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DiversityNursing Blog

How Do Race And Ethnicity Influence Childhood Obesity?

Posted by Erica Bettencourt

Wed, Apr 29, 2015 @ 10:54 AM

Written by James McIntosh 

children lying down in a circle smiling resized 600Obesity is a serious public health problem in the US and can affect anyone regardless of age. In particular, childhood obesity prevalence remains high. As well as compromising a child's immediate health, obesity can also negatively influence long-term health dramatically. Unfortunately, some racial and ethnic groups are affected by obesity much more than others.

For example, the US Department of Health and Human Services Office of Minority Health (OMH) report that African-American women have the highest rates of being overweight or obese, compared with other racial or ethnic groups in the US.

Approximately 4 out of 5 African-African women were found to be overweight or obese and, in 2011, African-American women were 80% more likely to be obese than non-Hispanic white women.

Researchers have identified that disparities in obesity prevalence can be found just as readily among children as among adults. It is alarming that these disparities exist to begin with, but more so that they exist so early in life for so many.

In this Spotlight feature, we take a brief look at the prevalence of childhood obesity in the US and the disparities in childhood obesity prevalence that exist among different racial and ethnic groups. We will examine what factors may contribute to this disparity and what action can be taken to remedy the situation.

A growing problem

"Obesity is the terror within," states Dr. Richard Carmona, the former Surgeon General. "Unless we do something about it, the magnitude of the dilemma will dwarf 9-11 or any other terrorist attempt."

These are strong words, but they illustrate the scope of the obesity problem. According to the Centers for Disease Control and Prevention (CDC), in 2009-2010, over a third (35.7%) of adults in the US were obese.

On average, childhood obesity in the US has not changed significantly since 2003-2004, and overall, approximately 17% of all children and adolescents aged 2-19 years are obese - a total of 12.7 million.

There are a number of immediate health problems that childhood obesity can lead to, including:

  • Respiratory problems, such as asthma and sleep apnea
  • High blood pressure and cholesterol
  • Fatty liver disease
  • Increased risk of psychological and social problems, such as discrimination and low self-esteem
  • Joint problems
  • Type 2 diabetes.

In the long term, obese children are much more likely to grow up to be obese as adults than children with healthy weights. Not only that, but the obesity experienced by these children is likely to be more severe, leading to further and more extreme health problems.

Significant disparities exist in obesity prevalence between different racial and ethnic groups. The CDC report the following obesity prevalence percentages among different youth demographics:

  • Hispanic youth - 22.4%
  • Non-Hispanic black youth - 20.2%
  • Non-Hispanic white youth - 14.1%
  • Non-Hispanic Asian youth - 8.6%.

From these figures taken from 2011-2012, we can see that levels of obesity among Hispanic and non-Hispanic black children and adolescents are significantly above average.

When the parameters are extended to include overweight children as well, the disparity persists. Around 38.9% of Hispanic youth and 32.5% of non-Hispanic black youth are either overweight or obese, compared with 28.5% of non-Hispanic white youth.

In 2008, Dr. Sonia Caprio, from the Yale University School of Medicine, CN, and colleagues wrote an article published in Diabetes Care in which they examined the influence of race, ethnicity and culture on childhood obesity, and what their implications were for prevention and treatment.

"Obesity in children is associated with severe impairments in quality of life," state the authors. "Although differences by race may exist in some domains, the strong negative effect is seen across all racial/ethnic groups and dwarfs any potential racial/ethnic differences."

However, if there are specific factors contributing to these disparities that can be addressed, the numbers involved suggest that attention should be paid to them. The long-term health of thousands of children in the US is at stake.

Socioeconomic factors

"Rarely is obesity in children caused by a medical condition," write the National Association for the Advancement of Colored People (NAACP) in their childhood obesity advocacy manual. "It occurs when more calories are eaten than calories burned."

The NAACP outline a number of factors that contribute to increases in childhood obesity, including:

  • The development of neighborhoods that hinder or prevent outdoor physical activity
  • Failure to adequately educate and influence families about good nutrition
  • Ignored need for access to healthy foods within communities
  • Limited physical activity in schools
  • Promotion of a processed food culture.

The CDC report that childhood obesity among preschoolers is more prevalent in those who come from lower-income families. It is likely that this ties in with the disparity with obesity prevalence among different racial and ethnic groups.

"There are major racial differences in wealth at a given level of income," write Caprio, et al. "Whereas whites in the bottom quintile of income had some accumulated resources, African-Americans in the same income quintile had 400 times less or essentially none."

Fast food and processed food is widely available, low cost and nutritionally poor. For these reasons, they are often associated with rising obesity prevalence among children. According to Caprio, et al., lower-cost foods comprise a greater proportion of the diet of lower-income individuals.

If adults need to work long hours in order to make enough money to support their families, they may have a limited amount of time in which to prepare meals, leading them to choose fast food and convenient processed food over more healthy home-cooked meals.

Living in high-poverty areas can also mean that children have limited access to suitable outdoor spaces for exercise. If the street is the only option available to children in which to play, they or their parents may prefer them to stay inside in a safer environment.

Hispanic youth and non-Hispanic black youth are more likely to come from lower-income families than non-Hispanic white youth. According to The State of Obesity, white families earn $2 for every $1 earned by Hispanic or non-Hispanic black families.

Over 38% of African-American children aged below 18 and 23% of Latino families live below the poverty line. This statistic suggests that the effects of living with a low income that increase the risk of obesity may be felt much more by African-American and Latino families and their children.

Not only do these socioeconomic factors increase the risk of obesity among these demographic groups but equally obesity can compromise a family's economic standing.

The NAACP point out that families with obese children spend more money on clothing and medical care. Additionally, as obese and overweight girls frequently start puberty at a younger-than-average age, there is a possibility that their risk of adolescent pregnancy is also higher.

Cultural factors

Alongside these socioeconomic factors, a number of additional factors exist that may be linked to an increased prevalence of childhood obesity among Hispanic and non-Hispanic black youth.

The NAACP give one such example, stating that one component of body image is how a person believes others view them or accept their weight:

"This also poses unique challenges in African-American communities because of cultural norms that accept, uplift and at times reward individuals who are considered 'big-boned,' 'P-H-A-T, fat,' or thick.'"

Cultural norms such as these may lead to parents remaining satisfied with the weight of their children or even wanting them to be heavier, even if they are at an unhealthy weight. Other sociological studies have also suggested that among Hispanic families, women may prefer a thin figure for themselves but a larger one for their children, according to Caprio, et al.

As well as being influenced by socioeconomic status, the type of foods eaten by children can be influenced by the cultural traditions of their families.

"Food is both an expression of cultural identity and a means of preserving family and community unity," write Caprio, et al. "While consumption of traditional food with family may lower the risk of obesity in some children (e.g., Asians), it may increase the risk of obesity in other children (e.g., African-Americans)."

As mentioned earlier, the promotion of a processed food culture may be a contributing factor to childhood obesity. As fast food companies target specific audiences, favoring cultural forms associated with a particular race or ethnicity could increase children's risk of being exposed to aggressive marketing.

Caprio, et al., report that exposure to food-related television advertising - most frequently fast food advertising - was found to be 60% among African-American children.

The amount of television that is watched may contribute as well; one study conducted by the Kaiser Family Foundation observed that African-American children watched television for longer periods than non-Hispanic white children.

A number of these cultural factors are associated with socioeconomic factors. African-American children may be more likely to watch television for longer, for example, if they live in areas where opportunities for playing safely outside are limited.

What can be done?

This subject area is far too detailed to do justice to in an article of this size, but these brief observations suggest that there should be ways in which the disparity in childhood obesity between racial and ethnic groups can be addressed.

Having more safe spaces to walk, exercise and play in low-income areas would give children a better opportunity to get the exercise need to burn the required number of calories each day. Improving the availability of and access to healthy food would give families more options when it came to maintaining a healthy, balanced diet.

The NAACP state that low-income neighborhoods have half as many supermarkets as the wealthiest neighborhoods, suggesting that for many low-income families, accessing healthy food can be a challenge.

These problems are ones that would need to be solved by local government and businesses that have influence over the planning and development of public living spaces. 

Caprio, et al. propose that a "socioecological" framework should be adopted to guide the prevention of childhood obesity. Such a framework would involve viewing children "in the context of their families, communities, and cultures, emphasizing the relationships among environmental, biological and behavioral determinants of health."

This approach would require large-scale collaboration, involving peer support, the establishment of supportive social norms and both the private and public sector working together.

"For health care providers to have a meaningful interaction about energy intake and energy expenditure with children/families, providers should have training in cultural competency in order to understand the specific barriers patients face and the influence of culture and society on health behaviors," the authors suggest.

In order for this disparity to be adequately addressed, a lot of work will need to be done. Not only might certain cultural norms need to be altered, but most importantly, environments will need to be provided in which children will have the opportunity to live as healthy lives as possible.

Topics: US, obesity, diversity, health, healthcare, CDC, public health, children, minority, ethnicity, race, childhood obesity

Diversity In Healthcare Jobs Up - But Should We Get Our Hopes Up?

Posted by Erica Bettencourt

Mon, Apr 27, 2015 @ 11:43 AM

Star Cunningham 

diversity2 resized 600The healthcare industry is in a constant state of flux. But while technologies are rapidly changing, the industry is still cast in monochrome with little racial or gender diversity. There are definitely large societal issues at root – like the massive expense of becoming a doctor and lack of adequate STEM education in many inner-city elementary schools – that will take a generation to solve. But while these massive gaps remain, it is often hard to see incremental progress.

Recently, I found a study that gave me a small glimmer of hope that progress is happening. According to Professional Diversity Network, recruiters and HR professionals accelerated their search for diverse talent in healthcare in January. Specifically, the Professional Diversity Network’s Diversity Jobs Index, which tracks the demand for diverse talent across sectors, jumped 11 percent from December 2014 in healthcare. 

The Professional Diversity Network pointed to a few factors that could have attributed to the change. For example, the study suggests that many more small clinics across the country, particularly in urban settings, have increased their workforces. 

While the Professional Diversity Network pointed to trends that could be the cause, I believe this is evidence that diversity programs like the Institute for Diversity, Ms. Tech and Instituto Health Sciences Career Academy are finally beginning to have an impact not just on awareness, but also on behaviors. 

Diversity programs are crucial because they not only acknowledge that problems exist, but they create communities to offer training and support to help women, minorities, and other under-acknowledged groups succeed. For example, IHSCA prepares inner city high school students for a career in healthcare with tutoring and mentorship programs. 

This is great news not only for the women, minorities, veterans or disabled professionals being employed, but also for the healthcare industry as a whole. Healthcare professionals service every ethnic group and gender, so the more that doctors and nurses can empathize and understand their patients, the better care they will give. In part, that empathy and understanding relies on working in a diverse environment.

So to answer the question I posed in the headline: yes we should get our hopes up. Healthcare executives are in fact beginning to value and invest in diversity, which is a sign of positive change. There is still a long way to go, and who knows if there will ever be an all minority board of a hospital, but we’re heading in the right direction.

Topics: diversity, Workforce, diverse, healthcare, health care, minority

City of Hope Is Leading The Way To Create A Talent Pipeline For Hispanics In Healthcare

Posted by Erica Bettencourt

Wed, Apr 22, 2015 @ 10:05 AM

Glenn Llopis

talentpipeline 370x229 resized 600Like many healthcare providers in the Los Angeles area, and well beyond to healthcare organizations throughout the United States, City of Hope has recognized the growing need for clinical professionals and staff that more closely mirror the patients it serves in its catchment area. And with a local population that is nearly half Hispanic, that means recruiting more Hispanics into the industry, as well as providing much needed career development opportunities. But whereas most in the industry are just beginning to acknowledge the need, City of Hope has taken the lead to recruit more Hispanics into the industry and also has started to build a Hispanic talent pipeline for the immediate and not so distant future.

According to Ann Miller, senior director of talent acquisition and workforce development, "Even when people in the industry recognize the need for more Hispanics, or just a more diverse workforce, it can feel overwhelming trying to figure out what actions to take and how to build a strategy around it. But once you see the data laid out in front of you, and see that 46 percent of your primary service area is Hispanic, you realize it would be optimal to figure out how to recruit a workforce that looks more like the population you are serving. Beyond that, it's also important to employ a bilingual staff that can speak the language and understand the culture to best meet the needs of the community being served."

Once you recognize the need, it's time to start asking the questions that will help you fill the gaps:

  • How do you find and appeal to the types of people you need to start building relationships with? Who are the influencers and the connectors?
  • How do you get your recruitment team looking toward the future and building a pipeline, when limited resources are focused on more immediate needs?
  • How do you get buy-in from senior management and enlist other departments throughout the organization?
  • How do you partner with others in the industry who recognize the need but have yet to become active in the pursuit of common goals? 

Here's how City of Hope has started to answer these questions as it takes the lead in addressing these timely industry issues. Stephanie Neuvirth, Chief Human Resources and Diversity Officer, has said that it's not easy to build a diverse healthcare or biomedical pipeline of talent, even when you understand the supply and demand of your primary service area and the business case becomes clearer. "Few in the industry are taking the helicopter perspective that is needed to really see the linkage between the different variables that must be factored in to solve the problem," she says. 

Even in healthcare, it's not simple, and it takes time to develop the paths, the relationships and the pipeline to cause real and sustainable change. It takes linking a workforce talent strategy to the broader mission and strategic goals of the organization. And it takes collaboration with the community, schools, government, parents and everyone who touches the pipeline to help achieve the necessary and vital missing pieces of the puzzle.

Talent Acquisition and Workforce Development

What you first have to realize is that there is an immediate but also a long-term gap to fill, which represent two sides of the same coin: talent acquisition and workforce development. We know we can best serve our community by mirroring the community that we serve, and that doesn't stop with the talent that we attract today; it's an imperative that depends on the talent pipeline that we build for the future.

City of Hope's approach has been to start fast and strong with some immediate steps that can then be built upon and cascaded out into a longer term strategy for the future. The good news is that if your goal is to look like the community you serve, you don't have to look far for the talent you need. It's right in your own backyard. But there's still a lot of work to be done in terms of educating people about potential careers in healthcare -- clinical and otherwise -- developing the workforce skills and knowledge that they will need, and planting the seeds in the next generation. 

It's particularly disheartening to hear about the young people graduating from high school and college who can't get jobs, when there are growing shortages in the healthcare industry - the nation's third largest industry, and projected to be its second largest in just seven years. According to a recent report by The Economist, U.S. businesses are going to depend heavily on Latinos - the country's fastest-growing and what it calls "irreversible" population -- to fill the gaps not just in healthcare but across all industries. 

If you look just at nursing, the single largest profession in California, you can see how far we have to go. Only 7 percent of the 300,000 nurses in the state are Hispanic. The clinical gaps extend to doctors, just 6 percent Latino; pharmacists, less than 6 percent; and the list goes on and on.

Teresa McCormac, nurse recruiter, is one of the people at City of Hope working to build the Hispanic talent pipeline, beginning with the need for Spanish speaking nurses. She is responsible for elevating City of Hope's presence in the community through word of mouth referrals and by getting active in broader outreach online, in publications and at local, college and national events, such as the National Association of Hispanic Nurses (NAHN) annual conference taking place in Anaheim, CA this July.

"It's important to have a passionate champion for the candidates, as well as our hiring managers and the organization. My role is to get the word out into the community about City of Hope and connect with the talent we need to fill our current and future openings," she says.

This requires a multi-prong approach to recruitment efforts, where you must act to attract candidates not only for current needs, but down the road five-ten years, and even further into the future. 

This begs the question: how do you get more Hispanics and other diverse students interested in the sciences and considering careers in healthcare? 

Traditionally, recruiters focus on those currently working in healthcare to fill immediate gaps, as well as those working in other industries with transferable skills, who might be interested in working in healthcare in a non-clinical capacity, such as IT or marketing. They also look at colleges with nursing and other clinical programs -- particularly those with high concentrations of Hispanics and other diverse students -- where they can conduct outreach efforts, build partnerships and establish a presence. 

But building a talent pipeline requires that you reach students well before the college years, when they are still in high school, and even earlier as middle and grade-schoolers. It takes time to get the message out there and have it stick, so the bigger and bolder you can go, the better. That was City of Hope's thinking behind the launch of its Diversity Health Care Career Expo in September 2014, which made quite an impact with the community and opened eyes to the variety of career opportunities within healthcare. It also opened City of Hope's eyes to the level of interest from the community when 1500 people showed up for this first of its kind event. 

What started as an idea for a diversity career fair to fill immediate positions quickly grew to encompass a workforce development component to include students, parents, as well as working professionals interested in transitioning into healthcare. The Career Expo brought a level of awareness never seen before in the community -- and did so very quickly. For example, it allowed healthcare professionals to connect the dots between math and science classes students were taking and how this learning applied in the real world of healthcare -- and the different careers these types of classes are helping to prepare them for if they stick with them. It also allowed parents to understand how to help their children prepare for jobs that are available and will continue to be available in the future. They also gained insights into how growing up with smartphones and other electronic devices has given their children a distinct advantage that previous generations didn't have -- enabling them to leverage their everyday use of technology into transferable skills that could lead towards a career in Information Technology, which offers a very promising career path within the healthcare and biomedicine industries. 

Catching students early on to spark their interest and expose them to healthcare careers and professionals who can encourage and support them along the way requires that you go out into the community as well. Toward that end, City of Hope has partnered with Duarte Unified School District and Citrus College on a program called TEACH (Train, Educate and Accelerate Careers in Healthcare).

According to Tamara Robertson, senior manager of recruitment, the TEACH partnership provides students with the opportunity to gain college credit while still in high school by taking college-level classes at no cost. This puts them on the fast track to higher education and career readiness by giving them essential skills and capabilities to enter the workforce soon after graduating high school, or to continue their education with up to one year of college coursework already completed. Eighteen students were accepted into the program in its first year.

Each partner plays a valuable role in the program. City of Hope provides students with opportunities to gain first-hand exposure to healthcare IT by giving overviews of the various areas within IT, providing summer internships, and offering mentoring and development interactions. Duarte High School is the conduit for the program by selecting the students for the program and facilitating the learning, and Citrus College develops the curriculum that enables students to earn college credits and IT certifications. It's ideal for students who may not have the means to continue on to college, but can work for an organization like City of Hope that offers opportunities to start their IT career as a Helpdesk or Technology Specialist. In addition, they can take advantage of tuition reimbursement should they choose to further their education and development.

In today's world, social media must be in the recruitment mix, especially if you want to engage with Hispanics who index higher on time spent on social media than the general population and any other group. Statistically, 80 percent of Hispanics utilize social media compared to 75 percent of African Americans and 70 percent of non-Hispanic whites. It's also a great way to reach not just active candidates in search of a new position, but passive ones employed elsewhere whose interest may be peaked when a more interesting opportunity presents itself. 

This is where Aggie Cooke, branding and digital specialist, comes in -- leveraging social media as a core component of City of Hope's outreach efforts to potential candidates. She takes a three-legged approach to the use of social media for recruitment:

1.  Branding - offering relevant content that portrays the culture and appeals to a candidate's values and broader career aspirations;

2.  Targeting - identifying potential candidates who have skills and experiences that the organization needs today and in the future; and

3.  Engaging - creating a relationship by inviting candidates to dialog with City of Hope.

You can reach more people through social media -- even if they're not active job seekers -- by posting information that is relevant to their field and interests. For example, oncology nurses will be interested in what you have to say about the latest developments in the world of oncology. 

Though it can seem overwhelming with so many messages out there competing for people's attention, you can break through with content that is authentic, timely and purposeful. You can also make an impact by tailoring your content to the medium you are using. For example, a story about a scientific breakthrough at City of Hope would play well on LinkedIn, while pictures of happy employees taking a Zumba class together would engage potential candidates on Instagram. Social media also enables you to expand the reach and prolong the life of live events. For example, attendees of the Career Expo last year engaged online with live tweets and Instagram pictures from the event and later provided comments and feedback about their experience that will be instrumental in planning this year's event.

Going forward, successful programs and events, like TEACH and the Diversity Health Care Career Expo, will be expanded upon, as City of Hope continues to lead the way in talent acquisition, workforce development and creating a talent pipeline for Hispanics and the future of healthcare.

Topics: diversity, Workforce, nursing, diverse, hispanic, health, healthcare, patients, culture, minority, career, careers, City Of Hope, recruiting, talent acquisition, clinical professionals, talent

HHS Secretary Kathleen Sebelius Statement on National Minority Health Month

Posted by Alycia Sullivan

Wed, Apr 09, 2014 @ 12:29 PM

In April, we commemorate National Minority Health Month, a time to raise awareness about health disparities that persist among racial and ethnic minorities. This year’s theme - “Prevention is Power: Taking Action for Health Equity” - embodies the ambitious goal put forward by the U.S. Department of Health and Human Services (HHS) to achieve “a nation free of disparities in health and health care.”

Despite some recent progress in addressing health disparities, great challenges remain. Minorities are far more likely than non-Hispanic whites to suffer from chronic conditions, many of which are preventable. This is a particularly troubling statistic, because chronic diseases account for seven of the ten leading causes of death in our nation.

For example, African Americans, American Indians and Alaska Natives are twice as likely to be diagnosed with diabetes and Native Hawaiians and Pacific Islanders are more than three times as likely to receive the same diagnosis. And Latinos are twice as likely to die from liver cancer.

While these persistent disparities are deeply troubling, there are some hopeful trends. The gap in life expectancy between African Americans and non-Hispanic whites has been closing, and is now the smallest it’s been since these statistics have been tracked.
Additionally, seasonal flu vaccination coverage has tripled for children over the past four years and has contributed to a reduction in vaccination disparities among minority children.

Thanks to the Affordable Care Act, health coverage is now more affordable and accessible for millions of Americans, including minority groups. For minority populations, the law addresses inequities in access to quality and affordable coverage.
The impact of the Affordable Care Act on communities across our nation is transformative. Over seven million African Americans, nearly four million Asian Americans and Pacific Islanders, and over eight million Latinos with private insurance now have access to expanded preventive services with no cost sharing. This includes screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for children and adults. Communities across the country are now stronger because the law invests in creating healthier communities, strong public health infrastructure, and preventing disease before it starts.

During Minority Health Month, we applaud the commitment of all of our federal, state, tribal, and local partners in our shared work to implement the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and the National Stakeholder Strategy for Achieving Health Equity. To learn more about National Minority Health Month and what HHS is doing to achieve health equity, please visit

Source: OMH

Topics: ACA, Minority Health Month, HHS, health, minority

TV may reinforce stereotypes about men in nursing

Posted by Alycia Sullivan

Wed, Sep 25, 2013 @ 10:49 AM

By Rob Goodier

(Reuters Health) - Fictional male nurses on television are sidelined in supporting roles, portrayed as the butt of jokes and cast as commentary providers or minority representatives, all of which makes it harder in reality to recruit men to nursing and retain them, according to a new study.

"People don't make decisions about which profession to choose just based on television, but students have told us that popular TV shows can help them choose a career, or that TV perpetuates negative stereotypes about nursing that they then have to address in practice," said Dr. Roslyn Weaver, an adjunct fellow at the University of Western Sydney School of Nursing and Midwifery, who led the research.

"So when men in nursing are almost invisible in popular culture or are stereotyped as incompetent or somehow ‘unmasculine', then men who choose to enter nursing can find it difficult to combat this," Weaver told Reuters Health by email. "Perhaps reflecting this, there are often higher attrition rates for male students than female students in nursing."

In the United States men account for roughly 9 percent of nurses, according to the census bureau. And that figure is similar in the United Kingdom and Australia.

Past research has documented "stereotypical images around nursing, such as the battle-axe, naughty nurse and handmaiden," Weaver and her colleagues write in the Journal of Advanced Nursing.

With a growing number of men entering the profession, the authors point out, it's just asdescribe the image important to examine how male nurses are portrayed in popular culture.

For their study, the researchers viewed one season of each of five American medical television dramas, including Grey's Anatomy, Hawthorne, Mercy, Nurse Jackie and Private Practice. They evaluated aspects of the episodes such as dialogue, costumes, casting, cinematography and editing to compile a perspective on the ways that male nurses are characterized.

To their credit, the shows tended to expose and reject stereotypes. But, in a contradictory
trend, they also reinforced the clichés by characterizing male nurses as men who are not traditionally masculine, the researchers found.

Common stereotypes that the shows reinforced include the nurse who is mistaken for a doctor and the gay or emasculated male nurse. Male nurses and midwives in the shows tend to suffer condescension from their colleagues and patients and are the object of comedy.

The male nurse characters also tend to hit multiple diversity targets in casting. The researchers coined the term "minority loading" to denote characters who represent more than one minority group, such as Angel Garcia on Mercy, a gay Hispanic male nurse, and Mo-Mo on Nurse Jackie, a gay Muslim male nurse.

The results were "pretty consistent" with a prior study of male nurses in film that Dr. David Stanley, an associate professor of nursing at the University of Western Australia, published in 2012.

"Apart from 'Nurse Jackie' the medical programs used in the analysis reflected programs aimed at a medically focused perspective of health where nursing is seen lower in relative status and where male nurses are seen as lower still," said Stanley, who was not involved in the current study.

Some of the stereotypes may persist off screen. Male nurses can be regarded as lazy or more readily promoted, Stanley told Reuters Health, though generally they are accepted by patients and female nurses alike.

Being in the minority may put male nurses at a disadvantage, Weaver said. "This not only means men might be stereotyped but they can also be excluded from particular clinical specialties, face difficulties dealing with older female patients and be expected to do more ‘masculine' work such as heavier manual work."

Improving recruitment efforts could help, and fewer negative stereotypes in television programs might make a difference, the researchers say.

SOURCE: Journal of Advanced Nursing, online September 4, 2003.

Topics: male nurse, minority, TV, stereotype

In Healthcare, Diversity Matters

Posted by Alycia Sullivan

Fri, Aug 23, 2013 @ 11:19 AM

by Crystal Loucel

Because minorities are more likely to receive less and lower-quality health care and suffer higher mortality rates from cancer, heart disease, diabetes, HIV/AIDS and mental health illnesses than their Caucasian counterparts, there have long been calls to increase the number of minority providers to reduce these health disparities. Numerous studies have shown that patients are more likely to receive quality preventive care and treatment when they share race, ethnicity, language and/or religious experience with their providers.

The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health found that a diverse workforce – and the diverse perspective it provides – contributes to enhanced communication, health care access, patient satisfaction, decreased health disparities, improved problem solving for complex problems and innovation. Moreover, the Health Resources and Services Administration (HRSA) has found that minorities could improve access to care in underserved areas more than nonminority providers (see The Rationale for Diversity in the Health Professions: A Review of the Evidence [HRSA, 2006]).

Yet minorities are still under-represented in the health care workforce generally and in nursing in particular. In 1908, when Israel Zangwill popularized the term melting pot to describe the American population, it was 89 percent white, 10 percent black and less than 1 percent Indian, Chinese, Japanese and “others.” Today’s melting pot is considerably more diverse, composed of more than one-third racial and ethnic minorities; moreover, the United States Census Bureau expects that portion to be more than half by 2050.

“Today the nursing workforce does not adequately reflect the diversity in the population including gender,” says Beverly Malone, CEO of the National League for Nursing. Latinos, African Americans, American Indians and Native Alaskans compose only 7.6 percent of the nursing workforce, a dismal figure compared to the 25 percent in the general population. UCSF’s nursing student population is doing a bit better – in 2009, the latest year for which data are available, these same groups composed 16 percent of the UCSF nursing student body – but there is certainly room for improvement. When Asian Americans are included, a 2008 HRSA report showed that minorities make up 35 percent of the total population but only 17 percent of the nursing population.

UCSF has been trying to respond to the 2004 Sullivan Commission Report, titled Missing Persons: Minorities in the Health Professions, which recommended that health profession schools hire diversity program managers and develop plans to ensure institutional diversity, including providing educational support, commitment, role modeling and dedicated recruitment. Currently, Judy Martin-Holland serves as associate dean for Academic Programs and Diversity Initiatives at UCSF School of Nursing, a role in which she recruits minority students, seeks to integrate more diversity in the curriculum, and offers support programs for minority students. In addition, after years of medical student advocacy, Renee Navarro, vice chancellor Diversity and Outreach, created the School’s first Multicultural Resource Center. Though the center currently has no budget, its director, Mijiza Sanchez, hopes to advocate for the types of programs that the commission has recommended, such as the mentoring that Sanchez herself offers students.

It’s also important to remember that minorities often face barriers to financing their education and would benefit from scholarships, loan forgiveness and tuition reimbursement programs.

In addition, universities should link to minority professional organizations to promote enhanced admissions policies, cultural competency training and enhanced minority student recruitment. For example, as volunteer past president of the San Francisco Bay Area chapter of the National Association of Hispanic Nurses (NAHN), I am proactively connecting to the UCSF student group Voces Latinas Nursing Student Association (VLNSA) to do just that. VLNSA is open to students of all ethnicities who are interested in working with the Latino community; the ability to speak Spanish is not required. And organizations like NAHN typically offer reduced student membership and benefits such as mentoring, résumé revision, job postings, volunteer opportunities, networking and more for students, without requiring them to be from any particular racial or ethnic background.

That last point is important, because no matter how diverse your workforce, the goal is to create an environment that is inclusive and allows everyone to express themselves. As minorities, we cannot address our specific health issues alone; rather, this is a challenge for all health care providers. Given what we know about diversity and its importance to health care, we must partner to creatively address and embrace an ever more diverse future.



Crystal Loucel is a second-year master’s student at UCSF School of Nursing and past president of the San Francisco Bay Area chapter of the National Association of Hispanic Nurses. She has a master’s in public health, specializing in global health, from Loma Linda University; has served as an AmeriCorps and Peace Corps volunteer in Honduras; was one of eight RNs chosen in 2012 for a General Electric-National Medical Fellowship in primary care; and is a 2012 scholarship recipient from the Deloras Jones Kaiser Foundation. An earlier version of this piece appeared in the UCSF student newspaper, Synapse.

Topics: diversity, nursing, healthcare, minority

Storytelling and Healing

Posted by Alycia Sullivan

Fri, Aug 09, 2013 @ 10:53 AM

Storytelling and Healing


The Navajo Sugar Monster

Long ago the Holy People predicted that a monster would take over the Navajos.

Our mothers and fathers would change…No longer were man and woman together.

One after another this monster ate away their faces.

It gnawed away Navajo identity….Everything turned from light to dark….Words ceased to exist.

The Holy People begin to cry.

The Navajo language meets its end…Mouths would soon close entirely.

X marked the spot….Over the eyes and mouths of the people.

The Navajo were not human anymore.

They were beings who craved only one thing

It was not water or food…Nor prayer or traditions…Nor love or family.

The Holy People were right.

Sugar is our monster.

A killer claiming Navajo lives…With a craving that could never be satisfied

Who are these monsters?

Mom? Dad?  Where are the elders? Where is my family?  Who will save us?

It’s going to claim the next generation if things don’t change…

We must stand and make a change…Stand up and fight against this monster

For you…For your family,

Your mother, Your father, Your children

For your Nation.”

by Chantelle Yazzie (A neo-traditional story published on Wellbound Storytellers.)


Native Peoples have higher rates of death by alcoholism (552%), diabetes (182%) and unintentional injuries (138%) than other Americans.  The story above is a neo-traditional story addressing the impact diabetes is having on the Navajo nation.  Neo-traditional stories are creations of today’s Native Americans; attempts at merging the old ways and addressing today’s problems.

Native American’s believe in the power of the story to heal.  Traditional healing stories are unique to particular nations and certain individuals, specifically elders and healers are the only ones who can tell these stories.

According to Teresa Lamsam, of Wellbound Storytellers, specific individuals have a responsibility for traditional healing stories. “Most of the stories that would be relevant [to healing] are considered to have healing within the telling of them — which is what creates the responsibility for the person who carries the story [the healer].  The person who receives the story [patient] also has responsibility.  Usually, a ceremony must accompany the story.”

Do you have a story to share about your experience with diabetes?  Can you create a healing story?

Source: Medivizor

Topics: minority, healing, storytelling, Navajo, Native American

Reflections on diversity

Posted by Alycia Sullivan

Mon, Jul 15, 2013 @ 02:40 PM

describe the imagedescribe the imageBy Heather Stringer

By 2043, the U.S. is projected to become a majority-minority nation for the first time in its history, according to the U.S. Census Bureau. Both the Hispanic and Asian populations will more than double between 2012 and 2060, and the black population will increase by 50% during the same time period. These statistics illustrate that nurses will be caring for a progressively diverse patient population and the increasing urgency to build a diverse RN workforce. 

“Patients come with an expectation that the caregiver will understand all of their care needs,” Deidre Walton, RN/PHN, MSN, JD, president and CEO of the National Black Nurses Association based in Silver Spring, Md., said. “When you have a diverse workforce, you have people with knowledge and skills to meet the diverse needs of patients. The patient’s cultural identification, spiritual affiliation, language and gender can all affect the care they need, and it is very important that the nurse understands that.” 

Although Walton said the healthcare community is far from reflecting the demographics of the American population, she has hope as she looks into the future because diversity in the nursing workforce is being highlighted as a critical priority by more than minority nursing organizations. 

“I am excited because organizations such as the Robert Wood Johnson Foundation and AARP have a diversity agenda, and that makes me hopeful that there will be change,” she said.

Increasing diversity in the workforce, as illustrated on the following pages, will take individual and group efforts. 

Job titles of minority nurses

According to the 2008 National Sample Survey of Registered Nurses, the largest sample to date, minority nurses were more likely to hold staff nurse positions than white, non-Hispanic nurses.

Black nurses comprise 5.4% of the RN workforce, and 13.8% are in management positions, which is higher than any other ethnic group. Walton, however, said far more black nurses still are needed in leadership positions because this 13.8% is taken from a small pool of nurses. 

“Some organizations have very active programs to promote diversity in leadership, but the diversity gap in leadership continues,” Walton said. “There is a gap between how many minorities are recruited and how many are actually hired. These minorities in leadership roles are able to participate in making changes to improve the practice environment and outcomes, and this is very important.” 

Percentage of RNs in staff nurse positions by race/ethnicity:
White, non-Hispanic: 64.8%
Black: 67.1%
Hispanic: 72%
Asian: 83%

RNs in management, by race/ethnicity:
12.9% of White, non-Hispanic RNs
13.8% of Black RNs 
10.9% of Hispanic RNs
7.2% of Asian RNs 

Distribution of RNs by race/ethnicity vs. national population demographics:
White, non-Hispanic: 83.2% vs. 65.6%
Hispanic, Latino: 
3.6% vs. 15.4%
Black: 5.4% vs. 12.2%
Asian or Native Hawaiian/Pacific Islander: 
5.8 % vs. 4.5%
American Indian/Alaska Native: 
0.3% vs. 0.8%

(Source: 2008 National Sample Survey of Registered Nurses)

Can patient ethnicity affect care?

According to a 2012 report from the Agency for Healthcare Research and Quality, racial and ethnic minorities face more barriers to care and receive poorer quality of care when they can get it. Findings from the report included:

Blacks received worse care than whites, and Hispanics received worse care than non-Hispanic whites for about 40% of quality measures.

American Indians and Alaska Natives received worse care than whites for one-third of quality measures.

Blacks had worse access to care than whites for one-third of measures, and American Indians and Alaska Natives had worse access to care than whites for about 40% of access measures.

Hispanics had worse access to care than non-Hispanic whites for about 70% of measures. 

Would a more diverse RN workforce correct some of these disparities? "Absolutely,” Walton said. “Diversity will improve patient-nurse communication, collaboration and clinical practice for patients of all backgrounds. If an African-American woman comes to the ED with abdominal pain, what is the likelihood that she will be diagnosed with a sexually transmitted disease as the cause of the pain rather than [staff] conducting other tests for a definitive diagnosis? When you have a culturally diverse RN workforce, they may not as easily dismiss symptoms and will advocate for a more intense work-up.” 

According to the 2008 National Sample Survey of Registered Nurses, only 0.3% of the RN workforce is American Indian or Alaska Native. This small percentage who are accepted into nursing school, earn their degree and enter the workforce often have overcome significant challenges, Bev Warne, RN, MSN, one of the founders of the Native American Nurses Association based in Phoenix, Ariz., said. “A survey in 2010 showed that 51% of Native American high school students graduate, so the drop-out rate is very high,” Warne said. “There are complex reasons for this. Studies show that many grow up in families that are poverty-stricken, so they suffer from poor nutrition and difficult family situations, and by the time they are in junior high they are already behind.” 

Warne believes the preparation to attain a formal education begins with good prenatal care, proper nutrition and support for parents. Even after Native Americans are accepted into nursing school, there are other challenges they may face.

“There are differences in values among Native people and Western people,” Warne said. “Generally Native Americans are raised in more of an extended family where there is an emphasis on inclusiveness. When they go into the college setting outside the reservation, they may confront Western values that promote individualism and competition, which is often the opposite of how they were raised. To be successful in this new setting, it is important for educators to get involved with students to discuss this new reality.”

It also can be difficult to transition to the Western medicine paradigm, Warne said. “In the Western hospital setting, caregivers tend to look more toward the physical aspects of illness, but from the Native perspective, they are accustomed to a holistic way of viewing a person.” 

Power to promote

Although it may seem difficult to make time to promote nursing to minorities within the community, here are a few simple strategies that are making a difference. 

Celia Besore, executive director and CEO, National Association of Hispanic Nurses: 
“I believe stories are really what lead people to consider nursing. The personal stories of nurses who were maybe the first to go to college in their families and now are very successful are the ones that inspire people. Our chapter members go into the community and do career fairs and visit schools, and that is when nurses can share their stories. There have been times when people have discouraged Hispanic students from going to nursing school because they think the students will not succeed, and our nurses can give them hope. We also tell young people that 30% of our members are student nurses, so they know they will not be alone.

“During these events, we also explain that now is a good time to be a minority in healthcare,” she continued. “We get calls from places that are desperately looking for Latino nurses. The word is starting to get out that it is an asset to understand the culture and language of minority patients, and hospitals want people with this experience.”

Mildred Crear, RN, MA, MPH, chairwoman for nursing and community education, Bay Area Black Nurses Association:
“Our chapter sponsors community health events like blood pressure drives, and this gives people in the community a chance to see us and ask what it takes to be a nurse. We share this information and then invite them to our meetings. We also do a lot of health fairs with churches and black sororities and fraternities where we do presentations about nursing, and this has been a really effective way of promoting the profession.”

Sharon Smith, RN, MSN, FNP-BC, president of the San Diego Black Nurses Association:
“I think it is critical to connect with people when they are young and try to mentor them. You can meet youth through church, in the community or through the events sponsored by your minority association. Our chapter visits high schools to recruit students, and we will go into the tough neighborhoods where it is harder for students to believe that they can do it. I share my own story that I grew up in North Carolina in one of the poorest counties, and I was told I would never finish high school. I told myself, ‘This is your thought, and not mine,’ and I went on to earn a BSN, a master’s degree and now I am pursuing a doctorate. You can do simple things like take them to work or communicate online, and this will show students the positives of a career in nursing.” 

It starts in the schools

Diversity in the nursing workforce is dependent upon a pipeline of diverse students who graduate from nursing school. This much-needed diversity among students, however, requires focus and resources, Julie Zerwic, RN, PhD, FAHA, FAAN, professor and executive associate dean at the University of Illinois at Chicago, College of Nursing, said. “Our school went through a period of time when there was no staff focused on watching diversity, so the number of underrepresented minorities in the program dropped,” she said. “If no one is paying close attention, you can lose momentum.” 

For example, the school recognized that a number of underrepresented minorities were not finishing their applications and would benefit from having a staff member available to receive phone calls and answer questions. The school also started offering application workshops. 

Although Zerwic hopes to see even more diversity among undergraduate nursing students, her institution has had significant success in recruiting graduate minority students. Zerwic credits a National Institutes of Health-funded program, the Bridges to the Doctorate Program, that helps the school to support potential minority doctoral students through mentoring, funding and coursework. 

University of Illinois at Chicago, College of Nursing, 2012-13
Undergraduate - black students: 10.2%
Undergraduate - Latino students: 9.6%
PhD - black or Latino students: 25%

Like the University of Illinois, diversity became a high priority in the School of Nursing at The University of Texas Health Science Center. “We knew that about 62% of the population in San Antonio was Hispanic, and to provide competent healthcare we needed to increase the number of Hispanic nursing students,” Hilda Mejia Abreu, PhD, MS, BA, associate dean for admissions and student services at UTHSC San Antonio, said. 

During the spring and fall, staff members travel throughout the U.S. to college fairs, schools, nursing association recruitment fairs and other activities to recruit minority students. The local Spanish-language channel also regularly features a 15-minute segment in which Mejia Abreu explains the college preparatory classes needed to apply for nursing school and how to finance an education. 

School of Nursing at the UT Health Science Center 
San Antonio, Spring 2013
Black: 5.2% • Hispanic: 32.3%
Asian: 10.7% • White: 45%

By comparison, below are the national diversity statistics for nursing schools:

Race/Ethnicity of Students Enrolled in Entry-Level 
Baccalaureate Nursing Programs in the U.S. in 2011
White, non-Hispanic: 72%
Black: 10.3%
Hispanic: 7%
Asian, Native Hawaiian or other Pacific Islander: 8.8%
American Indian or Alaskan Native: 0.5%

(Source: American Association of Colleges of Nursing) 

Overcoming the language barrier

For nurses who have arrived in the U.S. as adults and learned English as a second language, there typically are two distinct challenges they will face when communicating: being understood by Americans and understanding Americans, said Victoria Navarro, RN, MSN, MAS, president of the Philippine Nurses Association of America. 

“In the Philippines, we were colonized by Spain for about 400 years, so the Filipino language (Tagalog) that evolved has root words based in Spanish,” Navarro said. “We pronounce every syllable. In English, you have words with silent syllables or letters, so that in itself is something that we need to learn.” 

In addition to pronunciation, healthcare workers use jargon to communicate, and this is even more complicated when English is a second language. Navarro remembers when a physician told a Filipino nurse to get the “lytes.” The nurse turned off the lights, when in fact he had meant electrolytes. Other communication challenges Filipino nurses confront in the U.S. include:

In Tagalog, there are no long vowels, so it takes time and practice to learn to pronounce these sounds. 

There are no pronouns such as ‘he’ and ‘she’ in Tagalog, and there are no singular or plural verbs. It takes time to know when to say the proper pronoun or verb. Many people make mistakes initially.

Mental processing in the native language happens before responding in English. The literal translation from Tagalog to English could change the intent of the sentence.
In the Philippines, people have high respect for elders and do not speak unless they are asked something directly. For this reason, Filipino nurses may be considered passive by peers or patients. 

Navarro and Joseph Mojares, RN, BSN, president of the Philippine Nurses Association of Northern California, say proficiency can come with practice and time and made the following suggestions:

Do not be embarrassed to ask questions to clarify what others mean so you can learn the correct pronunciation and terminology.

Constantly immerse yourself in English-speaking environments and expose yourself to mainstream media at work and at home. 

Challenge yourself by taking classes in communication, leadership and public speaking so you can improve your English. 

Find mentors and preceptors who can encourage you and give you suggestions about how to present yourself and communicate. 

Tips for scholarship success

Jasmine Melendez, the scholarships and grants administrator at the Foundation of the National Student Nurses Association, has an insider’s view into the world of financial assistance. She has seen hundreds of scholarship applications, and said reviewers are looking for three things from applicants: financial need, high academic achievement and involvement in community health activities. 

“It is important to maintain a high GPA, but students who make time for some form of community service really set themselves apart,” Melendez said. 
Another way to stand out from the competition is to turn in well-crafted, accurate essays. “What I’ve been noticing is that students need to learn to write well,” she said. “When you convey a message, you want to make sure you convey it in a clear, concise manner with no spelling errors or grammar mistakes.” 

Here are other tips she suggests:

Get comfortable with the Internet because most scholarships are found on the Web. Websites that can help minority students find scholarships include: 

Check with minority-owned businesses to see whether they offer scholarships, and ask the financial aid office at your school about scholarships and applications.

The hospital association in your state may have access to scholarship information.

Don’t make the mistake of thinking scholarship deadlines are only in the first part of the year. There are scholarships available every quarter of the year.

Don’t disqualify yourself by not applying. Apply for everything and let the committee say no. 


Topics: healthcare, RN, patient, minority, ethnicity

Is Diversity in Nursing Education a Solution to the Shortage?

Posted by Alycia Sullivan

Fri, Jun 14, 2013 @ 11:14 AM

By Jane Gutierrez

nurseWhen you think of a nurse, what’s the first image that comes to mind? Chances are, you think of a woman — and for good reason. The vast majority of professional nurses in the U.S. are white women. In fact, only about six percent of nurses are male and, Considering males make up approximately half of the population and minorities are 30 percent, there’s a major disparity in the profession.

That disparity is reflected in equal measure in nursing schools, both in the student population and faculty. Experts argue improving the diversity in nursing education will improve health care by creating a more culturally sensitive healthcare workforce with improved communication abilities, reduced biases and stereotypes and fewer inequities, as well as increasing the diversity of the nurse education faculty.

At a time when the healthcare system is faced with a nursing shortage caused at least partially by a shortage of nurse educators, some argue males and minorities represent an untapped resource for recruiting new educators. They believe that by creating new opportunities to attract traditionally underrepresented populations to the field, we can both solve the shortage and make a measurable improvement to our healthcare delivery system.

Why Diversity Is an Issue

While minorities have made great strides in other traditionally white-dominated fields and women have done the same in traditionally male fields, nursing is one area where diversity initiatives seem to have been ineffective.

In the case of men, much of the resistance to nursing as a profession comes from a cultural perception of nursing being a “female” profession. Men report while they enjoy the care giving aspects of the job, it’s difficult when others ask questions or make comments deriding their career choice. For example, male nurses report being asked why they didn’t choose to become doctors, with the implication that they did not earn adequate grades or were too lazy to become doctors. In addition, men report feeling left out of the profession, with most training and professional development materials referring to nurses as “she” and a female-centric approach to teaching and training.

In the case of minorities, including African-Americans and Latinos, studies attribute the disparity in the nursing profession largely to lower overall academic achievement in those groups. Given that admission to nursing school generally requires at least a moderate level of academic achievement — and earning a

degree in nursing education requires at least a bachelor’s degree and some experience — it’s no surprise that groups that aren’t as academically advanced are lacking in the nursing profession.

Fixing the Problem

Because improving diversity in the nursing profession is a key to solving the nurse shortage — and by extension, the nurse educator shortage — the healthcare field is looking for new ways to recruit, mentor and retain minority nurses, male nurses and educators.

One step is to recruit potential professionals earlier — in some cases, as early as high school. Throughout the country, in the field in exchange for high school credit, with the goal of encouraging them to maintain their academic performance and attend nursing school.

However, academic performance is only part of the equation. The cost of education is another barrier to many potential students, regardless of sex or ethnicity. The cost for a four-year BSN program can be over $100,000 in some cases, while a two-year program generally runs between $5,000 and $20,000. Factoring in the master’s and doctoral degrees required to become nurse educators, and the cost only goes up.

In response, many schools, as well as states and the federal government, have instituted financial assistance programs designed specifically for minorities and males. The Federal Nursing Workforce Diversity program allows minority students to borrow money for school, and have some or all of their loans repaid if they agree to work in specific, undeserved areas. For those who want to become nurse educators, the government’s Nurse Faculty Loan Program offers partial or full repayment of student loans for agreeing to teach for at least two years after graduation.

With the nursing shortage only expected to grow, thanks to increased access to healthcare, reaching out to minorities and males only makes sense. Not only will it solve a serious problem, it will ensure quality, effective health care for future generations.

About the Author: Jane Gutierrez is a nurse educator and a member of her employer’s diversity initiative committee. She visits with local high schools to encourage students to consider careers in health care

Source: WideInfo

Topics: diversity, education, nursing, healthcare, minority, ethnicity

Closing The Gap

Posted by Alycia Sullivan

Thu, May 23, 2013 @ 09:57 AM

Closing the Gap lead photo

New learning institute builds on past success to diversify the dental profession

By Janet Edwards

At the age of 13, Esther Lopez, DDS, knew intimately her mother’s battle with cancer because she served as the primary translator between the patient, a native of Ecuador, and her doctors. Even at such a young age, Lopez vowed the excruciating experience would influence her life’s work. She didn’t know the term “public health” then, but that’s where she would later find fulfillment, through dentistry. In part, Lopez credits the now defunct, but still influential, Dental Pipeline program for helping her achieve that dream. A new project, the Dental Pipeline National Learning Institute, builds on the program that brought Lopez into dentistry.

Esther Lopez is a dentist in Oak Park, Ill. Through both private practice and volunteer public health efforts, she works with low-income and minority populations, groups that typically find Esther Lopez, DDSdental services inaccessible, complex, and unwelcoming. In large part, Lopez credits a now-defunct minority recruitment program, the Dental Pipeline, for the opportunity to do such work, a longtime ambition that often seemed out of reach.

Lopez is one of a small number of minority dentists in the country—only 9 percent of practicing dentists are African American, Hispanic, or American Indian. While these underrepresented groups comprise nearly 30 percent of the general population, they account for just 13 percent of first-year dental students. Dental schools and their community partners seek to close that gap through a new program that adopts lessons learned from the Dental Pipeline.

Dental Pipeline National Learning Institute
The original Dental Pipeline launched with funding from The Robert Wood Johnson Foundation (RWJF) and The California Endowment. In all, 23 (out of 62) U.S. dental schools were involved in the decade-long program, which ended in 2011. Widely credited with transforming dental education, the Dental Pipeline resulted in better access to care for underserved populations, along with more student exposure to community-based services and higher enrollment among minority students.

A new program launched in fall 2012, the Dental Pipeline National Learning Institute (NLI), is intended to build on that success. Project partners are the American Dental Education Association and the University of the Pacific Arthur A. Dugoni School of Dentistry, in San Francisco, Calif. Support comes from an initial 18-month, $650,000 grant funded by RWJF.

Eleven schools were tapped as NLI participants. Each institution receives $12,000 to cover the cost of building a recruitment project or community-based education component. The program includes a three-day training course covering best practices, advocacy and leadership, and various mentoring opportunities.  

Paul Glassman, DDS, professor and director of Community Oral Health at University of the Pacific, is project director. The primary goal is to expose other dental schools to Paul Glassman, DDS Project Director, National Leadership Institutemethodologies developed as part of the Dental Pipeline “so they wouldn’t be reinventing the wheel,” he says.   

Evidence of the Dental Pipeline’s success is found in the numbers, Glassman says. “Schools involved in the Pipeline managed to dramatically increase—double, triple, even quadruple—the number of underrepresented minority students entering their schools. [Enrollments of] other dental schools not involved in the program stayed static,” he says. 

The NLI is a one-year program. Participants are dental school faculty members who collaborate with a partner from a local organization, such as a minority-focused college or community health center. “We want some significant community partner involved because we’re really trying to emphasize the fact that in this very complex world that we live in, dental schools really can’t break through these barriers by themselves. The way to make progress in our current world is through partnerships and establishing networks,” Glassman says.  

Like its predecessor, the NLI is also designed to develop future leaders in the push to provide more diverse dental care in community-based health settings, Glassman says. Barriers to health care for low-income and minority individuals, which result in less dental care and more dental disease, are well documented, he adds.  

“Minority populations tend to have more dental disease than more affluent populations and majority populations. They tend to have more barriers to access to care, so they get care less regularly,” he says. Paying for dental care is a serious obstacle, along with language and cultural challenges. “They feel uncomfortable going into a dental office because they feel someone isn’t going to understand them,” he says.  

“We’re expecting people who go through this program to become future leaders in this area, so within their own school and their community, and maybe even regionally, they’re going to be someone steeped in this whole idea of the dental profession doing a better job of improving the health of underserved populations and keep the momentum going,” he says.

The Minority Enrollment Challenge  Kim D’Abreu,  Senior Vice President, ADEA

While the Dental Pipeline made positive inroads toward recruiting minority dental students, the NLI is designed to keep the momentum going, says Kim D’Abreu, senior vice president for access, diversity, and inclusion for the ADEA.   

The effort continues to face several high priority challenges. A large pool of minority students who could succeed in dental school remains untapped, D’Abreu says, including 12,500 students of color who graduate with majors in the biological sciences each year. “A 2003 focus group study published in the Journal of Dental Education found that early and frequent exposure to dentistry and dentists in practice is essential for minority students to consider the profession. Dental schools need additional tools and strategies to attract a talented group of underrepresented minority students,” she says. 

The process by which dental schools evaluate student candidates is undergoing review, Glassman says.        

“Traditionally, admission is based on grade point average, extracurricular activities, and other sorts of measures that aren’t necessarily the measures that students from minorities have excelled in … because they were working while they were in school and facing other social challenges in their lives,” he says. While it makes it harder for them to get through the admission process, it doesn’t necessarily mean they are less qualified or passionate about a career in dentistry, he says. Schools are now adopting a whole file review approach, one less focused on the numbers, Glassman says.  

The whole file review, which takes into consideration a host of cognitive and non-cognitive variables, has already proven to be effective and is just one of other successful admissions strategies shared with NLI institutional participants, D’Abreu says.

Engaging Students in Community Health
Along with recruitment of minority students, another goal of the Dental Pipeline was to get students to spend more of their clinical time in community health settings, a mission that continues under the NLI program.  

“(In the Dental Pipeline) we increased the number of days from three to four to up to 50 days for senior dental students as part of the education program,” Glassman says. “The hope is that in doing so, these students become more comfortable with community sites, they understand more about that kind of delivery mechanism, become more comfortable with diverse populations, and are better able to serve those populations in the future.”  

Esther Lopez knows too well the importance of that exposure. Her father, a Cuban-born immigrant, abandoned the family of three children, including a brother and sister, following the death of her mother. But in the midst of her undergraduate work in biology at DePaul University—coursework Lopez had hoped would lead to medical school—her father returned, homeless and afflicted with health issues that eventually led to two strokes. He had no job and no insurance. Between studies, Lopez pleaded with pharmaceutical companies for free medicine, and again served as a translator with various health agencies and doctors. 

“We were able to get some assistance,” Lopez says. “Things were going as well as they could have, considering the fact that we didn’t have health insurance. I really wanted to stay in school so I tried as best I could to find resources to help us along the way.”  

By the time her father died in 2000, Lopez, exhausted, had given up on medical school, but she was more determined than ever to help resolve the challenges facing low-income and minority individuals seeking medical care. She completed her bachelor’s degree, and then enrolled in the master’s program in public health at the University of Illinois at Chicago (UIC). With her coursework finished, Lopez continues to work on her thesis.  

While attending UIC, she joined a research project involving people with periodontal disease and diabetes.   

“We were trying to determine what needs existed for people that had diabetes, and if they even knew there was a corollary between that and periodontal disease, specifically in the Latino community. I got engaged, really excited, and decided dentistry intrigued me,” Lopez says. 

With the help of the Dental Pipeline, she enrolled in UIC’s College of Dentistry. “Dental school is really, 
really expensive. The fact that we have programs like the Dental Pipeline for people like me is just amazing,” she says. Lopez received some tuition reimbursement from the program and worked as a research assistant in exchange for remaining tuition waivers.  

While in dental school, she joined a group of fellow students in establishing the first student-run dental clinic in the United States.   

Located on the north side of Chicago, the clinic still operates in Goldie’s Place, which serves as a place for homeless adults to get back on their feet. In 1997, a single dentist began providing services. In 2008, Lopez and others created the student component.  

“Goldie’s Place helps dental students become part of the change, which is what I really wanted to do,” says Lopez, who served for a time as clinic director after graduating 
from dental school.  

As a student, she often spoke with colleagues about the challenges of health care in low-income communities. “A lot of times someone who comes from privilege has blinders to different barriers that exist. I think it’s more impactful when you’re hearing from a colleague about things that make it hard for you to succeed,” she says.   

No matter a person’s race, ethnicity, or income level, dental needs will always be the same: a cavity is always a cavity, an extraction is an extraction, Lopez says. “But the way they perceive disease is always different,” she says, a concept that young dental students initially struggle with at Goldie’s Place. “It’s hard for them to understand, but it’s true. When you come from an underprivileged background, it’s not that you’re neglecting yourself; it’s just that it’s more important to feed your child. Or pay your rent.”  

Communicating correct information in a way that is easy for clients to understand is imperative, Lopez says. “It’s important to service them understanding their cultural needs.”  

Today, many of her classmates continue to work with grassroots organizations. One student has written a manual on how to establish a student-run dental clinic based on the Goldie’s Place model. “They’re addressing dental health issues not one person at a time, but communities at a time,” Lopez says. Other community-based health organizations in Chicago are beginning to incorporate the model for student clinicians, she says.  

“I’m proud of the fact that … I was able to do something like participate in the Goldie’s Place dental clinic. There are so many great things going on there. Every time I hear of some success on their part it makes me happy. If it weren’t for the Dental Pipeline I wouldn’t have been able to do that. It’s meant a lot, not just for me, but for community members that really needed it.”  

Lopez continues to volunteer at Goldie’s Place, and as part of a Chicago Community Oral Health Forum project to assess the dental health needs of adults and children. The Dental Pipeline gave Lopez the opportunity to both share her hard-won knowledge in the realm of public health and to establish a meaningful career addressing the issues, she says.  

“I’m really excited that programs like this exist because they give students like me a chance to fulfill their dreams,” Lopez says. “It really does make me feel a sense of responsibility, because there was an organization that backed me, to really give back to the community in a significant way.”

Source: Insight Into Diversity 

Is something similar to the Dental Pipeline National Learning Institute happening in your area to increase the number of minorities that go in to the Nursing profession as well as offer Nursing access to undeserved populations? Comment below!




Topics: dentist, Dental Pipeline, Latino, diversity, hispanic, black, minority, ethnicity

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