Project Joy: faith based cardiovascular health promotion for African American women.
OBJECTIVE: The authors tested the impact on cardiovascular risk profiles of African American women ages 40 years and older after one year of participation in one of three church-based nutrition and physical activity strategies: a standard behavioral group intervention, the standard intervention supplemented with spiritual strategies, or self-help strategies. METHODS: Women were screened at baseline and after one year of participation. The authors analyzed intention-to-treat within group and between groups using a generalized estimating equations adjustment for intra-church clustering. Because spiritual strategies were added to the standard intervention by participants themselves, the results from both active groups were similar and, thus, combined for comparisons with the self-help group. RESULTS: A total of 529 women from 16 churches enrolled. Intervention participants exhibited significant improvements in body weight (-1.1 lbs), waist circumference (-0.66 inches), systolic blood pressure (-1.6 mmHg), dietary energy (-117 kcal), dietary total fat (-8 g), and sodium intake (-145 mg). The self-help group did not. In the active intervention group, women in the top decile for weight loss at one year had even larger, clinically meaningful changes in risk outcomes (-19.8 lbs). CONCLUSIONS: Intervention participants achieved clinically important improvements in cardiovascular disease risk profiles one year after program initiation, which did not occur in the self-help group. Church-based interventions can significantly benefit the cardiovascular health of African American women. (+info)
Reconceptualizing native women's health: an "indigenist" stress-coping model.
This commentary presents an "indigenist" model of Native women's health, a stress-coping paradigm that situates Native women's health within the larger context of their status as a colonized people. The model is grounded in empirical evidence that traumas such as the "soul wound" of historical and contemporary discrimination among Native women influence health and mental health outcomes. The preliminary model also incorporates cultural resilience, including as moderators identity, enculturation, spiritual coping, and traditional healing practices. Current epidemiological data on Native women's general health and mental health are reconsidered within the framework of this model. (+info)
Spirituality and health for women of color.
Spirituality among African American and Hispanic women has been associated with a variety of positive health outcomes. The purposes of this commentary are (1) to define spirituality, comparing it with religiosity, and briefly examine the historical, cultural, and contextual roots of spirituality among women of color; (2) to explore research data that support a relationship between spirituality and health, particularly among women of color; and (3) to present several examples of how spirituality may enhance public health interventions designed to promote health and prevention. (+info)
Religion/spirituality in African-American culture: an essential aspect of psychiatric care.
There is an astonishing diversity of religious beliefs and practices in the history of African Americans that influences the presentation, diagnosis, and management of both physical and mental disorders. The majority of African Americans, however, are evangelical Christians with religious experiences originating in the regions of ancient Africa (Cush, Punt, and to a great extent, Egypt), as well as black adaptation of Hebraic, Jewish, Christian, and Islamic beliefs and rituals. Consequently, more than 60 of the nation's 125 medical schools offer classes in spirituality and health. Although there is a lack of empirical evidence that religion improves health outcomes, physicians should understand patients as a biopsychosocial-spiritual whole. Asking about religion/spirituality during a health assessment can help the physician determine whether religious/spiritual factors will influence the patient's medical decisions and compliance. Two psychiatric case histories of African Americans are presented in which religion/spirituality significantly influenced treatment decisions and results. Neither of these patients suffered major debilitating medical comorbidity. (+info)
Spiritual beliefs may affect outcome of bereavement: prospective study.
OBJECTIVE: To explore the relation between spiritual beliefs and resolution of bereavement. DESIGN: Prospective cohort study of people about to be bereaved with follow up continuing for 14 months after the death. SETTING: A Marie Curie centre for specialist palliative care in London. PARTICIPANTS: 135 relatives and close friends of patients admitted to the centre with terminal illness. MAIN OUTCOME MEASURE: Core bereavement items, a standardised measure of grief, measured 1, 9, and 14 months after the patients' death. RESULTS: People reporting no spiritual belief had not resolved their grief by 14 months after the death. Participants with strong spiritual beliefs resolved their grief progressively over the same period. People with low levels of belief showed little change in the first nine months but thereafter resolved their grief. These differences approached significance in a repeated measures analysis of variance (F=2.42, P=0.058). Strength of spiritual belief remained an important predictor after the explanatory power of relevant confounding variables was controlled for. At 14 months the difference between the group with no beliefs and the combined low and high belief groups was 7.30 (95% confidence interval 0.86 to 13.73) points on the core bereavement items scale. Adjusting for confounders in the final model reduced this difference to 4.64 (1.04 to 10.32) points. CONCLUSION: People who profess stronger spiritual beliefs seem to resolve their grief more rapidly and completely after the death of a close person than do people with no spiritual beliefs. (+info)
Culturally based interventions for substance use and child abuse among native Hawaiians.
OBJECTIVE: This article presents an overview of child abuse among culturally diverse populations in Hawaii, substance use among culturally diverse students in Hawaii, and culturally based interventions for preventing child abuse and substance abuse in Native Hawaiian families. OBSERVATIONS: Native Hawaiians accounted for the largest number of cases of child abuse and neglect in Hawaii between 1996 and 1998. Alcohol and other drugs have increasingly been linked with child maltreatment. Native Hawaiian youths report the highest rate of substance use in Hawaii. Cultural factors such as spirituality, family, and cultural identification and pride are important in interventions with Native Hawaiians. CONCLUSION: Human services should continue to emphasize interventions that integrate "mainstream" and cultural-specific approaches. (+info)
Substance use among American Indians and Alaska natives: incorporating culture in an "indigenist" stress-coping paradigm.
OBJECTIVES: This article proposes a new stress-coping model for American Indians and Alaska Natives (AIs) that reflects a paradigmatic shift in the conceptualization of Native health. It reviews sociodemographic information on AIs, rates of substance abuse and related health outcomes, and the research supporting the model's pathways. OBSERVATIONS: Although health outcomes among AIs are improving, large disparities with other racial and ethnic groups in the United States remain. Many health-related problems are directly linked to high rates of substance use and abuse. CONCLUSION: Eurocentric paradigms focus on individual pathology. An "indigenist" perspective of health incorporates the devastating impact of historical trauma and ongoing oppression of AIs. The model emphasizes cultural strengths, such as the family and community, spirituality and traditional healing practices, and group identity attitudes. (+info)
Patient preference for physician discussion and practice of spirituality.
OBJECTIVE: To determine patient preferences for addressing religion and spirituality in the medical encounter. DESIGN: Multicenter survey verbally administered by trained research assistants. Survey items included questions on demographics, health status, health care utilization, functional status, spiritual well-being, and patient preference for religious/spiritual involvement in their own medical encounters and in hypothetical medical situations. SETTING: Primary care clinics of 6 academic medical centers in 3 states (NC, Fla, Vt). PATIENTS/PARTICIPANTS: Patients 18 years of age and older who were systematically selected from the waiting rooms of their primary care physicians. MEASUREMENTS AND MAIN RESULTS: Four hundred fifty-six patients participated in the study. One third of patients wanted to be asked about their religious beliefs during a routine office visit. Two thirds felt that physicians should be aware of their religious or spiritual beliefs. Patient agreement with physician spiritual interaction increased strongly with the severity of the illness setting, with 19% patient agreement with physician prayer in a routine office visit, 29% agreement in a hospitalized setting, and 50% agreement in a near-death scenario (P <.001). Patient interest in religious or spiritual interaction decreased when the intensity of the interaction moved from a simple discussion of spiritual issues (33% agree) to physician silent prayer (28% agree) to physician prayer with a patient (19% agree; P <.001). Ten percent of patients were willing to give up time spent on medical issues in an office visit setting to discuss religious/spiritual issues with their physician. After controlling for age, gender, marital status, education, spirituality score, and health care utilization, African-American subjects were more likely to accept this time trade-off (odds ratio, 4.9; confidence interval, 2.1 to 11.7). CONCLUSION: Physicians should be aware that a substantial minority of patients desire spiritual interaction in routine office visits. When asked about specific prayer behaviors across a range of clinical scenarios, patient desire for spiritual interaction increased with increasing severity of illness setting and decreased when referring to more-intense spiritual interactions. For most patients, the routine office visit may not be the optimal setting for a physician-patient spiritual dialog. (+info)