Essentials of Cultural Competence in Pharmacy Practice: Chapter 6 Notes Chapter Author: Dr. Wendy Brown Caucasian Patients

Learning Objectives 1. Understand Caucasian culture as the majority culture in the United States. 2. Articulate key health concerns affecting Caucasian individuals. 3. Recognize the high-risk behaviors present in Caucasian culture.

Caucasian Race Defined by the Oxford English Dictionary as “a broad division of humankind covering peoples form Europe, the Middle East, South Asia and North Africa” and as “white- skinned; of European origin.” White and Caucasian are used interchangeably. In the United States, Caucasians comprise the majority of the population and have historically been bestowed privileges because of this fact. Caucasian, as a race, is filled with great diversity impacted by many religions, ethnicities, and sexual orientations.

Communication Styles The primary language used by this majority culture is American English. There are within-group differences in non-verbal communication, though some commonalities among Caucasians exist (smiling, direct eye contact)

Family Roles The make-up of contemporary Caucasian families is varied. Earlier decades presented the ideal of the nuclear family, though it is no longer the norm. Cohabitation, marriage, divorce, and remarriage have shaped family roles. Most Caucasians marry. However, over half of all US marriages end in divorce. The greatest risk factors for separation or divorce include living in neighborhoods with high levels of poverty, receiving welfare and/or unemployment, and having a low level of income and/or education.

Biocultural Ecology and Relevant Disease States Cystic Fibrosis is the most significant genetically linked disease embedded in the Caucasian culture. Currently 1 in 3300 Caucasians has cystic fibrosis 1 in 29 Caucasians is a carrier Drug metabolism Caucasians are also known to have great variability in drug metabolism (i.e. NAT gene and CYP 450)

High-Risk Behaviors Notably high incidence of alcohol, illicit drug use, and sexual assault. Alcohol: 13.4% lifetime abstainers 17.09% former drinkers 42.34% light drinkers 15.18% moderate drinkers 11.29% heavier drinkers Illicit Drugs 4% of pregnant women reported using illicit substance within 1 month of being surveyed 7.2% reported currently using illicit drugs Sexual Assault 17.9% of Caucasian women reported being raped at some time in their lifetime.

Nutritional Trends There has been a historical shift from nutrient deficiencies to overconsumption, decreased diet quality and poor food choices for the majority of the Caucasian population. In 2004, a survey by the National Immunization Survey showed that 71.5% of Caucasian children were ever breastfed. Further, 53.9% of those ever breastfed continued breastfeeding until at least 6 months.

Pregnancy/Childrearing Practices Caucasian women have a higher rate of multivitamin use before becoming pregnant, typically have lower rate of pregnancy-related complications, and are equal to other races in prevalence of infant checkups and postpartum contraceptive use. According to abortion surveillance data reported by the Centers for Disease Control and Prevention, approximately 53% of women who obtained legal, induced abortions were Caucasian compared with 36% black and 8% other.

Death Rituals The underlying theme of death practices and beliefs is resolving loss. Most deceased bodies are embalmed, displayed in a chapel or funeral home for a few days, and then buried or cremated. Funerals are held to honor the deceased and the death is typically followed by a time of deep mourning and expression of pain and sadness by loved ones or survivors.

Spirituality The general population of Caucasians believes in one God and life after death. Many individuals have a religious affiliation and 77% think of spirituality in a “personal and individual sense” rather than in terms of “organized religion.” People with higher level of spirituality have a lower incidence of mortality from cardiac-related illness, lower blood pressure, less substance abuse, recover quicker from depression, and are better able to cope with serious illness.

Health Care Practice In a 2000 census, 89.3% of Caucasians had some form of health insurance. Among all adults, the likelihood of having health care coverage correlated primarily with education level and income. Caucasians report more pain than people of other races. The health care workforce, in general, lacks diversity. Thus, Caucasians continue to be the dominant group of both practitioners and patients.

Reflection Questions 1. How would you address the high incidence of alcohol, illicit drug use, and sexual assault in treating Caucasian patients? 2. As a pharmacist, how will you work with Caucasian patients to treat diseases more prevalent in Caucasians, such as cystic fibrosis and poor drug metabolism? 3. How will you use the information contained in this chapter to inform your practice?