physical assessment

Health Promotion Plan for the cessation of tobacco use in the Muslim culture in the U.S

Abstract In this paper I will describe the religion of Islam, its beliefs, traditions, rituals and heritage. I will then explore the family structure of the Muslim family and their correlation to nursing interview in consideration of their religion. Afterwards, I’ll explore the health issue of tobacco use among Muslim American and ways to promote its cessation and health care as a whole case.
Introduction
Primarily, a Muslim person is considered to be one who warships the Quran and believes in the fact that Mohammad is god’s prophet. The early form of Muslim culture was predominantly Arab. (Islamic Culture, 2013). Muslims believe that the purpose of existing is to love and serve god (Islam, 2013). As an example the word “Islam” means submission to the will of god (Islam at a glance, 2009). The Muslims believe that Islam originated over 1400 years ago in Mecca, Arabia. In addition, today, Mecca considered being the holiest and most sacred place for Islam. One of the five pillars of Islam is the Haj’, a pilgrimage to Mecca at least once in a lifetime.
Furthermore, the five pilgrims of Islam include the following: 1) daily prayers; 2) giving alms to the poor; 3) a pilgrimage to Mecca; 4) fasting during Ramadan; 5) the profession of faith (Liberti, 2010, p. 4). That is to say that the traditional religious Muslim will pray 5 times a day, will give a small donation of his wealth to the poor, will visit Mecca at least once during his life, will fast during the most important Muslim holiday the “Ramadan” and will worship god and his prophet Mohamed. During the Ramadan fast, Muslims are not allowed to eat during the day; however, they are allowed to eat during the night. Moreover, the Ramadan lasts a whole month, so it would be very hard to survive for so long without food. The next aspect of Islam is very different depending on the region of the world we are examining, and that is family structure. The father’s role is not doubtful regardless of the geographic place, he is the head of the family and nobody around the house can challenge his behavior or decisions. On the contrary, a female’s role is indeed very different. In most of the countries around the world a woman’s duty is to stay home and raise the children. She is not allowed to go to school or go to work. Astonishingly, some countries ban the women from driving a car alone without a supervision of a male. In contrast, in the U.S, Muslim women are encouraged to get education and go to work. Nevertheless, there are still few limitations to their health care approaches. A Muslim female will never be left alone without a man “supervising her” with the health care provider. She will not answer any questions or cooperate in general. Finally, there are two main streams in Islam: the Sunnites and the Shiites. These two groups are in constant fight with each other over minor differences in how to worship god correctly.
Interview and health care limitations Few aspects fall under the umbrella of limitation to interviewing and providing health care to the Muslim patient. The first limitation includes both the men and the women and it is very similar to the Jewish orthodox people that consulting their spiritual leaders instead of the doctors. The majority of the strictly religious population goes to see the sheikhs and consult him about different issues of the daily life, including many discreet health issues. For example: infertility problems will be discussed with the sheikh first and he will then in turn try to advise them on what to do or change in their daily routine from the point of view of Islam.
Second, the biggest issue of all Islamic people around the world is the family structure, meaning the man is the leader and what he says cannot be challenged. It has a small correlation to the first issue since there are no female sheikhs but only males that fulfill this important religious mission. Since the man has the final word in the house it shines on both directions and hurts the husband and his wife. The husband is being compromised from getting the right treatment as he is embarrassed and afraid to show he is sick and that he needs help. They’d rather hold it inside and ignore the problem just not to show any weakness in front of the wife and kids. On the other hand, the wife suffers as well. In some cases, the wife alerts the husband of a specific problem which he decides to disclose inside of the family instead of going out and taking care of it with a professional health care person. For example: psychiatric problems or sexual molestations might be hidden inside the family since it has a negative connotation and thus, be preferred to be kept inside.
The third aspect is the faith in god. Similarly to the Jewish religion, often times the Muslim will “blame” god for their condition and accepts it as a fact that cannot be changed. They believe that god is responsible for everything and thus doesn’t worry about health problems since they think of it as their destiny. In the research “Meeting the Health Care Needs of American Muslim” conducted by Padela and colleagues it showed that illnesses ranging from influenza to cancer are attributed by many Muslim-Americans to the influence of God, with some describing illness as "a disease of fate” (Padela, Gunter, & Kiwalli, 2011).
The fourth barrier touches the female population. There is a common set of rules of behavior for the Muslim woman. In cases of medical interview or even providing care, the female would not provide any personal and important information if the husband is not around. In extreme instances she would sit quiet and will not say a word. This, in my opinion, sets the biggest and hardest barrier to providing health care to the Muslim patient. Furthermore, it is also very common to provide health care from the same sex provider since the religion of Islam, same like the Jewish, is very strict and demands that there won’t be any interactions between men and women unless they are married. It is useless explaining that there may be a benefit in one provider over the other because he will be of the opposite sex.
The last barrier maybe a little marginal but still very influential. Many older Muslims do not believe in western medicine and prefer the old “house medications and treatments” (Liberti, 2010, p. 3). That may not only impact the regular (conventional) treatment, but also interfere with medication adherence. Furthermore, dangerously, homemade meds may interact with conventional drugs and create an adverse effect or simply cancel the effect of the drug.
Risk factors and causes for tobacco use Smoking has increased in the majority of the developing countries. On the contrary smoking has decreased in the U.S. in the last three decades. There are 4 million tobacco related deaths per year (globally). Lastly, most shocking, is that every minute 10 million cigarettes are sold worldwide (CDC, 2013). As of the dangers of smoking, we all know it affects almost every aspect of our health, ranging from different types of cancers to cardiac complications and through almost every system of the human body. In regards to the Muslim culture there are few factors that influence its strong affinity to tobacco use.
First, it’s simply culturally common. We can see a proof for that in the UN’s data website showing the number of people who smoke at the origin countries. As an example we see that countries like Tunisia (69%), Djibouti (57.5%), Iraq (50%), Jordan (48%) and Lebanon (46%) have a very high percentage of smoking people. (WHO, 2013). Obviously, a habit you were born into and grew up to is very hard to change.
Second, the culturally common tradition of smoking water pipe (hookah). Another negative ritual among the Muslim culture that according to some specialists is much more harming than smoking cigarettes. That happens because the water fumes mixed with the different type tobacco simply creates a dangerous mixture that emblems its damage inside the lungs and penetrates deeper into the alveoli.
Third, stress is one of the main causes for smoking in the Muslim culture. As we mentioned before, the male is the dominant figure in the house and the tasks of feeding and providing for the family falling exclusively on him. These facts have serious consequences on the level of stress experienced by Muslim males leading to excessive tobacco use.
Fourth and sometimes considered a minor factor is second hand smoking. Needless to mention, the dangers that second hand smoking has on the environment of the smoker itself; in this, the smoker puts not only himself in danger but also his all surroundings in the same lion’s pit. That is to say, that the numbers of people who really suffer from tobacco use are dramatically higher.
Last, the fact that tobacco use is the number one cause of death in the U.S. does not help these people to stop smoking. Even though the numbers are not as high as in their original countries, it still provides a fertile ground for smokers to keep on with their unhealthy habit. That is achieved by the numerous commercials and billboards we see everywhere we go nowadays.
Ways of prevention and intervention In this section I’ll develop a health promotion plan that will be divided into few directions and will cover aspects that will demonstrate practices that need to be adopted, measures to improve life expectancy and measures to close the cultural gap. In regards to the first target, developing practices and behaviors that needs to be adopted. In my opinion, the only way to change the behavior of these strict Muslims is via their religious leaders, like their sheikhs, for example. The regular American Muslims do not follow the old traditional rituals and harsh regulations, so I believe there is no problem there. The real problem lies in the old fashioned religious population that apprehend only what the sheikh says. They are not concerned about their health; rather they accept everything as given from Allah (god). I think the best way of action would be to create a program that will bring all the religious leaders together, in which a Muslim MD will explain the importance of the mission, that it health promotion and smoking cessation. The doctor must explain to them the dangers, risk factors and consequences of tobacco smoking. Consequently, the doctor must also convey to them that they have an extraordinary influence on the population and that basically the health of their followers is on their hands. Later, in their weekly/daily homilies and meetings and will convey the massage. He will preach and talk to the hearts of the followers and will explain them all that were explained to him. Hopefully, this may bring a little change in their point of view of smoking cessation and behavioral change. This part wraps around the behavioral changes and modifications, however, we also mentioned second hand smoking. In this part we can incorporate not only the religious leaders but also the community leaders as well. These individuals have a strong influence as well and I think it may have a positive effect on the population in convincing them not to smoke next to other family members. The second aspect we will cover will be improving quality of life and life expectancy in the Muslim population. There are few ways in incorporating a plan of action to reach the ultimate goal. First, we would distribute pamphlets at local community centers in neighborhoods of target population. This is done in order to increase exposure and educate people about tobacco use, its consequences and the ways to quit smoking. Second, we will distribute information brochures at the Muslim doctor’s offices also in the community in order for them to reach their target, which is Muslim population. From here it will be up to the MD’s discretion to who to suggest those pieces of information. A little addition to this solution is would be to distribute the same pamphlets, at points of interest for the Muslim cultured population. By doing so, we will be able to target the whole population regardless if they go to see the doctor or not. Remember, some individuals, do not want to show “weakness” and see the doctor in case of an illness. Therefore, people will see it in places unrelated to medicine and will understand that the matter is serious. Places of distribution include: kindergartens, schools, local delis and supermarkets, auto shops and car washes, children’s play grounds and shopping malls. Third aspect covered is closing the cultural gap. Here, I have to honest and say that I do not see it happening. Most of the cultures are living within themselves (to some extent) and partially distinct themselves from the “whole”. If we explore the huge diversity of cultures in the U.S. we will find that some assimilated pretty well and some not; in some cases, some cultures do not want and are not assimilating to the country they live in. Astonishingly, some cultures will also demonstrate on the streets and on TV and say that not only they will never assimilate to the country; they object it and everything in it. To my knowledge, the problem lies in the education and the way these people were brought up by their parents. The majority of the problem is in the older population that doesn’t need this assimilation, they are ok as they are and start to rely on their children at old age. However, I do see a hope. The younger population, the once who were born here or were brought here at a young age do assimilate and will assimilate because they understand that’s in order to live well in this country they must assimilate and respect the main spirit of the U.S. Therefore, I do not think there’s a magic trick that will help bring the Muslim culture closer, but on the other hand, I do see hope, and with time we will see the right and awaited change.

Personal statement
During the writing of this paper, I learned a great deal about the Muslim culture and its implication on nursing care. First, I’ve learned about their beliefs and rituals, and now I know what they cherish and what the most important things are for them. Most importantly, I’ve learned how to approach the Muslim patient. Now I know that I must treat only the male portion of the population and that I should not push for anything that’s not respected by their religion. Now I know the right approach in conveying medical care and info to them.

References
General statistics of middle eastern counties [ World Health Organization]. (2013, July/2013). Retrieved from who.int/emhj/v16/02/16_2_2013_0156_0161.pdf
Islam. (2013, June/2013). Islam [Blog post]. Retrieved from en.wikipedia.org/wiki/islam
Islam at a glance. (2009, 6/30/2009). Islam at a glance [Blog post]. Retrieved from www.bbc.co.uk/religion/religions/islam/ataglance/glances.shtml
Islamic Culture. (2013, July/2013). Islamic culture [Blog post]. Retrieved from en.wikipedia.org/wiki/islamic_culture
Liberti, D. [Darlene Liberti, RN]. (2010, July/5/2010). Muslim-American culture and tobacco use [Blog post]. Retrieved from www.slideshare.net/liberti/health-promotion-muslim-culture
Padela, A., Gunter, K., & Kiwalli, A. (2011). Religious beliefs shape health care attitudes among U.S. Muslims. Retrieved from www.uchospitals.edu/news/2011/20110812-muslim-health-attitudes.html
Smoking and tobacco use. (2013, April/2013). Global highlights of the year 2012 [Blog post]. Retrieved from www.cdc.gov/tobacco/data_statistics/worldwide_highlights/2012/map/html

References: General statistics of middle eastern counties [ World Health Organization]. (2013, July/2013). Retrieved from who.int/emhj/v16/02/16_2_2013_0156_0161.pdf Islam. (2013, June/2013). Islam [Blog post]. Retrieved from en.wikipedia.org/wiki/islam Islam at a glance. (2009, 6/30/2009). Islam at a glance [Blog post]. Retrieved from www.bbc.co.uk/religion/religions/islam/ataglance/glances.shtml Islamic Culture. (2013, July/2013). Islamic culture [Blog post]. Retrieved from en.wikipedia.org/wiki/islamic_culture Liberti, D. [Darlene Liberti, RN]. (2010, July/5/2010). Muslim-American culture and tobacco use [Blog post]. Retrieved from www.slideshare.net/liberti/health-promotion-muslim-culture Padela, A., Gunter, K., & Kiwalli, A. (2011). Religious beliefs shape health care attitudes among U.S. Muslims. Retrieved from www.uchospitals.edu/news/2011/20110812-muslim-health-attitudes.html Smoking and tobacco use. (2013, April/2013). Global highlights of the year 2012 [Blog post]. Retrieved from www.cdc.gov/tobacco/data_statistics/worldwide_highlights/2012/map/html