Over the past several decades, the population in the United States has become increasingly diverse with regard to race and ethnicity. Recent data indicate that the racial/ethnic minority population is composed of myriad groups, including Hispanic/Latino, African American, Asian, American Indian, and multiracial Americans (U.S. Census Bureau, 2015). Unfortunately, such racial and ethnic diversity is not reflected in the nursing population. According to a 2010 national survey conducted by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA, 2010), only 16.8% of the nearly 3 million RNs in the United States identify themselves as being a racial or ethnic minority.
The homogeneity of the nursing profession is believed to extend to sexual orientation as well. It is argued that the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community remains the largest minority group within the nursing profession (National League for Nursing [NLN], 2016). Unfortunately, limited data are available to accurately determine how many RNs in the United States identify as LGBTQ. Demographic data for LGBTQ RNs are not collected at the national or local levels; therefore, valid and reliable data for this population are sparse and tend to be limited to individual studies (Levesque, 2015; NLN, 2016).
Despite measures taken to enhance gender diversity within the profession, nursing remains largely a female-dominated workforce (U.S. Census Bureau, 2013). Recent studies suggest that men comprise only 9.1% of RNs licensed in the United States, and 12% of students enrolled in a baccalaureate nursing program (American Association of Colleges of Nursing [AACN], 2012). With only a 1.4% increase over the past 5 years of RNs who are male, there remains a tremendous underrepresentation of men in nursing (NLN, 2016).
Demographic data collected in recent years suggest that the nursing population is an aging one (American Nurses Association [ANA], 2014). According to the ANA (2014), the average age of the U.S. nursing workforce has increased in the past decade from 46 to 48 years. Similarly, only 14.8% of RNs currently practicing in the United States report being under the age of 30 (ANA, 2014). One factor that has contributed to the increasing mean age of practicing RNs is the high number of young nurses who elect to leave the nursing profession. Research has consistently shown that the youngest generation of RNs (i.e., age 30 years or younger) are significantly more likely to leave the nursing profession within the first 5 years of practice compared with older nurses (Hayes et al., 2012).
Marginalization in Nursing Education
The homogeneity of the nursing profession is largely a direct result of the significantly higher attrition rates that minority nursing students experience compared with nonminority students (Loftin, Newman, Dumas, Gilden, & Bond, 2012; Pitt, Powis, Levett-Jones, & Hunter, 2012; Shelton, 2012). It has been estimated that between 5% and 23% of nonminority students in the United States drop out of a baccalaureate nursing program, whereas the attrition rates of minority nursing students have been reported to be as high as 85% (Loftin et al., 2012). The U.S. educational system has been identified as being the single most important agent in the process of socialization into the nursing profession; however, minority students have consistently reported experiencing feelings of marginalization not only from peers, but also from nursing faculty and universities (Dapremont, 2011; Loftin et al., 2012; McDermott-Levy, 2011; West, Usher, Foster, & Stewart, 2014). Such feelings have been identified as a central theme in the attrition rates of minority nursing students (Loftin et al., 2012; Pitt et al., 2012; Shelton, 2012).
One factor that may contribute to the marginalization felt by minority nursing students is that cultural competence and diversity get little attention in the classroom and clinical settings (Carabez et al., 2015; Levesque, 2015; Sumpter & Carthon, 2011). The term cultural competence refers to the ability to deliver services while taking into consideration the individual's cultural beliefs, behaviors, and needs (Matteliano & Street, 2012). Nurse educators have the potential to influence students' understanding and level of cultural competence, as well as to foster an environment that embraces cultural diversity (Condon et al., 2013). Unfortunately, the best method for fostering cultural competence in nursing students remains ambiguous (Delgado et al., 2013). Results of a study conducted by Kardong-Edgren et al. (2010) suggest that nursing students graduate at the most basic level of cultural competency—cultural awareness. The literature suggests that cultural awareness alone is not sufficient to address the issues of structural and interpersonal racism and their effects on promulgating health disparities (Downing & Kowal, 2011; Truong, Paradies, & Priest, 2014). Similarly, despite the fact that the majority of accrediting agencies have called for nurse educators to be competent to teach cultural content to students, research suggests that few educators have achieved the level of cultural competence that is required to prepare nurses to care for an ethnically diverse patient population (Loftin et al., 2012; Sumpter & Carthon, 2011).
The issue of cultural competence in nursing students and faculty is noteworthy in that research has consistently demonstrated that nursing faculty and peers remain significant barriers to the success of minority nursing students. Behaviors reported by students ranged from unaware and unsupportive peers and faculty to outright discrimination and lack of respect for cultural differences (Loftin et al., 2012; Sumpter & Carthon, 2011; Ume-Nwagbo, 2012).
Marginalization and Racial/Ethnic Minority Students
Racial and ethnic minority students have consistently reported experiencing intense feelings of disconnect, isolation, and loneliness from their peers and faculty (Dapremont, 2011; Loftin et al., 2012; McDermott-Levy, 2011; West et al., 2014). Struggling with feelings of loneliness and isolation has been shown to significantly hinder a student's ability to effectively navigate the nursing curriculum (McDermott-Levy, 2011). Research also suggests that stereotypes and discrimination continue to plague the U.S. education system (Dapremont, 2011; Loftin et al., 2012; McDermott-Levy, 2011; West et al., 2014) This typecasting and negativity may lead students to feel like outsiders, which in turn may hinder minority students' ability to successfully complete their education (Levesque, 2015).
Marginalization of LGBTQ Students
The dearth of empirical data about this “silent minority” largely stems from the fact that many LGBTQ students and nurses elect to not divulge their sexual orientation to peers and university faculty for fear of discrimination and negative repercussions from peers, patients, and administrations (Röndahl, 2011). LGBTQ students also reported feeling that campus environments are less supportive of them (Rankin, Weber, Blumenfeld, & Frazer, 2010). Results of a study conducted by Rankin, Weber, Blumenfeld, and Frazer (2010) indicated that LGBTQ students were significantly less likely than heterosexual peers to feel comfortable in the campus climate in general and the classroom climate specifically. Furthermore, LGBTQ student participants seriously considered leaving their institution more often and feared for their physical safety far more than their heterosexual peers.
Marginalization of Gender Minority Students
It is postulated that the perpetuation of the feminine stereotype by the nursing profession, as well as the pervasive use of feminine language and value systems in nursing education, creates a situation of oppression for those who do not fit the stereotype (Kellett, Gregory, & Evans, 2014). The marginalization of male nurses' masculinity due to the feminine nature of the nursing profession and peer suspicions of homosexuality may cause feelings of anger and stress over discrimination (Kellett et al., 2014; Rajacich, Kane, Williston, & Cameron, 2013). Similarly, taking on the status of gender minority and being immersed in a new feminine social context often leaves male nursing students feeling bewildered, confused, and alienated (Kellett et al., 2014).
Marginalization of Nontraditional-Aged Students
Although nontraditional-aged students bring a rich and complex set of life experiences and circumstances to the collegiate environment, they may still be faced with varied support and negative sociocultural contexts of secondary education (Meyer, 2014). Research suggests that nontraditional-aged students remain a marginalized population through institutional policies and practices (Meyer, 2014). A review of the evidence reveals that nontraditional-aged students often struggle as they navigate through a system of higher education that has been created to accommodate traditional-aged students (Meyer, 2014; Willans & Seary, 2011). Willans and Seary (2011) conducted a qualitative study that explored nontraditional-aged students' engagement in secondary education. Students reported likening their experiences to being a novice paintball player who is constantly bombarded from all directions and worn down by the constant hits. For the nontraditional-aged student, these “hits” stemmed from tensions surrounding social interactions with peers, institutional protocols, and feeling marginalized on campus (Willans & Seary, 2011).
The most compelling argument in favor of diversifying the nursing profession is that it may lead to improvements in public health (Institute of Medicine [IOM], 2010). According to the IOM (2010), nurses from different cultural groups may be in a better position to work with patients from their own minority groups because personal experiences may transcend any cultural or linguistic barriers. However, the persistent lack of heterogeneity within the nursing workforce has necessitated a demographic imperative in which members of the predominant American culture familiarize themselves with other cultures.
Research suggests that health professionals from minority populations are more likely than their nonminority counterparts to provide leadership and advocacy for vulnerable populations. Minority nurses are key contributors and leaders in the development and implementation of care models aimed at addressing the unique needs of racial/ethnic and sexual minority populations (AACN, 2015; Phillips & Malone, 2014). Furthermore, the shared experiences of living as a minority in the United States may allow minority nurses to better understand and address the issues of violence, poverty, segregation, and racism that contribute to health disparities (Downing & Kowal, 2011; Truong et al., 2014).
Regarding marginalization, despite the increased attention and emphasis on diversifying the nursing profession, the existing body of literature about the factors that contribute to the attrition of minority nursing students remains lacking. For example, the vast majority of research conducted on minority attrition rates and barriers to the successful completion of nursing programs has been generated using qualitative methodology (Loftin et al., 2012; McDermott-Levy, 2011; West et al., 2014). Investigating this topic using quantitative methods may serve to expand the body of existing knowledge in this area and perhaps yield new insights about this long-standing issue. Similarly, although feelings associated with marginalization have been found to be a barrier in some qualitative studies (Dapremont, 2011; Loftin et al., 2012; McDermott-Levy, 2011; West et al., 2014), the concept has not been investigated as an independent phenomenon in undergraduate nursing students.
The purpose of this study was to investigate the relationship between marginality and minority status in undergraduate nursing students in University of Wisconsin system campuses. Quantitative methodology measuring marginalization with the Koci (2004) Marginality Index-70 (KMI-70) was conducted in the four University of Wisconsin system schools that offer baccalaureate nursing programs.
A nonexperimental, descriptive correlational design was used to investigate the relationship between minority status and marginalization in undergraduate nursing students in the University of Wisconsin. Institutional review board approval was obtained prior to the initiation of data collection procedures, and a convenience sampling plan was used for the research study. The demographic variables of race/ethnicity, sexual orientation, gender, and age were investigated in relation to marginality; therefore, the target population was all undergraduate nursing students currently enrolled full-time in a baccalaureate nursing program at one of the four target universities.
The KMI-70 is a 70-item instrument that uses a Likert scale for measurement and creates a total score that indicates the degree or level of marginalization experienced by an individual. Scores for the KMI-70 range from 70 to 280; the higher the score, the more marginalized the individual (Koci, 2004). In terms of reliability and validity of the instrument, the KMI-70 uses subscales from the Minnesota Multiphasic Personality Index-2 (MMPI-2). The MMPI-2 has been used extensively in a large variety of psychological and personality research and has been updated to reflect appropriate ethnic representation (Greene, 2000). Data on both the test–retest reliability and internal consistency measures of the MMPI-2 range from .58 to .91 (Hathaway & McKinley, 1989). The KMI-70 had not been used to evaluate marginalization in the nursing student population; therefore, a pilot study was conducted to evaluate the psychometric properties of the KMI-70 using baccalaureate undergraduate nursing students. Results of the pilot study indicated that the KMI-70 was found to have strong internal consistency reliability (Cronbach's α = .95).
Procedure and Implementation
After obtaining permission from the institutional review boards of each of the four baccalaureate undergraduate nursing programs in University of Wisconsin, the principal investigator contacted the students indirectly by sending e-mails to the undergraduate program assistant from each of the four campuses, which were then forwarded to the students. The e-mail contained and an informational flyer that provided a synopsis of the study and a link to the consent form, demographic questionnaire, and the KMI-70. Participant questionnaires and surveys were submitted anonymously using PsychData® research services.
Data analyses were performed using SPSS® version 21 software. A descriptive analysis of the data was also undertaken with regard to the demographics of student participants. A series of independent-samples t tests were conducted to evaluate differences in mean scores on the KMI-70 in relation to the demographic variables of interest. Two one-way ANOVAS were also conducted to investigate further the differences in mean scores between both the various racial/ethnic groups and age groups included in the study. The significance level was set at p < .05.
A total of 331 participants comprised the research sample, which constitutes 27.5% of the approximately 1,200 baccalaureate nursing student population on the four University of Wisconsin campuses. Table 1 presents a summary of the demographic data for study participants. A descriptive analysis of the data found that the majority of participants included in the study were female (87%) and between the ages of 18 and 24 years (81.3%). With respect to ethnicity, 86.4% identified as White/Caucasian, whereas the remaining participants identified as Hispanic/Latino (3.3%), Black/African American (3.6%), Asian/Pacific Islander (5.4%), or Other (1.2%). Of the participants included in the study, 96.4% reported English as being their primary or native language. In terms of sexual orientation, 93.7% indicated that they were heterosexual; the remaining participants identified as lesbian (1.2%), gay (1.2%), or bisexual (3.3%). One participant identified as belonging to the category of Other but did not specify further, and a second participant (0.3%) declined to answer the question.
With regard to reliability of the instrument, the KMI-70 was found to have strong internal consistency reliability (Cronbach's α = .954), which is consistent with findings from the pilot study (Cronbach's α = .948). Table 2 presents a summary of the mean scores and standard deviations obtained from the KMI-70. Results indicate that there was a significant difference in mean scores for minority (M = 177.5, SD = 29.3) versus nonminority students (M = 166.4, SD = 18.1); t(329) = 4.3, p ⩽ .001.
Means and Standard Deviations on Koci Marginality Index-70 by Demographic Variable
A t test was conducted to evaluate differences in mean scores for racial/ethnic minority and nonminority nursing students. Results indicate that racial/ethnic minorities scored significantly higher on the KMI-70 (M = 199.1, SD = 27.4) when compared to nonminority participants (M = 166.3, SD = 27.4); t(329) = −9.9, p ⩽ .001. Further analysis of race/ethnicity revealed that participants who identified as speakers of English as a non-native language (ENNL) reported higher marginality scores (M = 186.9, SD = 33.6) compared with scores obtained from participants whose primary or native language is English (M = 170.3, SD = 23.2); t(329) = −2.4, p = .037.
A one-way ANOVA was then conducted to investigate further the differences in mean scores between the various racial/ethnic groups with regard to KMI-70 scores. Results of the tests for normality regarding race/ethnicity are presented in Table 3. Although there was a significant difference in mean scores for White/Caucasian (nonminority) participants compared with Hispanic/Latino, Black/African American, or Asian/Pacific Islander (minority) participants, F(2,326) = 29.05, p < .001, results indicate no significant differences in mean scores between Hispanic/Latino, Black/African American, or Asian/Pacific Islander participants. Results of the ANOVA with a Tukey post hoc analysis are presented in Table 3.
Tukey Post Hoc Analysis of Mean Scores on the Koci Marginality Index-70 by Race/Ethnicity
A t test was also computed to determine whether sexual minorities experience higher levels of marginalization than non-minorities. Results did not reveal any statistically significant differences between sexual minority (M = 178.8, SD = 33.7) and nonminority participants (M = 170.3, SD = 23.0); t(328) = −1.5, p = .112 with regard to KMI-70 scores.
A t test was computed to determine whether male participants experience higher levels of marginalization than female participants. Results suggest that there was no statistically significant difference in mean scores for male participants (M = 166.1, SD = 25.6) versus female participants (M = 171.6, SD = 23.5); t(329) = −1.4, p = .428.
A t test was conducted to evaluate differences in mean scores for traditional-aged and nontraditional-aged participants. Results indicate that there was no significant difference in KMI-70 scores for nontraditional-aged participants (M = 166.9, SD = 19.8) compared with traditional-aged participants (M = 171.8, SD = 24.6); t(329) = 1.5, p = .111. A one-way ANOVA was then conducted to investigate further the differences in mean scores between the different age groups regarding KMI-70 scores. Results indicated there is no significant difference in marginality scores between participants with respect to age, F(4,326) = .63, p = .640. Results of the ANOVA are presented in Table 4.
Means and Standard Deviations of the Koci Marginality Index-70 by Age
Participants who belonged to a racial or ethnic minority group reported significantly higher levels of marginalization than those were reported by nonminority students. These findings are consistent with many qualitative studies that explored the lived experiences of racial and ethnic minority students as they traversed through nursing school (Dapremont, 2011; Loftin et al., 2012; McDermott-Levy, 2011; West et al., 2014). What is perhaps more alarming is how significant the gap is between racial and ethnic minorities in relation to nonminority participants, with regard to mean scores on the KMI-70. Results of the study revealed that participants who belong to a racial/ethnic minority generated KMI-70 scores that were an average of 33 points higher than scores obtained from nonminority participants. When compared with results of a pilot study by the researcher, marginality scores for racial/ethnic minority students in this study were nearly 42 points higher than the KMI-70 scores obtained from racial/ethnic minority students included in the pilot study.
One factor that may have influenced the large difference in mean scores is that fact that Wisconsin is a very racially homogenous state relative to other geographic areas of the United States. According the U.S. Census Bureau (2015), 83.3% of Wisconsin residents identified as Non-Hispanic White, whereas 45.3% of residents of the state where the pilot study was conducted are Non-Hispanic White. The racial/ethnic heterogeneity found in Wisconsin is mirrored at the national level as well, with only 61.6% of U.S. population belonging to the category of Non-Hispanic White (U.S. Census Bureau, 2015). Perhaps students who reside in racially homogenous geographical areas and attend nursing programs with an overwhelmingly White student body may feel increased levels of marginalization.
The difference in mean scores for ENNL participants versus nonminority individuals reached the level of statistical significance. This finding is consistent with previous studies that found a perceived lack of peer and faculty support was a significant predictor of attrition of ENNL students from undergraduate nursing programs (Malecha, Tart, & Junious, 2012; Olson, 2012; Suliman & Tadros, 2011).
Results of the study did not reveal any statistically significant differences between sexual minority and nonminority participants with regard to KMI-70 scores. These findings are inconsistent with the extant literature that suggests that LGBTQ individuals feel isolated and marginalized from peers and academic institutions (Carabez et al., 2015; Rankin et al., 2010). The sample size obtained for the study was small (N = 20), as it represents approximately 6% of the participants; however, this number is consistent with national measures that estimate that 4% of the U.S. population belongs to the LGBTQ community (U.S. Department of Health and Human Services, 2014).
There was no statistically significant difference in mean scores between gender minority (i.e., male) and nonminority (i.e., female) participants. These findings are not supported in the literature, as numerous studies have elucidated on the marginalization of men in nursing programs (Rajacich et al., 2013). Although not statistically significant, the KMI-70 scores for females was, on average, five points higher (M = 171.6) than those scores obtained from male participants (M = 166.1). The higher mean scores for female participants may stem from the fact that gender inequalities continue to exist in society.
Koci (2004) developed a marginality scale based on specific scales from the MMPI-2. The MMPI-2 is a broad-based test designed to assess a number of major patterns of personality, emotional, and behavioral disorders (Hathaway & McKinley, 1989). According to Roberts, Wood, and Caspi (2008), personality traits are defined as “the relatively enduring patterns of thoughts, feelings, and behaviors that distinguish individuals from one another” (p. 375). There is a general consensus that most personality traits present during adolescence and are relatively stable over time (Roberts, Wood, & Caspi, 2008). If females are exposed to gender inequalities and marginalization since birth (Williams, 2013), such prolonged exposure may significantly influence personality. Conversely, males are not considered a gender minority in the vast majority of social situations; therefore, the short interval of exposure to marginalization in nursing programs may not be enough in severity, duration, or both to alter their personality appreciably.
The difference in means scores on the KMI-70 for traditional versus nontraditional-aged students was not statistically significant. The results of this study contrast those of a multitude of studies finding marginalization to be a problem for nontraditional-aged students (Sims & Barnett, 2015; Willans & Seary, 2011). What is noteworthy is the fact that the mean score for traditional-aged students was five points higher (M = 171.8) than what was found for nontraditional-aged students (M = 166.7). One factor that may have contributed to the lower KMI-70 scores for nontraditional-aged students compared with traditional-aged students is that older students may be more resilient and better equipped to cope with feelings of isolation and “differentness” from peers. Nontraditional-aged students' cumulative life experiences may provide enhanced maturity and wisdom compared with traditional-aged students (Meyer, 2014).
Several limitations can be identified in the current study. First, the sample size for minority participants across all demographic categories was small. The sample used in this study also lacked representation of nursing students who self-identify as transgender or queer. Research suggests that the number of college students who either identify as transgender or are questioning their gender identity has increased over the past decade (Dugan, Kusel, & Simounet, 2012). The research sample constituted only 27.5% of the total baccalaureate nursing student population on the four University of Wisconsin system campuses. It is possible that students who felt marginalized by peers, faculty, or the university did not participate in the study. Perhaps a more robust sample of minority participants would have yielded statistical significance with a number of demographic variables, including gender, sexual orientation, and age.
Another limitation identified pertains to the ability to generalize the findings to other populations. Given that the scope of this study is specific to baccalaureate nursing programs in Wisconsin, the findings may not be transferable to undergraduate nursing students in other states or to students enrolled in other nursing programs, such as associate degree or graduate programs.
A final limitation pertains to the marginality tool used in the study. The KMI-70 is a lengthy tool that can be time consuming for participants to complete. Similarly, the KMI-70 evaluates marginalization based on many personality indicators; for individuals such as males who do not tend to be a marginalized class outside of the domain of nursing, such a tool may not be the most effective means by which to gather data from this population. The results of this study illuminate the need for the development of a marginality tool that speaks specifically to the various institutional, social, and personal factors that influence marginality within the domain of nursing education.
Research has shown that support from the university is a critical factor in the success of its minority student population (Condon et al., 2013; West et al., 2014). To effectively guard against the marginalization of minority students, nurse educators must promote a positive learning environment for all students (Condon et al., 2013). Research suggests that students' learning performance and social integration are enhanced when educators promote an inclusive and culturally diverse learning milieu (Harris, Rosenberg, & O'Rourke, 2014). To create a diverse cultural environment, nursing faculty must first engage in an ongoing process of self-examination about their own cultural beliefs and identity. Such a process can be facilitated by providing continuing education and faculty-focused workshops aimed at enhancing the cultural competence of nurse educators (Harris et al., 2014).
Although a great deal of attention has been placed on increasing student diversity on campus, ensuring diverse faculty is equally important with regard to improving student outcomes. Empirical evidence suggests that minority nursing students possess a strong desire to interact more consistently with mentors who are culturally concordant with their background (Harris et al., 2014). Faculty–student mentoring has been identified as an effective strategy for increasing and sustaining the diversity of students in nursing education (Harris et al., 2014). Mentoring offers students unique strategies that foster academic success, including enhanced communication and social contact between faculty, both of which facilitate the discussion of concerns, issues, and ideas (Harris et al., 2014). Mentoring is also associated with many positive psychological outcomes including enhanced self-image and self-efficacy, as well as the promotion of professional leadership skill development (Wilson, Brannan, & White, 2010).
Despite that much attention has been placed on diversifying the nursing profession, the field remains homogenous with regard to race, gender, and sexual orientation. The findings from this research study suggest that marginalization remains a significant issue for minority students throughout their nursing education. The continued homogeneity of the nursing profession has implications for the health of the U.S. population as well. Despite decades of attending to both the cultural competence of health care providers and diversity of health care clients, minimal inroads have been made using cultural competency to address health disparities. As population demographics continue to shift rapidly, it is imperative that the field of nursing better represent the individuals for whom they are caring.
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|Variable||n (%)||Cumulative %|
| Male||43 (13)||13|
| Female||288 (87)||100|
| 18–24||269 (81.3)||81.3|
| 25–33||40 (12.1)||93.4|
| 34–41||13 (3.9)||97.3|
| 42–49||8 (2.4)||99.7|
| 50–55||1 (0.3)||100|
| White or Caucasian||286 (86.4)||86.4|
| Hispanic or Latino||11 (3.3)||89.7|
| Black or African American||12 (3.6)||93.4|
| Asian/Pacific Islander||18 (5.5)||98.8|
| Other (Please specify)||4 (1.2)||100|
|English is primary or native language|
| Yes||319 (96.4)||96.4|
| No||12 (3.6)||100|
| Heterosexual||310 (93.7)||93.7|
| Lesbian||4 (1.2)||94.9|
| Gay||4 (1.2)||96.1|
| Bisexual||11 (3.3)||99.4|
| Other (please specify)||1 (0.3)||99.7|
| Declined to answer question||1 (0.3)||100|
Means and Standard Deviations on Koci Marginality Index-70 by Demographic Variable
| ⩾ 25||62||166.9||19.8|
| Nonminority||285||166.3||19.7||−9.9||< .001|
|English is primary language|
| Lesbian, gay, bisexual, transgender, questioning||20||178.8||33.7|
Tukey Post Hoc Analysis of Mean Scores on the Koci Marginality Index-70 by Race/Ethnicity
|Race (I)||Race (J)||Mean Difference (I-J)||SE||p|
|Black/African American||−37.3||6.1||< .001|
|Asian/Pacific Islander||−29.7||5.0||< .001|
Means and Standard Deviations of the Koci Marginality Index-70 by Age