The experiences of professional nurses who have migrated to Canada: cosmopolitan citizenship or democratic racism?

This interpretive research analyses the discourse of nurses who migrated to Canada and experienced racism. They also experienced reprisals when they formally complained about racism in a context of denial of the problem of racism by colleagues and employers. The present work focuses on two issues arising from the data: the problem of how to make racism visible among those who have a vested interest in denying its existence and the emotional cool of those filing grievances or complaints in contrast with the hot reaction of those being challenged when racism is named. We introduce two theoretical perspectives to address these phenomena called democratic racism and cosmopolitan citizenship, respectively. The former, as defined by Henry et al. (The Colour of Democracy: Racism in Canadian Society. Harcourt Brace, Canada, Toronto, 1996), describes the coexistence of both democratic values and practices that discount people of colour advertently or inadvertently. We outline the notion of cosmopolitan citizenship that is argued by Turner (Politics of the Global City. Routledge, London, 2000) to be an orientation resulting from global microcosms in cities teeming with diversity. The characteristic orientations of cool and stewardship are useful for describing some of the discourse expressed by each participant in our study all of whom challenged racism practices, not on nationalistic grounds, but rather out of concern for universal human rights. Their characteristics qualify them for cosmopolitan citizenship under Turner's perspective. We suggest that anti-racist activists have been cosmopolitan citizens for decades and argue that while cosmopolitan citizenship may have taken root in neo-liberal movements, it appears to have tactical attributes in the struggle with democratic racism. In conclusion, we advocate for a cosmopolitan citizenship ethic to facilitate a rational move toward racial integration in the profession through the sharing of power and privilege. One goal in confronting racism is the accountability for whiteness: immunity from responsibility or apology.     

Gender, race, and group behavior in group drug treatment

Background

Group drug counseling is the primary treatment modality used to treat drug dependence in community settings in the United States. Findings from the social psychology literature suggest that gender may influence how individuals participate in groups, and that race may moderate the effects of gender on group behavior. This study examined gender, race, and their interaction as predictors of alliance, participation, self-disclosure, and receipt of advice and feedback in drug counseling groups, and explored how gender and racial differences in drug counseling group behavior related to outcome of cocaine dependence treatment.

Method

Ratings of group behavior were made from videotaped sessions of group drug counseling drawn from a randomized trial of treatment for cocaine-dependent individuals (n = 438). Analyses examined the effects of race (African American or non-Hispanic White), gender, and the race by gender interaction on group behavior. Additional analyses examined race, gender, and group behavior, and interactions among these variables in predicting monthly cocaine use.

Results

Race and the race by gender interaction, but not gender alone, predicted many group behaviors. Non-Hispanic White women had the highest rates of self-disclosure and receipt of advice and non-positive feedback, followed by men of both races, with African American women having the lowest levels. These differences were unrelated to cross-sectional cocaine outcome.

Conclusions

Women, but not men, of different races acted differently in mixed-race, mixed-gender cocaine treatment groups, with African American women exhibiting less of several behaviors. Additional research on causes and consequences of these differences could inform interventions for drug-dependent women.     

Moderating effects of race in clinical trial participation and outcomes among marijuana-dependent young adults

Background

Few studies have examined clinical trial participation rates and treatment outcomes among underserved young adults who are dependent on marijuana, the most commonly abused illicit drug.

Method

The present study was a secondary analysis of a trial of court-referred marijuana-dependent young adults (ages 18–25) randomized to one of four treatment conditions: Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT), MET/CBT + Contingency Management (CM), Drug Counseling (DC) or DC + CM. African American (N = 81) participants were compared to White (N = 31) participants with respect to rates of participation in phases of treatment and substance use outcomes. In addition, the interaction of race and treatment condition was examined to ascertain if the interventions yielded different effects based on race.

Results

Among those who started treatment, African American young adults were significantly less likely to complete the treatment and posttreatment phases of the clinical trial than their White counterparts. Irrespective of treatment type, substance use outcomes (i.e., percentage of marijuana-negative specimens and longest duration of continuous abstinence) did not vary by race. However, there was a significant interaction effect between treatment type and race; African American young adults did not benefit differentially from any specific type of treatment, but CM was effective in reducing proportion of marijuana positive samples among White young adults.

Conclusions

Findings suggest that clinical trial treatment and posttreatment completion rates vary by race in this population, as does response to specific treatment types. More treatment research focusing specifically on African American marijuana-dependent young adults is warranted.     

Relationships and emotional wellbeing among African American and White advanced cancer caregivers

Objective

Advanced cancer family caregivers who have good relationships with other family members and with patient's health care providers (PHCPs) have less emotional distress than caregivers with poor relationships. Given a history of different experiences in medical settings among Whites and African Americans, we examined moderation effects by race.

Methods

Baseline data from an ongoing study were collected via telephone interviews with 397 family caregivers of advanced cancer patients at two cancer clinics. Depressed mood and anxiety were measured with the 14-item Profile of Mood States.

Results

Caregivers reporting good relationships with family (p < .001) and PHCPs (p < .001) had lower anxiety and less depressed mood (family, p < .01; PHCP, p < .001). Caregiver race moderated relationship quality: Whites with good PHCP relationships felt less depressed mood (p < .01) and anxiety (p < .01). African Americans with good family relationships showed less depressed mood (p < .05), but no association with anxiety.

Conclusion

Good relationships are important for caregivers, but PHCPs may have more influence on the wellbeing of White than of African American caregivers.

Practice implications

Developing relationships with caregivers of advanced cancer patients may improve wellbeing for caregivers. In addition, creating strategies to support family relationships may be a useful intervention, especially for African American advanced cancer caregivers.     

Provider factors and patient-reported healthcare discrimination in the Diabetes Study of California (DISTANCE)

Objective

We examined provider-level factors and reported discrimination in the healthcare setting.

Methods

With data from the Diabetes Study of Northern California (DISTANCE) - a race-stratified survey of diabetes patients in Kaiser Permanente Northern California - we analyzed patient-reported racial/ethnic discrimination from providers. Primary exposures were characteristics of the primary care provider (PCP, who coordinates care in this system), including specialty/type, and patient-provider relationship variables, including racial concordance.

Results

Subjects (n = 12,151) included 20% black, 20% Latino, 23% Asian, 30% white, and 6% other patients, with 2-8% reporting discrimination by racial/ethnic group. Patients seeing nurse practitioners as their PCP (OR = 0.09; 95% CI: 0.01-0.67) and those rating their provider higher on communication (OR = 0.70; 95% CI: 0.66-0.74) were less likely to report discrimination, while those with more visits (OR = 1.10; 95% CI: 1.03-1.18) were more likely to report discrimination. Racial concordance was not significant once adjusting for patient race/ethnicity.

Conclusions

Among diverse diabetes patients in managed care, provider type and communication were significantly related to patient-reported discrimination.

Practice implications

Given potential negative impacts on patient satisfaction and treatment decisions, future studies should investigate which interpersonal aspects of the provider-patient relationship reduce patient perceptions of unfair treatment.     

Correlation of N-myc downstream-regulated gene 1 expression with clinical outcomes of colorectal cancer patients of different race/ethnicity

AIM: To evaluate the role of N-myc downstream-regulated gene 1 (NDRG1) expression in prognosis and survival of colorectal cancer patients with different ethnic backgrounds. METHODS: Because NDRG1 is a downstream target of p53 and hypoxia inducible factor-1α (HIF-1α),we examined NDRG1 expression together with p53 and HIF-1α by immunohistochemistry. A total of 157 colorectal cancer specimens including 80 from Japanese patients and 77 from US patients were examined. The correlation between protein expression with clinicopathological features and survival after surgery was analyzed.in colorectal tumor compared with normal epithelium in both Japanese and US patient groups. Expression of NDRG1 protein was significantly correlated with lymphatic invasion,venous invasion,depth of invasion,histopathological type,and Dukes' stage in Japanese colorectal cancer patients. NDRG1 expression was correlated to histopathological type,Dukes' stage and HIF-1α expression in US-Caucasian patients but not in US-African American patients. Interestingly,Kaplan-Meier survival analysis demonstrated that NDRG1 expression correlated significantly with poorer survival in US-African American patients but not in other patient groups. However,in p53-positive US cases,NDRG1 positivity correlated significantly with better survival. In addition,NDRG1 expression also correlated significantly with improved survival in US patients with stages Ⅲ and Ⅳ tumors without chemotherapy. In Japanese patients with stages Ⅱ and Ⅲ tumors,strong NDRG1 staining in p53-positive tumors correlated significantly with improved survival but negatively in patients without chemotherapy. CONCLUSION: NDRG1 expression was correlated with various clinicopathological features and clinical outcomes in colorectal cancer depending on the race/ethnicity of the patients. NDRG1 may serve as a biological basis for the disparity of clinical outcomes of colorectal cancer patients with different ethnic backgrounds.     

Impact of race and ethnicity on counseling for alcohol consumption: a population-based, cross-sectional survey

BACKGROUND: Counseling for alcohol use is of proven utility, but whether disparities in provision of counseling exist is uncertain. METHODS: Using the 1999 Behavioral Risk Factor Surveillance System, a population-based telephone survey, we examined participant-reported physician counseling for alcohol use among 15,498 adults in 5 U.S. states. Participants reported their usual alcohol intake, risky drinking (intake of 5 or more drinks on occasion, greater than 60 drinks per month, or driving after drinking), and whether a doctor had spoken with them about alcohol use. RESULTS: Race and ethnicity were strongly associated with reported receipt of alcohol counseling. Compared with whites, black and Hispanic adults had 2-fold higher odds of reporting receiving counseling among all participants, among problem drinkers, and among abstainers. There were modest differences according to sex, income, self-reported health, and education, but not body mass index. Multivariable adjustment and restriction to participants who reported a recent checkup did not alter these findings. No such disparity was noted for general diet counseling. CONCLUSIONS: Clear racial and ethnic differences exist in physician counseling for alcohol use, with higher prevalence estimates among racial and ethnic minority populations. Although the cause of these differences is uncertain, systematic application of preventive medical services such as alcohol screening and counseling is needed for all patients.     

Ethnic differences in sleep quality accompany ethnic differences in night-time blood pressure dipping

BACKGROUND: African Americans exhibit a smaller nocturnal decrease in blood pressure (BP) than whites, and there are also reports of poorer sleep quality among African Americans. We examined the contribution of sleep quality to ethnic differences in BP dipping in African American and white male and female college students. We hypothesized that African Americans would exhibit blunted nocturnal BP dipping compared to whites, which would be partly accounted for by poorer sleep quality among African Americans. METHODS: Forty-three African American and 46 white college students aged 18 to 25 years completed an ambulatory BP protocol that included wrist actigraphy, which was used in conjunction with participant self-reports of sleep times for analyses of sleep quality. RESULTS: Although daytime and night-time BP did not differ according to ethnicity, African Americans had a smaller dip in systolic BP (P < .01), and African American women had a smaller dip in diastolic BP than whites (P < .01). Whites were more likely to be classified as a dipper (71%) than African Americans (41%) (P < .01). African Americans, compared to whites, spent less time in bed, were asleep for a shorter period of time, took longer to fall asleep, exhibited poorer sleep efficiency, and were awakened a higher percentage of the time by the inflation of the BP cuff (F > or = 4.85, P < .05). However, sleep quality did not appear to contribute to ethnic differences in diastolic BP dipping. CONCLUSIONS: Sleep quality accompanied ethnic differences in systolic and diastolic BP dipping, but did not account for these differences.     

Patient provider communication about the health effects of obesity

Objective

We assessed the influence of race/ethnicity and provider communication on overweight and obese patients’ perceptions of the damage weight causes to their health.

Methods

The study included 1071 overweight and obese patients who completed the 2002 Community Health Center (CHC) User survey. We used logistic regression analyses to examine determinants of patients’ perceptions of the impact of their weight on their health. Models were adjusted for covariates and weighting was used to account for the sampling design.

Results

Forty-one percent of respondents were overweight and 59% were obese. Non-Hispanic Blacks and Hispanics were half as likely as non-Hispanic Whites to believe weight was damaging to their health while controlling for covariates. Overweight/obese CHC patients who were told they were overweight by healthcare providers were almost nine times more likely to perceive that weight was damaging to their health compared to those not told.

Conclusions

We observed large racial/ethnic disparities in the perception that overweight is unhealthful but provider communication may be a powerful tool for helping patients understand that overweight is damaging to health.

Practice implications

Given obesity is a national epidemic, further attention to the role of patient provider communication in illness is essential with important implications for both health professional training and health care provision.