Three North Carolina Medicaid surveys conducted from 2000 to 2012 reported increasing numbers of Hispanic children enrolled in Medicaid and much lower trust in providers expressed by their adult caregiver respondents compared with responses for non-Hispanic Black and White children. To verify and explain this apparent trust chasm, we used bivariate and regression analyses. The variables employed included trust (dependent variable); child’s race/ethnicity, age, and sex; satisfaction and health status scales; two utilization measures; respondent’s age, sex, and education; geographical region; and population density of county of residence. Race/ethnicity was strongly associated with trust (p < .001), controlling for other independent variables. Access, satisfaction, and respondent’s age and education were also significant. Our results fit the Behavioral Model for Vulnerable Populations, which maps the role of significant variables in health-seeking behavior. After analyzing the concept of trust, we argue that lower acculturation explains lower Hispanic trust compared with non-Hispanic Blacks. We suggest policies to improve acculturation.

This article provides clinical guidelines for basic knowledge and skills essential for successful work with clients who have obsessive-compulsive disorder (OCD) across ethnic, racial and religious differences. We emphasise multiculturalist and anti-racist approaches and the role of culture in shaping the presentation of OCD in clients. Several competencies are discussed to help clinicians differentiate between behaviour that is consistent with group norms versus behaviour that is excessive and psychopathological in nature. Symptom presentation, mental health literacy and explanatory models may differ across cultural groups. The article also highlights the possibility of violating client beliefs and values during cognitive behavioural therapy (CBT), and subsequently offers strategies to mitigate such problems, such as consulting community members, clergy, religious scholars and other authoritative sources. Finally, there is a discussion of how clinicians can help clients from diverse populations overcome a variety of obstacles and challenges faced in the therapeutic context, including stigma and cultural mistrust.

Since COVID-19 first emerged internationally, Australia has applied a number of public health measures to counter the disease’ epidemiology. The public heath response has been effective in virus testing, diagnosing and treating patients with COVID-19. The imposed strict border restrictions and social distancing played a vital role in reducing positive cases via community transmission resulting in ‘flattening of the curve’. Now is too soon to assess the impact of COVID-19 on people’s mental health, as it will be determined by both short- and long-term consequences of exposure to stress, uncertainty, loss of control, loneliness and isolation. The authors explored cultural and societal influences on mental health during the current pandemic utilising Geert Hofstede’s multidimensional construct of culture and determined psychological and cultural factors that foster resilience. We also reflected on the psychological impact of the pandemic on the individual and the group at large by utilising Michel Foucault’ and Jacques Lacan’ psychoanalytic theories. Remote Aboriginal Australian communities have been identified as a high-risk subpopulation in view of their unique vulnerabilities owing to their compromised health status, in addition to historical, systemic and cultural factors. Historically, Australia has prided itself in its multiculturalism; however, there has been evidence of an increase in racial microaggressions and xenophobia during this pandemic. Australia’s model of cultural awareness will need to evolve, from reactionary to more reflective, post COVID-19 pandemic to best serve our multicultural, inclusive and integrated society.

The Supplemental Nutrition Assistance Program Education (SNAP-Ed) aims to prevent obesity and chronic disease among SNAP-eligible families by facilitating healthy eating and active living. This study aimed to capture the voices of California SNAP-Ed eligible parents to inform program planners of their challenges in feeding their families, their available supports and priorities for intervention. We conducted eight focus groups with 55 participants across five counties in California from May through August 2017. Trained researchers used Dedoose to code and analyze data for substantive themes and overarching findings.Ten key findings and 4 additional findings were identified. Participants experience multiple challenges, primarily inadequate income and limited access to high quality, affordable healthy food contrasted with easy access to affordable unhealthy food. Despite efforts to manage food resources, most struggle to afford adequate diets. Employed parents confront a particularly challenging dual poverty of money and time. Many parents report feeling guilt related to feeding their children. Participants appreciate available programs and services and suggest increasing community input; providing sustainable programs; lowering the cost of and improving access to healthy food; reducing access to unhealthy food; modifying food assistance efforts; and improving nutrition education and promotion. Overall, low-income parents in California struggle to feed their families the way they would like. Participants generally understand what to feed their children, but struggle with how to do it, perceiving their circumstances and environments as inhospitable to healthy eating. Participants' suggestions can help SNAP-Ed programs and other efforts better support families' needs.

Whilst some improvements to Indigenous education outcomes have occurred in recent years, there remains considerable inequity in the educational experiences and long-term engagement of Indigenous and non-Indigenous students. One of the factors contributing to the challenging environment for Indigenous students is dissonance of social norms, as a result of ethnic and socioeconomic differences between teacher and student. Many hegemonic culture teachers are unaware of Standpoint Theory and the way in which normative beliefs impact on classroom interactions and student outcomes at the cultural interface. This paper draws on the Theory of Planned Behaviour (TBP) to illustrate ways in which schools can identify areas of ethnic and socioeconomic prejudice impacting classroom interactions, and create shared social norms so that Indigenous students are most likely to experience positive educational engagement. Self-Determination Theory (SDT) is then applied to discuss the type of classroom environment that best enables students to internalise positive educational behaviours in an autonomous manner. Such internalisation is necessary to improve long-term outcomes and postschool educational engagement for Indigenous Australians. The theories explored indicate that motivation for behavioural change relies on the individual's self-perceptions of competence, autonomy and normative beliefs regarding the value of education, and that integration of new behaviours requires an emotionally supportive environment and provision of a meaningful rationale. This paper argues that good practice in Indigenous schooling will address these areas specifically.

Objectives: Racially/ethnically diverse communities suffer a disproportionate burden of adverse outcomes before, during and after a disaster. Using California as a locus of study, we sought to identify challenges and barriers to meeting the preparedness needs of these communities and highlight promising strategies, gaps in programs, and future priorities.

Methods: We conducted a literature review, environmental scan of organizational Web sites providing preparedness materials for diverse communities, and key informant interviews with public health and emergency management professionals.

Results: We identified individual-level barriers to preparing diverse communities such as socioeconomic status, trust, culture, and language, as well as institutional-level barriers faced by organizations such as inadequate support for culturally/linguistically appropriate initiatives. Current programs to address these barriers include language assistance services, community engagement strategies, cross-sector collaboration, and community assessments. Enhancing public-private partnerships, increasing flexibility in allocating funds and improving organizational capacity for diversity initiatives were all identified as additional areas of programmatic need.

Conclusions: Our study suggests at least four intervention priorities for California and across the United States: engaging diverse communities in all aspects of emergency planning, implementation, and evaluation; mitigating fear and stigma; building organizational cultural competence; and enhancing coordination of information and resources. In addition, this study provides a methodological model for other states seeking to assess their capacity to integrate diverse communities into preparedness planning and response.

(Disaster Med Public Health Preparedness. 2011;5:227–234)

A recent special section on cultural diversity across the Pacific, in this journal, highlighted the need for greater alignment between human services and cultural diversity in the region. Alignment entails detailing a local context. Samoan cultural constructs of emotion, particularly anger and shame, may precede suicidal behaviours among New Zealand-born (NZ-born) Samoan youth. These behaviours can stem from perceived ruptures in family unity, as youth partly identify with majority norms. A barrier to integration faced by acculturating youth is that the young person either lives with the shame of their offence, or avoids it by taking their life. It seems Samoan cultural constructs of emotion must be considered in effective service delivery for this population. Consistent with the articles in the special section, suicide prevention should focus on developing culturally competent tools tailored for NZ-born Samoan youth, so they may communicate their feelings without fear of disrupting cultural prescriptions and expectations, as well as functioning successfully in both the Samoan and Western worlds. Although the point is discussed in relation to one special population in the Pacific region, it is consistent with an emergent theme in the special section and subsequent commentaries: the need to integrate and acculturate human services.