Think Cultural: Communication Tools for the Clinician
April is National Minority Health Month, and the US Department of Health and Human Service's Office of Minority Health (OMH) has communication tools for healthcare providers at its Think Cultural Health Web site (https://www.thinkculturalhealth.hhs.gov). An online tutorial, the Guide to Providing Effective Communication and Language Assistance Services, is available in 2 tracks: 1 tailored to healthcare providers, with information on working with interpreters and cross-cultural communication skills, and another for healthcare administrators, with details on planning, implementing, and evaluating communication methods and language assistance services. These 2 guides are commensurate with the mandate for National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Language access resources at the site promote patient-centered, cross-cultural communication based upon the RESPECT model: rapport, empathy, support, partnership, explanations, cultural competence, and trust. The INTERPRET tool guides clinicians on how best to work with interpreters.
* I-Introductions: Introduce all persons in the room and relay their role.
* N-Note goals: Interview goals might include the diagnosis, treatment plan, and follow-up.
* T-Transparency: Explain to the patient that the interpreter will share the entire discussion.
* E-Ethics: Use qualified interpreters (not children or family members) to promote patient autonomy.
* R-Respect beliefs: A cultural broker may be necessary to explain cultural beliefs of limited English proficient patients.
* P-Patient focus: To maintain a patient-centered encounter, healthcare providers should interact with the patient instead of the interpreter.
* R-Retain control: Healthcare providers should direct the conversation to maintain a clinical focus.
* E-Explain: Use short sentences and simple language so that information conveyed by the interpreter is clear.
* T-Thanks: The interpreter and patient should be thanked for their time, and the need for language assistance should be charted.
The OMH profiles the following minority populations: black/African American, American Indian/Alaska Native, Asian American, Hispanic/Latino, and Native Hawaiian/Pacific Islander. Although these are the largest groups across the United States, each state has unique demographics that may require clinicians to modify their practice. For example, the Minnesota State Demographic Center relays that 1 in 14 state residents were foreign born and largely hailed from Mexico, India, Laos/Hmong, Somalia, Vietnam, Thailand, and China. Cohorts of increasingly diverse state populations enter the country as refugees (2475 in Minnesota in 2014) and require unique health screening and referrals (http://mn.gov/admin/demography/data-by-topic/immigration-language/index.jsp).
The National Association of State Offices of Minority Health has a listing of minority health resources at http://www.nasomh.com. The US Committee for Refugees and Immigrants has a healthy living toolkit available in an array of languages (ie, Arabic, Hmong, Somali, and Vietnamese) to address topics such as diabetes, heart disease, and obesity. It can be found at http://www.refugees.org/resources/for-refugees-immigrants/health/.
An overarching goal of the Think Cultural Health program is to advance health equity at every point of contact. Consider profiling language access resources in your workplace to facilitate care provided to the diverse patient population we encounter today.
Childhood Obesity: What Can We Do?
In the United States, approximately one-third of the 23.5 million kids and teenagers are overweight or obese. This increases the risk of serious health problems. We have all seen how unhealthy foods are sold in larger portion sizes and at lower prices, where healthier foods like fruits and vegetables are more expensive and less accessible for many. We have also watched lifestyles change from being physically active and playing outside to more sedentary and sitting inside playing computer-type games.
To address the obesity dilemma, the American Heart Association (AHA) and the Robert Wood Johnson Foundation have partnered on a program called Voices for Healthy Kids. The program aims to work with communities to create safe roads and parks for children to play and exercise and with schools to support and offer good nutritional meals and education for children and families to improve diets at home. The program provides grants and resources and is also working through advocacy to pass policies that support the initiative.
Voices for Healthy Kids will focus on 6 issues:
* Improving the nutritional quality of snacks and drinks in schools
* Reducing consumption of sugary drinks
* Protecting children from marketing for unhealthy foods and drinks
* Increasing access to affordable healthy foods
* Increasing access to safe spaces for physical activity
* Helping schools and youth programs increase children's physical activity levels
The goal of Voices for Healthy Kids is to help all children achieve a healthy weight. It is important for everyone to get involved, through partnerships with national organizations and grassroots groups and individual participation. Working with your local AHA chapters can begin the process. It may be that you get involved with the Parent Teacher's Association at your local school, present a PowerPoint presentation to the local Rotary Club for awareness and support, or present to other local groups in your communities that would support the initiative. No matter how small or big the action, it begins with each of us in our communities.
Alcohol: Is it Safe?
The AHA and the American Cancer Society have recommended for years that if you drink, do so in moderation. "Moderation" means an average of 1 to 2 drinks per day for men and 1 drink per day for women. One drink equals a 12-oz beer, 4 oz of wine, 1.5 oz of 80-proof spirits, or 1 oz of 100-proof spirits. Higher amounts of alcohol increase the risk of obesity, high blood pressure, stroke, breast cancer, suicide, accidents, and of course alcoholism. We have also heard that excessive drinking and binge drinking can lead to fetal alcohol syndrome, cardiomyopathy, cardiac arrhythmia, and sudden cardiac death. Given the risks associated with alcohol consumption, the AHA advises people not to start drinking if they do not already drink alcohol.
The Negative Effects of Alcohol
So how does alcohol cause cancer?
* Alcohol can damage body tissues especially in the mouth and throat. As the cells try to repair themselves, it can lead to DNA changes that can lead to cancer.
* Alcohol can help other chemicals such as tobacco smoke enter the cells in the esophagus, stomach, and duodenum easily. Alcohol can also slow the elimination of some harmful chemicals from the body.
* In the colon and rectum, bacteria can convert alcohol into acetaldehyde, a chemical that has been shown to cause cancer in laboratory animals.
* Alcohol and its byproducts can damage the liver, leading to inflammation and scarring. As the liver attempts to repair itself, there can be changes in DNA that could lead to cancer.
* Alcohol can lower the body's ability to absorb folate from foods. Low folate levels may increase the risk of breast and colorectal cancers.
* Alcohol can raise levels of estrogen in the body. This could affect a woman's risk of developing breast cancer.
* Alcohol can contribute to weight gain. Overweight and obesity are a known risk for many types of cancer.
The Positive Effects of Alcohol
For years, many studies have suggested that there is a reduction in cardiovascular mortality from drinking alcohol. Is it the relaxation, the flavonoids, and other antioxidants that reduce the heart disease risk? Or is it lifestyle factors such as physical activity and a diet high in fruits and vegetables and lower in saturated fats that reduce the cardiovascular mortality? No studies thus far have shown the specific effect of wine or other alcohol on the risk of developing heart disease or stroke. Further studies to determine the specific effect of alcohol on the risk of developing heart disease or stroke are needed.
So Is Alcohol Safe?
The World Cancer Report issued by the World Health Organization's International Agency for Research on Cancer in 2014 concluded that "Responsible drinking has become a 21st century mantra for how most people view alcohol consumption. But when it comes to cancer, no amount of alcohol is safe."
April is Alcohol Awareness Month. If you are looking for the benefits of alcohol without the risks, consider the flavonoids and antioxidants in fruits such as grapes and blueberries and some vegetables, rather than the alcohol.