Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students

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Edited by: Robert M. Huff, Michael V. Kline, Darleen V. Peterson & Lawrence W. Green

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  • Chapters
  • Front Matter
  • Back Matter
  • Subject Index
  • Part I: Foundations

    Part II: Cultural Overviews

    Part III: CASE STUDIES

    Part IV: CONCLUSIONS

  • Copyright

    Acknowledgements

    For Kathryn, my helpmate, my partner, my friend, my love.

    —R. M. H.

    This book is lovingly dedicated to my wife Anita and to all our wonderful children and grandchildren.

    —M. V. K.

    I dedicate this book to Joel, my husband and partner in life.

    —D. V. P.

    Foreword

    Some paradoxes face those seeking to promote health in multicultural institutions, communities, and societies in which equity stands as a central value. Some of these paradoxes arise from the inherently competitive, if not sometimes contradictory, goals that multiculturalism and equity seem to pursue. We prize diversity, but we loathe disparities, at least in matters of health. Can we protect and even promote diversity in ethnicity or culture while seeking to eliminate disparities in health? Is the culture of a practitioner bound to limit his or her ability to understand and promote a vision of health and to find a way of achieving health within another culture? This handbook for practitioners should help the practitioner bridge this cross-cultural divide.

    A second paradox arises from the global, to national, to regional and local, to family and individual lenses through which multiculturalism and equity are variously viewed and the sometimes contradictory actions taken at these various ecological levels to achieve equity. At the global, national, and state levels, we seek uniform policies that are legislated at these centralized levels to ensure equity across regions, while recognizing that the essence of diversity and multicultural sensitivity depends on local, family, and even individual autonomy. Can practitioners reconcile the policies they are required to implement with the social realities, histories, and cultural variations that they find locally? This handbook for practitioners should help them do so.

    A third paradox is that the only way to achieve equity in the face of inherited social, economic, and political inequalities and inequitable societal forces is to treat people or populations differently. The provinces of Alberta, British Columbia, and Ontario, for example, pay higher taxes than some other provinces to subsidize the Canadian commitment to health equity and universal health care through revenue sharing and income transfers to the poorer provinces. More affluent people must pay higher taxes to subsidize essential social and health services to the less affluent. Whole classes and regions, then, must be treated unequally in the name of equity. The only alternative to this strategy is to limit the concept of equity more severely to include only equality of economic opportunity and to ignore history, political traditions, prejudice, catastrophic illness, and conditions of birth and inheritance that give people unequal circumstances and starting points in availing themselves of their otherwise equal economic opportunities. This handbook will help make practitioners more sensitive to the histories, traditions, and sociocultural circumstances that matter.

    A fourth paradox arises for individuals in a multicultural society. Each of us must act toward other people of different ethnic origins with recognition and respect for their differences while treating them equally in every other way. But where do we draw the line in our behavior between differences and equality to achieve equity? In what ways should we be equal, and what are the “every other” ways? We face this daily in our relations between genders. Affirmative action in hiring or building ramps for disabled people to have equal access; avoiding sexual harassment in gender relations between teachers and students or between colleagues; and recognizing the disadvantages an employee, client, or student had at the beginning of a professional encounter, all reflect our efforts to reconcile these paradoxes.

    These instances of societal adjustments to inherent or inherited differences while seeking to achieve equity hold lessons for the health professions and other sectors seeking to promote health in multicultural populations. Cultural differences related to health can be obvious or subtle; malleable or rigid; prescribed or proscribed; and dictated by religious or secular traditions, edicts, norms, customs, or ideologies. The variable forms and sources of the differences can be a partial guide to how they should be treated in planning, implementing, and evaluating health promotion programs. But beyond these partial guides, the humanity of multiculturalism cannot and should not claim a science as its only compass. Some combination of philosophical commitment, cultural knowledge, human sensitivity, and open communication must be brought to bear in achieving the balance and proper trade-offs between distinctiveness and equality that multiculturalism and equity demand.

    Besides the paradoxes, the diversity issue presents another challenge for the practitioner. The tendency of those who produce “best-practice” guidelines too often generalize too glibly from the theories and evidence generated in mainstream populations or from the experiences of successful health promotion programs in one population. As guidance for practice in another population, especially another culture, this has led many programs down a primrose path of misplaced precision and misguided certainty about practices. The editors of this book, in the previous edition and in this new edition, have wisely avoided the overgeneralization or external-validity trap by addressing the question of promoting health for each of the major ethnic populations separately.

    With the integration and consolidation of material from a number of chapters from the previous edition, Huff, Kline, and Peterson have achieved a more readable and compact volume for instructional purposes. As in the previous edition, the book presents the experience of health promotion professionals in their work with specific racially, ethnically, and culturally identified populations. Each chapter can be read for the lessons it may hold for other professionals working with the same populations. Each can be read, with some greater caution, for the lessons it may hold for working with other populations. Generalizability may be the least appropriate scientific construct to be brought to bear in multicultural health promotion.

    Even within the culturally identified categories used in the chapter titles, such as Latino, African-American, American Indian, Alaska Native, Asian-American, Pacific Islander, and Arab-American, one finds vastly varied populations. One must exercise similar caution in generalizing from these categories to their counterparts living under national conditions other than the United States. The American Indian and Alaska Native counterpart “First Nations” populations of Canada and Aboriginal populations of Australia, for example, have some common historical colonization, economic disadvantage, and cultural characteristics vis à vis their respective majority neighbors. But each has distinct features and circumstances that would make some generalization from the American experiences in this book misguided if not hazardous for health promotion professionals working cross-culturally in other countries.

    These cautions notwithstanding, the authors of the chapters in this anthology of multicultural experience offer a wealth of insight and a treasure of stories and case studies that can enlighten the cultural knowledge and awaken the cultural sensitivity of practitioners everywhere. As a handbook for practitioners, this volume promises to serve health promotion well.

    One overriding lesson, principle, or prediction to be drawn from the multicultural experiences reflected in this handbook would be that promoting health in multicultural populations must ultimately be from within the cultures intended to benefit from the health promotion. Yes, collaboration between an ethnic minority population and professional practitioners from the majority culture can be helpful and productive, but such collaboration must be in the spirit of participatory research. Why participatory research? Because the health promotion task in every community is first to understand itself, second to communicate that understanding with consistency and credibility, and third to produce action from the understanding and commitment mobilized by its communication. These are the three elements of participatory research: systematic investigation or self-study, colearning, and action. Practitioners working cross-culturally can only participate in the self-study, learning, and action process effectively if the population affected by the issues is actively engaged in all three.

    Each of the chapters in this book brings a unique set of perspectives from the multicultural encounters represented by it. Each represents such encounters within the American context of multiculturalism, except one. The chapter by Frankish, Lovato, and Poureslami from Canada reminds us that we risk falling into another level of ethnocentrism if we view the issues of multiculturalism strictly through the American lens of health promotion or of interethnic encounters in the United States. The very naming of the ethnic groups as African-American, Asian-American, and Native American, for example, might lull us into parochialism about these ethnic populations. Thus, we would miss the opportunity to study and understand their counterparts in Canada, Australia, and other countries absorbing immigrant and indigenous populations and seeking to nurture the maintenance of their cultural heritages together with the inevitable experience of acculturation and assimilation into their mainstreams. The Canadian First Nations and the Australian Aboriginal populations, for example, have much to teach us about the multicultural experiences in health promotion, and the comparative study of these experiences can enlighten the efforts in all countries that must grapple with them. The contemporary European experience of immigration from Muslim countries and the massive refugee movement across the borders of war-torn countries in Africa and the Middle East make the subject addressed by this book all the more urgent in the broader global perspective.

    Lawrence W. Green DrPHAdjunct Professor, Department of Epidemiology and Biostatistics School of Medicine Co-Leader, Society, Diversity and Disparities Program Comprehensive Cancer Center University of California at San Francisco

    Preface

    It has been over seven years since the release of the second edition of Health Promotion in Multicultural Populations: A Handbook for Practitioners and Students. In that period, the United States has continued to grow more ethnically diverse. The editors recognize that ethnicity is a rather broad way in which to examine special populations. However, categorization by ethnicity does make it possible to focus on the unique characteristics of ethnic groups and their subgroups with respect to their cultural values, beliefs, customs, and mores and how these may affect programs seeking to improve their health and well-being. Regardless of the special populations being treated, we recognize that with the passage of time, many of these special populations have produced second or more generations of native-born children of native-born parents. In most instances, with or without mixed marriages, they straddle two or more cultures and face the challenges of living in both while seeking their own identities and lifestyle patterns. In addition, the number of recent and new immigrants coming from a myriad of countries has brought forth a variety of old and new health problems that now must be addressed. These problems and needs will require health practitioners and students of Health Promotion and Disease Prevention (HPDP) to think and act in new ways to effectively address the health care needs of these special population groups as well as those groups who are underserved and have been living in the United States going back even before its very beginning. There are, obviously, a number of difficulties associated with defining special population groups that present some challenges to a book such as ours. These include a variety of issues such as age, gender, and generational differences in which adoption of Western health care practices might be in conflict with more traditional practices (i.e., folk medicine, shamanism, tribal medicine practices, etc.).

    The editors also recognize that special populations can be defined on the basis of shared similarities, including chronic or acute health problems, disabilities, sexual orientation, and any number of other variables one might consider when trying to categorize people. It is not the aim of this book to try to address all these issues. Rather, we seek to combine theory, practice, and ethnic considerations that address the broad range of special population characteristics in the belief that, through this approach, practitioners and students can adapt these to their particular needs and issues.

    We recognize that the book is primarily focused on populations living in the United States and on practitioners and students working with these groups. Thus, making generalizations from the American experiences and practices covered in the text to other multicultural populations outside the United States should be done with caution. That said, we certainly want to encourage health promotion students and professionals working in other countries (outside the United States) to use the book because it does contain many methods, approaches, and take-off points that can be of value regardless of national differences. But, again, there must be an awareness of the differences and limitations as they attempt to transfer the information and experiences into their multicultural settings particularly in light of major system differences—that is, in political, economic, ecological, health care, and sociocultural climates and in the confusing use of different labels and categories by which target populations are described.

    Lawrence Green, in the Foreword to this third edition wrote, “promoting health in multicultural populations must ultimately be from within the cultures intended to benefit from the health promotion. Yes, collaboration between an ethnic minority population and professional practitioners from the majority culture can be helpful and productive, but such collaboration must be in the spirit of participatory research.” Participatory research should occur in all multicultural settings regardless of geographical locale. The need for intensive collaboration between the target group, community members, and practitioners should be emphasized from the outset of a program or intervention. This book, throughout, strongly encourages collaborative processes that can better ensure that any programs or interventions ultimately developed must be tailored to the needs, interests, and concerns of each specific target group.

    In the time period that has elapsed since the second edition, there have been many advances and improvements in theory and practice in health promotion and disease prevention (HPDP) including passage of the Patient Protection and Affordable Health Care Act signed into Public Law on March 23, 2010, with most of its major provisions effective by 2014. Given all of this, there has been an increased awareness of the impact of culture, cultural diversity, cultural competency, national differences, and health disparities on practitioners, instructors, and students. This increased awareness requires timely, relevant, appropriate, and current information concerning best practices and processes used in the field when working across multicultural population groups.

    This book has been written for a variety of practitioners and students representing the many disciplines involved in the fields of health promotion and education, public health, nursing, medicine, psychology, medical anthropology, sociology, social work, dentistry, physical therapy, radiologic technology, and all other helping professions that are in daily contact with culturally diverse population groups. It is our hope that this book will help to facilitate knowledge and practice activities that result in systematically designed and culturally sensitive, appropriate, and relevant HPDP activities and services for all those we serve.

    Overview of the Book

    This book is grounded in the premise that working within multicultural settings to promote health and prevent disease requires an understanding of the basics of program planning and an in-depth understanding of the cultural group and locale being targeted. The awareness of who these people are requires knowledge of their history and immigration patterns, cultural values and norms, cosmology and religious practices, social and political systems, health disparity status, health beliefs and practices, and other culture-specific demographic variables that characterize the population and/or subpopulations of interest.

    The structure and format of the third edition is similar to the second edition in that it has been written for practitioners in the field but also with students and instructors in mind. Thus, objectives at the beginning of each chapter as well as suggested discussion topics and/or exercises following each chapter have been maintained. Wherever possible, transitions between chapters has been included to facilitate better cross-referencing of material so that material learned in earlier chapters can be built on in later chapters as the reader progresses through the various sections of the book.

    As a classroom text, the authors offer the following suggestions for how this book can be used. Some of these guidelines come from their personal experiences with using the book in their own public health education classes. Because the text is a handbook and includes a number of sections that highlight diverse cultural and ethnic groups, having students read the entire text may not be the best way to use this book. Rather, the book should be used as a sampler where students seek out information and skills about different cultural groups that can be used as a basis for classroom discussion and related activities. That is, depending on the focus of the course, the instructor may have the class concentrate on the opening eight foundation chapters and then break the class into small groups to explore other sections as a group work assignment. Then, groups can come together to share their readings, compare and contrast similarities and differences between the multicultural groups that were assigned, and then look at how they might design health education and promotion interventions for specific problems the instructor might identify. This provides students with an opportunity to delve more deeply into their assigned multicultural group by studying the pertinent literature in depth on that group and the HPDP interventions that have been employed and reported on in the literature. This can lead to classroom presentations and or papers that explore their assigned multicultural group in much greater depth than the book is able to do.

    In the course we teach, students are required to read Part I of the book over several weeks. Issues are then discussed in class each week from the readings including the use of suggested “Discussion Questions and Activities” at the end of each of the chapters. Then, all members of the class are given an opportunity to select a multicultural group they are interested in for their individual research projects. We then focus on health disparities, cultural assessment and program planning, implementation, and evaluation using the chapters in the book as the basis for these discussions. As the semester progresses, students are required to prepare short presentations about their target group, including a historical overview of the target group, its migration and immigration to the United States, and its acculturation and assimilation practices; the health beliefs and practices relevant to that target group; suggestions for how to intervene with a HPDP program(s); and tips that others in the class could use if they found themselves working with that population group. Students are required to target a culture group living in a specific geographical locale and with a particular health issue they will focus on. There are many ways a text such as this one can be used in the classroom to help develop a sense of cultural competence and sensitivity as students prepare to enter their chosen professional fields, and we encourage instructors to share their experiences with us as they use the book in their classrooms. In the second edition of the book, there were six “Tips” chapters following each major part of the text. Each of these tips chapters have now been combined into a separate, comprehensive chapter broken down into general and specific tips for working with multicultural populations that practitioners and students can review and incorporate into their HPDP activities. We felt this would reduce redundancy from the second edition and improve usability of the book for all who read it.

    References from the second edition have been expanded in the process of chapter updating. Some selected web sites for increasing the student and the practitioner's knowledge of valuable resources and supplementary materials will be found throughout the book. We also hope these changes will appeal to health professionals using the book as a handbook or reference guide and make it easier for them to access important information they may need in their practice settings.

    This new edition has been reduced from 29 chapters to 20 chapters. We did this to enhance readability and utilization by practitioners, classroom instructors, and students. By doing so, it has allowed us to add six new chapters to the text. Specifically, two brand new chapters (Overview and Case Study) focused on Pacific Islander populations; a new American Indian Case Study focused on mental health; two new chapters (Overview and Case Study) focused on Arab-Americans; and a new chapter focused on cross-cultural communication and health literacy. The third edition then is divided into four parts.

    Part I includes eight chapters that seek to establish a foundation for the parts that follow and include, define, and discuss (1) culture, health promotion, and cultural competence; (2) traditional concepts of health and disease; (3) ethical issues when working with multicultural population groups; (4) an overview of current theories and models of behavior change as they relate to health promotion with multicultural populations and groups; (5) an overview of health disparities in multicultural population groups and discussion of the Patient Protection and Affordable Health Care Act; (6) a presentation and discussion of the cultural assessment framework; (7) an overview of health promotion and education planning models, theories, and practice issues; and (8) a presentation and discussion of health communication and health literacy when working with multicultural populations in the United States.

    Part II of the book presents six chapters focused on specific multicultural population groups and includes the following: Hispanic/Latino, African-American, American Indian and Alaska Native, Asian-American, Pacific Islander, and Arab-Americans. Each of these chapters present an overview devoted to understanding these special populations from a variety of perspectives including terms to define subgroups within the broader population, historical and demographic characteristics, immigration patterns, health and disease issues and concerns, health beliefs and practices, and considerations when working with these groups in HPDP.

    Part III of the book presents four case studies reflective of the groups discussed earlier and which have been included to help emphasize points made in Parts I and II of the text.

    The final section of the book (Part IV) presents a tips chapter discussed previously and then concludes with a final chapter discussing ongoing and future dilemmas and concerns that will be faced by practitioners and students working with multicultural populations in a variety of health care and community settings.

    Acknowledgments

    The editors deeply thank all those who helped in the preparation of this book. We especially thank our SAGE team of editors, Reid Hester, Sarita Sarak, and Jane Haenel; and our marketing manager, Nicole Elliott. We also want to thank Lana Todorovic-Arndt for her diligent copyediting of the entire draft. Finally, we thank our families for their support, encouragement, and patience during the preparation of this third edition.

    Publisher's Acknowledgments

    SAGE Publications gratefully acknowledges the contributions of the following reviewers:

    Justin Coran, University of Florida

    Mary Lou Gutierrez, Walden University

    Meghan Moran, San Diego State University

    Larry Williams, North Carolina Central University

    About the Editors

    Robert M. Huff is emeritus professor of public health education at California State University, Northridge (CSUN). Prior to joining the faculty at CSUN, he was a health education practitioner for the Charles Drew Postgraduate Medical School in Los Angeles, where he was actively involved in community hypertension education, screening, referral, and follow-up activities and in the Martin Luther King, Jr., General Hospital, where he directed patient education programming in the Department of Internal Medicine. He later moved to the Ventura County Health Care Agency–Public Health Services and the Ventura County Medical Center, where he established and directed the Department of Patient Education for inpatient and outpatient services and was the health education consultant for the hospital's Family Practice Residency Program. He also organized and managed an agencywide teleproduction facility; codeveloped and managed a countywide health promotion center; and consulted on a variety of public health programs, including chronic disease prevention, family life education, and HIV/AIDS awareness and prevention, where he was also an HIV alternative test site counselor for Public Health Services.

    He teaches both undergraduate and graduate courses in public health education in the areas of program planning and evaluation; health behavior change; communications and media; cross-cultural issues in public health; holistic health; ethics, human rights and cultural diversity, and other related courses. He has been an evaluation consultant for a variety of organizations and projects, including the VA Hospital in Sepulveda, California; the Violence Prevention Project with Ventura County Public Health Services; an alcohol and drug project in the student health center at CSUN; and the Youth Wellness Village Project funded by the California Wellness Foundation in Ojai, California. He also was an editorial consultant and coeditor for the Journal of Drug Education.

    His research interests combine his undergraduate training in anthropology with his graduate training in public health education to focus on multicultural health promotion and disease prevention programs in a variety of settings. He has a special interest in medical anthropology, traditional medicine, shamanism, and complementary and alternative medicine practices. He received his MPH degree in health education from CSUN and his PhD in confluent education from the University of California, Santa Barbara, Graduate School of Education.

    Michael V. Kline is emeritus professor of public health at California State University, Northridge. He taught undergraduate and graduate courses involved with training students and practitioners to design, implement, and evaluate health promotion and education programs within a variety of health settings, population groups, and public sector and community organizations. He directed the Master of Public Health Program for 12 years. Through the years, he has been actively involved in community organization activities relevant to assisting special populations to plan and organize health programs in their neighborhoods.

    He served in the capacities of editorial consultant, associate editor, and executive coeditor of the Journal of Drug Education. He continues his long association as behavioral sciences consultant with the Research and Evaluation Section, Planning Division, Alcohol and Drug Program Administration, Department of Public Health, County of Los Angeles. He has worked in several areas: alcohol prevention and education consultation, assistance in the development of data management and information systems, alcohol client tracking activities, and alcohol and drug program evaluation systems. He formerly was the executive director of several alcohol and drug treatment programs in Los Angeles, including the Edgemont House social model prototype program and the Golden State Community Mental Health Center Comprehensive NIAAA (National Institute on Alcohol Abuse and Alcoholism) alcohol treatment program. He was the director of the Los Angeles County Alcohol Training Consortium and associate state director of the California Alcohol Foundation. He also has been involved in providing extensive technical consultation and education in the development and evaluation of drinking driver programs. He formerly was the district director of health education, Southeast Region, Department of Health Services, County of Los Angeles. He also served as the medical care organizer for the Department of Health Services, Department of Hospitals, and Department of Mental Health, County of Los Angeles, in the early development of the Hubert Humphrey Health Center in South Los Angeles.

    He was a lecturer in Public Health at the University of California, Los Angeles School of Public Health and lecturer in Public Administration at the University of Southern California, School of Public Administration. He also was the director of public health education at the Orange County (California) Department of Public Health. He received his MPH degree in public health education and behavioral sciences from the University of California, Berkeley, School of Public Health. He received his DrPH degree in medical care organization and health administration from the University of California, Los Angeles, School of Public Health.

    Darleen V. Peterson is associate professor of community and global health at Claremont Graduate University (CGU). She also serves as the school's associate dean of academic affairs and is the founding director of the Master of Public Health (MPH) Program. Prior to joining the faculty at CGU, she served as an assistant professor of Clinical Preventive Medicine at the University of Southern California (USC), where she was the assistant director of the MPH program. She has taught graduate courses in health behavior theory, health communications, and supervised field training in public health. Her research interests include health communication, specifically the evaluation of statewide tobacco control campaigns and the assessment of protobacco marketing activities on youth smoking. She currently provides consultation on public health program accreditation to new and existing MPH programs. She received an MA in communications management from USC's Annenberg School for Communication, an MPH in Community Health Education from California State University, Northridge, and a PhD in preventive medicine (health behavior research) from the Keck School of Medicine of USC. She is a masters-level certified health education specialist (MCHES).

    About the Contributors

    Sawssan R. Ahmed PhD, is an assistant professor in the Department of Psychology at California State University, Fullerton. She received her doctoral degree in clinical psychology with specializations in community psychology and quantitative methods where her work focused on the relationship between sociocultural factors (including perceived racism, religiousness, and ethnic identity) and the physical and mental health of adolescents of color. She has completed postdoctoral work in health disparities and children's services research at the University of California, Los Angeles’ Center for Culture, Trauma, and Mental Health Disparities and at San Diego State University where she was the Oscar Kaplan Fellow in developmental issues. Her research interests include understanding the link between sociocultural risk and protective factors and health disparities in adolescents of color with specific interests in Arab-American and refugee youth.

    Shayma Alzubi MPH, received her master's degree in urban public health from the Charles Drew University (CDU) of Medicine and Science. While pursuing her degree, she volunteered as an HIV testing counselor with the CDU HIV Education and Community Outreach projects on their mobile testing unit. She also has a BS degree in biochemistry from the University of California, Riverside. As a public health professional, she hopes to work with the Arab-American communities to educate, empower, and mobilize them to improve their well-being.

    Lourdes A. Baezconde-Garbanati PhD, MPH, is an associate professor in preventive medicine at the Keck School of Medicine of USC. She also holds a joint appointment in sociology from the Dornsife School of Letters, Arts, and Sciences and a courtesy appointment at the Annenberg School for Communication and Journalism. She has devoted her career to increasing the understanding of the important role of culture in health behaviors with the goal of correcting health inequities. She works with various population groups though the emphasis is on Hispanic health. She conducts community-based participatory research in cancer control in the areas of women's cancers, tobacco prevention, and youth empowerment to eliminate obesity at the community level. She has received multiple awards from the National Institutes of Health (NIH) and is a nationally and internationally known expert on health disparities.

    Patricia Chalela DrPH, is an assistant professor at the Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio, Texas. Her areas of expertise include social and behavioral sciences, health communications and promotion, and health disparities research. Her main research interests are in chronic disease prevention and control, particularly the role of epidemiological, environmental and individual psychosocial factors on health and disease, and on racial/ethnic disparities with emphasis on Latino populations. Her research studies involve applied research methods with multidimensional strategies comprised of theory-driven hypothesis development and testing, and the design, implementation, and evaluation of theory-based interventions to promote healthy behaviors, improve health outcomes, and reduce health disparities among underserved populations.

    Michael R. Cousineau DrPH, is an associate professor of research in the Department of Family Medicine and director of the Center for Community Health Studies at the University of Southern California (USC), Keck School of Medicine. His primary research interests are health policy and health services evaluation research, access to care for low-income and uninsured families, governance and operation of safety-net providers, and health needs of vulnerable populations including the homeless.

    N. Tess Boley Cruz PhD, MPH, CHES, is an assistant professor of clinical preventive medicine in the Department of Preventive Medicine and the Institute for Prevention Research at the University of Southern California, Keck School of Medicine. She teaches in academic programs at USC, conducted evaluations of community-based programs, and trained health professionals in materials development for low-income populations. Her primary research interests are health disparities, health literacy, public health communication, tobacco marketing, and tobacco control.

    Diane Viscencio Dobbins MPH, RN, has 40 years of experience working in public health and community health nursing. She has advocated on behalf of maternal child health programs and populations for the State of California and the March of Dimes. She has been instrumental in the development of community collaboratives focused on teen pregnancy, breastfeeding, and family violence prevention. Her graduate work culminated in a thesis exploring the cultural competency of law enforcement agencies in three rural communities experiencing demographic changes. She is a lecturer at California State University, Northridge where she teaches both undergraduate and graduate MPH students in cultural competency, community organization, and current issues in public health.

    C. James Frankish PhD, is the director of the Centre for Population Health Promotion Research and is a professor in health care and epidemiology (medicine) and the College for Interdisciplinary Studies at the University of British Columbia. He has authored numerous papers on community participation, mental health and population health, health impact assessment, and participatory research. His prior work includes research on regional health boards and national studies of measures of health communities, health goals, and health promotion in primary care. His current projects focus on health promotion and homelessness, health literacy, and poverty and nutrition. He is on the board of the Lookout Homeless Shelter Society and is chair of the Impact of the Olympics on Communities Coalition.

    Kipling J. Gallion MA, is deputy director of the Institute for Health Promotion Research (IHPR) at the University of Texas Health Science Center at San Antonio, Texas, and is an accomplished health communications producer and researcher who has vast experience in program development and analysis. He has helped to develop different culturally tailored media strategies, technologies, and messages to promote positive health behavior changes, such as new public health service ads to promote Latino cancer screenings and new avenues to spread positive messages, like the social media realm of Facebook and Twitter. He is also involved in helping coordinate several IHPR research projects funded by National Cancer Institute (NCI), NIH, the Susan G. Komen for the Cure, and the Robert Wood Johnson Foundation.

    Patti (Rosa Patricia) Herring RN, MA, PhD, is an associate professor in the Department of Health Promotion and Education at Loma Linda University, Loma Linda, California. She is a codirector and coinvestigator for the Adventist Health Study-2 and consults in a variety of roles, including the San Bernardino County Head Start Program, The Inter-American Improvement Association, and the Moreno Valley Unified School District grant to serve underserved, minority, and disadvantaged children's academic and social development—a service learning project.

    Christopher Elliott Hodge MA, has worked in the area of cultural competency in American Indian populations. His research interests include childhood trauma, posttraumatic stress disorder (PTSD) and maladaptive behaviors in American Indian groups.

    Felicia Schanche Hodge DrPH, is a professor in the School of Nursing and School of Public Health at the University of California, Los Angeles. She has over 30 years of experience working in American Indian communities and has developed the Talking Circle intervention as a data collection measure as well as a method of delivering educational interventions. Her work includes health behavior research in chronic disease prevention and intervention in the areas of cancer, diabetes, smoking cessation, and adverse childhood events.

    Joyce W. Hopp PhD, MPH, CHES, RN, is a distinguished professor of Health Education at Loma Linda University, Loma Linda, California. She has taught in the Department of Health Promotion and Education in the School of Public Health since 1968. For 16 years, she served as dean of the School of Allied Health Professions at the university. She has served on the editorial board of the Journal of School Health and as a reviewer for numerous peer-reviewed journals in the field of health education. She has received awards for educating minority young people and for fostering cultural pluralism through 40 years of international health professions education.

    Sondos M. S. Islam PhD, MPH, MS, is an associate professor and director of the Urban Public Health Program in the College of Science and Health at Charles R. Drew University of Medicine and Science. She teaches graduate courses in program planning and evaluation, social and behavioral theories in public health, epidemiology, and biostatistics, and she chairs numerous MPH theses. Her expertise is in curriculum development and health program evaluation, and she is currently a Council on Education for Public Health (CEPH) certified site visitor. Her research is focused on the influence of cultural factors on Arabs’ and Arab-American health behaviors.

    Aimie F. Kachingwe PT, DPT, EdD, OCS, F.A.A.O.M.P.T., is an associate professor in the Department of Physical Therapy at California State University, Northridge. She is an American Physical Therapy Association Board certified clinical specialist in orthopedics and a fellow of the American Academy of Orthopaedic Manual Physical Therapists. Her research interests include the promotion of ethnic diversity in the profession of physical therapy and the incorporation of multiculturalism into health care educational curriculum.

    Marjorie Kagawa-Singer PhD, MA, MN, RN, is a professor in the Department of Asian American Studies at the University of California, Los Angeles (UCLA) School of Public Health in Los Angeles, California. Her clinical work has been in oncology and on the etiology and elimination of disparities in physical and mental health care outcomes for communities of color, with a primary focus on Asian-American and Pacific Islander communities. She serves on multiple local, state, and national committees addressing the impact of ethnicity on health care and health outcomes and is the principal investigator of the Los Angeles site for the National Cancer Institute–funded national Asian American Network on Cancer Awareness Research and Training.

    Christine Kho is a second-year medical student at the David Geffin School of Medicine. She is president of the UCLA chapter of the national Asian Pacific American Medical Student Association. This chapter advocates for reducing health disparities and improving health access in Asian Pacific Islander communities in the Greater Los Angeles area. She is committed to focusing her medical career on issues of social justice, especially as they pertain to the quality of health care for Asian-American, Native Hawaiian, and Pacific Islander communities.

    Chris Y. Lovato PhD, is an associate professor in the Department of Health Care and Epidemiology at the University of British Columbia (UBC) where she teaches program evaluation to graduate students. She is also director of the Evaluation Studies Unit for the Faculty of Medicine at UBC. Her primary areas of expertise are population health and program evaluation. Much of Dr. Lovato's research has focused on youth tobacco control including the evaluation of smoking cessation interventions. She has extensive experience in program evaluation and has provided consultation to numerous government and nongovernment agencies evaluating health-related programs.

    Omar M. Mahmood PhD, is a clinical psychologist specializing in neuropsychological assessment of children and adults. He has extensive experience conducting cognitive evaluations bilingually (English and Arabic) with patient populations in the United States and throughout the Middle East. He is also a research scientist at the University of California, San Diego, and the VA San Diego Healthcare System.

    Alfred L. McAlister PhD, is a professor at the University of Texas, Houston School of Public Health. He was the lead member of the research teams of the Stanford 3-Community Study in California and the North Karelia Project in Finland. He has been involved in the Centers for Disease Control and Prevention (CDC) AIDS Community Demonstration Projects, led several international research studies in Europe and Latin America, and participated in teaching and research in a variety of countries in Europe and Central and South America.

    Janelle F. Palacios PhD, CNM, RN, is a faculty researcher at the Native American Research and Training Center in the Department of Family and Community Medicine at the College of Medicine at the University of Arizona. She is a postdoctoral fellow in the School of Nursing at the University of California, Los Angeles, and is a practicing certified nurse midwife in Northern California. With over 11 years of experience working collaboratively with American Indian Communities, she has focused on the use of storytelling to elicit young parenting experiences. Her research interests include maternal/child health, parenting, adverse childhood experiences, reproductive health, substance abuse, and mental health.

    Paula Healani Palmer PhD, is associate professor and director of Global Programs at the Claremont Graduate University School of Community and Global Health. Her research focuses on the reduction of health disparities among ethnically diverse and underrepresented population in the United States and abroad. Recent research projects funded through the National Institutes of Health include community-based participatory research (CBPR) study that investigates how culture, social, and environmental cues, and neurocognitive characteristics impact cigarette smoking and quitting among Pacific Islanders and a study of mental health outcomes among China's internal migrants. Other funded projects include a CBPR project that studies the influences impacting smoked and smokeless tobacco use among immigrant Pakistanis, Indians, Nepalis, and Sri Lankans as well as a longitudinal study on mental health and social readjustment of tsunami victims in India and Sri Lanka. She has developed and teaches graduate courses on global health, disaster management, maternal and child health, ethics and culture, and leadership and management of global health organizations. She and her team utilize various types of technology to facilitate both virtual global learning environments and innovative methods of health promotion interventions.

    Iraj Poureslami PhD, is a senior research associate at the Human Early Learning Partnership and Centre for Population Health Promotion Research at the University of British Columbia. He is a WHO EMRO (World Health Organization Regional Office for the Eastern Mediterranean) mentor of health promotion, WHO Early Childhood Development Knowledge Network consultant, and member of the Canadian Council on Learning's health literacy expert panel. His research interests are in the sociocultural determinants of health and quality of life within ethnocultural communities in Canada. He has extensive knowledge and expertise on developing community-based health literacy information, audio-visual materials, and working with newcomer communities and their families in British Columbia.

    Amelie G. Ramirez MPH, DrPH, is a professor of epidemiology and biostatistics at the University of Texas Health Science Center at San Antonio, where she is also a founding director of the Institute for Health Promotion Research. Over the past 30 years, she has directed many research programs focused on human and organizational communication to reduce chronic disease and cancer health disparities affecting Latinos. She directs two national research networks, one funded by the National Cancer Institute and one funded by the Robert Wood Johnson Foundation. She has been recognized for her work to improve Latino health and advance Latinos in medicine, public health, and behavioral sciences and was the 2011 White House Champion of Change. She has served on many boards and advisory committees both nationally and locally in her community including the Institute of Medicine of the National Academies and the Susan G. Komen for the Cure Scientific Advisory Board.

    Gregory D. Stevens PhD, is an assistant professor of research in the Department of Family Medicine and Center for Community Health Studies at the University of Southern California, Keck School of Medicine. His research has focused on primary health care quality for vulnerable children, racial/ethnic and socioeconomic disparities in care, and patient-provider relationship issues involved in the delivery of well-child care and developmental services.

    Ian M. Thompson Jr. MD, is an internationally renowned expert in prostate, bladder, kidney, and testicular cancer. He received his undergraduate degree from West Point and his MD degree from Tulane University. He retired as a colonel from the U.S. Army, having served as chairman of the Department of Surgery at Brooke Army Medical Center as well as commander of the 41st Combat Support Hospital. He served in Saudi Arabia and Iraq as a general surgeon in a combat support hospital during Operation Desert Storm/Shield. He is the current director of the Cancer Therapy & Research Center at the University of Texas Health Science Center at San Antonio that is the only NCI-designated cancer center in South Texas. He is known as an international groundbreaker in the advancement of care and treatment for prostate cancer through his clinical trial experience and multiple large-scale cancer research studies.

    Christina Vane MPH, completed her master's at the University of Southern California with an emphasis in child and family health. She is currently a project manager in the Department of Family Medicine at the Keck School of Medicine at USC, focused on primary care and diabetes, and she has worked in health policy specifically focused on implementing health care reform in California. Her primary research interests lie in uninsured, underinsured, and undocumented populations.

    Soheila Yasharpour MPH, is project coordinator of the Infoshare Project at the David Geffen School of Medicine at the University of California, Los Angeles. She has been involved in a variety of health education projects addressing the needs of underserved communities and is currently working on a project focusing on information technology and bioinformatics in local hospitals and clinics in Los Angeles.

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