Health Promotion Plan: Reducing Tobacco Use in Russian-Americans

Russian Cultural Synopsis

There are several unique and noteworthy practices in Russian culture that can have a significant impact on health. Consumption practices tend toward the extreme, with food and drink supplied generously for guests and families alike, resources permitting, and with the extending of hospitality a common and expected practice (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 in Russia, family influence over all forms of consumption as well as other behaviors and practices remains quite strong (Ries, 2012). At the same time, independence and spontaneity are often observed in the decisions and behaviors of 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 Russians that differs significantly from attitudes typical in the United States. A much greater degree of respect and authority is given to parents and older generations in a household, rather than the youth expecting independence upon reaching adulthood (Ries, 2012). Due to the twentieth-century history of Russia and its people, religious beliefs are highly fragmented and varied among modern Russian populations, and this is perhaps more true of Russian emigrants than of those still living in Russia (Ries, 2012).

As far as Russian values and customs are concerned, the defining features are a combination of pride and a strong work ethic, leading to fierce independence, and at times aloofness, but also 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 their display, yet there is not the sense of distaste associated with work that can be seen among 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 tend to be somewhat looser (Ries, 2012; Mead et al., 2001).

During the Soviet era, an extreme emphasis on science and education existed in Russian culture, and this has carried into the modern period (Mead et al., 2001). For this reason, most Russians at home and abroad hold 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 make Russians more willing to accept, downplay, or ignore medical risks — even if their beliefs and values do not lead them to truly discount those risks (Ries, 2012; Mead et al., 2001). Though Russians generally hold a healthy view of medicine and the science behind it, this is not necessarily enough to overcome certain cultural proclivities and lead to rational, medically based choices in behavior (Ries, 2012).

Tobacco Use Among Russian-Americans

Though current data specific to tobacco use among Russian-Americans could not be found, previous studies and ongoing data regarding the Russian domestic population suggest 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 proportion of the population that smokes and in terms of the number of cigarettes smoked per day (Duncan & Simmons, 1996). The implications for the health of the Russian-American community are clear: given the known health risks of cigarette smoking and tobacco use, which grow more severe as usage increases, this community faces a high risk of widespread and significant health problems — including heart and lung disease — related to tobacco use.

Considerations for Health Interviews and History

Given the high degree of respect the Russian culture places on elders, questions regarding familial medical history should be framed and delivered in highly respectful, unobtrusive ways, and great care should be taken to avoid any unintentional appearance of judgment (Ries, 2012; Mead et al., 2001). There should also be a deliberate avoidance of any appearance of comparing personal medical history or biometrics to existing scales, so as not to offend personal pride or seem admonishing (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 that 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 considerations. First, this knowledge, combined with Russian pride, could lead to dishonesty in certain responses — specifically, exaggerating statements about health and underreporting activities known to be harmful. Second, a mistrust of non-Russian and particularly American doctors, rooted in complex cultural beliefs, could reduce a patient's perceived importance of accuracy or of advice received (Ries, 2012; Mead et al., 2001). Finally, the role of familial authority should be considered both in administering and interpreting health histories and interviews and in developing patient-specific interventions for tobacco use.