\fChapter 10 Asian American and Pacific Islander Populations Overview of Chapter Topics History of Asian Americans and Pacific Islanders Asian Americans and Pacific Islanders in the U.S. Beliefs about causes of health and illness Behavioral risk factors and common health problems among Asian Americans Behavioral risk factors and common health problems among Pacific Islanders Considerations for health promotion and program planning for Asian Americans and Pacific Islanders Overview of Chapter Topics Chapter summary and review questions Case studies: - I. Caucasian caregiver providing possibly inappropriate meals to an elderly Japanese woman - II. Condemnation by culturally traditional Japanese adults of organ donation Model program: The Families In Good Health program History of Asian Americans and Pacific Islanders Chinese Americans - Agreement on how they arrived in U.S. cannot be reached--may have been brought to U.S. as slaves - Worked on transcontinental railroad - Due to anti-Chinese discrimination lived in segregated areas - Chinese Exclusion Act of 1882 suspended immigration and naturalization until 1952 Vietnamese - Presence occurred in waves related to American involvement in Vietnam wars and hence reunification programs History of Asian Americans and Pacific Islanders Koreans and Asian Indians - Korean immigration began when they went to Hawaii to work on plantations and a wave related to Korean War - Asian Indian immigration not related to war immigration began as population in India increased Japanese - Began to immigrate mostly during 19th century to Hawaii and Western U.S. - Worked on plantations and farms History of Asian Americans and Pacific Islanders Hawaiians and Pacific Islanders - Native Hawaiians had distinct culture before becoming part of the U.S. - Islands changed when American and Europeans traders and planters arrived - Became 50th state in 1959 Asian Americans and Pacific Islanders in the U.S. Most diverse and fastest growing ethnic group in the U.S. Includes over 100 separate language groups Non-English languages frequently spoken in the home Populations concentrated in Western U.S. Asian Americans have origins in Far East, southeast Asia, and the Indian subcontinent Historically, Asian Americans are often omitted from health research Asian Americans and Pacific Islanders in the U.S. Asian Americans and Pacific Islanders in the U.S. Asian Americans and Pacific Islanders in the U.S. Beliefs About Causes of Health and Illness Beliefs vary depending on country or island of origin A common thread among Asian cultures is belief that health requires a body that is balanced Beliefs About Causes of Health and Illness Traditional Chinese beliefs - Related to beliefs about vital bodily energies (e.g., chi) - Harmony seen as essential to health - Balance between yin/yang, hot and cold, often seen as central to health and curative practices Beliefs About Causes of Health and Illness Traditional Vietnamese beliefs - Vary greatly by ethnic subgroups (e.g., H'mong) - Urban Vietnamese health beliefs/practices resemble those of Chinese traditional medical theories aAma and aDuonga are similar to Yin and Yang Use of herbs, massage, thermal treatments, and acupuncture to treat illness - Living things believed to consist of earth, air, fire, and water, with related qualities hot-cold and wet-dry Treatment seen as requiring application of the quality opposed to the one whose excess caused the illness Beliefs About Causes of Health/Illness Traditional Korean beliefs - Similarities to Chinese medicine belief in Yin and Yang belief in Kior chi, similar to Chinese chi herbal remedies commonly used Traditional Indian health beliefs/practices - Often related to Ayurvedic medicine - Western medicine also commonly employed Beliefs About Causes of Health/Illness Traditional Filipino beliefs/practices - Timbang encompasses a complex set of basic principles Belief in humors 'Hot' and 'cold' seen as critical in health/illness - Illness seen as resulting from mystical, personalistic, or naturalistic causes Beliefs About Causes of Health/Illness Healing traditions Among Other Asian Americans and Pacific Islanders Healing traditions in many Asian countries and Pacific islands use techniques from Chinese and Ayervedic medicine Cambodian traditional healers use coining, cupping, and pinching to treat problems associated with \"wind illness\" Beliefs About Causes of Health/Illness Healing traditions Among Other Asian Americans and Pacific Islanders - In general, Pacific Islander healing practices revolve around use of natural plant extracts and herbs kava root, betel nut - Hawaiian islanders, while using Western medicine, continue to be influenced by traditional practices Mind, body, and spirit viewed as a holistic whole Concepts of mana and lokohi are important Kahunas, traditional healers, generally use massage and hebalism but often specialize in treatment of specific problems Behavioral Risk Factors and Common Health Problems Among Asian Americans Barnes, et al. (2008) study of Asian Americans found: - Korean Americans are most likely to lack a regular source of health care - Vietnamese are more likely than other groups to consider a clinic as their primary source of health care - Asian Americans in general are more likely than either White or African American adults never to have seen a dentist - Financial cost is not the primary reason for Asian Americans' failure to seek health care Behavioral Risk Factors and Common Health Problems Among Asian Americans 2003 Office of Minority Health Study found that Asian Americans avoid medical practitioners because of - Language/cultural barriers - Fear of deportation - Lack of health insurance Behavioral Risk Factors and Common Health Problems Among Asian Americans Results of recent census and research data: - Most Asian American adults have never smoked Highest smoking rates found to be among Korean American and Japanese American adults - Alcohol use Japanese American adults more likely than other Asian Americans to be moderate to heavy users of alcohol Vietnamese American adults found to have the highest rates of abstinence, followed closely by Filipino Americans Behavioral Risk Factors and Common Health Problems Among Asian Americans Results of 2000 census and research data: - 60% overall reported being in excellent or very good health No differences in these reports between Asian American men and women - Most Asian American adults were found to be in a healthy weight range Filipino American adults more likely than other Asian American adults to be obese Behavioral Risk Factors and Common Health Problems Among Asian Americans Results of 2000 census and research data: - Only a small number of respondents reported doing regular physical activity - Asian American rates for hypertension are lower than those of African Americans, Whites, or Hispanic adults - Among Asian American populations, those of Filipino and Japanese extraction are more likely than those of Chinese, Korean, or Indian origin to be diagnosed with hypertension Behavioral Risk Factors and Common Health Problems Among Asian Americans Results of recent census and research data: - Immunization rates are generally lower for Asian Americans than for other groups - Most significant risks for Asian Americans are cancer, heart disease, stroke, diabetes, and unintentional injuries Asians are particularly at risk for \"silent heart attacks,\" a form of heart disease particularly deadly because of the lack of forewarning pain and other symptoms - High incidence of chronic obstructive pulmonary disease, hepatitis B, HIV/AIDS, smoking, tuberculosis, and liver disease Behavioral Risk Factors and Common Health Problems Among Asian Americans Attitudes toward mental health - In many Asian cultures, mental health problems are viewed as shameful and disgraceful - Discussions of such problems are avoided, and help is not often sought Behavioral Risk Factors and Common Health Problems Among Asian Americans Diet - Asian cultures tend not to be as concerned with nutrition as Western, mainstream culture - Flavor, aroma, texture, color, and yin/yang balance are considered more important than nutrition - Many Asians are lactose intolerant; dairy products are not a significant part of their diets - Primary food groups for Asians tend to be rice and noodles, vegetables, fruit, and meat or fish - Indian diets are strongly influenced by Hindu and Muslim dietary restrictions Behavioral Risk Factors and Common Health Problems Among Asian Americans Source: 2000 Oldways Preservation & Exchange Trust. www.oldwayspt.org. Reproduced with permission. Behavioral Risk Factors and Common Health Problems Among Pacific Islanders Data released by CDC in 2006 indicated that: - Native Hawaiians and Pacific islanders have poorer health than Americans as a whole - Most common health disorders are cancer, heart disease, stroke, obesity, and diabetes - Leading causes of premature death are obesity, cardiovascular disease, cancer, and diabetes Shift of Pacific Islander diets toward fast food and highly processed food results in poor nutrition and increased incidence of obesity and diabetes Significant Health Disparities Affecting Asian Americans and Pacific Islanders In 2001, Asian Americans and Pacific Islanders over 40 years old were found to be 2.5 times as likely as non-Hispanic Whites to have hepatitis B In 2004, Asian Americans were found to be 5.6 times as likely to have tuberculosis as Americans in general In 2004, Hawaiians and Pacific islanders were found to be 3.3 times as likely to have tuberculosis as Americans in general Considerations for Health Promotion and Program Planning Ensure good communication, using language translation where necessary Show consideration for family relationships and needs; include family in discussions When providing meals, make them appropriate to the specific culture Inquire regarding the use of herbs and other traditional forms of treatment Summary General term Asian American is used for people from many countries, cultures, and traditions across Asia These groups have varied health beliefs and healing practices, but many focus on the concepts of balance and harmony Chapter 11 Caucasian American Populations Overview of Chapter Topics Chapter introduction Amish Americans The Roma (Gypsies) Arabs and Middle Eastern Americans Chapter summary and review questions Case studies - I. Arab sensitivities regarding sexual modesty - II. Awareness of Muslim daily prayer requirements Model program: Dental Services for Amish Families Introduction The U.S. Census Bureau's term 'white' refers to a person having origins among any of the people of Europe, the Middle East, or North Africa. Introduction History Primarily a religious group Named for Jakob Amman, a Swiss Anabaptist Roots of Amish religious beliefs are in the 16th century European Anabaptist movement Amish Americans in the United States Concentrations of Amish populations; mainly in Lancaster, PA Amish social/cultural values - Primary stress is on maintaining separation from \"worldly\" modern and mainstream cultures Use of modern communication technologies and implements driven by non-natural power sources is severely restricted Use of these is tightly controlled - Strongly egalitarian society rooted in traditional farming practices Amish Americans in the United States Amish social/cultural values - Community mutual assistance and selfreliance highly valued - Strong patriarchal values with traditional gender roles - Elders highly respected Beliefs about Causes of Health and Illness Among the Amish Sin seen as cause of illness Traditional health care is organic and holistic, employing readily available herbal and folk medicines Reflexology and some chiropractic procedures are used, as well as brauche, involving laying on of hands Beliefs about Causes of Health and Illness Among the Amish Use of modern technology limited during pregnancy and birth - Amniocentesis and other invasive prenatal diagnostics avoided - Traditional herbal preparations are used to ease labor Behavioral Health Risk Factors and Common Health Problems Among Amish Americans Avoidance of alcohol and tobacco, coupled with high levels of physical activity, promotes good health for most Amish Americans - Low levels of obesity - Alcohol and drug use by young adults has led to increases in mental health problems, including depression, among them Amish strongly inclined to avoid modern medical practices Behavioral Health Risk Factors and Common Health Problems Among Amish Americans Avoidance of immunization puts Amish at risk for communicable diseases, particularly when traveling outside their own communities Intermarriage within the small Amish population, including marriage between first cousins, has lead to high incidence of certain genetic disorders - Forms of dwarfish, including Ellis-van Creveld syndrome and cartilage-hair hyperplasia Considerations for health promotion and program planning for Amish Americans Be aware of the cultural differences between the Amish and society as a whole Recognize the importance of privacy to this group Be sensitive to the formality of Amish family relationships Considerations for health promotion and program planning for Amish Americans Remember that the Amish may not understand matters that seem elementary to members of the wider society Explain procedures and instructions in such a way as to confirm understanding on the part Amish patients The Roma (Gypsies) History of the Roma The Roma in the United States Beliefs about Causes of Health and Illness Among the Roma Behavioral Risk Factors and Common Health Problems Among the Roma Considerations for Health Promotion and Program Planning for the Roma History Originally from northern India Immigrated into eastern and middle Europe beginning in the 11th century Immigrated into U.S. in two waves during 18th and 19th centuries The Roma language, Romany, is derived from Sanscrit - Until recently, this was a spoken language only The Roma in the United States Strong, exclusive cultural and social bonds maintained within Roma society - Roma loyalties are devoted hierarchically to their Roma 'nation', their clan, their vista (i.e., extended family), and their immediate family Older family members are accorded considerable authority in all decision making Isolation from larger community purposely maintained - Gadje (i.e., non-Roma people) seen as 'unclean' The Roma in the United States Basic statistical data on the Roma does not exist - Participation in the census and recording of births and deaths are avoided - Estimates of U.S. Roma populations range from 200,000 to 500,000 Roma populations tend to be concentrated in coastal urban areas plus Chicago and Houston Beliefs about Causes of Health and Illness Among the Roma Roma practices regarding maintenance of purity and avoidance of pollution are strict and elaborate - Illness seen as resulting in some cases from actions considered contaminating Good fortune and good health believed to be related Some diseases are believed to be caused by spirits or the Devil Beliefs about Causes of Health and Illness Among the Roma Distinctions seen between diseases of gadje origin and diseases specific to the Roma - Roma believe that gadje diseases can be cured by gadje doctors - However, hospital treatment is generally avoided, except for childbirth Women are considered unclean during pregnancy and for a number of weeks after delivery Beliefs about Causes of Health and Illness Among the Roma Serious illness seen as a matter to be dealt with by the clan - If hospitalization occurs, clan members will stay with the patient providing healing rituals and protection Specifically Roma diseases believed to be unconnected to gadje diseases and susceptible only to Roma healing practices - Roma health treatment is the prerogative of older female clan members known as drabarni (i.e., women with knowledge of medicines) Beliefs about Causes of Health and Illness Among the Roma Use of modern technology limited during pregnancy and birth - Amniocentesis and other invasive prenatal diagnostics avoided - Traditional herbal preparations are used to ease labor Behavioral Health Risk Factors and Common Health Problems Among the Roma Low life expectancy among the Roma in U.S. (48-55 years) Several factors put Roma at heightened risk for obesity, cardiovascular disease, hypertension, and diabetes - Belief that large body size reflects good fortune/health and thinness indicates poor fortune/health - Diet high in fat and salt - High smoking rates Behavioral Health Risk Factors and Common Health Problems Among the Roma Avoidance of immunization puts Roma at risk for many communicable diseases High-density living conditions lead to increased incidence of infectious disease, such as hepatitis Roma children are more likely than others to be born prematurely and/or with low birth weight High incidence of consanguineous marriage among Roma leads to increased risk of birth defects Considerations for health promotion and program planning for the Roma Mistrust of non Roma is a fundamental aspect of the Roma worldview Illness is an issue for the entire clan, which will typically be involved with visiting or staying with a hospitalized patient Clan and family elders will take a primary role in all decision making Considerations for health promotion and program planning for the Roma Try to accommodate Roma beliefs about cleanness and uncleanness - Provide separate soap, washcloths, and towels for upper and lower body parts Roma avoid contact with mainstream health system whenever possible, but when using it expect to have the best available doctors and treatments Arabs and Middle Easterners History of Arabs and Middle Easterners Arabs and Middle Easterners in the United States Beliefs about Causes of Health and Illness among Arabs and Middle Easterners Behavioral Risk Factors and Common Health Problems among Arabs and Middle Easterners Considerations for Health Promotion and Program Planning for Arabs and Middle Easterners History of Arab and Middle Eastern Americans Arabs are not a race or a single ethnic group - The 10 Arabic-speaking countries extend from the Atlantic coast of north Africa to the eastern edge of the Arabian peninsula Arab group identity is based on common language and a shared historical and cultural identity, largely religious - 92% of Arabs are Muslim Persians, the major group of non-Arab Middle Easterners, speak Farsi and are also Muslims Arabs and Middle Easterners in the United States Persons of Arab and Middle Eastern descent are a growing demographic group in U.S. - 2-3 million persons of Arab descent are believed to be living in U.S. - However, the 2000 U.S. Census found only 850,000 voluntarily reporting Arab ancestry Arab immigration to U.S. occurred in 3 waves - From late 1890s though end of WWI - Following establishment of Israel in 1948 - Following 1967 Arab-Israeli war and continuing to present Arabs and Middle Easterners in the United States Arabs and Middle Easterners have experienced increased discrimination and suspicion since the 2001 attacks on World Trade Center and Pentagon Arab culture centered on Muslim religion and family relationships (nuclear, extended, and clan) Arabs and Middle Easterners in the United States Sickness, birth, and death involve community participation Families are paternalistic, but women are highly respected, especially mothers Arabs and Middle Easterners in the United States Marriage considered basic to society; divorce strongly discouraged Having numerous children seen as desirable The Qur'an dictates strict dietary laws and requires dawn to dusk fasting during one Muslim month (Ramadan) - Proscribed foods include pork, blood - Alcohol use also forbidden Beliefs about Causes of Health and Illness Among Arabs and Middle Easterners Middle Eastern health practices are closely related and in many ways the sources of modern allopathic medicine - Early Greek medical theories were incorporated into Middle Eastern practices during 7th and 8th centuries Some premodern beliefs remain - Belief that bad thoughts or the 'evil eye' directed toward someone can cause illness for that person - Some Muslims may view illness as atonement for sins Beliefs about Causes of Health and Illness Among Arabs and Middle Easterners Great majority of Arabs and Middle Easterner Americans used Western allopathic medical care - Traditional healers are not frequently seen in U.S. - Midwives may be used during childbirth, but hospital birth is considered more prestigious As a whole, Middle Easterners believe in health maintenance through hygiene and healthy diet Beliefs about Causes of Health and Illness Among Arabs and Middle Easterners Beliefs about modesty may prompt both sexes to refuse treatment by practitioners of the opposite sex - If hospitalization occurs, clan members will stay with the patient, providing healing rituals and protection Iraqis in particular have a significant history of traditional healing practices Beliefs about Causes of Health and Illness Among Arabs and Middle Easterners Diet - Dairy products Yogurt and feta cheese are those most commonly consumed Milk generally consumed only in desserts/puddings - Protein Lamb the most frequently eaten meat; pork forbidden Heavy consumption of legumes Many Middle Easterners will not combine dairy products and shellfish Beliefs about Causes of Health and Illness Among Arabs and Middle Easterners Diet - Wheat or rice in some form used in every meal - Healthy rates of fresh fruit consumption - Vegetables preferred raw - Much use of olives and olive oil Beliefs about Causes of Health and Illness Among Arabs and Middle Easterners Source: 2000 Oldways Preservation & Exchange Trust. www.oldwayspt.org. Reproduced with permission. Beliefs about Causes of Health and Illness Among Arabs and Middle Easterners Health risks of this group generally mirror those of the majority of other Caucasian Americans - Heart disease and cancer are the major morbidity factors - Some recent immigrants may have heightened risk for genetic disorders due to interfamily marriages Considerations for health promotion and program planning for Arabs and Middle Easterners Common preference for same-sex providers, particularly among women Nurses seen as helpers not as health care professionals Members of this group may prefer receiving pills and/or injection, instead of medical counseling alone Considerations for health promotion and program planning for Arabs and Middle Easterners Be aware of Muslim halal dietary restrictions - Pork and alcohol strictly forbidden - Meat must be prepared according to halal requirements Provide for prayer requirements 5 times daily During Ramadan, sick people may be exempted from daytime fasting, but some devout Muslims who are ill may prefer to fast anyway Considerations for health promotion and program planning for Arabs and Middle Easterners Allow for receipt of food by right hand of Muslim patients - Left hand used for cleaning after excretion, and so seen as unclean Respect the modesty and privacy attitudes of members of this group Allow for visits by and input from the patient's Imam Summary People who are characterized as white are not just from Northern European decent. There is great diversity among this group. For example, the beliefs and practices of the Amish, Roma, and Arab and Middle Eastern vary. \f