Ghadban: Historical background

Roula Ghadban, NURS 7455

Introduction

My research interest, questions and future goals stem from my experience as a registered nurse working in the United States and in Lebanon. Lebanon, a small country in the Middle East, has long been known to attract visitors.  Its sceneries and charm are known worldwide. Before the Lebanese civil war that lasted for over 15 years, the capital Beirut was considered to be the Paris of the Middle East.  Even after the end of the war, and over the years, tourism has grown to be one of the main sources of income for Lebanon. Another reason many come to Lebanon is the medical care. The presence of the American University of Beirut Medical Center (AUBMC) leads many people from the Middle East to come to Lebanon for medical care.

After my relocation to the States, being considered an “Arab”, I have experienced firsthand how Arabs are viewed differently by the west. The vast majority of us have to bear the consequences of the few. You would think that in this day and age, discrimination would begin to diminish as people learned to be tolerant of diversity and more sensitive of other people’s experiences, but this is not the case.

The five sources chosen and discussed below summarize some facts about Arab American minority as a vulnerable population in the United States. They briefly discuss some general problems this population faces, specifically discrimination and health disparities. Discrimination can be a hurdle in this population’s process of acculturation thus affecting their health beliefs and actions and eventually leading to more health disparities.

Arab American Institute:

Arab Americans constitute an ethnicity made up of immigrants from the Arabic-speaking countries of southwestern Asia, Middle East and North Africa that have settled in the United States since the 1880s.  According to the Arab American Institute (2013), there are at least 1.9 million Americans of Arab descent that live in all 50 states. According to the 2010 U.S. Census, the city with the largest percentage of Arab Americans is Dearborn, Michigan, at nearly 40% of the total number of Arab Americans. While the majority of the population of the Arab World is composed of people of Muslim faith, most Arab Americans, in contrast, are Christians. According to the Arab American Institute, the breakdown of religious affiliation among Arab Americans is as follows: 63% Christians, 24% Muslims, 13% Other (Jewish and no affiliation). Poor health, in particular, heart disease and cancer are the number one causes of death for all minorities and Arab Americans in Michigan and it is well known that smoking is a major contributor to the heart disease and cancer.

American-Arab Anti-Discrimination Committee:

In the1970s American Arabs’ concerns about negative media images was stimulated as a result of the Israli-Arab conflict and war. The American-Arab Anti-Discrimination Committee (ADC) was initiated and mainly motivated by the unfair stereotyping of Arabs in media and anti-Arabism in general. The ADC Legal Department offers counseling in cases of discrimination, insult and hate crimes and provides assistance in selected lawsuits. ADC attorneys have addressed hundreds of cases against airlines and employers for discrimination on the basis of ethnicity and national origin and for discriminatory detentions of Arabs and Muslims without any probable reason. ADC’s Communications Department challenges stereotyping and bias in the media; with its media monitoring team responding to such incidents. The ADC Research Institute (ADCRI), founded in 1981, is an educational organization that sponsors research studies, seminars, conferences and publications about the discrimination faced by Arab Americans as well as promotes a better understanding of Arab cultural heritage. The institute also offers a bibliography of anti-Arab bias.

Discrimination can lead to lower level of acculturation and higher level of stress affecting this minority health status.

The association of perceived abuse and discrimination after September 11, 2001, with psychological distress, level of happiness, and health status among Arab Americans:

Prejudice and discrimination against Arabs and Muslims have increased dramatically since September 11 in the United States. In a population-based survey of Middle Eastern Arabic-speaking adults, 30% of Arabs and 50% of Muslims reported discrimination. Arab owned businesses were damaged, and individuals were verbally abused and physically assaulted, Perceived abuse and discrimination were associated with increased psychological distress, reduced levels of happiness, and worse health status in the Arab American minority in the States. The vast majority of this minority had to bear the consequences of the few. Abuse and discrimination can be the key points behind the health disparities in this population.

The health of Arab-Americans living in the United States: A systematic review of the literature:

Despite substantial negative attention paid to Arab Americans in the media and in public discourse, there is limited research about the health of this population in the United States and in the public health literature. Constituting such an important fraction of immigrants living in the U.S., Arab immigrants have been overshadowed in the academic literature on migration, health and health disparities by other immigrant groups such as Latinos for example. Published literature regarding health status among Arab-American populations is essentially lacking. There is a very small number of studies examined health among Arab immigrants. These minimal studies on the Arab population show that they experience poor health outcomes.

Unless there is further information about the health beliefs of Arab Americans in general, there will not be any effective health promotion interventions in this population with respect to their health disparities.

Arab immigrants: A new case for ethnicity and health:

Health disparities constitute a major problem among minorities in general and Arab Americans in specific in the United States. Although the elimination of racial and ethnic health disparities has been a recognized public health goal for a number of years, health disparities is still a major public health problem among minorities. Health disparity is defined as population specific differences in the presence of disease, health outcomes, or access to health care. Public health research has indicated the need for more aggressive tactics in order to eliminate health disparities among Arab American minority. It is everybody’s right to have fair and just distribution of social resources and opportunities needed to achieve wellbeing. Everybody, irrespective of race and ethnicity, should have equitable access to social and environmental elements that promote health. These elements include but are not limited to access to quality housing, education, employment, healthy foods, safety and medical car. A greater emphasis on social determinants is important to eliminate health disparities among minorities. More research on this population is needed especially that very little has been published about Arab American health status, behaviors, practices, and beliefs.

When two cultures come into contact, such as an immigrating family with the host country, the process of acculturation takes place.  Acculturation is the complex and continuous process of interaction between these two cultures that result in cultural and psychological changes (Berry, 2005).  Population migration from one country to another has become more prominent, and even when voluntary, moving to a new country can be taxing. Immigration goes hand in hand with acculturation, the process of adaptation and social changes to the new culture. All the reviewed literature was consistent in mentioning the importance of the role of culture and acculturation in health and health decisions among minorities. Acculturation has been widely used as a research variable to measure the effects of cultural beliefs and values on health and to study how those effects may change as individuals integrate some of the values of the mainstream culture. Thus it is important to understand the process of acculturation for the Arab Americans and the potential effects that level of acculturation may have on their health.

Research Aim and Question:

The general research aims and questions are:  1) study and improve health disparities in the Arab Americans minority, 2) implement health promotion interventions in this population. The specific aims are: 3) assess how the Arab ethnic identity and level of acculturation can be ethno-cultural predictors of health beliefs and concerns regarding the smoking effect on the Arab American minority cancer patients’ health, 4) assess the impact of acculturation on readiness and barriers to smoking cessation in Arab American cancer patients.

A distinctive aspect of this study is its focus on an understudied minority population in terms of smoking as a major health disparity.  Very minimal studies have been conducted and the problem of high prevalence of smoking among Arab Americans is still persistent. While more attention has been given to investigate different interventions to reduce cigarette smoking among White Americans diagnosed with cancer, little attention has been given to members of other ethnic groups like Arab Americans living in the U.S. 

References

American-Arab Anti-Discrimination Committee (2013). Retrieved from http://www.adc.org

Arab American Institute (2013). Retrieved from http://www.aaiusa.org

Berry, J. W. (2005). Acculturation: Living successfully in two cultures. International Journal of Intercultural Relations, 29, 697-712. doi:10.1016/j.ijintrel.2005.07.013

El-Sayed, A. M. & Galea, S. (2009). The health of Arab-Americans living in the United States: A systemic review of the literature. BMC Public Health, 9, 272-280. doi:10.1186/1471-2458-9-272

Padela, A. I. & Heisler, M. (2010). The association of perceived abuse and discrimination after September 11, 2001, with psychological distress, level of happiness, and health status among Arab Americans. American Journal of Public Health, 100 (2). 284-291. doi:10.2105/AJPH.2009

Read, J. G, Amick, B., & Donato, K. M. (2005). Arab immigrants: A new case for ethnicity and health? Social Science & Medicine, 61, 77-82. doi:10.1016/ j.socscimed.2004.11.054