A successful Minority Retention Project

Racial and ethnic minorities are underrepresented in the nursing profession. The high attrition rate of minority students from nursing schools contributes to this problem. Academic leaders are calling for change in nursing education and asking educators to work diligently to retain minority students. This article describes a Minority Retention Project that included interventions designed to enhance the integration of minority students into a supportive learning environment, assist them in using the available resources, and help them feel connected and supported by their peers and faculty. At the end of the first year of the project, the nursing school experienced 100% retention of minority nursing students. Increasing the retention and graduation of minority nursing students supports the continued effort to provide culturally competent health care.

Viewing clinical research career development through the lens of social cognitive career theory

Issues such as, over commitment, insufficient time, and lack of funding, threaten physicians' entry and sustainability in a research career pathway. Social cognitive career theory is presented as a conceptual framework to critically examine the limitations of the National Institutes of Health's (NIH) efforts to promote the career development of physician-scientists. Special attention is given to the unique challenges of promoting this career pathway for women and underrepresented minorities. The authors propose enhanced recommendations for the career development of physician-scientists and research questions for future studies and program development aimed at advancing the nation's efforts to promote clinical research.

Progress in the pipeline: replication of the minority training program in cancer control research

BACKGROUND

This paper evaluates the replicability of an NCI-funded didactic/experiential program to increase the diversity of doctorally-prepared cancer disparities investigators.

METHODS

The program was developed and operated successfully for three years in Northern California when a replication was established at UCLA. Feasibility, process, impact, and outcome measures on UCSF and UCLA summer-institute participants were compared.

RESULTS

Average participant rankings of the influence of the program on intention to apply for a doctorate were 9.1/10 (UCSF) and 8.6/10 (UCLA). A total of 22.5% of UCSF and 10% of UCLA participants have enrolled in, been accepted by, or completed doctoral programs. Among these alumni, 68% (21/31) of UCSF and 60% (3/5) of UCLA participants plan to conduct their doctoral research in cancer control.

CONCLUSIONS

This program has been successfully replicated and has met its objective to increase the pipeline of ethnically diverse doctoral-level public health researchers. Expansion of the program to other regions of the US is feasible and indicated.

Enhancing diversity in science: is teaching science process skills the answer?

The Biology Fellows Program at the University of Washington aims to enhance diversity in science by helping students succeed in the rigorous introductory biology classes and motivating them to engage in undergraduate research. The composite Scholastic Achievement Test scores and high school grade point averages of the Biology Fellows are comparable to those of students who are not in the program; however, they earn, on average, higher grades in introductory biology classes than non-Biology Fellows. Underrepresented minorities and disadvantaged students in the program also earn higher grades in the introductory biology classes than do their non-Biology Fellows counterparts. Analysis of the performance of Biology Fellows shows that the program assists students who are not proficient in certain science process skills and that students who lack these skills are at risk for failing introductory biology. This evaluation provides insight for designing programs that aim to enhance the performance of beginning students of biology, particularly for underrepresented minorities, who want to obtain a life science degree.

The Role of Faith-Based Institutions in Addressing Health Disparities: A Case Study of an Initiative in the Southwest Bronx

Although many public health initiatives have been implemented through collaborations with faith-based institutions, little is known about best practices for developing such programs. Using a community-based participatory approach, this case study examines the implementation of an initiative in the Bronx, New York, that is designed to educate community members about health promotion and disease management and to mobilize church members to seek equal access to health care services. The study used qualitative methods, including the collaborative development of a logic model for the initiative, focus groups, interviews, analysis of program reports, and participant observation. The paper examines three key aspects of the initiative's implementation: (1) the engagement of the church leadership; (2) the use of church structures as venues for education and intervention; and (3) changes in church policies. Key findings include the importance of pre-existing relationships within the community and the prominent agenda-setting role played by key pastors, and the strength of the Coalition's dual focus on health behaviors and health disparities. Given the churches' demonstrated ability to pull people together, to motivate and to inspire, there is great potential for faith-based interventions, and models developed through such interventions, to address health disparities.

Diversity of the allied health workforce: the unmet challenge

Although black and Hispanic people together constitute 25% of the American population, they represent only 18% of students enrolled in 4-year colleges and universities. The educational divide further widens within the health professions programs, where < 10% of enrolled students in the allied health professions are black or Hispanic. Health agencies have begun referring to the underrepresentation of minorities in the health professions as a public health crisis. Despite the increased focus that the national government is placing on underrepresented minorities, there has been little to no increase in the number of minorities enrolled in health professions programs. This report examines the roles of educational institutions, accrediting organizations, and the government in addressing diversification of the health workforce. The authors challenge stereotypes that reinforce the belief that the predominant reason for low enrollment by underrepresented minorities is inadequate numbers of qualified minorities.

Perceptions of the condom as a method of HIV prevention in Yemen

An HIV/AIDS situation analysis in Yemen was conducted in 2002 to assess knowledge and attitudes towards the male condom as a means of HIV prevention. Data were collected from 3 groups: the general population, a marginalized minority group and Yemenis returning from extended work abroad. Only 51.3% had ever heard of the male condom; of these, just 45.5% were aware of its protective benefit against infection. The major constraint to condom promotion was concern that it would undermine the sexual norms of the country. Reduction in sensation and doubts about its preventive efficacy were further constraints. Nonetheless, over 21% approved of condom promotion among high-risk groups.

Postretirement earnings relative to preretirement earnings: gender and racial differences

As the social security program comes under increasing financial pressure in the coming decades, the federal government will encourage elderly people to continue to work. Data from the Social Security Administration indicate that earnings are already a sizable component of retirement income. But there is public concern about how women and minorities will fare economically in this changing policy environment. To what extent can women and minorities keep earning money after they reach retirement age? This article presents the results of a study that investigated the postretirement earnings, relative to the preretirement earnings, of women and minorities, and compared the results with those for men and whites. The major finding, based on regression analyses, was that women's postretirement earnings, relative to their preretirement earnings, were greater than those of men. Furthermore, the regression results indicate that nonwhites' postretirement earnings could not be predicted by their preretirement earnings or by any of the independent variables used in the study, including age, gender, education, marital status, number of children, occupation, and preretirement earnings.

California's Minority Majority and the White Face of Nursing

Of the 33 million people in California, the nation's most populous state, minority groups now constitute the majority of the population. Many sources predict that by 2060, the entire country will mirror the diversity of California today. Like the rest of the country, California is experiencing a critical shortage of nurses that is predicted to increase in the coming years, and California's nursing workforce does not represent the racial and ethnic diversity of the state's population as a whole. If the nursing profession is to thrive in the coming years, educators and leaders must create a way to embrace people from diverse ethnicities and cultures. The purposes of this article are to determine whether ethnic minority groups have different success rates in California nursing programs, whether nursing programs with high percentages of diverse students have differing success rates, and to describe the institutional predictors of on-time completion rates, attrition rates, and NCLEX-RN first-time pass rates in California community colleges.

Stigma: barrier to mental health care among ethnic minorities

This paper explicates the stigma of mental illness as it is experienced by four ethnic minority groups in the United States. Concerns about prejudice and discrimination among individuals who suffer burdens related to mental illness are delineated. It is proposed that ethnic minority groups, who already confront prejudice and discrimination because of their group affiliation, suffer double stigma when faced with the burdens of mental illness. The potency of the stigma of mental illness is one reason why some ethnic minority group members who would benefit from mental health services elect not to seek or adequately participate in treatment. The combination of stigma and membership in an ethnic minority group can impede treatment and well-being, creating preventable and treatable mortalities and morbidities. The article concludes with recommendations for research and health policy implications.

High school census tract information predicts practice in rural and minority communities

PURPOSE

Identify census-derived characteristics of residency graduates' high school communities that predict practice in rural, medically underserved, and high minority-population settings.

METHODS

Cohort study of 214 graduates of the University of California, San Francisco-Fresno Family Practice Residency Program (UCSF-Fresno) from its establishment in 1970 through 2000. Rural-urban commuting area code; education, racial, and ethnic distribution; median income; population; and federal designation as a medically underserved area were collected for census tracts of each graduate's (1) high school address and (2) practice location.

FINDINGS

Twenty-one percent of graduates practice in rural areas, 28% practice in areas with high proportions of minority population (high minority areas), and 35% practice in federally designated medically underserved areas. Graduation from high school in a rural census tract was associated with rural practice (P < .01), Of those practicing in a rural site, 32% graduated from a rural high school, as compared with 11% of nonrural practitioners. Graduation from high school in a census tract with a higher proportion of minorities was associated with practice in a proportionally high minority community (P = .01). For those practicing in a high-minority setting, the median minority percentage of the high school census tract was 31%, compared with 16% for people not practicing in a high minority area. No characteristics of the high school census tract were predictive of practice in a medically underserved area.

CONCLUSION

Census data from the residency graduate's high school predicted rural practice and practice in a proportionally high minority community, but not in a federally designated medically underserved area.

Barriers to effective uptake of cancer screening among black and minority ethnic groups

AIM

To describe some of the factors that act as barriers to effective uptake of breast and cervical cancer screening services among black minority ethnic (BME) groups living in Brent and Harrow in the UK.

DESIGN

A series of focus groups among African Caribbean, African, Gujarati, Pakistani, Greek and Arabic groups were held to discover their perceptions of cancer screening, the barriers to effective uptake and some strategies for intervention.

SAMPLE

This consisted of 135 participants: 85 women and 50 men.

RESULTS

Analysis of focus group data has revealed poor knowledge, underlying health and cultural beliefs, attitudes, language and unhelpful attitudes of health professionals to be important barriers. In terms of strategies for effective intervention, the most popular strategy for improving uptake of screening services was community-based cancer awareness education that is sensitive to religious and cultural needs.

CONCLUSION

There is a need to provide community-based education to increase the uptake of screening services among BME groups. It is essential to plan concurrently to educate GPs and other health professionals in cultural beliefs and customs, language needs, racial awareness and communication skills.

Performance evaluation for diversity programs

This policy paper addresses the problem of underrepresentation of minorities in the health care professions. Projections are that by 2050 minorities will represent 49% of the U.S. population. Several notable reports suggest that the health care of underrepresented minorities is improved when providers of similar ethnic and racial backgrounds provide the care. However, minority representation in the health care professions has not kept pace with the increase of minorities in the population. A variety of groups (federal, state, private, and health professional educational institutions) have provided billions of dollars toward increasing the number of underrepresented minority health care providers. However, the effectiveness of these programs is not readily evident. Therefore, we recommend comprehensive evaluations of programs funded to increase diversity in the health professions and the development of a Minority Health Care Professionals Center to assume accountability for monitoring programs that receive funding to increase the number of underrepresented minority health care providers.

Educating families from ethnic minorities in type 1 diabetes-experiences from a Danish intervention study

Ethnic minorities may constitute vulnerable groups within Western health care systems as their ability to master severe chronic diseases could be affected by barriers such as different culture and health/illness beliefs, communication problems and limited educational background. An intervention focusing on immigrant families with children with type 1 diabetes is described. The intervention included the development of adapted educational material and guidelines, and a subsequent re-education of children, adolescents and parents from 37 families. The study demonstrated that it was possible to improve health outcome. During the study, the knowledge of diabetes increased, but with considerable differences between the families. HbA(1c) also decreased significantly during the intervention, but increased during follow-up. The paper discusses possible explanations and suggestions for optimising education and calls for new projects where ethnic minorities are active participants in the development of appropriate educational programs and material.

The Impact of Culturally Relevant Violence Prevention Models on School-Age Youth

The Family and Community Violence Prevention (FCVP) Program was established in 1994 to address the escalation of youth violence among ethnic minorities. This federally funded program adapted the public health model and organized Family Life Centers throughout the country to serve youth who were considered to be at risk for violence and other abusive behaviors. The purpose of this three-year study, 1999-2002, was to determine the effectiveness of the FCVP Program's six-component curriculum in reducing violence among participants. Results from posttest scores of 2,315 youth showed girls 12 and over to be most at risk for deviant behaviors; the program was most effective with boys under age 12. Academic performance and bonding to school were protective factors whereas exposure to violence was a risk factor for all four ethnic groups studied--African Americans, Hispanics, Native Americans, and Native Hawaiians. EDITORS' STRATEGIC IMPLICATIONS: Cultural anthropologists, public health specialists, and school officials should know that prevention programs can be designed to reflect the unique, culturally appropriate norms of specific ethnic minority groups, even as these programs address shared risk factors. The authors discuss the promising strategy of enhancing academic performance and school bonding to serve as protective factors against school violence, but they also describe age, gender, and cultural differences that must be addressed in future research.

Improving the adjustment of educationally disadvantaged students to medical school: the Summer Enrichment Program

The Summer Enrichment Program (SEP) is a 6-week pre-matriculation program that targets students who may be at an educational disadvantage and/or may have difficulties adjusting to the rigors of medical school. The objective of the current study was to determine whether the SEP (a) eased the transition to the first year of medical school and (b) had an impact on academic performance during the first year of medical school. All students from groups underrepresented in medicine, who had been invited to participate in the SEP, and all Humanities and Medicine Program students who matriculated at Mount Sinai School of Medicine between 1999 and 2003 and were still matriculated during the 2003-2004 academic year were asked to respond to a survey distributed in the spring of 2004. In addition, student academic profiles were reviewed. Responses to the survey indicated that the SEP provided important emotional benefits for those students who chose to attend the program. Virtually all students who had attended had praise for the program and felt that it eased the transition to medical school, helped build confidence and facilitated social connections. In addition, those students from groups underrepresented in medicine who attended the SEP had less academic difficulty (fewer course failures) in their first year of medical school.