Health Promotion Plan: Reducing Tobacco Use Amongst Members of the Russian-American Culture
Russian Cultural Synopsis
There are several unique or otherwise noteworthy practices in the Russian culture that could have an impact on areas of health. Consumption practices tend towards the extreme, with food and drink supplied amply for guests and families alike, resources permitting, and with the extending of hospitality a common and expected practice in the culture (Ries, 2012). Families tend to live together, with multiple generations occupying the same home, though quarters are far less cramped in the United States than they are for Russians still living in their native country, and family influence when it comes to all forms of consumption as well as other behaviors and practices is quite strong (Ries, 2012). At the same time, independence and spontaneity are often observed in the decisions and behaviors made by members of the Russian culture, which can sometimes lead to family conflict (Mead et al., 2001).
This familial devotion is one example of a cultural belief held by the Russians that differs significantly from the attitude in the United States' typical culture. A much greater degree of respect and authority is given to parents and other older generations in a household, rather than the youth seeking and expecting independence and freedom upon reaching adulthood (Ries, 2012). Due to the twentieth-century history of Russia and the Russian people, religious beliefs are highly fragmented and varied amongst modern Russian populations, and this is perhaps more true of Russian emigrants than those still living in Russia (Ries, 2012).
As far as the values and customs of the Russians are concerned, the defining features would have to be a combination of pride and a strong work ethic, leading to fierce independence and at times an aloofness but a high degree of productivity and determination (Ries, 2012; Mead et al., 2001). For example, it would be a point of pride for a Russian family to earn enough to have guests over, and to serve those guests lavishly and in excess (Ries, 2012). There is a definite value placed on material possessions and the showing-off of those possessions, yet there is not the sense of distaste associated with work that can be seen amongst many in the United States (Mead et al., 2001). Certain aspects of Russian culture are more formal than in the United States, such as the custom of using specific forms of address for elders and persons of varying levels of acquaintance and intimacy, while table manners are somewhat looser in this culture (Ries, 2012; Mead et al., 2001).
During the Soviet era, an extreme emphasis on science on education existed in the Russian culture, and this has extended to the modern period (Mead et al., 2001). For this reason, most Russians at home and abroad have a very "Western" view of health and illness, with a respect for physicians and medical advice (Ries, 2012). At the same time, certain fatalistic attitudes and machismo related to the pride noted above can also make Russians more willing to accept, downplay, or ignore medical risks even if their beliefs and values do not lead them to truly discount these risks (Ries, 2012; Mead et al., 2001). Though the Russians have a healthy view of medicine and the science behind it, that is, this is not necessarily enough to overcome certain other cultural proclivities and lead to rational, medically-based choices in behavior (Ries, 2012).
Tobacco Use Amongst Russian-Americans
Though current data could not be found regarding tobacco use amongst Russian-Americans, previous studies and ongoing data regarding the Russian domestic population suggests that tobacco use, specifically in the form of cigarettes, is quite high (Duncan & Simmons, 1996; Ries, 2012). If trends noted in previous studies have remained consistent, this is true both in terms of the number of smokers/proportion of the population in question that smokes, and terms of the amount smoked by these smokers in terms of cigarettes per day (Duncan & Simmons, 1996). Implications for the health of the Russian-American community are quite clear: given the known health risks of cigarette smoke and tobacco use, which grow more extreme as usage grows heavier, this community is at a high risk for widespread and significant health problems, including heart and lung issues, due to tobacco use.
Considerations for Interview/Health History
Given the high degree of emphasis the Russian culture places on respect for elders, questions regarding familial medical history should be framed and delivered in highly respectful manners that are as unobtrusive as possible, and great care should be taken to refrain from any unintentional appearance of judgment (Ries, 2012; Mead et al., 2001). There should also be an avoidance of any appearance of comparison between personal medical history/biometrics and any existing scale, so as not to offend personal pride or seem admonishing or instructive (Ries, 2012). These two considerations will help make the patient more accommodating and approachable.
Another element to consider when developing and administering an initial health interview is the high degree of knowledge and awareness members of the Russian culture are likely to have regarding their health and standard medical advice (Ries, 2012; Mead et al., 2001). This leads to two separate consideration: first, this knowledge combined with the aforementioned Russian pride could lead to dishonesty in certain responses, exaggerating statements regarding health and underreporting activities known to be harmful to health; second, a mistrust of non-Russian and particularly American doctors based on complex (or not-so-complex, in some cases) cultural beliefs could lead to a perception of reduced importance in accuracy or in advice received (Ries, 2012; Mead et al., 2001). Finally, the role of familial authority should be considered in administering and interpreting health histories/interviews and in the developing of patient-specific interventions for tobacco use.
Health Promotion Plan
An effective health promotion plan should begin with the specification of goals and objectives, then the development of strategies to achieve these goals (THCU, 2011). For the current scenario, the overarching goal is to reduce the rate and prevalence of tobacco use amongst members of the Russian culture living in the Unites States. More far-reaching goals that truly provide the impetus for this stated primary goal include improving heart and lung function and reducing incidence of cardiovascular issues, which are known risks of tobacco use and cigarette smoking. In order to meet these goals, certain Russian values and practices will need to be adapted.
The Russian pride and independence that forms such a large part of the Russian character will likely lead to resistance when it comes to encouraging an end to tobacco use, and familial reinforcement patterns are also likely to exist and to be quite strong in the Russian Culture (Duncan & Simmons, 1996; Ries, 2012). Health promotion plans should thus involve as many family members as possible, and perhaps even make a sort of contest out of quitting -- seeing how many hours, then days family members can go without cigarettes, and setting up extrinsic reward incentives for quitting. This would both allow for the pride and familial reinforcement to be adapted to encouraging a more positive outcome, and would also utilize the emphasis on material rewards that is strong in the Russian culture (Mead et al., 2001). In this way, the elements of Russian culture can be used in a way that promotes health, rather than attempting to counter the culture with intrusive recommendations.
Developing adequate indicators and measures for health outcomes must also be a part of an effective health promotion plan, and this can often be more complex and less easily objective than might initially be expected (THCU, 2001). At the same time, not all necessary or desirable measurements require extreme or even significant manipulation, and many strictly quantified elements are unaffected by cultural values or norms in terms of…