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116 Cultural Competence in Health Education and Health Promotion

Although most assessment models include epidemiological and environmental
factors, Huff and Kline (1999) recommend that health education practitioners take a
closer look at these factors. When epidemiological data are aggregated into larger cat-
egories of analysis, specific health issues in many racial and ethnic subgroups may be

concealed. For example, a health educator who examines the aggregate data on the

health status of Asians and Pacific Islanders might conclude that this group, as a whole,
is healthy. However, a closer look at the same data by individual Asian and Pacifi c
Islander subgroups would show that some of the subgroups have high incidences of
breast, lung, and liver cancer and hepatitis B (Spector, 2004).
In addition it is important to assess environmental factors, such as the presence of
advertising that might lead to use of health - damaging products and the numbers
of stores that sell alcohol and fast food, as these might be associated with health dis-
parities among racial and ethnic groups. A study by LaVeist and Wallace (2000) found
that liquor stores in the Baltimore area were more likely to be located in low - income

African American communities than in other communities. The findings of this study,
although not conclusive, suggest that the relative prevalence of liquor stores in low -
income African American communities may be associated with the disproportionate
share of alcohol - related problems experienced by residents of these communities.
Throughout the health education literature, health educators (Luquis, P é rez, &
Young, 2006; Luquis & P é rez, 2003; Stoy, 2000; Huff & Kline, 1999) have advocated
that people in this profession need to become more culturally competent and sensitive
to the racial and ethnic groups with which they work, and one level of the CAF is con-

cerned with taking into consideration specific cultural or ethnic characteristics. These
characteristics include cultural or ethnic identity, cosmology, time orientation, percep-
tions of self and community, social norms, values and customs, and communication

patterns (Huff & Kline, 1999). As stated earlier, Spector (2004) defines culture as the
beliefs, practices, habits, norms, customs, and so on, that individuals learn from their
families. Culture is complex and dynamic, and although we can assume that for the
most part people ’ s concept of their culture remains constant, cultural identity can
change through time (Luquis & P é rez, 2003). As individuals from different racial and
ethnic groups interact with members of other groups, new environments, and new situ-
ations, their cultural identity is reshaped (Bonder, Martin, & Miracle, 2001). Cultural
identity influences the individual ’ s behavior and health choices. Consequently, it is

important for health educators to begin a cultural assessment by establishing how the

targeted group identifies itself (Huff & Kline, 1999), as this identity will infl uence
other cultural characteristics of the group.
Moreover, in conducting an assessment, health educators need to be aware of spe-
cific racial and ethnic health care beliefs and practices, as these affect a group ’ s interac-

tion with the Western biomedical model and health promotion efforts. This level of the
CAF includes assessment of a group ’ s health and illness explanatory model, response
to illness, use of Western health care and health promotion services, and health behav-
ior practices. The Western biomedical model explains illness and disease in term of
pathological agents; however, a racial or ethnic group might follow a diagnostic model

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