Digital Commons Network^™

Difficult-To-Treat Rheumatoid Arthritis With Concomitant Yao Syndrome With Response To Dual-Inhibitor Therapy, Nawar Aljundi, Paramarajan Piranavan

Internal Medicine Faculty Publications

No abstract provided.

Clinical And Demographic Characteristics Of Participants In A Hepatitis C Treatment Trial In Rural Kentucky: How Policies Around Treatment Access May Impact Elimination Efforts In The United States, Jennifer R. Havens, Brittney D. Williams, Takako Schaninger, Virginia A. Shepherd-Tackett, Michelle R. Lofwall, Michele Staton, Sharon L. Walsh, Hannah K. Knudsen

Behavioral Science Faculty Publications

Introduction: The advent of curative direct acting antiviral (DAA) drugs to treat those actively infected with the hepatitis C virus (HCV) has allowed for discussion around HCV elimination. Restrictive state-by-state policies for the coverage of DAAs for Medicaid recipients may hamper elimination efforts in the United States by limiting access to these curative treatments. Methods: The purpose of the current analysis was to examine the sociodemographic, drug use and clinical characteristics of participants in the Kentucky Viral Hepatitis C Treatment (KeY Treat) study in the context of Medicaid policies in the United States. The goal of KeY Treat was to …

The Interaction Of Tobacco Retailer Density And Rurality With Tobacco Use Prevalence In Kentucky, Shyanika W. Rose, W. Jay Christian, Judy Van De Venne, Delvon T. Mattingly, Bethany Shorey Fennell, Saber Feizy, Mary Kay Rayens

Behavioral Science Faculty Publications

Purpose: Tobacco retailer density is a key correlate of tobacco use prevalence in the United States, but this relationship has typically been examined in urban areas. We examined the relationship between retailer density and tobacco use across Kentucky counties, a state with high smoking rates and a substantial rural population.

Methods: We obtained a list of tobacco retailers from the 2021 Kentucky Synar program, used for minor’s access inspections. We merged these data with county-level prevalence estimates for cigarette and smokeless tobacco use for each county in Kentucky, calculated using pooled 3-year estimates (2017-2019) of Kentucky Behavioral Risk Factor Surveillance …

Acceptability And Appropriateness Of Harm Reduction Vending Machines Compared To Syringe Service Programs In Appalachian Kentucky, Hannah K. Knudsen, Jennifer R. Havens, April M. Young

Behavioral Science Faculty Publications

Objective:

Many rural people who inject drugs do not use syringe service programs (SSPs). In addition, people who use drugs but do not inject may perceive that SSPs are not intended for their use. Harm reduction vending machines (HRVMs) may be preferred by some individuals. This study examines attitudes and preferences regarding HRVMs to consider possibilities for enhancing the reach of harm reduction services. Method:

Structured surveys were conducted with 712 people who use drugs in two rural Appalachian counties in Kentucky. Participants rated the acceptability/appropriateness of SSPs and HRVMs; HRVM preference was the difference between the two scales. Linear …

Decreasing Prevalence In Youth Depressive Episodes: Evidence From The 2021-2024 National Survey On Drug Use And Health, R. Andrew Yockey, Aminul Apu, Timothy Grigsby, Jacob Bleasdale, Delvon T. Mattingly, Rachel Hoopsick

Behavioral Science Faculty Publications

Background: Major depressive disorder (MDD) is a leading contributor to the global burden of disease and commonly develops during adolescence. The COVID-19 pandemic was linked to significant increases in depressive symptoms among youth, but less is known about whether these increases have continued in recent years.

Objective: Using the first four consecutive years of methodologically comparable national data since the pandemic, we examined changes in past-year major depressive episode (MDE) among U.S. adolescents aged 12–17 years from 2021 to 2024 and evaluated demographic and substance use factors.

Methods: We analyzed pooled, cross-sectional data from the 2021–2024 National Survey on Drug …

An Exploratory Study To Determine The Feasibility And Processes Needed To Implement The Immunization Neighborhood To Increase Hpv Vaccination Among African American Adolescents And Adolescents In The General Population: A Multi-Partner Perspective, Jennifer Cunningham-Erves, Freneka Minter, Pamela C. Hull, Amanda F. Dempsey, Alexandria Demons, Mariya Chalise, Consuelo H. Wilkins

Behavioral Science Faculty Publications

Limited education and healthcare access are major contributors to Human Papillomavirus (HPV) vaccination disparities among African American adolescents. The Immunization Neighborhood (IN) involves enhanced communication and collaboration among providers to address people’s needs by expanding access points and education to increase vaccination. Because needs of immunization providers and parents to effectively collaborate are unknown, this study explored the feasibility of and processes needed for IN utilization across key partners: pediatricians, pharmacists, school nurses, health department staff, and African American parent–child dyads. We conducted a semi-structured interviews in a qualitative, descriptive study with a purposive sample of 30 African American parent–child …

The Receipt Of Psychological Services And Acceptability Of Local Follow- Up Care For Childhood Cancer Survivors: Are There Rural Vs. Urban Differences?, Tyrone F. Borders, Abigayle Feather, Jerod L. Stapleton, John A. D’Orazio, Eric B. Durbin

Psychology Faculty Publications

Purpose This study examined rural and urban parents’ reports of their children’s receipt of general follow-up care and psychological services, ratings of the acceptability of common sources of follow-up care, and ratings of local/nearby follow-up care access and effectiveness.

Methods A cross-sectional, quantitative survey was conducted among 238 (139 urban, 46 rural adjacent, and 53 rural non-adjacent) parents of childhood cancer survivors (ages 2–17 and at least 2 years since cancer diagnosis) recruited through the Kentucky Cancer Registry. Bivariate analyses and multivariable logistic regressions adjusting for predisposing, enabling, and need factors tested for differences across residence in urban counties, rural …

Social Engagement Moderates The Relationship Between Cognitive Functioning, Depressive Symptoms, And Restless Sleep In Older Black Adults, Sunkanmi Folorunsho, Olufunmilola Abraham, Darlingtina K. Esiaka

Pharmacy Practice and Science Faculty Publications

INTRODUCTION: Older Black adults face higher dementia risk, but it is unclear whether social engagement offsets the effects of depression and restless sleep.

METHODS: We analyzed 1,905 Black adults aged 50+ from the 2016-2020 Health and Retirement Study (HRS). Linear mixed-effects models tested how depressive symptoms, restless sleep, and social engagement predicted baseline cognition and cognitive decline.

RESULTS: Higher depressive symptoms and restless sleep were associated with lower baseline cognition (about 0.2 and 0.5 points lower) and faster decline (β×time ≈ −0.07 and −0.05). Greater social engagement predicted higher baseline cognition (about 0.6 points higher) and slower decline (β×time ≈ …

A Deimplementation Framework For Curricular Hoarding In Pharmacy Education, Mary E. Fredrickson, Ashleigh Barrickman, Krista L. Donohoe, Angela L. Goodhart, Caroline Lindsay Ko, Daniel R. Malcom, Frank Romanelli, Marissa C. Salvo

Pharmacy Practice and Science Faculty Publications

Objective: To propose a holistic approach to managing curricular transformation that addresses various curricular obligations, incorporates the emotional component of curricular overload, and utilizes deimplementation science to reframe curricular change decisions. Findings: Given the need to codify processes and interventions that continually seek to ensure curricula are modernized, contemporary, and free of outdated teaching materials, we have developed a systematic deimplementation approach to address curricular overload. Its intent is to free space for more impactful learning and practices within pharmacy curricula that can lead to measurable improvements in workload, satisfaction, and learning outcomes for both students and faculty. Summary: By …

Non-Contact Optical Spectroscopy For Metabolic And Vascular Characterizations Of Orthotopic Tongue Cancer Models In Vivo, Md Zahid Hasan, Jing Yan, Sumit Sarker, Pranto Soumik Saha, Caigang Zhu

Biomedical Engineering Faculty Publications

Most tissue optical spectroscopy platforms use a fiber probe for light delivery and collection, while the inconsistent probe-sample contact could induce significant distortions in the measured optical signals, which consequently bring analysis errors. Moreover, it will be practically difficult to use a fiber probe for measurements in some cases such as oral cancer investigations using small animal models. To address the critical challenge, we report a portable, lens-based, optical spectroscopy device capable of quantifying key vascular and metabolic parameters in vivo without probe-sample contact. We combined lenses based diffuse reflectance and fluorescence spectroscopy into one portable platform to enable multi-parametric …

Combined Autofluorescence And Diffuse Reflectance Spectroscopy For Rapid Metabolic And Vascular Characterizations Of Orthotopic Tongue Tumors In Vivo, Pranto Soumik Saha, Jing Yan, Sumit Sarker, Zahid Hasan, Caigang Zhu

Biomedical Engineering Faculty Publications

Precise label-free quantification of tissue metabolic and vascular dynamics in vivo represents a critical challenge for cancer therapy prediction and longitudinal treatment assessment. In this study, we demonstrated a portable autofluorescence and diffuse reflectance spectroscopy device along with novel spectroscopic algorithms to quantify tissue vascular and metabolic parameters of orthotopic head and neck cancer models in vivo. Tissue-mimicking phantom studies were used to verify the dual-modal optical spectroscopy and easy-to-use spectroscopic algorithms for rapid and accurate estimation of tissue oxygen saturation, total hemoglobin contents, and intrinsic optical redox ratio. Animal studies were conducted to demonstrate the feasibility of our …

Noninvasive Diffuse Optical Monitoring Of Cerebral Blood Flow And Oxygenation Responses To Intermittent Hypoxia In Neonatal Rats, Pegah Safavi, Mehrana Mohtasebi, Chowdhury Azimul Haque, Faezeh Akbari, Xuhui Liu, Yiqi Yuan, Li Chen, Lei Chen, Guoqiang Yu

Biomedical Engineering Faculty Publications

Significance: Intermittent hypoxia (IH) is common in preterm neonates and can cause hypoxic–ischemic brain injury. Simultaneous monitoring of cerebral blood flow (CBF) and oxygenation is essential to detect oxygen delivery-extraction mismatches and guide intervention.

Aim: We aimed to adapt and test an innovative diffuse speckle contrast flow oximetry (DSCFO) system for continuous monitoring of cerebral hemodynamics during IH in neonatal rats, a model approximating human neonates.

Approach: Two compact laser diodes and a miniature CMOS camera were integrated into a fiber-free probe for continuous monitoring of changes in relative CBF (rCBF) and oxy- and deoxy-hemoglobin concentrations (Δ[HbO₂] and …

Comparative Evaluation Of R134a And Hfo‐1234ze Cryogen Spray Cooling Using A Mouse Model With Controllable Epidermal Pigmentation, Wangcun Jia, Yurie Jeong, Crystal Huynh, Oswald Lai, Emily Nguyen, Grant Swajian, Jade Niu, Ayana Kashikar, Joshua Khaw, Hong Pu, Bernard Choi, John August D'Orazio, J. Stuart Nelson, Bahman Anvari

Pediatrics Faculty Publications

Objectives: Cryogen spray cooling (CSC) is critical for protecting the epidermis during laser dermatologic procedures. The widely used cryogen, R134a, has a high global warming potential (GWP), motivating interest in environmentally favorable alternatives such as HFO-1234ze. This study evaluated whether HFO-1234ze provides epidermal protection comparable to R134a during laser exposure and investigated the mechanistic basis underlying any differences in cooling performance.

Methods: Laser-induced epidermal injury in conjunction with two cryogens was assessed in K14-SCF Mc1r^e/e mice with pharmacologically controllable interfollicular epidermal pigmentation. Laser treatment sites were assigned fluences relative to baseline skin lightness (L*) to span subthreshold …

From Barriers To Breakthroughs: Academic Advising And Resilience Among Online Social Work Students In Appalachia, Jessica Williamson

DSW Capstone Projects

This Doctor of Social Work (DSW) capstone project examines how academic advising can be leveraged as a resilience-informed intervention to support persistence among online social work students in the Appalachian region. Although online education has expanded access to higher education, Appalachian students continue to face significant structural, technological, and cultural barriers, including limited broadband access, financial instability, geographic isolation, and norms that emphasize self-reliance. These challenges contribute to lower retention and degree-completion rates, highlighting the need for intentional, context-responsive support strategies. This project integrates three scholarly products: a systematic literature review (SLR), a conceptual paper, and a practice application paper. …

Hardin Health Link: A Community-Integrated Paramedicine (Cip) Program In Hardin County, Kentucky, Samantha Jones

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Rural and mixed rural–urban communities face persistent disparities in access to timely emergency medical services (EMS), contributing to preventable morbidity and mortality from time-sensitive conditions such as cardiovascular disease, stroke, and injury. Hardin County, Kentucky, reflects these challenges due to its geographically dispersed population, high burden of chronic disease, and variability in EMS response times. This capstone proposes Hardin Health Link, a Community-Integrated Paramedicine (CIP) program designed to expand the traditional role of EMS providers through in-home health assessments, chronic disease monitoring, post-discharge follow-up, medication reconciliation, and connection to clinical and social services.

Guided by an evidence-informed framework, the program …

Stronger Starts: Advancing Maternal And Infant Health In Breathitt County, Kentucky, Madisyn Smith

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Maternal and infant health outcomes remain significantly poorer in rural Appalachian communities, where structural and socioeconomic barriers limit access to timely and comprehensive care. Kentucky reports elevated rates of preterm birth and infant mortality, with counties such as Breathitt County facing challenges including limited obstetric services, transportation barriers, and high poverty rates. These factors contribute to delayed prenatal care, fragmented services, and increased risk of adverse outcomes.

The Stronger Starts Initiative is an evidence-informed public health program designed to improve maternal and infant health outcomes through a coordinated, multi-level approach. The program integrates nurse-led home visiting, telehealth obstetric consultations, community-based …

Rapid Response To Recovery: Expand Integrated, Technology-Enabled Crisis Care, Madison Chandler

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Behavioral health challenges in rural communities continue to place significant strain on healthcare systems, particularly through repeated reliance on emergency departments for crisis care. Nelson County, Kentucky, reflects this pattern, with higher reported rates of poor mental health and limited access to behavioral health providers. This paper proposes the Beacon Behavioral Health Response Program, a community-based, multidisciplinary crisis intervention model designed to improve access to timely care and strengthen continuity of support. The program combines mobile crisis response—delivered by a licensed clinical social worker and a peer support specialist—with a technology-enabled component using the Luma AI-supported mental health platform. Together, …

A Program To Increase Prenatal And Postnatal Care Access In A Rural Kentucky County, Alyssa Thomas

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Prenatal and postpartum health care access is necessary for positive pregnancy and postpartum outcomes. Many rural areas in the United States are facing maternity care deserts, where there are no obstetric services available in their county. Maternity care deserts typically have higher rates in maternal mortality, low-birth weight, and pre-term births. Fleming County, Kentucky is a small rural community with a population of about 15,000 that is a maternity care desert. To improve prenatal and postpartum care access in this county, this program will use a mobile health clinic and community health workers (CHWs). The mobile health clinic will operate …

Implementation Of A Reminder/Recall Messaging Program In Kentucky, Laura Schwarz

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Childhood vaccination remains a critical public health priority, yet measles, mumps, and rubella (MMR) vaccination rates in several rural Kentucky counties fall below the 95% threshold required for herd immunity. Recent declines in coverage, compounded by socioeconomic disparities and barriers to healthcare access, place children at increased risk for vaccine-preventable diseases and outbreaks. This capstone project proposes the implementation of an evidence-based reminder/recall (R/R) text messaging intervention utilizing the Kentucky Immunization Registry (KYIR) to improve timely MMR vaccination among children aged 4–6 years before kindergarten entry.

The proposed program targets thirteen Kentucky counties with vaccination rates below 70% and documented …

Effects Of Tech-Based Self-Monitoring And An Interdependent Group Contingency On Group Engagement, Ariana K. Hefter

Theses and Dissertations--Early Childhood, Special Education, and Counselor Education

This study evaluated the effects of a class-wide self-monitoring (SM) intervention delivered via the I-Connect app and paired with an interdependent group contingency, on whole-group engagement in a general fourth grade classroom. Participants included 23 students during a 30-min instructional period. The researcher measured group engagement using momentary time sampling (MTS) with planned activity check (PLACHECK) with a fixed rotation schedule in 30-s intervals and recorded the percentage of students on-task per session. A withdrawal (ABAB) design was used to examine the effects across the baseline and intervention phases. Results indicated a slight increase in group engagement during the intervention …

Characteristics Of Pulmonary Vs. Extrapulmonary Tuberculosis Cases In Kentucky From 2020 To 2024, Mariam M. Alkhairat

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: Tuberculosis (TB) remains an important public health concern in the United States, especially among people experiencing social and clinical vulnerabilities. Extrapulmonary TB, which occurs outside of the lungs, can be harder to detect and diagnose than pulmonary TB. This study aimed to describe the demographic and clinical characteristics of people with active TB in Kentucky and to identify factors associated with extrapulmonary TB.

Methods: Secondary surveillance data were obtained from the Kentucky Department for Public Health (KDPH) using the National Tuberculosis Surveillance System (NTSS). The study sample included 301 confirmed active TB cases reported in Kentucky. Descriptive statistics were …

In Vivo Telemetry To Record Long-Term Cardiovascular Parameters, Temperature, And Activity In Spinal Cord Injury Rat Models, Sajeev Kaur, Anna M. Baur, Jillian A. Condrey, Dorottya P. Gal, Samir P. Patel, John C. Gensel

Spinal Cord and Brain Injury Research Center Faculty Publications

Higher-level spinal cord injury (SCI) above thoracic level 6 (T6) disrupts autonomic function and contributes to secondary complications, including fluctuations in blood pressure, heart rate, and temperature. In rats, the placement of telemetric implants in the descending aorta offers a robust methodology for assessing various cardiovascular parameters, such as systolic and diastolic pressure, mean arterial pressure, and heart rate. Core body temperature and animal activity can also be recorded following telemetric implant placement. A rat with a telemetric implant is kept on the receiver plate connected to a computer system for recording various parameters. Continuous long-term recordings at defined time …

Granulomatous Cellular Signatures In Nontuberculous And Tuberculous Mycobacterial Infections, Brianna M. Doratt, Ethan G. Napier, Mahdi Eskandarian Boroujeni, Sarah Douglas, Michael H. Davies, Luiz Bermudez, Eliot Spindel, Erin F. Mccaffrey, Ilhem Messaoudi

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Mycobacterium tuberculosis (Mtb) and nontuberculous mycobacteria (NTM) are acid-fast bacilli that trigger granuloma formation, a hallmark immune response aimed at containing infection. While the biology of Mtb granulomas has been widely investigated, far less is known about granulomas caused by NTM infection, despite the increasing prevalence and clinical challenge of NTM cases worldwide. Because granulomas influence infection control, pathology, and treatment response, understanding their cellular organization and signaling is critical to improving therapeutic strategies. Therefore, we characterized granulomas formed following infection of rhesus macaques with Mycobacterium avium subsp. hominissuis (MAH) and compared them to granulomas from cynomolgus macaques infected with …

The Impact Of Food Insecurity And Associated Variables On Colon Cancer In Kentucky: An Ecologic Study, Claire E. Lynch

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: Given colorectal cancer incidence rates are increasing, especially in socioeconomic disadvantaged areas, this study aims to determine if there is an association between specific socioeconomic variables, such as food insecurity, and colon cancer at the county-level in Kentucky.

Methods: Colorectal cancer age-adjusted incidence rates at the county-level were collected from the Kentucky Cancer Registry. Conty-level data was collected from County Health Ranking, The U.S Census Bureau, National Institute on Minority Health and Health Disparities and the Behavioral Risk Factor Surveillance System from 2019 to 2023. R was used to run statical analyses such as a linear regression and a …

Community Place Attachment As A Significant Correlate Of Motivation To Change Substance Use Behavior Among Adults Who Inject Drugs In Rural U.S., Janet K. Otachi, Shawndaya S. Thrasher, Keith J. Watts, Juma S. Mwenda, Hilary L. Surratt

Social Work Faculty Publications

Introduction: While motivation is critical for substance use disorder (SUD) recovery, many individuals fail to engage in treatment. The need to belong is a fundamental human motivation, yet the role of community place attachment (CPA) as a social asset in fostering motivation to change substance use behaviors (MCSUB) among people who inject drugs (PWID) is understudied. This paper examines the effect of CPA on PWIDs’ MCSUB.

Methodology: Cross-sectional data were collected from 350 PWID recruited from syringe service programs in rural Appalachian Kentucky (2018–2021). We used hierarchical multivariable linear regression to assess the association between CPA and MCSUB, controlling for …

Hepatitis C Virus Transmission Among People Who Inject Drugs In Rural United States: Mathematical Modeling Study Using Stochastic Agent-Based Network Simulation, Lin Zhu, Jennifer R. Havens, Abby E. Rudolph, April M. Young, Golnaz Eftekhari Yazdi, William W. Thompson, Liesl M. Hagan, Liisa M. Randall, Jianing Wang, Rebecca Earnest, Shayla Nolen, Benjamin P. Linas, Joshua A. Salomon

Center on Drug and Alcohol Research Faculty Publications

People who inject drugs (PWID) account for the majority of hepatitis C virus (HCV) infections in the United States. The injection-equipment-sharing network likely plays an important role in shaping the dynamics of HCV transmission. Recognizing the emerging HCV epidemic in rural communities, we developed an agent-based network simulation model of HCV transmission via injection equipment sharing and used data on rural PWID networks to inform model parameterization and calibration. We then simulated an array of networks that varied key network properties to understand their impact on the magnitude and distribution of HCV incidence. The results show substantial heterogeneity in HCV …

Noninvasive Optical Assessment Of Tissue Hemodynamics In Preterm Infants And Mastectomy Skin Flaps, Samaneh Rabienia Haratbar

Theses and Dissertations--Biomedical Engineering

Adequate tissue blood flow and oxygenation are essential for maintaining cellular viability and normal organ function. Disruptions in microvascular perfusion and oxygen delivery contribute to ischemia- and hypoxia-related diseases, including stroke, cancer, retinopathy of prematurity (ROP), and mastectomy skin flap necrosis. Reliable, noninvasive approaches for assessing tissue hemodynamics are therefore critical for improving diagnosis and therapeutic decision-making, particularly in settings where conventional methods are limited. This dissertation investigates the clinical and physiological importance of measuring tissue blood flow and oxygenation across neonatal and surgical applications using both clinical monitoring and advanced optical imaging techniques. In the first study, high-speed pulse …

Evaluating Training Effectiveness And Learning Transfer In The Kentucky Transportation Cabinet Safety Academy, Amanda L. Casolare

Theses and Dissertations--Civil Engineering

Effective evaluation of safety training is crucial to ensure that learning translates into safe work practices, particularly in high-risk public sector environments. The Kentucky Transportation Cabinet (KYTC) is developing a Safety Academy to enhance hazard recognition, risk management, and safety leadership within the organization. However, the Safety Academy has not yet been implemented, and formal evaluation methods for training have not been established. This study aimed to examine evidence-based training evaluation techniques and develop recommendations for evaluating the KYTC Safety Academy prior to program implementation.

This study employed an applied pre-implementation research design grounded in a comprehensive review of safety …

Other Eyes: The Dilemma Of Authorship And Autobiography In Sylvia Plath, John Ashbery, And Cristina García, Kevin J.B. O'Connor

Theses and Dissertations--English

This dissertation analyzes authorship in contemporary American literature, harnessing the writings—prose and poetry—of Sylvia Plath, John Ashbery, and Cristina García to challenge traditional classification and periodization schema. Hewing to the notion of authorship as a dilemma—a simultaneity of forces pressing upon the author, demanding a response—each chapter unravels critical moments of authorial expression that continually inscribe the importance of praxis and futurity. Comprehending authorship as a relational dilemma to be brooked, and indeed, overcome in a panoply of gestures, frees it theoretically from the perils of prior models by drawing attention to authorship’s agential and multi-modal aspects. Melding archival research …

Inside The Box: Containerization And The Limits Of Trade Unionism In The International Longshoremen's Association, 1945-1977, Calvin Horning

Theses and Dissertations--Geography

The International Longshoremen’s Association (ILA), the union of dock workers on the East Coast of the United States, saw a dramatic change in form and fortune in the middle of the 20^th century as the shipping industry and global labor underwent an immense reorganization. In the context of this reorganization, I argue that due to internal conservatism and racism alongside external state pressure, the ILA moved from an unruly, mafia-ruled union to a highly organized, professionalized, well-paid core of workers that served to support the United States’ capitalist-imperialist project.

Through archival material spanning over three decades, I analyze the …