Defining Substance Abuse in the Sudanese and Cambodian Refugee Communities

1
Defining Substance Abuse in the Sudanese and
Cambodian Refugee Communities

• Scott Gagnon and Amanda Lonsdale

2
(No Transcript)
3
(No Transcript)
4
History of Sudan

• Sudan was under British rule until 1956, when
  Sudan was given independence.
• The first military coup happened in 1958.
• In 1980 Gaafar Nimiery started a policy of
  Islamization, forcing people to adopt Islamic
  law.
• This led to a war between the National Islamic
  Front which was in the North and the Sudans
  Peoples Liberation Movement and Army which was
  made of people from the South.
• People are predominantly Muslim in the North and
  Christian or animismistic in the South.
• 2002 a cease fire was signed.

5
History of Cambodia

• Was under French rule until 1953
• The Vietnam war placed Cambodia between the US
  forces and the growing communist factions within
  its own borders.
• 1970 saw the first coup by a US friendly
  government.
• 1969 bombing of Cambodia together with other
  growing dissatisfaction led to the rise of the
  Khmer Rouge and ultimately the overthrowing of
  the government in 1975.
• This led to a cultural revolution by the Khmer
  Rouge, intellectuals, Monks, those suspected of
  supporting Western ideals were killed or put into
  work camps.
• Thousands fled to neighboring Thailand and were
  later sent to the US.

6
Cambodians and Sudanese in Maine

• There are about 1200 Cambodians living in Maine.
• Cambodian refugees began coming to Maine in about
  the 1980s.
• Most are Theravada Buddhists.
• There are about 2400 Sudanese living in Maine,
  they began settling in Maine in the 1990s.
• About 19 different tribes are represented in
  Maine.
• The largest groups in Maine are the Acholi, the
  Nuer and the Azande.
• The majority of people from both communities live
  in Portland with Biddeford/Saco area being the
  next largest populations.

7
Methodology

• Exploratory Research Design Qualitative data.
  Looking for explanatory patterns within anecdotal
  data.
• Grounded Theory approach. Themes identified in
  literature review used to validate themes in
  data.
• Data coded through Concept Mapping

8
Concept Map The Themes
9
Methodology Focus Groups

• Four Focus Groups
• Cambodian Adults/Parents
• Sudanese Adults/Parents
• Cambodian Youth (18 to 24 years of age)
• Sudanese Youth (18 to 24 years of age)
• Advisors went to community to find volunteers for
  participation in focus groups. Not a random
  sample.
• Town Meeting-style. Allowed for free-flow of
  discussion.
• Two protocols One for adults and one for youth.
• Protocols had set of discussion questions and
  three scenarios.
• Focus Groups were audio-taped with prior consent.

10
Focus Group Participation
11
Methodology Protecting the Human Participant

• Participants were given consent forms before each
  focus group.
• Consent forms were translated into respective
  language of participants.
• Consent form outlined purpose of research and how
  the information would be used.
• Informed of researchers intent to audio-tape the
  focus group.
• Interpreters present for help with consent forms
  and interpreting questions and answers.

12
Methodology Data Analysis

• Focus groups audio-tapes were transcribed and
  combined with notes taken by scribes.
• Themes from lit. review were highlighted and
  coded. This data formed the basis of our
  findings.
• New or unidentified themes were also highlighted
  and coded as emerging themes.

13
Limitations of the study

• Participants of focus groups are not a
  representative sample.
• Lack of research on these two refugee populations
  in Maine and the U.S.
• Reliance upon advisors. They are employed 40
  hours a week and timely responses were a
  challenge
• Resources, financial and time
• Language barriers

14
Relating Capstone to PPM

• Research will help direct health policy regarding
  these communities in Maine.
• Research helps identify the needs of the refugee
  immigrants dealing with social issues that were
  not issues at home.
• Research will help look at how funds are
  allocated and how policies will be developed to
  address social issues.
• The growth of refugee populations is an area of
  policy that needs to be addressed in Maine. In
  the long run, not addressing the needs of these
  populations will impact the State.

15
Findings Acculturation

• Both communities perceive a cultural war against
  their families, here in the U.S.
• Children from these communities feel a desire to
  fit in. Some try to fit in with a good
  crowd some with a bad crowd.
• Children spend more time with friends than family
  here in U.S. This differs with tradition in
  native countries.

16
Findings Family Factors

• Issues of time. Family members often have to
  work long hours during week. Leaves little time
  for family bonding.
• Familial cultural erosion. Parents wish to hold
  true to living the old ways while children want
  to adapt to a new American culture.
• Discipline is a stress between children and
  adults. This results in a perceived power
  struggle.
• Rebellion is a common theme to both cultures.

17
Findings Risk and Protective

• Family management. Discipline issues have lead
  parents to feel powerless in running their
  families. Feel if they cant discipline their
  way, the government should do it.
• Sudanese have narrow view on acceptable alcohol
  use by youth.
• Cambodians have broader view as long as they
  behave properly

18
Findings What was learned working with these
communities?

• Doing one on one interviews with community
  members may get better information.
• It takes time to earn trust and to build rapport.
• Each community is non-linear when it comes to
  time and schedules.
• Resentment that most programming lumps all
  refugees and immigrants together regardless of
  country of origin.

19
Findings other themes

• Families need training and education on substance
  abuse. What it looks like and where they can go
  for help.
• Community readiness Acholi and Nuer have
  systems for dealing with substance abuse. Youth
  and adult associations. Cambodians have less
  formal structure involving mostly adults.
• Connection to schools Families feel schools
  protect rights of the child over the rights of
  the parents.

20
Findings other themes

• Housing Sudanese live mostly in subsidized
  housing. They feel this environment contributes
  to problems.
• Sexual Behavior Sudanese see a rise in teenage
  pregnancy. They feel the cultural acceptance of
  boyfriend/girlfriend relationships in U.S.
  contributes to this.

21
Findings Observations

• Language Most Sudanese spoke good English, the
  exception seemed to be the women. The Cambodian
  youth spoke English with American accents. The
  Cambodian adults required an interpreter.
• Substance Use Alcohol and Marijuana substances
  of most use. Cambodian youth mentioned high
  alcohol use in adults.
• Conversations In Cambodian Focus Groups
  conversations were dominated by men. Female
  participants tended to try to have side
  conversations with female researcher.

22
Findings The Research Process

• May be more useful to go to community meetings to
  conduct research.
• Focus groups were discouraged at first but we
  found that people did open up and were candid
  with their conversations.
• Challenges with advisory group.
• Scheduling with focus groups needs to be flexible
  with each community.
• Focus group with Cambodian youth not as
  successful as others.

23
Recommendations

• It is important to work with individual groups as
  much as possible.
• Train prevention or treatment professionals from
  the communities you wish to work with, again
  being sensitive to the differentiations from
  tribe to tribe.
• Create programs that are where people live.

24
Recommendations cont..

• Creation of an intervention program for families
  where families violence is prevalent. Working
  with families on how to manage anger without
  violence is key.
• More parent education programs. Building
  community coalitions within the housing
  developments that include the community police
  force
• Translate relevant health information.
• Creation of after school programs.
• Further research needed on issue of substance
  abuses in refugee populations.

25
Questions and Scenarios Adult Groups Discussion
Questions 1. What are some of the things
parents in your community worry about when it
comes to their children? 2. How are things
different in Maine for parents and for children ,
compared to back in Cambodia/Sudan? 3. Do you
talk about drug and alcohol use with your
children? 4. Do you talk about drug use together
as a community? 5. Where do people go if they
think their child drinks too much or if their
child is on drugs? Scenarios 1. A 13 year old
child has been out with friends, he/she comes
home and smell of cigarettes and beer. . What do
you think of this situation? 2. Every night
there is a group of boys hanging out on the
street, they are smoking, being loud and they
stay out all night. What do you think of this
situation? 3. A child from your community, who
has always been a good child, suddenly starts
acting different. What do you think of this
situation?
26
Youth Groups Discussion Questions 1. What are
some issues/challenges teens from your community
might have to deal with on a daily basis? 2.
How are things different in Maine for parents and
for children, compared to back in Cambodia/Sudan?
3. What is substance abuse and how much of a
problem is it in your community? 4. Do you talk
about drug and alcohol use with your children? 5.
Do you talk about drug use together as a
community? 6. What do people do if they think
their child drinks too much or if their child is
on drugs? Scenarios 1. A kid is invited to a
party, his parents say no, but he wants to want
to go. How might some of the kids in your
community respond to this? 2. A kid goes to a
friends house where everyone is smoking pot and
drinking. They offer him a beer and some pot.
How might the kids in your community respond to
these offers? 3. A kid goes to a party with his
younger brother, both kids are drinking. The
younger boy has 2 beers and stops. The older boy
keeps drinking, he has 8 beers. What do you think
about this situation?