Cultural issues in serving minority populations: emphasis on Mexican Americans and African Americans

Collecting Hair Samples for Hair Cortisol Analysis in African Americans

The hormone cortisol is typically assessed in saliva, serum, or urine samples. More recently, cortisol has been successfully extracted from hair, including humans. The advantage of hair cortisol concentration is that it reflects a retrospective representation of hypothalamic-pituitary-adrenal (HPA) axis function over time, much like hemoglobin A1C represents glycemic control. However, obtaining hair samples can be challenging, due to the cultural beliefs and hair care practices of minority participants. For example, African Americans may be reluctant to provide samples. Additionally, few researchers are trained to collect hair samples from African Americans. The purpose of this paper is to present a culturally informed protocol to help researchers obtain hair samples from African Americans. To illustrate the representative results of this protocol implementation, de-identified data from African Americans that participated in a community-based study on chronic stress are provided. Hair practice preferences are assessed. The participants are made comfortable by showing pictures of hair samples prior to cutting their hair. The single strain twist and gently pull method is used to collect approximately 30 - 50 strands of hair from the posterior vertex region of the scalp. This protocol will significantly improve collection of hair samples from African Americans.

From Focus Groups to Workshops: Developing a Culturally Appropriate Cervical Cancer Prevention Intervention for Rural Latinas

Latinas in the United States are disproportionately affected by cervical cancer, a disease that can be prevented, detected, and treated. As the U.S. Latino population continues to grow, the need for effective, culturally appropriate programmatic efforts for preventing cervical cancer among this population is heightened. To improve timely Pap screening and follow-up care among low-income, rural Latinas, formative research was conducted with this population and used to inform the development of a community-based intervention. Focus groups were held with twenty-seven Latinas in a rural North Carolina county to assess knowledge, attitudes, and behaviors regarding cervical cancer prevention. Findings indicate that respondents were familiar with the importance of Pap screening; however, they were less knowledgeable about cervical cancer and perceived susceptibility was low. Factors related to Pap screening behavior included embarrassment, social support, partner influence, economics, patient-provider interactions, and reliance on clinic interpreters. The findings were used to tailor educational workshops to the cervical cancer prevention needs of low-income rural Latinas.

Clinician/Patient Connections in Ethnoculturally Nonconcordant Encounters With Political-Asylum Seekers: A Comparison of Physicians and Nurses

The article compares the ability of nurses and physicians to connect with patients in ethnoculturally nonconcordant clinical encounters with 41 randomly selected political-asylum seekers (PAS) residing at five Finnish reception centers in summer 2002. Doctors and nurses were equally unlikely to draw congruent assessments of the patient’s past and present health condition, mixed use of biomedical/ethnocultural practices, adherence with medication and eat/drink instructions, (dis)satisfaction, and future confidence in recommended biomedical and ethnocultural approaches. Nurses were considerably more likely to hold views that were congruent with the patient’s reported health care effectiveness in Finland. The findings suggest that doctors should request and place special weight on the insights of the principal attending nurse when assessing the potential contributions of personal, family, and host-society health care assets and inhibitors to a migrant patient’s overall health plan. The results also suggest that culturally sensitive health care training offers specific advantages to nurses who attend to PAS.

Kidney Transplant and the Digital Divide: Is Information and Communication Technology a Barrier or a Bridge to Transplant for African Americans?

Context

Barriers to kidney transplant for African Americans are well documented in the literature. Little information on ownership of information and communication technology and use of such technology in transplant populations has been published.

Objective

To characterize racial differences related to ownership and use of information and communication technology in kidney transplant patients.

Design

A single-center, cross-sectional survey study.

Setting

An urban Midwestern transplant center.

Participants

78 pretransplant patients and 177 transplant recipients.

Main Outcomes Measures

The survey consisted of 6 demographic questions, 3 disease-related questions, and 9 technology-related questions. Dichotomous (yes/no) and Likert-scale items were the basis for the survey.

Results

Cell phone use was high and comparable between groups (94% in African Americans, 90% in whites, P = .22). A vast majority (75% of African Americans and 74% of whites) reported being “comfortable” sending and receiving text messages. Computer ownership (94.3% vs 79.3%) and Internet access (97.7% vs 80.7%) were greater among whites than African Americans (both P < .01). Fewer African Americans were frequent users of the Internet (27.1% vs 56.3%) and e-mail (61.6% vs 79.3%) than whites (both P < .01). More African Americans than whites preferred education in a classroom setting (77% vs 60%; P < .005) and educational DVDs (66% vs 46%; P < .002).

Conclusion

The use of cell phone technology and text messaging was ubiquitous and comparable between groups, but computer and Internet access and frequency of use were not. Reaching out to the African American community may best be accomplished by using cell phone/text messaging as opposed to Internet-based platforms.

The influence of living along the U.S.-Mexico border on unintentional drug overdose death, New Mexico (USA), 2005-2009

BACKGROUND

The objective of this study was to characterize unintentional drug overdose death patterns among Hispanic ethnicity/sex strata by residence in New Mexico counties that border Mexico and non-border counties.

METHODS

We analyzed medical examiner data for all unintentional drug overdose death in New Mexico during 2005-2009. Logistic and Poisson regression was used to examine the relationship of unintentional drug overdose death with border residence and demographics. Risk of overdose death was examined by the interactions of ethnicity, sex and border residence.

RESULTS

During 2005-2009, the statewide drug overdose death rate was 17.6 per 100,000 (n=1812). Border decedents were more likely to have died from overdose of prescription opioids other than methadone (Schedule II, Adjusted Odds Ratio (aOR)=1.98; Schedule III/IV, aOR=1.56) but less likely to have died from heroin overdose (aOR=0.35), compared to non-border decedents. In population-based analyses, people living in border counties had lowest rates of overall overdose death and from illicit drugs, particularly heroin and cocaine. Hispanic males (adjusted incidence rate ratio [aRR]=2.41), Hispanic females (aRR=1.77) and non-Hispanic males (aRR=1.37) from non-border counties had higher risk of drug overdose death than their counterparts from border counties. Border residence had no effect on risk of drug overdose death among non-Hispanic females.

CONCLUSIONS

Residents in border counties incurred a protective effect for drug overdose death, most pronounced among Hispanics. There is a component of overdose death risk for which border residence is a proxy, likely an array of cultural and healthcare-related factors.

Evaluating a stage model in predicting monolingual spanish-speaking Latinas' cervical cancer screening practices: the role of psychosocial and cultural predictors

The goals of this study are to evaluate (a) the effectiveness of a stage model in predicting Latinas' self-report of obtaining a Pap test and (b) the unique role of psychosocial/cultural factors in predicting progress toward behavior change. One-on-one structured interviews with monolingual Spanish-speaking Latinas (n=190) were conducted. Most participants (85%) intended to obtain a Pap smear within 1 year; therefore, staging women based on intention was not possible. Moreover, results from the polychotomous hierarchical logistic regression suggest that psychosocial and cultural factors were independent predictors of Pap test history. A stage model may not be appropriate for predicting Pap test screening among Latinas. Results suggest that unique cultural, psychosocial, and demographic factors may inhibit cervical cancer screening practices. Clinicians may need to tailor messages on these cultural and psychosocial factors to increase Pap testing among Latinas.

Variation in complementary and alternative medicine (CAM) use across racial/ethnic groups and the development of ethnic-specific measures of CAM use

OBJECTIVES

The use of complementary and alternative medicine (CAM) is likely to vary among racial/ethnic groups because its use is related to cultural and health beliefs. Understanding patterns of CAM use among ethnic groups could inform clinical practice and the study of CAM use in a diverse population. The authors compared CAM use among Asian-Americans, American Indians, African Americans, Latinos, whites, and other racial/ethnic groups in order to develop ethnic-specific measures of CAM use and explore factors associated with such CAM use across ethnic groups.

DESIGN

A cross-sectional survey of a sample of 9187 adults representative of the California population was performed.

OUTCOME MEASURES

Ethnic-specific constructs for Asian-Americans, American Indians, African Americans, Latinos, and whites were devised.

RESULTS

The authors identified ethnic-specific CAM modalities for each ethnic group. Demographic and clinical factors associated with use of ethnic-specific CAM differed from the predictors of overall CAM use in the general population and varied by ethnicity.

CONCLUSIONS

Patterns of CAM use and ethnic-specific CAM use vary across racial/ethnic groups. Evaluation of CAM use in ethnically diverse populations should recognize ethnic-specific modalities and variation across ethnicity.

Globalization, migration health, and educational preparation for transnational medical encounters

Unprecedented migration, a core dimension of contemporary globalization, challenges population health. In a world of increasing human mobility, many health outcomes are shaped by transnational interactions among care providers and care recipients who meet in settings where nationality/ethnic match is not an option. This review article explores the value of transnational competence (TC) education as preparation for ethnically and socially discordant clinical encounters. The relevance of TC's five core skill domains (analytic, emotional, creative, communicative, and functional) for migration health and the medical-school curriculum is elaborated. A pedagogical approach that prepares for the transnational health-care consultation is presented, with a focus on clinical-clerkship learning experiences. Educational preparation for contemporary medical encounters needs to include a comprehensive set of patient-focused interpersonal skills, be adaptable to a wide variety of service users and global practice sites, and possess utility in addressing both the quality of patient care and socio-political constraints on migration health.

Nonprescribed antimicrobial drugs in Latino community, South Carolina

We investigated in a sample of Latinos the practices of antimicrobial drug importation and use of nonprescribed antimicrobial drugs. In interviews conducted with 219 adults, we assessed health beliefs and past and present behaviors consistent with acquiring antimicrobial drugs without a prescription in the United States. Many (30.6%) believed that antimicrobial drugs should be available in the United States without a prescription. Furthermore, 16.4% had transported nonprescribed antimicrobial drugs into the United States, and 19.2% had acquired antimicrobial agents in the United States without a prescription. A stepwise logistic regression analysis showed that the best predictors of having acquired nonprescribed antimicrobial drugs in the United States were beliefs and behavior consistent with limited regulations on such drugs. Many persons within the Latino community self-medicate with antimicrobial drugs obtained without a prescription both inside and outside the United States, which adds to the reservoir of antimicrobial drugs in the United States.

Access to health care for individuals with developmental disabilities from minority backgrounds

In this project we examined access to health care by individuals with developmental disabilities in Kansas from low-income populations and from minority backgrounds. Four criteria for determining access were employed: availability, accessibility, affordability, and appropriateness of care. Factors that pose barriers and that facilitate access are described and recommendations are set out, with particular reference to the 2002 Report of the Surgeon General of the United States, related to health status of people with mental retardation.

Where's Maria? A video to increase awareness about breast cancer and mammography screening among low-literacy Latinas

BACKGROUND

The need exists to educate and motivate medically disadvantaged Latinas to engage in regular mammography screening to reduce their high breast cancer (BC) mortality risk due to the illness' late detection.

METHODS

Qualitative research methods [e.g., focus groups, key informants] were primarily used during the basic and formative research phases in preproducing and producing a breast cancer educational video for low-literacy Latinas.

RESULTS

An 8-min video was created in an Entertainment-Education soap opera format. The purpose of the video is to create awareness about breast cancer and to motivate low-literacy Latinas who are at the precontemplation stage of behavior change to consider engaging in mammography screening. Thus, the video presents a compelling story of a Latina with whom the target audience can identify and become involved with the unfolding events of her story as she realizes her risk for breast cancer and struggles with the decision to engage in mammography. The content and format of the video include culturally relevant clues and modeling to influence Latinas' cognitive and subjective processes involved in making the decision to change.

CONCLUSIONS

Complex attitudinal and behavioral issues can be effectively targeted to decrease the influence that psychological barriers exert in Latinas low breast cancer screening rates.

Perspectives of Physicians, Families, and Case Managers Concerning Access to Health Care by Individuals With Developmental Disabilities

This study of the status of medical care for Kansans with developmental disabilities consists of reports from physicians, service providers, and family members. Overall, these three groups indicated satisfaction with medical care across the four criteria of availability, accessibility, appropriateness, and affordability. The bases for these results are outlined, and suggestions for improving satisfaction with health care are presented.

The challenge of culturally competent health care: applications for asthma

To better serve the increasingly diverse ethnic and racial communities in the United States, health care professionals must develop a knowledge base of cultural health practices. In asthma, a common disease, ethnic minority populations experience poorer outcomes when compared with whites. It is, therefore, imperative that providers have an improved understanding of how patients make decisions concerning their health. Cultural health practices, in concert with conventional treatments, often form a comprehensive asthma management strategy for the patient. The potential implication of alternative explanations for disease, as well as the role of diet and botanical supplements, is explored in this article in an effort to increase providers' sensitivity to nonbiomedical models of disease causality. This sensitivity is the first step in developing cultural competency.

The development of the Cultural Health Attributions Questionnaire (CHAQ)

Current general health belief measures that are used to assess health behaviors do not capture the full range of health beliefs present among Latinos. The purpose of this study was to develop a reliable and valid measure of Latino health beliefs, the Cultural Health Attributions Questionnaire (CHAQ). Three hundred forty participants were recruited in 2 metropolitan areas with large Latino populations. Exploratory factor analysis revealed 2 highly interpretable 12-item subscales: the Equity Attribution and the Behavioral-Environmental Attribution scales. Examination of the relationships between the subscales and measures of acculturation provided evidence of construct validity. Moreover, the prediction of health care behavior by the CHAQ also indicated initial criterion validity.

Assessing cultural sensitivity in printed cancer materials

OBJECTIVES

Printed cancer education materials (PCEMs) (pamphlets and fact sheets) are used to educate individuals about cancer prevention and awareness. Culture is an important variable affecting the retention and use of information in printed materials to African Americans that has not been fully addressed in the literature.

MATERIALS AND METHODS

The major goal of the Cancer Prevention Materials for African Americans project, funded by the Texas Cancer Council, was to assess cultural sensitivity of currently disseminated PCEMs targeting African Americans. The project consisted of conducting focus groups, forming an advisory committee, and developing and using the Printed Cancer Education Materials for African Americans Cultural Sensitivity Assessment Tool.

RESULTS

Cultural sensitivity of PCEMs was assessed in terms of format, visual message, and written message. The majority of the PCEMs (56.2%) were culturally insensitive, with the visual message being the weakest component of all the materials.

CONCLUSION

Future PCEMs targeting African Americans should include culturally sensitive visual messages to be more effective in delivering the cancer prevention message. The use of the assessment tool can assist cancer control specialists in developing culturally sensitive materials.

Correlates of prescription and over-the-counter medication usage among older Mexican Americans: the Hispanic EPESE study. Established Population for the Epidemiologic Study of the Elderly

OBJECTIVES

To determine the prevalence rates of prescription and over-the-counter (OTC) medication usage among community-dwelling older Mexican Americans.

DESIGN

Cross-sectional survey of a regional probability sample of older Mexican Americans.

SETTING

The 1992-1997 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, age 65 and over, living in the five Southwestern states of Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

2899 persons, age 65 and over, considered Mexican American, using appropriate weighting procedures to produce regional estimates.

OUTCOME MEASURES

Use of prescription and OTC medication within the last 2 weeks before the survey confirmed by in-home review of medication containers.

RESULTS

Medication users consumed a mean of 2.9 prescription and 1.3 OTC medications. Over half (58.9%, n = 1,798) of the participants used at least one prescribed medication, and 31.3% (n = 847) used at least one OTC medication within the 2 weeks before their participation in the study. Factors associated with both prescription and OTC medication usage were self-perceived health and number of co-morbid conditions. Factors associated only with prescription medication usage included female gender, alcohol usage, ADL dependency, and presence of additional insurance. Structural assimilation was associated only with OTC medication usage.

CONCLUSIONS

These data show lower prevalence rates of prescription medication usage among Mexican American older men and lower rates of OTC medication usage in older Mexican Americans of both genders than previously reported in other ethnic groups. This may reflect differences in time and geographic location of the Hispanic EPESE relative to other EPESE studies, ethnic differences in access to care as reflected by insurance in addition to Medicare, ethnic differences in survival, especially among males, or ethnic differences in medication preferences.

Cost of diabetes-related amputations in minorities

The objective of this study was to identify the direct cost and length of hospitalization of diabetes-related lower extremity amputations among Hispanics, African Americans, non-Hispanic whites, and Asians. The authors used a database from the office of Statewide Planning and Development in California that identified all hospitalizations for lower extremity amputations in the state in 1991. Amputation level was defined by the ICD-9-CM codes 84.11-84.18. The total hospital charges for diabetes-related lower extremity amputations for the state of California in 1991 was $141 million. The mean hospital charge (HC) per patient with all ethnic groups combined was $27,930; and the mean length of stay (LOS) was 15.9 days. African Americans had significantly higher mean charges ($32,383) and longer stays (17.3 days) compared to all other ethnic groups (p < .05). Toe-level amputations had lower HC (p < .05) and LOS (p < .01) than other amputation levels for all race groups. One-quarter of the population received multiple amputations during their hospital stay. These patients incurred significantly higher hospital charges ($44,731) and stayed in the hospital longer (23.4 days) than those receiving only a single amputation. There was a considerable variation in the HC and LOS among ethnic groups by level of amputation. The direct charges reported in this study suggest considerably higher overall direct costs than have been previously reported in the medical literature. The greater burden of disease experienced by African Americans is probably related to their higher amputation cost and longer hospitalization.

Barriers to the use of pharmacy services: the case of ethnic populations

The barriers that minority populations face with respect to the use of pharmacy services may differ from those faced by other populations. A pretested questionnaire was administered to a convenience sample of 96 Vietnamese residents of a mid-size Midwestern city. Perceptions of five common barriers to pharmacy services were investigated. Financial difficulty (47%), language (25%), and physical illness (14%) were the most serious barriers to pharmacy services, followed by transportation and unemployment. These researchers propose seven broad strategies that pharmacists might use to minimize the effect of the barriers. The use of these strategies could benefit patients by improving their health, and increase opportunities for pharmacists to provide pharmaceutical care to the rapidly growing Vietnamese community and other ethnic populations.