A study of utilization and satisfaction: implications for cultural concepts and design in aging services

This article describes the utilization and satisfaction patterns of Native Hawaiian elders with the Ke Ola Pono No Na Kupuna ("Good Health and Living for the Elderly") project funded under Title VI-B of the Older Americans Act. Data were collected through a self-administered questionnaire. Its unique, one of a kind, culturally specific program, which includes traditional Native Hawaiian meals, has a number of implications for policy considerations in designing aging programs that can serve ethnic minority aged more effectively. Changes in current federal policy that would enable federally mandated aspects of programs to provide for greater flexibility in providing culturally relevant programs and services for ethnic minorities would help to surmount some of the current problems and barriers to service delivery and utilization by ethnic minority groups. Allowing for greater involvement of ethnic minorities in program design will help to assure culturally relevant and appropriate activities and services and may increase the likelihood of success due to a sense of personal ownership and self-responsibility on the part of those involved.     

Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

Preventing child sexual abuse (CSA) in ethnic minority communities: A literature review and suggestions for practice in Australia

A systematic literature review was conducted to address the immense national gap in knowledge on child sexual abuse (CSA) and ethnic minority communities in Australia, which necessarily borrowed from overseas. One theme explored within the review was that of prevention, and it was found that school-based programs are the most common type of prevention effort. The literature also calls for ‘culturally tailored’ programs to avoid homogenising victims' needs, however in Western multicultural countries like Australia there is a risk that such school-based programs heighten racism for ethnic minority children. Thus, program elements that are culturally sensitive could be incorporated into universal programs instead. Universal programs are also beneficial because they help reach many children regardless of their cultural background, help send the message that all children are equally valued and protected, help create unity and support among diverse victims, and can be further justified by three relatively stable cross-cultural findings: (i) that the prevalence of CSA is high worldwide, (ii) all children require protection irrespective of gender, and (iii) perpetrators are usually known to the victim. To help mobilise their role, service providers could co-deliver school-based programs especially to address institutional CSA within schools. They could also provide training to other health professionals to improve their identification of CSA and confidence to probe; a form of early intervention and therefore ‘secondary prevention’. Overall, this review argues that the importance of family reputation in collectivist cultures needs to be taken into account when designing and evaluating prevention programs so that delays in disclosure and help-seeking due to cultural pressure are not mistaken as evidence for their ineffectiveness. The findings are significant because they help progress the ‘prevention’ field in Australia where literature is essentially absent, particularly in the school and service system arenas.     

How aware of child sexual abuse (CSA) are ethnic minority communities? A literature review and suggestions for raising awareness in Australia

A systematic literature review was conducted to help address the gap in national and international knowledge about child sexual abuse (CSA) and ethnic minority communities. This paper reports the findings of that review in relation to the theme of community awareness. The results suggest that awareness of CSA may be low in ethnic minority communities due to misperceptions that it is ‘a Western problem’. This in turn may be associated with norms in the country of origin which are asserted to transfer after migration, such as CSA being seen as a private family matter that does not invite systematic intervention from the state, low media and research attention, widespread acceptance of myths about CSA, and prohibitive norms on discussing matters to do with sex including abuse. Such trends are seen to be the result of, but also then further protect and preserve, collectivist and patriarchal structures. They also make it challenging for raising community awareness. Nevertheless, genuine community engagement through outreach/educational/preventative programs that empower minorities through co-delivery, are high on cultural competency, tailored to specific groups, and use a feminist framework where appropriate, are seen as necessary; they represent investment in minority communities and child safety of children from minority communities. Overall, realistic goals about the effectiveness of outreach educational programs, combined with value for culturally meaningful constructions of child safety, are seen as key toward the success of awareness-raising programs.     

Racial and Ethnic Differences in Family Caregiving in California

Abstract

Family caregivers are the main source of long-term care for older persons in the United States. At the same time, cultural values and beliefs shape decisions surrounding who provides care and whether families use formal support interventions to assist the caregiver. The current article examines how the family caregiving experience differs among racial and ethnic groups in terms of caregiver characteristics, service utilization, caregiver strain, and coping mechanisms. Telephone interviews were conducted in English and Spanish with a random sample of 1,643 respondents in California who provide care to someone age 50 or over. Bivariate analyses showed evidence of ethnic differences in the demographic characteristics of caregivers, intensity of care provided, caregiver health, level of financial strain, religious service attendance, formal service utilization and barriers to formal services. Odds ratios showed that White and African American caregivers were about two times as likely to use formal caregiver services as were Asian/Native Hawaiian/Pacific Islander and Latina American caregivers. Implied by these findings is the need for further understanding of caregiver service needs among diverse racial and ethnic groups.     

Research and policy with regard to ethnic minorities in the Netherlands: an historical outline and the state of affairs

This article presents an historical analysis of policy in postwar Netherlands concerning ethnic minorities. Between 1946-62, 250,000-300,000 repatriates, largely of Indonesian-Dutch descent, settled in the Netherlands. By 1983, 326,000 people were living in the Netherlands who were nationals of the 9 Mediterranean countries, with the largest groupings comprised by Turks (152,000) and Moroccans (100,500). Between 1960-83, the number of non-Dutch residents increased from 117,600 (1% of the population) to 542,600 (3.8%). It became apparent that government policy in this area was inadequate and that immigration was contributing to social problems. Members of minority groups who have immigrated to the Netherlands are staying in the country permanently and are at risk of sociocultural isolation. Since 1980, policy in this area has sought to create the conditions necessary to enable minority groups to participate in society, decrease their social and economic deprivation, and prevent discrimination through legal remedies. The Dutch minorities policy is not an immigrants policy, but rather a policy aimed at particular deprived groups with a separate culture who are at risk of stigmatization. Research has played an important role in the formulation of minorities policy and has focused on the supply side of the labor market process, housing, education, medical care, and social welfare. Research has aimed to contribute a solid theoretical foundation for the absorption process. Current government policies aimed at promoting the emancipation of minorities include stimulation of minorities' organizations, creation of opportunities to practice minority religions, mass media programs by and for minorities, the provision of education in the native language, and stimulation of minority representation of government bodies.     

"I No Like Get Caught Using Drugs": Explanations for Refusal as a Drug Resistance Strategy for Rural Native Hawaiian Youth

This exploratory study examined the use of explanations for refusal as a drug resistance strategy for rural Native Hawaiian youth. Fourteen gender-specific focus groups were conducted within seven middle or intermediate schools on the Island of Hawai'i (N = 64). Participants were asked to describe drug resistance strategies in response to 15 hypothetical culturally specific drug-related problem scenarios developed from earlier research. The findings indicate that variations in the types of explanations used for refusal were based on the type of drug offerer in the associated scenario (i.e., peer/friend, cousin, or parent). Participants also described the rationales for the use of different explanations with different drug offerers. The findings suggest that culturally grounded drug prevention programs for Hawaiian youth should incorporate the use of specific types of explanations for refusal, depending on the youths' relationship to the drug offerer.     

Outsider ethnic minorities and wage determination in China

While some studies on urban ethnic minorities in China indicate that they earn lower wages relative to the Han majority, others show little evidence of this gap. To understand this contradiction, the authors propose that the primary issue is a failure to fully disaggregate ethnic minority groups’ labour market experiences. Leveraging a large data set looking at China's ethnic minorities, findings suggest that “outsider minorities”, such as Tibetans and Turkic groups, suffer a significant wage penalty when controlling for covariates, while minorities in aggregate do not. These findings are robust across various specifications and have notable theoretical and policy implications.     

Effekte der Gruppengröße auf die Arbeitsmarktintegration von Migranten

Some ethnic minorities tend to be less successful in the German labour market compared to the indigenous population even when controlling for relevant resources. The paper uses data from the German Mikrozensus to investigate to what extent the remaining ethnic disadvantages can be explained by relative minority group size. On theoretical grounds, ethnic concentration can have an impact on the members of the own minority as well as on members of other ethnic groups. The paper finds empirical evidence that a strong ethnic concentration impedes structural assimilation of Turkish migrants with a higher level of education, as the ethnic mobility trap model would suggest. However, the share of the Turkish population in a county does not only have an impact on the labour market performance of Turkish migrants (endogenous effect) but also affects the economic success of Italians and Germans (exogenous effects). The empirical results indicate, that controlling for regional concentration can – at least for some minority groups and to some extent – explain remaining ethnic disadvantages.     

Program Knowledge and Racial Disparities in Savings Outcomes in a Child Development Account Experiment

This study investigated whether participants’ program knowledge was associated with savings outcomes in Child Development Accounts and whether differences in program knowledge explained racial and ethnic disparities in savings outcomes. We used data collected from White, Black, American Indian, and Hispanic treatment participants in the SEED for Oklahoma Kids (SEED OK) experiment (N?=?1126). Analysis results indicated that knowledge of SEED OK program features was low, especially among members of minority groups. Logit and Tobit regressions showed that program knowledge was positively related to the likelihood of holding a SEED OK account and to individual savings amounts. Gaps in program knowledge were associated with racial disparities in savings outcomes. If Whites and minorities had the same levels of program knowledge, gaps in savings outcomes would have significantly narrowed. The findings call for the development of policy designs and communication tools to enhance knowledge of program features among households with Child Development Accounts, especially racial- and ethnic-minority households.     

Program participation in a targeted land distribution program and household outcomes: evidence from Vietnam

We estimate whether a land reform program led to higher incomes for ethnic minority households. In 2002, in the Central Highlands of Vietnam, Program 132 directed the transfer of farm land to ethnic minority households that had less than one hectare of land. Using the 2002 Vietnam Household Living Standards Survey as a baseline, in 2008 we resurveyed over one-thousand households to provide a retrospective evaluation of the impact of their participation in Program 132. Contrary to official reports, our findings show that there was considerable deviation from the planned program parameters: many eligible households did not receive land, while ineligible households often did. We estimate that beneficiaries of the program in the province of Kon Tum experienced increases of household income largely in line with what one would expect from a small plot of poor farm land. Outside Kon Tum, where participation rates were substantially lower, the story is more mixed, and household incomes did not improve with program participation. Overall, our results underscore the limitations of simple transfers of land as a mechanism for improving the living standards of ethnic minorities. Our results also show the significant gap that can exist between program design and decentralized implementation. We discuss the potential implications for program evaluation.     

Ethnic validity: A model for families on uncharted seas

This paper provides an ethnic validity framework as a model for conceptualizing and understanding the lives of ethnic minority families and the individuals in them. It outlines the ecological context of minorities (nonculture- defining groups) in a culture defined and dominated by a culture- defining group majority. Cross- ethnic/racial and cross- cultural studies organized around themes of acculturation and psychosocial competence are cited to substantiate the utility of this model. Their findings also provide a basis for outlining individual, family, and societal intervention approaches which can facilitate each group's ethnic validity and lead to a culturally diverse society which is more equitable for all of its members.     

Ethnic Validity: A Model for Families on Uncharted Seas

This paper provides an ethnic validity framework as a model for conceptualizing and understanding the lives of ethnic minority families and the individuals in them. It outlines the ecological context of minorities (nonculture-defining groups) in a culture defined and dominated by a culture-defining group majority. Cross-ethnic/racial and cross-cultural studies organized around themes of acculturation and psychosocial competence are cited to substantiate the utility of this model. Their findings also provide a basis for outlining individual, family, and societal intervention approaches which can facilitate each group’s ethnic validity and lead to a culturally diverse society which is more equitable for all of its members.     

A survey of substance abuse prevention efforts at Virginia's colleges and universities

The extremes of college student substance use and the negative consequences students face as a result of such use are of great public health concern. Although a multitude of campus-based substance abuse prevention efforts have appeared in literature, a clear picture of the programs and policies currently in use at colleges and universities is not readily available. This research was undertaken to detail both the efforts aimed at general student samples and those targeting at-risk (eg, Greeks, student athletes) and historically underserved (eg, ethnic minorities, students with disabilities) student groups at colleges and universities in the Commonwealth of Virginia. While a variety of efforts were being made, there was a reliance on program orientations with limited scientific support. Four-year institutions used a wider array of outlets for their prevention messages. Targeted programs for at-risk groups were common but were largely unavailable specifically for ethnic minority students and students with disabilities.     

The dilemmas of pro-development actors: viewing state–ethnic minority relations and intra-ethnic dynamics through contentious development projects

Studies of ethnic minority peoples in Asia have long focussed on the relations between ethnic minority communities and the modern state and on the role of development in shaping these relations. This paper is concerned with how ethnic minorities respond to the state-led development. While there are numerous studies focussing on the collective agency of ethnic minorities opposing development projects, few studies consider the agency of pro-development actors. Pro-development actors are usually dismissed as co-opted, manipulated, inauthentic, or elite-driven, yet they can offer crucial insights into understanding state–ethnic minority relations and particularly intra-ethnic minority relations. This paper concentrates on pro-dam actors from the Lepcha minority in the Indian state of Sikkim to make four interlinked arguments. First, examining pro-development actors breaks the homogenous view of state–ethnic minority relations and shifts the focus to intra-ethnic relationships. Second, collective agency of ethnic minorities is not fixed in a particular relationship with the state nor does it have a particular position on development. Third, the long-term experience of development is vital in understanding how ethnic minorities manoeuvre and alter their position on contentious projects. Lastly, analysis of pro-development actors creates major dilemmas for researchers which are not easily overcome.     

Need-service matching in substance abuse treatment: Racial/ethnic differences

This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.     

Evaluation of community-based AIDS education and risk reduction projects in ethnic and racial minority communities: A survey of projects funded by the U.S. public health service

The purpose of this study was to describe proposed program evaluation methods used to determine effectiveness of selected federally funded AIDS education and risk reduction interventions focused on ethnic and racial minority populations. Funding for AIDS prevention programs has grown significantly since 1985, when the first allocation of $11 million was earmarked for general AIDS prevention and education. In 1987, funds specifically targeting minority populations were set aside from AIDS prevention and education programs. Nine agencies/divisions within the Department of Health and Human Services (DHHS) were identified as having funded AIDS prevention and education projects targeted toward ethnic and racial minority populations. The grants and contracts reviewed for this study were limited to those programs receiving Federal funding through DHHS. Few programs provided information within the broader context of sex education and drug education. The modification of needle-sharing behavior among IV drug users and unprotected sex with an IV drug user were the two most frequent risk factors targeted. All 63 programs used at least one formative evaluation method. The most frequently used formative techniques were monitoring achievement of project objectives and counting the number of people participating in program activities. Forty programs counted the amount of AIDS literature distributed. Thirty-three programs conducted a baseline assessment of AIDS knowledge, and 33 programs conducted a baseline assessment of risk behaviors for HIV infection. Results from this study support the National Academy of Sciences recommendation that while summative evaluation will ultimately be valuable, it would be premature to begin developing outcome evaluation strategies at the present time. It is incumbent upon program planners and evaluators to ensure that premature program evaluations are not made in an effort to eliminate direct federal funding of minority community-based strategies to stop the spread of HIV infection.     

Working on Womanhood (WOW): A participatory formative evaluation of a community-developed intervention

The well-documented disparities in availability, accessibility, and quality of behavioral health services suggest the need for innovative programs to address the needs of ethnic minority youth. The current study aimed to conduct a participatory, formative evaluation of “Working on Womanhood” (WOW), a community-developed, multifaceted, school-based intervention serving primarily ethnic minority girls living in underserved urban communities. Specifically, the current study aimed to examine the feasibility, acceptability, and initial promise of WOW using community-based participatory research (CBPR) and represented the third phase of a community-academic partnership. Qualitative and quantitative data were collected from 960 WOW participants in 21 urban public schools, as well as WOW counselors, parents, and school staff over the course of one academic year. Results demonstrated evidence of acceptability of WOW and noteworthy improvements for WOW participants in targeted outcomes, including mental health, emotion regulation, and academic engagement. Findings also indicated several challenges to implementation feasibility and acceptability, including screening and enrollment processes and curriculum length. Additionally, we discuss how, consistent with participatory and formative research, findings were used by program implementers to inform program improvements, including modifications to screening processes, timelines, curriculum, and trainings – all in preparation for a rigorous effectiveness evaluation.     

Minority schooling and intercultural education: a comparison of recent developments in the old and new EU member states

Comparative reports conducted by the author show different educational approaches concerning the schooling of ethnic minorities in the EU Member States as well as differences in the handling of issues of cultural diversity. Minority schooling in the new EU Member States primarily focuses on the education of national or autochthonous minority groups, in contrast to the old EU Member States, where language and compensatory programs for migrant minority students have been of main concern. In addition, there are also different conceptions of intercultural education in the respective countries. Differences in school achievement of various ethnic groups can be identified despite limited differential data on educational attainment in many countries. This paper addresses two main questions: first, in which ways can different educational approaches be effective in raising the educational attainment of ethnic minorities? Second, in which ways could they be most suitable for preparing all students for living in a culturally diverse society and to encourage tolerance towards cultural differences?     

Effective Recruitment for Parenting Programs Within Ethnic Minority Communities

This article describes the results of a demonstration project which focused on exploring recruitment and retention of ethnic minority families to a parent training program aimed to prevent substance abuse among their children. The Parenting for Drug-Free Children project sought to deliver a curriculum to parents from several ethnic groups in an urban setting. The targeted ethnic communities were African American, Latino, Native American, and Samoan. The project successfully recruited diverse groups of families to participate in a drug prevention program, many of whom had never participated before in a parenting program. The identification of key individuals for recruiting and accessing networks of potential participants proved to be an effective means of recruitment.