The use of culturally related health practices and health care utilization among Hispanic women in farmworker communities

Breast and cervical cancer screening rates continue to be lower in Hispanic women than other ethnic subgroups. Several factors have been identified that influence health care utilization. The use of preventive services (cancer screenings and adherence) in addition to yearly doctor visits are often used to measure health care utilization. A secondary analysis of an existing dataset containing baseline survey data collected from participants of an intervention trial to test the Cultivando La Salud (CLS) program was used to analyze the association between cultural health practice use (use of curandero,s obador, and herbal remedies) and health care utilization. The sample consisted of women 50 years of age and older living in farmer communities in four sites: Eagle Pass, TX, Anthony, NM, Merced, CA, and Watsonville, CA (n=708). Participants reported using a curandero (5.67%), sobador (29.79%), and herbal remedies (46.65%) at some point in their lives. The use of cultural health practices was found to significantly influence utilization of certain health care services: use of herbal remedies influence doctor visits, adherence to mammography screening and adherence to Pap test screening; use of a curandero influenced ever having a mammogram; use of a sobador influenced ever having a mammogram, ever having a Pap test, and Pap test adherence. In addition, women reporting use of curandero or herbal remedies were found to be more avoidant of the health care system than those that reported not using them. Further research is needed to further analyze the influence of cultural health practices on health care utilization. ^

A qualitative assessment of multi-level nutrition strategies for reducing racial and ethnic disparities in diabetes

The purpose of this study is to examine the stages of program realization of the interventions that the Bronx Health REACH program initiated at various levels to improve nutrition as a means for reducing racial and ethnic disparities in diabetes. This study was based on secondary analyses of qualitative data collected through the Bronx Health REACH Nutrition Project, a project conducted under the auspices of the Institute on Urban Family Health, with support from the Centers for Disease Control and Prevention (CDC). Local human subjects' review and approval through the Institute on Urban Family Health was required and obtained in order to conduct the Bronx Health REACH Nutrition Project. ^ The study drew from two theoretical models—Glanz and colleagues' nutrition environments model and Shediac-Rizkallah and Bone's sustainability model. The specific study objectives were two-fold: (1) to categorize each nutrition activity to a specific dimension (i.e. consumer, organizational or community nutrition environment); and (2) to evaluate the stage at which the program has been realized (i.e. development, implementation or sustainability). ^ A case study approach was applied and a constant comparative method was used to analyze the data. Triangulation of data based was also conducted. Qualitative data from this study revealed the following principal findings: (1) communities of color are disproportionately experiencing numerous individual and environmental factors contributing to the disparities in diabetes; (2) multi-level strategies that targeted the individual, organizational and community nutrition environments can appropriately address these contributing factors; (3) the nutrition strategies greatly varied in their ability to appropriately meet criteria for the three program stages; and (4) those nutrition strategies most likely to succeed (a) conveyed consistent and culturally relevant messages, (b) had continued involvement from program staff and partners, (c) were able to adapt over time or setting, (d) had a program champion and a training component, (e) were integrated into partnering organizations, and (f) were perceived to be successful by program staff and partners in their efforts to create individual, organizational and community/policy change. As a result of the criteria-based assessment and qualitative findings, an ecological framework elaborating on Glanz and colleagues model was developed. The qualitative findings and the resulting ecological framework developed from this study will help public health professionals and community leaders to develop and implement sustainable multi-level nutrition strategies for addressing racial and ethnic disparities in diabetes. ^

A systematic review of community-based colorectal cancer screening randomized controlled trials with multi-ethnic groups

Background. The CDC estimates that 40% of adults 50 years of age or older do not receive time-appropriate colorectal cancer screening. Sixty percent of colorectal cancer deaths could be prevented by regular screening of adults 50 years of age and older. Yet, in 2000 only 42.5% of adults age 50 or older in the U.S. had received recommended screening. Disparities by health care, nativity status, socioeconomic status, and race/ethnicity are evident. Disparities in minority, underserved populations prevent us from attaining Goal 2 of Healthy People 2010 to “eliminate health disparities.” This review focuses on community-based screening research among underserved populations that includes multiple ethnic groups for appropriate disparities analysis. There is a gap in the colorectal cancer screening literature describing the effectiveness of community-based randomized controlled trials. ^ Objective. To critically review the literature describing community-based colorectal cancer screening strategies that are randomized controlled trials, and that include multiple racial/ethnic groups. ^ Methods. The review includes a preliminary disparities analysis to assess whether interventions were appropriately targeted in communities to those groups experiencing the greatest health disparities. Review articles are from an original search using Ovid Medline and a cross-matching search in Pubmed, both from January 2001 to June 2009. The Ovid Medline literature review is divided into eight exclusionary stages, seven electronic, and the last stage consisting of final manual review. ^ Results. The final studies (n=15) are categorized into four categories: Patient mailings (n=3), Telephone outreach (n=3), Electronic/multimedia (n=4), and Counseling/community education (n=5). Of 15 studies, 11 (73%) demonstrated that screening rates increased for the intervention group compared to controls, including all studies (100%) from the Patient mailings and Telephone outreach groups, 4 of 5 (80%) Counseling/community education studies, and 1 of 4 (25%) Electronic/multimedia interventions. ^ Conclusions. Patient choice and tailoring education and/or messages to individuals have proven to be two important factors in improving colorectal cancer screening adherence rates. Technological strategies have not been overly successful with underserved populations in community-based trials. Based on limited findings to date, future community-based colorectal cancer screening trials should include diverse populations who are experiencing incidence, survival, mortality and screening disparities. ^

The prevalence of periodontal disease in Mexican American vs European American elderly in three distinct socio-economic communities in San Antonio, Texas

Purpose of the Study: This study evaluated the prevalence of periodontal disease between Mexican American elderly and European American elderly residing in three socio-economically distinct neighborhoods in San Antonio, Texas. ^ Study Group: Subjects for the original protocol were participants of the Oral Health: San Antonio Longitudinal Study of Aging (OH: SALSA), which began with National Institutes of Health (NIH) funding in 1993 (M.J. Saunders, PI). The cohort in the study was the individuals who had been enrolled in Phases I and III of the San Antonio Heart Study (SAHS). This SAHS/SALSA sample is a community-based probability sample of Mexican American and European American residents from three socio-economically distinct San Antonio neighborhoods: low-income barrio, middle-income transitional, and upper-income suburban. The OH: SALSA cohort was established between July 1993 and May 1998 by sampling two subsets of the San Antonio Heart Study (SAHS) cohort. These subsets included the San Antonio Longitudinal Study of Aging (SALSA) cohort, comprised of the oldest members of the SAHS (age 65+ yrs. old), and a younger set of controls (age 35-64 yrs. old) sampled from the remainder of the SAHS cohort. ^ Methods: The study used simple descriptive statistics to describe the sociodemographic characteristics and periodontal disease indicators of the OH: SALSA participants. Means and standard deviations were used to summarize continuous measures. Proportions were used to summarize categorical measures. Simple m x n chi square statistics was used to compare ethnic differences. A multivariable ordered logit regression was used to estimate the prevalence of periodontal disease and test ethnic group and neighborhood differences in the prevalence of periodontal disease. A multivariable model adjustment for socio-economic status (income and education), gender, and age (treated as confounders) was applied. ^ Summary: In the unadjusted and adjusted model, Mexican American elderly demonstrated the greatest prevalence for periodontitis, p < 0.05. Mexican American elderly in barrio neighborhoods demonstrated the greatest prevalence for severe periodontitis, with unadjusted prevalence rates of 31.7%, 22.3%, and 22.4% for Mexican American elderly barrio, transitional, and suburban neighborhoods, respectively. Also, Mexican American elderly had adjusted prevalence rates of 29.4%, 23.7%, and 20.4% for barrio, transitional, and suburban neighborhoods, respectively. ^ Conclusion: This study indicates that the prevalence of periodontal disease is an important oral health issue among the Mexican American elderly. The results suggest that the socioeconomic status of the residential neighborhood increased the risk for severe periodontal disease among the Mexican American elderly when compared to European American elderly. A viable approach to recognizing oral health disparities in our growing population of Mexican American elderly is imperative for the provision of special care programs that will help increase the quality of care in this minority population.^

Correlates of the desired family size among Indian communities.

The People of India database of the Anthropological Survey of India documents 631 cultural, ecological, and economic traits of the 4635 communities to which the entire Indian population is assigned. Focusing on 1342 communities of South India, we looked for correlates of low (1 or 2 children) and high (4 or more children) desired family size (DFS) reported as the norm for any given community by key informants. We found 10 cultural and 18 economic traits to be significantly correlated to high DFS and 21 cultural and 9 economic traits to low DFS. The economic traits so identified are compatible with high family size being desired by parents who have little capability of investing in quality of offspring, but whose children contribute economically from an early age. In contrast, communities desiring low family size are part of the modern intensive agriculture/organized industry/services sector and invest heavily in educating their children. A composite index based on 27 economic traits (CEI) has a high predictive value with respect to the DFS for the entire set of 4635 Indian communities. The 31 cultural traits highly correlated to high or low DFS constitute 5 clusters that can be identified as characterizing scheduled tribes, scheduled castes, rural and landless lower castes, urban upper castes, and Moslems. Whereas economic traits have similar influence on DFS within each of these ethnic categories, Moslems demonstrate a significantly higher DFS for lower values of CEI.

Mapping the awareness of inequalities in health programs in Spanish communities: moving forward together

The aim of this study is to map the awareness of gender, socioeconomic, immigrant and ethnic health inequalities in health at schools, maternal health and traffic injury health prevention programs. The study was conducted in the 19 health descentralized areas in Spain, 17 autonomous community (ACs) and the 2 autonomous cities (ACities). The data were collected from May 2008 to January 2009. The unit of analysis was the collection of policy documents setting out the programs mentioned above and the related support material in each AC. A reading guide was used to analyze the awareness of inequalities. With regard to health at schools, 2 of 10 programs show a high awareness of inequalities and include many specific proposals to be implemented at the local level. Regarding maternal health, 13 ACs have prepared support material with high awareness of inequalities to be implemented. A traffic injury program has been created in two ACs. We map the whole situation in Spain regarding the health programs that we have used as examples and their awareness of inequalities. We can conclude that there are differences between the regions studied in Spain and in general, the awareness of inequalities is low.

Wired communities in the city: Sydney, Australia

Questions relating to the ability of particular groups in society to access information and communications technologies (ICTs) have become a growing part of the academic and policy literature. The issues raised in this literature have revolved around a number of themes, many of which can be subsumed under concerns about a growing digital divide whereby society is being divided into information rich and information poor sectors. This differentiation can be between particular social groups irrespective of place, or between people in particular places be these large regional areas (e.g. metropolitan versus non-metropolitan) or localities and communities within an urban area. This paper focuses on the existence of a 'digital divide' across the Sydney metropolitan area. Using ABS 2001 census data the paper presents an analysis of computer and internet access and use for clusters of local communities and focuses on how usage differs across communities as differentiated by socio-economic status, household and family status and ethnic background

The Strategic Utility of ‘Chineseness’ in the Political Cultures of Diasporic Chinese Communities: Some Preliminary Thoughts

It is not especially controversial to suggest that the academic literature on Chineseness has for some time been focused upon the ‘porousness’ and ‘strategic’ possibilities of identity categories. This is most clearly observable in the legacy of cultural theory upon identity politics. In particular, terms such as hybridity have not only expanded the political potential for fragmenting conventional identifications, but also symbolised the sorts of ‘complicated entanglements’ within which individuals and communities are perpetually caught. The discursive mileage of hybridity has meant, over time, that it has also attracted criticism. Some of this criticism comes from academics engaged in more materialist forms of research. These sorts of contrary perspectives have often sought to ground hybrid identifications within the cultural and historical milieu from which they are enacted, whenever they are enacted.

A management tool for developing the relationships between large purchasing organisations and small ethnic minority suppliers

Purpose: The purpose of this paper is to scrutinise the characteristics of the relationship between large purchasing organisations (LPOs) and ethnic minority suppliers (EMSs) engaging with supplier diversity programmes and provide an assessment and developmental framework for such organisations. Design/methodology/approach: Having considered an array of purchaser-supplier relationship frameworks in relevant streams of literature, the paper draws on Lamming et al.'s framework to advance a tool for assessing and developing the relationship between LPOs and EMSs. Findings: The submitted relationship assessment and development framework brings in sharp focus the characteristics of the relationship between LPO and EMS, providing a systematic way to examine the inter-organisational context within which EMS development takes place. Research limitations/implications: The framework submitted could signpost future research in this field, which should take a longitudinal, processual approach. This is necessary to provide opportunities to examine the dynamics underlying the development of potent LPO-EMS relationships in a variety of settings, including negative instances. Practical implications: The paper has implications for corporate policy making and practice in this arena. Assessing the potency of LPOs-EMSs relationships by applying the proffered tool can help both parties engage with supplier diversity, to develop fruitful relationships that enhance their competitiveness. Social implications: The latter can have social implications, as EMSs often operate in and employ people from disadvantaged communities. Originality/value: The framework advanced in this article constitutes a novel tool that highlights the areas in which LPOs and EMSs should channel their efforts, in order to develop a potent relationship between them, which underpins the development of EMSs' supply capabilities. © Emerald Group Publishing Limited.

Transnationalism as a force for ethnic minority enterprise? The case of Somalis in Leicester

The extant literature on the phenomenon of transnational entrepreneurship has documented that in an era characterized by ‘superdiversity’, ethnic minorities use their diasporic networks to access an array of valuable resources in order to facilitate entrepreneurial activity. The article examines the connection between the notions of ‘superdiversity’, transnationalism and entrepreneurship by illuminating the dynamics of ‘transnational’ Somali business activity in Leicester. Considering this as a critical case, we attempt to address a gap in the literature on ethnic minority enterprise, which has struggled to address the ‘diversification of diversity’ that attends the arrival of new communities in the UK. Moreover, the article contributes to the discussion on the importance of ‘conditioning factors’ in explaining the ‘integration’ of new arrivals. Although familial and co-ethnic ties influence the availability and interaction of social, financial and human capital, this falls considerably short of neoliberal depictions of globalization. The political-economic context imposes harsh constraints upon Somali business activity which cannot be circumvented by the utilization of diasporic links, and transnational entrepreneurship is likely to be the preserve of a minority of minorities.

Health beliefs and health care options of disparate black communities in the United States

According to the 1999 U.S. Census, there were approximately thirty-three million African Americans and approximately 1.8 million non-Hispanic black immigrants in the United States. The 1997 U.S. Census estimated that there were as many as 554,000 foreign-born Haitians and 505,000 foreign-born Jamaicans living in the United States, mainly residing in Florida and New York. The U.S. Census claims that blacks are one of the largest emerging ethnic groups in America constituting at least twelve percent of this country's population. Because of this increase, their specific health beliefs and health care options are increasingly nationally significant. ^ In the present intra-black and inter-ethnic study, two hundred seventy African Americans, Haitian immigrants, and Jamaican immigrants residing in South Florida were quantitatively and qualitatively surveyed in order to investigate their health beliefs and health care options. According to the reviewed literature, the three black ethnic groups researched in this study have not been compared or contrasted before in relation to these beliefs and health care choices. ^ As was discovered by the present research, differing health beliefs and health care options were the cultural products of the ethnic differences of the researched communities. It was expected that differing health beliefs among the researched black groups might indicate disparate patterns of health care utilization of either western or non-western models. Additionally, it was projected that by investigating the health beliefs and the health care options of these emerging black ethnic groups, western health care providers in the United States could become better versed in medically servicing growing ethnically-disparate black populations. The study yielded results about the researched groups that supported major findings in the reviewed literature. The data were reported and examined, and theoretical generalizations from the data were discussed. The most important of these findings was that, within a race, health beliefs and health care options were determined by specific ethno-cultural variables dependent on national origins. ^

Ethnic identification: Impact on HIV/AIDS risk among migrant and seasonal workers in South Florida

Migrant workers are one of the most rapidly growing populations in the United States (U.S.) and have been significantly affected by HIV/AIDS. More than 9 million people in the U.S., primarily concentrated in Texas, Florida, Washington, California, Oregon, and North Carolina, are migrant farm workers. High prevalence rates are also suspected among migrant worker communities where risky health behaviors appear to be common. Constant mobility, isolation, limited education, substandard housing, and poverty are some of the factors that migrant workers experience and in many cases increases their HIV risk. Recent studies have suggested that ethnic identity or the level of attachment with one's ethnic group may influence engagement in HIV risk behaviors, a fact that may be important in the development of interventions among ethnic minorities. This study assesses the relationship between ethnic identity and HIV risk behaviors in two different samples; one assesses this relationship at baseline with a total of 431 African American migrant and seasonal workers in Immokalee, Florida. The second analyzes changes in ethnic identity and HIV behaviors in a sample of 270 Hispanic and African American migrant and seasonal workers in Immokalee, Florida. Data from baseline and 6-month follow-up were used in the analyses presented. The results suggest that individuals with higher levels of ethnic identity report lower levels of engagement in some, but not all, of the risky behaviors examined. These findings point to a potentially protective role for ethnic identity among this sample.

Outdoor experiential team -building and the college adjustment and persistence of freshmen in learning communities

Student retention is a primary goal in all higher education institutions. Students who are more adjusted to college life are more likely to persist. The purpose of this research was to determine the effects of an outdoor experiential team-building program on the college adjustment of first-semester freshmen in learning communities at a diverse, urban university. The participants in this quasi-experimental study were first-semester freshmen enrolled in learning communities. A total of 123 students participated, with 61 students in the experimental group and 62 students in the comparison group. There were no significant differences between the two groups in relation to age, gender, or ethnicity. The students in the experimental group participated in the team-building program, which consisted of three events spaced three and four weeks apart. At the end of the semester, students in both the experimental and comparison groups completed the Student Adaptation to College Questionnaire (SACQ), a 67-item self-report survey. ^ Independent samples t-test of the SACQ scores (for attachment to the institution, social adjustment, and overall adaptation to college) between groups was done, and the analyses revealed no statistically significant differences. Chi-square analyses revealed no significant difference in the enrollment pattern between the two groups over a four-year period. Repeated measures ANOVAs revealed that from the first semester of enrollment to the second semester there was a significant drop in GPA for students from the comparison group and no such drop in GPA for students from the experimental group who had participated in at least two of the team building activities. A repeated measures ANOVA was conducted for the first year by semester and ethnicity. No ethnic differences were found, and no interaction was found by ethnicity and semester. ^ Should colleges and universities continue to utilize outdoor experiential team-building programs as a creative way to influence students' connection to the institution they should further investigate its value on students' adjustment to college. Future studies should also consider other variables influenced by team-building programs that affect students' college adjustment, such as collaborative learning. Faculty should be included in the planning process to increase their participation. ^

Shared Education in contested spaces: How collaborative networks improve communities and schools

Societies which suffer from ethnic and political divisions are often characterised by patterns of social and institutional separation, and sometimes these divisions remain even after political conflict has ended. This has occurred in Northern Ireland where there is, and remains, a long-standing pattern of parallel institutions and services for the different communities. A socially significant example lies in the education system where a parallel system of Catholic and Protestant schools has been in place since the establishment of a national school system in the 1830s. During the years of political violence in Northern Ireland a variety of educational interventions were implemented to promote reconciliation, but most of them failed to create any systemic change. This paper describes a post-conflict educational initiative known as Shared Education which aims to promote social cohesion and school improvement by encouraging sustained and regular shared learning between students and broader collaboration between teachers and school leaders from different schools. The paper examines the background to work on Shared Education, describes a ‘sharing continuum’ which emerged as an evaluation and policy tool from this work and considers evidence from a case study of a Shared Education school partnership in a divided city in Northern Ireland. The paper will conclude by highlighting some of the significant social and policy impact of the Shared Education work.