DiversityNursing Blog

Written by James McIntosh

www.medicalnewstoday.com 

Obesity 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.

By JOANN S. LUBLIN

Is there such a thing as a diversity dividend?

A new study of 366 public companies in the U.S., Canada, U.K., Brazil, Mexico and Chile by McKinsey & Co., a major management consultancy, found a statistically significant relationship between companies with women and minorities in their upper ranks and better financial performance as measured by earnings before interest and tax, or EBIT.

The findings could further fuel employers’ efforts to increase the ranks of women and people of color for executive suites and boardrooms — an issue where some progress is being made, albeit slowly.

McKinsey researchers examined the gender, ethnic and racial makeup of top management teams and boards for large concerns across a range of industries as of 2014.  Then, they analyzed the firms’ average earnings before interest and taxes between 2010 and 2013. They collected but didn’t analyze other financial measures such as return on equity.

Businesses with the most gender diverse leadership were 15% more likely to report financial returns above their national industry median, the study showed. An even more striking link turned up at concerns with extensive ethnic diversity. Those best performers were 35% more likely to have financial returns that outpace their industry, according to the analysis. The report did not disclose specific companies.

Highly diverse companies appear to excel financially due to their talent recruitment efforts, strong customer orientation, increased employee satisfaction and improved decision making, the report said.  Those possible factors emerged from prior McKinsey research about diversity.

McKinsey cited “measurable progress” among U.S. companies, where women now represent about 16% of executive teams — compared with 12% for U.K. ones and 6% for Brazilian ones.  But American businesses don’t see a financial payoff from gender diversity “until women constitute at least 22% of a senior executive team,’’ the study noted.  (McKinsey tracked 186 U.S. and Canadian firms.)

The study marks the first time “that the impact of ethnic and gender diversity on financial performance has been looked at for an international sample of companies,’’ said Vivian Hunt, a co-author, in an interview.  Yet “no company is a high performer on both ethnic diversity and on gender,’’ she reported.

And “very few U.S. companies yet have a systematic approach to diversity that is able to consistently achieve a diverse global talent pool,” Ms. Hunt added.

McKinsey has long tracked workplace diversity. A 2007 study, for instance, uncovered a positive relationship between corporate performance and the elevated presence of working women in European countries such as the U.K., France and Germany.

Source: http://blogs.wsj.com

By Michelle Broder Van Dyke

A five-time national champion, Alysia Montano, was ready for another race on Thursday. But this race would be just a little different, since the former University of California star was 34-weeks pregnant.

“I’ve been running throughout my pregnancy and I felt really, really good during the whole process,” Montano said after the qualifying heat.

She finished last, but the crowd at Hornet Stadium still gave her a standing ovation. The 28-year-old ran the race in 2 minutes, 32.13 seconds. This comes about 35 seconds slower than her personal best of 1:57.34, which she ran in 2010 in Monaco.

Montano has been running all her life, and said she consulted with her doctor about her plan to continue running during her pregnancy, who encouraged the idea.

“That took away any fear of what the outside world might think ab
out a woman running during her pregnancy,” Montano said. “What I found out mostly was that exercising during pregnancy is actually much better for the mom and the baby. … I did all the things I normally do … I just happened to be pregnant. This is my normal this year.”

Source: buzzfeed.com

By  Jennifer Smola 

Sixty-one years after graduating from Mount Carmel College of Nursing, one of the school’s first black graduates is finally hanging up her stethoscope.

June Todd, 83, retired yesterday from Dr. Charles Tweel’s family-medicine practice on the Northwest Side. Todd graduated from Mount Carmel in 1952, in a class of 52 nurses. All were women, and, for the first time, four were black.

Todd, who lives in Worthington, attended Harding High School in Marion, north of Columbus. She considered studying library science, but her school librarian told her she would have a hard time getting a job in the North because of her race.

“I said, ‘That’s not going to work,’  ” Todd recalled. “So I decided I wanted to become a nurse."

Her race seldom made a difference during her nursing career, she said. And she has fond memories of her time at Mount Carmel.

“I loved the nuns,” she said. “Everybody was so nice.”

Tweel described Todd as a “ball of energy” who never missed work. She’s popular not only among her co-workers but with patients, who “like seeing her more than they like seeing me,” he said.

Enid Patterson, a patient for 10 years, said she was sad to see Todd go.

“She’s not just my nurse,” Patterson said. “She’s my friend.”

When Tweel hired Todd 13 years ago, she planned to stay only a year or two, she said, but she stuck around because she liked the work.

Her co-workers said she brought humor and energy to the office every day.

“She’s the only 80-some-odd-year-old woman that has an opinion on everything from Hillary Clinton to why Chris and Rihanna should not be together,” co-worker Beth Shahan said. “She’s very with-it and hip.”

Though Todd is retired, she says she’s not done working. She plans to volunteer at local nursing homes and perhaps at a Worthington library.

This table shows the number of students enrolled in generic (entry-level) Baccalaureate, Master's, and Doctoral (research-focused) programs in nursing from 2002 to 2011.

Credit

By Carolina Madrid

August 31, 2012

We tend to categorize every ethnic community outside of  Whites as a minority or diverse population group, but there’s a gray area that we’re failing to pay close attention to: the bicultural and multiracial population. It was the fastest-growing youth group in the country in the last decade, increasing almost 50 percent to 4.2 million, according to Census 2010.

As our nation’s population becomes more diverse, the bicultural population will continue growing and the segregated communications approaches that have worked in the past will not work with this audience any longer. Use the guide below as an overview to understanding biculturalism and how you can think about it in an upcoming campaign.

A cultural tug of war

Being bicultural, multicultural or multiracial means that you have ties to different cultures. It can mean that you grew up in the United States with roots in another country or that you have parents from distinct ethnic backgrounds. Either way, there’s usually a sense of being pulled in two different directions while trying to maintain both or assimilate into another.  Why does this matter? Because someone who you thought was a Hispanic, Spanish-speaking person may not be receptive to messaging that speaks solely to Latinos.

Inglés or Spanish?

The language preference of bicultural individuals varies.  Younger populations who went to school in the United States tend to prefer English, while older populations will favor their native language.  There’s also the second-generation population who doesn’t prefer one or the other. The language you use will largely depend on the demographic.

What am I?

The degree to which individuals associate themselves with a given cultural background also varies. Just as there are those who believe in maintaining a sense of heritage, there are those who don’t want to stay in touch with their roots and prefer to assimilate into only one culture. This is why it’s important to stay away from explicit cultural messaging that would isolate or turn off the bicultural or multiracial population.

Univision or CNN?

Just because someone speaks Spanish doesn’t mean he or she watches Univision, the nation’s largest Spanish-language network. In fact, he or she will likely prefer to watch English-language TV. Still, on CNN, there is an opportunity to reach the bicultural population with messaging about the Hispanic or Asian population.

Fusion nation

Fusion cuisine is a perfect example of the adaptation and merging of two different cultures. You appreciate the base flavor of the dish, while adding in contemporary ingredients and spices for a blend that’s the best of both worlds. Don’t be afraid to also use this approach in your communications programs, using a mix of messages.

Contextual decision-making

How you communicate with a bicultural population will also depend on the message that you’re trying to convey. Different scenarios will call for the incorporation of cultural messaging, while other times, this might seem forced. But what is certain is that early awareness and the ability to use it wisely will reap the rewards of a genuine connection.

 

by Mareisha Winters
Let’s talk about work.

There is a lot of attention being paid to our increasingly diverse workplace. There are all types of differences including race, gender, generations and thinking styles, just to name a few. LTAW’s focus this month is on some of the key diversity dimensions and how to navigate them for greater productivity and engagement.

The increasingly diverse global workforce has made cultural competence an imperative to sustain and enhance workplace performance and engagement.  What is culture and what is cultural competence?  Culture is the behavioral interpretation of how a group lives out its values in order to survive and thrive; the set of shared attitudes, beliefs, behaviors, values, goals, and practices that characterizes an institution, organization or group.  Cultural competence is the capability to shift cultural perspective and adapt behavior to cultural commonalities and differences.  Ongoing, continued learning is required for cultural competence.

The three largest minority groups in the US workforce today are: Hispanic/Latino (14.7%), Black/African-American (11.6%), and Asian American (4.6%).  The more different cultures work together, the more cultural competence is essential to avoid problems ranging from miscommunication to actual conflict.  These problems can compromise effective worker productivity and performance.

Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across cultures.  The purpose of this post is to understand the different barriers and hurdles that minority groups tend to face in the workplace.  Managers must understand that their style cannot necessarily be “one size fits all” if they have a multi-cultural team.  Below are some characteristics of the three main minority groups in the workplace.

Hispanics/Latinos

Hispanic culture tends to be risk adverse and more of a “we” vs. “I” culture.  This can negatively impact them in the workplace if it is not understood.  Their risk avoiding nature may not afford them the same chances to show their abilities and skills.  By not self-promoting as much as others, Hispanics may not be rewarded for their contributions.

Cultural competence can help Hispanics reach their full potential in the workplace.  Many employees make sweeping stereotypes about Hispanics.  Some are criticized for their accents, leading to assumptions on their abilities, level of education, and intelligence.  Hispanics tend to speak Spanish with each other because of comfort, but this can be confusing or seen to be exclusionary by others.

Mentoring can make the difference in retaining Hispanics.  Hispanic mentors serve as role models and better understand some of the cultural nuances of being Latino in the workplace.  Hispanic employees need formal and informal ways to connect with each other in order to maintain the relationship bonds they value.

Blacks/African Americans

Studies tell us that there is greater corporate flight amongst minorities, especially among African Americans.  Research conducted by the WP Carey School of Business showed that the predicted quit rate for whites was 3.73%, compared to 4.79% for African Americans.   Discriminatory environments and micro-behaviors are often cited as reasons African Americans leave an organization.  So what can a company do to make these employees feel more engaged? Based on findings from focus groups conducted by the Future Work Institute, the top five characteristics of an organization that retains African American employees include:

    A climate of inclusion
    Supportive interactions with leaders
    Offer of profit and loss responsibilities
    Opportunities for development and advancement at all levels
    Community involvement and social responsibility

As with Hispanics, mentoring is a key factor in the career development and retention of Blacks/African Americans.  Studies have shown that mentoring of African Americans leads to: increased performance, faster promotion rate, early career rate of advancement, greater upward mobility, higher income, job satisfaction and perceptions of great success and influence in an organization.

African Americans place a high value on interpersonal relationships with supervisors and co-workers, which impacts both job satisfaction and employee commitment.  Supportive work environments for African Americans include: collectivist (focus on group rather than individual outcomes) approaches to work, agreeableness and teamwork.

Asian Americans

The same Future Work Institute focus group study revealed the major hurdles for Asian Americans in the workplace.  The primary reasons that Asian Americans feel excluded in the workplace include:

    Lack of mentors with Asian perspective.  Because of the small number of Asian Americans in the US workforce, mentors with Asian perspective are limited.  Similar to Hispanics and African Americans, Asian Americans would benefit greatly from having mentors in the workplace.
    Glass ceiling.  Asian Americans who wish to move up the career ladder feel limited because they do not see Asian representation at the top.
    Lack of transparency.  The need for constructive feedback is essential for career development.
    Life is out of balance.   Often caught between the demands of kids, parents and work, Asian Americans feel their work and life is out of balance.  According to AARP, 73%of Asian Americans believe that children in their families should care for elderly parents, compared with 49%of the general population.
    Cultural differences.  The sentiment from many Asian Americans is that, “Our culture is very different from the _______ culture.”  There is a lack of cultural understanding which is a barrier for them in the workplace.

It is important to note that the data presented above does not apply to every person within that subgroup and that any generalizations should not be viewed as stereotypes.  We offer this information to provide guidance to leaders on how the differences in values and culture might influence workplace behaviors and needs and why cultural competence is such a vital skill for leaders to effectively manage the increasingly diverse workforce.

Value differences! Live inclusively!