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.

Faith in transplants

The number of people needing organ transplants outstrips supply--and this is particularly acute in black and minority ethnic groups. A reluctance to talk about the possibility of donation after death is coupled with misconceptions about religious teaching on the subject.

An educational program to increase cervical and breast cancer screening in Hispanic women: a Southwest Oncology Group study

We conducted a community-based pilot study to train Hispanic cancer survivors as promotoras (lay health educators) to encourage their social contacts to obtain breast and cervical cancer screening. Promotoras were recruited from a private oncologist's practice at a Minority-Based Community Clinical Oncology Program (MBCCOP). Five Hispanic women were trained to serve as promotoras by attending a 12-week course. They shared cancer screening information with family and social contacts and encouraged them to obtain Papanicolaou smears and/or mammograms. Study endpoints included the number of women recruited and trained to serve as promotoras, the number of contacts made per promotora, and the number of contacts who were screened; data were based on contact logs maintained for 1 year. Screening examinations were documented by a postcard returned by the contact or by review of community health clinic records. Five promotoras contacted 141 (range = 24-49 per promotora) women to share cancer screening information. Fifty Hispanic women obtained screening after contact with a promotora. Twenty-nine underwent mammography (ages 25-58) and 43 received a Papanicolaou smear (ages 23-62). Hispanic female cancer survivors can be trained as promotoras. Screening information conveyed by a promotora can successfully prompt Hispanic women to obtain mammography and Papanicolaou smears.

Relationship of abuse and pelvic inflammatory disease risk behavior in minority adolescents

PURPOSE

Little is known about the relationship between minority adolescent's experiences of sexual or physical abuse and the pathology of gynecological symptoms that might have an impact on the diagnosis of sexually transmitted disease (STD) or risk for pelvic inflammatory disease (PID). The objective of this study was to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID among Mexican American and African American adolescent women with a current STD.

METHODS

Mexican American and African American adolescent women (n = 373) with an STD underwent a targeted physical exam and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and risk behaviors known to be associated with PID to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID.

RESULTS

Bivariate comparisons found that abused adolescents (n = 232) reported more behaviors associated with increased risk for PID, including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found that abused adolescents were more likely to report pathologic genitourinary symptomatology than those who were not abused. Clinicians reported more abnormal physical exams but did not make any more presumptive diagnoses of PID for abused than nonabused adolescents.

CONCLUSIONS

Delayed treatment for PID dramatically worsens future fertility and chronic pelvic pain. These findings demonstrate that abused adolescent women are at high risk for PID. Because of its considerable impact on risk for PID, an assessment for abuse is essential in clinical management of adolescent women with STD and diagnosis of PID.

Addressing health disparities: African American consumer information resources on the web

The Web continues to rapidly evolve as a medium of information exchange. One major area where the Web is now playing a definitive role is in increasing consumer accessibility to health information for personal health and disease-related questions. The comprehensiveness of health information on the Web has the potential to empower consumers when making critical health-related decisions. Conversely, the myriad of information resources presents an array of challenges when seeking specific, credible, and timely health information. As the United States health care system continues to change, community concerns about the quantity, quality, and broad nature of information has become critical. In particular, the Web can play a vital role in health awareness and promotion by disseminating health information for traditionally underrepresented groups, particularly African Americans. Increased accessibility for this group has not always been the focus of attention; however, the growth of the Web coupled with heightened awareness of public health initiatives brings to the forefront numerous opportunities to provide tools that promote essential health information literacy.

KAP surveys and malaria control in Vietnam: findings and cautions about community research

The malaria disease burden is increasing in many countries despite the existence of effective preventative strategies and antimalarial drugs. An understanding of community perspectives and practices is one of the essential components of a successful malaria control program. This paper reports on a KAP (Knowledge, Attitudes and Practices) survey among the Raglai ethnic minority population in Ninh Thuan Province, Vietnam, which in 2003 had one of the country's highest confirmed rates of malaria. We found high levels of correct knowledge about malaria's transmission and symptoms, and self-reports of adequate bed net usage and appropriate health-seeking behavior. While the survey generated useful findings, an initial, qualitative investigation (eg, observation and focus group discussions) to explore the large numbers of potential influences on behavior and exposure risk would have provided a more robust underpinning for the design of survey questions. This would have strengthened its validity and generated additional information. The adoption of rigorous, multi-disciplinary research methods offers the best chance of contributing to the development of successful malaria control programs and effective policies.

Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom

OBJECTIVES

We measured perceived discrimination and its association with common mental disorders among workers in the United Kingdom.

METHODS

We conducted a secondary analysis of a national sample of 6 ethnic groups (n=2054). Discrimination was measured as reports of insults; unfair treatment at work; or job denial stemming from race, religion, or language. The outcome assessed was presence of common mental disorders.

RESULTS

The risk of mental disorders was highest among ethnic minority individuals reporting unfair treatment (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.2, 3.2) and racial insults (OR=2.3; 95% CI=1.4, 3.6). The overall greatest risks were observed among Black Caribbeans exposed to unfair treatment at work (OR=2.9; 95% CI=1.2, 7.3) and Indian (OR=3.1; 95% CI=1.4, 7.2), Bangladeshi (OR=32.9; 95% CI=2.5, 436.0), and Irish (OR=2.9; 95% CI=1.1, 7.6) individuals reporting insults.

CONCLUSIONS

Racial/ethnic discrimination shows strong associations with common mental disorders.

Sharing stories: complex intervention for diabetes education in minority ethnic groups who do not speak English

OBJECTIVE

To develop and refine a complex intervention for diabetes support and education in minority ethnic groups, delivered through bilingual health advocates.

DESIGN

Action research framework-a variety of methods used in an emergent and developmental manner, in partnership with clinicians, managers, and service users, drawing especially but not exclusively on narrative methods.

SETTING

Deprived inner London district.

INTERVENTIONS

Development and evaluation of three components of the complex intervention: a group based learning set for bilingual health advocates, in which stories about clients with diabetes formed the basis for action learning; advocate led support and education groups for people with diabetes, which used personal stories as the raw material for learning and action; organisational support to help to develop these new models and embed them within existing services.

RESULTS

Both advocate groups and user groups were popular and well evaluated. Through storytelling, advocates identified and met their own educational needs in relation to diabetes and the unmet needs of service users. In the advocate led user groups, story fragments were exchanged in a seemingly chaotic way that the research team initially found difficult to facilitate or follow. Stories were not so much told as enacted and were often centred on discussion of "what to do." Whereas some organisations welcomed, successfully implemented, and sustained the advocate led groups, others failed to do so. A key component of the complex intervention was organisational support.

CONCLUSIONS

An action research approach allowed engagement with an underserved group of health service staff and with hard to reach service users. The study produced subjective benefits to these groups locally as well as a worked-up complex intervention that will now be formally tested in a randomised controlled trial.

Diversity. Race to the top

Ten different providers deliver Breaking Through, including PricewaterhouseCoopers, Hay Management Group and Beacon Organisational Development. The first cohort started in January 2004 with 160 participants. All participants take a development centre module first but then take modules that best meet their needs.

Use of community health workers in research with ethnic minority women

PURPOSE

To explore roles and effectiveness of community health workers in research with ethnic minority women in the United States (US).

METHODS

Medline (1966-2002) and CINAHL (Cumulative Index to Nursing and Allied Health Literature; 1982-2002) databases were used to locate published research studies on the use of community health workers with ethnic minority women in the US. Key words for searches were community health workers, community health aides, health promoters, and community workers.

RESULTS

An integrative analysis of 24 studies showed that, despite varying roles and functions, evidence indicates that community health workers are effective in increasing access to health services, increasing knowledge, and promoting behavior change among ethnic minority women. Other advantages of using community health workers are to provide social support and culturally competent, cost-effective care. Recommendations for future directions of research with community health workers and ethnic minority women include improved conceptualization of the community health worker role, theoretical frameworks for research designs, enhanced methods for evaluating effectiveness, and increased community involvement.