Arab American Population Research Articles

Attributions and Relationship Satisfaction in an Arab American Population

Attributions and Relationship Satisfaction in an Arab American Population

Perspectives on Human Papilloma Virus Vaccination Barriers, Knowledge and Beliefs, and Practices: Providers Serving Arab-American Populations.

Little is known of HPV vaccination (HPVV) recommendation practices among healthcare providers who treat the Arab American community. Evidence indicates that HPVV patient uptake is low in this population. A survey was administered to healthcare providers (N = 46, 63% response rate) who treated ≥ 5% Arab American patients aged 9-26 years in areas of New York City and New Jersey with large Arab American populations. They were asked about barriers to HPVV recommendation and uptake among their Arab American patients. Providers (Doctors of Medicine and Osteopathy, Nurse Practitioners, and Physician Assistants) mostly worked in pediatrics (41%), primary care/internal medicine (26%), obstetrics/gynecology (20%), and family medicine (15%). Most (91%) were confident in their ability to effectively counsel their patients on HPVV. The most frequent provider-reported barriers to administering the HPVV to Arab American patients were patient cultural/religious practices (reported by 67%) and patient and provider difficulties with insurance reimbursement (44%). Most providers (84%) agreed that organizations/programs to increase HPVV uptake among Arab American patients were needed. Providers felt that HPVV uptake could be increased with educational materials in the patients' native languages ("very useful," 81%) and provider cultural competency training ("very useful," 65%). In responses to open-ended questions, cultural and religious HPVV barriers were a salient topic, as were linguistic barriers and provider burdens related to HPVV costs and regulations. HPVV uptake could potentially be improved with Arabic language education materials, provider education that is culturally and linguistically tailored to the Arab American community, and policies to address HPVV financial and regulatory burdens.

Association between Susceptibility to Systemic Lupus Erythematous and Polymorphisms in miR-146a and miR-499: A Meta-Analysis

Introduction: This study aimed to determine whether miR-146a and miR-499 polymorphisms are associated with susceptibility to systemic lupus erythematosus (SLE). Methods: We searched the MEDLINE, EMBASE, and Cochrane databases. We performed a meta-analysis on the association of miR-146a rs2910164, rs2431697, rs57095329, and miR-499 rs3746444 polymorphisms with susceptibility to SLE. Results: Twenty-one studies from 17 reports, with 18,910 patients and 29,622 controls, were included in the meta-analysis. Meta-analysis revealed no association between SLE and the rs2910164 C allele (odds ratio [OR] = 0.999, 95% confidence interval [CI] = 0.816–1.222, p = 0.990). Stratification by ethnicity indicated no association between the miR-146a C allele and SLE in Arab or Latin American populations. The meta-analysis revealed an association between SLE and the miR-499 rs374644 CC + CT genotype in the overall group (OR = 1.313, 95% CI = 1.015–1.698, p = 0.038). Furthermore, meta-analysis revealed a significant association between SLE and the miR-146a rs2431697 C allele in the overall group (OR = 0.746, 95% CI = 0.697–0.798, p = 0.038). The miR-146a rs2431697 C allele is protective against SLE risk. Stratification by ethnicity indicated an association between the miR-146a rs2431697 C allele and SLE in Asian and European, but not Arab populations. The meta-analysis showed an association between the miR-146a rs57095329 G allele and SLE in Asian, but not Arab populations. Discussion/Conclusion: This meta-analysis suggests that the miR-146a rs2431697 polymorphism is a protective factor against the risk of SLE, and that the miR-146a rs57095329 and miR-499 rs3746444 polymorphisms are associated with susceptibility to SLE. However, miR-146a rs2910164 was not associated with susceptibility to SLE.

Association between vitamin D receptor polymorphisms and vitiligo susceptibility: An updated meta-analysis.

Vitamin D receptor (VDR) polymorphisms may play an important role in the vitiligo susceptibility. There have been many studies looking at the associations between VDR polymorphisms and vitiligo risk, but the conclusions are still up for debate. This study aimed to determine whether polymorphisms in the VDR are associated to the susceptibility to vitiligo. Vitamin D receptor polymorphisms in vitiligo patients and controls were identified using PubMed/Medline and Embase databases. The relationships between the VDR ApaI, TaqI, BsmI, and TaqI polymorphisms and vitiligo were investigated using meta-analyses of all participants and Asian, Arab, European, and Latin American groups. This meta-analysis included 13 papers with 2034 patients and 2771 controls. In all individuals, there was no link between vitiligo and the VDR ApaI A allele (OR=0.889, 95% CI=0.713-1.109, p=0.298). However, in Asians (OR=0.721, 95% CI=0.553-0.940, p=0.016) but not in Europeans or Arabs, there was a link between the VDR ApaI A allele and vitiligo. Utilizing recessive, dominant, and homozygote contrast models, a link between vitiligo and the VDR ApaI polymorphism was discovered in Asians. Meta-analysis of the VDR BsmI polymorphism showed a significant association between vitiligo and the B allele (OR=0.812, 95% CI=0.686-0.961, p=0.015). In contrast, no connection between vitiligo and VDR polymorphisms was identified for TaqI and FokI polymorphisms. In the Asian population, ApaI and BsmI polymorphisms in VDR have been correlated to vitiligo susceptibility. However, TaqI and FokI polymorphisms in VDR are not associated with vitiligo susceptibility in European, Asian, Arab, and Latin American populations.

COVID-19 Vaccine Hesitancy among Arab Americans.

(1) Background: Coronavirus disease-2019 (COVID-19) vaccines have a significant impact on reducing morbidity and mortality from infection. However, vaccine hesitancy remains an obstacle in combating the pandemic. The Arab American (AA) population is understudied; thus, we aimed to explore COVID-19 attitudes within this community. (2) Methods: This was a cross-sectional study. An anonymous online survey was distributed to members of different AA associations and to the community through the snowball method. (3) Results: A total of 1746 participants completed the survey. A total of 92% of respondents reported having received at least one dose of a COVID-19 vaccine. A total of 73% reported willingness to receive a booster, and 72% plan to give their children the vaccine. On multivariate analysis, respondents were more likely to be vaccine-hesitant if they were hesitant about receiving any vaccine in general. They were less likely to be vaccine-hesitant if they were immigrants, over the age of 40, up to date on their general vaccination and if they believed that COVID-19 vaccines are safe and effective in preventing an infection. The belief that all vaccines are effective at preventing diseases was also associated with lower hesitancy. (4) Conclusions: This sample of AAs have higher vaccination rates and are more willing to vaccinate their children against COVID-19 when compared to the rest of the population. However, a reemergence of hesitancy might be arising towards the boosters.

COVID-19 in Arab Americans Revealed a Public Health Concern

COVID-19 infection can lead to severe consequences, especially among ethnic minorities. Data about COVID-19 infection outcomes in the Arab American population as a minority ethnic group compared to other racial and ethnic minorities are lacking. We conducted a retrospective observational cohort study that included 1,740 hospitalized adult patients with confirmed COVID-19 infection from March 12th, 2020, to January 30th, 2021, at a single center to compare baseline characteristics and outcomes in Arabs hospitalized with COVID-19 to patients from other ethnic groups during the same study period. Of those, we identified 320 Arab patients. We found that Arab American population suffered similar odds of complications and adverse outcomes despite having fewer risk factors for severe illness.

Medical Trainees Comfort and Confidence in Providing Care to Arab and Muslim Patients at a Large Academic Medical Center

Phenomenon There are currently 3.5 million Americans of Arab descent and 3.45 million Muslims living in the United States. These rapidly growing populations face significant health disparities, which is likely in part due to the lack of culturally competent physicians trained to treat these populations. While the Institute of Medicine calls for cross-cultural training for all providers, it is not clear if this need is being met. The purpose of this study is to examine medical trainees’ current level of cultural training and whether this corresponds to confidence in caring for Arab and Muslim patients. Approach The authors created an anonymous survey that was distributed via email to medical students and residents at Michigan Medicine between January and March 2020. Questions included trainees’ comfort and confidence level in caring for Arab and Muslim patients, as well education received on this topic. Findings Results showed that 41% of respondents were confident in their ability to take a history from an Arab patient immigrated to the U.S. Additionally, 55% of non-Muslim participants reported that they felt comfortable in caring for fasting patients, while only 24% felt confident in their ability to answer patient questions about fasting. Approximately half of respondents felt confident in their ability to examine an Arabic-speaking woman (47%) or woman wearing a hijab (49%). The majority of respondents had not received any training or education in the care of Arab patients (64%) or fasting patients (81%). Insight Medical trainees at one large academic medical center in the state with the second largest Arab-American population, and one of the largest populations of Muslim-Americans lack comfort and confidence in providing culturally competent care for Arab and Muslim patients. Education of trainees about Arab and Muslim health should be implemented into the curriculum to optimize care delivered to this patient population.

A Comprehensive Antiracist Framework for SLHS Education: A Sample Curriculum Related to Arab American Populations

Black, Indigenous, and People of Color (BIPOC) students in higher education programs in Speech, Language, & Hearing Sciences (SLHS) experience structural racism, entering a majority white profession, while confronting social inequalities in their personal and professional communities. A vision of an antiracist decolonized antiracist curriculum enhances the integration of BIPOC students in academic programs in the field, while also facilitating the preparation of non-BIPOC students to meet the needs of a growing and diverse community of individuals with communication disorders. Such a curriculum must be comprehensively designed to include pedagogy, community-based, and research based educational activities, and to adequately prepare students to be culturally responsive within our profession. The quantity and quality of available resources on diverse populations in the field is woefully limited, so this paper exemplifies the principles of this approach through research, teaching, and community-based learning activities focused on Arab Americans, to exemplify one possible application of such curricular transformation.

Characteristics and distribution of obesity in the Arab-American population of southeastern Michigan

BackgroundArab-Americans constitute ~ 5% of Michigan’s population. Estimates of obesity in Arab-Americans are not up-to-date. We aim to describe the distribution of and factors associated with obesity in an Arab-American population in Southeastern Michigan (SE MI).MethodsRetrospective medical record review identified n = 2363 Arab-American patients seeking care at an Arab-American serving clinic in SE MI, located in a city which is home to a large proportion of Arab-Americans in the United States (US). Body mass index (BMI) was the primary outcome of interest. Distribution of BMI was described using percentages, and logistic regression models were constructed to examine the association between obesity, other comorbid conditions and health behaviors. This cohort was compared to Michigan’s Behavioral Risk Factor Surveillance System (BRFSS) data from 2018 (n = 9589) and to a cohort seeking care between 2013 and 2019 from a free clinic (FC) located in another city in SE MI (n = 1033).ResultsOf the 2363 Arab-American patients, those who were older or with HTN, DM or HLD had a higher prevalence of obesity than patients who were younger or without these comorbidities (all p-value < 0.001). Patients with HTN were 3 times as likely to be obese than those without HTN (95% CI: 2.41–3.93; p < 0.001). Similarly, the odds of being obese were 2.5 times higher if the patient was diabetic (95% CI: 1.92–3.16; p < 0.001) and 2.2 times higher if the patient had HLD (95% CI: 1.75–2.83; p < 0.001). There was no significant difference in obesity rates between Arab-Americans (31%) and the BRFSS population (32.6%). Compared to Arab-Americans, patients seen at the FC had a higher obesity rate (52.6%; p < 0.001) as well as significantly higher rates of HTN, DM and HLD (all p < 0.001).ConclusionOverall obesity rates in Arab-Americans were comparable to the population-based BRFSS rates, and lower than the patients seen at the FC. Further studies are required to understand the impact of obesity and the association of comorbidities in Arab-Americans.

Association Between Signal Transducers and Activators of Transcription 4 rs7574865 Polymorphism and Systemic Lupus Erythematosus: A Meta-analysis

Objective. The purpose of this study was to determine whether the rs7574865 polymorphism of signal transducers and transcription 4 activators (STAT4) in multiple ethnic populations is associated with susceptibility to systemic lupus erythematosus (SLE). Methods. A meta-analysis on the STAT4 T allele rs7574865 polymorphism was performed in all subjects of study as well as in each ethnic population. Results. It included twenty-four manuscripts with 36 comparative studies of 22,898 SLE patients and 24,838 controls. The mean frequency of the STAT4 rs7574865 T allele was 28.5%, ranging from 14.3% to 35.7%, among the controls. T allele rates were 14.3%, 22.8%, 31.9%, 32.4%, and 35.7%, respectively in African American, European, Arab, Asian, and Latin American populations. Meta-analysis revealed a substantial correlation in all subjects between STAT4 rs7574865 and SLE (odds ratio=1.549, 95% confidence interval=1.459∼1.644, p＜0.001). Analysis after stratification of race showed a strong association between the STAT4 rs7574865 T allele and SLE in Europeans, Asians, Latin Americans, African Americans, and Arabs. Conclusion. This meta-analysis demonstrated that the STAT4 rs7574865 polymorphism in different ethnic groups was correlated with SLE susceptibility, and that its prevalence depended on ethnicity. (J Rheum Dis 2020;27:277-284)

Abstract C089: Racial/ethnic differences in smoking-related cancers in metropolitan Detroit

Abstract Metropolitan Detroit has a unique population structure, home to one of the highest concentrations of Arab Americans. Due to differences in prevalence of smoking between ethnic groups, we calculated incidence of smoking-related cancers among Arab Americans, Hispanics, non-Hispanic Whites and non-Hispanic Blacks in the metropolitan Detroit area. All first primary lung/bronchus, urinary bladder, and head and neck cancer cases diagnosed 2004-2015 were obtained from the Detroit Surveillance, Epidemiology, and End Results (SEER) Program from 2004-2015. Arab/Chaldean surname cases were identified using a validated name algorithm resulting in five different racial/ethnic categories: non-Arab non-Hispanic Whites (NANHW), non-Arab non-Hispanic Blacks (NANHB), Arab American (ArA), Hispanics, and Other Ethnicities. Frequency tables were created to analyze distribution of stage, cancer site, age group, and sex between ethnic groups. Using Integrated Public Use Microdata Series (IPUMS), population estimates for the 11-year period were generated for each ethnic group. Age-standardized incidence rates were calculated using the 2000 US Standard Million for each group of cancer sites (lung/bronchus, head/neck [HNC], and bladder) for each ethnic group. Rate ratios (RR) and 95% confidence intervals were calculated using International Association for Research on Cancer (IARC) Statistical methods for registries and NANHW as the reference group. From 2004-2015, there were 60,366 cases of smoking-related cancer reported to SEER, 1,346 of which were diagnosed in ArA. Among males, NANHB were more likely to be diagnosed with lung cancer over this time period (NANHB vs NANHW RR=1.23 95% CI (1.17, 1.30)). ArA and Hispanic males had significantly lower rates than NANHW (RR=0.81 95% CI (0.72, 0.90) and 0.66 (0.58, 0.76), respectively). NANHW, NANHB, and Hispanic males had similar HNC rates (Hispanic RR=0.84 95% CI (0.63, 1.12) and NANHB RR=1.15 (1.03, 1.29) vs NANHW). Arab males had a significantly lower rate of HNC compared to NANHW (RR=0.67 95% CI (0.53, 0.83)). NANHW and Arab males had similar rates of bladder cancer (RR=1.13 95% CI (0.98, 1.31)). NANHB and Hispanic males had significantly lower rates of bladder cancer compared to NANHW (RR=0.49 95% CI (0.45, 0.52) and 0.51 (0.43, 0.61), respectively). Similar patterns emerged among females for both lung and bladder cancers. Females also had similar rates of HNC comparing NANHW and NANHB (RR=1.09 95% CI (0.89, 1.32)), but in contrast to males, Arab women had a marginally lower rate of HNC (RR=0.75 CI (0.49, 1.17)), and Hispanic women had a significantly lower rate of HNC (RR=0.55 95% CI (0.35, 0.86)). We report previously observed differences in lung and bladder cancer and identify novel differences in HNC among subgroups in metropolitan Detroit. Our future analyses will expand to other registries in the US with significant ArA populations. Analyses should be attentive to ArA as a population subgroup, which will define research questions specific to this unique population. Citation Format: Juliana E. Fucinari, Julie J. Ruterbusch, Katie M. Zarins, Laura S. Rozek, Kendra L. Schwartz. Racial/ethnic differences in smoking-related cancers in metropolitan Detroit [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C089.

Examining Perceived Multicultural Counseling Competence and Negative Attitudes Toward the Arab American Population

The purpose of this quantitative study was to investigate the relationship between professional counselors’ general multicultural competence and negative attitudes held toward Arab Americans. Participants (N = 124) completed a survey, and a series of correlational, stepwise, and multiple regression analyses was conducted. Results indicated that counselors displayed higher levels of multicultural awareness than of multicultural knowledge. Furthermore, general multicultural awareness and specific knowledge of Arabs related significantly to negative attitudes held toward Arabs.El propósito de este estudio cuantitativo fue investigar la relación entre la competencia multicultural general de consejeros profesionales y las actitudes negativas mantenidas hacia personas estadounidenses de origen árabe. Los participantes (N = 124) completaron una encuesta, y se llevó a cabo una serie de análisis correlacionales, por pasos y de regresión múltiple. Los resultados indicaron que los consejeros mostraron niveles de conciencia multicultural mayores que los niveles de conocimiento multicultural. Además, la conciencia multicultural general y el conocimiento específico acerca de las personas árabes estuvieron significativamente relacionados con actitudes negativas mantenidas hacia personas árabes.

Using Community-Based Participatory Research to Explore Health Care Perceptions of a Select Group of Arab Americans.

Introduction: As the Arab American population grows in the United States, relatively little has been published about the health status of this population. The purpose of the research was to (1) discover health care perceptions of Arab Americans and (2) identify strategies to ensure the provision of culturally congruent health care. Method: Community-based participatory research methodology was used for this descriptive study. Interviews and focus groups were conducted with Arab Americans residing in northeast Pennsylvania. Results: Three themes were identified: (1) perceptions of health resulting in delays in seeking health care, (2) cultural values and practices resulting in need for culturally congruent provision of care, and (3) mistrust of the U.S. health care system resulting in underutilization of services. Discussion: Results indicate the need for nurses to implement culturally congruent community-based strategies and interventions for meeting health care needs of Arab Americans. By understanding the community's perceptions and attitudes, nurses will be better positioned to ultimately move toward the goal of reducing health disparities in this underserved population.

Knowledge Assessment and Screening Barriers for Breast Cancer in an Arab American Community in Dearborn, Michigan.

Breast cancer (BC) is the most common malignancy afflicting women during their lifetime. Screening for breast cancer can reduce mortality through early cancer detection. Lack of knowledge is an important barrier leading to low screening rates. Little research has evaluated breast cancer knowledge and barriers to receiving appropriate screening among Arab Americans. Given that the Arab American population has grown approximately 47% since 2000, this study was designed to assess breast cancer knowledge and screening barriers in an Arab American community. An anonymous survey addressing knowledge assessment and screening for breast cancer was distributed at the Arab Community Center for Economics and Social Services in Dearborn, MI between June 2015 and August 2017. The survey was modified based on a similar study that was conducted Among Adult Saudi women in a primary health care setting. 102 non-BC survivors, 48 BC survivors and 50 men participated in this study. Gaps in knowledge around the role of age and family history, as well as cancer presentation were noted among the participants. Additionally, 51% of non-BC survivors over the age of 40years have not had a screening mammogram in the past 2years with leading causes being absence of symptoms, lack of health insurance, and absence of family history. Healthcare providers and community organizations should work towards increasing knowledge levels, reducing misconceptions and improving screening rates for breast cancer among Arab Americans. Increasing community outreach and education and navigating the community's health beliefs and practices can optimize the process of information delivery to community members.

Abstract 122: Presentations Management and Outcomes of Arab-American Patients Hospitalized with Heart Failure Compared with Age and Gender Matched White American Patients

Background: Of approximately 200,000 Arab Americans residing in Michigan, 40,000 live in Dearborn, there is very little data exists on the presentations, management, and outcomes of Arab-American patients admitted with CVD. our research purpose is to evaluate whether there are any differences in the presentations, management, and hospital outcomes of Arab-American patients admitted with CHF as compared to the White American population. Method: Computerized list of all patients admitted in 2009 with the principal diagnosis of CHF at Beaumont Hospital- Dearborn (BH-D). Arab American cohort identified on the basis of Arabic/Middle Eastern names. Medical records obtained and data variables derived by chart review and age, gender, and same diagnosis matched White American patients chosen as controls and similar data obtained from chart. Result: There were 1,534 patients who presented to BH-D with a diagnosis of CHF in 2009. We had a total of 126 patients, 66 of whom were Arab-Americans and 60 of whom were Caucasians. The clinical presentations of how both groups presented to the hospital were different in both groups. Hypotension was a presenting sign in the Arab American population with a value of 17 % of the population presented with the hypotension as compared to 3% in the Caucasian population (p=0.038). Lightheadedness was also a significant clinical presentation in the Arab American population where 19 percent as compared to 2% of the Caucasian group (p=0.022). Chest pain was seen as a presenting symptom in the Arab American population in which 15 out of 60 patients presented with chest pain as compared to 7 out of 60 in the Arab American population (p=0.032). Dyspnea with and without exertion were similar in both groups with a mean of 0.97 and 0.90 respectively in the Arab American population (p=0.16) and 0.67 and 0.60 respectively in both groups (p=0.47). Acute treatments using evidence based measures such as placing patient on ACE- Inhibitor, beta blocker; nitrate, hydralazine, loop diuretic, IV nitro, dobutamine, and statins were very similar in both of the groups with no significant differences with p values of 0.69; 0.81; 0.84; 0.16; 0.99; 0.28; 0.48; and 0.10 respectively. We found that Arab Americans are more likely to have left ventricular hypertrophy on electrocardiogram than the Caucasian population at 33% versus 12% respectively (p=0.011). Core measures was found to be 100% in both groups of Left ventricular dysfunction, ACE-I/ARB with patients who have left ventricular dysfunction, and smoking cessation counseling. Discharge instructions as a core measure was found to be 90% in the Arab American population and 95% in the White American population. Conclusion: This is the FIRST study that evaluated presentations, management, and outcomes in Arab Americans admitted with CHF in a U.S. hospital. There is No DISPARITIES in management of Arab Americans patients admitted with CHF at BH-D.

Objective and subjective poor mental health indicators among Arab Americans in Michigan: a population-based study

ABSTRACT Background: Arab Americans are at high risk for poor mental health outcomes and are difficult to study at a population level due to a lack of racial/ethnic identifiers for this population. Methods: Using data from the standalone 2013 Michigan Arab Behavioral Risk Factor Survey (MI ABRFS) we aimed to understand whether the burden of mental health differed between Arab Americans and non-Arab, non-Hispanic Whites. Two measures of mental health were used: a subjective (number of poor mental health days experienced in the past 30 days) and an objective (being diagnosed with depression) measure. Additionally, we aimed to understand the sociodemographic, stress, and health-related variables associated with the objective and subjective measures of psychopathologies in the Arab American population in Michigan using population-weighted logistic regression models with survey design correction. Results: Arab Americans had increased odds of adverse mental health when compared to non-Arab, non-Hispanic Whites for the subjective measure of number of poor mental health days (OR: 1.62, 95% CI: 1.08, 2.41) and decreased odds of reporting the objective measure of diagnosed depression (OR: 0.54, 95% CI: 0.30, 0.98). Having more than one poor mental health day and being diagnosed with depression among Arab Americans was associated with being female, unmarried, unemployed, and having experienced abuse as a child. Discussion: Combining mental health screenings with primary care check-ups among Arab Americans may be an important step in identifying individuals with mental health needs and extending access to care.

Cultural Sensitivity of a Community-Based Falls Prevention Program Targeting Older Arab American

Falls are a frequent and costly cause of injuries and functional decline in the elderly. Tai Chi is a cost-effective strategy for preventing falls in older adults. Many senior centers have introduced Tai Chi programs to increase mobility and decrease the risk of falls. However, the practice has yet to be widely disseminated to ethnic minorities who are not culturally connected to Tai Chi. This paper describes implementation barriers and recruitment and retention challenges of Arab American participants in a Tai Chi intervention-based health promotion program, including issues related to community organization and staffing, recruitment and retention, need for building relationships, need for translation and interpreters, and cultural barriers & misconceptions. Understanding and paying adequate attention to these challenges may help facilitate in planning other health promotion interventions targeting Arab American population.

Challenges and strategies for conducting sensitive research with an Arab American population

Recruiting minority groups such as Arab Americans (Ar-Am) for research studies has been challenging. To date no studies were found that explicitly addressed challenges to recruit Ar-Am for sensitive research. The purpose of this article is to present the challenges across three pilot studies that involved Ar-Am samples and the strategies that were implemented to overcome these challenges. The challenges faced with conducting studies with Ar-Am included difficulty for participants to express emotions, influence of male/female authority to consent for the study, lack of trust to disclose sensitive information, language barrier, and slow recruitment. Having bilingual female recruiters of Arabic descent, engaging the women's family members in the consent process, and addressing the sensitive topics in culturally appropriate language were effective strategies to overcome these challenges. These strategies might be helpful for other researchers who recruit Ar-Am for sensitive research.

Diabetes self-management among Arab Americans: patient and provider perspectives.

BackgroundArab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. population. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers.MethodsQualitative content analysis was used to analyze five focus groups–two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients.ResultsFour distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships.ConclusionsFindings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.

The Anguish of Freedom: Using an Existential Approach With Arab Immigrants

Influxes of Arab immigrants and refugees have contributed to the growth of the Arab American population. Migration can trigger feelings of alienation and isolation, identity confusion, and loss of meaning. This article uses an existential framework to explore this population's culture and pre‐ and postmigration stressors and to better conceptualize their needs.