POST TRAUMATIC STRESS DISORDER (PTSD) IN ARAB AMERICAN REFUGEE AND RECENT IMMIGRANT WOMEN.

Routine male circumcision (RMC) has been found effective in preventing HIV infection in Africa; at the same time, incidence of HIV infection has been rising in China. Hence, RMC may be a possible means by which Chinese nationals could address increasing HIV infection rates. A focus group study was conducted to explore perceptions of RMC among mainland Chinese nationals. The results indicated that 1) 90% of participants considered RMC to be an unfamiliar and culturally sensitive topic; 2) 80% felt that being uncircumcised had not created significant health drawbacks for them or males they knew; and 3) the group believed that RMC would not be a good strategy to address rising HIV rates and were dubious about the idea of mandated RMC in China. For Chinese nationals, cultural traditions regarding RMC appear to outweigh concerns about HIV infection.

Intimate partner violence, depression, and barriers to service utilization in Arab American women.

How intimate partner violence (IPV), depression, and barriers to services affect Arab American women in the United States is not very well documented. This cross-sectional exploratory descriptive study examines (a) the relationship between depression and IPV and (b) whether living in the United States 10 or more years decreases barriers to reporting intimate partner violence and depression in a sample (N = 312) of Arab American women 19 years and older. Findings demonstrate significant relationships between women who were at risk for IPV and depression scores (r = .44, p < .001), and number of years living in the United States and barriers to service (r = .25, p < .001). There was a significant negative relationship between barriers to service and depression (r = -.30, p < .001), and barriers to service and IPV (r = -.23, p < .001), and number of years living in the United States and depression (r = .25, p < .001). Findings underscore the importance of screening referral and follow-up for Arab American women experiencing IPV and depression.

Functional and psychosocial status of Haitians who became users of lower extremity prostheses as a result of the 2010 earthquake.

The January 12, 2010 earthquake devastated Port-Au-Prince, the capital of the Republic of Haiti, and its surroundings. Among the 300,000 injured, 1,200 to 1,500 people underwent traumatic /surgical amputations. The purpose of this study was to describe the functional and psychosocial impact of prostheses users who suffered a traumatic lower-limb amputation after the earthquake of 2010 in Haiti. We recruited 140 participants in collaboration with a large health care organization in Port-au-Prince from October 2011 to May 2012. Participants underwent an evaluation of physical impairments and completed questionnaires translated into Haitian Creole. The Trinity Amputation and Prosthesis Experience Scale (TAPES), and the Locomotor Capabilities Index (LCI) were used in this study. The questionnaires were administered verbally in Haitian Creole by a trained staff. We conducted descriptive statistics and t-tests using SPSS for data analysis. Participants had a mean age of 34.9 ± 12.0; 51.4% were women; 48.6% were transfemoral amputees. The mean of TAPES general adjustment (3.65 ± 0.59) and adjust to limitation (3.67 ± 0.86) were higher than the score for the social adjustment (2.58 ± 0.49). The LCI showed over 90% of subjects were physically independent in self-care; fewer were independent walking on uneven ground or inclement weather (69%). The relatively poor social adjustment is consistent with the literature that describes limited acceptance of people with physical disabilities in Haitian society. Prostheses users in Haiti would benefit from a health delivery infrastructure that also addresses the psychosocial reintegration of individuals with physical disabilities.

A model of mother-child adjustment in Arab Muslim immigrants to the US.

We examined the mother-child adjustment and child behavior problems in Arab Muslim immigrant families residing in the U.S.A. The sample of 635 mother-child dyads was comprised of mothers who emigrated from 1989 or later and had at least one early adolescent child between the ages of 11 and 15 years old who was also willing to participate. Arabic speaking research assistants collected the data from the mothers and children using established measures of maternal and child stressors, coping, and social support; maternal distress; parent-child relationship; and child behavior problems. A structural equation model (SEM) was specified a priori with 17 predicted pathways. With a few exceptions, the final SEM model was highly consistent with the proposed model and had a good fit to the data. The model accounted for 67% of the variance in child behavior problems. Child stressors, mother-child relationship, and maternal stressors were the causal variables that contributed the most to child behavior problems. The model also accounted for 27% of the variance in mother-child relationship. Child active coping, child gender, mother's education, and maternal distress were all predictive of the mother-child relationship. Mother-child relationship also mediated the effects of maternal distress and child active coping on child behavior problems. These findings indicate that immigrant mothers contribute greatly to adolescent adjustment, both as a source of risk and protection. These findings also suggest that intervening with immigrant mothers to reduce their stress and strengthening the parent-child relationship are two important areas for promoting adolescent adjustment.

The effects of September 11 on Arab American nurses in metropolitan Detroit.

The purpose of this article is to determine the effects of 9/11 on Arab American nurses' workplace discrimination in the Detroit metropolitan area. Thirty-four Arab American nurses completed a survey about perceptions and experiences related to discrimination before and after the terror attacks on 9/11. Most participants did not experience demotion, but some experienced intimidation and patient rejection more often or with the same frequency following 9/11. September 11 continues to negatively affect Arab Americans in the work environment. Studies are needed to further examine the workplace discrimination relationship with specific health indicators for Arab Americans.

Smoking behavior in pregnant Arab Americans.

OBJECTIVES: To determine the smoking behavior in pregnant Arab American women who attended a Women, Infant and Children (WIC) program at a local county public health clinic and compare the incidence of smoking behaviors of pregnant Arab American women with pregnant women who were not Arab Americans. DESIGN AND METHODS: Data were extracted from a computer database that contained information from health history charts of pregnant Arab and non-Arab American women. The study sample was 830 women, 823 of whom were Arab American participants enrolled in the WIC program in Michigan. RESULTS: Approximately 6% of pregnant Arab Americans smoked during pregnancy. The prevalence of smoking behavior among pregnant Arab American women was similar to that of smoking behaviors of Hispanics and Asian Americans in the United States. CONCLUSION: Although smoking behavior is a serious problem among Arab American immigrants in general and in the Arab world in particular, cultural factors that support healthy behavior during pregnancy in the Arab culture seem to limit the use of tobacco in pregnant women. Nurses who care for Arab American pregnant women can use this information to better inform their care of these patients.

Psychometric evaluation of the Arabic language version of the Profile of Mood States.

We estimated the psychometrics of the parent and a short form of the Arabic language version of the Profile of Mood States (POMS). A sample of 537 Arab immigrants completed the POMS and a battery of other measures. Data analyses included confirmatory factor analyses and tests of reliability and concurrent validity. The fit of the proposed factor structure was acceptable if 14 pairs of error terms were allowed to correlate, but a better fit was obtained by creating a short form. The short form demonstrated good reliability and concurrent validity, but some factors were highly correlated. High factor correlations were not explainable by group differences in education or level of distress.

Recruiting and retaining Arab Muslim mothers and children for research.

PURPOSE: To describe successful and not-so-successful strategies for recruiting and retaining Arab Muslim immigrant women and their adolescent children for research. DESIGN AND METHODS: A longitudinal study of mother-child adjustment of Arab immigrants to the US is used for illustration. A panel of experts was assembled and provided culturally specific advice about gatekeepers, advertising, data collectors, data collection, and how to track and encourage participation at subsequent time points in the study. FINDINGS: Most of the strategies recommended by the panel were overwhelmingly positive, including advice about data collectors, how to collect data, financial incentives, avoiding offending families, and personal contacts. Hiring data collectors who were able to establish personal and culturally appropriate relationships with study participants was the single most successful recruitment and retention strategy. Advice from cultural experts about which gatekeepers to engage and how to advertise for study participants was not productive. CONCLUSIONS: Researchers should not only assemble a panel of cultural experts to provide advice about group specific strategies to build trust and maintain cultural sensitivity, but also to budget generously for time for data collectors to build and maintain rapport with study populations who, like Arab immigrant women, highly value personal relationships.

Improving global health care through diversity.

One of the major challenges facing the nursing profession is the globalization of nursing education, research, and practice. The word diversity is derived from the Latin word divertere meaning being different or having differences. Diversity in nursing practice means providing competent care to clients from different cultures, conducting research in multi-cultural settings, and implementing educational programs to diverse populations. Key principles and practices that provide a framework for diverse relationships in nursing practice, research, and education must be driven by a professional commitment in building a global community that is inclusive, respectful, and dedicated to global health care for all. Through international collaborations and individual and collective partnerships, nurses can build bridges between and among national health care systems, strengthen the international health care infrastructure, broaden health care delivery systems, and improve the quality of health care for all.

Predictors of Arab American Adolescent Tobacco Use.

This study examined personal, psychosocial, sociocultural, and environmental predictors in tobacco use for 1671 Arab American adolescents. Cigarette smoking in past 30 days was 6.9%. This increased from 1% at age 14 to 14% at age 18. Twenty-nine percent of the youths reported 'ever cigarette smoking.' Experimentation with narghile was 27%; it increased from 23% at 14 years to 40% at 18 years. All trends were significant (p < .001). Logistic regression analyses found ten predictors for 'smoked a cigarette in past 30 days' and nine and seven, respectively, for 'ever smoked a cigarette or narghile'. Friends and family members smoking were the strongest predictors of cigarette smoking and 'ever narghile use.' 'Ever narghile use' supported cigarette smoking.

Cancer among Arab Americans in the metropolitan Detroit area.

Detroit is home to one of the largest populations of Arab Americans outside of the Middle East, yet little is known about the cancer distribution in this ethnic group. The authors of this study created an Arab/Chaldean surname list and matched it with the Detroit SEER Registry to identify cancer cases of probable Arabic descent. We then determined proportional incidence ratios (PIR) for specific cancer sites among metropolitan Detroit Arab Americans as compared to non-Arab Whites, and contrasted the results with Middle Eastern data. Arab/Chaldean men had greater proportions of leukemia (29%), multiple myeloma (46%), liver (64%), kidney (33%), and urinary bladder (26%) cancers. Arab/Chaldean women had greater proportions of leukemia (23%), thyroid (57%), and brain (35%) cancers as compared with non-Arab White men and women. The cancers with significantly increased PIRs in the Detroit Arab/Chaldean population also are frequently diagnosed in Middle Eastern countries.

Arab-American adolescent tobacco use: four pilot studies.

OBJECTIVES: Four pilot studies were conducted to determine the (1) current tobacco use patterns and predictors among 14- to 18-year-old Arab-American youths; (2) psychometric properties of study measures (English and Arabic); (3) cultural appropriateness of Project Toward No Tobacco (TNT) for intervention; (4) accessible population for a longitudinal study. METHODS: Three studies were descriptive and one used a pretest-posttest design. From four Pilot Focus groups (N = 28 smokers) key tobacco use themes emerged along with information on study measures and the Project TNT intervention; Pilot Intervention tested the tailored Project TNT intervention with 9 Arab-American teens; Pilot Clinic (N = 44) determined the characteristics of the accessible teen health clinic population; and Pilot School (N = 119) obtained tobacco use data only. RESULTS: From Pilot Focus seven themes (being cool, "nshar ma'a al shabab" [hanging out with the guys], present [time] orientation, smoking feels and tastes good, keeps your mind off trouble, easy to get, and (many) "barriers to quitting") emerged from the data. In the Pilot Intervention a 37.5% cessation rate was found. In the Pilot Clinic study, 24% males and 17% females smoked. The current smoking rate in the Pilot School (N = 119) sample was 17%; 34% admitted to having ever smoked (even a puff). Significant predictors for current tobacco use included poor grades, stress, having many family members and peers who smoke, being exposed to many hours of smoking each day, receiving offers of tobacco products, advertising and mail, and believing that tobacco can help one to make friends. CONCLUSIONS: The four pilots contributed unique and essential knowledge for designing a longitudinal clinical trial on tobacco use by Arab-American adolescents.

Arab American adolescent perceptions and experiences with smoking.

The purpose of this pilot study was to gather information on Arab American adolescent tobacco use behavior. This information was used to modify the Project Toward No Tobacco Use cessation program so that it would reflect the cultural values of Arab American youths. Focus group interviews were conducted to collect qualitative data from 28 Arab American adolescents between the ages of 14 and 18 years. The number of participants in the focus groups ranged from three to eight; four sessions were conducted. A moderator, fluent in Arabic and English, facilitated the group's interactions. Each group addressed five interview questions. Discussions were audiotaped and transcribed with the expressed permission of study participants. Qualitative analysis consisted of careful reading of the transcripts and of the field notes for the purpose of identifying recurring themes around tobacco use. Those that emerged were Being Cool; Being able to "Nshar ma'a al shabab" (hang out with the guys); Present Orientation; Smoking feels good, tastes good, and keeps your mind off trouble; Availability and Accessibility of tobacco; and Barriers to Smoking Cessation Programs. The results of the focus group discussions provided valuable information about the tobacco use perceptions and behaviors of Arab American adolescents and the youths' need for a culturally relevant smoking cessation program.

Students' knowledge, attitudes, and beliefs about AIDS: a cross-cultural study.

This exploratory, comparative study was conducted to assess and compare the knowledge, attitudes, and beliefs toward AIDS between a group of Jordanian and a group of American students. A convenience sample consisting of 126 senior BSN (bachelor's of nursing) students, 63 from a university in Jordan and 63 from a university in Michigan, was selected for this study. A self-administered structured questionnaire was utilized. The questionnaire consisted of three parts: knowledge, attitudes, and beliefs toward AIDS in both cultures. Descriptive and inferential statistical analyses were used. The results indicated that the American students' responses concerning knowledge of HIV/AIDS were significantly greater (M = 73%) in comparison with Jordanian students' (M = 52%). The American students also reported more positive attitudes toward AIDS than those of their Jordanian counterparts. In terms of prevention of the spread of HIV/AIDS, more American students (82.5%) approved of the use of condoms as a precautionary measure toward the spread of the disease when compared to Jordanian students.

Safety in the use of compressed air versus oxygen for the ophthalmic patient.

Oxygen, routinely administered during surgery to avoid hypoxia, poses risks including increased likelihood of surgical room fires and predisposition to retinal phototoxicity in patients. Compressed air to supplement ventilation may be safer than oxygen. The purpose of this study was to determine whether hypoxia occurs more frequently when compressed air replaces supplemental oxygen during ophthalmic surgery. A convenience sample of 111 patients was randomly assigned to receive supplemental oxygen (group 1) or compressed air (group 2). Patients with serious cardiac or pulmonary disease were excluded. Blood oxygen levels were monitored during surgery by pulse oximetry. Oxygen was administered to all group 2 patients whose oxygen saturation fell to less than 90% or by more than 5% below baseline. No differences were observed between groups in age, ASA classification, type of surgery, or anesthetic drugs or doses. Minor, but statistically higher oxygen values were observed in group 1. The frequency with which oxygen saturation decreased below 90% or below 5% of baseline was similar in both groups. Supplemental oxygen is not required routinely in selected patients undergoing ophthalmic surgery. By using compressed air, the risk of operating room fires and retinal phototoxicity may be reduced.

The practice of honor crimes: a glimpse of domestic violence in the Arab world.

Domestic violence, especially violence against women, is a serious health problem in the United States and in many countries of the world. However, information on violence against women in the Arab culture is scarce. The purpose of this descriptive study is to investigate the incidence of violence against women in one Middle Eastern country. The focus of the research is to determine the cultural context in which violent crimes against women are committed and the social and legal implications of such crimes. The research method included: (1) a review of all court files of women murdered during 1995 in the country of Jordan and, (2) the social norms and sanctions against persons who commit crimes against women. Of 89 homicide cases reviewed, 38 involved female victims. Analysis of the court files of the 38 murdered women indicated that a male relative of the female victim, primarily the brother, committed the majority of the murders. The most common cause for the murders provided in the files was "honor crime." Honor crime was defined as crime committed against women by their male family members because the women had violated the honor of their family. Cultural norms and practices including the legal practices related to honor crimes support the practice of killing women for sexual misconduct and excuse perpetrators of the crimes from punishment.