Social, Cultural, and Religious Influences on Child Health Promotion



Social, Cultural, and Religious Influences on Child Health Promotion


Kim Mooney-Doyle



Learning Objectives


On completion of this chapter the reader will be able to:


• Define culture, cultural competence, ethnocentrism, and cultural relativity.


• Describe the subcultural influences on child development.


• Discuss the population of minority children in the United States.


• Identify the impact of culture on health.


• Identify the impact socioeconomic influences have on health.


• Identify areas of potential conflict of values and customs for a nurse interacting with different cultural and ethnic groups.


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evolve.elsevier.com/wong/essentials





Culture


Promoting the health of children requires a nurse to understand social, cultural, and religious influences on children and their families. This in turn depends on a purposeful awareness of the child’s sociocultural context and also of oneself. The purpose of this chapter is to share with nursing students the significance of providing nursing care with a sense of cultural humility as a way to provide optimal care to all children and their families and to further understand the intersection of social, religious, and cultural forces that affect the health of children, their families, and their communities. Why is this important? The U.S. population is constantly evolving; patients experience negative health outcomes when social, cultural, and religious factors are not considered as influencing their health care; families may incorporate other health systems such as Eastern medicine or traditional healing into their lives; and it is required by legislative, regulatory, and credentialing bodies (Tervalon, 2003). Educating health care providers is one way to reduce disparities in health care.


Cultural humility is a “commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and themselves” (Tervalon and Murray-Garcia, 1998, p. 118). It requires that health care providers participate in a continual process of self-reflection and self-critique that recognizes the power of the health care provider role, that views the patient and family as full members of the health care team, and that does not end after reading one chapter or attending one course but is an evolving aspect of being a health care provider. “Cultural competency is not an abdominal exam” (Kumagai and Lypson, 2009, p. 783). It is not a static endpoint to be checked off the list but an ongoing process that promotes deeper thinking and knowledge of oneself, others, and the world (Kumagai and Lypson, 2009).


Approaching nursing care from a position of cultural humility is important considering the ever-changing population. A sample of the demographic profile of the U.S. 2010 census includes 72.4% non-Hispanic white; 16.3% Hispanic/Latino; 12.6% Black/African American; and 3.6% Asian or American Indian/Alaskan Native (Humes, Jones, and Ramirez, 2011). Interestingly, the 2010 census data reveal that more than half of the population growth in the United States from 2000 to 2010 was attributable to increases in the Hispanic/Latino population. In addition, the population that defines their ethnicity as Asian grew faster than any other group, up 43% from the 2000 census. Children and adolescents 0 to 18 years of age comprised 24.3% of the U.S. population. The demographic profile includes white/non-Hispanic, 55.3%; Black/African American, 15.1%; Asian, 4.3%; Hispanic (any race), 22.5%; and all other, 4.7%. Traditionally, children younger than 5 years of age are highly underreported. This is problematic because the number and demographics of children determines the demand for schools, health care, and other services needed to meet the needs of families.


It is also important to understand nursing’s contribution to culturally congruent care. A holistic view of care was first described by Madeleine Leininger, the recognized founder of transcultural nursing, in her culture care diversity and universality theory (Leininger, 2001; Munoz and Luckmann, 2005). The theory provides an intellectual framework and a research methodology for providing culturally congruent patient care. Nurses must remain aware that every family, child, and health care provider comes to a clinical encounter with a cultural lens through which they see and interpret the world.


Culture is a rich context through which people view and respond to their world (see Cultural Considerations box). It also provides the lens through which all facets of human behavior can be interpreted (Spector, 2009). Culture is composed of individuals who share a set of values, beliefs, practices (e.g., language, dress, diet, health care), social relationships, laws, politics, economics, and norms of behavior that are learned, integrative, social, and satisfying. Culture is an ingrained orientation to life that serves as a frame of reference for individual perception and judgment. Culture is, essentially, the way of life of a group of people that incorporates experiences of the past, influences thought and action in the present, and transmits these traditions to future group members. Families pass their culture on to children, and the children perceive the world through this cultural lens. Culture adapts to the ever-changing world as group members abandon, modify, or assume new patterns of living and behavior to meet the group’s needs.



image Cultural Considerations


Cultural Definitions


Culture characterizes a particular group with its values, beliefs, norms, patterns, and practices that are learned, shared, and transmitted from one generation to another (Leininger, 2001). Culture differs from both race and ethnicity. Race is a term with roots in anthropology, distinguishing variety in humans by physical traits. Ethnicity is the affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. Gender is an individual’s self-identification as man or woman, and sex is the biological designation of male or female. Social class is a complex social construction that usually incorporates levels of education in the family, occupation, income, and access to resources. Socialization is the process by which society communicates its competencies, values, and expectations to children (Trawick-Smith, 2006). Culture is a complex whole in which each part is interrelated. It is an umbrella term that holds together many interrelated yet unique aspects of humanity, including beliefs, tradition, life ways, and heritage. It is much more than a country of origin or a demographic designation such as African American or white.


Material overt, or manifest, culture refers to the observable components of a culture, such as material objects (dress, art, utensils, and other artifacts) and actions. Nonmaterial covert culture refers to those aspects that cannot be observed directly, such as ideas, beliefs, customs, and feelings. Related to the large culture are many subcultures, each with an identity of its own. Children are socialized into a particular subculture rather than into the culture as a whole. Subcultural influences, such as ethnicity and social class, are discussed in more detail later in this chapter.


Cultures and subcultures contribute to the uniqueness of child members in such a subtle way and at such an early age that children grow up to think that their beliefs, attitudes, values, and practices are the “correct” or “normal” ones. By age 5 years, children can identify persons who belong to their cultural background. During later primary years, children can identify those from different cultures (Trawick-Smith, 2006). A set of values learned in childhood is likely to characterize children’s attitudes and behavior for life, influencing their long-range goals and their short-range, impulsive inclinations. Thus, every ongoing society socializes each succeeding generation to its cultural heritage.


The manner and sequence of the growth and development phenomenon are universal and fundamental features of all children; however, children’s varied behavioral responses to similar events are often determined by their culture. Culture plays a critical role in the parenting behaviors that facilitate children’s development (Melendez, 2005). Children acquire the skills, knowledge, beliefs, and values important to their own family and culture. Cultural backgrounds can influence the pace of acquisition of cognitive and motor skills as well as the child’s social and emotional development (Trawick-Smith, 2006).


Cultures may also differ in whether status in a group is based on age or on skill. Even children’s play and their types of games are culturally determined. In some cultures, children play in groups composed of members of the same gender; in others, they play in mixed-gender groups. In some cultures, team games predominate; in others, most play is limited to individual games.


Standards and norms vary from culture to culture and from location to location; a practice that is accepted in one area may meet with disapproval or create tension in another. The extent to which cultures tolerate divergence from the established norm also varies among cultures and subcultural groups. Although conforming to cultural norms provides a degree of security, it is a decided deterrent to change.



The Child and Family in North America


Context provides perspective for nursing care. The health and well-being of the child in the North American family is influenced by two distinct contexts: the context of family and the context of culture. Therefore, understanding these layers of influence on pediatric health is integral to developing a family-centered and culturally competent nursing practice (Thibodeaux and Deatrick, 2007). America’s orientation toward homogenization—“the great melting pot”—is changing because of its increasingly diverse population.


The frontier background of the American culture has contributed to the overall orientation to life and childrearing. Americans have always had a basic optimistic view of the world, a belief that things can be better and that the children can and will be better off than their parents. With this hopeful outlook, a general future orientation, and the possibility of upward social mobility, American culture typically encourages development of self-confidence and autonomy in children. Children are generally permitted a greater degree of freedom than in more tradition-oriented cultures.


Family life in North America is characterized by increasing geographic and economic mobility. Families are less reliant on tradition, are fragmented, and have limited opportunity to transmit and acquire the traditional and accepted customs of a culture. Consequently, young adults rely to a greater extent on the professed experts, peers, and the mass media for acquisition of acceptable patterns of behavior, including childrearing practices. Conflicting information can be a source of confusion and frustration as parents attempt to determine the comparatively stable, essential components of the culture and transmit these to their children.


Children in North America grow up with a number of adults who differ from one another but who all provide input as role models, teachers, and standards for behavior. Most children live in some form of nuclear family located in sharply differentiated neighborhoods determined by income and ethnic status within a highly technical, largely urban society. Class differences in childrearing persist, but they are becoming less divergent.


Early in life, children in minority cultures become aware of their cultural context and the discriminatory attitudes of the majority culture toward their racial or ethnic group. The direct effects of discrimination are anger and low self-esteem, which manifest in a variety of behaviors. The most important influences on development of a positive self-image are warm, understanding parents who actively foster their children’s growth. Parents who accept their children and react positively and constructively rather than in a negative manner will help their children develop feelings of self-worth, self-esteem, and self-acceptance. The more adequate children feel, the more positive their attitudes toward peers in both the majority and the minority groups and the greater their ability to withstand prejudice and intolerance and build lasting relationships.



Social Roles


Much of children’s self-concept comes from their ideas about their social roles. Roles are cultural creations; therefore, the culture prescribes patterns of behavior for persons in a variety of social positions. All persons who hold similar social positions have an obligation to behave in a particular manner. A role prohibits some behaviors and allows others. Because culture outlines and clarifies roles, it has a significant influence on the development of children’s self-concept (i.e., attitudes and beliefs they have about themselves).


A social group consists of a system of roles carried out in both primary and secondary groups. A primary group has intimate, continued, face-to-face contact; mutual support of members; and the ability to order or constrain a considerable proportion of individual members’ behavior. Two such groups are the family and the peer group, both of which have a great deal of influence on the child.


Secondary groups are groups that have limited, intermittent contact and generally less concern for members’ behavior. These groups offer little in terms of support or pressure toward conformity except in rigidly limited areas. Examples of secondary groups are professional associations and social organizations such as church groups.


A concept of social role also depends largely on whether a child is reared in a primary- or secondary-group community. Children are subjected to perceptibly different forms of parental training in these two types of environments.



Primary- and Secondary-Group Influences


Children are raised within a primary-group environment and within a secondary-group environment. The influences, strengths, and limitations of both groups are significant. In a primary-group community (e.g., family; peer group; some contemporary rural, religious, or ethnic communities), all members know each other, most belong to the same subgroups, and all are concerned about each member’s behavior. Community members have a high degree of material and psychologic support and one traditional set of values that the entire group agrees on and supports; thus, there is little conflict of values. In a stable community where the members remain within comparatively defined limits and relatives are likely to live close together, young members have ample opportunity to observe and absorb cultural practices and customs. Any member of the community feels justified in evaluating and censuring the conduct of another member.


Children reared in the relative isolation of secondary-group environmental influences tend to learn that there is only one acceptable way to respond to any given situation. The entire group agrees, and any tendency to deviate is met with collective disapproval. It is the parents’ duty to see that the children learn and follow social roles and modes of behavior defined and strengthened by the views of the community.


The childrearing orientation in a secondary-group environment, such as urban communities, can differ considerably from that of a primary-group environment. The interaction between primary and secondary groups may reinforce values when both groups endorse that value or create confusion or conflict when one group rejects a value accepted by the other. An urban community is dynamic. Many of the traditional behaviors and values may not meet the needs of the changing society. Consequently, parents are often uncertain about what to teach their children. They may wish to rear their children with values consistent with their own, but the differences in experience between the generations are too great. As a result, they often grant their children autonomy in some areas of decision making early in the developmental process, and other secondary groups assume a greater influence. None of the groups is highly dominant in its influence; therefore, the children are exposed to an eclectic set of values and expectations, some in agreement and some in conflict. From these they must ultimately select those that they determine to be best for them and adopt them to form a consistent set of roles and behaviors to incorporate into the self-concept.



Self-Esteem and Culture


Culture influences a child’s sense of self-esteem (Trawick-Smith, 2006). Some cultures are more collective in thought and action. A child from a collective culture will hold an inclusive view of him- or herself. Self-evaluation is related to the accomplishments or competencies of the entire family or community. School experiences that focus on personal achievement may promote positive self-esteem in some children but not in others who are more dependent on the success of a whole family or peer group. Their sense of control may not come from individual self-reliance but rather from a feeling of worth in their family or community (Trawick-Smith, 2006).


Families and culture also influence the criteria children use to evaluate their own abilities. Additionally, cultures vary in whether they instill an internal locus of control (a belief in the ability to regulate one’s own life). Effects on self-esteem are minimal if these beliefs are directed by parents and are in accordance with cultural customs (Trawick-Smith, 2006). Ethnic pride can help children to maintain a positive self-image and counteract the effects of prejudice, which can have a negative impact on emotional health (Trawick-Smith, 2006).



Cultural Shock and Cultural Sensitivity


Cultural shock is characterized by the inability to respond to or function within a new or strange situation. It can occur when the values and beliefs of a new cultural setting are radically different from those of the person’s native culture (Munoz and Luckmann, 2005). This state of shock or uneasiness can happen to a patient in a hospital or to a nurse caring for patients with different cultural backgrounds. Immigrants to a new country and persons from a subcultural group experience the same cultural shock when they must adjust to the ways of an unfamiliar subgroup or setting.


Numerous factors influence reactions to a new environment. Language barriers, including dialects and jargon specific to a subcultural group, inhibit effective communication. Habits and customs, such as different role behaviors or etiquette, and differences in attitudes and beliefs are puzzling to newcomers in an unfamiliar environment. The child and family experiencing cultural shock can feel an intense sense of isolation, loneliness, and fear.


Nurses are challenged to overcome cultural shock and develop cultural sensitivity, an awareness of cultural similarities and differences. Doing so helps the nurse practice culturally competent care. This requires changing the way people think about, understand, and interact within the world around them (see Critical Thinking Case Study). The development of cultural competence is an ongoing, interactive process that involves six elements (Dunn, 2002):



image Critical Thinking Case Study


Reducing Cultural Shock


A woman from the Middle East is visiting her child who is hospitalized for a serious illness. Her husband left for home a short time ago to wash and change clothes. She speaks little English. You need to obtain her consent for an emergency procedure. She is hesitant and refuses to sign the consent form. What should you do?




When minority groups immigrate from another country, a certain degree of cultural and ethnic blending occurs through the involuntary process of acculturation, gradual changes produced in a culture by the influence of another culture that cause one or both cultures to be more similar to each other. However, the changes occur to various degrees in different families and groups. Many groups continue to identify with their traditional heritage while adapting to the ill-defined concept of the “American way.” Acculturation may be referred to as assimilation, which is the process of developing a new cultural identity (Spector, 2009).



Subcultural Influences


Except in rare situations, children grow and develop in a blend of cultures and subcultures. In a large, complex society such as the United States, different groups have their own set of standards, values, and expectations within the collective ways of the large culture. Most subcultures were formed when groups of people clustered together by preference, external pressures from the majority culture, or geographic isolation. Although many cultural differences are related to geographic boundaries, subcultures are not always restricted by location. Some subcultures are even related to the stages of development and have traditions, games, loyalties, and rules. The behavior of school-age children and adolescents demonstrates age-related subcultures. The culture is handed down by word of mouth from one “generation” to the next, and its rituals and behavior standards are highly resistant to outside influence.


Children’s membership in a cultural subgroup is, for the most part, involuntary. They are each born into a family with a specific ethnic or racial heritage, socioeconomic level, and religious beliefs. Although the complex American society has countless subcultures and considerable variation in the way of life, the subcultures that seem to have the greatest influence on childrearing are ethnicity, social class, and occupational role. In addition, schools and peer-group subcultures are strong influences in the socialization of children.



image Nursing Alert


American cultures and subcultures can be so diverse that it is essential that nurses be aware of and knowledgeable about the predominant groups in their work community and apply this knowledge in their practice.



image Nursing Alert


Any generalization made about an ethnic group may not apply to certain groups or individuals.



Ethnicity


Ethnicity is the classification of or affiliation with any of the basic groups or divisions of humankind or any heterogeneous population differentiated by customs, characteristics, language, or similar distinguishing factors. Ethnic differences extend to many areas and include such manifestations as family structure, language, food preferences, moral codes, and expression of emotion. Some standards of behavior (e.g., the traditional role of the father) result from the cultural heritage of the specific ethnic group. Others reflect the interaction between subcultures, most notably between members of the majority culture and a minority subculture. The term ethnic has aroused strong negative feelings, and the general population often rejects this term (Spector, 2009).


To establish their place in the group, children learn to follow a mode of behavior that is in accordance with standards distinctive to the group and learn how they can expect others to behave toward them. They take their cues by observing and imitating those to whom they are exposed. For example, children of a racial minority form a perception of their role as a group member by observing how role models within the subgroup respond to treatment by people outside the subgroup. When they see group members display an attitude of inferiority, they assume this to be the appropriate behavior and incorporate these perceptions into their own self-concept.


In the United States, the cross-cultural lines are becoming blurred as subcultures are assimilated and blended into the larger culture (Fig. 4-1). Although ethnic differences in childrearing are probably diminishing, they remain important. It is particularly difficult for persons to attempt to maintain an identity within a subculture while living and conforming to the requirements of the larger culture.


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FIG 4-1 Youngsters from different cultural backgrounds interact within the larger culture. (© 2012 Photos.com, a division of Getty Images. All rights reserved.)

Ethnocentrism is the emotional attitude that one’s own ethnic group is superior to others; that one’s values, beliefs, and perceptions are the correct ones; and that the group’s ways of living and behaving are the best way (Spector, 2009). Ethnic stereotyping or labeling stems from ethnocentric views. Ethnocentrism implies that all other groups are inferior and that their ways are not in the best interests of the group. It is a common attitude among a dominant ethnic group and strongly influences a person’s ability to evaluate objectively the beliefs and behaviors of others. Nurses must overcome the natural tendency to have ethnocentric attitudes when caring for people from different cultures. Culturally competent nurses have empathy for others, maintain an openness to feeling what others feel, and remain curious and willing to ask questions to gain a better understanding. In addition, nurses have a basic respect for themselves and others and acknowledge the intrinsic value of all humans.



Minority-Group Membership


The United States has more racial, ethnic, and religious minority groups than any other country. Ethnic minority groups are becoming increasingly important because these groups are producing children at a faster rate than the majority white population. Consequently, the minority population is increasing. The rapidly emerging U.S. minority population will present special needs and require resources beyond what is currently available (Murdock, 2005).


The U.S. 2010 census revealed more than 300 million people in the United States. The Hispanic population included 16.3% of the total population (Humes, Jones, and Ramirez, 2011). Currently, Hispanics are the fastest growing minority in the United States and have many health needs that are not being met (Murdock, 2005). In 2050, almost 30% of the U.S. population is expected to be Hispanic (Murdock, 2005).



Socioeconomic Class


Family relationships may be stronger in some ethnic or cultural groups than in others. However, the influence of socioeconomic class cannot be overlooked. This relates to the family’s economic and educational levels. Strong family relationships exist among those of lower socioeconomic class who have few resources and must rely on the support of a family network to meet their physical and emotional needs. Middle- and upper-class people often have resources that reach beyond the extended family.



Communication Skills


Any concept that occurs to a person can be expressed in language. However, ease of communication and use of language codes vary among the social classes. Language is much more restricted in the lower classes, and grammar usage differs more than pronunciation. Persons in the middle classes use different grammar from those in the lower classes and are able to express more complicated ideas; persons in the lower classes use very simple grammar and are less likely to offer explanations.


These communication differences are highly significant in relation to school achievement. School is constructed around the elaborate language codes of the middle classes; therefore, children from the lower classes who lack an understanding of these language skills are placed at a decided disadvantage. This is particularly true for bilingual children and children from ethnic groups that have developed a unique dialect.


Historically, schools have participated in devaluing Native American languages, cultures, and traditional ways of learning and knowing. Unfortunately, Native American children have been deficient in their preparation for school (Beaulieu, 2000). Also, children of Native American nations have been at risk for low achievement, overrepresentation in special education, and dropping out (Demmert, 2001). Many regional dialects and variations in language usage must be considered when communicating with persons from these groups. English words that sound like words in a foreign language can cause considerable misunderstanding.



Schools


When children enter school, their radius of relationships extends to include a wider variety of peers and a new focus of authority. Although parents continue to exert the major influence on children, in the school environment, teachers have the most significant psychologic impact on children’s development and socialization. The teachers’ function is primarily limited to teaching, but similar to parents, they are concerned about the children’s emotional welfare. Both parents and teachers must constrain behavior and enforce standards of conduct.



Socialization


Next to the family, the schools exert the major force in providing continuity between generations by conveying a vast amount of culture from the older members to the young. This prepares children to carry out the traditional social roles they are expected to assume as adults in society. School is the center of cultural diffusion wherein the cultural standards of the larger group are disseminated to the local community. It governs what is taught and, to a large extent, how it is taught. School rules and regulations regarding attendance, authority relationships, and the system of penalties and rewards based on achievement transmit to children the behavioral expectations of the adult world of employment and relationships. School is often the only institution in which children systematically learn about the negative consequences of behaviors that depart from social expectations. In addition, the school provides an opportunity for some children to participate in the larger society in rewarding ways and often provides avenues for social mobility for both students and teachers. Individuals in the lower classes are offered the opportunity for further education and the capacity to move up in the social strata.


Teachers are responsible for transmitting the knowledge and values of the dominant culture (i.e., values on which there is broad consensus). They are expected to stimulate and guide children’s intellectual development, sense of esthetics, and creative problem solving.


Traditionally the socialization process of school began when the child entered kindergarten or first grade. Today, with more than 60% of mothers of preschool children working outside the home, this socialization process begins much earlier for a significant number of children in a variety of child care settings.


Children of some cultural groups fare less well in school. They come from underrepresented groups, including African-American, Mexican American, Puerto Rican, and Native American children (Trawick-Smith, 2006). These cultural variations can be attributed to high rates of poverty, different cognitive styles, ineffective schools, and parents’ views of schools as oppressive to cultural and traditional values (Trawick-Smith, 2006).



Communities


Surveys of more than 1 million youth in the United States in grades 6 to 12 have shown that persons who experience a higher number of specific assets in their lives are more likely to make healthy choices and avoid high-risk behaviors. These assets offer a framework for positive child and adolescent development. The child or adolescent’s community is made up of family, school, neighborhood, youth organization, and other members.


Four categories of external assets that youth receive from the community are (Search Institute, 2007):



Internal assets must also be nurtured in the community’s young members. These internal qualities guide choices and create a sense of centeredness, purpose, and focus. The four categories of internal assets are (Search Institute, 2007):




Peer Cultures


Peer groups also have an impact on the socialization of children (Fig. 4-2). Peer relationships become increasingly important and influential as children proceed through school. In school, children have what can be regarded as a culture of their own. This is even more apparent in unsupervised playgroups because the culture in school is partly produced by adults.


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FIG 4-2 Children from a variety of cultural and ethnic backgrounds begin to socialize in the child care setting.

During their lives, children are exposed to value systems such as those of the family, ethnic group, and social class. In peer-group interactions, they confront a variety of these sets of values. The values imposed by the peer group are especially compelling because children must accept and conform to them to be accepted as members of the group. When the peer values are not too different from those of family and teachers, the mild conflict created by these small differences serves to separate children from the adults in their lives and to strengthen the feeling of belonging to the peer group.


The kind of socialization provided by the peer group depends on the subculture that develops from its members’ background, interests, and capabilities. Some groups support school achievement, others focus on athletic prowess, and still others are decidedly against educative goals. Scholastic achievement is strongly related to the peer group’s value system. Many conflicts between teachers and students and between parents and students can be attributed to fear of rejection by peers. What is expected from parents regarding academic achievement and what is expected from the peer culture often conflict, especially during high school. Chapter 19 discusses this in further detail.


Although the peer group has neither the traditional authority of the parents nor the legal authority of the schools for teaching information, it manages to convey a substantial amount of information to its members, especially on taboo subjects such as sex and drugs. Children’s need for the friendship of their peers brings them into an increasingly complex social system. Through peer relationships, children learn to deal with dominance and hostility and to relate with persons in positions of leadership and authority. Other functions of the peer subculture are to relieve boredom and to provide recognition that individual members do not receive from teachers and other authority figures.


The peer-group culture has secrets, mores, and codes of ethics that promote group solidarity and detachment from adults. They have traditions and folkways, including age-related games and other activities, that are transferred from “generation to generation” of schoolchildren and that have a great influence over the behavior of all group members. As children move from one level to the next, they discard the folkways of the younger group as they adopt those of the new group. For example, a school-age child rides a bicycle to school; the high school student prefers a car. As they advance, children are forward oriented only—they look forward with anticipation but may look backward with contempt.



Biculture


Some children are exposed to the values, role relationships, and lifestyles of two or more cultures. This may occur because the child’s parents are from two or more different cultures. In Hawaii, for example, it is common for children to be from four or more cultures. Other children straddle cultures as members of a minority culture within the dominant culture. This biculture is sometimes observed in the playgroup but usually is not a significant factor until children enter school. Then they must unlearn some of the established practices of one culture to become socialized in the other, especially in role relationships. For example, children from Hispanic and Asian cultures are taught to look away when scolded; in U.S. schools, the teacher expects direct eye contact—“Look at me when I speak to you.” Children learn new roles and social behavior more rapidly than their adult counterparts.


This biculture is particularly marked in language differences. Bilingual children are said to be at a disadvantage in school situations of the dominant culture, in which there is controversy over bilingual education. Those supporting bilingual education adhere to the principle that children will understand more readily and perform more realistically (especially in testing situations) if learning is directed in their own language; others contend that children living in a dominant culture should adopt the ways of that culture, including its language. Children face less conflict when the school supports their language and culture even if the dominant language is used.



Mass Media


The media provide children with a means for extending their knowledge about the world in which they live and have helped narrow the differences between groups. However, many people are concerned about the enormous influence the media can have on developing children and on health promotion behaviors. Children and adolescents in the United States spend more than 6 hours per day using entertainment media (Council on Communications and Media, 2009). Increased use of entertainment media has been associated with the epidemic of obesity in children and adolescents and increased aggression in children (Council on Communications and Media, 2009; Jordan, 2004). Anticipatory guidance around media utilization is among the most important a nurse can offer to a family. Because it can influence many areas of concern, such as aggression, sex, drugs, alcohol, obesity, eating disorders, and academic achievement (Strasburger, 2010), two important questions that nurses can ask to open the dialogue are “How much entertainment screen time does your child or teen spend each day?” and “Is there a TV, Internet connection, or wireless connection in the child or teen’s bedroom?”


Researchers have established links between mass media and an increase in the use of tobacco, alcohol, and violent behavior in adolescents (Council on Communications and Media, 2009; Strasburger, 2010). The images of risky behavior presented by the media may serve to establish or reinforce teenagers’ perceptions of their social environment. Also, media content may directly influence risk perception; media protagonists seldom experience the adverse consequences of their behaviors despite their grossly distorted experiences with violence, illness, or crime.


Children may identify closely with people or characters portrayed in reading materials, movies, and television programs and commercials. Pediatric nurses can educate and support parents on the effects of mass media on their children through the following recommendations (Jordan, 2004):





Television


The medium that has the most impact on children in the United States today is television; it has become one of the most significant socializing agents in the lives of young children. Its programs and commercials provide multiple sources for acquiring information, modeling behaviors, and observing value orientations. Besides producing a leveling effect on class differences in general information and vocabulary, TV exposes children to a wider variety of topics and events than they encounter in day-to-day life. Television always has time to talk to children and is a form of access to the adult world. Positive results occur only when viewing is relatively light, yet the average child in the United States older than the age of 8 years spends more time watching television or using a computer and video games (>6 hours/day) than in any other activity except sleeping (Fig. 4-3) (Council on Communications and Media, 2009).


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FIG 4-3 The average child in the United States spends more time watching television than in any other activity except sleeping. (© 2012 Photos.com, a division of Getty Images. All rights reserved.)

Television can offer some beneficial effects on growing children by teaching healthy ideas and habits. Shows like Sesame Street promote school readiness by teaching letters and numbers, as well as teaching children about kindness and tolerance towards people who are different than them (Strasburger, 2010). Unfortunately, there is an imbalance in the availability of healthy and unhealthy media. Most researchers have concluded, however, that protracted television viewing can have negative effects on children. Increased verbal and physical aggressiveness, reduced persistence at problem solving, greater sex-role stereotyping, and reduced creativity have been reported repeatedly. In fairness, no one has yet defined the long-term effects of other electronic factors such as stereo headphones versus conversation, computer games or drills versus active social play, or DVDs versus books. However, clearly, children in the modern electronic environment are constantly stimulated from the outside, which allows them little time to reflect and develop the inner speech that feeds brain development.

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Jan 16, 2017 | Posted by in NURSING | Comments Off on Social, Cultural, and Religious Influences on Child Health Promotion
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