The law discussed in this paper presented a window of opportunity to ameliorate the deteriorating health status and reverse the impending mortality crisis. However, a number of barriers presented substantial setbacks toward realization of this legislation.
Objectives To review the existing epidemiological literature on suicide and alcohol related disorders and their social determinants in the U.S. Arctic, as it relates to U.S. government research and evaluation efforts, and to offer recommendations to boost research capacity in the U.S. Arctic and collaborations across the circumpolar arctic as part of global health initiatives. Study design: Synthetic literature review. Methods Published literature, federal and state reports on suicide and alcohol-related disorders, federal databases on research and program evaluation in the U.S Arctic were reviewed, with a focus on epidemiological trends over the past 50 years. Results Suicide and alcohol-related disorders play a significant role in health disparities t in the U.S. Arctic, with evidence of a disturbing prevalence trend over the past 50 years. Important variations exist in suicide rates across different regions of Alaska with different majority populations of Alaska Native cultural groups, and in selected key instances, within these regions, with immense implications for guiding effective prevention efforts. Consequences of alcohol abuse are severe and particularly significant in their impact upon Alaska Native people. Health related conditions associated with alcohol abuse are among leading causes of mortality. Conclusions Recommendations to boost research capacity in behavioural health in the U.S. Arctic are offered; specifically on strategies and methods of inquiry and analysis, distinctions between populations and communities in rural circumpolar contexts, future epidemiological and implementation research.
BACKGROUND: Language and culture relate in complex ways. Addressing this complexity in the context of language translation is a challenge when caring for patients with limited English proficiency (LEP).OBJECTIVE: To examine processes of care related to language, culture and translation in an LEP population is the objective of this study. DESIGN:We used community based participatory research to examine the experiences of Russian-speaking cancer patients in San Francisco, California. A Russian Cancer Information Taskforce (RCIT), including community-based organizations, local government, and clinics, participated in all phases of the study.PARTICIPANTS: A purposeful sample of 74 individuals were the participants of the study. APPROACH:The RCIT shaped research themes and facilitated access to participants. Methods were focus groups, individual interviews, and participant observation. RCIT reviewed data and provided guidance in interpreting results. RESULTS:Four themes emerged. (1) Local Russianlanguage resources were seen as inadequate and relatively unavailable compared to other non-English languages; (2) a taboo about the word "cancer" led to language "games" surrounding disclosure; (3) this taboo, and other dynamics of care, reflected expectations that Russian speakers derived from experiences in their countries of origin; (4) using interpreters as cultural brokers or establishing support groups for Russian speakers could help address barriers. CONCLUSIONS:The language barriers experienced by this LEP population reflect cultural and linguistic issues. Providers should consider partnering with trained interpreters to address the intertwining of language and culture. INTRODUCTIONReflecting the resumption of trans-national migration, the number of U.S. States residents over the age of 5 who speak a language other than English at home exceeded 45 million in the 2000 census.1,2 Addressing the health care needs of LEP patients requires attention to both language and culture, which connect in complex ways among diverse patient populations. [3][4][5][6] Research has documented that differences in language and culture can cause breakdowns in provider-patient communication; that communication may be aided by language and cultural concordance between providers and patients; and that when providers and patients do not share a common language, well-trained providers and professional interpretation services provide the best outcomes. for continued exploration include how language and culture together shape the clinical encounter, how the interaction of language and culture is affected by the presence of a trained interpreter, and how health care delivery systems can best meet the challenge of communicating across the linked landscapes of language and culture.
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