Introduction: a brief overview of the cultural group
Japanese Americans are Americans of Japanese heritage, some of whom moved to the United States with their families (first generation), whereas others were born to immigrant parents in America (second generation). Japanese Americans constitute more than 1.2 million of the United States population and are amongst the largest Asian American communities (Asakura, Murata, Kawamoto, Nakayama and Asakura, 2004, p.1).
In the United States, the average per capita income of Japanese Americans is about 15 percent higher as compared to the U.S. population in general (Health Forum, p.1). Moreover, 28 percent of Japanese Americans have bachelor’s degree, whereas this parameter for the U.S. population as a whole is 16%. Higher educational attainment is associated with higher probability of being insured (Health Forum, p.2). In general, Japanese Americans have lower rates of disease comparing to the rest of the population (Asakura, Murata, Kawamoto, Nakayama and Asakura, 2004, p.1), but contemporary research suggests that certain health concerns should be considered. For instance, Japanese Americans, especially females, are more vulnerable to personality disorders, various types of depressions and anxieties. As a result, “Japanese-American women have two times the suicide rate of white women in the United States. The majority of Japanese suicide victims are foreign born. Japanese Americans are less likely to communicate the intent to commit suicide. Depression in Japanese Americans is under-diagnosed and under-treated” (Huff and Kline, 1999, p.247).It also needs to be noted that Japanese American women are more predisposed to breast and ovarian cancer, as the prevalence of this medical condition in the specified population is 1.2 times higher than the average parameter for the United States. However, cancer survival rate is also the highest in this ethnic and cultural group. Another apparent problem of Japanese Americans, especially males, is alcoholism, but the issue is dangerously underestimated nowadays in some immigrant groups. Another negative aspect of the addiction is the fact that less than 30 per cent of Japanese Americans, suffering from alcohol addiction, receive appropriate treatment and psychological counseling.
As for the other diseases, “there is a higher prevalence of Diabetes and Hepatitis B among Chinese Americans, and hence, a higher prevalence of Hepatitis B-associated liver cancer. Hepatitis B infection is present in 80% of liver cancer cases” (ibid, p.256). Liver cancer is another health concern in this population, as the prevalence of this condition appears to be 5 times higher in the Japanese American population.
Culture study questionnaire
Your age: _____
Sex: a)male b)female
1)In the last 3 months, you have been involved in physical activity
a)3+ times a week b)once per week c)once per month d)rarer than once per month
2)Rate your stress level from 1 to 5. 1- no stress, 5-very high stress level _______
3)How often do you visit your physician for health check?
a)once per 3 months b)once per 6 months c)once per year d)rarer than once per year
4)Describe your smoking habits.
a) non-smoker b)smoke less than 5 cigarettes per day c)smoke 5-20 cigarettes per day d)smoke more than 20 cigarettes per day
5)Describe your attitude towards alcohol
a)total abstainer b)drink once per month c)drink 1-3 times per month d)drink more frequently than once per week
6)Do you feel you eat healthy? (55% carbohydrates, 20% protein, 25% fats).
a)you believe your diet is healthy b)as a rule, your diet is healthy c)your diet rather unhealthy d)your diet is unhealthy most of the time
7)As a rule, what do you eat for the following meals (if not applicable, put n/a):
Breakfast? _____________________________________________________
Brunch?________________________________________________________
Lunch?________________________________________________________
Afternoon luncheon?_____________________________________________
Dinner?________________________________________________________
Bedtime snack?_________________________________________________
8)How often do you eat:
– Fried foods such as French fries, fried chicken or hamburgers? ____ times per week
– Fruits and vegetables? ___ times per week
– Sweets treats like chocolate and candies? ____ times per week
– Cereals such as oatmeal or rice? ______times per week
– Meat such as chicken, veal and mutton? _____ times per week
– Snack foods such as crackers, potato chips, doughnuts, biscuits etc? ____ times per week
– Dairy products such as milk, cottage cheese and yoghurt? ____times per week
– Fish? ____ times per week
– Soups? ____times per week
9)How much (approximately) do you drink per day:
Green, red or white tea ____ounces in a day
Black tea _____ounces in a day
Coffee _____ounces in a day
Milk or yoghurt _____ounces per day
Water ____ounces per day
Juice _____ounces per day
Carbonated (fizzy) soda drinks such as coke, soda pop or fanta ____ounces a day
10)How often and how much do you normally eat?
a)5 times per day, small portions b)3-4 times per day c)1-2 times per day, small portions d)1-2 times per day, large portions
11)Your family status
a)single b)have stable partner c)common law d)married
12)Do you have children? (If the answer is “b”, go to question 14)
a) Yes b) No
13)How many children do you have?
a)one b) two c)three d)more than three children
14)How many children would you like to have?
a)one b) two c)three d)four or more
15)How many brothers and sisters do you have
a)I am only child b)one c)two d)three or more
16) Your education level (including the degree you are pursuing):
a)high school b)bachelor c)master d)postgraduate
17) Your professional area:
a) non-qualified manual work b)qualified manual work c)arts and humanities d)science and technology e)construction or design f)health care g)marketing and communications h)business, administration and management
18)Which language do you speak at home?
a)English b)the language of your cultural group
19)Do you celebrate the holidays of your cultural group?
a)Yes b)No
20)Do you observe the traditions of your cultural group and to what extent? (several options can be selected)
a)Do not observe b)celebrate the holidays of my cultural group and/or play traditional games c)your lifestyle and/or career choice is based upon the philosophy of your cultural group d)observe the traditions in the daily life (daily choices)
21)Your religious affiliation (if your answer is “a”, go to question 24):
a)atheist b)Christian c)Muslim d)Judaist e)Shinto f)Confucian g)Hindu h)other_________
22)How often do you attend temples/shrines or churches?
a)do not attend b)once per year and rarer c) once per 1-3 months d)once per 1 month and more frequently
23)How spiritual or religious do you believe you are?
a)not very b)more or less c)moderate d)very
24)Select the statements which you believe are true (several options can be selected):
– A man and a woman are equal
– Career should be a priority of all men
– Woman’s main destiny is maternity
– Men and women should be paid evenly for the same work
– Regardless of her working schedule, a wife should keep the house and cook for her husband and/or children
– Human fate is determined by origin (family background)
– Good education is a path to career success
– Hard work and goal-orientation are always rewarded
– It is unwise to choose mate or spouse without parental approval
In the next section, consider the statements and select a “True” or “False” option
25)Your friends are a negative influence.
a)True b)False
26)You seek to be like others but can’t.
a)True b)False
27)Your community or neighborhood is prejudiced against your cultural group.
a)True b)False
28)You believe your colleagues or classmates discriminate you on the basis of your ethnic background.
a) True b)False
29)You have to take care about a relative, partner or child confined to bed.
a)True b)False
30)People are critical of what you do.
a)True b)False
31)You feel your chores at home are not appreciated.
a)True b)False
32)Your parents and/or spouse (or partner) do not understand you
a)True b)False
Comparison of two cultural groups, conclusions about their differences and similarities
The above provided questionnaire is instrumental in understanding such characteristics of a cultural group as culture and practices, beliefs, family, religion, education, diet, health care and environment. When comparing Japanese Americans to the other ethnic group, Russian Americans, it is possible to find a number of differences. In particular, nutrition patterns are almost diametrically opposed: whereas Japanese Americans prefer predominantly light food such as fish, rice and vegetables and make no substantial difference between cold and hot dishes, Russian Americans are the lovers of hot food, especially soup and roasted veal (or pork unless they are Orthodox Judaists). Whereas Japanese Americans easily do without meat and dairy products, these two kinds of food are integral elements of Russian American diet (McKinney, Linton and Lajoie, 2006, p.3). Moreover, it needs to be admitted that Japanese Americans take in about 15 per cent fewer calories per day and eat less, but more frequently. Alcohol intake and smoking are also more widespread amongst Russian Americans, but they are found more resistible to the development of addition, as compared to Japanese Americans. However, traditional American food (fried chicken, hamburgers etc) is popular in these two groups as well.
Physical exercise is an important aspect in the lives of both Russian and Japanese Americans. Both groups prefer lighter muscle training, such as jogging, dancing, taking walks on fresh air. Health care practices are similar as well: both cultural groups are believed to have high pain threshold and thus try to avoid pain-killers whenever possible. The members of both groups have alternative beliefs concerning mental illness and thus might view disorder as a normal condition. Preventive health care is more common amongst Japanese Americans who attend physicians for health checks more often than Russian Americans.
As for cultural practices, both groups are quite adherent to the culture of the nation of origin. In particular, Russian Americans celebrate the so-called name days (along with birthdays) and believe their life choices are based upon the life philosophy inherent to the Russian culture, similarly do Japanese Americans. Their traditional holidays include Cherry Blossom Day, Girls’ Day etc. About 30 percent of Japanese Americans and 50 percent of Russian Americans do not use English at home. Religion, an important aspect of culture, is attributed to both Russian and Japanese Americans, whereas the majority of the former are Orthodox Christians, whereas the latter are affiliated to Buddhism, Shinto and Christianity.
Whereas extended family is a cultural phenomenon of both Japanese and Russian Americans, the modern members of these groups (especially the second or third generation) are more independent, prefer to live and provide for themselves on their own. They also do not rush to create their own families and rarely get married before the age of 25. The ideal of modern Russian and Japanese Americans is a nuclear family with two children. Japanese household structure includes well-established duties for each family member, ancestor worship and ‘the cult of male children’. A number of Russian and Japanese Americans assume the responsibility for a parent, partner or relative confined to bed. Russian Americans more frequently report discrimination and stereotyping in the neighborhood, community, educational or work environment, as compared to Japanese Americans. Japanese Americans are more likely to report the pressure of the environment, including high expectations and the necessity of “being like others”. As for education level, both Japanese and Russian Americans value good education and believe it is a reliable path towards career, so many of them have tertiary education (college, university, postgraduate studies). Profession choices of Japanese Americans include science, management and business, marketing and communications, whereas Russian Americans are more likely to choose arts and humanities, business or economics.
The beliefs and practical philosophies of Japanese and Russian Americans are quite dissimilar, especially in the context of gender roles. Japanese Americans are more adherent to the patriarchal family, where women need to combine their paid work with housekeeping and childrearing, whereas men are expected to be the major breadwinners. Russian Americans have a more egalitarian perspective of family and often do not share such beliefs; moreover, divorce and separation from family members is more acceptable in the Russian American culture, as compared to Japanese.
The importance of heightened cultural sensitivity and multicultural health care
Various national codes and standards position multicultural health care and cultural sensitivity as the “modus operandi” of nursing practice (Asakura, Murata, Kawamoto, Nakayama and Asakura, 2004, p.4). Due to the fact that nurses are most likely to maintain close physical contact with the patient (among health care specialists) , they should understand the practices which are encouraged as well as taboos of the particular culture. For instance, as it has been noted, the cultural taboo of discussing mental illness in detail exists among both Japanese and Russian Americans. Moreover, due to the fact that both of these groups seek allopathic care and pay attention primarily to eliminating physical symptoms, the nurse should be attentive and sensitive to the physical discomfort the patient experiences. The practice of enduring pain without informing about it common to both cultures should be also taken into consideration, i.e. it is important to regularly check whether the patient is experiencing the pain syndrome (most applicable to inpatient care).
It also needs to be admitted that working with Japanese American clients, each health care specialist should be aware of the fact that the patient cannot receive certain health services until family approval is achieved, if the ailment is serious or terminal, the specialist should discuss the situation with the head of the family or appoint family counseling/therapy – this form of treatment is particularly important in case of mental illness or addiction (Feng, 2002). In this sense, the respect for seniors is another essential component of health care provision, when dealing with elderly patients, it is necessary to inform the service user’s family members about the willingness to protect the patient, if hospitalization or resident care is required, the health care provider should not limit reasonable visitation of the patient, as the family member’s illness always becomes a common concern for all close relatives (Feng, 2002).
Nurses should also be able to manage the formalistic conformity attributed to Japanese Americans. Whereas those American cultural group which originate from Europe are more likely to state explicitly their concerns and express their fears, “Japanese American patients may not verbalize anxiety or doubts regarding their medical care in front of medical personnel, but then not to follow through with treatments. This can be misinterpreted as patient noncompliance or insincerity” (Huff and Kline, 1999, p. 290). In addition, in order to ‘save face’ of the household or community, the patient refuses to admit the fact of his/her illness and avoids using health care services. Such a position naturally seems destructive, rather than constructive, so the health care specialist should not merely set certain prescriptions and recommendations, but also discuss their observance in details: when, how, where, – the service user’s hesitation will finally disappear and he/she will ask questions and discuss his/her concerns.
References
- Asakura, T., Murata, A., Kawamoto, W., Nakayama, K. and Asakura, K. (2004). Socioeconomic Status, Acculturation, Discrimination, and Health of Japanese Americans: General Differences. Hawaii International Conference Materials.
- Asian and Pacific Islander American Health Forum. (2006). Health Brief: Japanese in the United States. APIA Forum Papers.
- McKinney, C., Linton, S. and Lajoie, R. (2006). Russians. Working Paper of University of Southern Mississippi.
- Huff, R. and Kline, M. (1999). Promoting health in multicultural populations: A handbook for practitioners. Thousand Oaks, CA: Sage.