Feldman, 2001). Consequently, when people move out of low-SES neighborhoods and into middle-class ones, their physical and mental health improve significantly even though their individual and household incomes remain the same (e.g., Fauth, Leventhal, & Brooks-Gunn, 2004; Leventhal & Brooks-Gunn, 2003).

Summary of SES and Suggestions for Improving Research Gender, ethnic, and ethnic X gender groups differ in SES, and hence SES must be controlled as a social contextual variable that might in part explain differences among these groups. The measures of SES used routinely in research (especially in psychology) are nonequivalent across these groups. Consequently, SES effects are not adequately assessed by such measures, and are not removed by controlling for or matching groups on SES so measured. The normative practice of measuring SES at the individual level obscures SES-disparities among diverse ethnic groups and among women of various ethnic, and by so doing, perpetuates the view that ethnic differences readily can be separated from and so persist across SES. Indeed, the tendency to attribute ethnic and ethnic X gender differences to ethnicity in part is maintained by use of individuallevel measures of SES. The cross-group equivalence of SES measures can be improved by adding area-based measures to individual-level ones. To facilitate this, Krieger’s group has calculated CT % BPL for every CT in the United States, and made those data publically available at www.hsph.harvard.edu/thegeocodingproject. Hence, this area-level measure of SES readily can be added to research and used in multilevel analyses—although doing so necessitates acquiring participants’ addresses to geographically code these. Alternatively, measures of economic hardship (e.g., insufficient money for food, utilities, and other essentials) can be used instead of or in addition to income measures to assess the differential meaning of “the same” income across ethnic and gender X ethnic groups. Valid, reliable hardship measures (e.g., of food insecurity) have been included (but rarely analyzed) in several state and national population-based health surveys (e.g., the California Health Interview Survey, CHIS) and hence are publically available (e.g., www. CHIS.ucla.edu). In the absence of hardship and/or area-based measures, income measures of SES must be interpreted with caution, their limitations (low reliability, nonresponse bias, missing data and imputation) detailed, their crossgroup nonequivalence underscored, and only tentative conclusions drawn about SES so measured. This is particularly critical in studies that compare ethnic groups, or compare women of different ethnic groups. To our knowledge, there are no studies of the possibility that personal/ household income may be an inadequate measure of SES for other groups—for example, immigrants/refugees, lesbians, older women, and people who have

Chapter 4


disabilities, to name a few. That each of these groups experiences widespread discrimination (detailed in later chapters) strongly suggests that a dollar may not go as far for them as it does for others, and thereby implies the need to use economic hardship as an alternative or additional SES measure. Likewise, there is little research on the extent to which these groups are relegated to specific neighborhoods that might vary in CT SES, resources (e.g., hospitals, daycare centers) or hazards (e.g., density of alcohol and tobacco outlets)— despite progress in feminist (e.g., Bondi & Rose, 2003; Jones, Nast, & Roberts, 1997; Palovskaya & Martin, 2007), cross-cultural (e.g., Mains, 2000), and queer geography (e.g., Doan, 2007; Knopp, 1999). We encourage use of geographic and multilevel analyses with gays/lesbians, women, immigrants, and other groups to improve measurement of the living conditions that largely constitute the experience of subordinate-group status and of SES. Such studies can use publicly available CT data, or can administer questionnaire-measures of neighborhood quality (e.g., Steptoe & Feldman, 2001).

Controlling for Other Obvious Differences Between Ethnic Groups In addition to well-known SES differences, ethnic groups, and diverse ethnic groups of women, also differ in other obvious but usually neglected ways. For example, as shown in Table 4.3, ethnic groups differ not only in marital status, but also in age and gender composition as well, and, women of different ethnic groups likewise differ in age and marital status. Differences in immigration (by gender-, age-, and marital-status), ethnic differences in mortality rates and in men’s mortality rates, and ethnic differences in men’s incarceration rates account for these patterns (e.g., Smelser, Wilson, & Mitchell, 2001). Researchers rarely control for these differences among ethnic groups or among different ethnic groups of women despite the many, self-evident social meanings and social correlates of age, marital status and gender. These correlates of ethnicity may account for variance typically attributed to ethnicity, and hence testing and controlling for such differences can enhance the validity of research.

A Nonobvious but Equivalent Social Correlate: Segregation Residential segregation is a reliable, social contextual correlate of ethnic-group membership, but rarely is measured in studies that compare ethnic groups, or compare women of different ethnic groups. Residential segregation refers to the geographic separation of Whites from ethnic minorities in residential areas (Iceland et al., 2002; Johnston et al., 2007). Segregation data are calculated by the US Census Bureau and are publically available in census datasets (e.g., www.censuscope.org). Such datasets reveal that the US continues to be characterized by high Black–White segregation, and is as segregated now as it was in 1910 (Iceland, et al., 2002; Massey & Denton, 1993). Nationwide, about 70% of the Black and White populations reside in segregated, mostly Black and mostly White neighborhoods (respectively), irrespective of their individual/household SES (e.g., Adelman, 2004; Farley, 2005), primarily as a result of the widespread housing discrimination noted previously here (HUD, 2002).

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Although Blacks continue to be more segregated than Hispanics, Asians, and American Indians, the segregation levels of Hispanics (in particular) and of other minority groups are moderately high, are increasing, and likewise hold across individual/household SES (Johnston et al., 2007). Thus, the majority of Blacks, along with substantial percentages of other ethnic-minority groups, reside in neighborhoods that are largely separate from those of Whites. These segregated White vs. minority neighborhoods are not only separate but also are unequal, such that ethnic-group samples usually are nonequivalent in area of residence. Minority neighborhoods differ significantly from White neighborhoods of matched CT-SES on numerous (contextual, independent) variables that are relevant to behavior and health. Hence, ethnic-group samples are nonequivalent on each of those independent variables. Below we summarize merely three of such neighborhood differences.

Quality of Available Health Care People generally seek physical and mental health care in the communities in which they reside. Because minorities and Whites reside in separate neighborhoods, they receive care in two different sets of medical facilities, staffed by two different sets of physicians (e.g., Smedley, Stith, & Nelson, 2003). The facilities and staff in settings in minority neighborhoods are significantly inferior to those in White neighborhoods. For example, hospitals/clinics in minority neighborhoods are more likely to lack diagnostic (e.g., imaging) equipment and specialists (e.g., cardiac surgeons, oncologists), have higher mortality rates and adverse negligent events (problems caused by treatment), and are staffed by physicians who are significantly less likely to be board-certified than those in healthcare settings for Whites (e.g., Bach, Pham, Schrag, et al., 2004; Fiscella, Franks, Gold, & Clancy, 2000; Lurie & Buntin, 2002; Smedley et al., 2003; van Ryn, 2002). Because board certification remains the most wellvalidated measure of physician competence (Sharp, Bashook, Lipsky, et al., 2002; Tamblyn, Abrahamowicz, Dauphinee, et al., 2002), this means that physicians who provide care in minority neighborhoods are significantly less competent than those in settings for Whites (e.g., Bach et al., 2004; Fiscella et al., 2000; Smedley et al., 2003). Indeed, physicians in healthcare settings in minority neighborhoods, compared to those in White neighborhoods, are significantly less knowledgeable about cancer prevention and screening; are less likely to follow screening recommendations for cancers and other chronic diseases; provide poorer management of diabetes and cardiovascular disease; and are significantly less likely to advise dietary modification and smoking cessation (e.g., Ashford, Gemson, Sheinfeld Gorin et al., 2000; van Ryn, 2002). These inferior healthcare facilities and less competent physicians play a significant role in minority and minority women’s physical and mental health and underutilization of physical and mental health services (Fiscella et al., 2000; Smedley et al., 2003).

Exposure to Environmental Hazards Segregated minority neighborhoods entail exposures to environmental hazards that are 5 to 20 times higher than those in White neighborhoods of matched

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CT-SES (CDC, 2005; Hofrichter, 2000; Morello-Frosch & Jesdale, 2006; MorelloFrosch & Lopez, 2006). This includes significantly higher exposure to air toxics, dioxins, persistent organic pollutants, known carcinogens, lead, arsenic, and mercury. These higher exposure levels are the result of “environmental racism,” the deliberate placement of air polluting factories, solid waste incinerators, and toxic waste dumps in minority neighborhoods (Morello-Frosch, 2002; Payne-Sturges & Gee, 2006; Pulido, Sidawi, & Vos, 1996). Different types of exposures vary across minority neighborhoods, with (for example) segregated Asian neighborhoods higher than all others in air-toxics, and Black, Hispanic, and American Indian neighborhoods higher in exposure to organic pollutants, irrespective of CT-SES (CDC 2005; Morello-Frosch & Jesdale, 2006). Such exposures have been shown to play a strong, causal role in diabetes, asthma, cancers, hypertension, low infant birth weight, and other chronic diseases among minorities, and may account for White-minority differences in these health outcomes (e.g., Morello-Frosch & Jesdale, 2006; Morello-Frosch & Lopez, 2006; Morello-Frosch, Pastor, & Sadd, 2001; Morello-Frosch & Shenassa, 2006; Olden & White, 2005). Indeed, studies have demonstrated that segregation—rather than race/ethnicity and/or SES—accounts for well-known, Black–White differences in death rates. Infant and adult mortality rates for nonsegregated Blacks do not differ from those of Whites, whereas such rates for segregated Blacks are 3 to 5 times higher than those of Whites (e.g., Collins & Williams, 1999; Polednak, 1997).

Quality of the Built Environment It is now well-accepted that the resources and amenities available in one’s neighborhood (i.e., built-environments) contribute significantly to health behavior, and generally account for more of its variance than individuallevel factors such as knowledge, beliefs, motivation, and even individual/ household SES (French, Story, & Jeffery, 2001; Giles-Corti & Donovan, 2003; Handy, Boarnet, Ewing, & Killingsworth, 2002). Important aspects of the built-environment include the number of supermarkets available for purchasing inexpensive fruits and vegetables; recreational facilities available for exercise; and the density of fast-food outlets available for consuming highfat, unhealthy meals. These neighborhood features are strong predictors of diet and physical activity, and of diet- and exercise-related problems such as obesity and diabetes, among women, ethnic-minorities, and older people in particular (Auchincloss, Diez Roux, Brown, et al., 2008; Diez Roux, Evenson, McGinn, et al., 2007; French, Harnack, & Jeffery, 2000; Li, Harmer, Cardinal, et al., 2008; Morland, Diez Roux, & Wing, 2006; Pereira Kartashov, Ebbeling, et al., 2005). For example, fruit and vegetable consumption (FVC) increases by 32% among Blacks vs. by 11% among Whites with each supermarket in their respective neighborhoods (Morland, Wing, & Diez Roux, 2002). Several (mostly nationwide) studies have demonstrated that the builtenvironments of minority neighborhoods are significantly poorer than those of White neighborhoods of comparable SES. Minority neighborhoods contain 2–4 times as many fast-food outlets (Block, Scribner, & DeSalvo, 2004; Powell, Chaloupka, & Bao, 2007), 2 to 3 times fewer supermarkets (Moore & Diez Roux, 2006; Powell, Slater, Mirtcheva, et al., 2007) and 3 to 8 times fewer recreational

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facilities than SES-matched White neighborhoods (Moore et al., 2008; Powell, Slater, Chaloupka, et al., 2006). For example, 82% of Latino and 70% of Black (vs. 38% of White) neighborhoods have no recreational facilities (Moore et al., 2008), and many Black neighborhoods also have no supermarkets (Morland & Filomena, 2007).

Summary of Segregation and Suggestions for Improving Research Irrespective of their individual/household incomes, most people of color and most Whites reside in separate, vastly unequal neighborhoods. Hence, ethnicgroup samples are (almost always) nonequivalent in where they live. These differences in residence are potentially powerful contextual variables that might in part explain differences in behaviors and in physical and mental health among ethnic groups – for example, differences between women and color and White women in physical activity, obesity, chronic disease, anxiety and depression. The normative practice of ignoring segregation in studies of diverse groups perpetuates attributing differences to people rather than to their contexts, and in so doing, reinforces racist and gendered-racist conceptualizations. Segregation readily can be added to studies by using publicly available census data on Blacks, Hispanics, Asians, American Indians, and multiracial/ ethnic groups. Alternatively, segregation can be included by asking people about the ethnic composition of their current and childhood neighborhoods (e.g., Landrine & Klonoff, 2000). In the absence of measurement of segregation, studies comparing ethnic and SES groups or diverse groups of women must highlight the probable nonequivalence of their samples, underscore the limitations entailed in ignoring participants’ lived social context, and interpret their findings with caution.

Improving Statistical Analyses of Nonequivalent Samples The examples above are merely two of the many ways in which diverse samples are nonequivalent. Because these samples are nonequivalent, it is inappropriate to use group to differences statistics (e.g., t-tests, ANOVA) to compare them. Such statistics were created to compare experimental vs. control groups to which participants were randomly assigned, with these groups thereby known to be equivalent on all independent variables (IVS) except group-membership (Campbell & Stanley, 1966; Cook & Campbell, 1979). Group equivalence is the underlying assumption of these statistics, and is inherent in the equations and in the null hypothesis: Because randomly assigned groups do not differ on all IVS except group membership, the null hypothesis—that they also do not differ on the dependent variable (DV)—is tested. When this hypothesis is rejected, it is concluded that there is not no-difference between the groups on the DV, and that differences found are due to group membership, that is, due to the sole IV in the study, the one used to create the groups compared. This model never was meant to be applied to ethnic, gender and other status groups for whom group-membership is not randomly assigned, and who thereby cannot be assumed to be equivalent on all IVS except group membership (Campbell & Stanley, 1966; Cook & Campbell, 1979). The use of

Chapter 4


such statistics to compare ethnic, gender, and other status groups violates the underlying assumption (of group equivalence) of those statistics and hence long has been regarded as inappropriate (e.g., Campbell & Stanley, 1966; Cook & Campbell, 1979; van de Vijver & Leung, 1997, 2000). Cross-cultural researchers have recommended using hierarchical regression models as an alternative analytic strategy (e.g., van de Vijver & Leung, 1997, 2000; Matsumoto & Yoo, 2006). In such analyses, numerous social contextual correlates of ethnicity are measured and are entered first as predictors, and (dummy-coded) ethnic-group membership is entered last. If categorical, ethnic-group membership contributes to variance in the DV above and beyond the contribution of the social contextual variables (and often it does not), the next step is determine precisely what it is about ethnicity that plays a role. That is, if variance remains that indeed is ethnic/cultural in origin, then researchers must identify the specific cultural variables entailed rather than (circularly) attributing ethnic differences to differences in ethnicity (e.g., Lehman, Chiu, & Schaller, 2004; Matsumoto & Yoo, 2006; Poortinga, van de Vijver, Joe, & van de Koppel, 1987; van de Vijver & Leung, 1997, 2000). Identifying specific cultural variables is known as “un-packaging” ethnicity and as “peeling the onion” of culture (Lehman et al., 2004; Matsumoto & Yoo, 2006; Poortinga et al., 1987). Hofstede’s dimensions of culture (Hofstede & Bond, 1984; Hofstede, 2001) are often used as the specific cultural variables (Coon & Kemmelmeier, 2001; Lehman et al., 2004; Matsumoto & Yoo, 2006; Triandis, 1995). These were derived from (repeatedly, over decades) administering a survey to N = 117,000 employees of multinational corporations in 72 different countries, with surveys presented in 20 languages. The three most frequently used of these cultural variables (Individualism-Collectivism, Power Distance, Uncertainty Avoidance) are summarized in Table 4.4, along with a few of their psychological correlates. Some measures of these variables are shown in Table 4.5. With ethnicity/culture now unpackaged and measured, the hierarchical regression is again conducted. Social contextual variables are entered first, specific cultural variables (i.e., measured ethnicity) entered next, and categorical (unmeasured) ethnicity (group-membership) is entered last. If the social contextual and cultural variables that account for ethnic differences on the DV have been discovered, then categorical ethnicity will drop-out of the equation, this the goal of cultural analysis (e.g., van de Vijver & Leung, 1997, 2000). Crosscultural researchers do not seek to find “ethnic differences” because these are invariably found as a function of sample nonequivalence alone. Instead, cultural researchers seek to discover the set of universal, social contextual and cultural variables (universal insofar as they are applicable to all groups) that explain ethnic differences on the DV; this is achieved when ethnic-group membership no longer contributes to the DV because it has been fully unpackaged into its constituent independent variables. As Poortinga et al. (1987, p. 22) put it, In our approach, culture is a summary label, a catchword for all the kinds of differences between cultural groups, but in itself, of virtually no explanatory value. Ascribing intergroup differences in behavior, for example, test performance, to culture does not shed much light on the nature of these differences. It is one of the main tasks of cross-cultural psychology to peel off cross-cultural differences, that

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4.4

Three Dimensions of Culture/Cultural Variables

Individualism-Collectivism (IC) is the extent to which the individual (Individualism, I) versus the family (Collectivism, C) has priority and primacy in a culture. Hence, it is the extent to which the culture shapes, reinforces, and values independent adults who seek to stand-out from others and pursue their own goals (I) vs. interdependent adults who seek to fit-in harmoniously with others and pursue goals representing duties and obligations to them (C). Power Distance (PD) is the extent to which members of the culture accept existing status and power hierarchies (e.g., by gender, age, social class) as natural, normal, desirable, and permanent, and so the extent to which they value knowing and keeping vs. ignoring and violating status-related interactional etiquette. Uncertainty Avoidance (UA) is the extent to which members of the culture feel uncomfortable with ambiguity, and hence the steps they have taken to reduce it. This is manifested as the preference and need for (high UA) vs. dislike and rejection (low UA) of highly-specific goals, evaluation criteria, rules, deadlines, expectations, guidance, and supervision. Differences Among Ethnic Groups Individualistic and collectivistic tendencies, as well as high/low PD and high/low UA tendencies are found among the members of all cultures and vary by gender. However, on the whole, Western European and European-American cultures tend to be high on I, and low on both PD and UA. Hispanic and African cultures (internationally and within the US) tend to be high on C and high on both PD and UA. Asian cultures (in the US and abroad) tend to be high on C, moderate to high on PD, but vary in UA. In general then, US minority groups (African-, Latino-, Asian-, and Native-Americans) tend to be significantly higher on C and on PD than American Whites, with African- and Latino-Americans higher on UA as well. Psychological Correlates of IC, PD, & UA These variables (IC in particular) account for significant variance in psychological differences among ethnic groups (Schaller & Crandall, 2004). This includes differences in self-construal and self-concept (Choi & Choi, 2002; Markus & Kitayama, 1991); emotional display rules (Mesquita, 2001); cognitive styles (Hong, Morris, Chiu, & Benet-Martinez, 2000; Nisbett, Peng, et al, 2001; Oyserman & Lee, 2008); nature of life satisfaction and subjective well-being (Diener, Oishi, & Lucas, 2003; Oishi & Diener, 2001); conflict-styles (Derlega et al., 2002; Morris & Fu, 2001); causal attributions for events and outcomes (Choi, Nisbett, & Norenzayan, 1999); optimism vs. pessimism (Chang, Asakawa, & Sana, 2001); speaking-up vs. self-silencing (Kim & Markus, 2002, 2005); seeking social support (Taylor, Sherman, Kim, et al., 2004); socialization and development (Greenfield, Keller, Fuligni, & Maynard, 2003; Rothbaum, Weisz, Pott, et al, 2000); and a wide variety of other psychological and behavioral characteristics (e.g., Schaller & Crandall, 2004; Triandis & Suh, 2002).

is, to explain these differences in terms of specific antecedent variables, until in the end they have disappeared and with them the variable culture...culture can be considered as an immense set of often loosely interrelated independent variables.

We recommend use of this data-analytic strategy in research with diverse ethnic, SES, age, sexual preference, and other samples as an alternative to group-differences statistics. In each case, it would be beneficial to un-package

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4.5

Measuring Cultural Variables

Cultural Variable

Examples of Scales (Ref.)

Individualism-Collectivism

Self-Construal Scale (Hardin et al., 2004; Singelis, 1994; Singelis et al., 1999) INDCOL Scale (Hui, 1988; Triandis et al., 1990, 1995) Context Specific IC Scale (Matsumoto et al., 1997)

Power Distance

Power Scale (Schwartz, 1994; Schwartz et al., 2001) Hofstede Power Distance Scale (Hofstede & Bond, 1984; Spector et al., 2001)

Uncertainty Avoidance

Uncertainty Coping Scale (Greco & Roger, 2001) Uncertainty Orientation Scale (Shuper & Sorentino, 2004; Shuper et al., 2004) Intolerance of Uncertainty Scale (Buhr & Dugas, 2002)

group membership into its constituent, measurable IVS until group membership disappears as an IV in regression equations. For example, Klonoff, Landrine & Campbell (2000) un-packaged gender into a few of its constituent IVS, namely, recent and lifetime sexist discrimination. They found that such discrimination accounted for well-known gender differences in depressive, anxiety, and somatic symptoms. Unpackaging gender, social class, sexual preference, age, and ethnicity—Whiteness in particular—into their constituent, social and contextual IVS potentially can highlight the source and explanation of the “differences” invariably found.

Method Equivalence Method equivalence refers to the extent to which the methods used to acquire the data are equal for the various groups in the study, with this operationalized as the extent to which all groups are equally familiar with the study methods (Harkness, van de Vijver, & Mohler, 2003; van de Vijver & Leung, 1997, 2000). Accordingly, discussions of method equivalence usually have highlighted lack of equivalence across groups in familiarity with reading, writing, taking tests (i.e., being asked questions to which the asker already knows the answer), being timed, using scantron forms, being interviewed (i.e., one-sided conversation), answering multiple-choice and Likert-type items, and being in laboratory settings (van de Vijver & Leung, 1997, 2000). Method equivalence is understood as achieved if all groups are equally familiar with such methods, and method bias is present if they are not.

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Familiarity-Related Method Equivalence Ethnic and SES groups typically differ in their familiarity with at least one of the above methods because they differ in their frequency of engaging in these activities outside of the study; hence some degree of method bias is present in all studies, and evident in participants’ questions about the tasks (van de Vijver & Leung, 1997, 2000). Such a lack of method equivalence affects participants’ responses to all rather than to some items, and thereby can diminish both internal and external validity. Such problems arise, however, only in studies where a single method (i.e., mono-method bias) with which groups are not equally familiar is used (van de Vijver & Leung, 1997, 2000).

Strategies for Decreasing Familiarity-Related Method Bias A simple yet effective procedure used to test for and correct lack of method equivalence is test-retest, that is, the repeated administration of the task. On re-test, all groups are likely to exhibit slight increases in performance (e.g., on cognitive tests) or more consistent, carefully considered responses (e.g., on scales) as a function of practice effects. However, where lack of method equivalence across groups exists, increases in scores and changes in survey/scaleresponses for low-SES groups and ethnic minorities significantly exceed those for the middle-class and Whites, thereby indicating that prior responses from minorities and the poor were at least in part an artifact of method bias (van de Vijver & Leung, 1997, 2000). The differential change across ethnic (SES and other) groups on retest raises questions about the validity of the fi rst set of minority responses/scores, that is, the extent to which these were in part a simple function of lack of familiarity with the method/materials. Thus, significant group-differences in test-retest reliability raise questions about methodbias related validity. An additional procedure for assessing and correcting familiarity-related method bias is to administer the measure in an alternative format, for example, to read a written survey to participants and fi ll-in their answers for them. Although adopted by some researchers, this procedure deviates from standardized administration and so may be frowned upon despite the potential decrease in mono-method bias achieved. Test-retest similarly is frowned upon because of the significant changes in minority scores that result. We agree with others (e.g., van de Vijver & Leung, 1997, 2000) that threats to validity due to method bias exceed those due to using test-retest and alternative administration. Moreover, the latter (e.g., reading a written survey) may increase the age-, literacy-, and disability-related diversity of the sample by increasing chances of participation. The normative practice failing (and indeed, refusing) to correct for familiarity-related method bias seems designed to curtail some forms of diversity via exclusion, while assuring the reproduction of highly contested, invidious ethnic differences.

Exclusion-Related Method Equivalence The familiarity dimension is merely one aspect of method equivalence. Perhaps more important is the extent to which the method is equivalent in

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terms of each group’s chances of participating in the study. Many normative methodologies differentially exclude diverse ethnic and SES groups from participation, and subsequently yield nonrepresentative minority (but not White) samples. Such methods entail what we refer to here as exclusion-related method bias. Foremost among such methods are conducting studies in English only, and the random digit-dial telephone survey (RDDTS) method.

English-Only Studies Nearly all studies published in psychology and in feminist journals, and the majority (>80%) of studies in medical and public health journals, were conducted in English-only, and excluded non-English-speaking participants (e.g., Frayne, Burns, Hardt, et al., 1996; Lee, Nguyen, Jawad, & Kurata, 2008; Link, Mokdad, Stackhouse, & Flowers, 2006). Small psychological, feminist, and clinical-trial studies, as well as the nationwide, population-studies that provide basic data on the physical and mental health of Americans (e.g., the Behavioral Risk Factor Surveillance System, BRFSS) continue to be conducted either solely in English, or at best, in English and in Spanish (Lee et al., 2008). This normative exclusion of non-English speakers from research is a barrier to health and social justice for minorities—minority women in particular (Killien, Bigby, Champion, et al., 2000). This is because English-fluent minority (i.e., Asian and Hispanic) samples do not represent their populations. Specifically, English-fluent samples exclude the approximately 40% of Asians and of Hispanics who do not speak English well (e.g., Frayne et al., 1996; Lee et al., 2008). Because English proficiency is a proxy for immigration status, years of U.S. residence, education, and income (Landrine & Klonoff, 2004; Corral & Landrine, 2008), the 40% of nonfluent Asians and Hispanics excluded tend to be the recent-immigrant and low-SES members of these groups (Lee et al., 2008). English-fluent samples thereby provide inaccurate estimates of the demographics—that is, the social and living conditions—of Asians and Hispanics. Likewise, the inability to speak English is a barrier to receiving health care (Bauer et al., 2000; Jacobs, Lauderdale, Meltzer, et al., 2001; Lee et al., 2008; Yeo, 2004). For example, non-English-speaking Hispanics, Asians, and Pacific Islanders are less likely to have a usual source of care (Jang, Lee, & Woo, 1998), have lower rates of receiving preventive services (Jerant, Fenton, & Franks, 2008; Lee et al., 2008), and are unlikely to be given follow-up appointments (Pitkin & Baker, 2000; Sarver & Baker, 2000) or adequate physical and mental health treatment (Carrasquillo et al., 1999; Institute of Medicine, 2003; Karter et al., 2000)—such that language barriers alone may account for Asian and Hispanic health disparities (Fiscella et al., 2002; Institute of Medicine, 2003). Studies of English-fluent Asian and Hispanic samples thereby provide not only grossly inaccurate demographic data, but also provide erroneous estimates of the health and health needs of these groups—those of women in particular. Data from the 2003 California Health Interview Survey (CHIS) illustrate these points. The CHIS was a statewide, random digit-dial telephone survey (RDDTS) of the physical and mental health and health behaviors of California adults (www.CHIS.ucla.edu). Unlike other (e.g., national) population surveys, the CHIS was conducted in English, Spanish, Chinese (Mandarin and Cantonese),

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Vietnamese, and Korean. Lee et al. (2008) compared Asians and Hispanics who participated in the CHIS in English vs. another language on demographic and health variables to highlight the nonrepresentativeness of English-fluent samples. A few of those findings are shown in Table 4.6. As shown in Table 4.6, Asians and Hispanics interviewed in English had annual incomes (Mean $70,500) three times higher than those of their cohorts who were interviewed in their native language (Mean $24,700). Likewise, Asians and Hispanics fluent in English were significantly more educated than those not fluent; differences between English- vs. non-English speakers in the percentage who had a high-school education or less were large and statistically significant. Similarly, Asians and Hispanics interviewed in English had spent a significantly greater percentage of their lives in the United States. Moreover, English-fluent Asians were significantly younger (e.g., by as much as 15 years) than their nonfluent cohorts. Importantly, non-English speaking Asian samples contained significantly greater percentages of women than the English-fluent samples. English-fluent vs. nonfluent Asian and Hispanic samples also differed in health status. For example, English-speakers were more likely to have health insurance, and less likely to have fair/poor (vs. good/excellent) self-rated health, with the latter differences quite large. For example, a mere 5.9% of Englishspeaking vs. 41% of Chinese-speaking Chinese rated their health as fair/poor, and, 17.6% of English-speaking vs. 44.4% of Spanish-speaking Hispanics rated their health as fair/poor. Non-English speakers also often had a higher prevalence of diabetes and hypertension (Table 4.6); had significantly poorer health behaviors (e.g., binge drinking), and were significantly more likely to report ethnic discrimination in health care (descriptive data and logistic regressions not shown here). These CHIS data suggest that studies conducted in English-only tend to exclude low-SES, older, recent-immigrant, and many and Asian and Latina women as well, and hence consist of largely acculturated Asian and Hispanic samples who do not represent their populations. Such data imply that the, primarily, samples in psychological and feminist studies are similar in the English-fluent Asian and Hispanic groups. Thus, psychological and feminist studies conducted in English-only are likely to draw inaccurate conclusions not only about psychological processes, attitudes, and behaviors, but also about the prevalence of intimate partner violence, sexual harassment, sexual assault, and mental health problems; and, thereby, may significantly underestimate physical, social, employment, rehabilitation, and mental health needs. By excluding many women and poor Asians and Hispanics, the English-only methodology perpetuates social, health, and economic disparities among Hispanics and Asians—women in particular (Killien et al., 2000).

Strategies for Decreasing Language-Related Method Bias Nonparticipation in research due to language barriers is a form of nonresponse bias (i.e., nonresponders differ significantly from responders) that requires correction to increase the validity and generalizability of data on Asians and Hispanics, as well as the inclusion of Asians, Hispanics, and Asian and Latina women in research and in clinical trials (e.g., Killien et al., 2000;

4.6

a

Demographic and Health Differences Between Fluent vs. Nonfluent English Speakers in the 2003 California Health Interview Surveya,b High school education (%)

Fair or poor health (%)

Have health insurance (%)

Diabetes (%)

Hypertension (%)

Mean age

Women (%)

Hispanics overall English Spanish

37.5 39.0

50.7 48.0*

$51,900 $21,800*

89.9 38.8*

53.9 90.8*

17.6 44.4*

81.0 55.0*

7.7 8.9

19.3 16.7*

Asians overall English Other

41.0 49.9*

50.5 58.9*

$76,300 $38,800*

27.3 17.9*

21.0 56.5*

12.5 44.4*

90.9 76.7*

6.8 7.8

20.7 25.9*

Chinese English Chinese

40.0 52.2*

51.8 61.0*

$82,100 $34,000*

65.2 28.2*

15.4 59.3*

5.9 41.0*

92.7 76.1*

3.8 7.2*

13.0 26.7*

Korean English Korean

34.8 48.1*

47.5 64.8*

$90,800 $61,300*

67.9 30.5*

25.8 34.3*

7.5 35.5*

76.1 66.8*

5.3 4.3

14.3 15.6

Vietnamese English Vietnamese

32.0 47.2*

38.8 53.3*

$82,200 $29,300*

65.8 28.4*

21.0 68.1*

10.6 56.9*

86.5 80.9*

1.1 10.5*

10.8 28.9*

Data culled from multiple tables in Lee et al. (2008). N = 42,044 *P 65 and revealed that older people are significantly more influenced than younger ones by high vs. low frequency scaling, and by item-order as well. We found no studies of possible gender differences, nor of differences among other groups (e.g., recent immigrants) in response to frequency-scaling or item-order.

Ethnic/Cultural Responses to Scaling Although there are no studies of frequency-scaling and item-order effects among U.S. ethnic groups, several studies indicate that minorities tend to respond to scaled items in unique but predictable patterns referred to as response styles. These raise the question of the extent to which ethnic differences are measurement artifacts reflecting lack of scalar equivalence (e.g., Arce-Ferrer, 2006; Gregorich, 2006; Harzing, 2006; Johnson, O’Rourke, Chavez, et al. 1997; Smith, 2004). Specifically, U.S. ethnic-minorities (i.e., African-, Asian-, and HispanicAmericans) tend to respond to scaled items in three ways known as the Extreme, Middle, and Acquiescent Response styles. The Extreme Response Style (ERS) is the tendency to choose extreme response-categories (i.e., the highest and lowest)

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irrespective of item-content; the Middle Response Style (MRS) is the tendency to select the mid-point response-category irrespective of item-content; and the Acquiescent Response Style (ARS) is the tendency to agree with items irrespective of their content (Arce-Ferrer, 2006; Cheung & Rensvold, 2000; Johnson et al., 1997; Marin, Gamba, & Marin, 1992; Smith, 2004). African- and HispanicAmericans tend to exhibit ERS, Asian-Americans tend to exhibit MRS, and U.S. Hispanics tend to also often exhibit ARS (e.g., Chen, Lee & Stevenson, 1995; Cheung & Rensvold, 2000; Clarke, 2000; Hui & Triandis, 1989; Marin, Gamba, & Marin, 1992; Warnecke et al., 1997). Of these response styles, ERS is the most common insofar as it is exhibited by Blacks, Hispanics, people >age 65, and lowSES groups (e.g., Arce-Ferrer, 2006; Cheung & Rensvold, 2000; Clarke, 2000).

Explaining Ethnic/Cultural Response Styles The explanation for these response styles is unclear; despite decades of research, precisely why African- and Hispanic-Americans tend to exhibit ERS (and Asian-Americans, MRS) to scaled items remains unknown. Some have suggested that ERS may reflect sincerity, conviction, and the need to give an unambiguous response for Blacks and Hispanics, whereas MRS might reflect conformity and the need to fit-in for Asians (e.g., Arce-Ferrer, 2006; Clarke, 2000; Gregorich, 2006; Hui & Triandis, 1989; Marin et al., 1992; Johnson et al., 1997). Likewise, some have hypothesized that ARS, ERS and MRS might reflect differences among ethnic-minority cultures in IC, UA, and PD. The latter hypothesis is supported by data that reveal significant international variability in response styles (e.g., Baumgartner & Steenkamp, 2001; Johnson, Kulesa, Lic, et al., 2005; van Herk, Poortinga, & Verhallen, 2004). For example, in a study of response styles among N = 18,000 participants from 19 countries on five continents, Johnson et al. (2005) found ARS more common in collectivist cultures. Associations between a specific response style (ARS, ERS, MRS) and a specific dimension of culture (IC, UA, PD), however, have been neither predictable nor consistent within or across international studies. An Alternative Explanation. An alternative hypothesis is that survey response styles among U.S. minorities might reflect the larger social context of inequality in which middle-class Whites are the implicit standard and norm. In that context, minorities and Whites alike might assume that scale numbers represent the distribution of behaviors/experiences among middle-class Whites, that the mid-point is the norm for this tacit reference group, and then respond accordingly: Whites select ratings near the mid-point (i.e., 2, 3, and 4 on a 1–5 scale). Hispanics and Blacks might select ratings ± 2 categories away from the midpoint (i.e., 1 and 5) to distinguish themselves from Whites and White norms (this constituting ERS only on 1–5 scales), and Asians might select ratings precisely at the midpoint to highlight the need to be viewed by others as conforming to those norms (MRS). This hypothesis is supported by the finding that minority ERS is significantly more common on 5-point scales than on 8-, 9-, and 10-point scales, and generally decreases as the number of response-categories increases (e.g., Arce-Ferrer, 2006; Clarke, 2000; Smith, 2003; van de Vijver & Leung, 2000). We suspect that the wider range of response-categories permits Hispanics

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and Blacks to separate themselves from Whites (by ± 2 scale points from the midpoint) without selecting the endpoints (i.e, without exhibiting ERS). For example, on a scale of 1 to 7 where 4 is the midpoint/implicit White norm, Blacks and Hispanics can select 2 and 6 rather than 1 and 7 (ERS). This hypothesis is meant to apply however only to nonthreatening items on which such responses do not elicit stereotype threat. For the latter type of items (e.g., health behaviors), minorities are likely to exhibit socially desirable responding (discussed below). This hypothesis readily can be tested by changing the implicit White reference group to an explicit Black/Hispanic one via instructions, survey letterhead, priming, and other manipulations. Blacks and Hispanics might exhibit MRS under such conditions. Likewise, Asians might exhibit MRS when the scaling reference group is implicitly White or explicitly Asian, but not when it is explicitly Black or Hispanic; Asians might exhibit ERS under the latter conditions. These data and hypotheses raise the question of the extent to which responses to scaled items reflect individual experiences vs. status hierarchies. In a deeply stratified, highly segregated society characterized by incessant, invidious comparisons, are responses to scaled items representations of experiences, the embodiment of the inequality, or both insofar as these might be synonymous?

Response-Style Threats to Validity Irrespective of their genesis and meaning, ERS, ARS, and MRS clearly diminish the validity of assessments, data, and statistical analyses. Unfortunately, most researchers compare ethnic (age, SES and other) groups without testing and controlling for these response styles (Cheung & Rensvold, 2000; Fischer, 2004; Harkness et al., 2003; Smith, 2004). Consequently, ethnic and SES groupdifferences in response styles can be misinterpreted as substantive differences on the construct under investigation—response styles can yield false-positive group differences (Cheung & Rensvold, 2000; Johnson et al., 2005). Thus, the critical question is the extent to which ethnic (SES, age, and other group) differences on measures composed of scaled items represent genuine differences or response style differences. Statistical analyses likewise are undermined by response styles. For example, ERS inflates standard deviations, decreases correlations, alters eigenvalues and factor structures, and distorts and diminishes regressions. Alternatively, ARS can manifest as a spurious factor composed exclusively of negatively keyed items, and result in failed confirmatory factor analyses across groups (e.g., Cheung & Rensvold, 2000; Clark, 2000; Johnson et al., 2005).

Socially Desirable Responding Socially desirable responding (SDR) refers to the tendency to present oneself in a positive light by providing answers that one assumes to be desirable irrespective of their veracity (Dudley, McFarland, Goodman, et al., 2005; Johnson & van de Vijver, 2003; Paulhus, 1991). Ethnic-minorities (i.e., Blacks, Hispanics, and Asians) exhibit significantly higher SDR than Whites/Europeans on a

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wide variety of measures entailing scaled items, with these differences often quite large—that is, effect sizes ranging from d = 0.37 to 1.04 (e.g., Dudley et al., 2005; Johnson & van de Vive, 2003). For example and as noted earlier, SDR may manifest in health research as the minority tendency to under-report the frequency of unhealthy behaviors (e.g., cigarette smoking, substance use), and over-report healthy ones such as cancer screening (Johnson & Bowman, 2003; Rauscher et al., 2008). Women in general, however (irrespective of ethnicity), tend to over-report cancer screening (i.e., relative to their medical records), in part because recalling such events is difficult and hence screening occasions are estimated (e.g., McGhee et al., 2002; Vernon et al., 2004), and in part because screening is a socially desirable behavior to report (Johnson, O’Rourke, Burris et al., 2005). Such over-reporting nonetheless is higher among minority than among White women, in telephone and household surveys, but with differences greater in the former (McGhee et al., 2002; Vernon et al., 2004). Like ARS and ERS, SDR similarly undermines the validity of assessments and data, and can be misinterpreted as substantive group differences (Dudley et al., 2005; Johnson & van de Vive, 2003). The explanation for SDR has varied by ethnic group. Distrust of researchers (because of prior abuse) might explain SDR among Blacks, and also might explain why Blacks tend to omit significantly more items than Whites and than other minorities as well (Dudley et al., 2005; Johnson & van de Vijver, 2003). Likewise, high-collectivism and associated needs to be viewed as meeting others’ expectations might explain SDR among Asians and Hispanics (Dudley et al., 2005; Johnson & van de Vijver, 2003).

Strategies for Improving Scaling and Suggestions for Research Many have documented the need to assess and control for ARS, MRS, and ERS, and have provided strategies for so doing. These (detailed elsewhere) include administering the Greenleaf Extreme Response Measure along with the study measures (Greenleaf, 1992a, 1992b), and use of structural equation modeling (SEM), item-response theory (IRT), standardization of raw scores, and other many other techniques (e.g., Arce-Ferrer, 2006; Cheung & Rensvold, 2000; Fischer, 2004; Gregorich, 2006; Welkenhuysen-Gybels et al., 2003). Likewise, several researchers have provided strategies for improving scaling to reduce response styles (e.g., Smith, 2003; van de Vijver & Leung, 2000). Foremost among these is using a wider number of response-categories (e.g., a 6 -, 8-, or 10-point scale) instead of the common, problematical, 5-point scale (e.g., Chang, 1994; Smith, 2003; van de Vijver & Leung, 2000). The wider number of categories permits Blacks and Hispanics to distinguish themselves from Whites without selecting the endpoints, and the even (rather than odd) number of categories has no midpoint and so obstructs MRS. Likewise, using a balanced mix of positive and negative statements decreases ARS because respondents cannot simply agree with all items (e.g., Gregorich, 2006; van de Vijver & Leung, 2000; Harkness et al., 2003). In addition, social desirability (SD) scales can be used to detect and control for SDR (Dudley et al., 2005; Johnson & van de Vijver, 2003). The most widely used SD scales include the Balanced Inventory of Desirable Responding (e.g., Leite & Beretvas, 2005; Li & Bagger, 2007), and the Marlow-Crowne Social

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Desirability Scale (e.g., Beretvas, Meyers, & Leite, 2002; Leite & Beretvas, 2005), the latter available in English and Spanish (Collazo, 2005). SD scales should be used with caution, however, in light of ongoing debate regarding their validity (e.g., Dudley et al., 2005), and the fact that many contain Likert-type scales. Finally, research continues to highlight the benefits of cognitive pretesting of surveys and interviews to improve items and scaling (Karabenick et al., 2007; Schwarz & Oyserman, 2001; Tourangeau, 2003; Tourangeau et al., 2000). Cognitive pretesting procedures entail verbal probing and interviewing of respondents of specific populations to assure that items and scaling are understood in the manner that researchers intend. Such techniques are relatively simple (e.g., respondents read items and scaling aloud and talk about what they’re thinking) and well-established (e.g., Willis, 2005) and can enhance scalar and item equivalence. In the absence of such efforts to control for response-styles, SDR, and other scaling effects, differences between ethnic (and other) groups, as well as between diverse groups of women, may be artifacts of such effects. Hence, findings on quantitatively scaled items must be interpreted cautiously, and their cross-group scalar limitations highlighted. Indeed, even when using the data-analytic strategy suggested here (i.e., hierarchical regression with social contextual variables, etc.) remaining variance attributed to ethnicity and other group membership may reflect scaling issues alone, and hence scalar equivalence must be assessed. The possibility that scaling is understood to represent the experiences middle-class Whites has not been empirically examined, and hence, we encourage tests of the various scaling hypotheses presented above. Similarly, to our knowledge, there are no studies of response styles among lesbians, recentimmigrants, low-SES, older, disabled, or a variety of other groups. The possibility that these groups may exhibit ERS, ARS, MRS, or SDR is worthy of investigation. Likewise, the possibility that a variety of such groups might benefit from scaling with a wider range of response-categories has not been examined, and the effect of frequency-scaling also has yet to be explored for these groups. Because subordinated, excluded, and stigmatized groups may be more sensitive to the context than others (Heatherton, Kleck, Hebl, & Hull, 2000; Williams, 2001), the context of items—from scaling to question order—is likely to play a role in their responses. Studies on these topics potentially can improve scaling for a diversity of groups, and thereby enhance the validity of research on them.

Item Equivalence Item equivalence refers to the extent to which each item in a questionnaire, interview or scale has the same meaning for the various groups in the study. Items are equivalent if members of different groups understand them in the same manner (Byrne & Watkins, 2003; Hambleton, 2006; Hambleton et al., 2005; Hambleton, Swaminathan, & Rogers, 1991). The question is: Do the objects, experiences, and behaviors to which items refer have the same meaning for different groups? The answer is that they do not, for at least a few items in any measure, no matter how simple the item. For example, when asked “Do you smoke cigars?”, 8% of Black adolescents report doing so (Yerger, Pearson, & Malone, 2001). For Black youth, however,

Chapter 4


“cigar” is interpreted to mean large, fat ones (smoked by Whites) and excludes cigarette-size ones such as the Philly and Black & Mild brands that are preferred by Blacks. When cigars are explicitly defined to include the latter, selfreported cigar use among Black youth is as high as 44% (Yerger et al., 2001). Similarly, girls vs. boys, and White vs. minority youth differ significantly in their interpretation of items about “having sex” (Sanders & Reinisch, 1999), and about “smoking” (MacPherson & Meyers, 2004). These words do not bring to mind the same behaviors and experiences for the different groups, thereby raising questions about the equivalence of such items, and so the comparability of responses to them. Simple adjectives likewise may not have the same meaning across groups, college students included. For example, Landrine, Klonoff, and Brown-Collins (1992) asked college-student women of different ethnic groups to apply standard, gender-stereotyped adjectives to themselves (using Likert-type scales), and to then define those adjectives by selecting from several definitions subsequently provided. For White women, the most common definition selected for “passive” was “I’m laid back and easy-going” whereas for Black women it was “I don’t say what I really think.” These differences in understandings raise the question of the extent to which ethnic differences on the item reflect differences in passivity vs. lack of item equivalence (Landrine et al., 1992). Unfortunately, many assume that items are equivalent across groups without assessing this (Byrne & Watkins, 2003; van Hemert et al., 2001).

Differential Item Functioning (DIF) When an item is interpreted significantly differently by diverse groups, it lacks equivalence and is said to be biased, that is, to exhibit differential item functioning (DIF). DIF exists when groups who have the same level on the construct under investigation score differently on an item measuring that construct. The logic here is that people who are similar in level on the underlying construct (e.g., high on depression or self-efficacy) should score roughly the same on each item used to assess that construct. If they do not, then the item on which they differ is a problem. This logic is called item response theory (IRT), the view that an unbiased item will elicit a similar response from people who are similar on the latent trait (construct) being assessed (Hambleton, 2006; Hambleton et al., 1991; Zenisky, Hambleton, & Robin, 2003). A wide variety of methods can be used to test for DIF, such as the MantelHaenszel statistic, confirmatory factor analysis (CFA), more than 5 different IRT-based procedures, structural equation modeling (SEM), and numerous other strategies (e.g., Gregorich, 2006; Holland & Wainer, 1993; Meade & Lautenschlager, 2004). Of these, the old (Lord, 1980) conditional (ANOVA) procedure is the simplest (but by no means the most desirable or stringent), and hence is described here as merely an example of IRT logic. In this technique, status groups (e.g., Hispanics and Whites) are divided into score-level groups on the construct, for example, high vs. low scorers on a depression scale. The status groups then are compared to each other within score-level group (i.e., comparisons are conditional on score level): High-scoring Hispanics are compared to high-scoring Whites, and low-scoring Hispanics similarly compared to low-scoring Whites on each item in the scale. IRT predicts that the scores

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on each item for the score-level matched groups will be the same. Hence, any item on which the groups differ significantly within score level is a biased, that is, the item has a different meaning for, and hence is not being interpreted in a similar manner by the groups. Testing for DIF invariably reveals that at least a few (and sometimes many) items in measures exhibit DIF by ethnicity, SES, age, and/or gender; on the whole and for the most part, DIF and biased items are found whenever tests for them are conducted (Gregorich, 2006), as highlighted below.

DIF in Widely Used Measures The CES-D. Cole et al. (2000) examined DIF by ethnicity and gender in the Center for Epidemiologic Studies-Depression Scale (CES-D; Cole, Kawachi, Maller, & Berkman, 2000). Blacks and Whites, and women and men were matched on their overall level of depressive symptoms (high vs. low) and then compared. Results revealed that Blacks were 2 to 3 times more likely than score-level matched Whites to give high responses to the items “people are unfriendly” and “people dislike me,” whereas women were twice as likely as score-level matched men to give high responses to the item about having “crying spells.” These three items clearly have different meanings—social rather than clinical ones—for these groups, and can lead to group differences in CES-D scores that are unrelated to depression (Cole et al., 2000). Hence, Cole recommended removal of these 3 items when comparing ethnic and gender groups to improve the cross-group validity of the CES-D. More recently, Yang and Jones (2007) replicated Cole et al. (2000) with a different sample, and by using CFA as an alternative test for DIF; they found precisely the same results and hence likewise suggested omitting those three items. Several other studies also found DIF in the CES-D by age, gender, SES and ethnicity, and specifically for African-, Asian-, and Mexican-Americans, and DIF likewise has been found in cross-national studies (e.g., Crockett, Randall, Shen, et al., 2005; Iwata & Buka, 2002; Iwata, Turner, & Llyod, 2002). Other Well-Known Measures. DIF by gender, ethnicity, age, and/or SES has been

found in the Beck Depression Inventory (e.g., Kim, Pilkonis, Frank, et al., 2002; Nuevo, Dunn, Dowrick, et al., 2008), and in some measures of stress, anxiety (e.g., Miysmoto, Hishinuma, Nishimura, et al., 2001; Smith & Reise, 1998; Van Dam, Earleywine, & Forsyth, in press), and self-esteem (e.g., Miysmoto et al. 2001; Ping & Fan, 2003). Similar DIF has been found in the Medical Outcomes Study (MOS) 36-Item Short Form Health Status Survey (SF-36), and in similar measures of quality of life (e.g., Crane, Gibbons, Narasimhalu, et al., 2007; Perkins, Stump, Monahan & McHorney, 2006). DIF also has been found in personality inventories such as the MMPI and the Hogan Personality Inventory (Sheppard, Han, Colarelli, et al., 2006; Waller, Thompson, & Wenk, 2000). Clinical-Decision Measures. DIF by gender, ethnicity, education, primary language (Spanish vs. English), and nationality consistently has been found in numerous measures that are used in clinical decision-making. Most problematic are the Mini-Mental State Examination (MMSE; e.g., Dorans & Kulick, 2006; Jones, 2006; Jones & Gallo, 2001; Morales, Flowers, Gutierrez, et al., 2006;

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Orlando-Edelen, et al., 2006; Ramirez, Teresi, Holmes, et al., 2006), and a variety of brief, cognitive screening tests (e.g., the Cognitive Abilities Screening Instrument, CASI) used in determining dementia and other disorders (e.g., Crane, van Belle, & Larson, 2004; Teresi et al., 2000, 2001). Consequently, many view the MMSE (in particular) and cognitive screening tests as biased against Mexican- and African-Americans, and have advised caution in their use for diagnostic purposes.

Strategies for Avoiding and Dealing With DIF DIF in any measure is of concern because it diminishes internal and external validity, and potentially can result in false-positive group differences (e.g., Byrne & Watkins, 2003; Gregorich, 2006). DIF in measures used for clinical decision-making is of greater concern because it can lead to flawed clinical conclusions, erroneous estimates of prevalence rates and of needs for services, and inappropriate interventions and allocation of resources (McHorney & Fleishman, 2006). When only a few items (e.g., 3 of 20 or 15%) are found to be biased, the consensus recommendation has been to remove these from the measure, and to conduct group-comparisons using the remaining, unbiased items, that is, those that assess the construct for all groups (e.g., Holland & Wainter, 1993; van de Vijver, 1994). Doing so, however, raises the question of the extent to which the remaining, unbiased items are sufficient to represent the construct. It is beneficial to answer this question empirically by using CFA, SEM and related strategies before proceeding with tests of hypotheses and with groupcomparisons. Alternatively, when more substantial percentages of items (>25%) are found to be biased, dropping them is difficult because the construct validity of the measure may be lost, and scores thereby rendered un-interpretable. The consensus in the literature is that such highly biased measures should not be used in comparative studies or in clinical decision-making, and that researchers and clinicians should find an unbiased, alternative measure (Holland & Wainer, 1993; van de Vijver, 1994; van de Vijver & Leung, 1997, 2000). The reasoning here is that if scores on >25% of items do not reflect variance on the construct but instead reflect social and cultural variance in interpretation of item-content, then the measure not only lacks cross-group item equivalence but also lacks cross-group construct validity. Bias in >25% of items has been found for numerous measures. For example, 40% of the items in the Perceived Stress Scale-10 (Cole, 1999), 38% of the items in the Hogan Personality Inventory (Sheppard et al., 2006), 42% to 66% of items in the MMSE (Orlando-Edelen et al., 2006), and 46% of the items in the CASI cognitive screening test (Crane et al., 2004) exhibit DIF by ethnicity, gender, primary language, or education. In addition to suggesting routine testing for DIF, many also have provided strategies for improving item-development to avoid DIF (e.g., Hambleton, 2006; Harkness et al., 2003; van de Vijver, 1994; van de Vijver & Leung, 2000). These include editing items to remove: Complex language (e.g., “All of the following are true except”); long questions; colloquialisms and metaphors not used in other cultures (e.g., feeling blue, feeling down, getting ahead); ambiguous time-frames (e.g., “frequently” and “often” should be replaced with more

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specific terms such as daily, weekly, monthly); objects, illnesses, symptoms, and situations that may not exist in all cultures or may have a different meaning cross-culturally; objects, behaviors, and situations that differ in frequency by gender (e.g., crying), culture (e.g., arguing, speaking up), age (e.g., things that happen at school, going to the doctor), gender X culture (e.g., driving), and SES (e.g., taking a vacation, going on spending sprees); ambiguous objects (e.g., alcohol should be replaced by specific types such as beer, wine, wine coolers, hard liquor); reference to spatial relationships (e.g., above, below, up, down); negatively worded items (e.g., “Which of the following is NOT”); and reference to games, foods, activities, customs, religion, forms of exercise, historic events, and local laws and customs. Likewise, cognitive pretesting of surveys and interviews (discussed earlier here) with a small diverse sample or numerous focus groups is beneficial for improving item equivalence (Karabenick et al., 2007; Tourangeau, 2003; Willis, 2005). In the absence of tests and controls for DIF, differences between ethnic and other groups may be artifacts of differences in item interpretation. Even when using the hierarchical regression/un-packing strategy recommended here, remaining variance attributed to ethnicity and other group membership nonetheless may reflect DIF, and hence issues of item equivalence must be addressed.

Conclusions Each issue of equivalence discussed here reveals that data are not separate from the methods, measures, and statistical analyses used to produce them, nor from the larger context of inequality in which such production occurs. The context of inequality shapes the use of methodologies and measures that shape the samples and the results obtained. The normative research practices highlighted here are particularly troublesome: The routine use of inappropriate, group-differences statistics to compare nonequivalent samples, obtained via nonequivalent methodologies, on nonequivalent scaling attached to nonequivalent items is scientifically flawed, and reflects and reproduces the social order. Ethnic and other group differences—among women in particular— “discovered” in this manner reflect little more than the practices used to discover them, and hence we recommend rejection of these normative research practices. This is not to suggest that there are no ethnic (or other group) differences because we do in fact suspect that there are. The differences that we suspect exist however are not those most often highlighted, namely, disparities in social, physical, cognitive, and mental health. Such disparities are not a part or a product of anyone’s culture—they are not valued by nor purposefully passed down from one generation to the next—no more than the segregation, discrimination, and poverty that cause them are part of anyone’s culture. The ethnic differences and differences among diverse women that we suspect exist (e.g., unknown, dynamic variables beneath simple, superficial IC, UA, and PD) have not been and probably cannot be discovered using normative practices. Radical hypotheses in feminist, community, and cultural psychology likewise cannot be tested using such practices; doing so is like pouring new wine into broken bottles, with only the bottles remaining. Thus, the challenge is for feminist,

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community, and cultural psychologists to continue to create new research practices—new methods, measures, and data-analytic strategies—that might discover what normative practices prevent us from even imagining.

Acknowledgment Supported by funds provided by Tobacco-Related Disease Research Program Grant No. 15AT-1300, and National Cancer Institute Grant No. 5F31CA110213.

References Abelson, R. P. (1995). Statistics as principled argument. Hillsdale, NJ: Erlbaum. Accordino, J. J., & Gary, T. (2000). Addressing the abandoned and vacant property problem. Journal of Urban Affairs, 22, 301–315. Adelman, R. M. (2004) Neighborhood opportunities, race, and class: The Black middle-class and residential segregation. City and Community, 3, 43–63. Anda, R. F., Dodson, D. L., & Williamson, D. F., et al. (1989). Health promotion data for state health departments: Telephone vs. in-person survey estimates of smoking and alcohol use. American Journal of Health Promotion, 4, 32–36. Anderson, J. E., Nelson, D. E., & Wilson, R. W. (1998). Telephone coverage and measurement of health risk indicators: Data from the National Health Interview Survey. American Journal of Public Health, 88, 1392–1395. Arce-Ferrer, A. J. (2006). An investigation into the factors influencing extreme response style. Educational and Psychological Measurement, 66, 374–392. Armstrong, K., Ravenell, K. L., McMurphy, S., & Putt, M. (2007). Racial/ethnic differences in physician distrust in the United States. American Journal of Public Health, 97, 1283–1289. Ashford, A., Gemson, D., Sheinfeld Gorin, S. N., Bloch, S., Lantigua, R., Ahsan, H., & Neugut, A. I. (2000). Cancer screening and prevention practices of inner-city physicians. American Journal of Preventive Medicine, 19, 59–62. Auchincloss, A. H., Diez Roux, A. V., Brown, D. G., Erdmann, C. A., & Bertoni, A. G. (2008). Neighborhood resources for physical activity and healthy foods and their association with insulin resistance. Epidemiology, 19, 146–157. Bach, P. B., Pham, H. H., Schrag, D., Tate, R. C., & Hargraves, J. L. (2004). Primary care physicians who treat Blacks and Whites. New England Journal of Medicine, 351, 575–584. Balfour, J. L., & Kaplan, G. A., (2003). Neighborhood environment and loss of physical function in older adults. American Journal of Epidemiology, 157, 472–473. Bauer, H. M., Rodriguez, M. A., Quinroga-Szukupinski, S., & Flores-Ortiz, Y. (2000). Barriers to health care for abused Latina and Asian immigrant women. Journal of Health Care for the Poor and Underserved, 11, 33–44. Baumgartner, H., & Steenkamp, J. B. (2001). Response styles in marketing research: A crossnational investigation. Journal of Marketing Research, 38, 143–156. Beebe, T. J., Jenkins, S. M., Anderson, K. J., Davern, M. E., & Rockwood, T. H. (2008). The effects of survey mode and asking about future intentions on self-reports of colorectal cancer screening. Cancer Epidemiology, Biomarkers, and Prevention, 17, 785–790. Beebe, T. J., McRae, J. A., Harrison, PA., Davern, M. E., & Quinlan, K. A. (2005). Mail surveys result in more reports of substance use. Journal of Clinical Epidemiology, 58, 421–424. Beretvas, S. N., Meyers, J. L., & Leite, W. L. (2002). A reliability generalization of the Marlowe-Crowne Social Desirability Scale. Educational and Psychological Measurement, 62, 570–589. Betancourt, H., & Lopez, S. R. (1993). The study of culture, ethnicity, and race in American psychology. American Psychologist, 48, 629–637. Bhandari, A., & Wagner T. (2006). Self-reported utilization of health care services: Improving measurement and accuracy. Medical Care Research Review, 63, 217–235. Block, J., Scribner, R., & DeSalvo, K. (2004). Fast food, race/ethnicity, and income: A geographic analysis. American Journal of Preventive Medicine, 27, 211–217. Blumberg, S. J., & Luke, J. V. (2007). Coverage bias in traditional telephone surveys of lowincome and young adults. Public Opinion Quarterly, 71, 734–749.

121

122


Blumberg, S. J., Luke, J. V., & Cynamon, M. L. (2006). Telephone coverage and health survey estimates: Evaluating the need for concern about wireless substitution. American Journal of Public Health, 96, 926–931. Bondi, L., & Rose, D. (2003). Constructing gender, constructing the urban: A review of AngloAmerican feminist urban geography. Gender, Place, and Culture, 10, 229–245. Braunstein, J. B., Sherber, N. S., Schulman, S. P., Ding, E. L., & Powe, N. R. (2008). Race, medical researcher distrust, perceived harm, and willingness to participate in cardiovascular prevention trials. Medicine (Baltimore), 87, 1–9. Buchwald, D., Mendoza-Jenkins, V., Croy, C., McGough, H., Bezdek, M., & Spicer, P. (2006). Attitudes of urban American Indians and Alaska Natives regarding participation in research. Journal of General Internal Medicine, 21, 648–651. Buhr, K., & Dugas, M. J. (2002). The Intolerance of Uncertainty Scale. Behavior Research and Therapy, 40, 931–945. Burton, A. (2007). Does poor housing raise diabetes risk? Environmental Health Perspectives, 115, 534. Byrne, B. M., & Watkins, D. (2003). The issue of measurement invariance revisited. Journal of Cross-Cultural Psychology, 34, 155–175. Campbell, D. T., & Stanley, J. C. (1966). Experimental and quasi-experimental designs for research. Chicago, IL: Rand McNally. Carrasquillo, O., Orav, J. E., Brennan, T. A., & Burstin, H. R. (1999). Impact of language barriers on patient satisfaction in an emergency department. Journal of General Internal Medicine, 14, 82–87. Centers for Disease Control. (2004a). The burden of chronic diseases and their risk factors. Atlanta, GA: Department of Health and Human Services. Centers for Disease Control. (2004b). Health, United States, 2004. Hyattsville, MD: CDC, National Center for Health Statistics. Centers for Disease Control and Prevention. (2004c). 2003 Behavioral Risk Factor Surveillance System Summary Data Quality Report. At http://www.cdc.gov/brfss. Centers for Disease Control. (2005). Third National Report on Human Exposure to Environmental Chemicals (NCEH Pub. No. 05–0570). Atlanta, GA: Centers for Disease Control. Chang, E. C., Asakawa, K., & Sanna, L. J. (2001). Cultural variations in optimistic and pessimistic bias. Journal of Personality and Social Psychology, 81, 476–491. Chang, L. (1994). A psychometric evaluation of 4-point and 6-point Likert-type scales in relation to reliability and validity. Applied Psychological Measurement, 18, 205–215. Chen, C., Lee, S., & Stevenson, H. (1995). Response style and cross-cultural comparisons of rating scales among East Asians and North American students. Psychological Science, 6, 170–175 Cheung, G. W., & Rensvold, R. B. (2000). Assessing extreme and acquiescence response sets in cross-cultural research using structural equation modeling. Journal of Cross-Cultural Psychology, 31, 187–212. Choi, I., & Choi, Y. (2002). Culture and self-concept flexibility. Personality and Social Psychology Bulletin, 28, 1508–1517. Choi, I., Nisbett, R. E., & Norenzayan, A. (1999). Causal attribution across cultures. Psychological Bulletin, 125, 47–63. Chuang, Y. C., Cubbin, C., Ahn, D., & Winkleby, M. A. (2005). Effects of neighborhood socioeconomic status and convenience store concentration on individual level smoking. Journal Epidemiology and Community Health, 59, 568–573. Chung, C., & Myers Jr., S. L. (1999). Do the poor pay more for food? An analysis of grocery store availability and food price disparities. Journal of Consumer Affairs, 33, 276–296. Clarke, I. (2000). Extreme response style in cross-cultural research: An empirical investigation. Journal of Social Behavior and Personality, 15, 137–152. Clark, M. A., Rogers, M., Armstrong, G. F., Rakowski, W., & Kviz, F. J. (2008). Differential response effects of data collection mode in a cancer screening study of unmarried women ages 40–75. BMC Medical Research Methodology, 8, 10–20. Cohen, D. A., Farley, T. A., & Mason, K. (2003). Why is poverty unhealthy? Social and physical mediators. Social Science and Medicine, 57, 1631–1641. Cohen, D. A., Mason, K., Bedimo, A., Scribner, R., Basolo, V., & Farley, T. A. (2003). Neighborhood physical conditions and health. American Journal of Public Health, 93, 467–471.

Chapter 4


Cohen, D. A., Spear, S., Scribner, R., Kissinger, P., Mason, K., & Wildgen, J. (2000). Broken windows and risk of gonorrhea. American Journal of Public Health, 90, 230–236. Cole, S. R. (1999). Assessment of differential item functioning in the Perceived Stress Scale 10. Journal of Epidemiology and Community Health, 53, 319–320. Cole, S. R., Kawachi, I., Maller, S. J., & Berkman, L. F. (2000). Test of item-response bias in the CES-D scale. Journal of Clinical Epidemiology, 53, 285–289. Collazo, A. A. (2005). Translation of the Marlowe-Crowne Social Desirability Scale into an equivalent, Spanish version. Educational and Psychological Measurement, 65, 780–806. Collins, C., & Williams, D. (1999). Segregation and mortality. Sociological Forum, 14, 495–523. Cook, T. D., & Campbell, D. T. (1979). Quasi-experimentation: Design and analysis issues for field settings. Chicago, IL: Rand McNally. Coon, H. M., & Kemmelmeier, M. (2001). Cultural orientations in the United States: (Re) Examining differences among ethnic groups. Journal of Cross Cultural Psychology, 32, 348–364. Corbie-Smith, G. (1999). The continuing legacy of the Tuskegee Syphilis Study. American Journal of Medical Science, 317, 5–8. Corbie-Smith, G., Thomas, S. B., & St. George, D. M. (2002). Distrust, race, and research. Archives of Internal Medicine, 162, 2458–2463. Corral, I., & Landrine, H. (2008). Acculturation and ethnic-minority health behavior. Health Psychology, 27(6), 737–745. Coughlin, S., Leadbetter, S., Richards, T., & Sabatino, S. (2008). Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002. Social Science and Medicine, 66, 260–275. Cozier, Y. C., Palmer, J. R., Horton, N. J., Fredman, L., Wise, L. A., & Rosenberg, L. (2007). Relationship between neighborhood median housing value and hypertension risk among Black women in the US. American Journal of Public Health, 97, 718–724. Crane, P. K., Gibbons, L. E., Narasimhalu, K., Lai, J. S., & Cella, D. (2007). Rapid detection of differential item functioning in assessments of health-related quality of life. Quality of Life Research, 16, 101–114. Crane, P. K., van Belle, G., & Larson, E. B. (2004). Test bias in a cognitive test: Differential item functioning in the Cognitive Screening Assessment Instrument (CASI). Statistics in Medicine, 30, 241–256. Crockett, L. J., Randall, B. A., Shen, U. L., Russell, S. T., & Driscoll, A. K. (2005). Measurement equivalence of the Center for Epidemiological Studies Depresson Scale for Latino and Anglo adolescents. Journal of Consulting and Clinical Psychology, 73, 47–58. Datta, G. D., Subramanian, S. V., Colditz, G. A., Kawaachi, I., Palmer, J. R., & Rosenberg, L. (2006). Individual, neighborhood, and state-level predictors of smoking among U.S. Black women. Social Science and Medicine, 63, 1034–1044. Dell, J. L., Whitman, S., Shah, A. M., Silva, A., & Ansell, D. (2005). Smoking in 6 diverse Chicago communities—A population study. American Journal of Public Health, 95, 1036–1042. Derlega, V. J., Cuker, C. S., Kuang, J. C. Y., & Forysyth, D. R. (2002). Interdependent construal of self and endorsement of confl ict resolution strategies in interpersonal, intergroup, and international disputes. Journal of Cross-Cultural Psychology, 33, 610–625. Diener, E., Oishi, S., & Lucas, R. E. (2003). Personality, culture, and subjective well-being. Annual Review of Psychology, 54, 403–425. Diez Roux, A. V., Evenson, K. R., McGinn, A. P., Brown, D. G., Moore, L., Brines, S., & Jacobs, D. R. Jr. (2007). Availability of recreational resources and physical activity in adults. American Journal of Public Health, 97, 493–499. Dillman, D. A. (2000). Mail and Internet surveys. New York: John Wiley & Sons. Dillman, D. A. Sangster, R. L., Tarnai, J., & Rockwood, T. (1996). Understanding differences in people’s answers to telephone and mail surveys. In M. T. Braverman & J. K. Slater (Eds.), Current issues in survey research (pp. 45–62). San Francisco: Jossey-Bass. Doan, P. (2007). Queers in the American city. Gender, Place, and Culture, 14, 57–74. Dorans, N. J., & Kulick, E. (2006). Differential item functioning on the Mini-Mental State Examination. Medical Care, 44 (11, Suppl. 3), S107–S11. Dudley, N. M., McFarland, L. A., Goodman, S. A., Hunt, S. T., & Sydell, E. J. (2005). Racial differences in socially desirable responding in selection contexts. Journal of Personality Assessment, 85, 50–64.

123

124


Edelen-Orlando, M. O., Thissen, D., Teresi, J. A., Kleinman, M., & Ocepek-Welikson, K. (2006). Identification of differential item functioning using item response theory and the likelihood-based model comparison approach: Application to the Mini-Mental State Examination. Medical Care, 44(11 Suppl. 3), S134–S142. Elliott, M. (2000). The stress process in neighborhood context. Health and Place, 6(4), 287–299. Estabrooks, P. A., Lee, R. E., & Gyurcsik, N. C. (2003). Resources for physical activity participation: Does availability and accessibility differ by neighborhood socioeconomic status? Annals of Behavioral Medicine, 25, 100–104. Evans, J., Hydman, S., Stewart-Brown, S., Smith, D., & Petersen, S. (2000). An epidemiologic study of the relative importance of damp housing in relation to adult health. Journal of Epidemiology and Community Health, 54, 677–686. Farley, J. E. (2005). Race not class: Explaining racial housing segregation in the St. Louis metropolitan area. Sociological Forces, 38, 133–150. Fauth, R. C., Leventahl, T., & Brooks-Gunn, J. (2004). Short-term effects of moving from public housing in poor to middle-class neighborhoods on low-income, minority adults’ outcomes. Social Science and Medicine, 59, 2271–2284. Feldman, P. J., & Steptoe, A. (2004). How neighborhoods and physical functioning are related. Annals of Behavioral Medicine, 27, 91–99. Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparity in health care by race, ethnicity, and language among the insured. Medical Care, 40, 52–59. Fiscella, K., Franks, P., Gold, M. R., & Clancy, C. M. (2000). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. Journal of the American Medical Association, 283, 2579–2584. Fischer, R. (2004). Standardization to account for cross-cultural response bias. Journal of Cross Cultural Psychology, 35, 263–282. Ford, E. S. (1998). Characteristics of survey participants with and without a telephone: Findings from the third National Health and Nutrition Examination Survey. Journal of Clinical Epidemiology, 51, 55–60. Frayne, S. M., Burns, R. B., Hardt, E. J., Rosen, A. K., & Moskowitz, M. A. (1996). The exclusion of non-English speaking persons from research. Journal of General Internal Medicine, 11, 39–43. French, S. A., Harnack, L., & Jeffrey, R. W. (2000). Fast food restaurant use among women in the Pound of Prevention Study. International Journal of Obesity, 24, 1353–1359. French, S. A., Story, M., & Jeffery, R. W. (2001). Environmental influences on eating and physical activity. Annual Review of Public Health, 22, 309–335. Gamble, V. N. (1993). A legacy of distrust: African Americans and medical research. American Journal of Preventive Medicine, 9, 35–38. Gamble, V. N. (1997). Under the shadow of Tuskegee. American Journal of Public Health, 87, 1773–1778. Gilbert, D., & Malone, P. S. (1995). The correspondence bias. Psychological Bulletin, 117, 21–38. Giles-Corti, B., & Donovan, R. J. (2002). Socioeconomic status differences in recreational physical activity levels and real and perceived access to a supportive physical environment. Preventive Medicine, 35, 601–611. Giles-Corti, B., & Donovan, R. J. (2003). Relative influences of individual, socialenvironmental, and physical-environmental correlates of walking. American Journal of Public Health, 93, 1583–1589. Gordon-Larsen, P., Nelson, M. C., Page, P., & Popkin, B. M. (2006). Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics, 117, 417–424. Greco, V., & Roger, D. (2001). Coping with uncertainty: The construction and validation of a new measure. Personality and Individual Differences, 31, 519–534. Greenfield, P. M., Keller, H., Fuligni, A., & Maynard, A. (2003). Cultural pathways through universal development. Annual Review of Psychology, 45, 461–490. Greenleaf, E. A. (1992a). Improving rating scale measures by detecting and correcting bias components in response styles. Journal of Marketing Research, 29, 176–188. Greenleaf, E. A. (1992b). Measuring extreme response style. Public Opinion Quarterly, 56, 328–351.

Chapter 4


Gregorich, S. E. (2006). Do self-report instruments allow meaningful comparisons across diverse population groups? Testing measurement invariance using the confi rmatory factor analysis approach. Medical Care, 44 (11 Suppl. 3), s78–s94. Groves, R. M., & Kahn, R. L. (1979). Surveys by telephone: A national comparison with personal interviews. New York: Academic Press. Ha, M. H., Lee, D. H., & Jacobs, D. R. (2007). Association between serum concentrations of persistent organic pollutants and self-reported cardiovascular disease prevalence. Environmental Health Perspectives, 115, 1204–1209. Haberstroh, S., Oyserman, D., Schwarz, N., Kuhnen, U., & Ji, L.-J. (2002). Is the interdependent self more sensitive to question context than the independent self? Journal of Experimental Social Psychology, 38, 323–329. Hambleton, R. K. (2006). Good practices for identifying differential item functioning. Medical Care, 44 (11 Suppl. 3), S182–S186. Hambleton, R. K., Merenda, P., & Spielberger, C. (2005). Adapting educational and psychological tests for cross cultural assessment. Mahwah, NJ: Erlbaum. Hambleton, R. K., Swaminathan, H., & Rogers, H. J. (1991). Fundamentals of item response theory. Newbury Park, CA: Sage. Handy, S. L., Boarnet, M. G., Ewing, R., & Killingsworth, R. E. (2002). How the built environment affects physical activity. American Journal of Preventive Medicine, 23(2S), 99–120. Harachi, T. W., Choi, Y., Abbott, R. D., Catalano, R. F., & Bliesner, S. L. (2006). Examining equivalence of concepts and measures in diverse samples. Prevention Science, 7, 359–368. Hardin, E. E., Leong, F. T. L., & Bhagwat, A. A. (2004). Factor structure of the Self-Construal Scale revisited. Journal of Cross-Cultural Psychology, 35, 327–345. Harkness, J. A., van de Vijver, F. J. R., & Mohler, P. P. H. (2003). Cross-cultural survey methods. Hoboken, NJ: John Wiley & Sons. Helms, J. (1992). Why is there no study of cultural equivalence in standardized cognitive ability testing? American Psychologist, 47, 1083–1101. Helms, J., Jernigan, M., & Mascher, J. (2005). The meaning of race in psychology and how to change it: A methodological perspective. American Psychologist, 60, 27–36. Hofrichter, R. (2000). Reclaiming the environmental debate. Cambridge, MA: MIT Press. Huang, X., Lessner, L., & Carpenter, D. O. (2006). Exposure to persistent organic pollutants and hypertensive disease. Environmental Research, 102, 101–106. Hausmann, L. R., Jeong, K., Bost, J. E., & Ibrahim, S. A. (2008). Perceived discrimination in health care and health status in a racially diverse sample. Medical Care, 46, 905–914. Heatherton, T., Kleck, R. E., Hebl, M. R., & Hull, J. G. (2000). The social psychology of stigma. New York: Guilford Press. Heine, S. J., Lehman, D. R., Peng, K., & Greenholtz, J. (2002). What’s wrong with cross-cultural comparisons of subjective Likert scales? Journal of Personality and Social Psychology, 82, 903–913. Herzog, A. R., & Rodgers, W. I. (1988). Interviewing older adults: Mode comparison using data from a face-to-face and telephone resurvey. Public Opinion Q, 52, 84–99. Hofstede, G. H. (2001). Culture’s consequences (2nd ed.). Thousand Oaks, CA: Sage. Hofstede, G., & Bond, M. (1984). Hofstede’s cultural dimensions. Journal of Cross-Cultural Psychology, 15, 417–433. Holland, P. W., & Wainer, H. I. (1993). Differential item functioning. Hillsdale, NJ: Erlbaum. Hong, Y.-Y., Morris, M. W., Chiu, C-Y., & Benet-Martinez, V. (2000). Multicultural minds. American Psychologist, 55, 709–720. Hui, C. H. (1988). Measurement of individualism-collectivism. Journal of Research in Personality, 22, 17–36. Hui, C., & Triandis, H. (1989). Effects of culture and response format on extreme response style. Journal of Cross-Cultural Psychology, 20, 296–309. Iceland, J., Weinberg, D. H., & Steinmetz, E. (2002). Racial and ethnic segregation in the United States, 1980–2000. Washington, DC: U. S. Government Printing Office, U.S. Census Bureau. Institute of Medicine. (2000). Clearing the Air: Asthma and indoor air exposures. Washington, DC: National Academy Press. Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press.

125

126


Iwata, N., Turner, J., & Llyod, D. (2002). Race/ethnicity and depressive symptoms in community-dwelling young adults: A differential item functioning analysis. Psychiatric Research, 110, 281–289. Jacobs, D. E., Clickner, R. P., Zhou, J. Y., Viest, S. M., Marker, D. A., Rogers, J. W., et al. (2002). The prevalence of lead-based paint hazards in U.S. housing. Environmental Health Perspectives, 110, A599-A606. Jacobs, D. E., Kelly, T., & Sobolewski, J. (2007). Linking public health, housing, and indoor environmental policy. Environmental Health Perspectives, 115, 976–982. Jacobs, E. A., Lauderdale, D. S., Meltzer, D., Shorey, J. M., Levinson, W., & Thisted, R. A. (2001). Impact of interpreter services on delivery of health care to limited Englishproficient patients. Journal of General Internal Medicine, 16, 468–474. Jackson, C., Jatulis, D. E., & Fortmann, S. P. (1992). The Behavioral Risk Factor Surveillance Survey and the Stanford Five-City Project Survey: A comparison of cardiovascular risk behavior estimates. American Journal of Public Health, 82, 412–416. Jang, M., Lee, E., & Woo, K. (1998). Income, language, and citizenship status: Factors affecting health care access and utilization of Chinese Americans. Health and Social Work, 23, 136–145. Jerant, A. F., Fenton, J. J., & Franks, P. (2008). Determinants of racial/ethnic colorectal cancer screening disparities. Archives of Internal Medicine, 168, 1317–1324. Ji, L.-J., Schwarz, N., & Nisbett, R. E. (2000). Culture, autobiographical memory, and behavioral frequency reports: Measurement issues in cross-cultural studies. Personality and Social Psychology Bulletin, 26, 585–593. Johnson, T. P., & Bowman, P. J. (2003). Cross-cultural sources of measurement error in substance use surveys. Substance Use Misuse, 38, 1447–1449. Johnson, T., Kulesa, P., Cho, Y. I., & Shavitt, S. (2005). The relation between culture and response styles: Evidence from 19 countries. Journal of Cross-Cultural Psychology, 36, 264–277. Johnson, T., O’Rourke, D. B., Burris, J. E., & Warnecke, R. B. (2005). An investigation of the effects of social desirability on the validity of self-reports of cancer screening behaviors. Medical Care, 43, 565–573. Johnson, T., O’Rourke, D., Chavez, N., Sudman, S. Warnecke, R., Lacey, L., & Horm, J. (1997). Social cognition and responses to survey questions among culturally diverse populations. In L. Lyberg, P. Biemer, P. Collins, et al. (Eds.), Survey Measurement and Process Quality (pp. 87–113). New York: Wiley. Johnson, T., & van de Vijver, F. (2003). Social desirability in cross-cultural research. In J. A. Harkenss, F. van de Vijver, & P. Mohler (Eds.), Cross-Cultural Survey Methods (pp. 193–202). New York: Wiley. Johnston, R., Poulsen, M., & Forrest, J. (2007). Ethnic and racial segregation in U.S. metropolitan areas, 1980–2000. Urban Affairs Review, 42, 479–504. Jones, J. (1993). Bad Blood: The Tuskegee Syphilis experiment. New York: Macmillian. Jones, J. P., Nast, H J., & Roberts, S. M. (1997). Thresholds in feminist geography: Difference, methodology, representation. New York: Rowman & Littlefield. Jones, R. N., & Gallo. J. J. (2001). Education bias in the Mini-Mental State Examination. International Psychogeriatrics, 13, 299–310. Karabenick, S. A., Woolley, M. E., Friedel, J. M., Ammon, B. V., Blazevski, J., Bonney, C. R., De Groot, E., et al. (2007). Cognitive processing of self-report items in educational research: Do they think what we mean? Educational Psychologist, 42, 139–151. Karlsen, S., & Nzroo, J. Y. (2002). Relation between racial discrimination, social class, and health among ethnic minority groups. American Journal of Public Health, 92, 624–631. Kawachi, I., & Berkman, L. (2003). Neighborhoods and Health. NY: Oxford University Press. Keeter, S., Kennedy, C., Clark, A., Tompson, T., & Mokrzycki, M. (2007). What’s missing from national landline RDD surveys? The impact of the growing cell-only population. Public Opinion Quarterly, 71, 772–792. Kempf, A. M., & Remington, P. L. (2007). New challenges for telephone survey research in the 21st century. Annual Review of Public Health, 28, 13–126. Kiefer, E. C., Willis, S. K., Odoms-Young, A. M., Guzman, J. R., Allen, A. J., Two Feathers, J., & Loveluck, J. (2004). Reducing disparities in diabetes among African-American and Latino residents of Detroit. Ethnicity and Disease, 14 (3 Suppl. 1), S27–S37.

Chapter 4


Killien, M., Bigby, J. A., Champion, V., Fernandez-Repollet, E., Jackson, R. D., Kagawa-Singer, M., et al. (2000). Involving minority and under-represented women in clinical trials. Journal of Women’s Health and Gender-Based Medicine, 9, 1061–1070. Kim, H. S., & Markus, H. R. (2002). Freedom of speech and freedom of silence: An analysis of talking as a cultural practice. In R. Shweder, M. Minow, & H. R. Markus (Eds.), Engaging cultural differences: The multicultural challenge in liberal democracies (pp. 432–452). New York: Russell-Sage Foundation. Kim, H. S., & Markus, H. R. (2005). Speech and silence: An analysis of the cultural practice of talking. In L. Weis & M. Fine (Eds.), Beyond silenced voices: Class, race, and gender in United States Schools. NY: SUNY Press. Kim, S. Egerter, S., Cubbin, C., et al. (2007). Potential implications of missing income data in population-based surveys. Public Health Reports, 122, 753–763. Kim, Y., Pilkonis, P. A., Frank, E., Thase, M. E., & Reynolds, C. F. (2002). Differential item functioning of the Beck Depression Inventory in late-life patients. Psychology and Aging, 17, 379–391. Kingsley, G T. (2003). Housing, health, and the neighborhood context. American Journal of Preventive Medicine, 24 (3S), 6–7. Kinne, S., & Topolski, T. D. (2005). Inclusion of people with disabilities in telephone health surveillance surveys. American Journal of Public Health, 95, 512–517. Klonoff, E. A., & Landrine, H. (1999). Do Blacks believe that HIV/AIDS is a government conspiracy against them? Preventive Medicine, 28, 451–457. Klonoff, E. A., Landrine, H., & Campbell, RR. (2000). Sexist discrimination may account for well-known gender differences in psychiatric symptoms. Psychology of Women Quarterly, 24, 92–98. Knopp, L. (1999). Queer theory, queer pedagogy: New spaces and new challenges in teaching geography. Journal of Geography in Higher Education, 23, 77–79. Krieger, N., Chen, J. T., & Selby, J. V. (1999). Comparing individual-based and householdbased measures of social class to assess class inequalities in women’s health. Journal of Epidemiology and Community Health, 53, 612–623. Krieger, N, Chen, J. T., Waterman, P. D., Soobader, M. J., Subramanian, S. V., & Carson, R. (2002). Geocoding and monitoring U.S. socioeconomic inequalities in mortality and cancer incidence: Does choice of area-based measure and geographic level matter? The Public Health Disparities Geocoding Project. American Journal of Epidemiology, 156, 471–482. Krieger, N., Chen, J. T., Waterman, P. D., Soobader, M. J., Subramanian, S. V., & Carson, R. (2003a). Choosing area-based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project. Journal of Epidemiology and Community Health, 57, 186–199. Krieger, N, Chen, J. T., Waterman, P. D., Soobader, M. J., & Subramanian, S. V., (2003b). Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence. Geocoding and choice of area-based socioeconomic measures B The Public Health Disparities Geocoding Project. Public Health Reports, 118, 240–260. Krieger, N., Chen, J. T., Waterman, P. D., Rehkopf, D. H., & Subramanian, S. V. (2003c). Race/ ethnicity, gender, and monitoring socioeconomic gradients in health: A comparison of area-based socioeconomic measures B The Public Health Disparities Geocoding Project. American Journal of Public Health, 93, 1655–1671. Krieger, N., Chen, J. T., Waterman, P. D., Rehkopf, D. H., & Subramanian, S. V. (2005). Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: The Public Health Disparities Geocoding Project. American Journal of Public Health, 95, 312–323. Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378. Landrine, H., & Klonoff, E. A. (1996). African-American Acculturation: Deconstructing Arace@ and reviving culture. Thousand Oaks, CA: Sage. Landrine, H., & Klonoff, E. A. (2000). Racial segregation and cigarette smoking among Blacks: Findings at the individual level. Journal of Health Psychology, 5, 211–219. Landrine, H., & Klonoff, E. A. (2004). Culture change and ethnic minority health-behavior: An operant theory of acculturation. Journal of Behavioral Medicine, 27, 527–555. Landrine, H., Klonoff, E. A., & Brown-Collins, A. (1992) Cultural diversity and methodology in feminist psychology. Psychology of Women Quarterly, 16, 145–163.

127

128


Larkin, L. K., Gonzalez, J. A., Mar, L. E., & Glantz, N. (2008). Latina recruitment for cancer prevention education via community-based participatory research strategies. Contemporary Clinical Trials, published online ahead of print, 8/23/08. Lee, R. E., & Cubbin, C. (2002). Neighborhood context and youth cardiovascular health behaviors. American Journal of Public Health, 92, 428–436. Lee, S., Nguyen, H. A., Jawad, M., & Kurata, J. (2008). Linguistic minorities in a health survey. Public Opinion Quarterly, 72, 470–486. Leite, W. L., & Beretvas, S. N. (2005). Validation of scores on the Marlowe-Crowne Social Desirability Scale and the Balanced Inventory of Desirable Responding. Educational and Psychological Measurement, 65, 140–154. Lehman, D. R., Chiu, C.-Y., & Schaller, M. (2004). Psychology and culture. Annual Review of Psychology, 55, 689–714. Leventhal, T., & Brooks-Gunn, J. (2003). Moving to opportunity: An experimental study of neighborhood effects on mental health. American Journal of Public Health, 93, 1576–1582. Li, A., & Bagger, J. (2007). The Balanced Inventory of Desirable Responding (BIDR). Educational and Psychological Measurement, 67, 525–544. Li, F., Harmer, P. A., Cardinal, B. J., Bosworth, M., Acock, A., Johnson-Shelton, D., & Moore, J. M. (2008). Built environment, adiposity, and physical activity in adults ages 50–75. American Journal of Preventive Medicine, 35, 38–46. Liao, Y., Tucker, P., Okoro, C. A., Giles, W. H., Mokdad, A. H., & Harris, V. B. (2004). REACH 2010 Surveillance for Health Status in Minority Communities B United States, 2001–2002. Morbidity and Mortality Weekly Report, Surveillance Summaries, 53 (6), 1–36. Link, M W., & Mokdad, A. H. (2005). Alternative modes for health surveillance surveys: An experiment with web, mail, and telephone. Epidemiology, 16, 701–704. Link, M. W., Mokdad, A. H., Stackhouse, H. F., & Flowers, N. T. (2006). Race, ethnicity, and linguistic isolation as determinants of participation in public health surveillance surveys. Preventing Chronic Disease, 3(1), 1–12. Lord, F. M. (1980). Applications of item response theory to practical testing problems. Hillsdale, NJ: Erlbaum. Lurie, N., & Buntin, M. B. (2002). Health disparities and the quality of ambulatory care. New England Journal of Medicine, 347, 1709–1710. Macintyre, S., & Ellaway, A. (2003). Ecological approaches: Rediscovering the role of the physical and social environment. In I. Kawachi & L. Berkman, Neighborhoods and health (pp. 332–348). New York: Oxford University Press. MacPherson, L., & Myers, M. G. (2004). Invariance study of an adolescent survey-based smoking-related cognitions scale. Preventive Medicine, 39, 1026–1035. Mains, S. (2000). An anatomy of race and immigration politics in California. International Journal of Social and Cultural Geography, 1/ 2, 143–154. Marin, G. Gamba, R. J., & Marin, B. V. (1992). Extreme response style and acquiescence among Hispanics. Journal of Cross-Cultural Psychology, 23, 498–509. Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98, 224–253. Massey, D. S. (2001). Residential segregation and neighborhood conditions in U.S. metropolitan areas. In N. J. Smelser, W. J. Wilson, & F. Mitchell (Eds.), America becoming: Racial trends and their consequences (pp. 391–434). Washington, DC: National Academy Press. Massey, D. S. (2004). Segregation and stratification. Du Bois Review, 1(1), 7–25. Massey, D. S., & Denton, N. A. (1993). American Apartheid: Segregation and the making of the underclass. Cambridge, MA: Harvard University Press. Massey, D., & Gross, A. (1994). Migration, segregation, and the geographic concentration of poverty. American Sociological Review, 59, 425–445. Matsumoto, D., & Yoo, S. H. (2006). Toward a new generation of cross-cultural research. Perspectives on Psychological Science, 1, 234–250. Matsumoto, D., Weissman, M., Preston, K., Brown, B., & Kupperbusch, C. (1997). Contextspecific measurement of individualism-collectivism on the individual level. Journal of Cross-Cultural Psychology, 28, 743–767. McHorney, C. A., & Fleishman, J. A. (2006). Assessing and understanding measurement equivalence in health outcome measures. Medical Care, 44 (11, Suppl. 3), S205–S210.

Chapter 4


McPhee, S. J., Nguyen, T. T., Shema, S. J., Nguyen, B., Somkin, C., Vo, P., et al. (2002). Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Preventive Medicine, 35, 463–473. Meade, A. W., & Lautenschlager, G. J. (2004). A comparison of item-response theory and confirmatory factor analytic methodologies for establishing measurement equivalence/ invariance. Organizational Research Methods, 7, 361–388. Meredith, W. (1993). Measurement invariance, factor analysis, and factorial invariance. Psychometrika, 58, 525–543. Meredith, W., & Teresi, J. A. (2006). An essay on measurement and factorial invariance. Medical Care, 44 (Suppl. 3), s69–s77. Mesquita, B. (2001). Emotions in collectivist and individualist contexts. Journal of Personality and Social Psychology, 80, 68–74. Mishra, S., Dooley, D., Catalano, R., & Serxner, S. (1993). Telephone health surveys: Potential bias from non-completion. American Journal of Public Health, 83, 94–99. Miysmoto, R., Hishinuma, E. S., Nishimura, S. T., Nahulu, L. B., Andrade, N. N., Hohnson, R. C., Makini, G. K., Yuen, N. Y., Kim, S. P., et al. (2001). Equivalence regarding the measurement and constructs of self-esteem and major life events in an Asian/Pacific Islander sample. Cultural Diversity and Ethnic Minority Psychology, 7, 152–163. Moore, L. V., & Diez Roux, A. V. (2006). Associations of neighborhood characteristics with the location and type of food stores. American Journal of Public Health, 96, 325–331. Moore, L. V., Diez Roux, A. V., Evenson, K. R., McGinn, A. P., & Brines, S. J. (2008). Availability of recreational resources in minority and low socioeconomic status areas. American Journal of Preventive Medicine, 34, 16–22. Morales, L. S., Flowers, C., Guttierrez, P., Kleinman, M., & Teresi, J. A. (2006). Item and scale differential functioning of the Mini-Mental State Exam assessed using the differential item and test functioning (DFIT) framework. Medical Care, 44 (11 Suppl. 3), S143-S151. Morales, L., Reise, S., & Hays, R. (2000). Evaluating the equivalence of health care ratings by Whites and Hispanics. Medical Care, 38, 517–527. Morello-Frosch, R. (2002). The political economy of environmental discrimination. Environmental Planning, C 20, 477–496. Morello-Frosch, R., & Jesdale, B. M. (2006). Separate and unequal: Residential segregation and estimated cancer risks associated with ambient air toxics in U.S. metropolitan areas. Environmental Health Perspectives, 114, 386–393. Morello-Frosch, R., & Lopez, R. (2006). The riskscape and the color line: Examining the role of segregation in environmental health disparities. Environmental Research, 102, 181–196. Morello-Frosch, R., Pastor, M., & Sadd, J. (2001). Environmental justice and southern California’s “riskscape”: The distribution of air-toxics exposures and health risks among diverse communities. Urban Affairs Review, 36, 551–578. Morello-Frosch, R., & Shenassa, E. D. (2006). The environmental “riskscape” and social inequality: Implications for explaining maternal and child health disparities. Environmental Health Perspectives, 114, 1150–1153. Morello-Frosch, R., Pastor, M., & Sadd, J. (2001). Environmental justice and southern California’s “riskscape”: The distribution of air-toxics exposures and health risks among diverse communities. Urban Affairs Review, 36, 551–578. Morland, K., Diez Roux, A., & Wing, S. (2006). Supermarkets, other food stores, and obesity. American Journal of Preventive Medicine, 30, 333–339. Morland, K., & Filomena, S. (2007). Disparities in the availability of fruits and vegetables between racially segregated urban neighborhoods. Public Health Nutrition, 21, 1–9. Morland, K., Wing, S., & Diez Roux, A. (2002). The contextual effect of the local food environment on residents’ diets. American Journal of Public Health, 92, 1761–1767. Morris, M. W., & Fu, H-Y. (2001). How does culture influence confl ict resolution? Social Cognition, 19, 324–349. Moss, N. E. (2002). Gender equity and socioeconomic inequality: A framework for the patterning of women’s health. Social Science and Medicine, 54, 649–661. Nash, D., Magder, L., Lustberg, M., Sherwin, R. W., Rubin, R. J., Kaufmann, R. B., et al. (2003). Blood lead, blood pressure, and hypertension in perimenopausal and postmenopausal women. Journal of the American Medical Association, 289, 1523–1532.

129

130


National Center for Health Statistics. (1998). Health United States, 1998, with Socioeconomic status and Health Chartbook. Hyattsville, MD: National Center for Health Statistics. National Institutes of Health. (1994, 2000). NIH Guidelines on the inclusion of women and minorities as subjects in clinical research. Available at http://grants.nih.gov. National Institutes of Health. (1998). Women of color health data book. Bethesda, MD: National Institutes of Health, Office of Research on Women’s Health, NIH Publication 98–4247. Nelson, D. E., Powell-Griner, E., Town, M., & Kovar, M. G. (2003). A comparison of national estimates from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. American Journal of Public Health, 93, 1335–1341. Nisbett, R. E. (2001). Culture and systems of thought. Psychological Review, 108, 291–310. Nisbett, R. E. (2003). The geography of thought. New York, NY: Free Press. Nisbett, R. E., Peng, K. Choi, I., & Norenzayan, A. (2001). Culture and systems of thought: Holistic versus analytic cognition. Psychological Review, 108, 291–310. Noe, T. D., Manson, S. M., Croy, C., McGough, H., Henderson, J. A., & Buchwald, D. S. (2007). The influence of community-based participatory research principles on the likelihood of participation in health research in American Indian communities. Ethnicity and Disease, 17 (1 Suppl. 1), S6–S14. Norenzayan, A., & Schwarz, N. (1999). Telling what they want to know: Participants tailor causal attributions to researchers’ interests. European Journal of Social Psychology, 29, 1011–1020. Nuevo, R., Dunn, G., Dowrick, C., Vasquez-Barquero, J. L., Casey, P., et al. (in press, 2008). Cross cultural equivalence of the Beck Depression Inventory. Journal of Affective Disorders. Published online ahead of print. O’Campo, P., Burke, J. G., Culhane, J., Elo, I. T., Eyster, J., Holzman, C., et al. (2008). Neighborhood deprivation and preterm birth among non-Hispanic Black and White women in eight geographic areas in the United States. American Journal of Epidemiology, 167, 155–163. Oishi, S., & Diener, E. F. (2001). Goals, culture, and subjective well-being. Personality and Social Psychology Bulletin, 27, 1674–1682. Oishi, S., Diener, E. F., Lucas, R E., & Suh, E. M. (1999). Cross-cultural variation in predictors of life satisfaction. Personality and Social Psychology Bulletin, 25, 980–990. Olden, K., & White, S. L. (2005). Health-related disparities: Influence of environmental factors. Medical Clinics of North America, 89, 721–738. Oyserman, D., & Lee, S. W. S. (2008). Does culture influence what and how we think? Effects of priming individualism and collectivism. Psychological Bulletin, 134, 311–342. Pagano, I. S., & Gotay, C. C. (2005). Ethnic differential item functioning in the assessment of quality of life in cancer patients. Health Quality of Life Outcomes, 7, 60–63. Partin, M. R., Grill, J., Noorbaloochi, S., Powell, A. A., Burgess, D. J., Vernon, S. W., et al. (2008). Validation of self-reported colorectal cancer screening behavior from a mixedmode survey of veterans. Cancer Epidemiology, Biomarkers, and Prevention, 17, 768–776. Paulhus, D. (1991). Measurement and control of response bias. In J. P. Robinson, P. R. Shaver, & L. S. Wrightsman (Eds.), Measures of personality and social psychological attitudes (pp. 17–59). San Diego, CA: Academic Press. Pavlovskaya, M., & St. Martin, K. (2007). Feminism and geographic information systems. Geography Compass, 1/3, 583–606. Payne-Sturges, D., & Gee, G. C. (2006). National environmental health measures for minority and low-income populations: Tracking social disparities in environmental health. Environmental Research, 102, 154–171. Pearl, M., Braveman, P., & Abrams, B. (2001). The relationship of neighborhood socioeconomic characteristics to birth-weight among 5 ethnic groups in California. American Journal of Public Health, 91, 1808–1814. Pearson, D., Cheadle, A., Wagner, E., Tonsberg, R., & Psaty, B. M. (1994). Differences in sociodemographic, health status, and lifestyle characteristics among American Indians by telephone coverage. Preventive Medicine, 23, 461–464. Pereira, M. A., Kartashov, A. I., Ebbeling, C. B., Van Horn, L., Slattery, M. L., Jacobs, D. R. Jr., et al. (2005). Fast food habits, weight gain, and insulin resistance (the CARDIA Study): 15-year prospective analysis. The Lancet, 365, 36–42. Perkins, A. J., Stump, T. E., Monahan, P. O., & McHorney, C. A. (2006). Assessment of differential item functioning for demographic comparisons in the MOS SF-36 health survey. Quality of Life Research, 15, 331–348.

Chapter 4


Ping, Y., & Fan, X. (2003). Assessing the factor structure invariance of self-concept measurement across ethnic and gender groups: Findings from a national sample. Educational and Psychological Measurement, 63, 296–318. Polednak, A. (1997). Segregation, poverty, and mortality in urban African Americans. New York: Oxford University Press. Poortinga, Y. H., Van de Vijver, F., Joe, R. C., & Van de Koppel, J. (1987). Peeling the onion called culture. In C. Kagitcibasi (Ed.), Growth and progress in cross-cultural psychology (pp. 22–34). Lisse: Swets & Zeitlinger. Powell, L. M., Chaloupka, F. J., & Bao, Y. (2007). The availability of fast food and full-service restaurants in the United States: Associations with neighborhood characteristics. American Journal of Preventive Medicine, 33(4 Suppl.), S240–S245. Powell, L. M., Slater, S., Chaloupka, F. J., & Harper, D. (2006). Availability of physical-activityrelated facilities and neighborhood demographic and socioeconomic characteristics: A national study. American Journal of Public Health, 96, 1676–1680. Powell, L. M., Slater, S., Mirtcheva, D., Bao, Y., & Chaloupka, F. J. (2007). Food store availability and neighborhood characteristics in the United States. Preventive Medicine, 44, 189–195. Pulido, L., Sidawi, S., & Vos, R. (1996). An archeology of environmental racism in Los Angeles. Urban Geography, 17, 419–439. Ramirez, M., Teresi, J. A., Holmes, D., Gurland, B., & Lantigua, R. (2006). Differential item functioning (DIF) and the Mini-Mental State Examination (MMSE). Medical Care, 44 (11 Suppl. 3), S95–S106. Rauscher, G. H., Johnson, T. P., Cho, Y. I., & Walk, J. A. (2008). Accuracy of self-reported cancer-screening histories: A meta-analysis. Cancer Epidemiology, Biomarkers, and Prevention, 17, 748–757. Ross, L., & Nisbett, R. E. (1991). The person and the situation. New York: McGraw-Hill. Rothbaum, F., Weisz, J., Pott, M., Miyake, K., & Morelli, G. (2000). Attachment and culture. American Psychologist, 55, 1093–1104. Rothman, A. J., Haddock, G., & Schwarz, N. (2001). How many partners is too many? Shaping perceptions of personal vulnerability. Journal of Applied Social Psychology, 31, 2195–2214. Sanders, S. A., & Reinisch, J. M. (1999). Would you say you ‘had sex’ if....? Journal of the American Medical Association, 281, 275–277. Sarver, J., & Baker, D. W. (2000). Effect of language barriers on follow-up appointments after an emergency department visit. Journal of General Internal Medicine, 15, 256–264. Schaller, M., & Crandall, C. S. (2004). The psychological foundations of culture. Hillsdale, NJ: Erlbaum. Schootman, M., Andersen, E., Wolinsky, F., Malmstrom, T., Miller, J., Yan, Y., & Miller, D. K. (2007). The effect of adverse housing and neighborhood conditions on the development of diabetes mellitus among middle-aged African Americans. American Journal of Epidemiology, 166, 379–387. Schwartz, S. H. (1994). Beyond individualism/collectivism: New cultural dimensions of values. In U. Kim & H. C. Triandis (Eds.), Individualism-collectivism (pp. 85–119). Newbury Park, CA: Sage. Schwarz, N. (1999a). Self reports: How the questions shape the answers. American Psychologist, 54, 93–105. Schwarz, N. (1999b). Frequency reports of physical symptoms and health behaviors: How the questionnaire determines the results. In D. C. Park, R. Morrell, & K. Shifren (Eds.), Processing medical information in aging patients (pp. 93–108). Mahway, NJ: Erlbaum. Schwarz, N. (2003). Self-reports in consumer research: The challenge of comparing cohorts and cultures. Journal of Consumer Research, 29, 588–594. Schwartz, S. H., Melech, G., Lehmann, A., Harris, M., & Owens, V. (2001). Extending the cross-cultural validity of the theory of basic human values with a different method of measurement. Journal of Cross-Cultural Psychology, 32, 519–542. Schwarz, N., & Oyserman, D. (2001). Asking questions about behavior: Cognition, communication, and questionnaire construction. American Journal of Evaluation, 22, 127–160. Seifert, K., Finlayson, T. L., Williams, D. R., Delva, J., & Ismail, A. I. (2007). Modifiable risk and protective factors for depressive symptoms in low-income African American mothers. American Journal of Orthopsychiatry, 77, 113–123.

131

132


Shadlen, M.-F., Larson, E. B., Gibbons, L. E., et al. (2001). Ethnicity and cognitive performance among older African-Americans, Japanese Americans, and Caucasians: The role of education. Journal of the American Geriatrics Society, 49, 1371–1378. Sharp, L. K., Bashook, P. G., Lipsky, M. S., Horowitz, S. D., & Miller, S. H. (2002). Specialty board certification and clinical outcomes. Academic Medicine, 77, 534–542. Shavers, V. L., Lynch, C. F., & Burmeister, L. F. (2000). Knowledge of the Tuskegee study and its impact on the willingness to participate in medical research studies. Journal of the National Medical Association, 92, 563–572. Shavers, V. L., Lynch, C. F., & Burmeister, L. F. (2002). Racial differences in factors that influence willingness to participate in medical research studies. Annals of Epidemiology, 12, 248–256. Shelton, D. (2008). Establishing the public’s trust through community-based participatory research: A case example to improve health care for a rural Hispanic community. Annual Review of Nursing Research, 26, 237–259. Sheppard, R., Han, K., Colarelli, S. M., Dai, G., & King, D. W. (2006). Differential item functioning by sex and race in the Hogan Personality Inventory. Assessment, 13, 442–453. Shuper, P. A., & Sorrentino, R. M. (2004). Minority vs. majority influence and uncertainty orientation. Journal of Social Psychology, 144, 127–147. Shuper, P. A., Sorrentino, R. M., Otsubo, U., Hodson, G., & Walker, A. M. (2004). A theory of uncertainty orientation. Journal of Cross-Cultural Psychology, 35, 469–480. Shweder, R., & Sullivan, M. A. (1993). Cultural psychology: Who needs it? Annual Review of Psychology, 44, 397–523. Singelis, T. (1994). The measurement of independent and interdependent self-construals. Personality and Social Psychology Bulletin, 20, 580–591. Singelis, T., Bond, M., Sharkey, W. F., & Lai, C. S. Y. (1999). Unpackaging culture’s influence on self-esteem and embarrassability: The role of self-construals. Journal of CrossCultural Psychology, 30, 315–341. Singh, G. K., Miller, B. A., Hankey, B. F., & Edwards, B. K. (2003). Area socioeconomic variations in U.S. Cancer Incidence, Mortality, Stage, Treatment, and Survival, 1975–1999. Bethesda, MD: NCI Cancer Surveillance Monograph Series No. 4, National Cancer Institute, NIH Pub. No. 03–5417. Smedley, A., & Smedley, B. D. (2005). Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race. American Psychologist, 60, 16–26. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press, Institute of Medicine. Smelser, N. J., Wilson, W. F., & Mitchell, F. (2001). America becoming: Racial trends and their consequences. Washington, DC: National Academy Press. Smith, L. L., & Reise, S. P. (1998). Gender differences on negative affectivity: An IRT study of differential item functioning on the Multidimensional Personality Questionnaire Stress Reaction Scale. Journal of Personality and Social Psychology, 75, 1350–1362. Smith, P. B. (2004). Acquiescent response bias as an aspect of cultural communication style. Journal of Cross-Cultural Psychology, 35, 50–61. Smith, T. (2003). Developing comparable questions in cross-national surveys. In J. A. Harkness, F. J. R van de Vijver, & P. P. Mohler (Eds.), Cross cultural survey methods (pp. 69–92). New York: Wiley. Spector, P. E., Cooper, C. L., & Sparks, K. (2001). An international study of the psychometric properties of the Hofstede Values Survey Module 1994. Applied Psychology: An International Review, 50, 269–281. Steptoe, A., & Feldman, P. J. (2001). Neighborhood problems as sources of chronic stress: Development of a measure of neighborhood problems, and associations with socioeconomic status and health. Annals of Behavioral Medicine, 23, 177–185. Sue, S. (1999). Science, ethnicity, and bias: Where have we gone wrong? American Psychologist, 54, 1070–1077. Tamblyn, R., Abrahamowicz, M., Dauphinee, W. D., Hanley, J. A., Norcini, J., Girard, N., et al. (2002). Association between licensure examination scores and practice in primary care. Journal of the American Medical Association, 288, 3019–3026.

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Taylor, S. E., Sherman, D. K., Kim, H. S., Jarcho, J., Takagi, K., & Dunagan, M. S. (2004). Culture and social support: Who seeks and why? Journal of Personality and Social Psychology, 87, 354–362. Teresi, J. A., Golden, R. R., Cross, P., et al. (1995). Item bias in cognitive screening measures. Journal of Clinical Epidemiology, 48, 473–483. Teresi, J. A., Holmes, D., Ramirez, M., et al. (2001). Performance of cognitive tests among different racial/ethnic and education groups. Journal of Mental Health and Aging, 7, 79–89. Teresi, J. A., Kleinman, M., & Ocepek-Welikson, K. (2000). Modern psychometric methods for detection of differential item functioning: Application to cognitive assessment measures. Statistics in Medicine, 19, 1651–1683. Teresi, J. A., Ocepek-Welikson, K., Kleinman, M., Cook, K. F., Crane, P. K. et al. (2007). Evaluating measurement equivalence using the item response theory log-likelihood ratio (RTLR) method to assess differential item functioning (DIF). Quality of Life Research, 16, 43–68. Thornberry, O. T., & Massey, J. T. (1988). Trends in United States telephone coverage across time and subgroups. In R. M. Groves, P. P. Biemer, L. E. Lyberg, J. T. Massey, W. L. Nicholls, & J. Waksberg (Eds.), Telephone survey methodology (pp. 25–49). New York: Wiley. Tourangeau, R. (2003). Cognitive aspects of survey measurement and mismeasurement. International Journal of Public Opinion Research, 15, 3–7. Tourangeau, R., Rips, L. J., & Rasinski, K. A. (2000). The psychology of survey response. Cambridge, UK: Cambridge University Press. Triandis, H. C. (1995). New directions in social psychology: Individualism and collectivism. Boulder, CO: Westview Press. Triandis, H. C., McCusker, C., & Hui, C. H. (1990). Multimethod probes of individualism and collectivism. Journal of Personality and Social Psychology, 59, 1006–1020. Triandis, H. C., & Suh, E. M. (2002). Cultural influences on personality. Annual Review of Psychology, 53, 133–160. Two Feathers, J., Kiefer, E. C., Palmisano, G., Anderson, M., Sinco, B., Janz, N., et al. (2005). Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership. American Journal of Public Health, 95, 1552–1560. U.S. Bureau of the Census. (1994). Statistical Brief: Phoneless in America. Washington, DC: Department of Commerce, Economics, and Statistics Administration. U.S. Bureau of the Census. (1996). Income by Educational Attainment for Person 18 Years and Older, by Age, Sex, Race, and Hispanic Origin. Washington, DC: U.S. Census Bureau. U.S. Department of Housing and Urban Development. (2002). Housing discrimination study. Washington, DC: U.S. Government Printing Office. Van Dam, N. T., Earleywine, M., & Forsyth, J. P. (2008). Gender bias in the 16-item Anxiety Sensitivity Index. Journal of Anxiety Disorders. Published online ahead of print. Vandenberg, R. J. (2002). Toward a further understanding of and improvement in measurement invariance methods and procedures. Organizational Research Methods, 5, 139–158. van de Vijver, F., & Hambleton, R. K. (1996). Translating tests: Some practical guidelines. European Psychologist, 1(2), 89–99. van de Vijver, F. J. R. (1994). Item bias: Where psychology and methodology meet. In A. Bouvy, F. J. R. Van de Vijver, et al. (Eds.), Journeys into cross-cultural psychology (pp. 111–126). Lisse: Swets & Zeitlinger. van de Vijver, F., & Leung, K. (1997). Methods and data analysis of comparative research. In J. W. Berry, Y. H. Poortinga, & J. Pandey (Eds.), Handbook of cross-cultural psychology, Vol 1: Theory and Method (pp. 259–300). Boston: Allyn & Bacon. van de Vijver, F., & Leung, K. (2000). Methodological issues in psychological research on culture. Journal of Cross-Cultural Psychology, 31, 33–51. van Hemert, D. A., Baerveldt, C., & Vermande, M. (2001). Assessing cross-cultural item bias in questionnaires. Journal of Cross-Cultural Psychology, 32, 381–396. van Herk, H., Poortinga, Y. H., & Verhallen, T. M. M. (2004). Response styles in rating scales: Evidence of method bias in data from six EU countries. Journal of Cross-Cultural Psychology, 35, 346–360. van Ryn, M. (2002). Research on the provider contribution to race/ethnic disparities in medical care. Medical Care, 40(Suppl.), I 40–I 50.

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Vernon, S. W., Briss, P. A., Tiro, J. A., & Warnecke, R. B. (2004). Some methodologic lessons learned from cancer screening research. Cancer, 101 (Suppl. 5), 1131–1145. Vupputuri, S., He, J., Muntner, P., Bazzano, L. A., Whelton, P. K., & Batuman, V. (2003). Blood lead levels associated with elevated blood pressure in Blacks. Hypertension, 41, 463–468. Waller, N. G., Thompson, J. S., & Wenk, E. (2000). Using IRT to separate measurement bias from true group differences on homogenous and heterogenous scales: An illustration with the MMPI. Psychological Methods, 5, 125–146. Warnecke, R. B., Johnson, T. P., Chavez, N., Sudman, S., O’Rourke, D., Lacey, L., et al. (1997). Improving question wording in surveys of culturally diverse populations. Annals of Epidemiology, 7, 334–342. Watts, C. S., McCormick, A. K., & Young, S. (2008). Building and maintaining trust in a community-based participatory research partnership. American Journal of Public Health, 98, 1398–1406. Weaver, C., Homes, S., & Glenn. N. (1975). Some characteristics of inaccessible respondents in a telephone survey. Journal of Applied Psychology, 60, 260–262. Welkenhuysen-Gybels, J., Billiet, J., & Cambre, B. (2003). Adjustment for acquiescence in the assessment the construct equivalence of Likert-type score items. Journal of CrossCultural Psychology, 34, 702–722. Williams, D. R. (2002). Racial/ethnic variations in women’s health. American Journal of Public Health, 92, 588–597. Williams, K. D. (2001). Ostracism. New York: Guilford Press. Willis, G. B. (2005). Cognitive interviewing: A tool for improving questionnaire design. Thousand Oaks, CA: Sage. Yang, F. M., & Jones, R. N. (2007). Center for Epidemiologic Studies-Depression Scale (CES-D): Item bias found with Mantel-Haenszel method was successfully replicated using latent variable modeling. Journal of Clinical Epidemiology, 60, 1195–1200. Yeo, S. (2004). Language barriers and access to care. Annual Review of Nursing Research, 22, 59–63. Yerger, V., Pearson, C., & Malone, R. E. (2001). When is a cigar not a cigar? African American youths’ understanding of ‘cigar’ use. American Journal of Public Health, 91, 316–317. Zenisky, A. L., Hambleton, R. K., & Robin, F. (2003). Detection of differential item functioning in large-scale assessments. Educational and Psychological Measurement, 63, 51–64.

II The Nature and Meaning of Gender


Sexism Reloaded: Worldwide Evidence for Its Endorsement, Expression, and Emergence in Multiple Contexts

5 Janet K. Swim, Julia C. Becker, Elizabeth Lee, and EdenReneé Pruitt

The present chapter focuses on understanding how gender and membership in other social groups are conjointly related to current manifestations of sexism. We examine this relation in three different ways. First, we examine whether the endorsement of sexist beliefs varies by country, allowing us to understand how women in different countries may differentially experience sexism. The primary focus of this section is an examination of cross-cultural comparisons of endorsement of traditional gender roles and the existence of contemporary sexist attitudes and beliefs. Second, we describe research on judgments of and discrimination against people who belong to multiple social groups. We do this by examining two research domains: double jeopardy research and crosscategorization research. Third, we examine the association between endorsement of sexist beliefs and other group-related beliefs (e.g., racist beliefs) both in terms of conceptual overlaps and in terms of association through third variables (e.g., system justification).

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Sexist Beliefs Around the World For the present review, we define sexist beliefs as those beliefs that maintain or promote inequality between women and men. There are a multitude of measures that assess sexist beliefs and a full review of all of these measures would be beyond the scope of the present chapter (see Beere, 1990; Swim, Becker, & DeCoster, 2007; Swim & Campbell, 2001; Swim & Hyers, 2008 for reviews of various measures of sexist attitudes and beliefs). Here we limit our review to endorsement of traditional gender roles and three measures of contemporary sexist beliefs, namely modern sexist, neosexist, and ambivalent sexist beliefs that can be considered measures of subtle sexist beliefs. We start by reviewing cross-cultural data on endorsement of traditional gender roles. Even though endorsements of traditional gender roles may be not be perceived as a contemporary form of sexist belief, we examine these for several reasons: (1) they are contemporary in many different countries and cultures; (2) endorsement of these beliefs is one of the most common methods of measuring endorsement of gender inequality; (3) assessment of these beliefs have a relatively long history of being used as markers of sexist attitudes; and, (4) because of these characteristics, endorsement of these beliefs are most easily compared across countries, women’s status in a country, and endorsement of traditional gender roles.1 After we review traditional gender roles, we examine cross-cultural data on some relatively recently developed measures of sexism. In many countries, gender relations have shifted away from considerable inequality to emerging egalitarianism as a consequence of cultural, political and social movements. Therefore, open endorsement of traditional gender roles have become less accepted in these countries. Yet, these egalitarian norms have not resulted in full gender equality as evidenced by the continued presence of sexist behaviors in the form of, for instance, sexual objectification, division of labor in the home, intimate violence, everyday sexist behaviors, and backlash against women in positions of power (Swim & Hyers, 2008). Rather than focus on open endorsement of sexist beliefs in the form of endorsement of traditional gender roles, researchers have focused attention on subtle manifestations of these beliefs. We therefore consider cross-cultural measures of subtle sexist beliefs.

Endorsement of Traditional Gender Roles In this section, we present data on the endorsement of traditional gender roles across several different regions of the world. First, we provide a qualitative review of research examining endorsement of traditional gender roles in different countries, with a focus on those studies that have made crosscultural comparisons. Next, we present data from International Social Survey Programme (ISSP) that represents an international comparison of endorsement of traditional gender roles across 36 different countries and over 46,000 respondents. Third, we present data from the United Nations (UN) that allows us to compare the enactment of traditional gender roles across many different countries. These data assess enactment of traditional gender roles at an aggregate level. After presenting the UN data, we compare the relation between

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country-level endorsement of traditional gender (from the ISSP) and enactment of traditional gender roles (from the UN).

Qualitative Review of Cross-Cultural Data Most cross-cultural studies examining endorsement of sexist attitudes and traditional gender roles compare a few nations and one of these nations is often the United States. A few studies make comparisons with large sets of countries such as work by Gibbons, Stiles, and Shkodriani (1991). They divided a sample of adolescents from 46 countries into students from wealthier, more individualistic countries versus those from less wealthy, more collectivistic countries. They found that students in the former group responded less traditionally than the latter group. We acknowledge that such cross-cultural research on gender attitudes could have construct validity problems due to possible differences in meaning of behaviors and roles across cultures. However, past work suggests liberalism and egalitarianism versus conservatism and tradition is a universal dimension underlying several measures of gender-role ideologies used cross-culturally. This suggests the existence of some unifying principle that creates similarities across the responses to the measures (see Gibbons, Hamby, & Dennis, 1997, for a review). While keeping this issue in mind, we review studies within major areas of the world in order to provide a global portrait of endorsement of traditional gender roles. These roles could be modified over time with further advancement in measurement but our portrait still provides a general picture of cross-cultural differences as we know it now.

United States Research conducted in the United States has documented a diminishing endorsement of traditional gender roles over time. For instance, from 1970 to 1995, men’s and women’s reporting of egalitarian gender role beliefs increased without much slowing or reversal (Twenge, 1997). Researchers explained this finding in light of many societal changes for women. With the peak of the feminist movement, women were entering the workforce at an increasing rate, and gender role expectations were changing as women’s roles changed (Eagly, Diekman, Johannesen-Schmidt, & Koenig, 2004). Reflecting an increase in workforce opportunities, women place a higher importance on obtaining a career than in the past. Two decades ago, women’s status-attainment goals had increased almost to the same level of men’s goals (Fiorentine, 1988). Additionally, when U.S. women were asked to pick which was the most important among the roles of “woman,” “wife,” “mother,” and “person,” the women most often picked “person” suggesting strong endorsement of egalitarian values (Suzuki, 1991). Cross-cultural comparisons highlight how these results can be particularly characteristic of the United States relative to other countries. Only a minority of women in the United States agreed that division of labor should be based on gender, as opposed to a majority of Japanese women (Japanese Prime Minister’s Office, 1982). This finding was later supported in an interesting study comparing the desire for a career, not just a job, among women from the United States, Japan, and Slovenia (Morinaga, Frieze, & Ferligoj, 1993). While U.S. women predictably reported a

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desire for a career—more so than women from the other countries—they also showed higher career desire compared to U.S. men. The multitude of studies on traditional gender role attitudes in the United States has allowed for tests of within-country differences in endorsement of these roles. Perhaps not surprisingly, many studies reveal that men are more likely than women to endorse traditional gender roles. Some studies indicate evidence that change over time is greater within women than men (Twenge, 1997). Yet it is also true that there is substantial variation within men’s endorsement of traditional attitudes (Ciabattari, 2001). Not only are there age differences in men’s endorsement of these attitudes, but there are also differences due to, for instance, the region of the country—with men from the south being more traditional than those from the north, mother’s employment status—with sons of employed mothers being more egalitarian—and participants’ educational levels—with more education leading to more egalitarianism, especially among older men. Differences in endorsement of traditional gender roles also come from differences in racial and ethnic group membership. Although there are studies that find no differences between African Americans and White Americans in their endorsement of traditional gender roles, Kane (2000) reports in her review of research on ethnic differences in such endorsements, that when differences are found, African Americans are usually found to be more egalitarian, particularly within the domain of paid employment. She also reports, however, that African Americans, particularly African American men, are more supportive than Whites of traditional gender roles in the family and in positions of leadership or power. Similarly, Anderson and Johnson (2003) found Asian Americans more likely than White Americans to endorse conventional roles in social domains, but not in employment domains. Kane also notes that less consistent findings emerge for Latino/as, perhaps due to within-group variations in country of origin. The role that acculturation processes can play in changing and maintaining traditional gender role attitudes and behavior (Espin, 1987; Hanassab, 1991) increases the need for research that examines differences between and within ethnic groups. Western Europe. The U.S. women’s movement had a great deal of impact in Europe, just as it did in the United States (Banaszak & Plutzer, 1993). In addition, there are similarities in social, economic, and historical changes between the two regions which have influenced women’s roles (Hunt, 2002). Therefore, it is not too surprising that gender-related attitudes in the United States and Europe are similar in terms of the extent to which traditional gender roles are endorsed. For instance, just as individuals have found a reduction in traditional gender roles in the United States, a study in Scotland illustrated that women born in the 1930s were more likely to endorse traditional gender roles than those born in the 1950s (Hunt, 2002). Yet there are also notable differences between the United States and Western Europe. For instance, data from the mid 1980s indicated that women in the United States were more likely to be employed, employed full-time, and be more highly educated than women from Germany, Austria and Great Britain (Davis & Robinson, 1991). Thus, researchers have been interested in the extent to which predictors of pro-feminist attitudes in Western Europe mirror those found in the United States. Although there have been fewer studies on this

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subject in European countries than in the United States, the results indicate that some predictors appear to be the same, such as gender, age, religion, and education, while other predictors, such as marital status, appear to be different (Banaszak & Plutzer, 1993; Davis & Robinson, 1991). One would also expect notable differences within Western European countries as well. These differences could be a function of differences in social policies that influence the way that women adjust to potential conflicts between family roles and work roles (Strandh & Nordenmark, 2006). There could also be differences between countries due to the different roles that religion plays and the impact of religion on gender roles (Banaszak & Plutzer, 1993; Davis & Robinson, 1991). Finally, as Europe has expanded to include former Soviet block countries, as noted in the next section, it is important to consider differences between Western and Eastern European countries. The Former Soviet Union and Eastern Europe. Arguably, this area of the world

is experiencing immense changes due to the fall of the Soviet Union. Not only are political and economic structures in flux, but so are the cultural values that were once sanctioned by the government. Under Communist law, both men and women were understood as equal stakeholders in the nation’s achievements (Olson et al., 2007). Thus, women were highly educated and worked in order to contribute to society as much as men did. Within this societal climate, sexism did not operate on a blatantly hostile level, but in a benevolent system where women were given generous maternity leaves and segregated to feminized work positions (Funk & Mueller, 1993; Report of the Socialist Federal Republic of Yugoslavia, 1989). Understandably, women are ambivalent as to whether Communism liberated or oppressed them (Hauser, Heyns, & Mansbridge, 1993). Data collected from 1989 to 1990 show that while Yugoslavian women had entered the workforce in increasing numbers, they were still expected to fulfill traditional gender roles as diligent wives and mothers (Massey, Hahn, & Sekulic, 1995). Although a feminist discourse was not widely discussed prior to 1990 when Soviet communism in effect fell in the region, there is some data that helps paint a current picture of women’s roles. Despite the emerging new political and economic structures, women’s status has not shown much improvement. Hauser et al. (1993) explain Soviet communist policies that required government quotas to ensure a certain level of women’s participation have now been abolished, resulting in women’s withdrawal from politics. Women continue to be burdened with responsibilities of both work and home, while men are not expected to contribute to domestic tasks (Rener & Ule, 1998). This inequality was evident in a survey of Russians on traditional gender roles (Henderson-King & Zhermer, 2003). Russians, more so than Americans, believed that essential gender differences give rise to traditional gender roles and perceived the segregated gender climate as unlikely to change. Similarly, a comparison between college students from Eastern European countries and the United States indicate those from the Eastern European countries endorse more traditional gender roles (Olson et al., 2007). Research has also focused on possible changes in attitudes in Eastern European countries considering the dramatic political changes that have occurred in this region. There was some hope that a previous finding that Slovenian women showed increased egalitarian ideas from 1991 to 1993 would

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be repeated (Frieze & Ferligoj, 1995). Also, Frieze et al.’s (2003) longitudinal study from 1991 through 2000 found Slovenian men’s rejection of gender equality increased. Yet, this review, which included a longer time period than reported in Frieze and Ferligoj (1995), indicated that women’s beliefs showed no change. Also, a data set of students from colleges in nine Eastern European countries from 1994 to 2000 indicated that endorsement of gender roles in these students had not changed significantly over this time period (Olson et al., 2007). Moreover, a rise in the public practice of religion has been found to be associated with an increase in sexist attitudes in Slovenia and Croatia (Frieze et al., 2003; Hauser et al., 1993). Latin America and the Caribbean. The research that pertains to Latinos and

gender roles often mentions the concept of machismo and marianismo. The concept of machismo describes proper male behavior as aggressive and powerful while the concept of marianismo describes women as gentle and selfsacrificing (Baldwin & DeSouza, 2001). The norms for women’s roles follow the example of Mary, an icon from the Catholic faith, who is celebrated as the ultimate mother. The simplicity of these portrayals of gender role values has been challenged (DeSouza, Baldwin, Koller, & Narvaz, 2004). Czys and Lazzaroto (1999) cite the changing economic realities for women, particularly in Brazil, that have led to changes in the acceptance of traditional gender roles. Namely, two-thirds of respondents believed all jobs and careers could be performed by either gender. In addition, Diekman, Eagly, Mladinic, and Ferreira (2005) found that men and women in these countries are perceived as possessing more masculine traits than before, reflecting the public roles they enact. DeSouza et al. (2004) raised two important issues: (1) gender equality in Latin American countries and the Caribbean depends on the progress made for women in North America (Brown, Newland, Anderson, & Chevannes, 1997); and (2) violence against women is a topic appearing repeatedly in gender-role literature on Latin America. Hirsch’s (2003) ethnography of 13 Mexican American families holding strong ties to both America and Mexico demonstrates how changes in Latino populations in the United States affect other countries’ populations. Modernity and exposure to egalitarian values are cited as sources of a shift away from traditional gender roles in Mexico. Other research highlights the importance of studying the prevalence of traditional gender roles, since they may be associated with domestic violence and the spread of HIV (Galanti, 2003; Marin, 1996). As the widespread endorsement of traditional gender roles is being cited as a health risk, efforts are being made to challenge men’s acceptance of violence against women (Barker & Loewenstein, 1997). Asia. This vast continent encompasses four UN-recognized regions and pre-

dictably varies widely in the extent to which particular cultures approve of sexist beliefs. One basis of traditional gender roles in these regions arises from gendered prescriptions sanctioned by Confucian norms and collectivistic values. Among other Confucius doctrines establishing a patriarchal family structure, a woman is expected to obey her father, husband, and son (Chia, Allred, & Jerzak, 1997). Rao and Rao (1985) also describe how collectivistic values of dependence and self-sacrifice support rigid sex roles such that women should

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possess stereotypically feminine traits such as caring, while men are expected and perceived to be ambitious (Gupta & Gupta, 1999). One consistent finding is that women tend to be more egalitarian than men and citizens of Asian countries tend to endorse sexist attitudes more than people in the United States (Chia et al., 1997; Khalid & Frieze, 2004; Morinaga et al., 1993; Nayak, Byrne, Martin, & Abraham, 2003). Traditional gender roles in Japan are less frequently endorsed, perhaps a function of the Japanese becoming more industrialized; however, it is worth noting that studies have also measured negative consequences of holding traditional gender beliefs in Japan. Suzuki (1991) documents the shifting emphasis Japanese women have placed on gender roles since the 1970s. Though women once particularly valued the role of being a mother, the significance placed on the roles of “woman,” “wife,” “mother,” or “person” are now more variable. For instance, Japanese women were more liberal in their endorsement of women’s rights in the workforce compared to their views of family roles. However, it is worth noting that the more individualistic Japanese women were, the more likely they chose “person” as most important. The taboo topic of spousal abuse has only recently been recognized as a consequence of cultural norms that devalue and restrict Japanese women’s roles and condone violence against women (Kozu, 1999; Nayak et al., 2003). Possibly even more problematic is the link Khalid and Frieze (2004) illustrate cross-culturally between endorsing traditional gender roles and marital violence toward women among those from Pakistan. China, on the other hand, has been even less open to measuring women’s status or attitudes towards women. Chia et al. (1997) explain how prior to 1986, social psychology was not an allowable area of study, but go on to review some studies that have shown Chinese are more traditional in beliefs about gender roles than Americans. Nevertheless, one hopeful finding emerged in their review: over half of women and men preferred spouses making joint decisions on major domestic issues. Women, more so than men, expressed a desire for gender equality, but both genders reported that they depended on their spouses in equal measure to their reliance on other social support sources. One unexpected result showed that men were expected to be responsible for teaching children at home. The authors explain that, while this may indicate that gender roles are being dismantled, the reality is that men tend to be more educated than women in the first place. The ideal Chinese man is described as skilled in the arts, books, and tradition. Africa. One unfortunate theme regarding the assessment of women’s status and roles in Africa is that there is a less than ideal amount of data available. In response to missing data in this region, the UN sponsors an African Statistics Day, a yearly event geared toward encouraging governments to collect statistics on its citizens (Millennium, 2006). Certainly, research conducted in Africa is not without its challenges, but enlightening findings are adding to a growing literature. As governments on the African continent focus on issues of health, studies are starting to shed light on how gender roles, and particularly the transmission of HIV/AIDS, are inextricably connected. Kalichman et al. (2005) found that acceptance of gender roles and rape myths predicted a higher

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risk of contracting AIDS for men. The study concluded that a greater push is needed to raise awareness of how traditional gender norms, HIV infection, and domestic violence are related. Such interventions have shown promising results in decreasing the amount of physical and sexual violence women in South Africa have experienced by a partner (Kim et al., 2007). Additionally, work in Nigeria (Kritz & Makinwa-Adebusove, 1999) even examines withincountry variation by studying how ethnicity affects women’s empowerment in the household. Furthermore, Wojcicki’s (2005) review of 36 studies conducted in Southern, Central, and Eastern Africa points to a number of complicated relations among marital status, socioeconomic status (SES), and women’s risk of HIV infection. Promising changes have been found within South Africa. In particular, South Africa’s relatively new institution of laws aimed at reducing gender inequality has contributed to a fresh consciousness among women’s views of their roles and rights. In qualitative interviews with educated South African women, Van Vlaenderen and Cakwe (2003) found that these women felt the pressures of balancing their desire to maintain their commitment to family while at the same time rejecting traditional gender roles and desiring more independence. Some other optimistic findings point out that while young men and women still endorse traditional gender roles, they recognize the significance of empowering women with more freedom to make choices about their health (O’Sullivan, Harrison, Morrell, Monroe-Wise, & Kubeka, 2006). Other Countries. For the most part, attitudes toward gender equality have been

studied disproportionally across countries with most research having been done within the United States and many cross-cultural comparisons focusing on comparisons with the United States. Thus, the above review does not cover all countries. Perhaps most notably missing are data from the Mideast. Like many regions of Africa, it is difficult to obtain data from this region of the world due to social and political considerations. However, it is important to consider endorsement of gender roles in these countries. For instance, there are differences between liberal and conservative Muslim interpretations of what the Qur’an says about women’s roles (Khalid & Frieze, 2004). Also missing from our review are studies from Canada, Australia, and New Zealand. One might expect much similarity between findings from the United States and Canada, its North American neighbor, and between Europe, particularly Britain, and Australia and New Zealand, given their histories and similar political structures. However, there may be important differences as well. Some of these may deal with issues regarding immigration, given that researchers have examined gender roles among Asian immigrants in these areas (Leung & Moore, 2003; Naidoo & Davis, 1988; Tang & Dion, 1999).

Cross-Cultural Data Assessing Endorsement of Traditional Gender Roles We examine cross-cultural differences in endorsement of traditional gender roles based upon data from the International Social Survey Programme (EA, Zentralarchiv fuer empirische Sozialforschung, 2002).2 The ISSP is composed of members from 39 different countries. Different survey research centers

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from these countries collect data on different social topics each year. In 2002, they collected their third set of data on family and changing gender roles which we used for the present study.3 The data for the present analyses represent responses from 46,638 adults who were randomly sampled from 36 countries. We calculated a measure of endorsement of traditional gender roles from this data set by examining 10 items that referred to different aspects of endorsement of traditional gender roles. Based upon factor analyses and reliability tests, we constructed a scale composed of five items (e.g., “A man’s job is to earn money; a women’s job is to look after the home and family,” Cronbach alpha = .68, see appendix for all items). The possible range was 1 (“strongly disagree”) to 5 (“strongly agree”) with higher scores indicating more traditional gender roles. Because of the large sample and the power that resulted from the tests, nearly all statistical tests were significant. Thus, we focus on patterns of results rather than significance tests. We first conducted a global comparison of endorsement of gender roles by six major regions of the world represented in the data. These regions are Europe, the United States, Australia and New Zealand, Russia, Asia, and Central and South America. A main effect of region occurred, F (5,91785) = 2833.74, p < .001. As illustrated in Figure 5.1, individuals from Europe, the United States, and Australia were least likely to endorse traditional gender roles, whereas those from Russia, Central and South America, and Asia were more likely to endorse traditional gender roles. Post hoc tests (p < .05) indicated that all mean differences between the regions were significant, except the mean difference between the United States and Australia. Women and men agreed more in countries where respondents were most likely to endorse traditional gender roles. Gender differences are significant in all countries (p < .001), except in Central and South America and in Russia. We then made comparisons within these different regions. There is a great deal of variability within these regions, F (34,91680) = 628.02, p < .001. The largest range within regions was found within Europe, with those from

5.1

5

Endorsement of traditional gender role attitudes by regions of the world

4

Men Women

3

2

1 USA

Australia Europe and New Zealand

Russia

Asia

Central and South America

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5.2 Endorsement of traditional gender roles by European countries 5

4

Men Women

3

2

Germany (East) Denmark Sweden Norway Finland Netherlands Ireland Germany (West) Great Britian Cyprus Northern Ireland Israel Spain France Flanders Switzerland Austria Slovenia Poland Czech Latvia Portugal Bulgaria Slovak Republic Hungary

1

East Germany being least likely to endorse traditional gender roles (M = 2.36) where as those from Hungary being most likely to endorse traditional gender roles (M = 3.53; see Figure 5.2). Again, there was more agreement between women and men in countries where respondents were most likely to endorse traditional gender roles. We classified countries into regions within Europe to get a better sense of patterns of data. Those in the Eastern countries (i.e., former Soviet countries) were most likely to endorse traditional gender roles (M = 3.36) and those in northern Europe (Denmark, Sweden, Norway, & Finland) were least likely to endorse traditional gender roles (M = 2.52). Thus, those from the former Soviet countries tended to be more similar to Russia than to Europe. Those in the western countries (e.g., France, Great Britain, M = 2.92) and southern countries (e.g., Spain, Italy, M = 3.00) fell in between northern and eastern Europe. Post hoc tests (p < .001) indicated that means differ significantly across all four European regions. The region with the next largest range of mean responses was Asia. There were only three countries represented within this region in this data set. There was a main effect of region, F (2,49120) = 622.90, p < .001. Those in the Philippines were most likely to endorse traditional gender roles (M = 3.57), while those in Japan were least likely to endorse traditional gender roles (M = 3.00). Taiwanese respondents fell in between these two (M = 3.30). There was no overall gender difference, F (1, 49117) = .06, ns. Results varied within Russia as well, F (10, 1670) = 1.86, p < .05; however, the range in Russia is similar to the range in the countries comprising the

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former eastern Block countries of Europe with the most liberal area being East Siberia (M = 3.37) and the most conservative being the Volga region of Russia (M = 3.59). The data did not follow a pattern where, for instance, those in the east or north were more liberal than those in the east, perhaps because there was relative homogeneity across areas of Russia in endorsement of traditional gender roles. We also tested for variability within regions of the United States. Consistent with other data sets, although not significant, F (1, 1164) = 2.29, ns, the pattern of effects indicated that those in the southern part of the United States were more likely to endorse traditional gender roles (M = 2.91) than those in the rest of the United States (M = 2.83). However, the range was not large relative to most other regions in the world and gender differences across the United States (F (1, 1150) = 18.74, p < .001, M = 3.01 versus 2.75, for men and women, respectively) were larger than regional differences.

United Nations Data The United Nations (UN) publishes indices that gauge global gender parity in an effort to promote the Millennium Development Goal (Millennium, 2006) of gender equality and empowerment (http://www.un.org/millenniumgoals/). These indices provide similar, relatively objective, and consistent indicators of women’s status that can be compared across countries (http://hdr.undp.org/ en/statistics/indices/gdi_gem/ retrieved 1–23–08). The Gender Empowerment Measure (GEM) assesses the relative power of women and men in political and economic spheres and their ability to take part in decision-making in these areas. The GEM includes assessment of, for instance, the ratio of income earned by women, the ratio of female professional and technical workers, administrators and managers, and the ratio of seats in Parliament held by women.4 We averaged indices within groupings used by the United Nations in 2001 (see Table 5.1). These groupings were based primarily on geographic regions, rather than, for instance, religious or political differences. The one exception is that the so-called developed nations include nations from various continents including the United States, Australia, France, Germany, Japan, Canada, and the United Kingdom. A number of nations maintain records of gender gaps in wages and literacy, but complete data affecting the GEM index are not consistently available. As a result, GEM rankings and scores are provided for the 70 out of 175 UN-recognized countries. The scale ranges from 0 to 1, with higher values indicating high gender empowerment, namely that women are making use of the resources available at a ratio comparable to men. Some areas of the world did not have GEM scores, particularly Oceania where there is no GEM data and Sub-Saharan Africa and the Caribbean where many nations’ scores are missing. Thus, the data are not without their limitations and within-country variations are absent, but the data give general geographic considerations. There are some interesting points that emerge from the data. First, the data indicate that it is useful to distinguish among Asian countries. South Asia, which represents many of the Middle Eastern countries (including Afghanistan and Iran) as well as other countries (including India and Nepal) has a lower GEM score than the other Asian countries. The East Asian countries (e.g., China and Korea) are also interesting because they are some of the

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5.1

United Nations Gender Empowerment Measure

Developed nationsa Caribbean Sub-Saharan Africa Southeast Asia Latin America West Asia Former Soviet Union East Asia South Asia North Africa

Number of countries providing data

Average rank out of 70 countries

Average score 0 ⴝ low 1 ⴝ high

30 4 2 5 14 5 5 1 3 1

19 23 30 45 49 52 57 63 65 68

.681 .634 .571 .488 .476 .377 .431 .363 .301 .253

Lower ranking numbers and higher scores indicate more gender equality. Other regions the UN recognizes that are not included in the table: Oceania (e.g., Australia and New Zealand, Melanesia, Micronesia, Polynesia), Least developed countries, Landlocked developing countries, and Small island developing states. a Developed nations include nations from various continents including the United States, Australia, France, Germany, Japan, Canada, and the United Kingdom.

wealthiest and most productive countries, but demonstrate lower GEM rankings compared to other similarly developed nations. Second, traditional gender roles are most likely to be enacted in the poorest regions of the world. Third, given the tendency for many cross-cultural studies to use the U.S. for comparison data, and given statements proclaiming that the United States represents the wealthiest nation in the world, readers might be interested to know that the United States has a GEM ranking of 10 and GEM score of .76. Seventeen of the 30 developed nations are at the top of the GEM rankings. Thus, like the other developed countries, the United States is highly ranked, but it is in the top third of the developed countries and in the middle range of the top-ranked developed nations. Finally, we tested whether there were relationships between enacted gender roles (as assessed by the UN data) and a country’s tendency to endorse traditional gender roles (as assessed by the ISSP data). We were able to obtain GEM ratings for 32 of the 37 countries included in the ISSP data set. We correlated the average attitudinal rating for each country with the matching UN GEM 2001 ratings and rankings. All correlations were large (all df = 31 and p < .001). The correlation between a country’s average endorsement of traditional gender roles and the GEM value was −.74, and (2) the GEM ranking was .85. These correlations might be considered surprising because low correlations between attitudes and behaviors are commonly found, and more specifically, because of evidence indicating that, despite lack of endorsement of traditional

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gender roles in the United States, there is still evidence of enactment of traditional gender roles (Biernat & Wortman, 1991; Fiorentine, 1988). However, the data do not represent an association between an individual’s attitudes and behaviors. Rather, the correlations can be understood as representing the association between aspects of the cultural context (i.e., culturally held attitudes) in which enactment of gendered behaviors occurs. In addition, there is likely to be a reciprocal relation between the enactment of gender roles in any particular country and the average tendency for individuals in that country to endorse traditional gender roles.

Cross-Cultural Data on Endorsement of Subtle Sexist Beliefs The above data relied on endorsement of traditional gender roles, while many in the United States have turned to measuring more subtle forms of sexist beliefs. There are at least two reasons why researchers have considered endorsement of subtle sexist behaviors. First, as noted above, there have been substantial changes in endorsement of traditional gender roles, perhaps most notably documented within the United States and Europe. Yet, there appears to be a discrepancy between endorsement of individuals’ beliefs and their behaviors. On one hand, this discrepancy could be attributed to a more general issue of attitudes not being particularly good predictors of behaviors. Yet the discrepancy also points to the possibility that individuals may not be expressing what they truly believe or that there are beliefs, other than endorsement of traditional gender roles that sustain the enactment of traditional gender roles (Swim, Aiken, Hall & Hunter, 1995). These lines of reasoning resulted in research on modern sexism and neosexism. Second, compared to other forms of prejudice, there may be unique characteristics of gender relations that make expressions of sexist beliefs less obvious. For instance, sexism is unique because it emerges within the context of patriarchal structures that also include interdependence between women and men as a result of heterosexual relationships (Jackman, 1994). Glick and Fiske (1996) took this point into account in their development of ambivalent sexism. Conceptualizations of subtle forms of sexism and their corresponding measures were developed in North America but have been tested cross-culturally with the implication that, if they are usable outside the United States, then these subtle forms of sexism can be observed in other cultures. After a brief description of subtle forms of sexism, we will summarize studies examining the applicability of these concepts in different cultures. Modern Sexism and Neosexism Scales. Modern Sexism and Neosexism Scales were simultaneously yet independently developed. Consistent with characterizations of modern racism (Gaertner & Dovidio, 1986; Kinder & Sears, 1981; McConahay, 1986), modern sexism is comprised of the denial of continued discrimination against women, antagonism towards women’s demands, and resentment about special favors for women (Swim et al., 1995, e.g., “Discrimination against women is no longer a problem in the United States” is an item from the Modern Sexism Scale). Assuming that gender inequity is still a problem, these beliefs represent resistance to efforts to address sexism, and a preference to maintain the status quo. Similar to the Modern Sexism

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Scale developed by Swim et al. (1995), Tougas, Brown, Beaton, and Joly (1995) developed the concept of neosexism in Canada, consistent with characterizations of symbolic racism (Sears, 1988, e.g., “Over the past few years, women have gotten more from the government than they deserve” is an item from the Neosexism Scale). They define their concept as the “manifestation of a conflict between egalitarian values and residual negative feelings towards women” (p. 843). Like comparable racism measures, their scale does not directly measure support for egalitarian values versus residual negative feelings. Tougas and her colleagues argue that, for the neosexists, the opposition to progressive social policies is a socially acceptable way to express their prejudice. Data support the validity of these scales. Confirmatory factor analyses indicate that these two scales measure constructs that are correlated with, but distinct from, endorsement of traditional gender roles and stereotypes (Swim et al., 1995; Swim & Cohen, 1997; Tougas et al., 1995). Data from our lab indicates that the distinction between modern and old-fashioned sexism is weaker for African Americans and Latino/a Americans than for Asians and White Americans. This may be a result of the two former groups being more likely to acknowledge the presence of discrimination and the need to address it (Pruitt & Swim, 2007). Convergent validity has been demonstrated from the association between endorsement of these beliefs and, for instance, perceptions of sexual harassment, underestimation of women and men in the work force, and negative attitudes toward affirmative action (see Swim & Hyers, 2008, for a list of studies illustrating the convergent validity of these scales). Distinctions can be made between the Neosexism and Modern Sexism Scales. Consider the three dimensions of modern sexism as outlined by Swim et al. (1995): (1) denial of continued discrimination; (2) antagonism toward women’s demands; and (3) resentment about special favors for women. Both scales include items assessing these three dimensions. Nevertheless, an examination of scale items reveals that those from the Modern Sexism Scale primarily come from the first construct, whereas those from the Neosexism Scale focus mostly on the last two subcomponents. Also it would appear that the Neosexism Scale includes two items that appear to reflect traditional sexist beliefs (i.e., “It is difficult to work for a female boss”). For this reason, researchers have argued that the two scales appear to measure different facets of the same construct (Campbell, Schellenberg, & Senn, 1997; Parks & Roberton, 2004). Data from our labs indicates that when this factor is analyzed by itself, the Modern Sexism Scale forms a one-factor structure for African Americans, Latino/as, Asians, and Whites, with adequate reliability (Pruitt & Swim, 2007). However, when analyzed with the Neosexism Scale, factor analyses support this distinction (e.g., Becker & Swim, 2008). Moreover, the reliability of the measures is improved when the items are separated into the two constructs. Because modern sexism and neosexism were developed in a North American sample, it is reasonable to ask whether both concepts can be observed in other countries. Both Modern Sexism and Neosexism scales have been adapted and validated in European countries. The Modern Sexism Scale was developed for Dutch (Barreto & Ellemers, 2005), Swedish (Ekehammar, Akrami, & Araya, 2000), and German contexts (Eckes & Six-Materna, 1998). The Neosexism Scale has been tested and confirmed in Spain (Moya & Exposito, 2001), Slovenia and Croatia (Frieze et al. 2003), Great Britain (Masser & Abrams, 1999), Australia

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(Cameron, 2001), and Germany (Eckes & Six-Materna, 1998). Despite cultural differences, the results were consistent with the earlier findings from the United States and Canada and demonstrate that the concepts of modern and neosexism are not specific to the context of North America, but emerge in analogous ways in European countries. The existence of modern sexist beliefs and the usability of these two scales scales must be assessed in cultures beyond North America and Europe, because the status of women is very different in various countries. It is possible for instance, that modern sexism would be relevant primarily in developed countries—those with relatively greater gender equality; the concept of denial of discrimination may only be applicable in places where gender equity is, at least on the surface, culturally valued and the concept of resentment toward women who have made efforts to obtain equality emerges only in countries where a substantial number of women have made efforts to change the structure of the gender system. Thus, the suitability of these concepts should particularly be tested in countries with lower scores on the United Nations indicators for gender equality. Moreover, since the endorsement of sexist and religious beliefs are related (i.e., Burn & Busso, 2005; Glick, Lameiras, & Castro, 2002; Frieze et al. 2003), it would be particularly interesting to examine the concept of modern sexism in samples from Islamic countries. Ambivalent Sexism. Ambivalent sexism (Glick & Fiske, 1996) is composed of benevolent and hostile sexism. Both maintain gender inequality, but, whereas hostile sexism is clearly negative, benevolent sexism conveys the same types of beliefs in a positive tone. Benevolent sexism includes protective paternalism (e.g., the belief that women should be protected by men), complementary gender differentiation (e.g., the belief that women have—typically domestic— qualities that few men possess), and heterosexual intimacy (e.g., the belief that women fulfill men’s romantic needs). Hostile sexism addresses dominative paternalism (e.g., women seek to gain power by getting control over men), competitive gender differentiation (e.g., women are easily offended) and hostile heterosexuality (e.g., women enjoy teasing men by seeming sexually available and then refusing male advances). Benevolent sexism has been argued and demonstrated to reduce women’s resistance to gender discrimination and contributes to a cultural ideology which idealizes women in traditional gender roles, while simultaneously subordinating them to subservient positions in society (Glick & Fiske, 2001a and b; Glick, Diebold, Bailey-Werner, & Zhu, 1997). Hostile and benevolent sexist beliefs are presumed to be legitimizing ideologies, which serve to justify status inequalities between women and men (e.g., Jost & Banaji, 1994; Sidanius & Pratto, 1999). Glick and Fiske (1996) developed the ambivalent sexism inventory (ASI) to measure both hostile and benevolent sexism in the United States. Confirmatory factor analyses of the ASI suggest that sexism encompasses separable hostile and benevolent components, which were moderately correlated (r = .40 to .50). Although Glick and Fiske suggested three subcomponents for the hostile and benevolent scales, subfactors were confirmed only for the benevolent sexism subscale. Consistent with an antipathy characterization of most measures of sexist beliefs, hostile sexism is moderately to strongly correlated with measures of blatant sexism such as the attitudes toward women scale

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(AWS, Spence & Helmreich, 1972), the rape myth acceptance scale (Burt, 1980), and also with the Modern Sexism Scale (Swim et al. 1995), and the Neosexism Scale (Masser & Abrams, 1999), whereas benevolent sexism is only weakly correlated with these measures, or is not correlated at all. Many studies have shown the predictive validity of the scales (see for example Burn & Busso, 2005, and Christopher & Mull, 2006). Abrams, Viki, Masser and Bohner (2003) found for instance, that hostile sexism and not benevolent sexism is associated with acquaintance-rape proclivity, whereas benevolent but not hostile sexism is correlated with blaming an acquaintance-rape victim for not behaving appropriately. Cross-cultural data also support the validity of the scales and indicate a coherent set of ideologies across cultures. Glick et al. (2000) analyzed the factor structure of the ASI in 19 different nations from Australasia, Europe, Africa and Latin America and found the same factor structure as has been found in United States samples. In all samples, men’s hostile sexism scores were higher than women’s scores. Gender difference for benevolent sexism was smaller in magnitude or even reversed (for a discussion of this phenomenon, see Glick et al., 2001; Fischer, 2006). Moreover, men’s hostile and benevolent sexism scores were negatively correlated with the United Nations indices of gender equality noted above. In our own lab, we have also found that Hostile and Benevolent sexism forms separate factors for African, Latino/a, Asian, and White Americans (Pruitt & Swim, 2007). In sum, although gender ideologies of different cultures might involve different domains, the results of the cross-cultural studies by Glick and Fiske suggest that benevolent and hostile attitudes are widespread, found on almost every continent of the world. Nevertheless, more validation studies using samples with more heterogeneous educational backgrounds are needed, because the data are mostly based on college students or convenience samples that may not be representative of larger populations. However, even with non-random samples, the ambivalent sexism scales correlated with national indicators of inequality. This supports their validity and suggests that the samples were not completely unrepresentative. Moreover, given the robust effects across the countries, we would predict that the ambivalent sexism inventory can be successfully administered in different subcultures.

Implications of Intersectionality for the Treatment of Women In the first section, we examined cross-cultural studies on the endorsement of sexist beliefs in order to understand the extent to which and how sexism might emerge for women in different countries. In this next section, we examine women’s experiences with discrimination (i.e., specifically behaviors rather than attitudes and beliefs) that would be influenced by being a member of an additional group of undervalued status. That is, here, we specifically examine research that has looked at the implications of multiple group membership on the likelihood of experiencing discrimination. Due to double minority status, women of different racial groups experience varying consequences of sexism. Consider the court case, Lam vs. University

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of Hawaii (as reported in Valdez, 1997). Lam, a female of Vietnamese descent, filed a lawsuit in response to being denied employment at the law school claiming that not being hired was the result of both race and gender discrimination. The university’s defense cited the hiring of both an Asian male and a White female for the same position as evidence of their impartiality, but this only served to display the privileges of being either male or White. Recognizing double bias as unique, the court decided that when the plaintiff claims discrimination based on combined biases, it is necessary for the defendant to demonstrate no bias due to either force. Like the legal counsel for the University of Hawaii, investigators of the social consequences of gender and race/ethnicity bias have historically considered the separate effects of each membership. Research on the double jeopardy hypothesis (Beal, 1970), however, addresses the conjunctive impact of race and gender. This hypothesis suggests that women of color are vulnerable to both racism and sexism and thus subject to more discrimination than White females and Black males. A different but related area of research—research on cross-categorization—examines the consequences of group membership based upon whether the target of a perpetrators’ judgment or behavior is an in-group member, out-group member, or combination therein. These two areas of research are similar in that they both examine the implications of joint membership in two separate groups. Yet, they also have distinct histories, make different predictions, and use different methodologies. It is important to consider both lines of research because they focus on different aspects of multiple group membership and the data base for these two traditions differs.

Double Jeopardy Historically, being a member of a double minority status was viewed as a positive element in the hiring process. Black women were seen as taking jobs from White women and Black men, due to the double advantage in affirmative action policies (Sokoloff, 1992). Currently, however, double jeopardy refers to greater disadvantages experienced by women of color. Investigators of the double jeopardy hypothesis suggest that there are two possible patterns of effects that may explain the experience of double jeopardy: additive double jeopardy and multiplicative double jeopardy. Additive double jeopardy treats racism and sexism as separate, independent experiences of discrimination (Berdahl & Moore, 2006; King, 1988). Additive double jeopardy is experienced when the independent effects of both racism and sexism are combined. Multiplicative double jeopardy (also called interactive double jeopardy; Sidanius & Veniegas, 2000) considers the interdependent and simultaneous oppression of racism and sexism (Almquist, 1975; Berdahl & Moore, 2006; King, 1988; Reid & Comas-Díaz, 1990). This hypothesis acknowledges the particular discrimination experienced by being both a woman and an ethnic minority. Instead of “adding” the effects of racism and sexism independently, multiplicative double jeopardy “multiplies” the effects together and attempts to account for unique experiences that women of color have with discrimination. The subordinate male target hypothesis has been proposed as another alternative to the double jeopardy hypotheses. The subordinate male target

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hypothesis puts forward that ethnic minority men, not women, experience harsher discrimination (Sidanius & Pratto, 1999; Sidanius & Veniegas, 2000). This concept derives from social dominance theory, which assumes that maintaining social hierarchies allows dominant members to withhold social benefits (e.g. money and power) from subordinate members. According to the subordinate male target hypothesis, White males fiercely sustain this hierarchy to handicap men of color more than to burden White women and women of color due to intrasexual competition resulting in men of color as likely targets of discrimination.

Research Testing Double Jeopardy Fully Crossed Studies. Most research is unable to test the double jeopardy hypothesis because studies did not include full designs crossing gender with another category of membership. Moreover, they do not include assessment of multiple types of discrimination (e.g., sexism and racism). Thus, most research only partially addresses the double jeopardy hypothesis and cannot distinguish between the additive and multiplicative models. One exception is Berdahl and Moore (2006) who examined both gender and ethnic harassment in the workplace. Women and men of color and White women and men were asked to recount their experiences with racism and sexism at work. Results supported the double-jeopardy hypothesis—women of color reported a greater amount of discrimination than men of color and both White men and women. Moreover, the authors interpreted these results as supportive of additive double jeopardy. Specifically, women experienced more sexual harassment than men; minorities experienced more ethnic harassment than Whites. When analyzing sexual and ethnic harassment together, there was a main effect for gender and race, but no interaction. There was, however, a marginal interaction between gender and race for ethnic harassment indicating that multiplicative double jeopardy effects may have been present. Other data, however support the subordinate male target hypothesis. Black men may be least likely to pay a fair price for the same automobile. Ayers and Siegelman (1995) sent Black, White, male, and female confederates to buy the same car. Results indicated that White males were offered the lowest price for the new automobile. Prices offered to White females were $216 higher; to Black females, $446 higher. Prices offered to Black males were even higher – $1,133 more than those offered to White male confederates for the same new car. Research on wage discrimination is frequently cited as evidence for double jeopardy; however, the findings are mixed and difficult to interpret. While all studies indicate that White men earn more than other groups, the relative rankings of the other groups vary. Some studies indicate that Black women earn substantially less than Black men, but slightly more than White women (King, 1988; U.S. Census Bureau, 2004). Other studies suggest that black women earn less than both Black men and White women (Alquemist, 1975; Brown & Ford, 1977; King, 1988; Sanchez-Hucles, 1997). In support of the double jeopardy hypothesis, Black women have been a part of the workforce longer than White women, yet remain in lower status jobs, are more likely to be the only minority in the workplace, and are generally paid less than Black men (Sanchez-Hucles,

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1997). Yet research on wage inequality confounds, for example, educational status, job skill level, and position within the company. These factors may also be confounded with gender, race, or both. Some studies do, however, consider the role of educational status on wage differences. King (1988), for example, suggests that Black women gain significantly more wages from a college education than White women. Comparing adults with a high school education, Black females earned the lowest income relative to White women, White men, and Black men. When considering those with at least one year of college, Black females had a slightly higher income than White females, but not more than males of either race. Partial Tests of Double Jeopardy. Partial support for the existence of double jeopardy comes from comparisons of Black and White women. One might assume that both Black women and White women face gender discrimination and that, in combination with Black women’s experiences with sexism, demonstrations of Black women’s experiences with racism would suggest an additive double jeopardy effect. Yet, double jeopardy is not explicitly tested; without male participants, results simply support the existence of racial discrimination. Several sources of data indicate that women of color experience more discrimination than White women. Some data addresses workplace discrimination. For instance, compared to White women, Black women are less likely to be offered an interview (Hitt, Zickmund, & Pickens, 1982), less positively rated in an interview (Hitt et al., 1982; Cesare, Dalessio, & Tannenbaum, 1988) and less often granted employment (McRae, 1991). Although most investigations compare Black women’s experiences with White women, some compare other minority women with White women and find similar patterns. For instance, an investigation of female nurses found that Latino women are given more difficult, lower paid, and filthier jobs than White women (Bullock & Waugh, 2004). Similarly, in Canada, although female electoral candidates of color are better educated than White female candidates, women of color have a lower likelihood of being elected (Black, 2000). Partial support for the double jeopardy hypothesis also comes from comparing Black women and Black men. Again, while one can assume both experience racial discrimination, the data more directly test gender discrimination than double jeopardy. Some of this data support Black women’s greater experience with discrimination than Black men, such as in wage inequality (e.g., Sanchez-Hucles, 1997) and Black males have had better advances in leadership positions (i.e., in church and corporate management), sports, and the job market (Berdhal & Moore, 2006). Yet several studies demonstrate domains where minority men experience more bias than their female counterparts, thus supporting the subordinate male target hypothesis. For instance, employers may be less likely to hire Black men than Black women due to negative stereotypes of Black men as lazy, ignorant and unlikely to take care of their families (Wilson, 1997). Black men are also more likely to be racially profi led and discriminated in the criminal justice system than Black women (Sidanius & Veniegas, 2000). It may be that experiences with discrimination are domainspecific, with some domains yielding preferences for Black men and others preferences for Black women.

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There are also a few studies that compare gay men’s and lesbian’s experiences with discrimination, but they do not report consistent findings (e.g., Ellis & Fox, 2001; Swim, Pearson, & Johnston, 2008). Some studies have also addressed triple minority status where individuals contend with racism, sexism and heterosexism (Bohan, 1996; Green & Boyd-Franklin, 1996; Bowleg, Huang, Brooks, Black, & Burkholder, 2003.) Yet, studies examining heterosexism are few in number and may not offer a complete view of gay men and lesbians. Challenges to Research Testing Double-Jeopardy Hypothesis. Category mem-

bership encompasses many different challenges and consequences that the literature has not thoroughly examined. More fully crossed studies are needed. Examining racial and gender discrimination simultaneously is important to test the double jeopardy hypothesis because discrimination that double minorities experience can be race-based, gender-based, or rooted in both race and gender. The jeopardy experiences of women and men in various non-ethnic groups should also be considered. Further, unexamined social groups may be confounded with the group memberships of interest. For example, when comparing White women and minority women’s health, researchers may confound income status with these groups, such that they are actually comparing middle income White women with lower-income women of color. There may also be developmental considerations where racism and sexism may be more salient at different points of the life span. For example, it is possible that minority women may deal with more racism in high school and more sexism in professional/home roles later in life. In all, the exploration of the combined effect of the sexist and non-sexist discrimination experiences of women of color will be an extensive undertaking for prejudice researchers.

Cross-Categorization Research on cross-categorization does not specifically address sexism or racism, but more simply looks at the tendency to categorize individuals as ingroup or out-group members and it explores the bias that might result from this classification (Dechamps, 1977; Dechamps & Doise, 1978). Research in this area has delimited a number of patterns that may emerge based upon in-group and out-group status. Six are illustrated in Table 5.2 (Crisp & Hewstone, 2006) and are based upon whether a target is a double out-group member (e.g., for a White male perceiver, a Black woman represents a double out-group member), a double in-group member (e.g., for a Black female perceiver, a Black woman represents a double in-group member), or a mixed or crossed category member (e.g., for a White female perceiver or a Black male perceiver, a Black woman represents a mixed target.) There is some overlap between the pattern of effects described in the cross-categorization literature and those described in the double-jeopardy literature. First, the additive effect is similar to the additive double jeopardy hypothesis because both predict a main effect for one dimension (e.g., gender), a main effect for another dimension (e.g., ethnic group membership), and no interaction. Second, the social inclusion pattern is similar to the multiplicative double jeopardy hypothesis because both predict an interaction between

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5.2

A Priori Predictions of Patterns of Evaluation Resulting From Cross-Categorizations Dimension 1: In-group

Dimension 1: Out-group

Pattern

Dimension 2: In-group


Dimension 2: In-group


1. Additive

ii

>

io

=

oi

>

oo

2. Dominance

ii

=

io

>

oi

=

oo

3. Social inclusion

ii

=

io

=

oi

>

oo

4. Social exclusion

ii

>

io

=

oi

=

oo

5. Hierarchical acceptance

ii

>

io

>

oi

=

oo

6. Hierarchical rejection

ii

=

io

>

oi

>

oo

ii represents double in-group; io and oi represent mixed or crossed categorization; oo represents double out-group.

the two dimensions and specifically predict double out-group members fare worse. However, there are important differences between the two literature sets. First, the cross-categorization literature delineates more possible patterns of effects of memberships in multiple groups than the double jeopardy literature. Several of these additional effects are illustrated in Table 5.2. Like the multiplicative double-jeopardy hypothesis, most of these other patterns are demonstrated by interactions between the effects of more than one group membership on judgments. However, unlike the multiplicative double-jeopardy hypothesis, in these other possible patterns, the double out-group may have experiences similar to another group. Second, research on the cross-categorization literature focuses on the influence of category membership on a particular judgment, rather than the experiences of a group of individuals imbedded in a particular cultural context. This means that the cross-categorization focuses on the effects of the immediate social context on judgments whereas the double-jeopardy hypothesis focuses more on the effects of a wider social context on judgments. This difference has several implications which illustrate further differences between the two literatures. One implication is that the double out-group can be a member of any set of groups in the cross-categorization literature but not in the double-jeopardy literature. The double-jeopardy hypothesis defines the double out-group member as a member of two culturally defined subordinate groups and, using labels found in the categorization literature,

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implicitly assumes that the target is a double out-group member relative to the perpetrator, and perhaps more explicitly a White male when considering the combination of race and gender categories. Thus, Black women are a double out-group in the double jeopardy literature but in the cross-categorization literature any group can be a double out-group, dependent upon the membership of the potential perpetrator. A second implication is that judgments in the cross-categorization literature are assumed to be a function of group memberships the perceiver either shares or does not share with the target and rather than a function of the status of the group in the wider cultural context. As a result, the cross-categorization literature does not explicitly address the subordinate male hypothesis. For instance, when considering a Black male as the target, the subordinate male hypothesis assumes that the perpetrator is a White male which would make the Black male a partial out-group and partial in-group member, as labeled in the cross-categorization literature. Yet, none of the hypotheses listed in Table 5.2 identify this group as the most likely to be a target of discrimination because they do not address the cultural context of dominance hierarchies that the subordinate male hypothesis rests on. A third implication is that tests of cross-categorization do not examine the cumulative effects of both racism and sexism as might be considered in the double-jeopardy literature. A fourth related implication is that the cross-categorization literature only examines one judgment at one time and does not consider the possibility that discrimination can come in different forms based upon, for instance, gender, race, or gender and race. A fi fth implication is that research on cross-categorization is more likely to attend to process variables such as what leads targets to be seen as members of one or more categories (McGarty, 2006) and attend to moderators like mood (Miller, Kenworthy, Canales, & Stenstrom, 2006). An additional difference between the two literatures relates to how the effects of cross-categorization are tested which points to an important theoretical difference between the two literatures. Some researchers testing the effects of cross-categorization on judgments examine the pattern of means for the four types of groups found in Table 5.2. This fully crossed set of comparisons is similar to those comparisons needed to test for double jeopardy. Generally speaking, studies testing cross-categorization have found that double in-groups are evaluated the most favorably, double out-groups the least favorably, and those with mixed group membership are evaluated in the middle (Midgal, Hewstone, & Mullen, 1998). However, this set of comparisons does not specifically test a central theoretical question of whether cross-categorization results in different judgments than simple categorization. In order to test this hypothesis, reactions to individuals based upon knowledge that an individual belongs to a single category must be compared with evaluations of individuals, based upon knowledge that they belong to two (or, theoretically, more) categories (Mullen, Migdal, & Hewstone, 2001). Thus, those who test this pattern of effects must include a fully crossed design and include targets for whom only information about one group membership is included. Vescio, Judd, and Kwan (2004) provide an illustration of this latter type of research. In one study, Asian and White male and female participants were asked to rate four targets based on a transcript where the targets discussed their adjustment to college. In one condition, only the target’s race information

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was given (half were Asian, the other half were White); a target’s gender always matched the participant’s gender. Thus, half of the targets in this group were in-group members, whereas the other half were out-group members. In another condition, both the target’s race and gender were provided. The targets were two Asian females, two Asian males, two White females, and two White males. Thus, two targets were double in-group members, four targets were partial in-group members, and two targets were double out-group members. Participants were asked to recall who said particular statements in the discussion as a measure of categorization. Participants’ reported liking and desire to have a similar discussion with the target were used as measures of bias. Results on categorization supported the cross-categorization hypothesis. Gender categorization was weaker when the target and participant were of the same race. Similarly, race categorization was weaker when the target and participant were of the same gender. Contrary to the hypothesis, however, there was no reduction in bias for partial in-group targets. Participants exhibited both race and gender bias, but the effect did not vary across condition. This pattern held in a second experiment where the in-group and out-group were represented by relationship status and size of hometown. Thus, the cross-categorization literature can potentially contribute to researchers interested in the double jeopardy hypothesis. First, the crosscategorization literature indicates that one can consider a number of different patterns of effects that go beyond additive and multiplicative-jeopardy models. This literature also highlights the distinction between comparing the effects of two category memberships on judgments versus comparing the effect of single category membership with multiple category memberships. Third, these studies highlight possible important moderators of the doublejeopardy hypothesis. It is also the case that the research on the double-jeopardy hypothesis can contribute to research on cross-categorization. Specifically, the cultural context in which cross-categorization judgments occur is made salient. For instance, in cross-categorization literature, given a different perceiver, Black women and White men can both be considered members of a double out-group. Yet, the double-jeopardy hypothesis highlights that being a Black woman culturally represents being a member of two lower status groups, while being a White man culturally represents being a member of two higher status groups. Moreover, attending to the cultural understanding indicates groups differ on more dimensions than just whether they are in-groups or out-groups as illustrated by different implications of cross-gender judgments (which can involve interpersonal attractions or patriarchal structures) versus cross-race judgments (which can involve issues surrounding dominance; Sidanius & Pratto, 1999). Finally, when examining the implications of being a multiple social group member, it may be imperative to discern the type of discrimination being experienced such as race or gender or both.

Intersections Between Sexist Beliefs and Other Beliefs In the next section, we explore general beliefs that arguably underlay sexist beliefs and provide psychological explanations for connections between

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experiences with sexism and experiences with other forms of prejudice. These connections can potentially provide insights into cross-cultural comparisons, as reviewed in the first section of this chapter, in endorsement of sexist beliefs and the ways that experiences with discrimination can be influenced by multiple group membership, as revised in the second section of this chapter. First, the tendency for sexism to be found across cultures, though perhaps in different forms, could be a function of the persistence of an underlying belief system. Yet, it is also the case that cross-cultural variation in the extent to which sexist beliefs are endorsed could be associated with variations in endorsement of these other belief systems (e.g., Heaven, Greene, Stones, & Caputi, 2000). Second, prejudice against women will likely occur not only because of people’s beliefs about gender intersecting with their beliefs about race, sexuality, and other social groups, but also because of the way that all of these beliefs intersect with other belief systems. Intersection with other belief systems means, for instance, that whether a specific encounter with hostile beliefs or discrimination is based upon gender, another group membership, or some combination of group memberships may not be clear to the target and potentially even to the perpetrator. Prejudice against different groups may manifest itself similarly across group memberships in the form of general dislike or disrespect without specific ties to group membership, because the psychological sources of prejudice may be more general. It is also possible that the particular behavioral or verbal manifestation of prejudice may differ depending on the category that intersects with gender (e.g., whether it is articulated as prejudice against or stereotypes about White lesbians versus heterosexual African American women) but the underlying source of the prejudice may be the same. In line with these arguments, research found that sexist beliefs are correlated with the endorsement of other types of prejudiced beliefs. For instance, research has demonstrated associations between modern sexist and modern racist beliefs (Swim et al., 1995), traditional gender roles and anti-gay and anti-lesbian beliefs (Whitely, 2001), and neosexist beliefs and lack of support for lesbian and gay rights (Masser & Abrams, 1999). Some have argued that these associations are a result of these different types of beliefs being grounded in general tendencies to be prejudiced as revealed by their association with measures predicting these general tendencies. Below we consider research on the general tendency to be prejudiced as revealed by research on right-wing authoritarianism (RWA; Altemeyer, 1981, 1988), social dominance orientation (SDO; Pratto, Sidanius, Stallworth, & Malle, 1994), and system justification (Jost & Banaji, 1994), which represent some of the most important and most researched concepts explaining individual differences in negative intergroup attitudes. The associations between these general belief systems and gender can help explain why sexist beliefs correlate with prejudiced beliefs, and therefore provide an explanation for intersections between sexism and other forms of prejudice. Thus, in contrast to examining the intersection between culture and endorsement of sexist beliefs or intersections between gender and other category membership, this next section examines intersections between endorsement of sexist beliefs and other belief systems.

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Right-Wing Authoritarianism Research on authoritarianism is rooted in the concept of “the authoritarian personality” of Adorno, Frenkel-Brunswik, Levinson, and Sanford (1950). Their goal was to identify a broad personality factor that explained the generalized negative intergroup attitudes displayed in the totalitarian regime of Nazi Germany. Addressing evolving measurement and conceptual issues, Altemeyer (1981, 1988) has more recently developed a theory of right-wing authoritarianism (RWA) defined as the combination of (1) Authoritarian submission (rigid submission to the established and seemingly legitimate in one’s society); (2) Authoritarian aggression (aggressive tendencies perceived to be sanctioned by established authorities directed against various persons and/or out-groups); and (3) Conventionalism (strict adherence to the conventions apparently sanctioned by society and its authorities). Many studies reveal that an authoritarian orientation is not only a powerful predictor of sexism (e.g., Christopher & Mull, 2006; Ekehammar, Akrami, Gylje, & Zakrisson, 2004; Sibley, Robertson, & Wilson, 2006; Whitley, 1999; Zakrisson, 2005), but is strongly related to an assortment of other negative attitudes (for an overview see Duckitt, 2006; Ekehammar et al., 2004; Sibley et al., 2006; Van Hiel & Mervielde, 2005).

Social Dominance Orientation Social dominance theory (Pratto et al., 1994; Sidanius & Pratto, 1999) is based on the observation that human societies are organized as hierarchies of socially constructed groups, with one or more dominant over one or more subordinate groups. Sidanius and Pratto (1999) propose that three different stratification systems exist in all societies: (a) the age system, in which older adults have disproportionate social power over children and younger adults; (b) the gender system, in which males have disproportionate social and political power compared with females; and (c) an arbitrary-set system, which is filled with socially constructed and highly salient groups based on characteristics such as ethnicity, estate, nation, race, and caste. Sidanius and Pratto (1999) argue that individuals vary in their endorsement of social dominance orientation (SDO), an individual difference variable assumed to have evolutionary roots, which describes how much individuals favor group-based inequality and hierarchically structured relationships among social groups. Men’s SDO scores are consistently higher than those of women. Many studies tested SDO’s strength in predicting sexism (Ekehammar et al., 2000; Pratto et al., 1994; Sidanius, Pratto, & Bobo, 1994, 1996) and other types of prejudice (for an overview see Duckitt, 2006; Ekehammar et al., 2004; Sibley et al., 2006; Van Hiehl & Mervielde, 2005). SDO is highly related to generalized prejudice. Zick et al. (2008) proposed a syndrome of Group-Focused Enmity (GFE) including prejudice towards several out-groups (e.g., racism, sexism, xenophobia, anti-Semitism, Islamophobia; cf. Allport, 1954). They found that these diverse types of prejudices shared a common ideology of inequality and could be attributed to a single second-order factor labeled GFE. Since SDO is defined as a preference for generalized group-based inequality, the common core of prejudices was highly related to SDO (r = .85).

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The Relationship Between SDO and RWA RWA and SDO have low to moderate intercorrelations (e.g. Altemeyer, 1988; Duckitt, 2001; Duriez & Van Hiel, 2002; Sidanius & Pratto, 1999; Whitley, 1999) and appear to be distinct, but complementary, predictors of prejudice. Duckitt and colleagues (2001, 2002) proposed a dual-process model of individual differences in prejudice, in which RWA and SDO influence prejudice against particular out-groups through different motivational mechanisms. RWA causes negative attitudes toward groups seen as threatening social control, security and order, such as deviant groups, whereas SDO causes negative attitudes toward groups that activate competitiveness for superiority, such as socially subordinate groups low in power and status. Consistent with Duckitt’s predictions, researchers (e.g., Christopher & Mull, 2006; Sibley et al., 2006; Whitley, 1999) also found that SDO predicts racism and hostile forms of sexism better than RWA which is more closely related to homophobia, religious ethnocentrism, and benevolent sexism (see Ekehammar et al., 2004, Stellmacher & Petzel, 2005, for further discussion).

System Justification System justification theory (SJT) (Jost & Banaji, 1994) explains societal group agreement with social stereotypes, as well as the prevalence of out-group favoritism and in-group derogation among members of disadvantaged groups (Jost & Burgees, 2000). Jost and colleagues postulated that people are not only motivated to evaluate themselves and the groups they belong to positively (see Social Identity Theory, Tajfel & Turner, 1979, and Social Dominance Theory), but also they also consider a superordinate societal system because of a desire to see social outcomes and arrangements as fair and deserved (see also Lerner, 2000). By legitimatizing social distributions, system justification reduces anxiety, guilt, dissonance, and uncertainty for both the advantaged and disadvantaged (Jost & Hunyady, 2002). Consequently, people may justify existing status hierarchies even if those hierarchies do not benefit them or their in-groups (Jost & Banaji, 1994). Hence, motives to promote one’s ego and one’s in-group and to justify the status quo are complementary for members of high status groups, but can be in conflict for low-status group members. Upholding the notion that every group in society possesses some advantages, as well as some disadvantages, increases system justification: Complementary representations of the poor as happier and more honest than the rich increased support for the status quo (Kay & Jost, 2003) and complementary representations of gender stereotypes of women as communal and men as agentic or of benevolent and hostile sexism increased system justification in women (Jost & Kay, 2005). Together, authoritarianism, social dominance orientation, and system justification constitute elements of an underlying belief system that are manifested in different types of prejudice, which can explain endorsement of various types of prejudice. Hence, one’s ability to address sexist beliefs is likely to be connected to one’s ability to simultaneously address multiple forms of prejudice and underlying belief structures. However, besides these ideological belief systems, it is important to consider differences in social norms

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between cultures, which are also important in explaining differences in prejudice between individuals, groups, and cultures.

Conclusion The research above shows numerous ways that being a member of multiple social groups can conjointly influence one’s experience with sexism. First, women from various countries and cultures are likely to experience sexism differently because of deviations in the likelihood that individuals from their countries and cultures endorse sexist beliefs. Women from individualistic and/or wealthier countries are less likely to find themselves faced with others who explicitly support traditional gender roles. However, women from these countries, as well as, perhaps, collectivistic or poorer countries, may face still more subtle expressions of sexist beliefs. Second, individuals may experience discrimination differently depending upon whether they are a member of more than one socially devalued group and whether they, relative to a person evaluating them, are members of more than one out-group. Being seen as a member of more than one social group can potentially alter the way that individuals are evaluated. This can potentially be harmful, if one is doubly devalued because of their multiple group memberships, or be helpful if one of the group memberships mitigates the effect of the other group membership. Third, individual’s experiences with sexism are interconnected with their experiences with other forms of discrimination because of the ideological belief systems that support hierarchal relationships, dominance structures, and justify the maintenance of the status quo. These ideological belief systems provide a different way of understanding the intersection between sexism and other forms of discrimination than focusing on the multiple types of social groups to which women belong.

Endnotes 1. There is a long history of studying gender stereotypes across cultures (e.g., Williams & Best, 1982). Endorsement of gender stereotypes can be sexist, for example when they reflect essentialist beliefs about characteristics of women and men and they can be of interest when considering stereotypes about women and men from different racial and ethnic groups. However, gender stereotypes can also be considered descriptive beliefs about women and men, which to some extent reflect the social roles that they occupy. These social roles can differ by cultures so there is ambiguity as to the extent to which differential endorsement of gender stereotypes in different cultures reflect essentialist’s beliefs or reflect different roles across cultures. Thus, in order to constrain the focus of our review, we selected measures of sexist beliefs that reflect more prescriptive or evaluative beliefs about women and gender equality. 2. Readers may wonder about Hofstede’s (1998) cross-cultural data on the masculinity of different countries. We do not include these data here

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because of the way in which the data were assessed. Masculinity scores are calculated by comparing the extent to which people value certain qualities in their place of work. Some are characterized as masculine (valuing recognition or the chance for promotion) and some as feminine (valuing pleasant co-workers and living in a desirable place). Thus, the scores are not assessing beliefs about, for instance, the way women and men should behave, but assess the extent to which characteristics associated with men are valued more than those associated with women. However, if one assumes that the masculine scores represent an assessment of a general population view on masculinity, it is interesting to note that the masculinity scores (as presented on http://www.geert-hofstede. com/hofstede_dimensions.phpx, retrieved March 21, 2008) are correlated with the endorsement of traditional roles from the ISSP data (r = .48, df = 25), for the 26 countries where we had matching data. 3. The ISSP would like to note the following by those who use their data set for publications. “The data used in this chapter were documented and made available through the Zentralarchiv fur empirische Socialforschung, Koeln. The data for the ‘ISSP’ were collected by independent institutions in each country …. Neither the original data collectors or the Zentralarchiv bear any responsibility for the analyses or conclusions presented here.” 4. The gender development indicator (GDI) is another U.N. indicator used to measure gender parity. However, this measure is based on the human development indicator (HDI) which is sensitive to the level of a country’s GDP. Therefore, the GDI is likely to be more confounded than GEM with factors such as democratization and wealth. This is evident by the little variation in scoring on the GDI and GEM presented by the most highly developed nations. We did, however, find a high correlation, r (68) = .77 between the GDI and GEM scores for the nations that provided such data. While the GDI quantifies a nation’s availability of opportunity to women, the GEM is conceptually a better measure of women’s enactment of the opportunities of power that are available to them. Nevertheless, criticisms of global gender parity indicators cite the neglect of other domains that are important to gender equality (Danner, Fort, & Young, 1999).

References Abrams, D., Viki, G. T., Masser, B., & Bohner, G. (2003). Perceptions of stranger and acquaintance rape: The role of benevolent and hostile sexism in victim blame and rape proclivity. Journal of Personality and Social Psychology, 84, 111–125. Adorno, T. W., Frenkel-Brunswik, E., Levinson, D. J., & Sanford, R. N. (1950). The authoritarian personality. New York: Harper & Row. Allport, G. W. (1954). The nature of prejudice. Reading, MA: Addison-Wesley. Almquist, E. M. (1975). Untangling the effects of race and sex: The disadvantaged status of Black women. Social Science Quarterly, 56, 129–142. Altemeyer, B. (1981). Right-wing authoritarianism. Manitoba, Canada: University Press. Altemeyer, B. (1988). Enemies of freedom. Understanding right-wing authoritarianism. San Francisco: Jossey-Bass. Anderson, S. J., & Johnson, J. T. (2003). The who and when of gender-blind, attitudes: Predictors of gender-role egalitarianism in two different domains. Sex Roles, 49, 527–532. Ayers, I., & Siegelman, P. (1995). Race and gender discrimination in the bargaining for a new car. American Economic Review, 85, 304–322.

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Baldwin, J., & DeSouza, E. (2001). Modelo de María and machismo: The social construction of gender in brazil. Revista Interamericana de Psicología, 35(1), 9–29. Banaszak, L. A., & Plutzer, E. (1993). The social bases of feminism in the European community. Public Opinion Quarterly, 57(1), 29–53. Barker, G., & Loewenstein, I. (1997). Where the boys are: Attitudes related to masculinity, fatherhood, and violence toward women among low-income adolescent and young adult males in Rio de Janeiro, Brazil. Youth & Society, 29, 166–196. Barreto, M., & Ellemers, N. (2005). The perils of political correctness: Men’s and women’s responses to old-fashioned and modern sexist views. Social Psychology Quarterly, 68, 75–88. Beal, F. (1970). Double jeopardy: To be Black and female. In T. Cade (Ed.), The Black woman: An anthology (pp. 90–100). New York: Mentor Book. Becker, J. C., & Swim, J. K. (2008). Legi, intellexi, condemnavi (I have read, comprehended, and condemned): Differential effects of attending to sexism and its harm on reducing modern and benevolent sexist beliefs. Unpublished manuscript, Philipps-University, Marburg. Beere, C. A. (1990). Gender roles: A handbook of tests and measures. New York: Greenwood Press. Berdahl, J. L., & Moore, C. (2006). Workplace harassment: Double jeopardy for minority women. Journal of Applied Psychology, 91, 426–436. Biernat, M., & Wortman, C. B. (1991). Sharing of home responsibilities between professionally employed women and their husbands. Journal of Personality and Social Psychology, 60, 844–860. Black, J. H. (2000). Entering the political elite in Canada: The case of minority women as parliamentary candidates and MPs. The Canadian Review of Sociology and Anthropology, 37, 143–166. Bohan, J. S. (1996). Diversity and lesbian/gay/bisexual identity: Intersecting identities, multiple oppressions. In J. S. Bohan, Psychology and sexual orientation: Coming to terms (pp. 122–139). New York: Routledge. Bowleg, L., Huang, J., Brooks, K., Black, A., & Burkholder, G. (2003). Triple jeopardy and beyond: Multiple minority stress and resilience among Black lesbians. Journal of Lesbian Studies, 7, 87–108. Brown, H. A., & Ford, D. L. (1977). Exploratory analysis of discrimination in employment of Black MBA graduates. Journal of Applied Psychology, 62, 50–56. Brown, J., Newland, A., Anderson, P., & Chevannes, B. (1997). Caribbean fatherhood: Underresearched, misunderstood. In J. L. Roopnarine & J. Brown (Eds.), Caribbean families: Diversity among ethnic groups. Advances in applied developmental psychology, 14 (pp. 85–113). Westport, CT: Ablex. Bullock, H. E., & Waugh, I. M. (2004). Caregiving around the clock: How women in nursing manage career and family demands. Journal of Social Issues, 60(4), 767–786. Burn, S. M., & Busso, J. (2005). Ambivalent sexism, scriptural literalism, and religiosity. Psychology of Women Quarterly, 29, 412–418. Burt, M. R. (1980). Cultural myths and supports for rape. Journal of Personality and Social Psychology, 38, 217–230. Cameron, J. E. (2001). Social Identity, modern sexism and perceptions of personal and group discrimination by women and men. Sex Roles, 45, 743–766. Campbell, B., Schellenberg, E. G. & Senn, C. Y. (1997). Evaluating measures of contemporary sexism. Psychology of Women Quarterly, 21, 89–102. Cesare, S. J., Dalessio, A., & Tannenbaum, R. J. (1988). Contrast effects for Black, White, male and female interviewees. Journal of Applied Social Psychology, 18, 1261–1273. Chia, R. C., Allred, L. J., & Jerzak, P. A. (1997). Attitudes toward women in Taiwan and China: Current status, problems, and suggestions for future research. Psychology of Women Quarterly, 21, 137–150. Christopher, A. N. & Mull, M. S. (2006). Conservative ideology and ambivalent sexism. Psychology of Women Quarterly, 30, 223–230. Ciabattari, T. (2001). Changes in men’s conservative gender ideologies: Cohort and period influences. Gender & Society, 15, 574–591. Crisp, R. J., & Hewstone, M. (2006). Multiple social categorization: Context, process, and social consequences. New York, NY: Psychology Press.

165

166


Czys, M. J., & Lazzaroto, G. D. (1999). Gender and work: The new role of women and their entrance into the workplace. Aletheia, 9, 63–68. Danner, M., Fort, L., & Young, G. (1999). International data on women and gender: Resources, issues, critical use. Women’s Studies International Forum, 22, 249–259. Davis, N. J., & Robinson, R. V. (1991). Men’s and women’s consciousness of gender inequality: Austria, West Germany, Great Britain, and the United States. American Sociological Review, 56, 72–84. Deschamps, J. C. (1977). Effect of crossing category memberships on quantitative judgement. European Journal of Social Psychology, 7, 517–522. Deschamps, J. C., & Doise, W. (1978). Crossed category membership in intergroup relations. In H. Tajfel (Ed.), Differentiation between social groups (pp. 141–158). London: Academic Press. DeSouza, E. R., Baldwin, J., Koller, S. H., & Narvaz, M. (2004). A Latin American perspective on the study of gender. In M. A. Paludi (Ed.), Praeger guide to the psychology of gender (pp. 41–67). Westport, CT: Praeger Publishers/Greenwood Publishing Group. Diekman, A., Eagly, A. H., Mladinic, A., & Ferreira, M. C. (2005). Dynamic stereotypes about women and men in Latin America and the United States. Journal of Cross-Cultural Psychology, 36, 209–226. Duckitt, J. (2001). A dual-process cognitive-motivational theory of ideology and prejudice. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 33, pp. 41–113). New York: Academic Press. Duckitt, J. (2006). Differential effects of right wing authoritarianism and social dominance orientation on outgroup attitudes and their mediation by threat from and competitiveness to outgroups. Personality and Social Psychology Bulletin, 32, 684–696. Duckitt, J., Wagner, C., du Plessis, I., & Birum, I. (2002). The psychological bases of ideology and prejudice: Testing a dual process model. Journal of Personality and Social Psychology, 83, 75–93. Duriez, B., & Van Hiel, A. (2002). The march of modern fascism: A comparison of social dominance orientation and authoritarianism. Personality and Individual Differences, 32, 1199–1213. EA [Zentralarchiv fuer empirische Sozialforschung] (Ed.). (2002). ISSP 2002. Family and Changing Gender Roles III. ZUMA report on the German study. Köln. Retrieved June 25, 2006, from http://www.gesis.org/en/data_service/issp/data/2002_Family_III.htm Eagly, A. H., Diekman, A. B., Johannesen-Schmidt, M. C., & Koenig, A. M. (2004). Gender gaps in sociopolitical attitudes: A social psychological analysis. Journal of Personality and Social Psychology, 87, 796–816. Eckes, T., & Six-Materna, I. (1998). Leugnung von Diskriminierung: Eine Skala zur Erfassung des modernen Sexismus [Denial of discrimination: A scale measuring modern sexism]. Zeitschrift für Sozialpsychologie, 29, 224–238. Ekehammar, B., Akrami, N., & Araya, T. (2000). Development and validation of Swedish classical and modern sexism scales. Scandinavian Journal of Psychology, 41, 307–314. Ekehammar, B., Akrami, N., Gylje, M., & Zakrisson, I. (2004).What matters most to prejudice: Big five personality, social dominance orientation, or right-wing authoritarianism? European Journal of Personality, 18, 463–482. Ellis, J., & Fox, P. (2001). The effect of self-identified sexual orientation on helping behavior in a British sample: Are lesbians and gay men treated differently? Journal of Applied Social Psychology, 31, 1238–1247. Espín, O. M. (1987). Psychological impact of migration on Latinas: Implications for psychotherapeutic practice. Psychology of Women Quarterly. Special Issue: Hispanic women and mental health, 11, 489–503. Fiorentine, R. (1988). Increasing similarity in the values and life plans of male and female college students? Evidence and implications. Sex Roles, 18, 143–158. Fischer, A. R. (2006). Women’s benevolent sexism as reaction to hostility. Psychology of Women Quarterly, 30, 410–416. Frieze, I. H., & Ferligoj, A. (1995). Evidence for changing gender-role attitudes in Slovenia in comparison to the United States. In A. Ferligoj & A. Kramberger (Eds.), Contribution to methodology and statistics, 10 (pp. 247–260). University of Ljubljana: Republic of Slovenia.

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Frieze, I. H., Ferligoj, A., Kogovsek, T., Rener, T., Horvat, J., & Sarlija, N. (2003). Gender-role attitudes in university students in the United States, Slovenia, and Croatia. Psychology of Women Quarterly, 27, 256–261. Funk, N., & Mueller, M. (Eds.). (1993). Gender politics and post-communism: Reflections from Eastern Europe and the former Soviet Union. New York: Routledge. Gaertner, S. L., & Dovidio, J. F. (1986). The aversive form of racism. In J. F. Dovidio & S. L. Gaertner (Eds.), Prejudice, discrimination and racism (pp. 61–89). New York: Academic Press. Galanti, G. (2003) The Hispanic family and male-female relationships: An overview. Journal of Transcultural Nursing, 14, 180–185. Gibbons, J. L., Hamby, B. A., & Dennis, W. D. (1997). Researching gender-role ideologies internationally and cross-culturally. Psychology of Women Quarterly, 21, 151–170. Gibbons, J. L., Stiles, D. A., & Shkodriani, G. M. (1991). Adolescents’ attitudes toward family and gender roles: An international comparison. Sex Roles, 25, 625–643. Glick, P., Diebold, J., Bailey-Werner, B., & Zhu, L. (1997). The two faces of Adam: Ambivalent sexism and polarized attitudes toward women. Personality and Social Psychology Bulletin, 23, 1323–1334. Glick, P., & Fiske, S. T. (1996). The Ambivalent Sexism Inventory: Differentiating hostile and benevolent sexism. Journal of Personality and Social Psychology, 70, 491–512. Glick, P., & Fiske, S. T. (2001b). Ambivalent sexism. In M. Zanna (Ed.). Advances in experimental social psychology (pp. 115–188), Vol. 33. New York: Academic Press. Glick, P., & Fiske, S. T. (2001a). An ambivalent alliance. Hostile and benevolent sexism as complementary justifications for gender inequality. American Psychologist, 56, 109–118. Glick, P., Fiske, S.T., Mladinic, A., Saiz, J. L., Abrams, D., Masser, B., et al. (2000). Beyond prejudice as simple antipathy: Hostile and benevolent sexism across cultures. Journal of Personality and Social Psychology, 79, 763–775. Glick, P., Lameiras, M., & Castro, Y. R. (2002). Education and Catholic religiosity as predictors of hostile and benevolent sexism toward women and men. Sex Roles, 47, 433–441. Green, B., & Boyd-Franklin, N. (1996). African American lesbians: Issues in couples therapy. In J. Laird & R. L. Green (Eds.), Lesbians and gay men in couples and families: A handbook for practitioners (pp. 251–271). San Francisco, CA: Josses Bass. Gupta, V., & Gupta, A. (1999). Real and ideal perceptions of woman and man. Journal of the Indian Academy of Applied Psychology, 25, 133–138. Hanassab, S. (1991). Acculturation and young Iranian women: Attitudes toward sex roles and intimate relationships. Journal of Multicultural Counseling and Development, 19, 11–21. Hauser, E., Heyns, B., & Mansbridge, J. (1993). Feminism in the interstices of politics and culture: Poland in transition. In N. Funk & M. Mueller (Eds.), Gender politics and postcommunism: Reflections from Eastern Europe and the former Soviet Union (pp. 257–273). New York: Routledge. Heaven, P. C. L., Greene, R. L., Stones, C. R., & Caputi, P. (2000). Levels of social dominance orientation in three societies. Journal of Social Psychology, 140(4), 530–532. Henderson-King, D., & Zhermer, N. (2003). Feminist consciousness among Russians and Americans. Sex Roles, 48, 143–155. Hirsch, J. (2003). A courtship after marriage: Sexuality and love in Mexican transnational families. CA: University of California Press. Hitt, M. A., Zickmund, W. G., & Pickens, B. A. (1982). Discrimination in industrial employment. An investigation of race and sex bias among professionals. Work and Occupations, 9, 217–231. Hofstede, G. (Ed.). (1998). Masculinity and femininity: The taboo dimension of national cultures. Thousand Oaks, CA: Sage. Hunt, K. (2002). A generation apart? Gender-related experiences and health in women in early and late mid-life. Social Science & Medicine. Special Issue: Social and Economic Patterning of Women’s Health in a Changing World, 54(5), 663–676. Jackman, M. R. (1994). The velvet glove: Paternalism, and conflict in gender, class, and race relations. Berkeley: University of California Press. Japanese Prime Minister’s Office. (1982). International survey on women’s issues. Tokyo: Japanese Prime Minister’s Office. Jim, J. C., Watts, C. H., Hargreaves, J. R., Ndhlovu, L. X., Phetla, G., Morison, L.A., et al. (2007). Understanding the impact of a microfinance-based intervention on women’s

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empowerment and the reduction of intimate partner violence in South Africa. American Journal of Public Health, 97, 1794–1802. Jost, J. T., & Banaji, M. R. (1994). The role of stereotyping in system justification and the production of false-consciousness. British Journal of Social Psychology, 33, 1–27. Jost, J. T., & Burgees, D. (2000). Attitudinal ambivalence and the confl ict between group and system justification motives in low status groups. Personality and Social Psychology Bulletin, 26, 293–305. Jost, J. T., & Hunyady, O. (2002) The psychology of system justification and the palliative function of ideology. In M. Hewstone & W. Stroebe (Eds.), European review of social psychology (Vol. 13, pp. 111–153). Hove: Psychology Press. Jost, J. T., & Kay, A. C. (2005). Exposure to benevolent sexism and complementary gender stereotypes: Consequences for specific and diffuse forms of system justification. Journal of Personality and Social Psychology, 88, 498–509. Kalichman, S. C., Simbayi, L. C., Kaufman, M., Cain, D., Cherry, C., Jooste, S., et al. (2005). Gender attitudes, sexual violence, and HIV/AIDS risks among men and women in Cape Town, South Africa. Journal of Sex Research, 42, 299–305. Kane, E. W. (2000). Racial and ethnic variations in gender-related attitudes. Annual Review of Sociology, 26, 419–439. Kay, A. C., & Jost, J. T. (2003). Complementary Justice: Effects of “poor but happy” and “poor but honest” stereotype exemplars on system justification and implicit activation of the justice motive. Journal of Personality and Social Psychology, 85, 823–837. Khalid, R., & Frieze, I. H. (2004). Measuring perceptions of gender roles: The IAWS for Pakistanis and U.S. immigrant populations. Sex Roles. Special Issue: Women and Islam, 51(5–6), 293–299. Kinder, D. R., & Sears, D. O. (1981). Prejudice and politics: Symbolic racism versus racial threats to the good life. Journal of Personality and Social Psychology, 40, 414–431. King, D. K. (1988). Multiple jeopardy, multiple consciousness: The context of a Black feminist ideology. Signs, 14, 42–71. Kozu, J. (1999). Domestic violence in Japan. American Psychologist, 54, 50–54. Kritz, M. M., & Makinwa-Adebusoye, P. (1999). Determinants of women’s decision-making authority in Nigeria: The Ethnic Dimension. Sociological Forum, 14(3), 399–424. Lerner, M. J. (2000). Just world belief. Encyclopedia of psychology (Vol. 4, pp. 425–427). Washington, DC: American Psychological Association. Leung, C., & Moore, S. (2003). Individual and cultural gender roles: A comparison of AngloAustralians and chinese in Australia. Current Research in Social Psychology, 8(21), 302–317. Retrieved August 6, 2009, from http://www.uiowa.edu/~grpproc/crisp/crisp.8.21.html Marin, B. V. (1996). Cultural issues in HIV prevention for Latinos: Should we try to change gender roles? In S. Oskamp & S. C. Thompson (Eds.), Understanding and preventing HIV risk behavior: Safer sex and drug use. The Claremont Symposium on Applied Social Psychology (pp. 157–176). Thousand Oaks, CA: Sage. Masser, B., & Abrams, D. (1999). Contemporary sexism. The relationship among hostility, benevolence and neosexism. Psychology of Women Quarterly, 23, 503–517. Massey, G., Hahn, K., & Sekulic, D. (1995). Women, men, and the “second shift” in socialist Yugoslavia. Gender & Society, 9, 359–379. McConahay, J. B. (1986). Modern racism, ambivalence, and the modern racism scale. In J. D. Dovidio & S. L. Gaertner (Eds.), Prejudice, discrimination, and racism (pp. 91–125). San Diego, CA: Academic Press. McGarty, C. (2006). Hierarchies and minority groups: The roles of salience, overlap, and background knowledge in selecting meaningful social categorizations from multiple alternatives. New York: Psychology Press. McRae, M. B. (1991). Sex and race bias in employment decisions: Black women considered. Journal of Employment Counseling, 28, 91–98. Migdal, M. J., Hewstone, M., & Mullen, B. (1998). The effects of crossed categorization on intergroup evaluations: A meta-analysis. British Journal of Social Psychology, 37(3), 303–324. Millennium development goals indicators: The official United Nations site for the MDG indicators. (2006). United Nations Statistics Division. Retrieved November 29, 2006, at http://millenniumindicators.un.org/unsd/mdg/Default.aspx

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Miller, N., Kenworthy, J. B., Canales, C. J., & Stenstrom, D. M. (2006). Explaining the effects of crossed categorization on ethnocentric bias. New York: Psychology Press. Morinaga, Y., Frieze, I. H., & Ferligoj, A. (1993). Career plans and gender-role attitudes of college students in the United States, Japan, and Slovenia. Sex Roles, 29, 317–334. Moya, M. M. C., & Exposito, F. (2001). Nuevas formas, viejos intereses: Neosexismo en varones espanoles/New forms, old interests: Neosexism among Spanish men. Psicothema, 13, 643–649. Mullen, B., Migdal, M. J., & Hewstone, M. (2001). Crossed categorization versus simple categorization and intergroup evaluations: A meta-analysis. European Journal of Social Psychology, 31(6), 721–736. Naidoo, J. C., & Davis, J. C. (1988). Canadian South Asian women in transition: A dualistic view of life. Journal of Comparative Family Studies. Special Issue: Family in India and North America, 19(2), 311–327. Nayak, M. B., Byrne, C. A., Martin, M. K., & Abraham, A. G. (2003). Attitudes toward violence against women: A cross-nation study. Sex Roles, 49, 333–342. O’Sullivan, L. F., Harrison, A., Morrell, R., Monroe-Wise, A., & Kubeka, M. (2006). Gender dynamics in the primary sexual relationships of young rural South African women and men. Culture, Health & Sexuality, 8, 99–113. Olson, J., Frieze, I. H., Wall, S., Zdaniuk, B., Ferligoj, A., Kogovšek, T., et al. (2007). Beliefs in equality for women and men as related to economic factors in central and eastern Europe and the United States. Sex Roles, 56, 297–308. Parks, C. A., Hughes, T. L., & Matthews, A. K. (2004). Race/ethnicity and sexual orientation: Intersecting identities. Cultural Diversity and Ethnic Minority Psychology, 10, 241–254. Parks, J. B., & Roberton, M. A. (2004). Attitudes toward women mediate the gender effect on attitudes toward sexist language. Psychology of Women Quarterly, 28, 233–239. Pratto, F., Sidanius, J., Stallworth, L. M., & Malle, B. F. (1994). Social dominance orientation: A personality variable predicting social and political attitudes. Journal of Personality and Social Psychology, 67, 741–763. Pruitt, E. R., & Swim, J. K. (2008). Asian, Black, Latino, and White responses to contemporary sexism scales: A comparison. Sex Roles. Manuscript under review. Rao, V. V. P., & Rao, V. N. (1985). Sex-role attitudes across two cultures: United States and India. Sex Roles, 13, 607–624. Reid, P. T., & Comas-Díaz, L. (1990). Gender and ethnicity: Perspectives on dual status. Sex Roles, 22, 397–408. Rener, T., & Ule, M. (1998). Back to the future: Nationalism and gender in post-socialist societies. In R. Wilford & R. L. Miller (Eds.), Women, ethnicity and nationalism: Politics of transition (pp. 120–132). London: Routledge. Report of the Socialist Federal Republic of Yugoslavia on the application of the convention on the elimination of all forms of discrimination against women. (1989). Belgrade: Printing Office of the SFRY. Sanchez-Hucles, J. V. (1997). Jeopardy not a bonus status for African American women in the work force: Why does the myth of advantage persist? American Journal of Community Psychology, 25, 565–580. Sears, D. O. (1988). Symbolic racism. In P. Katz & D. Taylor (Eds.), Eliminating racism: Profiles in controversy (pp. 53–84). New York: Plenum Press. Sibley, C. G., Robertson, A., & Wilson, M. S. (2006). Social dominance orientation and rightwing authoritarianism: Additive and interactive effects. Political Psychology, 27, 755–768. Sidanius, J., & Veniegas, R. C. (2000). Gender and race discrimination: The interactive nature of disadvantage. Reducing Prejudice and Discrimination: The Claremont Symposium on Applied Social Psychology (pp. 47–69). Mahwah, NJ: Lawrence Erlbaum Associates. Sidanius, J., & Pratto, F. (1999). Social dominance: An intergroup theory of social hierarchy and oppression. Cambridge: Cambridge University Press. Sidanius, J., Pratto, F., & Bobo, L. (1994). Social dominance orientation and the political psychology of gender: A case of invariance? Journal of Personality and Social Psychology, 67, 998–1011. Sidanius, J., Pratto, F., & Bobo, L. (1996). Racism, conservatism, affirmative action, and intellectual sophistication: A matter of principled conservatism or group dominance? Journal of Personality and Social Psychology, 68, 199–214.

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Solokoff, N. J. (1992). Black women and White women in the professions. New York: Routledge. Spence, J. T., & Helmreich, R. (1972). Who likes competent women? Competence, sex role congruence of interests, and subjects’ attitudes toward women as determinants of interpersonal attraction. Journal of Applied Social Psychology, 2(3), 197–213. Stellmacher, J., & Petzel, T. (2005). Authoritarianism as a Group Phenomenon. Political Psychology, 26, 245–274. Strandh, M., & Nordenmark, M. (2006). The interference of paid work with household demands in different social policy contexts: Perceived work-household confl ict in Sweden, the UK, the Netherlands, Hungary, and the Czech Republic. British Journal of Sociology, 57(4), 597–617. Suzuki, A. (1991). Egalitarian sex role attitudes: Scale development and comparison of American and Japanese women. Sex Roles, 24, 245–259. Swim, J. K., & Campbell, B. (2001). Sexism: Attitudes, beliefs, and behaviors. The Handbook of Social Psychology: Intergroup Relations, 4, 218–237. Swim, J. K., & Cohen, L. L. (1997). Overt, covert and subtle sexism. A comparison between the attitudes toward women and modern sexism scales. Psychology of Women Quarterly, 21, 103–118. Swim, J. K., & Hyers, L. L. (2009). Sexism. In T. Nelson (Ed.), Handbook of prejudice, stereotyping, and discrimination. New York: Psychology Press. Swim, J. K., Aiken, K. J., Hall, W. S., & Hunter, B. A. (1995). Sexism and racism: Old-fashioned and modern prejudices. Journal of Personality and Social Psychology, 68, 99–214. Swim, J. K., Becker, J. C., & DeCoster, J. (2007). Higher order structures for contemporary measures of sexist beliefs. Manuscript in preparation, Pennsylvania State University. Swim, K., Pearson, N. P., & Johnston, K. E. (2008). Daily encounters with heterosexism: A week in the life of lesbian, gay, and bisexual individuals. Journal of Homosexuality, 53, 31–48. Tajfel, H., & Turner, J. C. (1979). An integrated theory of intergroup confl ict. In W. G. Austin & S. Worchel (Eds.), The social psychology of intergroup relations (2nd ed., pp. 33–47). Monterey, CA: Brooks/Cole. Tang, T. N., & Dion, K. L. (1999). Gender and acculturation in relation to traditionalism: Perceptions of self and parents among Chinese students. Sex Roles, 41(1–2), 17–29. Tougas, F., Brown, R., Beaton, A. M., & Joly, S. (1995). Neosexism: Plus ca change, plus c’est pareil. Personality and Social Psychology Bulletin, 21, 842–849. Twenge, J. M. (1997). Attitudes toward women, 1970–1995: A meta-analysis. Psychology of Women Quarterly, 21, 35–52. U.S. Census Bureau. (2004). Median income of Black and White adults with a bachelors degree. Valdez, F. (1997). Queer margins, queer ethics: A call to account for race and ethnicity in the lab, theory, and politics of “sexual orientation.” Hastings Law Journal, 48, 1293–1341. Van Hiel, A., & Mervielde, I. (2005). Authoritarianism and social dominance orientation: Relationships with various forms of racism. Journal of Applied Social Psychology, 35, 2323–2344. Van Vlaenderen, H., & Cakwe, M. (2003). Women’s identity in a country in rapid social change: The case of educated South African women. Psychology and Developing Societies, 15, 69–86. Vescio, T. K., Judd, C. M., & Kwan, V. S. Y. (2004). The crossed-categorization hypothesis: Evidence of reductions in the strength of categorization, but not intergroup bias. Journal of Experimental Social Psychology, 40(4), 478–496. Whitley, B. E. (1999). Right-wing authoritarianism, social dominance orientation, and prejudice. Journal of Personality and Social Psychology, 77, 126–134. Williams, J. E., & Best, D. L. (1982). Measuring sex stereotypes: A thirty nation study. Newbury Park, CA: Sage. Wilson, W. J. (1997). When work disappears: The world of the new urban poor. New York: Vintage Books. Wojcicki, J. M. (2005). Africa – Socioeconomic status as a risk factor for HIV infection in women in East, Central and Southern Africa: A systematic review. Journal of Biosocial Science, 37, 1–36. Zakrisson, I. (2005). Construction of a short version of the right-wing authoritarianism (RWA) scale. Personality and Individual Differences, 39, 863–872.

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Zick, A., Wolf, C., Küpper, B., Davidov, E., Schmidt, P., & Heitmeyer, W. (2008). The syndrome of group-focused enmity: The interrelation of prejudices tested with multiple cross-sectional and panel data. Manuscript submitted for publication.

Appendix International Social Survey Programme Items Measuring Endorsement of Traditional Gender Roles 1. A preschool child is likely to suffer if his or her mother works. 2. All in all, family life suffers when a woman has a full-time job 3. A job is all right, but what most women really want is a home and children. 4. Being a housewife is just as fulfilling as working for pay. 5. A man’s job is to earn money; a woman’s job is to look after the home and family.

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Women’s Experiences of Sexist Discrimination: Review of Research and Directions for Centralizing Race, Ethnicity, and Culture

6 Bonnie Moradi and Cirleen DeBlaere

Bodies of prior research (and chapters in this volume) attend to women’s experiences of specific and blatant manifestations of sexism such as rape and sexual assault (e.g., Koss, 1990; Koss et al., 1994; Rozee & Koss, 2001), abuse by male partners (e.g., Browne, 1993), and workplace sexual harassment and discrimination (e.g., Fitzgerald, 1993; Gutek & Done, 2001). Until the past decade, however, research on every-day manifestations of sexist discrimination had been limited. Attention to every-day sexist events is important given that daily hassles and stressful life events have been linked with mental health concerns (e.g., Dohrenwend & Dohrenwend, 1974; Kanner, Coyne, Schaefer, & Lazarus, 1981) and that exposure to discrimination is conceptualized as a stressor (e.g., Allport, 1954; Barrett & Swim, 1998; Brooks, 1981; Clark, Anderson, Clark, & Williams, 1999; Enns, 1993; Landrine & Klonoff, 1996, 1997; Slavin, Rainer, McCreary, & Gowda, 1991; Smith, 1985). Indeed, Klonoff and Landrine (1995) posited that daily experiences of sexism are related to women’s psychological distress and empirical support for this perspective is growing (e.g., Klonoff, Landrine, & Campbell, 2000; Landrine, Klonoff, Gibbs, Manning, & Lund, 1995b; Moradi & Subich, 2002a, 2003, 2004; Swim, Hyers, Cohen, & Ferguson, 2001).

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Therefore, in this chapter, we focus on daily experiences of sexist discrimination and review relevant conceptual definitions, instruments, and research findings. Throughout the review, we highlight issues relevant to the roles of race, ethnicity, and culture (conceptualized to include sexual orientation).1 As this review reveals, however, attention to such issues has been limited; a search of the PsycINFO database illustrates this point. At the time of this writing, 1,338 articles included the terms “gender discrimination” or “sexism,” or “sexist events” or “sexist discrimination” in their abstracts. Of these articles, only 160 (12%) mentioned “African American” or “Black”; notably smaller proportions mentioned “Asian” or “Asian American” (25 articles, 2%), “Hispanic” or “Hispanic American” or “Latina” or “Latin” (16 articles, 1%), “Native American” or “American Indian” (6 articles, 65. There are over 200 people in the world who are called “Super-Centennials” (i.e., those who are 110 years or older), and that number is increasing. These changes will result in a considerable shift in the structure of the population, from a pyramid shape with substantially more younger than older people, to a beanpole shape with approximately equal numbers of people at all ages. To highlight the aging-related aspect of these changing demographics, note that from 1995 to 2050 the total population will increase by 50%, with the over-65 population increasing by 135%, and the over-85 population increasing by 401%. These are indeed significant changes (Gist & Hetzel, 2004; U.S. Census Bureau, 1997). There are important ethnic, race, and gender variations in these demographic changes. African Americans constitute approximately 10% of the U.S. population. In 2004, about 3 million or 8% of African Americans were over 65, and these numbers are projected to increase to 10.3 million in 2050, which would represent approximately 12% of the population (U.S. Administration on Aging, 2006). The overall Latino population is estimated at 12% of the U.S. population, with the number of older Latinos only 2 million people or 6%. By 2050, the total Latino population is expected to increase to 24% of the total population, i.e., 98 million, constituting 18%, 15 million, of the older population. Other minority groups are also substantially increasing in size, as are their aging populations. Comparable figures for older Asian Americans are 3% or approximately 1 million currently, increasing to 8% or almost 7 million by 2050. Immigrants from other parts of the world, including Central and South America and Africa, are also increasing in the U.S. (Federal Interagency Forum on Aging-Related Statistics, 2004). Although much less information is available about the elder populations of these groups, patterns signifying increases among them appear to be similar. One of the most interesting points about the aging population worldwide is that, due to the longer life expectancy of women, it is becoming increasingly female-dominated. Whereas at younger ages, more males than females are alive in every age group, the ratio begins to shift in mid-life. Due to the higher death rates among men, the gender differential favoring them reverses and the reversal accelerates with age, changing the population from approximately 80 males to every 100 females among 65 year olds to 44 males for every 100 females among 85 year olds (Gist & Hetzel, 2004). Thus, the study of older people, especially the oldest old, is increasingly the study of older women. We turn next to age and gender stereotypes, which are, unfortunately, disproportionately experienced by older women.

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Psychological Perspectives on Older Women

Stereotypes Stereotypes are the overgenerationalization of (typically) negative attributes towards a particular group. Many negative stereotypes concerning older people exist (Nelson, 2005; Palmore, 1999). Examples of age stereotypes include beliefs that the majority of older people are sick, frail, or demented; that all old men are cranky geezers; or that older women who date younger men are cougars. Such stereotypes lead to poor decisions by, for, and about older people in numerous areas including work, health, relationships, and quality of life (Pasupathi & Lockenhoff, 2002). The recent report from the National Research Council entitled When I’m 64 (Carstensen & Hartel, 2006) notes that these stereotypes often lead to lost opportunities vital for individual and collective fulfillment, because people tend to believe the stereotypes about themselves and others tend to undervalue the actual and potential contributions of older adults. Research indicating the importance of utilizing one’s potential for health and well-being (Levy, 2001) suggests that negative stereotyping and the consequent underutilization of older people’s contributions to society can have significant and long-term negative consequences. Some have argued that age stereotypes are due to gerontophobia, or the fear of and devaluation of older adults because they remind us of our own vulnerability and mortality (Palmore, 1999). Older women often experience sexism as well. Classic examples are the belief that women are universally irrational, emotional, and indecisive (but men never are). Gendered ageism includes harsh and negative judgments about the physical signs of aging. As women grow old, they are labeled as “over the hill” or “old bags,” but men are viewed as “prosperous” or “distinguished” (Calasanti & Slevin, 2001; Sontag, 1972; Stoller & Gibson, 1999). Older lesbians are subjected to additional discrimination and stigma by those who consider their lifestyle as deviant (Barker, 2004; Gabbay & Whaler, 2002; Morrow, 2001; Slevin, 2006). Given the objective fact that older women live longer than men, that they are often the long-term caregivers of children and spouses or partners, and that increasingly they occupy dual roles of caregiver and breadwinner, this gendered ageism seems particularly unjust. It should be noted that feminists are not free of ageism. While recognizing and attending to, even if belatedly, the needs of poor, African American, Latino, rural, inner city, lesbian, bisexual, transgendered, and immigrant women, the feminist movement has paid very little attention to older women. Years ago, Susan Sontag (1972) spoke of the double standard of aging, but many famous feminists, including by her own admission, Betty Freidan (1993), feared aging. Unfortunately, with a few notable exceptions (Calasanti, 2005; Calasanti & Slevin, 2001; Connidis, 2001; Estes, 2005), the situation has not improved among younger generations of feminists. The Feminist Movement of the 1960s and 1970s taught women that other women were not the enemy but rather sisters in a common struggle. Unfortunately, despite the fact that they had much experience to share, older women were not invited to be sisters in the struggle back then, and the situation has not substantially improved today. Much as younger women sometimes deny the gains made by or even the need for the Feminist Movement, older women are often viewed as individuals to be

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distanced from, in case wrinkles, gray hair, or cellulite might be contagious. We may have learned to embrace other women but apparently, only if they are young, preferably slim and good looking—or, at the least, not very old. Although both ageism and sexism have shown few signs of dissipating, some have argued that the sheer number of Baby Boomers, with their less traditional life experiences and more progressive attitudes, not to mention their enjoyment of technological advancements, better health, and active life styles, will have a significant impact on these negative stereotypes (Cutler & Hendricks, 2001). In addition, some lesbians believe their struggles with claiming their identity and living in a society that oppresses them have instilled important competencies and resilience that enable them to face aging more easily than heterosexual women might (Gabbay & Whaler, 2002; Slevin, 2006). Whether ageism and sexism will diminish in the future remains to be seen, but these examples offer hope for a new perspective on aging. In an effort to provide concrete evidence about age-related changes to help mitigate negative stereotypes, we now turn to an examination of physical and mental health among older women.

Age and Physical Health It has long been commonly accepted that the act of aging is synonymous with both physical and psychological deterioration. Early years were seen as the most productive ones, followed by a period of lesser growth in middle age, and then decline in later life (Carstensen & Freund, 1994; Hamarat, Thompson, Steele, Matheny, & Simons, 2002). As such, older persons were often viewed and categorized as unproductive individuals who were physically and financially dependent on others (Fernandez-Ballesteros, 2002; Maddox, Atchley, & Poon, 1987). However, more recent findings suggest that contrary to the stereotype, many older people, especially women, are active, physically fit, and financially independent. In the twenty-first century, a great deal of attention has been devoted to combating negative myths about aging. In point of fact, most older people, both men and women, remain healthy well into old age. The proportion of older Americans with chronic disability has steadily declined compared to previous decades. Even more encouraging is the fact that the majority of older Americans (i.e., 73% of those over 65), rate their health as good or better. Despite this good news about old age health in general, the improvements vary between the sexes. Reports concerning women indicate that they live longer than men but have more chronic illnesses and are differentially susceptible to various illnesses. Thus, women are more likely to experience hypertension, asthma, chronic bronchitis, and arthritic symptoms than men are, whereas men are more likely to have heart disease, cancer, diabetes, and emphysema than women. Although there are ethnic and race differences in the specific percentages, the five most common chronic illnesses across all groups are hypertension, arthritis, diabetes, heart disease, and cancer (Federal Interagency Forum on Aging-Related Statistics, 2004). Another common misconception is that age inevitably equals sensory loss. Indeed, Shakespeare wrote, in what might be the most famous example of

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ageism, that people face old age “Sans teeth, sans eyes, sans taste, sans everything.” While age is often accompanied by some sensory loss, this is much less prevalent than one might believe based on overgeneralizations. Among people older than 65 years of age, 28% have none of their natural teeth, 18% report trouble seeing, and 38% report any trouble hearing. These numbers do increase slightly but not astronomically with age, to 38%, 33%, and 60%, respectively among those aged 85 or more years. Also of interest are sex differences in oral health and sensory loss, including the fact women have poorer dental health (men: 26% versus women: 29%) and vision (men: 16% versus women: 19%) while men have greater hearing loss than women (men: 47% versus women: 30%) (Federal Interagency Forum on Aging-Related Statistics, 2004). The situation is not nearly as bad as Shakespeare would have us believe and in most cases technological advances, e.g., eye glasses, dentures, and hearing aids, significantly offset these losses. Still another age stereotype is that older people, especially older women, are not or should not be interested in sex. While physical and psychological disability may impede sexual functioning, this does not necessarily translate into a lack of interest in sexual expression. Most older people report being able to adjust adequately to any age-related physical changes that could limit sexual activity. Here, life span continuity seems to be key to sexual expression in the later years. Those who had an active sex life as younger people usually report that they continue to enjoy an active, if somewhat limited, sexual life. One problem, however, especially among women, is lack of available partners. Heterosexual men are disproportionately married in old age, whereas heterosexual women are disproportionately widowed or divorced. Coupled with men’s likelihood of dying at an earlier age, this means that a partner may no longer be available to older heterosexual women. A similar problem may occur for older lesbians, particularly those living in small towns and rural areas. Although some lesbians sustain long-term committed relationships, others lead a single lifestyle. Lesbians (and gay men) may also be subjected to the same ageist pressures to look and act youthful as are elders who prefer opposite-sex relationships (Connidis, 2006). Regardless of sexual orientation, then, lack of a partner, rather than physical disabilities, seems to be the cause of disrupted sexual activity, reduced satisfaction with sexual activity, and increased sense of isolation and loneliness (Calasanti & Slevin, 2001).

Age and Cognitive Functioning Many people are concerned about deteriorating cognitive functioning in the later years of life. One indicator of cognitive capacity is memory. Because much of the gerontological cognition research has focused on memory impairment, we use memory as an illustrative example. Interestingly, although some memory functioning declines with age, significant impairment occurs within a relatively small portion of the total over-65 population (12%). The proportion with serious memory loss increases very gradually with age (65–69 years: 5%; 70–74 years: 8%, 75–79 years: 14%, 80–84 years: 18%; 85 or more years: 32%) with only the oldest-old (85+) group having a significant portion with extensive memory impairment. Interestingly, although the pattern is similar for men and women,

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men consistently show greater memory impairment than women (Federal Interagency Forum on Aging-Related Statistics, 2004).

Age and Mental Health It was previously assumed that increasing age is inevitably associated with greater psychological distress. Although this can be true in some situations (because aging is often accompanied by significant losses) it is incorrect and unfair to categorize all older persons as having significant psychological challenges (Denmark, 1999). Quite the contrary, research has consistently shown the situation to be much more complicated. Campbell (1980) found that younger people were less satisfied with life than older people and 25 years later Mroczek and Spiro (2005), using a unique longitudinal study of men, found that life satisfaction peaked around 65 and then began to show a slight but steady decline. Field’s (1997) re-examination of data from the Berkeley Older Generation Study (a 60-year longitudinal investigation of men and women) showed that respondents rated the decades of their 20s, 30s, 50s and 60s equally satisfying, indicating that as they aged, their life satisfaction was stable. The respondents rated their childhood as the least satisfying life period. These findings suggest that as persons enter later life, they do not necessarily experience psychological distress. In fact, many women, especially those in the middle class, perceive aging as a release from unpleasant traditional domestic roles and stressful role conflict. These women report being pleasantly surprised by the emergence of a sense of freedom and a new, more confident, self (Stoller & Gibson, 1999). On the other hand, the physical changes associated with age are often accompanied by dissatisfaction. A consideration of the intersection of body image, gender and age is noteworthy. A significant literature (Calasanti & Slevin, 2001) indicates general body dissatisfaction among White women of all ages but much less dissatisfaction among African American and Hispanic women or among the lower as compared to the upper and middle class. Multimillion-dollar industries including cosmetics, elective plastic surgeries, and diet and exercise programs have developed to offset these body image dissatisfactions. Interestingly, rather than becoming less prevalent with age or across gender, among the middle class these interventions are being increasingly utilized by older as well as younger people, men as well as women. Clearly, the physical aspects of aging are associated with dissatisfaction for some, many of whom are choosing to confront that dissatisfaction with direct physical interventions. A prevalent myth regarding older women and mental health is that depression is very common. This is reinforced frequently by media personnel and others in society who often portray older women as lonely, sad widows, living sedentary lives. The research evidence is not entirely consistent. Feinson (1985) compiled comparison studies of the psychological health of young and old adults. Results indicated that most (N = 10) of the studies revealed no age difference in distress levels while many (N = 8) found that younger adults experienced significantly more distress than older adults. A more recent review of the research on the prevalence of depression among older persons also failed to find a more frequent incidence among older adults than among other age groups. In fact, Kessler and associates (2004) found that the psychological

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health of women tends to improve as they age. In addition, Weil (2007) found that women aged 75 to 84, and particularly those aged 85 and older, are less depressed than those aged 65 to 74. Akiyama and Antonucci (2002) examined a regionally representative Midwestern sample and found that gender did not predict depression among those over 65 years of age, although it did in younger groups. Apparently, depression declines with age, as does the higher level of depression among women. Indeed, Jones and Meredith (2000), using data from the Berkeley Growth Study mentioned above, examined longitudinal data of people from 14 to 62 years of age and found that the psychological health of women tends to improve as age. Older women showed fewer negative emotions and more emotional control than younger women. However, it should be noted that this issue remains controversial, with cross-sectional data often yielding different findings than longitudinal. Specifically, the former suggest higher levels of depression for successively older groups and the latter indicate decreased depression and smaller gender differences with aging. Many positive events can occur at this stage of older women’s lives, including becoming a grandmother, enjoying reduced parental and housekeeping demands, freedom from work stresses after retirement, and pursuing new personal goals (Denmark, 1999). These events and options can offset some of the difficulties, such as increased caregiving, older women might experience with aging. Older women in general accept their lives as having been wellspent, productive, and worthwhile (Hubbs-Tait, 1989). Nevertheless, some older people are depressed or have other psychological problems. Contrary to stereotype, however, psychological interventions can be administered successfully to older adults and are as effective as with younger persons (e.g., Nordhus, Vandenbos, Berg, & Fromholt, 1998; Qualls & Knight, 2006). It is important to understand that mental health problems do not intensify over time for most older persons (Denmark, 1999). As with other aspects of aging, mental health is influenced by racial/ethnic status and cultural background, the effects of which accumulate over the life course (Chisholm & Greene, 2007; Denmark, Rabinowitz, & Sechzer, 2005).

Cultural Influences Traditional American culture stresses strength and beauty but these are not necessarily the dominant values of other cultures. In contrast, other cultures, such as those in the Near and Far East, stress aging as a process that intensifies wisdom. These groups revere older persons for their experience and guidance (Brugman, 2006). For instance, in Indian cultures, younger generations generally look up to and respect older people and seek advice from them (Khanna, 2003). Other cultural traditions might clash with American values, implying potential adjustment difficulty for immigrants. For example, a recent report indicated that on average 50% of married women in India between the age of 15 and 49 are victims of beating, rape, or coerced sex, with the percentage being even higher, around 70%, in some rural areas (Burton, Duvvury & Varia, 2000). Given the high rates of immigration into the U.S., it is important to recognize that immigrants may adhere to the values and traditions common to their heritage regarding older persons and aging long after immigrating to the

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U.S. (Simpson, 2005). From a mainstream American vantage point, these values and traditions may be positive (e.g., the expectation of wisdom and respect with age) or negative (e.g., the acceptance of violence within marriage). Culture also influences health. Perceptions and definitions of typical experiences for women vary around the world. For instance, although difficulties associated with menopause are common in the U.S., women of high social castes in India rarely report negative symptoms of menopause, and hot flashes are extremely rare among Mayan women (Etaugh, 2007). Japanese women are also much less likely than Western women (i.e., from the U.S. and Canada) to have hot flashes (Antonucci & Akiyama, 2004; Etaugh & Bridges, 2006). These women may be more likely to exhibit menopausal symptoms once they become part of the U.S. culture. Similarly, while hypertension is rare among African Americans living in Africa, it is a major health problem among men and women of African descent living in the United States. Researchers have suggested that this difference is caused by the stressful life circumstances of racial discrimination experienced in the United States. Older women from minority groups must cope with the multiple intersecting challenges associated with racial or ethnic status, gender, age, and preference for same-sex intimate relationships. Research on lesbians in the U.S. (Anetzberger, Ishler, Mostade, & Blair, 2004), Canada (Brotman, Ryan, & Cormier, 2003), and Great Britain (Pugh, 2005) alike shows that they are more subject to discrimination in receipt of social services and less likely to have their health care needs met adequately than are heterosexual women. Socioeconomic status influences women’s aging experience, especially those from racial ethnic minority groups, because many are from poorer backgrounds. Black and Hispanic women often fare less well as they age than White women because they are likely to be poor and lack many advantages that could make aging processes easier (Denmark et al., 2005). At the same time, they might experience some advantages to which White women are not privy. In African American cultures, for instance, grandmothers play a significant role in childrearing and women are frequently a focal point of the family (Brown, Caldwell & Antonucci, 2008; Taylor, Jackson & Chatters, 1997). Similarly, in Native American cultures, women’s age and wisdom are revered. Also, Native American women report more satisfaction with their lives and greater enjoyment in spending time with older persons than do their European American counterparts (Comas-Diaz & Greene, 1994). Overall, diversity and culture should be examined when discussing older persons because they influence how background characteristics affect life experiences and aging processes. As we have illustrated, there are many misconceptions about women’s physical and mental health experiences in later life. This suggests the need for ongoing attention to the quality of health care services available to them. High quality, culturally sensitive, and comprehensive treatment should be available regardless of women’s insurance status or ability to pay for services. Given the striking gender imbalance in the over-60 population, not to mention women’s preeminent role as caregivers, better health services targeted particularly to older women are needed, with a parallel increase in training programs devoted to the preparation of both clinicians and researchers who work with this population. Recent research has suggested that social relations play an important role in mental and physical health (Berkman, 1986; Cohen, 2004; Uchino, 2004);

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this appears to be increasingly true in the later years (Antonucci, 2001; Shaw, Krause, Liang & Bennett, 2007). In the following section, we consider the significance of social relationships for older women’s well being.

Older Women’s Social Relationships It is widely accepted that women’s family and friendship relationships are considerably different from those of men. As simple as this assertion might seem, it is not absolutely clear that it is true and if true, the nature and meaning of these differences are not well understood. While it seems clear that there are some gender differences in social relations, there are many similarities. Women’s and men’s relationship experiences are influenced by many factors including culture, ethnicity, race, sexual orientation, income, education, occupation, and religion (Antonucci & Jackson, 2003). Understanding the nature of gender similarities and differences in social relations is complicated but several relatively simple principles are helpful. First, close social relationships tend to be long lasting and continuous, often spanning major portions of the life span (Antonucci, 2001). It is useful to think of family and friendships as cumulative in the sense that later experiences often build upon earlier ones. Hence, infants securely attached to their mothers have a much better chance of having a good relationship with their mother as an adult, and there is a strong possibility, though not a certainty, that the same infant will have better relationships with peers and other individuals in adulthood (Kasser, Koestner, & Lekes, 2002; McCarthy, 1999; Möller & Stattin, 2001). In most cultures, individuals grow and develop within a core group or convoy of close social relationships. This convoy is committed to maximizing their safety and security as well as helping them achieve optimal health and wellbeing (Antonucci, 2001). Personal and situational characteristics influence the composition of the convoy. This point might be clearest in the consideration of different cultures. For example, among traditional Japanese families (and this is changing in modern Japan), women joined the household of their husbands when they married, and if they married the eldest son they were expected to live with and care for his parents in their old age. This sharply contrasts with the U.S., where daughters are more likely to be the caregivers of their parents, regardless of whether or whom they marry (Akiyama, Antonucci, & Campbell, 1997). Culture and religion influence social relationships when groups mandate that social relationships are restricted to relatives or to members of the group. In the United States, socioeconomic differences in social relations have been documented, indicating that people of lower socioeconomic levels have dense social relations which are predominantly family oriented. This may be due to their lack of leisure time or the lack of geographic mobility among people from lower socioeconomic groups (Ajrouch, Blandon, & Antonucci, 2005).

Social Networks Social relations include at least three dimensions: social networks; social support; and support quality, with each dimension making unique contributions to life circumstances and well-being. Network or structural aspects of social relations refer to the objective characteristics of the people in the individual’s social

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network (e.g., the number, age, sex, relationship, and proximity of network members). These characteristics have been associated with well-being. Also, relationship roles are often reciprocal. Thus, a woman who is a wife has a husband or a partnered lesbian has a lover, a daughter or son has a parent, a mother or father has a child, and so on. Because of this reciprocity, a great deal of similarity occurs in the structural characteristics of men’s and women’s networks (Antonucci, 1994). At the same time, there are several general differences. For example, because women live longer than men and are less likely to remarry after being widowed or divorced or find a new partner after losing a lesbian lover, women are less likely than men to be married or partnered. This is increasingly so as women get older. In contrast, women tend to have more friends, especially close friends, than do men and this continues to be true into old age.

Social Support Another important aspect of social relations is social support. This refers to the actual exchange of goods and services, the amount of support provided and received. Types of support exchanged include aid or tangible support, affect or emotional support, and affirmation or moral support. Men and women generally claim equal amounts of support, although interesting differences emerge within specific relationships. For example, husbands and wives generally report giving and receiving equal amounts of support in spousal exchanges (Acitelli & Antonucci, 1994). On the other hand, women report receiving more support from their children than men do. Friendship relationships also suggest interesting differences. Women feel they both give and receive more support in friend relationships than do men (Crohan & Antonucci, 1989).

Support Quality A final dimension of social relations is the quality of the relationship. Women are more likely than men to report that their close relations, including with both family and friends, make too many demands on them and get on their nerves. It has been argued that women both benefit more from and are burdened more by their social relations (Akiyama, Antonucci, Takahashi, & Langfahl, 2003; Antonucci, Lansford, & Akiyama, 2001). These findings suggest an interesting view of gender differences in social relations. Apparently women take a different, though not necessarily better, view of their relationships. They feel more involved, responsible, and burdened by relationships than do men. If a network member has a problem, women seem to be more personally affected by the problem and to feel more responsible for helping the person solve that problem. Men, on the other hand, while concerned about the problems of others, do not assume personal responsibility for helping them solve their problems. Because often not much can be done to solve another person’s problems, the latter perspective might be psychologically healthier (Antonucci & Akiyama, 1987).

Social Support and Well-Being Another interesting area of inquiry that provides important insights into the nature of social relationships for men and women has to do with the

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effect of social relations on well-being. In a recent study of resilience among older people (>65), Fuller Iglesias, Sellars, and Antonucci (2008) found that those with larger networks and both higher positive and lower negative spousal relationship quality were less depressed and more satisfied with life. In general, women are more affected by their social relations than men. One study of older couples (Acitelli & Antonucci, 1992) asked both husbands and wives what support they provided to and received from their spouse. Findings indicate that wives’ well being, including both their marital and general life satisfaction, was significantly influenced by the amount of support they provided to and received from their husbands. In contrast, for their husbands, there was no significant relationship between the amount of support they provided to or received from their wives and their marital or life satisfaction. One of the most important aspects of social relations is the degree to which they can help individuals cope with the challenges they face in life, that is, the degree to which individuals are protected by or made more vulnerable by their social convoy. Predictably, higher quality social relations tend to be associated with better physical and mental health. Of special interest, however, is the buffering effect of social relations on well being, that is, the degree to which social relations help people cope with stressful life events. Although a classic finding in the literature is that people of lower socioeconomic status have poorer health, some studies have shown that this link can be attenuated if the individual has high quality social relations (Antonucci, Ajrouch, & Janevic, 2002). Such buffering effects suggest that women who are or feel stigmatized for any reason (e.g., gender, sexual preference, disability, race, class) or who face stressful life transitions can offset the negative consequences they might otherwise experience with strong social relations. Although the vast majority of studies on social support in old age do not assess characteristics of social support in relation to elders’ sexual preference, or implicitly assume heterosexuality among the research participants, recent reviews of older lesbians’ support needs and resources are available in Herdt and de Vries (2004) and Gabbay and Whaler (2002). In the next section, we consider some key life events of older people. We discuss transitions experienced by both men and women, but focus particular attention on how these transitions are experienced by older women.

Later-Life Transitions The life span developmental perspective on aging processes and outcomes suggests that transitions across the adult years bring both losses and gains. More effort toward regulation of losses may be needed in the later years as physical and social resources diminish (Baltes, Freund, & Li, 2005). Thus, some of the common events of the later years, such as retirement from a lifetime of work and uncoupling due to separation, divorce, or widowhood, pose special challenges requiring adaptation and compensation in the context of, perhaps, limited resources. Other events and situations, such as pursuing employment or volunteering and dating or remarriage/repartnering, may reflect social and other kinds of gains that contribute to resiliency in the later years.

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Retirement Given the high proportion of women aged 55 to 64 in the labor force (57% in 2006) and the relatively low rate of employment among women over 65 years of age (11%, U.S. Department of Labor, 2007a), more women than ever will be making the transition from employment to retirement. Life course patterns of paid work and retirement are generally more varied for women than for men because more of the former never enter the work force, work part-time, take time off for child-rearing then return to full- or part-time employment later on, or retire early to care for aged relatives (Beehr & Adams, 2003). Women’s marital status and finances influence their work and retirement trajectory more than men’s. For example, never-married, divorced, and widowed women without private pensions retire later than married women. Also, low-income women retire later than those with more financial resources and are more likely to pursue employment after retiring (Brown, Jackson, & Faison, 2007; Hogan, Perrucci, & Wilmoth, 2000). Adjustment to retirement depends on health, financial security, personal resources, and social support (Kim & Moen, 2001). Although retirement per se usually does not affect health, some women retire because of poor health or experience health decline as post-employment years go by. Many people look forward to pursuing activities of their own choosing in retirement, so health conditions that produce pain or limit activities can interfere with retirement satisfaction. Older women are less likely than older men to have adequate pensions and are more likely to live in poverty. In addition, women belonging to racial ethnic minority groups are more likely than White women to be poor (Administration on Aging, 2006). Thus, inadequate financial resources and worry over the costs of basic necessities and health care can also limit options in retirement and reduce psychological well being. On the other hand, Brown, Jackson and Faison (2006) have shown that among lower income African Americans access to a pension or retirement benefits can represent a particularly stable and, therefore, positive income period and thus be associated with positive well-being. Having high educational attainment, positive attitudes toward retirement, a sense of self-efficacy, and good self-esteem are examples of personal resources that contribute to retirement adjustment (Kim & Moen, 2001). Another is being a partner in a high-quality marriage or romantic partnership, which can help buffer the transition out of employment (Mutran, Reitzes, & Fernandez, 1997). Although both women and men possess these characteristics, men’s greater socioeconomic advantages accumulate over the life course, frequently enabling them to have more personal control regarding life choices and sources of life satisfaction in old age than women do (Moen & Spencer, 2006). Older women may be more advantaged than older men, however, when it comes to social resources that contribute to satisfaction in retirement. Women typically sustain strong family and friend ties throughout life (Blieszner & Adams, 1992; Connidis, 2001), and may be better positioned than men to have sources of companionship and support in retirement beyond their spouses or partners. Indeed, retired women who are childless, never-married, divorced, and widowed are less isolated than their male counterparts (Connidis, 2001).

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Working and Volunteering An increasing number of older adults work full- or part-time after retirement (Hardy, 2006). Some opt for continued employment mainly as a way of structuring time, sustaining cognitive stimulation and social ties, and staying active in the community. Likewise, many older adults engage in community volunteer work for similar reasons, with women more likely to volunteer than men (31% of women 55 to 64 years old and 25% of those 65 or older compared with 25% of men aged 55 to 64 years and 23% aged 65 or more years, U.S. Department of Labor, 2007b). Remaining productive by working, volunteering, and contributing to family life enhances quality of life and psychological well being among elders (Butler, 2005; Morrow-Howell, Hinterlong, Rozario, & Tang, 2003), suggesting the potential for developmental gain through these activities in late life. But for women who must remain employed in old age because of lifetime economic disadvantages and ongoing caregiving responsibilities, including the unexpected need to rear grandchildren, continued employment reflects social structural disadvantage, not a matter of choice or preference (Estes, 2005). These women may have little time for volunteering and may find work stressful and unhelpful to their psychological well being.

Uncoupling Among women who marry or have a marital-like romantic relationship (who comprise the majority of adult women), widowhood, separation, and divorce usually encompass multiple kinds of losses. Not only must women in these circumstances cope with the end of a close relationship, gender-based economic disadvantages render them vulnerable to significant decline in financial status (Estes, 2005). Older women, in particular, may experience loss of personal identity, especially if their self-identity was grounded mainly in the role of wife, as well as reduced physical and mental well being due to stress associated with grief, money worries, and other difficulties (Connidis, 2001; Ferraro, 2001; Lucas, Clark, Georgellis, & Diener, 2003). Women’s greater longevity than men’s, and their tendency to marry someone older than themselves, means that married women are highly likely to become widowed in middle or old age. About 28% of women aged 55 years and older are widowed, compared to 8% of men (U.S. Census Bureau, 2007a), and the proportion of widowed women escalates sharply with age to 43% of those 65 and older and 76% of those 85 and older, compared to 13% and 33% of men, respectively (U.S. Census Bureau, 2007b). Multiple characteristics and circumstances influence women’s adjustment to widowhood. Those who had been caring for frail or ill spouses for a long time may have come to accept the impending loss before it happened. They may be grateful their spouses are no longer suffering and relieved to be free of caregiving despite feeling intense grief. Widows of spouses or partners who died suddenly do not have the opportunity to prepare for their loss and must cope with many changes simultaneously. In either case, the health of those who become widowed can be harmed either by the demands of long-term caregiving or the stress associated with a sudden, unplanned event. Loss of a significant role and changes

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in other relationships, such as feeling left out of couple activities, take their toll on physical and mental health. Nevertheless, most widows recover from their bereavement and resume involvement in social activities after a year or two of more intense mourning (Ferraro, 2001; Hansson & Stroebe, 2007). Also, women are more advantaged than men when it comes to coping with the practical aspects of running their household, engaging in social interaction with family and friends, and maintaining the independent living status that elders prefer (Blieszner, 1993). Separation and divorce are less common among the current cohort of older adults than among younger people, but the rate has risen in recent times (Connidis, 2001). Thus, about 2% of women and men aged 55 years and older were separated in 2006. Comparable data for divorce are 13% of women and 11% of men (U.S. Census Bureau, 2007b). Older wives are more likely to initiate divorce than older husbands. Their reasons include relationship disillusionment such as falling out of love, boredom, or infidelity; personal change and a wish for a better life; verbal, physical, or emotional abuse by the spouse; and spousal substance abuse (Wu & Schimmele, 2007). Although being the initiator of divorce, having higher income, and dating or having romantic prospects are predictors of divorce adjustment for both women and men, it may be more difficult for older persons to adjust to divorce than younger ones because they had invested more in their marriages and have fewer chances for dating and remarriage (Wang & Amato, 2000). Adjustment is also affected by loneliness, social isolation, and depression. Older women are more likely than older men to have inadequate finances after divorce. Overall, though, most people who divorce in late life are satisfied with their decision (Wu & Schimmele, 2007).

Recoupling The same longevity differential that disadvantages older women with respect to widowhood also disadvantages them with respect to recoupling after latelife widowhood or divorce. That is, older women have fewer potential dating and marriage partners than older men do, and indeed, they are much less likely to remarry. Those who do pursue dating and remarriage have opportunities to counteract divorce- and widowhood-related losses with social and emotional gains. Remarriage for women, though, might threaten their personal and family economic standing if it means they would lose their previous spouse’s pension or shift their children’s inheritance to the new spouse’s offspring (Connidis, 2006). Older adults express mixed feelings about dating. On the one hand, unpartnered elders enjoy freedom from being accountable to someone else and having opportunities to pursue their own schedule and activities, arrange their belongings as they wish, and the like. On the other hand, many are interested in dating and, for some, in living with another person because they seek companionship and want to have fun with someone special, avoid loneliness, and share expenses (Connidis, 2006). This interest is not as prevalent among women as among men, however. An interesting developing phenomenon is “living apart together.” This is a new, emerging trend which to some represents the best of both worlds. Individuals consider themselves to be in a committed relationship but maintain separate households. It permits each individual

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to maintain the household and lifestyle they prefer, while enjoying the companionship of another (Levin, 2004). According to Carr’s (2004) research on widowed persons, widows were initially much less likely than widowers to express interest in dating but with time the difference decreased considerably suggesting that social norms about appropriate expressions of grief may have influenced widows’ earlier responses. Note, however, that emotional support from friends reduced both widows’ and widowers’ interest in dating, suggesting that multiple relationships can supply companionship and emotional support. Few older adults express interest in remarriage (Carr, 2004; Connidis, 2006) and the rate of remarriage after divorce and widowhood has declined in recent decades. Given that divorce usually occurs earlier in life than widowhood, it is not surprising that divorced persons are more likely to remarry than widowed persons. Also, many older widows who cared for a frail or ill husband are reluctant to risk resumption of the caregiving role (Connidis, 2001). As with dating, older women are much less likely than men to express interest in remarriage during the first six months of widowhood; although this gender difference diminishes with time. Again, receiving support from friends reduces interest in remarriage for both women and men (Carr, 2004). For those who do remarry in late life, happiness and success are typically high. Remarriage satisfies women’s desire for emotional attachment and companionship. It may also promote better relationships with their children by reducing children’s worry about their mothers being alone. As with younger couples, support from family and friends contributes to marital satisfaction among elders who are remarried (Connidis, 2001). In summary, research on late-life transitions shows that women who are disadvantaged by a lack of personal and social resources are more vulnerable to adjustment difficulties after retirement or widowhood, especially if they must struggle with poverty or poor health. Many women are resilient in the face of difficulties, however, and use life transitions as opportunities to create new circumstances and opportunities for themselves, pursue social relationships and interests with vigor, and continue along a positive developmental trajectory. One source of resilience for many persons is their spirituality, which may be manifested in beliefs and practices associated with a particular religious tradition as well as in other forms. Spirituality is often identified as a unique source of inspiration and strength in current cohorts of older adults, particularly among older women. In the following section we highlight some of the key findings on spirituality in old age, with a focus on experiences of older women.

Spirituality Gender comparisons show that older women report higher levels of religiosity than older men (Gatz & Fiske, 2003). Religious faith, public and private religiosity, and religious coping enable older persons to garner social support, reduce distress, and interpret the meaning of life and life events (Marcoen, 2005). Ethnographies probing the meaning of religion and spirituality to older women have identified several common themes. These include the importance

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of community, connectedness, caring, and congregational involvement for older women’s spiritual and psychological well being (Eldred, 2003; Melia, 2001; Moreman, 2004–2005; Ramsey & Blieszner, 1999; Stuckey, 1997). For example, women aged 65 or more years in the U.S. and Germany revealed several nuanced aspects of the value of community. Group participation was meaningful to them specifically because it occurred within the context of a spiritual community. “Community” was more a world of meaning than a form of social activity, reflecting deep friendships, both practical and religious assistance, love, safety, power for social action, strength through ritual and symbolism, and the place where a full range of human emotions is affirmed and accepted. For these women, their faith had a strong element of relationality along with their more abstract theological beliefs. They described their coping strategies as anchored within faith communities, demonstrated comfort with a wide range of emotions along their spiritual journeys, and shared ways in which they have attempted to practice their religion within the complicated context of family and other relationships. The results point to the importance of reframing questions about religion and aging from a focus on “How can a person cope with stress and multiple losses through religion?” to “How can people living their faith in family and community grow stronger and more resilient?” (Ramsey & Blieszner, 1999). More specifically, religious practices such as prayer and Bible study can reduce the risk of depression and other deleterious outcomes associated with poor health and stressful life events (Gatz & Fiske, 2003). For example, widowed women, who are at risk for elevated depressive symptoms and physical illness, have reported that involvement in church activities, prayer, and religious coping strategies enabled them to deal with difficulties in their lives. These aspects of religiosity provide a means of sustaining important friendships, receiving needed support, and playing meaningful roles as contributors to their communities (Michael, Crowther, Schmid, & Allen, 2003; Neill & Kahn, 1999; Noone & Guarino, 2003). Thus, although older women face various late-life hardships, those with religious beliefs and spiritual practices find their faith helps them to remain as strong and resilient as possible. Women’s experience of age is influenced by several factors including religion, social relations, and mental and physical health. These characteristics, in turn, are influenced by life circumstances, many of which vary by culture and country. Thus, a comprehensive feminist assessment of the conditions of older women’s lives includes attention to experiences of those from across the globe. In the final section of our chapter, we provide an international perspective on older women’s lives.

Psychology of Older Women From an International Perspective Demographics The number and percent of older people around the globe is increasing substantially (Antonucci, Okorodudu, & Akiyama, 2002). Today, one person in 10 is 60 years or older. By 2025, more than one billion individuals over the age of

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60 will be living, comprising one third of the population of countries such as Japan, Germany, and Italy (World Health Organization, 2002). While aging is of growing importance in more developed countries, it is even more so in less developed countries (World Health Organization, 2002), particularly in Asia and Africa. Seventy percent of all older people around the globe live in less developed areas and again, this proportion is expected to increase in the coming decades. In more developed nations, an increase in the average lifespan and in the proportion of older adults normally occurs only after an overall increase in the average level of affluence, typically over the span of several generations. In less developed countries, the graying of the population occurs much more rapidly. For example, the World Health Organization (2002) noted that while the proportion of older people in France doubled from 7% to 14% over a period of 115 years, the same increase will occur in China in just 27 years, less than a quarter of the previous period. In West Africa, the older population is projected to increase from 10 million in 1999 to 59 million in 2050. The average annual increase in the proportion of oldest old persons (those over 80 years of age) predicted between 2000 and 2050 will be about 4.4% in countries such as China, India, and Mexico, as compared to 2.2% in Europe and North America. As in the U.S., the majority of the older population world-wide is female. Growing older has many more implications for women than men because of the gender gap in longevity. In fact, women outnumber men at every segment of the older population, which is a direct result of higher death rates for men (Himes, 2008). Therefore, most older women of today will outlive their spouses and confront the challenges of later life independently. An international perspective is important because it provides a broad view of the diversity of older women’s roles and experiences. Some global issues affect women regardless of their country of origin and others are inherent to the culture and mores of a given region. Limiting psychological understanding to findings based on the stories and perspectives of older women in the U.S. or taking a Eurocentric position on aging matters both ignore the numerous global issues affecting women and the unique experiences of particular subgroups. Women across the world, regardless of ethnicity and country of origin, must negotiate being a woman in their specific social context. Analyzing the effects of these contexts can yield rich and important information for teaching, research, and professional practice in psychology.

Family Life The concept of family and women’s role in the family system also vary across cultures (Etaugh, 2007). Living with one’s extended family is much more common outside the U.S. and intergenerational ties may be stronger in other countries than commonly found in the U.S. For example, grandparents have a place of high esteem in other cultures. A study in rural Gambia found that the presence of a maternal grandmother doubles the survival rate of toddler grandchildren (Angier, 2002; Douglass & McGadney-Douglass, 2008). HelpAge (2007) reported that older women are the backbone of AIDS care in many areas of the world, but their role as caregivers in this context is frequently overlooked. At the same time, traditional support structures in many countries are

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eroding both because of rural-to-urban migration and the high rate of AIDSrelated deaths among younger family members. In fact, due to the devastating effect of HIV/AIDS on families throughout the world, many older women are increasingly acting as caregivers for family members affected by this disease (Ahmed Obaid, 2006). Analysis of violence within the family system must also be extended to a global perspective. Older women belong to an age group that is tightly linked to violence, including sexual violence, especially in areas of high conflict throughout the world (Ahmed Obaid, 2006). Although under-recognized in the developed world, the rates of elder abuse and mistreatment appear to be much higher in the developing world e.g., from as low as 14% to as high as 45% (Daichman, 2005). Depending on the culture, rituals considered to be acts of violence within Western societies are standard practice elsewhere. For instance, among Nigerian communities in Africa it is common for a widow to have her head shaved, to refrain from sitting on chairs during the mourning process, to be unable to claim any inheritance (unless there is a will), and to be secluded for a period of time (Kalu, 2004). These practices of widowhood have special implications for older women in areas where the men may die earlier than usual due to disease or violence. Older women may be participants in and perpetrators of violence against women as well as victims. Female genital mutilation in Africa, a practice of partially or totally removing the female external genitalia for nontherapeutic reasons, is conducted by women (older women, midwives, or birth attendants) and the girl’s mother and grandmother make arrangements for the procedure (Baron & Denmark, 2006). Rondon (2003) reports that women are placed in positions of lesser power in Latin American countries as well. The family as a structural unit is often based on patriarchy, with the male having a dominant position, and the female having a chaste and self-denying one. Violence within this family system springs from this form of gender inequality. Larrain (1993) reported that 26% of women surveyed from a representative sample in Santiago stated that they suffered at least one incident of violence in their lives. This violence does not stop when women mature and enter old age. In fact, the pattern of violence within the patriarchal system has already been established and it continues throughout a women’s lifetime. In Asian families, research is mixed concerning economic vulnerability of older women. Ofstedal, Reidy, and Knodel (2004) conducted a study of Asians 60 years or older and found that the men in the study were more likely to have higher levels of income than women, however, they found few gender differences in asset ownership, or reports of subjective economic well-being. The authors report that this is mostly due to the fact that many of these men and women were living in multigenerational households where they receive help and income from their family members. The family unit therefore is very important when discussing the lives of older women from this region of the world. One of the contributing factors to mixed results is that Asia is a large area of the world, comprising different countries, that, although related culturally, still can be quite distinct. Furthermore, according to Mason (1992), Asian families can be conceptualized in two different types: Patriarchal/ patrilineal systems found in East Asia and the northern tier of South Asia, and

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the bilateral systems found in Southeast Asia and the southern tier of South Asia (Mason (1992). In bilateral systems, elderly mothers are likely to receive as much care and economic support as fathers receive. However, in traditional patriarchal systems, the economic security of elderly women is far more tenuous. In parts of Southeast Asia, there is a longstanding tradition of women being vital parts of the labor system and holding property.

Implications On the international level, older women have increasingly been recognized as important assets and contributors to their societies, especially as caregivers to its most vulnerable members (Aboderin, 2005; Safir & Hill, 2007), although cultural differences have been under-recognized. In the U.S., the American Psychological Association adopted the Resolution on Gender and Cultural Awareness in International Psychology in 2004. One of the overall goals of this resolution is to encourage all psychologists to be culturally aware and culturally sensitive (Rice & Lykes, 2006). While this kind of statement is meant as a gesture of support and understanding from a Western organization, nevertheless, many women in less developed countries feel unfairly judged by Western societies. Often they feel that Western women do not understand them, and therefore, do not identify with what they perceive to be foreign aspirations, goals, and values. This kind of disconnect among women around the world leaves unrecognized the many assets and vulnerabilities of women in different life circumstances. Having an international, culturally sensitive perspective is also important with respect to older women in the U.S, as many of these women are from minority cultural groups or are immigrants from other countries. As noted earlier, the older population is becoming more racially and ethnically diverse (Himes, 2008). In 2000, about 84% of older adults were non-Hispanic Whites; in 2050 the proportion will drop to 64% (Himes, 2008). As the population of older adults becomes increasingly diverse, it is critical for psychologists to become better informed about the influence of culture on their psychological experiences. Fortunately, and in part due to psychologists working with nongovernmental organizations, the United Nations recognizes the importance of increasing both the status of older women worldwide and awareness of their contributions and needs: The former Secretary General, Kofi Annan, has offered his support and noted that countries around the world “need to recognize the different impact of ageing on women and men, to ensure full equality between them, and to integrate both a gender perspective and an age perspective into legislation, policies, programmes, and efforts to eradicate poverty” (Annan, 2005, p. 4). Agencies such as the United Nations must promote and ensure that countries are following standards that protect and provide for older women. United Nations initiatives such as the Declaration on the Elimination of Violence Against Women, the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), and Resolution 1325 which supports women as peace builders and protects them against gender-based violence are important steps (Sandis, 2006).

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Summary In this chapter, we reviewed the experience of aging from a variety of perspectives. We provided information about both men and women but focused particularly on the situation of women in the later years. As noted, demographic trends are fundamentally changing the population distribution in the U.S. and around the world. We considered empirical evidence concerning the physical and mental health of older people, noting both that older men and women are typically not as ill as generally assumed and that most older people spend many years without major illnesses. Of particular interest are the social relations of older people, especially women, because these relations strongly influence health and well being. We stressed, too, that men and women experience social relationships differently. Adaptation and adjustment to late-life transitions among older people in the U.S. were considered, as was the important role of spirituality in fostering resilience. We also provided a broader perspective on aging by including a brief but, hopefully informative, consideration of aging around the world. Globally it is noteworthy that women, especially older women, are important resources for their families and communities. Nevertheless, we also noted that women often are the recipient of what we labeled gendered ageism, wherein women are negatively stereotyped for reasons of both gender and age. Unfortunately, this sometimes extends to elder abuse and mistreatment. We noted, too, that feminists, with very few exceptions, have essentially ignored older women. Whether this is a result of ageism or simply a glaring oversight is not clear. Women comprise the majority of elders in the U.S. and other countries, yet remain a vulnerable group who deserve increased attention, care, and recognition. We hope that in the future feminist scholars will recognize, defend, embrace, and celebrate the older women in their lives.

References Aboderin, I. (2005). Changing family relationships in developing nations. In M. L. Johnson (Ed.), The Cambridge handbook of age and ageing (pp. 469–476). Cambridge, England: Cambridge University Press. Acitelli, L., & Antonucci, T. C. (1994). Gender differences in the link between marital support and satisfaction in older couples. Journal of Personality and Social Psychology, 67, 688–698. Administration on Aging. (2006). A profile of older Americans: 2006. Washington, DC: Author. Ahmed Obaid, T. (2006, October). Improving the quality of life for older persons: Advancing UN global strategies. Keynote Speech, International Day of Older Persons, United Nations, New York. Ajrouch, K. J., Blandon, A., & Antonucci, T. C. (2005). Social networks among men and women: The effects of age and socioeconomic status. Journal of Gerontology: Social Sciences, 60, S311–S317. Akiyama, H., & Antonucci, T. C. (2002). Gender differences in depressive symptoms: Insights from a life span perspective on life stages and social networks. In J. A. Levy & B. A. Pescosolido (Eds.), Social networks and health (Vol. 8, pp. 343–358). Greenwich, CT: Elsevier Science. Akiyama, H., Antonucci, T. C., & Campbell, R. (1997). Exchange and reciprocity among two generations of Japanese and American women. In J. Sokolovsky (Ed.), Cultural context of aging: Worldwide perspectives (2nd ed., pp. 127–138). Westport, CT: Greenwood Press.

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Akiyama, H., Antonucci, T. C., Takahashi, K., & Langfahl, E. S. (2003). Negative interactions in close relationships across the lifespan. Journal of Gerontology: Psychological Sciences, 58B, P70–P79. Anetzberger, G. J., Ishler, K. J., Mostade, J., & Blair, M. (2004). Gray and gay: A community dialogue on the issues and concerns of older gays and lesbians. Journal of Gay and Lesbian Social Services, 17, 23–45. Angier, N. (2002, November 5). The importance of grandma. New York Times, pp. D1–D4. Annan, K. (2005, October). Poverty reduction strategies with and for older persons. Welcoming Remarks, International Day of Older Persons, United Nations, and New York. Antonucci, T. C. (1994). A life span view of women’s social relations. In B. F. Turner & L. E. Troll (Eds.), Women growing older (pp. 239–270), Thousand Oaks, CA: Sage. Antonucci, T. C. (2001). Social relations: An examination of social networks, social support and sense of control. In J. E. Birren & K. W. Schaie (Eds.), Handbook of the psychology of aging (5th ed., pp. 427–453). New York: Academic. Antonucci, T. C., & Akiyama, H. (1987). An examination of sex differences in social support among older men and women. Sex Roles, 17, 737–749. Antonucci, T. C., & Akiyama, H. (2004). Aging and culture. Encyclopedia of applied psychology (Vol. 1., pp. 105–110). Amsterdam: Elsevier. Antonucci, T. C., & Jackson, J. S. (2003). Ethnic and cultural differences in intergenerational social support. In V. L. Bengtson & A. Lowenstein (Eds.), International perspectives on families, aging and social support (pp. 355–370). New York: Aldine de Gruyter. Antonucci, T. C., Lansford, J. E., & Akiyama, H. (2001). The impact of positive and negative aspects of marital relationships and friendships on well-being of older adults. Applied Developmental Science, 5, 68–75. Antonucci, T. C., Ajrouch, K. J., & Janevic, M. R. (2002). The effect of social relations with children on the education-health link in men and women aged 40 and over. Social Science and Medicine, 56, 949–960. Antonucci, T. C., Okorodudu, C., & Akiyama, H. (2002). Well-being among older adults on different continents. Journal of Social Issues, 58, 617–626 Baltes, P. B., Freund, A. M., & Li, S.-C. (2005). The psychological science of human ageing. In M. L. Johnson (Ed.), The Cambridge handbook of age and ageing (pp. 47–71). Cambridge, England: Cambridge University Press. Barker, J. (2004). Lesbian aging: An agenda for social research. In G. Herdt & B. de Vries (Eds.), Gay and lesbian aging: Research and future directions (pp. 29–72). New York: Springer Publishing Company. Baron, E. M., & Denmark, F. L. (2006). Female genital mutilation. In F. L. Denmark, H. H. Krauss, E. Halpern, & J. A. Sechzer (Eds.), Violence and exploitation against women and girls (pp. 339–355). Boston: Blackwell Publishing. Beehr, T. A., & Adams, G. A. (2003). Concluding observations and future endeavors. In G. A. Adams & T. A. Beehr (Eds.), Retirement: Reasons, processes, and results (pp. 293–298). New York: Springer. Berkman, L. G. (1986). Social networks, support, and health: Taking the next step forward. American Journal of Epidemiology, 123, 559–562. Blieszner, R. (1993). A socialist-feminist perspective on widowhood. Journal of Aging Studies, 7, 171–182. Blieszner, R., & Adams, R. G. (1992). Adult friendship. Newbury Park, CA: Sage. Brotman, S., Ryan, B., & Cormier, R. (2003). The health and social service needs of gay and lesbian elders and their families in Canada. The Gerontologist, 43, 192–202. Brown, E. E., Caldwell, C. H. & Antonucci, T. C. (2008). Religiosity as a moderator of family conflict and depressive symptoms among African American and White young grandmothers. Journal of Human Behavior and the Social Environment, 18, 397–413. Brown, E. E., Jackson, J. S., & Faison, N. A. (2006). The work and retirement experiences of aging Black Americans. In K. W. Schaie (Series Ed.) & J. B. James & P. Wink (Vol. Eds.), Annual review of gerontology and geriatrics: Vol. 26. The crown of life dynamics of the early postretirement period (pp. 39–60). New York: Springer. Brugman, G. M. (2006). Wisdom and aging. In J. E. Birren & K. W. Schaie (Eds.), Handbook of the psychology of aging (6th ed., pp. 445–476). New York: Academic. Burton, B., Duvvury, N., & Varia, N. (2000, May). Domestic violence in India: A summary report of a multi-site household survey. Washington, DC: International Center for Research on

253

254


Women [ICRW], (Domestic Violence in India No. 3/USAID Cooperative Agreement No. FAO–A–00–95–00030–00). Butler, R. N. (2005). Do longevity and health generate wealth? In M. L. Johnson (Ed.), The Cambridge handbook of age and ageing (pp. 546–551). Cambridge, England: Cambridge University Press. Calasanti, T. M. (2005). Is feminist gerontology marginal? Contemporary Gerontology, 11, 107–111. Calasanti, T. M. & Slevin, K. F. (2001). Gender, social inequalities, and aging. Walnut Creek, CA: Alta Mira Press. Campbell, A. (1980). A sense of well-being in America. New York: McGraw-Hill. Carr, D. (2004). The desire to date and remarry among older widows and widowers. Journal of Marriage and Family, 66, 1051–1068. Carstensen, L. L., & Freund, A. (1994). The resilience of the self. Developmental Review, 14, 81–92. Carstensen, L. L., & Hartel, C. R. (Eds.). (2006). When I’m 64. Washington, DC: National Academies Press. Chisholm, J., & Greene, B. (2007). Women of color: Perspectives on “multiple identities” in psychological theory, research and practice. In F. Denmark & M. Paludi (Eds.), Handbook of the psychology of women (pp. 40–69). Westport, CT: Greenwood Press. Cohen, S. (2004). Social relationships and health. American Psychologist, 59, 676–684. Comas-Diaz, L. & Greene, B. (Eds.). (1994). Women of color: Integrating ethnic and gender identities in psychotherapy. New York: Guilford Press. Connidis, I. A. (2001). Family ties and aging. Thousand Oaks, CA: Sage. Connidis, I. A. (2006). Intimate relationships: Learning from later life experience. In T. M. Calasanti & K. F. Slevin (Eds.), Age matters: Realigning feminist thinking (pp. 123–153). New York: Routledge. Crohan, S. E., & Antonucci, T. C. (1989). Friends as a source of social support in old age. In R. G. Adams & R. Blieszner (Eds.), Older adult friendship: Structure and process (pp. 129–146). Newbury Park, CA: Sage Publications. Cutler, S. J., & Hendricks, J. (2001). Emerging social trends. In R. H. Binstock & L. K. George (Eds.), Handbook of aging and social sciences (5th ed., pp. 462–480). San Diego: Academic Press. Daichman, L. S. (2005). Elder abuse in developing nations. In M. L. Johnson (Ed.), The Cambridge handbook of age and ageing (pp. 323–332). Cambridge, England: Cambridge University Press. Denmark, F. L. (1999, July). Older women’s lives: Myths and realities. La Psicologia Al Fin Del Siglo, Proceedings of the Interamerican Society for Psychology, 73–85. Caracas, Venezula. Denmark, F. L., Rabinowitz, V. C., & Sechzer, J. A. (Eds.). (2005). Engendering psychology. Boston: Pearson. Douglass, R. L., & McGadney-Douglass, B. (2008).The role of grandmothers and older women in the survival of children with kwashiorkor in urban Accra, Ghana. Research in Human Development. 5, 26–43. Eldred, J. (2003). Like spring without flowers: Why older women and churches need each other. Derby, England: Mental Health Association Care Group. Estes, C. L. (2005). Women, ageing, and inequality: A feminist perspective. In M. L. Johnson (Ed.), The Cambridge handbook of age and ageing (pp. 552–559). Cambridge, England: Cambridge University Press. Etaugh, C. A. (2007). Women in the middle and later years. In F. Denmark & M. Paludi (Eds.), Handbook of the psychology of women (pp. 271–302). Westport, CT: Greenwood Press. Etaugh, C. A., & Bridges, J. S. (2006). Women’s lives: A topical approach. Boston: Allyn & Bacon. Federal Interagency Forum on Aging-Related Statistics. (2004, November). Older Americans 2004: Key indicators of well-being. Washington, DC: U.S. Government Printing Office. Feinson, M. C. (1985). Aging and mental health: Distinguishing myth from reality. Research on Aging, 7, 155–174. Fernandez-Ballesteros, R. (2002). Social support and quality of life among older people in Spain. Journal of Social Issues, 58, 645–660.

Chapter 8


Ferraro, K. F. (2001). Aging and role transitions. In R. H. Binstock & L. K. George (Eds.), Handbook of aging and the social sciences (5th ed., pp. 313–330). San Diego: Academic. Field, D. (1997). Looking back, what period of your life brought you the most satisfaction? International Journal of Aging and Human Development, 45, 169–194. Friedan, B. (1993) The fountain of age. New York: Simon & Schuster. Gabbbay, S. G., & Whaler, J. J. (2002). Lesbian aging: Review of a growing literature. Journal of Gay and Lesbian Social Services, 14, 1–21. Gatz, M., & Fiske, A. (2003). Aging women and depression. Professional Psychology: Research and Practice, 34, 3–9. Gist, Y. J., & Hetzel, L. I. (2004). We the people: Aging in the United States. Census 2000 special reports. Washington, DC: U.S. Census Bureau Hamarat, E., Thompson, D., Steele, D., Matheny, K., & Simons, C. (2002). Age differences in coping resources and satisfaction with life among middle-aged, young-old, and oldestold adults. Journal of Genetic Psychology, 163, 360–367. Hansson, R. O., & Stroebe, M. S. (2007). Bereavement in late life: Coping, adaptation, and developmental influences. Washington, DC: American Psychological Association. Hardy, M. (2006). Older workers. In R. H. Binstock & L. K. George (Eds.), Handbook of aging and the social sciences (6th ed., pp. 201–218). Amsterdam: Elsevier. HelpAge. (2007, November). New reports highlight impact of HIV and AIDS on older people. Retrieved from http://helpage.org/Home Herdt, G., & de Vries, B. (Eds.). (2004). Gay and lesbian aging: Research and future directions. New York: Springer. Himes, C. L. (2008). Elderly Americans. Aging 07–08, 2–6. Hogan, R., Perrucci, C. C., & Wilmoth, J. M. (2000). Gender inequality in employment and retirement income: Effects of marriage, industrial sector, and self-employment. In V. Demos & M. T. Segal (Eds.), Social change for women and children (Advances in gender research, vol. 4, pp. 27–54). Stamford, CT: JAI. Hubbs-Tait, L. (1989). Coping patterns of aging women: A developmental perspective. In J. D. Garner & S. O. Mercer (Eds.), Women as they age: Challenge, opportunity, and triumph, (pp. 95–117). Binghamton, NY: Haworth. Jones, C. J., & Meredith, W. (2000). Developmental paths of psychological health from early adolescents to later adulthood. Psychology and Aging, 15, 351–360. Kalu, W. J. (2004). Violence against women in Africa: Impact of culture on womanhood. In L. L. Adler & F. L. Denmark (Eds.), International perspective on violence (pp. 185–207). Westport, CT: Praeger. Kasser, T., Koestner, R., & Lekes, N. (2002). Early family experiences and adult values: A 26-year, prospective longitudinal study. Personality and Social Psychology Bulletin, 28, 826–835. Kessler, R. C., et al. (2004). Age and depression in the MIDUS survey. In O. G. Brim, C. D. Ryff, & R. C. Kessler (Eds.), How healthy are we? A national study of well being at midlife (pp. 227–251). Chicago: University of Chicago Press. Khanna, J. (2003). Cultural contrasts in views about ageing and death between east and west. In R. Roth, L. Lowensein, & D. Trent (Eds.), Catching the future: Women and men in global psychology (pp. 248–257). Berlin: Pabst Science. Kim, J. E., & Moen. P. (2001). Is retirement good or bad for subjective well-being? Current Directions in Psychological Science, 10, 83–86. Levin, I. (2004). Living apart together: A new family form. Current Sociology, 52, 223–240. Levy, B. R. (2001). Eradication of ageism requires addressing the enemy within. The Gerontologist, 41, 578–579. Lucas, R. E., Clark, A. E., Gergellis, Y., & Diener, E. (2003). Re-examining adaptation and the set-point model of happiness: Reactions to changes in marital status. Journal of Personality and Social Psychology, 84, 527–539. Maddox, G. L., Atchley, R. C., & Poon, L. W. (1987). The encyclopedia of aging. New York: Springer. Marcoen, A. (2005). Religion, spirituality, and older people. In M. L. Johnson (Ed.), The Cambridge handbook of age and ageing (pp. 363–377). Cambridge, England: Cambridge University Press. McCarthy, G. (1999). Attachment style and adult love relationships and friendships: A study of a group of women at risk of experiencing relationship difficulties. British Journal of Medical Psychology, 72, 305–321.

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Melia, S. P. (2001). Solitude and prayer in the lives of elder Catholic women religious: Activity, withdrawal, or transcendence? Journal of Religious Gerontology, 13, 47–63. Michael, S. T., Crowther, M. R., Schmid, B., & Allen, R. S. (2003). Widowhood and spirituality: Coping responses to bereavement. Journal of Women and Aging, 15, 145–165. Moen, P., & Spencer, D. (2006). Converging differences in age, gender, health, and well-being: Strategic selection in the third age. In R. H. Binstock & L. K. George (Eds.), Handbook of aging and the social sciences (6th ed., pp. 127–144). Amsterdam: Elsevier. Möller, K., & Stattin, H. (2001). Are close relationships in adolescence linked with partner relationships in midlife? A longitudinal, prospective study. International Journal of Behavioral Development, 25, 69–77. Moremen, R. D. (2004–2005). What is the meaning of life? Women’s spirituality at the end of the life span. Omega: Journal of Death and Dying, 50, 309–330. Morrow, D. F. (2001). Older gays and lesbians: Surviving a generation of hate and violence. Journal of Gay and Lesbian Social Services, 13, 151–169. Morrow-Howell, N., Hinterlong, J., Rozario, P. A., & Tang, F. (2003). Effects of volunteering on the well-being of older adults. Journal of Gerontology: Social Sciences, 58, S137–S145. Mroczek, D. K. & Spiro, A., III (2005). Change in life satisfaction during adulthood: Findings from the Veterans Affairs Normative Aging Study. Journal of Personality and Social Psychology, 88,189–202. Mutran, E. J., Reitzes, D. C., & Fernandez, M. E. (1997). Factors that influence attitudes toward retirement. Research on Aging, 19, 251–273. Nelson, T. D. (Ed.). (2005) Ageism: Prejudice against our feared future self. Journal of Social Issues, 61(2). Neill, C. M., & Kahn, A. S. (1999). The role of personal spirituality and religious social activity on the life satisfaction of older widowed women. Sex Roles, 40, 310–329. Noone, M. E., & Guarino, A. B. (2003). Widows’ spiritual journeys: Do they quest? Journal of Religious Gerontology, 14, 119–138. Nordhus, I. H., VandenBos, G. R., Berg, S., & Fromholt, P. (Eds.) (1998). Clinical geropsychology. Washington, DC: American Psychological Association. Ofstedal, M. B., Reidy, E., & Knodel, J. E. (2004). Gender differences in economic support and well-being of older Asians. Journal of Cross-Cultural Gerontology, 19, 165–201. Palmore, E. B. (1999). Ageism: Negative and positive. New York: Springer. Pasupathi, M., & Löckenhoff, C. E. (2002). Ageist behavior. In T. D. Nelson (Ed.), Ageism: Stereotyping and prejudice against older persons (pp. 201–246). Cambridge, MA: MIT Press. Pugh, S. (2005). Assessing the cultural needs of older lesbians and gay men: Implications for practice. Practice, 17, 207–218. Qualls, S. H., & Knight, B. G. (Eds.). (2006). Psychotherapy for depression in older adults. Hoboken, NJ: John Wiley & Sons. Ramsey, J. L., & Blieszner, R. (1999). Spiritual resiliency in older women: Models of strength for challenges through the life span. Thousand Oaks, CA: Sage. Rice, J. K., & Lykes, M. B. (2006). Cultural gender awareness in international psychology. International Psychology Bulletin, 10, 12. Safir, M., & Hill, K. (2007). International aspects of the development of the psychology of women and gender. In F. Denmark & M. Paludi (Eds.), Handbook of the psychology of women (pp. 70–90). Westport, CT: Greenwood Press. Sandis, E. (2006). UN measures to stop violence against women. In F. L. Denmark, H. H. Krauss, E. Halpern, & J. A. Sechzer (Eds.), Violence and exploitation against women and girls (pp. 370–383). Boston: Blackwell Publishing. Simpson, A. R. (2005). Cultural issues and elder mistreatment. Clinics in Geriatric Medicine, 21, 355–364. Shaw, B. A., Krause, N., Liang, J., & Bennett, J. (2007). Tracking changes in social relations throughout late life. Journal of Gerontology: Social Sciences, 62B(2), S90–S99. Slevin, K. F. (2006). The embodied experiences of old lesbians. In T. M. Calasanti & K. F. Slevin (Eds.), Age matters: Realigning feminist thinking (pp. 247–268). New York: Routledge. Sontag, S. (1972) The double standard of aging. Saturday Review of the Society, 39, 29–38. Stoller, E. P., & Gibson, R. C. (Eds.). (1999). Worlds of difference (3rd ed.). Thousand Oaks, CA: Sage.

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Stuckey, J. C. (1997). A community of friends: The Sunday school class as a conduit for social contacts and social support among older women. Journal of Religious Gerontology, 10, 53–71. Taylor, R. J., Jackson, J. S., & Chatters, L. M. (1997). Family life in Black America. Thousand Oaks, CA: Sage. Uchino, B. N. (2004). Social support and physical health: Understanding the health consequences of relationships. New Haven, CT: Yale University Press. U.S. Census Bureau. (1997). Aging in the United States: Past, present and future (wall chart). Retrieved January 22, 2008, from http://www.census.gov/ipc/prod/97agewc.pdf U.S. Census Bureau. (2007a, June). Older adults in 2005. Washington, DC: Author. Retrieved November 30, 2007, from http://www.census.gov/population/pop-profi le/dynamic/ OLDER.pdf U.S. Census Bureau. (2007b, July). Current population survey, annual social and economic supplement, 2006. Washington, DC: Author. Retrieved November 20, 2007, from http:// www.census.gov/population/socdemo/age/2006older_table2.xls U.S. Department of Labor, Bureau of Labor Statistics. (2007a). Women in the labor force: A databook (Rep. 1002). Washington, DC: Author. Retrieved November 30, 2007, from http://www.bls.gov/cps/wlf-databook-2007.pdf U.S. Department of Labor, Bureau of Labor Statistics. (2007b, January 10). Volunteering in the United States, 2006 (News, USDL 07–0019). Retrieved November 30, 2007, from http:// www.bls.gov/rofod/1480.pdf Wang, H., & Amato, P. (2000). Predictors of divorce adjustment: Stressors, resources, and definitions. Journal of Marriage and the Family, 62, 655–668. Weil, J. (2007). Social class and depression: A study of older women with functional limitations living in the community. Dissertation Abstracts, 67 (3–A), 1172. World Health Organization. (2002). International plan of action on ageing: Report on implementation. Executive Board, 115th Session, Provisional agenda item. Wu, Z., & Schimmele, C. M. (2007). Uncoupling in late life. Generations, 31(3), 41–46.

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III Health and Therapy


9 Diversity and Women’s Mental Health

Nancy Felipe Russo

Challenging bias in the development, diagnosis, treatment, and prevention of women’s mental health problems emerged as an early theme for feminist psychology in the 1970s (American Psychological Association [APA] 1973, 1975, 1978). Ethnic diversity in mental health did not receive much attention initially (see Russo & Landrine, Chapter 1). This reflected a variety of factors, including an early focus on the practice of psychotherapy (APA, 1975, 1978), which primarily served middle-class White women as consumers (see Worell & Johnson [2001] for a more complete historical discussion). As feminist psychology evolved, however, diversity became increasingly salient (Adlemann & Enguidanos, 1995; Brown & Root, 1990; Comas-Díaz & Greene, 1994; Davis, Cole, & Rothblum, 1993; Greene, 2000; Kitzinger & Perkins, 1993; Landrine, 1992; Russo, 1985; Shum, 1996; Willie, Rieker, Kramer, & Brown, 1995). In 1978, the President’s Commission on Mental Health (PCMH) convened separate subpanels to address special populations, including women, ethnic minorities, and physically handicapped populations. The report of the Subpanel on the Mental Health of Women (1978) emphasized the importance of addressing the mental health effects of women’s social inequalities, stating “the mental

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health implications of the pervasive sexism that impacts … women of all ages, socioeconomic and racial/ethnic groups in our society must receive priority attention in policy formation and program implementation” (PCMH Subpanel, 1978, p. 1025). Subsequently, APA supported a national conference to develop a women’s mental health agenda that incorporated diverse women in every working group as well having a separate group devoted to special populations of women (Russo, 1985). These efforts had a common message, one that persists albeit in a more sophisticated and nuanced form today: Existing knowledge is inadequate for understanding gender differences in the etiology, diagnosis, treatment, and prevention of mental disorder. In building the needed knowledge base, it was considered essential to understand “the interaction of gender, ethnicity, social class, and other social categories that affect women’s lives and create multiple realities for women” (Russo, 1995, p. 374). When the National Conference on Education and Training in Feminist Psychology (Boston Conference) convened in 1993, diversity was clearly recognized as a critical component of feminist practice, with practice encompassing not only therapy, but also assessment, research, training, teaching, and curriculum development (Worell & Johnson, 1997). A crude but concrete indicator of the sea change that has occurred in attention to diversity and mental health concerns is the increasing number of publications identified for different time periods in PsycINFO keyword searches for this chapter. For the keywords “diversity + mentalhealth,” no relevant articles were identified previous to 1972; from 1972 to 1996, 30 publications were identified, including the announcement for a new journal, Cultural Diversity and Mental Health1 (Comas-Díaz, Griffith, Pinderhughes, & Wyche, 1995). From 1997 to the present, 152 publications were identified, including APA guidelines for multicultural education, training, research, practice, and organizational change for psychologists (APA, 2003). Similarly, when keywords “ethnic women and mental health” were used, the comparable figures were none, 32, and 75. For “lesbians and mental health,” the figures were none, 63, and 142; for “older woman and mental health,” none, 27, and 28; for “women and disability,” 1, 40, 190. Although the keyword search strategies were not comprehensive and should not be used to compare levels of attention across different types of groups, they do provide evidence of a substantial increase in work related to diverse populations over the past decades. The increasing attention to diversity and the concomitant demand for change in the practice of psychology is also reflected in the publication of a variety of APA publications designed to foster change. These include APA’s Guidelines on Physical and Social Accessibility (APA, 1982), Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (APA, 1990), Professional Practice Guidelines for Psychotherapy with Lesbian, Gay and Bisexual Clients (APA, 2000), Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (APA, 2003), Guidelines for Psychological Practice with Older Adults (APA, 2004), and the incorporation of diversity into APA’s Guidelines for Psychological Practice with Girls and Women (APA, 2007). A common theme in these efforts is the need to view mental health in its social/political context, with emphases on examining power inequities and social control mechanisms at home, at work, and in therapeutic relationships

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Diversity and Women’s Mental Health

(Brown, 2008a). In particular, feminists have focused on social conditions and unequal power relations experienced by women that increase risk for mental disorder, conditions that vary among diverse women across national boundaries. Around the world, such conditions include prejudice and discrimination, hunger, malnutrition, overwork (with women’s work lowly paid and often under dangerous conditions), inadequate educational and economic resources, gender-based violence (including sexual abuse and partner violence), and social disruption leading to displaced populations (including migration due to insufficient economic opportunity, social conflict and war, and natural disaster) (Cabral & Astbury, 2000; Demyttenaere et al., 2004). In particular, the relationship of women’s power and social status to risk for depression is evidenced by the link between rates of depressive symptoms with indicators of gender inequality that has been found cross-nationally (Arrindell, Steptoe, & Wardle, 2003), as well as within nations by regions (urban versus rural) and between states within the United States (Chen, Subramanian, Acevedo-Garcia, & Kawachi, 2005). In keeping with a concern for power inequities and with the principles of the Boston Conference (Greene & Sanchez-Hucles, 1997; Worell & Johnson, 1997), there has been an increasing shift of theoretical focus in feminist psychology from disorder to resilience and empowerment, and the development of a large body of literature that reflects a view of counseling and therapy as a means to counter oppression (e.g., Arredondo, 1999; Ballou, Hill, & West, 2008; Brown, 2008a; Gutierrez & Lewis, 1999; Kinsel, 2005; O’Leary & Bhaju, 2006; Korell & Lorah, 2007; Rabin & Slater, 2005; Sanchez-Hucles & Gamble, 2006; Worell, 2001; Wyche & Rice, 1997). This theme is expressed in the development of empowerment models that require understanding of stereotypes and how they function as well as the psychological and social environments within which women’s development takes place (e.g., McKay et al., 2007; Worell & Remer, 2003). Thus, today feminist therapy is conceptualized as taking a multicultural biopsychosocial approach, one that often encompasses meaning-making and spiritual concerns, and considers a woman in her social context (Brown, 2008a; see Enns & Byars-Winston, Chapter 13 in this volume for a more in-depth discussion of multicultural models of feminist therapy). To foster empowerment and resilience in clients requires an understanding of the client’s sociopolitical context, which varies with social difference. Multicultural knowledge and skills thus are essential for effective feminist practice. This chapter considers gender’s relation to mental health, the relation of gender to stress and coping among diverse women, and selected genderrelated factors experienced by diverse women that have implications for mental health, with a focus on stigma, prejudice, discrimination, and gender-based violence. It is hoped that this work will serve as a catalyst for conducting the future research needed to achieve a more complete understanding of how gender shapes mental health outcomes of diverse women.

Gender and Its Relation to Mental Health Understanding gender’s complex relationship to mental health requires challenging traditional biomedical conceptions of mental health, crossing

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interdisciplinary boundaries, and asking questions at multiple levels and from multiple perspectives, including the individual, the family, society, and culture (Hamilton & Russo, 2006; Russo & Tartaro, 2008; Wyche, 2001). As seen in the work represented in the other chapters of this book, today feminist psychologists are pursuing a more sophisticated and in-depth examination of gender in relation to diverse women’s development, roles, and life circumstances (Landrine & Russo, Chapter 1, this volume). Nonetheless, the struggle to develop more complex theoretical formulations that will increase understanding of difference and diversity continues. Theorizing how multiple dimensions of difference interact to affect women’s mental health and well-being requires recognizing “(1) no social group is homogenous, (2) people must be located in terms of social structures that capture the power relations implied by those structures, and (3) there are unique, nonadditive effects of identifying with more than one social group” (Stewart & McDermott, 2004, pp. 531–532). Consequently, at the same time that we consider gender-related factors that can affect diverse women’s mental health, we must also keep in mind that women will vary in their response to such factors, and that variance in women’s responses will both reflect their position in the social structure as well as how they integrate or engage their multiple social identities. Gender can be conceptualized as a cultural package of many interconnected elements that influence mental health and well-being separately as well as in combination (see Landrine & Russo, Chapter 1). These elements include gendered emotions, identities, values, expectations, norms, roles, environments, and institutions. Gender defines what is considered “normal” and appropriate behavioral, psychological, and social characteristics for males and females at different stages of their lives, and shapes personal and social identities. Roles assigned by gender may have lower power and status, leading to structured inequalities that translate into health disparities—in mental health status as well as health care (Russo & Tartaro, 2008). Gender operates at psychological, social, and situational levels. Violations of stereotypes and gender role expectations may lead to stigmatization, marginalization, and discrimination, with implications for mental health (Hamilton & Russo, 2006). For example, the relations of gender and race to mental health are affected by experiences of sexism and racism (Moradi & Subich, 2003; Thomas, Witherspoon, & Speight, 2008); likewise, the relationship of sexual orientation to mental health is affected by stigma and victimization associated with homosexuality (Herek & Garnets, 2007). Consequently, advancing understanding of gender’s relation to mental health must consider the complex interplay among biological, psychological, social, and contextual factors, including the interplay of multiple identities, social locations and conditions, and coping strategies (Brown, 2008b; Szymanski & Kashubeck-West, 2008). Keeping these concepts in mind, the remainder of this chapter summarizes selected recent research concepts and findings that can inform understanding of the relation of women’s diversity to their mental health outcomes. After a brief overview of epidemiological findings on gender and ethnic differences in patterns of mental disorder and a consideration of stress and coping perspectives, selected risk factors and life events that contribute to the development and expression of psychological disorder among diverse groups of women are considered, with a special focus on stigma, prejudice, and discrimination and

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gender-based violence. It is hoped that this selective summary of concepts and findings will foster an increased appreciation of the complexity and importance of addressing diversity issues in theory and research as well as in psychological education, training, and practice.

The Epidemiological Picture Large and complex gender differences in patterns of mental health disorder have been found in national and community surveys and in service delivery statistics (Kessler, Chiu, Demler, & Walters, 2005; Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993). Based on the National Comorbidity Survey, Kessler et al. (2005) identified gender differences in six classes or patterns of disorder (presented by level of severity) among adults 18 years or older: (1) unaffected respondents (higher among men); (2) pure internalizing disorders (higher among women); (3) pure externalizing disorders (higher among men); (4) comorbid internalizing disorders (higher among women); (5) comorbid internalizing and/or externalizing disorders dominated by comorbid social phobia and attention-deficit/hyperactivity disorder (higher among women); and (6) highly comorbid major depressive episodes (higher among women). No gender difference was found in a seventh class, highly comorbid bipolar disorder. High comorbidity was associated with severity—classes with the highest comorbidity (4, 6, 7) included about 7% of the sample, but represented 43.6% of the serious cases. With regard to gender differences in internalizing disorders (#2, #4, & #6 above), it has long been known women have higher rates mood and anxiety disorders (Silverman & Carter, 2006), and that anxiety is comorbid with depression, particularly for women (Breslau et al., 1995). Symptoms of anxiety disorders are correlated with other disorders as well, complicating diagnosis. In particular, research is needed that clarifies the origins and relationships among symptoms of anxiety and depressive disorders, which constitute the largest contributor to the gender gap in internalizing disorders. Unfortunately, epidemiological studies all too often will report differences by race/ethnicity or by gender, but do not simultaneously examine race/ ethnicity and gender. This reflects a standard approach for large data sets: to report global findings first and then follow up with analyses of subpopulation differences. The absence of interactive effects should be ascertained before such reports are issued to avoid errors in generalization and the creation of misperceptions. Epidemiological analyses must become more detailed as well as sensitive to methodological limitations if they are not to be Eurocentric and misleading. Further, rates and predictors of mental disorder can vary substantially within subpopulations (e.g., Chinese Americans versus Vietnamese Americans) of difference categories (Greene & Sanchez-Hucles, 1997). A national survey of Latinos and Asian Americans (Alegría et al., 2007), revealed that among the 4 Latina subethnic groups studied, Mexican heritage women were less likely than Puerto Rican women to have a depressive disorder, and Puerto Rican women had the highest overall lifetime and past-year prevalence rates compared to other women. Thus, global summaries of community surveys or

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service utilization data can mask important interactive effects of gender, ethnicity, and diagnosis on the development, diagnosis, course, and treatment of mental disorders. Given the history of androcentrism in psychology (Bem, 1994), in interpreting epidemiological findings it should be kept in mind that just because women may have lower rates of externalizing disorders than men doesn’t mean that the experiences of women and girls with regard to such disorders are unimportant or that gender has little influence on a particular disorder’s development, course, and outcomes. For example, girls are less likely to have conduct problems than boys, but regardless of gender, children with conduct problems are at risk for negative physical and mental health consequences, including alcohol and substance abuse (Bardone, Moffitt, Caspi, Dickson, & Silva, 1996). Girls with conduct problems are also more likely to violate gender norms than other girls by initiating sex at an earlier age, being more likely to engage in risky sex, and having more sexual partners than other girls (Ramrakha, Caspi, Dickson, Moffitt, & Paul, 2000; Serbin, Peters, McAffer, & Schwartzman, 1991). It is important to look beyond gender’s impact on rates and examine its effects on the development, course, and context of mental disorders among diverse women. For example, this is seen in the finding that diagnoses of depression and anxiety are more likely to be found together for women while depression and substance abuse are more likely to be paired for men. The extent to which this difference reflects a gender difference in pathways to depression versus diagnostic bias requires investigation. Research on the patterns of being depressed found in women’s daily experiences suggests that women may be more likely to experience short-term depressive episodes than men, possibly reflecting their day-to-day experience with life stressors (Kessler, 2006). How diversity influences the pathways identified in research that homogenizes women has yet to be determined. The variation in the magnitude of gender differences in health outcomes across U.S. racial/ethnic groups, underscores the importance taking diversity into account in clinical studies (Read & Gorman, 2006).

Service Delivery, Diagnosis, and Treatment The potent influences of social and cultural variables on mental health are reflected in gender differences in diagnosis and treatment. It is estimated that each year, 60% of individuals in the United States with a mental disorder go untreated, with this gap widest among the elderly, racial-ethnic minorities, individuals with low incomes, those who are uninsured, and who live in rural areas (Wang et al., 2005). Stigma, cultural beliefs, cultural norms with regard to expressing psychological distress and help seeking, diagnostic practices, treatment accessibility, and preference for alternative forms of treatment vary by gender and ethnicity and contribute to gender and ethnic differences in utilization statistics (Snowden & Yamada, 2006). Such differences underscore the importance of understanding the relationship of social and cultural factors to diagnosis, treatment, and delivery of mental health services to women. Regardless of ethnicity, when a gender difference in rates of mental disorder is found, the difference is in the direction of congruence with gender

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stereotypes and role expectations (Landrine, 1988, 1989). As noted above, around the world, higher rates of anxiety and mood disorders are found in women, whereas higher rates of substance and antisocial disorders are found for men (Alonso et al., 2004; Kessler et al., 2005; Klose & Jacobi, 2004; WHO, 2000). Further, for disorders incongruent with gender stereotypes and society’s female gender role expectations (such as alcoholism), women have been invisible and neglected. As Lopez (1989) pointed out more than two decades ago, diagnostic bias can come in multiple guises: overpathologizing (inappropriately perceiving patients whose behavior violates gender and ethnic norms as more disturbed), overdiagnosis (inappropriately applying a diagnosis as a function of group membership), and underdiagnosis (inappropriately avoiding application of a diagnosis as a function of group membership). Marecek (2001) uses the term “dangerous diagnoses” to refer to diagnostic categories that serve to reinforce the sexist, racist, and classist status quo by labeling women who violate heterosexist White middle-class gender role norms as mentally ill. These include nymphomania, hysteria, kleptomania, neurasthenia, masochism, and erotomania. The latter diagnosis gained wide public visibility when it was attributed to Anita Hill when she testified in the Senate hearings in conjunction with the confirmation of Clarence Thomas to the Supreme Court of the United States. For a discussion of the treatment of homosexuality, borderline personality, and masochism, as well as the enduring legacy of racism in the development and application of psychiatric diagnoses, see Kutchins and Kirk (2003). Both excessive and inappropriate drug treatment have been major issues, particularly for older women (Russo, 1995). There are many reasons for women to be given prescriptions for psychotropic drugs at higher rates than men, including gender differences in age, physical illnesses, psychiatric disorders, help seeking that leads to exposure to the medical system (thereby resulting in more prescriptions), and stressful life events (Hamilton, 1995). The influence of stereotyping may also be reflected in the finding that women are more likely than men to be given psychotropic drugs, while being less likely to receive vocational rehabilitation (Mowbray, Nicholson, & Bellamy, 2003). Cumulative adversity in childhood, including poverty and childhood physical and sexual abuse, have been linked to subsequent onset of multiple physical and mental health and substance use problems, complicating the task of diagnosis (Bair-Merritt, Blackstone, & Feudtner, 2006; Kendler et al., 2000; Molnar, Buka, & Kessler, 2001; Schilling, Aseltine, & Gore, 2008). Misdiagnosis of posttraumatic stress disorder due to sexual abuse, rape, or battering as clinical depression as well as misdiagnosis of borderline personality disorder are of particular concern (Russo & Tartaro, 2008).

Stress and Coping Perspectives: Considering Mental Health Outcome in Context That there is a relation between adversity, stress, and mental health outcomes is undisputed (Dohrenwend, 1998). The relation of cumulative adversity to mood and anxiety disorders has been documented in men and women across ethnic groups with demographic factors controlled (Turner & Lloyd, 2004).

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Unfortunately the intersecting impact of gender, ethnicity, and social class on mental health remained inadequately investigated, despite the fact that the strength of the relation of socioeconomic status to health outcomes varies across ethnic groups (Gold et al., 2006). From a stress and coping perspective, “isms” (e.g., sexism, racism, heterosexism) that confer stigma and justify prejudice and discrimination can be conceptualized as sources of both acute and chronic stress (Hwang & Goto, 2008; Klonoff, Landrine, & Campbell, 2000). Such stress takes a heavy toll on the physical and mental health of women and racial/ethnic and sexual minorities (e.g., Gee, Spencer, Chen, Yip, & Takeuchi, 2007; Hwang & Goto, 2008; Klonoff, Landrine, & Campbell, 2000; Miller & Major, 2000; Paradies, 2006). The goal now is to understand the mechanisms and processes that mediate and moderate negative mental health outcomes in response to stressful and negative events in the lives of diverse women. Stress and coping models have been applied to understand how genderrelated stressors and negative life events in diverse women’s lives—particularly sexist, racist, and other stigma-related events—undermine mental health and well-being (Moradi and DeBlaere discuss this literature in Chapter 6, this volume). A host of psychological and sociocultural factors have been found to foster resilience in the face of stress, including positive emotions, humor, optimism, spirituality, appraisals of meaning, social support, and active coping (Southwick & Vythilingam, 2005). In considering this complex interplay of stress and coping processes, the intersections of gender with other dimensions of social difference mean that the relation of gender to mental health may differ depending on one’s specific mix of social identities. When identities involve stigma, lead to prejudice and discrimination, and confer differential access to power and privilege, they may intersect with gender to magnify or diminish risk for developing mental health problems (Chishom & Greene, 2008; Fassinger & Arsneau, 2008). The mechanisms by which such intersections affect exposure to negative life events (e.g., exposure to physical and sexual violence, death of a parent or loved one, unwanted childbearing, illness), as well as access to psychological and social coping resources (collective self-esteem; social support) may differ depending on the particular combination of identities and the ability of individuals to shift among them. For example, African American women’s religious identity may be reflected in their use of Africentric coping styles, increasing the likelihood they will seek balance between physical, psychological, collective, metaphysical, and spiritual realms and to rely on family and the community, cooperation, belief in hard work, responsibility, achievement, and religious beliefs and rituals, including prayer, among other things (Utsey, Adams, & Bolden, 2000; Utsey, Ponterotto, Reynolds, & Cancelli, 2000). The centrality of women’s family roles, particular for women with a cultural heritage that emphasizes collective values, compounds effects of negative life events related to family roles, including family conflicts and role overload, intimate partner violence, and pressures related to care of dependent family members, old and young (Russo & Tartaro, 2008). Being a wife, mother, or caretaker can influence the relation between negative life events and trauma responses. For example, women who are wives and mothers have been found to be at higher risk for poorer mental health outcomes after natural

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disaster compared to other women, and marital status is a risk for women but not for men (Norris et al., 2002). Feelings and cognitions that are congruent with women’s gender roles, such as helplessness and emotional distress, may be more pronounced in cultures with traditional conceptions of those roles (Baker et al., 2005). For example, in a study of survivors of natural disaster, the gender gap in rates of PTSD was greater in the Mexican sample than the U. S. sample (Norris et al., 2001). How elements of the sociocultural context interact to increase risk for mental disorder among diverse populations may vary with the disorder considered. For example, after controlling for age, education, and presence of other specific disorders, marital dissatisfaction has been found to be uniquely related to major depression and PTSD for women, and dysthymia for men (Whisman, 1999). This complexity is also illustrated by work by Weissman, Leaf, and Bruce (1987) who examined predictors of panic and obsessive-compulsive disorders in Black and in White women. Those researchers found that panic disorders were higher among single mothers than married mothers, regardless of race. In contrast, married mothers, particularly those who were Black, were found to have a higher risk for obsessive-compulsive disorder compared to single mothers; the rates for Black married mothers exceeded those of Black single mothers by nearly 7 to 1. The comparable figure for White mothers was nearly 3 to 1. The relation of women’s marital roles to mental health may vary over the course of a disorder. For example, as Kessler (2006) has observed, at the same time that there is a stronger gender difference in depression among married than unmarried people, the first onset of major depression is similar in women and men regardless of marital status. Life events related to chronicity and recurrence of depression reflect gender role obligations, however. Thus, financial pressures are more strongly associated with depression for men than women, while the reverse is true for family problems. This combination creates a higher correlation between gender and depression among married people (Kessler, 2006). Both greater exposure to stressful life events and lack of access to coping resources (personal, social, and economic) have been found to contribute to the a consistent 2:1 gender gap in depression that has been reported across diverse ethnic groups (Keyes & Goodman, 2006). Women’s higher rates of depressive disorders compared to men, the consistency of this gender gap across diverse groups, and research linking depression to hopelessness (a reflection of powerlessness) and low self-esteem (a reflection of devaluation) has made theorizing the relation of gender to depression of particular interest to feminist psychologists. This work has underscored the multilevel nature of the risk factors for depression which encompass psychological attributes such as response styles, and social roles and conditions, including stigma, prejudice, and discrimination, work and family roles, poverty, and exposure to violence (Mazure & Keita, 2006; Jackson & Williams, 2006; see Hamilton & Russo, 2006, for a more detailed discussion). For more than two decades feminist psychologists have called for a more contextualized analysis of stress and coping that accounts for the larger realities of women’s lives including sexism, racism, and access to power (Banyard & Graham-Bermann, 1993; Landrine, 1995; Yoder & Kahn, 2003). A contextualized

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understanding of diverse women’s lives has been long overdue in the stress and coping literature. In particular, power differentials are reflected in the dynamics of stigma, prejudice, and discrimination, and gender-based violence.

Stigma, Prejudice, and Discrimination The mental health effects of stigma, prejudice, and discrimination are inextricably intertwined. Stigmatization of stressful life events can affect women’s willingness to seek help for dealing with those events, undermine their mental health, increase risk for psychological distress and disorder, lower the probability and effectiveness of help-seeking, and impede the therapeutic process. Basic research on both gender and stigma among diverse women is needed to refine conceptualization and measurement so that the relationships among gender, stigma, and mental disorder can be adequately understood and mental health interventions may be sensitized to the role of stigma in diverse women’s lives. Advances in the conceptualization and study of stigma underscore the profound and destructive impact that stigma can have on psychological and social functioning. Stigmatization labels people as different and devalued, resulting in loss of power, low status, and discrimination (Link & Phelan, 2001). Stigma may be hidden or visible, creating self-presentation and disclosure issues that can compound the stressfulness of managing a stigmatized identity (e.g., as in the decision whether to disclose being lesbian or gay, having an abortion, being an unwed mother, or contracting a sexually transmitted disease). It can also be uncontrollable or controllable, or linked to an individual characteristic (having herpes) versus group membership (belonging to a stigmatized religion, which could be Judaism, Christianity or Islam, depending on which religious group is in power in the larger society). Attributes, experiences, and behaviors that are stigmatized vary with culture and over time. Women have been stigmatized in countless ways: for being victims of childhood physical or sexual abuse, being raped, losing their virginity, having breasts that are judged by others as too small or too large, having a mastectomy, staying single, having more than one sexual partner, having menstrual cramps, being a lesbian, having a child when not married, being childless, having too many children (the negative reaction to “Octo-Mom” a recent example), being battered by their husbands, being too fat, being too thin, having an abortion, placing a child for adoption, working when children are young, being a “bad” mother, being menopausal, and being old, among other conditions. These are just a few examples of a variety of stigmatized gender-related attributes and conditions experienced in different ways by diverse women that have implications for mental health. A large body of literature has documented the effects of sexist, racist, and heterosexist stereotyping, stigma, prejudice, and discrimination on risk for psychological distress and psychopathology (Herek & Garnets, 2007; Landrine & Klonoff, 1997; Sue et al., 2007; Wyche, 2001). The impact of what has sometimes been called the “double burden” of gender and ethnic discrimination in mental health and its treatment has become well recognized (APA,

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2003; Brown, Abe-Kim, & Barrio, 2003; Brown, Riepe, & Coffey, 2005; Bryant et al., 2005; Sparks, 2002). Perceived discrimination has been linked to a variety of negative psychological outcomes in diverse groups (e.g., Araujo & Borrell, 2006; Kessler, Mickelson, & Williams, 1999; Moradi & Risco, 2006; Yoo & Lee, 2005). The experience of sexist and racist events has a well-documented relation to anxiety and mood disorders (Klonoff & Landrine, 1995; Landrine, Klonoff, Gibbs, Manning, & Lund, 1995). Experiencing sexist events (e.g., being treated unfairly by employer, called a sexist name like “bitch” or “cunt,” being exposed to degrading sexual jokes) has been found to account for gender differences in symptoms of anxiety, depression, and somatization (Klonoff, Landrine, & Campbell, 2000). Personal and collective self-esteem may partially (but not totally) mediate the link between perceived sexist discrimination and symptoms of anxiety and depression (Fischer & Holz, 2007). More work is needed on the relation of perceived discrimination to comorbidity of disorders. Among Asian Americans, perceived racial discrimination was found to double the risk of having had one disorder within the past 12 months, but tripled the risk of having had two or more disorders (Gee, Spencer, Chen, Yip, & Takeuchi, 2007). Stigma, particularly when attached to personal attributes such as gender, race/ethnicity, sexual orientation, age, and disability, can pose a threat to one’s personal and social identity, resulting in self-stigma and internalized oppression in response to perceived discrimination. Relations among stigma, personal and social identity development, and mental health are unclear, however. Although ethnic identity has been identified as a protective factor in the relation of perceived discrimination to mental health (e.g., Greene, Way, & Pahl, 2006), the literature is mixed (e.g., Mossakowski, 2003) and largely does not examine effects separately for women and men, let alone intersections with other identities. More needs to be known about the mechanisms by which social identities mediate or moderate the relation of life events to mental health outcomes for diverse women and men in various directions (Alvarez & Helms, 2001; Chen, LePhuoc, Guzman, Rude, & Dodd, 2006; Perry, Vance, & Helms, 2009). Developing such knowledge will require more attention to measurement issues across ethnic and racial identities as well as other aspect of social difference. This task complicated by the fact that the relation of perceived discrimination to mental health is different for U.S.-born individuals versus immigrants (Yoo & Lee, 2008), yet country of birth is not consistently controlled across studies. As Landrine and Corral (Chapter 4) have articulated, the challenges— empirical and epistemological—entailed in such work are severe and complex, and examination of intersections compounds the difficulties. In particular, more work is needed to establish measurement equivalence of such measures across gender with ethnic and racial groups. Complexities in interpretation of findings can arise from differences in willingness to attribute negative life events to discrimination when talking to out-group members. For example, both women and African Americans have been found to be more likely to report that a failing grade was caused by discrimination rather than lack of ability when they made the judgment privately and in the presence of a fellow stigmatized group member (Stangor, Swim, Van Allen, & Sechrist, 2002). The underrepresentation of disadvantaged

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populations in national surveys combined with differential disclosure of stigmatized events may contribute to inconsistencies in the literature. For example, one can find studies of prevalence of exposure to trauma that report no ethnic differences, higher rates of prevalence of trauma exposure among Whites, and higher rates of exposure for non-White respondents (Norris & Slone, 2007). Stigmas may be maintained by societal ideologies, such as sexism, racism, and heterosexism, ideologies that legitimize and perpetuate power and status differentials. They can affect mental health through a variety of psychological, interpersonal, and structural mechanisms, including activation of stereotypes, expectancy effects, social exclusion, and other forms of negative treatment, including interpersonal and institutional discrimination. For example, the ideology of heterosexism involves what has been called the heterosexual assumption—the idea that “everyone” is heterosexual, which results in sexual minorities becoming invisible, unacknowledged, and marginalized. When sexual minorities violate this assumption and become visible, they are viewed as deviant; hostility and discriminatory treatment toward them is consequently viewed as justified (Herek, Gillis, & Cogan, 2009). These ideologies can be viewed as manifestations of stigma in society’s institutions, and be distinguished from manifestations in interpersonal processes. More conceptualizing work needs to be done on stigma concepts across diversity dimensions. For example, in the case of sexual minorities, researchers have distinguished between enacted sexual stigma (overt negative actions against sexual minorities, such as hate crimes), felt sexual stigma (expectations about the circumstances in which sexual stigma will be enacted), internalized sexual stigma (personal acceptance of sexual stigma as part of one’s value system and self-concept; Herek, Gillis, & Cogan, 2009). Stigmatization may undermine mental health by interfering with perceiving or obtaining social support from others (Crocker, Major, & Steele, 1998; Major & O’Brien, 2005). The role of social support in buffering mental health effects of perceived discrimination across dimensions of social difference requires a more complex and nuanced investigation. How social support affects the relation of perceived discrimination to mental health may differ depending on the extent to which such perceptions are tied to feelings of exclusion and lack of belonging. Perceived racial discrimination has been found to be associated with lower perceptions of social support as well as greater symptoms of depression, and lower levels of life satisfaction among African American college students (Prelow, Mosher, & Bowman, 2006). It may also depend on whether social support is actually mobilized—it cannot be assumed that social support networks will mobilize to support individuals exposed to discrimination, even for individuals who have high levels of social support (Prelow et al., 2006). Disclosing stressful life events is an important part of the coping process (Tait & Silver, 1989), and for stigmas that can be concealed, the process of concealment may increase risk for physical and psychological problems (Pennebaker, 1995). Disclosure may result in social rejection and exclusion that have powerful negative effects as well, however, making management of stigma a highly stressful process. The role of shame in this process is particularly important to understand because of its possible implications for the therapist’s stance during treatment (Denious, Russo, & Rubin, 2004). If shame rather than

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guilt is the underlying problem, exposure of shame experiences may make the client “only feel worse” unless the therapist takes an active stance and communicates “positive regard” to the client (Wright et al., 1989, p. 229). More needs to be known about (1) the extent to which gender shapes stigmatized events in diverse women’s lives, and (2) how inequalities in power and social status undermines women’s ability to overcome stigmatization. Although stigma depends on power—social, political, and economic—power dynamics continue to be inadequately examined in investigations of stigma. As Link and Phelan (2001) observe, stigma is dependent on the power to label and negatively stereotype members of stigmatized groups, lower their status, and limit their access to major life domains such as education, jobs, housing, and health care. Thus, prevention and intervention in the relation of stigma to mental health will require a multilevel approach, targets at change both in (1) attitudes and beliefs, as well as (2) power relations that enable dominant groups to act on those stigmatizing attitudes and beliefs. Understanding of the interrelationships among gender, stigma, and mental health for diverse women is essential for intervention to be effective on either level (Hamilton & Russo, 2006).

Violence and Trauma Among all of the classes of gender-related life events reflective of power differentials between women and men, gender-based violence merits particular consideration due to its multiple, profound, and long-lasting effects (Dutton et al., 2006; Russo, Koss, & Ramos, 2000; Russo & Tartaro, 2008). Examination of stigma and power issues has only slowly emerged in the psychological literature on coping and trauma, and the investigation of differential access to and sanctions for the use of power from the point of view of diverse women is lacking. An example of this can be found in the failure of early studies of frequency of sexual activity among young girls to recognize the effects of the larger circumstance of girls being initiated into sex by older partners (Manlove, Ryan, & Franzetta, 2007). Feminist models of violence and trauma emphasize consideration of social, emotional, and political environments when examining traumatic effects (Brown, 2004). The cumulative exposure to sexist, racist, and homophobic adverse life events, the stigma attached to interpersonal violence, and the chronic nature of exposure to the reminder of the threat, complicate the picture for diverse women (Berg, 2006; Brown, 2004; Kimerling, Ouimette, & Weitlauf, 2008). Violence exposure overlaps with family issues and intimate violence is manifested in many forms, including childhood physical and sexual abuse, acquaintance rape, courtship violence and wife-battering, marital rape, and stalking. Further, ethnic women are more likely to live in poor communities with higher crime and violence rates, compounding their risk of violence exposure (Russo & Pirlott, 2006; see Chapters 14–16 in this volume). Violence exposure has wide ranging and long-lasting effects, and is linked to the development of multiple disorders, including anxiety, depression, and PTSD (Dutton et al., 2006; Kessler, 2006; Russo & Tartaro, 2008). Some theorists suggest that trauma symptoms in response to violence are not

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exclusively related to discrete events, but that symptoms can emerge from the chronic effects of discrimination, exclusion, and oppressive societal conditions (Adams, 1990; Berg, 2006; Root, 1992). Thus, understanding how gender affects exposure and response to violence and trauma in diverse populations is an important frontier for researchers who seek to understand the relation of gender to women’s mental health. One of the most widely recognized, severe, and well-studied outcomes of violence is posttraumatic stress disorder (PTSD) (Kimerling, Ouimette, & Weitlauf, 2008). PTSD has been identified as the fifth most common psychiatric disorder in the United States (Kessler et al., 2005), with women’s lifetime prevalence rates found to be more than double that of men (10.4% versus 5.0%) (Kessler, Sonnega, et al., 1995). Further, meta-analytic research has found that traumatic symptoms for women are likely to persist four times longer than for men (Norris, Foster, & Weisshaar, 2002; Olff, Langeland, Draijer, & Gersons, 2007). At the same time, males have been reported as having higher exposure to traumatic events (Kessler et al., 1995). Again, reporting and measurement issues make this finding controversial, and interaction with ethnicity has been inadequately examined. In addition to measurement equivalence concerns discussed by Landrine and Corral in Chapter 4, methodological issues include the limitations of checklists to accurately assess trauma exposure and responses, gender differences in self-reporting of trauma, and failure to consider base rates of psychopathology (Tolin & Foa, 2006). Taylor and Stanton (2007) discuss methodological and conceptual issues in research on life events, life stress, and life crises. Both longitudinal and experimental research designs that are based on transactional models will be needed for causal dynamics to be more fully understood. Even then, mental health problems themselves can also be both a cause and a consequence of gender-related stressful life events. Widening the definition of PTSD to recognize the effect of what Root (1992) has described as “insidious traumas” associated with being a member of a stigmatized social group is needed if responses to traumatic events are to be fully assessed and understood. Studies have found that life stress preceding and following an index trauma are critical risk factors for developing subsequent PTSD (Kimerling, Oimette, & Wolfe; 2002; Kimerling, Ouimette, & Weitlauf, 2008). However, with a few exceptions (e.g., Gnanadesikan, Novins, & Beals, 2005) studies of minority women and PTSD are lacking. Advancing the understanding of traumatic experiences in diverse populations will require recognizing the distinction between sex and gender; considering the effects of the social and cultural context, including power differentials and dynamics; and learning more about the intersecting factors that characterize trauma for women of diverse race and class backgrounds. Both risk and protective factors contribute to the variation in outcomes of traumatic events, and understanding those outcomes will require multifactor approaches grounded in the gendered contexts of women’s lives across ethnic groups (Gross & Graham-Bermann, 2006). Variation in women’s response to traumatic life events may reflect variations in factors related to coping and resilience. Research suggests that religion and spirituality represent valuable protective resources for these on African American women who experience trauma (Fallott & Heckman, 2005; Watlington & Murphy, 2006). Mitchell and colleagues (Mitchell et al., Kaslow,

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2006) also found that among economically disadvantaged African American women, the link between intimate partner violence (IPV) and depression was mediated by adaptive coping, spiritual well-being, and social support, while the relationship between IPV and anxiety symptoms was mediated by adaptive coping, social support, and ability to access resources. Goodman, Dutton, Vankos, and Wieinfurt (2005) conducted one of the few longitudinal studies of African-American women’s experience of interpersonal violence. They examined material and emotional resources, coping strategies and experiences of intimate partner abuse and reabuse. Over the course of the 1-year study, social support was found to be a critical protective factor for women with histories of lower levels of violence; however, for women reporting the most severe violence, social support did not protect against revictimization. Physically fighting back and other “resistance strategies” that involved direct confrontation predicted higher levels of reabuse, while leaving home and other resistance strategies that created distance did not increase the likelihood of continued violence. This research underscores the need to study protective factors within the context of power disparities in the lives of women who are experiencing gender-based violence. The task for future research is to integrate the psychological, social, and biological perspectives within the cultural and political context to provide a more complete picture of how gender shapes experiences of and responses to trauma among diverse women.

Diversity and Women’s Mental Health: Current Status, Future Prospects Conceptualizing gender as a dynamic social construct that interacts with intersecting dimensions of difference has profound implications for mental health research and service delivery. The chapters in this handbook have articulated complex variations in gender-related beliefs and stereotypes as well as women’s psychological and social environments as result of intersecting differences. The brief picture presented here has emphasized the complexity and the multilevel nature of the processes affecting the mental health of diverse women. It emphasizes the importance of addressing intersections that shape diverse women’s experiences of inequality and oppression; stigma, prejudice, and discrimination; and violence and trauma. The task for future feminist theorists is to conceptualize intersections—that is, to conceptualize and investigate how complex and interacting influences of multiple dimensions of difference affect women’s lived experiences over the life cycle in ways that have implications for women’s mental health. Understanding the complex ways that gender affects mental health in diverse populations is a fundamental challenge to mental health researchers and a necessary condition for improving the mental health in the United States. Ultimately, understanding factors affecting diagnosis and utilization of mental health services requires sophisticated biopsychosocial research approaches that simultaneously consider effects of gender, race/ethnicity, and other dimensions of difference in a biopsychosocial and community context over the life cycle. There is much work to be done, and as Landrine and Corral (Chapter 4) have emphasized, there are substantial theoretical, methodological,

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and statistical challenges to be overcome. Epidemiological studies must begin to focus on understanding the factors that explain gender differences among diverse women rather than simply controlling for them and consequently masking interaction effects. If the meanings and implications of variations in mental health outcomes identified at the epidemiological level are to be understood, however, closer connections between studies at epidemiological, contextual, social, and psychological levels of analyses are needed. Such connections should be synergistically informed by theory-based qualitative and quantitative findings with special attention to conceptual, sampling, measurement equivalence, and statistical issues (see Landrine & Corral, Chapter 4). Throughout, these efforts need to be enriched by an inclusion of “actual women’s voices and experiences” (Gross & Graham-Bermann, 2006, p. 401). Throughout, feminist theorists, researchers, practitioners and policy makers must remain vigilant to ensure continued progress in understanding diverse women’s mental health. The politicization of mental health research related to contraception and abortion (Denious & Russo, 2005) reminds us of the importance of the larger social context to the setting of research priorities, and the need for a focused agenda to guide advocacy efforts. It has been more than two decades since the publication of the Women’s Mental Health Agenda (Russo, 1985) and more than a decade since the Boston conference (Worell & Johnson, 1997). Given the great strides in the development of multicultural feminist knowledge, the time has come for the new generation of feminist psychologists to develop a multicultural feminist mental health agenda. There is an important lesson in the fact that, despite the profound influence of gender on mental health outcomes, the study of women’s experiences was identified as a priority of the National Institute of Mental Health only when forced to do so by Congress (Russo, 1990). With some minor exceptions, it is the public’s concern for health disparities that keeps investigation of the relation of social conditions to mental health among the priorities of national health funding agencies. Thus, public education aimed at understanding the link between social inequality and mental health problems should be included in the development of a multicultural feminist mental health agenda. A strong commitment to multicultural feminist advocacy is essential for needed change to occur in public policies as well as professional practices across mental health disciplines. A comprehensive approach to advocacy will be needed to establish the web of public policies needed to effect change in the etiology, diagnosis, treatment, and prevention of mental health problems of diverse women. In particular, continued monitoring of mental health funding and service delivery agencies will be needed as long as biomedical models dominate funding for women’s health research.

Endnotes 1. This journal was the predecessor to the journal Cultural Diversity and Ethnic Minority Psychology, sponsored by APA Division 45: Society for the Psychology Study of Ethnic Minority Issues.

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Acknowledgments I would like to express appreciation to Allen Meyer for his comments on the manuscript and to Kendra Michael and Heather Terrell for helping obtain copies of materials.

References Adams, P. (1990). Prejudice and exclusion as social traumata. In J. D. Noshpitz & R. D. Coddington (Eds.), Stressors and the adjustment disorders (pp. 362–391). New York: John Wiley. Adlemann, J., & Enguidanos, G. (Eds.). (1995). Racism in the lives of women: Testimony, theory, and guides to practice. New York: Harrington Park Press. Alegría, A., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97, 68–85. Almeida, D. M., & Kessler, R. C. (1998). Everyday stressors and gender differences in daily distress. Journal of Personality and Social Psychology, 75, 670–680. Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., et al. (2004). Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica Supplement, 21–27. Alvarez, A. N., & Helms, J. E. (2001). Racial identity and reflected appraisals as influences on Asian Americans’ racial adjustment. Cultural Diversity & Ethnic Minority Psychology, 7, 217–231. American Psychological Association (APA). (1990). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. Washington, DC: Author. APA. (2000). Professional practice guidelines for psychotherapy with lesbian, gay and bisexual clients. American Psychologist, 55, 1440–1451. APA. (2003). Guidelines for multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402. APA. (2004). Guidelines for practice with older adults. American Psychologist, 59, 236–260. APA. (2007). Guidelines for psychological practice with girls and women. American Psychologist, 62, 949–979. APA Division 44, Committee on Lesbian, Gay, & Bisexual Concerns Task Force. (2000). Guidelines for psychotherapy with lesbian, gay, and bisexual clients. American Psychologist, 55, 1440–1451. APA Task Force on Psychology and the Handicapped. (1982). APA guidelines on physical and social accessibility. American Psychologist, 37, 1379. APA Task Force on Sex Bias and Sex-Role Stereotyping in Psychotherapeutic Practice. (1975). Report of the Task Force on Sex Bias and Sex-Role Stereotyping in Psychotherapeutic Practice. American Psychologist, 30, 1169–1175. APA Task Force on Sex Bias and Sex-Role Stereotyping in Psychotherapeutic Practice. (1978). Guidelines for therapy with women. American Psychologist, 30, 1122–1123. APA Task Force on the Sexualization of Girls. (2007). Report of the APA Task Force on the Sexualization of Girls. Washington, DC: American Psychological Association. APA Task Force on the Status of Women in Psychology. (1973). Report of the Task Force on the Status of Women in Psychology, American Psychologist, 28, 611–616. APA Task Force on Women, Poverty, and Public Assistance. (1998). Making welfare to work really work. Task Force on Women, Poverty, and Public Assistance. Washington, DC: Author. Araújo, B. Y., & Borrell, L. N. (2006). Understanding the link between discrimination, mental health outcomes, and life chances among Latinos. Hispanic Journal of Behavioral Sciences, 28, 245–266. Arredondo, P. (1999). Multicultural counseling competencies as tools to address oppression and racism. Journal of Counseling and Development, 77, 102–108. Arrindell, W. A., Steptoe, A., & Wardle, J. (2003). Higher levels of state depression in masculine than feminine nations. Behavior Research and Therapy, 41, 809–817.

277

278


Ballou, M., Hill, M., & West, C. (Eds.). (2008). Feminist therapy theory and practice: A contemporary perspective. New York: Springer. Bair-Merritt, M. H., Blackstone, M., & Feudtner, C. (2006). Physical health outcomes of childhood exposure to intimate partner violence: A systematic review. Pediatrics, 117, 278–290. Banyard, V. L., & Graham-Bermann, S. A. (1993). Can women cope? A gender analysis of theories of coping with stress. Psychology of Women Quarterly, 17, 303–318. Bardone, A., Moffitt, T., Caspi, A., Dickson, N., & Silva, P. (1996). Adult mental health and social outcomes of adolescent girls with depression and conduct disorder. Development and Psychopathology, 8, 811–829. Bem, S. L. (1994). The lenses of gender: Transforming the debate on sexual inequality. New Haven, CT: Yale University Press. Berg, S. H. (2006). Everday sexism and posttraumatic stress disorder in women: A correlational study. Violence Against Women, 12, 970–988. Breslau, J., Aguilar-Gaxiola, S., Kendler, K. S., Su, M., Williams, D., & Kessler, R. C. (2005). Specifying ethnic differences in risk for psychiatric disorders in a USA national sample. Psychological Medicine, 35, 1–12. Breslau, N., Schultz, L., & Peterson, E. (1995). Sex differences in depression: A role for preexisting anxiety. Psychiatry Research, 58, 1–12. Brewin, C., Andrews, B., & Valentine, J. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 6, 748–766. Broman, C. L., Mavaddat, R., & Hsu, S.-Y. (2000). The experience and consequences of perceived racial discrimination: A study of African Americans. Journal of Black Psychology, 26, 165–180. Brown, B., Rieker, P., & Willie, C. (Eds.). (1995). Racism and sexism and mental health (pp. 297–350). Pittsburgh: University of Pittsburgh Press. Brown, L. S. (2004). Feminist paradigms of trauma treatment. Psychotherapy: Theory, Research, Practice, Training, 41, 464–471. Brown, L. S. (2008a). Feminist therapy. In J. L. Lebow (Ed.), Twenty-first century psychotherapies: Contemporary approaches to theory and practice (pp. 277–306). Hoboken, NJ: John Wiley & Sons. Brown, L. S. (2008b). Reflection on Kashubek-West, Szymanski, and Meyer’s major contribution. The Counseling Psychologist, 36, 639–644. Brown, L. S., & Root, M. P. (Eds.). (1990). Diversity and complexity in feminist therapy. New York: Haworth Press. Brown, L. S., Riepe, L. E., & Coffey, R. L. (2005). Beyond color and culture: Feminist contributions to paradigms of human difference. Women & Therapy, 28, 63–92. Bryant, R. M., Coker, A. D., Durodoye, B. A., McCollum, V. J., Pack-Brown, S. P., Constantine, M. G., & Bryant, B. J. (2005). Having our say: African American women, diversity, and counseling. Journal of Counseling and Development, 83, 313–319. Cabral, M., & Astbury, J. (2000). Women’s mental health: An evidence-based review. Department of Mental Health and Substance Dependence, Geneva, Switzerland: World Health Organization. Chen, G. A., LePhuoc, P., Guzman, M. R., Rude, S. S., & Dodd, B. G. (2006). Exploring Asian American racial identity. Cultural Diversity & Ethnic Minority Psychology, 12, 461–476. Chen, Y. Y., Subramanian, S. V., Acevedo-Garcia, D., & Kawachi, I. (2005). Women’s status and depressive symptoms: A multilevel analysis. Social Science and Medicine, 60, 49–60. Chishom, J. F., & Greene, B. (2008). Women of color: Perspectives on multiple identities in psychological theory, research, and practice. In F. L. Denmark & M. A. Paludi (Eds.), Psychology of women: A handbook of issues and theories (pp. 40–69). Westport: Greenwood Press. Clark, R., Anderson, N. B., Clark, C. R., & Williams, D. R. (1999). Racism as a stressor for African Americans: A biopsychosocial model. American Psychologist, 54, 805–816. Comas-Díaz, L., & Greene, B. (1994). Women of color: Integrating ethnic and gender identities in psychotherapy. New York: Guilford. Comas-Díaz, Griffith, E. E. H., Pinderhughes, K. F., & Wyche, K. F. (1995). Coming of age: Cultural diversity and mental health. Cultural Diversity and Mental Health, 1, 1–2. Crocker, J., Major, B., & Steele, C. (1998). Social stigma. In S. Fiske, D. Gilbert, & G. Lindzey (Eds.), Handbook of social psychology (Vol. 2, pp. 504–553). Boston, MA: McGraw-Hill.

Chapter 9


Davis, N. D., Cole, E., & Rothblum, E. D. (Eds.). (1993). Faces of women and aging (special issue). Women & Therapy, 14(1/2). Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J. P., et al. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association, 291, 2581–2590. Denious, J., & Russo, N. F. (2005). Controlling birth: Science, politics, and public policy. Journal of Social Issues, 61, 181–191. Denious, J., Russo, N. F., & Rubin, L. (2004). The role of shame in socio- and subcultural influences on disordered eating. In M. A. Paludi (Ed.), Praeger guide to the psychology of gender (pp. 219–237). Westport, CT: Praeger. DeSouza, E. R. (2008). Workplace incivility, sexual harassment, and racial micro-aggression: The interface of three literatures. In M. A. Paludi (Ed.), The psychology of women at work: Challenges and solutions for our female workforce, Vol 2: Obstacles and the identity juggle (pp. 65–84). Westport, CT: Praeger Publishers/Greenwood Publishing Group. Dohrenwend, B. P. (1998). Adversity, stress, and psychopathology. New York: Oxford University Press. Dutton, M. A., Green, B., Kaltman, S. I., Roesch, D. M., Zeffiro, T. A., & Krause, E. D. (2006). Intimate partner violence, PTSD, and adverse health outcomes. Journal of Interpersonal Violence, 21, 955–968. Fallot, R. D., & Heckman, J. P. (2005). Religious/spiritual coping among women trauma survivors with mental health and substance use disorders. Journal of Behavioral Health Services & Research, 32(2), 215–226. Fassinger, R. E., & Arseneau, J. R. (2008). Diverse women’s sexualities. In F. L. Denmark & M. A. Paludi (Eds.), Psychology of women: A handbook of issues and theories (pp. 484–508). Westport: Greenwood Press. Fischer, A. R., & Holz, A. B. (2007). Perceived discrimination and women’s psychological distress: The roles of collective and personal self-esteem. Journal of Counseling Psychology, 54, 154–164. Gee, G. C., Spencer, M., Chen, J., Yip, T., & Takeuchi, D.T. (2007). The association between self-reported discrimination and 12-month DSM–IV mental disorders among Asian Americans nationwide. Social Science and Medicine, 64, 1984–1996. Gnanadesikan, M., Novins, D. K., & Beals, J. (2005). The relationship of gender and trauma characteristics to posttraumatic stress disorder in a community sample of traumatized Northern Plains American Indian adolescents and young adults, Journal of Clinical Psychiatry, 66, 1176–1183. Goodman, L. A., Dutton, M. A., Vankos, N., & Wieinfurt, K. (2005). Women’s resources and use of strategies as risk and protective factors for re-abuse over time. Violence Against Women, 11, 311–336. Gold, R., Michael, Y. L., Whitlock, E. P., Hubbell, F. A., Mason, E. D., Rodriguez, B. L., et al. (2006). Race/ethnicity, socioeconomic status, and lifetime morbidity burden in the women’s health initiative. Women’s Health, 15, 1161–1173. Greene, B. (2000). African American lesbian and bisexual women. Journal of Social Issues, 56, 239–249. Greene, B., & Sanchez-Hucles, J. B. (1997). Diversity: Advancing an inclusive feminist psychology. In J. Worell & N. G. Johnson (Eds.), Shaping the future of feminist psychology: Education, research, and practice (pp. 173–202). Washington, DC.: American Psychological Association. Greene, M. L., Way, N., & Pahl, K. (2006). Trajectories of perceived adult and peer discrimination among Black, Latino, and Asian American adolescents: Patterns and psychological correlates. Developmental Psychology, 42, 218–238. Gross, M. M., & Graham-Bermann, S. A. (2006). Gender, categories and science-as-usual: A critical reading of Gender and PTSD. Violence Against Women, 12, 393–406. Gutierrez, L., & Lewis, E. (1999). Empowering women of color. New York: Columbia University Press. Hamilton, C., & Mahalik, J. (2009). Minority stress, masculinity, and social norms predicting gay men’s health risk behaviors. Journal of Counseling Psychology, 56, 132–141. Hamilton, J. A., & Russo, N. F. (2006). Women and depression: Research, theory, and social policy. In C. L. M. Keyes & S. H. Goodman (Eds.), Women and depression: A handbook

279

280


for the social, behavioral, and biomedical sciences (pp. 479–522). New York: Cambridge University Press. Hamilton, J. A. (1995). Sex and gender as critical variables in psychotropic drug research. In B. Brown, P. Rieker, & C. Willie (Eds.), Racism and sexism and mental health (pp. 297– 350). Pittsburgh: University of Pittsburgh Press. Helms, J. E. (1996). Toward a methodology for measuring and assessing racial as distinguished form ethnic identity. In G. R. Sodowsky & J. C. Impara (Eds.), Multicultural assessment in counseling and clinical psychology (pp. 143–192). Lincoln, NE: The Buros Institute of Mental Measurement. Herek, G. M., & Garnets, L. (2007). Sexual orientation and mental health. Annual Review of Clinical Psychology, 3, 353–375. Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32–43. doi: 10.1037/a0014672. Jackson, P. B., & Williams, D. R. (2006). Culture, race/ethnicity, and depression. In C. L. Keyes & S. H. Goodman (Eds.), Women and depression: A handbook for the social, behavioral, and biomedical sciences (pp. 328–359). New York, NY: Cambridge University Press. Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and co-twin control analysis. Archives of General Psychiatry, 57, 953–959. Kessler, R. C. (2006). The epidemiology of depression among women. In C. L. M. Keyes & S. H. Goodman (Eds.), Women and depression: A handbook for the social, behavioral, and biomedical sciences (pp. 22–37). New York: Cambridge University Press. Kessler, R. C., Chiu, C., Demler, W., & Walters, E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627. Kessler, R. C., McGonagle, K. A., Swartz, M., Blazer, D. G., & Nelson, C. B. (1993). Sex and depression in the national co-morbidity survey I: Lifetime prevalence, chronicity, and recurrence. Journal of Affective Disorders, 29, 85–96. Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40, 208–230. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060. Keyes, C. L. M., & Goodman, S. H. (Eds). (2006) Women and depression: A handbook for the social, behavioral, and biomedical sciences. New York: Cambridge University Press. Kimerling, R., Ouimette, P., & Weitlauf, J. C. (2008). Gender issues in PTSD. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 207–228). New York: Guilford Press. Kimerling, R., Ouimette, P., & Wolfe, J. (Eds.). (2002). Gender and PTSD. New York: Guilford. Kinsel, B. (2005). Resilience as adaptation in older women. Journal of Women & Aging, 17(3), 23–39. Kitzinger, C., & Perkins, R. (1993). Changing our minds: Lesbian, feminism and psychology. New York: New York University Klonoff, E. A., & Landrine, H. (1995). The Schedule of Sexist Events: A measure of lifetime and recent sexist discrimination in women’s lives. Psychology of Women Quarterly, 19, 439–472. Klonoff, L., Landrine, H., & Campbell, R. (2000). Sexist discrimination may account for wellknown gender differences in psychiatric symptoms. Psychology of Women Quarterly, 24, 93–99. Klose, M., & Jacobi, F. (2004). Can gender differences in the prevalence of mental disorder be explained by sociodemographic factors? Archives of Women’s Mental Health, 7(2), 133–148. Korell, S. C., & Lorah, P. (2007). An overview of affirmative psychotherapy and counseling with transgender clients. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 271–288). Washington, DC: American Psychological Association.

Chapter 9


Kutchins, H., & Kirk, S. A. (2003). Making us crazy—DSM: The psychiatry Bible and the creation of mental disorders. Simon & Schuster. Landrine, H., & Klonoff, E. A. (1997). Discrimination against women: Prevalence, consequences, remedies. Thousand Oaks, CA: Sage. Landrine, H. (1988). Depression and stereotypes of women: Preliminary empirical analyses of the gender-role hypothesis. Sex Roles, 19, 527–541. Landrine, H. (1989). The politics of personality disorder. Psychology of Women Quarterly, 13, 325–339. Landrine, H. (1992). Clinical implications of cultural differences. Clinical Psychology Review, 12, 481–416. Landrine, H. (1995). Bringing cultural diversity to feminist psychology. Washington, DC: American Psychological Association. Lee, R. M. (2003). Do ethnic identity and other-group orientation protect against discrimination for Asian Americans? Journal of Counseling Psychology, 50, 133–141. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. Lopez, S. (1989). Patient variable biases in clinical judgment: Conceptual overview and methodological considerations. Psychological Bulletin, 106, 184–203. Major, B., & O’Brien, L. T. (2004). The social psychology of stigma. Annual Review of Psychology, 56, 1–29. Manlove, J. S., Ryan, S., & Franzetta, K. (2007). Risk and protective factors associated with the transition to a fi rst sexual relationship with an older partner. Journal of Adolescent Health, 40(2), 135–143. Marecek, J. (2001). Disorderly constructs: Feminist frameworks for clinical psychology. In R. K. Unger (Ed.), Handbook of the psychology of women and gender (pp. 303–329). New York: John Wiley & Sons. Mazure, C. M., & Keita, G. P. (Eds.). (2006) Understanding depression in women: Applying empirical research to practice and policy. Washington, DC: American Psychological Association. McKay, K. M., Hill, M. S., Freedman, S. R., & Enright, R. D. (2007). Towards a feminist empowerment model of forgiveness psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 44, 14–29. Miller, C. T., & Major, B. (2000). Coping with stigma and prejudice. In T. F. Heatherton, R. E. Kleck, M. R. Hebl, & J. G. Hull (Eds.), The social psychology of stigma (pp. 243–272). New York: The Guilford Press. Mitchell, M. D., Hargrove, G. L., Collins, M. H., Thompson, M. P., Reddick, T. L., & Kaslow, N. J. (2006). Coping variables that mediate the relation between intimate partner violence and mental health outcomes among low-income, African-American women. Journal of Clinical Psychology, 62, 1503–1520. Molnar, B. E., Buka, S. L., & Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity Survey. American Journal of Public Health, 91, 753–760. Moradi, B., & Risco, C. (2006). Perceived discrimination experiences and mental health of Latina/o American persons. Journal of Counseling Psychology, 53, 411–421. Moradi, B., & Subich, L. M. (2003). A concomitant examination of the relations of perceived racist and sexist events to psychological distress for African American women. The Counseling Psychologist, 31, 451–469. Mossakowski, K. (2003). Coping with perceived discrimination: Does ethnic identity protect mental health? Journal of Health and Social Behavior, 44, 318–331. Noh, S., Beiser, M., Kaspar, V., Hou, F., & Rummens, J. (1999). Perceived racial discrimination, depression, and coping: A study of Southeast Asian refugees in Canada. Journal of Health and Social Behavior, 40, 208–230. Norris, F. H., Foster, J. D., & Weisshaar, D. L. (2002). The epidemiology of sex differences in PTSD across developmental, societal, and research contexts. In R. Kimerling, P. Ouimette, & J. Wolfe (Eds.), Gender and PTSD (pp. 3–42). New York: Guilford. Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1081–2001. Psychiatry, 65, 207–239.

281

282


Norris, F. H., Perilla., J. L., Ibanez, G. E., & Murphy, A. E. (2001). Sex differences in symptoms of post-traumatics stress disorder: Does culture play a role? Journal of Traumatic Stress, 14, 7–28. Norris, F. H., & Slone, L. B. (2007). The epidemiology of trauma and PTSD. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.). Handbook of PTSD: Science and practice (pp. 78–98). New York: Guilford Press. Mowbray, C. T., Nicholson, J., & Bellemy, C. D. (2003). Psychosocial rehabilitation needs of women. Psychiatric Rehabilitation Journal, 27, 101–113. O’Leary, V. E., & Bhaju, J. (2006). In J. Worell & C. Goodheart (Ed.), Handbook of girls’ and women’s psychological health: Gender and well-being across the lifespan (pp. 157–165). New York: Oxford University Press. Olff, M., Langeland, W., Draijer, N., & Gersons, B. P. R. (2007). Gender differences in posttraumatic stress disorder. Psychological Bulletin, 133, 183–204. Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35, 888–901. Perry, J. C., Vance, K. S., & Helms, J. E. (2009). Using the people of color racial identity attitude scale among Asian American college students: An exploratory factor analysis. American Journal of Orthopsychiatry, 79, 252–260. Prelow, H. M., Mosher, C. E., & Bowman, M. A. (2006). Perceived racial discrimination, social support, and psychological adjustment among African American college students. Journal of Black Psychology, 32, 442–454. Rabin, J. S., & Slater, B. R. (2005). Lesbian communities across the United States: Pockets of resistance and resilience. Journal of Lesbian Studies, 9, 169–182. Ramrakha, S., Caspi, A., Dickson, N., Moffitt, T. E., & Paul, C. (2000) Psychiatric disorders and risky sex in young adulthood: A cross sectional study in a birth cohort. British Medical Journal, 321, 263–266. Read, J. G., & Gorman, B. K. (2006). Gender inequalities in US adult health: The interplay of race and ethnicity. Social Science & Medicine, 62, 1045–1065. Root, M. P. (1991). Persistent disordered eating as a gender-specific, post-traumatic stress response to sexual assault. Special Issue: Psychotherapy with victims. Psychotherapy: Theory, Research, and Practice, 28, 96–102. Russo, N. F. (Ed.) (1985) A women’s mental health agenda. Washington, DC: APA. Russo, N. F. (1990). Overview: Forging research priorities for women’s mental health. American Psychologist, 45, 368–373. Russo, N. F. (1995). Women’s mental health: Research agenda for the twenty-fi rst century. In B. Brown, B. Kramer, P. Rieker, & C. Willie (Eds.), Mental health, racism, and sexism (pp. 373–396). Pittsburgh: University of Pittsburgh Press. Russo, N. F., Koss, M. P., & Ramos, L. (2000). Rape: A global health issue. In J. Ussher (Ed.), Women’s health: Contemporary international perspectives (pp. 129–142). London: British Psychological Society. Russo, N. F., & Pirlott, A. (2006). Gender-based violence: Concepts, methods, and fi ndings. Annals of the New York Academy of Sciences, 1087, 178–205. Russo, N. F., & Tartaro, J. (2008). Women and mental health. In F.L. Denmark & M.A. Paludi (Eds.), Psychology of women: A handbook of issues and theories (2nd ed., pp. 440–481). Westport: Greenwood Press. Russo, N. F., & Vaz, K. (2001). Addressing diversity in the Decade of Behavior: Focus on Women of Color. Psychology of Women Quarterly, 25, 280–294. Sachs-Ericsson, N., & Ciarlo, J. A. (2000). Gender, social roles, and mental health: An epidemiological perspective. Sex Roles, 43, 605–628. Schilling, E. A., Aseltine, R. H., & Gore, S. (2008). The impact of cumulative childhood adversity on young adult mental health: Measures, models, and interpretations. Social Science and Medicine, 66, 1140–1151. Serbin, L. A., Peters, P. L., McAffer, V. J., & Schwartzman, A. E. (1991). Childhood aggression and withdrawal as predictors of adolescent pregnancy, early parenthood, and environmental risk for the next generation. Canadian Journal of Behavioural Science, 23, 318–331. Shum, L. M. (1996). Asian-American women: Cultural and mental health issues. In J. A. Sechzer, S. M. Pfafflin, F. L. Denmark, A. Griffi n, & S. J. Blumenthal (Eds.), Women and

Chapter 9


mental health. Annals of the New York Academy of Sciences (Vol. 789, pp. 181–190). New York: New York Academy of Sciences. Silverman, W. K., & Carter, R. (2006). Anxiety disturbance in girls and women. In J. Worell & C. Goodheart (Eds.), Handbook of girls’ and women’s psychological health: Gender and well-being across the lifespan (pp. 60–87). New York, NY: Oxford University Press. Snowden, L. R., & Yamada, A.-M. (2005). Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143–166. Southwick, S. M., & Vythilingam, M. (2005). The psychobiology of depression and resilience to stress: Invitations for prevention and treatment. Annual Review of Clinical Psychology, 1, 255–291. Sparks, E. (2002). Depression and schizophrenia in women: The intersection of gender, race/ ethnicity, and class. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 279–305). New York: Guilford. Stewart, A., & McDermott, C. (2004). Gender in psychology. Annual Review of Psychology, 55, 519–544. Subpanel on the Mental Health of Women, President’s Commission on Mental Health. (1978). Report of the Special Population Subpanel on Mental Health of Women. Task Panel Report submitted to the President’s Commission on Mental Health (Vol. 3). Washington, DC: U.S. Government Printing Office. Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., et al. (2007). Racial microaggressions in everyday life: Implications for clinical practice, American Psychologist, 62, 271–286. Szalach, L. A., Erkut, S., Coll, C. G., Alarcon, O., Fields, J. P., & Ceder, I. (2003). Discrimination and Puerto Rican children’s and adolescent’s mental health. Cultural Diversity & Ethnic Minority Psychology, 9, 141–155. Szymanski, D. M., & Kashubeck-West, S. (2008). Mediators of the relationship between internalized oppressions and lesbian and bisexual women’s psychological distress. Counseling Psychologist, 36, 575–594. Tait, R., & Silver, R. C. (1989). Coming to terms with major negative life events. In J. S. Uleman & J. A. Bargh (Eds.), Unintended thought (pp. 351–382). New York: Guilford Press. Taylor, S. E., & Stanton, A. (2007). Coping resources, coping processes, and mental health. Annual Review of Clinical Psychology, 3, 377–401. Thomas, A. J., Witherspoon, K. M., & Speight, S. L. (2008). Gendered racism, psychological distress, and coping styles of African American women. Cultural Diversity and Ethnic Minority Psychology, 14, 307–314. Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132, 959–992. Turner, R. J., & Lloyd, D. A. (2004). Stress burden and the lifetime incidence of psychiatric disorder in young adults: Racial and ethnic contrasts. Archives of General Psychiatry, 61, 481–488. Utsey, S. O., Adams, E. P., & Bolden, M. (2000). Development and initial validation of the Africultural Coping Systems Inventory. Journal of Black Psychology, 6, 194–215. Utsey, S. O., Payne, Y. A., Jackson, E. S., & Jones, A. M. (2002). Race-related stress, quality of life indicators, and life satisfaction among elderly African Americans. Cultural Diversity and Ethnic Minority Psychology, 8, 224–233. doi: 10.1037/1099–9809.8.3.224 Utsey, S. O., Ponterotto, J. G., Reynolds, A. L., & Cancelli, A. A. (2000). Racial discrimination, coping, life satisfaction, and self-esteem among African Americans. Journal of Counseling and Development, 78, 72–81 Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelvemonth use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629–640. Watlington, C. G., & Murphy, C. M. (2006). The roles of religion and spirituality among African-American survivors of domestic violence. Journal of Clinical Psychology, 62, 837–857. Weissman, M. M., Leaf, F. J., & Bruce, M. L. (1987). Single-parent women: A community study. Social Psychiatry, 22, 29–36. Whisman, M. A. (1999). Satisfaction and psychiatric disorders: Results from the National Comorbidity Survey. Journal of Abnormal Psychology, 108, 701–706.

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284


Widiger, T. A., & Sankis, L. M. (2000). Adult psychopathology: Issues and controversies. Annual Review of Psychology, 51, 377–404. Williams, D. R. (2000). Race, stress, and mental health. In C. Hogue, M. Hargraves, & K. ScottCollins (Eds.), Minority health in America (pp. 209–243). Baltimore: Johns Hopkins University Press. Worell, J. (2001). Feminist interventions: Accountability beyond symptom reduction. Psychology of Women Quarterly, 25, 335–343. Worell, J. (2006). Pathways to healthy development: Sources of strength and empowerment. In J. Worell & C. D. Goodheart (Eds.), Handbook of girls’ and women’s psychological health: Gender and well-being across the lifespan (pp. 25–35). New York: Oxford University Press. Worell, J., & Johnson, D. (2001). Therapy with women: Feminist frameworks. In R. K. Unger (Ed.), Handbook of the psychology of women and gender (pp. 317–329). New York: John Wiley & Sons. Worell, J., & Johnson, N. (Eds.). (1997). Shaping the future of feminist psychology: Education, research and practice. Washington, DC: American Psychological Association. Worell, J., & Remer, P. (2003). Feminist perspectives in therapy: Empowering diverse women (2nd ed.). New York: Wiley. World Health Organization. (2000). Women’s mental health: An evidence based review. Geneva, Switzerland: World Health Organization. Wright, F., O’Leary, J., & Balkin, J. (1989). Shame, guilt, narcissism and depression: Correlates and sex differences. Psychoanalytic Psychology, 6, 217–230. Wyche, K. F. (2001). Sociocultural issues in counseling for women of color. In R. K. Unger (Ed.), Handbook of the psychology of women and gender (pp. 330–340). New York: John Wiley & Sons. Wyche, K. F., & Rice, J. K. (1997). Feminist therapy: From dialogue to tenets. In J. Worell & N. G. Johnson (Eds.), Shaping the future of feminist psychology: Education, research, and practice (pp. 57–72). Washington, DC: American Psychological Association. Yoder, J. D., & Kahn, A. S. (2003). Making gender comparisons more meaningful: A call for more attention to social context. Psychology of Women Quarterly, 27, 281–290. Yoo, H. C., & Lee, R. M. (2005). Ethnic identity and approach-type coping as moderators of the racial discrimination/well-being relation in Asian Americans. Journal of Counseling Psychology, 52, 497–506. Yoo, H. C., & Lee, R. M. (2008). Does ethnic identity buffer or exacerbate the effects of frequent racial discrimination on situational well-being of Asian Americans? Journal of Counseling Psychology, 55, 63–74. doi: 10.1037/0022–0167.55.1.63.

Ethnicity, Disordered Eating, and Body Image

10 Faith-Anne Dohm, Melanie Brown, Fary M. Cachelin, and Ruth H. StriegelMoore

It is well known that disordered eating and eating disorders are more prevalent among females than among males (Kessler, Berglund, Chiu, Demler, Heeringa, et al., 2004; Kessler, Chiu, Demler, & Walters, 2005; Lewinsohn, Hops, Roberts, Seely, & Andrews, 1993). What is less well known is that the primary eating disorders (that is, anorexia nervosa and bulimia nervosa) rank among the most common causes of disability among young women (Mathers, Vos, Stevenson, & Begg, 2000) and that the mortality rate associated with anorexia nervosa is higher than that associated with any other mental disorder (Millar et al., 2005; Sullivan, 1995; Zipfel, Lowe, Reas, Deter, & Herzog, 2000). Since the publication of Bringing Diversity to Feminist Psychology (Landrine, 1995), researchers have learned a great deal about the epidemiology of eating disorders in diverse groups of women. They have learned that—as will be discussed in more detail later in this chapter—eating disorders are significantly more common in White women than in women of other ethnic groups, but that levels of disordered eating are more similar in women across the ethnic groups studied. By eating disorders we mean the diagnostic syndromes of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder, a provisional diagnosis

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that was introduced into the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a specific example of Eating Disorders Not Otherwise Specified (American Psychiatric Association, 2000). By disordered eating, we mean a more inclusive term indicating elevated levels of individual symptoms such as dietary restraint, binge eating, weight concern, shape concern, eating concern, as well as the various inappropriate compensatory behaviors of vomiting, excessive exercise, laxative use, and diuretic use. Researchers also have learned that “the single best predictor of risk for developing an eating disorder is being female” (Striegel-Moore & Bulik, 2007, p. 182) and that risk can further be increased by a number of other factors including, as will be discussed in this chapter, negative body image. StriegelMoore and Bulik (2007) note that at present we have limited ability to answer the important question of which women in particular are at risk for developing an eating disorder. They state that the research: ... illustrates that the “prototypical” eating disorder case is a young, White, middle- or upper-middle class woman residing in Europe or North America, reflecting in part the legacy of defining eating disorders on the basis of White girls or women and the common practice in the field of relying on patient samples (biasing samples toward White, educated, and more affluent individuals). Our understanding of risk factors will remain woefully incomplete until research definitions and sampling strategies accommodate diversity in the population within and across nations” (p. 182).

Eating disorders are widely seen as problems afflicting primarily, if not exclusively, White girls and women, a view that lacks empirical evidence and therefore was described by Smolak and Striegel-Moore (2001) as the “myth of the golden girl.” Although recent studies (Alegría et al., 2007; Nicdao, Hong, & Takeuchi, 2007; Taylor, Caldwell, Baser, Faison, & Jackson, 2007) suggest that women of color are not immune to developing eating disorders, this myth continues perhaps in part because of the dominance of theoretical models that emphasize Western culture’s beauty ideal as a core risk variable in explaining risk for the development of an eating disorder (e.g., the “thin internalization model” of Stice and Agras, 1998; the “restraint model” of Polivy and Herman, 1985; or the more complex, multifactorial sociocultural model articulated some 30 years ago by Striegel-Moore, Silberstein, and Rodin, 1986). In brief, pursuit of an unrealistically thin beauty ideal is seen as a critical risk factor in a causal chain toward the development of anorexia nervosa or bulimia nervosa. Because it has been widely shown that women of color are less likely to report body image dissatisfaction than White women, lower prevalence of eating disorders among women of color compared to White women “makes sense” if risk is understood as deriving primarily from social pressures to be thin and internalization of such pressures. The persuasive logic of this hypothesized causal chain notwithstanding, few studies have employed methodologies that permit testing a causal pathway (for an extensive review and methodological discussion, see Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004). A growing body of literature asserts that girls and women from ethnic minority populations are not immune to developing eating disorder symptoms or syndromes (for reviews, see Crago & Shisslak, 2003; Striegel-Moore & Bulik, 2007), although there are indications that prevalence estimates vary depending

Chapter 10 Ethnicity, Disordered Eating, and Body Image

on the particular eating disorder symptom or syndrome under investigation and depending on the population being studied. Studies of the prevalence of eating disorders provide an initial indication that cultural factors may play a role in the etiology of eating disorders. Differences in prevalence may be explained in a number of ways. First, they may reflect “true” differences, (i.e., ethnicity is a risk or protective factor for the development of an eating disorder). For example, White women may indeed be more prone to developing an eating disorder for reasons that beg for an explanation (and the explanation may not be entirely cultural; there are examples of physical diseases that show a strong link with ethnicity and have biological foundations). Second, ethnic group differences may be the result of a culturally biased definition or of case finding approaches to eating disorders. Just as current definitions are biased toward females relative to males (witness the amenorrhea criterion for anorexia nervosa), current definitions favor White populations by emphasizing specific behavioral symptoms that are more commonly reported by White women than by women from other ethnic groups. For example, the low weight requirement for anorexia nervosa may be met more easily by White women than by Black women given these groups’ differences in body size. Third, ethnic group differences may reflect methodological shortcomings such as sampling bias or measurement error. Standard practice in epidemiological studies is to use a “branched” interview approach for case finding with one or two core questions being asked to initiate the detection of anorexia nervosa or bulimia nervosa and follow-up probes being asked only if the core questions have been answered affirmatively. For example, if a participant denies low weight, the interview does not probe further into possible symptoms of anorexia nervosa. This chapter reviews what we know about the prevalence of eating disorders and disordered eating, and considers what studies are needed to better document the extent of eating related pathology among non-White populations. While the first fundamental question is whether the prevalence or incidence of eating disorders is the same or different when comparing various ethnic groups, the second fundamental question is whether ethnicity affects the range, type, or potency of risk and protective factors for the development of an eating disorder. Consider for example the possibility that exposure to a given risk factor, the thin beauty ideal, is less common among Black girls than among White girls but that Black girls may be exposed to risk factors that are not commonly encountered by or play no role in the development of an eating disorder among White girls (e.g., racial discrimination). Finally, ethnicity has been shown to play a role in what happens to an individual who experiences an eating disorder: Women of color are less likely than White women to seek or receive treatment for an eating disorder. We will review the evidence concerning barriers to seeking or receiving health services for an eating disorder among women of color. What is less well explained in the research to date is whether the context for the development of eating disorders in diverse groups of women is similar across groups or whether the underlying pathways to the development of eating disorders in diverse groups of women are as diverse as the groups

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themselves. Landrine (1995) discusses the importance of understanding the context of behavior and states that to understand whether a behavior seen across diverse groups is the same behavior or merely superficially similar, one must understand the sociocultural context of the behavior. This is salient for our understanding of eating disorders. If women’s bodies have meaning for the value they place on themselves and if the value is based on different understandings, expectations, or views of their bodies, then what leads to the common outcome of disordered eating may be unshared context. If the unshared context is not understood, interventions that assume a common context are likely doomed to failure. In this chapter, we first introduce sociocultural factors, including acculturation, which are proposed to contribute to body image and eating disturbances. As a basis for exploring whether the context that lays the foundation for the development of disordered eating is understood, we then present recent research (i.e., primarily published from 2000 to 2007, but including a few earlier key articles) regarding ethnic/cultural differences and similarities in body image and regarding eating disorders and disordered eating in diverse groups of women. Our intent is not to do an exhaustive review of the recent research because that would be beyond the scope of this chapter. Our goal is to explore what currently is known and not yet known about body image and eating disturbances among diverse groups of women. Sociocultural perspectives relating to body image and eating disturbances are interwoven throughout the chapter as relevant. We conclude with a discussion of avenues for future research and intervention. Throughout this chapter, as we discuss the results of various studies that have been conducted, we use the general terms Asian, Black, Hispanic, and White regardless of the language that the studies’ authors used to identify the ethnicity of the women they studied, unless we are able to be more specific (e.g., Sahraoui women living in Morocco). Also, when we use the noun “females” we mean the combination of girls and women.

Sociocultural Factors In their recent article, Striegel-Moore and Bulik (2007) described two primary sociocultural factors associated with disordered eating that are supported by research. Socioeconomic status (SES) represents the first risk factor, although the research results are mixed regarding this factor. While Anorexia Nervosa has been shown, in some studies, to be more common among those with high SES (Lindberg & Hjern, 2003; McClelland & Crisp, 2001), it has not consistently been shown to be so associated. A similar association has not been found for Bulimia Nervosa, and there is some indication that Binge Eating Disorder is more common among individuals from lower socioeconomic or educational groups (Hudson, Hiripi, Pope, & Kessler, 2007). The second sociocultural risk factor that they identified was race/ethnicity, but they noted that the data available regarding this factor are particularly limited. At best what is suggested by the research is that being White may put one at increased risk of developing an eating disturbance characterized by severe dietary restriction or inappropriate compensatory behaviors.


Acculturation is another factor considered to contribute to disturbances of body image and eating. Acculturation refers to the extent to which ethnic minorities adopt the dominant Anglo culture. Evidence is plentiful that even within the United States differing cultural body ideals exist such that a thin ideal body shape may be irrelevant to the beauty ideal of women from non-White ethnic groups. Recent research by Roberts, Cash, Feingold, and Johnson (2006) confirms the view that significant ethnic differences in American women regarding body image are driven by a complex interaction of factors and cannot be explained simply by sociocultural pressures to be thin. Sociocultural exposure theory proposes that Black-White differences in body satisfaction will diminish over time as the thin body ideal becomes more pervasive in American culture. Research so far does not support this. Roberts et al. studied ethnic differences in body image between 1966 and 2002 and found that Black-White differences actually increased surrounding global body image, with Black participants reporting higher levels of global body image satisfaction relative to White participants, even though ethnic differences in weight-related body image have diminished somewhat. Understanding the sociocultural context is critical to unraveling the determinants of body image and the meanings of eating behaviors across ethnicities. Other studies have focused on specific sociocultural influences to understand body image and eating behaviors in specific ethnic groups. For Asian women, acculturation pressure and teasing have been hypothesized to play a role in the development of disordered eating behaviors. In a mother-daughter study in the United Kingdom conducted by Ogden and Elder (1998) to investigate cultural differences in body image ideals and eating behaviors between White and Indo-Asian (Indian, Pakistani and Sri Lankan) females, White females preferred thinner body sizes and reported greater levels of restrained eating than Indo-Asian females, but no evidence of a relationship between acculturation and weight concern was found. However, a study in the United States of female university students of South Asian descent found racial teasing—which arguably can be viewed as a general sociocultural influence and a potential press toward acculturation— but not formal measures of acculturation and ethnic identification, to be associated with disturbed eating behavior and body image (Iyer & Haslam, 2003). Echoing the results of the previously discussed study which evidenced the influence of racial teasing on women of South Asian descent (Iyer & Haslam, 2003), three types of teasing, including general appearance teasing, weight/ shape teasing, and ethnic teasing, and cultural conflict, but not acculturation, were significantly related to body dissatisfaction and maladaptive eating attitudes in a sample of women of South Asian American background residing in the United States (Reddy & Crowther, 2007). In Mumbai, India, teasing was found to be a primary direct influence on drive for thinness and mediated the relationship between body mass index (BMI, i.e., the ratio of weight in kilograms divided by the square of height measured in meters) and body dissatisfaction in adolescent Indian girls (Schroff & Thompson, 2004). For young adult Indian women in the same study, however, drive for thinness was predicted primarily by body dissatisfaction rather than by teasing, suggesting that teasing may become internalized as body dissatisfaction in adulthood. According to Iyer and Haslam (2003), their finding

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regarding racial teasing suggests that the majority culture’s response to the ethnic individual and not the individual’s relationship with her culture of origin may be the significant factor in disturbance in eating and body image. Making this complex story more complex, Abdollahi and Mann (2001) compared college-aged Iranian women living in Tehran and college-aged Iranian women living in Los Angeles and discovered that exposure to Western media for the women in Iran and more acculturation to Western norms for the women in the United States were not associated with more body dissatisfaction or symptoms of eating disorders. However, in partial support of acculturation theory, Cachelin, Monreal, and Juarez (2006) found that the ideal body image for more acculturated Mexican American women tended to be thinner than for those less acculturated; yet they also found that obese Mexican American women, independent of their level of acculturation, preferred a larger ideal body size. Using a bi-dimensional measure of acculturation, Cachelin, Phinney, Schug, and Striegel-Moore (2006) found that orientation toward Anglo American culture was significantly associated with eating disorders whereas orientation toward Mexican culture and strength of ethnic identity were not. These disparate results based on studies of different ethnic groups suggest that the relationship, if there is one, between level and direction of acculturation on the one hand and ethnic identification on the other with disturbances of body image and eating may be a complex and multifaceted one that is moderated by ethnicity itself and by other factors, such as current body size. Some support exists for the role of maternal influence, as a factor that varies from culture to culture and influences acculturation, in the development of body image and associated eating behaviors. A study of largely Hispanic mothers and daughters in New Mexico (ethnic identification of the daughters was 48% Hispanic, 41% Anglo, 7% Hispanic/Anglo, 3% Native American, and 1% Black) confirmed the importance of the maternal role in body image development for the girls in the study whose ages ranged from 8 to 13 years (HahnSmith & Smith, 2001). While no significant differences were found across ethnic groups, girls who reported higher levels of maternal identification had higher levels of self-esteem and lower levels of disturbed eating, and did not emulate their mothers’ body dissatisfaction even when present. Interestingly, girls who reported low maternal identification were similar to their mothers in expressing more body dissatisfaction when this was an issue for the mother. Although we cannot know whether this latter finding is a case of, “thou doth protest too much,” these results suggest that there are complex psychological dynamics underlying body image and disordered eating. These dynamics can only be understood in their sociocultural context. Further supporting the idea that it may be necessary to understand the psychological components of disordered eating in cultural context in order to fully comprehend disordered eating as a phenomenon are the findings from a study conducted in Turkey, which is regarded as a country that culturally bridges Asia and Europe (Canpolat, Orsel, Akdemir, & Ozay, 2005). Gender differences in body satisfaction and dieting behaviors mirrored those which one would expect in a Western country. Turkish girls (43%) were more likely than Turkish boys (18.3%) to report wishing to be thinner, suggesting that Turkish girls are more dissatisfied with their body weight and embrace a thinner body ideal. Half of the girls (49.6%) were frequent or sometimes dieters as compared


to a much smaller percentage of the boys (22.1%). While these results are not particularly surprising, the reasons for the Turkish girls’ body dissatisfaction and associated eating behaviors were more complex than simply a desire to be thin. For the Turkish girls, in addition to a thinner body ideal, low self-worth and low physical self-concept were found to have a greater influence on body dissatisfaction and dieting than being overweight had. Some evidence that different psychological factors influence disturbance in body image and eating behaviors across ethnicities was found in a study of White, Hispanic, and Black psychiatrically hospitalized adolescent females (White & Grilo, 2005). Different patterns of predictors were found for eating and body image disturbances across ethnicities. For the White patients, negative self-esteem predicted body image dissatisfaction (BID); BID, depression, peer insecurity, and history of abuse predicted dietary restraint; dietary restraint, anxiety, and BID predicted binge eating; and dietary restraint, anxiety, and BID predicted purging behavior. For the Hispanic patients, negative self-esteem predicted BID; BID and impulsivity predicted dietary restraint; anxiety predicted binge eating; and dietary restraint and BID predicted purging. For the Black patients, negative self-esteem, peer insecurity, and anxiety predicted BID; BID predicted dietary restraint; peer insecurity predicted binge eating; and dietary restraint predicted purging. The authors suggested that different psychological and behavioral factors may manifest and maintain these disturbances across ethnic groups. While begging important questions about the underlying factors that cause ethnic differences to occur, this research and other such studies that focus on identifying differences in behavior without identifying the cultural context in which the behavior occurs leaves one guessing about the possible individual and cultural dynamics contributing to these results. Exploration of the etiology of eating disorders needs to consider that body image is a multidimensional construct. Focusing exclusively on the weightrelated aspects of body image neglects other perhaps more relevant dimensions of body image, including psychological aspects. It is this weight-based approach to body image that leads directly to the fat-phobia model of anorexia nervosa, which has fallen short in explaining ethnic differences in body image and disordered eating behaviors, as well as in producing effective treatments for the disorder. While fear of fatness remains a DSM-IV diagnostic criterion for anorexia nervosa and pressure to conform to the thin ideal has been blamed on Western-cultural influences, this theory continues to provide an incomplete model for explaining disordered eating behaviors. This simplistic view takes a superficial approach to understanding the complex culturallybound meanings of behaviors. Roberts et al. (2006) found that, contrary to expectation, Black-White differences in global body image have actually increased over time, even though weight-related differences have diminished. “Together, these results suggest that ethnic differences cannot be explained by a single factor such as culturally-induced pressure to be thin” (p. 1125). Offering an alternative explanation of disordered eating behaviors, Roberts et al. consider self-esteem to be a factor closely linked with global body image. Global body image and self-esteem are important aspects of identity, and “… global body image measures may, in effect, be a proxy for global self-esteem” (p. 1125). They suggest that ethnic differences

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in self-esteem may better explain discrepancies in body satisfaction between Black and White females than do explanations centered on thinness as a body ideal in Western culture. Of note is that there is research based on a meta-analysis of numerous studies that shows that Black women report significantly higher levels of self-esteem overall than White women (Twenge & Crocker, 2002). Disordered eating behaviors may represent an effort to express psychological distress through the physical manifestations of self-starvation and other pathological eating behaviors rather than an attempt to achieve a culturally dictated thin body ideal. For example, if the goal were only to emulate the thin bodies shown in Western media, why would girls and women with Anorexia Nervosa not stop well short of death in their dieting behaviors? While disordered eating may begin as a seemingly normal effort to lose weight and be thin, the journey to pathological eating behaviors is clearly guided by much deeper sociocultural and psychological motivations.

Ethnicity and Body Image Much research in disordered eating has focused on the concept of body image as a facet of self-identity, and growing evidence suggests that disordered eating patterns may stem from negative body image or body dissatisfaction. In their recent meta-analysis of the literature relating to the association between ethnicity and body dissatisfaction, Grabe and Hyde (2006) noted that the research supports a predictive relationship between body dissatisfaction and disordered eating. Their sample included 98 studies published between 1960 and 2004, comprising a total of 42,667 participants. Their meta-analysis indicated that while White women generally appear to be more dissatisfied with their bodies, Black, Hispanic, and Asian women tend also to be dissatisfied with their bodies. Overall, the mean effect size suggested that White women report the highest levels of body dissatisfaction, followed in decreasing order by Hispanic women, Asian women, and Black women. However, the ethnic differences in body dissatisfaction generally were not large. A compelling and widely held explanation for the development of body dissatisfaction is offered by sociocultural theory which posits that mass media and cultural influences such as the Barbie doll provide powerful images in the formulation of body ideals (Levine & Harrison, 2004; Levine & Smolak, 1996; Pope, Olivardia, Gruber, & Borowiecki, 1999; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Dittmar, Halliwell, and Ive (2006) found that young girls who had been exposed to Barbie (i.e., an unrealistically thin ideal of beauty) had lower body esteem and preferred thinner body shape than girls who had not been exposed to the doll. This suggests that sociocultural influence may damage body image and increase risk for disordered eating. While Dittmar et al.’s (2006) study did not address ethnic differences (the sample consisted almost entirely of White middle-class girls in the United Kingdom), it did seek to identify the beliefs, values, and cultural influences that cause young White girls to vomit and starve themselves. To do so it utilized a contextual approach to understanding the culturally specific values that lead to pathological eating behaviors in an ethnic group that is rarely considered as such due to being in the majority. Contextualism is essential to deciphering


why significant differences exist in body image and the prevalence of disordered eating across ethnicities, even for diverse groups of American women who are all exposed to mainstream Western sociocultural influences. Most studies to date have focused on identifying ethnic differences in body image and disordered eating rather than adopting a contextual approach. Studies regarding body image for ethnic groups in the United States have indicated that Black women and men possess the most positive body image. A study of ethnicity and body image among Black, Asian, White and Hispanic adults found that White and Hispanic women and men showed more weight-related body image disturbance than Black and Asian women and men. Black women and men had the most positive overall body image (Altabe, 1998). Another study conducted by Smith, Thompson, Raczynski, and Hilner (1999) explored differences between Black and White ethnic groups in the United States on several aspects of body image and found that Black and White women and men had differing levels of investment in appearance and appearance dissatisfaction. After controlling for obesity, age, and education, Black women and men were found to be more invested in and satisfied with their appearance than White women and men were. In the same study, however, women of both ethnicities were found to have greater investment in appearance and more dissatisfaction with body image than men. Miller et al. (2000) supported the results of Smith et al.’s (1999) research in their investigation of ethnic differences in body image among Black, White, and Hispanic women and men. Their research showed that Black women and men have greater investment in appearance, more satisfaction with body image, and higher body-based self-esteem than other groups. Other research further supports the notion that ethnic differences in body image are more pronounced for women than for men. In a U.S. communitybased sample of Asian, Hispanic, Black, and White women and men, Cachelin and Regan (2006) found that dietary restraint, body dissatisfaction, and disordered eating were more common among women than men, and less common among Asian women than women from other ethnic groups. For men, dieting was not moderated by ethnicity. Miller et al. (2000) found that among Black, White, and Hispanic individuals, ethnic differences in body image, mainly relating to global body image and weight concern, were greater for women than for men, and gender differences were consistent across ethnic groups. Specifically, Black women were more satisfied with appearance and body image than women of other ethnic groups. Black women rated themselves significantly higher on sexual attractiveness and in self-esteem regarding their weight than did White women. Again consistent with Miller et al.’s findings, Smith et al. (1999) found that overweight Black women were more satisfied with their appearance than overweight White women, even though both groups reported similar discrepancies between current size and ideal size. Smith et al. suggested that Black women may have a more multifaceted definition of beauty than White women, and that their definition may place more emphasis on personal style and presentation than body size. This would enable Black women to feel attractive even when dissatisfied with body size. Valuations of appearance were also studied by Cash, Melnyk, and Hrabosky (2004), who found significant differences between Black and White women

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regarding their psychological investment in physical appearance. While Black and White women were equally motivated to appear attractive, Black women were less invested in their appearance as a self-evaluative criterion and were less perfectionistic in their concerns regarding appearance. Overall, these results strongly suggest that levels of body satisfaction are significantly different for women of various ethnic groups within the United States, particularly for White and Black women. Research also indicates that differences exist regarding ideal body image, with White women endorsing a thinner body ideal than women of other ethnicities. Perez and Joiner (2003) found that ideal body image differed significantly between Black and White women, with White women tending to choose thinner ideal body images, Black women tending to report being underweight, and White women tending to report being overweight. Not surprisingly, research findings further indicate that symptoms of disordered eating as well as disturbance in body image are more prevalent in White women who embrace a thinner body ideal as compared to Black women. In their sample of female and male adolescent psychiatric inpatients, Barry and Grilo (2002) found that White girls reported significantly higher eating-related and body image disturbances than girls of other ethnicities. In the Barry and Grilo study, a significantly higher proportion of White participants reported body image concerns than did Black or Hispanic participants. A Gender by Ethnicity interaction was observed: White girls had significantly higher eating-related and body image concerns than Black or Hispanic girls (who did not differ significantly from one another), while concerns did not differ significantly across ethnic groups for boys. While more evidence suggests pronounced differences between Black women and White American women, this and other research indicates that significant differences exist in body image and disordered eating between Hispanic and White girls as well. Additional research supports the view that White women suffer from both higher levels of body dissatisfaction and disordered eating. Perez and Joiner (2003) found that White women reported significantly more bulimic symptoms than Black women. Ethnicity and body image were independent significant predictors of bulimic symptoms. White women reported significantly more symptoms than Black women; the more overweight the women perceived themselves to be, the more bulimic symptoms they endorsed. However, Black and White women who considered themselves overweight or underweight relative to ethnic ideals reported more bulimic symptoms, with a curvilinear relationship being found between body dissatisfaction and bulimic symptoms. Based on their research, Perez and Joiner (2003) suggested that Black women may pressure themselves to achieve cultural standards of ideal body size just as White women do. The lower prevalence of disordered eating in Black women may not reflect immunity from cultural pressure to achieve ideals of attractiveness but rather may represent a distinctly different set of cultural ideals of beauty within Black culture that does not place as great an emphasis on thinness. Ethnic differences in body image, levels of body satisfaction and associated disordered eating patterns are further supported by research on obesity. White obese individuals have been found to have more body image disturbance and disordered eating patterns than obese members of other ethnic groups.


Sorbara and Geliebter (2002) studied obese women and men undertaking a diet program. At the start of the program, they found that White patients had higher body image disturbance scores, as indicated by both distortion and dissatisfaction measures, than both Black and Hispanic patients. White patients overestimated body size significantly more than Black patients did and were significantly more dissatisfied with their appearance than the Black patients were. White patients did not differ significantly from the Hispanic patients in this respect. Additionally, the White patients were significantly more likely than both Black and Hispanic patients to be binge eaters and to have had an early onset of obesity. Despite these differences at the start of the weight loss program, ethnic differences were no longer found to be significant after weight loss. Sorbara and Geliebter (2002) attributed their results to the greater cultural pressure to be thin that Whites experience. While differences in body image and disordered eating across ethnicities have been examined by most of the relevant research to date, some studies have adopted a more contextual approach to understanding culturally specific behaviors. One uniquely contextual study of Sahraoui women in Morocco, North Africa, explored a non-Western culture in which individuals value larger body size as an ideal of beauty and exhibit differing eating patterns that reflect these ideals (Rguibi & Belahsen, 2006). The majority (79.9%) of Sahraoui women regarded their body size as being appropriate and socially acceptable even though the majority of the women were overweight (30%) or obese (49%). Sahraoui women’s ratings of ideal size were significantly larger than ratings of healthy size. Most of the overweight and obese Sahraoui women did not desire to lose weight, and those dissatisfied with their body size were more likely to be trying to gain weight. The participants reported that their mothers, men, and traditional clothing influenced their ideal body size. Ideal body size was influenced by traditional clothing because the women felt that their traditional styles of dress looked better at higher weights, which points to the complexity of the nature of cultural influences in body image. Unlike the majority of research regarding ethnic differences in body image and eating behaviors, this study asked the subjects why they held their cultural beliefs and values, which allowed for behaviors to be understood as specific acts-in-context. A study by Altabe (1998) sought to address the complexities of the multiple factors associated with the construct of body image and to understand the differences in relative importance of each of these factors across ethnicities and gender. Altabe used both qualitative and quantitative measures to assess and compare multiple dimensions of body image across ethnic groups. Participants were asked to list personally and culturally ideal appearance traits (such as eye color, hair color, skin color, muscle tone, height, and weight). Interesting differences in the five most common ideal traits emerged across the four ethnic groups (Black, Asian, White and Hispanic) (Altabe, 1998). All groups identified tallness and thinness as ideal traits. Long hair was an ideal trait for all but the White women. Having a toned body was an ideal trait for Black and White women but not for Asian or Hispanic women. Differences in valuation of skin color reflect the complexity of this issue within cultures, particularly in the Black culture where dark skin tone is associated with stereotyped beliefs (Okazawa-Rey, Robinson, & Ward, 1987). Darker skin tone was reported as an ideal trait for all but the Black women, who identified lighter

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skin tone as an ideal. Brown hair was an ideal trait for Asian and Hispanic women, and blonde hair was an ideal trait for White women. Eye color was mentioned only by Black women, who expressed a preference for brown eyes. Thus, the women from diverse ethnic groups differed significantly from White American women not only on weight-related measures but also on nonweight related measures. These results support the view that the factors that comprise the construct of body image vary across ethnicities.

Summary Understanding sociocultural context is crucial to understanding the interplay of body image, body satisfaction, and eating patterns. The research regarding body image and body dissatisfaction has nicely begun to catalogue existing group differences. Studies that included some level of contextual analysis show that women from diverse groups may base their body image on different aspects of their bodies and that while disturbances in body image are common for women across cultures and of diverse ethnicities, the reasons for the disturbances may vary. Studies that have explored context even to a limited extent also provide a much fuller picture of the phenomenon of body image and related disturbances. To truly understand body image as a facet of identity, it is essential to grasp the multiple aspects that a particular culture considers relevant in valuing the body image construct. Barbie would not represent a powerful body image for the Sahraoui women; just as traditional Sahraoui dress would not be relevant to understanding the body image and eating patterns of White middle-class women.

Ethnicity And Disordered Eating Disordered eating is a significant problem particularly among adolescent and young women in many Westernized countries. Hoek and van Hoeken (2003) found in their review of the literature that overall the prevalence rate of anorexia nervosa and bulimia nervosa for female adolescents was 0.3% and 1%, respectively. Other reviewers have reported prevalence rates that range from 0% to 0.9% for anorexia nervosa, 0.5% to 4% for bulimia nervosa, and 0.59% to 1.5% for binge eating disorder (Annenberg Foundation Commission on Adolescent Eating Disorders, 2005). Recently, Alegría et al. (2007) reported that the prevalence rate for Hispanic females in the United States is 0.12% for anorexia, 1.91% for bulimia nervosa, and 2.31% for binge eating disorder. For Asian American females, the prevalence rates reported by Nicdao et al. (2007) are 0.12% for anorexia nervosa, 1.42% for bulimia nervosa, and 2.67% for binge eating disorder. For Black women, Taylor et al. (2007) reported the most recent rates as 0.14% for anorexia nervosa, 1.9% for bulimia nervosa, and 2.36% for binge eating disorder. The prevalence of disordered eating behavior that does not meet full clinical criteria for anorexia nervosa or bulimia nervosa is estimated to be greater than the prevalence for full syndrome disorders. For example, the prevalence of binge eating that does not meet criteria for bulimia nervosa or binge eating disorder has been reported as 5.8% for Hispanic females (Alegría


et al., 2007), 4.71% for Asian females (Nicdao et al., 2007), and 2.62% for Black females (Taylor et al., 2007). A common misconception is that eating disorders are a disease of middleor upper-class White females who are pathologically preoccupied with attaining unrealistically thin body ideals. As a result of this belief, eating disorders have been studied most frequently using clinical samples of White adolescent and adult females, which has further contributed to the perpetuation of this myth. Prevalence rates are misleading if based on clinical samples because women of color underutilize professional health services. Stereotyping disordered eating as a problem of White women hinders the recognition of eating problems in women of color (Gilbert, 2003; Gordon, Perez, & Joiner, 2002; Kessler, Demler, Frank, Olfson, Pincus, et al., 2005; Striegel-Moore et al., 2004; Striegel-Moore, Dohm, et al., 2005).

Disordered Eating in Diverse Groups of Women That binge eating and purging are significant problems for ethnic minority women is supported by Crago and Shisslak’s (2003) review of empirical studies of dieting behaviors, binge eating, and purging among American girls and women. Included in the review of research from 1980 to 2002 were over 285,000 participants in 50 studies of dieting behaviors, over 50,000 participants in 28 studies of binge eating, and over 62,000 participants in 19 studies of purging behaviors used for weight control (i.e., self-induced vomiting, laxative use, diuretic use). Black, White, Hispanic, American Indian, and Asian American girls and women were represented in the studies. The word “females” is used in the following sentences because the findings relate to both girls and women. According to Crago and Shisslak, the majority of studies indicated that dieting was more common for White females than for females from other ethnic groups; binge eating was equally common across the various ethnic groups; and the use of vomiting, laxatives, and diuretics for weight control was either equally common across ethnic groups or less common for White females than for females in other ethnic groups. Regan and Cachelin’s (2006) study of binge eating, self-induced vomiting, and use of laxatives, diet pills and diuretics among Asian, Hispanic, Black, and White women offers further evidence of substantial disordered eating behaviors of these types across ethnic groupings. As with an earlier study by Cachelin, Veisel, Barzegarnazari, and Striegel-Moore (2000), Regan and Cachelin found that disordered eating behaviors were exhibited by women of all ethnicities in the study, and the prevalence of specific behaviors varied by ethnicity. Binge eating was commonly reported by women of all four ethnic groups. Respectively, Asian, Hispanic, Black and White women reported binge eating rates of 20.0%, 15.8%, 19.7%, and 20.5%. Pronounced ethnic differences in self-induced vomiting, and the use of laxatives, diet pills or diuretics for weight control emerged for women in the study. Similar percentages of Hispanic (8.2%), Black (10.2%), and White (9.8%) women reported using selfinduced vomiting to control weight, but this behavior was much less common in Asian women (4.5%). Use of laxatives, diet pills or diuretics for weight control was common among Hispanic (21.3%), Black (33.9%), and White women (23.2%), but again was less common among Asian women (11%).

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Disordered Eating in Black and White Women In a large study (N = 2,046) of an economically and geographically diverse community sample of Black and White women assessed annually over a period of 10 years starting at age 9 or 10, Striegel-Moore et al. (2003) found that significantly more White women than Black women met lifetime criteria for diagnoses of anorexia nervosa, bulimia nervosa and binge eating disorder, but Black women were found to exhibit bulimia nervosa and binge eating disorder in substantial numbers. The most pronounced differences between Black and White women were found in the prevalence of anorexia nervosa and bulimia nervosa. Consistent with prior research indicating that anorexia nervosa is a rare disorder, only 1.5% of the White women and none of the Black women had developed anorexia nervosa. White women were also six times more likely than Black women to have experienced bulimia nervosa, with prevalence rates of 2.3% in White women and 0.4% in Black women. A smaller, but still significant, ethnic group difference was apparent for binge eating disorder, with 1.4% of Black women and 2.7% of White women meeting criteria for binge eating disorder. Binge eating disorder was the most common of the three eating disorders and the most prevalent eating disorder for Black women. Significant differences also were found for lifetime and current rates of obesity, with Black women experiencing higher rates of both lifetime and current obesity. Other research similarly challenges the view that ethnic minority women do not suffer from disordered eating. In a meta-analysis of 18 studies of disordered eating in Black and White women in the United States published between 1987 and 2001 and including a total of 25,442 participants, O’Neill (2003) found that White women had only slightly higher rates of disordered eating overall than Black women. While White females were significantly more likely to have “anorexia-type” disturbances, no significant differences were found between Black and White women for prevalence estimates of bulimia nervosa-related or binge eating-related disturbances. O’Neill stated that Black women suffer from eating disturbances related to bulimia nervosa and binge eating disorder in similar numbers as White women. It should be noted, however, that in only 5 of the 18 studies was a DSM diagnosis for the women established. Thus, the meta-analysis may be useful for understanding the prevalence of eating disorder symptoms, but not for understanding the prevalence of eating disorders. In support of O’Neill’s (2003) findings regarding the similar rates of disordered eating symptoms are the results of a study of 7,369 women that was conducted by Striegel-Moore, Wilfley, Pike, Dohm, and Fairburn (2000). Recurrent binge eating, which is a diagnostic feature of bulimia nervosa and binge eating disorder, and the inappropriate compensatory behaviors of selfinduced vomiting, use of laxatives and diuretics, and fasting for weight control appear to be significant problems for Black as well as White women. In this study, Black women and White women reported similar rates of binge eating. Of the 1,628 Black women, 8.4% had engaged in binge eating at least once in the preceding three months, while 8.8% of the 5,741 White women had engaged in binge eating during the same period. Also, again in comparison with White women, Black women were found to be as likely to have engaged


in self-induced vomiting and more likely to have used laxatives, diuretics or fasting for weight control. Pike, Dohm, Striegel-Moore, Wilfley, and Fairburn (2001) found that a community sample of Black and White women with binge eating disorder differed significantly on all features of the eating disorder. White women with binge eating disorder reported higher levels of dietary restraint, weight concern, eating concern, and shape concern, while Black women with binge eating disorder had a higher frequency of binge episodes and a higher rate of obesity. The Black and White women diagnosed with binge eating disorder also differed on their history of other eating disorders, with White women being eight times more likely to have a history of bulimia nervosa. Overall, Pike et al.’s (2001) results suggest that there is a different clinical presentation for Black women with binge eating disorder as compared to White women with the disorder. Black women were significantly more likely to be obese and were significantly less concerned with eating, weight, and shape despite reporting pathological levels of eating behaviors. This raises the question of whether underlying these ethnic differences in clinical presentation are ethnic differences in the context in which the disorder develops and thus in the pathway to the disorder. For example, Black women’s lower concern with weight and shape may indicate that striving to attain a thin body ideal may be less relevant to the development of disordered eating in Black women. The Pike et al. study (2001) suggests that disordered eating in Black women may have little to do with concern with weight and shape. According to Wechsler, Riggs, Stabb, and Marshall (2006) Black women express less desire to achieve a thin body ideal than White women express, and they have been shown to report significantly lower Drive for Thinness scores on the Eating Disorder Inventory-Second Edition (Garner, 1991), indicating that they are less preoccupied with weight and dieting. In contrast, White women report significantly higher levels of body dissatisfaction (Wechsler, Riggs, Stabb, & Marshall, 2006). This suggests that the factors that influence Black women to engage in disordered eating may differ from those that influence White women, for whom drive for thinness has been shown to be salient. Lovejoy (2001) offered explanations for the differences in body image and eating disorders between Black and White women based on a feminist perspective. In general Black women are more satisfied with their weight and appearance, are somewhat less likely to exhibit disordered eating behaviors, and have higher rates of obesity. Lovejoy suggests that White women may be more predisposed to develop eating disorders while Black women may be more predisposed to develop obesity. Lovejoy also postulated three reasons for observed differences in body image and disordered eating behaviors between Black and White women. The first is that Black women may have a cultural resistance to mainstream beauty ideals. “In fact, there is some evidence for a more flexible and more egalitarian aesthetic of beauty in some Black communities, an aesthetic that may enable Black girls and women to develop greater self-acceptance” (Lovejoy, 2001, p. 249). Black women may possess a more multidimensional definition of beauty that places less emphasis on rigid standards of physical appearance and more emphasis on personality, personal style, and attitude. Additionally, the cultural construction of Black gender roles, strong mother-daughter relationships, and

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more androgynous gender identities may be preventative for the development of eating disorders in Black women. Black women have long combined motherhood and working and have been raised to be independent and self-reliant because institutional racism has made it difficult for women to rely on men for economic support. Lovejoy’s final explanation for Black and White differences is that the positive body image of Black women may be an expression of denial of psychological and physical problems.

Disordered Eating in Hispanic Women Most research regarding ethnic differences in disordered eating has focused on Black and White women. The studies that have included Hispanic women indicate that they may engage in binge eating and use self-induced vomiting, laxatives, diet pills and diuretics for weight and shape control at the same rates as Black and White women (Crago & Shisslak, 2003; Regan & Cachelin, 2006). Research also suggests that disordered eating in Hispanic females is a significant problem. In a three-year longitudinal study of risk factors for the onset of disordered eating in adolescent girls, Hispanic ethnicity was found to be a potential risk factor for the development of eating disorder symptomatology in a sample of girls in grades 6–9 in Arizona (McKnight Investigators, 2003). A significant interaction effect was found between Hispanic ethnicity and a risk factor measuring thin body preoccupation and social pressure. While Hispanic and non-Hispanic girls who did not have disordered eating had similar scores on the thin body preoccupation and social pressure measure, Hispanic girls with disordered eating had significantly higher scores than their non-Hispanic counterparts on the measure. The McKnight study did not find the same result in a similar sample of girls in California (McKnight Investigators, 2003). The McKnight investigators suggested that the disparate findings between the girls in Arizona and California may be an artifact of the complexity of the construct of ethnicity. Smolak and Striegel-Moore (2001) also proposed that ethnicity is not a unitary construct but rather includes a number of diverse aspects such as immigration status, gender roles, discrimination, socioeconomic disparities, and acculturation. These results illustrate the complexity of demographic factors; a designation of “Hispanic” may reflect a wide range of cultural heritages. Moreover, differences in immigration status, family income or education, and other factors may contribute to differences between samples recruited at various sites in the U.S.

Disordered Eating in Asian Women Evidence suggests that Asian women suffer from eating disorders at similar rates to Black, White, and Hispanic women although purging behaviors appear to be less common in Asian women (Crago & Shisslak, 2003; Regan & Cachelin, 2006). Acculturation has been investigated as a possible explanation for development of disordered eating behavior in Asian women. The acculturation theory of eating disorders proposes that ethnic minority women tend to adopt the sociocultural values of the majority culture over time (Ball & Kenardy, 2002). According to this theory, individuals from non-Western cultures assimilate


thin body ideals, concern with body weight and shape, and the eating patterns of Western culture rendering themselves vulnerable to the development of eating disorders. Some support for acculturation as a risk factor for eating disorders was found by Ball and Kenardy (2002). In their sample of women in Australia whose ethnic composition included women born in Australia, Asia, Europe and other English and non-English-speaking countries, acculturation (as measured by time spent in Australia) was significantly associated with weight dissatisfaction, dieting, and binge eating. Other studies that have attempted to show a connection between acculturation and disordered eating behaviors have failed to find conclusive support for this theory in Asian women. However, some interesting results have emerged. Tsai, Curbow, and Heinberg (2003) studied sociocultural and developmental influences on body dissatisfaction and disordered eating attitudes and behaviors in two groups of Taiwanese women. One group consisted of Taiwanese-American women, and the other group was comprised of Taiwanese women in Taiwan. Contrary to sociocultural theory, which predicts that acculturation pressures to conform to the Western thin body ideal would cause the Taiwanese-American women to have more body dissatisfaction and disordered eating, the women in Taiwan expressed significantly greater levels of body dissatisfaction and disordered eating attitudes and behaviors. Disordered eating in acculturated and traditional Chinese-Australian women was studied by Humphry and Ricciardelli (2004). Similarities and differences in the risk factors for eating pathology between the two groups of women were observed. Lower levels of satisfaction with physical appearance, higher levels of parental overprotection, and higher levels of perceived pressure from female friends to lose weight predicted greater levels of eating pathology in both acculturated and traditional Chinese women. For the more acculturated women who identified weakly with Chinese culture, higher perceived pressure to lose weight from fathers and male friends was associated with higher levels of eating pathology. For women who identified strongly with traditional Chinese values, higher levels of parental care predicted higher levels of eating pathology. These studies of Asian women allude to the complex picture of risk factors for and implicated pathways to disordered eating.

Disordered Eating in Other Ethnic Groups Two unique investigations of disordered eating in other non-Western cultures shed further light on the relationship between ethnicity and disordered eating. Becker, Burwell, Navara, and Gilman (2003) explored binge eating and binge eating disorder in indigenous women in rural Fiji. Fifty ethnic Fijian women ranging in age from 18–69 years old in a traditional village were studied in context. The traditional Fijian culture is markedly dissimilar from Western culture in terms of attitudes toward weight, eating, and body shape. Of the indigenous Fijian women, 4% of the women met DSM-IV criteria for binge eating disorder, and 10% reported clinically significant binge eating behavior. These rates of binge eating disorder and binge eating were comparable to rates found in Western societies. History of obesity, dieting, and elevated concern with body shape were also found to be associated with binge eating for the

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Fijian women, reflecting results from similar studies of Western women. These results were found in a cultural context that is highly disparate from Western culture. Fijian culture endorses larger body sizes, and 44% of the respondents were obese (indicating that, just as with Western culture, most of the obese women did not report disordered eating behavior or meet diagnostic criteria for an eating disorder). Additionally, large appetites and focus on eating, feasts and food presentation are very important in Fijian culture. This study demonstrated that women in non-Western cultural contexts that do not necessarily endorse a thin body ideal also report disordered eating. A second study of a unique non-Western culture explored the eating behavior of female Chamorro university students in Guam and compared them to female White university students in California (Edman & Yates, 2004). The Chamorro are the indigenous people of the Pacific Island of Guam. Chamorro and White women were found to report similar levels of eating disorder symptoms and body dissatisfaction. For Chamorro women, no relationship was found between body dissatisfaction and drive for thinness, reflecting ethnographic studies in which Pacific Island women expressed greater acceptance of larger body sizes than White women (Edman & Yates, 2004). Chamorro women had higher BMI levels than White women and, although body dissatisfaction was unrelated to thinness, the Chamorro women expressed similar levels of body dissatisfaction as the White women. One explanation for this is offered by Edman and Yates (2004): Chamorro culture places great value on food reciprocity in social connection, and the women may value being socially connected through eating and food more than striving to achieve a thin ideal body size. For the Chamarro women emotional factors of self-satisfaction and anger discomfort were more strongly correlated with eating disorders than BMI or body dissatisfaction. This suggests that psychological factors rather than physical appearance may be more important in understanding eating disorders for the Chamorro women. Thus, recent research has begun to explore disordered eating in ethnic populations, with much of this work centering on identifying differences between Black and White populations. Overall, the evidence suggests that disordered eating occurs across the ethnic groups studied, but that the prevalence of the various eating disorders and of specific eating disorder symptoms may vary across ethnicity. However, the picture is far from complete, and recent research suggests that the risk factors for and pathways to disordered eating may be as unique and diverse as the cultural contexts in which they are manifest.

Risk Factors Research to identify risk factors for binge eating disorder has indicated much similarity for Black women and White women (Striegel-Moore, Fairburn, et al., 2005). Potential risk factors for binge eating disorder for both Black and White women have been found to include childhood obesity, family overeating or binge eating (but not familial anorexia nervosa, bulimia nervosa or dieting), family discord (family tension at mealtimes, frequent arguments between parents, low parental affection, and limited contact with parents), high parental demands (parental high expectations, frequent criticism, and parental ill health), negative affectivity, perfectionism, parental characteristics of high


rates of psychopathology, frequent separations from the child, and parenting style of low levels of affection with high levels of control. No ethnicity-specific risk factors were identified. As well, a significant association has been identified between abuse, both sexual and physical, and binge eating disorder for both Black and White women (Striegel-Moore, Dohm, Pike, Wilfley, & Fairburn, 2002) and between sexual abuse and eating disorders for Mexican American women (Cachelin, Schug, Juarez, & Monreal, 2005). In the Striegel-Moore et al. (2002) study, the association was particularly pronounced in Black women, with one-half of the Black women and one-third of the White women in the sample who had been diagnosed as having binge eating disorder reporting a history of childhood sexual abuse that predated the onset of their eating disorder. Binge eating disorder was also found to be related to physical abuse. “Alarmingly high rates of physical abuse were found among white women (49.0%) and black women (65.0%) with binge eating disorder, and for many women (31.4% white and 40.0% black), physical abuse was repeated and severe” (Striegel-Moore et al., 2002, p. 1905). In the Cachelin et al. (2005) study, 45% of the 80 Mexican American women diagnosed with an eating disorder reported being sexually abused prior to the onset of their eating disorder. Psychosocial risk factors for eating disorders were investigated in depth for Hispanic and White non-Hispanic women by George, Erb, Harris, and Casazza (2007). Ethnic differences were considered among the diverse cultural subgroups comprising the heterogeneous classification of Hispanic, or Spanishspeaking. The Hispanic participants identified their Hispanic backgrounds as Cuban (62%), Central American/Mexican (11%), Columbian (10%), Dominican (5%), Puerto Rican (5%), Brazilian (4%) and Venezuelan (3%). Significant differences were found for the groups on the Psychosocial Risk Factor Questionnaire (PRFQ; Whisenhunt, Williamson, Netemeyer, & Womble, 2000), which measures risk factors for eating disorders including social pressure for thinness, media pressure for thinness, concern for physical appearance, and perception of physical appearance. George et al. (2007) found that Dominican, Venezuelan, and Columbian women exhibited significantly higher overall scores on the PRFQ and higher scores on the Concern for Physical Appearance subscale of the PRFQ than White non-Hispanic, Cuban, and Central American/Mexican women, indicating that Dominican, Venezuelan and Columbian women may be at greater risk for eating disorders. Significant differences were also found across groups for BMI and ideal body image score on the Figure Rating Scale (Stunkard, Sorenson, & Schulsinger, 1983). Puerto Rican and Venezuelan women had significantly higher BMIs than non-White Hispanic, Cuban and Brazilian women. The mean score for ideal body image was the lowest for Brazilian women and the highest for Puerto Rican women. The findings regarding ideal body image indicate that, on average, Brazilian women endorsed significantly smaller ideal body size than White non-Hispanic, Columbian, Dominican, and Puerto Rican women. Puerto Rican women chose ideal body images significantly larger than those chosen by all of the other women except the Dominican and Venezuelan women. George et al. suggested that acculturation level, immigration and socioeconomic status, peer influences and family structure may all contribute to differences in risk for eating disorders across these ethnic communities.

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Diagnosis and Treatment Ethnic differences between Black and White women extend to the diagnosis and treatment of eating disorders. Striegel-Moore et al.’s (2003) study of a large, diverse community sample found that few Black or White women had ever received treatment for an eating disorder. This finding was particularly the case for Black women, who were even less likely than White women to have received treatment, with 28.1% of White women and 5.3% of Black women receiving treatment. In a series of studies, Cachelin, Striegel-Moore, and colleagues (Cachelin & Striegel-Moore, 2006; Cachelin, Striegel-Moore, & Regan, 2006; Cachelin, Veisel, Barzegarnazari, & Striegel-Moore, 2000; Cachelin, Rebeck, Veisel, & Striegel-Moore, 2001) found additional, but not consistent, evidence regarding barriers to eating-disorder treatment for women from ethnically diverse groups. Both the Cachelin et al. (2000) and Cachelin et al. (2001) studies, which included Asian, Hispanic, Black, and White women, found no ethnic group difference in the likelihood of seeking treatment. Whether there were ethnic differences in receiving treatment once it was requested was not reported in either study. In their two studies of White and Mexican American women diagnosed with eating disorders, Cachelin and Striegel-Moore (2006) and Cachelin, Striegel-Moore, and Regan (2006) found that Mexican American women were less likely than White American women to seek treatment for their eating problems and, when they did seek treatment, were less likely to be diagnosed with or treated for an eating disturbance. In this group of studies, the two studies that did not find an ethnic group difference may have suffered from small samples across multiple ethnic groups, whereas the studies that found such differences may have had the benefit of sufficient power provided by larger samples for only two ethnic groups. Overall, these studies suggest that recognition of and treatment for eating disorders is ethnically loaded and may reflect the pervasive view that White women alone suffer from these disorders. To explore this idea, Gordon, Perez, and Joiner (2002) investigated racial stereotyping in relation to eating disorder recognition. When college women of various ethnicities read a fictional girl’s thoughts and behaviors expressed in a diary, an eating disorder was recognized significantly more frequently when the girl was portrayed as White than when the same girl was portrayed as Hispanic or Black. While participants recognized disordered eating symptoms as frequently when the girl was White or non-White, the identification of an eating disorder was significantly less frequent when the girl was described as non-White. These results suggest that racial stereotyping may interfere with the recognition of eating disorders.

Summary As with the researchers who study body image, the researchers who study disordered eating are doing a good job of beginning to catalogue how the prevalence and presentation of disordered eating may vary across diverse groups of women. However, consistent with the research on body image, the research on disordered eating to date tells us little about the sociocultural context in which the disordered eating occurs. We have a better sense of who is at risk for


developing disordered eating (women from diverse ethnic groups) and when they are most likely to develop it (during adolescence), but we still know relatively little about why disordered eating occurs and whether the reasons vary across ethnicities and cultures.

Conclusion There is substantial evidence to suggest the need to understand the sociocultural context in which body image and eating disturbances develop. When the literature on body image and disordered eating has addressed relevant aspects of sociocultural context, it has provided intriguing and valuable information. Yet in much of the literature, there is little or no attention paid to the sociocultural context in which disturbances of body image and eating occur. This means that many important questions remain unanswered. For example, upon what is body image based; is it based on size, shape, or the perceived quality of particular body parts? Do the components that contribute to the formation of body image vary based on ethnicity, culture, or other sociocultural factors? Research also has clearly begun to study more diverse groups and to ferret out differences/similarities in manifest behavior. But what is behind those manifest behaviors, what are the specific pathways to disorders of body image and eating, and do those pathways vary based on sociocultural factors? Is a Turkish woman’s reason for struggling to be thin the same as an Asian woman’s reason? What is the basis for the desire to be thin: Is it to achieve some body ideal, to exercise self-control in the perceived absence of power within society, to conform to a thin-on-average culture, or to rebel against a not-thinon-average culture? The possible consequences of not understanding the context for disorders of eating and body image are of concern. Even from a behaviorist perspective, which may focus less on the precipitants of the disordered behavior than other perspectives would, we would need to know what is maintaining the behavior in order to effectively treat the behavior. The success of treatments and psycho-educational interventions hinges on our fully understanding the behavior; and our ability to fully understand the behavior hinges on our understanding the sociocultural context in which the behavior arises. Prevention, recognition, and treatment of eating disorders and associated problems cannot be effectively implemented on a large scale in diverse communities until greater understanding of culture and the context of specific risk factors is attained.

References Alegría, M., Woo, M., Cao, Z., Torres, M., Meng, X., & Striegel-Moore, R. H. (2007). Prevalence and correlates of eating disorders in Latinos in the United States. International Journal of Eating Disorders, 40(S3), S15–S21. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. Abdollahi, P., & Mann, T. (2001). Eating disorder symptoms and body image concerns in Iran: Comparisons between Iranian women in Iran and in America. International Journal of Eating Disorders, 30, 259–268. Altabe, M. (1998). Ethnicity and body image: Quantitative and qualitative analysis. International Journal of Eating Disorders, 23, 153–159.

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Annenberg Foundation Commission on Adolescent Eating Disorders. (2005). Defining eating disorders. In D. L. Evans, E. B. Foa, R. E. Gur, H. Hendin, C. P. O’Brien , M.E.P. Seligman, & B. T. Walsh (Eds.), Treating and preventing adolescent mental health disorders (pp. 257–281). New York, NY: Oxford University Press. Ball, K., & Kenardy, J. (2002). Body weight, body image, and eating behaviors: Relationships with ethnicity and acculturation in a community sample of young Australian women. Eating Behaviors, 3, 205–216. Barry, D. T., & Grilo, C. M. (2002). Eating and body image disturbances in adolescent psychiatric inpatients: Gender and ethnicity patterns. International Journal of Eating Disorders, 32, 335–343. Becker, A., Burwell, R. A., Navara, K., & Gilman, S. E. (2003). Binge eating and binge eating disorder in a small-scale, indigenous society: The view from Fiji. International Journal of Eating Disorders, 34, 423–431. Cachelin, F. M., Monreal, T. K., & Juarez, L. L. (2006). Body image and size perception of Mexican American women. Body Image, 3, 67–75. Cachelin, F. M., Phinney, J., Schug, R. A., & Striegel-Moore, R. H. (2006). Acculturation and eating disorders in a Mexican American community sample. Psychology of Women Quarterly, 30, 340–347. Cachelin, F. M., Rebeck, R., Veisel, C., & Striegel-Moore, R. H. (2001). Barriers to treatment for eating disorders among ethnically diverse women. International Journal of Eating Disorders, 30, 269–278. Cachelin, F. M., & Regan, P. C. (2006). Prevalence and correlates of chronic dieting in a multiethnic U.S. community sample. Eating and Weight Disorders, 11, 91–99. Cachelin, F. M., Schug, R. A., Juarez, L. L., & Monreal, T. K. (2005). Sexual abuse and eating disorders in a community sample of Mexican American women. Hispanic Journal of Behavioral Sciences, 27, 533–546. Cachelin, F. M., & Striegel-Moore, R. H. (2006). Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. International Journal of Eating Disorders, 39, 1544–1561. Cachelin, F. M., Striegel-Moore, R. H., & Regan, P. C. (2006). Factors associated with treatment seeking in a community sample of European American and Mexican American women with eating disorders. European Eating Disorders Review, 14, 1–8. Cachelin, F. M., Veisel, C., Barzegarnazari, E., & Striegel-Moore, R. H. (2000). Disordered eating, acculturation and treatment seeking in a community sample of Hispanic, Asian, Black, and White women. Psychology of Women Quarterly, 24, 244–253. Canpolat, B. I., Orsel, S., Akdemir, A., & Ozay, M. H. (2005). The relationship between dieting and body image, body ideal, self-perception, and BMI in Turkish adolescents. International Journal of Eating Disorders, 37, 150–155. Cash, T. F., Melnyk, S. E., & Hrabosky, J. I. (2004). The assessment of body image investment: An extensive revision of the appearance schemas inventory. International Journal of Eating Disorders, 35, 305–316. Crago, M., & Shisslak, C. M. (2003). Ethnic differences in dieting, binge eating, and purging behaviors among American females: A review Eating Disorders, 11, 289–304. Dittmar, H., Halliwell, E., & Ive, S. (2006). Does Barbie make girls want to be thin? The effect of experimental exposure to images of dolls on the body image of 5- to 8-year-old girls. Developmental Psychology, 42, 283–292. Edman, J. L., & Yates, A. (2004). Eating disorder symptoms among Pacific Island and Caucasian women: The impact of self-dissatisfaction and anger discomfort. Journal of Mental Health, 13, 143–150. Garner, D. M. (1991). Eating Disorder Inventory-2 Professional Manual. Odessa, FL: Psychological Assessment Resources. George, V. A., Erb, A. F., Harris, C. L., & Casazza, K. (2007). Psychosocial risk factors for eating disorders in Hispanic females of diverse ethnic background and non-Hispanic females. Eating Behaviors, 8, 1–9. Gilbert, S. C. (2003). Eating disorders in women of color. Clinical Psychology: Science and Practice, 10, 444–455. Gordon, K. H., Perez, M., & Joiner, T. E. (2002). The impact of racial stereotypes on eating disorder recognition. International Journal of Eating Disorders, 32, 219–224.


Grabe, S., & Hyde, J. S. (2006). Ethnicity and body dissatisfaction among women in the United States: A meta-analysis. Psychological Bulletin, 132, 622–640. Hahn-Smith, A. M., & Smith, J. E. 2001). The positive influence of maternal identification on body image, eating attitudes, and self-esteem of Hispanic and Anglo girls. International Journal of Eating Disorders, 34, 142–147. Hoek, H. W., & van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34, 383–396. Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358. Humphry, T. A., & Ricciardelli, L. A. (2004). The development of eating pathology in ChineseAustralian women: Acculturation versus culture clash. International Journal of Eating Disorders, 35, 579–588. Iyer, D. S., & Haslam, N. (2003). Body image and eating disturbance among South Asian-American women: The role of racial teasing. International Journal of Eating Disorders, 34, 142–147. Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H. C., & Agras, W. S. (2004). Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin, 130, 19–65. Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa, S., et al. (2004). The U.S. National Comorbidity Survey Replication (NCS-R): Design and field procedures. International Journal of Methods in Psychiatric Research, 13(2), 69–92. Kessler, R. C., Chiu, W. T., Dernier, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627. Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., et al. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352, 2515–2523. Landrine, H. (1995). Introduction: Cultural diversity, contextualism, and feminist psychology. In H. Landrine (Ed.), Bringing culture to feminist psychology: Theory, research, and practice (pp. 1–20). Washington, DC: American Psychological Association. Levine, M. P., & Harrison, K. (2004). The role of mass media in the perpetuation and prevention of negative body image and disordered eating. In J. K. Thompson (Ed.), Handbook of eating disorders and obesity (pp. 695–717). New York, NY: Wiley. Levine, M. P., & Smolak, L. (1996). Media as a context for the development of disordered eating. In L. Smolak, M. P. Levine, & R. Striegel-Moore (Eds.), The developmental psychopathology of eating disorders: Implications for research, prevention and treatment (pp. 235–257). Mahwah, NJ: Erlbaum. Lewinsohn, P. M., Hops, H., Roberts, R. E., Seeley, J. R., & Andrews, J. A. (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM–III–R disorders in high school students. Journal of Abnormal Psychology, 102, 133–144. Lindberg, L., & Hjern, A. (2003). Risk factors for anorexia nervosa: A national cohort study. International Journal of Eating Disorders, 34, 397–408. Lovejoy, M. (2001). Disturbances in the social body: Differences in body image and eating problems among African American and White women. Gender & Society, 15, 239–261. Mathers, C. D., Vos, E. T., Stevenson, C. E., & Begg, S. J. (2000). The Australian Burden of Disease Study: Measuring the loss of health from diseases, injuries and risk factors. Medical Journal of Australia, 172, 592–596. McClelland, L., & Crisp, A. (2001). Anorexia nervosa and social class. International Journal of Eating Disorders, 29, 150–156. McKnight Investigators. (2003). Risk factors for the onset of eating disorders in adolescent girls: Results of the McKnight longitudinal risk factor study. American Journal of Psychiatry, 160, 248–254. Millar, H. R., Wardell, F., Vyvyan, J. P., Naji, S. A., Prescott, G. J., & Eagles, J. M. (2005) Anorexia nervosa mortality in Northeast Scotland, 1965–1999. American Journal of Psychiatry, 162, 753–757. Miller, K. J., Gleaves, D. H., Hirsch, T. G., Green, B. A., Snow, A. C., & Corbett, C. C. (2000). Comparisons of body image dimensions by race/ethnicity and gender in a university population. International Journal of Eating Disorders, 27, 310–316.

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Nicdao, E. G., Hong, S., & Takeuchi, D.T. (2007). Prevalence and correlates of eating disorders among Asian Americans: Results from the National Latino and Asian American Study. International Journal of Eating Disorders, 40(S3), S22–S26. Ogden, J., & Elder, C. (1998). The role of family status and ethnic group behavior on body image and eating behavior. International Journal of Eating Disorders, 23, 309–315. Okazawa-Rey, M., Robinson, T., & Ward, J. V. (1987). Black women and the politics of skin color and hair. Women and Therapy, 6, 89–102. O’Neill, S. K. (2003). African American women and eating disturbances: A meta-analysis. Journal of Black Psychology, 29, 3–16. Pike, K. M., Dohm, F. A., Striegel-Moore, R. H., Wilfley, D. E., & Fairburn, C.G. (2001). A comparison of Black and White women with Binge Eating Disorder. American Journal of Psychiatry, 158, 1455–1460. Perez, M., & Joiner, T. E. (2003). Body image dissatisfaction and disordered eating in Black and White women. International Journal of Eating Disorders, 33, 342–350. Pope, H. G., Olivardia, R., Gruber, A., & Borowiecki, J. (1999). Evolving ideals of male body image as seen through action toys. International Journal of Eating Disorders, 26, 65–72. Reddy, S. D., & Crowther, J. H. (2007). Teasing, acculturation, and cultural confl ict: Psychological correlates of body image and eating attitudes among South Asian women. Cultural Diversity and Ethnic Minority Psychology, 13, 45–53. Regan, P. C., & Cachelin, F. M. (2006). Binge eating and purging in a multi-ethnic community sample. International Journal of Eating Disorders, 39, 523–526. Rguibi, M., & Belahsen, R. (2006). Body size preferences and sociocultural influences on attitudes towards obesity among Moroccan Sahraoui women. Body Image, 3, 395–400. Roberts, A., Cash, T. F., Feingold, A., & Johnson, B.T. (2006). Are Black-White differences in females’ body dissatisfaction decreasing? A meta-analytic review. Journal of Consulting and Clinical Psychology, 74, 1121–1131. Schroff, H., & Thompson, J. K. (2004). Body image and eating disturbance in India: Media and interpersonal influences. International Journal of Eating Disorders, 35, 198–203. Smith, D. E., Thompson, J. K., Raczynski, J. M., & Hilner, J. E. (1999). Body image among men and women in a biracial cohort: The CARDIA study. International Journal of Eating Disorders, 25, 71–82. Smolak, L., & Striegel-Moore, R. H. (2001). Challenging the myth of the golden girl: Ethnicity and eating disorders. In R. H. Striegel-Moore & L. Smolak (Eds.), Eating disorders: Innovative directions in research and practice (pp. 111–132), Washington, DC: American Psychological Association. Sorbara, M., & Geliebter. A. (2002). Body image disturbance in obese outpatients before and after weight loss in relation to race, gender, binge eating, and age of onset of obesity. International Journal of Eating Disorders, 31, 416–423. Stice, E., & Agras, W. S. (1998). Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis. Behavior Therapy, 29(2), 257–276. Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. American Psychologist, 62, 181–198. Striegel-Moore, R. H., Dohm, F. A., Kraemer, H. C., Schreiber, G., Crawford, P., & Daniels, S. (2005). Health services use in women with a history of a binge eating disorder. International Journal of Eating Disorders, 37, 11–18. Striegel-Moore, R. H., Dohm, F. A., Kraemer, H. C., Taylor, C. B., Daniels, S., Crawford, P. B., & Schreiber, G. B. (2003). Eating disorders in Black and White women. American Journal of Psychiatry, 160, 1326–1331. Striegel-Moore, R. H., Dohm, F. A., Pike, K. M., Wilfley, D. E., & Fairburn, C. G. (2002). Abuse, bullying, and discrimination as risk factors for Binge Eating Disorder. American Journal of Psychiatry, 159, 1902–1907. Striegel-Moore, R. H., Dohm, F. A., Wilfley, D. E., Pike, K. M., Bray, N. L., Kraemer, H. C., & Fairburn, C. G. (2004). Toward an understanding of health services use in women with Binge Eating Disorder. Obesity Research, 12, 799–806. Striegel-Moore, R. H., Fairburn, C. G., Wilfley, D. E., Pike, K. M., Dohm, F. A., & Kraemer, H. C. (2005). Toward an understanding of risk factors for Binge Eating Disorder in Black and White women: A community-based case-control study. Psychological Medicine, 35, 907–917.


Striegel-Moore, R. H., Wilfley, D. E., Pike, K. M., Dohm, F. A., & Fairburn, C. G. (2000). Recurrent binge eating in Black American women. Archives of Family Medicine, 9, 83–87. Stunkard, A. J., Sorenson, T., & Schulsinger, F. (1983). Use of the Danish adoption register for the study of obesity and thinness. In S. Kety, L. P. Rowland, R. L. Sidman, & S. W. Matthysse (Eds.), The genetics of neurological and psychiatric disorders (pp. 115–120). New York, NY: Raven Press. Sullivan, P. F. (1995). Mortality in Anorexia Nervosa. American Journal of Psychiatry, 152, 1073–1074. Taylor, J. Y., Caldwell, C. H., Baser, R. E., Faison, N., & Jackson, J. S. (2007). Prevalence of eating disorders among Blacks in the National Survey of American Life. International Journal of Eating Disorders, 40(S3), S10–S14. Thompson, J. K., Heinberg, L. J., Altabe, M., & Tantleff-Dunn, S. (1999). Exacting beauty: Theory, assessment, and treatment of body image disturbance. Washington, DC: American Psychological Association. Tsai, G., Curbow, B., & Heinberg, L. (2003). Sociocultural and developmental influences on body dissatisfaction and disordered eating attitudes and behaviors of Asian women. Journal of Nervous and Mental Disease, 191, 309–318. Twenge, J., & Crocker, J. (2002). Race and self-esteem: Meta-analyses comparing Whites, Blacks, Hispanics, Asians, and American Indians and comments on Gray-Little and Hafdahl. Psychological Bulletin, 128, 371–408. Wechsler, L. S., Riggs, S. A., Stabb, S. D., & Marshall, D. M. (2006). Mutuality, self-silencing, and disordered eating in college women. Journal of College Student Psychotherapy, 21, 51–76. Whisenhunt, B. L., Williamson, D. A., Netemeyer, R. G., & Womble, L. G. (2000). Reliability and validity of the Perceived Risk Factor Questionnaire. Journal of Eating and Weight Disorders, 5, 1–6. White, M. A., & Grilo, C. M. (2005). Ethnic differences in the prediction of eating and body image disturbances among female adolescent psychiatric inpatients. International Journal of Eating Disorders, 38, 78–84. Zipfel, S., Lowe, B., Reas, D. L., Deter, H. C., & Herzog, W. (2000). Long-term prognosis in Anorexia Nervosa: Lessons from a 21-year follow-up study. Lancet, 355, 721–722.

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Breast and Cervical Cancer Among Diverse Women

11 Ulrike Boehmer and Deborah J. Bowen

In this chapter, we critically reflect on the existing knowledge on breast and cervical cancer. We use a common framework to organize what is known about breast and cervical cancer into prevalence of morbidity and mortality, causes and risk factors, screening and surveillance, behavioral interventions to change women’s risk and screening behaviors, diagnosis and treatment, and survivorship. Our particular goal throughout this chapter is to point out cervical and breast cancer disparities for subgroups of women. For example, breast and cervical cancer mortality is not the same for all women in the United States; rather, for example, survival times after cancer differ depending on women’s race or ethnicity. We recognize breast and cervical cancer as social phenomena, meaning women’s social context, informed by their race, ethnicity, class, and sexual orientation, has direct implications on breast and cervical cancer. These disparities need more research and critical attention. The term “health disparities” has been defined in multiple ways by organizations, government agencies, and individuals such as researchers or public health practitioners. Our definition of health disparities refers to something other than simple differences in the health status or health care of different

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social groups. In our understanding, health disparities are inequities that result from economic, political, social, and psychological processes rather than biological ones. When applied to breast and cervical cancer and as we move through the chapter structure presented above (morbidity and mortality, causes and risk factors, screening and surveillance, behavioral interventions to change women’s risk and screening behaviors, diagnosis and treatment, and survivorship) we point to some disadvantaged subgroups of women who experience disparities in these areas. One of our limitations is that there are many disadvantaged subgroups of women. For example, women with disabilities, women living in rural areas of the US, immigrant women and those who are not proficient in English are all disparate subgroups with respect to breast and cervical cancer and other health issues (De Alba, Hubbell, McMullin, Sweningson, & Saitz, 2005; Ponce et al., 2006; Wei, Findley, & Sambamoorthi, 2006; Wingo et al., 2008). Little data are available outside of those for white, mostly well-off women, which is another limitation we are facing when stressing disparities in breast and cervical cancer. When addressing disparities, we chose to focus on some subgroups but not all possible disadvantaged groups. We made this choice because it is not possible to provide adequate attention to all disparate subgroups of women in the context of this chapter. We prioritized breast and cervical cancer disparities due to race, ethnicity, socioeconomic status, and sexual orientation. The biological model of cellular interactions is one explanatory framework for cancer-related morbidity and mortality. Some biological differences exist in that genetic factors contribute to differences in the prevalence of certain cancers. Women from population groups with an increased frequency of mutations in the genes BRCA1 and BRCA2 show higher incidence of breast cancer, such as Ashkenazi Jewish women (American Cancer Society, 2007). Further, genetic factors are also thought to affect the higher mortality of breast cancer in African American women, in that genetic factors result in a more aggressive tumor in African American women (American Cancer Society, 2007; Jones et al., 2004). We acknowledge the existence of biological differences, but methods for identifying or reducing genetic differences in breast and cervical cancer are not the focus of this chapter. Rather, in this chapter our concern is the existence of socially constructed differences, meaning disparities in breast and cervical cancer that affect disadvantaged women. By focusing on some of the subgroups of women within society who suffer from social inequities relating to breast and cervical cancer and by identifying why these inequities exist, we identify opportunities for reducing breast and cervical cancer disparities in women.

Prevalence of Breast and Cervical Cancer and Mortality In 2007, an estimated 178,480 women were told that they had a diagnosis of breast and 11,150 a diagnosis of cervical cancer (Jemal et al., 2007). In the same year, 40,460 women were died of breast and 3,670 of cervical cancer (Jemal et al., 2007). Breast cancer is the most common cancer in women, accounting for 26% of all new cancer cases and is, after lung cancer, the second highest cause of cancer mortality (Jemal et al., 2007).

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Breast and Cervical Cancer

The cancer burden has long been recognized as being unequally distributed among the population. Among these disadvantaged women are racial and ethnic minorities. For example, Hispanics/Latinas have the highest incidence of cancer of the cervix (Ward et al., 2004). African American women have an 18% higher death rate than White women for all cancer sites combined (Jemal et al., 2007). In particular, African American women have the highest mortality rate of breast and cervical cancers compared to all other racial and ethnic groups (Ward et al., 2004). The disparities in mortality have been linked to differences in stage, in that the proportion of women diagnosed with regionaland distant-stage disease is higher among African Americans, Hispanics/ Latinos, and American Indians/Alaskan Natives than among Whites and Asian Americans/Pacific Islanders (American Cancer Society, 2007; Ward et al., 2004). It is further important to recognize that racial and ethnic disparities exist in incidence. For example, Vietnamese women have four times higher incidence of cervical cancer than other Asian American and Pacific Islanders, which has been linked to Vietnamese women’s more recent immigrant status, greater poverty, and reduced access to medical care (American Cancer Society, 2007). Poverty and socioeconomic status is another demographic grouping that is related to disparities in cancer mortality and morbidity. Across all racial or ethnic groups, persons who live in areas that are more affluent have higher survival rates compared to persons in poorer areas (American Cancer Society, 2004; Ward et al., 2004). Another disparity is rooted in sexual orientation, in that lesbian identity has been linked to a higher incidence of breast cancer, due to lesbian women’s higher prevalence of risk factors for the disease and reduced access to care. Current surveillance data do not collect sexual orientation data, making it harder to unequivocally demonstrate this disparity (Bowen & Boehmer, 2007; Bowen, Boehmer, & Russo, 2006).

Causes and Risk Factors The causes of breast cancer in women are only partially understood. Researchers developed a list of risk factors, consisting of modifiable and nonmodifiable factors, which have been shown to increase a woman’s likelihood of developing breast cancer (American Cancer Society, 2007). These risk factors are being female, age, BRCA1 and 2 genes, personal or family history of breast cancer, high breast tissue density, hyperplasia, high-dose radiation to the chest, reproductive risk factors (which include never giving birth to a child, giving birth to a child after the age of 30, early onset of menstrual periods and/or late menopause, recent oral contraceptive use), being overweight or obese after menopause, use of hormone replacement therapy after menopause, physical inactivity, and drinking one or more alcoholic beverages per day. However, 70% of all women with breast cancer have none of these known risk factors. Another concern is that many of the risk factors for breast cancer are not modifiable through policies and behavior change. For example, no policies or interventions can affect being female or increased age, the most common risk factors of breast cancer.

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Other nonmodifiable factors that increase women’s likelihood of developing breast cancer are personal or family history of breast cancer, early age at menarche (before age 12), late pregnancy (after age 30) or never having given birth to a child, biopsy-confirmed atypical hyperplasia, high breast tissue density, radiation to the chest to treat Hodgkin’s, and white race (American Cancer Society, 2007). Mutations in the BRCA1 and BRCA2 gene account for 5% to10% of all breast cancers and these gene mutations exist in about 1% of the population (American Cancer Society, 2007). The modifiable risk factors for breast cancer are being overweight or obese after menopause, including central adiposity, physical inactivity, consumption of one or more alcoholic beverages per day, and postmenopausal use of hormone therapy (American Cancer Society, 2007; McTiernan, 2003). More of the risk factors for cervical cancer are modifiable. Persistent infection with high-risk types of the human papillomavirus (HPV) is the most important cause for cervical cancer. High-risk HPV types are detected in 99% of cervical cancers; approximately 70% of cervical cancers worldwide are caused by types 16 and 18 (Centers for Disease Control and Prevention, 2007). HPV infection is necessary for the development of cervical cancer, yet the majority of women with high-risk genital HPV infection do not develop cervical cancer. The time from HPV infection to cervical cancer is long, 10 or more years usually; this means there is an opportunity for prevention through screening and detection of HPV infection. Other factors associated with cervical cancer include cigarette smoking, increased parity, increased age, other sexually transmitted infections, immune suppression, and long-term oral contraceptive use (Centers for Disease Control and Prevention, 2007). One area of research into the causes of cancer that is intriguing but to date has yielded mixed results is that of exposure to environmental toxins. One recent article presents a review of environmental exposures and risk of breast cancer, finding evidence for the link between breast cancer and a few environmental chemicals (polychlorinated biphenyls, polycyclic aromatic hydrocarbons, and other organic solvents), although prospective studies are mixed in findings (Brody et al., 2007). This area of research is likely to be promising in the future, as methods for assessing environmental exposure become more sophisticated and more studies are conducted linking the potential interacting effects of environmental exposure, personal behaviors, and cancer incidence.

Primary Prevention and Surveillance Some means to prevent the onset of these cancers exist and early detection through screening is available for both cancers. Chemoprevention is a consideration for some women who are at increased risk for breast cancer. So far, Tamoxifen is the only FDA-approved medication to decrease the risk of invasive breast cancer in women, even though Raloxifene has been shown to be just as effective as Tamoxifen in reducing the breast cancer risk in postmenopausal women (American Cancer Society, 2007). It is of note that both medications are selective estrogen-receptor modulators capable of decreasing the incidence of estrogen receptor-positive breast cancers. Therefore they are most suitable for women who have an elevated breast cancer risk due to

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a personal or family history of breast cancer, but not useful for women with the BRCA1 gene which results in estrogen-negative breast cancer which are not preventable by these medications (United States Preventive Services Task Force, 2008). New advances have been made in the prevention of cervical cancer. In 2006, Gardasil™ the first vaccine for HPV-types 6, 11, 16, and 18 was licensed in the US for use among females aged 9 to 26 years (Centers for Disease Control and Prevention, 2007). Guidelines recommend females 11–12 years of age to be vaccinated and catch-up vaccination for females aged 13 to 26 years who have not been previously vaccinated (Centers for Disease Control and Prevention, 2007). Catch-up vaccination will be effective for women who have not yet been sexually active and are uninfected. Vaccination is a prevention of future infection with HPV; it does not protect women against cervical cancer if they are already infected at the time of vaccination. Vaccination is not a substitute for routine cervical cancer screening and it is recommended that vaccinated females still undergo cervical cancer screening (Centers for Disease Control and Prevention, 2007). With the advent of HPV vaccination, it is estimated that vaccination of an entire cohort of females aged 12 years will reduce the lifetime risk for cervical cancer by 20% to 66% in that cohort (Centers for Disease Control and Prevention, 2007). Further, decreases in Pap test abnormalities and cervical cancer precursor lesions are expected and decreases in cervical cancer incidence will occur more quickly with catch-up vaccination (Centers for Disease Control and Prevention, 2007). In the absence of more and better methods of prevention than chemoprevention for breast and HPV vaccination for cervical cancer, currently guidelines emphasize early detection of these cancers through screening. Data suggest that increased use of mammography, the best proven method of breast cancer screening to date, reduced breast cancer mortality from 1975 to 2000 (Berry et al., 2005; Breen et al., 2007). A decline in breast cancer incidence in 2003, was argued by some to be directly linked to the findings about hormone replacement therapy of the Women’s Health Initiative and the reduced use of hormone replacement therapy among postmenopausal women that followed (Ravdin et al., 2007). Others’ explanation for the decline in detected breast cancer incidence in the early 21st century is the documented drop in mammography rates (Breen et al., 2007). Mammography rates have an immediate impact on the detection of cancer and mortality. When screening increases, mortality goes down as earlier detection allows for treatment and eventual survival, whereas a drop in screening results in less detected incidence, later detection, and subsequent increased mortality. Similarly regular screening is recommended for the early detection of cervical cancer. Cervical cancer mortality was reduced by 75% after the introduction of the Papanicolaou test (also called Pap smear, or Pap test) approximately 50 years ago (Freeman & Wingrove, 2005). When all women use primary prevention and surveillance equally, benefits will be equitable among women. But surveillance rates differ, indicating that specific populations of women partake less in screening, and are therefore at risk of later diagnosis and possibly shorter survival. Among the population groups that tend to receive less screening are older women, women with disabilities, those who are unmarried, immigrant women who are less than 10 years in the United States, and lesbians (Bigby & Holmes, 2005; Bowen et al.,

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2006; Breen et al., 2007; Newmann & Garner, 2005; Selvin & Brett, 2003; Wei et al., 2006). Considerable focus has been on differences in screening by race and ethnicity. American Indians and Alaskan Natives have the lowest cervical cancer screening rates of all racial or ethnic groups and are the most likely to have an abnormal first pap test (Newman, 2005). While African American women have higher cervical cancer screening rates than White women (Hewitt, Devesa, & Breen, 2004; Newman, 2005), African American women have lower mammography rates than White and Hispanic women (Selvin & Brett, 2003). Differences in screening by race and ethnicity indicate that racial and ethnic minorities are vulnerable and underserved populations. Generally screening has been linked to higher socioeconomic status (Selvin & Brett, 2003). One question of interest has been whether racial differences in use of screening can be explained by racial and ethnic minorities’ lower socioeconomic status. The findings are inconsistent when studies considered both socioeconomic status and race. Some confirmed racial differences in screening, even after socioeconomic status had been considered; other studies found that socioeconomic status predicts screening behavior and that racial differences disappear once socioeconomic status has been considered (Bigby & Holmes, 2005; Krieger et al., 1999; Newmann & Garner, 2005). Some of these inconsistent findings can be explained by different measures of socioeconomic status; some used individual income, others poverty, or education. Providing access to mammography and Pap tests for uninsured low-income women can contribute toward reducing racial disparities in screening and early detection (Adams, Breen, & Joski, 2007). Access is pivotal, but does not explain disparities in their entirety; rather there is a multiplicity of reasons for differences in screening by population subgroups of women. Having a usual source of care is an important predictor of receiving screening (Hewitt, Devesa et al., 2004; Selvin & Brett, 2003). Physician characteristics have also been found to have an impact on screening. Younger, female physicians are more likely to recommend screening than older male physicians (Burns et al., 1995; Roetzheim, Fox, & Leake, 1995). Provider recommendation is strongly linked to screening compliance of women, but it has also been shown that physician’s recommendations are not consistently given to all women (Coughlin, Breslau, Thompson, & Benard, 2005; Fox & Stein, 1991; Halabi et al., 2000; MacDowell, Nitz-Weiss, & Short, 2000; O’Malley et al., 2001). Despite the existence of guidelines for screening, women who are poor, older, Black, or Hispanic are less likely than financially secure, middle-aged, White women to report receiving such a recommendation. Some health care providers have been shown to harbour the false assumption that if lesbians are not currently sexually active with men, they are not at risk for HPV, and therefore they may not routinely screen lesbian women (Marrazzo, 2004). This puts lesbians at risk for HPV infection, as they may acquire HPV from female sexual partners as well as from male partners if they chose to have sexual contact with males. Women themselves hold beliefs and attitudes about screening that interfere with participating in screening. Women’s reported reasons for not participating in screening can be broken down into differences in knowledge, attitudes and beliefs. Feeling healthy, having no breast or cervical symptoms, never thinking about it, not knowing they needed this type of test, and perceiving the procedures as too painful, unpleasant, or embarrassing have been

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mentioned by women who are not participating in screening (Coughlin et al., 2005; Halabi et al., 2000). The specific beliefs, attitudes, and knowledge differ by women’s economic and racial background as well as by their perception of being at risk for cancer (Lannin, Mathews, Mitchell, & Swanson, 2002). Some sexual minority women (defined as lesbians, bisexual women and women who have female partners) may perceive themselves to be at lower risk for sexually transmitted diseases and in their mind STDs are a concern only for heterosexual women and therefore, do not go for cervical cancer screening (Marrazzo, Coffey, & Elliott, 2005). When trying to improve surveillance and implement changes that will lead to increased surveillance for all women, both physician and patient characteristics and both provider and patients’ beliefs and attitudes have to be considered as they enable screening or represent a barrier to screening.

Behavioral Interventions to Change Women’s Risk and Screening Behaviors Changing behaviors associated with primary prevention is a growing area of research. Much of the interest in reducing risk factors has centered on behavioral factors, such as diet and physical activity. For example, recent reviews (Bowen & Beresford, 2002) and papers on dietary change among adult women highlight several points in this area: we know how to change the diets of motivated adults to prevent chronic disease; we have existing interventions that work across diverse cultural groups; and we can recruit samples from most ethnic groups and geographical regions of the United States to participate in dietary intervention. The results of the Women’s Health Trial and the Women’s Health Initiative (Beresford et al., 2006; Coates et al., 1999) have focused on relating large dietary changes to chronic disease risk in women. What we do not know how to do is to implement these types of interventions in populationbased samples of women. Public health dietary change, i.e., specific methods for changing the dietary habits of women from the general public, is beyond our scientifically derived knowledge at this point. Physical activity interventions are in a similar phase. Studies show that motivated women can be recruited and supported to increase physical activity (Irwin et al., 2004, 2003), but methods for aiding broader groups of women to achieve and maintain such changes are not always successful and therefore this is an active area of research and consideration. In addition to the possible methods of abstinence, monogamy, and minimizing the number of sex partners, condom use reduces the risk for acquiring HPV infection (Winer et al., 2006). Recent reviews and discussions have highlighted the importance of sexual behavior change in disease prevention (Wellings et al., 2006) and the efficacy of interventions to prevent infectious diseases such as sexually transmitted diseases (Shepherd, Peersman, Weston, & Napuli, 2000). One conclusion from these reviews is that multiple interventions are needed for different situations and populations, and that programs that focus on individual behavior change can be complemented by programs that change the social and environmental conditions relevant to using protection from chronic disease, such as mass communications on sexual behaviors

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(Bertrand, O’Reilly, Denison, Anhang, & Sweat, 2006; Sangani, Rutherford, & Wilkinson, 2004). International efforts to protect girls from HPV, including vaccines to inoculate girls against some HPV exposures, will be important in preventing cervical cancer in the future (Plummer & Franceschi, 2002). Because of the demonstrated effectiveness of breast and cervical cancer screening and the recognition of disparities in the delivery of these prevention procedures, the United States Congress passed the Breast and Cervical Cancer Mortality Prevention Act in 1990, to increase medically underserved women’s access to mammography and Pap tests (Freeman & Wingrove, 2005). The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has generally been applauded as an important step toward increasing the utilization of screening, but it has also been recognized that only 12% to15% of all eligible low-income women are reached by this program (Adams et al., 2007). Individual programs and interventions to increase mammography rates among women in selected populations have been found effective in increasing mammography generally (Bonfill, Marzo, Pladevall, Marti, & Emparanza, 2001; Mandelblatt & Kanetsky, 1995) and of low-income women specifically (Bailey, Delva, Gretebeck, Siefert, & Ismail, 2005). From these reviews, several efficacious intervention types were identified. Multiple component and peer education interventions are efficacious. More costly interventions such as in home visits have not been efficacious. Physician reminders with feedback are efficacious and have increased mammography recommendations. The community guide to public health practice has reviewed this area, and provided recommendations to improve public health practice (Task Force on Community Preventive Services, 2005).

Diagnosis and Treatment Women who receive a breast cancer diagnosis today have better survival than 25 years ago, due to the advances in treatment. Survival of cervical cancer has not substantially improved over the same time period (Jemal et al., 2007). As with many cancers, the chances of dying from breast or cervical cancer, increase when women are diagnosed with advanced tumors—a later cancer stage. The 5-year relative survival rate for localized breast cancer improved from 80% in the 1950s to 98% today (American Cancer Society, 2007). If the breast cancer is regional, has spread to the lymph nodes, the 5-year survival is 83%, and 26% for women diagnosed with metastatic breast cancer (American Cancer Society, 2007). The relative 5-year survival rate for localized cervical cancer is 92%, 56% for regional, and 15% for metastatic cervical cancer (American Cancer Society, 2007). As we have already discussed, those who participate irregularly, less than recommended, or not at all in screening, are likely to receive a later stage cancer diagnosis. Depending on the stage, the tumor size, other clinical characteristics, and a woman’s preference, treatment for breast cancer consists of a combination of surgery, either breast-conserving lumpectomy or mastectomy, radiation, and/or chemotherapy. Treatment may further involve hormonal therapy (e.g., tamoxifen) and immunotherapy (e.g., Herceptin). Treatment of invasive cervical cancer consists of surgery, radiation, and possibly chemotherapy.

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Preinvasive lesions can be treated with electrocoagulation, cryotherapy, laser ablation, or local surgery. In 2002, the Institute of Medicine released a report entitled, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which concluded that disparities in the health care delivered to racial and ethnic minorities exist, including significant racial differences in who receives appropriate cancer diagnostic tests and treatments (Smedley, Stith, & Nelson, 2002). A study of adjuvant treatment for breast cancer provided evidence of disparity in the rates at which White versus racial and ethnic minority women received adjuvant treatments, with significant under use in minority women (Bickell et al., 2006). One in three Black women and nearly one in four Hispanic women were under treated. The authors suggest how much progress could be made to eliminate cancer death and suffering by closing the gap on racial disparities in treatment (Bickell et al., 2006). Other studies have shown that cancer treatment differs also by socioeconomic status and age, in that older and poorer women are less likely to receive definite and appropriate treatment for breast and cervical cancer (Bradley, Given, & Roberts, 2002; Freeman & Wingrove, 2005). Five percent of women with cervical cancer do not receive treatment and this percentage increases with age. Up to 20% of women over age 65 with stage II–IV disease are receiving no treatment (Freeman & Wingrove, 2005). The reasons for these disparities are complex and indicate that policy changes, interventions, and more research are needed to alleviate these problems. The Institute of Medicine Report on Racial and Ethnic Disparities in Health Care suggested that removing barriers to equitable care and providing equal access may be the most significant step toward eliminating the existing healthcare disparities (Smedley et al., 2002). From the National Health Care Quality Report (NHQR) and the National Health Care Disparities Report (NHDR) which Congress initiated, we know that equal access is currently not a reality (Kelley, Moy, Stryer, Burstin, & Clancy, 2005). To the contrary, both, NHQR and NHDR, reported acute gaps in health care quality for certain ethnic, racial, and socioeconomic groups. In particular, Blacks and Hispanics experience worse quality of care for approximately half of the quality measures reported in the NHQR and NHDR. Hispanics and Asians experience worse access to care for approximately two thirds of access measures. Poor people experience worse care for approximately two thirds of the quality and access measures (Kelley et al., 2005). Another quality of care issue, which has been identified as a possible culprit for the documented cancer disparities, is the unequal participation of minorities in clinical treatment trials (Albrecht, Penner, & Ruckdeschel, 2003; Bruner, Jones, Buchanan, & Russo, 2006). A myriad of psychosocial issues emerge in the context of diagnosis and treatment (see also section on survivorship for more discussion of psychosocial issues). There are still many aspects about the diagnosis and the treatment that are poorly understood and which may have long-term implications for the well-being of women with these cancers and their families. Aspects of physician interactions, such as interpersonal communication, information exchange, and engaging patients in decision-making, are linked to positive outcomes (Arora, 2003; Baile & Aaron, 2005). Communication is recognized as an important clinical skill, and studies have linked good communication to greater cancer-related self-efficacy and better adjustment (Baile & Aaron,

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2005; Zachariae et al., 2003). There is ample room for physicians to improve their clinical skills by using good communication to share a cancer diagnosis with women and their loved ones (Lalos, 1997). When and how physicians are to involve women’s social support persons, how to communicate with a support person, are aspects of the treatment and decision-making process that have not been fully explored. Not all women are married or choose to involve their husbands. Some women may go through the diagnosis and treatment decision-making process alone or bring someone other than a husband to a doctor’s visit. This may bear additional challenges for a physician on how and what to communicate to a friend, a relative, a caregiver, or a female partner as these different support persons may have different roles (Boehmer, Freund, & Linde, 2005). For women with breast cancer who have been treated surgically with mastectomy, breast reconstruction is an additional consideration. The majority of women treated with mastectomy after breast cancer diagnosis, forego reconstructive surgery (Alderman, McMahon, & Wilkins, 2003; Polednak, 2001). Women’s decision-making on reconstruction is still not entirely understood, but intrapersonal and interpersonal factors such as body image, self-concept, total self-image, and women’s partner relationship have been identified as influences on women’s reconstructive choices (Boehmer, Linde, & Freund, 2007; Keith et al., 2003; Pruzinsky, 2002). Reconstructive surgery or the desire for reconstruction has also been linked to demographic characteristics, in that older and poorer women have significantly fewer reconstructions (Keith et al., 2003; Polednak, 2001), and African American and Asian women have reconstructive surgery less often than White women (Tseng et al., 2004). Reconstructive surgery is not a treatment in that it has no curative benefits. Evidence of psychological or more general quality of life benefits from reconstruction is inconsistent (Al-Ghazal, Fallowfield, & Blamey, 2000; Harcourt & Rumsey, 2001; Nissen et al., 2001; Pruzinsky, 2002; Rowland et al., 2000). Another consideration for women with cancer are therapies that are outside of conventional medicine as practiced in the United States, commonly referred to as complementary alternative medicine (CAM). The National Center for Complementary and Alternative Medicine (NCCAM) groups CAM into four domains. These are (a) mind–body medicine, which includes support groups, meditation, and prayer; (b) biologically based practices, which include dietary supplements and herbal products; (c) manipulative and body-based practices, which include massage and chiropractic; and finally (d) energy medicine, which refers to therapeutic touch and Reiki. The prevalence of CAM use by breast cancer patients is thought to be higher than among individuals in the general population (DiGianni, Garber, & Winer, 2002). Cancer patients use CAM as a supplement to standard medical methods, often for the purpose of offsetting side effects of conventional treatments and to improve a sense of well-being (Institute of Medicine, 2006; Jacobson, Workman, & Kronenberg, 2000; Sollner et al., 2000). There are inconsistent findings whether CAM use in women with cancer is an indication of psychosocial distress (DiGianni et al., 2002; Sollner et al., 2000). It has been suggested that CAM use is not rooted in a rejection of conventional medicine; instead, it is an indication of self-care (Bowen, Anderson, White, Powers, & Greenlee, 2002; Henderson & Donatelle, 2004). The types of CAM therapies used and the reasons for use varies by

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race and ethnicity in that African Americans have been thought to use most frequently spiritual healing, Chinese women herbal remedies, and Latina women dietary therapies and spiritual healing (Lee, Lin, Wrensch, Adler, & Eisenberg, 2000). A problematic issue is the lack of communication about CAM use between patients and their treating conventional medical providers (Lee et al., 2000). If physicians are unaware about women’s CAM use, possible interference between conventional and CAM therapies may go unnoticed, such as soy products which are thought to negate the tumor-fighting effects of Tamoxifen.

Interventions to Improve the Experience of Diagnosis and Treatment Little is known or published regarding the reduction of disparities in the diagnosis and treatment of breast and cervical cancer. To address unequal access to quality care, the National Cancer Institute launched through its Center to Reduce Cancer Health Disparities (CRCHD) the Patient Navigation Research Program: Eliminating Barriers to Timely Delivery of Cancer Diagnosis and Treatment Services (PNRP) (see website: http://crchd.cancer.gov). Patient navigation means that a navigator provides assistance to health care consumers, which include patients and their families, to move through the medical system. Assistance by a navigator can begin at the time of an abnormal finding, and last through diagnosis, treatment, to the completion of treatment. Currently there are nine PNRP projects with four study goals in common: (a) timely, definitive diagnosis following an abnormal test result; (b) timely treatment following positive diagnosis; (c) cost-effectiveness; and (d) patient satisfaction with the diagnostic and cancer care experience. While working toward these common goals, more navigators are trained, promising navigation approaches are tested and identified, and all work toward ensuring that best practice navigation models will be widely disseminated to communities who can most benefit. These programs are currently underway and in various stages (Dohan & Schrag, 2005). Nevertheless evidence to date is promising, in that patient navigation has increased survival rates among African American breast cancer patients in Harlem, and educated the larger community about cancer prevention and treatment.

After Diagnosis: Cancer Survivorship Cancer survivorship begins with the diagnosis, lasts throughout the remainder of life, and consists of different phases (Mullan, 1985). We know that a diagnosis of cancer has a profound impact on a woman’s life in that it doubles the likelihood of poor health and psychological problems compared to individuals without a cancer diagnosis (Hewitt, Rowland, & Yancik, 2003). Initially our knowledge about women’s experiences of surviving breast and cervical cancer stemmed from the early years of survivorship, the first phase of survivorship, immediately after diagnosis. Over the last decade, as the number of longterm survivors increased, more research has been devoted to the well-being

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of long-term survivors of cancer (Greenwald & McCorkle, 2007; Wenzel et al., 2005). Studies have assessed survivors’ physical, social, spiritual, sexual, and psychological concerns (Institute of Medicine, 2006). Even many long-term cancer survivors experience ongoing challenges in their well-being, in particular in their physical and psychological functioning (Institute of Medicine, 2006; Mellon & Northouse, 2001; Tomich & Helgeson, 2002; Wenzel et al., 2005), despite being disease free. Some effects of treatments subside with time, but sexual problems among cancer survivors are common, affecting about 50% of survivors (Broeckel, Thors, Jacobsen, Small, & Cox, 2002; Frumovitz et al., 2005; Ganz, Rowland, Desmond, Meyerowitz, & Wyatt, 1998; Schover, 2008; Thors, Broeckel, & Jacobsen, 2001). Similarly, there is evidence from many studies that a normalization of mood and positive adjustment occurs approximately one year after the diagnosis, but about a quarter of cancer patients suffer from long-term distress even years after their diagnosis (Anderson & Lutgendorf, 1997; Institute of Medicine, 2006). Studies have determined that about 25% of cancer survivors suffer from depression five or more years after the diagnosis (Deimling, Kahana, Bowman, & Schaefer, 2002; McDaniel, Musselman, Porter, Reed, & Nemeroff, 1995; National Institute of Mental Health [NIMH], 2002; Sarna et al., 2002). Other studies provide evidence of survivors’ Post Traumatic Stress Disorder (PTSD) due to the traumatic event, cancer (Baider & Kaplan De-Nour, 1997; Kangas, Henry, & Bryant, 2002), even 20 years later (Kornblith et al., 2003). Nevertheless, research studies point also to survivors’ resilience and a transformative positive impact of breast cancer on some women. Studies detected that some breast cancer patients rate their well-being better than controls, meaning women without cancer (Andrykowski et al., 1996; Ganz et al., 1996). Some survivors report positive changes, in that they derive positive meaning from their disease, reorder their life’s priorities, have an enhanced appreciation of life, and have grown after the traumatic event of cancer (Antoni et al., 2001; Bower et al., 2005; Cordova, Cunningham, Carlson, & Andrykowski, 2001; Greenwald & McCorkle, 2007; Sears, Stanton, & Danoff-Burg, 2003). Only 65 articles since 1966 have addressed cancer survivorship as it relates to racially diverse populations, concluded a review published in 2002 (Aziz & Rowland, 2002). So far, the existing studies indicate that African American cancer survivors experience poorer physical health after cancer, even after disease and treatment factors were controlled (Deimling, Schaefer, Kahana, Bowman, & Reardon, 2002). Compared with white survivors, they do not experience significantly more symptoms due to cancer treatment, suggesting that their poorer health may be related to comorbid conditions, rather than cancer and its treatment (Deimling, Schaefer et al., 2002). Studies focused on the psychological well-being of cancer survivors found racial differences. However, it is African American women with breast cancer who report better mental health compared to White women (Bowen et al., 2007; Ganz, Greendale, Petersen, Kahn, & Bower, 2003). With respect to age, it has been found that in comparison to older women, women who are younger at diagnosis have worse well-being, in particular in the social and psychological domains (Cimprich, Ronis, & Martinez-Ramos, 2002; Ganz et al., 1998, 2003; Kroenke et al., 2004). Breast cancer has mostly served as the model for survivorship. We know less about women with cervical cancer, and little or nothing about some subgroups

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of women and the implications a cancer diagnosis has on these women’s lives. For example, the adjustment of lesbian women to cancer is not known. Cancer has unknown implications on immigrant women who are bringing a different cultural background to their understanding of cancer and who may have special language barriers so they cannot partake in existing programs for survivors. To date, we know how mostly White women are doing over the short- and long-term, yet it is still unclear which women will adjust well psychologically, who will use the cancer experience to reorder life’s priorities, or who will feel depressed for years to come. If we knew more about groups of women who will later suffer from depression or knew about early warning signs to indicate how women will do later, programs could be developed to specifically target the women at risk of poor adjustment. Recognition grows that not only the woman with cancer is affected. Rather cancer has been called a family disease in that it affects a person’s immediate family or social support system. What is known about different women’s social support and closest supporters is uneven in that most research focused on spouses and on the first three years after a cancer diagnosis (Lewis, 2006). Research studies that allowed cancer patients of any marital status to select any adult whom they considered “in a close relational bond” suggest that survivors rely on a variety of supporters. Cancer survivors selected partners or spouses between 53% and 60% of the time, while the remaining proportion consisted of nonpartner supporters (Mellon & Northouse, 2001; Northouse et al., 2002; Sandgren, Mullens, Erickson, Romanek, & McCaul, 2004). Among this group were adult children 20% to 30%, siblings about 10%, and nonfamily members between 10% and 15% (Mellon & Northouse, 2001; Northouse et al., 2002; Sandgren et al., 2004). Also, some women may not have a significant supporter or may have lost their support person because of their illness (Courtens, Stevens, Crebolder, & Philipsen, 1996; Pedro, 2001). Women without a supporter are assumed by many to be an especially vulnerable group at risk for poor adjustment (Gluhoski, Siegel, & Gorey, 1997; Holmberg, Scott, Alexy, & Fife, 2001; Weisman & Worden, 1976).

Psychosocial Programs to Improve Survivorship The majority of psychosocial intervention studies with breast cancer patients focused on early phases of the disease, indicating that psychosocial interventions with long-term cancer survivors are mostly lacking (Hewitt, Herdman, & Holland, 2004). A number of meta-analyses of psychosocial intervention studies with adult cancer patients have documented that cancer patients derive benefits from participation in interventions (Clark, Bostwick, & Rummans, 2003; Graves, 2003; Hewitt, Herdman et al., 2004; Luebbert, Dahme, & Hasenbring, 2001; Newell, Sanson-Fisher, & Savolainen, 2002; Rehse & Pukrop, 2003) in that there are improvements in survivors’ emotional and functional adjustment or overall well-being. Shortly after diagnosis the need for psychosocial services is greatest, but some survivors report a continued need for psychosocial services, even many years later and use psychosocial services (BasenEngquist et al., 2003; Ganz et al., 2002; Hewitt, Herdman, et al., 2004; Wenzel et al., 2005). Some psychosocial interventions have been developed for the

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cancer survivor’s closest family member or both survivor and family member (Martire, Lustig, Schulz, Miller, & Helgeson, 2004). Interventions that included the spouse reduced depression in patients; for family members, positive effects were found for caregiving burden, depression, and anxiety (Martire et al., 2004). The information that psychosocial interventions improve well-being is derived from research studies that carefully evaluated the effects. Other means of support are peer support programming offered in the community by various organizations, telephone support, or online internet support groups. As most of these programs are not thoroughly evaluated it is less clear if these programs work and which benefits members derive from participation in these groups (Campbell, Phaneuf, & Deane, 2004). Again the participation of women of racial or ethnic minority background in support groups as well as participation in psychosocial interventions is low (Murthy, Krumholz, & Gross, 2004; Sears, Stanton, Kwan, et al., 2003; Simon et al., 2004; Zhu et al., 2000). There is a growing consensus of “one size does not fit all” (Guidry, Torrence, & Herbelin, 2005). This demands the development of interventions and cancer support programs that are culturally appropriate and tailored to the specific needs of the target population to be effective in accomplishing change in nondominant cultures (Kreuter, Lukwago, Bucholtz, Clark, & Sanders-Thompson, 2003; Resnicow, Baranowski, Ahluwalia, & Braithwaite, 1999).

Physical and Lifestyle Issues of Cancer Survivorship Survivors have a higher risk of developing a new cancer compared to those who have never had a cancer diagnosis. Therefore the biggest physical issues cancer survivors may have to face are a recurrence of the cancer for which they were initially treated or the independent development of a second cancer. Population-based studies indicate that 10% of new cancer diagnoses occur in survivors and second cancers are the sixth leading cause of cancer deaths (Institute of Medicine, 2006; Mayer et al., 2007). This makes surveillance of cancer survivors through cancer screenings important so secondary cancers or cancer recurrences will be detected early. One study of surveillance behaviors concluded that women with breast or cervical cancer were as likely as women without cancer to have Pap smears and mammograms, but cancer survivors were more likely to be screened for colorectal cancer compared to those without cancer (Mayer et al., 2007). Disparities in surveillance of breast cancer survivors have been documented, in that those who are older, Black, and unmarried are less likely to receive screening mammograms (Keating, Landrum, Guadagnoli, Winer, & Ayanian, 2006). A recent study demonstrated that receipt of screening mammography in breast cancer survivors decreases breast cancer mortality (Lash et al., 2007), highlighting the importance of cancer surveillance and the need for programs to increase surveillance of survivors, particularly survivors who are older, Black, or unmarried. Risky behaviors, such as smoking, physical inactivity, and an unhealthy diet which may have contributed to developing cancer initially, can threaten survival and increase the risk for recurrence and second cancers, as well as

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comorbidity, if these behaviors persist (Institute of Medicine, 2006). Weight gain has been recognized as a side effect of cancer treatments such as chemotherapy and hormone therapy. This problem is compounded by studies that suggest being overweight has negative implications for postmenopausal women’s survival of breast cancer (American Cancer Society, 2007; Norman et al., 2007; Rock & Demark-Wahnefried, 2002). For these reasons, cancer survivors need to be engaged in health promotion activities (Institute of Medicine, 2006). Studies indicate that there are few differences in lifestyles between cancer survivors and healthy populations or control groups. This means, cancer survivors are just as likely as the general population to be overweight, obese, inactive, or have a poor diet consisting of too few fruits and vegetables and high fat intake (Caan et al., 2005; Coups & Ostroff, 2005; Stull, Snyder, & Demark-Wahnefried, 2007). These study results contradicted prior thinking which suggested a cancer diagnosis causes a positive change in health behaviors (Demark-Wahnefried, Aziz, Rowland, & Pinto, 2005). Early studies in this field suggest that breast cancer survivors can participate in dietary change interventions and in physical activity interventions with successful behavior changes (Chlebowski et al., 2006; Irwin et al., 2003; McTiernan, 2003) with no loss to quality of life (Bowen, Kestin, McTiernan, Carrell, & Green, 1995; Tworoger et al., 2003). These studies to date have not linked the behavioral changes with increased survivorship, but it is expected that over the next five years such studies will provide answers to this important question. The proportion of women from disparities based populations is relatively low in these studies, providing no data on survivor behavior change in diverse populations.

Conclusion In this chapter, we have shown that breast and cervical cancer is different for subgroups of women. The most robust findings are that there are disparities in cervical and breast cancer prevention activities and outcomes between women of different racial or ethnic backgrounds. Prevalence of screening, incidence of these cancers, stage at diagnosis, or survival all are easily measurable concepts using national datasets and large scale trials. This contributes to the robustness of the findings of racial and ethnic disparities more generally. Fully understanding the patterns of disparity, how they relate to each other, and how they have shaped national health outcomes is of critical importance. The relative emphasis to date on the documentation of racial and ethnic disparities compared with the development and rigorous testing of methods to reduce these disparities is disheartening. The challenges of altering social structures, reinforcements, and barriers that drive cancer disparities must be met with a clear research agenda and funding for multiple activities. A better understanding of successful and appropriate methods of reducing these disparities would be useful, in addition to better measurement and statistical methods to be used in these studies. Intervention testing is an expensive business, and so is dissemination of efficacious interventions. This expense should be borne by multiple institutions and players, shared by those that both regulate and use the services of disparities groups.

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Less is known on whether disparities exist, when the category that distinguishes women is not regularly included in data collection activities, such as information on sexual orientation (Bowen & Boehmer, 2007) or on socioeconomic status. The MacArthur Network website is a useful source of research and measures on socioeconomic status that are innovative and target multiple aspects of this key variable. Other working groups can focus on specific populations to develop measures that can be included in national surveys and surveillance systems, to enable us to track disparities in multiple disease states and behavioral patterns. More research is needed on survivorship in general and in particular on what survivorship means to diverse subgroups of women. This is an exciting time for investigators, for community leaders, and for members of the disparities groups themselves. Renewed interest in disparities could lead to more answers about how to eliminate them from our culture.

References Adams, E. K., Breen, N., & Joski, P. J. (2007). Impact of the National Breast and Cervical Cancer Early Detection Program on mammography and Pap test utilization among white, Hispanic, and African American women: 1996–2000. Cancer, 109, 348–358. Albrecht, T. L., Penner, L. A., & Ruckdeschel, J. C. (2003). Understanding patient decisions about clinical trials and the associated communication process: a preliminary report. Journal of Cancer Education, 18, 210–214. Alderman, A. K., McMahon, L. Jr., & Wilkins, E. G. (2003). The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plastic and Reconstructive Surgery, 111, 695–703; discussion 704–695. Al-Ghazal, S. K., Fallowfield, L., & Blamey, R. W. (2000). Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. European Journal of Cancer, 36, 1938–1943. American Cancer Society. (2004). Cancer facts and figures 2004 (webversion ed.) Atlanta: ACS. American Cancer Society. (2007). Cancer facts and figures 2007 (webversion ed.) Atlanta: ACS. Anderson, B., & Lutgendorf, S. (1997). Quality of life in gynecologic cancer survivors. CA: A Cancer Journal for Clinicians, 47, 218–225. Andrykowski, M. A., Curran, S. L., Studts, J. L., Cunningham, L., Carpenter, J. S., McGrath, P. C., et al. (1996). Psychosocial adjustment and quality of life in women with breast cancer and benign breast problems: A controlled comparison. Journal of Clinical Epidemiology, 49, 827–834. Antoni, M. H., Lehman, J. M., Kilbourn, K. M., Boyers, A. E., Culver, J. L., Alferi, S.M., et al. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for earlystage breast cancer. Health Psychology, 20, 20–32. Arora, N. K. (2003). Interacting with cancer patients: The significance of physicians’ communication behavior. Social Science and Medicine, 57, 791–806. Aziz, N. M., & Rowland, J. H. (2002). Cancer survivorship research among ethnic minority and medically underserved groups. Oncology Nursing Forum, 29, 789–801. Baider, L., & Kaplan De-Nour, A. (1997). Psychological distress and intrusive thoughts in cancer patients. Journal of Nervous and Mental Disease, 185, 346–348. Baile, W. F., & Aaron, J. (2005). Patient-physician communication in oncology: Past, present, and future. Current Opinion in Oncology, 17, 331–335. Bailey, T. M., Delva, J., Gretebeck, K., Siefert, K., & Ismail, A. (2005). A systematic review of mammography educational interventions for low-income women. American Journal of Health Promotion, 20(2), 96–107. Basen-Engquist, K., Paskett, E. D., Buzaglo, J., Miller, S. M., Schover, L., Wenzel, L. B., et al. (2003). Cervical cancer. Cancer, 98, 2009–2014.

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Beresford, S. A. A., Johnson, K. C., Ritenbaugh, C., Lasser, N. L., Snetselaar, L. G., Black, H. R., et al. (2006). Low-fat dietary pattern and risk of colorectal cancer: The Women’s Health Initiative randomized controlled dietary modification trial. Journal of the American Medical Association, 295, 643–654. Berry, D. A., Cronin, K. A., Plevritis, S. K., Fryback, D. G., Clarke, L., Zelen, M., et al. (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine, 353, 1784–1792. Bertrand, J. T., O’Reilly, K., Denison, J., Anhang, R., & Sweat, M. (2006). Systematic review of the effectiveness of mass communication programs to change HIV/AIDS-related behaviors in developing countries. Health Education Research, 21, 567–597. Bickell, N. A., Wang, J. J., Oluwole, S., Schrag, D., Godfrey, H., Hiotis, K., et al. (2006). Missed opportunities: Racial disparities in adjuvant breast cancer treatment. Journal of Clinical Oncology, 24(9), 1357–1362. Bigby, J., & Holmes, M. D. (2005). Disparities across the breast cancer continuum. Cancer Causes and Control, 16, 35–44. Boehmer, U., Freund, K. M., & Linde, R. (2005). Support providers of sexual minority women with breast cancer: Who they are and how they impact the breast cancer experience. Journal of Psychosomatic Research, 59, 307–314. Boehmer, U., Linde, R., & Freund, K. M. (2007). Breast reconstruction following mastectomy for breast cancer: The decisions of sexual minority women. Plastic and Reconstructive Surgery, 119, 464–472. Bonfi ll, X., Marzo, M., Pladevall, M., Marti, J., & Emparanza, J. I. (2001). Strategies for increasing women participation in community breast cancer screening. Cochrane Database of Systematic Reviews (1), CD002943. Bowen, D. J., Alfano, C. M., McGregor, B. A., Kuniyuki, A., Bernstein, L., Meeske, K., et al. (2007). Possible socioeconomic and ethnic disparities in quality of life levels in a cohort of breast cancer survivors. Breast Cancer Research and Treatment, 106, 85–95. Bowen, D. J., Anderson, J., White, J., Powers, D., & Greenlee, H. (2002). Preferences for alternative and traditional health care: Relationship to health behaviors, health information sources, and trust of providers. Journal of the Gay and Lesbian Medical Association, 6, 3–7. Bowen, D. J., & Beresford, S. A. (2002). Dietary interventions to prevent disease. Annual Review of Public Health, 23, 255–286. Bowen, D. J., & Boehmer, U. (2007). The lack of cancer surveillance data on sexual minorities and strategies for change. Cancer Causes and Control, 18, 343–349. Bowen, D.J., Boehmer, U., & Russo, M. (2006). Cancer and sexual minority women. In I. Meyer & M. Northridge (Eds.), The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual, and Transgender Populations (pp. 523–538). New York: Springer. Bowen, D. J., Kestin, M., McTiernan, A., Carrell, D., & Green, P. (1995). Effects of dietary fat intervention on mental health in women. Cancer Epidemiology Biomarkers and Prevention, 4, 555–559. Bower, J., Meyerowitz, B., Desmond, K., Bernaards, C., Rowland, J., & Ganz, P. (2005). Perceptions of positive meaning and vulnerability following breast cancer: predictors and outcomes among long-term breast cancer survivors. Annals of Behavioral Medicine, 29, 236–245. Bradley, C. J., Given, C. W., & Roberts, C. (2002). Race, socioeconomic status, and breast cancer treatment and survival. Journal of the National Cancer Institute, 94, 490–496. Breen, N., Cronin, K. A., Meissner, H. I., Taplin, S. H., Tangka, F. K., Tiro, J. A., et al. (2007). Reported drop in mammography. Cancer, 109, 2405–2409. Brody, J. G., Moysich, K. B., Humblet, O., Attfield, K. R., Beehler. G. P., & Rudel, R. A. (2007). Environmental pollutants and breast cancer: Epidemiologic studies. Cancer, 109. 2667–2711. Broeckel, J. A., Thors, C. L., Jacobsen, P. B., Small, M., & Cox, C. E. (2002). Sexual functioning in long-term breast cancer survivors treated with adjuvant chemotherapy. Breast Cancer Research and Treatment, 75, 241–248. Bruner, D. W., Jones, M., Buchanan, D., & Russo, J. (2006). Reducing cancer disparities for minorities: A multidisciplinary research agenda to improve patient access to health systems, clinical trials, and effective cancer therapy. Journal of Clinical Oncology, 24, 2209–2215.

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Burns, R. B., Freund, K. M., Ash, A., Shwartz, M., Antab, L., & Hall, R. (1995). Who gets repeat screening mammography: The role of the physician. Journal of General Internal Medicine, 10, 520–522. Caan, B., Sternfeld, B., Gunderson, E., Coates, A., Quesenberry, C., & Slattery, M. (2005). Life After Cancer Epidemiology (LACE) Study: A cohort of early stage breast cancer survivors (United States. Cancer Causes and Control, 545–556. Campbell, H. S., Phaneuf, M. R., & Deane, K. (2004). Cancer peer support programs—do they work? Patient Education and Counseling, 55, 3–15. Centers for Disease Control and Prevention. (2007). Quadrivalent human papillomavirus vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP. Morbidity and Mortality Weekly Report, 56(RR2)). Chlebowski, R. T., Blackburn, G. L., Thomson, C. A., Nixon, D. W., Shapiro, A., Hoy, M. K., et al. (2006). Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. Journal of the National Cancer Institute, 98, 1767–1776. Cimprich, B., Ronis, D. L., & Martinez-Ramos, G. (2002). Age at diagnosis and quality of life in breast cancer survivors. Cancer Practice, 10, 85–93. Clark, M. M., Bostwick, J. M., & Rummans, T. A. (2003). Group and individual treatment strategies for distress in cancer patients. Mayo Clinic Proceedings, 78, 1538–1543. Coates, R. J., Bowen, D. J., Kristal, A. R., Feng, Z., Oberman, A., Hall, W. D., et al. (1999). The women’s health trial feasibility study in minority populations: Changes in dietary intakes. American Journal of Epidemiology, 149, 1104–1112. Cordova, M. J., Cunningham, L. L., Carlson, C. R., & Andrykowski, M. A. (2001). Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychology, 20, 176–185. Coughlin, S. S., Breslau, E. S., Thompson, T., & Benard, V. B. (2005). Physician recommendation for Papanicolaou testing among U.S. women, 2000. Cancer Epidemiology Biomarkers and Prevention, 14, 1143–1148. Coups, E., & Ostroff, J. (2005). A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Preventive Medicine, 40, 702–711. Courtens, A. M., Stevens, F. C., Crebolder, H. F., & Philipsen, H. (1996). Longitudinal study on quality of life and social support in cancer patients. Cancer Nursing, 19, 162–169. De Alba, I., Hubbell, F. A., McMullin, J. M., Sweningson, J. M., & Saitz, R. (2005). Impact of U.S. citizenship status on cancer screening among immigrant women. Journal of General Internal Medicine, 20, 290–296. Deimling, G. T., Kahana, B., Bowman, K. F., & Schaefer, M. L. (2002). Cancer survivorship and psychological distress in later life. Psycho-Oncology, 11, 479–494. Deimling, G. T., Schaefer, M. L., Kahana, B., Bowman, K. F., & Reardon, J. (2002). Racial differences in the health of older-adult long-term cancer survivors. Journal of Psychosocial Oncology, 20, 71–94. Demark-Wahnefried, W., Aziz, N. M., Rowland, J. H., & Pinto, B. M. (2005). Riding the crest of the teachable moment: Promoting long-term health after the diagnosis of cancer. Journal of Clinical Oncology, 23, 5814–5830. DiGianni, L. M., Garber, J. E., & Winer, E. P. (2002). Complementary and alternative medicine use among women with breast cancer. Journal of Clinical Oncology, 20, 34S–38S. Dohan, D., & Schrag, D. (2005). Using navigators to improve care of underserved patients: current practices and approaches. Cancer, 104, 848–855. Fox, S. A., & Stein, J. A. (1991). The effect of physician-patient communication on mammography utilization by different ethnic groups. Medical Care, 29, 1065–1082. Freeman, H., & Wingrove, B. (2005). Excess cervical cancer mortality: A marker for low access to health care in poor communities. Rockville, MD: NCI, Center to Reduce Cancer Health Disparities. Frumovitz, M., Sun, C. C., Schover, L. R., Munsell, M. F., Jhingran, A., Wharton, J. T., et al. (2005). Quality of life and sexual functioning in cervical cancer survivors. Journal of Clinical Oncology, 23, 7428–7436. Ganz, P. A., Coscarelli, A., Fred, C., Kahn, B., Polinsky, M. L., & Petersen, L. (1996). Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Research and Treatment, 38, 183–199.

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Ganz, P. A., Desmond, K. A., Leedham, B., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2002). Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. Journal of the National Cancer Institute, 94, 39–49. Ganz, P. A., Greendale, G. A., Petersen, L., Kahn, B., & Bower, J. E. (2003). Breast cancer in younger women: reproductive and late health effects of treatment. Journal of Clinical Oncology, 21, 4184–4193. Ganz, P. A., Rowland, J. H., Desmond, K., Meyerowitz, B. E., & Wyatt, G. E. (1998). Life after breast cancer: Understanding women’s health-related quality of life and sexual functioning. Journal of Clinical Oncology, 16, 501–514. Gluhoski, V. L., Siegel, K., & Gorey, E. (1997). Unique stressors experienced by unmarried women with breast cancer. Journal of Psychosocial Oncology, 15, 173–183. Graves, K. D. (2003). Social cognitive theory and cancer patients’ quality of life: A metaanalysis of psychosocial intervention components. Health Psychology, 22, 210–219. Greenwald, H. P., & McCorkle, R. (2007). Remedies and life changes among invasive cervical cancer survivors. Urologic Nursing Journal, 27, 47–53. Guidry, J. J., Torrence, W., & Herbelin, S. (2005). Closing the divide: Diverse populations and cancer survivorship. Cancer, 104(11 Suppl), 2577–2583. Halabi, S., Skinner, C. S., Samsa, G. P., Strigo, T. S., Crawford, Y. S., & Rimer, B. K. (2000). Factors associated with repeat mammography screening. Journal of Family Practice, 49, 1104–1112. Harcourt, D., & Rumsey, N. (2001). Psychological aspects of breast reconstruction: A review of the literature. Journal of Advanced Nursing, 35, 477–487. Henderson, J. W., & Donatelle, R. J. (2004). Complementary and alternative medicine use by women after completion of allopathic treatment for breast cancer. Alternative Therapies in Health and Medicine, 10, 52–57. Hewitt, M., Devesa, S. S., & Breen, N. (2004). Cervical cancer screening among U.S. women: Analyses of the 2000 National Health Interview Survey. Preventive Medicine, 39, 270–278. Hewitt, M., Herdman, R., & Holland, J. (Eds.) (2004). Meeting psychosocial needs of women with breast cancer. Washington, DC: The National Academies Press. Hewitt, M., Rowland, J., & Yancik, R. (2003). Cancer survivors in the United States: Age, health, and disability. Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 58, 82–91. Holmberg, S. K., Scott, L. L., Alexy, W., & Fife, B. L. (2001). Relationship issues of women with breast cancer. Cancer Nursing, 24, 53–60. Institute of Medicine (Ed.). (2006). From cancer patient to cancer survivor: Lost in transition. Washington, DC: Committee on Cancer Survivorship: Improving Care and Quality of Life, Institute of Medicine and National Research Council. Irwin, M. L., Tworoger, S. S., Yasui, Y., Rajan, B., McVarish, L., LaCroix, K., et al. (2004). Influence of demographic, physiologic, and psychosocial variables on adherence to a yearlong moderate-intensity exercise trial in postmenopausal women. Preventive Medicine, 39, 1080–1086. Irwin, M. L., Yasui, Y., Ulrich, C. M., Bowen, D., Rudolph, R. E., Schwartz, R. S., et al. (2003). Effect of exercise on total and intra-abdominal body fat in postmenopausal women: A randomized controlled trial. Journal of the American Medical Association, 289, 323–330. Jacobson, J. S., Workman, S. B., & Kronenberg, F. (2000). Research on complementary/ alternative medicine for patients with breast cancer: a review of the biomedical literature. Journal of Clinical Oncology, 18, 668–683. Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., & Thun, M. J. (2007). Cancer statistics, 2007. CA: A Cancer Journal for Clinicians, 57, 43–66. Jones, B. A., Kasl, S. V., Howe, C. L., Lachman, M., Dubrow, R., Curnen, M. M., et al. (2004). African-American/White differences in breast carcinoma: p53 alterations and other tumor characteristics. Cancer, 101, 1293–1301. Kangas, M., Henry, J. L., & Bryant, R. A. (2002). Posttraumatic stress disorder following cancer: A conceptual and empirical review. Clinical Psychology Review, 22, 499–524. Keating, N. L., Landrum, M. B., Guadagnoli, E., Winer, E. P., & Ayanian, J. Z. (2006). Factors related to underuse of surveillance mammography among breast cancer survivors. Journal of Clinical Oncology, 24, 85–94.

329

330


Keith, D. J. W., Walker, M. B., Walker, L. G., Heys, S. D., Sarkar, T. K., Hutcheon, A. W., et al. (2003). Women who wish breast reconstruction: Characteristics, fears, and hopes. Plastic and Reconstructive Surgery, 111, 1051–1056. Kelley, E., Moy, E., Stryer, D., Burstin, H., & Clancy, C. (2005). The national healthcare quality and disparities reports: An overview. Medical Care, 43(3 Suppl.), 13–8. Kornblith, A. B., Herndon II, J. E., Weiss, R. B., Zhang, C., Zuckerman, E. L., Rosenberg, S., et al. (2003). Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer, 98, 679–689. Kreuter, M. W., Lukwago, S. N., Bucholtz, D. C., Clark, E. M., & Sanders-Thompson, V. (2003). Achieving cultural appropriateness in health promotion programs: Targeted and tailored approaches. Health Education and Behavior, 30, 133–146. Krieger, N., Quesenberry Jr. C., Peng, T., Horn-Ross, P., Stewart, S., Brown, S., et al. (1999). Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, black, Hispanic, and white residents of the San Francisco Bay Area, 1988–92 (United States). Cancer Causes and Control, 10, 525–537. Kroenke, C. H., Rosner, B., Chen, W. Y., Kawachi, I., Colditz, G. A., & Holmes, M. D. (2004). Functional impact of breast cancer by age at diagnosis. Journal of Clinical Oncology, 22, 1849–1856. Lalos, A. (1997). The impact of diagnosis on cervical and endometrial cancer patients and their spouses. European Journal of Gynaecological Oncology, 18, 513–519. Lannin, D. R., Mathews, H. F., Mitchell, J., & Swanson, M. S. (2002). Impacting cultural attitudes in African-American women to decrease breast cancer mortality. American Journal of Surgery, 184, 418–423. Lash, T. L., Fox, M. P., Buist, D. S. M., Wei, F., Field, T. S., Frost, F. J., et al. (2007). Mammography surveillance and mortality in older breast cancer survivors. Journal of Clinical Oncology, 25, 3001–3006. Lee, M. M., Lin, S. S., Wrensch, M. R., Adler, S. R., & Eisenberg, D. (2000). Alternative therapies used by women with breast cancer in four ethnic populations. Journal of the National Cancer Institute, 92, 42–47. Lewis, F. M. (2006). The effects of cancer survivorship on families and caregivers. More research is needed on long-term survivors. American Journal of Nursing, 106(3 Suppl.), 20–25. Luebbert, K., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review. Psycho-Oncology, 10, 490–502. MacDowell, N. M., Nitz-Weiss, M., & Short, A. (2000). The role of physician communication in improving compliance with mammography screening among women ages 50 to 79 in a commercial HMO. Managed Care Q, 8, 11–19. Mandelblatt, J., & Kanetsky, P. A. (1995). Effectiveness of interventions to enhance physician screening for breast cancer. Journal of Family Practice, 40, 162–171. Marrazzo, J. M. (2004). Barriers to infectious disease care among lesbians. Emerging Infectious Disease Journal, 10, 1974–1978. Marrazzo, J. M., Coffey, P., & Elliott, M. N. (2005). Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women. Perspectives on Sexual and Reproductive Health, 37, 6–12. Martire, L., Lustig, A., Schulz, R., Miller, G., & Helgeson, V. (2004). Is it beneficial to involve a family member? A meta-analysis of psychosocial interventions for chronic illness. Health Psychology, 23, 599–611. Mayer, D., Terrin, N., Menon, U., Kreps, G., McCance, K., Parsons, S., et al. (2007). Screening practices in cancer survivors. Journal of Cancer Survival, DOI 10.1007/s11764–1100710007–11760. McDaniel, J. S., Musselman, D. L., Porter, M. R., Reed, D. A., & Nemeroff, C. B. (1995). Depression in patients with cancer. Diagnosis, biology, and treatment. Archives of General Psychiatry, 52, 89–99. McTiernan, A. (2003). Behavioral risk factors in breast cancer: Can risk be modified? Oncologist, 8, 326–334. Mellon, S., & Northouse, L. L. (2001). Family survivorship and quality of life following a cancer diagnosis. Research in Nursing and Health, 24, 446–459.

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Mullan, F. (1985). Seasons of survival: Reflections of a physician with cancer. New England Journal of Medicine, 313, 270–273. Murthy, V. H., Krumholz, H. M., & Gross, C. P. (2004). Participation in cancer clinical trials: Race-, sex-, and age-based disparities. Journal of the American Medical Association, 291, 2720–2726. National Institute of Mental Health (NIMH) (2002). Depression and cancer NIH Publication No. 2. Retrieved April, 2003. Newell, S. A., Sanson-Fisher, R. W., & Savolainen, N. J. (2002). Systematic review of psychological therapies for cancer patients: Overview and recommendations for future research. Journal of the National Cancer Institute, 94, 558–584. Newman, L. A. (2005). Breast cancer in African-American women. Oncologist, 10, 1–14. Newmann, S. J., & Garner, E. O. (2005). Social inequities along the cervical cancer continuum: A structured review. Cancer Causes and Control, 16, 63–70. Nissen, M. J., Swenson, K. K., Ritz, L. J., Farrell, J. B., Sladek, M. L., & Lally, R. M. (2001). Quality of life after breast carcinoma surgery: A comparison of three surgical procedures. Cancer, 91, 1238–1246. Norman, S. A., Potashnik, S. L., Galantino, M. L., De Michele, A. M., House, L., & Localio, A. R. (2007). Modifiable risk factors for breast cancer recurrence: What can we tell survivors? Journal of Women’s Health, 16, 177–190. Northouse, L. L., Mood, D., Kershaw, T., Schafenacker, A., Mellon, S., Walker, J., et al. (2002). Quality of life of women with recurrent breast cancer and their family members. Journal of Clinical Oncology, 20, 4050–4064. O’Malley, M. S., Earp, J. A. L., Hawley, S. T., Schell, M. J., Mathews, H. F., & Mitchell, J. (2001). The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: Who gets the message about breast cancer screening? American Journal of Public Health, 91, 49–54. Pedro, L. W. (2001). Quality of life for long-term survivors of cancer: Influencing variables. Cancer Nursing, 24, 1–11. Plummer, M., & Franceschi, S. (2002). Strategies for HPV prevention. Virus Research, 89, 285–293. Polednak, A. P. (2001). How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases. Plastic and Reconstructive Surgery, 108, 73–77. Ponce, N. A., Chawla, N., Babey, S. H., Gatchell, M. S., Etzioni, D. A., Spencer, B. A., et al. (2006). Is there a language divide in Pap test use? Medical Care, 44, 998–1004. Pruzinsky, T. (2002). Body image adaptation to reconstructive surgery for acquired disfigurement. In T. F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 440–449). New York: The Guilford Press. Ravdin, P. M., Cronin, K. A., Howlader, N., Berg, C. D., Chlebowski, R. T., Feuer, E. J., et al. (2007). The decrease in breast-cancer incidence in 2003 in the United States. New England Journal of Medicine, 356, 1670–1674. Rehse, B., & Pukrop, R. (2003). Effects of psychosocial interventions on quality of life in adult cancer patients: Meta analysis of 37 published controlled outcome studies. Patient Education and Counseling, 50, 179–186. Resnicow, K., Baranowski, T., Ahluwalia, J. S., & Braithwaite, R. L. (1999). Cultural sensitivity in public health: defined and demystified. Ethnicity and Disease, 9, 10–21. Rock, C. L., & Demark-Wahnefried, W. (2002). Nutrition and survival after the diagnosis of breast cancer: A review of the evidence.[erratum appears in J Clin Oncol 2002 Sep 15;20(18):3939]. Journal of Clinical Oncology, 20, 3302–3316. Roetzheim, R. G., Fox, S. A., & Leake, B. (1995). Physician-reported determinants of screening mammography in older women: The impact of physician and practice characteristics. Journal of the American Geriatrics Society, 43, 1398–1402. Rowland, J. H., Desmond, K. A., Meyerowitz, B. E., Belin, T. R., Wyatt, G. E., & Ganz, P. A. (2000). Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. Journal of the National Cancer Institute, 92, 1422–1429. Sandgren, A. K., Mullens, A. B., Erickson, S. C., Romanek, K. M., & McCaul, K. D. (2004). Confidant and breast cancer patient reports of quality of life. Quality of Life Research, 13, 155–160.

331

332


Sangani, P., Rutherford, G., & Wilkinson, D. (2004). Population-based interventions for reducing sexually transmitted infections, including HIV infection. Cochrane Database of Systematic Reviews, CD001220. Sarna, L., Padilla, G., Holmes, C., Tashkin, D., Brecht, M. L., & Evangelista, L. (2002). Quality of life of long-term survivors of non-small-cell lung cancer. Journal of Clinical Oncology, 20, 2920–2929. Schover, L. R. (2008). Reduction of psychosexual dysfunction in cancer patients. In S. Miller, D. Bowen, R. Croyle, & J. Rowland (Eds.), Handbook of behavior and cancer (pp. 379–389). Washington, DC: APA. Sears, S. R., Stanton, A. L., & Danoff-Burg, S. (2003). The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychology, 22, 487–497. Sears, S. R., Stanton, A. L., Kwan, L., Krupnick, J. L., Rowland, J. H., Meyerowitz, B. E., et al. (2003). Recruitment and retention challenges in breast cancer survivorship research: Results from a multisite, randomized intervention trial in women with early stage breast cancer. Cancer Epidemiology Biomarkers and Prevention, 12, 1087–1090. Selvin, E., & Brett, K. M. (2003). Breast and cervical cancer screening: sociodemographic predictors among White, Black, and Hispanic women. American Journal of Public Health, 93, 618–623. Shepherd, J., Peersman, G., Weston, R., & Napuli, I. (2000). Cervical cancer and sexual lifestyle: A systematic review of health education interventions targeted at women. Health Education Research, 15, 681–694. Simon, M. S., Du, W., Flaherty, L., Philip, P. A., Lorusso, P., Miree, C., et al. (2004). Factors associated with breast cancer clinical trials participation and enrollment at a large academic medical center. Journal of Clinical Oncology, 22, 2046–2052. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2002). Unequal treatment: confronting racial and ethnic disparities in health care. Institute of Medicine. Sollner, W., Maislinger, S., DeVries, A., Steixner, E., Rumpold, G., & Lukas, P. (2000). Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior: a survey. Cancer, 89, 873–880. Stull, V. B., Snyder, D. C., & Demark-Wahnefried, W. (2007). Lifestyle interventions in cancer survivors: Designing programs that meet the needs of this vulnerable and growing population. Journal of Nutrition, 137(1 Suppl.), 243S–248S. Task Force on Community Preventive Services (Ed.) (2005). The guide to community preventive services. What works to promote health? Oxford University Press. Thors, C. L., Broeckel, J. A., & Jacobsen, P. B. (2001). Sexual functioning in breast cancer survivors. Cancer Control, 8, 442–448. Tomich, P. L., & Helgeson, V. S. (2002). Five years later: A cross-sectional comparison of breast cancer survivors with healthy women. Psycho-Oncology, 11, 154–169. Tseng, J. F., Kronowitz, S. J., Sun, C. C., Perry, A. C., Hunt, K. K., Babiera, G. V., et al. (2004). The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer, 101, 1514–1523. Tworoger, S. S., Yasui, Y., Vitiello, M. V., Schwartz, R. S., Ulrich, C. M., Aiello, E. J., et al. (2003). Effects of a year-long moderate-intensity exercise and a stretching intervention on sleep quality in postmenopausal women. Sleep, 26, 830–836. United States Preventive Services Task Force. (2008). The Guide to Clinical Preventive Services. Recommendations of the U.S. Preventive Services Task Force: AHRQ. Ward, E., Jemal, A., Cokkinides, V., Singh, G. K., Cardinez, C., Ghafoor, A., et al. (2004). Cancer disparities by race/ethnicity and socioeconomic status. CA: A Cancer Journal for Clinicians, 54, 78–93. Wei, W., Findley, P. A., & Sambamoorthi, U. (2006). Disability and receipt of clinical preventive services among women. Womens Health Issues, 16, 286–296. Weisman, A. D., & Worden, J. W. (1976). The existential plight in cancer: significance of the first 100 days. International Journal of Psychiatry in Medicine, 7, 1–15. Wellings, K., Collumbien, M., Slaymaker, E., Singh, S., Hodges, Z., Patel, D., et al. (2006). Sexual behaviour in context: a global perspective. Lancet, 368, 1706–1728.

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Wenzel, L., DeAlba, I., Habbal, R., Kluhsman, B. C., Fairclough, D., Krebs, L.U., et al. (2005). Quality of life in long-term cervical cancer survivors. Gynecologic Oncology, 97, 310–317. Winer, R. L., Hughes, J. P., Feng, Q., O’Reilly, S., Kiviat, N. B., Holmes, K. K., et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354, 2645–2654. Wingo, P. A., Tucker, T. C., Jamison, P. M., Martin, H., McLaughlin, C., Bayakly, R., et al. (2008). Cancer in Appalachia, 2001–2003. Cancer, 112, 181–192. Zachariae, R., Pedersen, C. G., Jensen, A. B., Ehrnrooth, E., Rossen, P. B., & von der Maase, H. (2003). Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. British Journal of Cancer, 88, 658–665. Zhu, K., Hunter, S., Bernard, L. J., Payne-Wilks, K., Roland, C. L., & Levine, R. S. (2000). Recruiting elderly African-American women in cancer prevention and control studies: A multifaceted approach and its effectiveness. Journal of the National Medical Association, 92, 169–175.

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HIV/AIDS Among Women of Color and Sexual Minority Women

12 Jane M. Simoni, Teresa EvansCampbell, Michele P. Andrasik, Keren Lehavot, Dellanira Valencia-Garcia, and Karina L. Walters

In the United States, reactions to the Acquired Immunodeficiency Syndrome (AIDS) epidemic generally have reflected the prevailing sexism and racism of the larger society (Corea, 1993; Treichler, 1999). Early nomenclature included Gay-Related Immune Deficiency, or GRID, even though women were among the first to be diagnosed. Later the list of opportunistic infections required for an AIDS diagnosis, and thus allowing access to treatment, initially focused on those affecting men and not women—leading to the activist slogan that “Women don’t get AIDS, they just die from it.” Initially, scientific discourse constructed women as invulnerable, “inefficient,” or “incompetent” transmitters of HIV (Treichler, 1999, p. 20). Later, as the disease became more clearly linked to the lives of women of color, particularly African American women as well as sex workers, the discourse referred to women as dangerous “vectors of transmission” and sources of “contamination.” These contradictory public health discourses lead Treichler, (1999) to remark “… what I find truly dizzying is the ease and simultaneity with which women can be both invisible and culpable, transparent instrumental carriers and reservoirs of infection, dangerous and willful infectors, and naïve, irresponsible infectees” (p. 274).

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Within contemporary dominant national and global HIV prevention movements, women of color often are told that they must control the sexual situation, control “their” men, and place under control their sexual selves and bodies to prevent being a vector for HIV transmission in their communities and families. Thus, many public health interventions have been inadequate for addressing the HIV prevention needs of women. The solution is not to simply cognitively or behaviorally increase knowledge, motivation, or behavioral skills in condom use. Rather, the HIV pandemic for women of color must be contextualized within the historical and contemporary structural realities that are rooted in colonialism, racism, and gendered violence. These structural barriers serve to perpetuate and exacerbate HIV risk for women of color. Specifically, the history of sexual violence among women of color illustrates how it functions as a tool of colonialism and racism. Gendered violence includes symbolic and literal control over women’s bodies as well as their objectification (Smith, 2006). Notably, there is a growing literature on the direct connection between the sexual violence perpetrated on young girls and adolescents and behavioral sequelae that increase the risk of HIV infection in adulthood (Whitmire, Marlow, Quina, & Morokoff, 1999). Racialized ideologies are established through dominant discourses in which the bodies of women of color are seen as temptingly exotic and inherently violable. Dominant discourses acknowledge that gendered racism is present, but how it is manifest and tied to colonization remains inadequately explicated. The result is the normalization of death and destruction in women of color’s experiences without fully analyzing the functions of colonialism, racism, and gendered violence in escalating the AIDS epidemic among women of color. As Stoler noted, “Racism does not merely arise in moments of crisis, in sporadic cleansings. It is internal to the biopolitical state, woven into the web of the social body, threaded through its fabric.” (Ann Stoler, 1997, cited in Smith, 2006, p.9). The blatant disregard for women in early intervention efforts and their continued oppression has led, in part, to steadily increasing rates of HIV infection in women over the years, especially in women of color. Of the 127,150 U.S. women living with HIV/AIDS, 81% are women of color (Centers for Disease and Prevention [CDC], 2007b). Women now constitute 23% of all U.S. AIDS cases, up from 7% in 1985, and this percentage continues to rise (CDC, 2007b; Whitmire et al., 1999). In this chapter, we examine empirical data on African American, Latino, and American Indian women—the three racial/ethnic groups disproportionately affected by HIV/AIDS in the United States, as well as sexual minority women. For each group, we present the epidemiological data with respect to HIV; review historical, structural, and community-level risk factors for HIV infection; and suggest possible strategies for risk reduction that highlight community strengths and resilience.

African American Women HIV/AIDS has devastated the African American community. Compared to all other racial/ethnic groups in the United States, African Americans have higher

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HIV diagnosis rates, shorter survival times, and more HIV-related deaths. For example, of all African Americans diagnosed with AIDS since 1996, only 64% were alive after 9 years. This is in stark contrast to the figures of 81% for Asian/ Pacific Islanders, 74% for Whites, and 72% for Hispanic/Latinos (CDC, 2005, 2006a). For African American women, HIV has had the greatest impact on those between the ages of 20 and 49 years. The most common mode of transmission for African American women is unprotected sex with an HIV-positive man. African American women accounted for 70% of all high-risk heterosexual contact cases among women. Among the 157,252 diagnoses of HIV infection in the United States between 2001 and 2004, African Americans constituted more cases and had higher diagnosis rates than all other racial/ethnic populations (CDC, 2005, 2006a). Specifically, in the years between 2001 and 2004, the HIV/AIDS diagnosis rate for African American women in the United States was 4.1 times higher than the rate for Hispanic/Latin women, 8.7 times higher than the rate for American Indian/Alaskan Native women, 16.3 times higher than the rate for Asian/Pacific Islander women, and 20.9 times higher than the rate for White women. African American women account for the majority of HIV/AIDS diagnoses in the Southern (72%), the Northeastern (65%), and the Midwestern (64%) regions of the United States (CDC, 2006a). HIV/AIDS is one of a myriad of health and social issues affecting the African American community and it is directly tied to a host of social, historical, contextual, and political circumstances. As shown below, these factors often interact to exacerbate the effect of HIV in the community.

Poverty There is a great deal of empirical support for the associations among poverty, high risk behaviors, and HIV infection among African American women (Jipguep, Sanders-Phillips, & Cotton, 2004; Osmond et al., 1993). A history of racism and segregation has led to vast disparities in economic opportunities for African Americans in this country, leading to highly prevalent poverty. And poverty itself is probably the single greatest contributing factor to the HIV epidemic in the African American community. Indeed, the incidence of AIDS is seven times higher in communities with high (versus low) levels of economic deprivation (Zierler et al., 2000). There are pockets of segregated African American communities throughout the United States that are characterized by high unemployment rates, homelessness, and poverty, and lack a basic infrastructure for public health and social services (Williams, 2003). Not coincidentally, these regions also are plagued by a multitude of health problems including high rates of death, diabetes, stroke, heart disease, firearm deaths, infant mortality, obesity, and sexually transmitted infections (STIs) such as HIV.

Substance Abuse Impoverished African American women may use illicit substances to cope with their condition, although their search for immediate relief often leads to

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long-term unintended consequences (e.g., poorer health and poorer healthrisk decision-making). Substance abuse and its common sequelae of violence and mental health issues contribute to the high rates of HIV infection among African American women. African American women who use illicit drugs have more unprotected sex; more sexual partners (Logan, Cole, & Leukefeld, 2002); higher levels of depression and anxiety (Sterk, Theall, & Elifson, 2006); and are more likely to be financially, emotionally, and socially dependent on their sexual and romantic partners (Sanders-Phillips, 2002). These factors are major barriers in the negotiation of condom use. Women with a history of substance abuse reported that drug use often triggered or intensified violence and they avoided requesting condoms for fear of violent reprisals (El-Bassel, Gilbert, Rajah, Foleno, & Frye, 2000). Additionally, the use of illicit drugs may make women more susceptible to contracting HIV and other STIs because the drugs can weaken the immune system and because the women may turn to sex work to support their addiction (Logan et al., 2002).

Physical and Sexual Victimization African American women, especially those affected poverty and substance use, suffer disproportionate rates of victimization (U.S. Department of Justice [DOJ], 2007), creating a triad of risk factors for subsequent HIV infection. Indeed, the associations among substance use, sexual and physical assault, and high-risk behaviors among low-income African American women are well documented (Roberts, Wechsberg, Zule, & Burroughs, 2003; Wyatt et al., 2002). Low-income HIV-positive African American women have reported high levels of physical and sexual trauma (Cooperman, Simoni, & Lockhart, 2003; Simoni & Ng, 2002). Among these women, childhood abuse increases the risk of revictimization in adulthood. These factors interact to exacerbate risk, and some of the precise mechanisms have been studied. Poor women are more likely to be raised in homes where drugs are used and sold (Durr, 2005). When they engage in sex work to obtain money, substance-abusing mothers are often unable to hide their addictions from their children. As these children age, they find it difficult to escape from the drug culture surrounding them. For others, poverty often leads to sex work and, in an effort to relieve negative emotions, women often self-medicate by using drugs (Durr, 2005). Indeed, women often begin to use drugs to relieve shame and cope with previous trauma or unbearable stress (Sanders-Phillips, 2002), and women are introduced to intravenous drug use most often by male partners (McNair & Prather, 2004).

Incarceration Substance use, romantic entanglement, or economic involvement with substance users has led to disproportionate encounters with the criminal justice system for increasing numbers of African Americans. The “war on drugs” has resulted in racially disproportionate arrests, convictions, and sentences for people of color, particularly for African American men and women (Davis, 2003). Like poverty and substance use, incarceration increases factors that can lead to HIV infection. African Americans are more likely than individuals of other racial/ethnic

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groups to be incarcerated, in large part because of increased surveillance and racial profiling in African American communities. African Americans represent approximately 40% of the total state inmate population. By midyear 2006, approximately 5% of African American men were in custody compared to less than 1% of White men and almost 2% of Hispanic men (U.S. DOJ, 2007). Overall, African American men are incarcerated at more than six times the rate of White men. Between midyear 2005 and midyear 2006, there was a significantly greater increase in female prisoners than male prisoners. During this time, Black women were incarcerated at nearly four times the rate of White women and more than twice the rate of Hispanic women (U.S. DOJ, 2007). While incarcerated, men who do not identify as homosexual often engage in same-sex activities for a number of reasons, including the exchange of sex for drugs or money, lack of heterosexual partners, the threat or practice of rape, or to obtain favors and protection (Polonsky et al., 1994). Additionally, high-risk behaviors, such as tattooing and needle sharing during injection drug use, are common among incarcerated individuals (Hellard & Aitken, 2004; Polonsky et al., 1994), leading to an AIDS rate for incarcerated individuals that is six times the national rate (Dean-Gaitor & Fleming, 1999). The disproportionately high rate of incarceration of African American men, and increasingly among African American women, creates a highly viable bridge of transmission as this population with high rates of HIV/AIDS is placed back into the community after serving their time.

Sex Ratio Imbalance Presently, a sex ratio imbalance (more women than men) exists within the African American community. This imbalance, which may create several barriers to safer sexual practices, is a direct result of the high death rate of African American men resulting from HIV/AIDS and homicide (Population Resource Center, 2001) as well as disparities in incarceration. Fear of losing a male partner—often their only source of economic support—may prevent women from discussing condom use and negotiating for safer sex (McNair & Prather, 2004; Osmond et al., 1993). The scarcity of HIV-negative African American men is particularly disruptive to African American women because they are less likely than other women to date men of another race (Laumann & Youm, 1999).

Gender Role Attitudes During slavery, many African Americans enacted private ceremonies to sanction marriages (e.g., jumping the broom) and created families despite the ethnocidal attempts to dissolve or disempower strong familial ties. As a result, many African American women hold traditional attitudes toward gender roles, which, in turn, further strengthen the power differential between men and women in their communities. African American women often accept a certain amount of infidelity, believing that males are by nature sexually promiscuous (Timmons & Sowell, 1998). Of course, for reasons stated above, they often have no option but to accept these behaviors, whether they condone them or not. These attitudes may directly support the trend in African American

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communities of older men partnering with much younger (often minor) women (Wolfe, 2003). In these relationships, women have even less power to negotiate condom use. This may explain the high rates of pregnancy and sexually transmitted infections among low-income African American adolescents (CDC, 2000a) and why African Americans represent 73% of adolescent girls diagnosed with HIV and 66% of those with AIDS (CDC, 2000b).

Heterosexism Heterosexism is another contributor to high HIV prevalence in the African American community. Herek 1991) defined heterosexism as “conceptualizing human experience in strictly heterosexual terms and consequently ignoring, invalidating, or derogating homosexual behaviors and sexual orientation, and lesbian, gay, and bisexual relationships and lifestyles” (p. 958). The stigma associated with a sexual minority orientation hinders African American men who have sex with men from openly disclosing this behavior to female partners. Studies have shown that African American men who have sex with men must do so covertly and, at times, partner with women to avoid stigma from their community and to fulfill cultural expectations for gender normative behavior. In a sample of 65,389 men who had sex with men, African American men (41%) reported bisexuality more frequently than Hispanic (31%) or White (21%) men (Chu et al., 1992). In addition, African American women, although five times more likely to be infected by a bisexual man than White women (Chu et al., 1992), are often unaware of their partners’ bisexuality and HIV status (Chu et al., 1992; McNair & Prather, 2004).

Concurrent Relationships As a result of residential segregation, high incarceration rates of African American men, the sex ratio imbalance, and the practice of men who have sex with men also partnering with women, African American women have a limited number of male partners of their race from which to choose, and may have a greater likelihood of partnering with someone infected with HIV. These factors, in combination with a history of having established relationships disregarded by slave owners and the larger society, has led to the emergence of concurrent relationships (relationships that overlap in time) in the African American community and the existence of sexual networks in which infection can spread rapidly (Adimora & Schoenbach, 2005). Concurrent relationships are almost 2 times more prevalent among African American women (21%) than White women (11%; Adimora & Schoenbach, 2005) and seem to be more common among women who have been incarcerated, have a partner who has been incarcerated, have a history of exchanging sex for drugs or money, use crack cocaine, and engage in binge alcohol drinking (Adimora et al., 2004).

Denial Compounding these issues has been the reluctance of the African American community to acknowledge the threat of HIV/AIDS because of its potentially stigmatizing association with sexual and substance use behaviors. Land,

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(1994) argued that acknowledging HIV/AIDS may affirm the racist stereotypes depicting African American communities as neighborhoods rife with crime, prostitution, and substance abuse. In addition, the African American church, one of the most powerful institutions in the community, has historically supported the belief that homosexuality and drug use are sinful. These attitudes emphasize individual responsibility for health. As a result, religious and community leaders have often ignored or minimized the threat of HIV in the community and have done little to plan community-level health promotion strategies. Although African Americans are disproportionately affected by HIV/AIDS, there is much evidence suggesting they do not perceive themselves to be at risk. Many African Americans perceive HIV/AIDS as primarily a White gay male disease (Williams, 2003) and a punishment from God (Williams, 2003) and believe that being in a monogamous relationship offers effective protection against HIV (McNair & Prather, 2004; Thorburn, Harvey, & Ryan, 2005; Timmons & Sowell, 1998).

Myths, Rationalizations, and Conspiracies Even when African Americans acknowledge their risk of infection, they may subscribe to conspiracy theories of the origins of HIV and the intent of HIV prevention messages, which act as barriers to safer sexual practices. Many African Americans have endorsed beliefs that contraception is a means to achieve genocide by the government and White society (Osmond et al., 1993; Timmons & Sowell, 1998). Survey data from HIV-positive African Americans indicates that 25% to 50% believe that information about AIDS is being withheld from the public (Belenko, Shedlin, & Chaple, 2005; Whetten et al., 2006) and that AIDS was created by the government as a form of African American genocide (Klonoff & Landrine, 1999; Whetten et al., 2006). African American men and women who endorse conspiracy beliefs are more likely to have negative attitudes toward condoms and use condoms less consistently (Ross, Essien, & Torres, 2006). In addition, conspiracy beliefs may facilitate the spread of disease through the rejection of medical advice and a general distrust and avoidance of the health care system (Klonoff & Landrine, 1999; Whetten et al., 2006). It is important to note that conspiracy theories spring from justifiable mistrust among African American, who have experienced a history of medical improprieties, including efforts to control the fertility of African American women, experimentation without informed consent, and even outright deception (e.g., Tuskegee syphilis study; Jones, 1993; Roberts, 1998), at the hands of the U.S. government and the medical and research establishment.

Looking to the Future: Resilience and Protective Factors Among African American Women Interventions to combat HIV among African American women must attend to the unique experiences and important demographic factors representative of women who engage in high-risk behaviors (Scott, Gilliam, & Braxton, 2005). These efforts must address the diversity among African American women who engage in high-risk behaviors—such as substance use—as well as African

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American women who are in high-risk situations—such as being single and head of household—with regard to how these groups define their actions and situations that place them at risk for HIV (Jemmott & Brown, 2003; Logan et al., 2002). Interventions focusing on individual behavior change without addressing the social and contextual factors that limit growth and opportunity are likely futile. African Americans generally report less risky drug use and sexual behaviors than their White counterparts (Golub & Johnson, 2001), yet African Americans remain at high risk of STI and HIV infection even when their behaviors are normative (Hallfors et al., 2007. Future efforts must attend to social and contextual factors, concentrating on geographic areas that are high risk areas, taking steps to build infrastructure for public health and social services, and addressing high unemployment, poverty, violence, crime, homelessness, and substance use (Williams, 2003; Zierler et al., 2000) as well as justifiable mistrust of health systems. Additionally, prevention and intervention strategies must be targeted to prisons and jails (Belenko, Shedlin, & Chaple, 2005; Logan et al., 2002). Interventions in prisons and jails must be targeted both male and female inmates and their intimate partners. Interventions targeting inmates must include HIV testing, distribution of clean needles and condoms, and HIV transmission education. Interventions targeting partners of inmates must include HIV transmission education, as well as social, psychological, and support services (Comfort, Grinstead, Faigeles, & Zack, 2000). African American women have a long and proud history of surviving adversity and possess considerable adaptability in the face of oppressive social conditions (Cutrona et al., 2000; Bontempi, Eng, & Quinn, 2008). The utilization of this adaptability and agency to empower African American women has proven successful. African American women have founded organizations (e.g., The Balm in Gilead, Inc.; African Americans Reach and Teach Health Ministries) and are working to empower the African American community from within. African American women also have benefited from interventions incorporating a spiritual dimension (Drayton-Brooks & White, 2004); cultural pride; peer support (Jemmott & Brown, 2003); interpersonal relationships (Drayton-Brooks & White, 2004; Mize et al., 2002); active community roles (Cutrona et al., 2000); and positive self-concept and high self-esteem (Wolfe, 2003). Strengthening the bond between low-income African American adolescent girls and their mothers also has led to protection from high-risk behaviors (Aronowitz, Rennells, & Todd, 2005; Dancy, Crittenden, & Talashek, 2006). Clinical approaches that are skill-based (e.g., emphasize social skills training, correct condom use, identification of anatomy) or that focus on reducing or preventing interpersonal violence (e.g., anger management training, and peer conflict mediation) and reducing sexual risk behaviors (e.g., effective condom negation, and addressing beliefs relevant to HIV/STI risk reduction) also have proven to be effective for African American young adults (Jemmott et al., 2005). In summary, improving the health of African American women and protecting them from HIV requires their empowerment. African American women can best be empowered when structural and systemic barriers due to race, class, and gender are acknowledged and addressed.

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Latin Women (Latinas) Latin men (Latinos) and women (Latinas) are the fastest growing and largest minority group in the United States. At the end of 2004, over 40 million Latinos lived in the United States, and accounted for 14% of the total U.S. population (Pew Hispanic Center, 2006). While Latinos are often viewed as a homogenous group, there is vast heterogeneity among subgroups based on historical experiences of colonization, displacement, and immigration (Aguirre & Turner, 2004). Mexicans are the largest Latino subgroup, consisting of 66.9% of Latinos residing in the United States, followed by Central and South Americans (14.3%), Puerto Ricans (8.6%), and Cubans (3.7%; U.S. Census, 2001). Numerous studies have documented the paradox that foreign-born Latinos, despite having lower socio-economic status and experiencing numerous structural and cultural barriers, have better physical and mental health than U.S.-born Latinos (Alderete et al., 2000; Burnam et al., 1987). Nevertheless, health concerns such as HIV/AIDS are increasing at alarming rates among the various Latino populations.

Epidemiology of HIV Among Latinas Over the last 25 years, the HIV/AIDS pandemic has been steadily increasing among Latinas. In 2004, Latinas accounted for 15% of all women living with HIV/AIDS (CDC, 2004). Two major modes of HIV transmission have been identified in Latinas: heterosexual contact (69%), and injection drug use (29%; CDC, 2008). Across all ethnicities, the highest rates of HIV diagnosis were found among women between the ages of 15 to 39 (CDC, 2008). HIV/AIDS is now the fourth leading cause of death for Latinas living in the United States (CDC, 2007a). Previous research suggests that risk for exposure varies based on the country of origin, with multiple epidemics of HIV among distinct groups of Latinos residing throughout the United States (CDC, 2004; Diaz, Buehler, Castro, & Ward, 1993). For example, Puerto Rican women concentrated mainly in the Northeastern states are most at risk for HIV transmission due to higher rates of injection drug use (CDC, 2007a). Furthermore, recent evidence suggests that the mode of infection may vary by place of birth, indicating higher rates of male-to-male transmission for Latinos born in South America, Cuba, and Mexico, compared to those born in the United States (CDC, 2007d). These trends suggest that current HIV prevention interventions are having minimal impact on decreasing the risk of HIV infection among Latinas and underscore the need to increase our understanding of the factors that place the various subgroups of Latinas at risk for HIV. The following discussion highlights important factors among Latinas that need to be addressed in future HIV/AIDS prevention efforts. As among African American women, the various factors related to HIV risk are interconnected.

Acculturation and Immigration Acculturation generally refers to the process of cultural transition to a new society where immigrants are expected to alter their behaviors and attitudes to reflect those of the dominant culture. The construct of acculturation,

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however, and its measurement, definition, and relevance to health research is debated by experts (Berry, 2003; Cabassa, 2003; Escobar & Vega, 2000; Hunt, Schneider, & Comer, 2004), with some theorists arguing that it involves a linear process of relinquishing attributes of the old culture for the new culture and others arguing that it is a highly complex and multilayered process of inclusion of host norms and values and retention of core cultural values. Additionally, there is considerable diversity within and between Latino subgroups in terms of their acculturative experiences and levels of distress. As a result, Latinos are not likely to experience acculturation in a uniform fashion, necessitating that acculturation processes be contextualized by ethnic subgroup, country of origin, as well as gender. Conceptual and measurement problems may explain some of the contradictory findings related to acculturation and risk for HIV among Latinas. For example, on the one hand, a number of studies have identified acculturation as contributing to HIV risk behavior among Latinas. Specifically, Latinas with high acculturation levels have been found to have more sex partners (Carmona, Romero, & Loeb, 1999; Rojas-Guyler et al., 2005) and to be more likely to engage in unprotected sex (Marks, Cantero, & Simoni, 1998). On the other hand, highly acculturated Latinas are more likely to use and carry condoms (Marín et al., 1993), use condoms in a new sexual relationship, and show greater levels of sexual communication with sex partners (Rojas-Guyler et al., 2005). Furthermore, while some studies suggest that traditional cultural norms may serve as buffers for HIV risk factors, this may not be the case for immigrant women with low levels of acculturation and high levels of associated stress (Romero et al., 1998). Undocumented status and high rates of unemployment are major barriers to independence for Latinas because they can lead to economic reliance on male partners. The vulnerability of immigrant women is exacerbated because of inaccurate HIV information, language barriers, new cultural norms, and fears of deportation, which decrease a woman’s chance of seeking health care including obtaining HIV prevention information (Gómez et al., 1999). Immigrant women, especially if undocumented, may have more survival-related issues to deal with in their daily lives (e.g., unemployment, lack of food or shelter, residence in high crime areas, and fear of deportation), making HIV a less salient concern (Romero & Arguelles, 1993). In a qualitative study among new immigrants in a large U.S. city, Shedlin and colleagues (2005) found that there was a lack of accurate HIV/AIDS knowledge, including knowledge of prevalence, risks of transmission, and disease symptoms. Acculturation and immigration issues are complex topics that need to be considered within the context of women’s multiple identities and competing priorities; gender role expectations further complicate these associations.

Gender Roles Latin cultures are characterized by culture-bound ideals of familismo (the importance of family and kinship), respeto (importance of interpersonal respect), and the importance of gender roles (machismo and marianismo). These ideals impact gendered behaviors that affect HIV risk and transmission. Machismo characterizes a male who is a provider, a protector, and who

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is strong, courageous, and virile, although it is stereotypically associated with holding dominance and control in a relationship and having social and sexual freedoms that women do not have (Marin, 2003; Mirande, 1988; Pavich, 1986). Latinas cite perceptions of male partner control of condoms and female powerlessness over safer sex (scripted by traditional notions of machismo) as reasons they do not practice safer sex (Romero et al., 1998; Wingood & DiClemente, 1995). Although most studies indicate that sexual control and the responsibility for condom use falls on men, some men may be willing to engage in safer sex behavior (using condoms) when allowed to join their partners in family planning decisions (Riehman et al., 1998). A combination of traditional cultural values, religious beliefs, and gender role beliefs has characterized Latinas as super-mothers, passive, and subordinate to men. The term marianismo derives from the Virgin Mary and refers to an exaggerated feminine persona in Latin cultures. Latinas are expected to be self-sacrificing, chaste, and dependent on men, as well as restricted to the home environment (Arredondo, 2002; Peragallo, 1996). Marianismo has been found to affect women’s self-esteem and loss of power and control over their sex life and may place them at escalated risk of HIV transmission (Amaro, Vega, & Valencia, 2001; Marín, 2003; Valencia-Garcia, Starks, Strick, & Simoni, 2008). Attitudes towards condom use or safe sex communication are influenced by Latinas’ perceived need to uphold traditional values on how to behave around issues of contraception. Thus, they may find it difficult to speak with partners about HIV-related issues because it is not seen as an acceptable role for women (Gómez & Marin, 1996). Further, women who talk to their partners about sex or condoms may be perceived as sexually promiscuous and therefore may avoid sexual communication with their partners for fear of negative labels (Moreno, 2007). Moreover, many Latinas believe that they risk inciting their partner’s anger or violence if they broach the topic of condoms (Raj, Silverman, & Amaro, 2004; Amaro & Raj, 2000). Using or communicating about condoms requires that Latinas take a dominant role in a partnership, a stance that contradicts traditional norms. Theories that fail to account for these cultural norms may lead to the development of HIV prevention interventions with unrealistic expectations for women (Amaro, 1995).

Power Inequalities in Sexual Relationships Power inequalities, especially those that are gender based, are evident in both the social and interpersonal realms of Latinas and play a large part in sexual decision-making. Pulerwitz and colleagues (2002) examined relationship power in safer sex decision-making and found that women with lower levels of relationship power were less likely to report condom use. Sexual power occurs within the context of society where women are born into a patriarchal world and are disempowered both by their gender and the realities of a malecentered culture (Miller, 1986; Rao Gupta, 2000). Further, women lack control of their bodies, as demonstrated by the pervasive existence of physical and sexual assaults against women. These issues may be exacerbated in the case of Latinas because of the strict gender roles already mentioned. According to these social rules, it is difficult for women to feel they have the right or the

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ability to control what happens to their bodies. Under this type of misogynist, inequitable structure, women’s HIV prevention practices are difficult without male partner permission and participation. Further disempowering Latinas in their sexual relationships with men is their unequal economic status. Gender-based segregation of work results in women holding primary responsibility for unpaid labor in the home (e.g. childcare, housework) or low-paid positions outside the home in female-dominated professions such as domestic labor, social service, and childcare, occupations where they earn less money than males for comparable work (Zierler & Kreiger, 1997). Economic control by males maintains their dominance in society and in the home. Among immigrant families, women may be more heavily dependent on men for economic and social resources that, again, may exaggerate male control and dominance and heighten female passivity.

Sex-Related Behavioral Risk Factors Acculturative stress, strict gender norms, and power imbalances operate to increase Latinas’ sex-related risk for HIV. Compared to women from other racial/ethnic backgrounds, Latinas report extremely low levels of condom use with primary and secondary partners (Gómez et al., 1999; Rojas-Guyler, Ellis, & Sanders, 2005). Latinas are less likely to make contraception decisions without their partners’ approval, less likely to use contraception, and more likely to use ineffective methods compared to White and African American women (Wyatt et al., 2000). While Latinas are stereotypically viewed as being religious, the empirical literature does not support religiosity as influencing their contraceptive decision making (Mikawa et al., 1992; Wyatt et al., 2000).

Areas of Focus for HIV Prevention Interventions Among Latinas The increase of HIV/AIDS among Latinas calls for immediate attention to preventive interventions to curb this epidemic. Most of the HIV research on women has focused on examining factors related to sexual risk (Dixon, Peters, & Saul, 2003; Rojas-Guyer et al., 2005); less is known about the women who do not become infected and their protective factors. Future research should examine personal and cultural factors that may aid in identifying strengths and decreasing new infections among Latinas. For example, there may be culturally invoked patterns of protective behaviors that Latinas engage in during sexual negotiations that have yet to be documented for prevention development. The findings discussed above link lower levels of acculturation with lower sexual risk. Other research indicates that the longer Latinos remain in the United States, the more their mental health deteriorates (Alegría et al., 2007), and suggests that there are cultural protective factors that may be lost over time—such as family cohesion, ethnic pride, adherence to protective factors of marianismo, and spirituality. We should examine healthy relationships among Latin couples in terms of safer sex negotiation, communication about contraception use, and marital satisfaction for further clues to protective factors. Past interventions for Latinas have focused on teaching women to become more assertive; however, this strategy may be ineffective for Latinas since it

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requires them to adopt behavior that may be outside of their prescribed gender roles (Amaro & Raj, 2000; Choi, Wojcicki, & Valencia-Garcia, 2004). Choi et al. (2004) examined women’s verbal strategies when introducing the female condom to male partners, and found that women who used less direct verbal approaches were as effective as those using assertive approaches. Future HIV prevention/interventions for Latinas must address the context of gender, race/ethnicity, class oppression (Amaro & Raj, 2000; Marin, 2003), interpersonal violence (Beadnell, 2000; Wingood et al., 2006), socioeconomic inequality (Ickovics et al., 2002; Moss, 2002), and sexual relationship power (Pulerwitz et al., 2002). HIV interventions must also address the values of machismo and marianismo and their impact on sexual risk behavior for both genders, including sexual communication, homophobia, and men’s sexual risk behaviors. Finally, immigrant populations need special attention as expressions of sexuality for men and women may be different in a new society and change over time.

American Indian and Alaska Native Women American Indian and Alaska Native (AIAN) communities have endured a series of traumatic events over the past several centuries, which have had devastating consequences for the health and wellness of native people. In recent years, HIV/AIDS has emerged as a contemporary health trauma for AIAN communities. Although the number of AIDS cases among AIAN represents less than 1% of the total number reported to the CDC, these data belie the true impact of HIV/AIDS on Native communities. Viewing the numbers in relation to the total AIAN population, AIANs rank third in rates of AIDS diagnoses (after African Americans and Hispanics). Moreover, the rate of HIV diagnoses among AIANs in the United States continues to increase, rising from 9.5 per 100,000 in 2001 to 10.6 per 100,000 in 2005 (CDC, 2007a). Finally, of persons who received a diagnosis of AIDS during 1997–2004, AIANS had a shorter survival time than Asian/Pacific Islanders, Latinos/Hispanics, or Whites (CDC, 2007a). Moreover, high rates of other STIs increase the risk of contracting and spreading HIV. AIANS have the second highest gonorrhea rate and the third highest syphilis rate in the United States, suggesting that AIANS are engaging in unprotected sex that could facilitate HIV transmission as well (CDC, 2007a; Vernon, 2007). There are several important factors that may limit the number of HIV/AIDS cases reported among AIAN women. First, many states with the largest Native populations have not historically conducted HIV surveillance, leading to a significant gap in information about HIV/AIDS among AIAN populations. For example, California, New York, and Washington—states with relatively large AIAN populations—have historically limited surveillance to large urban centers. It is only in the past few years that they have initiated HIV surveillance at a statewide levels. Many AIAN women live in rural or reservation areas, and urban AIAN women often receive healthcare at tribal facilities. In addition, significant numbers of AIAN women do not have health insurance and cannot afford to pay out-of-pocket for HIV testing. Many others live in rural areas where health facilities are scarce. Even when HIV testing is available, AIAN women living in

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rural areas and close-knit tribal communities may avoid having an HIV test in a setting where they are well known or likely to encounter other tribal members. For those who have been tested, racial misclassification by health care providers can also contribute to lower official rates of HIV cases among AIAN women. One study in Los Angeles revealed that 56% of AIANs living with HIV/AIDS were classified as being of a different race (Hu, Harlan, & Frye, 2003). Given the range of factors that may limit documentation of HIV among AIANs, it is not surprising that official statistics for AIAN women are relatively low. Recent community-based studies, however, support the hypothesis that AIAN women actually have much higher rates of HIV/AIDS infection than previously documented. In two community samples of urban AIANs in NYC, for example, 2% to 3% of the women interviewed reported they were HIV-positive, and an additional 3% did not wish to disclose their HIV status (Simoni, Sehgal, & Walters, 2004; Walters, Simoni, & Harris, 2000). In general, AIANs living with HIV are more disproportionately female than their non-native counterparts (Diamond et al., 2001) and AIAN women are increasingly affected by HIV and AIDS. Indeed, the percentage of female HIV/AIDS diagnoses among AIANs rose from 19% in 2000 to 29% in 2004 (CDC, 2000b; 2005). Although the primary mode of exposure for AIAN women is heterosexual contact (69%), it is important to note that over a third of AIAN women contracted HIV through IV drug use (33%) (Office of Minority Health, 2006). AIAN women have a 3% higher rate of AIDS-related deaths than AIAN men (CDC, 2004).

Historical Trauma and Discrimination Over successive generations, AIAN people have experienced a series of traumatic assaults that have had enduring consequences for families and communities. An extensive literature documents these assaults, which have included community massacres, pandemics from the introduction of new diseases, forced relocation, the forced removal of children though Indian boarding school policies, and the prohibition of spiritual and cultural practices (Stannard, 1992; Thornton, 1987). In their influential work, Brave Heart and collaborators have suggested that the effects of historical trauma on health and mental health among the Lakota include a collection of common responses which they term “historical trauma response” including: obsessive rumination about the dead; survivor guilt; unresolved mourning; anger; depression; intrusive dreams and thoughts; and cardiovascular problems (Brave Heart, 1999a, 1999b, 2000). Additionally, contemporary AIAN communities suffer from an ongoing barrage of negative stereotypes and microaggressions that disparage and undermine AIAN identity (Walters, Simoni, & Evans-Campbell, 2002). There is a substantial literature linking discrimination to health outcomes in nonnative populations and daily discriminatory experiences have been found to have more negative health effects than single event traumas (Williams, Yu, Jackson, & Anderson, 1997). Among AIANs specifically, discrimination has been associated with withdrawn behavior, psychosomatization, anxiety, and depression (Whitbeck, Hoyt, & Bao, 2000). Numerous indigenous scholars speculate that historical trauma and current discrimination are linked to factors that increase HIV risk such as poverty,

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substance use, and interpersonal violence (Duran et al., 1998; Walker et al., 1996; Walters et al., 2002). These interconnected factors are reviewed below, along with the cultural strengths that bolster their resilience in the face of AIDS and ideas for intervening to prevent HIV among native women.

Poverty AIAN women are disproportionately affected by a host of socio-demographic factors that place them at increased risk for HIV infection. Approximately 32% of AIANs live in poverty—more than twice the national average of 13% for all races (U.S. Census, 2005). Poverty is associated with lower levels of education, poorer access to healthcare, and limited access to better treatment options, all of which, in turn, increase vulnerability to HIV and AIDS infection. In addition, conditions of poverty are associated with poor health and poor diet. For women living with HIV, poor diet is related to a weakened immune system, which in turn may increase the progression of HIV to AIDS (U.S. DOJ, 2004). Further, AIAN women have disproportionate rates of diseases associated with poverty including diabetes and tuberculosis. Such diseases may increase susceptibility to HIV/AIDS and, when co-occurring with HIV/AIDS, may make treatment more challenging. Living in poverty may also contribute to feelings of inadequacy and actual powerlessness among AIAN women. As a consequence, AIAN women may have difficulty negotiating safer sexual practices with their partners.

Substance Use AIANs have higher rates of current illicit drug use than any other racial/ ethnic group and intravenous drug use is on the rise among AIANs (Conway et al., 1992). AIANs are two to three times more likely than any other racial/ ethnic group to engage in excessive drinking (May, 1996). They have the highest alcohol-related mortality rates of any ethnic group in the United States and the highest mortality rate from illicit drug use (18% higher than any other ethnic group; CDC, 2001). For AIAN women, death rates due to chronic liver disease and cirrhosis are over three times that of women in general (20.5% versus 6.1%; CDC, 2001). Moreover, Native women are more likely to inject drugs than women of any other ethnic group, and they are more likely than others to partner with male IV drug users (Fenaughty et al., 1998). Research among AIAN indicates that substance abuse is linked to HIV risk behaviors. In a study of NYC urban AIANs, respondents who had used alcohol or other drugs recently were over 4 times more likely than others to engage in high-risk sexual behaviors (Walters, Simoni, & Harris, 2000). In a study of AIAN drug users, Baldwin and colleagues (2000) found that 50% of respondents had episodes of drinking until drunk and engaging in unprotected sex during blackout periods.

Interpersonal Violence Irene Vernon (2007) has pointed out that “power, poverty, violence, and HIV are linked in a number of studies, and this is a dangerous combination for

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American [Indian] women” (p. 745). The empirical data support that substance use is strongly linked to interpersonal violence in AIAN communities (Malcoe, Duran, & Montgomery, 2004), and AIAN women are the group at highest risk of violence, with a rate nearly 50% higher than that reported by African American women (98 per 1,000 versus 68 per 1,000; Greenfeld and Smith, 1999). Findings from the National Violence against Women Survey (NVAWS) show that the highest rates of all forms of violence occur among AIAN women, with 34.1% of AIAN women experiencing rape, 61.4% physical assault, and 17.0% reporting stalking during their lifetimes (Tjaden & Thoenes, 2000a). Additional research suggests that AIAN women have a higher rate of victimization through violent crime (Greenfeld & Smith, 1999) than non-native women and they may be disproportionately represented among domestic violence (DV) homicides (Arbuckle et al., 1996; Tjaden & Thoennes, 2000b). In a recent report of AIAN women in New York City, Evans-Campbell, Lindhorst, Huang, & Walters (2006) found that the majority of women in the sample (65.5%) had experienced at least one form of interpersonal violence. Twenty-eight percent reported a history of childhood physical assault, 48% reported a history of rape in their lifetimes, 42% stated they had been touched against their will at some point in their lives, and 40% indicated they had experienced assault from a spouse or romantic partner as an adult. In addition, 41% of the women reported being multiply victimized, defined as experiencing at least two types of the interpersonal violence explored in the study. Like poverty, a history of interpersonal violence is a critical factor impacting AIAN women’s vulnerability to HIV (Handwerker, 1993; Simoni, Sehgal, & Walters, 2004; Walters, Simoni, & Harris, 2000) identified sexual abuse as the most critical determinant of sexual risk behaviors and found it was strongly associated with lack of condom use, and number of partners in the past 5 years, as well as a history of sexually transmitted disease. A history of sexual abuse is also associated with sexual risk behaviors such as early sexual activity, having multiple sex partners, having unprotected sex (Walters & Simoni, 1999; Zierler, Feingod, Laufer, 1991), having sex with a stranger (Zierler et al., 1996), having anal sex, and having a partner who is physically abusive when asked to use condoms (Wingwood & DiClemente, 1995). In a study of urban AIAN women, those who had experienced any type of interpersonal violence had dramatically higher rates of engaging in HIV sex risk behaviors (ranging from 94%–96.6% depending on the type of violence) compared to women with no history of interpersonal violence (72.2%).Those who had experienced sexual abuse were 29 times more likely to engage in sexually risky or HIV behaviors compared to others (Evans-Campbell et al., 2006).

Sexual Risk Behaviors Several studies in the United States and Canada suggest that significant numbers of Native women engage in unsafe sexual practices, including not using condoms regularly. In a community-based study of urban AIAN women, Simoni and colleagues (2004) found that 91% had engaged in at least one HIVrisk behavior during their lifetime with 90% engaging in unsafe sex, and 58% engaging in high-risk sex during their lifetimes. Further, 48% of women surveyed had engaged in unprotected vaginal or anal intercourse in the last year

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and 27% reported a partner with at least one HIV risk factor, suggesting that they may have been exposed to HIV. In a study of HIV sexual-risk behaviors among off-reservation Canadian aboriginals, 61% of 400 sexually active participants reported never using condoms (Calzavara et al., 1999). Among respondents with more than one sexual partner, women were less likely than men to use condoms; 59% of women versus 31% of men reported never using a condom. There is also evidence that safe sexual practices among AIAN women may be related to racial discrimination and power differences. Fisher and colleagues (2000) found that White men who had sex with both White and AIAN women were less likely to use condoms with their AIAN partners.

Protective Factors While AIAN women experience a number of factors that put them at greater risk for HIV transmission, there are also a number of AIAN-specific cultural factors that may moderate their impact. Scholars have identified several protective mechanisms that may buffer the impact of trauma on AIAN health, including spirituality and traditional health practices, enculturation (Duran & Walters, 2004; Walters, Simoni, & Evans-Campbell, 2002), and a strong commitment to tribal community (Evans-Campbell & Walters, 2006). Although research exploring the impact of such protective factors on health outcomes is limited, emerging research highlights their potential as moderators of the effect of trauma on health. For example, Walters 1998) found that AIAN identity attitudes accounted for 10% to 21% of the variance in self-esteem, depression, anxiety, and interpersonal sensitivity after controlling for age, sex, education, household income, and reservation contact. For AIAN women living with HIV, cultural factors may facilitate health and healing.

Implications for Service Provision for AIAN Women Research on HIV/AIDS among AIAN women has important implications for practice. First, the overwhelming frequency of AIAN women experiencing HIV risk factors, such as traumatic victimization, highlights the need for strong violence prevention efforts targeted at AIAN communities. Scholars and practitioners should promote culturally responsive standards of training for HIV prevention efforts aimed at AIAN women specifically. For women who are HIV positive, providers should focus on the prevention of HIV-related health and mental health issues. To assist in this regard, it is incumbent upon service providers to complete an in-depth assessment of HIV risk factors and the possibility of ongoing HIV-related sequelae. AIAN women seek help through both Western-centered establishments and traditional Native interventions (Evans-Campbell et al., 2006). It is critical, therefore, that culturally-specific services are offered to women in conjunction with standard mental health services or as an alternative. Native and non-native providers should work together to provide comprehensive, culturally-responsive services to AIAN women. It is important to note that while AIAN women access a range of interventions, we do not have information regarding access to and quality of these interventions. Given the high rate of AIAN women with HIV and at risk for HIV, there is a need for in-depth study

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of help-seeking among AIAN women, exploring the barriers to access, quality of help received, and satisfaction with that help. It is also imperative that practitioners view the incidence of HIV/AIDS in AIAN communities within the context of historical trauma. Over many generations, infectious diseases such as smallpox, tuberculosis, and measles have devastated AIAN communities. HIV/AIDS is increasingly seen by AIAN practitioners and community members as another traumatic assault on AIAN communities. In addition to personal loss, an HIV diagnosis may trigger feelings related to intergenerational and community-level losses. Similarly, AIAN communities have experienced generations of traumatic assaults through racist health care policies and practices (e.g., forced sterilization, medical experimentation). Practitioners should be prepared to encounter mistrust when working with AIAN women and communities (Evans-Campbell & Walters, 2006). Given the history of medical experimentation in AIAN communities, AIAN women may also view drug therapies or other treatments with fear. They may refuse certain treatments altogether or need more time than others to develop trust in treatment options. Such mistrust is not surprising and may even be reframed as a healthy reaction to what—in other historical circumstances—would have been a real threat. Evans-Campbell and Walters (2006) outline a number of decolonizing practice strategies that are relevant for work with AIAN women and communities including the suggestion that practitioners enact a culturally relevant framework for practice. This work includes learning about the history of colonial violence directed at indigenous communities and its impact on Native health. Practitioners must also be cognizant of the tremendous diversity within AIAN communities and be open to tribally and culturally specific and holistic pathways to HIV testing and treatment. To facilitate culturally relevant services, agencies are encouraged use AIAN health care workers and health educators whenever possible. In smaller rural or tribal areas where confidentiality issues arise around HIV testing and treatment, hiring AIAN staff from different tribes or cultural regions may increase the likelihood that tribal members will access HIV testing and treatment services. Finally, it is incumbent upon practitioners to focus on strengths and resilience when working with AIAN women, helping women explore and document their personal histories of power, resilience, and resistance. Although all indigenous women share a history of colonization, they also share tremendous intergenerational resiliencies and strengths. Recognition of survival and coping in the face of traumas can inspire and engender a strong sense of pride and motivation to heal. Practitioners can assist women in uncovering personal healing strategies and identify how these strategies continue to manifest today, reconnecting women with the power of their history and culture.

Sexual Minority Women During their lifetimes, 8% to 20% of women engage in sex with other women (Marrazzo, Koutsky, & Handsfield, 2001). Although HIV transmission during female-to-female sexual contact is considered rare, case reports indicate that vaginal fluids and menstrual blood are potentially infectious (CDC, 1999).

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Despite the risks posed by female-to-female sex, women who have sex with women (WSW) have been relatively neglected by public health officials involved in HIV prevention and have suffered from lingering assumptions of their immunity to HIV infection. The CDC does not include female-to-female HIV transmission as an exposure category, and the prevalence of HIV infection among WSW is not specifically tracked. Even more problematic, because women are seldom asked about their partner’s gender, WSW with HIV who report having partners who are injection drug users may be considered to be infected heterosexually. The assumed low prevalence of HIV among WSW is used to justify their exclusion from tracking systems, and effectively erases the possibility of lesbian and bisexual transmission (Dworkin, 2005). This is coupled with ill-informed, stigmatizing, and heterosexist attitudes, such as that lesbian sex is too “infrequent, gentle, or boring” to transmit HIV (Treichler, 1999). WSW partners practice multiple kinds of sexual behaviors and assume a variety of sexual identities. Some may identify as lesbian or bisexual, while others may identify as heterosexual, yet still engage in sexual contact and/or romantic relationships with other women. Unsafe sexual practices for women having sex with women that may increase their risk for STIs in general and HIV more specifically include, for example, sharing of sex toys, anal sex, and sex during menstruation. Beyond female-to-female sex, these women may be at increased risk for HIV through several other means, including sex with men, intravenous drug use (IDU), and sexual abuse. Because most WSW of color are disproportionately affected by poverty, social invisibility, and heightened stigmatization of homosexuality from their racial/ethnic communities, their risks related to these factors may be exacerbated compared to those of White WSW (Arend, 2005; Tesoriero et al., 2000). One overlooked risk factor for HIV among WSW is sexual relations with men. Indeed, most WSW report having had sex with men, and many (20%–30%) continue to have sex with men as well as women (Diamant, Schuster, McGuigan, & Lever, 1999). More specifically, some studies have found that, compared to heterosexual women, women reporting sex exclusively with women more frequently reported prior sex with a gay or bisexual man or an HIV-infected partner (Koh, Gomez, Shade, & Rowley, 2005; Marrazzo, Koutsky, & Handsfield, 2001). These findings also have been obtained for women who have sex with both men and women, who also report more frequent sex with IDUs and more lifetime partners than heterosexual women (Marrazzo, Koutsky, & Handsfield, 2001). Thus, WSW may be more likely to have had sex with men at high risk for HIV infection. Due to socioeconomic factors and the stigma of homosexuality in communities of color, low-income WSW of color also may engage in sex work for survival, further elevating their risk for HIV. They may have sexual contact with multiple male and female partners without knowledge of their HIV status and cannot always negotiate the use of condoms with their paying and nonpaying customers (Campbell, 1999). Indeed, a recent qualitative study with 23 African American bisexual women found that multiple or concurrent partner relationships with both men and women placed these women at high risk for HIV, as protection was often not used (Champion, Wilford, Shain, & Piper, 2005). IDU is another risk factor that puts WSW at risk for contracting HIV. Generally speaking, IDU is a common route of exposure to HIV for women of

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color (Sanders-Phillips, 2002). The data indicate a vicious cycle in which early trauma and high levels of stress lead to early social drug use as a means of coping; this creates isolation, marginalization, and increased drug use, leading to increased risk for exposure to HIV (Sanders-Phillips, 2002). This cycle may be exacerbated for WSW of color who use drugs, and whose triply oppressed status as women, ethnic minorities, and sexual minorities intersect to foster even greater drug dependence and participation in the drug lifestyle. Indeed, in some studies, bisexual women reported injecting drugs or having sex with a substance user more commonly than did lesbian or heterosexual women (Koh, Gomez, Shade, & Rowley, 2005; Marrazzo, Koutsky, & Handsfield, 2001; Fethers, Marks, Mindel, & Estcourt, 2000). Further, compared to other women IDUs, WSW IDUs have been found to have higher-risk sexual and injection networks and to report higher levels of HIV-related risk behaviors (Friedman et al., 2003; Young, Friedman, Case, Asencio, & Clatts, 2000). In fact, report of same-sex behavior among female IDUs has been independently associated with a greater than two-fold risk of HIV infection (Friedman et al., 1997). Finally, sexual abuse and assault is another factor that puts WSW at risk for HIV. The literature on (predominantly White) lesbian, gay, and bisexual populations reveals that lesbian and bisexual women report more sexual assault experiences in both childhood and adulthood than heterosexual women (e.g., Balsam, Rothblum, & Beauchaine, 2005; Duncan, 1990; Tjaden, Thoeness, & Allison, 1999). In a study of HIV-positive mostly African American and Puerto Rican women in New York City, lesbian and bisexual women reported higher rates of lifetime sexual and physical abuse than heterosexual women (Cooperman, Simoni, & Lockhart, 2003). Though largely unknown, WSW of color may face higher rates of sexual abuse and assault compared to both their heterosexual peers and White WSW. In fact, the prevalence of abuse among the bisexual and lesbian women in this New York City study was higher than among lesbian women in the general population (Bradford, Ryan, & Rothblum, 1997). The National Lesbian Health Care Survey also found that African American and Latina lesbian women had significantly higher rates of abuse than White lesbian women (Bradford et al., 1997). Not only might HIV be contracted through the abuse itself, but the impact of the abuse, which often includes increased substance use and sexual risk behaviors, may further exacerbate HIV risk. For example, abuse and assault were linked with IDU and sexual risk behaviors among urban Native American women (Simoni, Sehgal, & Walters, 2004; Walters & Simoni, 1999). In summary, government researchers, health care providers and the AIDS service community have generally disregarded WSW’s risk for HIV infection. The common but erroneous belief that lesbian sexual practices are without risk underscores the need to raise visibility of WSW and to tailor preventive health services to suit their needs. Indeed, at least one significant barrier to programs and research addressing WSW is denial and disbelief that HIV infection through sexual transmission is possible for WSW. The myth remains that gay men are the only sexual minority group truly at risk for HIV through sexual transmission, and all other infections through sexual transmission are simply “unfortunate incidents.” The variance of sexual experiences reported by WSW presented here suggests otherwise. Yet despite the risks associated with lesbian sex and WSW’s sexual relations with men, there remains only a

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minimal effort to educate WSW regarding their risk for infection. In a survey exploring perception of HIV risk among lesbians, only 15% reported receiving safer sex education (Fishman & Anderson, 2003). WSW of color require specific attention as they may be at heightened risk for HIV, are less likely to be reached by education and health programs, have less access to services, and have not been adequately served by the few programs that have reached them. Another significant barrier to programs and research involving WSW is that most are based on the conceptualization of a lesbian and gay identity. Many WSW, however, may not think of themselves in terms of having a stable lesbian, bisexual, or heterosexual identity (Diamond, 2006). Thus, a challenge to prevention, intervention, and future research is to take women’s sexual plasticity and experiences of sexual identity development into account in order to successfully recruit and reach underserved WSW. Intervention programs most likely to succeed must be systematically and carefully designed, emphasizing empowerment in outreach, prevention, and psychoeducation. Empowerment practice models, however, must be conceived within the context of women’s particular culture. Many WSW of color do not view themselves as at risk for HIV because they do not identify with gay men or women of color who are heterosexual; therefore, risk-reduction messages need to be tailored to their specific needs and concerns, and issues of cultural and sexual diversity should be integrated into the content of the program. Such programs may take advantage of the strength of the networks and connections within lesbian and bisexual women’s communities. For example, in one study, HIV-positive lesbian and bisexual women had significantly greater support from friends and groups/organizations than heterosexual women (Cooperman, Simoni, & Lockhart, 2003). Given that effective HIV prevention programs for women focus on building good relationships and negotiation skills (Mize et al., 2002), providers should draw upon the strengths within WSW communities to address the unmet needs of this population.

Conclusion The AIDS epidemic in the United States has had a disproportionate impact on women of color. African American and Latin women together constitute only 24% of all United States women, yet they represent 82% of the estimated total of AIDS diagnoses for women in 2005 (CDC, 2007a). For African American women, the rate of AIDS diagnosis was 24 times (42.9/100,000) that of White women (2.1/100,000). For Hispanic women, the rate was 4 times higher (12.2), and for American Indian and Alaskan Native women the rate was nearly double (4.4) (CDC, 2007b,c). Additionally, sexual minority women are disproportionately at risk for acquiring HIV, primarily from heterosexual transmission and IDU. In response to the epidemic among women of color, public health officials have implemented interventions specifically targeting them. Options for women include avoiding contaminated injection drug syringes and other equipment, consistently using male or female condoms and spermicides, engaging in nonpenetrative sexual behaviors, or inquiring about the HIV status or risk

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of potential partners (a highly unreliable strategy). These prevention interventions assume women have individual agency in their sexual encounters and thus can control their environment or their own sexuality to prevent being a “vector” for HIV transmission to their partners and their children. The problem is that this approach depends upon cooperation from the (usually male) partner, highlighting the woman’s vulnerability due to her lack of control in sexual contexts (Whitmire et al., 1999). The limits of most behavioral interventions stem from their reliance on traditional social psychological theories of behavior change (Kalichman, 1998; Weinstein, 1993) that are decontextualized from the everyday realities for most women of color. Theories such as the health belief model (Rosenstock, Strecher, & Becker, 1994); the theory of reasoned action (Fishbein & Ajzen, 1975); and social cognitive theory (Bandura, 1994), for example, emphasize cognitions and intentions as predictions of risk behavior. Based in a Eurocentric framework of individualism (and tested mostly on gay White men), they assume individuals “have the freedom to choose a rational course of action, possess the necessary skills and recourses, and can translate their desired directly without interference in to a determinable likelihood of behavioral occurrence” (Cochran & Mays, 1993, p. 146). For the most part, they fail to address the needs of women of color and sexual minority women by failing to account for the broader cultural and social context of women’s sexual behavior (Amaro, 1995) and its relational context (Whitmire et al., 1999). Approaches more relevant to women—such as the theory of gender and power (Connell, 1987); gender and status interaction theory (Ridgeway and Smith-Lovin, 1999); indigenous stress-coping model (Walters & Simoni, 2002; Walters, Simoni, & Evans-Campbell, 2002) and social exchange theory (Emerson, 1972, 1981; Pulerwitz, Gortmaker, & De Jong, 2000)—may be especially useful in reducing HIV among women of color because they address comprehensively the interaction of gender, and interpersonal power, as well as social, historical, and economic factors. Women of color live their lives in the “dangerous intersections of gender and race” (Smith, 2006). As the sections in this chapter demonstrate, the specific ways these factors interact to affect HIV risk vary from one group of women to the next. For example, Latinas are stymied in their self-protection by strictly enforced gender roles that discourage their assertiveness in sexual matters, while African American women must deal with decreasing power in their heterosexual relationships based on the relative scarcity of African American men. There is vast heterogeneity within each group as well, much of which remains unexplored in the research literature. For example, there are few data on the impact of HIV/AIDS and the need for prevention among Native American women of different ages or African American women of different sexual orientations, and class remains relatively unexplored as a buffer for Latinas. Although important cultural distinctions exist, there is considerable overlap among the groups of women we examined on several of the key risks for HIV infection. Due to colonialism, racism, and sexism, women of color and sexual minority women generally battle poverty and structural barriers to wellness. Alcohol and other substance use, including IDU, is often a consequence of discrimination and poverty and affects each of the communities of women we discussed. The heterosexual women in each group are subject to

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power imbalances within their relationships with men and resulting interpersonal violence. Moreover, the impact of these key factors is synergistic and the effects interrelated. For example, historical and contemporary racism has limited economic opportunities for women of color. Poverty, in turn, is associated with homelessness and substance use, both factors that increase exposure to sexual violence and thus HIV infection (Whitmire et al., 1999). Also, sexism, heterosexism, and restrictive gender roles limit women’s power within their relationships to men and thus their ability to control sexual situations. As Irene Vernon, a Native scholar and HIV activist, has noted (2007), “Economic inequality can govern personal conduct and sexual control” (p. 745). This exploration of HIV/AIDS among women of color and sexual minority women highlights the importance of considering structural barriers to health and cultural context, two areas that the field of psychology has historically ignored. It must no longer ignore these areas. In the words of Squire (1993), “Professional psychology has a powerful place in practice and research around HIV and AIDS” (p. 1), but in order to respond adequately, it must expand its attention beyond the individual. Attention to these issues should be foremost in all aspects of HIV prevention and care, including how we devise targeted messages and strategies to prevent new infections, how we conduct outreach to encourage voluntary counseling and testing, how we bring into treatment those testing positive, and how we treat them once in care. Only in this way can we hope to stem the tide of rising new infections among women of color in the United States and competently care for those already living with the virus. Most likely, women will have a primary role in these efforts. Treichler 1999) observed that feminism has failed to influence the course of the HIV epidemic or challenge the socially constructed misconceptions about women’s risks and women’s roles. In what amounts to a call to arms, she exhorted: ... if women themselves cannot make sense of the epidemic, articulate its influence on their lives, and shape interventions that remedy their interests and perspectives, historical precedent holds out little promise that anyone else—whether scientists, physicians, policymakers, media professionals, or politicians—will do it for them. (pp. 235–236).

References Adimora, A. A., & Schoenbach, V. J. (2005). Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. The Journal of Infectious Diseases, 191 (Suppl.), S115–S122. Adimora, A. A., Schoenbach, V. J., Martinson, F., Donaldson, K. H., Stancil, T. R., & Fullilove, R. E. (2004). Concurrent sexual partnerships among African Americans in the rural south. Annals of Epidemiology, 14, 155–160. Aguirre, A., Jr., & Turner, J. (2004). American ethnicity: Dynamics and consequences of discrimination. New York: McGraw-Hill. Alderete, E., Vega., W. A., Kolody, B., & Aguilar-Gaxiola, S. (2000). Lifetime prevalence of and risk factors for psychiatric disorders among Mexican migrant farm workers in California. American Journal of Public Health, 90, 608–614. Alegría, M., Mulvaney-Day, N., Torres, M. Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United Status. American Journal of Public Health, 97, 68–75. Amaro, H. (1995). Love, sex, and power: Considering women’s realities in HIV prevention. American Psychologist, 50, 437–447.

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Amaro, H., & Raj, A. (2000). On the margin: Power and women’s HIV risk reduction strategies. Sex Roles, 42, 723–749. Amaro, H., Vega, R. R., & Valencia, D. (2001). Gender, context and HIV prevention among Latinos. In M. Aguirre-Molina, C. Molina, & R. E. Zambrana (Eds.), Health issues in the Latino community. San Francisco: Jossey-Bass. Arbuckle, J., Olson, L., Howard, M., Brillman, J., Anctil, C., & Sklar, D. (1996). Safe at home? Domestic violence and other homicides among women in New Mexico. Annals of Emergency Medicine, 27, 210–215. Arend, E. D. (2005). The politics of invisibility: Homophobia and low-income HIV-positive women who have sex with women. Journal of Homosexuality, 49, 97–122. Aronowitz, T., Rennells, R. E., & Todd, E. (2005). Heterosexual behaviors in early adolescent African American girls: The role of mother–daughter relationships. Journal of Family Nursing, 11, 122–139. Arredondo, P. (2002). Mujeres Latinas–santas y marquesas. Cultural Diversity and Ethnic Minority Psychology, 8, 308–319. Baldwin, J., Maxwell, C., Fenaughty, A., Tortter, R., & Stevens, S. (2000). Alcohol as a risk factor for HIV transmission among American Indian and Alaska Native drug users. American Indian & Alaska Native Mental Health Research, 9, 1–16. Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting and Clinical Psychology, 73, 477–487. Bandura, A. (1994). Social cognitive theory and exercise of control over AIDS infection. In R. DiClemente & J. Peterson (Eds.), Preventing AIDS: Theories, methods, and behavioral interventions (pp. 25–60). New York: Plenum. Beadnell, B., Baker, S. A., Morrison, D. M., & Knox, K. (2000). HIV/STD risk factors for women with violent male partners. Sex Roles, 42, 661–689. Belenko, S., Shedlin, M., & Chaple, M. (2005). HIV risk behaviors, knowledge, and prevention service experiences among African American and other offenders. Journal of Health Care for the Poor and Underserved, 16, 108–129. Berry, J. W. (2003). Conceptual approaches to acculturation. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 17–37). Washington, DC: American Psychological Association. Bontempi, J., Eng, E., & Quinn, S. (2008). Our men are grinding out: A qualitative examination of sex ratio imbalances, relationship power, and low-income African American Women’s health. Women’s Health, 48, 63–81. Bradford, J., Ryan, C., & Rothblum, E. (1997). National lesbian health care survey: Implications for mental health care. Journal of Lesbian Studies, 1, 217–249. Brave Heart, M. Y. H. (1999a). Oyate Ptayela: Rebuilding the Lakota Nation through addressing historical trauma among Lakota parents. Journal of Human Behavior in the Social Environment, 2, 109–126. Brave Heart, M. Y. H. (1999b). Gender differences in the historical trauma response among the Lakota. Journal of Health and Social Policy, 10, 1–21. Brave Heart, M. Y. H. (2000). Wakiksuyapi: Carrying the historical trauma of the Lakota. Tulane Studies in Social Welfare, 21–22, 245–266. Burnam, M., Hough, R., Karno, M., Escobar, J., & Telles, C. A. (1987). Acculturation and lifetime prevalence of psychiatric disorders among Mexican Americans in Los Angeles. Journal of Health and Social Behavior, 28, 89–102. Cabassa, L. J. (2003). Measuring acculturation: Where we are and where we need to go. Hispanic Journal of Behavioral Sciences, 25, 127–146. Calzavara, L., Bullock. S., Myers, T., Marshall, V., & Cockerill, R. (1999). Sexual partnering and risk of HIV/STD among aboriginals. Canadian Journal of Public Health, 90, 186–191. Campbell, C. (1999). Women, families and HIV/AIDS: A sociological perspective on the epidemic in America. Cambridge: Cambridge University Press. Carmona, J. V., Romero, G. J., & Loeb, T. B. (1999). The impact of HIV status and acculturation on Latinas’ sexual risk taking. Cultural Diversity and Ethnic Minority Psychology, 5, 209–221. Centers for Disease Control and Prevention (CDC). (1999). HIV/AIDS and U.S. women who have sex with women (WSW). Atlanta: U.S. Department of Health & Human Services.

Chapter 12


CDC. (2000a). National and state-specific pregnancy rates among adolescents—United States, 1995–1997. Morbidity and Mortality Weekly Report, 49, 605–611. CDC. (2000b). HIV/AIDS Surveillance Report, 12(1). CDC. (2001). HIV/AIDS among US women: Minority and young women at continuing risk. Atlanta: U.S. Department of Health & Human Services. Centers for Disease Control and Prevention. (2004). HIV/AIDS among American Indians and Alaska Natives. Atlanta: U.S. Department of Health & Human Services. CDC. (2004). Fact Sheet—HIV/AIDS among U.S. women: Minority and young women at continuing risk. Atlanta: Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention. CDC. (2005). HIV/AIDS surveillance report, 2004. Atlanta: U.S. Department of Health & Human Services. CDC. (2006a). Racial/ethnic disparities in diagnoses of HIV/AIDS—33 states, 2001–2004. Morbidity and Mortality Weekly Report, 55(5), 121–125. CDC. (2006b). Trends in HIV/AIDS diagnoses, MMWR 2005, 54(45), 1149–1153. Atlanta: U.S. Department of Health and Human Services. CDC. (2007a). CDC HIV/AIDS fact sheet: HIV/AIDS among women, 2005. Atlanta: U.S. Department of Health and Human Services. CDC. (2007b). HIV/AIDS surveillance report, 2005. Vol. 17. Atlanta: U.S. Department of Health and Human Services. CDC. (2007c). CDC HIV/AIDS fact sheet: HIV/AIDS among American Indians and Alaska natives, 2005. Atlanta: U.S. Department of Health and Human Services, CDC: March 2007, 1–6. CDC. (2007d). HIV/AIDS among Hispanics, United States, 2001–2005. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention. CDC. (2008). CDC HIV/AIDS fact sheet: HIV/AIDS among Women, 2005. Atlanta: U.S. Department of Health and Human Services. Champion, J. D., Wilford, K., Shain, R. N., & Piper, J. M. (2005). Risk and protective behaviours of bisexual minority women: A qualitative analysis. International Nursing Review, 52(2), 115–122. Choi, K., Wojcicki, J., & Valencia-Garcia, D. (2004). Introducing and negotiating female condom use in sexual relationships: Qualitative interviews with women attending a family planning clinic. AIDS and Behavior, 8, 251–261. Chu, S. Y., Peterman, T. A., Doll, L. S., Buehler, J. W., & Curran, J. W. (1992). AIDS in bisexual men in the United States: Epidemiology and transmission to women. American Journal of Public Health, 82, 220–224. Cochran, S. D., & Mays, V. M. (1993). Applying social psychological models to predicting HIVrelated sexual risk behaviors among African Americans. Journal of Black Psychology, 19, 142–154. Comfort, M., Grinstead, O. A., Faigeles, B., & Zack, B. (2000). Reducing HIV risk among women visiting their incarcerated male partners. Criminal Justice and Behavior, 27, 57–71. Connell, R. W. (1987). Gender and power: Society, the person, and sexual politics. Palo Alto, CA: Stanford University. Conway, G., Ambros, T., Chase, E., Hooper, E., Helgerson, S., Johannes, P., et al. (1992). HIV infection in American Indians and Alaska Natives: Surveys in the Indian health service. Journal of Acquired Immune Deficiency Syndrome, 5, 803–809. Cooperman, N. A., Simoni, J. M., & Lockhart, D. W. (2003). Abuse, social support, and depression among HIV-positive heterosexual, bisexual, and lesbian women. Journal of Lesbian Studies, 7, 49–66. Corea, G. (1993). The story of women and AIDS: The invisible epidemic. New York: HarperCollins. Cutrona, C. E., Russell, D. W., Hessling, R. M., Brown, P. A., & Murray, V. (2000). Direct and moderating effects of community context on the psychological well-being of African American women. Journal of Personality & Social Psychology, 79, 1088–1101. Dancy, B. L., Crittenden, K. S., & Talashek, M. (2006). Mother’s effectiveness as HIV risk reduction educators for adolescent daughters. Journal of Health Care for the Poor and Underserved, 17, 218–239.

359

360


Davis, A. (2003). Are prisons obsolete? New York: Seven Stories Press. Dean-Gaitor, H. D., & Fleming, P. L. (1999). Epidemiology of AIDS in incarcerated persons in the United States, 1994–1996. AIDS, 13, 2429–2435. Diamant, A. L., Schuster, M. A., McGuigan, K., & Lever, J. (1999). Lesbians’ sexual history with men: Implications for taking a sexual history. Archives of Internal Medicine, 159, 2730–2736. Diamond, L. M. (2006). What we got wrong about sexual identity development: Unexpected findings from a longitudinal study of young women. In A. E. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people (pp. 73–94). Washington, DC: American Psychological Association. Diaz, T., Buehler, J. W., Castro, K. G., & Ward, J. W. (1993). AIDS trends among Hispanics in the United States. American Journal of Public Health, 83, 504–509. Dixon, D., Peters, M., & Saul, J. (2003). HIV sexual risk behavior among Puerto Rican women. Health Care for Women International, 24, 529–543. Drayton-Brooks & White, N. (2004). Health promoting behaviors among African American Women with Faith-based support. ABNF, 15(5), 84–90. Duncan, D. (1990). Prevalence of sexual assault victimization among heterosexual and gay/lesbian university students. Psychological Reports, 59, 1307–1313. Duran, B., & Walters, K. (2004). HIV/AIDS prevention in “Indian Country”: Current practice, indigenous etiology models, and postcolonial approaches to change. AIDS Education and Prevention, 16(3), 187–201. Duran, E., Duran, B., BraveHeart, M. Y. H, & Yellow Horse-Davis, S. (1998). Healing the American Indian soul wound. In Y. Danieli (Ed.), International handbook of multigenerational legacies of trauma (pp. 341–354). New York: Plenum Press. Durr, M. (2005). Sex, drugs, and HIV: Sisters of Laundromat. Gender & Society, 19, 721–728. Dworkin, S. (2005). Who is epidemiologically fathomable in the HIV/AIDS epidemic? Gender, sexuality, and intersectionality in public health. Culture, Health, and Sexuality, 7, 615–623. El-Bassel, N., Gilbert, L., Rajah, V., Foleno, A., & Frye, V. (2000). Fear and violence: Raising the HIV stakes. AIDS Education and Prevention, 12(2), 154–170. Emerson, R. M. (1972). Exchange theory, part II: Exchange relations and networks. In J. Berger, M. Zelditch, Jr., & B. Anderson (Eds.), Sociological theories in progress (Vol. 2, pp. 58–87), Boston: Houghton Mifflin. Emerson, R. M. (1981). 1. Social exchange theory. In M. Rosenberg & R. H. Turner (Eds.), Social psychology: Sociological perspectives (pp. 30–65). New York: Basic Books. Escobar, J., & Vega, W. (2000). Mental health and immigration’s AAAs: Where are we and where do we go from here? The Journal of Nervous and Mental Disorders, 188, 736–740. Evans-Campbell, T., & Walters, K. L. (2006). Indigenous practice competencies in child welfare practice: A decolonization framework to address family violence and substance abuse among First Nations peoples. In R. Fong, R. McRoy, & C. Ortiz Hendricks (Eds.), Intersecting child welfare, substance abuse, and family violence: Culturally competent approaches. Birmingham, AL: CSWE Press. Evans-Campbell, T., Lindhorst, T., Huang, B., & Walters, K. (2006). Interpersonal violence in the lives of urban American Indian and Alaska Native women: Implications for health, mental health, and help-seeking American Journal of Public Health, 96, 1416–1422. Fenaughty, A., Fisher, D., Cagle, H., Stevens, S., Balkwin, J., & Booth, R. (1998). Sex partners of Native American drug use. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 17, 275–282. Fethers, K., Marks, C., Mindel, A., & Estcourt, C. S. (2000). Sexually transmitted infections and risk behaviours in women who have sex with women. Sexually Transmitted Infections, 76, 345–349. Fishbein, M., & Ajzen, I. (1975). Beliefs, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison Wesley. Fisher, D., Fenaughty, A., Paschane, D., & Cagle, H. (2000). Alaska Native drug users and sexually transmitted disease: Results of a five-year study. American Indian & Alaska Native Mental Health Research, 9, 47–57. Fishman, S. J., & Anderson, E. H. (2003). Perception of HIV and safer sexual behaviors among lesbians. Journal of the Association of Nurses in AIDS Care, 14, 48–55.

Chapter 12


Friedman, S. R., Neaigus, A., Jose, B. Curtis, R, Goldstein, M., Ildefonso, G., Rothenberg, R. B., & Des Jarlais, D C. (1997). Sociometric risk networks and risk for HIV infection. American Journal of Public Health, 87, 1289–1296. Friedman, S. R., Ompad D.C., Maslow, C., Young, R., Case, P., Hudson, S.M., Diaz, T, Morse, E., Bailey, S., Des Jarlais, D.C., Perlis, T., Hollibaugh, A., & Garfein, R.S. (2003). HIV prevalence, risk behaviors, and high-risk sexual and injection networks among young women injectors who have sex with women. American Journal of Public Health, 93, 902–906. Golub, A., & Jonson, B. D. (2001). Variation in youthful risks of progression from alcohol and tobacco to marijuana and to hard drugs across generations. American Journal of Public Health, 91, 225–232. Gómez, C. A., Hernandez, M., & Faigeles, B. (1999). Sex in the new world: An empowerment model for HIV prevention in Latina immigrant women. Health Education and Behavior, 26, 200–212. Gómez, C., & Marín, B. V. (1996). Gender, culture, and power: Barriers to HIV-prevention strategies for women. Journal of Sex Research, 33, 355–362. Greenfield, L. A., & Smith, S. K. (1999). American Indians and crime, NCJ 173386. Washington DC: Department of Justice. Handwerker W. (1993). Gender power differences between parents and high-risk sexual behavior by their children: AIDS/STD risk factors extend to a prior generation. Journal of Women’s Health, 20, 301–316. Hallfors, D. D., Iritani, B. J., Miller, W. C., & Bauer, D. J. (2007). Sexual and drug behavior patterns and HIV and STD racial disparities: The need for new directions. American Journal of Public Health, 97, 125–131. Hellard, M. E., & Aitken, C. K. (2004). HIV in prison: What are the risks and what can be done? Sexual Health, 1, 107–113. Herek, G. M., Kimmel, D. C., Amaro, H., & Melton, G. B. (1991). Avoiding heterosexist bias in psychological research. American Psychologist, 46, 957–963. Hu, Y. W., Harlan, M., & Frye, D. M. (2003). Racial misclassification among American Indians and Alaska Natives who were reported with AIDS in Los Angeles County 1981–2002. National HIV Prevention Conference, Atlanta, abstract WO-B075. Hunt, L. M., Schneider, S., & Comer, B. (2004). Should “acculturation” be a variable in health research? A critical review of research on U.S. Hispanics. Social Science & Medicine, 59, 973–986. Ickovics, J. R., Beren, S. E., Grigorenko, E. L., Morrill, A. C., Druley, J. A., & Rodin, J. (2002). Pathways of risk: Race, social class, stress, and coping as factors predicting heterosexual risk behaviors for HIV among women. AIDS and Behavior, 6, 339–350. Jemmott, J. B., Jemmott, L. S., Braverman, P. K., & Fong, G. T. (2005). HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic. Archives of Pediatrics and Adolescent Medicine, 159, 440–449. Jemmott, L. S., & Brown, E. J. (2003). Reducing HIV sexual risk among African American women who use drugs: Hearing their voices. Journal of the Association of Nurses in AIDS Care, 14, 19–26. Jipguep, M. C., Sanders-Phillips, K., & Cotton, L. (2004). Another Look at HIV in African American Women: The impact of psychosocial and contextual factors. Journal of Black Psychology, 30, 366–385. Jones, J. H. (1993). Bad blood: The Tuskegee syphilis experiment. New York: Free Press. Kalichman, S.C. (1998). Preventing AIDS: A sourcebook for behavioral interventions. Mahway, NJ: Lawrence Erlbaum. Klonoff, E. A., & Landrine, H. (1999). Do blacks believe that HIV/AIDS is a government conspiracy against them? Preventive Medicine, 28, 451–457. Koh, A. S., Gomez, C. A., Shade, S., & Rowley, E. (2005). Sexual risk factors among selfidentified lesbians, bisexual women, and heterosexual women accessing primary care settings. Sexually Transmitted Diseases, 32, 563–569. Land, H. (1994). AIDS and women of color. Families in Society, 75, 355–361. Laumann, E. O., & Youm, Y. (1999). Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States. A network explanation. Sexually Transmitted Diseases, 26, 250–261.

361

362


Logan, T. K., Cole, J., & Leukefeld, C. (2002). Women, sex, and HIV: Social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychological Bulletin, 128, 851–885. Malcoe, L., Duran, B., & Montgomery, J. (2004). Socioeconomic disparities in intimate partner violence against Native American women: A cross-sectional study. BMC Medicine, 2, 20. Marazzo, J. M., Koutsky, L. A., & Handsfield, H. H. (2001). Characteristics of female sexually transmitted disease clinic clients who report same-sex behaviour. International Journal of STD and AIDS, 12, 41–46. Marín, B. V., Tschann, J. M., Gómez, C. A., & Kegeles, S. M. (1993). Acculturation and gender differences in sexual attitudes and behaviors: Hispanic vs. non-Hispanic White unmarried adults. American Journal of Public Health, 83, 1759–1761. Marin, B.V. (2003). HIV prevention in the Hispanic community: sex, culture, and empowerment. Journal of Transcultural Nursing, 14, 186–92. Marks, G., Cantero, P. J., & Simoni, J. M. (1998). Is acculturation associated with sexual risk behaviors? An investigation of HIV-positive Latino men and women. AIDS Care: Psychological & Socio-medical Aspects of AIDS/HIV, 10, 283–295. May, P. (1996). Overview of alcohol abuse epidemiology for American Indian populations. In G. D. Sandefur, R. R. Rundfuss, & B. Cohen (Eds.). Changing numbers, changing needs: American Indian demography and public health (pp. 235–261). Washington, DC: National Academy Press. McNair, L. D., & Prather, C. M. (2004). African American women and AIDS: Factors influencing risk and reaction to HIV disease. Journal of Black Psychology, 30, 106–123. Mikawa, J. K., Morones, P. A., Gómez, A., Case, H. L., Olsen, D., & Gonzales-Huss, M. J. (1992). Cultural practices of Hispanics: Implications for the prevention of AIDS. Hispanic Journal of Behavioral Sciences, 14, 421–433. Miller, J. B. (1986). Toward a new psychology of women. Boston: Beacon Press. Mirande, A. (1988) Chicano fathers: Traditional perceptions and current realities. In P. Bronstein & C. P. Cowan (Eds.), Fatherhood today: Men’s changing role in the family (pp. 93–106). Oxford: John Wiley & Sons. Mize, S. J. S., Robinson, B. E., Bockting, W. O., & Scheltema, K. E. (2002). Meta-analysis of the effectiveness of HIV prevention interventions for women. AIDS Care, 14, 163–180. Moreno, C. L. (2007). The relationship between culture, gender, structural factors, abuse, trauma, and HIV/AIDS for Latinas. Qualitative Health Research, 17, 340–352. Moss, N. E. (2002) Gender equity and socioeconomic inequality: A framework for the patterning of women’s health. Social Science & Medicine, 54, 649–661. Office of Minority Health. (2006). HIV/AIDS and American Indians/Alaska Natives. Accessed from http://www.omhrc.gov/templates/content.aspx?ID=3026 Osmond, M. W., Wambach, K. G., Harrison, D. F., Byers, J., Levine, P., Imershein, A., & Quadagno, D. M. (1993). The multiple jeopardy of race, class, and gender for AIDS risk among women. Gender & Society, 7, 99–120. Pavich, E. G. (1986). A Chicana perspective on Mexican culture and sexuality. Journal of Social Work & Human Sexuality, 4, 47–65. Peragallo, N. (1996). Latino women and AIDS risk. Public Health Nursing, 13, 217–222. Pew Hispanic Center Web site: http://pewhispanic.org. Polonsky, S., Kerr, S., Harris, B., Gaiter, J., Fichter, R. R., & Kennedy, M. G. (1994). HIV prevention in prisons and jails: Obstacles and opportunities. Public Health Reports, 109, 615–625. Population Resource Center (2001). Executive summary: Black Americans: A demographic perspective. Obtained online on 7/11/2006 from http://www.prcdc.org/summaries/ blacks/blacks.html. Pulerwitz, J., Gortmaker, S. L., & DeJong, W. (2000). Measuring sexual relationship power in HIV/STD research. Sex Roles, 42, 637–660. Raj, A., Silverman, J. G., & Amaro, H. (2004). Abused women report greater male partner risk and gender-based risk for HIV: Findings from a community-based study with Hispanic women. AIDS Care, 16, 519–529. Rao Gupta, G. (2000). Gender, sexuality and HIV/AIDS: The what, the why and the how. Paper presented at the XIII International AIDS Conference, Durban, South Africa.

Chapter 12


Rao Gupta, G. (2002). How men’s power over women fuels the HIV epidemic. British Medical Journal, 324, 183–184. Ridgeway, C. L., & Smith-Lovin, L. (1999). The gender system and interaction. Annual Review of Sociology, 25, 191–216. Riehman, K. S., Sly, D. F., Soler, H., Eberstein, I. W., Quadagno, D., & Harrison, D. F. (1998). Dual-method use among an ethnically diverse group of women at risk of HIV infection. Family Planning Perspectives, 30, 212–217. Roberts, D. (1998). Killing the black body: Race, reproduction, and the meanings of liberty. New York: Vintage. Roberts, A. C., Wechsberg, W. M., Zule, W., & Burroughs, A. R. (2003). Contextual factors and other correlates of sexual risk of HIV among African American crack-abusing women. Addictive Behaviors, 28, 523–536. Rojas-Guyler, L., Ellis, N., & Sanders, S. (2005). Acculturation, health protective sexual communication, and HIV/AIDS risk behavior among Hispanic women in a large Midwestern city. Health Education and Behavior, 32, 767–779. Romero, G. J., & Arguelles, L. (1993). AIDS knowledge and beliefs of citizen and noncitizen Chicanas/Mexicanas. Latino Studies Journal, 4, 79–94. Romero, G., Wyatt, G. E., Chin, D., & Rodriguez, C. (1998). HIV-related behaviors among recently immigrated and undocumented Latinas. International Quarterly of Community Health Education, 18, 89–105. Rosenstock, M., Strecher, V., & Becker, M. (1994). The health belief model and HIV risk behavior change. In R. DiClemente & J. Peterson (Eds.), Preventing AIDS: Theories, methods, and behavioral interventions (pp. 5–24). New York: Plenum. Ross, M. W., Essien, E. J., & Torres, I. (2006). Conspiracy beliefs about the origin of HIV/ AIDS in four racial/ethnic groups. Journal of Acquired Immune Deficiency Syndromes, 41, 342–344. Sabogal, F., & Catania, J. A. (1996). HIV risk factors, condom use, and HIV antibody testing among heterosexual Hispanics: The national AIDS behavioral surveys (NABS). Hispanic Journal of Behavioral Sciences, 18, 367–391. Sanders-Phillips, K. (2002). Factors influencing HIV/AIDS in women of color. Public Health Reports, 117, 151–156. Scott, K. D., Gilliam, A., & Braxton, K. (2005). Culturally competent HIV prevention strategies for Women of color in the United States. Health Care for Women International, 26, 17–45. Simoni, J. M., Sehgal, S., & Walters, K. L. (2004). Triangle of risk: Urban American Indian women’s sexual trauma, injection drug use, and HIV sexual risk behaviors. AIDS and Behavior, 8, 33–45. Simoni, J. M., & Ng, M. T. (2002). Abuse, health locus of control, and perceived health among HIV-positive women. Health Psychology, 21, 89–93. Smith, A. (2006). Conquest. Cambridge, MA: South End Press. Squire, C. (1993). Women and AIDS: Psychological perspectives. Thousand Oaks, CA: Sage. Stannard, D. E. (1992). American holocaust: The conquest of the New World. New York: Oxford University Press. Sterk, C. E., Theall, K. P., & Elifson, K. W. (2006). The impact of emotional distress on HIV risk reduction among women. Substance Use & Misuse, 41, 157–173. Stoler, A. (1997). Race and the education of desire. Chapel Hill: Duke University Press. Tesoriero, J. M., Parisi, D., Sampson, S., Foster, J., Klein, S., & Ellenberg, C. (2000). Faith communities and HIV/AIDS prevention in New York State: Results of a nationwide survey. Department of Health and Human Services Public Health Report, 115, 544–556. Thorburn, S., Harvey, S. M., & Ryan, E. A. (2005). HIV prevention heuristics and condom use among African Americans at risk for HIV AIDS Care, 17, 335–344. Thornton, R. (1987). American Indian Holocaust and survival: A population history since 1492. Norman, OK: University of Oklahoma Press. Timmons, S. M., & Sowell, R. L. (1998). Perceived HIV-related sexual risks and prevention practices of African American women in the southeastern United States Health Care for Women International, 20, 579–591. Tjaden, P., & Thoennes, N. (2000a). Extent, nature and consequences of intimate partner violence: Findings from the national violence against women survey, NCJ 181867. Washington, DC: National Institute of Justice and Centers for Disease Control.

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Tjaden, P., & Thoennes, N. (2000b). Full report on the prevalence, incidence and consequences of violence against women, NCJ 183781. Washington, DC: National Institutes of Justice. Tjaden, P., Thoeness, N., & Allison, C. J. (1999). Comparing violence over the life span in samples of same-sex and opposite-sex cohabitants. Violence and Victims, 14, 413–425. Treichler, P. (1999). How to have theory in an epidemic: Cultural chronicles of AIDS. Chapel Hill: Duke University Press. U.S. Census Bureau. (2001). The Hispanic population: Census 2000 brief. Web site http://www. census.gov/population/www/cen2000/briefs.html. U.S. Census Bureau. (2005). American Indian, Alaska Native tables from the statistical abstract of the United States: 2004–2005. U.S. Department of Justice. (2005). Crime and victim statistics. Retrieved from http://www. ojp.usdoj.gov/bjs on July 20, 2006. U.S. Department of Justice. (2007). Prison and jail inmates at midyear 2006. Bureau of Justice Statistics Bulletin. NCJ 217675. Vernon, I. (2007). American Indian women, HIV/AIDS and health disparities. Substance Use and Misuse, 42, 741–752. Walker, R. D., Lambert, D. M., Walker, P. S., Kivlahan, D. R., Donovan, D. M., & Howard, M. (1996). Alcohol abuse in urban Indian women: A longitudinal study for assessment and risk evaluation. AI/AN Mental Health Research Journal, 7, 1–47. Walters, K. L. (1998). Urban American Indian identity attitudes and acculturative styles. In H. N. Weaver (Ed.), Voices of first nation people. NY: Haworth Press. Walters, K. L., & Simoni, J. M. (1999). Trauma, substance use, and HIV risk among urban American Indian women. Cultural Diversity and Ethnic Minority Psychology, 5, 236–248. Walters, K. L., & Simoni, J. M. (2002). Reconceptualizing Native women’s health: An “indigenist” stress-coping model. American Journal of Public Health, 92, 520–524. Walters, K. L, Simoni, J. M., & Evans-Campbell, T. (2002). Substance use among American Indians and Alaska Natives: Incorporating culture in an “indigenist” stress-coping paradigm. Public Health Reports, 117, 104–117. Walters, K. L., Simoni, J. M., & Harris, C. (2000). Patterns and predictors of HIV risk among urban American Indians. In American Indian and Alaska Native Mental Health Research: A Journal of the National Center. Special Issue: HIV risk, prevention strategies and AIDS care for American Indians and Alaska Natives, 9(2), 1–21. Weinstein, N. D. (1993). Testing four competing theories of health-protective behavior. Health Psychology, 12, 324–333. Whetten, K., Lesserman, J., Whetten, R., Ostermann, J., Thielman, N., Swartz, M., & Stangl, D. (2006). Exploring lack of trust in care providers and the government as a barrier to health service use. American Journal of Public Health, 96, 716–721. Whitbeck, L., Hoyt, D., & Bao, W. (2000). Depressive symptoms and co-occurring depressive symptoms, substance abuse, and conduct problems among runaway and homeless adolescents. Child Development, 71, 719–730. Whitmire, L. E., Marlow, L. L., Quina, K., & Morokoff, P. J. (1999). Childhood trauma and HIV: Women at risk. Ann Arbor, MI: Taylor & Francis. Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socioeconomic status, stress and discrimination. American Journal of Health Psychology, 2, 335–351. Williams, P. B. (2003). HIV/AIDS case profi le of African Americans: Guidelines for ethnicspecific health promotion, education, and risk reduction activities for African Americans. Family and Community Health, 26, 289–306. Wingood, G. M., & DiClemente, R. J. (1995). The role of gender relations in HIV prevention research for women. American Journal of Public Health, 85, 592. Wingood, G. M., Diclemente, R. J., Harrington, K. F., Lang, D. L., Davies, S. L., Hook, E. W., et al. (2006). Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence. American Journal of Public Health, 96, 1085–1090. Wolfe, W. A. (2003). Overlooked role of African American males’ hypermasculinity in the epidemic of unintended pregnancies and HIV/AIDS cases with young African American women. Journal of the National Medical Association, 95, 846–852. Wyatt, G. E., Vargas Carmona, J., Burns Loeb, T., Guthrie D., Chin, D., & Gordon, G. (2000). Factors affecting HIV contraceptive decision-making among women. Sex Roles, 42, 495–521.

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Wyatt, G. E., Myers, H. F., Williams, J. K., Kitchen, C. R., Loeb, T., Carmona, J. V., Wyatt, L. E., Chin, D., & Presley, N. (2002). Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health, 92, 660–665. Young, R. M., Friedman, S. R., Case, P., Asencio, M. W., & Clatts, M. (2000). Women injection drug users who have sex with women exhibit increased HIV infection and risk behaviors. Journal of Drug Issues, 30, 499–524. Zierler, S., Feingod, L., Laufer, D., Velentgas, P., Kantrowitz-Gordon, I. & Mayer, K. (1991). Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. American Journal of Public Health, 81, 572–575. Zierler, S., Witbeck, B., & Mayer, K. (1996). Sexual violence, women and HIV infection. American Journal of Preventative Medicine, 12, 304–10. Zierler, S., & Krieger, N. (1997). Reframing women’s risk: Social inequalities and HIV infection. Annual Review of Public Health, 18, 401–436. Zierler, S., Krieger, N., Tang, Y., Coady, W., Siegfried, E., DeMaria A, Auerbach J. A. (2000). Economic deprivation and AIDS incidence in Massachusetts. American Journal of Public Health, 90, 1064–1073.

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13 Multicultural Feminist Therapy

Carolyn Zerbe Enns and Angela M. Byars-Winston

In her book entitled Feminism Is for Everyone, bell hooks (2000) defined feminist consciousness as a commitment to ending all forms of domination, oppression, and privilege. According to hooks, feminist consciousness includes an examination of the ways in which sexism interacts with racism, classism, colonialism, heterosexism, ethnocentrism, privilege, ageism, and ableism. The goal of feminist consciousness is to empower all people, including men, to create a world of equality that is reflected at individual, interpersonal, institutional, national, and global levels. Mary Ballou and Carolyn West (2000) echoed this inclusive theme in their statement that “feminist therapy is unwaveringly rooted in the search for and valuing of ALL women’s experiences” (p. 274). Laura Brown (1994) added that “feminist therapy cannot arise from a theory that would require someone to choose which aspect of her identity is the one to be liberated while others lie silenced, unattended to, or rendered marginal” (p. 69). In other words, feminist therapy needs to be multicultural at its very core. In keeping with this theme, the ethical guidelines of the Feminist Therapy Institute (FTI, 2000) identify cultural diversities and oppressions as one of four crucial domains of ethical decision making

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and behavior (see www.feminist-therapy-institute.org for more information). In addition, the recently approved Guidelines for Psychological Practice with Girls and Women (American Psychological Association, APA, 2007) centralize themes related to multiculturalism and diversity within the 11 guidelines. We use broad definitions for multiculturalism and diversity, often interchangeably, as articulated in the APA Practice Guidelines for Girls and Women (2007) and Guidelines on Multicultural Education, Training and Research (2003). The terms multiculturalism and diversity recognize the experiences and impact of gender, sexual orientation, race, ethnicity, class status, ability status, and other cultural group memberships on personal and collective identities. Feminist therapists have sometimes fallen short of enacting the values listed above, leading some to conclude that although many writers, theorists, and therapists (especially White women) have given lip service to multiculturalism and diversity, they have often relied on theories and research that are embedded primarily in the life experiences of middle class White women and uncritically applied these perspectives to all women (e.g., Brown, 1994; Silverstein, 2006; Yoder & Kahn, 1993). In her 1990 critique, Laura Brown proposed that feminist therapy theory was “neither diverse nor complex” (p. 3), but instead, made nominal references to women of color and reflected the family and social structures of White women. Although the task of creating a truly multicultural feminist therapy remains a challenge, the contributions of theorists and therapists who speak explicitly to the principles of multicultural feminist therapy have gradually led to more inclusive definitions and practices (Ballou, Hill, & West, 2008; Williams & Barber, 2004). Over the past 40 years, feminist therapy has grown into an important framework for conceptualizing mental health and psychotherapy, and at present, many introductory counseling and psychotherapy texts include chapters on both multiculturalism and feminist therapy (e.g., Corey, 2009; Murdock, 2008; Sharf, 2007; Sommers-Flanagan & Sommers-Flanagan, 2004). We refer readers interested in an overview of basic concepts and techniques to these sources. In this chapter, we (a) discuss basic assumptions regarding the integration of multiculturalism and feminism; (b) describe the types of multicultural feminist theories, tools, and applications that support practice; and (c) focus on some of the challenges of implementing multicultural feminist therapies. The list of significant contributors to multicultural feminist therapy is extensive and reflects the richness multicultural feminist approaches. We will provide brief glimpses of themes reflected in the work of multicultural feminist authors, and comment on some of the shared features of their work. Johnella Butler (2000) stated that “when we study women of color, we raise our awareness and understanding of the experiences of all women either implicitly or directly” (p. 177). By placing the scholarship of women with diverse life experiences and ethnicities at the center of inquiry, the lives of privileged persons are more likely to be decentered and knowledge is more likely to be transformed. To achieve our goals for this chapter, we have chosen to follow Butler’s (2000) advice and highlight the contributions of theorists and therapists of color, as well as those who have addressed how race and ethnicity intersect with other social identities such as sexual orientation. Our assumption is that multicultural feminist therapy is relevant to all consumers of psychological services, including men and those from relatively privileged

Chapter 13 Multicultural Feminist Therapy

backgrounds. Developing an understanding of culture, oppression, and privilege is not only important for empowering those with limited power, but also for increasing commitment to power sharing on the part of those with greater privilege. Although this chapter focuses primarily on multicultural feminist therapy, the basic principles are also relevant to other forms of psychological practice such as pedagogy, supervision, and research. In addition, although we discuss multicultural feminist perspectives affecting the psychology and therapeutic needs of all people, we primarily focus on their implications for individuals in United States society.

Basic Assumptions: Multiplicity, Intersectionality, and Power The foundations discussed in this section are consistent with themes identified in the Guidelines for Psychological Practice with Girls and Women (2007) and the Guidelines on Multicultural Education and Training, Research, Practice, and Organizational Change for Psychologists (APA, 2003), which encourage psychologists to: (a) be aware of the effects of socialization, stereotyping, and unique life events of girls and women from diverse cultural groups; (b) use information about oppression, privilege, and identity development in their practice; and (c) understand the impact of bias and discrimination on the physical and mental health of those with whom they work. These guidelines also encourage practitioners to: (d) recognize how their own socialization, attitudes, and knowledge bases may affect their practices; and (e) implement culturally sensitive and affirming practices. The terms multiplicity, intersectionality, and power provide a broad umbrella framework for understanding the basic values that support multicultural feminist practice. First, all people are embedded in multiple social and institutional structures that are imbued with different levels of power. Second, the various aspects of a person’s identity are nonadditive and indivisible so that each element of one’s identity, such as religion, sexual orientation, or nationality, shapes how other elements of identity such as gender are experienced (Wing, 2000). The salience of any one aspect of identity may vary across situations. Finally, all groups of people are characterized by within-group diversity (Stewart & McDermott, 2004; Worell & Remer, 2003). The reader is referred to Chapter 2 in this volume for an extended discussion of multicultural feminist theory.

Multiple Identities and Oppressions Feminists of color were among the first to point out the need for a multidimensional understanding of gender. For example, feminist theorist Barbara Smith (1983) emphasized the “simultaneity of oppression” (p. xxxii) due to interlocking and inseparable aspects of identity, and the Combahee River Collective (1982) called for a commitment to addressing issues for which race, sex, and class oppression operate simultaneously. More recently, Patricia Hill Collins’ articulation of Black feminist theory (2000) identified the value of articulating

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shared challenges and standpoints of a collective group, while also acknowledging that “there is no essential or archetypal Black woman whose experiences stand as normal, normative, and thereby authentic” (Collins, 2000, p. 28). Although separating one aspect of identity (e.g., race, sexual orientation, class) from other components is often impossible, some aspects of a person’s identity are more likely to be associated with privilege (e.g., Whiteness and middle-class status), and other aspects often contribute to the salience or extent of oppression or disadvantage (e.g., disability, race). For example, as the foreground and background of one’s various identities shift across contexts, a woman of color may sometimes experience discrimination due to skin color, but may also experience privilege because she is highly educated or of middleclass background. She may be a target of oppression when a male coworker sexually harasses her, but may also participate in subtle racist, classist, or sexist behaviors toward her secretary who holds less power. For some women, gender may only rarely be experienced as the most significant marker of identity, but may be filtered through or modified by other social identities such as race, ethnicity, or class (Wing, 2000). Race is often inextricably linked to one’s sense of self as a woman because discrimination on the basis of skin color and racial characteristics permeates class, gender, and sexual identities (Higginbotham, 1992; Root, 1995). For many women of color, racism is a far more visible, virulent, and everyday experience than is sexism. However, levels of perceived discrimination can also vary within racial-ethnic groups for a variety of reasons, including skin tone. For example, Elizabeth Klonoff and Hope Landrine’s (2000) study of Blacks with hypertension found that those who were dark-skinned were 11 times more likely to report high levels of discrimination than were their counterparts who were light-skinned. In general, multicultural feminists have spoken of the inadequacy of thinking of gender as the primary, most important, or unifying form of oppression that links women (e.g., Espín & Gawelek, 1992; Greene, 1994). The varying cultural identities, stereotypes, and levels of privilege of subgroups of women may also influence how oppression and advantage are experienced. For example, Janice Yoder and Lynne Berendsen’s (2001) qualitative study of White and African American women fire fighters found that both groups of women encountered the negative outcomes of token status and marginalization. Women from both groups reported inadequate instruction, hostility, silence, limited support, and strained relationships with male coworkers. However, White women did not report experiencing many of these issues as consistently, persistently, or intensely as their African American counterparts. In addition, whereas White women were more typically stereotyped as fragile and encountered paternalistic overprotection, African American women were more likely to be stereotyped as beasts of burden, or as self-reliant and enduring. Finally, African American women were more consistently aware of the “omnirelevance” (p. 27) of race and gender interactions in contrast to White women, who often seemed unaware of race-related privilege in their relationships with White male coworkers. Findings from the aforementioned studies illustrate that oppression and privilege are not merely additive. As the number of one’s marginalized social identities increase, discrimination may be compounded, leading to a multiplication of disadvantaged statuses. When oppression is viewed as additive, or as


double or triple jeopardy, oppression and discrimination can be interpreted “as equivalent to the mathematical equation, racism plus sexism plus classism equals triple jeopardy” (King, 1988, p. 47). An additive analysis lends itself to the conclusion that all women are victimized by sexism and some women are also oppressed by racism (Hooks, 1984; Spelman, 1988). Such conclusions imply that a woman’s ethnic or racial identity can be subtracted from her larger identity, when in fact, these aspects of experience may be inseparable.

Multiple Identities and Research Relevant to Multicultural Feminist Therapy Reliance on traditional empirical methods and traditional comparison groups has sometimes contributed to ethnocentrism and inattentiveness to multiple identities that support feminist multicultural therapy (Landrine, Klonoff, & Brown-Collins, 1992; Wyche, 1993; Yoder & Kahn, 1993). For example, when studying women’s attitudes toward an issue, researchers often compare the attitudes of two groups, such as those of African American women and White women. Such comparative research can be used to debunk stereotypes, but too frequently, White women are implicitly viewed as “women in general” (Yoder & Kahn, 1993, p. 848) or the normative group from which other groups deviate. This approach can reinforce stereotypes, provide limited information about the shifting sands of privilege and oppression, and obscure information about differences within specific groups of women. Many traditional forms of quantitative research are “embedded in a context of race, class, and ethnic stratification and thereby recapitulate racist, classist, and ethnocentric forms of relationships” (Landrine, Klonoff, & Brown-Collins, 1992, p. 147). For example, quantitative studies of gender differences based only on White people are often considered to be generalizable while those that compare men and women of color are seen as nongeneralizable. However, the pairing of “objective” experimental research with person-centered approaches can be used to explore more nuanced and complex meanings. Landrine et al. (1992) found, for example, that although White women and women of color responded similarly to objective rating scales, there were substantial racial/ethnic differences with regard to subjective interpretations of terms such as passive and assertive. These findings point to the importance of an intersectional perspective in research that supports multicultural feminist psychology. Multicultural feminist therapists often emphasize the value of qualitative approaches for conveying the richness and depth of women’s complex identities (e.g., Barrett et al., 2005; Chin, 2005; Espín, 1999). For example, Oliva Espín (1999) examined the narratives of Latinas to explore the complex phases, gains, losses, and outcomes associated with the crossing of “emotional and behavioral boundaries” (p. 19) triggered by migration. The migration experiences of the Latinas whom she interviewed revealed complicated themes related to gender roles, loss and grief, access to power, sexuality, sexual orientation, and language. Women’s life phases and complex life circumstances also contributed to the myriad choices these women made. Her research points out that even when women share a set of intersections such as ethnicity, gender, and sexual orientation, they experience diverse situational and contextual demands that lead to diverse life choices.

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Multidimensionality and Theory A therapist’s theoretical foundation can have a profound impact on how she or he views problems and change. Women of color feminisms, social constructionism, postmodern perspectives, transnational feminisms, lesbian feminisms, and queer theory provide useful frameworks for understanding the complexity of oppression and resistance (see Enns, 2004, and Sinacore & Enns, 2005, for elaborations). Likewise, a wide range of theories relevant to culture-specific approaches, critical psychology, and social reconstructionist perspectives support the work of multicultural feminist therapists (Ali & Ancis, 2005). Feminists of color have played central roles in creating pluralistic feminisms. For example, Patricia Hill Collins (2000) articulated Black feminist thought, which emphasizes the centrality of self-definition and self-valuation, an analysis of the interlocking aspects of oppression, and the integration of Black women’s culture, Afrocentric values, and feminism. Similarly, Chicana feminists have addressed the intertwining of many concerns such as language issues, patriarchal ideologies, immigration and migration, acculturation strategies, and religion. Unique to Chicana feminisms are concepts related to borderland living, or the challenges of navigating the emotional, psychological, and geographical spaces that mark boundaries between cultures, as well as the sixth sense that is required to juggle cultural these complexities (Anzaldúa, 1987; Hurtado, 2003). These feminisms also provide insights about creating bicultural and hybrid identities, which are becoming increasingly prominent within transnational contexts. The interface of 20th century American and European feminisms with Africa, Asia and Latin America has prompted more intentional discourse on the link between globalization and multicultural feminist psychology; this link has been extensively discussed by Sinacore and Enns (2005). In general, women of color play a particularly important role in feminist theory development because they simultaneously hold “insider” information that facilitates their survival within dominant culture and outsider status because they may not be fully accepted within society. As a result of this “outsider-within” perspective, they often develop insights about issues that remain invisible to those who are accorded privileged status (Collins, 2000). To summarize this section, we highlight key themes that support multicultural feminist theory. First, these models theorize from difference and centralize perspectives that have been marginalized (Bell, Morrow, & Tastsoglou, 1999). Second, they seek to restructure the canon of knowledge, explore the strengths and resilience of devalued groups, foster positive personal and collective identity among persons of oppressed groups, and support empowerment and liberation (which can be two distinct experiences) of people who have faced injustice (Ali & Ancis, 2005; Sleeter, 1996). Third, these theories recognize that psychological “truths” vary across time, location, and culture (Enns, 2004; Stewart & Mc Dermott, 2004; Worell & Remer, 2003). Finally, they reflect the multidimensional nature of experience, self-reflexive attitudes and a recognition that “our experiences of others will always be partial” (Hoodfar, 1997, p. 213), and a commitment to forming alliances across difference and various social change agendas (Kirk & Okazawa-Rey, 2001; Roffman, 2008).


Shared Principles of Multicultural Feminist Therapy Therapist Self-Awareness It is important for multicultural feminist practitioners to be knowledgeable about the ways in which their positionalities, or locations within social structures, are reflected in their experiences of disadvantage and discrimination and/or access to unearned entitlements due to their various privileged statuses. White feminists have often ignored differences among women, leading bell hooks to assert that White feminists’ emphasis on the common oppression of all women provided White women with a “vehicle to enhance their own individual, opportunistic ends” (1981, p. 150) and to reinforce patronizing attitudes toward women of color. When women of color have been invited to work as allies with White women, they have often been asked do so within the parameters established by White women, thus limiting opportunities for true mutuality (Hurtado, 2003). bell hooks (1984) also argued that whereas the basis for solidarity among White women has been shared victimhood, viewing themselves primarily as victims without also recognizing their race or class privileges may allow White women to conveniently absolve themselves of responsibility for confronting the ways in which they may help maintain status quo social arrangements. Feminists of color have noted that White feminists who are unaware of the complexity of privilege and oppression are often guilty of subtle condescension or misguided responses. These behaviors may include (a) dysfunctional rescuing, based on the belief that women of color lack the resources to help themselves; (b) seeing problems only in personal terms, and ignoring the impact of systemic racism on people’s lives; or (c) avoiding contact with women of color for various reasons, such as unwillingness to learn about women of color experiences (Essed, 1991). Laura Brown (1991) observed that when White people grow up in the dominant White culture, they are likely to be either covertly or overtly racist to some degree. As a result, antiracism training and an understanding of the following dimensions are crucial forms of preparation for multicultural feminist practice: (a) the therapist’s feelings and knowledge of her own interlocking social identities and her willingness to use this self-awareness to learn about the multiplicative identities of clients; (b) her or his comfort level with diverse language, traditions, values, and behavioral styles, (c) the ability to be both vulnerable and powerful in interactions with people of color and other oppressed people; and (d) the ability to hear and affirm the anger and pain of others without becoming defensive, paralyzed, or guilt-ridden (Adams, 2000; Adleman & Enguídanos, 1995; Brown, 1995; Cross, Klein, Smith, & Smith, 1982). Practitioners who are feminists of color must likewise be conscious of how their positionalities and sociocultural identities impact their clinical work. Lillian Comas-Díaz and Frederick Jacobsen 1995) described unique transferential and countertransferential dynamics that may emerge in clinical dyads when the therapist is a person of color and the client is White. Recapitulations of societal status and power differences, fears of the other person’s difference, and biased projections may be especially salient. Whether the client is White or another person of color, the therapist of color may be challenged regarding

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clients’ perceptions of their credibility and consequently experience anger and resentment toward clients for needing to prove their competence. For therapists of color in predominantly White clinical settings, some may also experience guilt for not working with their own communities of color. To effectively recognize and resolve cultural transference processes, therapists of color must identify, recover, heal, and be liberated from oppressive forces that have negatively shaped their worldviews.

A Coping and Strength Perspective Multicultural feminist therapy is not only based on knowledge of oppressions, but also the strength and coping resources that individuals display as “enactors, not victims” (Reid & Kelly, 1994, p. 483). For example, Chicana feminists have often drawn insights from their experiences as women who have lived on the physical borders between nations and have experienced family histories associated with multiple oppressions such as land theft, immigration, colonization, or the imposition of religious traditions. A mestiza, who “straddles cultures, races, languages, nations, sexualities, and spiritualities” (Bernal, 1998, p. 561), often develops a sixth sense that facilitates the negotiation of challenges and contradictions associated with borderland identities. Gloria Anzaldúa (1987) proposed that women of color develop la facultad, a survival tactic which is based on knowledge of one’s own painful experiences of marginalization and discrimination. La facultad involves an intuitive perceptiveness of power dynamics in everyday experiences, and allows one to “adjust quickly and gracefully to changing (and often threatening) circumstances” (Moya, 2001, p. 469). Chéla Sandoval (1991) also coined the phrase “differential consciousness” as a foundation for developing survival skills when living with multiple identities. Differential consciousness allows women the ability to emphasize specific aspects of their personal identity to achieve important goals and become adept at “shifting their ideologies and identities in response to different configurations of power” (Moya, 2001, p. 461). Living at the borders of cultures has also facilitated a “syncretic form of consciousness” (Sandoval, 1998, p. 352), which has allowed Chicana feminists to function as a “mobile crossing” or “chiasmus” (p. 352) between people who claim different linguistic, national, cultural, ethnic, and class identifications. Historical survival for many women of color required their personal suffering as a function of economic, occupational, and sexual exploitation. This suffering and survival bred self-sacrificing beliefs and over self-reliance as well as historical resistance and social agency (Byars-Winston, 2004). An emphasis on resilience highlights the leadership and creative survival skills of women of color, but an overemphasis on strength may lead to ignoring stresses experienced by women of diverse groups. For example, the widely held Mammy stereotype reinforces the image of the notion that Black women are able to “selflessly meet the needs of others” (West, 1995, p. 461). This stereotype does not give Black women permission to experience genuine vulnerability and fear when it is appropriate. Chronic stressors associated with racism, sexism, financial responsibilities, and the work–family interface are related to Black women’s vulnerability to stress-related physical and psychological problems compared to their White counterparts (Taylor, 1999; Walter, 2006).


When practitioners place an exclusive focus on clients’ problems, they are likely to ignore client’s inner strengths, resources, and capacity for growth. However, when they overemphasize diverse women’s resilience and ability to act as “pillars of strength,” the costs of being overburdened may be invisible to them. Endurance and being strong are not the same as overcoming oppression and experiencing transformation (hooks, 1981). Coping models that recognize diverse risk profiles of women as well as their strengths and support systems are optimal foundations for practice (Keith, 2003).

An Ecological Biopsychosocial Perspective In order to maintain a multidimensional worldview, it is essential to conceptualize problems and strengths in context. At the innermost core, the specific biological, psychological, and coping patterns of a person highlight her or his individuality. Assessment of these concerns and strengths can be facilitated, in part, through mainstream medical and psychological assessment practices as well as by a variety of nonsexist psychological theories (Enns, 2003). Multicultural feminist therapists need to be careful, however, to apply all models in such a way that they attend to strengths as well as difficulties; and describe the person’s characteristic patterns without subtly reinforcing stereotypes (e.g., along ethnic or gender lines), “pigeonholing” the person’s concerns (Lerman, 1996), or limiting the therapist’s ability to see the person in her or his environment. A multicultural feminist ecological perspective facilitates conceptualization of the complex systems that surround the individual’s core (Ballou, Matsumoto, & Wagner, 2002; Barrett & Ballou, 2008; Yakushko & Chronister, 2005). These systems include: (a) a microsystem, which includes familial, spiritual, educational, and other support systems and institutions with which one interacts regularly; (b) an exosystem, which includes social, governmental, legal, and political policies and institutions with which a person may or may not have direct contact but that impact on a person’s privileges, opportunities, oppressions, and general flexibility of movement; and (c) a macrosystem, which reflects factors such as cultural values, global influences, worldviews, and ideologies. Intersecting with all of these systems are the statuses of race, ethnicity, class, gender, sexual orientation, disability, age, historical time period, and other influences that are relevant to ecological systems. This ecological perspective helps multicultural feminist therapists consider empowerment perspectives at both individual and social change levels. Multicultural feminist therapists also seek to reframe traditional diagnostic categories to reflect a contextual perspective (Gentile, Kisber, Suvak, & West, 2008). For example, some personality disorders are associated with social class, gender, and marital status stereotypes (Landrine, 1989). In light of the potentially pejorative and confining aspects of categories such as the personality disorders, Laura Brown (1992) suggested using the construct of “oppression artifact disorders” to convey that many long-term or entrenched personality styles and problems in living represent reactions to stressors that are “embedded in the framework of the culture in which an individual develops” (p. 223). The relevance of a contextual analysis is reinforced further by research findings that reveal subtle associations between systemic influences and individual distress. First, both psychological and physical symptoms are associated

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with perceptions of discrimination (e.g., Klonoff, Landrine, & Campbell, 2000). Second, although the literature on racism and sexism reveals blatant forms of sexism and racism have decreased substantially during recent decades (Campbell, Schellenberg, & Senn, 1997), contemporary sexism and racism often assume more clandestine forms, which have been labeled by terms such as modern sexism and racism and unintentional or symbolic racism and sexism (Dovidio, Gaertner, Kawakami, & Hodson, 2002; Gaertner & Dovidio, 2005; Swim, Aiken, Hall, & Hunter, 1995). Finally, there is substantial evidence that stereotypes about one’s social identities (e.g., race, gender, disability, sexual orientation) may be internalized at nonconscious levels and dampen one’s performance or perceived potential (e.g., through stereotype threat); and that these unconscious negative attitudes and implicit biases can have a negative impact on a wide range of interactions and behaviors (Dovidio et al., 2002; Steele, 1997). These negative outcomes are most likely to appear in ambiguous or complex circumstances and when negative outcomes can be explained through multiple mechanisms other than a particular “ism.” These “kinder and gentler” (Glick & Fiske, 1997, p. 121), or less blatantly hostile, “isms” may be no less damaging or pernicious than overt biases. For instance, an undergraduate woman in an organic chemistry course may receive unsolicited help on a homework problem from a male peer during a study group. Although he does not directly communicate his sexist assumption (e.g., “women are not skilled in math or science”), his action indirectly communicates his belief about her (lack of) competence. Given the subtle and contradictory nature of contemporary forms of oppression, it may be more difficult for individual men and women to recognize and resist their effects. As a result, attentiveness to these changing and often unrecognized issues is crucial.

General Principles for Multicultural Feminist Practice The second major section of this chapter discusses the application of principles related to critical consciousness or consciousness raising, social identity assessment, empowerment goals, the integration of traditional psychotherapy systems with multicultural feminist principles, and the challenges of working within intercultural dyads. Goals and interventions associated with three of these principles are clarified further in Table 13.1. These principles and applications build on the six practice applications of the Guidelines for Psychological Practice with Girls and Women (2007). These guidelines call on practitioners to (a) rely on approaches that are effective for working with diverse groups of girls and women, (b) foster relationships and practices that lead to empowerment and expanded alternatives, (c) use unbiased and appropriate assessment procedures, (d) consider problems in their sociopolitical context, (e) acquaint themselves with community and educational resources, and (f) work to change institutional and systemic biases.

Conscientization and Consciousness-Raising Liberation, critical, and feminist theorists speak about the importance of consciousness-raising or conscientização as a foundation for personal


13.1

Three Goals and Interventions of Multicultural Feminist Practice

Critical Consciousness Development Decolonization Reintegration of healthy identities Social Identity Assessment Identity exploration Self-definition and clarification Empowerment Power sharing Self-valuation Social activism

empowerment and activism. Conscientização is a Portuguese word and is defined as “learning to perceive social, political, and economic contradictions, and to take action against the oppressive elements of reality” (Freire, 1970, p. 19). Developing critical consciousness involves helping individuals recognize the systems of oppression in which they exist, articulate their roles and positions in these systems, and devise concrete strategies to empower themselves and others to engage in social action (Burbules & Berk, 1999; Thomas & Speight, 2005). Through conscientization, individuals become aware of the ways in which they have become unsuspecting hosts to the colonizing effects of dominant culture, a first step in recovering their voices. For example, they discover how they have internalized their colonizers’ beliefs about themselves, and how these self-views may have been translated into passive resistance mechanisms such as silence, accommodation, evasiveness, ingratiation, and manipulation. Similarly, the feminist concept of consciousness-raising involves using knowledge about personal distress, inequality, and stigmatization to inform self-awareness, theory, and activism. Individuals explore how unequal social power may have contributed to their own diminished sense of self, limited their options, or exacerbated their personal vulnerability and fear (Fisher, 2001). Consciousness-raising also includes considering how institutions, families, and work contexts promote inequities that foster distress as well as examining how one’s social identities are related to systems of privilege and oppression. Consciousness-raising requires flexibility, a willingness to listen to and learn from others (especially from those who experience multiple forms of oppression), and reflection about how one’s own perceptions of others may have become distorted by living in an unequal world. The new interpretive framework that comes from consciousness-raising can be liberating in and of itself, but also becomes the foundation for developing personal and social action plans (Tabol & Walker, 2008). Recognizing ways in which the “personal is political” and the “political is personal” is a foundation of consciousness-raising. For many women of color,

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however, an even more relevant phrase may be: the “public is personally political” (Hurtado, 1989, p. 849). Social policies and institutionalized racism have often restricted the personal lives of people of color and poor people, who then have difficulty creating private lives on their own terms. Whereas middle class White women typically experience at least some choice (e.g., choosing whether to work for monetary remuneration) and a clear division between private and public realms, the “personal” choices imposed on many women of color, including those with middle class status, by social policies and institutionalized racism may limit their daily realities all the more. Thus, understanding the reciprocal and differential interactions between public, personal, and political realties is essential (Hurtado, 1996, 2003).

Ethnocultural Therapy, Decolonization, and Conscientização Lillian Comas-Díaz’s (1994, 2000) ethnocultural approach is especially consistent with the concepts of conscientização and consciousness-raising. Oppressed people have often experienced the suppression or eradication of their own cultures and have been required to accommodate themselves to the norms of the dominant culture as a condition of survival. Comas-Díaz (2000) used the phrase “post-colonization stress disorder” to name the consequences of cultural imperialism and racism, which include victimization, alienation, self-denial, identity conflicts, assimilation within the dominant culture, and/or ambivalence about oneself and the dominant culture. This label does not pathologize individuals, but depicts the repetitive trauma experienced by many people of color, and signifies “adaptive reactions in contending with profound social pathology” (p. 1321). Colonized people often become the target of pejorative stereotypes or become convenient scapegoats for social problems. For example, women of color may be blamed for family problems and stresses that are the product of institutional racism. Greene (1990) cogently described the myth that Black women’s presence in the workplace is to blame for the discrimination against Black men in the workplace. The fallacious underlying assumption is that Black women’s gender makes them more desirable as workers (double minority status), which edges Black men out of work and reduces men’s ability to economically contribute to their families. This assumption obscures the fact that historically neither Black men nor women have had power over their roles in the workplace. In addition, the values of the dominant culture are typically valued and seen as good, even by colonized peoples, and that which is associated with minority cultures is seen in negative terms. For instance, the dominant culture’s standards of beauty that idealize Caucasian features can be especially harmful to Black women and other women of color (Greene, 1992). Black women are rewarded for attempting to replicate Caucasian standards, and the internalization of these standards is reflected in Black women’s stress levels, health problems, self-perceptions, and concerns about body type, facial characteristics, hair texture, and skin color (Tabol & Walker, 2008; Taylor, 1999; West, 1995). Opportunities to express anger about confining images and to deconstruct and correct self-referent beliefs that result from narrow, polarized images are important to self-recovery (Thomas & Speight, 2005). The expression of anger


is complicated by the reality that the expression of strong feelings outside of psychotherapy may result in becoming the target of institutional racism and being labeled as a troublemaker or “angry minority” (Comas-Díaz & Greene, 1994; Kaiser & Miller, 2003). Thus, working through anger within the therapy relationship and finding productive methods for anger expression in daily life are especially important aspects of consciousness-raising. Another challenge involves differentiating between the ways in which one experiences discrimination from external sources and how internalized negative images influence one’s behavior (Comas-Díaz, 1994). This clarification process helps clients make informed decisions about what they can change as individuals and what desired changes will require social activism. To summarize, decolonizing multicultural feminist therapy involves the restoration of personal dignity as well as supporting personal transformation. Decolonization therapy focuses on building awareness, developing skills for countering internalized colonization, creating an integrated and healthy identity that is “independent of the colonizer’s idealized White female standard” (Comas-Díaz, 1994, p. 291; Thomas & Speight, 2005), and helping clients engage in actions that empower themselves as well as change the hurtful conditions around them (Comas-Díaz, 1994, 2000). The APA Multicultural Guidelines and professional organizations such as the National Council of La Raza (Rios-Ellis et al., 2005) encourage therapists to consider using indigenous cultural practices to advance mental health and well-being in marginalized groups.

Social Identity Analysis Social identity analysis represents a structured approach to exploring the many identities that are relevant to a person’s self definition, and often facilitates consciousness-raising. Authors have used phrases such as gender role analysis (Brown, 1990), the cultural genogram (e,g., Vasquez & Magraw, 2005), and power analysis (e.g., Worell & Remer, 2003) to describe aspects of this assessment process. The phrase social identity analysis conveys the importance of multidimensional analysis of all the identities that are relevant to a person’s self definition (e.g., age, gender, sexual orientation, race/ethnicity). Clients may be encouraged to chart how their social locations are associated with privilege or disadvantage/oppression in one’s life (Worell & Remer, 2003). An alternative is to use a series of open-ended questions or a structured genogram to explore how cultural statuses are experienced. Genograms, a pictorial display of an individual’s relationships and history, are especially useful for depicting intergenerational themes that are relevant to the client, such as how gender roles were learned and experienced in the family or how racism was experienced across generations. Encouraging clients to tell their cultural stories, which may include information about their ethnocultural group’s origins, migration, and identity, may also support the development of a healthy personal identity (Comas-Díaz, 1994, 2000). Storytelling about significant people (e.g., mothers), and recollections about how these people negotiated life tasks or dealt with oppression, can form the foundation for further clarification of personal hopes and dreams. Drawing on culturally relevant myths, legends, and spiritual traditions may also represent a rich source of positive images (Comas-Díaz, 1991; LaFromboise, Heyle, &

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Ozer, 1990; True, 1990). Integrating indigenous cultural practices, such as spiritual healing methods and a client’s original language, with feminist principles can also enhance multicultural feminist therapy (Espín, 1988). During the past 20 years, many identity development approaches have been proposed and provide pathways for understanding how to affirm devalued identities. According to most models, when individuals begin identity exploration, they typically accept and internalize dominant stereotypes about their group. As they face injustice, they encounter the reality or experience “revelation” about the impact of their devalued identities, and begin to question societal assumptions. In addition to experiencing anger and other emotions toward people and institutions who promote stereotypes and oppressive practices, they may immerse themselves in their cultures of origin and learn to celebrate experiences and traditions that have been devalued by society. Following additional reflection, they increasingly affirm and integrate identities into a positive and holistic sense of self (Adams, 2001; Ossana, Helms, & Leonard, 1992). In contrast to identity models that focus on nondominant statuses, White identity development models (e.g., Hardiman, 2001; Tatum, 2002) illustrate the difficulty that White persons often have acknowledging that their Whiteness is associated with privilege. To reduce internal conflict and absolve themselves of guilt associated with racism, they may also adopt an unhealthy “rescuing” mode of relating to those with minority statuses, distort reality, and deny racism, or avoid contact with persons who hold racial minority statuses (Tatum, 2002). When individuals move beyond denial or a “guilty White liberal perspective,” they begin to explore racism and other systems of advantage, and accept responsibility for the roles they have played in perpetuating racism and other oppression. They also learn to become allies of persons who are oppressed and commit themselves to activism directed toward empowering others and challenging the racism of other White people. To summarize, addressing multidimensional identity development is an important component of multicultural feminist therapy.

Empowerment and Social Activism Many of the goals and strategies of multicultural feminist therapy fall under the umbrella term of empowerment, which involves helping individuals see themselves as active agents on behalf of themselves and others. Although symptoms are a major impetus for seeking help and are often viewed from a deficit framework, multicultural feminist therapists view them from a coping and empowerment framework. Symptoms often arise from efforts to communicate with others or influence environments that are constricting or oppressive. Marjorie Klein (1976) noted that, “Not all symptoms are neurotic. Pain in response to a bad situation is adaptive, not pathological” (p. 90). Empowerment, then, involves reframing difficulties and redirecting one’s energies to optimize well-being. Judith Worell (2001) proposed ten goals of feminist empowerment, including self-esteem and self-valuing, positive daily functioning, gender and culture awareness, perceived self-efficacy and control, self-nurturing capacities, problem-solving skills, behavioral flexibility, assertiveness, the ability to access


and use community resources, and participation in social activism. In addition, multicultural feminist empowerment emphasizes three integrated dimensions: personal, interpersonal, and sociopolitical (Morrow & Hawxhurst, 1998). Although remediation of problems is one aspect of empowerment, prevention, education, and community change are also important for building resilience (Worell, 2001). A reciprocal model of influence supports growth as multicultural feminist therapists implement egalitarian values and communicate confidence in the client’s decision-making skills (Rawlings & Carter, 1977). The therapist shares power with the client to facilitate the client’s emerging problem-solving skills and to support the “transfer of power and expertise in the process of selftransformation” (Wykoff, 1977, p. 394). A variety of tools such as reframing, power analysis, and self-disclosure can also be used in this process (Worell & Remer, 2003).

Integrating Traditional Psychotherapy Systems and Multicultural Feminisms Multicultural feminist therapists typically integrate multicultural feminist values with a wide range of available psychotherapy systems. Judith Worell and Pam Remer (2003) offer a series of questions that can be used by practitioners to evaluate and reconstruct aspects of traditional psychotherapy systems that have the potential to support biased or limiting views of clients if applied without modification. One model that emerges from such a reconstruction process involves integrating feminist and psychodynamic models to address the therapeutic needs of African American women. Although critical of traditional psychodynamic approaches, Leslie Jackson (2000) argued that a transformed psychodynamic approach is valuable for addressing the diverse social and cultural environments of African American women as well as attending to the intrapsychic, internalized legacies arising from racism, degrading and stereotyped images of women, and slavery. The psychodynamic emphasis on the therapeutic relationship offers a positive model for reexperiencing one’s past in a safe context, provides a space where clients can work through negative internalized images, and helps to “reawaken the humanness” (p. 11) of the client. Carmen Williams (2005) proposed that the limitations within feminist and multicultural theories can also complicate the reconstruction process described above. For example Afrocentric theories imply that certain traits are “inherently and essentially African without regard to gender differences” (p. 279). Similarly, some feminist theories (e.g., cultural feminism) identify certain traits, such as emotional relatedness and empathy, as fundamentally gender based. Womanism (i.e., African American feminism), a theoretical model originally proposed by Alice Walker, rejects the dualism (race or gender) common to ethnocentric and some feminist theories, and emphasizes integrated analyses of race, gender, class, and sexual orientation as well as a focus on wholeness of self, community building, compassion, empowerment, and selfdetermination (Williams). Williams proposed that womanist models are most likely to provide a holistic integration of gender, class, race, and sexual orientation variables.

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Many multicultural feminist therapists have also articulated important foundations for multicultural feminist therapy for specific groups of women. For example, Lillian Comas-Díaz (1987) described a feminist model for working with mainland Puerto Rican women, and Oliva Espín (1987) articulated feminist principles for working with Latinas dealing with the impact of migration. Both authors have emphasized the importance of “giving voice to silence” (Espín, 1993b) and have addressed how culture, political oppression, colonial history, migration and other contextual factors interact with gender in the formation of challenges and symptoms. Espín (1994) also recommended ethno-specific feminist therapy, or the therapeutic pairing of a woman of color with a therapist of a similar background. Such a partnership may decrease potential power differences, enhance the potential for an egalitarian relationship, and potentially increase the likelihood that the therapist can serve as an effective, culturally similar role model. However, a therapeutic relationship between a White therapist and a woman of color can provide a positive opportunity to learn about dealing effectively with similarities and differences.

Intercultural Therapeutic Dyads It is important to acknowledge that when the social identities (e.g., race, ethnicity, sexual orientation) of a client and therapist diverge, the process of forming a therapeutic alliance is often more complex than when both persons share similar ethnic identities or experiences (Shorter-Gooden & Jackson, 2000). At times, White therapists’ desires to appear “color blind” or their anxieties about acknowledging difference may contribute to ineffective interventions. Although color blindness is dangerous because it may lead to the avoidance of critical issues, it is also dangerous for therapists to uncritically comply with a client’s belief that “one’s discriminated status justifies a failure to take into account the feelings or needs of others” (Greene, 1986, p. 54). Because of anxiety, guilt feelings about racism, or fears that their own racism may influence the psychotherapy experience, White feminist therapists may also fear confronting the client about the clients’ behaviors that may have been hurtful to others. White therapists with limited self-awareness may act out roles that range from being a “self-appointed advocate” to a “self-effacing sympathizer” (Trotman, 2000, p. 259). Whereas the self-appointed advocate acts in paternalistic ways and shows a lack of respect for the client, the self-effacing therapist becomes trapped by feelings of guilt and the symbolism of her White skin, and cannot be genuine or fully available to the client. The self-aware therapist is able to facilitate a nondefensive exploration of issues related to difference, which provides a productive foundation for empowering work with clients (Greene, 1986). Consistent self-monitoring on the part of therapists is important for guarding against minimizing the impact of race, ignoring factors other than race and ethnicity that the client and therapist need to confront, and recognizing occasions when therapists are not able to adequately empathize with clients of color. Lillian Comas-Díaz (1994) suggested that although therapists in cross-cultural dyads may understand the client’s experience from a cognitive perspective, they may have difficulty empathizing at an affective level.


Collaborative efforts between a White therapist and a person of color can be enhanced through “empathic witnessing” in which “the therapist recognizes his or her ethnocultural ignorance of the client’s reality and reaffirms, through empathic witnessing, the client’s experience and reality” (pp. 294–295).

Concluding Thoughts Multicultural feminist therapy offers clients ways to (a) integrate the gender, racial, and cultural aspects of their identities; (b) identify the interconnections between their internal and ethno-sociocultural realities; (c) acknowledge and cope with anger related to the oppression in their lives; and (d) become agents of change on their own behalf as well as the wider society (Comas-Díaz, 1987; Espín, 1987, 1994). Although feminism and multiculturalism are intricately linked by the common goal of social justice (Silverstein, 2006), the complexity paradigm necessary for attending adequately to clients’ personal priorities and social locations is still incomplete (Reid, 2002). It is our hope that the themes discussed in this short chapter provide ideas of directions that will lead to the further development of multicultural feminist therapies.

References Adams, J. M. (2000). Individual and group psychotherapy with African American women: Understanding the identity and context of the therapist and patient. In L. C. Jackson & B. Greene (Eds.), Psychotherapy with African American women: Innovations in psychodynamic perspectives and practice (pp. 33–61). New York: Guilford Press. Adams, M. (2001). Core processes of racial identity development. In C. L. Wijeyesinghe & B. W. Jackson III (Eds.), New perspectives on racial identity development: A theoretical and practical anthology (pp. 209–242). New York: New York University Press. Adleman, J., & Enguidanos, G. (Eds.). (1995). Racism in the lives of women: Testimony, theory and guides to antiracist practice. New York: Haworth Press. Ali, S. R., & Ancis, J. R. (2005). Multicultural education and critical pedagogy approaches. In C. Z. Enns & A. L. Sinacore (Eds.), Teaching and social justice: Integrating multicultural and feminist theories in the classroom (pp. 69–84). Washington, DC: American Psychological Association. American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402. American Psychological Association. (2007). Guidelines for psychological practice with girls and women. American Psychologist, 62, 949–979. Anzaldúa, G. (1987). Borderlands, la frontera: The new mestiza. San Francisco: Aunt Lute Books. Ballou, M., Hill, M., & West, C. (Eds.). (2008). Feminist therapy theory and practice: A contemporary perspective. New York: Springer. Ballou, M., Matsumoto, A., & Wagner, M. (2002). Toward a feminist ecological theory of human nature: Theory building in response to real-world dynamics. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 99–141). New York: Guilford Press. Ballou, M., & West, C. (2000). Feminist therapy approaches. In M. Biaggio & M. Hersen (Eds.), Issues in the psychology of women (pp. 273–297). New York: Kluwer Academic/Plenum. Barrett, S., & Ballou, M. (2008). The person of the client: Theory. In M. Ballou, M. Hill, & C. West (Eds.), Feminist therapy theory and practice: A contemporary perspective (pp. 39–54). New York: Springer. Barrett, S. E., Lau Chin, J., Comas-Díaz, L., Espín, O., Greene, B., & McGoldrick, M. (2005). Multicultural feminist therapy: Theory in context. Women and Therapy, 28 (3/4), 27–61.

383

384


Bernal, D. D. (1998). Using a Chicana feminist epistemology in educational research. Harvard Educational Review, 68, 555–579. Brown, L. S. (1991). Antiracism as an ethical imperative: An example from feminist therapy. Ethics and Behavior, 1, 113–127. Brown, L. S. (1992). A feminist critique of the personality disorders. In L. S. Brown & M. Ballou (Eds.), Personality and psychopathology: Feminist reappraisals (pp. 206–228). New York: Guilford. Brown, L. S. (1994). Subversive dialogues: Theory in feminist therapy. New York: Basic Books. Brown, L. S. (1995). Anti-racism as an ethical norm in feminist therapy practice. In J. Adleman & G. Enguidanos (Eds.), Racism in the lives of women: Testimony, theory, and guides to antiracist practice (pp. 137–148). New York: Haworth Press. Brown, L. S. (1997). The private practice of subversion: Psychology as Tikkun Olam. American Psychologist, 52, 449–462. Brown, L. S. (2005). Don’t be a sheep: How this eldest daughter became a feminist therapist. Journal of Clinical Psychology, 61, 949–956. Bryant, R. M., Coker, A. D., Durodoye, B. A., McCollum, V. J., Pack-Brown, S. P., Constantine, M. G., & O’Bryant, B. J. (2005). Having our say: African American women, diversity, and counseling. Journal of Counseling and Development, 83, 313–319. Burbules, N. C., & Berk, R. (1999). Critical thinking and critical pedagogy: Relations, differences, and limits. In R. S. Popkewitz & L. Fendler (Eds.), Critical theories in education: Changing terrains of knowledge and politics (pp. 45–65). New York: Routledge. Butler, J. E. (2000). Transforming the curriculum: Teaching about women of color. In J. A. Banks & C. A. M. Banks (Eds.), Multicultural education: Issues and perspectives (4th ed., pp. 174–193). New York: Wiley. Byars-Winston, A. (2004). Culture-centered counseling with women of color. In D. Atkinson & G. Hackett (Eds.), Counseling diverse populations (3rd ed., pp. 324–343). Boston: McGraw-Hill. Campbell, B., Schellenberg, E. G., & Senn, C. Y. (1997). Evaluating measures of contemporary sexism. Psychology of Women Quarterly, 21, 89–102. Chin, J. L. (2000). Paradigms for Asian American women: Power and connections. In J. L. Chin (Ed.). Relationships among Asian American women (pp. 223–230). Washington, DC: American Psychological Association. Chin, J. L (2005). Learning from my mother’s voice: Family legend and the Chinese American experience. New York: Teachers College Press. Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd ed.). New York: Routledge. Comas-Díaz, L. (1987). Feminist therapy with mainland Puerto Rican women. Psychology of Women Quarterly, 11, 461–474. Comas-Díaz, L. (1991). Feminism and diversity in psychology: The case of women of color. Psychology of Women Quarterly, 15, 597–609. Comas-Díaz, L. (1994). An integrative approach. In L. Comas-Diaz & B. Greene (Eds.), Women of color: Integrating ethnic and gender identities in psychotherapy (pp. 287–318). New York: Guilford Press. Comas-Díaz, L. (2000). An ethnopolitical approach to working with people of color. American Psychologist, 55, 1319–1325. Comas-Díaz, L., & Greene, B. (1994). Women of color with professional status. In L. ComasDíaz & B. Greene (Eds.), Women of color: Integrating ethnic and gender identities in psychotherapy (pp. 347–388). New York: Guilford Press. Comas-Díaz, L., & Jacobsen, F. (1995). The therapist of color and the White patient dyad: Contradictions and recognitions. Cultural Diversity and Mental Health, 1, 93–106. Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Wadsworth. Cross, T., Klein, F., Smith, B., & Smith, B. (1982). Face-to-face, day-to-day—Racism consciousness raising. In G. T. Hull, P. B. Scott, & B. Smith (Eds.), All the women are White, all the Blacks are men, but some of us are brave (pp. 52–56). Old Westbury, NY: The Feminist Press. Dovidio, J. F., Gaertner, S. L., Kawakami, K., & Hodson, G. (2002). Why can’t we just get along? Interpersonal biases and interracial distrust. Cultural Diversity and Ethnic Minority Psychology, 8, 88–102.


Enns, C. Z. (2003). Contemporary adaptations of traditional approaches to the counseling of women. In M. Kopala & M. Keitel (Eds.), Handbook of counseling women (pp. 3–21). Newbury Park, CA: Sage. Enns, C. Z. (2004). Feminist theories and feminist psychotherapies: Origins, themes, and diversity (2nd ed.). Binghamton, NY: Haworth Press. Espín, O. M. (1987). Psychological impact of migration on Latina: Implications for psychotherapeutic practice. Psychology of Women Quarterly, 11, 489–503. Espín, O. M. (1988). Spiritual power and the mundane world: Hispanic female healers in urban U.S. communities. Women’s Studies Quarterly, 16 (3/4), 33–47. Espín, O. M. (1993). Giving voice to silence: The psychologist as witness. American Psychologist, 48, 408–414. Espín, O. M. (1994). Feminist approaches. In L. Comas-Diaz & B. Greene (Eds.), Women of color: Integrating ethnic and gender identities in psychotherapy (pp. 265–286). New York: Guilford Press. Espín, O. M. (1999). Women crossing boundaries: A psychology of immigration and transformations of sexuality. New York: Routledge. Espín, O. M., & Gawelek, M. A. (1992). Women’s diversity: Ethnicity, race, class, and gender in theories of feminist psychology. In L. S. Brown & M. Ballou (Eds.), Personality and psychopathology: Feminist reappraisals (pp. 88–107). New York: Norton. Essed, P. (1991). Understanding everyday racism: An interdisciplinary theory. Newbury Park, CA: Sage. Feminist Therapy Institute (2000). Feminist therapy code of ethics (revised, 1999). San Francisco: Feminist Therapy Institute. Fisher, B. M. (2001). No angel in the classroom: Teaching through feminist discourse. Lanham, MD: Rowman & Littlefield. Freire, P. (1970). Pedagogy of the oppressed (M. B. Ramos, Trans.). New York: Seabury Press. Gaertner, S. L., & Dovidio, J. F. (2005) Understanding and addressing contemporary racism: From aversive racism to the common group identity model. Journal of Social Issues, 61, 615–639. Gentile, L., Kisber, S., Suvak, J., & West, C. (2008). The practice of psychotherapy: Theory. In M. Ballou, M. Hill, & C. West (Eds.), Feminist therapy theory and practice: A contemporary perspective pp. 67–86. New York: Springer. Glick, P., & Fiske, S. T. (1997). Hostile and benevolent sexism: Measuring ambivalent sexist attitudes toward women. Psychology of Women Quarterly, 21, 119–136. Greene, B. A. (1986). When the therapist is White and the patient is black: Considerations for psychotherapy in the feminist heterosexual and lesbian communities. In D. Howard (Ed.), The dynamics of feminist therapy (pp. 41–65). New York: Haworth Press. Greene, B. (1990). What has gone before: The legacy of racism and sexism in the lives of black mothers and daughters. In L. Brown & M. P. Root (Eds.), Diversity and complexity in feminist therapy (pp. 207–230). New York: Haworth Press. Greene, B. (1992). Still here: A perspective on psychotherapy with African-American women. In J. C. Chrisler & D. Howard (Eds.), New directions in feminist psychology: Practice, theory, and research (pp. 13–25). New York: Springer. Greene, B. (1994). African American women. In L. Comas-Diaz & B. Greene (Eds.), Women of color: Integrating ethnic and gender identities in psychotherapy (pp. 10–29). New York: Guilford Press. Hardiman, R. (2001). Reflections on White identity development theory. In C. L. Wijeyesinghe & B. W. Jackson III (Eds.), New perspectives on racial identity development: A theoretical and practical anthology (pp. 108–128). New York: New York University Press. Higginbotham, E. B. (1992). African American women’s history and the metalanguage of race. Signs: Journal of Women in Culture and Society, 17, 251–274. Hoodfar, H. (1997). Feminist anthropology and critical pedagogy: The anthropology of classrooms’ excluded voices. In S. de Castell & M. Bryson (Eds.), Radical in(ter)ventions: Identity, politics, and difference/s in educational praxis (pp. 211–232). Albany, NY: State University of New York Press. hooks, b. (1981). Ain’t I a woman. Boston: South End Press. hooks, b. (1984). Feminist theory: From margin to center. Boston: South End Press. hooks, b. (2000). Feminism is for everybody. Cambridge, MA: South End Press.

385

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Hurtado, A. (1989). Relating to privilege: Seduction and rejection in the subordination of while women and women of color. Signs: Journal of Women in Culture and Society, 14, 833–855. Hurtado, A. (1996). The color of privilege: Three blasphemies on race and feminism. Ann Arbor: University of Michigan Press. Hurtado, A. (2003). Voicing Chicana feminisms: Young women speak out on sexuality and identity. New York: New York University Press. Jackson, L. C. (2000). The new multiculturalism and psychodynamic theory: Psychodynamic psychotherapy and African American women. In. L. Jackson & B. Greene (Eds.), Psychotherapy with African American women: Innovations in psychodynamic perspectives and practice (pp. 1–14). New York: Guilford Press. Kaiser, C. R., & Miller, C. T. (2003). Derogating the victim: The interpersonal consequences of blaming events on discriminating. Group Processes and Intergroup Relations, 6, 227–237. Keith, V. M. (2003). In and out of our right minds: Strengths, vulnerabilities, and the mental well-being of African American women. In D. R. Brown & V. M. Keith (Eds.), In and out of our right minds: The mental health of African American women (pp. 277–291). New York: Columbia University Press. King, D. K. (1988). Multiple jeopardy, multiple consciousness: The context of a Black feminist ideology. Signs: Journal of Women in Culture and Society, 14, 42–72. Kirk, G., & Okazawa-Rey, M. (Eds.). (2001). Women’s lives: Multicultural perspectives (2nd ed.). New York: McGraw Hill. Klein, M. H. (1976). Feminist concepts of therapy outcome. Psychotherapy: Theory, Research and Practice, 13, 89–95. Klonoff, E. A., Landrine, H., & Campbell, R. (2000). Sexist discrimination may account for well-known gender differences in psychiatric symptoms. Psychology of Women Quarterly, 24, 93–99. Klonoff, E. A., & Landrine, H. (2000). Is skin color a marker for racial discrimination? Explaining the skin color-hypertension relationship. Journal of Behavioral Medicine, 23, 329–338. LaFromboise, T. D., Heyle, A. M., & Ozer, E. J. (1990). Changing and diverse roles of women in American Indian cultures. Sex Roles, 22, 455–476. Landrine, H. (1989). The politics of personality disorder. Psychology of Women Quarterly, 13, 325–339. Landrine, H., Klonoff, E. A., & Brown-Collins, A. (1992). Cultural diversity and methodology in feminist psychology: Critique proposal, empirical example. Psychology of Women Quarterly, 16, 145–163. Lerman, H. (1996). Pigeonholing women’s misery. New York: Basic Books. Morrow, S. L., & Hawxhurst, D. M. (1998). Feminist therapy: Integrating political analysis in counseling and psychotherapy. Women and Therapy, 21(2), 37–50. Moya, P. M. L. (2001). Chicana feminism and postmodernist theory. Signs: Journal of Women in Culture and Society, 26, 441–483. Murdock, N. (2008). Theories of counseling and psychotherapy: A case approach (2nd ed.). Old Tappan, NJ: Prentice-Hall. Ossana, S. M., Helms, J. E., & Leonard, M. M. (1992). Do “womanist” identity attitudes influence college women’s self-esteem and perceptions of environmental bias? Journal of Counseling and Development, 70, 402–408. Rawlings, E., & Carter, D. (1977). Feminist and nonsexist psychotherapy. In E. I. Rawlings & D. K. Carter (Eds.), Psychotherapy for women (pp. 49–76). Springfield, IL: C.C. Thomas. Reid, P. T. (2002). Multicultural psychology: Bringing together gender and ethnicity. Cultural Diversity and Ethnic Minority Psychology, 8, 103–104. Reid, P. T., & Kelly, E. (1994). Research on women of color: From ignorance to awareness. Psychology of Women Quarterly, 18, 477–486. Rios-Ellis, B., Aguilar-Gaxiola, S., Cabassa, L., Caetano, R., Comas-Diaz, L., Flores, Y., Gonzales, H., Lopez, S., Lopez Zetina, J., Arroyo, L. E., Rodriguez Chandler, L., Leon, R., & Ugarte, C. (2005). Critical disparities in Latino mental health: Transforming research into action. White paper. Institute for Hispanic Health, NCLR (National Council of La Raza).


Roffman, E. (2008). Ethics and activism: Theory—Identity politics, conscious acts, and ethical aspirations. In M. Ballou, M. Hill, & C. West (Eds.), Feminist therapy theory and practice: A contemporary perspective (pp. 109–125). New York: Springer. Root, M. P. (Ed). (1995). The multiracial experience: Racial borderlands as the new frontier (pp. 167–190). Thousand Oaks, CA: Sage. Sandoval, C. (1998). Mestizaje as method: Feminists-of-color challenge the canon. In C. Trujillo (Ed.), Living Chicana theory (pp. 352–370). Berkeley: Third Woman Press. Sharf, R. S. (2007). Theories of psychotherapy and counseling: Concepts and cases. Belmont, CA: Wadsworth. Shorter-Gooden, K., & Jackson, L.C. (2000). The interweaving of cultural and intrapsychic issues in the therapeutic relationships. In L.C. Jackson & B. Greene (Eds.), Psychotherapy with African American women: Innovations in psychodynamic perspectives and practice (pp. 15–32). New York: Guilford Press. Silverstein, L. B. (2006). Integrating feminism and multiculturalism: Scientific fact or science fiction? Professional Psychology: Research and Practice, 37, 21–28. Sinacore, A. L., & Enns, C. Z. (2005). Diversity feminisms: Postmodern, women-of-color, antiracist, lesbian, third-wave, and global perspectives. In C. Z. Enns & A. L. Sinacore (Eds.), Teaching and social justice: Integrating multicultural and feminist theories in the classroom (pp. 41–68). Washington, DC: American Psychological Association. Sleeter, C. E. (1996). Multicultural education as social activism. Albany, NY: State University of New York Press. Smith, B. (Ed.). (1983). Home girls: A Black feminist anthology. New York: Kitchen Table, Women of Color Press. Sommers-Flanagan, J., & Sommers-Flanagan, R. (2004). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques. Hoboken, NJ: Wiley. Spelman, E. V. (1988). Inessential woman. Boston: Beacon Press. Steele, C. M. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist, 52, 613–629. Stewart, A., & McDermott, C. (2004). Gender in psychology. Annual Review of Psychology, 55, 519–544. Swim, J. K., Aikin, K. J., Hall, W. D., & Hunter, B. A. (1995). Sexism and racism: Old fashioned and modern prejudices. Journal of Personality and Social Psychology, 68, 199–214. Tatum, B. D. (2002). Why are all the Black kids sitting together in the cafeteria? And other conversations about race (rev. ed.). New York: Basic Books. Taylor, J. Y. (1999). Colonizing images and diagnostic labels: Oppressive mechanisms for African American women’s health. Advances in Nursing Science, 21(3), 32–45. Thomas, A. J., & Speight, S. L. (2005). Internalized oppression among Black women. In J. L. Chin (Ed.), The psychology of prejudice and discrimination: Bias based on gender and sexual orientation (Vol. 3, pp. 113–132). Westport, CT: Praeger. Tobol, C., & Walker, G. (2008). The practice of psychotherapy: Application. In M. Ballou, M. Hill, & C. West (Eds.), Feminist therapy theory and practice: A contemporary perspective (pp. 87–108). New York: Springer. Trotman, F. K. (2000). Feminist and psychodynamic psychotherapy with African American women: Some differences. In L. C. Jackson & B. Greene (Eds.), Psychotherapy with African American women: Innovations in psychodynamic perspectives and practice (pp. 251–274). New York: Guilford Press. True, R. H. (1990). Psychotherapeutic issues with Asian American women. Sex Roles, 22, 477–486. Vasquez, H., & Magraw, S. (2005). Building relationships across privilege: Becoming an ally in the therapeutic relationship. In M. P. Mirkin, K. L. Suyemoto, & B. F. Okun (Eds.), Psychotherapy with women: Exploring diverse contexts and identities (pp. 64–83). New York: Guilford. Walter, I. (2006), Sept. 28. No woman, no cry. The Black Commentator, Issue 199. West, C. M. (1995). Mammy, Sapphire, and Jezebel: Historical images of black women and their implications for psychotherapy. Psychotherapy: Theory, Research, and Practice, 32, 458–466. Williams, C. B. (2005). Counseling African American women: Multiple identities—multiple constraints. Journal of Counseling and Development, 83, 278–283.

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Williams, E. N., & Barber, J. S. (2004). Power and responsibility in therapy: Integrating feminism and multiculturalism. Journal of Multicultural Counseling and Development, Extra, 32, 390–401. Wing, A. K. (Ed.). (2000). Global critical race feminism: An international reader. New York: New York University Press. Worell, J. (2001). Feminist interventions: Accountability beyond symptom reduction. Psychology of Women Quarterly, 25, 335–343. Worell, J., & Remer, P. (2003). Feminist perspectives in therapy: Empowering diverse women (2nd ed.). New York: Wiley. Wyche, K. F. (1993). Psychology and African-American women: Findings from applied research. Applied and Preventive Psychology, 2, 115–121. Wyckoff, H. (1977). Radical psychiatry techniques for solving women’s problems in groups. In E. I. Rawlings & D. K. Carter (Eds.), Psychotherapy for women (pp. 392–403). Springfield, IL: C.C. Thomas. Yakushko, O., & Chronister, K. M. (2005). Immigrant women and counseling: The invisible others. Journal of Counseling and Development, 83, 292–298. Yoder, J. D., & Berendsen, L. L. (2001). Outsider within: the firehouse: African American and White women fi refighters. Psychology of Women Quarterly, 25, 27–36. Yoder, J. D., & Kahn, A. S. (1993). Working toward an inclusive psychology of women. American Psychologist, 48, 846–850.

IV Violence and Harassment


Sexual Assault Among Diverse Populations of Women: Common Ground, Distinctive Features, and Unanswered Questions

14 Antonia D. Abbey, Angela J. Jacques-Tiura, and Michele R. Parkhill

Feminist scholars and advocates have changed the way Americans think about sexual violence. Prior to the wave of feminist activism in the 1970s, rape was narrowly defined as physically forced vaginal intercourse (Searles & Berger, 1987). Rape occurred when a stranger used overwhelming physical force to subdue a virtuous woman. Marital rape was legal and the term date rape did not exist. Rape is currently defined in most jurisdictions as vaginal, anal, or oral sexual intercourse obtained through force or threat of force; lack of consent; or inability to give consent due to age, intoxication, or mental status (Bureau of Justice Statistics, 2006). Sexual assault victimization is a more inclusive term that is used to describe the full range of forced sexual activities including physically forced sexual contact (e.g., kissing, touching) and verbally coerced sexual penetration, as well as acts that constitute rape. There are many forms of verbal pressure that are morally reprehensible, yet outside the limits of existing law (Falk, 1998). Although recognizing that men can be sexually assaulted was an important aspect of rape reform, the vast majority of sexual assault victims are women and the vast majority of perpetrators are men (Bureau of Justice Statistics, 2006; Tjaden & Thoennes, 1998).1

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Despite the successes of the women’s movement, rape myths are still widely accepted including the erroneous beliefs that many women make false accusations, that men are unable to stop themselves once sexually aroused, that “no” often means “yes,” that women who sexually tease men deserve what they get, and that drinking women are looking for sex (Burt, 1980; Lonsway & Fitzgerald, 1995). Societal stereotypes about victims of sexual assault have limited the effectiveness of rape reform laws; thus, there has not been a concomitant increase in successful prosecutions (Seidman & Vickers, 2005). Although many sexual assault survivors are denigrated, the situation is frequently worse for women of color, women living in poverty, women with disabilities, and lesbian and bisexual women. These women are marginalized and vilified by many segments of society, frequently being depicted as deserving victims (Balsam, Rothblum, & Beauchaine, 2005; Mansell, Sobsey, & Calder, 1992; Wenzel, Tucker, Hambarsoomians, & Elliot, 2006; West, 2006). In addition to coping with dominant cultural biases, survivors’ responses to sexual assault and the responses of their support networks are influenced by their subcultures’ beliefs about sexual assault and norms about seeking help (Holzman, 1996). This chapter reviews the literature on sexual assault victimization among diverse populations of adult women. It also describes treatment issues, identifies gaps in the literature, and provides recommendations for future research. First, the general sexual assault victimization literature is briefly reviewed to provide a context for the remainder of the chapter.

Characteristics of Sexual Assault in General Population Studies Risk Factors Few risk factors have been identified beyond being female. Although sexual assault victimization occurs throughout the lifespan, it is most common in late adolescence and early adulthood (Bureau of Justice Statistics, 2005; Tjaden & Thoennes, 1998). Childhood sexual abuse is a consistent predictor of adolescent and adult sexual assault victimization (Humphrey & White, 2000; Wyatt, 1992).

Characteristics For most women sexually assaulted in adolescence or adulthood, the perpetrator is a man they know: a date, husband, steady partner, or friend (Koss, 1988; Masho Odor, & Adera, 2005; Moracco, Runyan, Bowling, & Earp, 2007; Tjaden & Thoennes, 1998). Most sexual assaults occur in private locations: the victim’s home, the perpetrator’s home, someone else’s home, or a car (Abbey, Ross, McDuffie, & McAuslan, 1996; Koss, 1988; Tjaden & Thoennes, 1998). Approximately half of all sexual assaults involve alcohol consumption by the perpetrator, the victim, or both (Abbey, Zawacki, Buck, Clinton, & McAuslan, 2004; Kilpatrick, Resnick, Ruggiero, Conoscenti, & McCauley, 2007; Tjaden & Thoennes, 1998). Weapons are rarely used, although most victims report that

Chapter 14 Sexual Assault of Women

the perpetrator used some type of force or threatened to harm them or someone else (Koss, 1988; Masho et al., 2005; Tjaden & Thoennes, 1998).

The Recovery Process Sexual assault victimization has a negative impact on physical, psychological, and social well-being, thereby depriving women of their basic human rights (United Nations, 2006). Approximately half of sexual assault victims report that they experienced physical injuries and most are concerned about the risk of pregnancy and sexually transmitted diseases (Bureau of Justice Statistics, 2002; Resnick et al., 2002). Long-term health consequences include increased gynecological problems, gastrointestinal disorders, and physical complaints; more sick days; poorer perceived health; and greater health care utilization (Golding, 1999; Leserman, 2005; Stein et al., 2004). Mental health consequences include anxiety, depression, suicidal thoughts, post traumatic stress disorder symptoms, difficulty trusting others, and substance abuse (Elliott, Mok, & Briere, 2004; Masho et al., 2005; Silverman, Raj, Mucci, & Hathaway, 2001). Many survivors report that they no longer believe that the world is fair or safe or that other people are intrinsically good (Frazier, Conlon, & Glaser, 2001). Negative responses from service providers are so ingrained that they have been labeled secondary rape (Campbell et al., 1999). Although some sexual assault survivors are hurt by the negative responses they receive from friends and family to whom they disclose, many others benefit from the support they receive (Ahrens, Campbell, Ternier-Thames, Wasco, & Sefl, 2007; Ullman, Townsend, Filipas, & Starzynski, 2007). Most sexual assault survivors also exhibit impressive resilience and growth. One year after being sexually assaulted, many survivors report that they have a greater appreciation of life and their own strengths (Frazier et al., 2001).

Overview of Chapter Culture and personal experience influence the meaning of sexual assault victimization and the recovery process (Bletzer & Koss, 2006). This chapter reviews sexual assault victimization research conducted with women of color, women living in poverty, women with disabilities, and lesbian and bisexual women. We struggled with how best to organize this review. There were too few studies that assessed comparable concepts for a standard quantitative review; however, there were too many studies to describe them all. Some of the studies with large representative samples used limited measures, thus they provided less insight into the topic than did some smaller studies with strong theory and measures. Rather than providing a comprehensive review, we focused on the studies that make the largest contributions to current knowledge regarding sexual assault victimization among diverse groups of adult women. Additional aspects of diversity were considered (e.g., religious denomination, low educational attainment, living in rural areas); however, too few articles were found to review. Each of the major sections below includes a discussion of the unique challenges faced by survivors, a brief review of relevant empirical research, and a

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summary with treatment suggestions. A table is included in each section that summarizes information from studies that reported prevalence rates among that population of women. Given the great variability in the types of studies reviewed, several studies in each section are described in sufficient detail to provide readers with a clear understanding of the state of current research. The final section of the chapter focuses on methodological issues that limit our ability to form conclusions based on this literature and provides suggestions for future research. Our goal is to stimulate methodologically rigorous qualitative and quantitative research that begins to fill the gaps in current knowledge about how recovery from sexual assault victimization is affected by ethnicity, poverty, disabilities, sexual orientation, and other diverse characteristics of women.

Women of Color That guilt affected me most of my life. I didn’t have no respect for myself. (Cheyenne woman, Bletzer & Koss, 2006, p. 18). My husband used to say, “I am married to you, I don’t have to ask or apologize for anything.” (Pakistani American woman, Abraham, 1999, p. 604).

Women of color in the United States must contend with negative ethnic and racial stereotypes which are used to justify their oppression and sexual objectification. Many ethnic minority groups have been systematically abused by the American government and its citizens, and this history of maltreatment has left a “soul wound” (Goldsmith, Hall, Garcia, Wheeler, & George, 2005, p. 405) that must be taken into account to fully understand the impact of sexual assault victimization on women of color. Table 14.1 summarizes information from studies that examined sexual assault prevalence rates among women of color. As can be seen from the table, several of these studies included representative samples of the United States population. Other studies focused on specific regions of the country and a few focused on college students. Measures of sexual assault victimization included one to nine questions. Operationalizations of sexual assault victimization ranged from unwanted sex of any type to physically forced penetrative sex. Using the definitions provided at the beginning of the chapter, the scope of a measure is labeled as rape in the table if it assessed penetrative acts obtained through physical force, threats of physical force, lack of consent or inability to give consent. The scope of a measure is labeled as sexual assault victimization (SAV) if it assessed nonpenetrative sexual acts or verbally coercive strategies or if it used nonspecific terminology, such as unwanted sex. If the measure assessed acts that constituted rape and other forms of sexual assault in such a way that the rates of each could be separately calculated, then both terms are included in the table. Most sexual assault researchers distinguish sexual victimization that occurs in adolescence or adulthood from that which occurs in childhood (typically using a cutoff at age 14 or 16). As can be seen from the table, however, many of these studies did not make this distinction and assessed lifetime experiences. Reported rates of sexual assault victimization vary tremendously depending

14.1 Citation

Sexual Assault Victimization Prevalence Information for Women of Color

Samplinga

Nb,c

Studies With Women From Multiple Ethnic Groups Kalof, 2000 Representative within 37 AA 20 H one college campus 51 API 237 W

Sexual Assault Victimization Response Sourced # items Scopee Rate

Since Age Prevalencef

NA

SES mod.

9

Rape, SAV

In college

28% AA 23% API

37% H 35% W

36%

NVAW mod.

9

Rape, SAV

Lifetime

27% AA 29% Oth

28% W

Masho et al., 2005

Representative RDD sample of Virginia

313 AA 145 Oth

Moracco et al., 2007

Representative RDD sample of United States

163 AA 21 API 69 Mul 52 Oth

86 H* 26 AIAN 1465 W

73%

Authors

2

SAV

18

18% AA 16% H* 0% API 24% AIAN 38% Mul 14% W 13% Oth by someone they knew

Tjaden & Thoennes, 1998, 2006

Representative RDD sample of United States

780 AA 133 API 397 Mul

235 H 88 AIAN 6217 W

72%

NWS mod.

5

Rape

Lifetime

19% AA 7% API 24% Mul

91%

SES mod.

8

Rape, SAV

14

68% AA 57% W

Studies With a Focus on African American Women Abbey et al., Representative sample 338 AA 1996 from one college 700 W Carmody & Washington, 2001 Wingood & DiClemente, 1998

1311 W

12% H 34% AIAN 18% W

Representative sample from one college

178 AA 445 W

72%

SES mod.

9

Rape, SAV

Lifetime

38% AA raped 33% W raped

Street outreach, media ads in San Francisco

165 AA

NA

Authors

1

SAV

15

14%

(Continued)

14.1

Sexual Assault Victimization Prevalence Information for Women of Color (continued)

Citation

Samplinga

Nb,c

Wyatt, 1992

Representative RDD sample in Los Angeles

126 AA 122 W


Since Age Prevalencef

73%

Studies With a Focus on American Indian or Alaskan Native Women Respondent-driven 112 AIAN 83% Evanssampling Campbell et al., 2006

Authors

1

Rape

18

25% AA 20% W

AIS

2

Rape, SAV

Lifetime

48% raped

Malcoe et al., 2004

Tribally operated nutrition clinic in Oklahoma

312 AIAN

96%

Authors

1

SAV

Lifetime

12% by partner

Yuan et al., 2006

Random selection from 6 tribes in United States

793 AIAN

NA

NVAW

4

Rape

18

14%

19%

CTS2

7

Rape, SAV

Lifetime

29% US born by partner 20% migrant by partner 12% immigrant by partner

68%

Authors

1

SAV

16

10% H age 18–39 26% W age 18–39

Studies With a Focus on Hispanic or Latin American Women Community healthcare 292 H Hazen & Soriano, 2007 system clients with partner

Sorenson et al., 1987, 1992

Representative sample of housing units in 2 areas of Los Angeles

766 H 678 W

Studies With a Focus on Asian American or Pacific Islander Women 56% Hicks, 2006 Representative sample 181 API of Chinese Americans in Boston

Authors

1

SAV

Lifetime

2% by partner

Notes: a RDD = random digit dialing, b Some of the studies had larger samples (e.g., included men). Sample sizes reported here correspond to the relevant analyses. c AA = African American or Black, API= Asian American or Pacific Islander, AIAN = American Indian or Alaska Native, H = Hispanic or Latin American, Mul = Multi-ethnic, Oth = Other or not reported by participants, W = White or Caucasian. d AIS = American Indian Services Utilization and Psychiatric Epidemiology Risk and Protective Factors Project, CTS2 = Conflict Tactic Scale revised, SES = Sexual Experiences Survey, NVAW = National Violence Against Women study, NWS = National Women’s Study, mod. = modified version of scale. e Rape includes penetrative acts obtained through physical force, threats of physical force, lack of consent and inability to give consent. Sexual assault victimization (SAV) includes nonpenetrative sexual activities, verbally coercive strategies, and nonspecific terminology, such as unwanted sex. Some measures did not include the full range of items included in the definitions of rape and sexual assault. If the author only used one item and it combined elements of sexual assault and rape (e.g., forced you to engage in any type of sexual activity), then it was labeled SAV in the table. f If SAV and rape items were included, the prevalence rate provided is the SAV rate unless otherwise noted. *H = Hispanics of any race computed in separate analysis; combined here for ease of presentation.

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on the scope of forced sexual activity, age range, phrasing of questions, and number of questions included. Higher rates of sexual assault victimization are usually uncovered with multiple behaviorally-specific questions that use lay language, rather than with questions that use legal labels, such as “rape” or “sexual assault” (Hamby & Koss, 2003; Koss et al., 2007; Lynch, 1996). A quick perusal of Table 14.1 highlights the difficulties associated with attempts to compare prevalence rates across studies, as well as efforts to provide an “overall” or “average” prevalence rate. The National Violence Against Women Survey asked a nationally representative sample of 8,000 women reached by telephone about their experiences as victims of violence (Tjaden & Thoennes, 1998; 2006). Completed rape was assessed with four behaviorally specific questions about lifetime vaginal, oral, or anal sex obtained through physical force or the threat of force. Attempted rape was assessed with a separate single question about attempted vaginal, oral, or anal sex when penetration did not occur. As can be seen in the first section of Table 14.1, 34% of American Indian and Alaskan Native women, 24% of mixed race women, 19% of African American women, 18% of non-Hispanic White women, 12% of Hispanic women, and 7% of Asian and Pacific Islander women reported that they had been raped (Tjaden & Thoennes, 1998; 2006).2 Although this study has many methodological strengths, it used a fairly limited definition of sexual assault victimization, including only penetrative sexual acts achieved through physical force or threats of force. Additionally, this study undersampled low income women and women living in group settings due to the requirement that participants have telephones and permanent residences. American Indian and Alaskan Native women also have low rates of telephone ownership. Differences in sexual assault victimization prevalence rates reported by women from different ethnic groups may reflect genuine differences or they may reflect differences in interpretations of questions and willingness to disclose sexual assault experiences to a researcher. It is also important to acknowledge the great diversity within ethnic groups. It is rare for studies that focus on any of these ethnic groups to include large enough samples to describe the important differences within broad designations such as Native American or Latina. Furthermore, there are individual differences in acculturation, personality, attitudes, and past experiences that influence how women respond to sexual assault. All of these explanations help to account for the variability found across the studies summarized in Table 14.1. With these caveats, the sections which follow summarize research that has examined the characteristics and consequences of sexual assault victimization for African American, American Indian and Alaskan Native, Latina, and Asian American and Pacific Islander women.

African Americans Unique Challenges Many researchers have emphasized the need to consider America’s history of slavery and racism in order to understand African American women’s


responses to sexual assault victimization (Donovan & Williams, 2002; Holzman, 1996; West, 2006; Wyatt, 1992). Stereotypes which depicted African American women as hypersexual temptresses helped justify their routine rape by slave owners. These stereotypes are still commonly endorsed and used to deprecate African American victims (Donovan & Williams, 2002; George & Martínez, 2002). During the 19th century, some rape laws were race-specific and excluded African American victims (West, 2006). Furthermore, the history of lynching African American men who were accused of raping White women and the current high rates of incarceration of African American men have added to African Americans’ distrust of the criminal justice system (Donovan & Williams, 2002; Nash, 2005). Thus, some African American women feel conflicted about reporting a sexual assault committed by an African American man to the authorities because they perceive the legal system as racist and unjust (Nash, 2005; Sorenson, 1996; Washington, 2001; West, 2006). Studies such as the Tuskegee syphilis experiment have made many African Americans suspicious about scientific research and this may reduce disclosure to researchers about sexual assault victimization. Several authors have observed that stereotypes about African American women’s strength during times of adversity can influence their responses to sexual assault victimization (Donovan & Williams, 2002; West, 2006). In many circumstances, this is a positive self-image that empowers African American women to help themselves, friends, family, and community. However, when this persona is strongly internalized, African American women may be uncomfortable admitting to themselves or others that they need help coping with a traumatic event such as sexual assault (Donovan & Williams, 2002; West, 2006).

Literature Review There are surprisingly few articles that examine sexual assault victimization of African American women. Some of these studies include only African Americans (Long, Ullman, Starzynski, Long, & Mason, 2007; Washington, 2001; Wingood & DiClemente, 1998), whereas others compare the experiences of women from different ethnic groups (Abbey et al., 1996; Carmody & Washington, 2001; Neville, Heppner, Oh, Spanierman, & Clark, 2004; Wyatt, 1992). Wyatt (1992) conducted a pioneering study comparing the sexual assault victimization experiences of 126 African American and 122 White American women who were age 18 to 36 (see Table 14.1). Participants were asked about forced vaginal or anal sex since the age of 18. Twenty-five percent of African American women and 20% of White women had been raped, which was a nonsignificant difference. African American women were somewhat more likely than White American women to wait to tell anyone about what happened for several years and African American women also were somewhat less likely to report that their confidants’ responses were supportive. Common longterm effects reported by both groups of women included sleep disturbances, fear, anxiety, depression, and avoidance of sex. There were no significant differences in attributions of responsibility to the perpetrator or themselves; however, African Americans were more likely than Whites to attribute responsibility to the riskiness of their living circumstances. Overall, Wyatt concluded

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that African American and White survivors had similar responses to rape victimization. Abbey et al. (1996) compared the sexual assault victimization experiences of 338 African American and 700 Caucasian college students at a large, urban commuter university (see Table 14.1). A modified version of the Sexual Experiences Survey (SES; Koss et al., 1987) assessed physically forced sexual contact, verbally coerced sexual intercourse, physically forced sexually penetrative acts, and penetrative sex when the woman was unable to give consent due to intoxication or any other reason. African American women were significantly more likely than Caucasian women to have been victims of sexual assault (68% versus 57%), including rape (39% versus 30%). African American students were significantly less likely than Caucasian students to report that either they or the perpetrator consumed alcohol during the assault (30% versus 51%). There were no ethnic differences on a variety of other measures including age at the time of the assault, relationship to the perpetrator, location of the assault, number of dating partners, or past sexual experiences. Long et al. (2007) interviewed a convenience sample of 495 African American women in Chicago. Only participants who had experienced an unwanted sexual experience since the age of 14 were included. Of the participants, 63% reported that they were coerced or forced to engage in vaginal intercourse. (This study is not summarized in Table 14.1. because, rather than assessing prevalence, it sampled only women who had been sexually assaulted.) Approximately one-third of the participants were physically injured. Although 76% of participants told someone about the sexual assault, almost one-third waited at least a year to tell anyone. Among those survivors who discussed the sexual assault with someone, more than 80% reported that at least one person was helpful. The perpetrator was blamed most for the assault, followed by one’s own behavior, society, chance, and one’s character. Long et al. also examined differences based on women’s age and years of education. As compared to more educated survivors, less educated survivors reported more help from informal and formal sources. Less educated survivors also had higher characterological self-blame and lower societal self-blame than more educated survivors. The authors suggest that less educated African American women may be exposed to less information about sexual assault than more educated women. Thus, they may be more likely to believe rape myths and, therefore, blame themselves. Older survivors told fewer informal support sources about the sexual assault victimization and experienced more behavioral self-blame. The authors suggest that older women may be more likely to have grown up with the myth of the African American matriarch and feel that they must handle their problems on their own. This study highlights the importance of disentangling the effects of ethnicity, education, and age. These studies demonstrate the difficulty in forming conclusions based on the existing literature. Each research team used different conceptualizations and measures of sexual assault victimization and focused on different risk factors and consequences. Some researchers contrasted findings for African American and White American survivors; whereas other researchers focused exclusively on African American survivors. As described in the next three sections, this variability also exists in research with American Indian and Alaskan Native, Latina, and Asian American and Pacific Islander sexual assault survivors.


American Indians and Alaskan Natives Unique Challenges There are more than 500 recognized Native American groups that speak approximately 200 different languages and have great diversity in their cultural traditions (Wahab & Olson, 2004). Approximately one-third of American Indians and Alaskan Natives currently live on reservations or in traditional Alaskan villages (Ogunwole, 2006). The United States has a long history of marginalizing its Native inhabitants, including land removal, forced relocation, introduction of alcohol, resource exploitation, and denigration of women (Hamby, 2004; Malcoe, Duran, & Montgomery, 2004; Wahab & Olson, 2004). This oppression has contributed to high levels of unemployment and substance abuse (Wahab & Olson, 2004). Up until the 1970s, many American Indian youth were removed from their families and forced to attend boarding schools. These youth experienced high rates of sexual abuse by teachers, priests, and other staff members (Jaimes, 1992; Wahab & Olson, 2004). Colonists’ perceptions of Natives as impure and immoral were used to justify rape (Smith, 2005). As demonstrated by the high rate of interracial rape experienced by American Indian women as compared to women of other ethnicities, American Indian women are still frequently perceived by men of other ethnicities as appropriate targets for sexual assault (Luna-Firebaugh, 2006). Respect for elders is a strong tradition among many American Indian tribes and this can reduce sexual assault disclosure if victims feel that by doing so they will disgrace their elders (Goldsmith et al., 2005). Many American Indian and Alaskan Native women have been treated poorly by government officials. Thus, like African American women, they frequently do not want to report sexual assaults committed by men from their community because of their deep mistrust of the criminal justice system. They also frequently seek services from traditional health care and spiritual providers, as well as Western providers (Hamby, 2004).

Literature Review Few studies have focused on sexual assault victimization among American Indian and Alaskan Native women (Evans-Campbell, Lindhorst, Huang, & Walters, 2006; Malcoe et al., 2004; Norton & Manson, 1995; Yuan, Koss, Polacca, & Goldman, 2006). Yuan et al. (2006) examined the risk factors for rape victimization among 793 women from six Native American tribes: three in the Southwest, one in the Northwest, one in the Northern Plains, and one in the Northeast (see Table 14.1). Participants were interviewed in their homes by trained Native American interviewers from either the same or a different tribe, at the preference of tribal executives. Completed rape since age 18 was assessed using the four items from the National Violence Against Women survey (Tjaden & Thoennes, 1998). The rape rate was 14% overall, although it ranged from 4% to 29% across tribes. The authors noted that tribes that permitted alcohol sales had higher rape rates. They also noted that rape rates were lower in tribes that used interviewers from the same tribe, suggesting that women may have been more reluctant to disclose to someone from the same tribe. Predictors of rape included being separated, divorced, or cohabitating;

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childhood emotional abuse, physical neglect, or sexual abuse; and alcohol dependence. Women who had spent more of their life off the reservation were more likely to have been raped. Unexpectedly, women who were involved in traditional beliefs and practices were also more likely to have been raped. Although it is impossible to determine from cross-sectional data, the authors suggested that some survivors may have increased their involvement in traditional practices as a coping response. Evans-Campbell et al. (2006) used respondent-driven sampling methods to survey 112 American Indian and Alaska Native women living in New York City (see Table 14.1). Participants were asked if they had ever been raped or had sex when forced or threatened with harm. Forty-eight percent of the participants reported that they had been raped in their lifetime. As compared to women with no history of physical or sexual abuse, women who had been raped had lower incomes, were less likely to work full-time, rated their health less positively, were more likely to have experienced depression, and were more likely to have sought psychological counseling and traditional Native healing.

Latinas Unique Challenges Approximately 14% of the U.S. population is of Hispanic origin (U.S. Census Bureau, 2005). Thirty-eight percent of Hispanics living in the United States were born in another country, including Mexico, Puerto Rico, Cuba, and countries throughout Central and South America. Each of these countries has its own cultural traditions, although many Latina women were raised with the image of womanhood defined by marianismo, which involves sexual purity and care for others without regard for one’s own suffering (Holzman, 1996). Many Hispanic women also follow Catholic teachings, which extol female virginity and propose that women should resist rape even at the cost of their lives. Sexual assault victims may bring dishonor to their male family members who failed to protect them. These norms discourage Latina sexual assault victims from disclosing what happened because of the shame it brings to themselves, their families, and their elders (Goldsmith et al., 2005; Ramos Lira et al., 1999). Sorenson and Siegel (1992) observed that these cultural norms may serve as a protective factor for traditional Latina women. They may be at reduced risk of date rape because they are discouraged from dating until late adolescence and are often chaperoned on dates.

Literature Review There are only a handful of empirical studies that examine sexual assault victimization among Hispanic women. Sorenson and Siegel (1992) summarized the findings from several articles written by their research team that examined sexual assault victimization experiences among 1,444 adult women in the Los Angeles area with 53% self-identified as Hispanic (see Sorenson, Stein, Siegel, Golding, & Burnam, 1987 for the prevalence data in Table 14.1). Victimization experiences were assessed with a single question that asked about being


pressured or forced into sexual contact of any type. As found in other studies, rates of sexual assault victimization were lower among Hispanics than non-Hispanic Whites. Among women aged 18 to 39, 10% of Hispanic women and 26% of non-Hispanic White women had been sexually assaulted; whereas among women aged 40 and older, 6% of Hispanic women and 16% of nonHispanic White women had been sexually assaulted. Overall, sexual assault characteristics were similar for Hispanics and non-Hispanics. Most perpetrators were friends or acquaintances who used verbal pressure to obtain forced intercourse. Common responses to the assault were anger, depression, anxiety, fear, guilt, and dishonor. Approximately two-thirds of Hispanic and nonHispanic White survivors had talked to someone about the sexual assault and both groups were equally likely to report the incident to the police. The only difference in survivors’ responses was that non-Hispanic Whites were more likely than Hispanics to discuss the sexual assault with a therapist. Hazen and Soriano (2007) compared sexual assault victimization prevalence rates for three groups of Latina women, primarily of Mexican descent (see Table 14.1). Women born in the United States, immigrants (legal status not reported), and migrant seasonal workers were randomly selected from the files of a community health care system. Participants were required to be between the ages of 18 and 45 and to be in a relationship with an intimate partner or to have had contact with a former intimate partner within the past 12 months. Sexual assault by one’s partner was measured using the revised Conflict Tactics Scale, a standardized scale that assesses multiple forms of partner violence (Straus, Hamby, Boney-McCoy, & Sugarman, 1996). Twentynine percent of the U.S.-born women had been sexually assaulted by an intimate partner during their lifetimes, as compared to 20% of migrant workers and 12% of immigrants. Sexual assault victimization rates were higher among women who were divorced, separated, or never married; whose incomes were above the poverty level; who had no children; and whose partners had some post-high school education. Although the authors did not measure acculturation, they suggested that the higher rates of partner sexual assault reported by Latina women born in the United States may reflect the struggle to adjust to the majority, mainstream culture while facing discrimination and economic stressors. The low rates of partner sexual assault victimization reported by immigrants may have reflected fear of the legal repercussions of reporting (Sorenson, 1996).

Asian Americans and Pacific Islanders Unique Challenges Asia and the Pacific Islands are home to approximately four billion people that can be divided into more than 30 countries or ethnic groups. The most common countries of origin for Asian Americans are China, India, Philippines, Vietnam, Korea, and Japan (U.S. Census, 2005). Although each country has unique cultural traditions, most of these cultures have a collectivist orientation that contrasts with the United States’ individualistic orientation. Collectivist cultures value duty, harmony, hierarchy, and relatedness. In most Asian

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cultures, women’s modesty and restrained sexuality are valued and social norms restrict sex to marriage (Okazaki, 2002). Asian American women may be reluctant to disclose sexual assault victimization because their culture discourages open discussions of sex, emphasizes female chastity before marriage, and holds women responsible for sex outside of marriage (Abraham, 1999; Okazaki, 2002). They may be worried about stigmatizing their family and community, experiencing shame and loss of face, and disrespecting elders and men (Goldsmith et al., 2005; H.N. Weaver, 2005).

Literature Review We were able to locate only a few studies that described sexual assault victimization among Asian American women, and most countries of origin were not represented (Abraham, 1999; Hicks, 2006). Abraham (1999) conducted in-depth qualitative interviews with 25 Indian, Pakistani, and Bangladeshi immigrant women who had experienced some form of marital abuse. (This study is not summarized in Table 14.1 because it included only women who were sexually assaulted.) Sixty percent of these women had been forced to have sex with their husbands against their will. Most of these women reported that they were first forced to have sex on their wedding night and that their husbands were physically aggressive and paid no attention to their needs. This made them feel empty, lonely, and objectified. Additionally, South Asian culture dictates that husbands have the power to control their wives’ reproduction, deciding when and if they will become mothers. As described by the women interviewed by Abraham, this belief translates into many forced impregnations and abortions.

Immigrant Populations Rape has been used as a tool of war throughout recorded history (Brownmiller, 1975). Hynes (2004) provided a chilling account of the systematic use of rape during war and its long-term effects on women’s health. Reports are still emerging regarding the approximately 200,000 women abducted by the Japanese military during Word War II who were sexual slaves and repeatedly raped. During the past few decades, detailed reports of mass rapes have emerged from many areas of conflict including Bosnia, Cambodia, the Congo, Darfur, Rwanda, and Sierra Leone. Many women who have immigrated to the United States from war torn areas have been raped by soldiers or guards in refugee camps (Goldsmith et al., 2005; Okazaki, 2002). Those who make it out often survived through silence and denial. In addition to the physical and mental health toll, these experiences produce long lasting distrust of authorities, making disclosure and help-seeking unlikely.

Summary and Treatment Implications Given past and current discrimination against women of color, it is not surprising that many women are reluctant to disclose sexual assault victimization to outsiders. Recent immigrants, especially those without legal status, may be particularly disinclined to trust representatives of government agencies. Cultural norms regarding women’s sexual purity, respect for elders, and family


honor also discourage many victims from seeking services. Despite these many reasons for nondisclosure, reported rates of sexual assault victimization are high among women of color. Although there have been several large, nationally representative studies that focused on establishing sexual assault victimization prevalence rates among women of different ethnic groups, very few studies have focused on understanding the diversity within groups. Clearly more research is needed with women of color that examines the psychosocial consequences of victimization and the recovery process. Advocates for women of color have emphasized the importance of providing culturally appropriate services (Hamby, 2004; Holzman, 1996; LunaFirebaugh, 2006; Okazaki, 2002; Russo & Vaz, 2001). Holzman (1996) provided many practical suggestions for counseling sexual assault victims from different ethnic groups. Standard presumptions regarding individualism, selfdetermination, open communication, and emotional expressiveness often conflict with other cultures’ focus on interdependence, deference to authority, indirect communication, and emotional restraint. When therapists try to empower survivors, they must recognize the many forms of power available to women, rather than viewing power solely from a Western, individualistic perspective (Russo & Vaz, 2001). Service providers need to understand different cultures’ norms and modify their standard procedures if they expect women from diverse cultures to utilize their services. In focus groups with women from several ethnic groups, Sorenson (1996) discovered that when shelters did not have appropriate grooming supplies or familiar foods, women reported they felt unwelcome and left as soon as possible. Women from some cultures may appreciate group counseling sessions because of the communal focus, but others may experience intense shame or discomfort if asked to speak about what happened in front of others (Holzman, 1996). Survivors may also feel uncomfortable in support groups comprised of women from other ethnic groups who may have different needs and ways of expressing themselves. Nash (2005) quoted an African American woman who felt she was being pressured by her therapist to attend a treatment group. The woman stated, “I told her, ‘Black folks don’t “do” group. We “do” church … I will not sit there and tell all these White women my business’ ” (p. 1437). Traditional healing rituals and processes, such as sweat lodges and talking circles, can be of great benefit to many survivors (Hamby, 2004). Service providers need to educate themselves about the traditions of their clients and partner with providers from other cultures in order to fully meet survivors’ needs.

Women Living in Poverty [The alcohol and drugs] made the feeling go away, and (with it) the pain and problems, too. (homeless woman, from Nyamathi, Bayley, Anderson, Keenan, & Leake, 1999, p. 106).

Unique Challenges Almost 15% of American women are living in poverty (U.S. Census, 2005). There are large ethnic disparities with 25.6% of African Americans, 25.4% of

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American Indians, 22.4% of Hispanic Americans, 17.6% of Native Hawaiians and other Pacific Islanders, 11.5% of Asians, and 9% of non-Hispanic White Americans living in poverty. Women with disabilities are almost twice as likely to be living in poverty than are women without disabilities (23.3% versus 12.7%). Almost 40% of the homeless are women (U.S. Census, 2005). American society is built on rags to riches stories in which poor children can grow up to be millionaires if they work hard enough. A corollary of this myth is that the poor have not tried hard enough and deserve their fate. Americans have negative attitudes toward individuals living in poverty, individuals receiving public assistance, and the homeless (Phelan, Link, Moore, & Stueve, 1997; Weaver, Shapiro, & Jacobs, 1995). These negative attitudes extend to rape victims who are blamed for being out late or walking through a high crime neighborhood, even if they were trying to get to work or buy groceries for their children. As described by Tyler, Whitbeck, Hoyt, and Cauce (2004), both lifestyle exposure and routine activity theory posit that people are more likely to be victimized if their routine activities expose them to dangerous people and locations. Women living in poverty are likely to reside in neighborhoods and to have jobs that increase their risk of exposure to potential perpetrators. Homeless women are at even greater risk of being victimized because of their increased exposure to potential perpetrators in shelters and on the street.

Literature Review Table 14.2 summarizes the sexual assault prevalence data from studies of women living in poverty, including homeless women. Many of these studies located women living in poverty by sampling residents of subsidized housing, although participants were also recruited from other types of agencies that provide services to low income women. Most of the studies that focused on homeless women located them through homeless shelters, although a few used street sampling. As can be seen from the table, sexual assault victimization was assessed with one to ten items. Operationalizations of sexual assault victimization ranged from forced sexual contact to rape. The time frame also varied considerably across studies, ranging from lifetime experiences to those which occurred during the past 30 days. Ingram, Corning, and Schmidt (1996) surveyed women who lived in lowincome housing and women who were homeless, through service agencies in three cities (see Table 14.2). Sexual assault victimization was measured with the SES which includes a range of types of forced sexual behaviors and strategies. Rates of sexual assault victimization were extremely high among both groups of women, although homeless women reported higher rates than did women living in low income housing. Among the women who were homeless, 58% had been raped since age 14 and 77% had experienced some type of sexual assault, including rape. Among the women living in low-income housing, 45% had been raped since age 14 and 65% had experienced some type of sexual assault, including rape. For both groups of women, sexual assault victimization was significantly positively correlated with frequency of criminal victimization and sexual harassment, and significantly negatively correlated with how much meaning they found in their daily lives. For homeless women, sexual assault victimization was also significantly positively correlated with the amount of

14.2

Sexual Assault Victimization Response Sourceb # items Scopec Rate

Since Age Prevalenced

Citation

Sampling

Na

Ingram et al., 1996

Service agencies in 3 Midwestern cities

113 homeless 116 low income

65%

SES

10

Rape, SAV

14

58% homeless raped 45% low income raped

North et al., 1994

Representative sample of St. Louis shelters

300 homeless

96%

Authors

1

Rape

Lifetime

21%

Rayburn et al., 2005

Representative sample of service agencies in Los Angeles County


90%

NWS mod.

4

Rape, SAV

18

21% rape

Tolman & Rosen, 2001

Random sample of public assistance recipients in Michigan Representative sample of shelters and meal programs in Los Angeles County

753 low income

86%

CTS mod.

1

SAV

Lifetime

19% by partner

394 homeless

88%

Authors

1

SAV

Past 30 days

9%

Representative sample of service agencies in Los Angeles County


81%

NWS mod.

4

Rape, SAV

Past 12 months

6.7% homeless raped 0.4% low income raped

Wenzel et al., 2000

Wenzel et al., 2004

a

Sexual Assault Victimization Prevalence Information for Women Living in Poverty

Some of the studies had larger samples (e.g., included men). Sample sizes reported here correspond to the relevant analyses. CTS = Conflict Tactics Scale, NWS = National Women’s Study, SES = Sexual Experiences Survey, mod. = modified version of scale. c Rape includes penetrative acts obtained through physical force, threats of physical force, lack of consent and inability to give consent. Sexual assault victimization (SAV) includes nonpenetrative sexual activities, verbally coercive strategies, and nonspecific terminology, such as unwanted sex. Some measures did not include the full range of items included in the definitions of rape and sexual assault. If the author only used one item and it combined elements of sexual assault and rape (e.g., forced you to engage in any type of sexual activity), then it was labeled SAV in the table. d If SAV and rape items were included, the prevalence rate provided is the SAV rate unless otherwise noted. b

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distress they experienced in the past few months. For women living in low income housing, sexual assault victimization was also significantly positively correlated with dissatisfaction with their living environment and frequency of negative social exchanges, and significantly negatively correlated with social support satisfaction. This study’s findings illustrate the importance of assessing survivors’ social environment and personal resources. Wenzel and her colleagues have conducted several studies of low income and homeless women (Rayburn et al., 2005; Wenzel et al., 2004, 2006). Rayburn et al. (2005) describe the results from a longitudinal study of 402 women sampled from shelters and 408 sampled from low-income housing units in Los Angeles County (see Table 14.2). Women were asked if they had experienced forced vaginal, anal, or oral sex or other undesired sex acts since the age of 18 and within the past 6 months. At the initial interview, 21% of these women reported being raped since age 18 and almost 2% had been raped in the past six months. Being raped in the past six months was a bivariate predictor of depression at the six month follow-up. Wenzel, Koegel, and Gelberg (2000) examined antecedents of recent sexual and physical assault victimization in a sample of homeless women (see Table 14.2). Nine percent of the women reported that they had been sexually assaulted and 18% had been physically assaulted in the past 30 days. Women who had experienced either type of victimization were compared to those who reported neither. Assault victims were more likely to have slept outdoors during the past month, to be drug dependent, to obtain income from survival strategies such as selling sex or drugs, to have a diagnosis of schizophrenia or mania, and to have physical health limitations. All of these factors heighten women’s vulnerability to predatory men.

Summary and Treatment Implications The extremely high rates of sexual assault victimization reported in some studies of impoverished women are striking. Women who reside in lowincome housing complexes frequently live in neighborhoods with high rates of violence and drug sales that increase their vulnerability to being sexually assaulted. They are likely to have high levels of stress and limited resources; thus, they may experience more severe and more long-lasting physical and mental health consequences of sexual assault (Ingram et al., 1996). Women living in poverty may have little time or energy to deal with the psychological distress caused by sexual assault when they are unable to meet basic needs such as feeding their children (Holzman, 1996). Based on past experience, impoverished women may use coping strategies like endurance and patience, which may not be well understood by middle class service providers who prefer active control-oriented coping strategies (Holzman, 1996). Macro-level solutions are needed to help impoverished sexual assault survivors escape from high-risk living environments and receive needed medical and mental health treatment. Research that finds higher rates of sexual assault among homeless women than housed low-income women suggests that housing is a protective factor (Ingram et al., 1996; Wenzel et al., 2000, 2006). Many women are sexually assaulted in their homes by partners or friends; however, homeless women


have the additional risk of being assaulted by acquaintances or strangers they cannot escape on the street. High rates of mental health and substance abuse problems among the homeless also make them vulnerable targets. Service providers need to reach out to these women at shelters and food banks to provide necessary links to community services. Ingram et al. (1996) suggested that prevention programs should be conducted in shelters that focus on rape education, self-defense training, buddy programs, and helping women recognize their personal coping strengths.

Women With Disabilities The father of a girlfriend kissed and fondled me … in exchange for helping me up and down steps. (woman with physical disability, from Nosek, Foley, Hughes, & Howland., 2001, p. 184). We may be vulnerable, but we don’t have to be victims. (woman who is quadriplegic due to multiple sclerosis, from Newroe, 1999, p. 53).

Unique Challenges The Americans with Disabilities Act (1990) defines disability as “a physical or mental impairment that substantially limits one or more of the major life activities.” Using this definition, approximately 15% of American women have a disability (U.S. Census, 2005). There are many negative stereotypes about women with disabilities that make them invisible and reduce societal concern about their victimization experiences (Curry, Hassouneh-Phillips, & Johnston-Silverberg, 2001). Women with disabilities are perceived as asexual, unfeminine, passive, dependent, and oblivious to pain. When individuals with disabilities report abuse, they are often disbelieved, because it is assumed that no one would want to have sex with them. The insensitivity to pain myth allows others to minimize these women’s need for treatment services. Advocates for women with disabilities have argued that they experience higher rates of abuse than other women because their physical and cognitive impairments increase their vulnerability to sexual assault (Mansell et al., 1992; Powers, Curry, Oschwald, & Maley, 2002). Individuals with disabilities who live in institutional settings are at extremely high risk of experiencing repeated sexual abuse from staff members (Andrews & Veronen, 1993). Independently living women with disabilities experience the same forms of sexual assault victimization experienced by women without disabilities, and have the added burden of sexual assault victimization by attendants and caregivers (Curry et al., 2001; Powers et al., 2002). Women with disabilities often report being unwilling to disclose sexual abuse by caregivers because of concerns about finding alternative care. They often report that they have no back-up care and losing this attendant would require them to move from their home to an institution (Nosek et al., 2001; Powers et al., 2002). Many individuals with disabilities are treated as children and assumed to be asexual; thus they often do not receive adequate sex education. This puts

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them at increased risk of sexual victimization because they are not taught self-protective behaviors or assertiveness skills. Other factors that increase the risk of sexual assault victimization among women with disabilities include perpetrators’ belief that there is less risk of discovery and providers’ unwillingness to believe victims’ stories of abuse (Andrews & Vernonen, 1993). Women with cognitive impairments may be particularly trusting of others and unable to discern perpetrator manipulative strategies.

Literature Review Table 14.3 presents sexual assault victimization prevalence information abstracted from studies of women with physical and cognitive disabilities. As can be seen from the table, we found only three studies that provided prevalence data. One of these studies used a representative sample of a single state; whereas the others recruited participants from independent living centers which provided services for individuals with disabilities. Sexual assault victimization was measured with one to three questions that asked about forced sexual activity of any type. Two studies assessed lifetime sexual victimization experiences and one assessed victimization in the past year. Nannini (2006) examined the initial encounter records at 30 Massachusetts rape crisis centers across a nine-year time period (not included in the table because all participants were sexual assault victims). Ten percent of the 16,672 women treated at these centers reported having some type of disability. The experiences of women with disabilities and women without disabilities were similar in many ways, although there were some differences. Women with disabilities were older, on average, when sexually assaulted and were more likely to have been sexually assaulted on at least one prior occasion. Women in both groups were most likely to be sexually assaulted by a friend or family member; however, women with disabilities were more likely than other women to be sexually assaulted by a caregiver or service provider. Women in both groups were most likely to report that the assault occurred in their home; only four percent of women with disabilities reported that the assault occurred in an institutional setting. Women with disabilities were less likely than women without disabilities to have told a family member or a friend about the sexual assault; however, they were more likely to have reported the sexual assault to the police and to have received medical treatment. This finding appears to conflict with the reports described earlier about the reluctance of women with disabilities to report sexual assault because of concerns about being believed and finding alternative care (Curry et al., 2001). This apparent inconsistency might be explained by the sampling strategy; women who seek care from rape crisis centers represent only a subset of sexually assaulted women. Young, Nosek, Howland, Chanpong, and Rintala. (1997) recruited women with physical disabilities from independent living centers and through announcements in various publications (see Table 14.3). Each woman who responded was sent two surveys and asked to give one to a friend without disabilities. Forty percent of the women with disabilities and 37% of the women without disabilities had been sexually abused during their lifetime. Approximately 90% of the women in both groups were sexually assaulted by someone they knew, with dating partners, spouses, and family members being

14.3

a

Sexual Assault Victimization Prevalence Information for Women with Disabilities Sexual Assault Victimization Response Sourcec # items Scoped Rate

Citation

Samplinga

Nb

Since Age Prevalencee

Martin et al., 2006

Representative RDD survey of North Carolina

1443 with disability 3883 without disability

NA

BRFSS

1

SAV

Past 12 months

1.5% with disability 0.6% without disability

Powers et al., 2002

Independent living centers mailed surveys to all clients

200 with disability

12%

Authors

3

SAV

Lifetime

53% by any perpetrator 16% by caregiver

Young et al., 2007

Independent living centers and ads across US

439 with disability 421 without disability

45%

Authors

1

SAV

Lifetime

40% with disability 37% without disability

RDD = random digit dialing, Some of the studies had larger samples (e.g., included men). Sample sizes reported here correspond to the relevant analyses. c BRFSS = Behavioral Risk Factor Surveillance System. d Rape includes penetrative acts obtained through physical force, threats of physical force, lack of consent and inability to give consent. Sexual assault victimization (SAV) includes nonpenetrative sexual activities, verbally coercive strategies, and nonspecific terminology, such as unwanted sex. Some measures did not include the full range of items included in the definitions of rape and sexual assault. If the author only used one item and it combined elements of sexual assault and rape (e.g., forced you to engage in any type of sexual activity), then it was labeled SAV in the table. e If SAV and rape items were included, the prevalence rate provided is the SAV rate unless otherwise noted. b

412


the most common perpetrators. Women with physical disabilities were more likely than women without disabilities to be sexually assaulted by an attendant. Also, the sexual abuse experienced by women with physical disabilities went on for a longer period of time than did the abuse experienced by women without disabilities (3.9 years versus 2.5 years). The authors suggested that women with physical disabilities may have less access to domestic violence shelters and feel powerless to escape an abusive partner or caregiver. Powers et al. (2002) were particularly concerned about abuse perpetrated by caregivers. They sent recruitment materials to independent living centers and service agencies in four regions of the country to obtain a sample of women with physical disabilities who lived in non-congregate community residences and relied on aid from paid or unpaid personal assistants at least three times a week (see Table 14.3). Fifty-three percent of participants reported that they had been sexually abused at least once in their lifetime. Eleven percent of he participants had been touched sexually in an unwanted way by a caregiver and 5.5% were forced into unwanted sexual activity by a caregiver. Participants were also asked to rate the importance of various barriers in preventing them from stopping caregivers’ abuse. The highest ratings were given to the shortage of providers and lack of back up care, not knowing who to call for help, fearing backlash from the caregiver, and believing crisis center staff would not understand their situation.

Summary and Treatment Implications In several of the studies reported here, some participants needed help from caregivers or agency staff in order to complete the surveys because of their disabilities. Although reported victimization rates were high, concerns about confidentiality may have discouraged some women from disclosing past victimization. It is important that researchers use measurement strategies that allow women with disabilities as much privacy as possible, such as audiotaped self-interviews or interviews with trained survey staff rather than service providers. Women with physical, learning, and emotional disabilities have unique challenges that increase their risk of experiencing sexual assault victimization. Many of these women need to be touched by others in order to perform basic activities of daily living such as bathing and dressing. Women with cognitive and emotional impairments may have difficulty recognizing early signs of inappropriate behavior, thus heightening their risk. Many women with disabilities have learned that others do not take their concerns seriously and that their options for care are limited. Thus they often are unwilling to report sexually assaultive victimization experiences. All these factors make women with disabilities appealing targets for men who enjoy exerting control over women. Mansell et al. (1992) made several suggestions about adaptations that can be made to traditional therapies to make them more appropriate for victims with disabilities, including using co-therapists to ensure expertise in sexual assault and disability-relevant issues. Law enforcement, hospital, and crisis center staff who work with sexual assault victims need to understand the unique needs of survivors with different types of disabilities (Andrews & Veronen, 1993). For example, speech problems and disorientation are exacerbated by emotional


distress for many individuals with cerebral palsy. Thus, some sexual assault victims with cerebral palsy have been mistakenly identified as intoxicated and not taken seriously. Victims need an advocate who understands the dimensions of their disability and can ensure that they receive adequate care.

Lesbian and Bisexual Women They think that I haven’t found the right one, that’s why I’m a lesbian. They say that I haven’t found the one with a big one. (lesbian describing men’s reactions to her in Finlinson et al., 2003, p. 282). We’ve got a partner who wants to be [sexual] and a survivor who is saying “no”— would that qualify as sexual abuse? There is power and control … it could get in the way. (service provider describing issues with lesbian clients, from Ristock, 2003, p. 337)

Unique Challenges Researchers who focus on issues of concern to lesbian and bisexual women seldom include detailed questions about sexual assault in their surveys. Morris and Balsam (2003) suggested that this topic has been avoided because researchers did not want to reinforce the cultural myth that sexual abuse by a man can make some women become lesbians. If differences are found in rates of sexual assault victimization reported by heterosexual women and lesbians, there are many possible explanations. Lesbian and bisexual women may be the targets of sexual assault victimization because of their sexual orientation (Balsam et al., 2005; Pilkington & D’Augelli, 1995). Adolescents who disclose their sexual orientation are frequently rejected by their families and are at heightened risk of running away, thereby increasing their risk of being sexually assaulted (Balsam et al., 2005; Whitbeck et al., 2004). Lesbians may also be more willing to disclose past sexual abuse than heterosexual women because the process that they went through to acknowledge their sexual orientation made them more comfortable acknowledging other stigmatizing life experiences (Hughes, Johnson, & Wilsnack, 2001). Another explanation for the relatively limited amount of research in this area concerns feminists’ theories of sexual assault. Feminists have struggled to change societal perceptions of sexual assault as a crime of passion to one of patriarchal control and dominance over women (Brownmiller, 1975; Burt, 1980). These theories do not easily transfer to relationships between women, although issues of power, control, and how to negotiate conflict are issues that must be addressed in most relationships (Lockhart, White, Causby, & Isaac, 1994; Waldner-Haugrud, 1999). Stereotypes about women being nonviolent may lead both lesbian and heterosexual researchers to ignore sexual, emotional, verbal, and physical violence within lesbian relationships (Waldner-Haugrud, 1999). Furthermore, measures of sexual assault victimization have been developed primarily to document women’s experiences with male perpetrators. The types of sex which are forced and the tactics used to obtain forced sex may differ when the perpetrator and the victim are both women (Waldner-Haugrud, 1999). As documented in the literature review below, often when lesbian and

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bisexual women are explicitly surveyed about sexual assault victimization, the perpetrator’s gender is not assessed. When it is assessed, the perpetrator is usually a man. Thus, research which documents high rates of sexual assault among lesbian and bisexual women does not demonstrate that women are frequent perpetrators.

Literature Review Table 14.4 summarizes information about adolescent and adult sexual assault victimization prevalence in studies with lesbian and bisexual women. One of these studies examined a representative sample of the United States population, whereas the others focused on organizations, periodicals, and events developed for lesbian and bisexual women. Sexual assault was measured with one to 10 questions that assessed a range of types of forced sexual activities. The timeframe ranged from age 14 to the past two years. Some studies compared the rates for lesbian, bisexual, and heterosexual women, whereas other studies only included lesbian and bisexual women. Moracco et al. (2007) conducted a nationally representative telephone survey of adult women, with 42 participants identifying themselves as lesbian or bisexual and 1,751 identifying themselves as heterosexual (see Table 14.4). Sexual assault was operationalized as any type of forced sexual experience since the age of 18. Two questions were asked, with one focused on perpetrators the woman knew and one focused on strangers. Forty-seven percent of lesbian and bisexual women reported being sexually assaulted by someone they knew as compared to 13% of heterosexual women. Twenty-two percent of lesbian and bisexual women reported being sexually assaulted by a stranger as compared to 5% of heterosexual women. Perpetrators’ gender was not assessed. Morris and Balsam (2003) distributed questionnaires to sites frequented by lesbian and bisexual women, as well as through mailing lists and social networks (see Table 14.4). Participants were asked one question about sexual assault victimization since age 16 and then to describe their relationship to the perpetrator. Thirty-four percent of participants had been sexually assaulted by a man and 6% had been sexually assaulted by a woman. Only 3.5% of the perpetrators were female lovers, girlfriends, or partners. Current psychological distress was higher among survivors of sexual assault as compared to women who had not been sexually assaulted. Many women who were sexually abused in childhood included a handwritten statement on the questionnaire that this was not the reason they were lesbian. The authors suggest that childhood sexual abuse may force girls to think about sexuality at an earlier age, hence leading lesbians to recognize their sexual identity at an earlier age. Balsam et al. (2005) recruited lesbians, gays, bisexuals, and their heterosexual siblings to obtain a comparison group that would have comparable family history demographics (see Table 14.4). Sexual assault victimization was measured with a modified 10-item SES which assesses a range of types of forced sexual activities and strategies since age 14. Rape victimization rates among lesbian and bisexual women were approximately twice as high as rape rates for heterosexual siblings (16% & 17% versus 8%). The vast majority of perpetrators were men. Among women who were rape survivors, 24% of lesbians, 14% of bisexual women, and none of the heterosexual women reported that the

14.4


Citation

Samplinga,b

Nc

Balsam et al., 2005

LGB periodicals and organizations in US

54%

SES mod.

Bradford et al., 1994 Heidt et al., 2005 Hughes et al., 2001

LGB health organizations in US LGB community events and organizations Newspaper ads, flyers, social networks in Chicago Representative RDD sample of United States Bookstores, mailing lists, community and social groups Organization mailing list, chain referrals, in 2 cities

332 lesbian 125 bisexual 340 heterosexual 1925 lesbian

42%

Authors

1

123 lesbian

NA

10

63 lesbian 57 heterosexual

NA

SES mod. Authors

42 lesbian, bisexual 1751 heterosexual

73%

2413 lesbian, bisexual 203 lesbian

Morocco et al., 2007 Morris & Balsam, 2003 Otis & Skinner, 1996

a

Sexual Assault Victimization Prevalence Information for Lesbian and Bisexual Women

10

Rape, SAV

SAV

Since Age Prevalencef 14

Adult

16% lesbian raped 17% bisexual raped 8% heterosexual raped 19%

Rape, SAV

18

36%

1

SAV

18

39% lesbian 42% heterosexual

Authors

2

SAV

18

24%

Authors

1

SAV

16

47% lesbian or bisexual 13% heterosexual by someone they knew 34% by male perpetrator 6% by female perpetrator

53%

Authors

4

SAV

Past 2 years

4% by male perpetrator 1% by female perpetrator

RDD = random digit dialing, LGB = lesbian, gay, and bisexual. c Some of the studies had larger samples (e.g., included men). Sample sizes reported here correspond to the relevant analyses. d SES = Sexual Experiences Survey, mod. = modified version of scale. e Rape includes penetrative acts obtained through physical force, threats of physical force, lack of consent and inability to give consent. Sexual assault victimization (SAV) includes nonpenetrative sexual activities, verbally coercive strategies, and nonspecific terminology, such as unwanted sex. Some measures did not include the full range of items included in the definitions of rape and sexual assault. If the author only used one item and it combined elements of sexual assault and rape (e.g., forced you to engage in any type of sexual activity), then it was labeled SAV in the table. f If SAV and rape items were included, the prevalence rate provided is the SAV rate unless otherwise noted. b

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perpetrator was a woman. Participants’ relationship to the perpetrator was not assessed, so it is not known if male perpetrators were aware of lesbians’ and bisexual women’s sexual orientation or if some of the assaults occurred in the context of dating relationships.

Summary and Treatment Implications Although lesbian and bisexual women report high rates of sexual assault victimization, most of this sexual violence did not occur in their relationships with women. Instead, most of these sexual assaults were perpetrated by men. Questions were not included in these studies regarding the context in which adolescent and adult sexual assault victimizations occurred; thus it is not known if most occurred at a point in time when participants were dating men, were perpetrated by men who did not know them or their sexual preference, or by men who intentionally sexually assaulted them because of their sexual orientation. The trajectory of recovery from sexual assault victimization is likely to vary for lesbian and bisexual women sexually assaulted under these different types of circumstances. Mental health professionals working with lesbian and bisexual women need to carefully screen for past sexual assault victimization under these varying types of circumstances. Balsam (2003) observed that some lesbian and bisexual rape survivors may not want to disclose their sexual orientation to service providers due to concerns about discrimination, yet they are less likely to receive satisfactory care under these circumstances. Balsam also suggested that the lesbian and bisexual community may be unsupportive of women sexually abused by another woman because of its history of minimizing the extent of partner violence in lesbian relationships.

Conclusions and Recommendations for Future Research Sexual assault victimization remains a hidden epidemic that adversely affects all women, regardless of ethnicity, class, health status, or sexual orientation. Women with identities that are marginalized by mainstream society face a variety of unique challenges that can heighten their vulnerability to sexual assault victimization and its negative consequences. Cultural norms of the larger society, as well as the myriad of groups through which individuals define their identities, provide a lens through which survivors respond to sexual assault (Neville & Heppner, 1999). Thus, the meaning of sexual assault and its consequences are influenced by survivors’ cultural beliefs (Holzman, 1996). Furthermore, aspects of survivors’ cultural identity influence institutional responses to their requests for help. Victim blame is endemic; however, the extent to which survivors feel they must hide what happened because of the shame they will bring on themselves and their families is strongly determined by cultural norms. Each woman will respond uniquely to sexual assault victimization based on her own history and resources, thus it is important to avoid making assumptions based solely on one aspect of identity such as sexual orientation or ethnicity.


The current state of the sexual assault victimization literature does not allow detailed conclusions to be made about the role of ethnicity, poverty, disability, sexual orientation or other aspects of diversity. Thus, this concluding section highlights important directions for future research.

Assess Characteristics and Consequences of Sexual Assault Victimization Although it is important to demonstrate the high rates of sexual assault victimization among diverse populations of women to mobilize support for prevention and treatment services, we strongly encourage researchers to focus future efforts on systematically assessing the characteristics and consequences of sexual assault victimization among diverse groups of women. What circumstances put different groups of women at increased risk of exposure to sexually assaultive men? What types of individual and external resources influence the course of recovery among diverse groups of women? How do cultural norms influence the likelihood that survivors will disclose to others and how others will respond to them? What types of individual and cultural resilience factors enhance the recovery process? Although many theoretical papers have discussed the effects of cultural images of women on the recovery process, such as the strong matriarch for African American women or for Latina women, only a few researchers have attempted to assess sexual assault survivors’ adherence to these beliefs and how they affect the recovery process (Long et al., 2007; Neville et al., 2004; Yuan et al., 2006). Additionally, many researchers have argued that members of marginalized groups are unlikely to disclose sexual assault victimization to others because of cultural norms and the expectation of receiving negative responses from others both outside and within their cultural group. Some of the studies reviewed in this chapter found fairly high rates of disclosure to informal and formal support providers (Long et al., 2007; Nannini, 2006; Sorenson & Siegel, 1992; Wyatt, 1992); thus more nuanced hypotheses are needed to evaluate the circumstances that affect disclosure among diverse populations.

Use Qualitative and Quantitative Methods Future research will be most meaningful if it includes qualitative as well as quantitative methods and if it is developed by research teams with expertise in both sexual assault and the populations of women being studied. Qualitative research is needed to ensure that questions designed to assess sexual assault victimization are appropriate for women from different groups and have the same meaning to participants as they do to researchers (cf. Hamby & Koss, 2003; Testa, VanZile-Tamsen, Livingston, & Koss, 2004). For example, Sorenson (1996) found confusion among immigrants regarding what types of force were illegal in the United States. Qualitative research can also identify important cultural norms that need to be assessed and different responses to sexual assault victimization among diverse groups of women (Bletzer & Koss, 2006).

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Use State-of-the-Art Survey Research Methodologies Many of the studies reviewed in this chapter have methodological limitations. General population surveys frequently do not include questions about important aspects of diversity such as disability status and sexual orientation (for exceptions see Martin et al., 2006; Moracco et al., 2007). General population studies also seldom have sufficient numbers of participants from these diverse groups to establish reliable prevalence estimates. Strategies commonly used to obtain representative surveys of the general population such as random digit dialing are not optimal for hidden populations. It is challenging to develop sampling methodologies for hard-to-reach groups that are truly representative, rather than oversampling members who are most visible (e.g., sampling lesbians and bisexuals at popular venues or sampling women with disabilities from health care service providers). New approaches to systematically sampling hidden populations that have shown promise need to be more widely used, such as respondent-driven sampling (Heckathorn, 2002). Other studies had low response rates and relied on mail surveys, paper and pencil surveys, or surveys administered by program staff. Survey researchers have established an extensive literature that describes strategies to improve questionnaire design and maximize response rates (Fowler, 1993). Audio computer-assisted personal interviews allow participants to privately answer questions which are read aloud to them through a computer. Research suggests that many people are more willing to disclose sensitive information to a computer than to another person (Newman et al., 2002). There are trade-offs associated with different methodological choices and clearly some methodologies are more appropriate for use with some populations than others. Researchers need to give careful thought as to how to maximize the willingness of survivors from diverse backgrounds to share their stories with them.

Conduct Longitudinal Studies Researchers also need to recognize that cross-sectional surveys provide only a snapshot and do not establish causality. There are complex relationships between childhood sexual abuse, domestic violence, living in poverty, being homeless, mental health problems, and substance abuse that contribute to sexual revictimization. Longitudinal studies that follow young women throughout their adult years are essential in order to examine how different life experiences contribute to sexual assault recovery and revictimization among diverse populations of women.

Establish Collaborations Between Researchers With Different Areas of Expertise Sexual assault researchers need to routinely include questions that assess a variety of sociocultural factors so that they can more accurately describe the diverse subgroups represented in their studies. Sexual assault researchers who do not have expertise working with a specific population should collaborate with others who have that expertise to ensure that their questions are appropriate and cover issues important to that population. For example, sexual


assault researchers who are unfamiliar with the disability literature may not be aware of the unique role of caregivers as perpetrators among women with disabilities. Consequently, they may not realize the importance of asking questions that determine if the sexual assault victimization occurred in the caregiving context and/or involved threats to withhold care. Sexual assault researchers who are unfamiliar with gender role norms among South Asian populations may not be aware of cultural norms regarding husbands’ sexual prerogatives. Consequently, they may not realize the frequency with which marital rape occurs and the conflict that women immigrants experience between the norms of their country of origin and their new country (Sorenson, 1996). In a complementary manner, researchers who have expertise with a specific population but not with sexual assault should collaborate with sexual assault researchers to ensure that they assess sexual assault adequately. Many of the studies described in this chapter did not use state-of-the-art measures of sexual assault victimization, thus it is unlikely that the full scope of the problem was uncovered. Furthermore, as demonstrated by the information included in the tables, comparisons cannot be made across studies when most researchers develop their own measures that assess different dimensions of sexual assault victimization across different timeframes. The characteristics of childhood sexual abuse and its consequences differ from adolescent and adult sexual assault; thus it is important to use measures that allow these two forms of sexual victimization to be distinguished. Information about the victim’s age, relationship to perpetrator, and the perpetrator’s gender should be routinely collected. This chapter focused exclusively on sexual assault victimization, partially because other chapters in this book focus on other types of interpersonal violence and partially because most researchers assess only one form of violence.3 Most women, however, experience multiple forms of interpersonal violence and must cope with them simultaneously. Thus it is important that more research considers the co-occurrence of different forms of violence and how this affects the recovery process (McHugh et al., 2005).

Consider Multiple Aspects of Diversity Every woman has multiple identities. Yet with few exceptions (Bradford et al., 1994; Honeycutt et al., 2001; Long et al., 2007; Morris & Balsam, 2003), most researchers do not consider the intersection of different aspects of diversity and how these multiple identities affect women’s experiences with sexual assault victimization. For example, are lesbian and bisexual Mexican American survivors treated differently by friends and family than heterosexual Mexican American survivors or European American lesbian and bisexual survivors? Do survivors with disabilities who have high incomes receive better treatment from service providers than those living in poverty? These are just a few of the many complex questions that need to be addressed in order to develop prevention and treatment programs that meet all women’s needs.

Advocate for an End to Sexual Violence After documenting war’s frequently ignored, horrendous effects on women and children, Hynes (2004) stated that she found hope in the belief that if

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people were, “faced with the full harm of war, and not fed the sanitized version ... we—at least enough of us—could be compelled to make war stoppable.” (p. 442). Researchers and practioners who care about ending sexual violence against women need to find ways to make it “stoppable” by insuring through advocacy that their experiences are used to guide public policy.

Endnotes 1. The terms victim and survivor are used in this chapter to acknowledge both aspects of sexual assault. Women who have been sexually assaulted have been victimized and demonstrate their survival skills throughout the recovery process. 2. There is controversy regarding the most appropriate terms to describe ethnic groups and those preferred by researchers are not always preferred by group members. Rather than imposing specific labels, we mirror the language of the studies reviewed. Some of the studies reviewed here included male and female victims. Given this chapter’s focus on women’s victimization experiences, only women’s data are reported. 3. Some of the studies reviewed in this paper included multiple forms of violence. Due to page constraints and overlap with other chapters, only sexual assault victimization findings were described.

Acknowledgments Rochelle DeCastro assisted with the literature review.

References Abbey, A., Ross, L. T., McDuffie, D., & McAuslan, P. (1996). Alcohol and dating risk factors for sexual assault among college women. Psychology of Women Quarterly, 20, 147–169. Abbey, A., Zawacki, T., Buck, P. O., Clinton, A. M., & McAuslan, P. (2004). Sexual assault and alcohol consumption: What do we know about their relationship and what types of research are still needed? Aggression and Violent Behavior, 9, 271–303. Abraham, M. (1999). Sexual abuse in South Asian immigrant marriages. Violence Against Women, 5, 591–618. Ahrens, C. E., Campbell, R., Ternier-Thames, N. K., Wasco, S. M., & Sefl, T. (2007). Deciding whom to tell: Expectations and outcomes of rape survivors’ first disclosure. Psychology of Women Quarterly, 31, 38–49. American with Disabilities Act (1990). 42 United States Code, Section 12102. Andrews, A. B., & Veronen, L. J. (1993). Sexual assault and people with disabilities. Journal of Social Work and Human Sexuality, 8, 137–159. Balsam, K. F. (2003). Traumatic victimization in the lives of lesbian and bisexual women: A contextual approach. Journal of Lesbian Studies, 7, 1–14. Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting and Clinical Psychology, 73, 477–487. Bletzer, K. V., & Koss, M. P. (2006). After-rape among three populations in the Southwest: A time for mourning, a time for recovery. Violence Against Women, 12, 5–29. Bradford, J., Ryan, C., & Rothblum, E. D. (1994). National lesbian health care survey: Implications for mental health care. Journal of Consulting and Clinical Psychology, 62, 228–242.


Brownmiller, S. (1975). Against our will: Men, women and rape. New York: Simon & Schuster. Bureau of Justice Statistics. (2002). Rape and sexual assault: Reporting to police and medical attention, 1992–2000. Washington, DC: U.S. Department of Justice. NCJ 194530. Bureau of Justice Statistics. (2005). Violent victimization of college students, 1995–2002. Washington DC: U.S. Department of Justice. NCJ 206836. Bureau of Justice Statistics. (2006). Criminal victimization in the United States, 2005. Washington DC: U.S. Department of Justice. NCJ 214644. Burt, M. R. (1980). Cultural myths and supports for rape. Journal of Personality and Social Psychology, 48, 217–230. Campbell, R., Sefl, T., Barnes, H. E., Ahrens, C. E., Wasco, S. M., & Zaragoza-Diesfeld, Y. (1999) Community services for rape survivors: Enhancing psychological well-being or increasing trauma? Journal of Consulting and Clinical Psychology, 67, 847–858. Carmody, D. C., & Washington, L. M. (2001). Rape myth acceptance among college women: The impact of race and prior victimization. Journal of Interpersonal Violence, 16, 424–436. Curry, M. A., Hassouneh-Phillips, D., & Johnston-Silverberg, A. (2001). Abuse of women with disabilities: An ecological model and review. Violence Against Women, 7, 60–79. Donovan, R., & Williams, M. (2002). Living at the intersection: The effects of racism and sexism on Black rape survivors. Women and Therapy, 25, 95–105. Elliott, D. M., Mok, D. S., & Briere, J. (2004). Adult sexual assault: Prevalence, symptomatology, and sex differences in the general population. Journal of Traumatic Stress, 17, 203–211. Evans-Campbell, T., Lindhorst, T., Huang, B., & Walters, K. L. (2006). Interpersonal violence in the lives of urban American Indian and Alaska Native women: Implications for health, mental health, and help-seeking. American Journal of Public Health, 96, 1416–1422. Falk, P. J. (1998). Rape by fraud and rape by coercion. Brooklyn Law Review, 64, 44–180. Finlinson, H. A., Robles, R. R., Colon, H. M., Lopez, M. S., Negron, M. D., Oliver-Velez, D., et al. (2003). Puerto Rican drug users’ experiences of physical and sexual abuse: Comparisons of sexual identities. The Journal of Sex Research, 40, 277–285. Fowler, F. J., Jr. (1993). Survey research methods. Newbury Park, CA: Sage. Frazier, P., Conlon, A., & Glaser, T. (2001). Positive and negative life changes following sexual assault. Journal of Consulting and Clinical Psychology, 69, 1048–1053. George, W. H., & Martínez, L. J. (2002). Victim blaming in rape: Effects of victim and perpetrator race, type of rape, and participant racism. Psychology of Women Quarterly, 26, 110–119. Golding, J. M. (1999). Sexual-assault history and long-term physical health problems: Evidence from clinical and population epidemiology. Current Directions in Psychological Science, 8, 191–194. Goldsmith, R. E., Hall, G. N., Garcia, C., Wheeler, J., & George, W. H. (2005). Cultural aspects of sexual aggression. In K. H. Barrett & W. H. George (Eds.), Race, culture, psychology, and law (pp. 403–418). Thousand Oaks CA: Sage. Hamby, S. L. (2004). Sexual victimization in Indian country: Barriers and resources for native women seeking help. Harrisburg, PA: VAWnet. http://www.vawnet.org. Hamby, S. L., & Koss, M. P. (2003). Shades of gray: A qualitative study of terms used in the measurement of sexual victimization. Psychology of Women Quarterly, 27, 243–255. Hazen, A. L., & Soriano, F. I. (2007). Experiences with intimate partner violence among Latina women. Violence Against Women, 13, 562–582. Heckathorn, D. D. (2002). Respondent-driven sampling II: Deriving valid population estimates from chain-referral samples of hidden populations. Social Problems, 49, 11–34. Heidt, J. M., Marx, B. P., & Gold, S. D. (2005). Sexual revictimization among sexual minorities: A preliminary study. Journal of Traumatic Stress, 18, 533–540. Hicks, M. H.-R. (2006). The prevalence and characteristics of intimate partner violence in a community study of Chinese Americans. Journal of Interpersonal Violence, 21, 1249–1269. Holzman, C. G. (1996). Counseling adult women rape survivors: Issues of race, ethnicity, and class. Women & Therapy, 19, 47–62. Honeycutt, T. C., Marshall, L. L., & Weston, R. (2001). Toward ethnically specific models of employment, public assistance, and victimization. Violence Against Women, 7, 126–140. Hughes, T. L., Johnson, T., & Wilsnack, S. C. (2001). Sexual assault and alcohol abuse: A comparison of lesbians and heterosexual women. Journal of Substance Abuse, 13, 515–532.

421

422


Humphrey, J. A., & White, J. W. (2000). Women’s vulnerability to sexual assault from adolescence to young adulthood. Journal of Adolescent Health, 27, 419–424. Hynes, H. P. (2004). On the battlefield of women’s bodies: An overview of the harm of war to women. Women’s Studies International Forum, 27, 431–445. Ingram, K. M., Corning, A. F., & Schmidt, L. D. (1996). The relationship of victimization experiences to psychological well-being among homeless women and low-income housed women. Journal of Counseling Psychology, 43, 218–227. Jaimes, M. A. (1992). American Indian women: At the center of indigenous resistance in contemporary North America. In M. A. Jaimes (Eds.), The state of native America (pp. 311–344). Boston: South End Press. Kalof, L. (2000). Ethnic differences in female sexual victimization. Sexuality & Culture: An Interdisciplinary Quarterly, 4, 75–97. Kilpatrick, D. G., Resnick, H. S., Ruggiero, K. J., Conoscenti, L. M., & McCauley, M. S. (2007). Drug-facilitated, incapacitated, and forcible rape: A national study. Washington, DC: U.S. Department of Justice, NCJ 219181. Koss, M. P. (1988). Hidden rape. In A. W. Burgess (Ed.), Rape and sexual assault II (pp. 3–25). New York: Garland. Koss, M. P., Abbey, A., Campbell, R., Cook, S., Norris, J., Testa, M., et al. (2007). Revising the SES: A collaborative process to improve assessment of sexual aggression and victimization. Psychology of Women Quarterly, 31, 357–370. Koss, M. P., Bailey, J. A., Yuan, N. P., Herrera, V. M., & Lichter, E. L. (2003). Depression and PTSD in survivors of male violence: Research and training initiatives to facilitate recovery. Psychology of Women Quarterly, 27, 130–142. Koss, M. P., Gidycz, C. A., & Wisniewski, N. (1987). The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. Journal of Consulting and Clinical Psychology, 55, 162–170. Leserman, J. (2005). Sexual abuse history: Prevalence, health effects, mediators, and psychological treatment. Psychosomatic Medicine, 67, 906–915. Lockhart, L. L., White, B. W., Causby, V., & Isaac, A. (1994). Letting out the secret: Violence in lesbian relationships. Journal of Interpersonal Violence, 9, 469–492. Long, L. M., Ullman, S. E., Starzynski, L. L., Long, S. M., & Mason, G. E. (2007). Age and educational differences in African American women’s sexual assault experiences. Feminist Criminology, 2, 117–136. Lonsway, K. A., & Fitzgerald, L. F. (1995). Attitudinal antecedents of rape myth acceptance. Journal of Personality and Social Psychology, 68, 704–711. Luna-Firebaugh, E. M. (2006). Violence against American Indian women and the ServicesTraining-Officers-Prosecutors Violence Against Women (STOP VAIW) program. Violence Against Women, 12, 125–136. Lynch, J. P. (1996). The polls-review: Clarifying divergent estimates of rape from two national surveys. Public Opinion Quarterly, 60, 410–430. Malcoe, L. H., Duran, B. M., & Montgomery, J. M. (2004). Socioeconomic disparities in intimate partner violence against Native American women: A cross-sectional study. BMC Medicine, 2, 20. Mansell, S., Sobsey, D., & Calder, P. (1992). Sexual abuse treatment for persons with developmental disabilities. Professional Psychology: Research and Practice, 23, 404–409. Martin, S. L., Ray, N., Sotres-Alvarez, D., Kupper, L. L., Moracco, K. E., Dickens, P. A., et al. (2006). Physical and sexual assault of women with disabilities. Violence Against Women, 12, 823–837. Masho, S. W., Odor, R. K., & Adera, T. (2005). Sexual assault in Virginia: A population-based study. Women’s Health Issues, 15, 157–166. McHugo, G. J., Caspi, Y., Kammerer, N., Mazelis, R., Jackson, E. W., Russell, L., et al. (2005). The assessment of trauma history in women with co-occurring substance abuse and mental disorders and a history of interpersonal violence. Journal of Behavioral Health Services & Research, 32, 113–127. Moracco, K. E., Runyan, C. W., Bowling, J. M., & Earp, J. A. L. (2007). Women’s experiences with violence: A national study. Women’s Health Issues, 17, 3–12. Morris, J. F., & Balsam, K. F. (2003) Lesbian and bisexual women’s experiences of victimization: Mental health, revictimization, and sexual identity development. Journal of Lesbian Studies, 7, 67–85.


Nannini, A. (2006). Sexual assault patterns among women with and without disabilities seeking survivor services. Women’s Health Issues, 16, 372–379. Nash, S. T. (2005). Through Black eyes: African American women’s constructions of their experiences with intimate male partner violence. Violence Against Women, 11, 1420–1440. Neville, H. A., & Heppner, M. J. (1999). Contextualizing rape: Reviewing sequelae and proposing a culturally inclusive ecological model of sexual assault recovery. Applied & Preventive Psychology, 8, 41–62. Neville, H. A., Heppner, M. J., Oh, E., Spanierman, L. B., & Clark, M. (2004). General and culturally specific factors influencing Black and White rape survivors’ self-esteem. Psychology of Women Quarterly, 28, 83–94. Newman, J. C., Des Jarlais, D. C, Turner, C. F., Gribble, J., Cooley, P., & Paone, D. (2002). The differential effects of face-to-face and computer interview modes. American Journal of Public Health, 92, 294–297. Newroe, K. (1999). A cautionary tale. If you are a victim of abuse, it’s not your fault. New Mobility, 3, 53–64. North, C. S., Smith, E. M., & Spitznagel, E. L. (1994). Violence and the homeless: An epidemiological study of victimization and aggression. Journal of Traumatic Stress, 7, 95–110. Norton, I. M., & Manson, S. M. (1995). A silent minority: Battered American Indian women. Journal of Family Violence, 10, 307–318. Nosek, M. A., Foley, C. C., Hughes, R. B., & Howland, C. A. (2001). Vulnerabilities for abuse among women with disabilities. Sexuality and Disability, 19, 177–189. Nyamathi, A., Bayley, L., Anderson, N., Keenan, C., & Leake, B. (1999). Perceived factors influencing the initiation of drug and alcohol use among homeless women and reported consequences of use. Women & Health, 29, 99–114. Ogunwole, S. U. (2006). We the people: American Indians and Alaska Natives in the United States, Census 2000 Special Reports. Washington, DC: U.S. Department of Commerce. Okazaki, S. (2002). Influences of culture on Asian Americans’ sexuality. The Journal of Sex Research, 39, 34–41. Otis, M. D., & Skinner, W. F. (1996). The prevalence of victimization and its effect on mental well-being among lesbian and gay people. Journal of Homosexuality, 30, 93–121. Phelan, J., Link, B. G., Moore, R. E., & Stueve, A. (1997). The stigma of homelessness. Social Psychology Quarterly, 60, 323–337. Pilkington, N. W., & D’Augelli, A. R. (1995). Victimization of lesbian, gay, and bisexual youth in community settings. Journal of Community Psychology, 23, 34–56. Powers, L. E., Curry, M. A., Oschwald, M., & Maley, S. (2002). Barriers and strategies in addressing abuse: A survey of disabled women’s experiences. Journal of Rehabilitation, 68, 4–13. Resnick, H., Monnier, J., Seals, B., Holmes, M., Nayak, M., Walsh, J., et al. (2002). Raperelated HIV risk concerns among recent rape victims. Journal of Interpersonal Violence, 17, 746–759. Ristock, J. L. (2003). Exploring dynamics of abusive lesbian relationships: Preliminary analysis of a multisite, qualitative study. American Journal of Community Psychology, 31, 329–341. Russo, C. F., & Vaz, K. (2001). Addressing diversity in the decade of behavior: Focus on women of color. Psychology of Women Quarterly, 25, 280–294. Searles, P., & Berger, R. J. (1987). The current status of rape reform legislation: An examination of state statues. Women’s Rights Law Reporter, 10, 25–43. Seidman, I., & Vickers, S. (2005). The second wave: An agenda for the next 30 years of rape law reform. Suffolk University Law Review, 38, 467–491. Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. Journal of the American Medical Association, 286, 572–579. Smith, A. (2005). Conquest: Sexual violence and American Indian genocide. Cambridge, MA: South End Press. Sorenson, S. B. (1996). Violence against women: Examining ethnic differences and commonalities. Evaluation Review, 20, 123–145.

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Sorenson, S. B., & Siegel, J. M. (1992). Gender, ethnicity, and sexual assault: Findings from a Los Angeles study. Journal of Social Issues, 48, 93–104. Sorenson, S. B., Stein, J. A., Siegel, J. M., Golding, J. M., & Burnam, M. A. (1987). The prevalence of adult sexual assault: The Los Angeles Epidemiologic Catchment Area project. American Journal of Epidemiology, 126, 1154–1164. Stein, M. B., Lang, A. J., Laffaye, C., Satz, L. E., Lenox, R. J., & Dresselhaus, T. R. (2004). Relationship of sexual assault history to somatic symptoms and health anxiety in women. General Hospital Psychiatry, 26, 178–183. Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised Conflict Tactic Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283–316. Testa, M., VanZile-Tamsen, C., Livingston, J. A., & Koss, M. P. (2004). Assessing women’s experiences of sexual aggression using the sexual experiences survey: Evidence for validity and implications for research. Psychology of Women Quarterly, 28, 256–265. Tjaden, P., & Thoennes, N. (1998). Prevalence, incidence, and consequences of violence against women: Findings from the national violence against women survey. Washington, DC: U.S. Department of Justice, NCJ 172837. Tjaden, P., & Thoennes, N. (2006). Extent, nature, and consequences of rape victimization: Findings from the national violence against women survey. Washington, DC: U.S. Department of Justice, NCJ 210346. Tolman, R. M., & Rosen, D. (2001). Domestic violence in the lives of women receiving welfare. Violence Against Women, 7, 141–158. Tyler, K. A., Whitbeck, L. B., Hoyt, D. R., & Cauce, A. M. (2004). Risk factors for sexual victimization among male and female homeless and runaway youth. Journal of Interpersonal Violence, 19, 503–520. Ullman, S. E., Townsend, S. M., Filipas, H. H., & Starzynski, L. L. (2007). Structural models of the relations of assault severity, social support, avoidance coping, self-blame, and PTSD among sexual assault survivors. Psychology of Women Quarterly, 31, 23–37. United Nations. (2006). In depth study on all forms of violence against women. Report of the Secretary General. http://daccessdds.un.org/doc/UNDOC/GEN/N06/419/74/PDF/ N0641974.pdf United States Census Bureau. (2005). American community survey. Washington, DC: U.S. Department of Commerce. Wahab, S., & Olson, L. (2004). Intimate partner violence and sexual assault in Native American communities. Trauma, Violence, & Abuse, 5, 353–366. Waldner-Haugrud, L. K. (1999). Sexual coercion in lesbian and gay relationships: A review and critique. Aggression and Violent Behavior, 4, 139–149. Washington, P. A. (2001). Disclosure patterns of Black female sexual assault survivors. Violence Against Women, 7, 1254–1283. Weaver, H. N. (2005). Reexamining what we think we know: A lesson learned from Tamil refugees. Affilia, 20, 238–245. Weaver, R. K., Shapiro, R. Y., & Jacobs, L. R. (1995). The polls—trends: Welfare. Public Opinion Quarterly, 59, 606–633. Wenzel, S. L., Koegel, P., & Gelberg, L. (2000). Antecedents of physical and sexual victimization among homeless women: A comparison to homeless men. American Journal of Community Psychology, 28, 367–390. Wenzel, S. L., Tucker, J. S., Elliott, M. N., Hambarsoomians, K., Perlman, J., Becker, K., et al. (2004). Prevalence and co-occurrence of violence, substance use and disorder, and HIV risk behavior: A comparison of sheltered and low-income housed women in Los Angeles County. Preventive Medicine, 39, 617–624. Wenzel, S. L., Tucker, J. S., Hambarsoomians, K., & Elliott, M. N. (2006). Toward a more comprehensive understanding of violence against impoverished women. Journal of Interpersonal Violence, 21, 820–839. West, C. M. (2006). Sexual violence in the lives of African American women: Risk, response, and resilience. Harrisburg, PA: VAWnet. http://www.vawnet.org. Whitbeck, L. B., Chen, X., Hoyt, D. R., Tyler, K. A., & Johnson, K. D. (2004). Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. The Journal of Sex Research, 41, 329–342.


Wingood, G. M., & DiClemente, R. J. (1998). Rape among African American women: Sexual, psychological, and social correlates predisposing survivors to risk of STD/HIV. Journal of Women’s Health, 7, 77–84. Wyatt, G. E. (1992). The sociocultural context of African American and White American women’s rape. Journal of Social Issues, 48, 77–91. Young, M. E., Nosek, M. A., Howland, C., Chanpong, G., & Rintala, D. H. (1997). Prevalence of abuse of women with physical disabilities. Archives of Physical Medicine and Rehabilitation, 78, S34–S38. Yuan, N. P., Koss, M. P., Polacca, M., & Goldman, D. (2006). Risk factors for physical assault and rape among six Native American tribes. Journal of Interpersonal Violence, 21, 1566–1590.

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Intimate Partner Violence: Perspectives From Racial/ Ethnic Groups in the United States

15 Irene Hanson Frieze and Karen Y. Chen

An important mental and physical health issue for women is the presence of violence in their closest relationships. Violence in couples is called intimate partner violence or IPV by researchers today. Such violence can exist at various levels from extreme violence with serious injury, to relatively low level forms of “violence” such as pushing or shoving. It can be one-sided, with one member of the couple being highly violent and the other relatively nonviolent, or it can be more mutual with both members engaging in violence (see Williams & Frieze, 2005). It is estimated that expenditures for medical care, mental health services, and lost productivity from injury and premature death for intimate partner violence against women in the United States costs over $8 billion per year (Max, Rice, Finkelstein, Bardwell, & Leadbetter, 2004). Estimates of the prevalence of physical violence among couples vary depending on how the questions are asked, and how the sample is obtained. Men and women also tend to make different estimates about the presence of violence in a relationship, with women being more likely to notice their own violence and violence from their partners and to report on this in surveys (Graham & Wells, 2001). Williams and Frieze (2005), looking at different types of couple violence

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in a nationally representative sample of over 4,000 men or women who were part of a couple that was living together or married, found that 18% of couples had some type of severe or mild violence in their relationships. However, less than 7% of the sample reported severe violence (involving kicking, hitting, biting, chocking, using a weapon, or beating up the partner). More than 60% of those labeled as having “violent” relationships reported only mild violence (verbal threats, slapping, throwing objects, or pushing or shoving). In another community sample that used a national representative sample, Anderson (2002) found that 10% of all couples reported some type of violence to each other in the last year. Looking at the patterns of violence in more detail, it was noted that in 7% of the couples, both were violent. For 2% of the couples, only the woman was violent, and for 1%, only the man was violent. So, even though the percentages were lower (probably because of the limited time period of only 1 year), the same general pattern was seen of more women reporting engaging in violent acts toward their partner than men in Anderson’s study. Severity of violence was not assessed in this study, but it did appear that much of the “violence” was not severe. Much of the research on couple violence considers any use of physical aggression as violent (Frieze, 2005b). This is unfortunate, since more recent research is suggesting that the nature of IPV may be very different in mild violence situations as compared to those in which severe violence and battering occurs (see Frieze, 2005b). In the following sections we describe these violent relationships in more detail. As can be seen, women, even more than men, do react to both mild and severe violence in a variety of ways. In addition to physical injury, women who are targets of partner violence suffer from a variety of physical and mental health problems, and are more likely to react to the stress associated with these relationships with negative health indicators such as smoking, alcohol and drug abuse, eating disorders, and sexual risktaking (Heise, Ellsberg, & Gottmoeller, 2002). After analyzing general patterns in violent relationships, we then look in more detail at how these relationships operate for different groups as a function of socioeconomic status, race, immigrant status, sexuality, and disability.

Types of Violence in Relationships Describing the Severely Violent Relationship: The Battered Woman When people think of violent partnerships, most think of a battering man and his abused female partner. As noted above, this is not the most common situation in which partners use physical violence with each other. But, such relationships do occur and have important social consequences. Many researchers looking at intimate partner violence have this type of battering situation in mind, although they generally do not restrict the study to those using severe violence. This is the type of situation in mind when a legal defense based on the “Battered Woman Syndrome” is used (Allard, 2005). Because of the focus on battering in research on intimate partner violence, we examine this type of relationship in detail.

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Intimate Partner Violence

In the most typical pattern of severe couple violence, a husband or male partner becomes extremely violent toward his wife or female partner, using physical violence as well as psychological abuse or belittling of his partner. Often, the batterer is violent to his children as well, meaning that physical child abuse is also present. It is not unusual for the batterer to abuse alcohol or drugs. These related issues create additional complexities, making it difficult to clearly know how much the violence itself is contributing to the reactions found in battered women. (Frieze, 2005a). An essential component of this type of relationship is a high level of “coercive control” exercised by the batterer over his partner (Dutton & Goodman, 2005). Such control includes routine surveillance of the woman by the batterer, as he monitors her behavior and controls whom she interacts with. In these relationships, high levels of violence become routine, with the woman living in constant fear that something she does will initiate another round of violence. Over time, the female victim develops low self-esteem, after hearing so often that she deserves the physical abuse. She may fight back, but typically her resistance is ineffective in stopping the violence, and she often receives a more severe beating when she tries to respond with her own violence. She may also seek help from the police or escape from a particularly violent incident and go to a shelter for battered women or another safe location, but this typically does not stop the violence. She may leave briefly, but often returns to the batterer. Another form of partner aggression is psychological. This is often associated with severe physical violence, but does not have to be. Psychological aggression can include attempts to dominate or undermine the partner, indifference toward the partner, monitoring of the partner’s behavior, and isolation of the partner (Jones, Davidson, Bogat, Levendosky, & von Eye, 2005). These behaviors tend to occur together and can be found in severely violent relationships as well as in less physically violent partnerships. Reactions to these nonviolent forms of aggression can be just as severe as toward acts of physical aggression (Frieze, 2005a; Jones et al., 2005). Women’s Reactions to Severe Violence. Women have both emotional and physical reactions to severe violence (Frieze, 2005a). Injuries or illness sustained from such violence heightens the battered women’s risk for hospital visits (Coker, Smith, Bethea, King, & McKeown, 2000). For example, violence from one’s partner results in high levels of stress, which in turn creates a weakened immune system for the battered woman and raises her likelihood of illness. At some point in the relationship, many victims of severe partner violence do seek formal help (Frieze, 2005a). This can be from the police, from social agencies such as shelters or safe houses, from counselors, or from clergy or religious institutions. Given the increasing attention to intimate partner violence, hospital emergency rooms are beginning to screen for partner violence and may provide referrals (Koss, Bailey, Yuan, Herrera, & Lichter, 2003; Weiss, Ernst, Cham, & Nick, 2003). Help may also be available through fi ling of legal action to bar an abusive person from the home. Leaving a Violent Partner. Battered women remain in these abusive relation-

ships for a variety of reasons (Frieze, 2005a). They may love their abuser, in

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spite of his violence. They may feel that he needs her and that she needs to remain with him because of this need. Other reasons include feeling unable to live on her own (feelings that grow out of low self esteem caused by psychological abuse), lack of financial resources to leave and live on her own or as a single parent (the batterer typically controls money within the couple and gives her little access to funds), or lack of any social support network that might assist her in leaving. The lack of social support is again typical because a batterer often systematically cuts off outside social contact for the battered woman, and monitors her behavior to ensure that she does not have close ties to family or friends. If the battered woman does actually try to break up the relationship by leaving, it is common for the batterer to try to find where she has gone and to threaten her if she is not willing to come back. Many women in this situation file for legal protection, but this is not always effective. The abuser may ignore the restraining order and seek her out. He may ask her to come back to him, or may react with extreme violence. Because of this, relationship violence tends to become even more severe during this break-up time (Frieze, 2005a). Battered Women’s Shelters. Shelters are probably one of the most important institutional sources of help for survivors of severe partner violence (O’Leary, 2000; Sedlak, 1988). Shelters are generally open to the public and are low cost. They generally accept women and their children, but they may not take all women. Some shelters may not allow women to bring adolescent male children. Others require that the women be over 18 years of age. Shelters may be of more assistance for victims of severe violence than for those involved in other types of less violent relationships. Shelters are often crowded and shelter workers have to make decisions about whom to admit and whom to reject. Such decisions may be based on beliefs about who the typical battered woman is. Those who do not fit this pattern may be rejected (Rothenberg, 2003). Perhaps because of difficulties in being accepted, or in getting to a shelter, or because of embarrassment about seeking help for IPV or other reasons, it appears that relatively few battered women seek help from shelters (Frieze, 2005a). Other studies have suggested that battered women may delay seeking help at a shelter or other social service agency because they fear their partners will be arrested or jailed. And, there are no shelters at all for men who are victims of marital or couple violence. Gondolf (1998) surveyed a sample of women who had sought police protection for partner violence. Only 7% of these women had ever stayed at a domestic violence shelter. Seeking Help From the Police. One of the solutions for dealing with a physically

abusive partner is calling the police for protection. In the 1980s and 1990s, many women protested that police were not doing enough to help battered women. Calls to police often resulted in a brief visit from the police, a short talk with the batterer, and the police leaving. Afterward, the batterer might become even more abusive. Much frustration was expressed about this. As a result of strong lobbying by feminist groups upset about situations in which police were called, but no arrests were made, mandatory arrest laws were passed in many communities. Such laws required that if there was evidence of physical violence, the violent person had to be arrested. Unfortunately, such laws have resulted in many women as well as men being arrested. The women may have been fighting back, or may have initiated violence first, but are arrested in

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either case. Knowledge that this could happen may make women less likely to call for help (Frieze, 2005a). Most IPV Is Not Battering. The pattern of IPV that has just been described is only one of many types of physical aggression that can occur in intimate partner relationships. Other patterns may involve lower levels of violence, or mutual violence between partners. In a small percentage of relationships, the female partner is highly violent toward her male partner. Although there has been very little research looking at these different types of relationships, researchers are currently working in this area.

Less Violent Forms of Intimate Partner Aggression Severe violence by a battering man against his female partner is not the only type of couple violence, nor even the most common form of physical aggression in couples. A good deal of evidence suggests that many intimate partners and other family members engage in low-level or mild violence with each other. Researchers have begun to examine these less extreme forms of physical aggression recently in married couples and in same-sex and heterosexual couples living together (Frieze, 2000). Milder forms of physical aggression have been found to be especially associated with dating couples. Many of the studies of dating violence rely primarily on samples of college students. It is estimated that couple violence of some type occurs in at least 20% of dating relationships, and perhaps far more (Slashinski, Coker, & Davis, 2003). But, studies of more diverse samples do not always find these high rates. Using the National Violence Against Women survey, a nationally representative sample, Slashinski et al. (2003) reported that about 8% of women and 2% of men reported at least one type of physical violence from a dating partner. Many of the reported incidents of violence in this study would be classified as mild violence, although more severe violence was also found. Victims of either mild or more severe violence did show higher rates of depressive symptoms and therapeutic drug use. The women victims were also more likely to report recreational drug use. A meta-analysis published by Archer (2000) of marital and dating violence studies found that many studies have shown that women actually engage in more acts of physical aggression than men. Such data are difficult to relate to the work on battered women, especially since there is such clear evidence of battered women being abused by partners. But, further examination of these studies indicated that much of the “violence” found in many couples consists of hitting, slapping, shoving, or other relatively minor acts of physical aggression. As noted above, many of the samples used were studies of dating violence in college students. Even with these limitations, as Archer noted, the majority of those who do suffer injury from violent behavior of a romantic partner are women. But, at the same time, it is clear that there are some women who can and do engage in highly violent acts toward their partners. As researchers begin to re-examine the findings on couple violence, one of the questions being raised is whether low-level violence has health consequences. In one study attempting to answer this question, Williams and Frieze (2005) used data from the National Comorbidity Survey to look at the psychological consequences of mild and severe violence. It was found that even mild

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violence had some association with psychological distress and marital dissatisfaction, although a stronger relationship was found for women than for men. In spite of this general finding, there was a small subsample of women and men who did not appear to have adverse reactions to couple violence, but little is known about this group. Other work has similarly noted that both sexes react negatively to partner violence, but women’s reactions tend to be more severe (Coker, Weston, Creson, Justice, & Blakeney, 2005). In spite of women having negative reactions even to minor violence, it does not appear that they are as likely to see help at shelters for battered women, as those with more severe violent victimization (e.g., Graham-Kevan & Archer, 2003).

Intimate Partner Violence in Different Groups of Women The past research on intimate partner violence has focused primarily on White or Black women and heterosexual couples, and has generally not considered other racial and ethnic minority groups, such as Latinas or Asian women, or partner violence in same-sex couples (see YllÖ, 2005, for more discussion of these omissions in the research). Fortunately, an increasing body of literature is beginning to include different racial and ethnic groups and analyzes the experiences of different groups of women. We draw on this literature in this chapter. The available evidence suggests that despite differences in language, religion, and custom, intimate partner violence occurs across all social and economic levels. But, the interplay of gender with race, ethnicity, class, and immigration creates a complex framework for understanding intimate partner violence across racial and ethnic groups (Goel, 2005; Raj & Silverman, 2002a; Shiu-Thornton, Senturia, & Sullivan, 2005; Sokoloff & Dupont, 2005; Yoshihama, 2001). As we look at the experiences of women within different groups, we have omitted any detailed discussion of the reactions of men to violence from a female or a male partner. Some men clearly experience such violence, but there has been relatively little research on their experiences, especially looking at the experiences of men within different ethnic or other groups.

Experiences of White/Anglo Women As mentioned earlier in this chapter, much of the existing body of research on women victimized by an intimate partner has not considered that different types of women might have unique experiences in terms of their own behavior and the reactions of others to their victimization. Much of this work has implicitly assumed that the experiences of White women are the same as those for other groups. As we discuss in the remainder of this chapter, this is clearly not the case. There are major differences in the experiences of partner violence in different groups of women. At the same time, although research has often assumed that all women are the same, and that White women are the prototypical battered women, very little research has examined the specific experiences of certain types of White women, such as those who are middle or upper income. There is extensive evidence that partner violence is related to income, as well as to education levels (Kaukinen, 2004). Thus, poor White women are the most likely to suffer IPV. As will be discussed, poor women of all groups

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have special problems in coping with partner violence. But higher SES, White women can also be victims of IPV. Such women may find it easier to get help, than poor White women or women of color, regardless of income level. Their financial resources give them more options for shelter as they try to escape a violent partner. Women with more economic resources may be able to find temporary housing in hotels or other temporary housing and may be less interested in finding free shelter. Such women may also be more successful in getting assistance from police and the legal system generally because they fit the image of the “battered woman” more closely. However, more systematic and targeted studies are needed to better understand specific issues relating to White women’s experiences of partner violence. Research assuming that data from White women will generalize to everyone has examined a variety of issues in relationships and how they relate to partner violence. For example, issues such as consumption of alcohol and how that might relate to partner violence have been examined. Alcohol is predictive for all groups, with violence levels higher in men who tend to drink a lot (Frieze, 2005a). Another general predictor of emotional abuse, in particular, is incompatibility in status between the woman and man in the relationship (Kaukinen, 2004). But, such studies have not explicitly asked whether these findings generalize across all groups.

Experiences of Poor Women Many studies have shown that rates of previous violent victimization in the United States are especially high for women who are very poor or are homeless (e.g., Browne & Bassuk, 1997). Controlling for ethnicity, Cunradi, Caetano, and Schafer (2002) found the male to female violence was greater in low income Blacks and Hispanics than in those within these groups with higher incomes. This study did not find an effect of income for Whites, although the average income levels for White families were much higher than for the other ethnic groups. Similar findings were reported in a study of low income pregnant women in Chicago (Sagrestano, Carroll, Rodriguez, & Nuwayhid, 2004). In this study, income levels were also significantly related to violence levels, after controlling for ethnicity. There are several reasons why being poor is associated with IPV. First, when poor women do attempt to find and maintain employment, the batterer’s actions may make this difficult. Researchers have suggested that men may be threatened by their partner’s employment and may wish to keep their partners financially dependent (Kaukinen, 2004). In interviews with female welfare recipients who were attempting to find employment, Brush (2002) found that batterers might sabotage their car, not show up at a promised time to provide child care, steal the car keys, or engage in other behaviors making it difficult to get to work. Once on the job, women also reported harassment at work from the batterers. Such strategies can keep women from receiving benefits, because of an inability to meet employment requirements (Leone, Johnson, Cohan, & Lloyd, 2004). Among a low income Black and Hispanic sample of women from Chicago, Leone et al. (2004) found that the most violent men were also the most likely to try to interfere with their partner’s attempts to find and keep jobs, either through interference, or by causing their partners to miss work because

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of injuries. Unfortunately, current requirements for public assistance now require women to have paid employment or other work activities. Such regulations may make it difficult for some women to use such assistance to build job experience or even to assist in basic needs (Green & Brownell, 2007). The presence of children can also affect the reactions of young poor women to partner violence. Milan and her associates (Milan, Lewis, Ethier, Kershaw, & Ickovics, 2005) studied some of the special problems faced by low-income adolescent women, especially when they have children. In this group of low-income women, some had children. Almost 20% of the total group reported being victims of some type of moderate to severe violence in the last year from a male partner. Many of the young women also reported using mild to severe violence toward their male partners. When either female- or maleinitiated violence was present, the young women reported more depression. The researchers expected to find higher violence victimization in the women with children, but found no differences as a function of motherhood status. They did note, though, that women without children were likely to break up when there was violence in their relationship. For the young mothers, violence was not associated with breakups. Perhaps these women did not feel as able to leave their partners. Perhaps because of their lack of resources, low SES women may be especially likely to seek emergency assistance from a battered women’s shelter (Murray, 1988). When women do finally permanently leave a severely violent relationship, they often suffer financial difficulties and these fears may keep them in abusive relationships (e.g., Josephson, 2005; Wilcox, 2000). Wilcox interviewed working-class white women who left an abusive partner in England and found that many of the women had large debts incurred during the violent relationship, as well as having to spend money to set up a new household. This was especially difficult for those women with children. Wilcox suggests that in England, the group of single mothers living in poverty as a result of leaving a batterer should be better assisted by social welfare agencies with their financial problems. It appears likely that similar financial problems would occur for poor women in the United States who do leave their abusers. Evidence for this may be seen in data that homeless women are highly likely to have experienced partner violence during adulthood (Josephson, 2005). Poor women may also be able to rely on family for some assistance. Although the general pattern outlined earlier for the battered woman suggests that she may become socially isolated, a recent study of poor mothers’ social networks found that many of the women did have regular contact with family members. However, the women in the sample who were victims of severe violence from their partner were less likely to have contact with friends (Coohey, 2007).

Experiences of Black Women As discussed earlier, in general, low income and poverty have been found to predict higher levels of male to female partner violence as compared to higher income groups (e.g., Fox, Benson, DeMaris, & Van Wyk, 2002). Blacks are more likely to have a lower socioeconomic status than other racial and ethnic groups. Perhaps because of this, Black women are more often represented in groups of battered women than other racial and ethnic groups (e.g., Caetano, Schafer,

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& Cunradi, 2001; West, 2002). Hampton, Carrillo, and Kim (2005) also point to the fact that, because of poverty and lack of community stability, Black women may have weaker social ties and fewer people they can call on for social support as another causal factor for higher levels of IPV in Black couples. Evidence for IPV being a problem for many Black women can be seen in data from many sources. For example, emergency room visits due to partnercaused injuries are relatively common for Black women. The higher rates of violence against Black women can also be seen in studies showing that Black women were more likely to be hospitalized from injuries inflicted by a partner and more likely to have been assaulted with a weapon (Gondolf, Fisher, & McFerron, 1991; Joseph, 1997). In research drawing upon a national random U.S. sample, it was found that some level of mutual physical aggression is found in most couples reporting any form of violence or acts of physical aggression, but Black women are especially likely to fight back or engage in mutual violence (Caetano, Ramisetty-Mikler, & Field, 2005). Some Black women do use extreme violence. Often this is mutual, with both partners quite violent (e.g., Milan et al., 2005). Both Black women and men report injuries from partner violence (Weston, Temple, & Marshall, 2005). Other studies have also found that, controlling for SES, Black women more likely to use physical aggression against their partner than other ethnic groups (West, 2002; Weston et al., 2005). As is typical of IPV generally, much of this partner violence is low level violence. In addition to physical aggression, Black women have been found to report using verbal threats against their partners. Those women who are violent toward a partner may be arrested or forced to participate in batterers’ programs. This is especially likely to happen for Black women (YllÖ, 2005). In addition to fighting back, Goodman and her colleagues (Goodman, Dutton, Weinfurt, & Cook, 2003) found that in a sample of mostly Black, low income women with at least one child, the reaction most often reported to partner violence was some other type of resistance such as ending the relationship or refusing to do what the partner asked. Placating the abuser by trying to keep things quiet for him, trying not to cry, or doing what he wanted were the next most common type of reactions. Neither of these types of reactions were seen as especially helpful. More helpful strategies included getting help from friends or calling police or getting other legal help. Unfortunately, Black women may find it difficult to get emotional support from friends and family or from institutions when in violent relationships (Hamberger & Phelan, 2004). It has been argued that Black women may have special problems in seeking help from others because they are stereotyped as more aggressive and dominant (West, 2002). Thus, Black women may not receive the sympathy accorded to other battered women. Data cited earlier from Taylor and Sorenson (2005) suggests that even other Blacks may not be as sympathetic to battered women generally as Whites are. If Black women are also violent toward their partners this may further limit the sympathy they receive from others. Such behavior may make it difficult for Black women to use a legal defense based on the Battered Women Syndrome, which assumes a generally passive victim who eventually fights back (Allard, 2005). Police may also respond to such stereotypes and not be helpful when a Black woman does call for assistance from a violent partner. One recent study of crisis

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intervention services requested by police officers for those involved in partner violence found that Blacks were the least likely to be offered such services (Kernic & Bonomi, 2007). As noted earlier, women with few financial resources may be especially likely to seek emergency assistance for battering at a battered women’s shelter. But, these are not always available. In a previous study of shelters in the southern part of the United States, Donnelly, Cook, and Wilson (1999) found that publicly funded shelters tended to be located in predominantly White neighborhoods and employed predominantly White staff. Such shelters may not be receptive or accessible to Black women. Acceptance of violence generally may reflect the more violent cultures in which many Black women live. Researchers argue that many poor Blacks live in areas of extreme poverty, and that this is more common for them than for members of other poor ethnic groups. Violent crime rates tend to be quite high in such communities (Hampton et al., 2005; Taylor, Esbensen, Peterson, & Freng, 2007). Thus, Black women are quite likely to be exposed to violent behavior. Perhaps because of such factors, there is evidence that Blacks generally are more accepting of violence among family members than other groups (e.g., Taylor & Sorenson, 2005). For example, in a 1996 study of college students, the highest approval of a husband assaulting his wife was found among African Americans (Locke & Richman, 1999). Another study with a small sample of African American adolescents assessed the effects of exposure to nonviolent rap videos that featured women in subordinate roles to men (Johnson, Adams, & Ashburn, 1995). After exposure, both male and female youths were more accepting of a male grabbing and pushing his dating partner when she kissed an old friend, although effects were statistically significant only for young African American women. The young African American men overall were more accepting, regardless of their having seen the rap video or not. Not all Black women are accepting of partner and other forms of violence. Recent activist groups are now working to end high levels of violence in their communities (Richie, 2005). Richie, an activist working on these issues, argues that by ignoring high levels of partner violence in Black communities, and saying that anyone can be a victim, resources have been more focused on White middle-class women, and not on the groups most in need of help. She states, “what began as an attempt to avoid stereotyping and stigma has resulted in … [the] victimization of women of color in low income communities is invisible …and cast as something other than a case of gender violence.” (Richie, 2005, p. 53). Richie (2005) further argues that there has been an over reliance on seeking help from the police for problems of partner violence. As police attempt to solve such problems, she argues that “everyday safety in communities of color is being threatened by more aggressive policing … increased use of force, mass incarceration, and brutality.” (p. 54). A further complication is the mandatory arrest laws discussed earlier. In a “critical resistance statement” by the activist group Incite (2005), the argument is made that not only has the mandatory arrest policy failed to work in reducing partner violence, but is has also brought many women of color into direct conflict with the law. The group argues that by relying on the police, there is less energy for women to organize collectively to end the violence.

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Experiences of Immigrant Women Both Latina and Asian women are more likely to be immigrants or to be children of immigrants than other racial and ethnic groups. Aside from racial and ethnic differences, immigrant experience can also be a confounding factor when understanding IVP. Social and environmental factors related to work, school, and finances contribute to occurrence of intimate partner violence for both foreign-born and U.S.-born populations (Perilla, Bakeman, & Norris, 1994). However immigrants can face additional stressors related to their immigration status (e.g., adapting to a new culture and environment, and learning a new language) that can exacerbate the incidence of intimate partner violence and help explain higher rates of violence in some ethnic groups (Hyman, Forte, Du Mont, Romans, & Cohen, 2006; Menjivar & Salcido, 2002). There may well be differences in levels of violence across immigrant groups, but there has been little, if any, research directly addressing this issue. However some literature suggests that attitudes toward partner violence, including endorsement of certain values or beliefs, may vary across countries or by immigrant populations (Archer, 2006). And the varying attitudes can explain why partner violence appears to be greater in certain populations. The literature suggests that immigrants frequently are more accepting of husband violence than U.S.-born individuals (e.g., Perilla, Bakeman, & Norris, 1994). Examples of this can be found in many different studies drawing on quite varying samples. One study found that South Asian immigrants who were more likely to support patriarchal social norms were less likely to identify a woman in an abusive situation as a victim of spousal abuse (Ahmad, Riaz, Barabata, & Stewart, 2004). In a study of Pakistani immigrants in the United States, Khalid and Frieze 2004) found that those with less egalitarian views of the roles of women and men were more in agreement that “One way a husband can show his wife he loves her is to occasionally slap her.” This same study found that more egalitarian women immigrants agreed strongly with the idea that “Husband who beat their wives should be put in jail,” but this idea was not associated with gender-role attitudes for men. Reactions to violence may also vary by immigrant status, with the research suggesting that immigrants may experience greater physical and emotional problems as a result of intimate partner violence compared to native-born individuals. Lown and Vega (2001) sampled over 3000 Mexican American men and women in the California area and found that Mexican American women who were abused were more likely to report poorer health and persistent health problems compared to those who were not abused. Additional research suggests that immigrant women may sustain, in fact, more severe physical and emotional problems from intimate partner violence than native born women (Ahmad, Ali, & Stewart, 2005; Raj & Silverman, 2003). South Asian immigrants, who were victims of domestic violence in the United States, reported more sexual health problems, including unwanted pregnancies (Raj, Liu, McClearySills, Silverman, 2005). For South Asians living in London, violence by the husband was highly correlated with suicide attempts (Hicks & Bhugra, 2003). Social isolation is a common occurrence with immigrant survivors of intimate partner violence (Abraham, 2000; Dasgupta, 2000; Menjivar & Salcido, 2002). Isolation may occur more easily for immigrant women since many leave

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behind families and loved ones in their native country and enter a new environment where they are unfamiliar with the language, culture, or geographic area. Abraham’s 2000) qualitative study with South Asian immigrant women clearly detailed the role of isolation as a factor to marital abuse. Shahida, one of the participants, described how her husband restricted and monitored her outside activities, limited her access to money, and threatened to shame her by sending her back to her family. Isolation can even occur when immigrant women live near family and relatives. Many ethnic groups espouse traditional views about marriage and gender roles and value family unity and harmony over individual rights and needs. The woman might not receive the necessary support to leave an abusive relationship. Community members may choose to ignore signs of intimate partner violence in its community or perceive it as acceptable behavior to prevent disgracing its community (Menjivar & Salcido, 2002; Yoshihama, 2002). Even when family members are aware of marital abuse in their family, the woman may have difficulty leaving the abusive relationship. Family and community members, who are frequently the primary source of social support for the immigrant woman, may not support the woman leaving the abusive relationship. If she chooses to leave, she risks becoming an outcast in her family and community and being perceived as a “bad wife,” making her feel profoundly guilty and shamed. However this is in conflict with advice generally given by social service providers, who expect her to leave her home and ties to receive assistance at a shelter. Immigrant women also face other difficulties which prevent them from leaving an abusive relationship. Some of the reasons include having fewer resources and limited understanding of the criminal justice system or knowledge of domestic violence services (Davis, Erez, & Avitabile, 2001; Menjivar & Salcido, 2002; Raj & Silverman, 2002a; Raj & Silverman, 2003). The batterers also frequently threaten to jeopardize the immigration status of their victim and children to prevent the victim from seeking help or reporting the abuse to local law enforcement (Menjivar & Salcido, 2002; Raj & Silverman, 2002b). In the United States, many immigrant women rely on their husbands for their legal right to remain in this country and for petitioning for their permanent residency status. Many immigrant spouses cannot attain legal immigration status because their U.S. citizen or legal permanent resident spouse does not file for permanent residency status on their spouse’s behalf, thus continuing their dependence on the abuser. Dutton, Orloff, and Hass (2000) found that 72% of citizen and legal permanent resident spouses in an abusive relationship did not file immigration papers for their wives. Shelters for battered women, in general, are geared toward the needs of nonimmigrant, English-speaking women, and often ignore or overlook the needs of immigrant women (see Donnelly, Cook, van Ausdale, & Foley, 2005). Lack of linguistically and culturally appropriate services may also prevent many immigrant women from seeking help and using shelters (Menjivar & Salcido, 2002; Raj & Silverman, 2002a). There needs to be cultural sensitivity and cultural competency when providing services to battered women. For example, immigrant battered women may require bicultural and bilingual services (Raj & Silverman, 2002a). Some religious women, such as Muslims and Orthodox Jews, may require special accommodations at shelters regarding

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food preparation. Some social service agencies specifically assist immigrant women in domestic violence situations and are linguistically and culturally appropriate, but very few exist.

Experiences of Latinas Latinas or Hispanic women come from many countries to the United States, but the large majority, about two-thirds, were originally of Mexican origin (West, 2005). It is estimated that more than half of Latinas were born in the United States, but many are themselves immigrants or children of immigrants. Thus, many of the issues discussed earlier about immigrant women would apply to this group. Like other women of color, there is evidence that Latinas experience more violence than women of European descent (see a review by Weston et al., 2005). Such conclusions are based, though, on a consideration of race or ethnicity alone. Since this variable is so often confounded with income levels, the conclusion of higher rates of couple violence in Latinas may instead be an effect of higher rates of poverty in Latinas as in Black women (Weston et al., 2005). Although the research that does look at Latinas tends to group them together as a single group, there may be large variations within this category. West (2005) argues that rates of partner violence are higher among those of Mexican descent than other Latina groups. There is evidence that many Latinas are victims of IPV. Domestic violence has been linked, in particular, with increased psychological distress for Latinas (Ramos & Carlson, 2004). Special programs have been developed to assist Latina battered women. Booker (1999) proposes using poetry along with support groups for these women. She uses literary works written by Latin American women to show how poetry can connect to everyday life. She finds that these women develop a deeper understanding of themselves and “recover their voices” through poetic expression. Although there has been little research on this question of whether or not Latinas victimized by a violent partner seek assistance from the police, some recent studies have begun to examine this question. Rennison (2007) suggests that Latinas might be especially reluctant to call the police because of a sense that this would threaten the authority of the head of household. Questions might be raised about immigrant status as well. Even legal immigrants might fear being accused of being illegal. Rennison does find that more educated Latinos are generally more likely to report any crimes to the police than those who are less educated. This pattern for education was not found for any other ethnic group.

Experiences of Asian Women Asian women are not a homogenous group since Asian American women come from over 30 different cultures and speak different languages. They are generally grouped together in the few studies that have looked at them, but there are important within group differences. At the same time, there are some similarities. First, like Latinas, many are immigrants or children of immigrants. Asian cultures place a special value on family ties and on getting along with within

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their communities. Asians also place strong value on protecting the integrity of their family and community and not airing their problems to strangers. Thus, saving face is also important. Such values may make it especially difficult for Asian women who are abused to seek help from others outside their immediate family (Bograd, 2005). Partner violence does occur in Asian Americans, but at lower reported rates than other minority groups (West, 2005). West argues that underreporting may be a special problem for this group because of concerns about family unity and harmony. Cultural values and norms have been shown to influence coping mechanisms of battered women, such that coping and help-seeking styles may differ across racial and ethnic groups (Bui, 2003; Yoshihama, 2002). Current literature with intimate partner violence typically dichotomizes coping strategies as “active versus passive.” Observable, behavioral efforts are described as “active” strategies, and unobservable, cognitive or emotional efforts are “passive” strategies (Finn, 1985). In general, research has linked “active” strategies to lower levels of psychological distress and “passive” strategies with higher levels of psychological distress (Kemp, Green, Hovanitz, & Rawlings, 1995). However in some cultures, it may be difficult for battered women to engage in certain “active strategies.” For example, as will be discussed, some cultures place collective welfare and family harmony over one’s individual needs and rights. Some women’s use of “passive” strategies is likely a reflection of such cultural prescriptions. Yoshihama (2002) examined different coping strategies used by battered women of Japanese descent (both U.S.-born and Japan-born). The results showed that U.S.-born women were more likely to use “active” strategies, including confronting the partner and seeking help from friends, and perceive these types of strategies to be more effective compared to Japan-born women. But Japan-born women were twice as likely to engage in “passive” strategies, such as minimizing the seriousness of the situation and avoiding a potentially violent situation, than U.S.-born women. For U.S.-born women, the more effective they perceived their “active” strategies to be, the lower their psychological distress. However for Japan-born women, greater perceived effectiveness of “active” strategies was related to greater psychological distress, whereas greater perceived effectiveness of “passive” strategies was related to lower psychological distress.

Experiences of Lesbians It is evident that same sex partners can and do have violent relationships (e.g., Balsam & Szymanski, 2005; Letellier, 1994; McClennen, Summers, & Daley, 2002). Unfortunately, it appears that people may not consider same-sex IPV to be as serious as similar levels of couple violence in heterosexual relationships (Poorman, Seelau, & Seelau, 2003). In an analysis of a national random sample of U.S. households conducted from 1995 through 1996 (the NVAW Survey), Tdaden et al. (1999) analyzed a small sample of men and women reporting living with a same-sex partner. These groups represented about 1% of the larger national sample. Within this sample, 11% of women reported being physically assaulted or raped by a female intimate partner, while 15% of the men reported

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being assaulted or raped by a male intimate partner. Although this difference was not statistically significant, possibly because of the small sample size, it may suggest that IPV among same-sex couples may be higher among men than women. Lesbians may also face challenges related to their sexual orientation when seeking help. Specifically, lesbians who are battered by their female partner may have special problems in seeking help because in doing so they acknowledge their status as lesbians. If they are not public about their sexual orientation, it may be impossible for them to get help from any type of social service agency. Particular stresses exist for lesbian women who internalize “negative messages about themselves and their relationships.” Such internalized homophobia, along with more experiences of discrimination from others, is related to higher rates of partner violence (Balsam & Szymanski, 2005). IPV issues for survivors who are both gay and a racial or ethnic minority appear to be especially complex because of issues of both racism as well as discrimination against gays (Robinson, 2002). Unfortunately, there has been very little formal research on same-sex violence in different racial and ethnic groups.

Experiences of Disabled Women As this chapter has indicated, partner violence appears to be especially associated with groups in the society who are subject to various forms of discrimination. Another group who also can be considered as part of this general pattern is women with physical disabilities. In a much larger study looking at status discrepancies of many types, Kaukinen (2004) found that women who were physically disabled experienced significantly more emotional abuse and physical violence than physically-abled women. Other studies have also pointed to an association of abuse with disability, although samples are often limited. In a qualitative study of women with physical disabilities, about one-third of the women responded to open-ended questions about physical abuse (Nosek, Foley, Hughes, & Howland, 2001). Such abuse was not necessarily associated with romantic partners, but might be perpetrated by any caregiver. Needing assistance with tasks of daily living, and financial dependence appeared to be important predictors of such abuse, and may be related to higher levels of stress in the caregivers. Other studies have looked specifically at intimate partner violence levels in those with disabilities. But, in such studies, “disability” is defined very broadly to include a variety of medical conditions. There is an association between these disabilities and IPV. The causal direction of such findings is not clear, though. For example, Coker, Smith, and Fadden (2005) found in a medical clinic sample that women who had ever experienced IPV were more than twice as likely as those who had not to report some type of disability. The most common disabilities were heart disease, back problems, chronic pain, arthritis, and asthma. All these problems may have come about because of the high levels of stress associated with being abused, or might reflect direct reactions to the violence. Unfortunately, when women with physical disabilities are abused by their male partners, very few feel they can seek any type of assistance for this type

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of abuse (Milberger et al., 2003). Some of the women in this study did try to seek help, but this was not always a positive experience. For example, some women were told they were not welcome at a battered women’s shelter because it lacked facilities for assisting with the disability. In other cases, police were called, but the police failed to take any action. Other women did not know where to find help, or said they could handle the problem themselves.

Summary and Conclusions As this chapter has indicated, women, regardless of their race or ethnicity, immigration status, and sexual orientation, experience violence in their closest relationships. In a few cases, this violence is severe, and the women are labeled as “battered” women. The experiences of these women have some similarities, but there are also differences across groups. We have attempted to indicate some of these differences in this chapter and to suggest areas where more research is needed to better understand and help these survivors of battering. Much of the existing data has focused on one, or possibly two groups of women, but very few have considered the intersections of race, social class, and sexual orientation (Bograd, 2005). Such work is needed to better understand the concerns of real women. We also note that in addition to severe violence in some couples, there are other patterns of intimate partner violence. Fergusson and colleagues (Fergusson, Horwood, & Ridder, 2005) suggest that when examining intimate partner violence, certain important dimensions should be considered. These include the level of overall violence, the frequency of the violence, and the level of injury.

References Abraham, M. (2000). Isolation as a form of martial violence: The South Asian immigrant experience. Journal of Social Distress and the Homeless, 9(3), 221–236. Ahmad, F., Ali, M., & Stewart, D.E. (2005). Spousal-abuse among Canadian immigrant women. Journal of Immigrant Health, 7(4), 239–246. Ahmad, F., Riaz, S., Barata, P., & Stewart, D. (2004). Patriarchal beliefs and perceptions of abuse among South Asian immigrant women. Violence Against Women, 10, 262–282. Allard, S. A. (2005). Rethinking battered woman syndrome: A Black feminist perspective. In N. J. Sokoloff & C. Pratt (Eds.), Domestic violence at the margins: Readings on race, class, gender, and culture (pp. 194–205). New Brunswick, NJ: Rutgers University Press. Anderson, K. L. (2002). Perpetrator or victim?: Relationships between intimate partner violence and well-being. Journal of Marriage and Family, 64, 851–863. Archer, J. (2000). Sex differences in aggression between heterosexual partners: A metaanalytic review. Psychological Bulletin, 126, 651–680. Archer, J. (2006). Cross-cultural differences in physical aggression between partners: A social-role analysis. Personality and Social Psychology Review, 10, 133–153. Balsam, K. F., & Szymanski, D. M. (2005). Relationship quality and domestic violence in women’s same-sex relationships: The role of minority stress. Psychology of Women Quarterly, 29, 258–269. Barata, P. C., McNally, M. J., Sales, I. M., & Stewart, D. E. (2005). Portuguese immigrant women’s perspectives on wife abuse: A cross-generational comparison. Journal of Interpersonal Violence, 20, 1132–1150. Bograd, M. (2005). Strengthening domestic violence theories: Intersections of race, class, sexual orientation, and gender. In N. J. Sokoloff & C. Pratt (Eds.), Domestic violence at

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the margins: Readings on race, class, gender, and culture (pp. 25–38). New Brunswick, NJ: Rutgers University Press. Booker, M. (1999). Poetry, healing and the Latin American battered woman. Journal of Poetry Therapy, 13, 73–79. Browne, A., & Bassuk, S. (1997). Intimate violence in the lives of homeless and poor housed women. American Journal of Orthopsychiatry, 67, 261–278. Brownridge, D. A., & Halli, S. S. (2002). Double jeopardy? Violence against immigrant women in Canada. Violence and Victims, 17, 455–471. Brush, L. D. (2002). Work-related abuse: A replication, new items, and persistent questions. Violence and Victims, 17, 743–757. Bui, H. N. (2003). Help-seeking behavior among abused immigrant women: A case of Vietnamese American women. Violence Against Women, 9, 207–239. Cachelin, F. M., Shug, R. A., Juarez, L. C., & Monreal, T. K. (2005). Sexual abuse and eating disorders in a community sample of Mexican American women. Hispanic Journal of Behavioral Sciences, 27, 533–546. Caetano, R., Ramisetty-Mikler, S., & Field, C. A. (2005). Unidirectional and bidirectional intimate partner violence among white, black and Hispanic couples in the United States. Violence and Victims, 20, 393–406. Caetano, R., Schafer, J., & Cunradi, C. B. (2001). Alcohol-related intimate partner violence among White, Black, and Hispanic couples in the United States. Journal of Interpersonal Violence, 17, 1308–1322. Coker, A. L., Smith, P. H., & Fadden, M. K. (2005). Intimate partner violence and disabilities among women attending family practice clinics. Journal of Women’s Health, 14, 829–838. Coker, A. L., Smith, P. H., Bethea, L., King, M. R., & McKeown, R. E. (2000). Physical health consequences of physical and psychological intimate partner violence. Archives of Family Medicine, 9, 451–457. Coker, A. L., Weston, R., Creson, D. L., Justice, B., & Blakeney, P. (2005). PTSD symptoms among men and women survivors of intimate partner violence: The role of risk and protective factors. Violence and Victims, 20, 625–643. Coohey, C. (2007). The relationship between mothers’ social networks and severe domestic violence: A test of the social isolation hypothesis. Violence and Victims, 22, 503–512. Cunradi, C. B., Caetano, R., & Schafer, J. (2002). Socioeconomic predictors of intimate partner violence among White, Black, and Hispanic couples in the United States. Journal of Family Violence, 17, 377–389. Dasgupta, S. D. (2000). Charting the course: An overview of domestic violence in the South Asian community in the United States. Journal of Social Distress and the Homeless, 9(3), 173–185. Davis, R. C., Erez, E., & Avitabile, N. (2001). Access to justice for immigrants who are victimized: The perspectives of police and prosecutors. Criminal Justice Policy Review, 12 (3), 183–196. Donnelly, D., Cook, K., & Wilson, L. (1999). Provision and exclusion: The dual face of services to battered women in three Deep South states. Violence Against Women, 5, 483–490. Donnelly, D. A., Cook, K. J., van Ausdale, D., & Foley, L. (2005). White privilege, color blindness, and services to battered women. Violence Against Women, 11, 6–37. Dutton, M. A., & Goodman, L. A. (2005). Coercion in intimate partner violence: Toward a new conceptualization. Sex Roles, 52, 743–756. Dutton, M. A., Orloff, L. E., & Hass, G. A. (2000). Characteristics of help-seeking behaviors, resources and service needs of battered immigrant Latinas: Legal and policy implications. Georgetown Journal on Poverty Law & Policy, 7, 245–305. Fergusson, D. M., Horwood, L. J., & Ridder, E. M. (2005). Partner violence and mental health outcomes in a New Zealand birth cohort. Journal of Marriage and the Family, 67, 1103–1119. Finn, J. (1985). The stresses and coping behavior of battered women. Social Casework, 66, 341–349. Fox, G. L., Benson, M. L., DeMaris, A. A., & Van Wyk, J. (2002). Economic distress and intimate violence: Testing family stress and resources theory. Journal of Marriage and the Family, 64, 793–807. Frieze, I. H., & Browne, A. (1989). Violence in marriage. In L. Ohlin & M. Tonry (Eds.), Family violence (pp. 163–218). Chicago: University of Chicago Press.

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Frieze, I. H. (2000). Violence in close relationships—Development of a research area: Comment on Archer. Psychological Bulletin, 126, 681–684. Frieze, I. H. (2005a). Hurting the one you love: Violence in relationships. Belmont, CA: Thompson Wadsworth. Frieze, I. H. (2005b). Female violence against intimate partners: An introduction. Psychology of Women Quarterly, 29, 229–237. Goel, R. (2005). Sita’s Trousseau: Restorative justice, domestic violence, and South Asian culture. Violence Against Women, 11, 639–665. Gondolf, E. W. (1998).The victims of court-ordered batterers: Their victimization, helpseeking, and perceptions. Violence Against Women, 4, 659–676. Gondolf, E. W., Fisher, E., & McFerron, J. R. (1991). Racial differences among shelter residents: A comparison of Anglo, Black, and Hispanic battered women. In R. L. Hampton (Ed.), Black family violence: Current research and theory (pp. 103–114). Lexington, MA: Lexington Books. Goodman, L., Dutton, M. A., Weinfurt, K., & Cook, S. (2003). The intimate partner violence strategies index: development and application. Violence Against Women, 9, 163–186. Graham, K., & Wells, S. (2001). The two worlds of aggression for men and women. Sex Roles, 45, 595–622. Graham-Kevan, N., & Archer, J. (2003). Physical aggression and control in heterosexual relationships: The effects of sampling. Violence and Victims, 18, 181–196. Green, D. L., & Brownell, P. (2007). Poverty, women, welfare, work and domestic violence. In A. R. Roberts (Ed.), Battered women and their families: Intervention strategies and treatment programs (3rd edn., pp. 423–450). New York: Springer. Hamberger, L. K., & Phelan, M. B. (2004). Domestic violence screening and intervention in medical and mental healthcare settings. New York: Springer. Hampton, R. L., Carrillo, R., & Kim, J. (2005). Domestic violence in African American communities. In N. J. Sokoloff & C. Pratt (Eds.), Domestic violence at the margins: Readings on race, class, gender, and culture (pp. 127–141). New Brunswick, NJ: Rutgers University Press. Heise, L., Ellsberg, M., & Gottmoeller, M. (2002). A global overview of gender-based violence. International Journal of Gynecology and Obstretrics, 78, S5–S14. Hicks, M. H., & Bhugra, D. (2003). Perceived causes of suicide attempts by U.K. South Asian women. American Journal of Orthopsychiatry, 73, 455–462. Hyman, I., Forte, T., Du Mont, J., Romans, S., & Cohen, M. M. (2006). The association between length of stay in Canada and intimate partner violence among immigrant women. American Journal of Public Health, 96, 654–659. Incite (2005). Critical resistance statement. In N. J. Sokoloff & C. Pratt (Eds.), Domestic violence at the margins: Readings on race, class, gender, and culture (pp. 107–111). New Brunswick, NJ: Rutgers University Press. Johnson, J. D., Adams, M. S., & Ashburn, L. (1995). Differential gender effects of exposure to rap music on African American adolescents’ acceptance of teen dating violence. Sex Roles, 33, 597–605. Jones, S., Davidson, W. S., II, Bogat, G. A., Levendosky, A., & von Eye, A. (2005). Validation of the subtle and overt psychological abuse scale: An examination of construct validity. Violence and Victims, 20, 407–416. Joseph, J. (1997). Woman battering: A comparative analysis of Black and White women. In G. K. Kantor & J. L. Jasinski (Eds.), Out of darkness: Contemporary perspectives on family violence (pp. 161–169). Thousand Oaks, CA: Sage. Josephson, J. (2005). The intersectionality of domestic violence and welfare in the lives of poor women. In N. J. Sokoloff & C. Pratt (Eds.), Domestic violence at the margins: Readings on race, class, gender, and culture (pp. 83–101). New Brunswick, NJ: Rutgers University Press. Kaukinen, C. (2004). Status compatibility, physical violence, and emotional abuse in intimate relationships. Journal of Marriage and the Family, 66, 452–471. Kemp, A., Green, B., Hovanitz, C., & Rawlings, E. (1995). Incidence and correlates of posttraumatic stress disorder in battered women: Shelter and community samples. Journal of Interpersonal Violence, 10, 43–55. Kernic, M. A., & Bonomi, A. E. (2007). Female victims of domestic violence: Which victims do police refer to crisis intervention? Violence and Victims, 22, 463–473.

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Khalid, R., & Frieze, I. H. (2004). Measuring perceptions of gender roles: The IAWS for Pakistanis and U.S. immigrant populations. Sex Roles, 51, 293–300. Kim, J. Y., & Sung, K. (2000). Conjugal violence in Korean American families: A residue of the cultural tradition. Journal of Family Violence, 15, 331–345. Koss, M. P., Bailey, J. A., Yuan, N. P., Herrera, V. M., & Lichter, E. L. (2003). Depression and PTSD in survivors of male violence: Research and training initiatives to facilitate recovery. Psychology of Women Quarterly, 27, 130–142. Krahe, B., Bieneck, S., & Moller, I. (2005). Understanding gender and intimate partner violence from an international perspective. Sex Roles, 52, 807–827. Leone, J. M., Johnson, M. P., Cohan, C. L., & Lloyd, S. E. (2004). Consequences of male partner violence for low-income minority women. Journal of Marriage and the Family, 66, 472–490. Letellier, P. (1994). Gay and bisexual male domestic violence victimization: Challenges to feminist theory and responses to violence. Violence and Victims, 9, 95–106. Locke, L. M., & Richman, C. L. (1999). Attitudes toward domestic violence: Race and gender issues. Sex Roles, 40, 227–247. Lown, E. A., & Vega, W. A. (2001). Intimate partner violence and health: Self-assessed health, chronic health, and somatic symptoms among Mexican American women. Psychosomatic Medicine, 63, 352–360. Max, W., Rice, D. P., Finkelstein, E., Bardwell, & Leadbetter, S. (2004). The economic toll of intimate partner violence against women in the United States. Violence and Victims, 19, 259–272. McClennen, J. C., Summers, A. B., & Daley, J. G. (2002). The lesbian partner abuse scale. Research on Social Work Practice, 12, 277–292. Mehotra, M. (1999). The social construction of wife abuse: Experiences of Asian Indian women in the United States. Violence Against Women, 5, 619–640. Menjivar, C., & Salcido, O. (2002). Immigrant women and domestic violence: Common experiences in different countries. Gender & Society, 16(6), 898–920. Milan, S., Lewis, J., Ethier, K., Kershaw, T., & Ickovics, J. R. (2005). Relationship violence among adolescent mothers: Frequency, dyadic nature, and implications for relationship dissolution and mental health. Psychology of Women Quarterly, 29, 302–312. Milberger, S., Israel, N., LeRoy, B., Martin, A., Potter, L., & Patchak-Schuster, P. (2003). Violence against women with physical disabilities. Violence and Victims, 18, 581–589. Murray, S. B. (1988). The unhappy marriage of theory and practice: An analysis of a battered women’s shelter. National Women’s Studies Association Journal, 1, 75–92. Nosek, M. A., Foley, C. C., Hughes, R. B., & Hoiwland, C. A. (2001). Vulnerabilities for abuse among women with disabilities. Sexuality and Disability, 19, 177–189. O’Leary, K. D. (2000). Are women really more aggressive than men in intimate relationships? Comment on Archer 2000. Psychological Bulletin, 126, 685–689. Orloff, L. E., & Kelly, N. (1995). A look at the violence against women’s act and gender-related political asylum. Violence Against Women, 1, 380–400. Perilla, J. L. (1999). Domestic violence as a human rights issue: The case of immigrant Latinos. Hispanic Journal of Behavioral Sciences, 21, 107–133. Perilla, J., Backeman, R., & Norris, F. H. (1994). Culture and domestic violence: The ecology of abused Latinas. Violence and Victims, 9, 325–339. Poorman, P. B., Seelau, E. P., & Seelau, S. M. (2003). Perceptions of domestic abuse in samesex relationships and implications for criminal justice and mental health responses. Violence and Victims, 18, 659–669. Raj, A., & Silverman, J. (2002a). Violence against immigrant women: The roles of culture, context, and legal immigrant status on intimate partner violence. Violence Against Women, 8, 367–398. Raj, A., & Silverman, J. (2002b). Intimate partner violence against South Asian women in greater Boston. Journal of American Medical Women Association, 57, 111–1114. Raj, A., & Silverman, J. (2003). Immigrant south Asian women at greater risk for injury from intimate partner violence. American Journal of Public Health, 93, 435–437. Raj, A., Liu, R., McCleary-Sills, J., & Silverman, J. (2005). South Asian victims of intimate partner violence more likely than non-victims to report sexual health concerns. Journal of Immigrant Health, 7, 85–91.

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Ramos, B. M., & Carlson, B. E. (2004). Lifetime abuse and mental health distress among English-speaking Latinas. Affilia, 19(3), 239–256. Rennison, C. M. (2007). Reporting to the police by Hispanic victims of violence. Violence and Victims, 22, 754–772. Renzetti, C. M. (1992). Violent betrayal: Partner abuse in lesbian relationships. Thousand Oaks, CA: Sage. Richie, B. E. (2005). A Black feminist reflection on the antiviolence movement. In N. J. Sokoloff & C. Pratt (Eds.), Domestic violence at the margins: Readings on race, class, gender, and culture (pp. 50–55). New Brunswick, NJ: Rutgers University Press. Robinson, A. (2002). “There’s a stranger in this house”: African American lesbians and domestic violence. Women & Therapy, 25, 125–132. Rothenberg, B. (2003). “We don’t have time for social change”: Cultural compromise and the battered women syndrome. Gender & Society, 17, 771–787. Sagrestano, L. M., Carroll, D., Rodriguez, A. C., & Nuwayhid, B. (2004). Demographic, psychological, and relationship factors in domestic violence during pregnancy in a simple of low-income women of color. Psychology of Women Quarterly, 28, 309–322. Sedlak, A. J. (1988). Prevention of wife abuse. In V. B. Van Hasselt, R. L. Mossison, A. S. Bellack, & M. Hersen (Eds.), Handbook of family violence (pp. 319–358). New York: Plenum. Shiu-Thornton, S., Senturia, K., & Sullivan, M. (2005). “Like a bird in a cage”: Vietnamese women survivors talk about domestic violence. Journal of Interpersonal Violence. 20, 959–976. Simon, T. R., Anderson, M., Thompson, M. P., Crosby, A. E., Shelley, G., & Sacks, J. J. (2001). Attitudinal acceptance of intimate partner violence among U.S. adults. Violence and Victims, 16, 115–126. Slashinski, M. J., Coker, A., & David, K. E. (2003). Physical aggression, forced sex, and stalking victimization by a dating partner: An analysis of the national violence against women survey. Violence and Victims, 18, 595–617. Sokoloff, N. J., & Dupont, I. (2005). Domestic violence at the intersections of race, class, and gender: Challenges and contributions to understanding violence against marginalized women in diverse communities. Violence Against Women, 11, 38–64. Sorenson, S. B., & Taylor, C. A. (2003). Personal awareness of domestic violence: Implications for health care. Journal of the American Medical Women’s Association, 58, 4–9. Sorenson, S. B., & Telles, C. A. (1991). Self-reports of spousal violence in a Mexican-American and non-Hispanic white population. Violence and Victims, 6, 3–15. Stark, R., & McEvoy, J. (1970). Middle class violence. Psychology Today, 4, 52–65. Taylor, C. A., & Sorenson, S. B. (2004). Injunctive social norms of adults regarding teen dating violence. Journal of Adolescent Health, 34, 468–479. Taylor, C. A., & Sorenson, S. B. (2005). Community-based norms about intimate partner violence: Putting attributions of fault and responsibility into context. Sex Roles, 53, 573–589. Taylor, T. J., Esbensen, F., Peterson, D., & Freng, A. (2007). Putting youth violent victimization into context: Sex, race/ethnicity, and community differences among a multisite sample of youths. Violence and Victims, 22, 702–720. Tjaden, P., Thoennes, N., & Allison, C. J. (1999). Comparing violence over the life span in samples of same-sex and opposite-sex cohabitants. Violence and Victims, 14, 413–425. Vandello, J. A., & Cohen, D. (2003). Male honor and female infidelity: Implicit cultural scripts that perpetuate domestic violence. Journal of Personality and Social Psychology, 84, 997–1010. Weiss, S. J., Ernst, A. A., Cham, E., & Nick, T. G. (2003). Development of a screen for ongoing intimate partner violence. Violence and Victims, 18, 131–141. West, C. M. (2002). Black battered women: New directions for research and black feminist theory. In L. H. Collins, M. D. Dunlap, & J. C. Chrisler (Eds.), Charting a new course for feminist psychology (pp. 216–237). Westport, CT: Praeger. West, C. M. (2005). Domestic violence in ethnically and racially diverse families. In J. Sokoloff & C. Pratt (Eds.), Domestic violence at the margins: Readings on race, class, gender, and culture (pp. 157–173). New Brunswick, NJ: Rutgers University Press.

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West, C. M., Kantor, G. K., & Jasinski, J. L. (1998). Sociodemographic predictors and cultural barriers to help-seeking behavior by Latina and Anglo American battered women. Violence and Victims, 13, 361–375. Weston, R., Temple, J. R., & Marshall, L. L. (2005). Gender symmetry and asymmetry in violent relationships: Patterns of mutuality among racially diverse women. Sex Roles, 53, 553–571. Wilcox, P. (2000). Lone motherhood: The impact on living standards of leaving a violent relationship. Social Policy and Administration, 34, 176–190. Williams, S. L., & Frieze, I. H. (2005). Patterns of violent relationships, psychological distress, and martial satisfaction in a national sample of men and women. Sex Roles, 52, 771–784. Yllo, K. A. (2005). Through a feminist lens: Gender, diversity, and violence: Extending the feminist framework. In D. R. Loseke, R. J. Gelles, & M. M. Cavanaugh (Eds.), Current controversies on family violence (pp. 19–34). Thousand Oaks, CA: Sage. Yoshihama, M. (2001). Immigrants-in-context framework: Understanding the interactive influence of socio-cultural contexts. Evaluation and Program Planning, 307–318. Yoshihama, M. M. (2002). Battered women’s coping strategies and psychological distress: Differences by immigration status. American Journal of Community Psychology, 30, 429–452. Yoshihama, M., & Horrocks, J. (2002). Posttraumatic stress symptoms and victimization among Japanese American women. Journal of Consulting and Counseling Psychology, 70, 205–215.

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Sexual Harassment in the Lives of Women of Color

16 NiCole T. Buchanan and Carolyn M. West

Sexual harassment is a common occupational hazard for working women, with approximately half of all working women experiencing at least one sexually harassing incident in the workplace (Fitzgerald & Shullman, 1993; Illes, Hauserman, Schwochau & Stibal, 2003). Sexual harassment has been associated with a variety of negative psychological, health, and work/academic outcomes, such as increased posttraumatic stress, depression, anxiety, job and supervisor and job dissatisfaction, diminished work productivity, and physical health problems (e.g., Avina & O’Donohue, 2002; Schneider, Swan, & Fitzgerald, 1997; Willness, Steel, & Lee, 2007); which may persist for years after the harassment has ended (Glomb, Munson, Hulin, Bergman, & Drasgow, 1999). To date, sexual harassment research has largely focused on the experiences of White women with little consideration of Women of Color’s unique experiences with sexual harassment.1 Thus, questions remain regarding potential differences and similarities in the nature, frequency, and perceptions of sexual harassment across diverse groups of women. Although progress has been made, there continue to be gender and racial inequalities in the labor market, which disadvantages working Women of Color

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(Browne & Misra, 2003; Kim, 2006) and has the potential to influence how they are sexually harassed. Double or multiple jeopardy theory (Beal, 2008; King, 1988) suggests that Women of Color are multiply marginalized due to race, gender, and often social class, which places them at increased risk of victimization. Thus, sexual harassment should manifest more frequently and severely for women who hold multiple intersecting marginalized identities (Beal, 2008; Bowleg, Huang, Brooks, Black, & Burkholder, 2003; DeFour, David, Diaz, & Thompkins, 2003; King, 1988), which has been supported in recent studies (Berdahl & Moore, 2006; Buchanan, Settles, & Woods, 2008). In addition to higher rates of a single form of harassment, Women of Color may also be targeted with multiple types of harassment based on these identities (e.g., racial and sexual harassment), which has been associated with greater detriment to their psychological well-being than experiencing a single form alone (Buchanan, Bergman, Bruce, Woods, & Lichty, 2009; Buchanan & Fitzgerald, 2008). Moreover, because Women of Color live at the intersection of multiple forms of oppression, including race, gender, and often social class oppression, they often experience racialized sexual harassment (Buchanan, 2005a; Buchanan & Ormerod, 2002; Cho, 1997; Cortina, Fitzgerald, Drasgow, 2002; Patel, 2007; Texiera, 2002), which is distinct from either racial or sexual harassment in that it simultaneously combines both forms such that neither is distinct, such as calling someone a “Black whore” (Buchanan, 2005a; Buchanan & Ormerod, 2002). Consequently, when sexual harassment occurs against the backdrop of multiple forms of workplace abuse, victims report elevated levels of distress (Buchanan et al., 2009; Buchanan & Fitzgerald, 2008; Cortina et al., 2002). The purpose of this chapter is to review sexual harassment research as it pertains to Women of Color in the United States. Although a review of the experiences of Women of Color from across the globe is beyond our scope, there is evidence that both race and gender influence women’s harassment and victimization experiences around the world (e.g., DeSouza & Solberg, 2003; Sigal et al., 2005). We first review the legal, behavioral, and psychological definitions of sexual harassment and then examine the research on racial/ ethnic differences in the frequency, perceptions, psychological consequences, and coping strategies related to sexual harassment among African American, Latina, and Asian American women. Finally, we conclude with suggestions for future research.

Definitions of Sexual Harassment Legal Definitions Sexual harassment has been defined as both a legal and a psychological phenomenon (Gutek & Done, 2001). Title VII of the Civil Rights Acts of 1964 and 1991 prohibit employment discrimination based on race, color, religion, sex and national origin 2. As originally conceptualized, Title VII included gender-based discrimination, but did not address sexual harassment (Equal Employment Opportunity Commission [EEOC], 1980). It was not until the 1976 ruling in Williams v. Saxby that sexual harassment was legally recognized as a form of sex discrimination that violated Title VII. Subsequent cases further

Chapter 16 Sexual Harassment

identified specific behaviors constituting sexual harassment. For example, Barnes v. Costle (1977) determined that quid pro quo (attempts to coerce sexual compliance via job-related threats or promises of benefits, e.g., termination or a job promotion) constituted a violation of Title VII. Similarly, Meritor Savings Bank v. Vinson (1986) set legal precedent for the recognition of a hostile environment as a form of sexual harassment. A hostile environment may be created when an employee perceives the workplace milieu to be hostile, or an employee’s work performance is hindered, as a result of unwanted genderbased comments and behaviors, regardless of whether or not they result in tangible or economic job consequences.

Psychological and Behavioral Definitions Psychologists have defined sexual harassment within a stress and coping framework (Lazarus & Folkman, 1984) that encapsulates the individual’s appraisal of her/his experience. From this perspective, sexual harassment is defined as “an unwanted sex-related behavior at work that is appraised by the recipient as offensive, exceeding her resources, or threatening her well-being” (Fitzgerald, Swan, & Magely, 1997, p. 20). Alternatively stated, the individual must appraise the situation as stressful and initiate a complex coping process, which can vary considerably based on individual factors, such as age or ethnicity, contextual factors of the organization (e.g., tolerance of sexual harassment or gender segregation), and the nature of the harassment, such as its frequency or severity. This perspective may explain why some targets of harassment report little or no distress while others experience harassment as a traumatic and significant psychological stressor (Avina & O’Donohue, 2002). Behaviorally, sexual harassment has been classified into three distinct, but related dimensions (Fitzgerald, Gelfand, & Dragow, 1995). First, gender harassment refers to comments and behaviors that suggest insulting, hostile, and degrading attitudes toward women without the objective of gaining sexual submission. This can be further divided into two subtypes: sexist hostility (misogynistic conduct that demeans women without overt sexual content, such as comments that women are intellectually inferior to men) and sexual hostility (explicit sexual gestures or jokes, showing sexually explicit materials). Second, unwanted sexual attention includes uninvited touching, fondling, or repeated requests for dates or sexual interactions. Frequently, legal allegations of a hostile environment result from gender harassment and unwanted sexual attention. The third type of sexual harassment, sexual coercion, is the same as the legal definition of quid pro quo and refers to unwanted sexual attention with direct or implied job-related bribes or threats. These forms of sexual harassment can occur in varying degrees of severity and can co-occur within the same workplace (Gelfand, Fitzgerald, & Drasgow, 1995; Langhout, Bergman, Cortina, Fitzgerald, Drasgow, & Hunter Williams, 2005).

The Role of Race in Sexual Harassment The research on sexual harassment among ethnic minority women has generally focused a distinct set of questions (Murrell, 1996). First, are commonly

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accepted estimates of harassment frequency, largely based on reports from White women, accurate for Women of Color? Do Women of Color experience unique forms of sexual harassment or higher rates of particular forms of sexual harassment when compared to White women? Third, are there racial differences between Women of Color and White women? Third, are there racial differences between Women of Color and White women in their perceptions and definitions of sexual harassment? Does ethnicity affect work-related, physical health, or psychological consequences for targets of sexual harassment? And finally, do Women of Color utilize culture-specific or distinct coping strategies to deal with sexual harassment?

Sexual Harassment Frequency Findings regarding the frequency and prevalence of sexual harassment across racial groups are contradictory. When compared to White women, some researchers found that Women of Color had comparable or lower rates of sexual harassment (e.g., Culbertson & Rosenfeld, 1994; Kalof, Eby, Matheson, & Kroska, 2001; Piotrkowski, 1998; Shupe, Cortina, Ramos, Fitzgerald, & Salisbury, 2002; Wyatt & Riederle, 1994). For example, using a single-item assessment, Piotrkowski (1998) found no significant differences in rates of gender harassment among White and African American women clerical workers. Similarly, there were no racial differences in the overall rates of sexual harassment, gender harassment, and unwanted sexual attention in a college sample of Black, Hispanic, Asian, and White college students (Kalof et al., 2001) or African American, Hispanic, and White active duty female Navy officers (Culbertson & Rosenfeld, 1994). Conversely, when compared to men and White women, Women of Color reported higher rates of sexual harassment (Berdahl & Moore, 2006; Bergman & Drasgow, 2003; Cortina, Swan, Fitzgerad & Waldo, 1998; Gruber & Bjorn, 1982; Hughes & Dodge, 1997; Mecca & Rubin, 1999; Nelson & Probst, 2004). Ethnic minority women reported higher rates of sexual harassment than ethnic minority men, White men, and White women in a multiracial sample (Asian, Caribbean, African, Latin American, Aboriginal, Arab, and Pacific Islander) of 238 employees from five separate organizations (Berdahl & Moore, 2006). In a sample using female undergraduates (e.g., Cortina et al., 1998) and in a sample of more than 22,000 ethnically diverse military personnel (Bergman & Drasgow, 2003; Fitzgerald, Magley, Drasgow, & Waldo, 1999), ethnic minority women reported higher mean rates of sexual harassment, and in some cases twice the rate, when compared to White women. Moreover, these studies used the Sexual Experiences Questionnaire (SEQ; Fitzgerald et al., 1988), which is a behaviorally based measure of sexual harassment and its subscales, gender harassment, unwanted sexual attention, and sexual coercion). This measure does not use the term “sexual harassment” until the final item, avoiding labeling biases that tend to underestimate prevalence rates (Magley, Hulin, Fitzgerald, & DeNardo, 1999). The SEQ has been validated for use with many ethnic minority and cultural groups (e.g., Buchanan & Fitzgerald, 2008; Cortina, 2001; DeSouza & Solberg, 2003; Gelfand et al., 1995) and is currently the most psychometrically sound and comprehensive assessment of psychological/behavioral dimensions of sexual harassment (Arvey & Cavanaugh, 1995; Paludi & Paludi, 2003).


The contradictory findings on racial differences in the frequency of sexual harassment may be partially explained by the failure to consider contextual factors that increase women’s vulnerability, such as job status (e.g., white- vs. blue-collar work), and the failure to consider racial differences in subtypes and severity of harassment. For example, African American women experienced high rates of sexual harassment when they were employed in blue-collar or traditionally male-dominated positions, such as police officers (Texeira, 2002), transit workers (Mansfield, Koch, Henderson, Vicary, & Young, 1991), autoworkers (Gruber & Bjorn, 1982), and military personnel in various branches of the armed forces (Fitzgerald et al., 1999). Women of Color also may experience differing rates of sexual harassment subtypes and severity. In a Los Angeles community sample of women employed in a variety of positions from unskilled labor to professional status, White women experienced higher rates of unwanted touch and comments, however, Black women reported higher rates of unwanted explicitly sexual verbal propositions and comments constituting sexual coercion (Wyatt & Riederle, 1995). Among autoworkers, Black women reported more severe forms of sexual harassment than White women (Gruber & Bjorn, 1982). Although this was not replicated in a subsequent study of autoworkers (Gruber & Bjorn, 1986), racial differences in severity have been supported among samples of firefighters (Yoder & Berendsen, 2001) and military personnel (Buchanan et al., 2008). More recently, a sample of nearly 8,000 Black and White women military personnel examined differences in sexual harassment subtypes by both race and organizational status, operationalized via military rank, and found that White women reported more overall sexual harassment (Buchanan et al., 2008). However, when sexual harassment subtypes were considered, White women reported more gender harassment and crude behavior, whereas Black women reported more unwanted sexual attention and sexual coercion. Enlisted women reported higher rates of each subtype than officers. Further, Black enlisted personnel reported more sexual coercion than White enlistees, but officers reported similarly low rates regardless of ethnicity. These findings suggest that high organizational status may buffer the increased risk associated with ethnic minority status.

Perceptions and Definitions of Sexual Harassment Across Cultural Groups Cultural groups differ in their perceptions and definitions of acceptable sexual behaviors and interactions, including sexual harassment (Cortina, 2001; Shupe et al., 2002; Wasti, Bergman, Glomb, & Drasgow, 2000). Studies have examined participants’ perceptions from vignettes of potentially harassing interactions and their perceptions of their own sexual harassment experiences. Vignette studies have found many similarities in how individuals perceive harassment. For example, across a professionally diverse sample of Air Force Academy cadets, undergraduates, and business employees, Black, Hispanic, and White women all rated behaviors in a vignette as more sexually harassing if they were committed by a perpetrator that was male, older, low in social status, high in organizational status and power, or physically unattractive (Hendrix, 2000). Another study presented sexual harassment vignettes that manipulated the race of the perpetrator and target (Black or White) to Black and White

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undergraduate women and found similar ratings regardless of the race of the participant (Shelton & Chavous, 1999). However, perceptions of the severity of the harassment did differ depending on the race of the target and the perpetrator. When the perpetrator was a White man, particularly a supervisor, Black and White participants rated the event as sexual harassment, but rated harassment of a White woman as more severe than that of a Black woman. Further, when the vignettes described a Black woman being harassed by a Black man, both Black and White participants were more likely to perceive the behavior as appropriate and humorous, particularly if he was a coworker. According to the investigators, these findings likely reflect a tendency to “trivialize” sexual harassment when the victim and perpetrator are African American (Shelton & Chavous, 1999). Results from vignette studies may not reflect individuals’ reactions and perceptions of personally experienced sexual harassment (Gutek & Koss, 1993; Woodzicka & LaFrance, 2001). To address this, researchers have examined how culture affects the perceptions of women who have experienced sexual harassment. For example, compared to highly acculturated Mexican American women and White women, more Latinas with low to moderate levels of acculturation interpreted certain behaviors (e.g., staring/ogling, comments about their body) as sexually motivated and offensive (Cortina, 2001; Fitzgerald et al., 1999; Shupe et al., 2002). In a qualitative study of Latinas, one participant stated, “What I’ve seen is that [White women] are more open … if it’s something sexual they’ll laugh and giggle about it, and I would take that offensively” (Cortina, 2001, p. 176). This quote reinforces the assertion that behaviors may carry different meanings across cultures.

Coping With Sexual Harassment Coping refers to cognitive or behavioral strategies that an individual uses to minimize the harm caused by a stressful event or series of events (Lazarus & Folkman, 1984). Fitzgerald, Swan, and Fisher (1995) extended the LazarusFolkman model to define coping with sexual harassment as either problemfocused (externally-focused) or emotion-focused (internally-focused). Magley (2002) extended this further to define a 2-dimensional model with engagement–disengagement and cognitive-behavioral dimensions. Within this model, engagement–disengagement reflects the extent to which an individual actively addresses the problem, with engagement reflecting more active involvement. Cognitive strategies address the problem internally or psychologically (e.g., minimizing or avoiding thinking about the harassment) and behavioral strategies address the problem by attempting to change the situation itself, such as transferring to a new workplace or telling the perpetrator to stop. Few studies have attempted to incorporate the role of race/ethnicity or culture in the coping process (examples include: Buchanan, Settles, & Langhout, 2007; Cortina, 2004; Magley, 2002; Wasti & Cortina, 2002); yet, women do not necessarily respond to sexual harassment in uniform ways as a result of a variety of cultural and contextual constraints. Compared to more highly acculturated Latinas and White women, fewer less acculturated Latinas quit their jobs after being sexually harassed, perhaps due to their greater economic vulnerability and more limited employment options (Cortina, 2004; Shupe et al.,


2002), Latinas also have reported using more avoidance, denial, and seeking social support to cope with harassment than formal organizational mechanisms, such as filing a formal complaint or talking with a supervisor (Cortina & Wasti, 2005; Watsi & Cortina, 2002). Conversely, in a Los Angeles community sample of 248 Black and White women, comparable percentages of both racial groups used the following strategies to cope with sexual harassment: demanding that the harassment stop, verbally threatening the harasser or pushing him, consulting with others about the harassment, avoiding the harasser, or trying get the harasser fired (Wyatt & Riederle, 1995). Finally, there may be vast within ethnic groups differences in coping responses. One study of sexually harassed Black women in the military found six distinct patterns of coping and that these patterns of coping were differentially related to psychological well-being and work-related outcomes (Buchanan et al., 2007).

Outcomes Related to Sexual Harassment Across racial and ethnic groups, sexual harassment has been associated with negative psychological, physical, and health-related outcomes (see Avina & O’Donohue, 2002; Fitzgerald, Drasgow, et al., 1997; O’Connell & Korabik, 2000). Nevertheless, factors related to culture affect outcomes, such as level of acculturation, relative social and organizational status, and beliefs regarding gender roles. For example, Latinas who are less acculturated are more offended by potentially sexually harassing behaviors than are more highly acculturated counterparts (Cortina, 2004; Shupe et al., 2002), and being more offended is associated with greater detriment to job satisfaction and psychological well-being (Langhout et al., 2005). Among military personnel, race and organizational status affected the frequency of sexual harassment subtypes and outcomes. Specifically, enlisted women reported more distress following gender harassment, unwanted sexual attention, and sexual coercion than did officers, and Black women experienced more psychological distress associated with gender harassment than did White women (Buchanan et al., 2008). Feminist consciousness has been associated with greater psychological well-being and resiliency (Fischer & Good, 2004; Snyder & Hasbrouck, 1996), better ability to cope with sexist experiences (Klonis, Endo, Crosby, & Worell, 1997), and an increased likelihood of a woman perceiving her negative experience as sexual harassment (Fischer, Tokar, Good, Hill, & Blum, 2000). However, among undergraduate women, gender role attitudes and race have been found to moderate the relationship between sexual harassment and psychological wellbeing (Rederstoff, Buchanan, & Settles, 2007). As predicted, sexually harassed White women who endorsed feminist beliefs were protected psychologically, whereas sexually harassed Black women who held stronger feminist ideologies reported greater clinical distress. The authors theorized that while embracing a feminist ideology may be protective for White women, it may create a “double consciousness” for Black women. This double consciousness increases their awareness of both race- and gender-based oppression and concomitantly heightens the detrimental effects on Black women’s psychological well-being. Together, these findings demonstrate that although women, regardless of their race or ethnicity, are harmed by sexual harassment, these relationships may be attenuated or exacerbated by factors related to race and culture.

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To conclude, many researchers speculate that women of color may be at greater risk for sexual harassment due to race-based stereotypes that overly sexualize them, their lack of social and organizational power, economic vulnerability, and marginalized status as members of at least two stigmatized groups (women and people of color) (Collins, 2000; Murrell, 1996; Luthar, Tata, & Kwesiga, 2009). However: Although race appears to be an important determinant for describing frequencies and risks of harassment experiences and may affect the coping responses of the targets, race does not moderate the relationships among sexual harassment, and the variables proposed as its antecedents and outcomes (Bergman & Drasgow, 2003, p. 143). Alternatively stated, race alone is not the sole factor that shapes sexual harassment for Women of Color. Other factors must also be considered, such as: (1) characteristics of the harassing behavior or the perpetrators (e.g., the frequency, duration, and type of harassment experienced as well as the number, race, and level of power held by the harassers); (2) contextual factors specific to the organization (e.g., the organization’s tolerance for harassing behavior, the gender or ethnic ratios of employees, token status, and whether the worksite is predominantly White, male, or blue-collar); and (3) individual characteristics that may increase vulnerability to harassment, such as a victims’ age, income, and acculturation level (Cortina et al., 2002; Wyatt & Riederle, 1995).

Sexual Harassment Among Specific Racial Groups Combining different ethnic groups, without consideration of the diversity between or within these ethnic groups, is problematic and can mask important factors that affect their sexual harassment. Stereotypes, cultural norms and gender-role expectations differ across Black, Latina, and Asian women and such differences influence their harassment experiences as well as their perceptions of harassment and styles of coping. In the next section we review research on sexual harassment specific to Black women, Latinas, and women of Asian descent in the United States. In particular, we focus on the prevalence, nature, and types of sexual harassment experienced, consequences of harassment on their psychological well-being, and their strategies for coping with harassment.

African American Women Under slavery and for many decades after slavery, there were no legal protections for Black women who were sexually exploited. Further, sexual stereotypes of Black women, such as the Jezebel, presented them as sexually insatiable, grossly immoral, and thus, unable to be a true victim of sexual assault (Bell, 2004; Collins, 2000; West 2008). These sexualized representations of Black women persist to the present (Bryant-Davis, 2005; Poran, 2006; Sanches-Hucles, Hudgins, & Gamble, 2005; Wilcox, 2005) and result in others viewing Black women in a sexualized manner (Bell, 2004; Collins, 2000; Settles, 2006; West, 2008). Such stereotypes also have been associated with increased endorsement of violence against Black women (Gillum, 2002), disparate treatment of Black women who have been sexually assaulted (Campbell,


Wasco, Ahrens, Sefl, & Barnes, 2001; Davis, 1998), and sexual crimes against Black women being investigated less rigorously, prosecuted less frequently, and punished less severely than similar crimes against White women (Donovan & Williams, 2002; Neville & Hamer, 2001). Black women’s work history in the United States may also affect how they are perceived by others and how they are sexually harassed. The “cult of true womanhood” became the standard for the ideal woman by the mid-1800s and defined the ideal woman as submissive, self-sacrificing, pious, sexually restrained, and dedicated to caring for her family and home to the exclusion of paid employment (Browne & Kennelly, 1999; Collins, 2000; Frankenberg, 2003; Perkins, 1983; Scully & Bart, 2003; Welter, 1966). The cult of true womanhood did not apply to Black women and did not reflect the realities of their lives. From slavery to the present, Black women have been seen less as “proper women” (Santamarina, 2006; Stone & McKee, 1999; Yoder & Berendsen, 2001) and as more capable of performing traditionally masculine jobs (e.g., industrial and field work) (Davis, 2002; Pascale, 2001). These differences in the perceptions of Black women workers, particularly when combined with sexualized stereotypes of Black women, are likely to affect the frequency and nature of their harassment experiences (Adams, 1997; Buchanan et al., 2008).

Sexual Harassment Frequency Among Black Women The frequency of sexual harassment among Black women has been found to vary based on their location. In university settings, between 30% and 62% of Black female undergraduates reported at least one sexually harassing experience during college (Cortina et al., 1998; Kalof et al., 2001; Mecca & Rubin, 1999). Among low income Black union workers in Boston, approximately onethird of women had experienced at least one type of sexual harassment in the year prior to the survey (Krieger, Waterman, Hartman, Bates, Stoddard, Quinn, et al., 2006). A comparable rate (34%) of Black women in a Los Angeles community sample had reported sexual harassment, which primarily took the form of sexual propositions, such as “Let me see how that blouse fits” (Wyatt & Riederle, 1995, p. 314). Black women employed in blue-collar, lower status positions or traditionally male-dominated professions, such as the auto industry (Gruber & Bjorn, 1982), law enforcement (Texeira, 2002), and the military (Fitzgerald et al., 1999) appear to be at greater risk. For example, African American women enlistees in the Navy reported more sexual harassment as compared to African American women Navy officers (41% vs. 29% respectively; Culbertson & Rosenfeld, 1994). More than two-thirds of Black women firefighters also reported undesired sexually suggestive looks and gestures, pressure for dates, and sexist name calling (Yoder & Aniakudo, 1996, 1997). Examining only total harassment scores may mask Black women’s relatively high rates of severe and sexualized types of sexual harassment. In a study of more than 7000 female military personnel, Black women, particularly those with low organizational status (enlisted personnel), reported significantly higher rates of unwanted sexual attention and sexual coercion (25% and 8% respectively) compared to Black female officers (10% and 2%) or White female officers (14% and 2%; Buchanan et al., 2008). Similarly, Mecca

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and Rubin (1999) discovered that although gender harassment (48%) was the most frequently reported form of sexual harassment in their college sample of 100 African American women, they also reported uncommonly high rates of seductive behavior (13%; inappropriate and offensive sexual advances such as unwanted personal discussions or proposition) and sexual seduction (19%; being touched by a professor in a sexual manner). Black women firefighters described being targeted for “pranks” or “initiation rites,” some of which were reminiscent of adolescent stunts, such as pouring eggs into the victim’s boots. Other pranks were malicious or even life-threatening, for example, having the victim’s car towed away or tampering with her equipment in a manner that could result in injury or death (Yoder & Aniakudo, 1996; 1997). Racialized sexual harassment, which is distinct from either racial or sexual harassment and combines multiple forms of oppression, is also a common experience (Buchanan, 2005a; Buchanan & Ormerod, 2002; Cho, 1997; Texiera, 2002). For example, on her first day at work, one White coworker said to a Black female firefighter: “I’m gonna tell you why I don’t like you. Number one…cuz you’re Black. And number two, cuz you’re a woman” (Yoder & Aniakudo, 1996, p. 263). Black college women described a particularly distressing category of harassment based on racial stereotypes concerning their sexuality or physical features (e.g., Black women are sexually promiscuous or have large buttocks; Mecca & Rubin, 1999). This form of sexualization also occurs in professional settings. In focus groups with university administrators, academic advisors, bankers, and Black women in other professional and executive-level positions, there were numerous accounts of inappropriate sexual comments. For example, one woman was told by her White male coworker, “I bet you are a slave to sex” (Buchanan & Ormerod, 2002, p. 115), conjuring both the enslavement of Black women and the stereotypes of them as hypersexed. Women also described a form of covert sexual harassment (Buchanan, 2005a) that could be conceptualized as racialized gender harassment that appeared to be differentially targeted toward Black women. These behaviors were typified by comments implying Black women were incompetent or irresponsible. Others described difficulties with White subordinates, often women, who refused to perform job duties for Black female supervisors despite the tasks being part of their job requirements and tasks they had done previously for White male supervisors (such as making photocopies or coffee). Participants perceived these events as refusals to engage in behaviors that might imply that they were “serving,” or were subordinate to, a Black woman.

Black Women, Coping Responses, and Consequences of Sexual Harassment For some Black women, sexualized comments evoke particularly strong feelings because rape, childhood sexual abuse, and sexual harassment during and after slavery were pervasive and frequent experiences (Collins, 2000; Davis, 1998). The Jezebel stereotype, which stigmatized Black women as hypersexual, was used to justify this sexual violence (Bell, 2004; West, 2008). Under slavery, these crimes were deemed property crimes against the assaulted woman’s slavemaster, not a sexual assault against the victim (Davis, 1998).


Despite legal changes, Black women continued to be perceived as potentially culpable in the eyes of some hospital staff, rape advocates, police officers, and court officials (Campbell et al., 2001; Donovan & Williams, 2002; Neville & Hamer, 2001). These historical traumas are intergenerational and continue to live in the collective memories of contemporary African American women. As a result, some Black women have developed a culture of silence, secrecy, and shame around sexual harassment (Adams, 1997; Davis, 2003; West, 2006); as such, many avenues of coping with sexual assault and harassment, such as seeking legal redress, may not be considered viable options. Consequently, some Black women may remain silent when sexually harassed and may even be reluctant to label offensive behavior as sexual harassment. Even when the behavior was identified as disgusting and hostile, approximately one-third of participants in a community sample of Black women took no action against the perpetrator (Wyatt & Riederle, 1995). Similarly, of the 52% of Black undergraduate women who endorsed at least one item on the Sexual Experiences Questionnaire (Fitzgerald et al., 1988), the majority (96%) did not label this offensive conduct as sexual harassment (Mecca & Rubin, 1999). Other Black women remained silent due to fear of retaliation in the form of economic sanctions or job loss, whereas others did not want to reinforce stereotypes about the hypersexual or angry Black woman (Taylor & Richardson, 2006; West, in press). When the harasser was an African American man, victims were sometimes pressured by community members and harassers to minimize the behavior. One participant explained, “As an African American, for whatever reason, Black men feel like there is a window of ‘okayness.’ They feel, because your [sic] Black, ‘I can come and talk to you like there are no laws being broke, just because we are of the same [race/culture]” (Taylor & Richardson, 2006, p. 82). On the other hand, many women did not passively accept their victimization. To illustrate, a majority of Black women firefighters directly confronted the harassers and several used physical self-defense tactics to counter the sexual harassment (Yoder & Aniakudo, 1995). In a community sample, 24% of Black respondents did one of the following when confronted with workplace sexual harassment: reprimanded the harasser and demanded that he stop; threatened him verbally, pushed or kicked him; reported the offensive behavior, or attempted to have the harasser fired (Wyatt & Riederle, 1995). In a study of nearly 3,000 Black women serving in the U.S. Armed Forces, several patterns of coping were defined, many of which used active coping strategies including confronting the perpetrator and formally reporting his behavior (Buchanan et al., 2007). However, these patterns of coping were associated with differences in their psychological well-being and work-related outcomes. Ironically, those engaging in the most direct and assertive forms of coping had the worst outcomes. Further, some coping responses can strengthen women in the long-term; specifically, embracing a Black feminist ideology can empower African American women to actively fight against sexual harassment by mobilizing at a grassroots level or using the media to educate the larger community (Ransby, 1995; West, in press). As stated previously, sexual harassment is associated with negative mental health consequences and several factors can further exacerbate its harm. For example, harassment attacking multiple salient identities (such as one’s

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race and one’s gender) may be especially upsetting (Settles, 2006; King 2003). Further, experiencing multiple forms of trauma or a single trauma that occurs many times is not only common, but is also associated with increased psychological harm (Green, et al., 2000; Krupnick, Green, Stockton, Goodman, Corcoran, & Petty, 2004). Consistent with this, 78% of African American women who had been harassed at work, compared to 43% of their nonharassed counterparts, reported a history of sexual violence (Wyatt & Riederle, 1994), and psychological well-being was further impaired when a victim has a prior history of sexual violence, such as childhood sexual abuse or adult rape. Further, although embracing a Black feminist epistemology can increase activism and improve one’s sense of agency following harassment (Ransby, 1995; West, in press), there may be a psychological cost. Among sexually harassed Black women in college, those who endorsed more feminist attitudes reported the most psychological distress. To explain these counterintuitive findings, the researchers posited that “… for Black women, feminist, nontraditional gender attitudes may indicate a greater awareness of inequity among different groups in society. This awareness, or double consciousness, may be costly…” (Rederstorff et al., 2007, p. 57). Furthermore, Black feminist undergraduates may be more aware of the history of sexual mistreatment and the social and legal response, thus they may be more reluctant to seek counseling or legal recourse given that these systems have been historically unresponsive to sexual violence against African American women (Campbell et al., 2001; Donovan & Williams, 2002; Neville & Hamer, 2001). Together, this implies that experiencing sexual harassment together with racial harassment will also be associated with poorer outcomes; however few studies have examined the combined effects of experiencing both. In a sample of 91 Black working women, sexual harassment and racial harassment uniquely predicted a multitude of psychological and work-related outcomes, and those who experienced both forms of harassment reported significantly worse outcomes (Buchanan & Fitzgerald, 2008). Moreover, the interaction of sexual and racial harassment was statistically significant indicating that when both sexual and racial harassment were present and either form became frequent, dissatisfaction with one’s supervisor and perceptions of organizational tolerance of harassment increased significantly. These findings provide evidence that when studying the harassment experiences of Black women, and analysis of both race and gender-based harassment is essential.

Latinas Latinos represent the largest ethnic minority group in the United States and demographic projections indicate that they will continue to increase in numbers over the next several decades (Pew Research Center, 2005; U.S. Bureau of the Census 2007), which places increasing numbers of Latinas in American workplaces where the potential for sexual harassment is high. Similar to Black women, Latinas in the United States are stereotyped, sexualized, and subjected to double jeopardy. These factors combined with cultural values within Hispanic culture, such as collectivism, impatia, familism, machismo, and traditional gender-role norms (Romero, 2004), and other variables related to culture, such as level of acculturation to the dominant U.S.


culture, are likely to affect how Latinas experience, perceive, and cope with sexual harassment (Cortina, 2004; Cox, Dorfman, & Stephan, 2005)

Sexual Harassment Frequency Among Latinas Across a variety of workplaces and positions, Latinas reported substantial rates of sexual harassment. For example, among low-income union workers in Boston, 17.4% of Hispanic women experienced at least one type of sexual harassment in the year prior to the survey (Krieger et al., 2006). Higher rates were reported among Hispanic women military personnel: sexist hostility (63.1%), sexual hostility (73.4%), unwanted sexual attention (45.1%), and sexual coercion (12.2%; Fitzgerald et al., 1999). Latinas with less organizational status in the military are at greater risk; with enlisted Latinas reporting more sexual harassment than Latina officers (48% vs. 32%, respectively; Culbertson & Rosenfeld, 1994). In a sample of low income Latinas (primarily of Mexican descent) who were enrolled in public adult schools or job training centers in San Diego, similarly high rates of sexual harassment (60%) were found (Cortina, 2001). Latinas who are employed in academic and professional settings also experience sexual harassment (Taylor & Richardson, 2006). For instance, in one study 60% of Latina college students had been harassed (Cortina et al., 1998). Latinas in another university sample reported lower, yet substantial rates of overall sexual harassment (30.8%), gender harassment (23%), and unwanted sexual attention (7.7%; Kalof et al., 2001). Among 152 Latinas (primarily Mexican American) employed at a large public university, one-third reported sexual harassment and believed it was one of the most underreported problems in the organization (Segura, 1992). Similar to the experiences reported by Black women, sexual harassment among Latinas often occurred in conjunction with other forms of sexual harassment and racial harassment (Cortina et al., 2002). Almost one-third (30%) of participants surveyed by Cortina (2001) had encountered three forms of sexual harassment (sexist hostility, sexual hostility, or unwanted sexual attention) and those experiencing personal sexual harassment were also likely to have witnessed someone else being sexually harassed. In another predominately Latina sample, 69.2% had observed the sexual harassment of others within their organization, such as observing a coworker being targeted by male supervisors or coworkers who were telling suggestive stories or offensive jokes, heard someone make offensive remarks about the appearance, body, or sexual activities of someone else (Hitlan, Schneider, & Walsh, 2006). One culturally-relevant concern is that Latinas vary in their level of acculturation, or the extent to which they have integrated the mainstream U.S. culture into their lifestyles. Acculturation levels have been associated with the frequency and perceptions of harassment, and with how women respond and cope when harassed. Studies have demonstrated that rather than increasing Latinas’ vulnerability to harassment, remaining ensconced in traditional Hispanic culture may be protective. As a collectivistic culture, in-group safety and security are paramount (Triandis, 1995); therefore, less acculturated Latinos may be more protective of one another and buffer one another from sexual harassment (Shupe et al., 2002). For example, among food plant

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workers, more acculturated Latinas reported higher rates of sexual harassment than their less assimilated counterparts (61% vs. 23%, respectively; Shupe et al., 2002). On the other hand, lower levels of acculturation may be associated with other factors that increase Latinas’ vulnerability to sexual harassment, particularly if they lack citizenship status or work in low status positions, such as workers in maquiladoras (assembly plants along the U.S.-Mexico border where workers produce consumer goods for export to the United States; Arriola, 1999–2000), maids and domestic household workers (Vellos, 1996–1997), and farm and migrant workers (Castaneda & Zavella, 2003). Economic vulnerability, limited employment alternatives, language barriers, and fear of deportation among recent Hispanic immigrants could increase their exposure to sexual harassment and make them less willing to report the offensive conduct.

Latinas, Coping Responses, and Consequences of Sexual Harassment Sexual harassment has been consistently associated with mental health problems and psychological distress, including feelings of anger and powerlessness. For some victims, stereotypes of “hot Latinas” who are hypersexual or low-income and uneducated “baby-makers” added to their distress (Segura, 1992; Taylor & Richardson, 2006). A variety of other factors have been associated with Latina’s perceptions of severity and distress associated with sexual harassment, such as the frequency of personal harassment and exposure to bystander sexual harassment (Hitlan et al., 2006), sexual harassment that co-occurs with racial harassment, the perpetrator’s level of power within the organization, and the victim’s higher level of acculturation (Cortina et al., 2002). Although lower acculturation appears to buffer Latinas from being harassed, it is not clear if it also buffers or exacerbates negative outcomes when they are harassed. Less acculturated Latinas in the food processing plants reported more negative job-related effects, but similar levels of psychological distress as highly acculturated Latinas (Shupe et al., 2002). Conversely, in a community sample, as Latinas became more acculturated with the dominant White American culture, they experienced sexual harassment as more severe (Cortina et al., 2002), which was associated with lower satisfaction with work, coworkers, and supervisors; job withdrawal in the form of absenteeism, tardiness, and neglect of nonmandatory job duties; as well as increased depressive, anxious, and somatic symptoms. These researchers speculate that greater affiliation with the dominant U.S. culture may be associated with more feminist beliefs, which in turn fosters greater awareness of sexual harassment. Furthermore, as Latinas adopt more U.S. cultural standards, they may encounter conflict with more traditional family members and friends, which may limit their support system. With a limited support system, sexual harassment and the stress associated with the offensive conduct may be perceived as more severe (Cortina et al., 2002). In order to cope with sexual harassment, Latinas most commonly attempted to procure assistance from female friends (68%) and family members (52%). Generally, these informal support networks were perceived as supportive. However, Latina victims experienced less positive support when they were


faced with more severe sexual harassment, possibly because family members began to blame the victim for “allowing” the sexual harassment to continue. Latinas, particularly if they were less acculturated, who received unsupportive social responses experienced sharp declines in job satisfaction as sexual harassment intensified in severity (Cortina, 2004). In addition, greater social proximity to the harasser was associated with less willingness to disclose the offensive conduct to family members. Given the highly cohesive and interconnected makeup of traditional Hispanic families and communities ( familismo), Latinas may be disbelieved or silenced when they reveal the misconduct of a perpetrator who is a member of the extended family network (Cortina, 2004). Moreover, in-group members may use their cultural familiarity to gain access to their victims and to ensure her silence. As one Latina explained, “I think a Hispanic male is more likely to say something to me than he would a Caucasian woman, because he would feel like we have that ‘special bond’, that I wouldn’t be offended” (Taylor & Richardson, 2006, p. 82). In other cases, there is a culture of silence around sexual harassment within Hispanic social networks. For example, two female coworkers, who had been harassed and remained silent, discouraged a Latina community worker from reporting her sexual harassment “for fear that exposing the perpetrators would undermine their movement and embarrass the Latino community” (Ontiveros, 1997, p. 189). To conclude, sexually harassed Latinas sought help from multiple sources, particularly if they had been harassed by an organizationally powerful man or perceived the harassment to be severe. Overall, 38% of Hispanic American working women in a community sample, sought help from formal, organizational sources to resolve their sexual harassment complaints. More specifically, they spoke to a supervisor about the offensive conduct, reported the harasser, and filed a grievance (Cortina, 2004). Although some of the Latinas admitted that they feared retaliation or were concerned about being labeled a troublemaker, they found ways to assert themselves and document their dissatisfaction with their mistreatment (Segura, 1992). For instance, some victims directly challenged sexual harassment, while others used subtle and nonverbal methods to communicate their displeasure, such as frowning and failing to reciprocate interest (Cortina & Wasti, 2005).

Asian Women Although the research on this population is limited, anecdotal accounts and interviews (Cho, 1997–1998; Davar, 1999) and empirical studies suggest that working women of Asian descent experience substantial rates of sexual harassment. For example, Asian American or Pacific Islander women military personnel reported sexist hostility (58.7%), sexual hostility (66.2%), unwanted sexual attention (40.2%) and sexual coercion (10.8%) (Fitzgerald et al., 1999). Sexual harassment is a problem on college campuses as well (e.g., Chen, 1997; Green & Kim, 2005). One professor asserted, “At almost every campus where I have been, both as a student and faculty member, I have encountered appalling cases of sexual harassment against Asian Pacific and Asian Pacific American women” (Cho, 1997–1998, p. 181). As evidence of this, 46% of Asian/East Indian American college students had been harassed (Cortina et al., 1998); however,

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in another college sample students who identified as Asian, Pacific Islander, or Filipino reported somewhat lower rates (33%; Kalof et al., 2001). Economic marginalization, language barriers, citizenship status, and lack of familiarity with sexual harassment laws in the United States made some Asian women especially vulnerable to sexual harassment , such as Filipinas who worked as live-in caregivers (Welsh, Carr, MacQuarrie, & Huntley, 2006) and Asian immigrant women who were employed in garment factories (Louie, 2001). Many victims attributed their sexual harassment to sexualized stereotypes of Asian women, including portrayals of them as exotic geishas, prostitutes who service military personnel, and “mail-order” brides who are gracious, uncomplaining servants (Cho, 1997–1998). In a college sample of Asian American women, including women of Chinese, Japanese, Korean, Filipina, South Asian, and Vietnamese descent, 69% believed that Asian American women’s sexual harassment differed from that experienced by White women and that these differences were related to how women from their ethnic group were perceived, or misperceived, by the harasser (Chen, 1997). For example, one South Asian women was told that she was overreacting to her supervisor’s “multicultural interest” when “he said he’d read in the Kama Sutra about all the sexual tricks ‘my people’ could do” (Davar, 1999, p. 42). At other times, the cultural expectation that they would respond passively, and thus be less likely to resist, made Asian American women prime targets of sexual harassment. Despite these challenges, some Asian American women have organized other workers, complained, or taken legal action to stop their harassment (Cho, 1997–1998; Davar, 1999; Louie, 2001). Asian American women face similar challenges in their harassment experiences and ability to cope other Women of Color. Acculturation levels also influence their perceptions and responses to sexual harassment. The limited research suggests that less acculturated, more traditional Asian Americans are more tolerant of sexual harassment than Asian Americans who are more affiliated with the dominant U.S. culture (Kennedy & Gorzalka, 2002). Also, Asian American women report elevated rates of intersecting forms of harassment, such as racialized sexual harassment, which often conjures sexualized stereotypes of Asian women (Cho, 1996, 1997; Holder, Nee, & Ellis, 2000). Finally, Asian culture is generally collectivistic and Asian Americans are attentive to loss of face, the shame associated with behaving in a way that embarrasses the group or one’s family. Loss of face often promotes behaviors that maintain, while discouraging behaviors that disrupt, intergroup harmony (Zane & Mak, 2003) and has been associated with a variety of behaviors among Asian Americans, including reduced sexual aggression (Hall, Sue, Narang, & Lilly, 2000; Hall, Tetan, DeGarmo, Sue, & Stephens, 2005). However, loss of face may also limit the coping responses of Asian American women who have been sexually harassed, particularly if the perpetrator is an in-group member.

Conclusion Several points can be gleaned from the research on sexual harassment in the lives of African American, Hispanic, and Asian American women. First, although Women of Color who are employed in lower-status, blue-collar, or male-dominated professions may be somewhat more vulnerable to sexual


harassment, it remains a problem for women, particularly Women of Color, employed in all professions (e.g., Baker, 2004). Second, the perpetrators of sexual harassment may be male or female supervisors, coworkers, and even subordinates. In fact, as members of at least two socially marginalized groups (women and people of color), they may be more vulnerable to contrapower harassment by less organizationally powerful Caucasian employees, of either gender, who may use their societal race and/or gender privileges to undermine the authority of Women of Color (Rospenda, Richman, & Nawyn, 1998). Third, it is possible to experience sexual harassment independently or in conjunction with other forms of harassment. For example, a sexually harassed Latina who is employed in a mostly Hispanic context may not perceive herself to be a victim of racial harassment. More commonly, however, Women of Color experience racialized sexual harassment, which combines elements of both racism and sexism (Buchanan & Ormerod, 2002; Buchanan, 2005a; Cho, 1997; Texiera, 2002). Related to this, Women of Color consistently mentioned the links between sexual harassment and stereotypes or oppressive images, such as Black women Jezebels, hot-blooded Latinas, and Asian geishas. Such misrepresentations are deeply rooted in the history of sexual violence against these respective ethnic groups (Cho, 1997; Davis, 2003) and continue to influence the contemporary sexual harassment experiences of Women of Color. Further, although Women of Color may be more distressed by interracial sexual harassment (Woods, Buchanan, & Settles, 2007), they are often encouraged to honor a code of silence regarding intraracial sexual harassment in order to protect men of color and their communities from negative attention (Ontiveros, 1997). These demands can come at a high personal cost to Women of Color’s well-being. Last, despite these challenges, women of color are active help seekers and use a variety of strategies to cope with and resist sexual harassment, including consulting with their social support system of friends and relatives, filing lawsuits, and directly confronting their harassers. Women of Color are not only victims, but resilient survivors (Hill, 1997; West, in press).

Future Directions To date, there has been a dearth of research addressing the sexual harassment of Women of Color and this research has been peppered across many fields, such as psychology and sociology, without a critical mass of research from any one discipline. This is particularly surprising given that Black women have been overrepresented as plaintiffs in sexual harassment lawsuits. In fact, many of the first cases used to define sexual harassment case law were brought forward by Black women (e.g., Barnes v. Costle, 1977; Meritor Savings Bank v. Vinson, 1986) and one of the most publicized debates on sexual harassment involved Anita Hill and Clarence Thomas, who were both Black (Crenshaw, 1992; Hill, 1997). Increasingly, scholars have recognized the need for additional research in this area (e.g., DeFour et al., 2003; Murrell, 1996) and identified several domains for future investigation. In particular, future investigators should strive to conduct more research on especially vulnerable populations, sexual harassment in different settings, and improve and expand research methodologies.

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More Research on Diverse Populations There is a need for more research on racial differences and similarities in sexual harassment, including frequency and prevalence rates, perceptions and definitions of sexual harassment, and the psychological, physical, and jobrelated consequences associated with this form of workplace abuse. To date, the vast majority of research on race and harassment has focused on Black, Latina, and East Asian women, with little research on multiracial/biracial, Native American, South Asian, or immigrant women. These are groups that may be especially vulnerable to sexual harassment or face unique forms of harassment and constraints on their responses, yet they are often neglected by researchers (Chew, 2007; Rospenda, Richman, & Shannon, 2009; Tjaden & Thoennes, 2006). Available research suggests that Native American women are also at high risk for sexual harassment. When compared to other ethnic groups, Native American women in the military worked in organizational environments that were more tolerant of sexual harassment and they reported the highest rates of sexual harassment including: sexist hostility (73.8%), sexual hostility (82%), unwanted sexual attention (55.6%), and sexual coercion (26.1%; Fitzgerald et al., 1999). Anecdotal and qualitative findings among multiracial college women indicate that multiracial women may be at risk of sexual exploitation and sexual harassment (Buchanan & Acevedo, 2004; Buckley & Carter, 2004). In the only quantitative study of harassment among this population, undergraduate multiracial women experienced the highest rates of sexual harassment compared to Black, White, Latino/a, and Asian men and women (Buchanan et al., 2009). These findings imply that multiracial women are especially vulnerable, yet they are largely absent from the extant literature. In addition to assessing similarities and differences across racial/ethnic groups, it is important to also consider within group and individual differences. Race and gender stereotypes manifest differently across groups, and cultural norms and gender-role expectations also differ within groups. Thus, nuances and cultural factors may differentially influence Latinas from Mexico, Spain, and Puerto Rico, or Black American and Black Caribbean women may cope with harassment differently. Nevertheless, the ethnic composition of racial groups are rarely reported in sexual harassment research or formally examined. In addition, future researchers need to expand their investigations to consider Women of Color of various ages, levels of racial identity or acculturation, and income and professional statuses. In particular, there is a special need for information on sexual harassment among lesbian, gay, bisexual, and transgendered women. When compared to their heterosexual counterparts, sexual minorities encounter more harassment in the work place (Krieger et al., 2006) and in university settings (Cortina et al., 1998; Defour et al., 2003). Interestingly, perpetrators sometimes tailor their types of harassment based on the victim’s perceived sexual orientation. Single heterosexual women may be pestered for dates and sexual interactions, while lesbians may be treated with hostility because they are uninterested in romantic relationships with men (Hoffmann, 2004). By including these multiple identities, researchers can better articulate how race, socioeconomic class, gender, and sexual orientation converge to influence the victim’s experience with sexual harassment.


Sexual Harassment Across Diverse Settings In addition to workplaces and colleges, girls/Women of Color have reported sexual harassment in elementary and high school settings with a variety of negative outcomes, including some not commonly reported among adults, such as stealing and fighting (Goldstein, Malanchuk, Davis-Kean, & Eccles, 2007).2 Future researchers should explore these associations and devise prevention and intervention programs for these young victims. There is also a need to investigate Women of Color’s experiences with sexual harassment in faith communities (Whitson, 1997), low-income housing (Reed, Collinsworth, & Fitzgerald, 2005; Tester, 2008), social settings (Wyatt & Riederle, 1995) and public settings, such as the street (Perry, 2007). Even professionally dressed African American women have been solicited as prostitutes (Buchanan & Ormerod, 2002; Wyatt, 1997), and women continue to be harassed and assaulted publically, often with the implicit consent of onlookers. For example, nearly 60 women were surrounded and assaulted, and then doused with water and beer when they attempted to leave the New York City’s 2000 Annual Puerto Rican Day Parade. Rather than intervene, bystanders videotaped the assaults and police were slow to respond to the victims’ pleas for help (Laniya, 2005). These forms of sexual harassment can be traumatic and should not be minimized simply because they may not fall under the legal protections provided for harassment in the workplace or in educational institutions.

Improve Methodology, Policies, and Interventions Traditionally, researchers have utilized problematic forms of “ethnic lumping” to address limitations related to small sample sizes of ethnic minorities. Frequently, multiple ethnic groups (e.g., Asians, Arabs, and Africans) are combined and categorized as “minorities” (e.g., Berdahl & Moore, 2006). In other cases, researchers have combined several groups, for example Korean, Chinese, and Japanese, and categorized them as “Asian American” women without consideration of ethnic subgroup differences (e.g., Chen, 1997). Still, other researchers have conducted research using “Latinas” or Hispanic women, which exclusively or primarily consisted of Mexican American women rather than Latinas as a whole (e.g., Segura, 1992). Although each of these represent strong studies with important findings, these practices limit our understanding of the generalizability of research findings and distort our knowledge of whom the results represent. In order to make meaningful racial or ethnic subgroup comparisons, larger samples are required. Conversely, researchers can focus on emic approaches that seek to explore the phenomenon within a specific group without conducing comparisons across groups. Appropriate assessment of the harassment experiences of Women of Color remains a significant concern and culturally-sensitive instruments are needed. Although standardized measures, such as the Sexual Experiences Questionnaire (Fitzgerald et al., 1988), appear to reliable and valid, researchers may need to modify these scales to include items that better capture the experiences of Women of Color. For example, Cortina (2001) used focus group responses to create additional items for the Sexual Experiences Questionnaire that were representative of the experiences of Latinas (SEQ-L; Cortina, 2001).

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Other researchers also have successfully used qualitative methods, such as focus groups, to better understand sexual harassment in the lives of Women of Color (e.g., (Buchanan, 2005a; Taylor & Richardson, 2006), which has lead to the development of a measure of racialized sexual harassment (Buchanan, 2005b). To investigate sexual harassment among recent immigrants, nonEnglish speakers, and women who are isolated or unfamiliar with traditional research methods, investigators may need to conduct life history interviews or immerse themselves into these marginalized communities via participantobservation methodology (Castaneda & Zavella, 2003). Various forms of qualitative research methodologies can be an invaluable first step in assessing contextual, cultural, and perceptual experiences of Women of Color as well as factors that limit their ability to respond effectively. With this knowledge investigators can develop theoretical models that reflect universal as well as issues of particular relevance to Women of Color, such as race-based stereotypes that are relevant to particular ethnic groups (Cortina et al., 2002). Policies and practices must also be adapted to address the unique experiences of Women of Color. Many organizational policies and federal laws against sexual harassment separate experiences based on race and those based on sex; yet, the literature presented here indicates that they often cooccur. As such, it is important that legislation and policy actively incorporate racialized sexual harassment into their descriptions of prohibited behaviors under sexual harassment and racial harassment. Trainings and interventions must also address this reality if they are to be effective in preventing the types of harassment experiences commonly perpetrated against Women of Color. Further, race and gender are not independent of other factors, such as organizational status or socioeconomic status, which may also increase the likelihood of a woman being targeted for harassment. Therefore, interventions addressing multiple factors that increase a woman’s risk of harassment are needed. To conclude, the larger phenomenon of sexual harassment appears to be etic or universal. However, for Women of Color, sexual harassment is often racialized, rooted in a long history of discrimination and sexual violence, and fostered by the current inequities in the workplace and academic settings. Consequently, researchers must continue to explore how racism and other forms of oppression carve unique contours into an otherwise common experience.

Endnotes 1. The term Women of Color is used to refer collectively to the four ethnic groups mostly commonly discussed in this chapter (African American or Black, Latina or Hispanic American, Asian American, and Native American), where possible, the specific ethnic subgroup will be identified (e.g., Mexican American). The terminology used to refer to racial groups may vary based on regional, political, and personal preference. However, the authors will use the terminology used by researchers in the original article referenced in this chapter.


2. Sexual harassment in federally funded schools and universities is prohibited under Title IX of the Education Amendments of 1972, which states that students cannot be discriminated against, excluded from participation, or denied educational benefits on the basis of his or her sex. Therefore, under Title IX, schools that receive federal funds are accountable sexually harassing behavior by a student or staff member if the school could reasonably have known that it was occurring and resulted in a student being denied equal access to educational programs or activities (Mann & Miller, 2000; Stein, 1999). The Office for Civil Rights of the U.S. Department of Education established school sexual harassment policy and procedure mandates and guidelines to ensure school compliance with Title IX in 1997 and 2001 (Office for Civil Rights, U.S. Department of Education, 1997, 2001, Paludi & Paludi, 2003).

References Adams, J. (1997). Sexual harassment and black women: A historical perspective. In W. O’Donohue (Ed.), Sexual harassment: Theory, research, and treatment (pp. 213–224). Boston: Allyn & Bacon. Arriola, E. R. (1999–2000). Voices from the barbed wires of despair: Women in the Maquiladoras, Latina critical legal theory, and gender at the U.S.-Mexico Border. DePaul Law Review, 49, 729–815. Arvey, R. D., & Cavanaugh, M. A. (1995). Using surveys to assess the prevalence of sexual harassment: Some methodological problems. Journal of Social Issues, 51, 117–138. Avina, C., & O’Donohue, W. (2002). Sexual harassment and PTSD: Is sexual harassment diagnosable trauma? Journal of Traumatic Stress, 15, 69–75. Baker, C. N. (2004). Race, class, and sexual harassment in the 1970s. Feminist Studies, 30, 7–27. Barnes v. Costle, 561 F.2d 983 (DC Cir. 1977). Beal, F. M. (2008). Double jeopardy: To be Black and female. Meridians: feminism, race, transnationalism, 8, 166–176. Bell, E. L. (2004). Myths, stereotypes, and realities of black women: A personal reflection. The Journal of Applied Behavioral Science, 40, 146–159. Berdahl, J. L., & Moore, C. (2006). Workplace harassment: Double jeopardy for minority women. Journal of Applied Psychology, 91, 426–436. Bergman, M. E., & Drasgow, F. (2003). Race as a moderator in a model of sexual harassment: An empirical test. Journal of Occupational Health Psychology, 8, 131–145. Bowleg, L., Huang, J., Brooks, K., Black, A., & Burkholder, G. (2003). Triple jeopardy and beyond: Multiple minority stress and resilience among black lesbians. Journal of Lesbian Studies, 7, 87–108. Browne, I. & Kennelly, I. (1999). Stereotypes and realities: Images of Black women in the labor market. In I. Browne (Ed.), Latinas and African American women at work: Race, gender, and economic inequality pp. 302–326. New York: Russell Sage Foundation. Browne, I. & Misra, J. (2003). The intersection of gender and race in the labor market. Annual Review of Sociology, 29, 487–513. Bryant-Davis, T. (2005). African American women in search of scripts. In E. Cole & J. H. Daniel (Eds.), Featuring females: Feminist analysis of media (pp. 169–183). Washington, DC: American Psychological Association. Buchanan, N. T. (2005a). The nexus of race and gender domination: Racialized sexual harassment of African American women. In J. E., Gruber & P. Morgan (Eds.), In the company of men: Male dominance and sexual harassment pp. 295–320. Boston: Northeastern University Press. Buchanan, N. T. (2005b), August. Incorporating race and gender in sexual harassment research: The Racialized Sexual Harassment Scale (RSHS). In N. T. Buchanan (Chair), Expanding sexual harassment research to include diverse populations and intersecting forms of harassment. Symposium presented at the meeting of the International Coalition Against Sexual Harassment, Philadelphia, PA.

469

470


Buchanan, N. T., & Acevedo, C. (2004). When face and soul collide: Therapeutic concerns with racially ambiguous and non-visible minority women. Women & Therapy, 27, 119–131. Buchanan, N. T., Bergman, M. E., Bruce, T. A., Woods, K. C., & Lichty, L. F. (2009). Unique and joint effects of sexual and racial harassment on college students’ well-being. Basic & Applied Social Psychology, 31, 267–285. Buchanan, N. T., & Fitzgerald, L. F. (2008). The effects of racial and sexual harassment on work and the psychological well-being of African American women. Journal of Occupational Health Psychology, 13, 137–151. Buchanan, N. T., & Ormerod, A. J. (2002). Racialized sexual harassment in the lives of African American women. In C. M. West (Ed.), Violence in the lives of Black women: Battered, black, and blue pp. 107–124). Binghamton, NY: The Haworth Press. Buchanan, N. T., Settles, I. H., & Langhout, R. D. (2007). Black Women’s coping styles, psychological well-being, and work-related outcomes following sexual harassment. Black Women, Gender and Families, 1, 100–120. Buchanan, N. T., Settles, I. H., & Woods, K. C. (2008). Comparing sexual harassment subtypes for Black and White women: Double jeopardy, the Jezebel, and the cult of true womanhood. Psychology of Women Quarterly, 32, 347–361. Buckley, T. R., & Carter, R. T. (2004). Biracial (Black /White) women: A qualitative study of racial attitudes and beliefs and their implications for therapy. Women & Therapy, 27, 45–64. Campbell, R., Wasco, S. M., Ahrens, C. E., Sefl, T., & Barnes, H. E. (2001). Preventing the ‘second rape’: Rape survivor’s experiences with community service providers. Journal of Interpersonal Violence, 16, 1239–1259. Castaneda, X., & Zavella, P. (2003). Changing constructions of sexuality and risk: Migrant Mexican women farmworkers in California. Journal of Latin American Anthropology, 8, 126–151. Chen, E. W. (1997). Sexual harassment from the perspective of Asian-American women. In C. R. Ronai, B. A. Zsembik, & J. R. Feagin (Eds.), Everyday sexism in the third millennium pp. 51–62. New York: Routledge. Chew, P. K. (2007). Freeing Racial Harassment from the Sexual Harassment Model. University of Pittsburgh School of Law Working Paper Series, 54. Retrieved March 24, 2009,from http://law.bepress.com/pittlwps/papers/art54. Cho, S. (1997). Converging stereotypes in racialized sexual harassment: Where the model minority meets Suzie Wong. The Journal of Gender, Race, & Justice, 1, 177–211. Civil Rights Act of 1964, Pub. L. No. 88–352, 78 Stat. 241, 1964. Civil Rights Act of 1991, 42 U.S.C. §§ 1981, 2000e et seq. Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd Edition). New York: Routledge. Cortina, L. M. (2001). Assessing sexual harassment among Latinas: Development of an instrument. Cultural Diversity and Ethnic Minority Psychology, 7, 164–181. Cortina, L. M. (2004). Hispanic perspectives on sexual harassment and social support. Personality and Social Psychology Bulletin, 30, 570–584. Cortina, L. M., Fitzgerald, L. F., & Dragow, F. (2002). Contextualizing Latina experiences of sexual harassment: Preliminary tests of a structural model. Basic and Applied Social Psychology, 24, 295–311. Cortina, L. M., Swan, S., Fitzgerald, L. F., & Waldo, C. (1998). Sexual harassment and assault: Chilling the climate for women in academia. Psychology of Women Quarterly, 22, 419–441. Cortina, L. M., & Wasti, S. A. (2005). Profi les in coping: Responses to sexual harassment across persons, organizations, and cultures. Journal of Applied Psychology, 90, 182–192. Cox, R., Dorfman, P. W., & Stephan, W. (2005, August). Determinants of Sexual Harassment Coping Strategies in Mexican American and Anglo Women. Paper presented at the annual meeting of the Academy of Management National Conference, Honolulu, HI. Crenshaw, K. (1992). Whose story is it, anyway? Feminist and antiracist appropriations of Anita Hill. In T. Morrison (Ed.), Race-ing Justice, En-gendering Power: Essays on Anita Hill, Clarence Thomas, and the Construction of Social Reality pp. 402–440. Culbertson, A. L., & Rosenfeld, P. (1994). Assessment of sexual harassment in the active-duty Navy. Military Psychology, 6, 69–93. Davis, A. Y. (1998). Reflections on the Black woman’s role in the community of slaves. In J. James (Ed.), The Angela Y. Davis Reader (pp. 111–128). Malden, MA: Blackwell.


Davis, A. Y. (2002). Don’t let nobody bother yo’ principle’: The sexual economy of American Slavery. In S. Harley and The Black Women and Work Collective (Eds.), Sister Circle: Black women and work pp. 103–127). New Brunswick, NJ: Rutgers University Press. Davis, A. Y. (2003). Slavery and the roots of sexual harassment. In C. A. MacKinnon & R. B. Siegel (Eds.), Directions in sexual harassment law (pp. 457–479). New Haven, CT: Yale University Press. Davar, T. (1999). Sexual harassment is a serious problem for Asian American women. In L. I. Gerdes (Ed.), Sexual harassment (pp. 38–46). San Diego, CA: Greenhaven Press. DeFour, D. C., David, G., Diaz, F. J., & Thompkins, S. (2003). The interface of race, sex, sexual orientation, and ethnicity in understanding sexual harassment. In M. Paludi & C. A. Paludi (Eds.), Academic and workplace sexual harassment: A handbook of cultural, social science, management and legal perspectives (pp. 31–45). Westport, CT: Praeger. DeSouza, E. R., & Solberg, J. (2003). Incidence and dimensions of sexual harassment across cultures. Westport, CT: Praeger Publishers/Greenwood Publishing Group. Donovan, R., & Williams, M. (2002). Living at the intersection: The effects of racism and sexism on Black rape survivors. Women & Therapy, 25, 95–105. Equal Employment Opportunity Commission. (1980). Guidelines on discrimination because of sex, 29 C.F.R. Section 1604.11. Fischer, A. R., & Good, G. E. (2004). Women’s feminist conscious-ness, anger, and psychological distress. Journal of Counseling Psychology, 51, 437–446. Fischer, A. R., Tokar, D. M., Good, G. E., Hill, M. S., & Blum, S. A. (2000). Assessing women’s feminist identity development: Studies of convergent, discriminant, and structural validity. Psychology of Women Quarterly, 24, 15–29. Fitzgerald, L. F. (1993). Sexual harassment: Violence against women in the workplace. American Psychologist, 48, 1070–1076. Fitzgerald, L., Drasgow, F., Hulin, C. L., Gelfand, M. J., & Magley, V. J. (1997). Antecedents and consequences of sexual harassment in organizations: A test of an integrated model. Journal of Applied Psychology, 82, 578–589. Fitzgerald, L. F., Gelfand, M. J., & Drasgow, F. (1995). Measuring sexual harassment: Theoretical and psychometric advances. Basic and Applied Social Psychology, 17, 425–445. Fitzgerald, L. F., Magley, V. J., Drasgow, F., & Waldo, C. R. (1999). Measuring sexual harassment in the military: The Sexual Experiences Questionnaire (SEQ-DoD). Military Psychology, 11, 243–263. Fitzgerald, L. F., & Shullman, S. L. (1993). Sexual harassment: A research analysis and agenda for the 1990s. Journal of Vocational Behavior, 42, 5–27. Fitzgerald, L. F., Shullman, S. L., Bailey, N., Richards, M., Swecker, J., Gold, Y., Ormerod, M., & Weitzman, L. (1988). The incidence and dimensions of sexual harassment in academia and the workplace. Journal of Vocational Behavior, 32, 152–175. Fitzgerald, L. F., Swan, S., & Fischer, K. (1995). Why didn’t she just report him? The psychological and legal implications of women’s responses to sexual harassment. Journal of Social Issues, 51, 117–138. Fitzgerald, L. F., Swan, S., & Magley, V. (1997). But was it really sexual harassment: Psychological, behavioral, and legal definitions of sexual harassment. In W. O’Donohue (Ed.), Sexual harassment: Theory, research, and treatment (pp. 5–28). New York: Allyn & Bacon. Frankenberg R. (1993). White Women, Race Matters: The Social Construction of Whiteness. Minneapolis: University of Minnesota Press. Gelfand, M. J., Fitzgerald, L. F., & Drasgow, F. (1995). The structure of sexual harassment: A confirmatory analysis across cultures and settings. Journal of Vocational Behavior, 47, 164–177. Gillum, T. L. (2002). Exploring the link between stereotypic images and intimate partner violence in the African American community. Violence Against Women, 8, 64–86. Glomb, T. M., Munson, L. J., Hulin, C. L., Bergman, M. E., & Drasgow, F. (1999). Structural equation models of sexual harassment: Longitudinal explorations and cross-sectional generalizations. Journal of Applied Psychology, 84, 14–28. Goldstein, S. E., & Malanchuk, O., Davis-Kean, P. E., & Eccles, J. S. (2007). Risk factors of sexual harassment by peers: A longitudinal investigation of African American and European American adolescents. Journal of Research on Adolescence, 17, 285–300.

471

472


Green, B. L., Goodman, L. A., Krupnick, J. L., Corcoran, C. B., Petty, R. M., Stockton, P., & Stern, N. M. (2000). Outcomes of single versus multiple trauma exposure in a screening sample. Journal of Traumatic Stress, 13, 271–286. Green, D. O., & Kim, E. (2005). Experiences of Korean female doctoral students in academe: Raising voice against gender and racial stereotypes. Journal of College Student Development, 46, 487–500. Gruber, J. E., & Bjorn, L. (1982). Blue-collar blues: The sexual harassment of women autoworkers. Work and Occupations, 9, 271–298. Gruber, J. E., & Bjorn, L. (1986). Women’s responses to sexual harassment: An analysis of sociocultural, organizational, and personal resource models. Social Science Quarterly, 67, 814–826. Gutek, B. A., & Done, R. S. (2001). Sexual harassment. In R. K. Unger (Ed.), Handbook of the psychology of women and gender. New York: Wiley. Gutek, B. A., & Koss, M. P. (1993). Changed women and changed organizations: Consequences of and coping with sexual harassment. Journal of Vocational Behavior, 42, 28–48. Hall, G. C. N., Sue, S., Narang, D. S., & Lilly, R. S. (2000). Culture specific models of men’s sexual aggression: Intra- and interpersonal determinants. Cultural Diversity & Ethnic Minority Psychology, 6, 252–267. Hall, G. C. N., Tetan, A. L., DeGarmo, D. S., Sue, S., & Stephens, K. A. (2005). Ethnicity, culture, and sexual aggression: Risk and protective factors. Journal of Consulting and Clinical Psychology, 73, 830–840. Hernandez, T. K. (2001). Sexual harassment and racial disparity: The mutual construction of gender and race. Journal of Gender Race & Justice, 4, 183–224. Hendrix, W. H. (2000). Perceptions of sexual harassment by student-employee classification, marital status, and female racial classification. Journal of Social Behavior and Personality, 15, 529–544. Hill, A. (1997). Speaking truth to power. New York: Doubleday. Hitlan, R. T., Schneider, K. T., & Walsh, B. M. (2006). Upsetting behavior: Reactions to personal and bystander sexual harassment experiences. Sex Roles, 55, 187–195. Hoffmann, E. A. (2004). Selective sexual harassment: Differential treatment of similar groups of women workers. Law and Human Behavior, 28, 29–45. Holder, K. A. Nee, C., & Ellis, T. (2000). Triple Jeopardy? Black and Asian women police officers’ experiences of discrimination. International Journal of Police Science and Management, 3, 68–87. Hughes, D., & Dodge, M. A. (1997). African American women in the workplace: Relationships between job conditions, racial bias at work, and perceived job quality. American Journal of Community Psychology, 25, 581–599. Illes, R., Hauserman, N., Schwochau, S., & Stibal, J. (2003). Reported incidence rates of workrelated sexual harassment in the United States: Using meta-analysis to explain reported rates disparities. Personnel Psychology, 56, 607–631. Kalof, L., Eby, K. K., Matheson, J. L., & Kroska, R. J. (2001). The influence of race and gender on student self-reports of sexual harassment by college professors. Gender & Society, 15, 282–302. Kennedy, M. A., & Gorzalka, B. B. (2002). Asian and Non-Asian attitudes toward rape, sexual harassment, and sexuality. Sex Roles: A Journal of Research, 46, 227–238. Kim, J. (2006). Gender inequality in the U.S. Labor Market: Evidence from the 2000 Census. In M. F. Karsten (Ed.), Gender, race, and ethnicity in the workplace: Issues and challenges for today’s organizations pp. 269–290. Westport, CT: Praeger. King, D. K. (1988). Multiple jeopardy, multiple consciousness: The context of Black feminist ideology. Signs, 14, 42–72. King, K. R. (2003). Racism or sexism? Attributional ambiguity and simultaneous memberships in multiple oppressed groups. Journal of Applied Social Psychology, 33, 223–247. King, K. (2005). Why is discrimination stressful? The mediating role of cognitive appraisal. Cultural Diversity and Ethnic Minority Psychology, 11, 202–212. Klonis, S., Endo, J., Crosby, F., & Worell, J. (1997). Feminism as life raft. Psychology of Women Quarterly, 21, 333–345. Krieger, N., Waterman, P. D., Hartman, C., Bates, L. M., Stoddard, A. M., Quinn, M. M., Sorensen, G., & Barbeau, E. M. (2006). Social hazards on the job: Workplace abuse,


sexual harassment, and racial discrimination—A study of Black, Latino, and White lowincome women and men workers in the United States. International Journal of Health Services, 36, 51–85. Krupnick, J. L., Green, B. L., Stockton, P., Goodman, L. A., Corcoran, C. B., & Petty, R. M. (2004). Mental health effects of adolescent trauma exposure in a female college sample: Exploring differential outcomes based on experiences of unique trauma types and dimensions. Psychiatry: Interpersonal, and Biological Processes, 67, 264–279. Langhout, R. D., Bergman, M. E., Cortina, L. M., Fitzgerald, L. F., Drasgow, F., & Hunter Williams, J. (2005). Sexual harassment severity: Assessing situational and personal determinants and outcomes. Journal of Applied Social Psychology, 35, 975–1007. Laniya, O. O. (2005). Street smut: Gender, media, and the legal power dynamics of street harassment, or Hey Sexy and other verbal ejaculations. Columbia Journal of Gender and Law. 14, 91. Available online. Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer Publishing Company, Inc. Louie, M. C. (2001). Sweatshop warriors: Immigrant women workers take on the global factory. Cambridge, MA: South End Press. Luthar, H. K., & Tata, T., & Kwesiga, E. (2009). A model for predicting outcomes of sexual harassment complaints by race and gender. Employee Responsibilities and Rights Journal, 21, 21–35. Magley, V. J. (2002). Coping with sexual harassment: Reconceptualizing women’s resistance. Journal of Personality and Social Psychology, 83, 930–946. Magley, V. J., Hulin, C. L.; Fitzgerald, L. F., & DeNardo, M. (1999). Outcomes of self-labeling sexual harassment. Journal of Applied Psychology, 84, 390–402. Magley, V. J., & Shupe, E. I. (2005). Self-labeling sexual harassment. Sex Roles, 53, 173–189. Mann, J. A., & Miller, F. W. (2000). Title IX: A student’s right to a harassment-free education. The Journal of Cases in Educational Leadership, 3(2), 1–7. Mansfield, P. K., Koch, P. B., Henderson, J. R., Vicary, M., & Young, E. W. (1991). The job climate for women in traditionally male blue-collar occupations. Sex Roles, 25, 63–79. Mecca, S. J., & Rubin, L. J. (1999). Definitional research on African American students and sexual harassment. Psychology of Women Quarterly, 23, 813–817. Meritor Savings Bank v. Vinson. (1986). 477 U.S. 57. Morrison, T. (Ed.) (1992). Race-ing justice, En-gendering power: Essays on Anita Hill, Clarence Thomas, and the construction of social reality. New York: Pantheon Books. Murrell, A. J. (1996). Sexual harassment and women of color: Issues, challenges, and future directions. In M. S. Stockdale (Ed.), Sexual harassment in the workplace: Perspectives, frontiers and response strategies (pp. 51–66). Thousand Oaks, CA: Sage Publications. Nelson, N. L., & Probst, T. M. (2004). Multiple minority individuals: Multiplying the risk of workplace harassment and discrimination. In J. L. Chin (Ed.), The psychology of prejudice and discrimination: Ethnicity and multiracial identity (pp. 193–217). Westport, CT: Praeger Publishers/Greenwood Publishing Group, Inc. Neville, H. A., & Hamer, J. (2001). ‘We make freedom’: An exploration of revolutionary Black feminism. Journal of Black Studies, 31, 437–461. O’Connell, C. E., & Korabik, K. (2000). Sexual harassment: The relationship of personal vulnerability, work context, perpetrator status, and type of harassment to outcomes. Journal of Vocational Behavior, 56, 299–329. Office for Civil Rights, U.S. Department of Education. (1997). Sexual harassment on campus: A policy and program of deterrence. Retrieved February 23, 2008, from http://www.eric. ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/12/ef/99.pdf. Office for Civil Rights, U.S. Department of Education. (2001). Revised Sexual Harassment Guidance: Harassment of Students by School Employees, other students, and third parties. Retrieved February 23, 2008 from http://www.ed.gov/about/offices/list/ocr/docs/ shguide.pdf. Ontiveros, M. L. (1997). Three perspectives on workplace harassment of women of color. In A. K. Wing (Ed.), Critical race feminism: A reader pp. 188–191. New York: New York University Press. Paludi, M., & Paludi, C. (2003). Academic and workplace sexual harassment: A handbook of cultural, social science, management, and legal perspectives. Westport, CT: Praeger Publishers/Greenwood Publishing Group, Inc.

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474


Pascale, C. (2001). All in a day’s work: A feminist analysis of class formation and social identity. Race, Gender & Class, 8, 34–59. Perkins, L. (1983). The impact of the ‘Cult of True Womanhood’ on the education of Black women. Journal of Social Issues, 39, 17–28. Perry, I. (2007). Let me holler at you: African American culture, postmodern feminism, and revisiting the law of sexual harassment. The Georgetown Journal of Gender and the Law, 8, 111–130. Patel., N. R. (2007). The construction of South-Asian-American womanhood: Implications for counseling and psychotherapy. Women & Therapy, 30, 51–61. Pew Research Center. (2005). January. Hispanics: A people in motion. Washington, DC: Andrew Kohut. Piotrkowski, C. S. (1998). Gender harassment, job satisfaction, and distress among employed White and minority women. Journal of Occupational Health Psychology, 3, 33–43. Ransby, B. (1995). A righteous rage and a grassroots mobilization. In G. Smitherman (Ed.), African American women speak out on Anita Hill-Clarence Thomas (pp.45–52). Detroit: Wayne State University Press. Reed, M. E., Collinsworth, L. L., & Fitzgerald, L. F. (2005). There’s no place like home: Sexual harassment of low income women in housing. Psychology, Public Policy, and Law, 11, 439–462. Rederstoff, J., Buchanan, N. T., & Settles, I. H. (2007). The moderating roles of race and genderrole attitudes and the relationship between sexual harassment and psychological wellbeing. Psychology of Women Quarterly, 31, 50–61. Romero, E. (2004). Hispanic identity and acculturation: Implications for management. Cross Cultural Management, 11, 62–72. Rospenda, K. M., Richman, J. A., & Shannon, C. A. (2009). Prevalence and mental health correlates of harassment and discrimination in the workplace: Results from a National Study. Journal of Interpersonal Violence, 7, 819–843. Rospenda, K., Richman, J., & Nawyn, S. (1998). Doing power: The confluence of gender, race, and class in contrapower sexual harassment. Gender & Society, 12, 40–60. Sanchez-Hucles, J., Hudgins, P. S., & Gamble, K. (2005). Reflection and distortion: Women of color in magazine advertisements. In E. Cole & J. H. Daniel (Eds.), Featuring females: Feminist analysis of media (pp. 185–198). Washington, DC: American Psychological Association. Santamarina, X. (2006). Belabored Professions: Narratives of African American Working Womanhood. Raleigh, NC: University of North Carolina Press. Schneider, K. T., Swan, S., & Fitzgerald, L. F. (1997). Job-related and psychological effects of sexual harassment in the workplace: Empirical evidence from two organizations. Journal of Applied Psychology, 82, 401–415. Scully, D., & Bart, P. (2003). A funny thing happened on the way to the orifice: Women in gynecology. Feminism & Psychology, 13, 11–16. Settles, I. H. (2006). Use of an intersectional framework to understand Black women’s racial and gender identities. Sex Roles, 54, 589–601. Segura, D. A. (1992). Chicanas in white-collar jobs: ’you have to prove yourself more.’ Sociological Perspectives, 35, 163–182. Shelton, J. N., & Chavous, T. M. (1999). Black and White college women’s perceptions of sexual harassment. Sex Roles, 40, 593–615. Shorter-Gooden, K. (2004). Multiple resistance strategies: How African American women cope with racism and sexism. Journal of Black Psychology, 30, 406–425. Shupe, E. I., Cortina, L. M., Ramos, A., Fitzgerald, L. F., & Salisbury, J. (2002). The incidence and outcomes of sexual harassment among Hispanic and non-Hispanic White women: A comparison across levels of cultural affi liation. Psychology of Women Quarterly, 26, 298–308. Sigal, J., Gibbs, M. S., Goodrich, C., Rashid, T., Anjum, A. & Hsu, D. (2005). Cross-cultural reactions to academic sexual harassment: Effects of individualist vs. collectivist culture and gender of participants. Sex Roles, 52, 201–215. Smitherman, G. (Ed.) (1995). African American women speak out on Anita Hill-Clarence Thomas. Detroit: Wayne State University Press.


Snyder, R., & Hasbrouck, L. (1996). Feminist identity, gender traits, and symptoms of disturbed eating among college women. Psychology of Women Quarterly, 20, 593–598. Stein N. (1999). Classrooms and courtrooms: Facing sexual harassment in K-12 schools. New York: Teacher’s College Press, Columbia University; 1999. Stone, L., & McKee, N. P. (1999). Gender and Culture in America. Upper Saddle River, NJ: Prentice-Hall. Taylor, J., & Richardson, B. (2006). Powerlessness, resistance, and the understood ‘ They: ‘ Sexual harassment at the intersection of race and gender In M. P. Orebe, B. J. Allen, & L. A. Flores (Eds.), The same and different: Acknowledging the diversity within and between cultural groups pp. 68–94. Washington, DC: National Communication Association. Texeira, M. T. (2002). ‘Who protects and serves me?’: A case study of sexual harassment of African American women in one U.S. law enforcement agency. Gender & Society, 16, 524–545. Tester, G. (2008). An intersectional analysis of sexual harassment in housing. Gender & Society, 22, 349–366. Tjaden, P., & Thoennes, N. (2006). Extent, nature, and consequences of rape victimization: Findings from the National Violence Against Women Survey (NCJ 210346). Washington, DC. U.S. Department of Justice Office of Justice Programs. Retrieved November 4, 2005 from http://www.ncjrs.gov/pdffi les1/nij/210346.pdf Triandis, H. C. (1994). Culture and social behavior. New York: McGraw-Hill. U.S. Bureau of the Census. (2007). Minority Population Tops 100 Million. Retrieved May 1, 2008, from http://www.census.gov/Press-Release/www/releases/archives/population/ 010048.html. Vellos, D. (1996–1997). Immigrant Latina domestic workers and sexual harassment. American University Journal of Gender and the Law, 5, 407–432. Wasti, S. A., Bergman, M. E., Glomb, T. M., & Drasgow, F. (2000). Test of the cross-cultural generalizability of a model of sexual harassment. Journal of Applied Psychology, 85, 766–778. Wasti, S. A., & Cortina, L. M. (2002). Coping in context: Sociocultural determinants of responses to sexual harassment. Journal of Personality and Social Psychology, 83, 394–405. Welsh, S., Carr, J., MacQuarrie, B., & Huntley, A. (2006). ‘I’m not thinking of it as sexual harassment’: Understanding harassment across race and citizenship. Gender and Society, 20, 87–107. Welter, B. (1966). The Cult of True Womanhood: 1820–1860. American Quarterly, 18, 151–174. West, C. M. (2006). Sexual violence in the lives of African American women: Risk, response and resilience. Harrisburg, PA: VAWnet, a project of the National Resource Center on Domestic Violence/Pennsylvania Coalition Against Domestic Violence. Retrieved November 4, 2007 from http://new.vawnet.org/Assoc_Files_VAWnet/AR_SVAAWomen.pdf. West, C. M. (2008). Mammy, Jezebel, Sapphire, and their Homegirls: Developing an ‘oppositional gaze’ toward the images of Black women. In J. Chrisler, C. Golden, & P. Rozee (Eds.), Lectures on the psychology of women (4th ed., pp. 286–299) New York: McGraw Hill. West, C. M. (in press). Resistance as recovery: How feminism helped me win a sexual harassment complaint. In A. White (Ed.). Consciously living feminism: Feminist theory and practice among African American women and men. Whitson, M. H. (1997). Sexism and sexual harassment: Concerns of African American women of the Christian Methodist Episcopal church. Violence Against Women, 3, 382–400. Wilcox, P. (2005). Beauty and the Beast: Gendered and raced discourse in the news. Social & Legal Studies, 14, 515–532. Willness, C. R., Steel, P., & Lee, K. (2007). A meta-analysis of the antecedents and consequences of workplace sexual harassment. Personnel Psychology, 60, 127–247. Woods, K. C., Buchanan, N. T., & Settles, I. H. (2007). Sexual harassment across the color line: Experiences and outcomes of cross- vs. intra-racial sexual harassment among Black women. Manuscript submitted for publication. Woodzicka, J. A., & LaFrance, M. (2001). Real versus imagined gender harassment. Journal of Social Issues, 57, 15–30. Wyatt, G. E. (1997). Stolen women: Reclaiming our sexuality: Taking back our lives. New York: John Wiley & Son, Inc. Wyatt, G. E., & Riederle, M. (1994). Sexual harassment and prior sexual trauma among African American and White American women. Violence and Victims, 9, 233–247.

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Wyatt, G. E., & Riederle, M. (1995). The prevalence and context of sexual harassment among African American and White American women. Journal of Interpersonal Violence, 10, 309–321. Yoder, J. D., & Aniakudo, P. (1995). The responses of African American women fi refighters of gender harassment at work. Sex Roles, 32, 125–137. Yoder, J. D., & Aniakudo, P. (1996). When pranks become harassment: The case of African American women fi refighters. Sex Roles, 35, 253–270. Yoder, J. D., & Aniakudo, P. (1997). ‘Outsiders within’ the fi rehouse: Subordination and difference in the social interactions of African American women fi refighters. Gender & Society, 11, 324–341. Yoder, J. D. & Berendsen, L. L. (2001).’Outsider within’ the fi rehouse: African American and White women fi refighters. Psychology of Women Quarterly, 25, 27–36. Zane, N., & Mak, W. (2003). Major approaches to the measurement of acculturation among ethnic minority populations: A content analysis and an alternative empirical strategy. In K. M. Chun, P. B. Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, an applied research (pp. 39–60). Washington, DC: American Psychological Association.

V Politics, Policy, and Advocacy


“Making Room at the Table”: Gender, Ethnic, and Class Inequities

17 Heather E. Bullock, Bernice Lott, and Karen Fraser Wyche

Imagine a very wealthy family blessed with five children. Four of their children have enough to eat and comfortable, warm rooms in which to sleep. One of their children does not. She is often hungry and lives in a cold room …. Imagine this family giving four of their children nourishing meals three times a day, snacks to fuel boundless child energy, but sending the fifth child from the table …. Imagine this very wealthy family making sure that four of their children get all of their shots … but ignoring their fifth child. Imagine this family sending four of their children to good schools in safe neighborhoods … and sending the fifth child to crumbling school buildings (Edelman, 2001, p. 109). With one in five U.S. children living below official poverty thresholds, our wealthy nation does indeed have a fifth child as described by Edelman (2001). It is not only children who bear the brunt of poverty, however, but also women and mothers (and their adult partners). Between 2000 and 2005, the percentage of women in poverty rose to from 11.3% to 12.9% of the U.S. population –14.6 million women (National Women’s Law Center, 2006). African American women and Latinas twice as likely to live in poverty as White women (Editorial, 2006a). Of all families headed by women, over 25% live below the poverty line,

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and 50% of all persons who are poor live in such households (Kahne, 2007). These statistics tell us a great deal about class and its intersections with race/ ethnicity, gender, and family status. Edelman’s plea that we stop neglecting poverty and “make room at our table” applies to our discipline of psychology (Lott, 2002; Reid, 1993; Saris & Johnson-Robledo, 2000). Despite ample documentation of the far-reaching consequences of class disparities on health, well-being, and human welfare, poverty and low income, like the fifth child, remain “invisible.” Social class is rarely treated as a core dimension of human diversity. It was absent from publicity materials for the first three National Multicultural Summits (biannual conferences sponsored by divisions of the American Psychological Association), and socioeconomic status receives little attention in Psychology of Women Quarterly, the flagship journal of the Society for the Psychology of Women (White, 2005). Until recently this was also true of our major professional organization, APA, which did not approve the creation of a permanent Committee on Socioeconomic Status until 33 years after the formation of the Committee on Women Psychology (1973), 27 years after the Office of Ethnic Minority Affairs (1979) was established, and 26 years after the Committee on Lesbian, Gay, and Bisexual Concerns (1980) was created. Our aim in pointing out these discrepancies is to underscore the institutional and scholarly neglect of SES/social class within psychology and the importance of the new Committee’s charge to promote “psychology’s contribution to the understanding of SES and the lives and well-being of the poor” (Socioeconomic Status Office: About Us, n.d.). In this chapter, we contribute to a “class-conscious” psychology by examining the correlates and consequences of women’s poverty, particularly in relation to family and employment. We focus on the structures underlying women’s poverty, the role of stereotypes in justifying class disparity, and the potential of feminist, multicultural analyses to challenge these inequities. We attend closely to intersections of class with race/ethnicity and gender to emphasize that privilege and oppression do not operate in isolation. To more deeply examine these intersections, we analyze Hurricane Katrina’s effect on the women of New Orleans. We conclude with suggestions for developing a truly multicultural, feminist approach to class and class inequality.

Women and Poverty: Who Are the Poor? The Complexity of “Poverty” With terms like “poor,” “low-income,” “working-class,” and “low SES” used interchangeably in social science research and political discourse, we must first specify who we see as the focus of our discussion. Our approach here is to provide an operational rather than a conceptual definition. In doing so, we excavate the structural underpinnings of poverty and challenge constructions of class inequality that situate responsibility for poverty on the backs of poor women. The U.S. government defines poverty in terms of whether individual or family income falls below official poverty thresholds. Based on a formula

Chapter 17 Socioeconomic Inequities

created in 1964, the so-called “poverty line” is based on three times the cost of feeding a family a minimal diet ($16,075 for or a family of three in 2007 and 21,200 for a family of four). In 2007, it was estimated that 37.3 million people (12.5% of the U.S. population) were poor (U.S. Census Bureau, 2008). These estimates would be even higher if calculations of poverty were updated to accurately reflect family expenses such as medical expenses, transportation, and childcare (Bernstein & Sherman, 2006; Christopher, 2005). Broader conceptualizations of poverty, those that contextualize poverty rather than simply position an individual or family above or below the “poverty line,” deepen our understanding of structural inequities and how they affect poor women’s lives. Recognizing that employment does not protect women from poverty, we include in our focus on low-income women, full-time minimum wage workers; women working part time without benefits; women who cycle in and out of the Temporary Assistance to Needy Families program; and women whose families would not survive without food stamps, Medicaid or housing subsidies. Our focus also includes families receiving cash assistance in the form of “welfare” or Temporary Assistance to Needy Families (TANF). Currently less than half of all families with children qualify for such aid, and the vast majority of these are headed by women. As with minimum wage workers, these families also “work” at jobs that do not pay a living wage. Restrictive “welfare reform” policies mandate that adults in single-parent households participate in specified “work activities” for an average of 30 h per week and two-parent families must work 55 h per week (Parrott et al., 2006), but do not specify minimum hourly wages. In addition to working outside the home, only 6 weeks of job search may count as an acceptable work activity, and only a lifetime total of 12 months of vocational education (Pear, 2006). Recently reauthorized welfare regulations require that states adopt a more stringent formula to calculate work participation rates and that the same definitions of “permissible work” be universally employed. We also include in our focus families who have exceeded their 60 month TANF lifetime limit—families in which parents, primarily mothers, are “so beleaguered by personal problems and parenting that they have not been able to keep jobs” (Eckholm, 2006e). It is estimated that, nationally, one million poor mothers with two million poor children are neither receiving benefits nor employed; they are referred to as “the disconnected.” An additional 10–20% of former recipients lack employment or other means of support within a year or two of leaving the welfare rolls (Eckholm, 2006e). But employment does not assure financial security. A study of California TANF recipients (London & Mauldon, 2006) found that 84% of employed respondents did not have jobs with health insurance, 87% did not have sick leave, and 83% lacked vacation leave. Almost all of these families were earning wages that qualify them for continued cash aid. By low-income women and mothers we mean those who cannot afford to buy a home. In Rhode Island, for example, it was estimated that the minimum wage per hour needed to buy a single family house at the close of 2005 (in the lowest priced town market) was $30.50; this means earning $63,441 a year (“Income needed to afford a home in R.I.,” 2006). Other families cannot afford to rent either a house or an apartment, and for this reason we include those

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who are homeless or precariously housed. In any given year, approximately 3.5 million people, 1.35 million of them children, are homeless (National Coalition for the Homeless, 2006), and these numbers are increasing. A 2005 survey of 24 cities by the U.S. Conference of Mayors found an average increase of 6% in requests for shelter (cf. “Poll: Requests,” 2005). Of those in emergency and transitional housing in 2005, nearly a quarter were minors, 59% were ethnic minorities, and about a quarter had disabilities (Ohlemacher, 2007). Accompanying the home foreclosure crisis in 2008 has been a huge increase in the numbers coming to shelters for temporary housing. Our focus also includes the families of farm workers who pick fruits and vegetables, such as those earning 45 cents for each 32-pound of tomatoes picked, and who must pick more than 3,500 pounds to earn $50. With an average annual income of $7,500–$10,000, most field workers have no health insurance, sick leave, or other benefits (“Working Families,” 2006). Nearly onefourth earn less than $7,500 a year (Clarren, 2005). We include day laborers, who are primarily undocumented immigrants, and who line up at hiring sites for jobs in construction, landscaping, painting, and roofing. Although mostly single, one interview study of close to 3,000 such workers found that 36% are married and 66% reported having children. Their median earnings are $10 per hour, ranging from $1,400 in “good” months to $500 in “bad” ones (Greenhouse, 2006). We include their families as well.

Blurring Class Lines: Of Economy and Exploitation Over the past three decades, the income gap continued to widen (Krugman, 2006b), leaving a growing number of individuals and families struggling to meet their basic needs. The share of national income going to wages is now at the lowest level on record since 1929, while the share of national income going to corporate profits is at its highest level since 1950 (Aron-Dine & Shapiro, 2007). The consequences of such inequity are widely felt. An increasing number of families move in and out of poverty as industries close, jobs are lost, and families must accommodate to sharp decreases in their resources. Deindustrialization is a problem in both urban and rural areas. A small town in Oregon that lost its logging and milling industries provides a dramatic illustration (Eckholm, 2006d). Families in which wage earners previously earned $20 to $30 an hour now earn the state minimum of $7.50. As a consequence, families were frequenting charity food pantries, hitchhiking to a nearby city for work, and worrying about money to pay rent for lot space in a trailer park. We believe such stories illustrate the “fuzzy” line between “low-income” and “working class.” Adair (2005) and other scholars argue for a distinction between “the working class and the poor … [based] on income, resources and material security” and the fact that “the poorest families in our nation are headed by single mothers” (p. 35). She adds, “many working-class families do have health care, own their own modest homes, eat regular meals, take occasional vacations, [and] send some of their children to college” (p. 36). These differing material realities, it is asserted, create divergences in the experiences and treatment of poor and working-class families. This is a compelling argument, but we do not see sharp lines between the poor and those working families who earn wages in unstable jobs and are insufficient to provide for


adequate health care, homes in safe neighborhoods, rainy day savings, or economic security. Put simply, we are concerned with women and families situated at the nexus of structural inequity—those with the least access to resources, including socioeconomic and political power. Everyday economic exploitation of low-income groups is vividly illustrated by a Brookings Institute study (2006) of the so-called “ghetto tax” paid by low-income urban residents in 12 U.S. cities. Approximately 4.2 million lower income homeowners (earning less than $30,000 annually) paid higher than average prices for their mortgages; 4.5 million households paid higher than average auto loans; and at least 1.6 million adults paid excessive fees for furniture, appliances, and electronics. Basic financial services, groceries, and insurance were also overpriced. Based on these findings, Eckholm (2006b) estimates that poor urban residents are charged hundreds if not thousands of dollars for basic necessities. A 1-% drop in these costs would add up to over $6.5 billion in new spending power for lowincome families (Fellowes, 2006).

Structured Inequality and Survival: Employment and Family Challenges for Low-Income Women A rich body of feminist scholarship focuses on work and family, but all too often, middle-class concerns overshadow the issues of greatest importance to low-income women. As a consequence, the psychological literature tells us far more about hitting “the glass ceiling” than surviving in the low-wage labor market, more about coping with harassment in professional and academic settings than in the “pink-collar” and industrial or service workforce, and more about “juggling” work and family demands than the consequences of chronic hardship on personal and family well being. We now turn our attention to these areas of concern and, in doing so, suggest that class-blind understandings of women’s work and family experiences are inadequate.

Employment Low Wage Work: Underpaid and Undervalued Regardless of whether the U.S. economy is strong or weak, low-income groups rarely get their fair share. During the recent economic expansion “the median worker’s wage fell 1.3%; for low-wage workers the decline was greater: 1.9%” (Bernstein, 2006). At the same time, in 2004, half of all executives earned more than 104 times what the average worker did (Dash, 2006). Among the lowest paid workers, 77% do not have jobs that provide sick leave (cf. Greenhouse, 2006b). Single parents, especially, are often caught between needing to meet inflexible work demands and needing to deal with immediate family problems, with too few resources for successful, effective problem solving. Lack of economic fairness in the workplace is an even greater problem for women than for men. Gender inequality is greater in the United States than in other industrialized countries around the world, with women receiving lower

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wages than men in practically all job categories and in all relationship categories (cf. Drescher, 2007). Women constitute the largest group of minimum wage workers—61% (Burk, 2006). Yet, with incredible irony, our laws mandate that, in order for poor women to receive cash assistance, they must choose a low paying job over full-time care for their children. While Congress has authorized funds for childcare, the amounts fall woefully short of what is needed (National Women’ Law Center, 2006a). The federal childcare assistance program, the Child Care and Development Block Grant (CCDBG), reaches only one of seven eligible children. Head Start reaches approximately half of all eligible children (Children’s Defense Fund, 2005). The argument that poor women must be forced to work by law in order to receive public assistance rests on strongly held assumptions about a “culture of poverty” that produces dependence on welfare, poor work attitudes, and lack of achievement motivation. Such assumptions are repeatedly challenged by empirical data. Hayes and Way (2003) interviewed a small sample of 18 young Midwestern, African American women and their mothers. The daughters, who had been raised primarily by their single mothers, had received some form of public assistance growing up. Respondents discussed valuing employment and self-sufficiency, and periodically had found and held jobs. The themes that emerged in these interviews are consistent with so-called middle class values: work is a necessity; try to advance; strive for a college education; don’t start a family too soon; and believe in yourself. The authors of the study note, however, considerable variability in how these beliefs were translated into behavior since “choices were confined to a relatively narrow range of options by the material conditions of their lives” (p. 380). Similarly, an ethnographic study of women in Harlem found a strong desire for full-time work and continued education among informants (Mullings, 2004). Work also figured prominently into the plans of new, single mothers in a 16-city study (Powers & Livermore, 2003). These findings stand in sharp contrast to cultural explanations for women’s poverty. The federal minimum wage is currently $7.25, up from $6.55 in 2008. Sadly, this is still not sufficient to raise families’ economic resources. A family of four would be lifted 5% above the poverty line rather than being 11% below it (Fusman & Parrott, 2007). About 22 states now mandate hourly wage minimums that are higher than the federal rate. Some cities have followed suit. In 2006, Chicago passed a bill (subsequently vetoed by Mayor Daley) that would require “big box” stores (e.g.,Wal-Mart, Home Depot) to increase their wages to $10 an hour by 2010, with at least $3 worth of benefits. That this was considered “groundbreaking” (Eckholm, 2006c) is indicative of the position lowincome people occupy in the social and political consciousness of this country. Once again, a simple bit of math tells the story that a minimum wage worker who works 40 hours a week, at the current rate, for 52 weeks a year will earn $10,700, far below the poverty line for families.

Disrespect and Discrimination When low-income women talk about their lives, they describe coping with discrimination, instability, low and uncertain wages both in the formal and informal employment sector, and trying to “piece together resources from


exchanges, private charities, and state benefits” (Mullings, 2004, p. 56). Lowincome women have long histories of workforce participation and want paid work—the problem is not antiwork attitudes among the poor but few options. Poor women are most likely to work in “unstable, low-paid, dead-end jobs, with little job mobility and few, if any, benefits” (Bok, 2004, p. 39f.). This is certainly the case for TANF leavers, with most former recipients cycling in and out of low paying jobs and earning an average of $8.00 an hour (Parrott et al., 2006). TANF recipients experience job placement discrimination and negative assessments of their potential for jobs beyond the entry level (Jacob, 2005). Bonds’ study (2006) of welfare recipients’ experiences with employers and private welfare agencies in Milwaukee, Wisconsin, shows how prominently ethnicity figures in employer judgments. Despite having higher education levels and job training completion rates, African American welfare recipients did not fare better than White recipients in terms of employment. Moreover, African American welfare recipients were more likely to be required to take pre-employment and drug tests than their White counterparts. In low-wage job sites, disrespect and devaluation are common. For example, a large study of low-income union workers in a variety of workplaces in the northeast (Krieger et al., 2006) found that 40% of respondents earned wages below the federal poverty line. Within this sample, more than half reported having been exposed, during the previous year, to at least one of eight types of workplace abuse that included sexual harassment and racial discrimination, with Black women reporting the highest rates of abuse. Testimony from New York City workfare participants provides further documentation of workplace abuse including “being ordered to pick up dead animals, feces, condoms, dirty needles, rusty nails, glass, and other hazardous materials without protective gloves; being prevented from using bathrooms and instead being forced to urinate on the street or the sides of highways” (Goldberg, 2001, p. 199). A class action suit was filed against New York City for assigning workfare participants to jobs with no regard for their health or medical condition, in some instances, with fatal consequences.

Family For many low-income-women, family and work concerns are intertwined because taking a paid job for mothers of young children requires childcare. But, low-income families face other special stressors. One significant correlate of being poor is moving frequently with consequent disruptions in children’s schooling and in positive neighborhood/community connections. These concerns are documented in a case study of a rural school district in New York (Schafft, 2006). In addition to documenting the relationship between residential moves and economic disadvantage and crises, other family stressors included anxieties about children’s health and nutrition, the poor quality and safety of their neighborhoods, having utilities shut off as bills go unpaid, wearing ill-fitting clothing, not being able to afford children’s requests, and domestic violence. These conditions have been documented repeatedly in other carefully conducted studies (e.g., Adair, 2005; Edin & Lein, 1997). The stress of skipping meals, reliance on food pantries, eviction and homelessness are everyday facts of life for poor women (Mullings, 2004).

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“Kinwork”—the creation of women-centered networks in which childcare and other resources are exchanged—can alleviate some stressors (Mullings, 2004), but problems associated with substandard housing are not easily remedied. A study of hospital discharges in Illinois over a ten-year period (Shenassa, Stubbendrick, & Brown, 2004) found that poor housing conditions were correlated with injuries to children, the most prevalent being falls and burns. Similar concerns surfaced in Wells’ (2005) study of a small group of women who were assisted by Habitat for Humanity to move with their families to adequate housing. Prior to relocation they described their living conditions as: uncertain, crowded, hazardous, physically deteriorated, and in dangerous neighborhoods.

Feeding the Family For poor mothers, feeding one’s family often means buying low quality, high calorie foods because it is more affordable. It is not surprising, therefore, to learn that teenagers from poor households are growing overweight at a faster rate than others, regardless of gender. This conclusion comes from a nationally representative study of almost 11,000 teens aged 12 to 17 (Miech et al., 2006). This is not simply a matter of individual health choices within the home, but a public health crisis fueled by corporate greed and systemic inequalities in public school funding. Soda machines are common in low-income schools, which sign exclusive “pouring rights” contracts with major corporations, to fund their educational programs (Nestle, 2000). Mothers without adequate financial resources must scrimp and “go without” to feed their children and stretch a poor diet across days. Focus group participants at two homeless shelters in a midwestern city (Richards & Smith, 2006) spoke of the strategies they used to feed their families. These included, in addition to the use of food stamps, pawning personal items, scrounging in dumpsters, donating blood, and prostitution. Our nation’s unwillingness to acknowledge this most basic of deprivations is vividly illustrated by the fact that the U.S. Department of Agriculture, in describing the situation of 11 million people unable to obtain adequate food, does not use the word “hunger” (cf. Williamson, 2006). Instead the term “food insecurity” is used to describe households in which access to food is inconsistent or uncertain. Low-income families are most likely to experience both food insecurity (uncertain availability of food) and food insufficiency (insufficient food intake) and to turn for assistance to food pantries run by charitable organizations. A 2005 report by the U.S. Conference of Mayors of a survey of 24 cities reported a 12% increase in the use of such services over the preceding year and that 76% of the cities had increases (cf. “Poll: Requests,” 2005). In 2006, the situation grew worse with the annual U.S. Conference of Mayors report documenting a 7% increase from 2005 in requests for food (cf. Lambert, 2006). According to the U.S. Department of Agriculture (cf. Williamson, 2006) 35 million people had “trouble keeping food on the table at least part of the year” in 2006 (p. A14). A group of investigators (Siefert et al., 2001), studying a sample of single mothers who were former or current public assistance recipients in an urban Michigan county, found a clear relationship between food insufficiency and


physical and mental health problems. Yet, research confirms that increased food insecurity is among the predictable consequences for families who reach welfare time limits or have their benefits reduced or eliminated (Bloom, Farrell, & Fink, 2002; Reichman, Teitler, & Curtis, 2005).

Health Health insurance, which provides the only access to health care for most U.S. families, is predominantly tied to employment, yet 47% of those who are in the workforce do not have coverage through their jobs (Bernstein, 2006). Recent statistics show 46.6 million in the United States without health insurance, with 82% of the noninsured living in households headed by an employed adult (Gross, 2006). The percentage of women without health insurance has increased dramatically from 13.8 in 2000 to 15.6 in 2005 (National Women’s Law Center, 2006b). These numbers include the lowest-paid workers who receive “no benefits.” Those who qualify for Medicaid, under the newest rules in The Budget Reduction Act of 2005, will have to pay higher copayments under new authority granted to states, and it is estimated that 65,000 people, primarily children, will lose all health insurance as a result (Krugman, 2006a). What this means for families is clear—putting off visits for diagnosis and treatment, not filling prescriptions, weighing health costs against food costs against rent costs, and so on. The fact that many doctors refuse to treat Medicaid patients is a further barrier to access. In Maryland, for example, only about 900 of the state’s 5,500 dentists accept Medicaid patients (Otto, 2007). Such sacrifices and hardships would be unnecessary if the United States adopted a universal single-payer health system similar to that in Canada and many other industrialized countries. Such a system, referred to by some as “Medicare for Everybody,” would also be cost efficient and assure quality health coverage for all (e.g., see Bernasek, 2007; Sirota, 2006). A bill calling for a single-payer system of privately delivered, publicly-financed healthcare, sponsored by the U.S. Rep. John Conyers (HR 676) is now in Congress. A single-payer system would eliminate disparities in access to health care and would also help to reduce the extent to which low-income patients experience disrespect and discrimination within the present health-care system. In one study (Kaplan et al., 2006), residents of the South Bronx in New York City spoke in focus groups of “humiliating encounters” and “feeling undervalued” in interactions with health care personnel. Long waiting lines in clinics, being rushed through doctor examinations, and negative attitudes by health care personnel were reported by just about every participant, one of whom referred to such experiences as “ghetto care.” The investigators concluded that “The people with whom we spoke intuitively knew what the research shows: that the resulting stress, fear, anger and sense of defeat directly affect health…, health behaviors …, and how one perceives and utilizes the health care system” (p. 124). Currently there are state efforts to provide health care, within the existing private insurance framework, with 16 states now covering children in low-income families (Pear & Hernandez, 2007). Reproductive health care illustrates a site where racism, sexism, and classism converge. In a study of how ethnically diverse low- and middleincome women perceive the treatment they receive from reproductive health

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care providers, Downing, LaVeist, and Bullock (2007) found that low-income Latinas reported being discouraged from having children more frequently than middle class White women. Yet, ironically, federal funds may not be used to pay for abortions for women who receive Medicaid assistance. Reduced funding for federal reproductive health programs has been linked to a sharp increase in the number of unintended pregnancies among poor women, resulting in an increase in both abortions and in the birth of unplanned children. Data gathered by the Guttmacher Institute found an increased rate of unplanned pregnancies of almost 30% among poor women from the mid-1990s to 2001, with such pregnancies four times that among more affluent women (cf. Simon, 2006). Implicated in this phenomenon is lack of access to affordable birth control products and procedures, and lack of knowledge about the variety of effective contraceptive devices currently available. Giving birth to a healthy baby who will survive is the hope of all parents. For those who are poor in the United States, the chances of this happening are not as good as they are for parents in most modern countries. The United States continues to rank near the bottom in newborn survival rates, with a newborn death rate of 5 per 1,000 live births. African American babies are twice as likely as White babies to be born prematurely and to have a low birth weight; with 9 deaths for every 1,000 live births (Tanner, 2006a). Poverty and poor health access are clearly implicated in these data. They are also implicated in data about the chances of poor children getting sick. A national study of more than 57,000 children below the age of 18 found heightened health risks, and such chronic conditions as asthma and diabetes, among children in lowincome single-parent homes whose mothers were poorly educated, regardless of their race/ethnicity or even health insurance coverage (cf. Kotulak, 2006). Life circumstances for low-income mothers and their children can be understood by thinking about the significance of such statistics, and they can also be understood by thinking about how differently the health needs of poor and more affluent mothers are accommodated. For example, while women in management (at Starbucks headquarters, for example) can choose to pump breast milk for their nursing infants in a well-supplied, pleasant room set aside for this purpose, “if the mothers who staff the chain’s counters want to do the same, they must barricade themselves in small restrooms intended for customers, counting the minutes left in their breaks” (Kantor, 2006). Starbucks is not unique in providing far different opportunities for different classes of working mothers. Many low-income mothers simply give up on nursing their infants when they go back to work, as the impediments they face to continue to do so are just too great, to the disadvantage of their own and their children’s health.

Violence and Sexual Assault Domestic violence cuts across class lines but, for low-income families, there are fewer social and economic resources available to deal with it and a greater likelihood that employment, education, and family life will be disrupted. Poor women’s efforts to leave abusive partners are hampered by lack of funds and other resources. Women living in public housing fear loss of eligibility if they report domestic violence from partners who are not on the lease for their


apartment (Raphael, 2001). Moreover, “the high degree of disorder and low morale in public housing projects reduces community cohesion and the proclivity of people to support and help one another” (Raphael, 2001, p. 704). Among a sample of mid-western mothers who were current or former TANF recipients, intimate partner violence was found to negatively affect employment stability and contribute to going from one job to another (Riger, Staggs, & Schewe, 2004). Not surprisingly, studies of women in homeless shelters, transitional housing, and domestic violence shelters find high rates of violence previously experienced by mothers and witnessed by their children (Anooshian, 2005; Pyles, 2006). Thousands of low-income women experience violence in rental housing where they are “subjected to predatory sexual advances at the hands of landlords, building managers, and property owners,” (Reed, Colllinsworth, & Fitzgerald, 2005, p. 439 f.), with most such incidents never reported. With affordable rental units in short supply, the power of landlords or their surrogates increases. They can evict tenants or threaten to give false information to authorities (who provide subsidies) regarding drug use or other rule infractions. Reed et al. (2005) analyzed archival data from 39 victim-witnesses (primarily low-income women of color) in three federal lawsuits against landlords charged with sexual harassment. The categories of harassment that were identified from 389 separate incidents included degrading references to women in general, crude verbal behavior, verbal sexual approaches, unwanted physical contact, sexual bribery, and threats—similar to incidents of workplace harassment. A major difference is that the homes of low-income tenants can be invaded; even if there are lease restrictions on this, many tenants are unaware of them or fear eviction if they complain. For low-income women, joining the military may be the only route to a higher education and financial security (Holland, 2006). These women are particularly vulnerable to sexual assault. Recruiters who have been accused of raping young women are more likely to victimize those who turn to military service out of economic need. Typically, the reasons the [assault] victims have given “for going along with the abuse was that they did not want to alienate the recruiters” (Holland, 2006). Women migrant farm workers, in addition to being among the lowest paid of all workers, also experience a high rate of sexual harassment and assault from the men who control their jobs (Clarren, 2005) and their male coworkers (Waugh, 2006). Fear of job loss or deportation keep the women (who are largely immigrants or undocumented) from reporting the rude comments, groping, propositions, and rapes to which they are subjected. Workers in Salinas, California, refer to one company’s field as the field de calzon, or a ‘field of panties,’ because so many supervisors rape women there, … [while] female farmworkers in Florida call the field “the Green Motel” (Clarren, 2005, p. 42).

Hurricane Katrina: A Case Study of Inequity As a metaphor for structural inequality and social vulnerability, Hurricane Katrina and its aftermath are best viewed through an intersectional lens that considers a wide range of sociodemographic variables (e.g., gender, race/

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ethnicity, social class, marital status) and long-standing historical differences in power and privilege.

Intersectionality and the Ecology of Marginalization Analyses of impact and recovery patterns reveal staggering differences in resilience and disaster recovery. Ecological approaches (i.e., Bronfenbrenner, 1993), which consider individual well being in conjunction with community level (e.g., residential stability, safety, resources, religion, culture) and socioecodemographic variables (e.g., family structure, SES, ethnic heterogeneity) are particularly useful. Such an approach to pre-Katrina New Orleans and the surrounding area reveals deep-seated class, race, and gender inequality before the storm and foreshadows poststorm hardships. Pre-Katrina, the city’s predominantly African American women residents lived in concentrated poverty and worked in low wage jobs. As cashiers, maids/cleaners, cooks, childcare providers, and waitresses, nursing aides, and bookkeepers, African American women earned median incomes ranging from $11,400 for cashiers to $20,000 for bookkeepers (Williams, Sorokina, JonesDeWeever, & Hartman, 2006). Among cashiers, 80% were African American women compared to only 8% White women. Similarly, African American women were 90% of the maids (median salary $12,000) and 75% of the home health aides (median salary $15,000) compared to 3% and 1% White women, respectively (Williams et al., 2006). Law, one of the highest paid professions for women in New Orleans (median salary of $63,000) was racially segregated in the opposite direction—87% of female lawyers were White women and 8% were African American. Race-based educational disparities figure heavily into occupational and income inequity. Only 18.9% of African American women (and 16.8% African American men) in New Orleans had completed college compared to 50.6% of White women (and 61.8% of White men). Lack of social capital places New Orleans at a relative disadvantage nationally. African American women in New Orleans working full time earned a median annual income of $19,951, considerably less than the national average of $28,581 for African American and $36,445 for White women (Williams et al., 2006). Intersection of race and gender underscore pay disparities: for every dollar earned by White Louisiana men, White women earned 66.7 cents, Hispanic women 56.7 cents and Black woman 48.9 cents. The economic marginalization of African American women helps maintain racial and wage stratification and provides a labor pool for those White women who can afford their services as domestic workers and child care providers. How do such factors affect disaster recovery? Will displaced African American women be able to find work in new hometowns? Will service sector jobs be available, especially for those with limited education? Probably not— these jobs are likely to be fi lled by longer-term residents. And, for women who return to New Orleans, jobs unrelated to the reconstruction industry are hard to find. Restricted employment opportunities are exacerbated by the continued absence of community resources that bolster employment opportunities and quality of life (e.g., health services, schools, safe neighborhoods, faithbased organizations).


Pre- and post-Katrina comparisons of population, employment, and housing in New Orleans show declines in all of the areas that are essential to the survival of any community. Consider housing. prior to Katrina, 88% of public housing residents in the city of New Orleans were women (Vail, 2006). The lower Ninth ward in Orleans Parish, one of the poorest areas in the city, had the largest segment of houses deemed in danger of collapse following Katrina (Cutter et al., 2006). Yet, in areas with poverty rates greater than 41%, federally backed loans to homeowners averaged less than 10% of all the loans granted as of December 2005 (Cutter et al., 2006). For low-income residents eligible for Section 8 vouchers (subsidized housing based on income eligibility), no assistance was available through HUD because this agency does not respond to emergencies. Rather, it is FEMA that helps with housing needs in a disaster, but following Katrina, housing assistance had to be continually negotiated as to length and benefit level. Faced with endless bureaucratic hassles, many women instead opted for FEMA trailers because other lodging was too difficult, expensive, or nonexistent (Winston et al., 2006). These trailers are now the basis of newly segregated poor communities. Other, less quantifiable, but equally important social supports have also been weakened. Social networks and community-based resources, including faith-based organizations, are disrupted by geographic displacement, helping to decimate the fabric of the community life. An emerging literature on the long-term consequences of Katrina suggests that long-term trauma is normative. For example, many of Katrina’s vulnerable survivors—poor African American children and young adults, single mothers, and those with limited education—were sent to states in which they had no history or support network (Brodie, Weitzman, Altman, Blendon, & Benson, 2006). One month after the storm, Elliott and Paris (2006) sampled 1,294 respondents from the Gallup Organization database of persons registered with the Red Cross. African American workers with annual incomes between $10,000 and $20,000 were almost four times as likely to lose their preKatrina jobs as White workers, underscoring interactions of ethnicity, income fragility, and regional capital. Women, parents, and those with severely damaged housing reported the highest levels of stress. In Houston, a city where many Katrina evacuees were sent, longitudinal analyses of survivors are underway. Wilson and Stein (2006) held three interviews (September 2005, November 2006, and July 2006) with 362 evacuees who were living in motels or apartments after moving from the Superdome, hotels, or the homes of friends/relatives. Their findings are discouraging. Prior to their arrival in Houston, 60% of the interviewees were employed outside the home, but now less than 20% were working. Lack of an adequate public transportation system in Houston was among the most commonly cited obstacles to employment. Of those working, 74% reported earning less than $15,000 per year and, given that most respondents were single heads of households (54.9% versus 27% partnered), these evacuees and their families were living well below official poverty thresholds. With limited prospects (only about 22% had attended or graduated from college), the uncertainty felt by these survivors is palpable. Nevertheless, 68.6% say they will probably remain in Houston and report that their lives are better with respect to quality of the area schools,

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personal safety, and housing. This says a great deal about pre-Katrina living conditions in New Orleans for poor women.

The Social Construction and Politics of “Deservingness” Disaster victims are typically the focus of public sympathy and the recipients of an outpouring of private and governmental aid. This was not the case with Katrina—race, gender, and class powerfully shaped public response to Katrina’s victims and survivors. Not since the War on Poverty during the 1960s and early 1970s has the U.S. public seen the politics of race, poverty, and inequality play out so publicly as it did in the days following Katrina (Lieberman, 2006). And, as is the case with other arenas in which poor people of color are disproportionately affected (e.g., welfare policy; Hochschild, 2006), public opinion about Katrina is divided on color lines. A post-hurricane poll conducted by the Pew Research Center found that that 63% of White respondents believed that President Bush did all that he could quickly, while 85% of African Americans disagreed (Fymer, Strolovitch, & Warren, 2006). Ethnic polarization is also evident in the finding that 75% of surveyed African Americans compared to only 25 % of White respondents attributed delayed responsiveness to Katrina victims to race (cf. Herring, 2006). When queried about Katrina and its aftermath, 75% of African Americans but less than 50% of Whites perceived racial inequality as a significant problem. Raced (and classed and gendered) attitudes also surfaced in a persistent hum of victim-blaming questions about Katrina survivors. Why didn’t the residents leave earlier? How has a lack of patriarchal family structures contributed to the suffering of African American women and their children in New Orleans (Ransby, 2006)? How did neighborhood dysfunction contribute to the disaster (Gilbert, 2000)? Was the racial inequality broadcast across the world during the flooding the result of the victim’s own shortcomings? How these questions are answered vary by social location, privilege, and politics, with Katrina constructed as a “third world” type disaster by some, and for others, a “third world” people in New Orleans. Whether Katrina is viewed as a powerful revelation of American’s “dirty little secret” about persistent poverty and racial inequality (Bobo, 2006) or as symbolizing the reemergence of a lawless, chronically poor Black “underclass” (Gilbert, 2000) has important policy implications and consequences for the delivery of assistance. It is well documented in the social psychological literature that structural explanations for racial and economic inequality are correlated with support for progressive social policies, while the individualistic attributions are positively correlated with restrictive policy initiatives (Lott & Bullock, 2007). In the United States, individualistic attributions for inequality tend to enjoy stronger support than structural explanations. This bias is stronger among privileged ethnic and socioeconomic groups than less privileged groups—a trend that is evident in the polarization of public opinion about federal responsiveness to Katrina. By neglecting the structural roots of inequality, media coverage of Hurricane Katrina encourages individualistic, depoliticized understandings of the storm’s differential impact. A content analysis of 322 newspaper articles published in three major newspapers in the month following the storm identified three


emergent themes: (1) economic/corporate concerns were emphasized over human consequences; (2) negative depictions of survivor characteristics were more prevalent than sympathetic representations; and (3) critical analyses of race and class inequities in relation to long-term recovery plans and governmental responses were notably absent (Bullock & Truong, 2007). Race and class inequities were presented only superficially, and in some cases reinforced by stereotypical depictions of low-income people of color (e.g., looters). Findings from an experiment by Iyengar and Morin (2006) confirm the negative impact of such imagery. Participants who read a news story that included information about looting were significantly less generous toward Katrina survivors than respondents who read stories about general devastation from the storm or personal accounts of survival. Significant race-of-the-target effects were also found in that African Americans were awarded aid for a shorter period of time than Whites. Dark-skinned Blacks, Hispanics, and Asians were also awarded lower levels of financial assistance than their light skinned counterparts. Judgments about “deservingness” are evident in reports of Katrina survivors about their interactions with others. It is not uncommon for survivors to report being the target of subtle insults in their host communities. “Oh, you are one of them” is a common response when applying for a job, an apartment, or trying to cash a check and being asked to show identification (personal communication). These microaggressions are a form of social distancing and reinforce insider/outsider boundaries (Sue, Bucceri, Lin, Nada, & Torino, 2007). They also serve to reaffirm belief in meritocracy and a just world.

Where Do We Go From Here? Toward a Class-Conscious Multicultural Psychology While some believe that poor women are seen in a more favorable light now that welfare recipients are required to work outside the home (Pear & Eckholm, 2006), we suspect that the “long history of viewing poverty as a vice and wealth as a virtue” (Bullock, 2005, p. 109) is not easily overturned. Adair’s (2005) discussion of stereotypes distinguishing the poor from the working class challenges this “things are getting better” interpretation of the “ending welfare as we know it” period and highlights the structural and intersecting intergroup inequities we have identified here. She contends that working class persons are viewed respectfully, as diligent, in two-parent households, heterosexual, and White, while the poor are perceived as “marked by race,” single mothers who make bad, if not pathological, choices, and are dangerous parasites. Thus, “poor women … are positioned as boundary markers, denoting the unacceptable and illegal ‘others’ of the working class” (p. 37). She provides examples of ways in which “both in and out of the academy, poor unmarried mothers are overtly…feared, blamed, mocked, ridiculed, and punished.” Her argument is reinforced and illustrated by the words “Personal Responsibility” in the title of the 1996 legislation that ended traditional welfare programs and established TANF, and by its clearly stated aim of encouraging marriage. Poor women are thus put into a unique position in U.S. society, one in which the government can legitimately question their “moral decisions about marriage, procreation and family” (Drescher, 2007, p. 228).

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Psychologists and other professionals are not exempt from the biases that pervade U.S. society. Among a sample of school principals, physicians, and social workers, Zellman (cf. Bullock, 2004a) found that child abuse was more often attributed to families designated as “lower” than those considered “middle” class. Disconnects have been reported between the beliefs of persons who are poor and members of the professions who serve them. For example, Bullock (2004b) found that a sample of social workers were less likely to regard prejudice as a factor contributing to poverty and were less likely to support increased funding for welfare programs than was true of their welfare clients. Another example is in remarks by Aronson (2006) on classism in psychotherapy with poor clients. In attempts to explain therapeutic failures, clients are presented as the problem–they have unrealistic expectations; they do not complete the necessary preliminary diagnostic contact sessions. Such attributions for client “failure” contradict what we learn from Katrina—that prevention and post-disaster health and well being are embedded within a broad cultural and economic framework. Among Katrina’s many lessons is the importance of social location in shaping experience of disaster and the need for tailored rather than generic interventions (see www.nctsn. org). Multifaceted analyses must include attention to class, ethnic, and gender dynamics. For example, focusing exclusively on Black Katrina survivors renders other ethnic minorities invisible, reducing Katrina to a one-dimensional “Black versus White” problem. There are few investigations of Hispanic/Latino and Asian American survivors in the Gulf region (Maruyama & Ruscher, 2006) even though 124,000 Hispanics and 70,000 Asians lived in counties affected by Katrina and worked in industries affected by this disaster (poultry processing plants for Latinas/os and shrimping industry for Vietnamese; Kao, 2006). Feminist psychology has much to offer in terms of understanding economic injustice. An important starting place is ensuring that poverty and class-based privilege receive the research and advocacy attention they warrant. Ultimately, “making room at the table” will require significant changes in research, teaching, practice, and the policies that both we and the APA advocate for (see Saegert et al., 2007). Much more is needed than simply “adding” social class to our list of variables of interest, our lectures and syllabi (Task Force on the Inclusion of Social Class in the Psychology Curricula, 2008). We also must add social class concerns to our advocacy agenda. And, in seeking to redress structural inequities in power and privilege, we must remember to turn our gaze inward and critically analyze how class-based inequities are reinforced in our work as psychologists and reproduced in our professional relationships. A truly multicultural psychology, one that is actively engaged in eliminating the overt and hidden injuries of class, stands in the balance.

References Adair, V. C. (2005). The missing story of ourselves: Poverty class in academe. Labor Studies in Working-Class History of the Americas, 2, 33–47. Anooshian, L. J. (2005). Violence and aggression in the lives of homeless children. Journal of Family Violence, 20, 373–388. Aron-Dine, A., & Shapiro, I. (2006, October 13). New data show extraordinary jump in income concentration in 2004. Retrieved on January 8, 2007, from http://www.cbpp.org/7-1006inc.htm


Aron-Dine, A., & Shapiro, I. (2007, January 16). Share of national income going to wages and salaries remain at record low, share of income going to corporate profits at highest level since 1950. Retrieved January 16, 2007, from http://www.cbpp.org/8–31–06inc.htm Aronson, H. (2006). Treating “the poor”—Classism or a rigid loyalty to theory? American Psychologist, 61, 335–3336. Bernasek, A. (2006, December 31). Health care problem? Check the American psyche. The New York Times. Retrieved January 2, 2007, from http://www.nytimes.com/2006/12/31/ business/yourmoney/31view.html Bernstein, J. (2006, February 28). Wages lag behind productivity. The Providence Journal, p. B4. Bernstein, J., & Sherman, A. (2006, March 28). Poor measurement: New census report on measuring poverty raises concerns. Retrieved on January 8, 2007, from http://www. cbpp.org Bloom, D., Farrell, M., & Fink, B. (2002) Welfare time limits: State policies, implementations, and effects on families. ERIC, ED # 467886. Bobo, L. D. (2006). Katrina: Unmasking race, poverty, and politics in the 21st century. DuBois Review, 3, 1–6. Bok, M. (2004). Education and training for low-income women: An elusive goal. Affilia, 19, 39–52. Bonds, M. (2006). Race and welfare reform: The Wisconsin works W-2 experience. Journal of Health and Social Policy, 21, 37–54. Brodie, M., Weitzman, E., Altman, D., Blendon, R., & Benson, J. (2006). Experiences of hurricane Katrina evacuees in Houston shelters: Implications for future planning. American Journal of Public Health, 96, 1402–1409. Brookings Institute. (2006, July). From poverty, opportunity. Putting the market to work for lower income families. Retrieved November 20, 2006, from, http://www.brookings.edu/ metro/pubs/20060718_PovOp.htm Bronfenbrenner, U. (1993). The ecology of cognitive development: Research models and findings. In R. Wozniak & K. Fisher (Eds.), Development in context (pp. 33–44). Hillsdale, NJ: Erlbaum. Bullock, H. E. (2004a). Diagnosis of low-income women. In P. S. Caplan & L. Cosgrove (Eds.), Bias in psychiatric diagnosis (pp. 115–120). Jason Aaronson: Lanham, MD. Bullock, H. E. (2004b). From the front lines of welfare reform. Journal of Social Psychology, 144, 571–588. Bullock, H. E. (2005). The advantages of “higher ground.” In J. Brown Childs (Ed.), Hurricane Katrina: Response and responsibilities (pp. 108–110). Santa Cruz, CA: New Pacific Press. Bullock, H. E., & Truong, S. (2007). At the eye of storm: Race, class, and media framing of hurricane Katrina. Unpublished manuscript. Burk, M. (2006, Fall). The sin of wages. Ms., v. xvi (no. 4), pp. 59–60. Center on Budget and Policy Priorities. (2006, September 1). Poverty remains higher, and median income for non-elderly is lower, than when recession hit bottom: Poor performance unprecedented by four-year recovery period. Retrieved on November 21, 2006, from http://www.cbpp.org/8-29-06pov.htm Children’s Defense Fund. (2005). The state of America’s children. Retrieved January 19, 2007, from http://www.childrensdefense.org/site/PageServer?pagename=research_publications Christopher, K. (2005). The poverty line 40 years later: Alternative poverty measures and women’s lives. Race, Gender, & Class, 12, 34–53. Clarren, R. (2005, Summer). The green motel. Ms, v.xv (no. 2), 40–45.E Cutter, S. L., Emrich, C. T., Mitchell, J. T., Boruff, B. J., Gall, B. J. Schmidtlein, M., et al. (2006). The long road home: Race, class and recovery from Hurricane Katrina. Environment, 48, 8–20. Dash, E. (2006, April 9). Off to the races again, leaving many behind. The New York Times, pp. BU1, 5. Downing, R. A., LaVeist, T., & Bullock, H. E. (2007). Intersections of ethnicity and social class in provider advice regarding reproductive health. American Journal of Public Health, 97, 1803–1807. Drescher, S. (2007). Why welfare fails. In J. W. White (Ed.), Taking sides: Clashing views in gender (3rd ed., pp. 224–230). Dubuque, IA: McGraw-Hill.

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Eckholm, E. (2006a, February 18). Report on impact of federal benefits curbing poverty ignites a debate. The New York Times. Retrieved February 20, 2006, fromhttp://www. nytimes.com/2006/02/18/national/18poverty.html Eckholm, E. (2006b, July 19). Study documents “ghetto tax” being paid by the urban poor. The New York Times. Retrieved July 20, 2006, from http://www.nytimes.com/2006/07/19/ us/19poor.html. Eckholm, E. (2006c, July 27). Chicago orders “big box” stores to raise wage. The New York Times. Retrieved July 28, 2006, from http://www.nytimes.com/2006/07/28/us/27chicago. html Eckholm, E. (2006d, August 20). In rural Oregon, these are the times that try working people’s hopes. The New York Times, p. YT12. Eckholm, E. (2006e, August 22). A welfare law milestone finds many left behind. The New York Times, Retrieved August 23, 2006, from http://www.nytimes.com/2006/08/22/ us/22welfare.html. Eckholm, E. (2006f, December 1). Medicaid plan prods patients toward Health. The New York Times. Retrieved January 24, 2007, from: http://www.nytimes.com/2006/12/01/ us/01medicaid.html?ex=1322629200&en=c048bc8822c17b0b&ei=5088&partner=rssnyt& emc=rss Edelman, M. W. (2001). America’s fifth child: It’s time to end child poverty in America. In C. Hartman (Ed.), Challenges to equality: Poverty and race in America (pp. 106–113). Amonk, NY: M.E. Sharpe. Edin, K., & Lein, L. (1997). Making ends meet: How single mothers survive welfare and lowwage work. New York: Russell Sage. Editorial (2006a, January 3). A fair day’s pay. The New York Times. Retrieved January 5, 2006, from http://www.nytimes.com/2006/01/05/opinion/03tues1.html Editorial (2006b, August 30). Downward mobility. The New York Times. Retrieved August 31, 2006, from http://www.nytimes.com/2006/08/30/opinion/30wed1.html Elliott, J. R., & Pais, J. (2006). Race, class, and Hurricane Katrina: Social differences in human responses to disaster. Social Science Research, 35, 295–321. Fellowes, M. (2006, July). From poverty, opportunity: Putting the market to work for lower income families. Retrieved November 11, 2006, from http://www.brookings.edu/metro/ pubs/20060718_PovOp.htm. Fusman, J., & Parrott, S. (2007, January 5). A $7.25 minimum wage would be a useful step in helping working families escape poverty. Retrieved January 14, 2007, from http://www. cbpp.org/1–5–07mw.htm Fymer, P., Strolovitch, D., & Warren, D. (2006). New Orleans is not the exception: Re-politicizing the study of racial inequality. DuBois Review, 3, 37–57. Gilbert, M. R. (2000). Identity, difference, and the geographies of working poor women’s survival strategies. In K. B. Miranne & A. H. Young (Eds.), Gendering the city (pp. 65–87). Lanham, MD: Rowman & Littlefield. Greenhouse, S. (2006a, January 22). Broad survey of day laborers finds high level of injuries and pay violations. The New York Times, p. YT17. Greenhouse, S. (2006b, December 5). With the Democratic Congress, groups gear up for fight over paid sick days. The New York Times. Retrieved December 6, 2006, from http://www. nytimes.com/2006/12/05/washington/05labor.html. Greenhouse, S., & Leonhardt, D. (2006, August 28). Real wages fail to match a rise in productivity. The New York Times Retrieved August 31, 2006. from http://www.nytimes. com/2006/08/28/business/28wages.html. Goldberg, C. A. (2001). Welfare recipients or workers? Contesting the workfare state in New York City. Sociological Theory, 19, 187–218. Gross, D. (2006, December 3). National health care: We’re halfway there. The New York Times, p. BU4. Hayes, E., & Way, W. (2003). Low-income African American women’s cultural models of work: Implications for education-for-work policies and practice. Journal of Education and Work, 16, 363–383. Iyengar, S., & Morin, R. (2006, June 8). Natural disasters in Black and White: How racial cues influenced public response to hurricane Katrina. Retrieved February 25, 2007, from http://www.washingtonpost.com/wp dyn/content/article/2006/06/07/AR2006060701177. html.


Herring, C. (2006). Hurricane Katrina and the racial gulf. DuBois Review, 3, 129–144. Hochschild, J. L. (2006). Ambivalence about equality in the United States or, did Tocqueville get it wrong and why does it matter? Social Justice Research, 19, 43–62. Holland, M. (2006, March 21). Marine recruiters accused of rape: California high school students file suit. Retrieved March 25, 2006, from http://www.wsws.org/articles/2006/mar2006/ mari-m21.shtml. Hulse, C. (2006, August 4). Wage bill dies; Senate backs pension shift. The New York Times, p. A1. Income needed to afford a home in R.I. (2006, May 17). The Providence Journal, p. A4. Jacob, J. M. (2005). Factors influencing hiring decisions for welfare recipients. Unpublished doctoral dissertation, University of Rhode Island, Kingston. Kao, G. (2006). Where are the Asian and Hispanic victims of Katrina? A metaphor for invisible minorities in contemporary racial discourse. DuBois Review, 3, 223–231. Kahne, H. (2007). Low-wage single-mother families in this jobless recovery: Can improved social policies help? In J. W. White (Ed.), Taking sides: Clashing views in gender (3rd ed., pp. 231–237). Dubuque, IA: McGraw-Hill. Kantor, J. (2006, September 1). On the job, nursing mothers find a 2-class system. The New York Times. Retrieved September 2, 2006, from: http://www.nytimes.com/2006/09/01/ health/01nurse.html. Kaplan, S. A., Calman, N. S., Glob, M., Davis, J., Ruddock, C., & Billings, J. (2006). Racial and ethnic disparities in health: A view from the South Bronx. Journal of Health Care for the Poor and Underserved, 17, 116–127. Kotulak, R. (2006, May 2). Disadvantaged kids get sick more often, study reports. The Chicago Tribune. Retrieved February 27, 2007, from http://www.tilrc.org/docs/0506kids.htm. Krieger, N., Waterman, P. D., Hartman, C., Bates, L. M., Stoddard, A. M., Quinn, M. M., et al. (2006). Social hazards on the job: Workplace abuse, sexual harassment, and racial discrimination—A study of Black, Latino, and White low-income women and men workers in the United States. International Journal of Health Services, 36, 51–85. Krugman, P. (2006a, June 5). Shameless in the Senate. The New York Times. Retrieved June 7, 2006, from http://select.nytimes.com/2006/06/05/opinion/05krugman.html. Krugman, P. (2006b, August 18). Wages, wealth, and politics. The New York Times. Retrieved August 20, 2006, from http://select.nytimes.com/2006/08/18/opinion/18krugman.html. Lambert. L. (2006, December 14). More Americans hungry, homeless in 2006—mayors. Retrieved December 15, 2006, from http://www.alertnet.org/thenews/newsdesk/N14462540.htm. Lieberman, R. C. (2006). The storm didn’t discriminate: Katrina and the politics of color blindness. DuBois Review, 3, 7–22. London, R. A., & Mauldon, J. G. (2006, November). Time running out: A portrait of California families reaching the CalWORKs time limits in 2004. Retrieved January 1, 2007, from http://cjtc.ucsc.edu/cjtc.html. Lott, B. (2002). Cognitive and behavioral distancing from the poor. American Psychologist, 57, 100–110. Lott, B., & Bullock, H. E. (2007). Psychology and economic injustice: Personal, professional, and political intersections. Washington, DC: American Psychological Association. Maruyama, G., & Ruscher, J. (2006). Postscript and a call for change. Analyses of Social Issues and Public Policy, 6, 255–261. Miech, R. A., Kumanyika, S. K., Stettler, N., Link, B. G., Phelan, J. C., & Chang, V. W. (2006). Trends in the association of poverty with overweight among U.S. adolescents. JAMA, 295, 2327. Mullings, L. (2004). Domestic policy and human security in the U.S. Peace Review, 16, 55–58. National Coalition for the Homeless. (2006). How many people experience homelessness? (NCH Fact Sheet #2). Retrieved January 11, 2007, from http://www.nationalhomeless. org/publications/facts.html. National Women’s Law Center. (2006a, February). New TANF work requirements likely to exacerbate huge unmet need in child care: Increased state investments needed to ensure families’ success. Retrieved March 30, 2006, from www.nwlc.org National Women’s Law Center. (2006b, September). Info-Exchange. Email communication from [email protected]. National Women’s Law Center. (2006). Losing ground: An overview of poverty, income and health insurance trends among women, 2000–2005. Washington, DC.

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Nestle, M. (2000). Soft drink “pouring rights:” Marketing empty calories. Public Health Reports, 115, 308–319. Ohlemacher, S. (2007, February 28). Government estimates 754,000 homeless people. Retrieved March 1, 2007, from http://www.truthout.org/docs_2006/022807T.html Otto, M. (2007, February 28). For want of a dentist: Pr. George’s boy dies after bacteria from tooth spread to brain. The Washington Post, B01. Parrott, S., Schott, L., Sweeney, E., Baider, A., Ganzglass, E., Greenberg, M., et al. (2006, May 9). Implementing the TANF changes in the Deficit Reduction Act: Win-win solutions for families and states. Retrieved December 28, 2006, from http://www.cbpp.org/5–9–06tanf. htm Pear, R. (2006, June 28). New rules force states to curb welfare rolls. The New York Times. Retrieved June 30, 2006, from http://www.nytimes.com/2006/06/28/washington/ 28welfare.html Pear, R., & Eckholm, E. (2006, August 21). A decade after welfare overhaul, a shift in policy and perception. The New York Times. Retrieved August 22, 2006 from: http://www. nytimes.com/2006/08/21/washington/21welfare.html Poll: Requests for food, shelter up. (2005, December 20). The Providence Journal, p. A3. Powers, R. S., & Livermore, M. M. (2003). Will unwed mothers seek employment? The role of government and social support. Gender Issues, 21, 31–49. Pyles, L. (2006). Toward safety for low-income battered women: Promoting economic justice strategies. Families in Society, 87, 63–70. Ransby (2006). Katrina, Black women, and the deadly discourse on Black poverty in America. Du Bois Review, 3, 215–222. Raphael, J. (2001). Public housing and domestic violence. Violence Against Women, 7, 699–706. Reed, M. E., Collinsworth, L. L., & Fitzgerald, L. F. (2005). There’s no place like home: Sexual harassment of low income women in housing. Psychology, Public Policy, and Law, 11, 439–462. Reichman, N. E., Teitler, J. O., & Curtis, M. A. (2005). TANF sanctioning and hardship. Social Service Review, 79, 215–236. Reid, P. T. (1993). Poor women in psychological research: Shut up and shut out. Psychology of Women Quarterly, 17, 133–150. Richards, R., & Smith, C. (2006). The impact of homeless shelters on food access and choice among homeless families in Minnesota. Journal of Nutrition Education and Behavior, 38, 96–105. Riger, S., Staggs, S., & Schewe, P. (2004). Intimate partner violence as an obstacle to employment among mothers affected by welfare reform. Journal of Social Issues, 60, 801–818. Roberts, S. (2006, August 30). Census figures show scant improvement in city poverty. The New York Times. Retrieved August 31, 2006, from http://www.nytimes.com/2006/08/30/ nyregiion/30income.html Saegert, S. C., Adler, N. E., Bullock, H. E., Cauce, A. M., Lui, W. M., & Wyche, K. F. (2007). Task Force Report on Socioeconomic Status. Available at http://www2.apa.org/pi/SES_task_ force_report.pdf>http://www2.apa.org/pi/SES_task_force_report.pdf Saris, R. N., & Johnson-Robledo, I. (2000). Poor women are still shut out of mainstream psychology. Psychology of Women Quarterly, 24, 233–235. Schafft, K. A. (2006). Poverty, residential mobility, and student transiency within a rural New York school district. Rural Sociology, 71, 212–231. Shenassa, E. D., Stubbendick, A., & Brown, M. J. (2004). Social disparities in housing and related pediatric injury. American Journal of Public Health, 94, 633–639. Siefert, K., Heflin, C. M., Corcoran, M. E., & Williams, D. R. (2001). Food insufficiency and the physical and mental health of low-income women. In M. C. Lennon (Ed.), Welfare, work, and well-being (pp. 159–177). New York: Haworth Press. Simon, S. (2006, June 26). The birth control divide. The Los Angeles Times. Retrieved June 26, 2006, from http:www.latimes.com/feature/health/la-he-birthcontrol26jun26. Sirota, D. (2006, May 4). Careless industry: How corporate America perpetuates the health care crisis. In These Times (pp. 32–35). Socioeconomic Status Office: About Us. (n.d.). Retrieved June 18, 2008, from http://www.apa. org/pi/ses/aboutus.html


Sue, D. W., Bucceri, J., Lin, A., Nada, K., & Torino, G. (2007). Racial microaggressions and the Asian American experience. Cultural Diversity and Ethnic Minority Psychology, 13, 72–81. Task Force on the Inclusion of Social Class in the Psychology Curricula. (2008). Resources for the inclusion of social class in the psychology curricula. Retrieved September 1, 2008, from: http://www.apa.org/pi/ses/task_force_rep.html Tanner, L. (2006a, May 9). U.S. newborn survival rate ranks low. Retrieved February 18, 2007, from http://www.tilrc.org/docs/0506newborn.htm Tanner, L. (2006b, May 23). Obesity rises faster in poor teens. The Washington Post. Retrieved January 30, 2007, from http://www.washingtonpost.com/wp- dyn/content/ article/2006/05/23/AR2006052301016_pf.html U.S. Census Bureau. (2008, August). Income, poverty, and health insurance coverage in the United States (P60–235). Retrieved September 7, 2008, from http://www.census.gov/ prod/2008pubs/p60–235.pdf Vail, S. (2006). The calm in the storm: Women leaders in gulf coast recovery. San Francisco, CA: Women’s Funding Network. Waugh, I. M. (2006). Latinas negotiating traffic: Examining the sexual harassment experiences of Mexican American farm working women. Unpublished doctoral dissertation, University of California, Santa Cruz. Wells, N. M. (2005). Our housing, our selves: A longitudinal investigation of low-income women’s participatory housing experiences. Journal of Environmental Psychology, 25, 189–206. White, J. W. (2005). Psychology of Women Quarterly, 2000–2004. Psychology of Women Quarterly, 29, 107–109. Williams, E., Sorokina, O., Jones-DeWeever, & Hartman, H. (2006). The women of New Orleans and the Gulf Coast: Multiple disadvantages and key assets for recovery. Washington, DC: Institute for Women’s Policy Research. Williamson, E. (2006, November 23). In government report, “hunger” is called “low food security”. The Providence Journal, p. A14. Wilson, R. K., & Stein, R. M. (2006). Katrina evacuees in Houston: One-year out. Unpublished manuscript. Winston, P., Golden, O., Finegold, K., Rueben, K., Turner, M., & Zuckerman, S. (2006). After Katrina: Federalism after Hurricane Katrina. Washington, DC: Urban Institute. Working Families e-Activist Network. (2006, May 16). Tell McDonalds and Chipotle to support fair wages for farm workers, The Working Families e-Activist Network, AFL-CIO. http:www,unionvoce.org/

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Feminism and Disability: Synchronous Agendas in Conflict

18 Margaret A. Nosek

The dawning of feminist awareness happens for each of us in our own time. For many women with disabilities, the awakening to our femininity and our rights and power as women comes late, if at all. The overriding concerns related to our disability can consume our attention and energy and subvert any feelings of ownership toward feminist ideals. The course of the dawning of feminist awareness can be charted in various disability contexts, that is, for women who experience disability from birth, or gradually with onset later in life, or suddenly as a result of trauma or illness. It may also take a different course according to the continuum of severity, that is, at one extreme, for women whose disability may not be immediately apparent to others, to the other extreme for women whose disability requires the use of adaptive equipment or cognitive assistance and significantly interferes with their life activities. Despite such a heterogeneous population as the focus of this discussion, we will attempt to extract the salient disability issues as they interface with feminist issues, discuss their synchronicity and conflicts, and offer a call to action for strengthening the disability feminist movement.

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This chapter offers a glimpse into the disparities and discrimination that women with disabilities face in their daily lives. It begins with a description of the context within which the population of women with disabilities lives and some history on how we have been swept along as unrecognized players in the disability rights movement and the feminist movement. After a brief overview of disability in the feminist agenda, there is an introduction to some of the issues of concern to women with disabilities, including identity and self worth, individual autonomy, connectedness and social support, control of one’s body, sexuality, violence and abuse, discrimination, employment and income inequities, and disparities in health and access to health care. We end with a call to action for bringing women with disabilities together to form a stronger political and social force for change. We draw on three resources for illustrating these issues: (1) the small but profound literature on disability and feminism; (2) 15 years of research conducted by the Center for Research on Women with Disabilities; and (3) personal experiences as reported by some of our research participants, plus my own experience as a woman born with a slowly progressive neuromuscular disorder who now uses a power wheelchair, ventilator, and array of personal assistants in order to carry on with life’s duties. Many important and emerging topics of concern to women with disabilities, including global women’s issues, the environment, and caregiver issues are, unfortunately, beyond the scope of this chapter.

Disability: The Context The independent living movement that emerged in the 1970s took the first concrete steps to move toward a more functional definition of disability and toward cross-disability advocacy. Regardless of what diagnosis led to an individual’s disability, these community-based, consumer-controlled, grassroots organizations offered information and referral, peer counseling, independent living skills training, and advocacy services to help people with disabilities attain greater self-determination and autonomy. Stark inequities in options for living independently, including affordable housing, accessible public transportation, consumer-controlled attendant care, and access to employment and income benefits, were perceived as rooted in disability-based discrimination. Local and state-wide organizations dedicated to promoting disability rights and equal opportunity across diagnostic categories began to emerge in the 1970s. Their first accomplishment toward establishing people with disabilities as a protected class of citizen came with the passage of the Rehabilitation Act of 1973, specifically Section 504. Only after massive and vocal demonstrations led by the American Coalition of Citizens with Disabilities (ACCD) were the regulations that empowered Section 504 finally signed in 1978. An unprecedented collaboration among these groups and many other disability organizations together with a wide variety of civic and business organizations lobbied for and won passage of the Americans with Disabilities Act (ADA) of 1990 (“Americans with Disabilities Act” 1990). After the demise of ACCD in the 1980s, two other cross-disability advocacy organizations have risen to prominence, the American Association for People with Disabilities and the Coalition of Citizens with Disabilities. Throughout nearly four decades of

Chapter 18 Feminism and Disability

cross-disability advocacy, women’s issues have never been prominently on the agenda of any of these organizations. In the language of the ADA, we finally achieved a purely functional definition of disability: (a) a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (b) a record of such an impairment; or (c) being regarded as having such an impairment (“Americans with Disabilities Act” 1990). Although this general and far reaching definition has been controversial and subject to several limiting Supreme Court decisions, it was a decisive step in moving away from defining disability according to specific diagnostic categories, which could encompass wide-ranging levels of severity, and toward an understanding of disability that places the primary emphasis on limitations in life functioning. In the early 21st century, the World Health Organization (WHO) further advanced the understanding of disability by recognizing it as a universal human experience, shifting the focus from cause to impact, and placing all underlying health conditions on an equal footing. The International Classification of Functioning, Disability, and Health (ICF) (World Health Organization, 2007) is a classification of health and health-related domains that describe body functions and structures such as a mobility impairment, activities such as selfcare, and participation in life activities. The domains are classified from body, individual, and societal perspectives, and functioning and disability are seen as the result of a complex interaction between a person’s health condition and the contextual factors of the environment such as employment. Although the ICF is a step in the right direction, it still focuses on what’s wrong, abnormal, or deviant about disability rather than on the abilities and strengths of the individual man or woman who happens to live with disability. The ICF does not address issues salient to women with disabilities who experience serious if not life-threatening social inequities and injustices including extreme poverty and violence that would not occur if disability were not present in their lives. For women, disability is an experience deeply rooted in gender- and disability-based discrimination. The legacy of the categorical approach to disability unfortunately lingers. Historic disability labeling, disability-specific service organizations, withindisability community stigmatization, and lack of contact among people with different disabilities continue to limit the power of cross-disability advocacy by women with disabilities—constituting multilevel and within-community marginalization. To do justice to all the various groups of women that comprise this mixture would require an in-depth discussion of the disparate issues surrounding physical, intellectual, sensory, and emotional disabilities, plus the vast array of chronic health conditions. This is not possible within this chapter. To the extent possible, I will address issues common across this heterogeneous group, but when more specificity is needed, the focus will be on women with physical disability.

The Demographic Context Women with disabilities comprise 15.4% of the 137 million noninstitutionalized, civilian women over age 5, compared to 14.3% of 130 million men (United States Census Bureau, 2005). They are significantly more likely than women

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with no limitations to live alone, be divorced, have less education, be unemployed, and live in poverty (Chevarley, Thierry, Gill, Ryerson, & Nosek, 2006). The demographic characteristics of this population will change substantially in the coming years due to the improved survival rate of low birth-weight newborns, resulting in higher rates of children with activity limitation and permanent disability (National Center for Health Statistics, 2005) as well as the aging and functional decline experienced by baby boomers. The combination of longer life expectancy and increased disability rates is expected to more than triple the number of persons over age 65 with severe or moderate disabilities in the next 50 years (Siegel, 1996). Our society is not prepared for the rapidly expanding population of women with disabilities across the life span that will face serious and possibly worsening social disadvantages (Nosek, 2006). Population-based studies show that more than a quarter of women with disabilities live below the poverty level (American Community Survey, 2003a; Chevarley et al., 2006; Iezzoni, McCarthy, Davis, Harris-David, & O’Day, 2001). For women with disabilities aged 21 to 64, two and a half times as many live in poverty as do women with no disability in the same age group (26.4% vs. 10.5%). In every age group, more women than men with disabilities live in poverty (American Community Survey, 2003a). Some are at greater risk of experiencing the devastating consequences of poverty such as rural women with disabilities who have aptly been called “the poorest of the poor” (Mulder et al., 2000).

Attitudinal and Environmental Context Persistent negative stereotypes about disability have a serious effect on girls and women who are born with or acquire functional limitations. Viewed as “damaged goods” (Gill, 1996; Phillips, 1990), their sexuality is either devalued or overlooked altogether. Because they are not expected to seek or achieve satisfying intimate relationships, they are often not prepared to develop socially, to understand their sexuality or reproductive potential, or to recognize when they are being treated inappropriately or in an abusive relationship (Nosek, Foley, Hughes, & Howland, 2001; Nosek, Howland, Rintala, Young, & Chanpong, 2001). This stereotype even penetrates the health care system, where primary physicians and obstetricians/gynecologists may forego wellwoman care if it is too difficult or time consuming to perform the exams (Nosek & Howland, 1997; Nosek et al., 1996). It can also be seen in law enforcement, where reports of abuse against women with disabilities are often not viewed as serious or credible, particularly in cases of abuse against women with mental impairments or those living in institutional settings (Nosek, Howland, & Young, 1997). Environmental barriers are seen in restricted access to education, which is correlated with extremely low employment rates for women in this economically disadvantaged population. Women with disabilities who have high educational attainment are less than half as likely to be employed as women in general (American Community Survey, 2003b). The combination of being unemployed and unmarried deprives many women with disabilities of access to private health insurance or retirement benefits. The accumulated effect of overt and subtle messages of being inadequate and literally being excluded from the social mainstream may account for some of the significant


psychological and social health problems that many women with disabilities experience.

Personal and Social Functioning Functional limitations define disability as the inability to carry out the normal physical or mental activities of daily living. These limitations might affect walking, writing or manipulating small objects, lifting, self-care, housekeeping, working for pay, caring for children, decision-making, or social interactions, for example. Women are affected by functional limitations at higher rates as they age, increasing from 6% of women ages 18 to 44 to 40% of those age 65 or older (Chevarley et al., 2006). Quite often, the limitations an individual experiences from a disabling condition are made more severe by barriers in the environment. A classic case is the woman who has a stroke or spinal cord injury from an accident and is able to regain substantial function using adaptive equipment such as a wheelchair while in a rehabilitation center, but is rendered nearly helpless on returning home to an environment that is riddled with steps, narrow hallways and doorways, high kitchen counters, and small bathrooms. Resources are often not available to modify the woman’s living environment so that she can function more independently. Unfortunately, these resources are becoming scarcer and only available to women in the more privileged class, including those with good health insurance or wealthy families. Women who do not enjoy these resources are forced to be homebound—a situation which, under any other circumstances, would be labeled confinement.

Disability and the Feminist Agenda In the last 20 years, issues unique to women with disabilities have not been part of the feminist agenda. Many disabled feminist activists have begun to identify and raise public consciousness about this significant oversight (Begum, 1992; DePauw, 1996; Elshout, 1994; Encounters with strangers: Feminism and disability, 1999; Ferri & Gregg, 1998; Lloyd, 1992; Lloyd, 2001; Marston, 1997; Morris, 1992; Schriempf, 2001). According to Rosemarie Garland-Thomson, the premier synthesizer of disability and feminist issues, “feminist theories all too often do not recognize disability in their litanies of identities that inflect the category of woman. Repeatedly, feminist issues that are intricately entangled with disability—such as reproductive technology, the place of bodily differences, the particularities of oppression, the ethics of care, the construction of the subject—are discussed without any reference to disability” (GarlandThompson, 2003). Some particularly insightful writing by disabled feminist theorists and scholars have examined in depth the conflicts between these synchronous agendas (Begum, 1992; Blackford, Cuthbertson, Odette, & Ticoll, 1993; Deegan & Brooks, 1985; DePauw, 1996; Elshout, 1994; Fawcett, 1996; Ferri & Gregg, 1998; Fiduccia & Wolfe, 1999; Fine & Asch, 1988; Garland-Thompson, 1994, 2003; Garland-Thomson, 2001; Lloyd, 2001; Lonsdale, 1990; Morris, 1991; Morris, 1993; Wendell, 1996). Garland-Thomson has framed feminist disability

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theory as linking integration and transformation, both of which are fundamental to feminism and to the larger civil rights movement that informed it (Garland-Thompson, 2003). “Just as feminism has expanded the lexicon of what we imagine as womanly, has sought to understand and destigmatize what we call the subject position of woman, so have disability studies examined the identity disabled in the service of integrating people with disabilities more fully into our society” (Garland-Thompson, 2003). Coming from the humanities perspective, she set the goal of feminist disability studies as augmenting the terms and confronting the limits of the ways we understand human diversity, the materiality of the body, multiculturalism, and the social formations that interpret bodily differences. She claims that integrating disability as a category of analysis and a system of representation deepens, expands, and challenges feminist theory. “Disability—like gender—is a concept that pervades all aspects of culture: its structuring institutions, social identities, cultural practices, political positions, historical communities, and the shared human experience of embodiment. To borrow Toni Morrison’s notion that blackness is an idea that permeates American culture (Morrison, 1992), disability too is a pervasive, often unarticulated, ideology informing our cultural notions of self and other” (Garland-Thompson, 2003). Taking this a step further, one could view disability as having been invented for the purposes of ableism (discrimination favoring those who do not have disabilities), just as one could say that race was invented for the purposes of racism (personal communication with Lovell Jones, M.D., June 2007). Many view disability as a dimension of human variation, rejecting totally the medical approach to disability as pathology and incompetence. The conflict between the omnipresent with variation vs. pathologic approach to disability augments the feminist approach to beauty with variation vs. so-called ugliness. Garland Thomson states that disability feminism has contributed to the feminist movement in five important ways (Garland-Thompson, 2003). First, it understands disability as a system of exclusions that stigmatizes human differences. Second, it uncovers communities and identities that the bodies we consider disabled have produced. Third, it reveals discriminatory attitudes and practices directed at those bodies. Fourth, it exposes disability as a social category of analysis. Fifth, it frames disability as an effect of power relations. The disability rights movement has yet to embrace feminist ideals even though the two movements share principles of equality of opportunity and equal access to the American dream. In all of the advocacy efforts mentioned above, disability was the prevailing unifying factor and was viewed as either male dominant or gender-neutral. Nevertheless, for every issue in the feminist movement there are specific disability concerns; and for every issue in the disability rights movement there are specific feminist concerns. If the essence of feminism is empowerment, then we must put all theories aside and look specifically at those individual, lifestyle, and social factors that serve to either diminish or enhance the power of women with disabilities to believe they are women of value and to exert control over their lives. The following discussion will focus on the factors of identity and self-worth, individual autonomy, connectedness and social support, control of one’s body, sexuality, violence and abuse, discrimination, income inequities, and health


disparities. The chapter will conclude with a call to action for women with disabilities and their allies.

Issues of Concern to Women With Disabilities Identity and Self-Worth Much can be learned about the reality of living with a disability by reading some of the excellent personal accounts and anthologies compiled by women with disabilities (Browne, Connors, & Stern, 1985; Mairs, 1996; Matthews, 1983; J. Morris, 1993; Rousso, 1988; Saxton & Howe, 1987). These narratives and interpretations of personal experiences offer insight into the struggle to develop a positive sense of self and understanding of one’s place in a generally hostile world, a struggle that faces all women who have a medical condition that our society labels a disability. Identity and self-worth are discussed together here with the understanding that regardless of how a woman establishes her identity or how that identity is defined by others, it can empower her only to the extent she believes herself to be a woman of value. The path of discovering womanhood is often in conflict with the path of discovering an identity as a person with a disability. The critical life stage in which this occurs is adolescence but for many women with disabilities it comes much later. The normal processes of adjusting to bodily changes, discovering sexuality, and exploring new dimensions of social relationships can be seriously interrupted by the medical and social influences that accompany disability. For girls born with significant disabilities, such as cerebral palsy, spina bifida, some types of neuromuscular disorders, or congenital malformations, understanding of their physical differences from others in their family and circle of friends comes as a normal part of their development. Some families stop at nothing to ensure that their young daughter is treated the same as other siblings and has every opportunity for social interaction as her peers. In my own case, my mother was so committed to helping me be “normal” that she even carried me on her back up the hiking trails at Girl Scout camp. Nothing can replace these landmarks of growing up, but the stigma of being different still took its toll. Friendships with girls came naturally for me and were deeply fulfilling, but when pubescent sexual yearnings emerged nothing but frustration followed. Boys were happy to be friends but lacked the willingness and courage to initiate a date with someone who seemed so untouchable. In the 1960s, when children with disabilities were forced to go to special schools, most students in regular schools were not accustomed to accepting those with differences as equals. Now, after more than 30 years of legislation mandating integration in all aspects of public education, our society seems to be coming closer to a popular understanding of disability as another characteristic of being and not the stigmatizing, isolating, medicalized phenomenon of the past. Whatever attitudinal and social progress has been generated from this legislation and the evolving educational landscape, the process of establishing an identity as an “ordinary girl” remains as difficult as ever. For every doctor’s

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appointment, illness, or surgery that requires extended absence from school, you are reminded that you are different. For every gym class or sporting event from which you are excluded, you are reminded that you are different. For every social event where you have to search for someone to accompany you, you are reminded that you are different. No matter how beautiful, outgoing, talented, or popular you are, there is always the specter of being different, defective, or damaged. The challenge is to garner strength from supportive family and friends to develop an identity as a valued woman. Although value may be acknowledged for certain aspects of self, such as academic achievement, the understanding and appreciation of value in social and sexual realms may come much later and is much harder to gain. A participant in one of our studies (a 36-year-old polio survivor with scoliosis) commented on this dilemma, “I always felt like a neutral sex. It’s like I’m not a woman, not a man. I don’t know what I am because I was never approached like a woman and I guess that as I grow older and mature more, I have begun to proclaim that identity as a woman and thinking even if no man approached me, I am still a woman, I am still attractive.” She goes on to say, “And as I get to know more and more of my self-worth, it sort of helps me to identify myself, thinking I am a woman created by God and I am so precious and I am so loved and I have so much beauty inside of me. I should let it come out. I should not hide it” (Nosek, Howland et al., 2001). Girls and women who experience disability suddenly or gradually beginning in later adolescence or adulthood, as with arthritis, multiple sclerosis, other types of neuromuscular disorders, and traumatic injuries to the spine or brain, have the advantage of building on an existing disability-free sense of self. Although they may have grown up with feelings of exclusion, isolation, inadequacy, and rejection, these experiences could be attributed to reasons other than disability. When disability is added to the mix, it can cause considerable self-doubt and require accommodation into one’s sense of self. Women may be at risk for complicated and difficult-to-resolve emotional trauma if the onset of disability is accompanied by simultaneous multiple losses such as the end of an intimate relationship, loss of employment, loss of visibility, or loss of independence (Gill, 1996; Jans & Stoddard, 1999; Nosek, 1996). Experience with loss is also associated with jeopardized self-esteem (Cornwell & Schmitt, 1990). Self-esteem, the sense of self-respect, worthiness, and adequacy (Rosenberg, 1979) and the self-evaluation of one’s self-concept (Hudson, 1982), plays an important role in the well-being of women with disabilities (AbraidoLanza, Guier, & Colon, 1998; Nosek, Hughes, Swedlund, Taylor, & Swank, 2003). Unfortunately, the self-esteem of women with physical disabilities and chronic conditions may be compromised for a number of reasons (Cornwell & Schmitt, 1990; Nosek, Howland et al., 2001), including their internalization of the social stigma, exclusion, and devaluation that society often imposes on persons with physical impairment (Goffman, 1963; Wright, 1980). In addition, self-esteem has been shown to be affected by health status, as evidenced by decreased self-esteem during periods of symptom exacerbation, at times of increased functional limitations, and when secondary conditions emerge (Gatten, Brookings, & Bolton, 1993; Maynard & Roller, 1991; Schlesinger, 1996). Although research on self-esteem among women with physical disabilities is sparse, the findings that are available indicate that


levels of self-esteem in women with disabilities may be lower than those of women without disabilities (Nosek et al., 2003).

Individual Autonomy Striving for independence and self-sufficiency is a basic element of human development. Erickson (Erickson, 1950) has posited it as the second of eight developmental stages and labeled it “autonomy versus shame and doubt.” Using the same rhetoric, individualist feminism encourages women to take full responsibility over their own lives (McElroy, 2002). According to GarlandThomson (Garland-Thompson, 2003), feminist theory has adopted this notion in its equality model, which sometimes prizes individualistic autonomy as the key to women’s liberation. The damage done to the cause of disability by positioning shame and doubt as the polar opposite of autonomy is inestimable. This is the foundation of the “bootstrap” mentality that devalues anyone who cannot maintain an autonomous existence. This fantasy ideal of autonomy has little relevance to a society that revolves around dependence on technology and government-subsidized economic and environmental infrastructure, yet the prejudicial attitudes that evolved from it persist. If we are not able to tie our shoes without assistance, we should be ashamed and doubt our value. If a woman cannot wash dishes or iron clothes, she is not viable as a wife. This attitude continues to pervade current rehabilitation services that focus to the point of obsession on being normal at whatever cost. The new concept of disability acknowledges the need for assistance and accommodates it in estimations of independence. The independent living model regards control over one’s life as paramount. The key concept is choice— having a choice of acceptable life options and having the power to make decisions about those options without coercion (Nosek & Fuhrer, 1992). A typical example is the person with a disability who wants to move out of their parents’ house and live on their own. Doing so is not a viable option if the individual lacks independent living skills, is not independently mobile due to lack of assistive technology such as a power wheelchair, does not have the money required to pay for an apartment, and is totally dependent on parents for providing assistance with personal daily activities such as bathing and dressing. This type of forced dependence results from a lack of resources, information, and role models. The situation is more dire for those with more severe limitations and it affects men as much as women. The independent living movement is dedicated to removing these barriers by providing counseling about developing a positive sense of self and making good decisions, information about funding for assistive technology and housing, training on how to manage money and household responsibilities, training and referral for locating and managing attendants, and referral to job training programs. In this way, individuals become empowered to live independently by obtaining and managing the assistance they need. Although the leaders of the independent living movement have included many powerful disabled women, feminist issues have not been a priority. Only recently and in certain locations has it acknowledged the fact that women with disabilities experience more oppression and more limited life options than men with disabilities.

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These disproportionately oppressive forces on women’s autonomy became clear in a study we conducted of Hispanic and Asian women with disabilities (Parkin & Nosek, 2002). From the women we interviewed, we heard repeated references to overprotective families; discouragement of sexual expression; low expectations for ever marrying, working, or living independently; serious problems with depression after the onset of disability; and a desperate lack of resources for caring for their children without a supportive spouse. The independent living movement, for the most part, has failed to address or even acknowledge women’s needs for assistive technology related to child care, such as accessible cribs and lifting devices; domestic violence; and pervasive gender-based barriers and discrimination in employment. One key element for living independently with a severe physical disability is attendant care. Women are at a distinct disadvantage in finding and affording attendants compared to men because men have the option of receiving these services from their wives or intimate partners without having to pay for it. Examples are replete of men with spinal cord injuries who marry their nurses and women nursing their husbands through serious illnesses, particularly in their older years. Women, on the other hand must often pay for this type of assistance in order to maintain their independence. Because of their serious lack of financial resources many are forced to live dependent on their families or be institutionalized in nursing homes. The issue of individual autonomy for women with disabilities is, therefore, subject to pervasive negative attitudes on the part of family and society about the woman’s right and potential to live independently, to be economically selfsufficient, and to fulfill traditional roles of womanhood. This is compounded by documented and persistent discrimination in education, employment, and access to the resources needed to achieve and maintain individual autonomy throughout the lifespan. These factors will be discussed shortly.

Connectedness and Social Support New approaches to the psychology of women, especially those emanating from the Wellesley Centers on Women and authors Jean Baker Miller and Judith Jordan, emphasize the importance of women’s development of self in relation to others and their ability to make and maintain affiliation and relationships (Miller, 1986). They focus on the need for empathy and mutual involvement (Jordan, 1999). Women with disabilities face many barriers to the establishment of these mutually supportive relationships, especially with other women with disabilities. Connectedness is linked with psychological and physical well-being and health (Jordan, 1991). It involves moving beyond perceived social support to include empathy and mutual involvement in one another’s lives, involving not just the receiving but also the giving of support (Jordan, 1992; Reid-Cunningham, Snyder-Grant, Stein et al., 1999). The literature on social support suggests that having a confidant can serve as a buffer against negative health outcomes for women and possibly contribute to increased longevity (Belle, 1982). When connectedness is missing, the resulting disconnection and isolation can lead to health deterioration (Jordan, 1999; Miller & Stiver, 1991). Disconnections, chronic isolation, and depression appear to be common


experiences for many women with disabilities who may be socially isolated due to mobility limitations. A study of older persons revealed that being a woman, having a disability, and being socially isolated were among the factors predicting risk for depression (Roberts, Kaplan, Shema, & Strawbridge, 1997). Intimate, family connectedness may be disrupted as a result of having a disability. Women with disabilities are more likely to be divorced than are men with disabilities (Trieschmann, 1987), removing marriage as a potential buffer against stress and social isolation. Our many workshops and discussion groups with women with disabilities reveal that they yearn for and benefit from opportunities to develop and nurture mutual and caring relationships with one another, to heal multiple losses, and to attain optimal levels of wellness through these connections. The downside of “mainstreaming” or inclusion in regular educational, recreational, and other types of programs is that it indirectly reinforces the stigma of associating with people with disabilities and limits opportunities for peer interaction. Safe, inclusive, and accessible personal development programs are important for women with physical disabilities. “A disabled woman in a peer group can realize that she is not alone in her feelings about her unique body and uncommon life circumstances” (Saxton, 1985). Women with disabilities can serve as mutual role models to enhance visibility and offer empowerment for women who have been described as roleless. Such group settings break disability-related isolation, build connections, offer resources, and deconstruct internalized multiple oppressions, including ableism and sexism (Deegan, 1985; Saxton, 1985). The relational context of a women’s group offers opportunities to discuss issues difficult to share in mixed gender groups and helps women learn about common experiences and their own gender- and disability-related uniqueness. In addition to their psychological and physical health outcomes, women with disabilities who have participated in our health promotion workshops typically report that they have benefited from the opportunity to share on many levels including their identity as whole women, the desire for wellness, a commitment to barrier-free environments and optimal independence, and experiences of connectedness and mutuality with women similar to themselves.

Control of One’s Body Often referred to as bodily integrity in the feminist literature, control of one’s body is a cornerstone of women’s rights. Individualist feminism opposes government interference in the choices adults make with their own bodies, as it contends such interference creates a coercive hierarchy (e.g., patriarchy) (McElroy, 2002). For women in general, it consists of the right to control reproduction by means of birth control or abortion. For women with disabilities, however, it involves far more—battling the emphasis on normality in appearance and functioning, medical approaches that focus exclusively on cure or management of disability for the convenience of others, and dealing with extremes of reproductive rights and rights of survival that result from forced sterilization, eugenics, selective abortion, and genetic testing. The basis of the bodily control dilemma for women with disabilities is idealized notions of normalcy and the commercialization of health and fitness. In comparison to these ideals, women with disabilities are viewed as abnormal

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and expected to pass as normal to the extent possible, hide their defects from public view even if it means sequestering themselves in total isolation, or taking whatever measures are necessary to remove their defect. Garland-Thomson has finely articulated disability specific issues on women’s control over their bodies in this extended quote (Garland-Thompson, 2003). Perhaps feminist disability theory’s most incisive critique is revealing the intersections between the politics of appearance and the medicalization of subjugated bodies. The beauty system’s mandated standard of the female body has become a goal to be achieved through self-regulation and consumerism (Haiken, 1997; Wolf, 1991). Both cosmetic and reconstructive procedures commodify the body and parade mutilations as enhancements that correct flaws to improve the psychological well-being of the patient. This flight from the nonconforming body translates into individual efforts to look normal, neutral, unmarked, to not look disabled, queer, ugly, fat, ethnic, or raced. The emphasis on cure reduces the cultural tolerance for human variation and vulnerability by locating disability in bodies imagined as flawed rather than social systems in need of fixing. A feminist disability studies would draw an important distinction between prevention and elimination. Preventing illness, suffering, and injury is a humane social objective. Eliminating the range of unacceptable and devalued bodily forms and functions the dominant order calls disability is, on the other hand, a eugenic undertaking. The ostensibly progressive sociomedical project of eradicating disability all too often is enacted as a program to eliminate people with disabilities through such practices as forced sterilization, so-called physician-assisted suicide and mercy killing, selective abortion, institutionalization, and segregation policies. The cultural mandate to eliminate the variations in form and function that we think of as disabilities has undergirded the reproductive practices of genetic testing and selective abortion (Parens & Adrienne, 2000; Rapp, 1999; Saxton, 1998). Some disability activists argue that the “choice” to abort fetuses with disabilities is a coercive form of genocide against the disabled (Hubbard, 1990). A more nuanced argument against selective abortion comes from Adrienne Asch and Gail Geller, who wish to preserve a woman’s right to choose whether to bear a child, but who at the same time object to the ethics of selectively aborting a wanted fetus because it will become a person with a disability (Asch & Geller, 1996). Asch and Geller counter the quality-of-life and prevention-of-suffering arguments so readily invoked to justify selective abortion, as well as physician-assisted suicide, by pointing out that we cannot predict or, more precisely, control in advance such equivocal human states as happiness, suffering, or success. The practices of genetic and prenatal testing as well as physician-administered euthanasia, then, become potentially eugenic practices within the context of a culture deeply intolerant of disability. Disability itself demands that human interdependence and the universal need for assistance be figured into our dialogues about rights and subjectivity. At the Center for Research on Women with Disabilities, our interviews with women with disabilities, especially those who have their onset at birth or early childhood, revealed excessive exposure to medical environments in order to approach ideals of normalcy (Nosek, Howland et al., 2001). It is not unusual to find women who have had 20 or more surgeries before reaching adolescence in an attempt to remove or neutralize their disabling condition. Less invasive but nonetheless effacing is being excessively subjected to therapies and orthotic interventions such as bracing.


The resulting effect of these interventions is to sacrifice the full experience of childhood, education, and social interactions, to allow time for the relentless pursuit of normalcy. A very difficult decision point for families is determining when such medical interventions have reached the limit of their effectiveness and when it is time to accept a deviation from normalcy and let a child learn to adapt. There is little difference between the genders in these experiences, yet no one has examined the long-term impact on men vs. women in their sense of control over their bodies and how these early experiences affect their sexuality, relationships, or attitude toward maintaining good health. The most extreme and convoluted example of medical interventions to control the bodies of women with disabilities in disregard their reproductive rights can be seen in forced sterilizations, unauthorized hysterectomies, x-ray screening without protection of reproductive organs, and overuse of Norplant and Depo Provera. These practices reflect primitive, eugenics-based fears that “damaged” women should be prevented from producing “damaged” offspring (Fiduccia & Wolfe, 1999). Ever since surgical sterilization was invented, it has been an accepted practice to control the reproductive potential of women with intellectual disabilities and others whom society has deemed unfit to bear children or fulfill the role of mother. The most heinous application of the practice of forced sterilization is to “prevent” sexual abuse of women who are institutionalized for reasons of cognitive or psychiatric impairment. In fact, the only thing accomplished by this is to hide the extremely high prevalence of such sexual abuse by eliminating pregnancy as its outcome. Mothers of girls with intellectual disabilities or severe physical disabilities are very often pressured by medical professionals to consent to hysterectomy in order to eliminate the difficulties of managing menstruation, even though the procedure is not medically justifiable. A recent extreme example of this is the Ashley X case and the resulting “Ashley treatment.” Nine-year-old Ashley is a girl with severe physical and mental disabilities. Her parents requested that their daughter be treated with medications (large doses of estrogen) to halt her physical growth, and with surgeries to remove her breasts and uterus so that she would be easier for them to manage as she grew. These procedures were approved by the ethics committee at their local university-based Children’s Hospital and even endorsed in an article published in the October 2006 issue of Archives of Pediatrics and Adolescent Medicine (Gunther & Diekema, 2006). Although an editorial in the same issue labels such procedures as ill-advised (Brosco & Feudtner, 2006), it defers to public opinion and general acceptance of the practice as the final judge. A firestorm of outcry from the disability rights community followed news coverage of this event. Protests were lodged by organizations including Disability Rights Education and Defense Fund, American Association on Intellectual and Developmental Disabilities, “Not Dead Yet,” and Feminist Response in Disability Activism, which organized picketing outside the Chicago headquarters of the American Medical Association demanding that it endorse a policy condemning such practices. Disability rights organizations argued that aside from the gross disrespect for the bodily integrity of the individual that this practice represents, the nexus of the problem lies in society. Ashley’s parents argued that if she were to grow to maturity they would be unable to care for her and forced to place her in an institution. The disability rights and disability feminist response was that supports such as respite care

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and technologies to assist the parents should be investigated before endorsing the mutilation of their child. Numerous other cases have come to light since this event, all surrounding girls or women. In its ultimate expression, the issue of control over one’s body is seen in right-to-die cases, again almost exclusively involving women. The majority of patients who sought the “assisted suicide” services of Dr. Jack Kevorkian, until he received a prison sentence from 10 to 25 years for second-degree murder, were women with long-term disabilities. Representatives of the disability rights movement argued that these women resorted to suicide after being denied the benefits of knowing about and interacting with other women who are living successfully with long-term disabilities, social and financial supports including the provision of attendant care that could alleviate some of the stress that comes with living with disability, and medical attention for depression.

Sexuality Conventional social opinion is that women with disabilities are asexual (Adcock & Newbigging, 1990; Danek, 1992; Lesh & Marshall, 1984), have no need for intimacy or sexual expression, and are incapable of being a sexual partner (Hanna & Rogovsky, 1992). Prior to the last decade, sexuality was rarely examined from the perspective of women with disabilities (Nosek, 1996). The association of physical disability in women and physiological, psychological, emotional, and interpersonal problems with sexuality is well documented. The national comparative study of women with and without physical disabilities (Nosek, Howland et al., 2001) found that both groups had equivalent sexual desire, but women with disabilities tended to engage in sexual activity less frequently and reported lower levels of sexual satisfaction. Difficulties with sexual response are especially prevalent in women who have a central nervous system disorders, such as spinal cord injury, multiple sclerosis, brain injury, or stroke (Ferreiro-Velasco et al., 2005; Sipski, 2001; Sipski & Arenas, 2006; Zorzon et al., 1999). Living in contradiction to the stereotype of asexuality steadily wears away at the self-esteem and social behaviors of women with disabilities. In normal social contexts, we are considered unapproachable, if not because we are on a pedestal, then because we do not stimulate interest in desired partners. Consider the beauty queen vs. the poster child (Ferri & Gregg, 1998). Both images are exploitative, oppressive, and perpetuate false stereotypes about women. The beauty queen image portrays nondisabled women exclusively by their sexuality, while the eternal poster child image categorizes women with disabilities as absent of sexuality (Blackwell-Stratton, Breslin, Mayerson, & Bailey, 1988). Whereas the feminist movement strives to eliminate general regard for women as sex objects, women with disabilities are, for the most part, exempt from that issue. Those of us who have highly visible disabilities and use assistive devices for mobility are, aside from situations of sexual abuse or harassment, rarely subjected to the gestures, sounds, and touch of sexual advances. I always wondered what it would be like to be the object of a cat call. I found out at a large Halloween party during my adventurous 30s where I was dressed in an anatomically correct mermaid costume with strategically placed raisins. At first I was startled by the whistles, not realizing they were intended for me, but


then I was amused when one man, thinking he was out of ear shot, said to his comrade, “Cool costume; I wonder where she got that electric wheelchair.” Women with disabilities typically experience extraordinary barriers to dating and establishing intimate relationships. Interviews with 31 women who had a range of physical disabilities revealed that they perceived themselves to be older than their nondisabled peers at the time of their first date and first serious relationship (Rintala et al., 1997). Some women with early onset of disability reported lacking age-appropriate social skills associated with dating, but even those who appeared to be socially outgoing and have strong social skills reported that friendships were less likely to evolve into romantic relationships for them compared to their nondisabled friends. Potential dating partners experienced negative peer pressure or mistakenly believed that the woman was physically unable to participate in sexual activities. Practical barriers including dependence upon parents for personal assistance, the use of an assistive device or medical equipment, such as a wheelchair or urinary catheter, were factors often affecting intimacy. Women whose disabilities were largely invisible, such as arthritis, lupus, or early stages of multiple sclerosis, reported frustration with partners who expected them to function normally. Women with adult onset disability talked about having difficulty reestablishing trust and being willing to take risks. Many problems in pursuing positive relationships, especially dealing with the expectations of others and establishing a positive self-identity, are even more difficult for women with disabilities who come from minority cultures (Parkin & Nosek, 2002). Here are some comments from the women we interviewed (Nosek, Howland et al., 2001). About frustrations with dating, a 46-year-old woman with bilateral upper extremity amputations since birth told us, “I seem to attract men who want to take care of me. My basic feeling was that they wanted me to be their doll.” A 37-year-old polio survivor said, “I have never dated a man that has been as close as what I’d want him to be because I think it’s the wheelchair that scares him away. They’re afraid to get too close for some reason or other. I don’t really know why that is. It’s not that I hadn’t tried.” When disability occurs with a gradual onset after marriage, the process of adjustment must involve spouse and family who may be more likely to deny the existence of the condition because they do not feel the increasing pain and weakness themselves. A 38-year-old woman with lupus told us, “I have considered getting one of those electric carts, but every time I bring it up, my husband says, oh, you don’t need that, just stay home. If this ever gets worse, maybe he’ll consider it, but right now, he wants to deny still that there’s any disability.” A 43-year-old woman with rapidly progressing rheumatoid arthritis said, “I felt the rejection from my spouse, and as I got worse physically, the rejection was even more, in the sense that he wouldn’t touch me, we didn’t hold hands, there was no hugging.” In our research, women told us that their most effective sexual coping strategy to compensate for functional limitations was experimentation. Once an interested partner is found, it helps to have a willingness to try various positions, use commercial lubricants when necessary (many disability-related medications have the side effect of vaginal dryness), and communicate about how to maneuver around assistive devices to allow for maximal sexual pleasure. Accommodating fatigue and pain might involve planning sexual activity for times in the day when

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rest and/or medications have their best effect. The operational word here is willingness. A 37-year-old married polio survivor in one of our studies commented on the issue of spontaneity, “In the movies, the woman can go and she can jump on the guy’s lap and do all these gymnastic things, but I have to get him to put me in bed. That takes out some of the spontaneity, but it doesn’t take out the thrill.” Some disabling conditions affect sexual responsiveness. A 51-year-old married woman with multiple sclerosis and post-polio syndrome told us, “I think my disability has affected my response to sex and this happens with a lot of MS [multiple sclerosis] people. I am not easily aroused. It takes a lot of patience and I’m very grateful that my husband has had a lot of patience. I do not probably respond as fast as most females do to sexual stimulation.” For women who do not have bowel or bladder control due to their disabling condition, accidents are sometimes a concern. A 26-year-old married woman with paraplegia told us, “I still pee sometimes during sex. It’s just one of those things where you just have to lay a towel down. Or get the mat out. That’s what we do; get the mat and the towel. It’s no big deal to him” (Nosek, Howland et al., 2001).

Violence and Abuse The reaction of the general public, medical professionals, and disability-related service providers to information about violence against women with disabilities is often one of shock and disbelief, as if they believe that disability is somehow a protective factor against this major public health problem. While there are no national population-based data on prevalence of violence against women with disabilities, there is growing and convincing evidence that disability introduces additional vulnerability for violence into women’s lives. The Center for Research on Women with Disabilities conducted numerous studies on how to identify, deal with, and prevent abuse against women with disabilities. Here are some quotes from women we have interviewed about this topic. A 32-year-old woman with congenital osteogenesis imperfecta said, “My mother wasn’t around much, and I always felt in my sisters’ way, like I held them back from things they wanted because they had to help care for me. My sisters would slap me and shut me in my room.” A 49-year-old woman with spinal cord injury since age 17 told us, “After my child was born, my husband became jealous and didn’t want me to get up and take care of her. He would take my chair away from me and tied me up when I pulled myself out of bed. I left him the first chance I had” (Nosek, Howland et al., 2001). Violence, insecurity, and fear of rejection or abandonment, plus a lack of awareness among helping professionals combined with the architectural and program inaccessibility of most battered women’s resources, result in many women with disabilities staying in destructive relationships (Nosek et al., 1997). A national study of approximately 1,000 women, half of whom had physical disabilities and the other half did not, showed that women with disabilities are more likely to experience abuse at the hands of a greater number of perpetrators, both intimate partners and strangers including medical professionals, and for longer periods than are women without disabilities (Young, Nosek, Howland, Chanpong, & Rintala, 1997). Other studies have shown that women with disabilities have a 40% greater chance of experiencing physical, emotional, or sexual violence when compared to women without disabilities


and women with disabilities appeared to be at particular risk for severe forms of violence (Brownridge, 2006). Women with disabilities were less likely than women without disabilities to have experienced physical assault alone; however, women with disabilities were more than four times as likely to experience sexual assault compared to women without disabilities (Martin et al., 2006). Another of our investigations of women with physical disabilities revealed a 10% rate of physical, sexual, or disability-related violence in the past year (McFarlane et al., 2001). A follow-up analysis revealed that women who were less mobile, either because of impairment or lack of assistive devices, who were younger, who experienced greater social isolation, and who had higher levels of depression were more likely to report abuse within the past year (Nosek, Taylor, Hughes, & Taylor, 2006). Violence against women with disabilities can be subtle, hidden, and masked by overriding disability-related health concerns. It is only in rare cases that women with disabilities who have violence-related injuries will present in a clinic or emergency department and be treated according to standard protocols for documentation or collection of evidence by medical professionals and law enforcement officials. There are many ways to inflict suffering upon women with disabilities in conflicts of power and control, both by commission and omission. And there are many ways to use the disability itself plus societal attitudes toward women with disabilities and the people who care for them to obfuscate criminal intent and actions. Many assume that women with disabilities do not date, do not live with significant others, do not marry, and do not desire such relationships, especially if they exhibit visible signs of disability such as use of a wheelchair or disfigurement. The assumption follows that an abnormal appearance makes such women undesirable to potential perpetrators of sexual assault. Findings from various studies do not support these assumptions; indeed, perpetrators often use these perceptions in rationalizing that women with disabilities are safe targets and their crime would be less likely to be reported. Nearly two decades ago, the Disabled Women’s Network of Canada (Ridington, 1989) surveyed 245 women with disabilities and found that 40% had experienced abuse. Spouses and ex-spouses were the most frequent perpetrator, and fewer than half of the women reported the abuse due to their fear and dependency on the abuser. The problem of abuse is magnified for women with intellectual disabilities or mental illness. Women with disabilities experience circumstances compromising their natural defenses, such as social isolation and dependence on technology. With higher rates of health care utilization than women in general (Nosek, 2000; Nosek, Howland et al., 2001), women with disabilities are exposed to situations in which strangers may remove their assistive devices or perform intimate services or procedures. Women frequently report that they are unable to enter or exit their homes without another person’s assistance. Architectural and environmental barriers keep women with mobility impairments from using community and social network resources. Some women with disabilities may not have opportunities for learning to recognize abuse, and others believe that abuse must be tolerated to meet their needs for survival or intimacy. Our research has led to the identification of specific disability-related types of abuse (Nosek, Foley et al., 2001). Although all women are vulnerable

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to emotional, physical, and sexual abuse, the critical need for assistance with activities of daily living is likely to increase the woman’s vulnerability. Intimate partners, for example, may demand sexual activity in return for helping the woman get out of bed; prevent a woman from using a wheelchair or other assistive device; or refuse to help with an important personal need, such as getting to the bathroom, bathing, dressing or eating (Nosek, Foley et al., 2001; Powers et al., 2002). These types of abuse would probably not occur if the woman did not have a disability that required assistance with essential activities of daily life. Studies confirm a high prevalence of disability-related abuse by personal assistants who are either intimate partners or hired attendants (Nosek, Howland, et al., 2001; Powers et al., 2002; Saxton et al., 2001). According to a study by Powers and colleagues (Powers et al., 2002), the most harmful abuse by personal attendants included threatened or actual physical harm, unwanted sexual behavior, financial abuse, medication manipulation, and denial or destruction of assistive equipment. Maltreatment occurring in a disability-related health care or service setting is often difficult to identify and may be disguised as being medically necessary or essential for service delivery. Many are the reports of women being sexually violated while being fitted for an orthotic device, roughly handled by an x-ray technician, ignored when complaining of pain, or fondled while tied to a wheelchair in a special transit van. While such settings are working toward protection of privacy and dignity and appropriate response to consumers’ needs, past events have deeply scarred many women with disabilities, negatively affecting their willingness to receive medical treatment. According to the National Institute of Mental Health (National Institute of Mental Health, 2005) abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. Not surprisingly, then, depression and experience with abuse have been linked in research on women with disabilities (Hughes, Swedlund, Petersen, & Nosek, 2001; Nosek, Taylor et al., 2006). Because poverty is so strongly associated with disability and women, many women with disabilities are economically dependent on their spouses and families, which creates additional vulnerability for abuse. A large-scale analysis of the 2005 Behavioral Risk Factor Surveillance System survey found that women with disabilities who have been abused reported significantly higher levels of unemployment compared to women without disabilities who had been abused (Smith & Strauser, 2007, Sept. 8). The authors recommend implementation of mechanisms to assist women with disabilities in preventing further abuse by providing career and employment skill training could potentially help break the cycle of violence.

Discrimination Women, people with disabilities or appearance impairments, ethnic Others, gays and lesbians, and people of color are, according to Garland-Thomson (Garland-Thompson, 2003), variously the objects of infanticide, selective abortion, eugenic programs, hate crimes, mercy killing, assisted suicide, lynching, bride burning, honor killing, forced conversion, coercive rehabilitation, domestic violence, genocide, normalizing surgical procedures, racial profiling, and neglect. She claims that all these discriminatory practices are legitimized


by systems of representation and by collective cultural stories that shape the material world, underwrite exclusionary attitudes, inform human relations, and mold our senses of who we are. Discrimination based on the combination of disability and sex is experienced on the individual and family levels, overtly and covertly throughout society, and insidiously in funding and social policies. Few families would regard overprotection as a form of discrimination but that certainly is its effect. When one member of a family is not given the same opportunities as other members in the guise of saving her embarrassment or protecting her from disappointment, it is more often parents that would be embarrassed or disappointed. These actions deny girls and women the opportunity to develop in normal social contexts and learn the rules of social interactions that they will have to live by when the protection of their parents is no longer available. Discrimination in the larger society stems mostly from negative attitudes and ignorance. Employers often have no idea how a person with a disability could perform a job or function at the worksite, but if that person can present the required documentation of education and past performance they deserve equal consideration for the position. Just as an interviewer cannot ask a woman about who will take care of her children while she works, they cannot ask a woman with a disability how she will use the restroom during work hours. Women with disabilities often have to struggle to be active participants in their children’s education because, although school systems might be very willing to provide accommodations to their students, they do not think it is their obligation to provide the same accommodation to the parent. Many organizations, including women’s rights organizations, are not fully aware of their responsibility to hold accessible meetings, thereby unintentionally but nonetheless effectively excluding participation by women with disabilities. On the policy level, the marriage penalty and the institutional bias in Medicaid services have a disproportional negative effect on women. The marriage penalty refers to the policy of the Social Security Administration whereby a woman who receives Supplemental Security Income becomes ineligible when she marries because the income of her spouse counts as her own. This results not only in the loss of income payments but also all the benefits that come with it, including Medicaid, subsidized attendant care, and subsidized housing (Fiduccia & Wolfe, 1999). This forces many women to live in secret with their intimate partners and be subject to invasions of their privacy by employees of the involved federal agencies. Institutional bias is reflected in the funding patterns for Medicaid. Government funding is much more easily available to pay for a nursing home placement than to support the services individuals need to stay in their own homes. That this disproportionately affects women is evidenced by the fact that they constitute the large majority of nursing home residents. Many factors conspire to force the institutionalization of women. It is much less likely that they will have a spouse or family member who can care for them when the need arises. Because they are significantly less likely than men to have a career outside of the home or occupy higher paying positions that offer private health insurance, they are less likely to contribute to the Social Security system and be eligible for its benefits. There are fewer women than men in the armed forces and therefore fewer have access to the Veterans Administration benefits. Once institutionalized because of disability, it is even more difficult

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for women to regain their proper place in the community. Although the feminist aspects of this dilemma have not surfaced in its advocacy, the organization ADAPT (http://www.adapt.org) is vigorously pursuing legislation to remove the institutional bias of Medicaid funding. On the international level, women with disabilities have been excluded from two important documents produced by the United Nations. “A Comprehensive and Integral Convention on Protection and Promotion of the Rights and Dignity of Persons with Disabilities” has been in negotiation among United Nations member states since 2002. The gender perspective is, however, almost completely absent. Similarly, the United Nations “Convention on the Elimination of all Forms of Discrimination against Women” is lacking any reference to disability. Two German organizations, NETZWERK ARTIKEL 3 and Sozialverband Deutschland (http://www.un-disabledwomen.org/), have undertaken a campaign to make women with disabilities more visible in these UN activities.

Employment and Income Inequities Work place rights, including advocacy for equal pay for equal work and the removal of glass ceilings in vocational advancement, have been a fundamental component of feminist activism. Women with disabilities, however, are most often trapped in an array of oppressive factors that keep them unemployed and living in poverty. Extreme disparities in employment for women with disabilities are well documented (Baldwin & Johnson, 1995; Burke, 1999; Smith Randolph & Andresen, 2004). Some estimates of employment rates for women with significant disabilities are as low as 26% (Chevarley et al., 2006). As stated earlier, more than twice as many women with disabilities live in poverty compared to women without disabilities. On average, women with disabilities who work full time earn only $.46 compared to every dollar earned by men without disabilities (U. S. Census Bureau, 2006). A deeply entrenched system of work disincentives and benefit programs maintain women with disabilities as the most seriously economically disadvantaged segment of the U.S. population. A report to Congress by the American Psychological Association (Mulder et al., 2000) classified women with disabilities living in rural America as “the poorest of the poor.” From the earliest ages, parents of children with disabilities are encouraged to apply for Supplemental Security Income. This government benefit program includes small monthly payments, Medicaid coverage, and—depending on the state – eligibility for other government subsidized programs, such as low income housing and respite care or attendant care. While all of these programs combined can make survival or even independent living more feasible for people with disabilities, the eligibility requirements are strict. Earned income at even the most minimal level would deem a woman ineligible and cause her to lose critical, life-sustaining services. Even though newly established programs help such individuals gradually move into employment while still maintaining some of these services, the income ceiling is too low to allow for economic self-sufficiency. The cost of attendant care alone is beyond the reach of someone with significant functional limitations even at the upper-middle-class income level. Access to postsecondary education and job training opportunities for women is greater now than ever before through the network of state vocational


rehabilitation agencies, although disparities have been documented in the amount of services offered to men compared to women (Bounds, Schopp, Johnstone, Unger, & Goldman, 2003). More serious disparities exist in job placement and retention. When it comes to finding a job, the barriers related to disability far outweigh the barriers related to gender. The combination of gender and disability can be devastating. Women are much more likely than men to have cyclical or fluctuating underlying physically disabling health conditions, such as lupus or multiple sclerosis, which affect their ability to work consistently. As such, functional limitations reduce the field of possible career paths. They also trigger all the negative stereotypes about disability on the part of human resource personnel and at least small business employers’ concerns about having to pay for health benefits for this high health care utilization population, this on top of the negative stereotypes about women in the job market. The Americans with Disabilities Act requires employers to offer reasonable accommodation to their employees with disabilities. These accommodations can include offering modified work hours, exchanging nonessential job tasks with other employees, providing accessible workspace, and offering personal assistance with certain tasks, as long as doing so would not place an excessive burden on the employer and would not change the essential nature of the job. Unfortunately, few people with disabilities know that they have a right to ask for these accommodations and few employers actively inform their employees about this right. There are no statistics available on disparities between disabled men and women in receiving workplace accommodations, but anecdotal evidence indicates that women are far less likely to request it. Another critical issue in workplace rights for women is return to work after the onset of disability. Much has been written about factors that predict successful return to work after various types of injury (amputation, spinal cord injury, brain injury, back injury), progressive disabling conditions (arthritis, multiple sclerosis), chronic health conditions (heart disease, cancer), and mental illness. Sadly, few of these studies examine gender as a predictor variable. Among those that do examine gender, results are mixed. One study of women compared to men with traumatic brain injury found that women were more likely to decrease hours or stop working after their injury, except in the oldest age group (Corrigan et al., 2007). There was a strong association between being married and not returning to work. The authors predict that the nature of brain injury makes it more difficult to do the multitasking that is required of women who work and also are responsible for child care and housekeeping. They point out that future studies should examine the role of domestic violence in the employment of women with brain injury, the type of work they were doing, whether they have childcare responsibilities, and how much support they receive from vocational rehabilitation services. For women with disabilities, only issues relating to obtaining and maintaining work have been examined. Serious disparities exist in the amount of vocational rehabilitation services received, barriers in the work place, and factors related to disability and family obligations that interfere with employment. Questions about the advancement of women with disabilities in their careers have never even been posed. The awakening to feminism for me pivoted around issues of work and income. Although I was familiar with the feminist movement (being a child

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of the 60s and 70s), I did not perceive that it had any relevance to me. Equal standing in a relationship assumes that you have an existing relationship. I never even dated until I was well into my career, so the whole notion of sexual politics was foreign to me. My passion for civil rights was ignited over the discrimination I faced because I was a person with a disability. When the opportunity came to conduct research on sexuality of women with disabilities, I learned not just about sexual inequities but about the whole scope of discrimination faced by women. The awakening moment for me was when I learned that male faculty members at the same rank as I and who had fewer funded research projects were earning twice my salary. My outrage over this translated into confrontation with my supervisor that resulted in gradual salary increases that never quite achieved parity. This situation had nothing to do with disability; it was solely because I was a woman.

Health Disparities and Access to Health Care Disability has yet to achieve its proper place in the discussion of health disparities. Several major Federal initiatives to remove health disparities have only addressed disability as a consequence of poverty, low education levels, lack of access to health care, and other disparity factors, but fail to acknowledge people with disabilities as a health disparity population. As a major national health policy and service focus, issues related to people with disabilities are almost completely ignored unless they happen to fall within the domain of another protected group, such as racial and ethnic minorities, the homeless, migrants, or women, and even then they are rarely mentioned as a subpopulation warranting attention. In the 2006 National Health Disparities Report issued by the Agency for Health Care Research and Quality (U.S. Department of Health and Human Services, 2006) one page out of 212 is devoted to the health concerns of people with disabilities, and that is limited to oral health only. Only a few studies have examined disparities in the health status of women with disabilities. Chevarley and colleagues (Chevarley et al., 2006) identified significant disparities in general health status, smoking, having hypertension, being overweight, and experiencing mental health problems for women with function limitations compared to those with no limitations. They were also less likely to have received Pap smear tests or mammograms, and were more likely to be unable to get general medical care, dental care, prescription medicines, or eyeglasses, regardless of age group, compared with women with no limitations. The main reasons reported for being unable to receive general care were financial problems or limitations in insurance. A study of women veterans with spinal cord injury and dysfunction found that they were more likely to have heart disease and lower health status, and were less likely to receive recommended dental care, colon cancer screening, mammogram, or Pap smears than women veterans with no disabilities (Lavela, Weaver, Smith, & Chen, 2006). The difference seemed to hinge on whether the receipt of services required the use of equipment, body adjustments, and potential discomfort due to disability. Two studies examined disparities in specific disability categories. Workingage women with cognitive disabilities, despite having similar likelihoods of potential access to health care compared to nondisabled women, had markedly


worse rates of receiving cervical cancer and breast cancer screenings, similar rates of routine check-ups, and yet had better rates of receipt of influenza shots. They were also less likely to be satisfied with their medical care than were nondisabled women (Parish & Saville, 2006). The assumption that childbirth is not a concern for women with disabilities underlies the serious lack of consumer and clinical information about risks and precautions of pregnancy, labor, and delivery for women with various disabilities. The specific gynecological and obstetrical needs of women with disabilities have only recently reached the attention of medical education programs (Welner, 1999; Welner & Haseltine, 2004). The wellness needs of women with disabilities are rarely, if ever, addressed in medical training, resulting in a healthcare work force that is unequipped to deal with ordinary health needs in the context of disability. Medical providers have little or no opportunity to learn about sexual and reproductive health in the context of disability, either in preservice training or continuing education. The often heard remark, “I treat all my patients the same” illustrates the lack of familiarity most physicians have with secondary conditions and other specific health maintenance needs of people with disabilities (Nosek & Simmons, 2007). There is widespread agreement among people with disabilities that they experience substantial difficulty finding physicians and other medical providers who have the knowledge about disability necessary to provide them with quality health care (Nosek, Howland et al., 2001). An innocent question to a woman with a disability about how she is treated in healthcare settings is likely to spark ire if not vitriol. Here is a sample of what some women have told us (Nosek, Howland, et al., 2001). A polio survivor who immigrated to the United States with her family said, “When I used to go to my doctor, my sister who spoke English went, my mother, who didn’t speak English, went and myself. And when the doctor would ask a question, my sister would ask my mom, and then my mom would tell my sister, and then she would translate it to the doctor. So it’s like I was just there for the physical thing, and—and they had their little conversation. So this is how I saw the medical profession, as somebody that you really don’t speak to directly.” We found an astonishing high rate of women who reported being refused medical services outright. A 22-year-old woman with paraplegia told us, “I had a discharge and I didn’t know what it was from and I told my doctor and she told me to find an OB/ GYN doctor. When I called the doctor’s office they would say O.K. but when you said something about being in a wheelchair the nurse would say let me talk to the doctor and we will get back with you. I called about four doctors and none of them would see me because I was in a wheelchair. When they called back they said no. They preferred not to deal with patients in wheelchairs.” Many are the reports of being treated in medical settings without respect or dignity and of being stripped publicly for the sake of teaching medical students. Systems barriers generate from several sources, including the built environment, health care coverage programs, and policies governing the delivery of medical services. Barriers in the built environment include not only inaccessible medical facilities and services, but also equipment that is not usable by people with certain disability-related limitations. The lack of elevating examination tables and mammography equipment that can only accommodate women in a standing position have been cited as serious barriers for women

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with physical disabilities who are trying to get well woman care and breast and cervical cancer screening (Centers for Disease Control and Prevention, 1998; Nosek & Howland, 1997). Limitations in the coverage of health services under Medicaid, Medicare, and private health insurance plans severely limit the ability of people with disabilities to access quality health care services (Iezzoni & O’Day, 2006). Many times the equipment and medications needed by people with disabilities are simply not covered under these plans; other times coverage is so minimal as to make obtaining them unfeasible. Policies that require screening by a primary care provider before accessing specialists and the ensuing delays in treatment can result in the unnecessary worsening of secondary conditions that women with disabilities must deal with on a regular basis. These limitations in coverage cross the spectrum of health care insurance, but are more severe in publicly funded programs. Many physicians will not accept government payment for services and government funded clinics are characterized by excessive demand and extreme delays in delivering services. Although many assume that all people with disabilities receive government income support and health coverage, there is a large and growing segment of the population that is not disabled enough or not poor enough to qualify for these benefits (Nosek & Simmons, 2007). Because women are larger consumers of health care services than men, this is a seriously unrecognized and unaddressed disability feminist issue. Some systems barriers stem from policies that are created by individual practices. Some physicians refuse outright to see women with disabilities, claiming they are not equipped to handle their special needs and that they would be better served by seeing specialists (Nosek & Howland, 1997). The Americans with Disabilities Act requires that all providers of health care offer services to women with disabilities that are equally accessible and equal in quality compared to services provided to others. Furthermore, specialists are even less likely to have knowledge or experience related to the ordinary health needs of women with disabilities. While many women with disabilities claim that they receive all the health care they need from their disability-related specialist, it is wholly inappropriate to expect, for example, a rheumatologist to provide well woman checkups. There are many serious consequences of these barriers to sexual and reproductive health care for women with disabilities. The greatest is the failure to detect many potentially life-threatening health problems, including sexually transmitted infections, HIV/AIDS, pelvic inflammatory disease, and ectopic pregnancy, as well as the failure to prevent problems with infertility, pregnancy, labor, delivery, and postpartum care (Nosek & Simmons, 2007). Lower levels of cancer screening result in diagnosis at later stages and higher mortality rates compared to women without disabilities (Caban, Kuo, Mahnken, Nosek & Freeman, 2007; Caban, Nosek, Graves, Esteva, & McNeese, 2002 ). Disparities in the prevalence of certain health conditions are also evident for women with disabilities. Population-based and sample-based studies show us that women with severe mobility impairments compared to women without impairments are more than six times as likely to experience depression (51.0% vs. 8.5%) (Health Resources and Services Administration, 2007; Hughes, Robinson-Whelen, Taylor, Petersen, & Nosek, 2005), more than five times


more likely to have diabetes (36.3% vs. 7.1%) (Nosek, Hughes et al., 2006; Pleis & Lethbridge-Çejku, 2006), five times more likely to have osteoporosis (25.5% vs. 5.3%) (Health Resources and Services Administration, 2007; Nosek, Hughes et al., 2006), and nearly twice as likely to be obese (47.6% vs. 24.3%) (Chevarley et al., 2006; Pleis & Lethbridge-Çejku, 2006). If disparities of this breadth and magnitude existed for men, they would not remain on the shelves of academics for very long.

Call to Action Collective advocacy by women with disabilities on the local level is only recently getting off the ground. It has been referred to as the next powder keg waiting to be lit in the disability rights movement. Feedback we have gotten from centers for independent living around the country that have collaborated with our research by offering our health promotion workshops for women with disabilities has indicated a desperate thirst for women-to-women interaction. Although some of these centers continue to offer the workshops beyond the research studies and offer ongoing attention to the needs of women with disabilities, national organized advocacy is minimal. What would Saul Alinsky say about a population so large and rapidly growing, so severely disadvantaged in every aspect of its status, and so victimized by discrimination and institutionalized oppression, that was almost totally unrepresented by organized advocacy? Whereas the feminist movement has national organizations and networks, local peer activities, information, media, conventions, lobbyists, and advocates, no such infrastructure is available yet for women with disabilities. The National Organization of Women has a disability rights advisory committee and recently held a Women with Disabilities Feminist Activist Strategy Caucus at the NOW Action Center to develop new strategies to fully integrate issues of women with disabilities into all of NOW’s work (Manning, 2007). One new organization has begun national outreach, the Chicago-based Feminist Response in Disability Advocacy (FRIDA) (http:// fridanow.blogspot.com), but so far only over the issue of forced sterilization and surgical abuse of women with severe disabilities. Other countries are far ahead of the United States in organized advocacy for women with disabilities. DisAbled Women’s Network (DAWN) Canada (http://www.dawncanada.net/) has been active for more than 10 years and is well established, with representatives across Canada, an agenda of national and local activities, and a long list of publications about issues of concern to women with disabilities, from smoking cessation to career development. Women with Disabilities Australia (WWDA) (http://www.wwda.org.au/) has received many national and international accolades for its work on unlawful sterilization of women and girls with disabilities, reproductive health, violence against women with disabilities, and leadership and mentoring. Its well-established systemic advocacy offers women with disabilities in Australia and internationally a model of information and action. Where is the fire in the belly of disabled women in the United States? It is probably consumed with just surviving. Most don’t even identify as having a disability or being part of an oppressed population. For the average woman

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with a disability there is a serious lack of information about issues important to her, a lack of peer contact that makes her feel isolated and stigmatized, no exposure in the media, no events to attend, and no sense of advocating for a shared cause. The resulting deprivation is not only material and cognitive, it is also spiritual. According to Flinders (1998) the patriarchy controls women by separating them from their own desires and feelings, separating women from one another, and demonizing the religious practices of women, thus closing off the wellspring of their own spirituality. Women with disabilities are suffering from the patriarchy that all women face plus the patriarchy that has dominated disability services and the disability rights movement. I close with a call for action on the part of women with disabilities and their allies. Essential elements of such action include: 1. Organize. Using models from the women’s movement in the United States and organizations of women with disabilities in Canada and Australia, we must create a national organization for the liberation of women with disabilities. Along with this must come an infrastructure for Internet-based and print communication, information dissemination, events to promote organizing and issue oriented action, legislative lobbying, and a range of opportunities for involvement on the local, regional, and national levels. 2. Use the power of the peer. The most powerful tool we have for making changes in the lives of women with disabilities is one-on-one contact. Through whatever means available, women with disabilities must reach out to one another for mutual support, information sharing, and developing bonds of sisterhood. 3. Teach. Those of us who are able to articulate the modern understanding of disability and the lives of women who live successfully with functional impairments have an obligation to seize every opportunity to communicate this understanding to families, friends, medical professionals, service providers, and the public at large so that they may examine their own attitudes and behaviors in that light. 4. Demand answers. The days are over when women with disabilities should be expected to sit by quietly while they are excluded from the mainstream of health promotion campaigns, educational opportunities, and the workforce. We must raise the expectation of involvement and representation on each of these fronts and demand answers when equity is not reached. 5. Tap the media. Encourage media coverage of issues of concern to women with disabilities and the portrayal of successful, healthy, active women with disabilities in publicity related to all topics. Creating a public interest in the serious inequities in education, employment, health and health care, and participation in society for women with disabilities will be the force behind the ultimate removal of the disparities we have documented. Just as it is now common practice to include diversity in the racial and ethnic representation of women portrayed in health promotion materials and publicity, for example, women with disabilities must also be represented. By whatever means necessary, the generation of new knowledge about successful living with disability must reach the print and broadcast media so it can be available to women with disabilities, their allies, those who serve


us, those who make policies and legislation that affect us, and the public at large. By generating media coverage of these issues we can increase the demand for information and the elimination of discrimination. Women with disabilities, though lacking a tightly organized movement, have a synchronous agenda with the general feminist movement. We fight for our rights, albeit most often on an individual basis, to occupy our rightful place in society, to work, to earn a living wage, to be in loving relationships, to bear children, and to have equal opportunity to receive education, quality health care, and all the benefits available to everyone living in the United States. The key word here is “fight.” For the most basic elements of survival we must fight, often on a daily basis. The great injustice and the great conflict between the synchronous agendas is that we are hardly recognized as women, either by society or by organizations of women. We are expecting to participate as if we were women only and our disabilities had no meaning. The issues that we face disproportionately or uniquely are hardly evident in the feminist movement. One of the most enduring roots of the gross social inequities and discrimination faced by women with disabilities is social isolation. Even those who are surrounded by loving families, who are participants in progressive education and health care programs, and who are working may perceive that they are the only ones dealing with their particular disability-related problems. At astoundingly expanding rates, there are more and more of us, as baby boomers enter their golden years, as severely disabled neonates survive with the assistance of technology, and as the ravages of war continue to suck the life blood from our nation’s strongest youth, now more than ever including women. The exclusion and isolation of women with disabilities in all stages of the life span from the mainstream of society must end. We all have the responsibility to use the power of our influence to bring light to pathways by which this can happen.

Acknowledgment I would like to thank my colleague Rosemary B. Hughes, PhD, former director of the Center for Research on Women with Disabilities and now at the Rural Institute on Disability at the University of Montana, not only for her assistance in editing this chapter but also for the fundamental contribution she has made to our accomplishments as the author of all of our health promotion intervention workshops and principal investigator on studies that have examined their effectiveness.

References Abraido-Lanza, A. F., Guier, C., & Colon, R. M. (1998). Psychological thriving among Latinas with chronic illness. Journal of Social Issues, 54, 405–424. Adcock, C., & Newbigging, K. (1990). Women in the shadows: women, feminism and clinical psychology. In E. Burman (Ed.), Feminists and Psychological Practice (pp. 132–188). London: Sage. American Community Survey. (2003a). Sex by age by disability status by poverty status for the civilian noninstitutionalized population 5 years and over. Summary Table P060. Retrieved July 31, 2006 from http://factfi nder.census.gov/servlet/DTTable?_bm=y&state=dt&-context=dt&-ds_name=ACS_ 2004_EST_G00_&-mt_name=ACS_ 2004_

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E ST_G20 0 0 _ B18 030&-t r e e _ id=30 4&-a l l _ ge o _ t y p es =N&-_ c a l ler = ge o sele c t&geo_id=05000US48201&-search_results=01000US&-format=&-_lang=en. American Community Survey. (2003b). Sex by age by physical disability by employment status for the civilian noninstitutionalized population 5 years and over, Summary Table PCT041. Retrieved July 31, 2006, from http://www.census.gov/hhes/www/disability/data_title. html#2000. Americans with Disabilities Act. (1990). (Vol. 42 U.S.C. Secs. 12101–12213 (1995)). Asch, A., & Geller, G. (1996). Feminism, bioethics and genetics. In S. M. Wolf (Ed.), Feminism, bioethics: Beyond reproduction (pp. 318–350). Oxford, UK: Oxford University Press. Baldwin, M. L., & Johnson, W. G. (1995). Labor market discrimination against women with disabilities. Industrial Relations, 34, 555–577. Begum, N. (1992). Disabled women and the feminist agenda. Feminist Review, 40, 70–84. Belle, D. (1982). Social ties and social support. In D. Belle (Ed.), Lives in stress: Women and depression (pp. 133–144). Beverly Hills, CA: Sage. Blackford, K., Cuthbertson, C., Odette, F., & Ticoll, M. (1993). Women and disability [Feature issue]. Canadian Women’s Studies, 13(4). Blackwell-Stratton, M., Breslin, M. L., Mayerson, A. B., & Bailey, S. (1988). Smashing icons: Disabled women and the disability and women’s movement. In M. Fine & A. Asch (Eds.), Women with disabilities: Essays in psychology, culture, and politics (pp. 306–332). Philadelphia, PA: Temple University Press. Bounds, T. A., Schopp, L., Johnstone, B., Unger, C., & Goldman, H. (2003). Gender differences in a sample of vocational rehabilitation clients with TBI. NeuroRehabilitation, 18, 189–196. Brosco, J. P., & Feudtner, C. (2006). Growth attenuation: A diminutive solution to a daunting problem. Archives of Pediatric and Adolescent Medicine, 160, 1077–1078. Browne, S. E., Connors, D., & Stern, N. (Eds.). (1985). With the power of each breath: A disabled women’s anthology. Pittsburgh, PA: Cleis Press, A Women’s Publishing Company. Brownridge, D. A. (2006). Partner violence against women with disabilities: Prevalence, risk, and explanations. Violence Against Women, 12, 805–822. Burke, R. J. (1999). Disability and women’s work experiences: An exploratory study. International Journal of Sociology and Social Policy, 19, 21–33. Caban, M. E., Kuo, Y. F., Mahnken, J. D., Nosek, M. A., & Freeman, J. L. (2007). Mammography use may partially mediate disparities in tumor size at diagnosis in women with social security disabilities. Women Health, 46, 1–17. Caban, M. E., Nosek, M. A., Graves, D., Esteva, F., & McNeese, M. (2002). Breast carcinoma treatment received by women with disabilities compared with women without disabilities. Cancer, 94(5), 1391–1396. Centers for Disease Control and Prevention. (1998). Use of cervical and breast cancer screening among women with and without functional limitations-United States, 1994– 1995. Morbidity and Mortality Weekly Report, 47, 853–856. Chevarley, F., Thierry, J. M., Gill, C. J., Ryerson, A. B., & Nosek, M. A. (2006) Health, preventive health care, and health care access among women with disabilities in the 1994–1995 National Health Interview Survey. Women’s Health Issues, 16, 297–312. Cornwell, C. J., & Schmitt, M. H. (1990). Perceived health status, self-esteem, and body image in women with rheumatoid arthritis or systemic lupus erythematosus. Research in Nursing and Health, 13, 99–107. Corrigan, J. D., Lineberry, L. A., Komaroff, E., Langlois, J. A., Selassie, A. W., & Wood, K. D. (2007). Employment after traumatic brain injury: Differences between men and women. Archives of Physical Medicine and Rehabilitation, 88, 1400–1409. Danek, M. M. (1992). The status of women with disabilities revisited. Journal of Applied Rehabilitation Counseling, 23, 7–13. Deegan, M. J. (1985). Multiple minority groups: A case study of physically disabled women. In M. J. Deegan & N. A. Brooks (Eds.), Women and disability: The double handicap (pp. 37–55). New Brunswick, NJ: Transaction. Deegan, M. J., & Brooks, N. A. (Eds.). (1985). Women and disability: The double handicap. New Brunswick, NJ: Transaction Books, Rutgers University. DePauw, K. P. (1996). “Space: The final frontier”: The invisibility of disability on the landscape of women studies. Frontiers, 17, 19–23.


Elshout, E. (1994). Women with disabilities: A challenge to feminist theology. Journal of Feminist Studies in Religion, 10, 99–134. Encounters with strangers: Feminism and disability. (1999). London: The Women’s Press Ltd. Erickson, E. H. (1950). Childhood and society. New York: W.W. Norton & Co. Fawcett, B. (1996). Postmodernism, feminism and disability. International Journal of Social Welfare, 5, 259–267. Ferreiro-Velasco, M. E., Barca-Buyo, A., de la Barrera, S. S., Montoto-Marques, A., Vazquez, X. M., & Rodriguez-Sotillo, A. (2005). Sexual issues in a sample of women with spinal cord injury. Spinal Cord, 43, 51–55. Ferri, B. A., & Gregg, N. (1998). Women with disabilities: Missing voices. Women’s Studies International Forum, 21, 429–439. Fiduccia, B. W., & Wolfe, L. R. (1999). Women and Girls with Disabilities: Defining the Issues: An Overview. Washington, DC: Center for Women Policy Studies and Women and Philanthropy. Fine, M., & Asch, A. (Eds.). (1988). Women with disabilities: Essays in psychology, culture, and politics. Philadelphia, PA: Temple University Press. Flinders, C. L. (1998). At the root of this longing: Reconciling spiritual hunger with feminist thirst. New York: HarperCollins. Garland-Thompson, R. (1994). Redrawing the boundaries of feminist disability studies. Feminist Studies, 20, 583–597. Garland-Thompson, R. (2001). Re-shaping, re-thinking, re-defining: Feminist Disability Studies. Washington, DC: Center for Women Policy Studies. Garland-Thompson, R. (2003). Integrating disability, transforming feminist theory, NWSA Journal, 14, 1–32. Gatten, C. W., Brookings, J. B., & Bolton, B. (1993). Mood fluctuations in female multiple sclerosis patients. Social Behavior and Personality, 21, 103–106. Gill, C. (1996). Becoming visible: Personal health experiences of women with disabilities. In D. M. Krotoski, M. A. Nosek, & M. A. Turk (Eds.), Women with physical disabilities: Achieving and maintaining health and well-being (pp. 5–15). Baltimore, MD: Paul H. Brookes. Goffman, E. (1963). Stigma: Notes on management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall. Groch, S. (2001). Free spaces: creating oppositional consciousness in the disability rights movement. In J. J. Mansbridge & A. D. Morris (Eds.), Oppositional consciousness: The subjective roots of social protest (pp. 65–98). Chicago: University of Chicago Press. Gunther, D. F., & Diekema, D. S. (2006). Attenuating growth in children with profound developmental disability: A new approach to an old dilemma. Archives of Pediatric Adolescent Medicine, 160, 1013–1017. Haiken, E. (1997). Venus envy: A history of cosmetic surgery. Baltimore, MD: Johns Hopkins University Press. Hanna, W. J., & Rogovsky, E. (1992). On the situation of African-American women with disabilities. Journal of Applied Rehabilitation Counseling, 23, 39–45. Health Resources and Services Administration. (2007). Women’s Health USA 2007. Rockville, Maryland: U.S. Department of Health and Human Services. Hubbard, R. (1990). Who should and who should not inhabit the world? In R. Hubbard (Ed.), The politics of women’s biology (pp. 179–198). New Brunswick, NJ: Rutgers University Press. Hudson, W. W. (1982). The clinical measurement package: A field manual. Chicago: Dorsey Press. Hughes, R. B., Robinson-Whelen, S., Taylor, H. B., Petersen, N., & Nosek, M. A. (2005). Characteristics of depressed and non-depressed women with physical disabilities. Archives of Physical Medicine & Rehabilitation, 86, 473–479. Hughes, R. B., Swedlund, N., Petersen, N., & Nosek, M. A. (2001). Depression and women with spinal cord injury. Topics Spinal Cord Injury Rehabilitation, 7(1), 16–24. Iezzoni, L. I., McCarthy, E. P., Davis, R. B., Harris-David, L., & O’Day, B. (2001). Use of screening and preventive services among women with disabilities. American Journal of Medical Quality, 16(4), 135–144. Iezzoni, L. I., & O’Day, B. L. (2006). More than Ramps: A guide to improving health care quality and access for people with disabilities. New York: Oxford Univ Press.

529

530


Jans, L., & Stoddard, S. (1999). Chartbook on women and disability in the United States: An infouse report. Washington, DC: U.S. Department of Education, National Institute on Disability and Rehabilitation Research. Jordan, J. V. (1991). The meaning of mutuality. In K. A., Jordan, J. V., Miller, J. B., Stiver, I. P., and Surrey, J. L., (Ed.), Women’s growth in connection: Writings from the stone center. New York (pp. 81–96). New York: The Guilford Press. Jordan, J. V. (1992). The relational self: A new perspective for understanding women’s development. Contemporary Psychotherapy Review, 7, 56–71. Jordan, J. V. (1999). Work in progress: Toward connection and competence. Wellesley, MA: The Stone Center, Wellesley College. Lavela, S. L., Weaver, F. M., Smith, B., & Chen, K. (2006). Disease prevalence and use of preventive services: comparison of female veterans in general and those with spinal cord injuries and disorders. Journal of Women’s Health, 15, 301–311. Lesh, K., & Marshall, C. (1984). Rehabilitation: Focus on women with disabilities. Journal of Applied Rehabilitation Counseling, 15, 18–21. Lloyd, M. (1992). Does she boil eggs? Toward a feminist model of disability. Disability, Handicap & Society, 7, 207–221. Lloyd, M. (2001). The Politics of disability and feminism: Discord or synthesis? Sociology, 35, 715–728. Longmore, P., & Umansky, L. (Eds.). (2001). The new disability history: American perspectives. New York: New York University Press. Lonsdale, S. (1990). Women and disability. New York: St. Martin’s Press. Mairs, N. (1996). Waist-high in the world: A life among the nondisabled. Boston: Beacon Press. Manning, H. A. (2007). Insurance companies label eating disorders “behavioral illnesses,” refuse to cover mental health costs. National NOW Times. Marston, C. L. (1997). Handling media research on disability: Toward including a feminist “exile” perspective on theory and practice, Association for Education in Journalism & Mass Communication. Chicago, IL. Martin, S. L., Ray, N., Sotres-Alvarez, D., Kupper, L. L., Moracco, K. E., & Dickens, P. A. (2006). Physical and sexual assault of women with disabilities. Violence Against Women, 12, 823–837. Matthews, G. F. (1983). Voices from the shadow: Women with disabilities speak out. Toronto, ON, Canada: The Women’s Educational Press. Maynard, F. M., & Roller, S. (1991). Recognizing typical coping styles of polio survivors can improve rehabilitation. American Journal of Physical Medicine and Rehabilitation, 70, 70–72. McElroy, W. (Ed.). (2002). Liberty for women: Freedom and feminism in the twenty-first century: Ivan R Dee. McFarlane, J., Hughes, R. B., Nosek, M. A., Groff, J. Y., Swedlund, N., & Mullen, P. D. (2001). Abuse assessment screen-disability (AAS-D): Measuring frequency, type, and perpetrator of abuse toward women with physical disabilities. Journal of Women’s Health and Gender-Based Medicine, 10, 861–866. Miller, J. B. (1986). Toward a new psychology of women. Boston: Beacon Press. Miller, J. B., & Stiver, I. P. (1991). Work in progress: A relational reframing of therapy. Wellesley, MA: The Stone Center, Wellesley College. Morris, J. (1991). Pride against prejudice: Transforming attitudes to disability. Philadelphia, PA: New Society. Morris, J. (1992). Personal and political: A feminist perspective on researching physical disability. Disability, Handicap & Society, 7, 157–166. Morris, J. (1993). Feminism and Disability. Feminist Review, 43, 57–70. Morris, J. (1993). Independent lives: Community care and disabled people, Hampshire, England: Macmillan Press. Morrison, T. (1992). Playing in the dark: Whiteness and the literary imagination. Cambridge, MA: Harvard University Press. Mulder, P. L., Shellenberger, S., Streiegel, R., Jumper-Thurman, P., Danda, C. E., Kenkel, M. B., et al. (2000). The behavioral health care needs of rural women: An APA report to Congress: American Psychological Association. National Center for Health Statistics. (2005). Health, United States, 2005, with Chartbook on Trends in the Health of Americans. Table 58: Limitation of activity caused by chronic


conditions, according to selected characteristics: United States, selected years 1997–2003. Retrieved August 28, 2006, from www.cdc.gov/nchs/data/hus/hus05.pdf National Institute of Mental Health. (2005). Depression: What every woman should know. Retrieved November 23, 2006, from http://www.nimh.nih.gov/publicat/depwomenknows. cfm Nosek, M. A. (1996). Wellness among women with physical disabilities. Sexuality and Disability, 14(3), 165–182. Nosek, M. A. (2000). The John Stanley Coulter lecture. Overcoming the odds: the health of women with physical disabilities in the United States. Archives of Physical Medicine and Rehabilitation, 81, 135–138. Nosek, M. A. (2006). The changing face of women with disabilities: Are we ready? Journal of Women’s Health and Gender-Based Medicine, 15, 996–999. Nosek, M. A., Foley, C. C., Hughes, R. B., & Howland, C. A. (2001). Vulnerabilities for abuse among women with disabilities. Sexuality and Disability, 19(3), 177–190. Nosek, M. A., & Fuhrer, M. J. (1992). Independence among people with disabilities: I. A heuristic model. Rehabilitation Counseling Bulletin, 36(1), 6–20. Nosek, M. A., & Howland, C. A. (1997). Breast and cervical cancer screening among women with physical disabilities. Archives of Physical Medicine and Rehabilitation, 78(12, Suppl. 5), S39–S44. Nosek, M. A., Howland, C. A., Rintala, D. H., Young, M. E., & Chanpong, G. F. (2001). National study of women with physical disabilities: Final report. Sexuality and Disability, 19, 5–39. Nosek, M. A., Howland, C. A., & Young, M. E. (1997). Abuse of women with disabilities: Policy implications. Journal of Disabilities Policy Studies, 8, 157–176. Nosek, M. A., Hughes, R. B., Petersen, N. J., Taylor, H. B., Robinson-Whelen, S., Byrne, M., et al. (2006). Secondary conditions in a community-based sample of women with physical disabilities over a 1-year period. Archives of Physical Medicine Rehabilitation, 87, 320–327. Nosek, M. A., Hughes, R. B., Swedlund, N., Taylor, H. B., & Swank, P. (2003). Self-esteem and women with disabilities. Social Science and Medicine, 56, 1737–1747. Nosek, M. A., Rintala, D. H., Young, M. E., Howland, C. A., Foley, C. C., Rossi, C. D., et al. (1996). Sexual functioning among women with physical disabilities. Archives of Physical Medicine and Rehabilitation, 77, 107–115. Nosek, M. A., & Simmons, D. K. (2007). People with disabilities as a health disparities population: The case of sexual and reproductive health disparities. California Journal of Health Promotion, 5, 68–81 [Special Issue on Health Disparities & Social Justice]. Nosek, M. A., Taylor, H. B., Hughes, R. B., & Taylor, P. (2006). Disability, psychosocial, and demographic characteristics of abused women with physical disabilities. Violence Against Women, 12, 838–850. Parens, E., & Adrienne, A. (2000). Prenatal Testing and Disability Rights. Georgetown, MD: Georgetown University Press. Parish, S. L., & Saville, A. W. (2006). Women with cognitive limitations living in the community: Evidence of disability-based disparities in health care. Mental Retardation, 44, 249–259. Parkin, E. F., & Nosek, M. A. (2002). Collectivism versus independence: Perceptions of independent living and independent living services by Hispanic Americans and Asian Americans with disabilities. Rehabilitation Education, 14, 375–394. Phillips, M. J. (1990). Damaged goods: Oral narratives of the experience of disability in American culture. Social Science and Medicine, 30, 849–857. Pleis, J. R., & Lethbridge-Çejku, M. (2006). Summary health statistics for U.S. adults: National health interview survey, 2005 Vol. 10 (232): National Center for Health Statistics. Powers, L. E., Curry, M. A., Oschwald, M., Maley, S., Saxton, M., & Eckels, K. (2002). Barriers and strategies in addressing abuse: A survey of disabled women’s experiences. Journal of Rehabilitation, 68, 4–13. Rapp, R. (1999). Testing women, testing the fetus: The social impact of amniocentesis in America. New York: Routledge. Reid-Cunningham, M., Snyder-Grant, D., Stein, K., et al., (1999). Work in progress: Women with chronic illness: Overcoming disconnection. Wellesley, MA: The Stone Center. Ridington, J. (1989). Beating the odds: Violence and women with disabilities (Position Paper 2). Vancouver: DisAbled Women’s Network: Canada.

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Rintala, D. H., Howland, C. A., Nosek, M. A., Bennett, J. L., Young, M. E., Foley, C. C., et al. (1997). Dating issues for women with physical disabilities. Sexuality and Disability, 15, 219–242. Roberts, R. E., Kaplan, G. A., Shema, S. J., & Strawbridge, W. J. (1997). Does growing old increase the risk for depression? American Journal of Psychiatry, 154, 1384–1390. Rosenberg, M. (1979). Conceiving the self. New York: Basic Books. Rousso, H. (Ed.). (1988). Disabled, female and proud! Ten stories of women with disabilities Boston, MA: Exceptional Parent Press. Saxton, M. (1985). A peer counseling training program for disabled women: A tool for social and individual change. In M. J. Deegan & N. A. Brooks (Eds.), Women and disability: The double handicap (pp. 95–104). New Brunswick, NJ: Transaction. Saxton, M. (1998). Disability rights and selective abortion. In R. Solinger (Ed.), Abortion wars: A half century of struggle 1950–2000 (pp. 374–393). Berkeley: University of California Press. Saxton, M., Curry, M. A., Powers, L. E., Maley, S., Eckels, K., & Gross, J. (2001). “Bring my scooter so I can leave you”: A study of disabled women handling abuse by personal assistance providers. Violence Against Women, 7, 393–417. Saxton, M., & Howe, F. (Eds.). (1987). With wings: An anthology of literature by and about women with disabilities, New York, NY: The Feminist Press. Schlesinger, L. (1996). Chronic pain, intimacy, and sexuality: A qualitative study of women who live with pain. Journal of Sex Research, 33, 249–256. Schriempf, A. (2001). (Re)fusing the amputated body: An interactionist bridge for feminism and disability. Hypatia, 16, 53–79. Shapiro, J. P. (1994). No pity: People with disabilities forging a new civil rights movement. New York: Times Books. Siegel, J. (1996). Aging into the 20-first century 20-first century. Washington, DC: National Aging Information Center, Administration on Aging, U.S. Department of Health and Human Services. Sipski, M. L. (2001). Sexual function in women with neurologic disorders. Physical medicine and rehabilitation clinics of North America, 12, 79–90. Sipski, M. L., & Arenas, A. (2006). Female sexual function after spinal cord injury. Progress in brain research, 152, 441–447. Smith, D. L., & Strauser, D. R. (2007). Examining the impact of physical and sexual abuse on the employment of women with disabilities in the United States: An exploratory analysis. Disability and Rehabilitation, 30, 1039–1046. Smith Randolph, D., & Andresen, E. M. (2004). Disability, gender, and unemployment relationships in the United States from the behavioural risk factor surveillance system. Disability and Society, 19, 403–414. Trieschmann, R. B. (1987). Aging with a disability. New York: Demos. U.S. Census Bureau. (2006). Table 3. Work Experience and Mean Earnings in 2005—Work Disability Status of Civilians 16 to 74 Years Old, by Educational Attainment and Sex: 2006. Retrieved February 9, 2008, from http://www.census.gov/hhes/www/disability/cps/ cps306.xls U.S. Department of Health and Human Services. (2006). National Healthcare Disparities Report. Retrieved January 25, 2007, from http://www.ahrq.gov/qual/nhdr06/nhdr06report.pdf Welner, S. (1999). Conducting a physical examination on a woman with a disability. Sexuality And Disability, 17, 199–203. Welner, S. L., & Haseltine, F. (2004). Welner’s guide to care of women with disabilities. Philadelphia: Lippincott, Williams & Wilkins. Wendell, S. (1996). The rejected body: Feminist philosophical reflections on disability. New York and London: Routledge. Wolf, N. (1991). The beauty myth: How images of beauty are used against women. New York: William Morrow and Co. World Health Organization. (2007). International classification of functioning, disability and health, April 24, 2007, from http://www3.who.int/icf/icftemplate.cfm Wright, B. A. (1980). Psychology and rehabilitation. Princeton, NJ: Institute on the Roles of Psychology and Psychologists in Rehabilitation.


Young, M. E., Nosek, M. A., Howland, C. A., Chanpong, G., & Rintala, D. H. (1997). Prevalence of abuse of women with physical disabilities. Archives of Physical Medicine and Rehabilitation, 78 (12, Suppl. 5), S34–S38. Zorzon, M., Zivadinov, R., Bosco, A., Bragadin, L. M., Moretti, R., Bonfigli, L., et al. (1999). Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups. Multiple Sclerosis, 5, 418–427.

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The Experience of Immigrant and Refugee Women: Psychological Issues

19 Oksana Yakushko and Oliva M. Espín

Immigration is undoubtedly the strongest shaping force in U.S. history (e.g., Hing, 2004) and one of the most significant topics of political debate at the present moment. Current global changes account for unprecedented movements of individuals across the world in search of better life opportunities and conditions (Marsella & Ring, 2003). The U.S. Census Bureau reports show that that approximately 12% of the U.S. population is foreign-born and that three out of four individuals who are foreign-born have immigrated to the United States since 1980 (Larsen, 2004). Immigrant and refugee women are a large proportion of the immigrant group. Slightly over half of all legal immigrants are women (U.S. Census, 2005) whereas it is estimated that women constitute 42% of undocumented immigrants (Fry, 2006). The United Nations (1994, 1995) unequivocally states in documents concerning the status of women immigrants and refugees that improving the status of women is increasingly recognized as fundamental to improving the basic human rights of over half the population of the world and also contributing to social economic progress...Women’s migration, both internally

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within developing countries and internationally across borders ... to developed countries, is inextricably linked to the status of women in society.

This assertion is followed by questions yet unanswered: But what do we know about women’s migration? ... For example, does migration lead to improvements in the status of women, breaking down patriarchal structures and enhancing women’s autonomy or does it lead to perpetual dependency?

Despite the importance of these issues, attention to the experiences of immigrant and refugee women in the psychological and feminist literature has been somewhat sporadic until recently. A number of scholars have begun to examine the combined effects of gender and immigration in women’s lives and their implications for mental health. For example, researchers have focused on immigrant women’s psychological distress (Rodriguez & DeWolfe, 1990), posttraumatic stress symptoms and victimization (Yoshihama & Horrucks, 2002), adaptation strategies (McIntyre & Augusto, 1999), and identity changes (Weeks, 2000). Cole, Rothblum, and Espín (1992) devoted an issue of Women and Therapy (later published as a book) to the mental health of refugee women. Books that address issues specific to Latina and Asian American women highlight difficulties faced by racial and ethnic minority immigrant women (Falicov, 1998; Kawahara & Espín, 2007; Uba, 1994). Recent research on intersectionality provides a perspective which could be useful in a study of the complex interconnecting influences of culture, gender, social class and sexuality on immigrant women’s lives (Mahalingam & Leu, 2005; Stewart & McDermott, 2003). Moreover, work on postcolonial critique of acculturation research has been offered to understand the postcolonial underpinnings of the sociocultural factors that affect immigrant and refugee women’s lives (Bhatia & Ram, 2001; Ong, 1999). This chapter attempts to address some of these questions within the context of psychology and the provision of mental health services, including counseling and psychotherapy, for women immigrants and refugees. Building on the existent literature, we first provide an overview of issues immigrant women face upon relocation to the United States. Second, we outline mental health concerns and personal experiences of immigrant women and identify strategies for working with this population. Because no single chapter can adequately address every aspect of the tremendously heterogeneous, complex, and rich experience of immigrant women we have chosen to focus on several specific areas related to women’s migration and adjustment. For example, indepth discussions related to interpersonal violence and reproduction in the lives of immigrant women are presented in other parts of this book. Thus, throughout this chapter, we highlight the distinct experiences of immigrant women who are legal immigrants, undocumented migrant workers, and refugees, and discuss migration stresses as well as the psychological impact of processes of acculturation and the concurrent transformation of identities.

Psychological Effects of Legal Status Migration can be voluntary or forced, and can result in differing legal statuses. The three prevalent broad categories of relocation in the United States are:

Chapter 19 Immigrant Women

(1) legal immigration, (2) refugee relocation, and (3) undocumented or “illegal” immigration. Legal immigration refers to relocation of foreign-born noncitizens who are granted legal permanent residence by the U.S. federal government. Legal permanent residence provides the right to remain in the country indefinitely, to be gainfully employed, and to seek benefits of U.S. citizenship through naturalization (Mulder et al., 2001). This status does not give the right to vote or receive some benefits, such as some federal subsidies reserved for U.S. citizens. A different type of immigration status is granted to individuals who are considered refugees. Refugees are defined by the 1967 United Nations Protocol on Refugees as those people outside their country of nationality who are unable or unwilling to return to that country because of persecution or well-founded fear of persecution (Mulder et al., 2001). The U.S. Refugee Act of 1980 stated that under circumstances outlined by the UN Protocol, the United States will allow a certain number of individuals of any country to enter the United States as refugees (United Nations, 2004). This number is determined by the U.S. President and Congress and has a ceiling. The third category of U.S. immigrants represents individuals who seek to relocate to the United States in search of employment and better living conditions. Often referred to as the “illegal” or “undocumented” population, the unauthorized migrant population consists primarily of two groups, (1) those entering the United States without inspection and (2) those entering the United States with legal temporary visas but staying beyond the time allotment of their visas (Mulder et al., 2001). Research by the Pew Hispanic Center (2005) estimates that 10 to 12 million individuals reside in the United States without legal documents. While, on the one hand, the United States prides itself on being “a nation of immigrants,” reception of those seeking a new home in this country has not always been welcoming as some idealized accounts purport it to be (e.g., Johnson, 2004). Immigrant and refugee women’s legal status and economic eligibilities in the United States are significant and have distinct psychological and social consequences (Berger, 2004). The vicissitudes of legal status as well as the experiences that have preceded the migration itself have profound psychological and mental health consequences for all immigrants and refugees. Even though popular opinion as well as most studies of migration continue to perceive the immigrant as male, the reality is that the presence of females is central to the process. This is not only because women are members of immigrant families, but also because there are many women who migrate alone and become sources of financial support for the families left behind in the home country. The work of immigrant women, married or not, becomes the key to the survival of the immigrant community. For example, in many cases, “the success of small-businesses [headed by immigrants] comes at the expense of subordinated immigrant women” (Pesar, 2003, p. 24).

Migration and Stress Migration is a highly stressful experience that influences immigrant and refugee women’s well-being. Rumbaut (1991) has stated that “migration can produce profound psychological distress among the most motivated and well-prepared individuals, and even in most receptive circumstances” (p. 56). Immigrant

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women may experience posttraumatic stress, mourning and grieving of multiple losses, acculturative stress, loneliness, loss of self-esteem, strain and fatigue from cognitive overload, uprootedness, and perceptions that they are unable to function competently in the new culture (Berger, 2004; Espín, 1997, 1999; Garza-Guerro, 1974; Yakushko & Chronister, 2005). Immigrant women may carry the brunt of responsibility for a move to a new country, showing an untiring commitment through the premigration stage, and may collapse upon arrival in their host community (McIntyre & Augusto, 1999). Immigrant women who have experienced greater stress directly related to immigration and relocation report higher levels of depression (Miller & Chandler, 2002). Refugee women, in particular, undergo severe psychological stress as a result of their premigration traumatization history and forced relocation (Cole et al., 1992). Mollica, Wyshak and Lavelle (1987) categorized sources of trauma that may have been experienced by refugees into four categories: (1) deprivation such as the lack of food or shelter; (2) physical injury, rape, or torture; (3) incarceration or reeducation camps; and (4) witnessing torture and killings. Refugee women may experience profound physical symptoms as the result of extreme psychological or other traumas prior to their relocation such as the loss of spouses and children in wars or military upheavals (Bemak & Chung, 2000; Prendes-Lintel, 2001). For example, in a sample of 300 Cambodian refugee women, 22% reported a loss of a spouse and 53% reported a loss of another close family member such as a child or a parent (Chung, 2000). Lastly, refugee women’s migration process may be further complicated by experiences of sexual; or physical abuse while in resettlement camps (Bemak & Chung, 2002; Prendes-Lintel, 2001). In addition to these individual and systemic factors, premigration mental health issues may also account for differences in how immigrant and refugee women cope with migration stress (Ben-Sira, 1997). Voluntary migration, optimistic expectations, language skills, and availability of support are associated with more positive mental health outcomes for immigrants (Escobar, Nervi, & Gara, 2000; Espín, 1987; Espín, 1999; Hondagneu-Sotelo, 1994; Salgado de Snyder, 1994). Women’s personality factors, such as cognitive flexibility, optimism, and positive coping styles also contribute to less problematic relocation experiences (Schwartz, 2002).

Acculturation Acculturation, the process of adjusting to the values and behaviors of a new culture, is the most common factor used to discuss immigrants’ mental health needs (Flannery, Reise, & Yu, 2001; Hays, 2001; Ortega, Rosenheck, Alegría, & Desai, 2000; Salgado de Snyder, 1994). Models of acculturation emphasize several patterns consisting of rejecting or accepting host community’s cultural values and practices as well as rejecting or maintaining immigrant’s home cultural values and practices. These patterns result in different styles of immigrants’ adaptation that range from rejection/encapsulation or deculturation/ marginalization to assimilation or integration/biculturalism (e.g., Berry, 1990). Scholars have found support for integration or biculturalism as the healthiest acculturation outcome in terms of immigrants’ mental health (González, Haan, & Hinton, 2001; Szapocznik & Kurtines, 1980; Wong-Rieger & Quintana, 1987).


Studies focusing on the relationship between immigrant and refugee women’s mental health and their levels of acculturation have shown inconsistent results. For example, a review of five large-scale studies examining the prevalence of mental disorders among Mexican-born and U.S.–born Mexican Americans living in the United States, showed that Mexican-born immigrants have better mental health profiles than U.S.-born Mexican Americans (Escobar, Nervi, & Gara, 2000). In this review, Mexican-born immigrant women, in particular, had lower prevalence of serious mental disorders and substance abuse. Similarly, Hernández (2006) highlighted that across all groups of immigrants, children who are recent immigrants display far fewer behavioral and mental health disorders than children who are born to immigrant parents in the United States (i.e., first or second generation immigrants). This phenomenon has been termed the “epidemiological paradox,” and growing scholarship is seeking to examine the reasons why greater acculturation to U.S. culture may be related to more negative mental health outcomes for immigrants (e.g., Portes & Rumbault, 2006). However, research results are contradictory. Some studies indicate that recent immigrants’ may be at an increased risk for mental health difficulties possibly due to lack of acculturation. Hovey (2002) demonstrated that newly arrived immigrants from Mexico were at high risk for depression and suicide. In a sample of elderly Mexican immigrants, recent immigrants and those who were less acculturated appeared to have higher levels of depression than those who were acculturated or who were born in the United States (González, Haan, & Hinton, 2001). Women from the former Soviet Union, who are less acculturated, especially in terms of English language proficiency, have higher levels of depression (Miller & Chandler, 2002; Miller, Sorokin, Wang, Feetham, Choi, & Wilbur, 2006). Several scholars have attempted to resolve the inconsistent findings by examining acculturation as a complex multifaceted process. Tormala and Deaux’s (2006) research on Caribbean immigrants suggest that integration or assimilation may not be the best option for some immigrant groups. In a sample of Korean immigrants, Oh, Koeske, and Sales (2002) found that those aspects of acculturation that facilitated immigrants’ social integration, such as proficiency in the English language, were inversely related to depression. Similarly, in a sample of immigrant women from the former Soviet Union, those acculturative patterns that contributed to women’s lower social alienation were associated with their lower symptoms of psychological distress (Miller et al., 2006). However, abandonment of cultural identity, traditions, and values, associated with higher acculturation, may be directly related to higher levels of depression (Oh, Koeske, & Sales, 2002). The acculturation patterns of refugee women may be especially complex because of frequent severe premigration trauma (Bemak & Chung, 2002). Experiences of torture, physical deprivation, assaults, forced relocation, multiple losses, and separation from family and community are likely to complicate the process of adaptation to a new country for refugee women. Refugee women’s relocation to a new country has been shown to result in feelings of helplessness and disorientation (Bemak & Greenberg, 1994). According to Bemak (1989), acculturation of refugee women may take on a more developmental process with the first phase focusing on women’s safety and security followed by phases of greater bicultural adjustment and of

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stronger orientation toward future goals. Refugee women’s struggle to adapt to a host community may be directly related to the coping strategies developed to survive severe trauma. For example, refugee women who may have experienced rape, torture, or witnessing atrocities may have learned to play “dumb” in order to stay alive (Chung & Okazaki, 1991). Many of these coping patterns may be seen as maladaptive by individuals from the host community and may impede women’s adaptation to a new country (Stein, 1986). Among other barriers to refugee women’s adaptation may be their ambivalence about their relocation, wishing to return to their home communities in order to make a difference or rebuild lives, and the survivor guilt of having successfully escaped unlike the others who did not (Bemak & Chung, 2002; Brown, 1982; Tobin & Friedman, 1983). These barriers may prevent refugee women from attempting to integrate into their new communities through learning a language or gaining adequate employment. Very few studies have focused on the experiences of acculturation among immigrant women who reside in the United States without legal documents. A study by Hovey and Magaña (2003) found that Mexican women who work as migrant farm helpers reported higher levels of depression, anxiety, and suicidal ideations related to higher acculturative stress. Undoubtedly, multiple barriers to the cultural adaptation of undocumented immigrant women based on the fear of deportation play a significant role in women’s adjustment and well-being. In addition to differences in immigrant and refugee women’s acculturation patterns based on their migration experiences, individual factors play an important role in the process and speed of women’s adaptation to their new environment. Successful acculturation may be influenced by women’s age, economic resources, desire to adapt, the support of family and community, women’s cultural norms and values, as well as women’s ability to address psychological barriers such as their previous traumatic experiences (Bemak & Chung, 2002; Berger, 2004).

Employment Finding employment in the host society is central to the financial stability and emotional adpatation of immigrants. But the finding of employment presents a special challenge to immigrant and refugee women (Yakushko, 2006). Although some immigrant women choose to migrate to the United States primarily in order to support their families such as in the case of many undocumented migrants, many immigrant and refugee women experience a dramatic downturn in terms of career opportunities (Berger, 2004; Yakushko, 2006). Immigrant and refugee women may face unemployment, underemployment, and disqualification of their previously held professional credentials (Berger, 2004). Immigrant women are less likely than immigrant men to obtain employment in their former occupation and are often forced to work in the lowest levels of the occupational ladder in the United States (Yakushko, 2006). For example, Foner (2001) interviewed immigrant women residing in New York City and found that the majority of these women experienced a loss of professional status in moving from being a scientist, a teacher or a clerical worker to domestic


worker. Moreover, immigrant women are disproportionately employed in physically demanding jobs and in industries where there is substantial potential for injury (Pransky, Moshenberg, Benjamin, Portillo, Thackrey, & Hill-Fotouhi, 2002; National Network on Immigrant and Refugee Rights, 2000). Earnings for immigrant women are typically low (Larsen, 2004), and income is frequently directed toward supporting families left at home (Mehta, Gabbard, Barrat, Lewis, Carroll, & Mines, 2000). In addition, although “few women are entrepreneurs, many women work long hours, often unpaid, in family businesses” (Kofman et al., 2000, p. 41), significantly contributing to the financial success of the household. “We need to look more closely at the gender relations that underpin so many of these enterprises [because] social class categories that define women’s position according to that of the (male) head of household are always unsatisfactory, but in this instance are virtually meaningless” (p. 41). Employment difficulties significantly contribute or interfere with immigrant and refugee women’s mental health. For example, securing employment, economic hardship, and job demands were identified as major stressors contributing to mental distress and illness among Latina [and possibly other women] immigrants (Finch, Catalano, Novaco, & Vega, 2003).

Migration and Developmental Stage One of the most significant factors in the migration experience, and obviously one of utmost importance for the provision of services to this population, is the life stage/age at the time of resettlement. This connection between age and the impact of a life event is almost self-evident. It confirms psychologist Abigail Stewart’s assumption that “one important factor in the attachment of individual meaning to social events is an individual’s age, because of the connection between age and stage of psychological development.” (1994, p. 231). Those who migrate as children seem to adapt faster and more easily (SuárezOrozco & Suárez-Orozco, 2001; Zhou, 2006). However, children whose lives have been affected by major social or historical events, such as migration, may be affected in their broad values and expectations about the world at a deeper psychological level (Suárez-Orozco & Suárez-Orozco, 2001). “Children’s experiences of social historical events are, of course, fi ltered through their experiences in their own families” (Stewart, 1994, p. 232). Because the migration altered the course of their psychological and material lives early in life, those who have migrated at a very early age, are less able to image who and what they could have been without the impact of migration. According to some studies, most conflicts concerning acculturation are manifested—either presently or in the past—by those women who migrated during adolescence (Espín, 1999; Espín, 2006). Negotiating gender roles, sexual behavior, and sexual identity in both the home and host cultures becomes one of the major developmental tasks for immigrant adolescents. Thus, young women or adolescent girls confront the question of how to “become American” without completely losing their cultural heritage. Conflicts over parental authority often are played out around issues of appropriate gender norms and sexual behavior (Espín, 1999): Dating and other behaviors related to sexuality

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become the focus of conflict between parents and daughters. This is understandable because of the multiple tasks required of young women immigrants. As a young immigrant woman constructs her cultural identity in a new country, she simultaneously develops a sexual identity. The inherent connection between discourses on sexuality and sources of power in a new and different cultural context may result in split identities for young women immigrants. Religious and cultural injunctions may further limit the young woman’s decision-making. Young women from “racialized” groups may confront additional conflicts concerning their sexuality and body image. They have to find a balance between the imposed hypersexualization of immigrant women as “exotic” and the “hyperpurity” expected of them by their families and communities (Espiritu, 2001). Nevertheless, many young immigrant women successfully negotiate a place for themselves despite these injunctions and limitations and struggle to find their own identity. In general, those who migrate after adolescence appear to be less conflicted about their identity. This is due in part to their already somewhat solid identities before undergoing the extra tasks involved in the migration. However, as previously discussed, they may find greater difficulties adapting to a new cultural context precisely because their mature identities are less flexible than those of younger individuals (Espin, 1999).

The Impact of Nuclear and Extended Families Experiences that occur in nuclear and extended families due to relocation may profoundly affect immigrant and refugee women’s mental health. Women are viewed in many traditional patriarchal societies as keepers and transmitters of cultural values, and consequently, experience increased pressure to focus on their families after relocation, often at the expense of their own well-being (Espín, 1999; Narayan, 1997; Simons, 1999). Immigrant women frequently encounter intergenerational conflict with their children and older family members, who adhere to traditional gender roles and cultural values to a far lesser or far greater degree (Darvishpour, 2002; Perilla, 1999). Separation from family creates feelings of isolation and loss of social support which has been associated with poor mental health among women who are residing in the United States. both legally and without legal documentation (Berger, 2004; Magaña & Hovey, 2003). One of the typical patterns of migration is the “mother first” relocation in which mothers enter the United States through their employment status as domestic workers, leaving their children with relatives until they can be reunited (Berger, 2004). Suárez-Orozco, Todorova, and Louie (2002) found that in a sample of 385 early adolescents originating from China, Central America, the Dominican Republic, Haiti, and Mexico, 85% of the participants had been separated from one or both parents for extended periods. Miranda, Siddique, Der-Martirosian, and Belin (2005) found that Latina immigrants who were separated from their children were 1.5 times more likely to suffer from depression than those women who either were not separated from their children or were not mothers.


Evolving family power dynamics that occur after relocation also may result in increased incidences of domestic violence. The National Council for Research on Women (1995) documented that nearly half of immigrant women surveyed experienced domestic violence and that this violence intensified after their relocation. In a study with 280 immigrant Latina women ages 14 to 56, Hass, Dutton, and Orloff (2000) found that 136 women reported experiences of physical abuse by their intimate partners, whereas 33 women reported experiences of psychological abuse. The National Council for Research on Women (1995) documented that nearly half of immigrant women surveyed experienced domestic violence and that this violence intensified after their relocation. Women who have refugee status experience similar high incidences of interpersonal violence because their relationships are often marked by severe distress due to trauma and relocation (Bhuyan, Mell, Senturia, Sullivan, & ShiuThornton, 2005). Family dysfunction, including violence, has been related to migrant women’s higher suicidal ideations, depression, and anxiety (Hovey & Magaña, 2003). Concerns and fears such as visa status or fear of deportation for self or the spouse may prevent immigrant and refugee women from asking for help (Abraham, 2000; Holtzman, 2000; Moghissi & Goodman, 1999). Especially difficult is the situation of women who are undocumented immigrants and who experience domestic violence while in the United States; women who reside in the United States without their documents are least likely to seek help and protection from domestic violence. The U.S. federal government has made provisions for women and their children who are abused with passage of the Violence Against Women Act of 1994 and the Battered Immigrant Women Protection Act of 1999, the goal of which is to remove immigration laws as a barrier that has kept battered immigrant women and children locked in abusive relationships (U.S. House of Representatives, 2000). Although new laws provide a temporary visa status and protections against deportation to undocumented immigrant women and children who are experiencing domestic violence in their homes, multiple barriers continue to exist for women who find themselves in these situations in seeking and obtaining legal and mental health help.

Gendered Power Differentials and Migration As immigration researcher Patricia Pesar (2003) and other authors (e.g. Espín, 1999, 2006; Hondagneu-Sotelo, 1994, 2003) tell us, it is important to acknowledge that “although household members’ orientations and actions may sometimes be guided by norms of solidarity, they may equally be informed by hierarchies of power along gender and generational lines” (Pesar, 2003, p.24). The impact of migration on gender relations and the impact of gendered power structures on the migratory process cannot be ignored if we are to have a clearer picture of how migration experiences intersect with women’s individual psychological processes. To fully grasp the interplay of gender and the migratory process it is important to understand that even though women migrate for a whole range of reasons such as poverty, displacement from the land, debt, and many other external constraints that they share with men, the

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impact of these problems is always gendered because of the impact of specific problems such as wage differentials in sender areas and in receiving areas (Kofman et al., 2000). Indeed, “all women face the constraints of sex segregation in employment” (p. 25). In addition to these common economic needs and their gendererd consequences, “some noneconomic factors are especially important causes of migration for women. Social constraints facing women […] also influence sex selectivity patterns in migrations streams. Marital discord and physical violence, unhappy marriages and the impossibility of divorce [as well as other instances of sexual/gendered oppression] often influence women’s decision to migrate” (Kofman et al., 2000, p. 21). Women’s agency, “viewed within the context of resisting oppression and exploitative structures […] is particularly vital for a gendered account of migration, because it so often assumed that women simply ‘follow’ men and that their role in migration is reactive rather than proactive” (Kofman et al., 2000, p. 23). In other words, it is important to keep in mind “the extent to which [women’s] migration is not simply an enforced response to economic hardship by single, widowed or divorced women [or wives following their husbands] but also a deliberate, calculated move on the part of individual gendered actors to escape from a society where patriarchy is an institutionalized and repressive force” (Kofman et al., 2000, p. 24). Therefore, “so-called ‘cultural’ issues such as concerns with the body, sexuality and representation, might also be significant for a gendered account of migration” (Kofman et al., 2000, p. 34). We cannot ignore “the impact of immigrant women’s regular wage work has on gender relations” (Pesar, 2003, p. 27). “Employed immigrant women generally gain greater personal autonomy and independence…[W]omen’s regular access to wages and their greater contribution to household sustenance frequently lead to more control over budgeting and other realms of domestic decision making … [There is evidence that] migration and settlement bring changes in traditional patriarchal arrangements” (Pesar, 2003, p. 27). Many women learn to contest the patriarchal narratives of ethnic solidarity and thus, change the content of some of those narratives (Pesar, 2003). It is, therefore, essential to keep in mind that “households are not the cozy rational decision making units that neoclassical economists would lead us to believe. Migration decisions reflect the power relations within the household and are influenced by both individual as well as collective interests” (Kofman et al., 2000, p. 26). Migration offers women the opportunity to trangress established gender roles. It can be an impetus for women to challenge traditional gender roles and power structures. Women’s gender roles may shift because of their relocation to a country with more gender egalitarian norms or because of the necessity of their greater participation in the workforce (Espín, 1999; Knorr & Meier, 2000; Lim, 1995). For example, Mexican immigrant women’s employment may change women’s identity and family dynamics in considerable ways including increasing women’s economic contributions and bargaining power (McCloskey, Southwick, Fernandez-Esquer, & Locke, 1995; Perilla, 1999; Salgado de Snyder, 1994). Women may view immigration as a chance to leave unsatisfying partnerships or improve their gender role status by increasing control over household decisions and building personal autonomy (Foner, 1986; Foner, 2001; Hondagneu-Sotelo, 1994; Pedraza, 1991; Simon, 1992). At times, displacement empowers women to develop new selves. A number of


immigrant women perceive migration as providing “a space and permission to cross boundaries and transform their sexuality and sex roles” including embracing a nonheterosexual identity (Espín, 1999, 2006). The opportunities in work, education, and routines of life provided by the migration are present in women’s stories. Regardless of differences in their countries of birth concerning the roles of women, many women appear to benefit from the liberating effect of being “outsiders” in the new culture (Espín, 1999). But migration can also contribute to a situation where immigrant women embrace more traditional gender roles while embodying a “reimagined” home culture in their new cultural milieu (Mahalingam & Leu, 2005). Migration carries with it the possibility of limiting women’s private spheres of influence and their moral authority within traditional cultural contexts. Traditional patriarchal contexts have always provided the opportunity to carve separate—if inferior—spaces for women. The cultural transformations brought about by migration upset these spaces without yet giving women full access to equal power in the public sphere. For immigrant daughters, it may become difficult to invest their mothers with positive images and characteristics when migration has limited the mothers’ sphere of influence even further (Espín, 1999; 2006). For many immigrant women various social and cultural antecedents, such as experiences of previous trauma or challenges of maintaining transnational families (i.e., leaving their children behind, see Parreñas, 2002; Roopnarine & Krishnakumar, 2006) may place boundaries on women’s ability or desire to transgress culturally prescribed gender roles. Indeed, migration can be both emancipatory and subjugating for women. Gains seem to be more pronounced in the economic domain whereas gender subordination may continue in different forms (Pesar, 2003). In any case, for both men and women, “[n]ew learning opportunities emerge, as host society institutional structures interact with the psychological equipment immigrants bring and create in the host society” (Rogler, 1994, p. 706). Successfully negotiating these new identities and relationships occurs on many levels and depends on a variety of contextual factors, such as the quality of women’s premigration relationships and current social support network. In any case, we cannot deny the significance of women’s gender roles and sexuality in the process of migration as demonstrated by U.S. immigration policy, which is largely based on ideas about gender and sexuality, particularly women’s sexuality. Perhaps the simplest illustration is the importance placed by immigration legislation and enforcing authorities on issues such as prostitution, lesbianism, and pregnancy—all of which have been used as exclusion criteria for female immigrants at one point or another (Luibhéid, 2002). Immigration legislation and enforcement have been major sites for the construction and regulation of immigrant women’s identities. And through the control of immigrant women’s sexuality, prevalent “moral” perspectives on all women in the United States have been postulated. Yet, while there is a well-developed scholarship about how official immigration policies aim to reproduce racial, ethnic, and class distinctions, there is minimal work on the role of U.S. immigration policies in the creation of sexual and gender norms (Luibhéid, 2002). Immigrant women in the United States experience multiple sources of social oppression. These forces include, but are not limited to, xenophobia,

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racism, sexism, and discrimination based on poverty and employment (Berger, 2004; Marsella & Ring, 2003; Yakushko, in press; Yakushko & Chronister, 2005). Immigrant individuals are often portrayed as criminal, poor, violent, desperate to live in the United States, and noneducated (Espanshade & Calhoun, 1993; Muller & Espanshade, 1985; Portes & Rumbaut, 2006). Contrary to stereotypes, research shows that women immigrating to the United States have higher educational levels than the national averages of their home countries, and often desire to return home (Fry, 2006; Guarcnaccia, 1997; Portes & Rumbaut, 2006). Undocumented women immigrants have no legal rights and are often abused emotionally (e.g., harassment), physically (e.g., poor working conditions), and economically (e.g., no consistent pay or health benefits) by U.S. employers, government or social service systems (Yakushko & Chronister, 2005). Without the right to vote and stay in the United States legally, immigrant women have little power to change oppressive social structures. “Patriarchal structures take many different economic, social and political forms throughout the world” (Kofman et al., 2000, p. 25); women immigrants and refugees encounter these many forms both in their home countries and in receiving societies. Power differentials and hierarchies are governed by gender ideologies as well as by economic or racial inequalities. And these power differentials affect women’s experience of migration and the psychological consequences this experience may have for them. Power differentials and gender oppression are not only imposed by “outside” forces. They are also present inside many immigrant communities (Espín, 1999; 2006). In all societies, the sexual and gender role behaviors of women serve a larger social function beyond the personal. They are used by enemies and friends alike as “proof” of the morality—or decay—of social groups or nations. In most societies, women’s sexual behavior and their conformity to traditional gender roles signifies that family’s value system. Thus, in many societies, a daughter who does not conform to “traditional morality” can be seen as “proof” of the lax morals of the family. This is why struggles surrounding acculturation in immigrant and refugee families center frequently on the issues of daughters’ sexual behaviors and women’s sex roles in general. For parents and young women alike, acculturation is closely connected with being sexually promiscuous (Espín, 1999). Frequently, women are made to “carry” cultural values and behaviors at the expense of their own lives. Cultural pressures to be the “bearers of culture” may bring significant stress to the lives of immigrant women from various ethnic groups (Dion, 2006; Espiritu, 2001; Pesar, 1998). Women’s bodies are policed in the name of tradition. Policing women’s bodies and sexual behavior becomes for immigrant communities the main means of asserting moral superiority over the host culture. This is not just a benign manifestation of interesting “traditions.” It may cost some women their lives. Groups that are transforming their way of life through a vast and deep process of acculturation, focus on preserving “tradition” almost exclusively through the gender roles of women. Women’s bodies become the site for struggles concerning disorienting cultural differences. Gender becomes the site to claim the power denied to immigrant men by racism (Espín, 1999, 2006).


Conversely, it is important to recognize that some of the rigidity concerning the roles of women that we observe in immigrant communities is an attempt to protect and safeguard what remains of emotional stability; so much of it is lost with migration. It is as if the immigrants’ psychological sense of safety and their sense of self depended on a sharp contrast between two sets of cultural values conceived as rigidly different and unchangeable. The preservation of “old versions” of women’s roles becomes central to this sharp contrast. For people who experience a deep lack of control over their daily lives, controlling women’s sexuality and behavior becomes a symbolic demonstration of orderliness and continuity. Policing women’s bodies and behaviors is an attempt at preserving the past amidst the constant transformation of social norms. It gives immigrants the feeling that not all is changing. Obviously, it is easier for immigrants to maintain control over their private world than over their public lives: work schedules, types of work and schooling, housing, and the structures of daily life are controlled by the customs and demands of the new society. But, in the privacy of their homes, they can seek to maintain the sense that they are still in control. This is why frequently women themselves join actively in adhering to “traditions” that, from the point of view of outsiders, appear to curtail their own freedoms and opportunities for self-fulfillment (Espín, 1999). Pressures on immigrant women’s roles and sexuality also emerge from cultural values and attitudes present in the host society which imposes its own burdens and desires on immigrant women through prejudices and racism. While “returning women to their ‘traditional roles’ continues to be defined as central to preserving national identity and cultural pride” (Narayan, 1997, p. 20) by some immigrants, those same values and behaviors are perceived by their hosts as a demonstration of immigrants’ “backwardness” and need for change. Yet another oppressive factor comes from people eager to be “culturally sensitive.” Under the guise of respect, some members of the host society may “racialize” and “exoticize” immigrant women, particularly those who come from non-European countries. Tragically, they contribute to the oppression of immigrant women in the name of respecting their culture and preserving their values. Frequently, when outsiders to a given cultural group are trying to be “sensitive,” they attribute behaviors that would be unacceptable in members of the majority culture as being part of “the culture” of this group. This perspective can distort efforts to enhance cultural awareness into dangerously destructive practices for women—even more so, because they are carried out with such good intentions. Conscientious U.S. professionals often believe that wife abuse is “part of these people’s culture.” Therefore, it should be tolerated. A common legal issue contributing to women’s struggle to gain protection from violence is that “culture” is used as a defense against the victims of domestic violence (Renteln, 2002). Obviously, wife abuse is also part of mainstream U.S. culture and, as helping professionals or educators, we would not dream of advocating tolerance for it in mainstream United States. Even though the displacement of anger to women and children among immigrant and ethnic minority men who feel deeply frustrated in their efforts to obtain recognition from mainstream society can be understood by professionals, acceptance of

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violence against women as an outlet for their frustration or as a legitimate reaction to their own oppression is unjustifiable and immoral. And it should not be cloaked in the mantle of cultural sensitivity (Espín, 1999; 2006). Needless to say, these attitudes have a serious impact in the provision of ethical and effective mental health services and psychological treatment of women immigrants and refugees. In an effort to manage some of the guilt generated by largely unacknowledged racism, it is possible to easily forget that sexism is no more deserving of respect when it is spoken in other languages or dressed in other cultural robes. Similarly, racism is not to be tolerated in the name of advancing “women’s rights.” The balance between these two is a delicate, but absolutely necessary one. Sensitivity toward other cultures does not imply unquestioning acceptance of patriarchal definitions of cultural identities and behaviors. We should ask ourselves why is the focus placed on women’s roles rather than other aspects of culture and traditions. Deployment of “tradition” and “culture” to justify sexist or racist behavior should never remain unproblematized (Espín, 2006). Conversely, much is made about the incidence of male dominance in immigrant cultures by individuals in the host culture. It is important to remember that any expression of male dominance among immigrants is nothing but the specific culture’s version of the myth of male superiority that exits in most cultures, including mainstream American culture. And, although many immigrants of both sexes still subscribe to the traditional ideas of male superiority and its consequent forms of expression, many reject it outright. In fact, research shows that the pace of acculturation tends to be slower for females than males in all aspects but one: Females of all ages appear to acculturate faster than their male counterparts when it comes to gender roles (Ginorio, 1979). Cultural values and prejudices also influence how immigrant women are represented in psychological science. Societal intolerance has led many social scientists to narrowly conceptualize immigrant women as oppressed and helpless (Darvishpour, 2002) and to disregard women’s strengths, resilience, resourcefulness, and community networks (Cole, Rothblum, & Espín, 1992). Such systemic forces of oppression and discrimination play a powerful role in shaping immigrant women’s mental health and their access to counseling resources.

Language Issues in Clinical Work With Immigrant Women Providing culturally-relevant mental health services to immigrant women in the United States involves language use (Espín, 1987; Yakushko & Chronister, 2006). In the course of counseling or psychotherapy work, it becomes evident that language changes are central to the transformation of identity. Indeed, language—the forced learning of the new and the loss of the old linguistic community—is central to the migration experience. In fact, language change is one of the most difficult problems the immigrant faces—and we are not referring to issues of vocabulary, grammar, or pronunciation. Language loss and its concomitant sense of identity loss and transformation are one of the most powerful components of the immigrant experience. In her


autobiographical account of migration, Lost in Translation, writer Eva Hoffman (1989) vividly describes the intensity of this experience for immigrants: Linguistic dispossession is ... close to the dispossession of one’s self... [There is feeling that] this language is beginning to invent another me... [And] there is, of course, the constraint and the self-consciousness of an accent that I hear but cannot control ... (p. 121).

Beyond allowing the immigrants to function in the new context, a new language has profound impact on their sense of self and identity as Hoffman’s statements illustrate. The immigrant learns “to live in two languages;” similarly, she learns to live in two social worlds. Learning to “live” in a new language is not merely an instrumental process. It is not a neutral act. It implies becoming immersed in the power relations of the specific culture that speaks the specific language. Paradoxically, learning the language of the host society implies learning one’s place in the structures of social inequality. For adults, to speak with a foreign accent places one in a subordinate position within those power relations. For children, for whom immigration usually implies schooling in a language other than the language of their parents, this process involves a “creation” of their incipient identities as members of a second-class group in the new country. Because they usually are not old enough to have developed a full identity as members of the home culture community, the process of language learning has deep psychological implications that impact their sense of who they are (Espín, 1987, 1999, 2006). “One of the primary places where issues of national culture and family coherence come together is the question of language” (Bammer, 1994, p. 96). This issue becomes further complicated when different generations within a family have different levels of proficiency in the different languages spoken. While the first language or mother-tongue may be taken to mean the native language of the mother, in the case of immigrants or refugees, children may be more fluent in the language of the host culture which is really their first language rather than the language their mothers speak best (Bammer, 1994). In other words, language can play a complex role, both binding and dividing family members. For not only do parents and children often end up with different native languages, their different relationships to these languages can have notable social consequences (Bammer, 1994, p. 100).

Every language is linked to a culture. Every language depends on the concrete context that provides it with its meaning and its boundaries. “Language determines one’s knowledge of the world, of others, and of oneself. It provides a basis of support for one’s identity” (Grinberg & Grinberg, 1984, p. 109). To some extent, our language and our way of life are one and the same. When parents and children are fluent in different languages, they may, in fact, be guided by different cultural codes. The parents’ lack of fluency in the new language and the children’s lack of fluency in the “mother-tongue,” subvert authority in the family. The power of children is increased because they become “cultural brokers” while the power

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of parents is decreased because they depend on their children’s assistance to survive in the new world. The inordinate amount of power children may acquire because of their language proficiency can be at the source of conflicts over authority issues. It also magnifies children’s conscious or unconscious fears that their parents are now unable to protect them as they used to (Espín, 1999, 2006). An immigrant’s resistance to language learning may be an expression of a desire for self-preservation. Entering the world of a new language may pose a threat for the individual’s sense of identity. Individuals who learn the new language at a fast pace may have less of a stake in preserving another identity. This may be why the young learn faster. Conversely, learning a new language provides the immigrant with the opportunity to “create a new self.” This facilitates working through early intrapsychic conflicts, and finding new ways of self-expression that may not have been available in the world of the first language (Espín, 1999). People who learn to use two languages have two symbols for every object. Thus, from an early age they become emancipated from linguistic symbols—from the concreteness, arbitrariness, and “tyranny” of words—developing analytic abilities... to think in a terms more... independent of the actual word ... By contrast, monolinguals may be at a disadvantage (Portes & Rumbaut, 2006, pp. 212–213).

Clearly, the access to more than one language pushes at the boundaries of what is “sayable” or “tellable.” While the first language is usually the “language of emotion” even for individuals who are fluently bilingual, in some cases, the second language could become a vehicle for expressing concerns that could be too embarrassing to verbalize in the first language. Since the use of language is essential in counseling and psychotherapy, understanding its many implications for the immigrant woman client is of utmost importance (Espín, 1999, 2006).

Race and Migration Other factors are also important in the provision of mental health services for immigrant and refugee women. In particular, it is essential to understand the interplay of racism and sexism on the process of immigrant’s identity development. Racism and sexism derive their strength from each other. The racial hierarchization of immigrants is also sexualized. The sexualization of “foreign” women, the perverse interest in the erotic “other,” in other words, the embodiment of gendered racism are deeply embedded in immigration policies and public responses to immigrants throughout the world (Kofman et al., 2000). Conversely, religious differences and the threats traditional values associated with immigrants can pose for European and North American societies have also become the key signifier in binary oppositions of gender relations and sexuality between immigrants and their host communities (Kofman et al., 2000). It will be very easy to assume that most poor, uneducated women immigrants do not understand the meaning and subtleties of women’s oppression,


and to assume that those among them who do are probably just imitating or copying U.S. white middle-class feminists. It will be easy to dismiss any woman who expresses concern or opposition to male domination by labeling her as a traitor who has “sold herself” to “American” influence. The reality is that in all cultures (United States and European cultures included); there will be resistance to women’s transformations of their roles by those invested in maintaining the status quo. And, in all cultures, women are perfectly capable of undertaking this transformative task. Those who have a stake at preventing the development of consciousness among women will not be pleased when those women take their lives in their own hands. Sometimes, apparent “cultural sensitivity” is nothing but another variety of racism that, in fact, fosters a conservative politics which locks women into the past. Some of these practices perpetuate the “colonial gaze” and reinforce exclusionary practices used by those who have a vested interest in keeping women outside critical sites of power over their own lives (Espín, 2006). Indeed, when trying to understand other cultures, we need to reflect about the implications of maintaining a customary system that targets mainly women. Before we can engage in effective counseling or psychotherapy with immigrant women, we need to reflect on the implications of what seems to be respect for customs that target mainly women and have serious consequences for their right to bodily and emotional integrity. The question is, obviously, how we preserve sensitivity and respect for others and their cultural differences while continuing to foster liberatory/emancipatory ideals and principles applicable to all oppressed groups, not just to some with exclusion of others. It is not enough to be supported in efforts at liberation from ethnic oppression if women’s gender oppression is not taken into consideration. Perhaps if we reflect on how we address our own racism, sexism, classism, heterosexism (and other “isms”) in a more careful way, we would be more able to refine our understanding and manifest a more authentic cultural sensitivity. This will demand more work to develop awareness about the interlocking nature of oppression and the continued weight of its many subtle forms, a daunting but necessary task. It will imply paying attention and questioning the nature of power and the structures that perpetuate the exercise of that power—something, we might add, psychologists are not very good at doing (Espín, 2006). As in any counseling or psychotherapy situation, no matter how strong the similarities created by the experience of migration, vast differences in personal experiences are always present. Differences originate in the dissimilar countries of birth, ages at migration, historical period when the migration took place, circumstances surrounding it, and all other processes for each individual life. Each immigrant or refugee woman carries the history of all these events intertwined with her personal history. Yet, despite the differences among them, several behavioral patterns reveal themselves when one listens to women immigrants. They work hard at creating new lives for themselves, at renegotiating gender roles with both the traditions of their home culture and the expectations of the host country. Their experiences illustrate the simultaneous process of acculturation and identity formation. In general, most immigrants end up adapting successfully despite differences in individual histories and personalities and in their choice of individual paths.

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Resilience and Sources of Strength Immigrant and refugee women have many internal and external resources that contribute to their resilience and strength (Cole, Rothblum, & Espín, 1992). For the majority of immigrants, moving to a new culture is viewed as a difficult but hopeful choice toward their goals of safety, prosperity, and wellbeing for themselves and their children (Zajacova, 2002). Voluntary immigration, positive expectations, language skills, and support are associated with more positive mental health outcomes for immigrants (Escobar, Nervi, & Gara, 2000; Hondagneu-Sotelo, 1994; Salgado de Snyder, 1994). Immigrant women can have strong internal resources and may see work involvement as a chance to improve their self-esteem through providing a service to their families and community (Yee, 1992). Immigrant women can also become involved in political activism, which may help buffer them from the disempowering and stressful events of their relocation (Light, 1992). Berger (2004) interviewed a number of immigrant women and identified several sources of women’s resilience. According to Berger, immigrant women identified social, familial, personal, circumstantial, and spiritual factors as key contributors to their successful ability to cope with difficulties of migrating to a new culture. Among the specific examples of these factors were availability of role models, networks with other immigrant women, close family ties, motherhood as a source of power, personality traits such as optimism, hardiness, and determination, opportunities to return home, and personal spiritual beliefs. Immigrant and refugee women’s mental health and adjustment will be influenced by their positive expectations, resilience, and the internal and external resources they can access. These resources as well as stressors experienced by women are the significant factors address by services.

Some Concluding Thoughts Ultimately, the question faced in working with these immigrant and refugee women is who “owns” their lives? “Modern” ideas about women’s rights and free choices concerning their lives have not entirely replaced more “traditional” ideas about gender obligations and differences in rights. These questions are alive in all societies. Yet they become more poignant and dramatic in the context of traditional groups trying to acculturate in a new context which is itself in transition concerning the role of women. Perhaps the transformational tales created by women themselves allow them to get in touch with their own power. Hopefully, the ideas discussed in this chapter will contribute to awareness and increased understanding of women’s experiences of crossing geographical and emotional boundaries.

References Abraham, M. (2000). Speaking the unspeakable: Marital violence among South Asian immigrants in the United States. New Brunswick, NJ.: Rutgers University Press. Bammer, A. (1994). Mother tongues and other strangers: Writing “family” across cultural divides. In A. Bammer (Ed.), Displacements: Cultural identities in question (pp. 90–109). Bloomington: Indiana University Press.


Bemak, F. (1989). Cross-cultural family therapy with Southeast Asian refugees. Journal of Strategic and Systemic Therapies, 8, 22–27. Bemak, F., & Chung, R. C.-Y. (2002). Counseling and psychotherapy with refugees. In P. B. Pedersen, J. G. Draguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across cultures, (2nd ed., pp. 209–232). Thousand Oaks, CA: Sage. Bemak, F., & Greenberg, B. (1994). Southeast Asian refugee adolescents: Implications for counseling. Journal of Multicultural Counseling and Development, 22, 115–124. Ben-Sira, Z. (1997). Immigration, stress, and readjustment. Westport, CT: Praeger. Berger, R. (2004). Immigrant women tell their stories. New York: The Haworth Press. Berry, J. W. (1990). Psychology of acculturation. In R. W. Brislin (Ed.), Applied cross-cultural psychology (pp. 232–253). Newbury Park, CA: Sage. Bhatia, S., & Ram, A. (2001). Rethinking “acculturation” in relation to diasporic cultures and postcolonial identities. Human Development, 44, 1–18. Bhuyan, R., Mell, M., Senturia, K., Sullivan, M., & Shiu-Thornton, S. (2005). “Women must endure according to their Karma”: Cambodian immigrant women talk about domestic violence. Journal of Interpersonal Violence, 20, 902–921. Brettell, C. B. (2002). From Ellis Island to JFK: Comparison in anthropology and history. Journal of American Ethnic History, 21, 68–73. Bronfenbrenner, U. (1979). The ecology of human development. Cambridge: Harvard University Press. Brown, G. (1982). Issues in resettlement of Indochinese refugees. Social Casework, 63, 155–159. Chronister, K. M., McWhirter, B. T., & Kerewsky, S. D. (2004). Prevention from an ecological framework. In R. K. Conyne & E. P. Cook (Eds.), Ecological counseling: An innovative approach to conceptualizing person-environment interaction. Alexandria, VA: ACA Press. Chung, R. C.-Y. (2000). Psychosocial adjustment of Cambodian refugee women: Implications for mental health counseling. Journal of Mental Health Counseling, 23, 115–126. Chung, R. C.-Y., & Okazaki, S. (1991). Counseling Americans of Southeast Asian descent: The impact of the refugee experience. In C. C. Lee & B. L. Richardson (Eds.), Multicultural issues in counseling: New approaches to diversity (pp. 107–126). Alexandria, VA: American Association for Counseling and Development. Cole, E., Espín, O. M., & Rothblum, E. D. (Eds.). (1992). Refugee women and their mental health: Shattered societies, shattered lives. New York: Haworth Press. Darvishpour, M. (2002). Immigrant women challenge the role of men: How the changing power relationship within Iranian families in Sweden intensifies family confl icts after immigration. Journal of Comparative Family Studies, 33, 270–296. Dion, K. (2006). On the development of identity: Perspectives from immigrant families. In R. Mahalingam (Ed.), Cultural psychology of immigrants (pp. 299–314). Mahwah, NJ.: Lawrence Erlbaum. Dion, K. K., & Dion, K. L. (2001). Gender and cultural adaptation in immigrant families. Journal of Social Issues, 57, 511–521. Escobar, J. I., Nervi, C. H., & Gara, M. A. (2000). Immigration and mental health: Mexican Americans in the United States. Harvard Review of Psychiatry, 8(2), 64–72. Espanshade, T. J., & Calhoun, C. A. (1993). An analysis of public opinion toward undocumented migration. Population Research and Policy Review, 12, 189–224. Espín, O. M. (1987). Psychological impact of migration on Latinas: Implications for psychotherapeutic practice. Psychology of Women Quarterly, 4, 489–503. Espín, O. M. (1997). Latina realities: Essays on healing, migration, and sexuality. Boulder, CO: Westview Press. Espín, O. M. (1999). Women crossing boundaries: A psychology of immigration and transformation of sexuality. New York: Routledge. Espín, O. M. (2006). Gender, sexuality, language and migration. In R. Mahalingam (Ed.), Cultural psychology of immigrants (pp. 241–258). Mahwah, NJ: Lawrence Erlbaum. Espiritu, Y. L. (2001). “We don’t sleep around like White girls do”: Family culture and gender in Filipina American lives. Signs, 26, 415–450. Falicov, C. J. (1998). Latino families in therapy: A guide to a multicultural practice. New York: Guilford. Finch, B. K., Catalano, R. C., Novaco, R. W., & Vega, W. A. (2003). Employment frustration and alcohol abuse/dependence among labor migrants in California. Journal of Immigrant Health, 5, 181–186.

553

554


Flannery, W. P., Reise, S. P., & Yu, J. (2001). An empirical comparison of acculturation models. Personality & Social Psychology Bulletin, 27, 1035–1045. Foner, N. (1986). Sex roles and sensibilities: Jamaican women in New York and London. In R. J. Simon (Ed.), International migration: The female experience (pp. 133–151). Totowa, NJ: Rowan & Allenheld. Foner, N. (2001). Benefits and burdens: Immigrant women and work in New York City. In R. J. Simon. (Ed.), Immigrant women (pp. 1–20). New Brunswick: Transaction. Foner, N. (2002). Response. Journal of American Ethnic History, 21, 102–119. Garza-Guerrero, A. C. (1974). Culture shock: Its mourning and the vicissitudes of identity. Journal of the American Psychoanalytic Association, 22, 408–429. Gil, R. M. (1996). Hispanic women and mental health. In J. A. Sechzer & S. M. Pfafflin (Eds), Women and mental health. Annals of the New York academy of sciences (pp. 147–159). New York: New York Academy of Sciences. Ginorio, A (1979). A comparison of Puerto Ricans in New York with native Puerto Ricans and Caucasian—and Black—Americans on two measures of acculturation: Gender role and racial identification. (Doctoral dissertation, Fordham University). Dissertation Abstracts International, 40, 983B–984B. Glenn, E. N. (1991).Racial ethnic women’s labor. The intersection of race, gender, and class oppression. In R. L. Blumberg (Ed.), Gender, family and economy: The triple overlap (pp. 181–193). Newbury Park: Sage. González, H. M., Haan, M. N., & Hinton, L. (2001). Acculturation and the prevalence of depression in older Mexican Americans: Baseline results of the Sacramento Area Latino Study on Aging. Journal of the American Geriatrics Society, 49, 948–953. Grinberg, L., & Grinberg, R. (1984). Psicoanálisis de la migración y del exilio. Madrid: Alianza Editorial (English translation by N. Festinger. perspectives on migration and exile. New Haven, CT: Yale University Press, 1989). Guarnaccia, P. J. (1997). Social stress and psychological distress among Latinos in the United States. In I. Al-Issa & M. Tousignant (Eds.), Ethnicity, immigration, and psychopathology (pp. 71–94). New York: Plenum Press. Hass, G. A., Dutton, M. A., & Orloff, L. E. (2000). Lifetime prevalence of violence against Latina immigrants: Legal and policy implications. International Review of Victimology, 7, 93–113. Hays, P. A. (2001). Addressing cultural complexities in practice: A framework for clinicians and counselors. Washington, DC: American Psychological Association. Helms, J. E. (1995). An update of Helm’s White and people of color racial identity models. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 181–198). Thousand Oaks, CA: Sage. Hernández, D. J. (2006). Immigration and diversity transforming America in the 21st century. Opening plenary session conducted at the meeting of Expert Summit on Immigration of the American Psychological Association, San Antonio, TX. Hing, B. O. (2004). Defining America through immigration policy. Philadelphia: Temple University Press. Hoffman, E.(1989). Lost in translation. NY: Dutton. Holtzman, J. D.(2000). Dialing 911 in Nuer: Gender transformations and domestic violence in a Midwestern Sudanese Refugee community. In N. Foner, R. Rumbaut & S. J. Gold (Eds.), Immigration research for a new century: Multidisciplinary perspectives (pp. 390–408). New York: Russell Sage. Hondagneu-Sotelo, P. (1994). Gendered transitions: Mexican experiences of immigration. Berkeley: University of California Press. Hondagneu-Sotelo, P. (1999). Gender and contemporary U.S. immigration. American Behavioral Scientist, 42, 565–576. Hondagneu-Sotelo, P. (Ed.). (2003). Gender and U.S. migration. Berkeley: University of California Press. Hovey, J. D. (2000). Acculturative stress, depression, and suicidal ideation in Mexican immigrants. Cultural Diversity and Ethnic Minority Psychology, 6, 134–151. Hovey, J. D., & Magaña, C. J. (2003). Psychosocial predictors of anxiety among immigrant Mexican migrant farm workers: Implications for prevention and treatment. Cultural Diversity and Ethnic Minority Psychology, 8, 274–289. Johnson, K. R. (2004). The huddled masses myth: Immigration and civil rights. Philadelphia: Temple University Press.


Kanuha, V. (1994). Women of color in battering relationships. In L. G. Comas–Diaz & B. Greene (Eds.), Women of color: Integrating ethnic and gender identities in psychotherapy (pp. 428– 454). New York: The Guilford Press. Kawahara, D., & Espín, O. M. (Eds.). (2007). Feminist reflections on growth and transformations: Asian-American women in therapy. NY: Haworth Press. Kofman, E., Phizacklea, A., Raghuram, P., & Sales, R. (2000). Gender and international migration in Europe: Employment, welfare and politics. NY: Routledge. Larsen, L. J. (2004). The foreign-born population in the United States: 2003. Current population reports, P20–551. Washington, DC: U.S. Census Bureau. Law, A. O. (2002). The diversity visa lottery—A cycle of unintended consequences in United States immigration policy. Journal of American Ethnic History, 21, 3–27. Light, D. (1992). Healing their wounds: Guatemalan refugee women as political activists. In E. Cole, O. M. Espin, & E. D. Rothblum (Eds.), Refugee women and their mental health: Shattered societies, shattered lives (pp. 297–308). New York: Haworth Press. Lott, B. (2002). Cognitive and behavioral distancing from the poor. American Psychologist, 57, 100–110. Luibhéid, E. (2002). Entry denied: Controlling sexuality at the border. Minneapolis: University of Minnesota Press. Magaña, C. G., & Hovey, J. D. (2003). Psychosocial stressors associated with Mexican migrant farm workers in the Midwest United States. Journal of Immigrant Health, 5, 75–86. Mahalingam, R., & Leu, J. (2005). Culture, essentialism, immigration and representations of gender. Theory & Psychology, 15, 841–862. Marsella, A. J., & Ring, E. (2003). Human migration and immigration: An overview. In L. L. Adler & U. P. Gielen (Eds.), Migration: Immigration and emigration in international perspective (pp. 3–22). Westport, CT: Praeger. McCloskey, L. A., Southwick, K., Fernandez-Esquer, M. E., & Locke, C. (1995). The psychological effects of political and domestic violence on Central American and Mexican immigrant mothers and children. Journal of Clinical Child & Adolescent Psychology, 23, 95–116. McIntyre, T. M., & Augusto, F. (1999). The Martyr Adaptation Syndrome: Psychological Sequelae in the adaptation of Portuguese-speaking immigrant women. Cultural Diversity and Ethnic Minority Psychology, 5, 387–402. McWhirter, E. H.(1994). Counseling for empowerment. Alexandria, VA: American Counseling Association. Mehta, K., Gabbard, S. M., Barrat, V., Lewis, M., Carroll, D., & Mines, R. (2000). Findings from the National Agricultural Workers Survey (NAWS) 1997–1998: A demographic and employment profile of United States farm workers. U.S. Department of Labor, Office of the Assistant Secretary for Policy, Office of Program Economics, Report No. 8. Miller, A. M., & Chandler, P. J. (2002). Acculturation, resilience, and depression in midlife women from the former Soviet Union. Nursing Research, 51, 26–32. Miller, A. M., Sorokin, O., Wang, E., Feetham, S., Choi, M., & Wilbur, J. (2006). Acculturation, social alienation, and depressed mood in midlife women from the former Soviet Union. Research in Nursing & Health, 29, 134–146. Miranda, J., Siddique, J., Der-Martirosian, C., & Belin, T. R. (2005). Depression Among Latina immigrant mothers separated from their children. Psychiatric Services, 56, 717–720. Mollica, R. F., Wyshak, G., & Lavelle, J. (1987). The psychosocial impact of war trauma and torture on Southeast Asian refugees. American Journal of Psychiatry, 144, 1567–1572. Montgomery, P. A. (1994). The Hispanic population in the United States: March 1993. Report from the U.S. Bureau of the Census, Current Populations Reports, Series P20–475. Washington, DC: US Government Printing Office. Mulder, T. J., Hollmann, F. W., Lollock, L. R., Cassidy, R. C., Costanzo, J. M., & Baker, J. D. (2001). U.S. Census Bureau measurement of net international migration to the United States: 1990–2000. Retrieved January 3, 2004, http://www.census.gov/population. Muller, T., & Espanshade, T. J. (1985). The fourth wave: California’s newest immigrants. Washington, DC: Urban Institute. Narayan, U. (1997). Dislocating cultures: Identities, traditions, and third world feminism. New York: Routledge. National Council for Research on Women. (1995). Intervening: Immigrant women and domestic violence. Issues Quarterly, 1, 12–14.

555

556


Niemann, Y. F. (2001). Stereotypes about Chicanas and Chicanos: Implications for counseling. The Counseling Psychologist, 29(1), 55–90. Oh, Y., Koeske, G. F., & Sales, E.(2002). Acculturation, stress and depressive symptoms among Korean immigrants in the United States. Journal of Social Psychology, 142, 511–526. Ong, A. (1999). Cultural citizenship as subject making: Immigrants negotiate racial and cultural boundaries in the United States. In R. D. Torres, L. F. Miron, & J. X. Inda (Eds.), Race, ethnicity and citizenship: A reader (pp. 262–294). Oxford: Blackwell. Ortega, A. N., Rosenheck, R., Alegría, M., & Desai, R. A. (2000). Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics. Journal of Nervous & Mental Disease, 188, 728–735. Parreñas, R. S.(2002). Care crisis in the Philippines: Children and transnational families in the new global economy. In B. Ehrenreich & A. R. Hochschild (Eds.), Global woman: Nannies, maids and sex workers in the new economy (pp. 39–54). New York: Metropolitan Books. Pedraza, S.(1991). Women and migration: The social consequences of gender. Annual Review of Sociology, 17, 303–325. Perilla, J. L. (1999). Domestic violence as a human rights issue: The case of immigrant Latinos. Hispanic Journal of Behavioral Sciences, 21, 107–133. Pernice, R. (1994). Methodological issues in research with refugees and immigrants. Professional Psychology: Research & Practice, 25, 207–213. Pesar, P. R. (2003). Engendering migration studies. In P. Hondagneu-Sotelo (Ed.) Gender and U.S. migration (pp. 20–42). Berkeley: University of California Press. Portes, A., & Rumbaut, R. G. (2006). Immigrant America: A portrait (3rd Ed.). Berkeley, CA: University of California Press. Pransky, G., Moshenberg, D., Benjamin, K., Portillo, S., Thackrey, J. L., & Hill-Fotouhi, C. (2002). Occupational risks and injuries in non-agricultural immigrant Latino workers. American Journal of Industrial Medicine, 12, 117–123. Prendes-Lintel, M. (2001). A working model in counseling recent refugees. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp. 729–752). Thousand Oaks, CA: Sage. Renteln, A. D. (2002). In defense of culture in the courtroom. In R. A. Shweder, M. Minow, & H. R. Markus (Eds.), Engaging cultural differences: The multicultural challenge in liberal democracies (pp. 194–215). New York: Russell Sage. Rodriguez, R., & DeWolfe, A. (1990). Psychological distress among Mexican-American and Mexican women as related to status on the new immigration law. Journal of Consulting and Clinical Psychology, 58, 548–553. Rogler, L. H. (1994). International migrations: A framework for directing research. American Psychologist, 49, 701–708. Roopnarine, J., & Krishnakumar, A. (2006). Conceptual and research considerations in the determinants of child outcomes among English-speaking Caribbean immigrants in the United States: A cultural-ecological approach. In R. Mahalingam (Ed.), Cultural psychology of immigrants. Mahwah, NJ.: Lawrence Erlbaum. Roopnarine, J., & Krishnakumar, A. (2006). Conceptual and research considerations in the determinants of child outcomes among English-speaking Caribbean immigrants in the United States: A cultural-ecological approach. In R. Mahalingam (Ed.), Cultural psychology of immigrants (pp. 277–298). Mahwah, NJ.: Lawrence Erlbaum. Rumbaut, R. G. (1991). The agony of exile: A study of the migration and adaptation of Indochinese refugee adults and children. In F. L. Ahearn & J. L. Athey. (Eds.), Refugee children: Theory, research, and services (pp. 53–91). Baltimore: Johns Hopkins University Press. Sakamoto, I. (2006). A model of cultural negotiation and the family: Experiences of Japanese academic migrants in the U.S. In R. Mahalingam (Ed.), Cultural psychology of immigrants (pp. 337–364). Mahwah, NJ.: Lawrence Erlbaum. Salgado de Snyder, V. N. (1994). Mexican women, mental health, and migration: Those who go and those who stay behind. In R. G. Malgady & O. Rodriguez (Eds.), Theoretical and conceptual issues in Hispanic mental health (pp. 114–139). Melbourne, FL: Krieger.


Schmidley, A. D. (2001). Profile of the foreign born population in the U.S., 2000. U.S. Census Bureau Current Population Reports, Series pp. 23–206. Washington, DC: U.S. Government. Retrieved January 3, 2004, http://www.census.gov/population. Schnittker, J. (2002). Acculturation in context: The self-esteem of Chinese immigrants. Social Psychology Quarterly, 65, 56–76. Simon, R. J. (1992). Sociology and immigrant women. In D. Gabaccia (Ed.), Seeking common ground: Multidisciplinary studies of immigrant women in the United States pp. 23–40. Westport, CT: Greenwood. Simons, L. (1999). Mail order brides: The legal framework and possibilities for change. In G. A. Kelson & D. L. DeLaet (Eds.), Gender and immigration (pp. 127–143). New York: New York University Press. Stein, B. N. (1986). The experience of being a refugee: Insights from the research literature. In C. L. Williams & J. Westermeyer (Eds.), Refugee mental health in resettlement countries. The series in clinical and community psychology (pp. 5–23). Hemisphere. Stewart, A. J. (1994). The women’s movement and women’s lives: Linking individual development and social events. In R. Josselson (Ed.), The narrative study of lives (Vol. 2, pp. 230–250). Thousand Oaks, CA: Sage. Stewart, A. J., & McDermott, C. (2004). Gender in psychology. Annual Review Psychology, 55, 519–544. Suárez-Orozco, C., & Suárez-Oroszco, M. M. (2001). Children of immigration. Cambridge, MA: Harvard University Press. Suárez-Orozco, C., Todorova, I. L. G., & Louie, J. (2002). Making up for lost time: The experience of separation and reunification among immigrant families. Family Process, 41, 625–643. Tobin, J. J., & Friedman, J. (1983). Spirits, shamans, and nightmare death: Survivor stress in a Hmong refugee. American Journal of Orthopsychiatry, 53, 439–448. U.S. Census Bureau. (2005). Statistical abstracts of the United States: 2004–2005. Retrieved on August 16, 2006 from the world wide web at http://www.census.gov/ prod/2004pubs/04statab/pop.pdf. Uba, L. (1994). Asian-Americans: Personality patterns, identity, and mental health. New York: Guilford. United Nations Expert Group Meeting on International Migration Policies and the Status of Female Migrants. (1995). International Migration Policies and the Status of Female Migrants. New York: United Nations. United Nations International Research and Training Institute for the Advancement of Women (1994). The migration of women: Methodological issues in the measurement and analysis of internal and international migration. New York: United Nations. United Nations. (2004). The United Nations High Commissioner for Refugees: 2004 statistical yearbook. Retrieved on February 21, 2007 from the world wide web at http://www.unhcr. org/statistics/STATISTICS/44e96c842.pdf van der Veer, G. (1992). Counselling and therapy with refugees. New York: John Wiley & Sons. Weeks, K. A. (2000). The Berkeley wives: Identity revision and development among young temporary immigrant women. Asian Journal of Women’s Studies, 2, 78–89. Wong-Rieger, D., & Quintana, D. (1987) Comparative acculturation of Southeast Asian and Hispanic immigrants and sojourners. Journal of Cross-Cultural Psychology, 18, 345–362. World Health Organization (WHO) (1996). Mental health of refugees. Geneva, Switzerland: Author and Office of the United Nations High Commissioner for Refugees. Yakushko, O. (2006). Career development of immigrant women. In W. B. Walsh & M. J. Heppner (Eds.). Handbook of career counseling of women (pp. 387–426). Hillsdale, NJ: Lawrence Erlbaum. Yakushko, O. (2009). Xenophobia and prejudice: Understanding negative attitudes about recent immigrants. The Counseling Psychologist, 37, 36–66, DOI: 10.1177/0011000008316034. Yakushko, O., & Chronister, K. (2005). Immigrant women and counseling: The invisible Others. Journal of Counseling and Development, 83, 292–299. Yee, B. W. K. (1992). Markers of successful aging among Vietnamese refugee women. In E. Cole, O. M. Espin, & E. D. Rothblum. (Eds.). Refugee women and their mental health: Shattered societies, shattered lives (pp. 221–238). New York: Haworth Press.

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Yoshihama, M., & Horrucks, J. (2002). Posttraumatic stress symptoms and victimization among Japanese American women Journal of Consulting and Clinical Psychology, 70, 205–215. Zajacova, A. (2002). Constructing the reality of the immigrant life. Journal of Social Distress & the Homeless, 11, 69–79. Zhou, M. (2006). Negotiating culture and ethnicity: Intergenerational relations in Chinese immigrant families in the United States. In R. Mahalingam (Ed.), Cultural psychology of immigrants (pp. 315–336). Mahwah, NJ: Lawrence Erlbaum.

Women in the Workplace: Acknowledging Difference in Experience and Policy

20 Susan Clayton, Amber L. Garcia, and Faye J. Crosby

The problems of working women are the problems of women: most women work. In 2005, 66% of women between the ages of 20 and 64 were employed at least part-time (U.S. Census Bureau, 2005). Although in the past, women of color were more likely to work than White women, ethnic differences are not large: the lowest labor force participation, at 56%, was found among Latinas, while the highest rate, among Black women, was 62%. At present, working is more associated with privilege than with disadvantage. England, Garcia-Beaulieu and Ross (2004) found the strongest predictors of employment, across all ethnic groups, were education (positively associated) and children (negatively associated); husbands’ earnings had little effect. The authors conclude,”Economic need is not … the major factor driving women’s employment” (p. 496). Work outside of the home is now an accepted part of life for women of all class and ethnic backgrounds. Nevertheless, to understand and evaluate the situation of working women we need to take a complex perspective, one that is mindful of work for all women, not just those who are White, middle-class, and heterosexual. In this chapter, we will start by considering the place of work in women’s lives. We

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begin by briefly asking what women get out of work, and what makes it satisfying. We follow with an examination of the ways in which work and family interact for women. This will lead to a discussion of the underrepresentation of women in leadership positions, and of discrimination against working women more generally. Agreeing with Eagly and Carli (2007) that changes are needed at multiple levels, including institutional as well as individual, we argue that specific policies are needed to support working women. We close by discussing affirmative action as a tool for systemic change and encourage more research attention to diversity among women as it relates to experience in the workplace.

Why Work? Women’s Job Satisfaction In general, working outside the home appears to be good for women. It enhances access to social support, buffers stresses that occur within the home, enhances self-esteem and—not insignificantly—increases income (Barnett & Hyde, 2001). These advantages seem to be found across ethnic groups (Bridges & Orza, 1996; McLoyd, Cauce, Takeuchi, & Wilson, 2000). But not all jobs are equally satisfying. Organizational research has been concerned with assessing variability in job satisfaction, based on the assumption that it predicts outcomes such as turnover rate and overall job performance. Starting in the late 1970s, and prompted by the increasing proportion of the workforce comprising women, researchers have looked for gender differences in these constructs. Studies on gender differences in job satisfaction have found mixed results, depending on other organizational attributes. One relevant factor concerns the gender balance in a workplace. Some studies have found that women in predominantly male workplaces are less satisfied with their jobs compared to men. For example, Kennedy and Lawton (1992) found that women were less satisfied with jobs as salespersons in an industrial company compared with men. Also, Long (1998) found that women who constituted significantly less than half of the workforce in their place of employment were less likely than men to be satisfied with their jobs. Some of the earliest work in this area was Rosabeth Kanter’s (1977) research on women sales managers. She highlighted the stigma experienced by women who are considered “tokens” or solo representatives of their gender group within an organization. In interviews, these women reported feeling highly visible, excessively scrutinized, and isolated. Even though not measured directly in Kanter’s study, job satisfaction was likely affected given the pressure to perform well and to avoid confirming gender-stereotypes. In support of this idea, Simpson (1997) interviewed female M.B.A. graduates and found that only 8% of tokens viewed prospects within their organization as good compared to 28% of nontokens. Studies that have examined job satisfaction for women and men in gender similar vs. gender diverse organizations have also found mixed results (cf. Tolbert, Graham, & Andrews, 1999; Williams & O’Reilly, 1998). Using a sample of over 23,126 British employees in over 2,000 organizations, Peccei and Lee (2005) examined the effect of gender similarity on job satisfaction, controlling for several demographic (e.g., race, age, marital status) and structural

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Women in the Workplace

(e.g., type of industry, size of workplace) variables. They found an interaction between gender similarity and employee sex, such that men reported more job satisfaction in male dominated settings compared to more gender diverse or female dominated settings. Women, on the other hand, had similar levels of job satisfaction across levels of gender similarity. Additionally, women, on average, had lower levels of job satisfaction compared to men. Other studies have found either no gender differences or higher levels of job satisfaction in women compared to men. Schul and Wren (1992) found no gender differences in job satisfaction among employees at a skincare company. In situations where women report similar levels of job satisfaction as men, despite having lower pay and status than them, this finding has been labeled”the paradox of the contented female worker” (Crosby, 1982) and has been replicated in several studies (Baxter, Lynch-Blosse, & Western, 1996; Buchanan, 2005). Women may be more satisfied when they choose to compare their situation to that of other women rather than to men, something that may be particularly likely in predominantly female settings. Together, these studies suggest that the particular type of job, and particular organizational culture and policies might influence whether or not gender differences in job satisfaction appear. If women in general, such as those interviewed by Kantor (1977) and Simpson (1997), sometimes feel isolated and stigmatized because of their solo or token status, then women or color and lesbian women might feel particularly stigmatized in the workplace. Unfortunately, there has been little research on this topic, though some research has found that women of color experience less job satisfaction compared to their White counterparts (Allen, Epps, Guillory, Suh, & Bonous-Hammarth, 2000; Mau & Kopischke, 2001). Organizations are increasingly concerned with the job satisfaction and retention of employees from various backgrounds. All employees, but perhaps especially employees from underrepresented or nontraditional backgrounds, want to feel they are safe from discrimination within the workplace, that they will be given the same opportunities for advancement as other employees, and that they will be treated fairly. Employees who do not feel included in an organization might feel uncomfortable at work, unable to communicate work-related issues and concerns to their supervisors, and have lower levels of job satisfaction (Bettencourt & Brown, 1997). Mor-Barak and Levin (2002) examined feelings of organizational inclusiveness (e.g., access to information, connectedness to coworkers, influencing the decision-making process) in employees in a large high-tech firm; they also measured job satisfaction. Overall, employees who were women and/or ethnic minority group members reported feeling less included in this job setting than other workers. Additionally, inclusiveness was the strongest predictor of job satisfaction, with lower levels of inclusiveness related to lower levels of job satisfaction. At the organizational level, there are several strategies that employers can take to improve job satisfaction. The fairly simple strategy for addressing diversity issues in the workplace is to establish an antidiscrimination policy at work: one that is clear and that is made clear to employees. Day and Schoenrade (2000) found that in organizations where there was a clear antidiscrimination policy, lesbian women and gay men were more likely to report

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higher levels of affective organizational commitment and job satisfaction compared to employees at organizations without such a policy. In this same study, the researchers also found that perception of support from top management was also positively related to these factors. Employers can take steps to create a culture of inclusiveness and establish norms of nondiscrimination. A clear antidiscrimination policy has the potential to affect the entire job climate, and to establish norms for appropriate work behavior. Homosexual workers are likely to have higher levels of job satisfaction in workplaces that have visible antidiscrimination policies (Day & Schoenrade, 2000). Driscoll, Kelley, and Fassinger (1996) examined the effect of workplace climate on lesbian women’s job satisfaction and found that lesbian women who reported working in an organization that had a positive workplace climate (e.g., feeling the workplace was friendly toward lesbians) had higher levels of job satisfaction. Workplace climate also had a positive influence on one’s ability to cope with workplace stress—which was also positively related to job satisfaction. For organizations, the message is that by creating a workplace environment where all employees feel safe from discrimination and feel valued, then employee job satisfaction and their ability to cope with workplace stress increase. Many women work in organizations that are resistant to change—unwilling or unable to offer flexible working schedules, unaware of the discriminatory effects company policies might have on employees from particular social groups. Even so, there are still small changes that can be made by managers and fellow employees that can improve job satisfaction. Gatmon et al. (2001) examined the effect of discussions of gender, ethnicity, and sexual orientation between psychology interns and their supervisors. The results indicated that when supervisors and interns had discussions of gender, cultural, and/or sexual orientation differences, interns were more likely to report satisfaction with the supervisor and a stronger working alliance. The researchers point out that supervisors may be reluctant to initiate such discussions of cultural differences and similarities, for fear of appearing “overly concerned with diversity issues” (p. 109) or because they don’t think that such a discussion is necessary. Nevertheless, it may be useful for both workplace polices and coworkers to acknowledge the different concerns associated with women in order to prevent difference from becoming a disadvantage. Antidiscrimination policies and gender balance in the workforce may enhance women’s prospects for finding satisfaction in their work. These are structural changes that may be slow or difficult to attain. Efforts to promote a workplace culture that is actively supportive of, and open to, difference are also likely to have a positive effect on the morale of female workers, and may be easier for individual supervisors to implement

Work as a Part of Life: Combining Work and Family The growing proportion of women in the workforce has meant a concomitant increase in the proportion of people who define themselves as both workers and parents. The”traditional” family, in which the father bears primary responsibility for earning an income and the mother bears primary responsibility for

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house- and childcare, has long since become unrepresentative: 78% of employees in 2002 were members of dual-earner couples (Barnett, 2002). The majority of mothers, even mothers of infants, are also in the workforce (Barnett). Increasingly, both partners in a marriage are likely to consider both their work and their home roles to be important. Women and men show equivalent levels of identification with their employment roles, controlling for job attributes and differences in job-related qualifications (Eagly & Carli, 2004). Similarly, women and men are equally affected by work and family: There are no gender differences in the effect of job role quality, marital quality or parental role quality on psychological distress (Barnett, 2002). The roles, however, are not evenly balanced. Women tend to be responsible for more than their share of household work (Deutsch, 1999; Steil, 2000). Recent research suggests that married mothers spent 19.3 hours a week on housework in 2000, compared to 9.7 hours by married fathers; for childcare, the mothers spent 12.9 hours a week and the fathers spent 6.5 (Bianchi, Robinson, & Milkie, 2006). Gender differences in responsibility for childcare have been found in societies around the world (Deutsch). Among the household tasks, women do more of the routine daily work while fathers do things like playing with children and household repairs (Steil). Men, meanwhile, tend to work more hours outside the home than women do, although the total number of hours women devote to work inside and outside the home is greater than the equivalent number for men. Women are more likely than men to leave work for family obligations (Eagly & Carli, 2004). Considering both work and family to be important can have positive effects on mental and physical health, as well as on the quality of one’s marital relationship. Role overload, however, is not good. These gender differences in how family and work are combined can have costs for women’s career success (cf. Clayton, 2005) as well as their mental and physical health. Beyond certain limits, increased work demands lead to psychological distress (Barnett & Hyde, 2001). Trying to combine work and family can result in what some scholars call “the motherhood penalty” (Crittenden, 2001) and others (Crosby, Biernat, & Williams, 2004; Williams, 2000) describe as “the maternal wall.” The idealization of the mother who is constantly available to her children, along with the professional who is constantly available to his or her employer, makes it challenging for mothers to reach high status positions (Williams, 2000). At the top of the professional hierarchy, for example, women scientists nevertheless lose career opportunities because they are less likely than men to move from one job to the next, bargaining for better working conditions and higher benefits. Shauman and Xie (1996) found that female scientists were more likely to be married to fellow scientists or other professionals than were male scientists. Perhaps as a consequence, having children had a negative effect on their mobility compared to the mobility of the men. The division of household labor is partly based on the division of labor outside the home: men’s household work increases when their wives’ employed hours go up (Wright, Shire, Hwang, Dolan, & Baxter, 1992). Also important, however, are attitudes about gender roles. Household work is still primarily seen as women’s work, and this has behavioral consequences (Steil, 2000). Coltrane and Adams (2001) found that men’s support for traditional gender

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roles was negatively correlated with the percentage of housework they did. Wright et al. (1992) also found that gender ideology, particularly among men, was a predictor of the proportion of housework they did. When Lundgren, Fleischer-Cooperman, Schneider, and Fitzgerald (2001) surveyed dual-career couples in which one parent was working reduced hours in order to devote time to childcare, the most common explanation given for the choice of which parent would work fewer hours among both husbands and wives was “external normative constraints” – that is, norms about family and work that were perceived to exist in society at large, “beyond the boundaries of the couple” (p. 264). Use of this explanation was significantly correlated with traditional gender norms among women. Traditional attitudes may be powerful even when the individual does not believe them (cf. Steele, 1997); merely the way in which they permeate the culture has an impact on individual decisions. Complicating the impact of gender differences in the work/family balance are perceptions of fairness. Multiple studies have shown that an even division of labor is not necessarily considered fair, nor is an uneven division seen as unfair (Mikula, 1998). Most men and women across ethnicities consider the current division of labor to be fair, even though it is demonstrably unequal. Men, however, are more likely to believe this than women, and Black men are the most likely to consider the division fair. More highly educated people are more likely to perceive the division of labor as unfair (Lennon & Rosenfield, 1994). The gender differences in household labor do not seem to be related to class differences (Wright et al., 1992). There are, however, differences associated with ethnicity. John, Shelton, and Luschen (1995) looked at 1987 survey data from 13,000 respondents and found that White men did less housework than Black or Latino men. McLoyd et al. (2000) reviewed the literature and found that White men spent less time supervising their children than did Latino or Black fathers. Black and Latino men also had more positive attitudes about working wives, although they combined this with more traditional beliefs about gender roles in the home. Ethnic differences in household labor divisions were not attributable to education, age, children, or number of hours worked. Black women may have more positive attitudes about combining work and family than do White women. Black women have the highest labor force participation rate among mothers of infants (U.S. Census Bureau). Bridges and Etaugh (1996) compared the attitudes of Black and White college women and found a number of differences: Black women wanted to return to work more quickly after the birth of a child (30 months as compared to 48 for White women), and anticipated more benefits to the child and fewer costs to the mother from maternal employment than did White women. Interestingly, expectations about personal benefits and costs for child predicted desired employment timing for White women but none of the predictors measured were significant for Black women. This may suggest that Black women take returning to work for granted rather than engaging in a mental calculation of costs and benefits. In other research, Bridges and Orza (1996) surveyed Black and White women and found no differences in perceptions of personal cost, personal reward, time for child, costs or benefits for child, or time for husband associated with their work role. Black women did, however, report more marital conflict associated with their work role than did White women.

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Combining employment and family is likely to remain the norm for women. There are structural factors that can make this easier. Family-friendly workplace policies can enhance both “employee morale and commitment and the quality of family life” (Haley, Perry-Jenkins, & Armenia, 2001, p. 228). That the 24/7 model of the ideal worker is a glorification of one way of being and not a business necessity is seen from the economic successes of organizations that institute family-friendly policies that run counter to the ideal (Alliance for Work Progress, 2005; Bond, Galinsky, Kim, & Bowfield, 2005; Catalyst, 2002, 2004; Friedman, Christensen, & deGroot, 1998; see also Wright, Ferris, Hiller, & Kroll, 1995). Such policies can range from family leave programs to support for breastfeeding to more informal support from supervisors and coworkers. Galinsky (2001) reports that companies with more women in top executive positions are more likely to have family-friendly policies; the causal direction of the relationship is unclear, but either way it is an important finding. Certainly, leaves are useful, but although there do not appear to be ethnic differences in perception of the need for leaves or in the reasons for taking a leave, there are differences in who actually takes them: married, White women are particularly likely to take a leave under the Family and Medical Leave Act, while Black women and people with low incomes are least likely (Gerstel & McGonagle, 1999). In addition, Haley et al. (2001) found some negative consequences of longer maternal leaves by new mothers on the psychological well-being of both mothers and fathers, and suggest that this may be due to the leave’s effect in suggesting that the mother is primarily responsible for childcare. Leaves need to be supplemented by supportive norms that encourage people to combine work and family at the same time, rather than just taking time off from one to engage with the other. Haley et al. found strong relationships between perceived support from supervisors and coworkers and reduced distress and anxiety among first-time mothers. Not all women have equal access to the kinds of workplaces that promote a healthy interaction between family and career. Although combining work and family is no longer something that distinguishes women from different class or ethnic backgrounds, the ability to do so without being overwhelmed may be. Sexual orientation is particularly relevant to the ability to effectively combine work and family. With discrimination still legal, and domestic partner benefits the exception rather than the rule, lesbians are not only ineligible for some benefits for their families but may perceive little support in their workplaces to even discuss their family stresses and accomplishments. The best workplace will combine supportive policies with supportive norms, through an atmosphere that is open to discussing the challenges and encouraging of flexibility in attempts to meet those challenges.

Work and Status: Women as Leaders Women are working, but they are not leading. Occupational segregation has declined in the past few decades, but women are still seriously underrepresented in positions of leadership, and particularly in roles that entail authority over other people (Killeen, Lopez-Zafra, & Eagly, 2006). This is especially true for women of color. They do best in politics: of the 81 (15.1%) women currently

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in Congress, 20 (24.7%) are women of color; of the 1683 women in state legislatures, 331 (19.6%) are women of color (Center for American Women in Politics, 2006). In the overall workforce, however, 35.2% of those in management occupations are women, but only 6.3% are Black, Asian, or Latina. Among White officials and managers, 34% are female; similarly, 36% of Latino managers and 36% of Asian managers are female. A full 48% of Black managers are female, but this reflects the higher number of Black women than Black men in the workforce (Equal Employment Opportunity Commission, 2006). Why are women so scarce among the political and financial leadership of this country? Do women make different career choices in order to look after their families? Eagly and Carli (2004) reviewed four possible explanations for the gender disparity in leader emergence: differences in human capital, differences in motivation, different styles, and discrimination. They found insufficient support for the first two explanations, but evidence for the final two. Different career choices do not explain the gender gap. Women and men do not differ in their desire for achievement (Hyde & Kling, 2001). To find the key to puzzle of women and leadership, one must look at the attitudes of Americans toward what it means to be a good candidate for a job, a good worker, or a good leader (Crosby & Bearman, 2006). One must also consider sexist attitudes that derogate the abilities of women. A major factor in explaining the gender disparity is stereotyping. It has repeatedly been shown that the image of a leader or a manager is the image of a man rather than a woman; this has been found across the decades and in a number of different countries (Gutek, 2001; Powell, Butterfield, & Parent, 2002; Schein, 2001). In a 2002 study, Powell et al. surveyed both undergraduate students and MBA students and found that, although there had been some changes over time, both groups still believed that a good manager had characteristics that are more strongly associated with men than with women. The effect of this stereotype can be a tendency to evaluate women leaders more harshly than their male counterparts, and to give them fewer opportunities to succeed. Based on a review of research, Eagly and Karau (2002) conclude that both of these processes operate. There has not been enough research on the ways in which ethnicity interacts with gender in work-related stereotypes, but the research that does exist suggests there may be differences. Lott and Saxon (2002) found that judgments about a woman were affected in complex ways by both ethnicity and social class. Pratto and Espinoza (2001) assessed college students’ responses to resumes that were purportedly from men and women of White, Black, or Hispanic heritage. The students differentially “hired” the job applicants into hierarchy-enhancing or hierarchy-attenuating roles based on an interaction between applicant ethnicity and gender. The belief that women don’t have the attributes of good leaders affects women as well as men. Work on stereotype threat (e.g., Steele, 1997) reminds us that stereotypes are prescriptive as well as descriptive; women who are aware of the stereotype may be less likely to aim for careers in which they will be leaders. In a 2005 study by Davies, Spencer, and Steele, women who were exposed to female gender stereotypes through television commercials expressed less interest in leadership positions than did men, or women who saw neutral commercials. Lips (2001) has found that women see leadership roles as being less possible than men do, so they may be less likely to invest

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the effort required to pursue such a career. In some cases, the women also see leadership roles as less appealing, because they anticipate relationship problems resulting from their pursuit of high-powered careers. This pattern may begin early on, with female students making choices about courses and majors based on their expectations for success in a given field and the perceived value of succeeding in that field (Eccles, 1994). We are not aware of any studies that specifically looked at differences among ethnic groups in the United States. Several studies, however, have examined gender differences in perceptions of leadership role among different cultural samples. Lips (2001) compared college students from Virginia with a similar sample from Puerto Rico. She found that, overall, women were more likely to anticipate relationship problems associated with leadership roles than were men, but that Virginia women in particular were more negative about the leadership roles than were the Puerto Rican women. Lips speculated that this may reflect the distinctive nature of femininity in U.S. Southern culture, where it may be viewed as incompatible with leadership in a way that is not true for femininity in Puerto Rico. Killeen et al. (2006) compared women in two countries that were expected to have different perceptions of the relationship between gender and leadership, the United States and Spain. The proportion of managers and CEOs who are women is significantly smaller in Spain than in the United States, as is the ratio of female to male earned income. Killeen et al. asked men and women to envision themselves as a CEO, vice-president, or midlevel manager in either a stereotypically male or a stereotypically female industry. Results show that men and women perceived leadership roles as equally positive in the United States, but Spanish women saw them as less positive than did Spanish men. In both countries the men tended to rate the leadership roles as more possible than the women did. Men also perceived more positive impacts of the roles on interpersonal relationships than did women. Perceived impact on personal relationships was the strongest predictor of rated possibility of a leadership role. More important than the culture of the country was the culture of the occupation: women tended to expect a more positive job environment in a feminine industry (clothing) than in a masculine one (autos). This is consistent with the finding, cited earlier, that women may experience lower job satisfaction in a male-dominated workplace (e.g., Kennedy & Lawton, 1992; Long, 1998; Simpson, 1997). Notably, this was not true for the highest-status position; apparently women thought if their positions were important enough they would not be confined by the stereotypes of others. Previous research has found that subordinates are more affected by stereotypes than are superordinates (Gutek, 2001). Women’s expectations that leadership may have negative consequences are not unfounded. A number of studies have shown that women who seem too powerful may be disliked (Carli, 2001), although women who are too nice may also be discredited (Rudman & Glick, 2001). Rudman (e.g., Rudman & Fairchild, 2004) has looked at the social consequences of gender deviance, and has found both that people can be socially punished and stigmatized when they fail to conform to gender stereotypes, and that fear of this social stigma can lead people to disguise the ways in which they deviate from the gender norms.

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If qualified women have an equivalent desire for achievement to men, but recognize that there are potential negative consequences of leadership, what can they do? One possibility is for them to develop a leadership style that is not inconsistent with gender stereotypes. Eagly and her colleagues (e.g., Eagly, Johannesen-Schmidt, & van Engen, 2003) have conducted extensive investigations into the question of whether women have a different leadership style than men. Leadership theorists have distinguished transformational and transactional leaders; the former focuses on developing their organization and the potential of their subordinates, while the latter are more concerned with making sure their subordinates meet objectives. Transformational leadership is perceived to be more consistent with female stereotypes than is transactional leadership. A meta-analysis by Eagly et al. confirmed that female leaders demonstrated a more transformational leadership style than did male leaders, and in particular scored higher on charisma, idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration (although it is important to note that the effect sizes were small). They were also higher on contingent reward, an aspect of transactional leadership. In the studies that measured outcomes, female leaders tended to produce better outcomes. Notably, the studies included in the meta-analysis were based not on student samples but on people who were actually in organizational leadership roles. Eagly et al. speculate that the effect may be due to several factors, including women’s attempt to succeed without violating gender norms and the tendency to evaluate women leaders more critically, so that those who remain are exceptionally capable. When contemplating the future for women’s leadership at work, it is important to think not just about how women need to change in order to become leaders but how the context can change to better facilitate women’s leadership (e.g., Eagly & Carli, 2007). Gender balance in the workplace will help, so that women do not feel like tokens. In addition, Eagly and Karau (1991) note that women are more likely to emerge as leaders when tasks are socially complex and involve groups larger than dyads, working together over a long term. Yoder, Schleicher, and McDonald (1998) found that training alone did not increase female leaders’ effectiveness; they needed also to be legitimized by a male authority figure. Yoder (2001) has examined this issue extensively and suggests that organizations need to make clear that women are legitimate and provide them with the resources they need. Beyond that, women are likely to find less-hierarchical contexts more supportive. Social support is particularly important for women in leadership positions, who are less likely to be effectively mentored than are men (Gutek, 2001; Hite, 2004), and for women of color, who may be isolated from both gender and ethnic support networks (Bailey, Wolfe, & Wolfe, 1996; Hite, 2004).

The Persistent Problem: Gender Discrimination and Its Effects Lack of support in the workplace, and outdated policies predicated on a traditionally gendered division of labor, may be considered to be sources of passive discrimination. Active discrimination also still exists, despite laws and

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regulations put into place to address the issue (Crosby, Stockdale, & Ropp, 2007). In 1986, the Supreme Court of the United States delivered a landmark decision on the case, Price Waterhouse vs. Hopkins. In this case, Ann Hopkins, a senior manager with the accounting firm Price Waterhouse, successfully demonstrated to the Court that she had been denied a partnership on the basis of her sex. With support from social psychologist Susan Fiske, Ms. Hopkins showed that it was her gender stereotype-inconsistent behavior—not being especially warm and nurturing—and not her actual performance that influenced evaluations of her ability to be partner (Fiske, Bersoff, Borgida, Deaux, & Heilman, 1991). Discrimination may take many forms, including restricted access to desirable assignments and promotions, biased performance evaluations, and more subtle interpersonal behaviors. Women may be excluded, for example, from important social networks. Vescio, Gervais, Snyder, and Hoover (2005) showed experimentally that men who were encouraged to engage in stereotyping were likely to withhold organizational resources from female subordinates in a work context. Women also performed less well than men when they were devalued, but when they were not devalued they performed at equally high levels. Discrimination is still a problem, and one which may have a disproportionate impact on women of color. In one study, nearly 30% of workers from stigmatized groups reported being discriminated against in terms of hiring, firing or promotion (Kessler, Mickelson, & Williams, 1999). Although most studies of discrimination focus on either gender or ethnicity, Weber and Higginbotham (1997) interviewed a matched sample of Black and White women managers to examine their experiences of both. Black women were not only more likely to perceive discrimination against Black people in the workplace (68% compared to 29%), they were also more likely to report gender discrimination (74% compared to 56%) than were White women. 42% of Black women and 25% of White women felt they had personally experienced unfair treatment, when thinking about themselves as either women or Black women (p. 169). Among those who perceived it, Black and White women were equally likely to mention four categories of gender discrimination (in order of frequency): (a) treatment as inferior based on sexist stereotypes, (b) hiring and promotion discrimination, (c) need to prove themselves, and (d) lower salaries or compensation. Sexual harassment was mentioned by only a few women. Black women were more likely to mention differences in work assignments and responsibilities compared to White women (Weber & Higginbotham, 1997). We can look at both the numbers of women and minority workers in management or executive positions, at rates of pay, and at self-report studies on perceived discrimination for estimates of the degree to which discrimination is a problem in the workplace. Pay discrimination is one of the most obvious and objective measures of sex discrimination. It is well documented that American women earn less than their male counterparts, approximately 77% of what men earn on an annual basis (Institute for Women’s Policy Research, 2007). Women of color fare even worse than White women. For example, according to the most current data, the wage ratio between Black women and White men is 69%, and the greatest wage ratio is between Hispanic women and White men at 59% (Institute for Women’s Policy Research, 2004). Pay discrimination has an effect on weekly pay and the ability of women to take care of themselves and

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their families. Pay discrimination also has a cumulative effect, such that the AFL-CIO estimates that over her lifetime, the average 25-year-old woman will earn $450,000 less than a man (2006). Therefore, pay discrimination continues to affect women once they retire and have less money per month from Social Security (which is based, in part, on lifetime earnings) and from pension plans. Pay discrimination is so normalized that women expect they will make less money than men. Keaveny and Inderrieden(2000) found that women reported lower pay expectations than men, women expect lower pay raises than men, and women reported greater satisfaction with their current pay compared to men, despite the fact they reported making less money than men. Women may also expect lower pay than men because they believe they deserve less compensation than men, an explanation that has been referred to as depressed entitlement (Major, 1994). This explanation takes into account social structural elements related to gender and pay, such as status. Women perceive themselves as having lower social status,’ they then perceive their work as being less valuable so they demand and expect lower wages, and they view wage differences as being justified because of their lower status compared to men. However, in a study by Hogue and Yoder (2003), when status differences between men and women were diminished, women expect higher compensation, indicating that the depressed entitlement effect is not unavoidable. In addition to its direct economic impact, discrimination in the workplace can have negative effects on one’s physiological and psychological well-being. Din-Dzietham, Nembhard, Collins, and Davis (2004) found that perceived discrimination was associated with higher levels of hypertension and bloodpressure in a sample of African American participants. Other studies that have looked at physical health have also found that higher levels of perceived discrimination are associated with negative health outcomes such as limited mobility (Pavalko, Mossakowski, & Hamilton, 2003). In terms of psychological consequences, perceived discrimination has been linked with higher levels of depression and anxiety and lower levels of psychological well-being (Gee, 2002). Perceived sex discrimination has also been shown to be related to stress, an important indicator of psychological and physiological well being. For example, the Schedule of Sexist Events (SSE; Klonoff & Landrine, 1995), which measures perceptions of sexist discrimination in women, is correlated with measures of stressful events. Also, the Sexist Discrimination in the Workplace subscale of the SSE has been shown to be related to organization self-esteem, such that women who report more sexist events have lower organization-based self-esteem (Yoder & McDonald, 1998). In a longitudinal study of over 1700 working women, Pavalko et al. (2003) examined the relationship between perceived discrimination and health outcomes. Perception of discrimination was a reliable predictor of subsequent emotional and physical health, even when controlling for prior health status. The results of this study suggest that, even when we take into account a woman’s emotional and physical health status when she starts a job, experiencing discrimination in the workplace can have a negative influence on her overall well-being. One might think that members of two stigmatized groups, a woman and a person of color, might be more likely to suffer negative outcomes from discrimination than someone with only one stigmatized group membership.

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From one perspective, women of color are more likely to have perceived discrimination throughout their lives, so it is possible that they have developed more coping skills for dealing with everyday discrimination. In a comparison of European American and African American women, Pavalko et al. (2003) found that in Whites, discrimination was associated with distress, but not with physical health. For Black women, just the opposite pattern was found; perceived discrimination was associated with physical health but not distress. The findings from this study suggest that Black women have devised emotional coping strategies for dealing with discrimination, probably as the result of being more familiar with racism. White women, however, experience more immediate distress as a response to discrimination. For these women, experiencing discrimination in the workplace is likely to be a new event, so they have not yet developed strategies for dealing with this stress. From a different perspective, the context of the workplace itself probably influences the ability of women of color to cope with the stress from perceived discrimination. Specifically, women of color who are numerically underrepresented or are considered to be a “token” representative of their ethnic group within an organization might experience greater levels of stress and negative outcomes as a result of perceived discrimination. Women of color who are numeric minorities might be viewed by their coworkers as beneficiaries of affirmative action and viewed as less competent than their White counterparts. The strain of being the lone representative for one’s ethnic group and the fear of confirming negative stereotypes about one’s group might have an influence on psychological well-being and job performance. Lord and Saenz (1985) found that participants in a laboratory study who were the numerical minority in a simulated work-group situation and were made aware of their difference from the majority group demonstrated poorer memory and taskperformance skills than participants who were in the majority. If women of color in management positions also have solo status, as might be expected, and those women perform poorly because of the stress due to this status, then the second guessing of these women’s competence and deserved position will only serve to undermine their confidence even more. The examination of discrimination experiences of women of color illustrates the complexity of the relationship between different social identities, such as ethnicity and gender. West and Fenstermaker (1995) argue that social identities, such as gender, race, and class, are more meaningfully thought of as being “accomplished in interaction with others” (p. 23). They advocate thinking about the context in which individuals experience group memberships as a way to understand the interactional influence of multiple group memberships, instead of simply thinking about individuals as members of different groups. Indeed, reconceptualizing group memberships within social situations might help to explain why some women are more attuned to situations of subtle sex and race discrimination (Benokraitis, 1997). Or, it might help to explain why some women might be more affected than others by gender stereotypes, such as in stereotype threat research (Sekaquaptewa & Thompson, 2003). In sum, discrimination still exists, partly in gender stereotypes held by both men and women that undermine women’s abilities to advance in the working world. The profound effects of gender discrimination, compounded for many with discrimination on the basis of ethnicity or sexual orientation,

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pervade all aspects of working women’s lives: financial, social, and physical. Active attention and intervention is required to nullify this problem.

Toward Solutions: Affirmative Action Given that discrimination, past and present, has interfered with women initially finding their way into the pipeline and eventually moving into positions of leadership, it is obvious that steps must be taken to counter the present effects of past discrimination and to reduce continuing forms of discrimination. Structural change is needed. One way to produce situational change is through affirmative action. Affirmative action occurs whenever an organization goes out of its way to assure that individuals of both genders and all ethnic groups are treated equitably, not just in hiring but also in promotion and advancement (Crosby, 2004). It differs from passive equal opportunity in a number of ways (Crosby, 1994). With equal opportunity, the assumption is that fairness is the default option, so that discrimination, when it occurs, is intentional and easy to spot. With affirmative action, the assumption is that unfairness may exist, even when no one presently intends for it to exist, so that organizations need to be vigilant. Affirmative action also assumes that many little injustices may go unnoticed, even by those who are disadvantaged, but yet may add up to major imbalances (Crosby, Iyer, Clayton, & Downing, 2003). Affirmative action is the only form of remediation of injustice in the American legal system that does not require that the parties bringing a complaint have”standing,” meaning that they have to have been personally harmed. Thus, although one can invite one’s sister or one’s neighbor to join with oneself in a legal action, one cannot bring a law suit on behalf of one’s sister or neighbor, only on behalf of oneself. In contrast, affirmative action does not have to rely on the aggrieved to come forward on their own behalf (Crosby et al., 2003). Much is gained by not relying on the aggrieved because, as a large literature now shows, most people imagine that they are not personally harmed by situations that they know to harm others in their membership group (Clayton & Crosby, 1992). Thus, for example, women who are discriminated against often imagine that they are not subject to discrimination, even when they acknowledge that sex discrimination is a powerful force generally (Crosby, 1982). Clearly, affirmative action enables structural changes that reside at the heart of efforts to diminish sex discrimination.

How Affirmative Action Operates Affirmative action has been in existence in the United States since the 1960s. The policy has been subjected again and again to legal challenge (Crosby & Smith, 2007; Smith & Crosby, 2007; Spann, 2000), and as a result has undergone some modifications. As Reskin (1998) has noted, there are three distinguishable forms of affirmative action in employment: court-ordered, contractual, and voluntary. Court-order, affirmative action occurs as a result of lawsuits in which the plaintiffs have been able to prove that an organization severely discriminated against a class of persons and in which part of the remedy is reform in the organization. In recent years, court-ordered

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affirmative action plans have not been a conspicuous feature of the American legal landscape. More consequential is contractual affirmative action, started in 1965 by Lyndon Johnson. Executive Order (EO) 11246 states that the federal government, with its three million employees, and any contractor of the federal government above a certain size (50 employees) doing more than a “certain amount of business” with the government ($50,000) must be an affirmative action employer. Firms that do not wish to be affirmative action employers are free to so refrain, as long as they do not actively discriminate and as long as they do not conduct business with the federal government. It is estimated that about one-quarter of the civilian work-force in America is subject to the law of EO 11246. Most of the nation’s largest employers have government contracts as do many smaller concerns. What does it mean to be an affirmative action employer in the eyes of EO 11246? The first step of the plan is to engage in self-monitoring according to a prescribed methodology. One section of the Code of Federal Regulations spells out in detail how organizations are to engage in the self-monitoring process. The gist is that the organization is to compare its utilization of people in the targeted classes (i.e., women if looking at gender; and African Americans, Hispanic Americans, Asian Americans, and Native Americans if looking at the dimension of race or ethnicity) with the availablility of people in the targeted classes for specified job classifications. Availability can be calculated in a number of ways so long as it reasonably takes into account the issues of measurable job qualifications and geographic reach. An example may demystify the process. Picture a research university. Virtually all major research universities in the United States hold contracts with the federal government in excess of $50,000; and so they are all affirmative action employers. Universities employ individuals in a variety of different jobs categories. For each category, they need to count the number of women who are employed and compare this number against the projected availability for women in the specific job category. To project availability, they must take cognizance of the skills or training required for the job and also note the reach of the hiring area. Typically, for the professoriate, job candidates are sought nationally (or internationally) and the minimum qualifications include an advanced degree like a Ph.D. or an M.D. But for administrative assistants, it is typically assumed that a high school diploma or some college is the minimum educational credential, and the job candidates are presumed to come from a 35-mile radius of the school. To calculate the availability of women for the professoriate, the affirmative action office would generally consult national sources pertaining to the production of PhDs. To calculate the availability of women for administrative assistant jobs, census data would be consulted. When a discrepancy exists between the estimated availability and the actual incumbency figures, the organization is required to make a good-faith effort to close the gap. Goals and time-tables are legal and appropriate; but it is neither appropriate nor legal to set quotas or to trammel on the interests of White men by excluding them from hiring pools. Typical plans for correction include outreach, enhanced training of hiring personnel, and well-specified tie-breaking procedures. An organization that underutilizes women might, for example, declare that if there is a woman candidate among the top three

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qualified candidates, she will be offered the job first. Organizations that consistently fail to make good-faith efforts to remediate documented imbalances are subject to fines and to disbarment as a federal contractor. Disbarment rarely occurs. In addition to the many contractual affirmative action employers, there are many voluntary affirmative action employers. Voluntary affirmative action plans that follow the format of contractual plans are entirely legal. No institution is charged with keeping track of voluntary employers. Yet, officials at the Office of Federal Contract Compliance Programs (OFCCP), the governmental institution that oversees the implementation of EO 11246, are eager to offer help and advice to firms that wish to establish procedures that are both legal and effective.

Effectiveness of Affirmative Action Many social scientists are dubious about the effects of affirmative action, and some see the policy as downright harmful to its intended beneficiaries. A review of the empirical literature reveals, however, that affirmative action in employment and education has generally had positive effects for its beneficiaries and for the organizations that have strong affirmative action plans (Crosby, 2004, chapter 4). By comparing the situation of women employed by federal contractors with the situation of women employed by other firms in equal sectors of the market, economists (e.g., Leonard, 1996) have calculated that EO 11246 has increased the number of women who are employed and contributed to their rates of promotion and their level of pay. A considerable amount of scholarship has gone into studies that purport to show how affirmative action undermines the self esteem and feelings of competence of its intended beneficiaries. Although the preponderance of the evidence shows that undermining occurs rarely and only under very constrained circumstances, the textbooks insist on reporting the undermining effects without noting how very unusual they are (Crosby & Bearman, 2006).

Attitudes Toward Affirmative Action There is a voluminous literature on attitudes toward affirmative action (Crosby, 2004; Crosby, Iyer, & Sinchareon, 2006; Harrison, Kravitz, Mayer, Leslie, & Lv-Arey, 2006; Kravitz, Harrison, Turner, Levine, Chaves, Brannick, Denning, Russell, & Conrad, 1997). Harrison et al. and Kravitz et al. distinguish between two types of factors that may influence attitudes toward affirmative action: (a) factors pertaining to the people holding the attitudes, and (b) factors associated with the programs. Of course, some Americans endorse affirmative action more strongly than others (Crosby et al., 2006; Harrison et al., 2006). More educated people like affirmative action better, on average, than do people with less education. Liberals like affirmative action better than conservatives. Women and people of color like affirmative action better than men and White people. People who perceive the persistence of discrimination tend to endorse the policy, especially if they have a devotion to meritocracy; and people who imagine that

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discrimination no longer operates tend to oppose the policy, again especially if they have a devotion to meritocracy (Son Hing, Bobocel, & Zanna, 2002). The type of policy also makes a difference. Throughout the United States, soft forms of affirmative action such as outreach are more popular than more solid forms such as tie-break hiring (i.e., hiring the woman when a male and a female candidate are deemed to be equivalent). The more individualistic, the more popular the program; and the more group-based, the less popular. Group-based practices have been repeatedly challenged, and sometimes restricted, in court cases. A cross-national study gives insight into how the American attachment to individualism colors reactions to affi rmative action (Ozawa, Crosby, & Crosby, 1996). The study presented a set of Japanese women and men and a set of American women and men with a description of a fictitious company that was said to have discriminated against women in terms of hiring. The American women were moderately outraged by the company’s actions; the American men and the Japanese women were somewhat outraged; and the Japanese men were not at all outraged. All four groups were presented with a variety of possible remedies, including the equal opportunity remedy of making sure that the company hired the best people, regardless of their gender. Of special interest were the reactions to a remedy that, although not labeled as such, could have been dubbed the affi rmative action remedy. This remedy worked by making sure that a certain percentage of the people hired were women, assuming they were qualified for the jobs. Although the Americans were much more upset than the Japanese about the discrimination, they were much less willing than the Japanese to endorse group-based remedies for the problem. The Americans also scored higher than the Japanese on a measure of individualism while the Japanese scored higher than the Americans on collectivism. There are different ways to conceptualize affirmative action, and the different conceptualizations provoke different reactions. One factor that affects support for affirmative action is the conceptualization of the beneficiary group. Clayton (1996) found that support for programs that benefit women was greater than for those designed to support ethnic minorities, showing the importance of group-based attitudes in affecting opinions that are ostensibly based on an evaluation of the policy. Affirmative action can be described as a means for punishing those who had enjoyed special privilege, in which case endorsement of the policy among nonminority students is associated with White guilt. When one conceives of the policy in more neutral (and veridical) terms, the association disappears. Mischaracterizations of the policy, which are not infrequent, may explain why affirmative action is not always embraced, even by justice-loving Americans (Crosby, 2004). Yet affirmative action policies may be particularly crucial in helping women who are in the workforce to continue to advance into leadership positions. As long as we are attached to the idea that all achievement is individually produced and that advancements are to reflect individual achievements, we will be disturbed by the policy of affirmative action (Bowen & Rudenstine, 2003); and as long as we cling to such an idea, we will not change the status quo.

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Attitudes and Policies Negative attitudes toward affirmative action impair its effectiveness in combating gender discrimination. Why is affirmative action so threatening? There are several reasons. It is complicated and thus challenges the desire for simple justice (Vescio, Cuddy, & Crosby, 2008). It exposes the lie that there are no group-based differences that affect people’s access to rewarding work. It tacitly questions our attachment to individualism, in part because it places responsibility on the workplace and workplace policies rather than on the individual worker to remedy the problems of discrimination. For affirmative action to continue to work effectively, we need also to change our mindset to rethink not only our ideas about women and men but also our ideas about the ways in which workplaces respond to social needs. Soon one half of America’s workers will be women. If organizations, and the country in general, want to maximize the return on human capital, they need policies that will encourage the full realization of individual women’s potential as workers, parents, and leaders.

Conclusion: Directions for Policy and Research To understand women’s experience with work, and to make continued progress toward gender equity, we need to consider both attitudes and policies. The research reviewed above shows that biased attitudes toward women, based on gender stereotypes, hamper women’s attempts to balance work and family and to achieve high status positions in their careers. This bias does not reside only in sexist employers or coworkers, but is represented in pervasive cultural norms about the appropriate roles for women. Proactive workplace policies, which acknowledge the difference in the way men and women are situated as workers, are necessary to combat these gender attitudes. Such policies can include a clear statement of nondiscrimination, support for combining work and family, mentoring programs to train women for leadership positions, and affirmative action to bring more women into nontraditional careers. In addition, the policies need to address the multiple possible sources of bias, from gender stereotypes to racism and assumptions of heterosexuality. In writing this chapter, we have frequently confronted the dearth of research that explicitly addresses the way in which multiple social categories combine to affect the experience of working women. Just as researchers in the 60s and 70s made generalizations about all people while only studying men, so researchers today often make generalizations about women that ignore the experiences of different subgroups. There is a particular need for research that examines stereotypes about women of different ethnicities, social class, or sexual orientation as they are reflected in reactions to women leaders or in attitudes toward affirmative action policies. Both policy and research need to become more adept at attending to difference. A more nuanced awareness of the significance associated with difference between men and women as well as between different subgroups of women may, paradoxically, encourage the differentiation that will help to break down monolithic conceptions of gender.

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References AFL-CIO (n.d.). It’s time for working women to earn equal pay. Retrieved November 17, 2006, from http://www.aflcio.org/issues/jobseconomy/women/equalpay/. Allen, W. R., Epps, E. G., Guillory, E. A., Suh, S. A., & Bonous-Hammarth, M. (2000). The Black academic: Faculty status among African Americans in U.S. higher education. Journal of Negro Education, 69, 112–127. Alliance for Work-Life Progress (2005). What happens when employees enjoy flexible work arrangements? They are happy and more productive. Retrieved January 1, 2006, from http://www.awlp.org/pub/fortune-section-05.pdf Bailey, D., Wolfe, D., & Wolfe, C. R. (1996). The contextual impact of social support across race and gender: Implications for African American women in the workplace. Journal of Black Studies, 26, 287–307. Barnett, R. C. (2002). Dual-earner couples: Good/bad for her and/or him? In D. Halpern & S. Murphy (Eds.). From work-family balance to work-family interaction (pp. 151–172). Mahwah, NJ: Erlbaum. Barnett, R. C., & Hyde, S. J. (2001). Women, men, work, and family: An expansionist theory. American Psychologist, 56, 781–796. Baxter, J., Lynch-Blosse, M., & Western, J. (1996). Gender differences in work satisfaction. Australian Journal of Social Issues, 31, 291–309. Benokraitis, N. V. (1997). Sex discrimination in the twenty-fi rst century. In N. V. Benokraitis (Ed.), Subtle sexism (pp. 5–33). Thousand Oaks, CA: Sage. Bettencourt, L. A., & Brown, S. W. (1997). Contact employees: Relationships among workplace fairness, job satisfaction and prosocial service behaviors. Journal of Retailing, 73, 39–61. Bianchi, S. M., Robinson, J. P., & Milkie, M. A. (2006). Changing rhythms of American family life. New York: Russell Sage Foundation. Bond, G. T., Galinsky, E., Kim, S. S., & Brownfield, E. (2005). The 2005 national study of employers. New York: Families and Work Institute. Bowen, W. G., & Rudenstine, N. L. (Feb 7, 2003). Race-sensitive admissions: Back to basics. The Chronicle of Higher Education, B7– B10. Bridges, J. S., & Etaugh, C. (1996). Black and White college women’s maternal employment outcome expectations and their desired timing of maternal employment. Sex Roles, 35, 542–562. Bridges, J. S., & Orza, A. M. (1996). Black and White employed mothers’ role experiences. Sex Roles, 35, 377–385. Buchanan, T. (2005). The paradox of the contented female worker in a traditionally female industry. Sociological Spectrum, 25, 677–713. Carli, L. L. (2001). Gender and social influence. Journal of Social Issues, 57, 725–241. Catalyst 20. (2002). Making change: Creating a business case for diversity. New York: Catalyst. Catalyst 20. (2004). The bottom line: Connecting corporate performance and gender diversity. New York: Catalyst. Center for American Women in Politics, Retrieved October 6, 2006, from www.rci.rutgers. edu/~cawp Clayton, S. (1996). Reactions to social categorizations: Evaluating one argument against affirmative action. Journal of Applied Social Psychology, 26, 1472–1493. Clayton, S. (2005). Jobs with justice. Social Justice Research, 18, 465–480. Clayton, S., & Crosby, F. (1992). Justice, gender and affirmative action. Ann Arbor, MI: University of Michigan Press. Coltrane, S., & Adams, M. (2001). Men’s family work: Child-centered fathering and the sharing of domestic labor. In R. Hertz & N. N. L. Marshall (Eds.), Working families: The transformation of the American home. (pp. 72–99). Berkeley, CA: University of California Press. Crittenden, A. (2001). The price of motherhood. New York: Metropolitan Books. Crosby, F. F. J. (1982). Relative deprivation and working women. New York: Oxford University Press. Crosby, F. F. J. (1994). Understanding affi rmative action. Basic and Applied Social Psychology, 15, 13–41.

577

578


Crosby, F. F. J. (2004). Affirmative action is dead; Long live affirmative action. New Haven, CT: Yale University Press. Crosby, F. F. J., & Bearman, S. (2006). The uses of a good theory. Journal of Social Issues, 19, 413–437. Crosby, F. F. J., Biernat, M., & Williams, J. (2004). The maternal wall: Introduction. Journal of Social Issues, 60, 675–682. Crosby, F .F. J., Iyer, A., Clayton, S., & Downing, R. (2003). Affirmative action: Psychological data and the policy debates. American Psychologist, 58, 93–115. Crosby, F. F. J., Iyer, A., & Sinchareon, S. (2006). Understanding affi rmative action. Annual Review of Psychology, 57, 585–611. Crosby, F. F. J., & Smith, A. A. E. (2007). The University of Michigan Cases: Social scientific studies of diversity and fairness. In R. R. L. Weiner, B. Bornstein, R. Schopp, & S. Willborn (Eds.), Legal decision making in everyday life: Controversies in social consciousness. New York: Springer. Davies, P. P. G., Spencer, S. J., & Steele, C. C. M. (2005). Clearing the air: Safety moderates the affects of stereotype threat on women’s leadership aspirations. Journal of Personality and Social Psychology, 88, 276–287. Day, N. N. E., & Schoenrade, P. (2000). The relationship among reported disclosure of sexual orientation, anti-discrimination policies, top management support and work attitudes of gay and lesbian employees. Personnel Review, 29, 346–363. Deutsch, F. F. M. (1999). Having it all: How equally shared parenting works. Cambridge, MA: Harvard University Press. Din-Dzietham, R., Nembhard, W.W. N., Collins, R., & Davis, S. S. K. (2004). Perceived stress following race-based discrimination at work is associated with hypertension in African Americans. The metro Atlanta heart disease study, 1999–2001. Social Science and Medicine, 58, 449. Driscoll, J. J. M., Kelley, F. F. A., & Fassinger, R. R. E. (1996). Lesbian identity and disclosure in the workplace: Relation to occupational stress and satisfaction. Journal of Vocational Behavior, 48, 229–242. Eagly, A., & Carli, L. (2004). Women and men as leaders. In J. Antonakis, A. Cianciolo, & R. Sternberg (Eds.), The nature of leadership (pp. 279–301). Thousand Oaks, CA: Sage. Eagly, A., & Carli, L. (2007). Through the labyrinth: The truth about how women become leaders. Cambridge, MA: Harvard Business School Press. Eagly, A., Johannesen-Schmidt, M. M. C., & van Engen, M. M. L. (2003). Transformational, transactional, and laissez-faire leadership styles: A meta-analysis comparing women and men. Psychological Bulletin, 129, 569–591. Eagly, A., & Karau, S. S. J. (2002). Role congruity theory of prejudice toward female leaders. Psychological Review, 109, 573–598. Eccles, J. S. (1994). Understanding women’s education and occupational choices. Psychology of Women Quarterly, 18, 585–610. Equal Employment Opportunity Commission. Retrieved November 12, 2006, from www. eeoc.gov/stats/jobpat/2003/national.html England, P., Garcia-Beaulieu, C., & Ross, M. (2004). Women’s employment among Blacks, Whites, and three groups of Latinas: Do more privileged women have higher employment? Gender & Society, 18, 494–509. Fiske, S. S. T., Bersoff, D. D. N., Borgida, E., Deaux, K., & Heilman, M. M. E. (1991). Social science research on trial: Use of sex stereotyping research in Price Waterhouse v. Hopkins. American Psychologist, 46, 1049–1060. Friedman, S. S. D., Christensen, P., & deGroot, J. (1998). Work and life: The end of the zerosum game. Harvard Business Review, 76, 119–129. Galinsky, E. (2001). A new view of work and family life. In R. Hertz & N. N. L. Marshall (Eds.), Working families: The transformation of the American home (pp. 168–186). Berkeley: University of California Press. Gatmon, D., Jackson, D., Koshkarian, L., Martos-Perry, N., Molina, A., & Patel, N., et al., (2001). Exploring ethnic, gender, and sexual orientation variables in supervision: Do they really matter? Journal of Multicultural Counseling and Development, 29, 102–113. Gerstel, N., & McGonagle, K. (1999). Job leaves and the limits of the Family and Medical Leave Act: The effects of gender, race, and family. Work and Occupation, 26, 510–534.

Chapter 20


Gutek, B. B. A. (2001). Women and paid work. Psychology of Women Quarterly, 25, 379–393. Haley, H. L., Perry-Jenkins, M., & Armenia, A. (2001). Workplace policies and the psychological well-being of first-time parents: The case of working-class families. In R. Hertz & N. N. L. Marshall (Eds.), Working families: The transformation of the American home (pp. 227– 250). Berkeley: University of California Press. Harrison, D. D. A., Kravitz, D. D. A., Mayer, D. D. M., Leslie, L. L. M., & Lv-Arey, D. (2006). Understanding attitudes toward affirmative action programs in employment: Addressing reactions to redressing discrimination. Journal of Applied Psychology, 91, 1013–1036. Hite, L. L. M. (2004). Black and White women managers: Access to opportunity. Human Resource Development Quarterly, 15, 131–146. Hyde, J. J. S., & Kling, K. K. C. (2001). Women, motivation, and achievement. Psychology of Women Quarterly, 25, 364–378. Institute for Women’s Policy Research. (2004). The status of women in the states. Retrieved December 1, 2006, from http://www.iwpr.org/States2004/SWS2004/index.htm John, D., Shelton, B., & Luschen, K. (1995). Race, ethnicity, gender, and perceptions of fairness. Journal of Family Issues, 16, 357–379. Kanter, R. R. M. (1977). Men and women in the corporation. New York: Basic Books. Keaveny, T. T. J., & Inderrieden, E. J. (2000). Gender differences in pay satisfaction and pay expectations. Journal of Managerial Issues, 12, 363–379. Kennedy, E., & Lawton, L. (1992). Men and women in industrial sales: Satisfaction and outcomes. Industrial Marketing Management, 21, 5–14. Kessler, R. R. C., Mickelson, K. K. D., & Williams, D. D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health & Social Behavior, 40, 208–230. Killeen, L. L. A., Lopez-Zafra, E., & Eagly, A. A. H. (2006). Envisioning oneself as a leader: Comparisons of women and men in Spain and the United States. Psychology of Women Quarterly, 30, 312–322. Kravitz, D. D. A., Harrison, D. D. A., Turner, M. M. E., Levine, E. E. L., Chaves, W., Brannick, M. T., et al. (1997). A review of psychological and behavioral research on affi rmative action. Industrial-Organizational Psychologist, 34, 141–149. Lennon, M. M. C., & Rosenfield, S. (1994). Relative fairness and the division of housework: The importance of options. American Journal of Sociology, 100, 506–531. Leonard, J. (1996). Wage disparities and affirmative action in the 1980’s. American Economics Review, 86, 285–289. Lips, H.H. M. (2001). Envisioning positions of leadership: The expectations of university students in Virginia and Puerto Rico. Journal of Social Issues, 57, 799–814. Long, B.B. C. (1998). Coping with workplace stress: A multiple-group comparison of female managers and clerical workers. Journal of Counseling Psychology, 45, 65–78. Lord, C.C. G., & Saenz, D.D. S. (1985). Memory deficits and memory surfeits: Differential cognitive consequences of tokenism for tokens and observers. Journal of Personality and Social Psychology, 49, 918–926. Lott, B., & Saxon, S. (2002). The influence of ethnicity, social class, and context on judgments about U.S. women. Journal of Social Psychology, 142, 481–499. Lundgren, L.L. M., Fleischer-Cooperman, J., Schneider, R., & Fitzgerald, T. (2001). Work, family, and gender in medicine: How do dual-earners decide who should work less? In R. Hertz & N.N. L. Marshall (Eds.), Working families: The transformation of the American home (pp. 251–269). Berkeley: University of California Press. Mau, W.C. & Kopischke, A. (2001). Job search methods, job search outcomes, and job satisfaction of college graduates: A comparison of race and sex. Journal of Employment Counseling, 38(3), 141–149. McLoyd, V., Cauce, A. A. M., Takeuchi, D., & Wilson, L. (2000). Marital processes and parental socialization in families of color: A decade review of research. Journal of Marriage and the Family 62, 1070–1093. Mikula, G. (1998). Justice in the family—Multiple perspectives on the division of labor: Introduction. Social Justice Research, 11, 211–213. Mor-Barak, M., & Levin, A. (2002). Outside of the corporate mainstream and excluded from the work community: A study of diversity, job satisfaction and well-being. Community, Work and Family, 5, 133–157.

579

580


Ozawa, K., Crosby, M., & Crosby, F. (1996). Individualism and resistance to affirmative action: A comparison of Japanese and American samples. Journal of Applied Social Psychology, 26, 1138–1152. Pavalko, E. K., Mossakowski, K.K. N., & Hamilton, V.V. J. (2003). Does perceived discrimination affect health? Longitudinal relationships between work discrimination and women’s physical and emotional health. Journal of Health and Social Behavior, 44, 18–33. Peccei, R., & Lee, H-J. (2005). The impact of gender similarity on employee satisfaction at work: A review and re-evaluation. Journal of Management Studies, 42, 1571–1592. Powell, G. G. N., Butterfield, D. D. A., & Parent, J. J. D. (2002). Gender and managerial stereotypes: Have the times changed? Journal of Management, 28, 177–193. Pratto, F., & Espinoza, P. (2001). Gender, ethnicity, and power. Journal of Social Issues, 57, 763–780. Price Waterhouse v. Hopkins, 109 S. Ct. 1775 19 (1989). Reskin, B. (1998). The realities of affirmative action in employment. Washington, DC: American Sociological Association. Rudman, L. L. A., & Fairchild, K. (2004). Reactions to counter stereotypic behavior. Journal of Personality and Social Psychology, 87, 157–176. Rudman, L. L. A., & Glick, P. (2001). Prescriptive gender stereotypes and backlash toward agentic women. Journal of Social Issues, 57, 742–762. Schein, V. V. E. (2001). A global look at psychological barriers to women’s progress in management. Journal of Social Issues, 57, 675–688. Schul, P. P. L., & Wren, B. B. M. (1992). The emerging role of women in industrial selling: A decade of change. Journal of Marketing, 56, 38–54. Sekaquaptewa, D., & Thompson, M. (2003). Solo status, stereotype threat, and performance expectances: Their effects on women’s performance. Journal of Experimental Social Psychology, 39, 68–74. Shauman, K. K. A., & Xie, Y. (1996). Geographic mobility of scientists: Sex differences and family constraints. Demography, 333, 455–468. Simpson, R. (1997). Masculinity at work: The experience of men in female dominated occupations. Work, Employment, and Society, 18, 349–368. Smith, A. A. E., & Crosby, F. F. J. (2007). From Kansas to Michigan: The path from desegregation to diversity. In G. Adams, M. Biernat, N. Branscombe, C. Crandall, & L. Wrightsman (Eds.), The social psychology of racism and oppression: Setbacks and advances since Brown v. Board of Education. Washington, DC: APA Books. Son Hing, L. L. S., Bobocel, D. D. R., & Zanna, M. M. P. (2002). Meritocracy and opposition to affirmative action: Making concessions in the face of discrimination. Journal of Personality and Social Psychology, 83, 493–509. Spann, G. G. A. (2000). The law of affirmative action: Twenty-five years of Supreme Court decisions on race and remedies. New York: New York University Press. Steele, S. (1997). A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist, 52, 613–629. Steil, J. J. M. (2000). Contemporary marriage: Still an unequal partnership. In C. Hendrick & S. S. S. Hendrick (Eds.), Close relationships: A sourcebook (pp. 125–152). Thousand Oaks, CA: Sage. Tolbert, P. P. S., Graham, M. M. E., & Andrews, A. A. O. (1999). Group gender composition and work group relations: Theories, evidence, and issues. In G. G. N. Powell (Ed.), Handbook of gender and work (pp. 179–202). Thousand Oaks, CA: Sage. U.S. Census Bureau. (2005). American community survey: Employment status. Retrieved January 22, 2007, from http://factfinder.census.gov/servlet/STTable?_bm=y&-geo_ id=01000US&-qr_name=ACS_2005_EST_G00_S2301&-ds_name=ACS_2005_EST_ G00_&-redoLog=false&-CONTEXT=st Vescio, T. T. K., Cuddy, A., & Crosby, F. F. J. (2008). Racism, complexity, and affirmative action. In J. J. A. Krosnick, I. I. A.Chiang, J., Forgas, & A. Kruglanski (Eds.), New explorations in political psychology. New York: Psychology Press. Vescio, T. T. K., Gervais, S. S. J., Snyder, M., & Hoover, A. (2005). Power and the creation of patronizing environments. Journal of Personality and Social Psychology, 88, 658–672. Weber, L., & Higginbotham, E. (1997). Black and White professional-managerial women’s perceptions of racism and sexism in the workplace. In E. Higginbotham & M. Romero

Chapter 20


(Eds.), Women and work: Exploring race, ethnicity, and class (pp. 153–175). Thousand Oaks, CA: Sage. West, C. & Fenstermaker, S. (1995). Doing difference. Gender and Society, 9, 8–37. Williams, J. C. (2000). Unbending gender: Why family and work conflict and what to do about it. Oxford University Press. Williams, K. Y. & O’Reilly, C. A. (1998). Demography and diversity in organizations: A review of 40 years of research. Research in Organizational Behavior, 20, 77–140. Wright, E. O., Shire, K., Hwang, S., Dolan, M. & Baxter, J. (1992). The non-effects of class on the gender division of labour in the home. Gender and Society, 6, 252–282. Wright, P., Ferris, S. P., Hiller, J. S., & Kroll, M. (1995). Competitiveness through management of diversity: Effect on stock price valuation. Academy of Management Journal, 38, 272–87. Yoder, J. D. (2001). Making leadership work more effectively for women. Journal of Social Issues, 57, 815–828. Yoder, J. D., Schleicher, T. L., & McDonald, T. W. (1998). Empowering token women leaders: The importance of organizationally legitimated credibility. Psychology of Women Quarterly, 22, 209–222.

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21 Afterword: Looking Toward the Future

Hope Landrine and Nancy Felipe Russo

We hope that the body of work presented in this volume will serve as a source of inspiration, and as a foundation for the continuing development of a multicultural feminist psychology that is reflective and applicable to the lives of diverse women. The concept of diversity often is used to represent the complexities of intersecting social categories. As such, the nature and meaning of diversity changes as the nature and number of social categories change. Thus, it is important to maintain flexibility in our “diversity-mindfulness” (Russo & Vaz, 2001) so that the social constructions and understandings of the past do not limit our vision of the future. This Handbook has focused on some of the theoretical, empirical, and methodological advances of the past decade of feminist psychology. Although a wide array of issues and topics were covered, other equally important ones were not, lest the scope of the project become encyclopedic. Foremost among these critical but omitted topics are the role of cultural and other forms of diversity in ■ gender role socialization ■ gender identity and gender-identity development

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■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

childhood sexual abuse pornography and sex trafficking substance use and abuse the development, course, and treatment of a variety of physical and mental disorders the nature, meaning, health, and future of couples, marriages, and families reproductive health and reproductive rights religion and spirituality career development the predictors and development of leadership health behaviors (e.g., smoking, exercise) and health conditions (e.g., obesity), and the nature and predictors of well-being, happiness, and life satisfaction

In addition to the need to address diversity in the above topic areas, there remains the pressing need to increase multicultural-feminist advocacy, research, and theory on largely neglected groups of women—e.g., U.S. women of all sexualities and ethnicities who are low income, Native American, homeless, rural, incarcerated, or have disabilities, as well as such women in countries other than the United States. Likewise, it remains essential to develop a wide range of new interventions and public policies to improve the physical and mental health of all women via the application of multicultural-feminist values, principles, strategies, and knowledge. Our ability to meet the challenges facing us in the 21st century in part depends on our effectiveness at equipping women with the self-reflective, multicultural feminist knowledge and skills required to pursue these topics and to advocate for social change. Developing and maintaining a self-reflective, feminist, diversity-mindfulness that invariably leads to understanding our own “isms” is a difficult goal. It involves analyses of our own thoughts, feelings, and perceptions, and of the extent to which the content and structure of these reflect and reinforce the structured social, cultural, and gender inequalities we seek to change. Although this goal may be challenging, the need to achieve it is self-evident, and our success thus far suggests that we can indeed do so for feminist psychology in our lifetime. Feminist psychology, however, is merely one area in which self-reflective, multicultural-feminist understandings are needed. Solutions to the many problems that our world now faces likewise require such understandings: Global warming, the world-wide economic crisis, corrupt political leadership, terrorism, war, widespread rape and famine, and new emerging infections all disproportionately affect women and people of color in the U.S. and around the globe. Each of these crises is a part and a product of structured gender, cultural, and economic inequality, and hence multicultural-feminist knowledge is relevant to analyses and potential solutions to each. The challenge for feminist psychology in the 21st century then is not simply to work to improve our science and practice, but also to work equally-hard to improve our world by being ever mindful of our role in its problems and solutions. Thus, our challenge is to develop, disseminate, and apply multicultural-feminist knowledge and understandings not only to issues regarded as “women’s” but also widely and broadly to issues rarely regarded as such. The challenge is to reveal and to

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document the gendered-racist nature of the problems confronting the world, to articulate their differential impact on diverse women and men as a function of the complex politics of difference, and to inform new, creative, and effective solutions.

References Russo, N. F., & Vaz, K. (2001). Addressing diversity in the Decade of Behavior: Focus on Women of Color. Psychology of Women Quarterly, 25, 280–294.

587


Index

A Abstract theory, 39 Academic writing, 35 Accountability, 36–37 Acculturation, 289 and HIV infection, 343–344 patterns of refugee women, 538–540 Acquiescent Response Style, 113 ADAPT, 520 Additive double jeopardy hypothesis, 154, 156–157 Affective responses, to discrimination, 182–183 African Americans Reach and Teach Health Ministries, 342 African American women. See also HIV/AIDS body image, 289 breast and cervical cancer in, 313, 322 double consciousness of, 455 and double jeopardy hypothesis, 158 effects of prejudice, 216–217 experience of interpersonal violence, 275 experiences of initimate partner violence, 434–436 feminists and international commitments, 38 fire fighters, negative outcomes of token status and marginalization, 370 forms of discrimination against, 174–175 cardiovascular health, 201 confronting of, 186 coping behavior, 185 diary data of Swim and colleagues, 176–177, 182 psychological distress, 199–200 sexist and racist discrimination, 179–180 and social status, 185 SSE scores relative to sexual harassment, 175 stress experiences of, 200

gender discrimination, 155–156 and gender role attitudes, 140 genocide, 341 homonegative attitudes of, 213–214 identity, 31, 33 and intimate partner violence, 275 lesbian with a physical disability, social context of, 33 positive attitudes about combining work and family, 564 religious identity, 268 sexual assault victimization rape, 398 sexual harassment coping strategies, 458–460 frequency, 457–458 stigmatization, 340 vulnerability to stress-related physical and psychological problems, 374–375 wage inequality, 155 writers and self-reflexivity, 34–35 African women, identity, 31 Afro-centric values, 372 Age stereotypes, 235 Ambivalent sexism, 151–152 American Individualism, 109–110 Androcentrism, 266 Angry minority, 379 Anorexia Nervosa, 285–286, 298 Anxiety disorders, 265 Anxious somatic depression, 197–198 Arthritic symptoms, 236 Asian women body image dissatisfaction, 289 and eating disorder(s), 289, 300–301 experiences of initimate partner violence, 439–440 sexual harassment, 463–464 Thai women, 224 Asthma, 236 Australian women, 224 Authoritarian aggression, 161

589

590

Index

Authoritarian submission, 161 Autobioethnography, 35

B Balanced Inventory of Desirable Responding, 115 The Balm, 342 Barnes v. Costle, 451 Basotho women, 224 Battered Woman Syndrome, 428 Behavioral Risk Factor Surveillance System, 101 Beijing Conference, 18 Benevolent sexism, 151, 152, 162 Bias and American Individualism, 109–110 diagnostic, 267 exclusion-related method, 101 familiarity-related method, 100 mono-method, 100 nonresponse, 102 Biased beliefs and attitudes, 23 Binge Eating Disorder, 285, 288 risk factors, 302–303 Biological model, for cancer-related morbidity and mortality, 312 Black feminist theory, 369 Black–White differences, in global body image, 291–292 Black–White segregation neighborhoods. See Minority neighborhoods Black women, psychology of, 5. See also African American women Blatant sexism, 151 Bodily control dilemma, for women with disabilities, 511–514 Body image dissatisfaction, 286 and associated eating behaviors, 290–291 Black-White differences, 291–292 Indian women, 289 Iranian women, 290 Mexican American women, 290 psychological factors influencing, 291 South Asian American women, 289 toned body and hair, 295 White women, 289 Borderlands Theory, 33–34 Borderline personality, 267 Boston marriages, 222 Breadwinner, 23

Breast and cervical cancer in African American women, 313 behavioral interventions, 317–318 biological model for, 312 and BRCA1 and BRCA2 gene mutations, 314 cancer survivorship, 321–323 physical and life style issues, 324–325 psychosocial interventions, 323–324 surveillance behaviors, 324 catch-up vaccination, 315 causes and risk factors, 313–314 chemoprevention, 314 and communication, 319–320 complementary alternative medicine therapies, 320–321 diagnosis and treatment, 318–321 interventions for improved, 321 differences in screening by race and ethnicity, 316 health care services, disparities, 319 high-risk types, 314 in Hispanics/Latinas, 313 HPV infection and, 314, 317 individual programs and interventions to increase mammography rates, 318 influence of poverty and socioeconomic status, 313 mammography, 315 mortality, 312–313 Papanicolaou test, 315 Patient Navigation Research Program: Eliminating Barriers to Timely Delivery of Cancer Diagnosis and Treatment Services, 321 prevalence, 312–313 primary prevention and surveillance, 314–317 reproductive risk factors, 313 role of dietary changes, 317 screening behaviors, 317–318 sexual behavior change, 317 treated with mastectomy, 320 in Vietnamese women, 313 women with disabilities, 523–524 Bringing Cultural Diversity to Feminist Psychology: Theory, Research, and Practice, 5–6 Buddhism, 215 The Budget Reduction Act of 2005, 487 Bulimia Nervosa, 285–286, 288

591

Index

C California Health Interview Survey, 101–103 Cambodian refugee women, 538 Cancer and women, 236. See also Breast and cervical cancer Cancer survivors, 17. See also Breast and cervical cancer Center for Epidemiologic StudiesDepression Scale, 118 Chajul community, impact of war, 67 Chicana feminisms, 38, 372 Child Care and Development Block Grant, 484 Children, of Chejul, 69–71 Chinese man, ideal, 143 Christianity, 270 Chronic bronchitis, 236 Cognitive Abilities Screening Instrument, 119 Color blindness, 382 Commission for Historical Clarification, 65 Community psychology. See also Participatory and action research contributions of participatory action research in, 63–64 feminist understandings of, 60–63 history, 58–59 research methodologies, 59–60 Comorbidity, 265 Compulsory heterosexuality, 214 Concurrent relationships, 340 Confirmatory factor analysis, 117 Confucius doctrines, 142 Conscientização, 377–378 Consciousness-raising, feminist concept of, 377 Contextual correlates, of ethnic-group cultural variables, 97–98 health care centers, 94 segregation, 93–96 socioeconomic status, 87–93 Conventionalism, 161 Convention on the Elimination of All Forms of Discrimination against Women, 251 Coronary artery calcification, 201 Couple violence, 19 Cross-categorization research, 9, 156–159 Cross-cultural research, on gender attitudes, 139

D Dangerous diagnoses, 267 Declaration on the Elimination of Violence Against Women, 251 Deservingness, politics of, 21–22 Diabetes, 236 Diagnostic and Statistical Manual of Mental Disorders, 286 Dialogue, importance of, 8 Differential item functioning, 117–118 instruments, 118–119 strategies for improving, 119–120 “Difficult dialogue” programs, 7–8 Disabilities, women with attitudinal and environmental context, 504–505 call for action, 525–527 collective advocacy, 525–527 definition, 502–503 demographic context, 503–504 and feminist agenda, 505–507 issues bodily control dilemma, 511–514 discrimination, 518–520 employment and income inequities, 520–522 health disparities and access to health care, 522–525 individual autonomy, 509–511 self-esteem, 508–509 sexuality, 514–516 violence and abuse, 516–518 personal and social functioning, 505 wellness needs of, 523 DisAbled Women’s Network Canada, 517, 525 Diversity mindfulness, 9 “diversity-mindfulness,” concept of, 7–8 Division 35 Task Force on Cultural Diversity in Feminist Psychology, 5 Double jeopardy hypotheses, 9, 154–159 Double minority status, 153 Double or multiple jeopardy theory, 450 Dysthymia, 269

E Eating Disorder Inventory-Second Edition, 299 Eating disorders, 15 compensatory behaviors of self-induced vomiting, 298 definitions, 285–286

592

Index

Eating disorders (Continued) diagnosis and treatment, 304 and ethnicity, 287, 292–296 etiology of, 291 prevalence of, 286–287 risk factors, 303 sociocultural influences, 288–292 symptoms, 304 use of laxatives and diuretics, 297–298 Ecological perspective, of multicultural feminist practice, 375–376 Egalitarianism, 138 Emphysema, 236 Empiricism, 39 Employment status, of women, 139–140 Employment difficulties, for refugee women, 540–541 Enacted sexual stigma, 272 Endorsements, of traditional gender roles, 138–139 cross-cultural differences, 144–147 global comparison studies, 145–147 English-fluent sample study, 101–103 Equivalence-issues, for racial/ethnic groups group, 96 item, 116–120 method exclusion-related, 100–104 familiarity-related, 100 random digit dial telephone surveys, 104–110 sample ethnic minority status groups, 84–85 medical facilities, 94–99 residential segregation, 93–94 social contextual correlates, 86 socioeconomic status measures, 87–93 scalar, 110–116 scaling affects, on research reports, 110–113 statistical analyses, 96–97 translations of, 104 types, 85–86 Erotic energies, 218 Ethgender, 174 Ethnicity and eating disorders Asian American females, 296 Asian women, 300–301 in Black and White women, 298–300 Chamorro women, 302 Cuban and Brazilian women, 303

diverse group of women, 297 Fijian women, 301–302 Hispanic females in the United States, 296 Hispanic women, 300 Mexican American women, 303 Puerto Rican and Venezuelan women, 303 risk factors, 302–303 Taiwanese women, 301 Ethnic minority women, in psychology, 5 Evangelism, 76 Exclusion-related method bias, 101 Experience sampling method, 177 Extreme Response Style, 112

F Familiarity-related method bias, 100 Families immigrant and refugee women’s mental health, 542–543 inequity and work concerns, 485–487 older women, psychological perspectives of, 241–243, 249–251 poverty and work concerns, 485–487 women’s family roles, centrality of, 268 Familismo, 344–345 Family histories, 36 Felt sexual stigma, 272 Female Berdache, 225 Feminism, 38, 56–57, 372 Feminist activism, 57 Feminist counseling and therapy, 17 Feminist empowerment, 380–381 Feminist identity development attitudes and sexist events, 195 Feminist Movement, 235 Feminist practice, defined, 6 Feminist psychology, 586–587 beginning, 3–4 and U.S. feminist movement, 5–6 Feminist research, 4 contributions of participatory action research in, 64–65 empirical work, 39 Feminists of color, 39 methodologies, 57–58 multicultural feminist practitioners, 40 multiculturalism in, 8 principles of the Boston Conference, 263 Feminist researchers, 58

593

Index

Feminist Response in Disability Advocacy, 525 Feminist scholarship, 56–57 Feminist therapy, multicultural APA Multicultural Guidelines, 379 assumptions in multidimensionality, 369–372 multiple identities, 371 general principles aspects of traditional psychotherapy systems, 381–382 conscientization and consciousnessraising, 376–378 empowerment and social activism, 380–381 ethnocultural approach, 378–379 intercultural therapeutic dyads, 382–383 social identity analysis, 379–380 goals and interventions, 377 Guidelines for Psychological Practice with Girls and Women, 376 models, 372 shared principles antiracism training, 373 Chicana feminists, insights of, 374 multicultural feminist ecological perspective, 375–376 strength and coping resources, 374–375 therapist self-awareness, 373–374 Financial and material interdependence Azande women, 221 Chinese women, 221 Mati Creole women, 222 South African black women, 222 Fundamental Attribution Error, 86

G Gardasil, 315 Gay-affirmative messages, 216 Gay-Related Immune Deficiency, 335 Gender, concept, 264 Gender-based discrimination. See Sexist discrimination Gender-based violence, 18–21 Gender differences, in job satisfaction, 560–561 Gendered ageism, 15, 235 Gendered racism, 9, 174 Gender Empowerment Measure, 147–149

Gender equality, in Latin American countries and the Caribbean, 142 Gender harassment, 451 Genograms, 379 Gerontophobia, 235 Ghetto care, 487 Ghetto tax, 483 Global poverty, 76 Greenleaf Extreme Response Measure, 115 Group-Focused Enmity, 161 Guatemalan Foundation of Forensic Anthropology, 65 Guatemalan health organization, 66

H Heart disease, 236 Herceptin, 318 Heterosexism, 213, 340 Heterosexual assumption, 272 Heterosexual-identified American women, 216 Heterosexual single women, 44 Hispanic women sexual assault victimization rape, 398 HIV/AIDS, 143–144 African American women, 336–337 concurrent relationships, 340 conspiracy theories of the origins, 341 denial, 340–341 gender role attitudes, 339–340 heterosexism, 340 incarceration rates, 338–339 physical and sexual victimization, 338 poverty, 337 resilience and protective factors, 341–342 sex ratio imbalance, 339 use of illicit substances, 337–338 American Indian and Alaska Native women effects of historical trauma and discrimination, 348–349 effects of poverty, 349 health care service provisions, 351–352 interpersonal violence, 349–350 in NYC, 348 protectors factors, 351

594

Index

HIV/AIDS (Continued) sexual risk behaviors, 350–351 statistics, 348 substance abuse, 349 surveillance, 347 Asian/Pacific Islander women, 337 disabled women, 524 Latin women (Latinas) acculturation and immigration, 343–344 epidemiology, 343 gender roles, 344–345 power inequalities in sexual relationships, 345–346 preventive interventions, 346–347 Puerto Rican women, 343 sex-related risk factors for, 346 research on African American and Latino men who have sex with men, 213 sexual minority women, 352–355 in women of color, 336 HIV infection, 17 Homophobia, 213 Homophobic cultural communities, 216 Homosexuality, 37, 267 negative responses to, 226 Hostile sexism, 151, 162 Hurricane Katrina and its aftermath, case analysis, 489–493 Hypertension, 236, 240

I Immigrants and refugees, status acculturation process, 538–540 and developmental stage, 541–542 employment status, 540–541 and gendered power differentials, 543–548 impact on nuclear and extended families, 542–543 legal issues in clinical work, 548–550 migration and stress, 537–538 psychological effects of legal statuses, 536–537 racial issues, 550–551 resilience and strength, 552 Immigration and HIV infection, 343–344 Incarceration and HIV infection, 338–339 Individualism-Collectivism, 98–99 Individual rights, Western concepts of, 39

Inequity access to health care, 487–488 and class-conscious multicultural psychology, 493–494 and disrespect and discrimination, 484–485 family and work concerns, 485–486 feeding one’s family, 486–487 food insecurity, 486 Hurricane Katrina and its aftermath, case analysis, 489–493 job placement discrimination and negative assessments, 485 reproductive health care, 487–488 single mothers, 486–487 violence and sexual assault, 488–489 Initimate partner violence and alcohol consumption, 433 battering, 428–431 experiences of Asian women, 439–440 of Black women, 434–436 of disabled women, 441–442 of immigrant women, 437–439 of Latinas, 439 of lesbians, 440–441 of poor women, 433–434 of White women, 432–433 forms of physical aggression, 431–432 leaving the abuser, 429–430 pattern of, 431 physical and emotional problems due to, 437 and presence of children, 434 seeking help from police, 430–431 shelters for battered women, 430 social isolation due to, 437 women’s reactions to severe violence, 429 Internalized sexual stigma, 272 International Social Survey Programme, 138 Interpersonal violence and HIV infection, 349–350 Intersectionality and application of Borderlands Theory, 33–34 and children’s multicultural television, 40 empirical study of, 46–48 identificational, 47 implications on treatment on women, 152–159

595

Index

and inadequacies of legal system, 31–32 and mental health status, of women, 275–276 and multicultural feminist practice, 369 between sexist beliefs and other beliefs, 159–163 and social identities, 33–34 and societal structures, 32 Intimate partner violence, 18–19 Islam, 270 Item response theory, 117

J Japan, traditional gender roles in, 143 Japanese women, 143 coping strategies used by battered women, 440 Jewish Canadian women, 180–181 Jezebel stereotype, 20 Judaism, 270

K Knowledge production and accountability, 35–36 in multicultural feminist theory, 38 research methodologies, 42–43 and sexuality, 37–38

L Labeling disability, 22 LGBTQ self-label, 220 public, 214, 226 self, 214, 216 sexuality of women of color, 14 sexually-based identity, 214–215 stigmatization, 270 La facultad, 374 Lam v. University of Hawaii, 152–153 Latina lesbians, 213 Latinas breast and cervical cancer, 313 experiences of initimate partner violence, 439 sexist discrimination, 193 sexual assault victimization, 402–403 sexual harassment, 460–463 coping strategies, 462–463 frequency, 461–462 Legal immigration, 537

Lesbian and gay Asians, 213 Lesbian couples, 44 Lesbian/gay/bisexual/transgender/queer individuals, 14 discourses in psychology of, 212–213 experiences of initimate partner violence of lesbians, 440–441 financial and material interdependence, 221–222 and mental health, 262 older, 235, 237 sexual assault victimization of women, 413–416 sexual fantasies, 218 sexual regulation and subjugation of sexual minority women, 218 Lesbian-identified women, 216 Lesbianism, 220 Lesotho culture, 223 Life span continuity, 237 Life span developmental perspective, on aging processes recoupling after late-life widowhood or divorce, 246–247 retirement, 244 uncoupling, 245–246 working and volunteering, 245 Low-income groups, 483–484 and food insecurity, 486

M Machismo, 142, 344–345, 347 Marianismo, 142, 344–347 Marlow-Crowne Social Desirability Scale, 115–116 Masochism, 267 Mayan beliefs and practices, 76 Mayan communities genocide against, 65 health of women, 240 Medical Outcomes Study 36-Item Short Form Health Status Survey, 118 Mental health status, of women, 15 cumulative adversity to mood and anxiety disorders, 267–268 depressive disorders, 269 disclosure of stressful life events, 272 “double burden” of gender and ethnic discrimination, 270 effects of stigma, prejudice, and discrimination, 270–273

596

Index

Mental health status, of women (Continued) epidemiological studies, 265–266 gender-based violence and trauma, 273–275 gender’s complex relationship to, 263–265 influences of social and cultural variables, 266–267 intersecting differences, 275–276 publications, 262 Puerto Rican women, 265 response to traumatic life events, 274–275 stigmas, 272–273 stress and coping perspective, 267–270 Men who have sex with men, 217 Meritor Savings Bank v. Vinson, 451 Mestiza, 374 Middle Response Style, 113 Millennium Development Goal, 147 Mini-Mental State Examination, 118–119 Minority neighborhoods, 93 exposures to environmental hazards, 95 fruit and vegetable consumption, 95 infant and adult mortality rates, 95 quality of built-environments, 95–96 recreational facilities, 95–96 Modern sexism, 12, 149–151 Modern Sexism Scale, 149, 152 Mono-method bias, 100 Mood and anxiety disorders, 267 Multicultural feminist psychology, 8 Multicultural feminist theory academic achievement, 41–42 core concepts, 30–38 developmental life cycle of women, 41 emerging trends, 38–40 future prospects, 46–48 inclusion of psychology, 40–41 innovative themes, 42–46 older women and nontraditional families in, 43–45 origins, 30 young men of color in, 45–46 young women’s voices in, 43 Multicultural feminist therapies, 18 Multicultural feminist therapy, 17 Multiplicative double jeopardy, 154 Multiplicative jeopardy, 9

N Narratives, personal, 35 National Breast and Cervical Cancer Early Detection Program, 318 National Conference on Education and Training in Feminist Practice, 6 common themes, 7 theoretical models and understandings of diversity, 8 National Conference on Education and Training in Feminist Psychology (Boston Conference), 262–263 National Program of Reparation, Guatemala, 65 Neosexism, 149–151 Neosexism Scale, 150 NETZWERK ARTIKEL 3, 520 Nonresponse bias, 102 NOW Action Center, 525

O Older women, psychological perspectives of age and cognitive functioning, 237–239 age and physical health, 236–237 Berkeley Older Generation Study, 238 and body image dissatisfactions, 238 cultural traditions, 239–241 demography African Americans, 234 Asian Americans, 234 Baby Boomers, 2010, 234 international perspective, 248–249 Latino population, 234 life expectancy, 234 Super-Centennials, 234 U.S. Census Bureau statistics, 2005, 234 family and friendship relationships, 241–243 implications, 251 later-life transitions close relationships, 245–246 employment status and volunteering, 245 recoupling after late-life widowhood or divorce, 246–247 retirement, 244 separation and divorce, 246 prevalence of depression among, 238–239 role in the family system, 249–251

597

Index

spirituality, 247–248 stereotypes, 235–236 Omnirelevance, 370 Operationalizations, of sexual assault victimization, 394

P Panic disorders, 269 Participatory and action research, 10, 36, 42, 57 challenges, 72–74 influence of globalization, 75–76 psycho-educational projects in Chajul, using photography, 66–72 reflexivity, 72 Perceived discrimination, 271 Pew Hispanic Center, 537 Photography-based participatory action research project. See Photovoice, of Chejul Physical intimacy, 223–224 Post-colonization stress disorder, 378 Post-nuclear family, 44 Posttraumatic stress disorder, 267, 269, 274 Poverty, 21 access to health care, 487–488 complexity of, 480–482 conceptualizations of, 481 and disrespect and discrimination, 484–485 and employment, 483–484 family and work concerns, 485–486 feeding one’s family, 486–487 income gap, 482–483 and initimate partner violence, 433–434 and minimum wage per hour, 481–482 sexual assault victimization, 405–409 violence and sexual assault, 488–489 Poverty and HIV infection, 349 Power Distance, 98–99 Power inequalities and HIV infection, 345–346 Prejudiced beliefs, 160 President’s Commission on Mental Health, 4, 261 Price Waterhouse v. Hopkins, 569 Psychological aggression, 429 Psychological Correlates, 98 Psychological symptomatology, 196 Psychological well-being, of girls and women, 21 Psychotherapy, 17, 381–382

Public intimacies and cultural differences, 224–227 Puerto Rican women and leadership roles, 567

R Random digit dial telephone surveys, 101, 104–110 cell phone only households, 105–106 health outcomes, 105–106 landlines and poverty, 104–105 strategies for, 109–110 vs. differences in the health of ethnicminorities, 107–108 vs. household minority samples, 106–107 vs. mail methodologies on people with disabilities, 109 Recoupling, after late-life widowhood or divorce, 246–247 Refugees, 537–538 Residential segregation, 93 Response styles, 112–115 among U.S. minorities, 113–114 validity issues, 114 Right-wing authoritarianism, 160–161 and social dominance theory, 162 Risk factors, of sexual violence, 18 Role obligations, at home and at work, 23 Romantic friendships, 222

S Same-sex relationships, 13 erotic experiences for women of color, 219 Scaling affects, on research reports, 110–113 response styles, 112–115 strategies for improving, 115–116 Schedule of sexist events Cronbach’s alphas for, 175 development of, 175 factor structure of, 176 and sample of African American/Black women, 176 validity of, 175 Scotch verdict, 223 Self-effacing therapist, 382 Self-esteem and sexist discrimination, 189–190, 192, 198 Self-reflexivity, 34 and changes in research, 35–36

598

Index

Sensory loss, 236–237 Sexism, 235 sympotomatology, 198 Sexist beliefs Africa, 143–144 Asia, 142–143 Australia, 144 Canada, 144 cross-cultural differences in, 144–147 cross-cultural research on gender attitudes, 139 endorsement of traditional gender roles, 138–139 Former Soviet Union and Eastern Europe, 141–142 Latin America and the Caribbean, 142 Mideast, 144 New Zealand, 144 and religion, 141 South Africa, 144 subtle forms, 149–152 United Nations data, 147–149 in United States, 139–140 Western Europe, 140–141 Sexist discrimination affective responses to, 181–183 belief in meritocracy, 193 cognitive and behavioral responses to, 184–187 confrontation of, 186 coping and empowerment approaches, 188 definition, 174–175 diary data of Swim and colleagues, 176–177, 182 and different psychological correlates, 195–200 and external and internal attribution conditions, 183 feminist identity and related attitudes, 198–199 and identity-related constructs, 194–195 interpersonal costs associated with confrontation, 186–187 Jewish Canadian women, 180–181, 199 Latina/o identification, 193 measures of women’s experiences of perceived, 175–177 older lesbians, 235 outcomes of different responses, 187–188 people with disabilities, 518–519

perceived gender-based discrimination, 195–196 and perceived persistence, 182–183, 203 performance of a racially/ethnically diverse sample of women, 190–191 pervasive sexism condition, 191–192 and pessimism, 193–194 and physical health, 201–202 prevalence and types of, 177–181 psychological and physical health correlates of, 189–194 and psychophysical health outcomes, 197 racial/ethnic minority lesbian women, 185 recommendations for research, 202–204 schedule of sexist events measure, 175–177 self-esteem, 189–190, 192, 198 in the workplace, 568–572 Sexist events, 178–179 Sexist hostility, 451 Sexual assault, 18 victimization, 18, 391–392. See also Violence Sexual coercion, 451 Sexual Experiences Questionnaire, 452 Sexual harassment, 449. See also Violence future directions, 464–468 legal definitions, 450–451 psychological and behavioral definitions, 451 racialized, 450 role of race African American women, 456–460 Asian women, 463–464 coping behavior, 454–455 frequency and prevalence of, 452–453 Latinas, 460–463 outcomes related to, 455–456 perceptions and definitions of acceptable behaviors, 453–454 vignette studies, 453–454 Sexual harassment, 18 among women of color, 20 Sexual hostility, 451 Sexuality, 37–38 of diverse women, 219–220 heteropatriarchal model of, 217 individual identity based on, Asian cultures, 224

599

Index

multiple forms of sexual expression, 219 problematic heteropatriarchal views of, 219 women with disabilities, 514–516 Sexual orientation research and breast and cervical cancer, 313 emotional and romantic connection, 222–223 erotic intimacy, 223–224 Euro-American sexual minorities, 227 financial and material interdependence, 221–222 forms of public expressions, 224–227 influence of immigration, 226 intersecting identities, 212–213 issues with parameters, 217–220 LGBTQ issues, 212–213 notions of sexual identity, 214–217 re-visioning of sexual minority women of color, in U.S. society, 220–221 sexual regulation and subjugation of sexual minority women, 218 and social class, 226 Sexual pleasure, 218 Sexual prejudice, 216–217 Sexual risk behaviors and HIV infection, 350–351 Shelters, for battered women, 438–439 Social dominance orientation, 160 Social dominance theory, 161 and right-wing authoritarianism, 162 Social dominance theory, 154 Social identities, 33–34 Socialization, 40 Socially desirable responding, 114–115 Social relationships and old age social networks, 241–242 social support, 242 support quality, 242 well-being, 242–243 Sociocultural exposure theory, 289 Socioeconomic status measurement area-based, 90–92 and battered women, 434 and breast and cervical cancer, 313 census-tract level, 91 difficulties with income measures, 90 eating disorders, 288 English-fluent samples, 102 ethnic groups, 93 household income, 87–89 individual income, 87–89

influences women’s aging experience, 240 strategies for, 92–93, 96 Stigma, 266 Stigmatization, 270 Stonewall gay liberation movement, 214 Substance abuse and HIV infection, 337–338, 349 Subtle sexist behaviors, 149–152 System justification theory, 162–163

T Tamoxifen, 314 Temporary Assistance to Needy Families, 481, 485, 489 Therapist self-awareness, 17 Traditional gender role attitudes, 140 Transgender people, 215

U Uncoupling, in older adulthood, 245–246 United Nations Gender Empowerment Measure, 99 Unwanted sexual attention, 451 U.S.-Central American Free Trade Agreement, 66

V Violence, 142 atrocities and marginalization, of women in Chajul, 66–67 characteristics, 392–393 coping and trauma, 273–275 couple, 19 gender-based, 18–21 against the indigenous population of Guatemala by colonial forces, 65 intimate partner, 18 recovery process, 393 risk factors, of sexual violence, 18 sexual assault victimization African American women, 398–400 American Indians and Alaskan Natives, 401–402 Asian Americans, 403–405 Latinas, 402–403 lesbian and bisexual women, 413–416 long-term health consequences, 393 mental health consequences, 393 Pacific Islands, 403–405

600

Index

Violence (Continued) rape, 398 sexual assault survivors, 393 women living in poverty, 405–409 on women of color, 394–398 women with disabilities, 409–413 against women with disabilities, 516–517

W Wage inequality research, 154–155 Wellness needs, of women with disabilities, 523 Western Europe, pro-feminist attitudes in, 140–141 White “academic feminism,” 39 White feminist theory, 44 White patriarchy, 45 White privilege, 35 White vs. minority neighborhoods. See Minority neighborhoods exposures to environmental hazards, 94–95 medical facilities, 94

White women’s obsessions, of body image, 15 White women writers, 35 Widowhood, women’s adjustment to, 245 Williams v. Saxby, 450 Women of color sexual harassment frequency, 452 Women’s family roles, centrality of, 268 Women who have sex with women, 217 Women with Disabilities Australia, 525 Working women changes through affirmative action, 572–576 family-friendly workplace policies, 565 gender discrimination and effects, 568–572 and job satisfaction, 560–562 occupational segregation, 565–566 and positions of leadership, 565–568 work family relations, 562–565

Handbook of Diversity in Feminist Psychology

Handbook of psychology. Research methods in psychology

Handbook of psychology. Experimental psychology

Handbook of Psychology, Assessment Psychology

Handbook of psychology. Educational psychology

Handbook of psychology. Biological psychology

Handbook of psychology. Assessment psychology

Handbook of psychology. Clinical psychology

Handbook of Psychology, Experimental Psychology

Handbook of psychology. Health psychology

Handbook of psychology. Forensic psychology

Handbook of Psychology, Biological Psychology

Handbook of psychology. Developmental psychology

Handbook of psychology. History of psychology

Handbook of Traffic Psychology

Handbook of Positive Psychology

Handbook of Personality Psychology

Handbook of psychology

Handbook of psychology

Handbook of Positive Psychology

Handbook of Environmental Psychology

Handbook of psychology

Handbook of psychology

Handbook of psychology

Handbook of Psychology, History of Psychology

Handbook of Health Psychology

Handbook of psychology

Handbook of Cultural Psychology

Handbook of psychology

Handbook of Environmental Psychology

Handbook of Diversity in Feminist Psychology

Handbook of psychology. Research methods in psychology

Handbook of psychology. Experimental psychology

Handbook of Psychology, Assessment Psychology

Handbook of psychology. Educational psychology

Handbook of psychology. Biological psychology

Handbook of psychology. Assessment psychology

Handbook of psychology. Clinical psychology

Handbook of Psychology, Experimental Psychology

Handbook of psychology. Health psychology

Handbook of psychology. Forensic psychology

Handbook of Psychology, Biological Psychology

Handbook of psychology. Developmental psychology

Handbook of psychology. History of psychology

Handbook of Traffic Psychology

Handbook of Positive Psychology

Handbook of Personality Psychology

Handbook of psychology

Handbook of psychology

Handbook of Positive Psychology

Handbook of Environmental Psychology

Handbook of psychology

Handbook of psychology

Handbook of psychology

Handbook of Psychology, History of Psychology

Handbook of Health Psychology

Handbook of psychology

Handbook of Cultural Psychology

Handbook of psychology

Handbook of Environmental Psychology

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