The Influence of Ethnic and Mainstream Cultures on African Americans’ Health Behaviors: A Qualitative Study
The Present Study
2.1. Research Design
2.2. Participants and Recruitment Strategies
2.4. Ethical Considerations
2.5. Thematic Analysis
3.1. Culturally-Derived Barriers to and Facilitators of a Healthy Lifestyle
3.1.1. “It’s a Strength”: Drawing upon Ethnic Culture to Improve Health Behavior
“I feel like, our strengths and determination have help with healthy lifestyle; we tend to be very determined in doing anything we want to do; and it it’s a fight; it’s a strength and a fight to stand through a lot of harsh stuff. I feel like that strength, if it can be just implemented into healthy living, then I think that determination to want to change lifestyle from eating the traditional, unhealthy, greasy, heavily salted, to healthy living can change a lot of things in the culture”.
“In terms of the strengths, I think the strengths we have is that we’re a resilient people and we know that we have the potential within us to improve, but we just need… we need to make it a culture of speaking and engaging with each other about the things that are relevant to our health and happiness. And our eating habits. And once we can spread that word we can make that become more of a culture in the black community in terms of what we eat. I think it will make a tremendous difference. There are traces of that starting already”.
“With the little that we some of us, many of us do have we’ve learnt to like stretch and make a lot of it. Even with like the food that we have a lot of our ethnic food came from like. Even back from when we were enslaved and we like, like we had like you know not the best portions of particular animal or, um but we learnt how to you know like make it really good”.
“In my church they encourage you to eat healthy and if you’re stressed out, church is an avenue where you can find some type of relief so I would say that church would be one of the biggest things that helps”.
“This is the body that God gave me and I need to make sure I’m doing the best I can with it to; taking care of myself honors God because you know, gluttony is a sin and you’re not supposed to over-eat, you’re not supposed to do all of this stuff. So it’s the spirituality and the appreciation of the body and the understanding what when I eat healthy, I feel better”.
“We all love to dance. I love to dance, where I grew up dance was the exercise you went to; an African weekly dance class or any kind of dance class like we did, all kinds of dance, modern, hip-hop like, even Zumba that used to be my primary way of exercising”.
“[…] Music. I think one thing you know, we’re trendsetters. That’s, you know, um … if given the opportunity, we’re an active people […] when we don’t have the opportunity, we find a way sometimes to enjoy ourselves and dancing, you know, is a strong culture in the black community”.
“[…] The music, the rhythm, and dance - it is all like a big healthy thing but it’s not framed as that. Like when kids go to dance and you see them dancing, I mean their dances are very aerobic. You don’t always think of it as them exercising but it is”.
3.1.2. Difficulties Changing a Culturally Ingrained Proclivity for ‘Unhealthy’ Behaviors
“Within our community we’ve always been like, “the greasier the food, the better”. We still like cooking with lard and, you know, it is just ingrained […] it’s literally a passed down thing from one generation to another”.
“It [traditional ethnic food] is a cultural connotation and it’s also almost a spiritual thing. It’s, you know […] And a loving thing because it’s a part of this joy in cooking, and there’s that, you know, feeling of love you’re preparing for your family”.
“Soul food’ is not the healthiest food; and the food people typically choose to eat, as a culture, isn’t the most healthy. But there’s strong family bonds that happen around this food. So it’s kind of a disconnect. Family bonds are strong, but the nutrition typically isn’t that great”.
3.1.3. The ‘Healthy’ Individual: Aligning Health Beliefs and Behaviors with that of Mainstream Culture
“I think there’s a lot of values that Americans place on health that are really important; like it’s more of a priority than in African American culture […] I think health should be a priority to people”.
“I feel like we can definitely learn a lot more about just caring for our bodies in general. Even just things like drinking more water, which some of us don’t like to do haha. You know drinking more water and just taking care of like both emotionally and mentally and also physically our well-being. So for sure”.
“Mainstream American culture promotes that you exercise every day; and promotes staying active and keep moving; and even if today’s not basketball today, still go outside and take a walk kind of a thing”.
3.1.4. “The Best of Both Worlds”: Combining Cultural and Mainstream Approaches to Health
“Everything that’s out there when it comes to healthy behaviors we can implement into our everyday lives and it could be the best of both worlds; it’s something new and something refreshing and then it’s been a part of you for generations; and putting them both together can be amazing”.
“I pick and choose. Okay let’s go to food. So the first one would be not eating out too much, that’s something I grew up with in my ethnic culture, try and cook your own food. But then one thing I adapted from mainstream culture is - like I said, I’m a vegetarian- eating more greens and stuff like that. My answer would be pick and choose because I choose what’s good from my culture and I choose what’s good in my mainstream America, and I try to combine it”.
“I would say that in terms of eating habits eating more fresh vegetables and fruits and stuff like that, it’s probably more from mainstream American culture, and then more of a focus on athleticism as a woman comes from my African American culture”.
“You can choose to, prepare your traditional meals but opt for a better healthier version. Um don’t heavily season it, don’t overcook it, or um implement different areas of this healthy kick into the foods you’ve loved since you were a kid, and try new things and see what works for you”.
“I’m going to have my chicken baked instead of fried, how is that? Maybe I’ll have a baked potato instead of French fries. Small things like that. But they [people in the community] need to see that and they need to see other black folks doing it. So it’s, it’s a communal thing and it needs to be in their face”.
3.1.5. The Importance of Support from the Ethnic and Mainstream Community
“With everything that’s going on now, you see that well-being, your emotional and physical well-being is very much influenced by the way that you’re treated within these urban environments. And I think there’s a higher percentage of African Americans who are not just, not well, because we know that we kinda live in an anti-black society”.
“Let’s start with systematic racism. I think it’s different for every person. I was fortunate enough to be able to attend Colombia University so I have slipped through the cracks of oppression and been able to have this great education here. But not everyone can make it out and not everyone can have those opportunities to see past a bunch of negativity whether it be from racist employers or racist police or people who would judge you by your appearance and not know what’s in your head. Um, so I think that’s one thing that’s a daily challenge to a lot of people”.
“I don’t know, I have very little faith in mainstream America right now and I have very little faith that they care enough to do anything different for the African American community. I think, they would have to see us as human before they would even be able to help us be healthier and I just don’t think that enough of them believe in our humanity”.
“Having friends who do it [lead healthy lifestyle] can help – if you know that group of people [that] work out and run from Central Park and back, I feel like that you’re more likely like to engage in that type of behavior if you know your friends are doing it”.
“My friend and I really encouraged each other. So I would be like “oh I’m really dying for chicken wings” she would be like “No don’t do it!”. And so like having that support that is really great. She would be like “oh I was at work today and I’m thinking about having a donut” and I’m like “don’t do it! You don’t want to do it”!
“One of the things that my family really pressures me to do this eat healthy now because of the financial burden that it brings on later. So like my dad who has high blood pressure and diabetes […] and he has to pay about $900 a month for medicine because of the choices that he made earlier in life so he encourages me to eat healthy and have a healthy lifestyle because of the financial burden it’s caused. My mom on the other hand, she favors having a small frame being lean, being skinny and she pressures me to eat healthy because of that”.
“Family members with high blood pressure, and, some family members with diabetes motivate me a little bit more to want to continue exercising and healthy eating just so I won’t have those complications later on in life”.
“My mum makes smoothies, she’s tried juicing […] And like she goes to the gym sometimes, but mostly if I’m with her, she’s more motivated to go. So I guess that companionship helps her to be more inclined to work out […] I think I do influence my family too. ‘Cause I’m always talking about eating healthy and you know they joke around with me about like, oh you’re eating this and it’s not gluten free, like so they’ll poke fun at me but I definitely influence them. I feel like they have made some improvement in their food options as far as leaning more toward the healthy side because of me, so….”
3.2. Practical Considerations beyond Culture When Adopting a Healthier Lifestyle
3.2.1. “It’s is not worth it to eat healthy”: The Cost of Having a Healthy Lifestyle
“I think having things that are affordable. That’s number one. That’s a pretty big issue. If it’s something that’s free in the neighborhood or it’s more affordable for them [African Americans] I feel like that will make them more like “okay I can do this. I can afford $10 once a week”. So I definitely feel like having more affordable options for fitness and for food is definitely would help us”.
“If you have a choice between an apple for $1 for a full meal for $1, that may not be the healthy choice but that’s gonna make you full, you will choose the second option”.
“I think that people would consider eating healthy it if it was economically feasible, but you know if you have cheaper ingredients, if it’s cheaper to use butter than it is to use olive oil, then they’re going to use the butter”.
3.2.2. Access to Healthy Foods, Healthy Living, and Education
“If healthy food and wellness, and lifestyle was sitting right there in front of you, I don’t think anybody’s choosing unhealthy option. It’s not like if presented with option A – a life of prosperity, happiness, wellness, healthy, long-life, longevity, and option B – devastation, terrible diet, health, diabetes, anyone would say “I think I want B”, you know. So if it’s not presented to you don’t even know you can choose it”.
“If we have the access … to fruit stands and the stores and the, you know, the health foods stores that they tend to have in other areas, I think it would work; I just think that we have to actually be able to see it in the area, you know. ‘Cause if we see it we’re gonna to be intrigued by something new. So I think if you put it within the community I think it’ll work because initially we do wanna live a long period of time I think like everyone else”.
“Education I feel like is number one. So for people to know exactly where to find healthier options for food, where to find your exercise programs or fitness programs within their community so you don’t have to travel so far”.
“Showing people how to incorporate different foods into your diets is important. And now I’m ordering cookbooks and stuff so I can see different foods and spices, but like for people who haven’t ventured out to learn about different healthy foods, they don’t know what they eat, or how food affects their body, or how to cook them. So education is a key”.
3.2.3. Personal Factors and Motivation
“I feel like it [healthy lifestyle] has to first start with you motivating yourself. Some people feel like maybe it’s too late, I’ve gotten too far, I can’t start now. So that self-doubt probably is already there”.
Conflicts of Interest
Appendix A. Participants’ Level of Education and Cultural Identification
|Participants’ Number #||Education||Cultural Identification|
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|Completed high school||4|
|Cultural Identification, self-identified|
|Identified more with their ethnic culture||6|
|Identified more with their mainstream culture||1|
|Identified equally with both cultures||14|
|Please think for a moment about the values, strengths, and beliefs that are common in your African American culture. Also think about the behaviors that are common in your African American culture that relate to health and wellbeing (defined as the state of being comfortable, healthy, and happy). Now I want to ask you some questions related to the connection of these values and strengths to healthy lifestyle and wellbeing.|
|1||In general, what do you think helps African Americans living in urban areas: (1) eat healthy; (2) be active; and (3) increase their wellbeing? (Probe: please think about specific behaviors, e.g., ways of preparing food, portion size, food labels, type of exercise etc.)|
|2||In general, what do you think makes it difficult for African Americans living in urban areas to: (1) eat healthy; (2) be active; and (3) increase their wellbeing? (Probe: please think about specific behaviors, e.g., ways of preparing food, portion size, food labels, type of exercise etc.)|
|3||Which cultural strengths, beliefs, or values do you think can help African Americans living in urban areas: (1) eat healthy; (2) be active; and (3) increase their wellbeing?|
|4||What can mainstream American culture learn from African Americans about healthy lifestyle, specifically regarding: (1) eating healthy; (2) being active; and (3) wellbeing? (Probe: Any specific behaviors you may think of?)|
|5||What can African Americans learn from mainstream American culture about healthy lifestyle specifically related to: (1) eating healthy; (2) being active; and (3) wellbeing? (Probe: Any specific behaviors you may think of?)|
|6||As someone living in the US, you are exposed to components of both your African American culture and to mainstream American culture. When you think about the healthy lifestyle behaviors that you engage in, would you say that these are more common in mainstream American culture, or more common in your African American culture? Do you pick and choose, so to speak, different health behaviors from both cultures?|
|7||Do you think that African Americans can pick and choose healthy behaviors and practices from both their mainstream and ethnic culture in order to optimize their health? Can they do so without compromising their cultural identity? (Probe: Would it be difficult? Or easy? Do you do it? Do you know people who do it? What’s difficult about it, if anything? What is easy about it, if anything? What would make it easier for people to do it?)|
|8||What should members of mainstream American culture do more of to facilitate the improvement of health and wellbeing, specifically healthy eating, and exercise, of African American communities? (Probe: Think of health providers, individuals, and mainstream organizations such as schools or work places.)|
|Now, I want you to talk specifically about those people in your African American culture who try to lead a healthy lifestyle. Please think about specific person or a group of people you know.|
|1||What do they typically do that helps them lead a healthy lifestyle? (Probe: Any specific behaviors you may think of related to (1) eating healthy; (2) being active; and (3) wellbeing?)|
|2||What helps them engage in these behaviors? (Probe: The role of other people, family friends?)|
|3||How does your family affect your healthy lifestyle choices related to: (1) eating healthy; (2) being active; and (3) wellbeing?|
|4||How do your friends affect your healthy lifestyle choices regarding: (1) eating healthy; (2) being active; and (3) wellbeing?|
|Is there anything else that you would like to add that could be important to understanding health behaviors and healthy lifestyles for African Americans?|
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Swierad, E.M.; Vartanian, L.R.; King, M. The Influence of Ethnic and Mainstream Cultures on African Americans’ Health Behaviors: A Qualitative Study. Behav. Sci. 2017, 7, 49. https://doi.org/10.3390/bs7030049
Swierad EM, Vartanian LR, King M. The Influence of Ethnic and Mainstream Cultures on African Americans’ Health Behaviors: A Qualitative Study. Behavioral Sciences. 2017; 7(3):49. https://doi.org/10.3390/bs7030049Chicago/Turabian Style
Swierad, Ewelina M., Lenny R. Vartanian, and Marlee King. 2017. "The Influence of Ethnic and Mainstream Cultures on African Americans’ Health Behaviors: A Qualitative Study" Behavioral Sciences 7, no. 3: 49. https://doi.org/10.3390/bs7030049