Cultural concepts of distress among Albanian young adults living in Switzerland - a qualitative study

Objectives

Existing research recognizes the critical role that social, sociodemographic, and acculturative processes play in increasing vulnerability for experiencing psychological distress among second-generation migrants. However, to date, far too little attention has been given to the study of psychological distress in this social group. The main objective of this study is to examine cultural identities, as well as expressions and causes of psychological distress among second-generation Albanian-speaking migrants in Switzerland.

Methods

Semi-structured qualitative interviews were conducted with 13 Albanian-speaking participants between 19 and 35 years of age using the interview of the Barts Explanatory Model Inventory. Data were analyzed by qualitative content analysis using MAXQDA-2018 software.

Findings

Study participants showed bicultural identities, which caused value conflicts and a feeling of being "caught" between Swiss and Albanian culture. Some participants experienced the fear of disappointing their parents. Others find it difficult to deal with conflicting norms and values. Parentification was another important cause within their cultural concept of distress. At the same time, (implicit) social support, i.e., spending time with the family and the community, was an important coping mechanism.

Conclusion

Second-generation immigrants are exposed to specific risk factors for psychological distress. A better understanding of these risk factors and their coping mechanisms is essential for providing them with meaningful support services, both in prevention and psychotherapy.

Intertribal Talking Circle for the prevention of alcohol and drug use among Native American youth

The purpose of this study was to examine the impact of a culturally based intervention, the Intertribal Talking Circle program, compared to a standard alcohol and drug abuse education, the Be A Winner program. Community-based participatory research was used to implement a two-condition, quasi-experimental study. The sample included 540 Native American youth ages 10-12 years old from three tribal areas in the United States. Data were collected at baseline, 6 and 12-months post-intervention for both the intervention and control groups using demographic, cultural identity, alcohol use, and drug use questionnaires. Regression models evaluated participants' improvement in decreasing alcohol and drug use and increasing cultural identity. Findings revealed that alcohol and drug use decreased more significantly among youth who participated in the Intertribal Talking Circle (ITC) intervention program than youth who participated in a standard alcohol and drug abuse education Be A Winner (BAW) program. Cultural identity also increased more significantly among participants who completed the Talking Circle intervention program. Native American youth ages 10-12 years old respond positively to a culturally based intervention for the reduction of alcohol and drug use. The findings highlight the importance of cultural values and identity and their significance in preventing and reducing alcohol and drug use among Native American youth.

Impact of Race, Socioeconomic Status, and Geography on Healthcare Outcomes for Children With Sickle Cell Disease in the United States: A Scoping Review

A large proportion of patients with sickle cell disease (SCD) identify as Black or African American (AA). Social bias and stigma in healthcare outcomes for children with SCD are impossible to explore without considering the impact of racial/cultural identity, socioeconomic status (SES), and geography. It is important to understand the current influences of social movements, expanded health insurance coverage, and telehealth on these variables when considering healthcare outcomes for patients with SCD. The objective of this study was to determine the roles of racial identity, SES, and geography in healthcare outcomes for the pediatric population of children with SCD in the United States (US). This study is a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases utilized included Cochrane, CINHAL, Medline, and Nursing and Allied Health Collection, all accessed through the EBSCO Information Services. Studies met the following inclusion criteria: published in English, pediatric patients residing in the US, and published between 2017 and 2022. Search terms included "sickle cell" AND "pediatric", which were then combined with "minority" OR "racial" OR "rural" OR "urban" OR "poverty" OR "income" OR "socioeconomic status". The initial search yielded 635 unique articles, with 17 articles meeting full inclusion criteria. Overall, it was clear that there are examples of positive effects of race, low SES, and rural geographic location on positive health outcomes, though a large number of studies oscillated between showing negative associations or no association at all. Barriers to care for patients with SCD are multifaceted, making it difficult to isolate and analyze the impact of individual variables. Many studies demonstrated the significance of family, community, and institutional relationships as positive support for patients with SCD. This review highlights the need for additional research on the healthcare outcome benefits of patient/familial support groups aiming to bring together patients who share racial experience and SCD diagnosis regardless of SES and geography.

A qualitative analysis of the documentation of DSM-5 Cultural Formulation Interviews with non-native speaking patients in a Swedish mental health care setting

Introduction

Cultural variety in expressed symptom presentations of mental health problems creates difficulties in transcultural diagnostic assessments. This emphasizes the need of culturally sensitive diagnostic tools like the Cultural Formulation Interview (CFI). Although the CFI is being implemented worldwide there is a lack of studies analyzing what kind of information it provides when used with new patients in routine psychiatric assessments, and how CFI information contributes to diagnostic evaluations. This study aimed to find out what information the CFI questions revealed when used with non-native Swedish speaking patients. We also wanted to understand how the CFI may facilitate identification of psychiatric diagnoses among these patients.

Materials and methods

The CFI was used as part of a routine clinical psychiatric assessment in an outpatient clinic in Sweden. Interpreters were used in the consultations when needed. A qualitative thematic analysis was used to analyze the documented CFI answers from non-native speaking patients.

Results

We found that the CFI information contained contextualized descriptions of dysfunction and current life conditions, as well as expressions of emotions, often described along with somatic terms.

Discussion

Our results indicate that the narrative approach of the CFI, giving contextualized information about distress and functioning, can facilitate clinicians' identification of psychiatric symptoms when language, psychiatric terms and understandings are not shared between patient and clinician.

Growing Together Through Our Cultural Differences: Self-Expansion in Intercultural Romantic Relationships

Intercultural romantic relationships are increasingly common and although the obstacles such couples face are well documented, the factors that facilitate their success are less studied. Although cultural differences may present challenges, they also offer opportunities for self-expansion-personal growth via new perspectives, knowledge, and identities. In three studies using cross-sectional, dyadic, longitudinal, and experimental methods (NTotal = 896), self-expansion was associated with relationship quality and identity outcomes (i.e., identity integration, cultural self-awareness). Self-expanding through a partner's culture (i.e., cultural self-expansion) was uniquely related to identity outcomes, beyond self-expanding more generally (relational self-expansion). Furthermore, actively sharing cultures and discussing their differences were linked to greater cultural and relational self-expansion, which in turn differentially predicted partners' relationship quality and cultural identities. These studies provide a first look at the role of self-expansion in intercultural relationships, demonstrating that the way couples negotiate their cultures is linked to both relational and personal outcomes.

Legacy of culture heritage building revitalization: place attachment and culture identity

Introduction

Cultural heritage buildings are revitalized to promote culture instead of being neglected or demolished. For locals, the revitalization of heritage buildings symbolizes a commitment to the community and a taste of collective memory. The study attempts to test the effectiveness of heritage cultural building on visitors' post-experience behavior through cultural identity and place attachment. "Cultural activities engagement" and "knowledge transfer" serves as moderating attributes. Their moderating the effects on cultural identity and place attachment are examined, respectively.

Method

A valid sample size of 348 from four heritage buildings located in Hong Kong: Tai Kwun, Police Married Quarters (PMQ), Mei Ho House and The Mills. A data analysis platform for PLSSEM is chosen for this study.

Results

Results demonstrate that the effectiveness of heritage building revitalization on visitors' local cultural identity and emotions leading to place attachment.

Discussion

In our study, the effectiveness of heritage building encompasses three elements which includes appearance and components; technology and planning as well as contribution. Knowledge transfer positively moderates the effectiveness of heritage building revitalization and cultural identity. However, cultural activity engagement negatively moderates place attachment. Findings also exhibit that place attachment in heritage building revitalization leads to a positive experience extension. For the practical contribution, the study provides insights to policy makers and planners for historic building design such as appearance and components, technology in facilitating local visitors' local identity.

Digital Dilemmas: A Comprehensive Review of the Psychosocial and Sleep Effects of Web Streaming on the Indian Youth

The rapid growth of web streaming platforms in India has ushered in a transformative era in entertainment consumption, particularly among the youth. This comprehensive review explores the psychosocial and sleep effects of web streaming on the younger generation. Examining the impact on social interactions, mental health, academic performance, cultural identity, and sleep patterns, the study delves into the intricate dynamics shaping the lives of Indian youth in the digital age. Key findings reveal the subtle yet significant changes in face-to-face interactions, the emergence of virtual relationships, and the potential influence on stress, anxiety, and depression due to addictive binge-watching behaviours. Moreover, the review highlights the challenges to academic performance through disruptions in study habits and increased screen time. Cultural and identity influences, both in terms of representation and misrepresentation, are explored, emphasizing the need to analyze the portrayal of Indian culture in web content critically. The sleep effects of web streaming, including sleep deprivation due to late-night binge-watching and the consequences of blue light exposure on melatonin production, add a crucial dimension to the discussion. Technological solutions such as screen time limitations, parental controls, and educational programs promoting media literacy and responsible digital consumption emerge as potential coping mechanisms. In conclusion, the study provides a nuanced understanding of the complexities surrounding web streaming and its impact on the youth in India. The implications for policy and practice underscore the importance of a balanced approach to digital consumption. At the same time, a call to action emphasizes the need for collaborative efforts in promoting responsible digital habits among the youth.

The impact of cultural healthcare practices on Children's health in the United Arab Emirates: a qualitative study of traditional remedies and implications

Aim

This qualitative study investigates the impact of cultural practices on children's health in the United Arab Emirates (UAE) by examining the use of traditional remedies and home treatments by mothers.

Methods

Twenty-five participants, all mothers who had employed traditional treatments or home remedies for their children during periods of illness, were included in the study. The participants represented a diverse range of educational backgrounds, from school diploma holders to university degree graduates, with ages spanning from 20 to 50 years. Hailing from different Arabic countries and cultural subgroups, the majority of participating mothers were from the UAE.

Results

Through in-depth interviews, three major themes emerged from the participants' experiences. Firstly, a strong connection between culture, religion, and healthcare practices was evident. Many mothers opted for cultural remedies as their first line of defense against illnesses due to the practices' strong foundations in their cultural heritage. Herbal remedies, Quranic healing, and other traditional methods were perceived to be both effective and spiritually comforting, reinforcing participants' sense of cultural identity. Secondly, participants highlighted unintended consequences of relying solely on traditional treatments. Some instances were reported where the use of ineffective remedies resulted in delays in seeking appropriate medical care for their children, potentially compromising their health. Additionally, certain misconceptions regarding the safety and efficacy of traditional remedies were identified, emphasizing the need for evidence-based healthcare education.

Conclusion

This qualitative study sheds light on the intricate interplay between culture, traditional remedies, and children's health in the UAE. The incorporation of diverse participants from various Arabic countries and cultural subgroups enriches the study's applicability to broader Arabic cultures. By recognizing the significance of cultural healthcare practices and striking a balance with evidence-based care, healthcare providers can create a more inclusive and effective healthcare environment for children in the UAE. Future research should explore diverse samples and develop targeted interventions to further advance cultural awareness and understanding in healthcare practices.

Understanding the cultural identity of EFL learners from the eco-linguistics perspective: evidence from students in arts college before and after the COVID-19 epidemic period

The identity development process has individual and societal components and is inherently intertwined with one's broader sociocultural milieu. The correlation between the personal and social aspects of an individual's identity considerably influences their behavior within their environment. This study examines cultural identity changes among English as a Foreign Language (EFL) students by conducting a questionnaire survey based on the anxiety/uncertainty management theory by Gudykunst (1995, 1998). The questionnaire was distributed twice: Study 1 used data from 483 students and Study 2 used data from 359 students. After each study, 20 students' descriptions of Chinese and Western cultures were analyzed in NVivo. Guided by the ecological research paradigm, this study examines the impact of individual differences on cultural identity at the macro-, meso-, exo-, and micro- levels. The findings suggest that social context can influence an individual's cultural identity, and cultural identity development accompanies being "oneself."

Systematic Review for Survey Instruments to Measure Cultural Identification of Native Hawaiians, Pacific Islanders, and Filipinos

Numerous studies have used survey instruments to measure the degree of cultural identity/identification for a racial group to examine how they identify with their heritage or cultural group. However, only a few systematic reviews have summarized the survey instruments for Native Hawaiians, Pacific Islanders, and Filipinos. This systematic review aimed to summarize reliable and validated survey instruments that assessed the cultural identity/identification of Native Hawaiians, Pacific Islanders, and Filipinos in 3 steps: (1) identifying studies that meet the inclusion and exclusion criteria; (2) evaluating the psychometric properties of the instrument with reported validity and reliability test results; and (3) summarizing the selected studies. A search was conducted in PubMed, PsycINFO, Web of Science, and Health and Psychosocial Instruments databases for published articles related to the cultural identification for the 3 racial groups. Sixteen unique articles met the inclusion/exclusion criteria: 7 for Filipinos, 3 for Native Hawaiians, 1 for Pacific Islanders, 2 for Asian Americans, and 3 for non-specific Indigenous people. Three reviewers assessed the psychometric properties of the 16 articles using the pre-determined criteria and summarized the survey instruments and study outcomes. All the selected articles discussed their survey instrument's validity. This review can serve as a resource for researchers who want to apply a culturally tailored survey instrument for Native Hawaiians, Pacific Islanders, and Filipinos in their research studies.

Outcomes of LGBTQ culturally sensitive training among civilian and military healthcare personnel

BACKGROUND

Lesbian, gay, bisexual, transgender, or queer (LGBTQ) military servicemembers are at higher risk of developing health problems compared to heterosexual peers. To improve outcomes and address negative attitudes, previous literature has recommended education of healthcare personnel. The purpose of our study was to evaluate the knowledge and skill outcomes of an LGBTQ cultural sensitivity training program.

METHODS

We used a pretest/posttest design. Participants completed the Ally Identity Measure (AIM) to assess three subscales: knowledge and skills, openness and support, and oppression awareness. Participants included both military and civilian healthcare personnel from multiple disciplines. Descriptive statistics and pairwise analyses were used.

RESULTS

A total of 101 participants answered both pretest and posttest. Across all AIM subscales, posttest scores demonstrated statistically significant (P < 0.001) increases from mean pretest scores. Completion rates for the pretest and posttest were 99% and 93%, respectively. The majority of participants were female (75%) and non-Hispanic (87%), composed of Caucasians (39%) and Asians (33%). Over one-third (39%) of participants were aged 30-39. Fifty percent were active-duty military and more than half (58%) of all participants did not have prior training in LGBTQ patient care. Statistically significant differences were found between the pretest and posttest scores for the knowledge and skills subscale (M = 2.64-3.70). The most significant increases were observed in Item 12 and Item 15 (M = 2.72-3.70) regarding awareness of theories and skill development to provide proper support, respectively.

CONCLUSION

These significant findings contribute to the currently limited research exploring LGBTQ cultural sensitivity training in both civilian and military settings. To our knowledge, this is the first time a cultural sensitivity training of this depth has been provided to active-duty servicemembers. Further research and development of similar educational programs integrating interactive participation can potentially aid in the delivery of improved care and military readiness for all servicemembers.

The contribution of cultural identity to subjective well-being in collectivist countries: a study in the context of contemporary Chinese culture

INTRODUCTION

Though the important effect of cultural identity on subjective well-being is widely acknowledged, the details of how different cultures' unique features influence well-being remain to be revealed. To address this issue in the context of Chinese culture, the present study investigates whether and how the prominent features of Chinese culture-collectivism and red culture-shape Chinese people's subjective well-being.

METHODS

The Red Cultural Identity Scale, Subjective Well-Being Scale, Collectivism Scale, and Perspective-Taking Scale were used to assess 1,045 Chinese residents.

RESULTS

The results showed that red cultural identity positively predicted participants' subjective well-being through the mediated role of collectivism. Furthermore, perspective-taking was found to moderate the mediating effect of collectivism.

DISCUSSION

These results demonstrate that the way cultural identity predicts subjective well-being is highly correlated to specific cultural features, e.g., the opinion of values, which was significant in practice with a cross-cultural background.

Adjustment to Chinese Culture and Mental Health Issues among Foreign Students on Chinese University Campuses during the COVID-19 Pandemic: A Collaborative Ethnographic Study

Foreign students in China may have difficulty adjusting to Chinese culture and may experience mental health problems related to acculturation, interpersonal issues, and social communication within the context of campus life. Therefore, this study attempts to apply a collaborative ethnography approach to explore the adjustment to Chinese culture and mental health issues among foreign students on Chinese campuses during the COVID-19 pandemic. We spent 16 months exploring the feelings and perceptions of 82 foreign international undergraduate students at six Chinese higher education institutions regarding their adjustment to Chinese culture and gathered their suggestions about how to address the mental health issues experienced by foreign learners in China. The results show that international students tend to have a limited understanding of Chinese culture and rely on very few channels for information-in particular, the Internet, teachers' lectures, and daily life-which can easily result in mental health problems and thoughts of marginalization.In addition, the results showed that international students' mental health problems are subjectively positively correlated with their own personality, cultural intelligence, and cultural identification ability and objectively related to their cultural distance and all aspects of the educational work of international students. It is suggested that Chinese higher education institutions should strengthen their attention to the mental health of international students in China and promote international students' cross-cultural adaptation abilities and understanding of Chinese culture.

Knowing Who You Are (Becoming): Effects of a university-based elder-led cultural identity program on Alaska Native students' identity development, cultural strengths, sense of community, and behavioral health

In part due to cultural loss and identity disruption over many generations from colonial and neocolonial forces, significant emotional/behavioral health disparities exist among Alaska Native (AN) people. Such forces are apparent in higher education, where many AN students feel othered and are more likely to withdraw without a degree than their nonnative counterparts. A strong cultural identity has been found to buffer psychosocial difficulties. The AN Cultural Identity Project (CIP) was developed from the best available scientific literature, local data from AN students, and traditional wisdom from Elders to support cultural identity development. This 8-week Elder-led program incorporated storytelling, experiential learning, connection, exploration, and sharing of identity and cultural strengths to help students remain grounded in their cultures across settings in the hopes of improving emotional/behavioral health outcomes. Through a stepped-wedge design randomized controlled trial, we examined the impact of CIP on cultural identity, cultural strengths, sense of community, and emotional/behavioral health across two cohorts of 44 AN students who ranged in age from 18 to 54 years. On average, students attended 75% of the program. The program had positive impacts on students' cultural identity development, endorsement of cultural strengths, sense of community with AN people at the university, and overall emotional/behavioral health. While gains in some outcomes were sustained over time, others were not, suggesting the potential benefits of a lengthened program. As the first program of its kind directed at AN university students of diverse cultural groups in urban settings, CIP shows promise for supporting emotional/behavioral health through cultural identity development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does "who I am" influence "how I feel"? Cultural identity and mental health among Hong Kong Chinese adolescents

Securing a clear sense of identity is a critical issue in adolescence, yet the role that cultural identity plays in the well-being of youths remains unclear. This study aims to examine the relationship between cultural identity and mental health among three groups of adolescents in Hong Kong with different residential backgrounds. Data came from a cross-sectional survey with 2180 4th-9th grade students in Hong Kong. Cultural identity was assessed by whether the youths identify themselves as local Hong Kong people, mainland Chinese, both Hong Kong and mainland Chinese, or confused about which group to belong to. Mental health was assessed by self-esteem, mental well-being, happiness, social anxiety, and depression. Multiple linear regression was performed to examine the relationship between cultural identity and mental health, adjusting for sociodemographic variables. The regression results suggested adolescents with confused cultural identity scored lower in all positive indicators of mental health compared with those with a clear cultural identification. No significant association was found between cultural identity and social anxiety/depression. Uncertainty in cultural identification may be detrimental for the mental health of adolescents living in a multicultural society. Interventions may consider cultivating clear cultural identities among adolescents to promote their mental health.

Exploring the mechanism of consumer purchase intention in a traditional culture based on the theory of planned behavior

There has been a growing interest among scholars and practitioners in cultural empowerment due to the importance of this subject. In this study, we aim to explore the connection between traditional cultural symbols and cultural identity, further estimating how two variables stimulate consumers' emotional value to generate consumers' purchase intention. Based on existing traditional cultural literature and the theory of planned behavior (TPB), we first proposed a research framework and then empirically tested the relationship among traditional culture symbols, cultural identity, emotional value, and consumers' purchase intention. The survey data was tested using structural equation modeling (SEM) and the following conclusions were drawn. First, the cognition of traditional cultural symbols and cultural identity has a direct and significant impact on the emotional value thereby, eliciting consumers' purchase intention. Second, traditional cultural symbols are directly and indirectly (i.e., through emotional value or cultural identity) positively associated with consumers' purchase intention, also cultural identity is directly and indirectly (i.e., through emotional value) associated with consumer purchase intention. Finally, emotional values mediate the indirect effect of traditional culture and cultural identity on purchase intention, and cultural identity plays a moderating role between traditional cultural symbols and consumers' purchase intention. Our findings help to expand the existing literature on consumer purchase intentions by rationally using traditional cultural symbols in the product design and suggesting relevant marketing strategies. The research results can provide valuable inspiration for promoting the sustainable development of the national tidal market and repeating consumers' purchasing intentions.

How does short video use generate political identity? Intermediate mechanisms with evidence from China's small-town youth

Introduction

China's Small-town Youth is an important social class connecting urban and rural development. Its ideological status is closely related to social stability and development so that the study of political identity of small town youth in China has become an important topic.

Methods

Based on survey and in-depth interviews, this paper investigates the intermediate mechanism of short videos use on political identity of China's Small-town Youth.

Results and discussion

The study found that the use of short videos by China's Small-town Youth has a significant positive impact on political identity, and media trust and political trust play a complete mediating role between the use of short videos and political identity. Cultural identity as the main content of China's political ideology propaganda, cannot affect political trust. This research provides theoretical basis and practical enlightenment for the systematic understanding of the spiritual world and political beliefs of China's Small-town Youth, and for exploring how to enhance their political identity through short videos use.

An empirical study on cultural identity measurement and its influence mechanism among heritage tourists

In the effort to integrate culture and tourism, an important strategy for the prosperity and sustainability of tourism, it is necessary to factor in tourists' cultural identity and emotional interaction with cultural heritage to keep pace with the trends of cultural heritage tourism. Drawing on in-depth interviews and software such as Nvivo and Smart-PLS, this study aims to develop and verify cultural identity measures for cultural heritage tourists, construct a theoretical model of cultural identity, travel experience, place attachment, satisfaction, and revisit intention, and verify the theoretical relationship between these dimensions in the Archaeological Ruins of Liangzhu City. The results show that cultural identity is positively associated with travel experience and place attachment but not significantly associated with satisfaction; travel experience is positively associated with place attachment and revisit intention; place attachment is positively associated with satisfaction; place attachment is positively associated with revisit intention; satisfaction is positively associated with revisit intention. This qualitative and quantitative research enriches the theoretical achievements concerning cultural identity among cultural heritage tourists and proposes recommendations for management practice accordingly.

The Impact of Cultural Memory and Cultural Identity in the Brand Value of Agricultural Heritage: A Moderated Mediation Model

Improving the brand value of agricultural cultural heritage can promote the development of the local social economy. Meanwhile, cultural memory and brand value are inseparable. Therefore, this study took the Anxi Tieguanyin Tea Culture System as the research object, collected 679 questionnaires, adopted a structural equation model, and applied SPSS 26.0 and Amos 24.0 software (IBM; Armonk, NY, USA) to study the influence of agricultural heritage cultural memory on brand value. This study innovatively develops a scale of agricultural heritage cultural memory, enriches the outer edge of cultural memory theory research, broadens the vision of agricultural heritage research, and provides a useful reference for the inheritance of agricultural heritage and the promotion of brand value.

From digital museuming to on-site visiting: The mediation of cultural identity and perceived value

Introduction

Museums use digital resources to provide online services to the public, and a "digital museuming" boom has started. The mechanism of online museum visiting and its impact on willingness to visit on site has become an important issue of widespread concern. Therefore, based on the theory of presence and cognitive-emotional-behavioral theory, this paper introduces perceived value and cultural identity as mediating variables to explore the influence of the digital museuming experience on the willingness to visit on site from the audience's perspective.

Method

Questionnaires were distributed, using the snowball sampling method, and 429 valid questionnaires were returned.

Results

The empirical test presents the following results: (1) virtual reality technology multi-dimensionally expands the digital museuming experience; (2) immersion, interaction and available experience promote willingness to visit on-site; (3) hedonic experience in the process of digital museuming cannot be ignored; and (4) perceived value and cultural identity play a mediating role.

Discussion

User experience of visiting virtual museums, perceived value and cultural identity influence user willingness to visit museums in the field, but perceived value does not enhance the user's cultural identity, maybe due to the inability of the online experience to increase the depth of the experience.

Can cultural tourism experience enhance cultural confidence? The evidence from Qingyuan Mountain

A questionnaire survey was conducted among 600 visitors to the region using Qingyuan Mountain, a 5A picturesque location in Quanzhou City, Fujian Province, as the research site. A total of 489 valid questionnaires were received. The links between cultural involvement, cultural experience, cultural identity, cultural confidence, and cultural loyalty were experimentally examined using a structural equation modeling technique. The results showed that cultural experience was a mediating factor in the processes of the influence of cultural involvement on cultural identity and the influence of cultural involvement on cultural confidence, but the influence of cultural involvement on cultural identity and the influence of cultural involvement on cultural confidence were not supported. The study accordingly condenses theoretical contributions to academia and management insights for businesses.

Designing Culturally Responsive Education Strategies to Cultivate Young Children's Cultural Identities: A Case Study of the Development of a Preschool Local Culture Curriculum

The researcher investigated how the teachers at the preschool integrated the vision of the preschool, educational goals, and community resources to develop and implement the local culture curriculum as well as what problems they encountered in the process. Thereafter, the researcher developed strategies that can be used to solve such problems. The researcher discovered that the most important aspects of the local culture curriculum were (1) its ability to pique the children's interest in history and the humanities through the lens of the children's experiences at the market, and (2) its integration of local culture and the community, specifically through interactions between young children and adults at a vegetable market. The implementation of the local culture curriculum involved the following steps: (1) establishing a thematic network; (2) planning the activities, including exploring the children's previous experiences and adjusting the curriculum and teaching methods accordingly; (3) conducting the activities, including visiting and participating in work at the market; (4) evaluating the activities; and (5) creating thank you cards and formulating plans for store renovation. Some of the obstacles the teachers encountered in the development and implementation of the vegetable-market-themed local culture curriculum were (1) shortages of preschool teachers willing to teach outdoor courses, (2) concerns about young children's safety, and (3) young children's lack of experience. Finally, on the basis of my conclusion, the researcher developed the following culturally responsive education strategies: (1) integrating aspects of local culture and the community into courses, (2) situating local culture courses in learning areas, (3) developing local culture curriculum that are rich in humanities, and (4) developing local culture curriculum based on parent-teacher cooperation to overcome teacher shortages at preschools. The results of this study may serve as a reference in the development of a local culture curriculum and other strategies to cultivate young children's cultural identities.

How do aesthetics and tourist involvement influence cultural identity in heritage tourism? The mediating role of mental experience

As heritage is the precious treasure of human society, heritage also carries the genes of culture. It is of vital importance to effectively develop heritage tourism resources and explore the mechanisms that influence tourists' cultural identity. This study has integrated the stimulus-organism-response (SOR) framework with the attitude-behavior-context (ABC) theory to construct a hypothetical model of heritage tourism aesthetics, tourist involvement, mental experience, and cultural identity so as to figure out their relationships. The questionnaires were collected to investigate the impact paths and mechanisms between heritage aesthetics, tourist involvement, mental experience, and cultural identity. The structural equation model was used to examine the relationship between heritage tourism aesthetics, tourist involvement, mental experience, and cultural identity. The main findings include: (1) the positive impact of aesthetics driving mental experience and cultural identity is significant; (2) the impact of tourist involvement on mental experience and cultural identity is also significant; (3) the impact of aesthetics on cultural identity is not significant, but mental experience mediates the relationship between aesthetics and cultural identity in heritage tourism. This study provides a new research framework and perspective for the aesthetics, tourist involvement, mental experience, and cultural identity of tourists in heritage tourism. This study also provides practical implications for government culture sectors to propagandize culture and for heritage destination managers to better manage heritage sites.

Cultural identity affiliation and alcohol use and related consequences among American Indian and White adolescents: A latent profile analysis

BACKGROUND

Adolescent alcohol use is a significant public health concern and rates of alcohol use are higher among American Indian (AI) adolescents than national samples of non-AI youth. A potential factor in understanding AI alcohol use is cultural identity, which can vary widely based on experiences of historical trauma. We used latent class analysis to examine cultural identity in AI and White adolescents and their alcohol use outcomes in relation to the latent class solutions.

METHODS

The samples included 3189 AI adolescents (M_age  = 14.76, 48.9% female) and 1579 White adolescents (M_age  = 15.56, 48.7% female) living on or near a reservation. Participants completed self-report measures of AI and White cultural identity affiliation, alcohol use, and alcohol-related problems. We examined (1) the best-fitting latent class solution with respect to American Indian (AI) and White cultural identity; (2) equivalence of the latent class solution; and (3) alcohol use outcomes across the optimal latent class solution.

RESULTS

Latent profile analyses indicated an optimal 3-class solution in both the AI and White samples, which differed by level of affiliation with AI and White cultural identity. While the optimal number of classes were similar across racial groups (configural profile similarity), the nature of the classes differed (structural profile dissimilarity). The three classes represented low overall scores on AI and White cultural identity (Marginalized), a mixture of high and low scores on AI and White cultural identity (Third Culture), and overall high scores on AI and White cultural identity (Bicultural). Alcohol-related problems predicted membership in the Third Culture class compared with the Marginalized class and the Bicultural class. Specifically, youth in the Third Culture class reported significantly fewer alcohol-related problems than youth in the Marginalized and Bicultural classes. Alcohol use did not predict latent class membership.

CONCLUSIONS

The future-oriented nature of the Third Culture class may provide protection against adverse alcohol-related outcomes. Research is needed to test interventions that target greater future orientation and future plans to integrate culture into adolescents' lives.

Food as Culture among African Women: Exploring Differences between North and South (Morocco-Senegal)

The goal of this exploratory study was to analyze the influence of culture on African women’s diet considering their role as primary caregivers. The analysis differentiated between Moroccan and Senegalese women and identified the key elements that influence their dietary habits and their health. Using a qualitative methodology, we performed a triangulation of data based on a literature review and a panel of experts, all of which served as the basis for the interview script to conduct 14 semi-structured interviews (n = 7 Moroccan and n = 7 Senegalese). This study reflects the substantial relationship between dietary habits, cultural identity, and health that healthcare providers need to acknowledge. It is important for healthcare practitioners to be culturally competent in order to provide holistic and individualized care.

ICIRAS: Research and reconciliation with indigenous peoples in rural health journals

Aim

We aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications.

Context

This is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals—the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health—recognised that Indigenous peoples' identity could be embedded in authorship details.

Approach

An environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is ‘nothing about Indigenous people, without Indigenous people’ in rural health research publications.

Conclusion

Improving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call‐to‐action for research journals and institutions to rigorously improve publication governance that signals “Editing with IndigenUs and for IndigenUs”.

Understanding Aboriginal Models of Selfhood: The National Empowerment Project's Cultural, Social, and Emotional Wellbeing Program in Western Australia

Culturally safe and responsive interventions that acknowledge Aboriginal models of selfhood are needed. Such interventions empower Aboriginal peoples and communities by increasing self-determination over individual and community social and emotional wellbeing (SEWB). In response to this need, the National Empowerment Project developed the Cultural, Social, and Emotional Wellbeing Program (CSEWB). The CSEWB aims to strengthen SEWB and cultural identity and subsequently reduce psychological distress in Aboriginal peoples. An Aboriginal Participatory Action Research approach ensured community ownership and engagement. Seven research questions and a culturally modified adaption of the Most Significant Change technique informed a thematic analysis of the evaluation content. Aboriginal adults (n = 49; 53% ≥50 years, 66% female, 34% male) from three Western Australian urban communities participated in the program evaluation workshops. Participants reported the benefits of enhanced SEWB and reduced psychological distress. This research reaffirms the need for culturally safe programs that acknowledge social determinants of health and are guided by the SEWB framework. Long-term commitment from the government is needed to support such programs.

Qualitative content analysis of cultural formulations of clients suffering from conversion disorder in North India

INTRODUCTION

Conversion disorder is easily one of the least understood neuropsychiatric disorders. There is a great deal of ambiguity with respect to symptom presentation, assessment, etiology, diagnosis, and treatment. However, a common clinical practice associated with the assessment and management of the conversion disorder is the evaluation of a stressor. Recent studies in India have indicated that family stressors are the most frequent. Sociocultural aspects of the client's environment and the illness experience thus form an important part of the client's diagnostic formulation. These aspects also determine help-seeking, treatment adherence, and thus, the outcomes.

MATERIALS AND METHODS

Fifteen clients suffering from conversion disorder in a tertiary mental health setting in North India, recruited through purposive sampling, were interviewed in-depth. Data were elicited using the cultural formulation interview (CFI). Qualitative content analysis was carried out.

RESULTS

The content analyses summarized the cultural experiences of clients suffering from conversion disorder under structured domains of the CFI. The results are presented in tables along with content examples and represent individual client experiences and conceptualizations of diagnosis, treatment, and implications of suffering from conversion disorder. The findings of this study aim to describe and highlight the cultural experiences of clients with respect to their psychopathology. The most striking recurrent theme in the cultural formulations were the lack of understanding of the nature and cause of illness both in the client as well as the clinician, and therefore a lack of trust and hope in the treatment.

CONCLUSION

The findings of the current study shed light on the cultural experiences of clients with conversion disorder. These findings emphasize the need for clinicians to incorporate the individual and collective cultural experiences of clients and cultural sensitivity in addition to the clinical diagnoses. The Cultural Formulation Interview of the DSM-5 was found to be very helpful in this regard and we encourage its use by clinicians, especially with clients suffering from conversion disorder, given the strong influences of socio-cultural experiences on psychopathology as well as the intervention.

Psychosocial Experiences That Support Positive Self-Concept in Children with Cleft Lip and Palate Adopted From China

Objective

Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population.

Design

Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis.

Setting

Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit.

Patients, Participants

Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents.

Results

Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme.

Conclusions

Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.

An update on the assessment of culture and environment in the ABCD Study®: Emerging literature and protocol updates over three measurement waves

Advances in our understanding of risk and resilience factors in adolescent brain health and development increasingly demand a broad set of assessment tools that consider a youth's peer, family, school, neighborhood, and cultural contexts in addition to neurobiological, genetic, and biomedical information. The Culture and Environment (CE) Workgroup (WG) of the Adolescent Brain Cognitive Development (ABCD) Study curates these important components of the protocol throughout ten years of planned data collection. In this report, the CE WG presents an update on the evolution of the ABCD Study® CE protocol since study inception (Zucker et al., 2018), as well as emerging findings that include CE measures. Background and measurement characteristics of instruments present in the study since baseline have already been described in our 2018 report, and therefore are only briefly described here. New measures introduced since baseline are described in more detail. Descriptive statistics on all measures are presented based on a total sample of 11,000+ youth and their caregivers assessed at baseline and the following two years. Psychometric properties of the measures, including longitudinal aspects of the data, are reported, along with considerations for future measurement waves. The CE WG ABCD® components are an essential part of the overall protocol that permits characterization of the unique cultural and social environment within which each developing brain is transactionally embedded.

The Țigani Community Adaptability to Changes in Rural Romania and the COVID-19 Impact

Romanian rural villages are struggling to survive present times when youngsters leave for a better life in the city while elders work the land like a hundred years ago. Our paper integrates human environments research with public health preparedness, presenting the Țigani (Gypsy/Roma) ethnic group from rural Romania as an example to the world. The future security of mankind will require a new understanding of the human place in its environment. That will lead to a new society, not the most powerful or intelligent, but the one that is more adaptable to changes, with sensitive and interconnected community members. Therefore, the Țigani ethnic group that fought for its rights and flourished despite unfavorable odds, including the recent COVID-19 pandemic, represents the best example for a new world that prioritizes humans, promotes health and wellbeing, facilitating innovation and transformative networks environmental integration. This research attempts to quantify the Țigani′s unique attributes that helped their communities survive and made them more adaptive to change. Always marginalized, they identified the other ethnic groups’ weaknesses to penetrate the villages and learned to use the smartphone apps to communicate, for their trades, coppersmith, metal roof tiles and drainage systems. Our research was based on Geographical Information System, Microsoft Power Bi analytics data visualization tools and statistical analysis with SPSS V20 to demonstrate what enables their flourishing and what resistance they face locally. We argue that the Țigani′s intense social cooperation, strong sense of family, community and mutual assistance helped them to fight COVID-19, generating their significant adaptability to the societal changes and their power to keep intact their cultural identity. The results show how the constant growing Țigani population changed and may change Romania′s rural environments in the future.

Acculturation and attitudes toward code-switching: A bidimensional framework

AIMS AND OBJECTIVES

Code-switching, the spontaneous switching from one language to another within a single speech event, is often performed by bilinguals who have mastered a communicative competence in two languages. It is also a social strategy - using linguistic cues as a means to index social categories and group solidarity. Code-switching is, therefore, linked to attitudes, seen as a reflection of the speaker and their values and identities. Traditionally perceived negatively, attitudes toward code-switching have been shown to be acceptable in certain cases, such as in multilingual contexts. However, it has yet to be determined empirically whether attitudes toward code-switching are associated with individual social characteristics, including cultural identity and identity negotiation. Adopting the bidimensional model of acculturation, the goal of the study was to investigate the relationships among cultural identity and code-switching attitudes. Specifically, we sought to examine whether the bidimensional framework can be used to characterize and distinguish biculturals and whether such distinctions result in differences in code-switching attitudes and other related factors.

DATA AND ANALYSIS

Cantonese-English bilinguals (n = 67) reported their language background and completed questionnaires relating to identity and code-switching.

FINDINGS

The findings suggest the bidimensional model was successful in classifying biculturals versus non-biculturals and, additionally, that biculturals could be differentiated according to their strength of cultural identification, which we designated as strong biculturals, Canadian-oriented biculturals, Chinese-oriented biculturals, and weak biculturals. Findings also revealed significant group differences in code-switching attitudes and other factors, such as code-switching comfort and preference, among the bicultural subgroups.

IMPLICATIONS

The study supports the hypothesis that code-switching is linked to bicultural identity. The results conclude that a more nuanced classification of biculturals is meaningful, as individual differences in cultural identification among biculturals are linked to significant differences in code-switching comfort, code-switching preference, code-switching attitudes, and multicultural attitudes.

Multiculturalism, Culture Mixing, and Prejudice: Effects of Priming Chinese Diversity Models Among Hong Kong University Students

In two studies, we investigated how Hong Kong university students reacted to descriptions of China as multicultural vs. assimilatory, examining effects on emotions, prejudice toward Mainland Chinese, attitudes toward Hong Kong/China culture mixing, and cultural identities. Study 1 compared a multicultural priming condition to a control condition and found that the multiculturalism prime significantly reduced desire to socially distance from Mainland Chinese. Study 2 compared multiculturalism, assimilation, or control primes' effects, and found that the multiculturalism prime, through increased positive emotions, indirectly reduced social distancing from Mainland Chinese and disgust toward culture mixing, and increased Chinese ethnic identity and multicultural identity styles; the assimilation prime had the opposite indirect effects through increasing negative emotions. Results show new evidence of the importance of emotion in how non-immigrant regional groups, who are both minority and majority culture members, react to different diversity models. Multicultural frames increased positive emotions, with downstream positive effects on both intergroup attitudes and integrated identities.

"The Land Nurtures Our Spirit": Understanding the Role of the Land in Labrador Innu Wellbeing

We examined Indigenous views of wellbeing, aiming to understand how the Labrador Innu view influence of land on their health. The Innu live in two First Nation communities (Sheshatshiu and Natuashish) in the subarctic portion of the province of Newfoundland and Labrador, Canada. Their views on land and wellbeing are context specific and have not been studied; our research addresses this significant gap in literature. Findings highlight that the experience of being on the land with family and community, learning cultural knowledge, and gaining a sense of identity play a major role in enhancing wellbeing. Externally imposed policies and programs conceiving Indigenous land as a physical place only fail to understand that land sustains wellbeing by emplacing knowledge systems and cultural identity.

Indigenous youth reconnect with cultural identity: The evaluation of a community- and school-based traditional music program

Reconnecting Indigenous youth with their cultural traditions has been identified as an essential part of healing the intergenerational effects of forced assimilation policies. Past work suggests that learning the music of one's culture can foster cultural identity and community bonding, which may serve as protective factors for well-being. An 8-week traditional song and dance program was implemented in a school setting for Indigenous youth. An evaluation was conducted using a mixed-method design to determine the impact of the program on 35 youth in the community. A triangulation of qualitative and quantitative data revealed several important themes, including personal development, cultural development, social development, student engagement in school-based programming, and perpetuating cultural knowledge. The program provided students with an opportunity to connect with their cultural traditions through activities that encouraged self and cultural expression. Community responses suggested that this type of programming is highly valued among Indigenous communities.

Maintaining cultural identity: A systematic mixed studies review of cultural influences on the self-care of African immigrants living with non-communicable disease

AIM

To understand and identify cultural factors influencing the self-care practices of African immigrants living with chronic illness in countries outside Africa.

BACKGROUND

The influence of cultural factors on self-care is relatively unexplored in African immigrants with non-communicable diseases (NCDs).

DESIGN

Systematic Mixed Studies review.

DATA SOURCES

PubMed, Psych Info, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus and Sociological Abstract computerized databases. No limit was placed on publication date.

REVIEW METHODS

Results-based convergent design was used. The Mixed Method Appraisal Tool was used to evaluate the studies. Quantitative studies were synthesized narratively while qualitative studies were synthesized using thematic synthesis.

RESULTS

We identified 251 articles and nine fulfilled our inclusion criteria. The studies were published between 2006 and 2019, with six qualitative and three quantitative studies. Studies were conducted in the United States, Australia, Sweden, the Netherlands and the United Kingdom. Most studies examined the influence of culture on self-care of diabetes (n = 6), while the rest focused on hypertension (n = 3). Findings highlight that cultural norms and practices, non-Western approaches to interpreting and managing illness, cultural connotations of health behaviours and structural challenges influencing self-care. Cultural food preferences made adherence to prescribed diets challenging. Family support facilitated self-care. Maintaining cultural identity was both a driver and constraint to engaging in self-care.

CONCLUSION

The complex interplay of cultural and structural factors influences the willingness of Africans who have immigrated to a developed country to follow recommended self-care practices. Considering these cultural norms and structural barriers can help to explain the self-care behaviours of African immigrant populations.

IMPACT

Clinicians and policymakers who account for structural factors and integrate cultural factors into care facilities, treatment protocols and policy can be influential in promoting self-care in African immigrant populations.

US military spouses' experiences transitioning abroad: A narrative analysis

Moving to a new country and culture has emotional, social, financial, health, and cultural consequences. Military spouses face a wide range of stressors when relocating or sojourning, placing them at risk for a variety of health challenges. The aim of this study was to describe the transition experiences of military spouses who sojourn abroad as part of a service member's assignment. Using qualitative narrative inquiry, semi-structured interviews of 13 US military spouses living in Italy were conducted. Narrative thematic and structural analysis was used to analyze the data. Six themes represent the transition experience: adding stress to an already stressful situation, managing a new set of worries and fears surrounded by the unknown, reestablishing an everyday life from chaos, battling social, personal, and physical isolation, reinventing myself to move beyond simply functioning to control, and pondering about life, returning, and repatriation. Internationally, the nursing profession has a responsibility to understand the transition experience of military spouses to overseas assignments so appropriate strategies aimed at strengthening resiliency, building cultural flexibility, and maintaining health and well-being can be provided, while minimizing negative consequences. Additionally, nurses and health care providers can play a role by continually developing culturally congruent and sensitive practice.

'Where and how do you buy medicines?' A pilot survey of consumption strategies among the public in Sweden

Background

Substandard and falsified (SF) medical products are a major danger to public health. They affect every region of the world, and have been identified in all major therapeutic categories. Studies from medicine, pharmacology, law and public health dominate this research area with a focus on the supply side. However, the spread of SF medical products cannot be fully understood without information about the demand side or a sociocultural perspective on market formation. The aim of this short report is to present findings from a pilot study that examines the attitudes of the Swedish public regarding consumption of medicines.

Methods

We conducted a pilot survey in 2016 ‘Where and how do you buy medicines?’ using LimeSurvey, an open-source online survey software. In total 155 respondents completed the survey.

Results

The majority of respondents turn to doctors within healthcare for prescription-only medicines (POM). Simultaneously, some respondents would consider buying POMs without prior contact with experts even if medicines may come from unsafe sources.

Conclusions

There is a tendency that people move away from formal healthcare towards an unregulated market. In parallel, people’s approach to doctors becomes more personalized and pragmatic than in former patriarchal relationships. Risk becomes a negotiable concept.

Qualitative Analysis of Cultural Formulation Interview: Findings and Implications for Revising the Outline for Cultural Formulation

The DSM-IV Outline for Cultural Formulation (OCF) was a framework for assessment based on principles of cultural psychiatry. The Cultural Formulation Interview (CFI) for DSM-5 provided a tool enabling wider use of cultural formulation in clinical cultural assessment. Validation to justify the inclusion of the CFI in DSM-5 involved quantitative analysis of debriefing interviews of patients and clinicians for feasibility, acceptability and clinical utility. We now further examine qualitative field trial data from the CFI interviews and the debriefing interviews in Pune, India. Administration of the CFI was followed by routine diagnostic assessment of 36 psychiatric outpatients-11 found to have severe mental disorders (SMD) and 25 with common mental disorders (CMD). Domain-wise thematic analyses of the CFI and debriefing interviews identified recurrent themes based on cultural identity, illness explanatory models, stressful and supportive social relationships, and the impact of political, economic, and cultural contexts. A tendency to elaborate accounts, rather than simply name their problem, and more diverse past help-seeking distinguished CMD from SMD groups. Patients valued the CFI more than clinicians did, and most patients did not consider cultural background differences of clinician-patient relationships to be relevant. Qualitative analysis of CFI data and critical analysis of domain mapping of CFI content to the structure of OCF domains indicated the value of revising the dimensional structure of the OCF. A proposed revision (OCF-R) is expected to better facilitate clinical use and research on cultural formulation and use of the CFI.

Improving immunization uptake rates among Gypsies, Roma and Travellers: a qualitative study of the views of service providers

BACKGROUND

Gypsies, Roma and Travellers are at risk of low uptake of routine immunizations. Interventions to improve uptake in these communities are seldom evaluated. As part of a qualitative study exploring barriers and facilitators to immunization uptake in Travellers, we report service provider (SP) perspectives.

METHODS

We interviewed immunization SPs working with six Traveller communities across four UK cities. Participants included frontline staff and those with strategic or commissioning roles. Semi-structured interviews explored perceived attitudes of Travellers to vaccinations, local service delivery, and opportunities and challenges to improving uptake. Audio-recordings were transcribed, analyzed thematically and mapped to a socio-ecological model of health.

RESULTS

39 SPs participated. Four overarching themes were identified: building trusting relationships between SPs and Travellers; facilitating attendance at appointments; improving record keeping and monitoring and responding to local and national policy change. Travellers were perceived as largely supportive of immunizations, though system and organizational processes were recognized barriers to accessing services.

CONCLUSIONS

Findings were broadly consistent across Traveller groups and settings. The barriers identified could often be addressed within existing infrastructure, though require system or policy change. Development of a culturally competent system appears important to enable equity in access to immunizations for Travellers.

Language and identity in an Indigenous teacher education program

The Inuit Bachelor of Education (IBED) and the associated Inuktitut language training, developed by the Nunatsiavut Government, has been an opportunity to explore the relationships between cultural identity and learning an Indigenous heritage language as a second language. Language holds the collective knowledge of a group and cultural identity is one’s own perception of connection to the group. A group of preservice teachers are being interviewed twice a year for three years. This study uses narrative methods to give voice to the pre-service teachers’ experiences through their personal stories of learning Inuktitut. The narratives thus far reflect how language learning may contribute to an increased awareness of, and connection to, one’s Indigenous group. The strengthening of cultural identity can enhance wellbeing, which has implications for the learning of these pre-service teachers and the impact on their future students. This is a preliminary report from the on-going research.

Second-generation Western Muslims: A qualitative analysis of multiple social identities

The relationships between social identities are important when discussing the national and religious identities of Muslims in Western contexts. This study explored the identity narratives of second-generation Muslim young adults to consider the relevance of bicultural identity and acculturation theories commonly employed in research with this group. The sample comprised 20 Muslim young adults of diverse ethnicities and backgrounds from Montreal, Berlin, and Copenhagen who participated in semi-structured interviews that explored how they negotiate their social identities in light of their unique life course trajectories. This article focuses on two major themes underlying second-generation identity development: the importance of personal experience in the development of social identities; and the enmeshment of multiple social identities. We then discuss the results of our findings in light of the complex nature of social identity, group membership, and political categorization.

Cultural identity in Siberia and in analytical practice

This paper discusses the main features of Siberian identity formed throughout the historical development of Siberia under the influence of social, economic, geographical, climatic, and other factors. Siberian cultural identity is closely connected with the mythology and ancient religion of the indigenous peoples of Siberia - shamanism, whose rituals, images, symbols, and motifs are often manifested in the clients' dreams. Following an in-depth study of Siberian history and culture, I formulate a complex of homelessness rooted in a deep collective trauma that left its imprint on people's psyche. Three clinical cases presented in the paper reveal a deep relationship between cultural complexes and collective traumas on the one hand, and individual complexes and traumas, on the other. My psychotherapeutic practice shows that a client's awareness of their history and culture brings them closer to the meaning and source of their suffering, which, in turn, helps them find their own way of individuation, rather than relive the transgenerational trauma of their ancestors.

Aesthetic Experiences Across Cultures: Neural Correlates When Viewing Traditional Eastern or Western Landscape Paintings

Compared with traditional Western landscape paintings, Chinese traditional landscape paintings usually apply a reversed-geometric perspective and concentrate more on contextual information. Using functional magnetic resonance imaging (fMRI), we discovered an intracultural bias in the aesthetic appreciation of Western and Eastern traditional landscape paintings in European and Chinese participants. When viewing Western and Eastern landscape paintings in an fMRI scanner, participants showed stronger brain activation to artistic expressions from their own culture. Europeans showed greater activation in visual and sensory-motor brain areas, regions in the posterior cingulate cortex (PCC), and hippocampus when viewing Western compared to Eastern landscape paintings. Chinese participants exhibited greater neural activity in the medial and inferior occipital cortex and regions of the superior parietal lobule in response to Eastern compared to Western landscape paintings. On the behavioral level, the aesthetic judgments also differed between Western and Chinese participants when viewing landscape paintings from different cultures; Western participants showed for instance higher valence values when viewing Western landscapes, while Chinese participants did not show this effect when viewing Chinese landscapes. In general, our findings offer differentiated support for a cultural modulation at the behavioral level and in the neural architecture for high-level aesthetic appreciation.

Racial Discrimination and Low Household Education Predict Higher Body Mass Index in African American Youth

OBJECTIVE

The purpose of this study was to examine the relationships between environmental factors, including household education, community violence exposure, racial discrimination, and cultural identity, and BMI in African American adolescents.

METHODS

A community-based sample of 198 African American youth (120 girls, 78 boys; ages 11-19 years) from Washtenaw County, Michigan, were included in this analysis. Violence exposure was assessed by using the Survey of Children's Exposure to Community Violence; racial discrimination by using the Adolescent Discrimination Distress Index; cultural identity by using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents; and household education by using a seven-category variable. Measured height and body weight were used to calculate BMI.

RESULTS

Racial discrimination was positively associated with BMI, whereas household education was inversely associated with BMI in African American adolescents (discrimination: β = 0.11 ± 0.04, p = 0.01; education: β = -1.13 ± 0.47, p = 0.02). These relationships were significant when accounting for the confounding effects of stress, activity, diet, and pubertal development. Significant gender interactions were observed with racial discrimination and low household education associated with BMI in girls only (discrimination: β = 0.16 ± 0.05, p = 0.003; education: β = -1.12 ± 0.55, p = 0.045). There were no significant relationships between culture, community violence exposure, and BMI (all p's > 0.05).

CONCLUSION

Environmental factors, including racial discrimination and low household education, predicted higher BMI in African American adolescents, particularly among girls. Longitudinal studies are needed to better understand the mechanisms by which these environmental factors increase obesity risk in African American youth.

Cultural Identity Confusion and Psychopathology: A Mixed-Methods Study Among Refugees and Asylum Seekers in the Netherlands

Although there is ample empirical evidence that traumatic events, postmigration stress, and acculturation problems have a great impact on the mental health of refugees, so far no studies have included cultural identity after migration in the equation. This mixed-methods study conducted among Afghan and Iraqi refugee and asylum-seeker psychiatric patients aims to fill this gap. Associations between postmigration stress, symptoms of anxiety and depression disorders, and symptoms of posttraumatic stress disorder were significant. When differentiated for the two groups, associations with postmigration stress were no longer significant for Afghan patients, who were predominantly younger and more often single, lower educated, and without resident status compared with Iraqi patients. Qualitative results indicate that, in addition to psychopathology and postmigration stress, acculturation problems contribute to confusion of cultural identity. The findings suggest that reduction of postmigration stress and acculturation problems may clarify cultural identity and as such may contribute to posttraumatic recovery.

African American Living Donors' Attitudes About APOL1 Genetic Testing: A Mixed Methods Study

RATIONALE & OBJECTIVE

African American live kidney donors ("donors") have a greater risk for kidney failure than European American donors. Apolipoprotein L1 gene (APOL1) variants in African Americans may be associated with this disparity.

STUDY DESIGN

Cross-sectional mixed-methods design.

SETTING & PARTICIPANTS

African American donors at 1 transplantation center.

ANALYTICAL APPROACH

Semistructured interviews assessed attitudes about APOL1 genetic testing, willingness to undergo APOL1 testing, hypothetical decisions about donating with 2 APOL1 variants, and demographics. Surveys assessed perceptions of ethnic identity and genetics knowledge. Interview transcriptions were analyzed using thematic analysis. Survey data were analyzed using descriptive statistics.

RESULTS

23 donors participated in semistructured interviews. Most (96%) reported that transplantation centers should routinely offer APOL1 genetic testing to all African American potential donors. Most (87%) would have been willing to undergo APOL1 testing before donating. Although study participants noted that APOL1 testing may deter African American potential donors from donating, most (61%) would have donated even if they had 2 high-risk APOL1 variants. Several themes emerged. Study participants believed that APOL1 testing was beneficial for providing information to help donors make informed donation decisions. Participants expressed concern about APOL1 variants placing donors at harm for kidney failure, and therefore valued taking preventive health measures. Participants believed that potential donors would experience psychological distress from learning that they have 2 gene variants and could harm their recipients. Participants were apprehensive about insurance coverage and costs of APOL1 testing and feared that APOL1 genetic test results could discriminate against African Americans.

LIMITATIONS

Findings may not be generalizable to African American potential donors.

CONCLUSIONS

Findings suggest that African American donors support APOL1 genetic testing yet fear that APOL1 variants and genetic testing could adversely affect donors' health and ethnic identity. Transplantation centers using APOL1 genetic testing should address African American donors' concerns about APOL1 genetic testing to optimize future donors' informed consent practices.

The Associations Between Cultural Identity and Mental Health Outcomes for Indigenous Māori Youth in New Zealand

Objectives: To explore the relationships between Māori cultural identity, ethnic discrimination and mental health outcomes for Māori youth in New Zealand.

Study Design: Nationally representative, anonymous cross-sectional study of New Zealand secondary school students in 2012.

Methods: Secondary analysis of Māori students (n = 1699) from the national Youth'12 secondary school students survey was undertaken. Theoretical development and exploratory factor analysis were undertaken to develop a 14-item Māori Cultural Identity Scale (MCIS). Māori students reporting > 8 items were classified as having a strong MCIS. Prevalence of indicators were reported and logistic regression models were used to explore how wellbeing (WHO-5), depressive symptoms (Reynolds Adolescent Depression Scale-SF), and suicide attempts were associated with the MCIS.

Results: After adjusting for age, sex, ethnic discrimination and NZ Deprivation Index (NZDep), a strong Māori cultural identity (MCIS) was associated with improved wellbeing scores (OR 1.53, 95% CI 1.18–2.01) and fewer depressive symptoms (OR 0.53, 95% CI 0.38–0.73). Experiencing discrimination was associated with poorer wellbeing scores (OR 0.50, 95% CI 0.39–0.65), greater depressive symptoms (OR 2.2, 95% CI 1.55–3.18), and a previous suicide attempt (OR 2.47, 95% CI 1.71–3.58). Females less frequently reported good (WHO-5) wellbeing (OR 0.33, 95% CI 0.26–0.42), increased (RADS-SF) depressive symptoms (2.61, 95% CI 1.86–3.64) and increased suicide attempts [OR 3.35 (2.07–5.41)] compared to males. Wellbeing, depressive symptoms and suicide attempts did not differ by age or neighborhood level socio-economic deprivation, except those living in neighborhoods characterized as having medium level incomes, were less likely to have made a suicide attempt (OR 0.49, 95% CI 0.27–0.91).

Conclusions: Māori youth who have a strong cultural identity were more likely to experience good mental health outcomes. Discrimination has a serious negative impact on Māori youth mental health. Our findings suggest that programmes, policies and practice that promote strong cultural identities and eliminate ethnic discrimination are required to improve mental health equity for Māori youth.

Future Directions in Research and Intervention with Youths in Poverty

This article aims to integrate theory and empirical findings about understanding and fostering the process of resilience and adaptation in children and families who live in poverty. In this article, we draw from multiple, somewhat distinct, scholarly streams to identify sources of protection, integrating across the literatures on stress and coping, psychophysiology, cultural identity development, and empowerment theory. Because living in poverty cuts across other dimensions of social differentiation and structural inequality, intersectionality theory frames our discussion of how to leverage poverty-affected youths' diverse experiences. We present a framework to guide intervention and research on resiliency promotion, describe the Building a Strong Identity and Coping Skills intervention stemming from the framework, and suggest possible avenues and next steps for both interventions and research.