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Ethnic/racial minority groups are less likely to discuss issues involving end-of-life treatment preferences and utilize palliative care or hospice services. Some barriers may be differences in language, religion, lower levels of health literacy, or less access to healthcare services and information. The purpose of this article is to conduct a systematic review on interventional studies that investigated methods to overcome the barriers faced by ethnic/racial minorities when accessing end-of-life services, including completing advanced directives, accepting palliative care, and enrolling in hospice.
Literature searches using four standard scientific search engines were conducted to retrieve articles detailing original research in an interventional trial design. All studies were conducted in an outpatient setting, including primary care visits, home visits, and dialysis centers. Target populations were those identified from ethnic or racial minorities.
Nine articles were selected to be included in the final review. All were full-text English language articles, with target populations including African Americans, Hispanic or Latinos, and Asian or Pacific Islanders. Measured outcomes involved level of comfort in discussing and knowledge of palliative care services, desire for aggressive care at the end-of-life, completion of advance directives, and rate of enrollment in hospice.
Significance of Results
Three main avenues of interventions included methods to enhance patient education, increase access to healthcare, or improve communication to establish better rapport with target population. Studies indicate that traditional delivery of healthcare services may be insufficient to recruit patients from ethnic/racial minorities, and outcomes can be improved by implementing tailored interventions to overcome barriers.
How politically powerful is business in American politics? Does the political power of business distort the quality of democratic representation? This chapter reviews the literature on these vital questions, discussing selected studies in political science, sociology, history, and other fields. It finds that assessments of business influence in American politics have varied considerably over time, but it also observes there has been a broad turn in recent scholarship toward the notion that business is “more equal” than other groups in the American political system. A small but growing number of studies—especially studies focusing on politics in our time—has begun to provide credible evidence of business influence. We have also seen the introduction of some exciting new ideas about the ways that business influence, economic inequality, and political representation may be theoretically connected. But definitive conclusions remain elusive. We do not really know whether business is disproportionately powerful and how business influence affects the performance of American democracy. The chapter concludes with some suggestions about the kind of studies that are needed going forward.
Does minority political protest lead to governmental responsiveness? Although minority protest has played a large role in conveying minority grievances to government since the civil rights era, little is known of how marginalized voices navigate a majoritarian political system to influence the behavior of political officials. Using protest data that spans across several decades into a post–civil rights era, we show that minority protests have a large effect on the early stages of governmental responsiveness, but the influence of minority protest actions are heavily linked to the party system. Placing protests on an ideological scale, we find that protests that express liberal issues increases vote share for Democratic candidates, while protests that espouse conservative issues offer Republican candidates a greater share of the two-party vote. However, minority protests, which often express liberal concerns, uniquely lead to a greater percentage of the two-party vote share for Democratic candidates. In addition, this study shows that minority protest produces a “vulnerability effect,” which leads quality candidates to enter subsequent races to challenge incumbents.
Recent literature on discursive opportunities shows broad consensus on the importance of media communication in determining the success of minority mobilization. However, the impact of media discourse on formal forms of political participation is less clear. This article examines to what extent, if any, media coverage on immigrant minorities shapes the parliamentary activities of “minority representatives” in the Netherlands and the UK. We investigate whether salience and tone on minorities have impact on how often and in what ways minority members of parliament address ethnic and/or religious constituencies. To study this relationship between media coverage and parliamentary activity, we conduct two separate content analyses of parliamentary questions and newspapers between 2002 and 2012 in the Netherlands and the UK. Multivariate analyses reveal that a more negative tone in newspaper coverage results in more suppressive framing in the Dutch parliament. Our findings for the British case indicate a negative effect of media salience and minority presence on parliamentary salience.
Having frequent family dinners is associated with better diet quality in children; however, it is unknown whether the frequency of certain family meal types (i.e. dinner) is more strongly associated with better child weight and diet quality compared with other meal types (i.e. breakfast, lunch). Thus, the current study examined the frequency of eating breakfast, lunch or dinner family meals and associations with pre-school children’s overall diet quality (HEI-2010) and BMI percentile.
Cross-sectional baseline data (2012–2014) from two randomized controlled childhood obesity prevention trials, NET-Works and GROW, were analysed together.
Studies were carried out in community and in-home settings in urban areas of Minnesota and Tennessee, USA.
Parent–child (ages 2–5 years) pairs from Minnesota (n 222 non-Hispanics; n 312 Hispanics) and Tennessee (n 545 Hispanics; n 55 non-Hispanics) participated in the study.
Over 80 % of families ate breakfast or lunch family meals at least once per week. Over 65 % of families ate dinner family meals ≥5 times/week. Frequency of breakfast family meals and total weekly family meals were significantly associated with healthier diet quality for non-Hispanic pre-school children (P<0·05), but not for Hispanic children. Family meal frequency by meal type was not associated with BMI percentile for non-Hispanic or Hispanic pre-school children.
Breakfast family meal frequency and total weekly family meal frequency were associated with healthier diet quality in non-Hispanic pre-school children but not in Hispanic children. Longitudinal research is needed to clarify the association between family meal type and child diet quality and BMI percentile.
After 1945, German Breslau was transformed into Ur-Polish Wroclaw at Stalin's behest. Most of the remaining prewar population was expelled, and a stable population of a few hundred with German ethnic background is estimated to have lived in the city since then. This paper is based on qualitative analysis of 30 oral history interviews from among the self-defined German minority. It pays close attention to historical context, urban milieu, and salient narratives of identity as shaping forces, which include the suppression of German culture under Communism, prevalent intermarriage between Germans and Poles, and the city's qualified reinvention as “multicultural” after Polish independence in 1989. Together with the group's relatively small numbers, these narratives play out in their hybrid approach to ethnicity, often invoking blended cultural practices or the ambiguous geographical status of the Silesian region, to avoid choosing between “national” antipodes of “German” and “Polish.” The results follow Rogers Brubaker's insight into ethnicity as an essentializing category used to construct groups where individual self-perception may differ; and the concept of “national indifference,” previously applied to rural populations. It also suggests we might better approach circumscribed “minority” identities such as these, by seeing them as a form of “sub-culture.”
Social relationships can impact youths’ eating and physical activity behaviours; however, the best strategies for intervening in the social environment are unknown. The objectives of the present study were to provide in-depth information on the social roles that youths’ parents and friends play related to eating and physical activity behaviours and to explore the impact of other social relationships on youths’ eating and physical activity behaviours.
Convergent parallel mixed-methods design.
Low-income, African American, food desert neighbourhoods in Baltimore City, MD, USA.
Data were collected from 297 youths (53 % female, 91 % African American, mean age 12·3 (sd 1·5) years) using structured questionnaires and combined with in-depth interviews from thirty-eight youths (42 % female, 97 % African American, mean age 11·4 (sd 1·5) years) and ten parents (80 % female, 50 % single heads of house, 100 % African American).
Combined interpretation of the results found that parents and caregivers have multiple, dynamic roles influencing youths’ eating and physical activity behaviours, such as creating health-promoting rules, managing the home food environment and serving as a role model for physical activity. Other social relationships have specific, but limited roles. For example, friends served as partners for physical activity, aunts provided exposure to novel food experiences, and teachers and doctors provided information related to eating and physical activity.
Obesity prevention programmes should consider minority youths’ perceptions of social roles when designing interventions. Specifically, future research is needed to test the effectiveness of intervention strategies that enhance or expand the supportive roles played by social relationships.
Under post-welfarist realignments in neoliberal democracies, the provision of welfare is increasingly conditional on claimants fulfilling certain (behavioural) obligations. Under these shifts, an increased focus on the cultural dimensions of conduct and belonging redefines the basis for citizenship and extends the risk of subversion to include incivility or cultural difference. Critically, this recasting of the state-citizen social contract occurs with potentially exclusionary effects by legitimising ethnic and culturalist explanations that attribute blame to individuals/groups based on their perceived failure to follow normative models of social and spatial integration. The significance of these neoliberal welfare shifts for many of those most at risk of exclusion—black and minority ethnics (BME) and indigenous populations—has received little attention. Responding to this gap from within housing studies, this article reports on qualitative research on the fulfillment of government responsibilities for tenancy support provision under reforms to Indigenous housing welfare in Australia. Based on interviews with Indigenous housing stakeholders, it identifies programmatic, organisational and operational issues hampering tenant support provision that challenge how the ideal of ‘fair reciprocity’ was satisfied at the outset of the reforms. Given contemporary policy discourse on community cohesion and integration, the ways in which current programmatic oversights signal this neoliberal programme and its attempts to reinforce perceptions and constructions of cultural difference to politicise and pathologise the behaviours of particular individuals and communities is significant. Key questions arise about how the needs of minority groups might inform the types of ‘opportunities’ required to achieve the conditions for fair reciprocity within the contractual welfare state.
National surveys show that people from minority ethnic groups tend to be less satisfied with social care services compared with the white population, but do not show why. Research indicates that barriers to accessing services include lack of information, perceptions of cultural inappropriateness and normative expectations of care. Less research has examined the experience of minority ethnic service users after they access services. This study conducted in-depth interviews with 82 South Asian and White British service users and family carers, the majority of whom were older people. Thematic analysis was used. The key theme was understanding the social care system. Participants with a good understanding of the system were more able to adapt and achieve control over their care. Participants with a poor understanding were uncertain about how to access further care, or why a service had been refused. More White British than South Asian participants had a good understanding of the system. There was more in common between the South Asian and White British participants' experiences than might have been expected. Language was an important facilitator of care for South Asian participants, but ethnic matching with staff was less important. Recommendations include better communication throughout the care process to ensure service users and carers have a clear understanding of social care services and hence a better experience.
The incidence of tuberculosis (TB) in native ethnic minorities remains high in developed countries. Arabs, the major ethnic minority in Israel, comprise 21% of its population. This retrospective study compared TB incidence, demographic, clinical, laboratory, genotyping characteristics and treatment outcomes in all Israeli-born citizens diagnosed with TB between 1999 and 2011 by ethnicity, i.e. Israeli-born Arabs (IA) and Jews (IJ). A total of 831 Israeli-born TB patients were reported. Of those, there were 530 (64%) IJ and 301 (36%) IA, with an average annual TB rate of 1·1 and 1·6 cases/100 000 population, respectively, lower than the national average (7·0 cases/100 000 population). TB rates in IA and IJ declined and converged to 1 case/100 000 residents. IA TB patients were more likely to be older, have more pulmonary TB and have lower treatment success rates than IJ. Older age and HIV co-infection, but not ethnicity, were predictive of non-success in TB treatment. Ten mixed IA–IJ clades were detected by spoligotyping and three mixed IA–IJ clusters were identified by MIRU-VNTR typing. Only one IA–IJ couple recalled mutual contact. In conclusion, TB rate in IA was higher than in IJ, but declined and converged in both to 1 case/100 000. Treatment success was high in both groups, and was unrelated to ethnicity.
This study examines religion and spirituality among advanced cancer patients from an underserved, ethnically-diverse population by exploring patient conceptualizations of religion and spirituality, the role of religion and spirituality in coping with cancer, and patient interest in spiritual support.
Qualitative semi-structured interviews were conducted with patients who had participated in a study of a “mind-body” support group for patients with all cancer types. Analysis based on grounded theory was utilized to identify themes and theoretical constructs.
With regard to patient conceptualizations of religion and spirituality, three categories emerged: (1) Spirituality is intertwined with organized religion; (2) Religion is one manifestation of the broader construct of spirituality; (3) Religion and spirituality are completely independent, with spirituality being desirable and religion not. Religion and spirituality played a central role in patients' coping with cancer, providing comfort, hope, and meaning. Patients diverged when it came to spiritual support, with some enthusiastic about interventions incorporating their spiritual values and others stating that they already get this support through religious communities.
Significance of results:
Spirituality plays a central role in the cancer experience of this underserved ethnically-diverse population. While spirituality seems to be a universal concern in advanced cancer patients, the meaning of spirituality differs across individuals, with some equating it with organized religion and others taking a more individualized approach. It is important that psychosocial interventions are developed to address this concern. Future research is needed to further explore the different ways that patients conceptualize spirituality and to develop spiritually-based treatments that are not “one size fits all.”
To test the feasibility of developing evidence-based mental health training to build capacity to respond to natural disasters in black communities and the adaptation of a train-the-trainer (TTT) model for black community leaders and clinical providers in distressed areas at risk of natural disasters.
A core curriculum was developed based on a training needs assessment and resource review. Participants were recruited using network sampling in eastern North Carolina. The core curriculum was tested for usability, revised, and then pilot tested among five mental health providers. Three of the five were trained to lead one-day workshops tailored for black community leaders and clinical providers. Process data were collected, and workshop participants completed posttraining knowledge tests, evaluation forms, and debriefing focus groups.
Ten providers and 13 community leaders pilot tested the training. Posttest knowledge scores were generally higher among clinical providers. Perceived effectiveness of training was higher among community-based organization leaders than clinical providers. Evaluations indicated that the workshop components were culturally relevant and well received by all participants. We identified ways to facilitate recruitment, provide optional e-learning, evaluate effectiveness, and extend trainer support in future field trials.
The curriculum and TTT model provide culturally competent disaster mental health preparedness training for black communities. (Disaster Med Public Health Preparedness. 2013;7:302-312)
Twin studies have seldom addressed ethnicity as one of the possible factors that create unique combinations of genetic and environmental influences. The major objective of the Carolina African American Twin Study of Aging is to identify the proportion of the genetic and environmental sources of individual variation in measures of health and behavioral factors in a sample of adult African Americans. Drawn from birth records from the State of North Carolina, this in-person study used public records to identify a cohort of twins between 22 and 92 years of age (X = 49.82 yrs, SD = 14.62), 39.7% of which were men. Members of non-intact twin pairs and siblings were also recruited to explore alternative models to the classic twin design. To date, the project has contributed to knowledge about blood pressure, forced expiratory volume, chronic illness, body mass index, and waist-hip ratio memory, personality, social, and demographic factors, mortality, and mental health.
Background: To compare the frequencies of risk factors, we describe risks for depression as a function of race among consecutively admitted participants in a randomized clinical trial of indicated depression prevention in later life.
Methods: Seventy-two black and 143 white participants were screened for risk factors for depression.
Results: Black participants were more likely to have fewer years of education and lower household income. They were more likely to be obese, live alone, experience functional disability, have a history of alcohol and drug abuse, and have lower scores on the Mini-mental State Examination and the Executive Interview (EXIT). White participants were not found to have greater prevalence or higher mean score on any risk factor. On average, black participants experienced approximately one more risk factor than white participants (t(213) = 3.32, p = 0.0011).
Conclusions: In our sample, black participants had higher frequencies of eight risk factors for depression and a greater mean number of risk factors compared to white participants.
A mentor is a person who takes a special interest in the professional development of a junior colleague and provides guidance and support. Mentoring can be beneficial for students, residents, junior colleagues and researchers and can be very rewarding for the physician who provides this guidance. Although mentoring is a well-recognized topic in academic medicine, relatively little has been written about mentoring in emergency medicine (EM). Consequently, we conducted a literature review on mentoring in EM and present our findings in this paper. We discuss different models of mentoring, factors that foster the development of strong mentorship programs, the responsibilities of mentors and mentees, and issues specific to mentorship of female, minority and research physicians. We also present several case scenarios as a basis for recommendations for teachers and learners in EM.
The main purpose of the study reported here was to examine the early linguistic predictors of reading (e.g., Knowledge About Print, Listening Comprehension, Receptive Vocabulary, Rapid Naming of Objects and Letters, and Phonological Awareness), for a sample of 77 Spaniards, 48 Latinos, and 30 Gypsies kindergartens (mean age = 5 years 9 months) living in Spain. The relative contribution of ethnic background, neighbourhood socioeconomic status (SES), age, and gender was assessed. Findings revealed that ethnic background, neighborhood SES, and age differentially predicted children's pre-literacy skills. The implications of these results for understanding the role played by these demographic and socio-cultural variables in alphabetic literacy acquisition are discussed. The second purpose of this study was to add to the growing literature on the nature of reading challenges in children who are learning to read a transparent orthography-Spanish. Cross-linguistic research between different subtypes of readers will add to understand the impact of language characteristics in reading acquisition. Finally, the present study suggested that early assessment of pre-literacy skills can be a highly effective way to determine the instructional needs of students who are at risk for reading failure before formal reading instruction begins.
Two hundred-thirteen children in grades 1 through 8 were asked to rapidly generate as many names of animals as they could in 60 seconds. These children were age appropriate for their grade level in school, did not receive any form of special education services, and as a group showed (estimated) average intellectual ability. They were primarily from minority (particularly Hispanic) backgrounds and came from families with low socioeconomic status. Normative data are presented. Hierarchical multiple regression analysis revealed that the age range/grade level score accounted for 21.5% of the variability in fluency scores and the Vocabulary level of the child accounted for an additional 5.7%. Level of performance on this animal fluency task was not lower than what has been reported in primarily white children from middle socioeconomic backgrounds. (JINS, 2008, 14, 143–147.)
Conduct disorder (CD) is a relatively common disorder of childhood and adolescence in the USA with substantial associated morbidity, yet little has been published on CD among Asians and Native Hawaiian/Pacific Islanders (NH/PI) in the USA.
We used the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to examine the prevalence and correlates of retrospectively reported CD within Asians and NH/PI (18 years and older). We also completed logistic regressions to explore factors associated with CD within Asians (n=1093) and, separately, NH/PI (n=139) and to explain racial differences in CD prevalence.
Asians were about a third as likely [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.22–0.58] whereas NH/PI were about two and half times more likely (OR 2.6, 95% CI 1.31–5.06) to have had CD compared with Caucasian respondents. Within Asians and NH/PI, CD was strongly associated with adult antisocial behavior, substance use and affective disorders. Demographic factors, the age that subjects came to the USA, measures of family environment and family history could not explain the observed differences in prevalence of CD for NH/PI relative to Caucasians.
Asian and NH/PI youth with CD represent a subgroup of Asian youth at very high risk for a number of serious psychiatric disorders. Further investigation is needed to explain the high CD prevalence among NH/PI.
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