At the millennium, about forty percent of the United States populace who were under age nineteen years were minorities. Culture, race and ethnic group play important roles in health related beliefs, behaviors and access to optimal healthcare services.
Although America may be viewed traditionally as a great melting pot, and this assumes the importance of cultural assimilation for societal cohesiveness, the persistence of ethnic diversity is also meritorious. All cultures however, are not valued equally. The health of adolescents is affected by historic, political, economical and cultural factors.
To understand cross-cultural issues and the health of teens, several terms need definition:
- Minority is a group of individuals who differ from the majority of individuals in race, religion or culture.
- Culture is a group’s unique thoughts, communications, customs, beliefs, actions, values and institutions. This includes beliefs on health and illness.
- Race refers to a population of individuals who have common physical characteristics.
- Ethnic group is a grouping of individuals who share a common and distinct culture, language and religion.
- Acculturation is the process of adopting the culture of the majority group.
Racial and ethnic minorities carry a disproportionate amount of health and economic inequality. Research has shown that minority children with chronic disease have fewer visits to clinicians, fewer prescribed medications and more visits to an emergency room compared to white children with the same degree of illness. And minority adolescents generally are at higher risk for poor access to health care services.
Teen health behaviors vary also by race. According to a national survey by the Centers for Disease Control and Prevention, thirty-nine percent of white high school males engaged recently in binge drinking behaviors. This compares to twenty-five percent of African American teens engaging in the same behavior. Asian teens binge drink less frequently than white teenagers. However, according to the same survey, fifty-eight percent of adolescent African American males were sexually active compared to thirty-two percent of white male teens.
Take, for example Latinos. A Latino is a person who is living in the United States and can trace his or her origin to the Spanish-speaking regions of Latin American. This will include the Caribbean, Mexico, Central and South America. Latinos are expected to outnumber African Americans as the largest minority group in the United States by 2005. Latinos have five identified cultural values that may have consequences on healthcare behaviors.
- Simpatia: a value placed on politeness and pleasantness in a stressful situation. A lack of simpatia in a clinician may result in a teen not giving an accurate medical history, non-compliance with his or her prescribed medications or dissatisfaction with the clinical encounter.
- Personalismo: this is an expectation that a Latino will develop a warm and personal relationship with a clinician. Teens sensing a lack of personalismo may also be noncompliant with medications, not satisfied with the clinician visit and not return for follow up care.
- Respeto: this is best referred to as respect between patient and clinician and clinician and patient. Lack of respect may lead to noncompliance with medication, dissatisfaction with the clinician and failure to follow up.
- Familismo: this refers to the loyalty to the extended family that extends beyond the needs of the particular individual. Consultation with the extended family may be necessary prior to a decision on important medical matters.
- Fatalismo: this is the feeling that the individual can do little to alter fate. This may lead to Latino teens delaying care for important medical issues.
Traditional Latinos also value virginity in females before marriage. Some women maintain virginity by having anal intercourse with their partner. But anal intercourse may more readily lead to sexually transmitted illness since condoms are not necessary to prevent pregnancy, and the anal mucosa or lining is more likely to suffer injury during sex than the mucosa of the vagina.
Language problems may also be major barriers to healthcare access by teens. The lack of ability for the teen to speak the same language as his or her clinician could have profound impact on access to health care, use of health services and the adolescent’s health status.
Certain ethnic groups may also have folk illnesses that are culturally constructed diagnoses that often conflict with our biomedical understanding of disease. For example, the following are two frequently encountered Latino childhood folk illnesses:
- Empacho: a condition where a substance such as food causes an obstruction by getting stuck to the stomach or intestines. Symptoms include vomiting, diarrhea, cramps, bloating and stomachache.
- Mal Ojo: termed the evil eye, this occurs when an individual with “strong eyes” intentionally or not, looks at a child. The strong eyes of this individual are said to heat up the child’s blood causing fever, crying, vomiting and gas.
Of course, there are many cultures represented among the adolescents in the United States. It is not possible for any individual clinician to be sensitive to all of the cultural beliefs that may be carried by teens. And this could lead to problems. In Anne Fadiman’s book The Spirit Catches You and You Fall Down, she describes a Hmong (Asian) child with a seizure problem. The child’s parents felt the seizures were due to a wandering of her soul; her American physicians felt that they were due to the traditional biomedical model of disease: a misfiring of her neurons. This misunderstanding between the child’s family and the doctors led to a bad outcome for the child who suffered severe seizures and brain damage.
Teens who are new to the United States will probably also suffer culture shock symptoms. The food, weather and germs are a few of the elements that could affect the well being of teens new to this country. Of course, language, beliefs, economic status and health insurance may affect access to health care.
For teens that are from another culture or ethnic group, it is very important to communicate effectively with their clinician. To facilitate this, one might bring along a translator if the teen does not speak the same language as her or her clinician. This does assume that the translator will respect the confidential relationship with the teen’s clinician. Adolescents might also attempt the following:
- Describe their medical problem in their own words as they understand it
- Tell their clinician what they think is causing their illness even if it sounds ridiculous
- They should try to describe when and why the medical problem started
- Adolescents should say to their clinician what they think may help them to get better
Related topics:
Medical decision-making, sexual intercourse, sexually transmitted diseases, virginity
