Jewish Russian Immigrants in the US and around the world. Health Needs. Part 2: Health challenges Olga Greg and the Supercourse team University of Pittsburgh

Somatic problems: Acute physical illness Chronic diseases Disabilities

Jewish Genetic Disorders Mendelian Disorders are the direct result of mutated genes Disease Predisposition Genes are disorders which result from the combination of specific genes

Mendelian Disorders Bloom Syndrom Canavan Disease Crohn's Disease Factor XI Deficiency Familial Dysautonomia (Riley-Day syndrome) Fanconi Anemia Gaucher Disease Mucolipidosis IV Niemann-Pick Disease Non-Classical Adrenal Hyperplasia Nonsyndromic Hearing Loss Tay-Sachs Disease Torsion Dystonia

Disease Predisposition Genes  Breast Cancer (BRCA1 and BRCA2)  Familial Colon Cancer and BRCA2)

Common diseases seen in immigrants from Russia include: diabetes hypertension coronary disease gastrointestinal problems tuberculosis alcohol and substance abuse

Alcohol Problems: The alcohol dehydrogenase (ADH2) gene relates to alcohol dependence, alcohol consumption, and reported alcohol-related symptoms. However, the association of ADH2 with alcohol-related behavior is not well characterized in Ashkenazic Jews*. Although alcoholism is a tremendous problem in Russia, the incidents of alcohol abuse in Russian immigrants is very low.**

Cultural beliefs influencing health behaviors Some immigrants believe that disability or illness is caused by something the individual did not do right, such as not eating well or not dressing warmly enough. Good health is equated with absence of pain. Illnesses that do not cause pain often go undiagnosed and under-treated, such as Type 2 diabetes, hypertension, and high cholesterol.

Non-somatic problems: Stress / Distress Intergenerational conflict Language barrier Social isolation

Demoralization Depression resulting from an undermining of morale Upset or destruction of normal function A state of disorder and confusion

Symptoms of demoralization:* loss of control loss of hope anger/bitterness sense of failure feeling life was a burden loss of meaning and a belief that life's meaning is dependent on health

Stigma around mental illness Mental illness is often regarded as disgraceful. Immigrants often do not disclose a family history of mental illness or past treatment.

Acculturation challenges Acculturation to both American and Jewish cultures is related to psychological adaptation, peer relations, and school and family outcomes. Both acculturations reduce loneliness and increase perceived support from parents. Different dimensions of acculturation, such as language and identity, are differentially related to adaptation.

Language Problems Refugees and migrants from non-English speaking cultures have little preparation for their new English speaking environment Their limited English language skills exacerbate resettlement problems regardless of previous economic and social status

Communication challenges No ability to discuss health promotion issues such as smoking, diet, physical activity, vitamins and medication intake with their physician. Lack of knowledge of medical terminology Relying on relatives with lack of medical knowledge to translate medical documents Lack of knowledge about preventive behaviors

Cultural difficulties Lack of understanding of US health care etiquette Expect more compassion and emotional closeness with their physician Rather than appreciating the privacy and autonomy of the American medical culture, patients may complain about the quality of medical treatment they receive Question the physician’s ability to understand their problems.

Home remedies use Often doctor’s health recommendations are rejected or substituted by home remedies and treatments Home remedies are often used prior to seeking medical attention

Conclusions and patient care implications It is important to understand patients’ background and cultural norms. Russian Jewish immigrants might have needs and cultural norms that are different from other population groups Address the physical, emotional, and spiritual health of individuals and families Ensure effective patient-provider communication

Recommendations? Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Failing to support and foster culturally competent health care for racial and ethnic minorities can increase costs for individuals and society through increased hospitalizations and complications.

Conclusions Russian Jewish immigrants have unique educational, cultural, and health background Several genetic mutations (such as breast cancer associated BRCA) are more prevalent in Jewish populations While public health programs have been tailored to different ethnic, racial, and cultural minorities, they rarely addressed the needs of this population group This lecture provides a short summary about this group that would be helpful in guiding public health interventions and educational programs