dr. ronald e. mcnair acknowledgements - University of St. Thomas
dr. ronald e. mcnair acknowledgements - University of St. Thomas
dr. ronald e. mcnair acknowledgements - University of St. Thomas
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DR. RONALD E. MCNAIR<br />
Ronald E. McNair, an engineer, scientist, and astronaut on the space shuttle<br />
Challenger, was born on October 12, 1950 in Lake City, South Carolina.<br />
McNair was the son <strong>of</strong> an auto mechanic. His perseverance in the face <strong>of</strong> poverty<br />
and prejudice led him to complete his bachelor’s degree (magna cum laude) in<br />
physics from North Carolina A&T <strong>St</strong>ate <strong>University</strong> in 1971. Five years later,<br />
he earned a Ph.D. in physics from the Massachusetts Institute <strong>of</strong> Technology.<br />
Dr. McNair was nationally recognized for his work in the field <strong>of</strong> laser physics<br />
and received many honorary degrees, fellowships, and commendations. His achievements were not<br />
limited to academia. He was a sixth degree black belt in karate and an accomplished saxophonist.<br />
In 1978, Dr. McNair was selected for the NASA space program and was the second African American<br />
to fly in space. His life ended tragically on January 28, 1986 when the Challenger space shuttle exploded<br />
and crashed into the ocean, taking his life and the lives <strong>of</strong> six other astronauts.<br />
The McNair Program at the <strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong> is dedicated to preserving his legacy <strong>of</strong> scholarship<br />
and commitment to excellence.<br />
ACKNOWLEDGEMENTS<br />
McNair <strong>St</strong>aff<br />
Program Director/Principal Investigator<br />
David F. <strong>St</strong>eele, Ph.D.<br />
Assistant Director<br />
Cynthia J. Fraction, MA<br />
Graduate Assistants<br />
Maleeha Abbas<br />
Sarah Muenster-Blakley<br />
Journal Production<br />
Maleeha Abbas, Project Manager & Editor<br />
Susan M. Moro, Layout & Design<br />
Sarah Muenster-Blakley, Editor<br />
<strong>St</strong>ephanie <strong>St</strong>okman, Editor<br />
Cynthia J. Fraction, Project Director<br />
McNair Faculty Mentors<br />
Ken<strong>dr</strong>a Garrett, Ph.D., <strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Jean Giebenhain, Ph.D.,<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Ruthanne Kurth-Schai, Ph.D., Macalester College<br />
Paul Lorah, Ph.D., <strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Christie Manning, Ph.D., Macalester College<br />
Louis Mansky, Ph.D., <strong>University</strong> <strong>of</strong> Minnesota
TABLE OF CONTENTS<br />
DO I MATTER, OR AM I JUST A NAME ON A CHART?<br />
CANCER PATIENTS’ EXPERIENCES WITH HEALTH CARE PROFESSIONALS . . . . . . . . . . . . . . . . . 1<br />
Oluwademilade Adediran ’13<br />
ENHANCING EARLY CHILDHOOD EDUCATION FOR LOW-INCOME CHILDREN:<br />
EXPLORING POSSIBILITIES FOR INCORPORATING MONTESSORI METHODS<br />
WITHIN THE HEAD START PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19<br />
Kesha Berg ’13<br />
EXPLORING THE INFLUENCE OF HIV-1 RESISTANT CONFERRING MUTATIONS<br />
ON ANTIRETROVIRAL DRUG RESISTANCE IN HIV-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41<br />
Mon<strong>dr</strong>aya Howard ’13<br />
WASTE(LESS): A PSYCHOLOGICAL APPROACH TOWARD REDUCING FOOD WASTE . . . . . . . . 47<br />
Bridgette Kelly ’12<br />
HEALTH CARE ACCESSIBILITY IN THE TWIN CITIES METROPOLITAN AREA<br />
HMONG COMMUNITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61<br />
Chia Lee ’13<br />
A QUALITATIVE ANALYSIS OF TEACHERS’ PERCEPTION TOWARDS HMONG<br />
AMERICAN STUDENTS’ ACADEMIC ACHIEVEMENT IN MINNESOTA . . . . . . . . . . . . . . . . . . . . . . 72<br />
Mai-Eng Lee ’12
ABSTRACT<br />
The purpose <strong>of</strong> the present study is to explore what female musicians, who were 1-5 years<br />
post-treatment for breast cancer, had to say about their experience <strong>of</strong> mattering within<br />
the context <strong>of</strong> their health care. According to Tucker, Dixon and Griddine (2010),<br />
mattering is defined as “the experience <strong>of</strong> moving through life being noticed by and<br />
feeling special to others who also matter to us” (p. 134). In 1890, William James<br />
reflected on mattering by saying “one <strong>of</strong> the worst injustices in the world would be to<br />
live life being unnoticed by others” (as cited in Tucker, Dixon & Griddine, 2010, p.<br />
135). Although the concept <strong>of</strong> mattering has been around for more than a hun<strong>dr</strong>ed<br />
years, it has only recently been studied more systematically. Research related to<br />
mattering has been applied to multiple subjects such as relationship fulfillment,<br />
education, and workplace satisfaction (Kawamura & Brown, 2008; Connolly, 2002;<br />
Tucker et al., 2010). The current study examines the experience <strong>of</strong> mattering within<br />
a health care context. Common themes identified from 38 interview transcripts indicated<br />
patients felt they did not matter when the doctors treated them as merely a cancer patient<br />
and a name on a chart. This meant the doctors did not collaborate with the patients<br />
and did not individualize their care. The results also state women disliked when they<br />
were given their diagnosis over the phone by nurses who did not have sufficient<br />
information. Patients felt they mattered when physicians seemed to care about their<br />
livelihood. When doctors explained treatment options allowing for patient input, the<br />
patient felt they mattered. Patients reported extreme approval <strong>of</strong> their doctors when they<br />
received something such as a call from them to see how they were coping with treatments.<br />
Further research with doctors is needed in order to understand how health care pr<strong>of</strong>essions<br />
perceive patients.<br />
In the 19 th Century the father <strong>of</strong> modern psychology, William James, stated<br />
“one <strong>of</strong> the worst injustices in the world would be to live life being unnoticed<br />
by others” (as cited in Tucker, Dixon, & Griddine, 2010, p. 135). Mattering,<br />
as William James believed, is essential in order for an individual’s healthy<br />
development (Tucker et al., 2010). Mattering to others in our lives is the<br />
“experience <strong>of</strong> moving through life being noticed by and feeling special to<br />
others who also matter to us” (Tucker et al., 2010, p. 135). It can also be<br />
thought <strong>of</strong>, however, as a feeling that “we make a difference in the lives <strong>of</strong><br />
other people and that we are significant to the world around us” (France &<br />
Finney, 2009, p.104).<br />
Though the concept <strong>of</strong> mattering has been around since the 19th Century, it<br />
has only begun to be studied systematically in recent years, being applied to<br />
multiple subjects such as relationships, education, and workplace satisfaction.<br />
For example, it has been found that college students are more likely to stay at<br />
a particular college if they feel they matter to the institution (Tucker et al.,<br />
2010). In addition, workers are more satisfied with their place <strong>of</strong> employment<br />
if they feel like they matter to the company (Connolly, 2002). Kawamura and<br />
Brown (2008) examined relationship satisfaction by looking at division <strong>of</strong><br />
housework data collected from homemakers and exploring how much women<br />
perceived that they mattered to their husbands. The researchers measured how<br />
much the women reported the division <strong>of</strong> housework to be equal. What was<br />
DO I MATTER, OR AM I<br />
JUST A NAME ON A<br />
CHART? CANCER<br />
PATIENTS’<br />
EXPERIENCES WITH<br />
HEALTH CARE<br />
PROFESSIONALS<br />
Oluwademilade Adediran ’13<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Mentor<br />
Jean Giebenhain, Ph.D.<br />
Pr<strong>of</strong>essor <strong>of</strong> Psychology<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
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interesting about this study was the more wives reported<br />
they mattered to their husbands, the more likely they were<br />
to report the division <strong>of</strong> house work was equal, even if this<br />
was not the case. In other words, work equality depended<br />
upon how much the women felt they mattered to<br />
husbands.<br />
Mattering has also been shown to be a key factor in<br />
mental health and wellness among adolescents (Rayle,<br />
2005). A study conducted with high school students aimed<br />
to show the link between mattering to significant others,<br />
such as family, and the overall wellness <strong>of</strong> students. This<br />
study defined wellness in terms <strong>of</strong> physical, emotional, and<br />
psychological well-being. <strong>St</strong>udents felt they mattered to<br />
their families when they were assured they were significant,<br />
viewed as important, depended on by their families, and<br />
when their families were concerned with their fate and paid<br />
attention to them. It was found that females felt they<br />
mattered to their families more than males. Furthermore,<br />
it was also reported that mattering significantly predicted<br />
wellness for females. In other words, when females scored<br />
high for mattering, they also scored high in wellness.<br />
Though studies have looked at a wide range <strong>of</strong> topics<br />
pertaining to mattering, little has been done in regards to<br />
mattering in a health care context as relating to lifethreatening<br />
diseases.<br />
Human beings are multi-cellular organisms composed<br />
<strong>of</strong> structural and functional units called cells. Cells grow<br />
and divide in a controlled way to produce more cells as they<br />
are needed to keep the body healthy. When cells become<br />
old or damaged, they die and are replaced with new cells.<br />
This work <strong>of</strong> art called the body, though complex and aweinspiring,<br />
is not perfect. There are several diseases which<br />
afflict the body without warning and threaten the life and<br />
livelihood <strong>of</strong> the host. Oftentimes, in the division <strong>of</strong> cells,<br />
something goes wrong and abnormal cells divide without<br />
control and are able to invade other tissues. The most<br />
common term for this abnormality is “cancer.” The<br />
National Cancer Institute reports that there are over a<br />
hun<strong>dr</strong>ed types <strong>of</strong> cancers, among which the most common<br />
to women is malignant neoplasms, or breast cancer.<br />
According to the National Cancer Institute, there were<br />
207,090 reported new cases <strong>of</strong> breast cancer in 2010 within<br />
the United <strong>St</strong>ates alone. Modern advancements in medicine<br />
have made it possible for more women to survive breast<br />
cancer than ever before (Salonen et al., 2011). Using the<br />
2<br />
latest data available, survival rates for those diagnosed with<br />
breast cancer are 89% after 5 years, 81% after 10 years, and<br />
73% after 15 years. This is a significant increase in survival<br />
rates compared to previous years (American Cancer Society,<br />
2010). These increased survival rates indicate the need for<br />
issues related to survivorship and long-term quality <strong>of</strong> life<br />
to be added to overall treatment considerations (Kaiser et<br />
al., 2009). If the patient matters, there could be a shift in<br />
efforts to not only wipe out the cancer cells but to try and<br />
preserve the livelihood <strong>of</strong> the patient after treatments are<br />
over. Livelihood in this case refers to the patient’s ability<br />
to return to their employment or the way in which they<br />
make their income. Medical advances allow doctors to<br />
provide more personalized care for their patients. During<br />
treatment, <strong>of</strong>tentimes doctors become focused in their<br />
work <strong>of</strong> eradicating the cancer cells they forget treatment,<br />
at least in some aspects, should be based on requirements<br />
defined by women with breast cancer (Landmark, bohler,<br />
Loberg, & Wahl, 2008). Research suggests the women are<br />
experts on their own lives and ideal doctors will listen to<br />
them and try to find ways to preserve their livelihood post<br />
treatment (Theisel, Schielein, & Splebl, 2010). The key<br />
topic to preserving the life and livelihood <strong>of</strong> a patient is<br />
whether or not the patient matters to the medical<br />
pr<strong>of</strong>essionals as an individual.<br />
One such study that looked at the doctor-patient<br />
interaction as a part <strong>of</strong> mattering did so by studying<br />
interpersonal trust (Kaiser et al., 2009). The study looked<br />
at breast cancer patients’ trust in several <strong>of</strong> their health care<br />
providers. The study assessed breast cancer patients’ trust<br />
in regular providers, diagnosing physicians, and their<br />
cancer treatment team. In this study, patient trust was<br />
associated with patient satisfaction and treatment<br />
adherence. Findings suggest a trusting relationship with a<br />
regular provider facilitated higher satisfaction with other<br />
specialists (Kaiser et al., 2009). Though this study had<br />
important findings, it does not explain why patients were<br />
more likely to trust other specialists if they trusted their<br />
primary doctor. Mattering could be one <strong>of</strong> the key<br />
components <strong>of</strong> trust in a doctor-patient relationship. If a<br />
patient feels they matter to their primary doctors, they<br />
might trust them more. This trust could be carried over to<br />
other specialists the doctor recommends.<br />
Another qualitative study that assessed the relationship<br />
between patients and doctors was conducted with 13
Oluwademilade Adediran<br />
Psychology Mattering<br />
individuals dying <strong>of</strong> cancer (Janssen & MacLeod, 2010).<br />
Results indicated the patients felt they mattered to the<br />
doctors when treated as more than a cancer patient.<br />
Patients felt like more than just a cancer patient when<br />
doctors sought to find “common ground” with their patients.<br />
A common ground for the patients meant the doctors did<br />
not only inform patients they have an illness, but sat with<br />
them to answer any questions they might have. In some<br />
cases, the patients would encourage the doctor to be livelier<br />
by telling jokes. The patients remarked that this seemed<br />
to make doctors feel more comfortable and in return they<br />
seemed to be able to look past patients’ cancer to the<br />
patients’ lives. The doctors who made patients feel like they<br />
mattered were the ones who sat with the patients and<br />
listened for extended periods <strong>of</strong> time, without trying to<br />
rush <strong>of</strong>f to another patient. A woman from the study said,<br />
“Doctors should not just say this is a woman <strong>of</strong> 76 who’s got so<br />
and so, past history <strong>of</strong> such and such. You heal a whole person.<br />
We are not just a lump, an amorphous lump; we are body mind<br />
and soul” (Janssen & MacLeod, 2010, pg. 252). Doctors<br />
who were able to look into the patients lives were seen as<br />
caring and made patients feel they mattered. These two<br />
studies show ideal doctors are ones who valued or seemed<br />
to value the interactions with their patients. Good doctorpatient<br />
interactions are essential to the concept <strong>of</strong> mattering<br />
in a health care context.<br />
<strong>St</strong>udies investigating what patients perceive as the ideal<br />
doctor indicate patients want someone who is accessible,<br />
takes their time, is friendly and congenial, shows<br />
commitment and interest, is understanding and sensitive,<br />
and is responsive to the needs <strong>of</strong> patients (Theisel et al.,<br />
2010; O’Connor, 2011). Oftentimes, doctors lose sight <strong>of</strong><br />
the life and livelihood <strong>of</strong> the individual. Rarely do they<br />
take into account patient considerations about how they<br />
should be medically treated or what factors need to be<br />
considered in order to reduce the negative impact on their<br />
livelihood (Landmark et al., 2008). Part <strong>of</strong> mattering is<br />
looking to see how treatments will affect the individual.<br />
Do doctors take into account the patient’s life and<br />
livelihood when treating the individual? Are treatments<br />
specific to the individual or do doctors follow the same<br />
protocols for all patients? Dibbelt, Schaidhammer,<br />
Fleischer, and Greitemann, (2009) identify that the most<br />
important variable in mattering as related to health care is<br />
the ability for the doctor to let the patient decide what is<br />
next. This study emphasized the need for the doctor to be<br />
open to change and let the patients’ physical and emotional<br />
conditions, as well as communication, dictate what<br />
treatment should follow. In summary, when doctors sought<br />
to build a relationship with the patients that involved more<br />
than eradicating the cancer, the patients felt cared for, and<br />
ultimately reporting they felt as if they mattered to the<br />
doctor.<br />
The present study on mattering seeks to improve upon<br />
previous research in that it is conducted with a specific<br />
group in order to see what the patients had to say about<br />
their health care providers and identify factors <strong>of</strong><br />
specialized care that made breast cancer patients feel as if<br />
they mattered. This study is also unique in that it focuses<br />
on how doctors personalize care for patients. Uncovering<br />
whether or not breast cancer patients felt they mattered to<br />
their doctors is also an aim <strong>of</strong> this current research.<br />
Mattering, in the context <strong>of</strong> this research, refers to the<br />
“experience <strong>of</strong> moving through life being noticed by and<br />
feeling special to others who also matter to us” (Tucker et<br />
al., 2010, p. 135). Oftentimes it is not until a woman<br />
moves into survivorship that she realizes her body is no<br />
longer the same and her quality <strong>of</strong> life decreases (Salonen<br />
et al., 2011; Sanson-Fisher et al., 2010). This change in<br />
quality <strong>of</strong> life is problematic for musicians because <strong>of</strong> the<br />
direct impact it has on their careers.<br />
This current study is unique because it will use a special<br />
participant pool comprised <strong>of</strong> musicians. Being a musician<br />
constitutes a livelihood that hinges on the ability to play<br />
an instrument or sing at a specific pitch. Breast cancer<br />
treatments, including lumpectomies, lymph node removal,<br />
mastectomies, radiation, and chemotherapy, <strong>of</strong>ten damage<br />
physical functions such as lung capacity and upper body<br />
strength which can interfere with an artist’s ability to make<br />
music. Survivors can have long-term issues with pain,<br />
neuropathy, and lymphodema, not to mention chronic<br />
fatigue and a plethora <strong>of</strong> other side effects from treatments<br />
(Fisher et al., 2010). Using musicians for this study is<br />
critical because a condition such as lymphodema causes<br />
swelling <strong>of</strong> the arms. For a woman who does not have to<br />
use her arms at work, this might not be problematic.<br />
However, musicians who play string instruments use their<br />
arms for instrument support and sound production.<br />
Musicians were used for this study based on the direct<br />
affects cancer treatments can have on their livelihoods. In<br />
3
UST McNair Scholars Program Research Journal<br />
the case <strong>of</strong> musicians, if a woman is a singer or plays a wind<br />
instrument, lung scaring from radiation may diminish her<br />
lung capacity necessary to perform at the level she once did.<br />
Weaknesses as a result <strong>of</strong> lymph node removal, or injury<br />
from ports or <strong>dr</strong>ains, may make horn or violin players<br />
unable to hold their instruments for even short periods <strong>of</strong><br />
time.<br />
Most musicians train for a lifetime to perfect their craft.<br />
Music is <strong>of</strong>ten their way <strong>of</strong> life, and if treatments damage<br />
their way <strong>of</strong> life, it is incredibly difficult to find another<br />
means to make money and live. Medical specialists ought<br />
to understand the musician’s strong feelings toward her<br />
music. The patient should matter enough to doctors that<br />
they take their time to find other viable treatments that<br />
have less <strong>of</strong> an impact on the women’s ability to make<br />
music. The purpose <strong>of</strong> mattering in this study is to answer<br />
the question, if the patient matters to the doctor, and music<br />
matters to the patient, will the patient’s music matter to<br />
the doctor?<br />
The research goals for this project are tw<strong>of</strong>old. The first<br />
is to explore what female musicians who had cancer say<br />
about their experiences with their health care pr<strong>of</strong>essionals,<br />
particularly if these women felt as though they mattered.<br />
In addition, it explores what behaviors from their doctors<br />
made them feel like they mattered and which ones made<br />
them feel like they didn’t matter. The second is to observe<br />
if health care pr<strong>of</strong>essionals took into account the women’s<br />
livelihoods when prescribing treatments. (This research is<br />
part <strong>of</strong> an ongoing study to access female musicians’<br />
experiences with the health care system. This particular<br />
study uses the existing interview transcripts conducted by<br />
Drs. Jean Giebenhain and Sarah Schmalenberger, along<br />
with Charles Gessert, M.D. and Lisa <strong>St</strong>arr, CNP.) To<br />
achieve these goals, content analysis will be performed on<br />
the interview transcripts <strong>of</strong> thirty-eight female musicians<br />
who are one to five years post-treatment for breast cancer.<br />
METHODS<br />
I conducted content analysis (qualitative data analysis)<br />
on existing coded interview transcripts <strong>of</strong> 38 female<br />
musicians who were 1-5 years post-treatment for breast<br />
cancer. These interviews were originally conducted as part<br />
<strong>of</strong> an ongoing study by Drs. Giebenhain, Schmalenberger,<br />
4<br />
and Gessert, as well as Lisa <strong>St</strong>arr, CNP (For a fuller<br />
discussion <strong>of</strong> the participant pool and original methods see:<br />
Schmalenberger, Giebenhain, <strong>St</strong>arr, & Gessert, 2008). The<br />
interviews were analyzed for themes particularly related to<br />
mattering. The Nvivo 9 qualitative s<strong>of</strong>tware package was<br />
used to assist the analysis in order to identify themes<br />
associated with what women had to say about their<br />
experiences with health care pr<strong>of</strong>essionals. Analysis<br />
identified specific information related to behaviors health<br />
care providers exhibited that contributed to whether<br />
women felt as if they mattered or not.<br />
RESULTS<br />
NON-MATTERING BEHAVIORS<br />
After reviewing the coded transcripts, there were themes<br />
that emerged from the experiences <strong>of</strong> our participants.<br />
Themes related to mattering are identified below:<br />
Diagnosis delivered over the phone/<strong>St</strong>aff was not<br />
knowledgeable or helpful.<br />
There were several behaviors from healthcare<br />
pr<strong>of</strong>essionals that made the women feel they didn’t matter.<br />
Patients experienced extreme dislike <strong>of</strong> their health care<br />
pr<strong>of</strong>essionals when they were informed <strong>of</strong> their diagnosis<br />
over the phone. The women remarked the dislike came<br />
from the way the message was delivered. The nurse or<br />
technician who would make the call lacked compassion<br />
when giving the women their diagnosis. They would<br />
simply say the test results came in and the diagnosis is<br />
cancer. They would then tell the women to schedule<br />
surgery. In most instances when a diagnosis was delivered<br />
poorly, the women were not able to schedule treatment for<br />
weeks. Patients expressed extreme dislike <strong>of</strong> this system,<br />
saying it was cold and forced them to sit with the news <strong>of</strong><br />
their diagnosis for weeks without support. They also<br />
remarked that the nurses were not able to answer questions<br />
and lacked information that was critical to them. An<br />
example <strong>of</strong> these behaviors was encountered by a woman<br />
who was diagnosed over the phone. She said “The first bad<br />
thing about being told I had breast cancer was um, my doctor<br />
didn’t even tell me, it was like a nurse I didn’t even know just<br />
sort <strong>of</strong> called and said oh, um your result was positive and then,
Oluwademilade Adediran<br />
Psychology Mattering<br />
I don’t know anything else, bye, hung up.” The patient then<br />
called the nurse back to get some more explanation. She<br />
explained the situation by saying “I called back, the nurse<br />
goes, well we just got preliminary results, and we don’t know<br />
anything else. I said why didn’t the doctor call me? The nurse<br />
says oh well, it’s her day <strong>of</strong>f, so she couldn’t call you.” As the<br />
situation played out on the phone, the patient recalled<br />
being told, “Why don’t you call the hospital and try to find out<br />
something?” this patient was extremely dissatisfied with the<br />
lack <strong>of</strong> empathy exhibited by this hospital. The fact the<br />
doctor could not call herself was “jaw <strong>dr</strong>opping” to the<br />
patient.<br />
Physician did not ad<strong>dr</strong>ess side effects <strong>of</strong> treatments/ did not<br />
collaborate with patients.<br />
Patients who met with doctors to receive their diagnosis<br />
reported the experience was negative when doctors simply<br />
lectured and gave the medical aspects <strong>of</strong> the cancer. The<br />
patients explained that when doctors focused on the<br />
medical aspect <strong>of</strong> the cancer, they overlooked the women’s<br />
opinions on how they should be treated. The patients felt<br />
they did not matter when doctors did not answer questions<br />
and failed to give information on what treatment would<br />
mean for their livelihoods. There are several examples in<br />
the transcripts <strong>of</strong> patients being given medications without<br />
full explanations as to what the side effects could be. When<br />
women researched the medications and came back with<br />
questions, <strong>of</strong>ten times the response from the doctor was<br />
negative. In one instance, a woman was prescribed Taxol,<br />
an anti-cancer chemotherapy <strong>dr</strong>ug. The women researched<br />
the <strong>dr</strong>ug and proceeded to talk to her doctor about her<br />
findings. She said,<br />
“When I talked to the doctor about the Taxol, he was so nonunderstanding,<br />
so uncompassionate about it. He’s like well,<br />
just do it and, you know…I mean, he… I don’t feel that I<br />
was respected for my fear or my decision on what this was<br />
going to be, and, um, I felt that it was a valid fear, or a<br />
valid… you know, um, question. And I just felt really<br />
disconnected by the doctor with… you know, it’s like…<br />
okay, well, um, if you want to live you going to do this, um,<br />
without any understanding that what it was for me to live,<br />
you know, what it… what it took for me as a human, as a<br />
person, as an individual, um, you know… if I couldn’t have<br />
my music, or if I couldn’t have… and for some other people<br />
who are passionate about something if they don’t have that<br />
in their lives anymore, how are they going to adjust and how<br />
are they going to survive. Piano or my music to me is really<br />
my coping mechanism for everything else that I do. And to<br />
be left without it… and I don’t think that he had enough<br />
understanding about that.”<br />
This woman is one <strong>of</strong> the many patients who were not<br />
understood when trying to articulate their fears about<br />
medications.<br />
Lack <strong>of</strong> concern for livelihood<br />
Most women reported telling their doctors they were<br />
musicians and asked how treatments would impact their<br />
ability to play. The results show that when the doctors<br />
focused on the cancer first and everything else second, the<br />
women had a negative experience. These women would also<br />
report that the doctors only cared about them as a cancer<br />
patient and not as a whole person with a life outside <strong>of</strong><br />
cancer. The doctors who treated the women simply like a<br />
cancer patient failed to individualize care that would allow<br />
for the women to be able to play music at their current<br />
level post treatment. One participant who sang for a living<br />
was concerned about her ability to sing post treatment.<br />
This woman, among others, reported some doctors did not<br />
understand their lung capacity had been reduced after<br />
treatment. Doctors who did not realize that certain<br />
musicians, such as singers, had extraordinary lung capacity<br />
when compared to a normal person only focused on healing<br />
the patient as a normal person. When measured for lung<br />
capacity, this woman was told she was at ideal levels for a<br />
female, but not at the extraordinary level she once was.<br />
This patient reported that doctors simply did not know<br />
how musicians functioned. She said, “But [doctors] don’t<br />
know, they don’t know what’s necessary for a singer to sing, they<br />
don’t know how those parts work. Aa, aa, it’s like you know I<br />
remember long ago going to an ear, nose, and throat specialist. He<br />
did not understand musicians and he was one <strong>of</strong> those who was<br />
more interested in getting <strong>of</strong>f to his weekend trip so told me there<br />
was nothing wrong with my voice when I couldn’t sing above an<br />
F. This was my upper range; he said my speaking voice was just<br />
fine so my singing voice should be fine.” Women felt they did<br />
not matter to health care pr<strong>of</strong>essionals when their concerns<br />
were met with cynicism and doubt.<br />
Did not assist patient with “survivorship”<br />
Many patients also expressed a dislike <strong>of</strong> the attention<br />
given to them post treatment. These patients explained<br />
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that for doctors, it was truly “Cancer first.” When<br />
treatments were over and patients inquired as to what to<br />
do in order to regain their physical capacity to make music,<br />
they found doctors were nonresponsive. A patient who was<br />
a violinist asked her doctors what she should do in order<br />
to be able to hold her instrument for long periods <strong>of</strong> time.<br />
She was given a sheet containing exercises, which included<br />
crawling ones hand up a wall and moving a broomstick up<br />
higher each day. The woman said “I wish they had said a<br />
little bit more about what to do instead <strong>of</strong> just giving me this paper,<br />
here do these exercises.” Several other patients experienced this<br />
same situation, and remarked they would have liked more<br />
attention paid to how they were going to regain their<br />
physical capacity to make music.<br />
MATTERING BEHAVIORS<br />
Physician stayed away from medical jargon / medical team<br />
was encouraging.<br />
When doctors had patience and explained all possible<br />
options to the patient, allowing the patient to make an<br />
informed choice, the patient seemed satisfied. Doctors who<br />
stayed away from medical jargon and strove to not<br />
overwhelm the patient were seen as understanding. An<br />
example <strong>of</strong> this comes from a woman who recalled what it<br />
was like when she was diagnosed. She said, “They gave me a<br />
book at the library, the book had information about what doctors<br />
do when someone is diagnosed. It said they give you a bag with a<br />
bunch <strong>of</strong> stuff in it like a satin pillow case, when your hair falls<br />
out, and about, you know, the people that replaced your eyelashes<br />
and stuff like that. This book actually scared the (*****) out <strong>of</strong><br />
me.” When the woman told her doctor her concerns, he<br />
explained to her what she was reading in the book in nonmedical,<br />
plain terms. She said she was assured by the doctor<br />
that he would explain each treatment procedure to her and<br />
be there during the procedures in case she needed comfort.<br />
Analysis showed this type <strong>of</strong> personal relationship between<br />
both doctor and patient facilitated the thought the patient<br />
mattered. The most desirable doctors were those who in<br />
some cases would encourage the women to continue<br />
playing their music. A woman recalled the help she<br />
received from her health care pr<strong>of</strong>essionals by saying “I got<br />
a lot <strong>of</strong> psychological help from my doctor and my nurses, they were<br />
cheering me on saying I was doing great and it was better for me<br />
to keep making music than sit home and worry, which I really<br />
6<br />
agree, I’m glad that I kept playing and teaching.” This type <strong>of</strong><br />
encouragement made women feel as if the cancer was not<br />
going to define who they were. Patients reported these<br />
doctors were truly “human” and made them feel like they<br />
were not just an accumulation <strong>of</strong> cancer cells but a whole<br />
person with feelings. Doctors made patients feel like they<br />
mattered when they treated the women respectfully and<br />
looked at them as a person. A patient stated her doctor was<br />
very nice to her and it “kind <strong>of</strong> makes you feel like I’m not like<br />
old and ugly and cancerous because, you know, he was being so<br />
nice to me.”The women explained the term “human” by<br />
saying that these doctors understood how they were feeling<br />
and were responsive to their needs. These doctors wanted<br />
to heal the patient as a whole person and not just as<br />
cancerous host.<br />
Physical contact (if welcomed by patient).<br />
Some patients found it helpful when the doctor would<br />
make physical contact (e.g. hand on the shoulder) in order<br />
to help them understand that they were not alone in the<br />
ordeal. A patient explained, “He[ the doctor] never seemed alo<strong>of</strong><br />
or cold, or never even on the operating table, you know, when they’re<br />
getting ready to give you all <strong>of</strong> those <strong>dr</strong>ugs, and you know, it’s the<br />
hand on the shoulder and just those little things that they do that<br />
just make you feel so human and not just another patient.” Some<br />
patients, however, did not feel comfortable engaging in this<br />
type <strong>of</strong> physical contact from doctors when they did not<br />
know them well or were just meeting for the first time. A<br />
patient remarked that she disliked contact with her doctor<br />
by saying, “When I got into the <strong>of</strong>fice she was very patronizing.<br />
She put her arm around me. I don’t know this lady. She puts her<br />
arm around me and tells me I have cancer. It was hard to take it<br />
all in with this woman <strong>dr</strong>aped over me.”<br />
Interested in patients’ wellbeing<br />
When doctors asked how treatments were affecting the<br />
patient’s wellbeing, the patient felt they mattered. The<br />
patients reported that it is absolutely essential a person find<br />
a doctor who they not only trust because they are a good<br />
doctor, but somebody they really wants to go and talk to.<br />
It is also important they feel good just being in the doctor’s<br />
presence. A patient stated she loved being in her doctor’s<br />
presence. She went on to say “He was so kind and like he<br />
would put his hand on my shoulder. You know, just he would touch<br />
and um, like ask me questions that didn’t necessarily relate to the
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diagnosis, but I just really felt like he cared about how this was<br />
all affecting me as a person.” When doctors made the patient<br />
comfortable, the patient seemed to trust and want to be in<br />
the presence <strong>of</strong> the doctor.<br />
Going above and beyond the call <strong>of</strong> duty<br />
The ultimate behavior that made patients feel they<br />
mattered to their healthcare pr<strong>of</strong>essionals was when doctors<br />
went above and beyond the call <strong>of</strong> duty. Patients reported<br />
extreme approval <strong>of</strong> their doctors when they received a call<br />
from them to see how they were coping with treatments.<br />
The doctors who contacted patients made the participants<br />
feel they mattered because those doctors put the patient<br />
first. Among many examples, there are a few that stand<br />
out. A woman stated that “my doctor would call me, like, um,<br />
during the week after, you know, the surgery or something and just<br />
say yeah, I’m just calling to see if you have any questions, how<br />
are things going and I’m like oh my gosh my doctor is calling me<br />
at 5:30 in the evening just to see how I am!” This patient<br />
experienced satisfaction because this doctor did not have<br />
to call her, but nevertheless, this doctor took time from his<br />
day to make sure his patient was alright. Another example<br />
<strong>of</strong> a doctor going beyond the call <strong>of</strong> duty occurred when a<br />
patient told her doctor that she was a musician. The doctor<br />
asked her if she would be willing to come and play her<br />
music in the hospital. This gesture meant a great deal to<br />
this woman because she was dealing with depression due<br />
to the effects the breast cancer and the treatments were<br />
having on her life and livelihood. She was happy because<br />
she felt she mattered to the doctor and was able to give<br />
back to others in her position by playing her music for<br />
them. In summation, I believe women who experienced<br />
these types <strong>of</strong> interactions felt as if their doctors were<br />
saying “I know that being able to play your music matters<br />
to you. You are my patient and you matter to me, therefore<br />
your ability to play also matters to me.”<br />
THE IMPACT OF DOCTOR-PATIENT INTERACTIONS ON<br />
MATTERING<br />
From the analysis, it appears mattering occurs within a<br />
tw<strong>of</strong>old interaction. Those patients who came in with<br />
questions and had researched what cancer medications can<br />
do to the body felt prepared to interact with the doctor.<br />
Women who either brought a friend to ask questions, or<br />
researched and asked the doctor as many questions they<br />
could felt they mattered when the doctor answered their<br />
questions. A patient recalled her experience with her doctor<br />
by saying “I brought a friend with me because in the midst <strong>of</strong><br />
this you need someone who will be a real advocate. This friend<br />
who went with me, boy, she interrogated the doctor up one side and<br />
down the other. She asked him questions like, how <strong>of</strong>ten have you<br />
done a mastectomy. The doctor was patient and answered<br />
everything.” Patients who came in with questions for the<br />
doctor felt the doctor was competent and caring when he<br />
or she answered the questions. The second portion <strong>of</strong> this<br />
interaction process is that the doctor should respond to the<br />
patient. The doctors who answered all the patient’s<br />
questions were seen as caring and compassionate as well as<br />
competent. A patient called her doctor as “caring” when<br />
the doctor took the time to answer all <strong>of</strong> her queries. The<br />
patient identified above went on to say “I could email her<br />
and she would email me back within hours, ah, and she might<br />
answer and say I am at a conference in China, you know, what<br />
do you want to know? But she was just always there to answer<br />
any questions that I had, no matter where she was. “When<br />
patients and doctors achieved this ideal interaction, the<br />
patient felt they mattered to the doctors as a person and<br />
not just as a cancer patient.<br />
Participant perception <strong>of</strong> “types <strong>of</strong> doctors”<br />
Results from analysis show that patients perceive two<br />
types <strong>of</strong> doctors and two types <strong>of</strong> patients. A patient put it<br />
best by saying, “the first types <strong>of</strong> doctors are those who do not<br />
seem like interaction with patients and simply want to prescribe<br />
medication in order to treat whatever is afflicting the person.” The<br />
second types <strong>of</strong> doctors, just like the first, prescribe<br />
medication to the patient in attempt to heal and give the<br />
individual their life back. The difference between these<br />
doctors lies in the interaction component <strong>of</strong> the second<br />
doctor. The second doctor is also concerned with the<br />
patients’ livelihood during and after treatments and<br />
therefore seeks to interact and understand how treatments<br />
are affecting the individual.<br />
Types <strong>of</strong> patients<br />
Analysis showed there are also two types <strong>of</strong> patients. A<br />
participant articulated what the two types <strong>of</strong> patients were<br />
by saying “there are people who go to the doctor and they don’t<br />
want to know anything and they just want to put their trust in<br />
the doctor and be led and do what the doctor said and that’s maybe<br />
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half. And then there are the patients who want to be participants<br />
by talking one on one with the doctor and want all the information<br />
that is possible and they want to be involved in the decision<br />
making.” Analysis <strong>of</strong> the transcripts shows many women<br />
saying what one patient said best, “there needs to be a match<br />
on the doctors who are comfortable with each kind <strong>of</strong> patients.”<br />
Most <strong>of</strong> the participants fit the criteria for the second<br />
patient who wants to be involved in the care they receive<br />
because they wanted to be able to perform their music after<br />
treatments. Many <strong>of</strong> the women gave advice to future<br />
patients by saying “If there is a mismatching <strong>of</strong> the right doctor<br />
to the right patient, there will be conflict and the patient might<br />
not feel cared for.” There are several examples <strong>of</strong> this<br />
mismatching <strong>of</strong> patients to doctors, or instances where<br />
patients did not feel comfortable with the doctors they had.<br />
One particular example occurred with a woman who had<br />
difficulty with her health care pr<strong>of</strong>essionals. She recalled<br />
and said “I had to deal with so many nonmedical people when<br />
you went for radiation, there were like six people standing around,<br />
you know. And here I’m lying down with my breast hanging down<br />
being ready to get shot up and they were like wearing uniforms.<br />
They looked almost like airline attendants. And I thought why<br />
do they need all <strong>of</strong> these people around here.” This woman felt<br />
uncomfortable with the situation in the operating room.<br />
Though her doctors were in the room, she remarked she<br />
did not feel as if she could talk to them due to the lack <strong>of</strong><br />
intimacy she felt.<br />
Mattering in the long term/Survivorship<br />
Analysis revealed many women looking for support and<br />
a sense they mattered from their doctors after treatments<br />
were over. Most women commented they found they<br />
received the most attention when they were going through<br />
the cancer treatments. When the treatments were over,<br />
they recalled having problems adjusting to their damaged<br />
bodies as relating to performing and making music. A<br />
woman expressed her concern toward this topic by saying<br />
she found doctors focus more on the short term (e.g.<br />
getting rid <strong>of</strong> the cancer) than the long term (e.g. good<br />
quality <strong>of</strong> life). She went on to say, “I don’t think medical<br />
doctors understand holding an instrument for a solid hour, it’s not<br />
easy. I suppose a way to make them understand is to relate it to<br />
some sport. They might have a better understanding that it is very<br />
difficult to hold an instrument after having lymph nodes taken<br />
out.” Almost all <strong>of</strong> the women in this study remarked that<br />
8<br />
there needs to be more attention given to living with the<br />
long term effects <strong>of</strong> cancer treatments. The women<br />
remarked <strong>of</strong>ten they do not want to bother their medical<br />
team when they come in for routine checkups because they<br />
feel the doctors are <strong>of</strong>ten busy with other patients. The<br />
doctors who truly made women feel like they mattered<br />
were the ones who ad<strong>dr</strong>essed these issues. A patient put<br />
best what others were trying to articulate by saying,<br />
“I felt like my all the medical care that I had was excellent.<br />
I don’t find a lot <strong>of</strong> attention to long term care and how are<br />
you are in the long run. I think doctors have a lot <strong>of</strong> time to<br />
surround, mainly when I go to my oncologist appointment,<br />
which I will in April, a few key questions will be asked<br />
and they will get my ****bones and see**** and they will<br />
check on the critical things and do I have cancer. There are<br />
no signs that I have cancer. And sometimes my oncologist does<br />
ask about my comfort level and I guess, I always kind <strong>of</strong> get<br />
the idea, you know, they are busy dealing with people who<br />
are dying from cancer, they are not all that concerned with<br />
how am I doing in the long term. And I have never said<br />
that I’m doing poorly. I have continued to pursue this soreness<br />
and each time I go in I say well, you know, can you, to begin<br />
with I wanted physical therapy and he was willing to, you<br />
know, write a prescription for that and the massage is<br />
helping so he took my massage person’s card, um, but I guess<br />
I would hope for a little bit more attention to the long term<br />
effects.”<br />
CONSEQUENCES OF MATTERING<br />
It is important to note that many women in this study<br />
wanted to matter to their doctors. A patient recalled her<br />
experience with her doctors by saying “I had to switch doctors<br />
because they just didn’t seem to understand, you know. I wanted<br />
someone who would understand and be able to tell me how these<br />
treatments would affect my voice as a musician.” Many patients<br />
echoed what this woman said by saying they preferred the<br />
second type <strong>of</strong> doctor because it seemed this ideal doctor<br />
cared about them as a patient as well as a person.<br />
DISCUSSION<br />
The aim <strong>of</strong> this research was to see if patients perceive<br />
they matter to their health care providers. Patients stated<br />
mattering to doctors was very important in receiving quality<br />
care. Patients <strong>of</strong>ten switched doctors when they felt they<br />
didn’t matter to their health care providers. The main
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Psychology Mattering<br />
finding from this study was doctors made patients feel like<br />
they mattered when they took the time to talk, answered<br />
questions, and view the patient as a person who wanted to<br />
be able to have good quality <strong>of</strong> life after treatments. The<br />
results also indicated women felt they were merely cancer<br />
patients when they were given their diagnosis over the<br />
phone and by nurses who did not have sufficient<br />
information. Results from the current study coincide with<br />
findings from previous research from Janssen & MacLeod,<br />
(2010) which also found that patients dislike being treated<br />
as only as their cancer and not as people.<br />
This research also investigated whether or not patients<br />
perceived whether doctors took their life and livelihood<br />
into account when prescribing treatments. It seems some<br />
doctors are still focused on the elimination <strong>of</strong> the cancer<br />
and fail to look at long term effects <strong>of</strong> cancer treatments.<br />
Some doctors failed to ad<strong>dr</strong>ess the side effects <strong>of</strong> treatments,<br />
which led to patient difficulty in regaining their livelihood<br />
(Schmalenberger, S., Giebenhain, Gessert, & <strong>St</strong>arr, 2011;<br />
Schmalenberger, Giebenhain, <strong>St</strong>arr, & Gessert, 2011). The<br />
patients from this study remarked if the doctor could give<br />
them back their lives but take away their means <strong>of</strong><br />
providing for themselves, their quality <strong>of</strong> life had been<br />
greatly diminished. Being musicians is their passion,<br />
identity, and way <strong>of</strong> life. These women have trained for a<br />
lifetime to make music, and therefore cannot merely switch<br />
pr<strong>of</strong>essions.<br />
Medical treatments are essentially universal and not<br />
individualized. Doctors usually follow the same protocols.<br />
In the present study, largely ignored? Or downplayed the<br />
fact these women were musicians whose careers depend on<br />
their finely tuned physical abilities. Results from this study<br />
indicate when dealing with patients, they perceived the<br />
doctor was concerned with the cancer to the exclusion <strong>of</strong><br />
anything else. Some doctors asked the patient how<br />
treatments were affecting them, but the major focus was<br />
on getting rid <strong>of</strong> the cancer, everything else came second.<br />
Research indicates more women than ever are found to<br />
survive breast cancer. This rise in survival rates can be<br />
attributed to better methods <strong>of</strong> detection and intervention.<br />
Because we are more likely to survive cancer today, it makes<br />
sense that health care providers need to broaden their focus<br />
to include individualized treatments to successfully<br />
eliminate the cancer as well as minimize threats to patients’<br />
careers. This will help maintain the patients’ quality <strong>of</strong> life<br />
after treatments are over.<br />
Taking into consideration the concerns <strong>of</strong> the present<br />
sample, recommendations for improved holistic health care<br />
might include the following: in order for doctors to better<br />
suit their patients and do no harm as the Hippocratic Oath<br />
states, doctors could facilitate better communication with<br />
patients. This could help patients perceive they matter as<br />
people and are not just a name on a chart. Patients ought<br />
to be able to tell their doctors they are a mechanic, surgeon,<br />
pr<strong>of</strong>essional athlete, or ballet dancer, and therefore must (if<br />
at all possible) be able to do specific activities after<br />
treatments have ended. Doctors ought to share with the<br />
patient all possible treatment options, probabilities <strong>of</strong><br />
success, as well as the pros and cons <strong>of</strong> each treatment<br />
option. This will ensure the patient has input about how<br />
they would like to be treated. Furthermore, health care<br />
pr<strong>of</strong>essionals might consider creating a relationship that<br />
conveys they care for the patient. The relationship need<br />
only include specific characteristics which include: 1) the<br />
doctor could listen to the patient and direct them to<br />
resources which could give the woman further information<br />
about treatment options; 2) the doctor could keep the lines<br />
<strong>of</strong> communication open by making sure that meetings with<br />
the patient last as long as they need to; 3) doctors ought to<br />
take their time when meeting with each patient and not<br />
try to hurry through the process. This patience exhibited<br />
by the doctor could imply to the patient they can share<br />
their thoughts.<br />
The recommendations stated above were found to be<br />
what the ideal doctor should engage in according to study<br />
conducted by Theisel (2010). This “ideal” interaction does<br />
not facilitate more work for the doctor who has many<br />
patients to help, but helps him or her understand where<br />
the patient is coming from. The complaints from the<br />
women were not just that the doctor did not take his or<br />
her time. It was that the doctor was not purposeful in the<br />
use <strong>of</strong> his or her time. A patient explained “I see my surgeon,<br />
oncologist, and radiation oncologist every couple <strong>of</strong> months. And I<br />
have to tell you, when I go in for my treatment there, the visits get<br />
quicker and quicker.” Practical constraints in the age <strong>of</strong><br />
managed care imply it is hard for a doctor to be able to give<br />
each patient the attention they might deserve. Though this<br />
is the case, doctors ought to make their patients feel they<br />
matter by purposefully using the time they are allotted per<br />
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patient. To ad<strong>dr</strong>ess time constraints, the doctor could enlist<br />
the help <strong>of</strong> other health care pr<strong>of</strong>essionals such as nurses<br />
and patient navigation advocates in order to make the<br />
patient feel they matter. Research from Kaiser et al. (2009)<br />
indicated the patient is more likely to trust the doctor if<br />
they feel they matter. Much more than this, if the patient<br />
feels they matter to the doctor, they are more likely to trust<br />
other specialists the doctor recommends to them.<br />
Health care providers, such as nurses or patient<br />
navigation advocates, could perhaps also play a bigger role<br />
in making the patient feel like they matter from the very<br />
first phone call to the patient. If the woman must receive<br />
the diagnosis over the phone, the nurse or doctor giving<br />
the news ought to have information for the woman about<br />
the illness, and possible treatment plans. The pr<strong>of</strong>essional<br />
could take into account the woman’s feelings on the subject<br />
and not be cold in the delivery <strong>of</strong> the news. The health care<br />
pr<strong>of</strong>essional could attempt to schedule an informational<br />
meeting with the woman as soon as possible, even if an<br />
appointment with the physician is not possible within a<br />
week. This will ensure women do not sit with news <strong>of</strong> their<br />
cancer for weeks without information and support.<br />
When interviewed, the post-breast cancer participants<br />
in the current study had several suggestions for health care<br />
pr<strong>of</strong>essionals. A woman remarked she wants doctors to be<br />
concerned with the quality <strong>of</strong> her life after treatments by<br />
saying,<br />
10<br />
“I just feel like, um, the medical community needs to have a<br />
little more understanding <strong>of</strong> what quality <strong>of</strong> life is for an<br />
individual person, not just the treatment but the fact that,<br />
You’re going to live, but are you going to live with good<br />
quality or with just what you need to survive. Living and<br />
surviving and, being successful are really different things to<br />
everybody. You know what I mean. There are different<br />
qualities and different aspects that have to go into all those<br />
things. You know. You can live but if you’re not living the<br />
quality <strong>of</strong> life or the success that you need for your life, then<br />
it seems a lot pointless.”<br />
Results from this study imply there needs to be more<br />
attention to long term side effects from treatments, and<br />
strategies to cope with and heal from those side effects. A<br />
woman in this study remarked there have been<br />
improvements, but there is still work to do. The woman<br />
went on to say, [the medical center I go to] “has a newsletter<br />
that goes out to patients that have had breast cancer and I have<br />
seen more awareness developing in that <strong>of</strong> sort <strong>of</strong> like long term<br />
kind <strong>of</strong> thing, you know, exercise classes or what are the effects<br />
after you have had cancer 10, 5-10 years later. I have seen a little<br />
bit more attention given to the issue rather than just talking about<br />
it.” This study shows what many breast cancer patients are<br />
sure to agree with: having breast cancer is not just<br />
something someone has at some point in their life, it is<br />
something the person has to deal with her entire life. Due<br />
to this factor, doctors should give more attention to post<br />
treatment or survivorship issues.<br />
In order to ad<strong>dr</strong>ess long-term survivorship issues, there<br />
could be a specialist who provides occupational assessments<br />
for patients. These exist in some breast centers today. The<br />
specialist assesses the patient’s physical abilities prior to<br />
any form <strong>of</strong> treatment in order to see what it is the patient<br />
does for a living. For example, a patient might receive an<br />
assessment that discovers he or she is a pianist. This would<br />
be particularly helpful because the occupational assessment<br />
specialist can pinpoint the muscles and ligaments in the<br />
arms involved in playing piano. Doctors would receive this<br />
information and would therefore be careful <strong>of</strong> these<br />
locations, or perhaps pick other lymph nodes in the arms<br />
to remove if possible. Better quality <strong>of</strong> life would be<br />
reached if doctors are aware this patient needs to be able<br />
to play the piano after treatment. They would be more<br />
careful to place ports or <strong>dr</strong>ains in locations that would<br />
facilitate less harm to the patient.<br />
Another way to learn about survivorship issues would<br />
be to create more survivor support groups. When women<br />
were diagnosed in this study, they recalled being given<br />
information about several focus groups that could help<br />
them deal with the issues they were having adjusting to<br />
life with cancer. There could be more groups focused on<br />
the issues women have post-cancer treatments. These<br />
groups ought not to be focused on simply stating<br />
grievances women have, because many patients stated they<br />
did not want to feel sorry for themselves, but they should<br />
focus on support from other patients who have been<br />
through what they were now undergoing (Johnson, 2010).<br />
Doctors and other health care pr<strong>of</strong>essionals should interact<br />
with the patients in order to ascertain what women need<br />
in terms <strong>of</strong> support. It could be the case that some women<br />
want hard facts about survival rates and statistics while<br />
some patients want to be in a group setting where they can<br />
talk about the issues they are having. Interaction with
Oluwademilade Adediran<br />
Psychology Mattering<br />
patients will help doctors understand the patient and their<br />
needs, so they can direct patients to appropriate resources.<br />
This research was conducted with only interviews from<br />
patients and not health care providers. It would be<br />
interesting for future research to acquire interviews from<br />
doctors as well. This would provide an understanding<br />
about how health care pr<strong>of</strong>essionals view their interactions<br />
with patients. In summation, the health care field, though<br />
has made many advances, still needs to focus on individual<br />
patients. Doctors could perhaps see patients as someone’s<br />
father, mother, sister, or brother, and therefore understand<br />
the patient as a whole matters. If the focus <strong>of</strong> health care<br />
pr<strong>of</strong>essionals shifts from not just curing a disease but to<br />
also ensure the livelihoods <strong>of</strong> patients are protected,<br />
patients might experience higher qualities <strong>of</strong> life. In<br />
addition, if the patient matters to the doctor, it might be<br />
easier for doctors to see the patient as a person, and<br />
therefore the doctor will involve patients in making<br />
decisions. If the patient matters to the doctor, then this<br />
could imply the doctor will keep the patients’ interests in<br />
mind. When the doctor says the diagnosis is cancer, it is a<br />
challenge to not only to defeat the cancer but to return to<br />
life after the treatments are over. Doctors ought to feel an<br />
obligation, as stated by the Hippocratic Oath, to work to<br />
integrate quality treatments into good quality <strong>of</strong> life for<br />
patients.<br />
In summation, this research identified two primary areas<br />
that require attention from health care pr<strong>of</strong>essionals. First,<br />
there needs to be better interactions with the patient as was<br />
also found in the study conducted by Kaiser (Kaiser et al.,<br />
2009). Second, there ought to be more thought given to<br />
long term effects <strong>of</strong> cancer treatments and the woman<br />
should continue to matter over time. Though the next<br />
steps <strong>of</strong> this research points to viewing health care<br />
provider’s views on mattering, the more immediate step is<br />
to focus on occupational assessments. As this study has<br />
demonstrated, <strong>of</strong>ten times doctors do not take into account<br />
the patients livelihood when prescribing treatments. Next<br />
steps in research will not only look at health care providers<br />
views on mattering, but also look at ways to implement<br />
occupational assessments in more treatment centers.<br />
REFERENCES<br />
American Cancer Society. (2010). Survival rates for breast cancer<br />
by stage. Retrieved from www.cancer.org/Cancer/<br />
ProstateCancer/DetailedGuide/prostate-cancer-survival-rates<br />
Connolly, K. M. (2002). Work: Meaning, mattering, and job<br />
satisfaction. In D. S. Sandhu (Ed.), Counseling employees: A<br />
multifaceted approach. (pp. 3-15) Alexan<strong>dr</strong>ia, VA, US:<br />
American Counseling Association.<br />
Dibbelt, S., Schaidhammer, M., Fleischer, C., & Greitemann, B.<br />
(2009). Patient–doctor interaction in rehabilitation: The<br />
relationship between perceived interaction quality and longterm<br />
treatment results. Patient Education and Counseling,<br />
76(3), 328-335. doi:10.1016/j.pec.2009.07.031<br />
France, M. K., & Finney, S. J. (2009). What matters in the<br />
measurement <strong>of</strong> mattering?: A construct validity study.<br />
Measurement and Evaluation in Counseling and Development,<br />
42(2), 104-120. doi:10.1177/0748175609336863<br />
Janssen, A. L., & MacLeod, R. D. (2010). What can people<br />
approaching death teach us about how to care? Patient<br />
Education and Counseling, 81(2), 251-256. doi:10.1016/<br />
j.pec.2010.02.009<br />
Johnson, A. (2010) Informational Social Support: Female<br />
Musicians Cope with Breast Cancer<br />
Kaiser, K., Rauscher, G. H., Jacobs, E. A., <strong>St</strong>renski, T. A.,<br />
Ferrans, C. E., & Warnecke, R. B. (2011). The import <strong>of</strong> trust<br />
in regular providers to trust in cancer physicians among<br />
white, african american, and hispanic breast cancer patients.<br />
Journal <strong>of</strong> General Internal Medicine, 26(1), 51-57.<br />
doi:10.1007/s11606-010-1489-4<br />
Kawamura, S., & Brown, S. L. (2010). Mattering and wives’<br />
perceived fairness <strong>of</strong> the division <strong>of</strong> household labor. Social<br />
Science Research, 39(6), 976-986. doi:10.1016/<br />
j.ssresearch.2010.04.004<br />
Landmark, B. T., bøhler, A., Loberg, K., & Wahl, A. K. (2008).<br />
Women with newly diagnosed breast cancer and their<br />
perceptions <strong>of</strong> needs in a health-care context: A focus group<br />
study <strong>of</strong> women attending a breast diagnostic center in<br />
norway. Journal <strong>of</strong> Clinical Nursing, 17(7), 192-200.<br />
doi:10.1111/j.1365-2702.2008.02340.x<br />
National Cancer Institute. (2010). Survival statistics. Retrieved<br />
from http://www.cancer.gov/statistics/glossary/survival<br />
O’Connor, S. J. (2011). Listening to patients: The best way to<br />
improve the quality <strong>of</strong> cancer care and survivorship. European<br />
Journal <strong>of</strong> Cancer Care, 20(2), 141-143. doi:10.1111/j.1365-<br />
2354.2011.01242.x<br />
Rayle, A. D. (2005). Adolescent gender differences in mattering<br />
and wellness. Journal <strong>of</strong> Adolescence, 28(6), 753-763.<br />
doi:10.1016/j.adolescence.2004.10.009<br />
Salonen, P., Kellokumpu Lehtinen, P., Tarkka, M., Koivisto, A.,<br />
& Kaunonen, M. (2011). Changes in quality <strong>of</strong> life in patients<br />
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UST McNair Scholars Program Research Journal<br />
with breast cancer. Journal <strong>of</strong> Clinical Nursing, 20(1-2), 255-<br />
266. doi:10.1111/j.1365-2702.2010.03422.x<br />
Sanson-Fisher, R., Bailey, L. J., Aranda, S., D’Este, C.,<br />
<strong>St</strong>ojanovski, E., Sharkey, K., & Sch<strong>of</strong>ield, P. (2010). Quality<br />
<strong>of</strong> life research: Is there a difference in output between the<br />
major cancer types? European Journal <strong>of</strong> Cancer Care, 19(6),<br />
714-720. doi:10.1111/j.1365-2354.2009.01158.x<br />
Schmalenberger, S., Giebenhain, J.E., Gessert, C.E., & <strong>St</strong>arr, L.<br />
(2011, July). The disabling affects <strong>of</strong> breast cancer treatment<br />
on women musicians. Paper session presented at the<br />
Minnesota Symposium in Disability <strong>St</strong>udies. Mpls, MN.<br />
Schmalenberger S, Giebenhain J, <strong>St</strong>arr L, & Gessert C E. (2008).<br />
The medical and occupational well-being <strong>of</strong> musicians after<br />
breast cancer. American Journal <strong>of</strong> Clinical Oncology 31(5), 517.<br />
Schmalenberger, S., Giebenhain, J.E., <strong>St</strong>arr, L., & Gessert, C.E.<br />
(2011, July). Musician survivors: Breast cancer’s effect on<br />
their livelihood. Paper session presented at the 29th Annual<br />
Symposium <strong>of</strong> the Performing Arts Medicine Association.<br />
Aspen, CO.<br />
Theisel, S., Schielein, T., & Spleßl, H. (2010). Der „ideale“ arzt<br />
aus sicht psychiatrischer patienten. [the “ideal” doctor from<br />
the view <strong>of</strong> psychiatric patients.]. Psychiatrische Praxis, 37(6),<br />
279-284. doi:10.1055/s-0030-1248403<br />
Tucker, C., Dixon, A., & Griddine, K. (2010). Academically<br />
successful African American male urban high school<br />
students’ experiences <strong>of</strong> mattering to others at school.<br />
Pr<strong>of</strong>essional School Counseling, 14(2), 135-145.<br />
12
Oluwademilade Adediran<br />
Psychology Mattering<br />
Section one<br />
Themes<br />
Doctor did not consider the patient’s<br />
whole life<br />
Section one<br />
Doctors did not understand music was a<br />
big part <strong>of</strong> the patient’s life:<br />
Doctors did not understand their patients<br />
Section one<br />
Lack <strong>of</strong> intimacy and sensitivity by staff:<br />
IMPORTANT MATTERING QUOTES FROM PARTICIPANTS<br />
The following quotes below are behaviors exhibited by healthcare<br />
pr<strong>of</strong>essionals patients felt were cold or alo<strong>of</strong>. The main finding in this section<br />
was patients felt the doctors could have done more to make them feel more<br />
comfortable and like they cared for their wellbeing outside <strong>of</strong> removing the<br />
cancer. i.e. seeing how cancer treatment would affect their music playing<br />
Quotes from patients<br />
“Well, when we talked about the Taxol the doctor was so non-understanding, so<br />
uncompassionate about it. “The doctor said if you want to live you got to do this,<br />
without any understanding <strong>of</strong> what it was for me to live, you know, what it took for<br />
me as a human, as a person, as an individual. If I couldn’t have my music, or if I<br />
couldn’t have… and for some other people who are passionate about something if<br />
they don’t have that in their lives anymore, how are they going to adjust and how<br />
are they going to survive. Because piano to me, or my music to me is really my<br />
coping mechanism for everything else that I do. And to be left without it I don’t<br />
think that there’s enough understanding about that.”<br />
“They [doctors] don’t know, they don’t know what’s necessary, they don’t know how<br />
those parts work. Aa, aa. I remember long ago going to an ear, nose, and throat<br />
specialist, um, who did not understand musicians and he was one <strong>of</strong> those who was<br />
more interested in getting <strong>of</strong>f to his weekend trip so told me there was nothing<br />
wrong with my voice when I couldn’t sing above an F, you know, in my upper range.<br />
He said my speaking voice was just fine so he thought.”<br />
“The first thing that happened? They gave me a book at the library. What they do<br />
when someone is newly diagnosed is they give you a bag with a bunch <strong>of</strong> stuff in it<br />
like a satin pillow case, when your hair falls out, and you know, the people that<br />
replaced your eyelashes and stuff like that. They give you a book which actually<br />
scared the (*****) out <strong>of</strong> me.”<br />
“I got to tell you it’s like a parallel universe were I was treated. They kind <strong>of</strong> function<br />
like the New York City Board <strong>of</strong> Ed in that they have so many nonmedical personnel<br />
around there, the way the Board <strong>of</strong> Ed. It continues to astound me how many noneducation<br />
people they have there. Taking up space, taking up payroll, taking up<br />
money. The hospital I went to was that way also. You know, you’d go outside and<br />
you’d see all the uniforms out there standing around on a cigarette break and I’m<br />
thinking this is a (*****) cancer hospital. I bet I mean I had to deal with so many<br />
nonmedical people when you went for radiation, there were like six people standing<br />
around, you know. And here I’m lying down with my breast hanging down being<br />
ready to get shot up and they were like wearing uniforms. They looked almost like<br />
airline attendants. And I thought why do they need all <strong>of</strong> these people around here.<br />
You know, I mean maybe I should be grateful that these surroundings were pretty,<br />
you know, like with flowers and nice painting and nice carpeting, but all I could<br />
think <strong>of</strong> was, god dam, this is why they charge so much. You know, thank God I<br />
had insurance because I know people who didn’t.”<br />
13
UST McNair Scholars Program Research Journal<br />
14<br />
Listening<br />
Section one<br />
Doctors not listening<br />
Delivery techniques<br />
Section one<br />
Poor diagnosis delivery and<br />
technical help:<br />
section two<br />
Doctors showed patients they cared for them<br />
Section two<br />
Caring behaviors exhibited by doctors/<br />
health care pr<strong>of</strong>essionals: (physical)<br />
“You know, honest to God when I tell them [doctors] about problems I am having,<br />
they look at me like I should just be grateful that I’m here instead <strong>of</strong> bringing up<br />
the things that are real issues in keeping my life going. And I can understand that<br />
because, you know, the oncologist has a crappy job, you know, I mean, they deal<br />
with people and a large percentage <strong>of</strong> their client base, eventually die in a short<br />
period <strong>of</strong> time. so, I think when somebody comes in who is still alive after 2 years<br />
or 3 years and they are complaining about something like that they look at you like<br />
you’re an ingrate, you know.”<br />
“I said well you know… when the old ladies are passing me twice at the mall there’s<br />
a real problem. So I went back to the oncologist who poo poed me and said, you<br />
know, it’s in my mind, and you know, I’m, you know, I’m just you know bouncing<br />
back or something like that. He pretty much blew me <strong>of</strong>f.”<br />
“Right. Um, the first thing was, the first bad thing being told you have you have<br />
breast cancer was um my doctor didn’t even tell me it was like a nurse I didn’t even<br />
know just sort <strong>of</strong> called and said oh, um your result was positive and then, I don’t<br />
know anything else, bye, hung up.”<br />
“Yea and so she goes, why don’t you call the hospital and try to find out something.<br />
I was calling and they were going, we can’t tell you, its confidential, and I said yea<br />
it’s about me but so they wouldn’t tell me anything and I called the nurse and said<br />
have the doctor call me but she never did, which was jaw <strong>dr</strong>opping. I switched<br />
doctors after that. I refused to see her anymore.”<br />
The following quotes below, are behaviors exhibited by healthcare<br />
pr<strong>of</strong>essionals which made patients feel doctors care about them more than a<br />
cancer patient. There are also recommendations given by patients. The<br />
patients stated that if these criteria were met, they would feel more<br />
comfortable with their doctors and trust them more.<br />
“I had fabulous doctors, I mean my, my oncologist… it didn’t hurt at all that he<br />
was young and just absolutely good looking and … I don’t know, he was just so<br />
kind, he would put his hand on my shoulder. You know, just… he would touch and<br />
ask me questions that didn’t necessarily relate to the diagnosis, but I just really felt<br />
like he cared about how this was all affecting me. He wanted to speak with my<br />
husband. He insisted that, you know my husband be there for all <strong>of</strong> those initial<br />
talks about all <strong>of</strong> the options and so forth. He was so kind and so gentle, and I would<br />
say that it’s absolutely essential that you find a doctor who you not only trust because<br />
you know that he’s a good doctor, but somebody that you really want to go and talk<br />
to, you know, that you feel good just being in his presence. And like I said I was<br />
really thrilled that he was young, I mean, he was younger than I was but, it was<br />
really stupid, but it kind <strong>of</strong> makes you feel like I’m not like old and ugly and<br />
cancerous because, you know, he was being so nice to me.”<br />
“My doctor would call me during the week after, the surgery or something and just<br />
say, yeah, I’m just calling to see if you have any questions, how are things going<br />
and… I’m like oh my gosh my doctor is calling me at 5:30 in the evening just to<br />
see how I am!”
Oluwademilade Adediran<br />
Psychology Mattering<br />
Section two<br />
Caring behaviors exhibited by doctors/<br />
health care pr<strong>of</strong>essionals: (psychological)<br />
Recommendations to doctors<br />
Section two<br />
Listen to patients and let them<br />
guide you:<br />
Section two<br />
Answer questions:<br />
“I had a lot <strong>of</strong> psychological help from my doctor and my nurses, they were cheering<br />
me on saying I was doing great and it was better for me to keep doing this than sit<br />
home and worry, which I really agree, I’m glad that I kept playing and teaching.”<br />
“Um… I didn’t feel like I was fighting for me life because I kept getting<br />
encouragement from my doctor and from the nurses that my situation while it was<br />
not good, it wasn’t horrible, I mean it could have been a whole lot worse. They<br />
decided that with my history and with it being a HER2 positive tumor that they<br />
needed to treat it aggressively to make sure it didn’t come back. That was actually<br />
their focus the whole time, they kept telling me we’re making you this sick to make<br />
sure that it, you know to REDUCE the possibility <strong>of</strong> it coming back. So mostly I<br />
was just thinking I had to endure this so that maybe I wouldn’t have to do it again.”<br />
“I thought I was going to die. I thought between the kidney disease and the cancer<br />
and the chemo and all that stuff, yeah, I thought I wasn’t going to make it...but<br />
that didn’t last very long. That was about 2 weeks and then I expressed that to my<br />
doctor and I think what I said, “I felt like I had a loaded gun pointed at my head”<br />
and he laughed and he said “Oh well, they’re waving it around, but they’re not<br />
pointing it at you!” his humor helped me get past it.”<br />
Be as honest as you can and listen to your patients and remember that they’re people<br />
and it could be your daughter or your wife or your mother.”<br />
“Listen and investigate. Don’t tell me… oh… yeah… well, we just… you know.<br />
Listen, investigate, and don’t even necessarily sympathize, I don’t want that. Just<br />
find out what the problem is. And if you don’t know then tell me that.”<br />
“Well, yeah, even though they try to <strong>dr</strong>ess it up, it’s um…I don’t know, what I<br />
would tell the medical pr<strong>of</strong>ession…is basically let the patient guide your response,<br />
rather than having a programmed or a canned response or treatment…you know<br />
that you tell everybody.”<br />
“Well that they are treating a human being and, you know, I think that it is kind<br />
<strong>of</strong> symptomatic in the medical pr<strong>of</strong>ession across the board not just with cancer<br />
patients but I think but it should be particularly in terms <strong>of</strong> people who are seriously<br />
ill and facing cancer that they are dealing with a person who has or who had up to<br />
that point a full life and, um, that things that they enjoyed and, um, that what they<br />
are going through is very scary and not to be, um, sarcastic or flip with their answers<br />
that anything that the patient has to ask them is a worthwhile question no matter<br />
how silly it sounds. To not be intimidated by questions and I went in, I did a lot <strong>of</strong><br />
reading on the internet and I put together all kinds <strong>of</strong> questions and some doctors<br />
were okay with it and others weren’t. Um, but you know the fact is that my approach<br />
was that knowledge is power and if you don’t take the time and ask the questions<br />
and try to get answers that you understand, um, at least for me that I felt like that<br />
I was just floundering that I that I needed that that to hold on to.”<br />
15
UST McNair Scholars Program Research Journal<br />
16<br />
Section two<br />
Understand musicians:<br />
Section three<br />
Patient Resilience<br />
Section three<br />
Understand that the show must go on:<br />
Section three<br />
Patients would have like more<br />
information<br />
“Yeah, I guess, maybe if they [doctors] can put in their mind, kind <strong>of</strong> move<br />
musicians in the same category as athletes, and that you really have to think about<br />
all the possible physical, I mean obviously they know the anatomy and what’s<br />
connected to what and that obviously is going to affect your playing.”<br />
“I just feel like, um, the medical community needs to have a little more<br />
understanding <strong>of</strong> what quality <strong>of</strong> life is for an individual person, not just the<br />
treatment but the… or the fact that, okay, yeah! You’re going to live, but are you<br />
going to live with the quality or with what you need to survive. Because living and<br />
surviving and being successful are really different things to everybody. You know<br />
what I mean. There are different qualities and different aspects that have to go into<br />
all those things. You know. Yeah, you can live but if you’re not living the quality <strong>of</strong><br />
life or the success that you need for your life, then it seems a lot pointless.”<br />
The following quotes below reflect what patients wanted doctors to<br />
understand. The patients wanted to get back to their music as soon as<br />
possible and wanted the doctors to understand and aid them in this.<br />
“They told me after the biopsy, they said… no, you’re not going to want to go back<br />
to work. Well, fortunately I had a winter break so that wasn’t a problem. But then<br />
after the surgery, he said you’re not going to want to go back for a while. But I had<br />
a winter break, so I had a week <strong>of</strong>f. But then I was right back at school on Monday.<br />
They couldn’t believe it. They’re like; you’ve got to be kidding. I said… No, I’ve<br />
got to work. So I did.”<br />
“I said well how long it is going to take to recover. She said most people lay up for<br />
about a week. I said, no I can’t do that. So I had the surgery on Friday and I was<br />
back at school on Monday. She couldn’t believe it. I was walking like bent over, but<br />
I was determined that I had to be back. So I guess I’m crazy, but that was pretty<br />
amazing.”<br />
“I wish they had told me maybe a little bit more about how bad chemo could really<br />
get. But they wouldn’t know that because everybody is different, some people breeze<br />
through chemo and I was, I flunked everything about chemo. I was the worst chemo<br />
patient ever.<br />
Everything that could go wrong did. I wish they had prepared me for that a little<br />
bit more.”<br />
“After surgery nobody told me that you can’t lift you arm. I mean they sort <strong>of</strong> said<br />
yea you might have a little stiffness, well hell I couldn’t put the dishes away, you<br />
know. The bowls that went up on the high shelf, I couldn’t put them away. They<br />
weren’t real big on telling me the treatment effects, they were just so focused on<br />
getting rid <strong>of</strong> the breast.”<br />
They would say here are some exercises, and here is a sling, goodbye, and see you<br />
later. They were kind <strong>of</strong> not real, maybe that’s not their job. They weren’t real<br />
specific on the fact that they were going to take lymph nodes out.<br />
It seems like everybody is real focused on their job. The surgeon is a surgeon and<br />
the radiologist is the radiologist. They can’t really do their job well if they don’t<br />
talk to the next guy, because it is all connected. You need all <strong>of</strong> them as the team.<br />
They <strong>of</strong>ten don’t seem to interact with each other. You just get sent to the next<br />
person for the next thing that was already found and they ask you the same questions.
Oluwademilade Adediran<br />
Psychology Mattering<br />
Section four<br />
More attention to survivorship<br />
Section four<br />
Long term care options<br />
The quotes below reflects a collective voice <strong>of</strong> the participant in the study.<br />
The women were experiencing difficulties such as neuropathy or chest pains<br />
after they were supposed to be cured. The women wanted long term care<br />
targeted at these issues which persist after treatments were over.<br />
“I don’t find a lot <strong>of</strong> attention to long term care and how are you and not that I<br />
think doctors have a lot <strong>of</strong> time to surround, mainly when I go to my oncologist<br />
appointment, now which I will in April, a few key questions will be asked and they<br />
will get my ****bones and see**** and they will check on the critical things and<br />
do I have cancer. There are no signs that I have cancer. And sometimes my oncologist<br />
does ask about my comfort level and I guess, I always kind <strong>of</strong> get the idea, you know,<br />
they are busy dealing with people who are dying from cancer, they are not all that<br />
concerned with how am I doing in the long term. And I have never said that I’m<br />
doing poorly. I have continued to pursue this soreness and each time I go in I say<br />
well, you know, can you, to begin with I wanted physical therapy and he was willing<br />
to, you know, write a prescription for that and the massage is helping so he took my<br />
massage person’s card, um, but I guess I would hope for a little bit more attention<br />
to the long term effects.”<br />
“I wish they had said a little bit more about what to do instead <strong>of</strong> just giving me<br />
this paper, here do these exercises maybe sort <strong>of</strong>.”<br />
“I see them [doctors] every 6 months. I see my surgeon and my oncologist and my<br />
radiation oncologist. And I have to tell you, I mean, I go on in my treatment there,<br />
the visits get quicker and quicker but if I need to know stuff they are very good<br />
about it.”<br />
I would hope for a little bit more attention to the long term effects. I am in the …<br />
medical system and they do have a newsletter that goes out to patients that have<br />
had breast cancer. I have seen more awareness developing in that <strong>of</strong> sort <strong>of</strong> like long<br />
term kind <strong>of</strong> thing, you know, exercise classes or what are the effects after you have<br />
had cancer 10, 5-10 years later. I have seen a little bit more attention given to talking<br />
about it but I haven’t heard a lot from my doctors.<br />
5 years ago or so there was a point in which I was thinking, I should go back and<br />
she the surgeon because, um, yes they took care <strong>of</strong> the mastectomy, they took care<br />
<strong>of</strong> it and everything but I’m still having a lot <strong>of</strong> issues in that area and she should<br />
know about it. I felt like, wow, here it is, 9 years out and this surgeon should know<br />
what happened. You know, that I still have problems with these scar areas<br />
17
UST McNair Scholars Program Research Journal<br />
18<br />
Quasi-<strong>St</strong>atistics on mattering<br />
More attention to life quality
ABSTRACT<br />
Early childhood education is critical to support healthy child development, promote<br />
educational equity, and prepare an educated, economically productive, and civically<br />
engaged populace. The goal <strong>of</strong> this project is to explore possibilities for enhancing early<br />
childhood education for low-income chil<strong>dr</strong>en by incorporating key principles and practices<br />
<strong>of</strong> the Montessori education within Head <strong>St</strong>art programs. Head <strong>St</strong>art is the primary<br />
source <strong>of</strong> early childhood education for low-income chil<strong>dr</strong>en. The Montessori method,<br />
accepted worldwide as a premier approach to early childhood education, is rarely seen<br />
within Head <strong>St</strong>art classrooms. <strong>St</strong>udies exploring the integration <strong>of</strong> these two approaches<br />
to early childhood education are almost non-existent. This project summarizes Maria<br />
Montessori’s theory <strong>of</strong> development, educational philosophy, and educational methods as<br />
well as the history and common practices <strong>of</strong> the Head <strong>St</strong>art program. Research on the<br />
effectiveness <strong>of</strong> each method is discussed. Recommendations are made for the incorporation<br />
<strong>of</strong> Montessori practices within Head <strong>St</strong>art classrooms based on exploration <strong>of</strong> the two<br />
approaches, as well as consultation with the director <strong>of</strong> a Montessori training center and<br />
school and an educational coordinator <strong>of</strong> a Head <strong>St</strong>art program.<br />
Nearly 42 percent <strong>of</strong> America’s chil<strong>dr</strong>en are low-income (National Center<br />
for Child Poverty, 2010). It is absolutely crucial to provide quality early<br />
childhood education to all chil<strong>dr</strong>en, but especially low-income chil<strong>dr</strong>en to<br />
ensure they have the skills necessary to succeed. Quality education is necessary<br />
to support each child in reaching his or her full potential. Chil<strong>dr</strong>en from lowincome<br />
backgrounds are <strong>of</strong>ten at a disadvantage in life, but quality early<br />
childhood education can provide chil<strong>dr</strong>en the foundation they need to thrive.<br />
The continual review <strong>of</strong> common approaches to early childhood education<br />
provides opportunities to enhance it, thus enhancing the educational<br />
opportunities available to America’s chil<strong>dr</strong>en.<br />
Extensive research points to the necessity <strong>of</strong> quality early childhood<br />
education for all chil<strong>dr</strong>en (Follari, 2007). Research suggests the importance <strong>of</strong><br />
early childhood education by confirming the key to learning lies in educating<br />
chil<strong>dr</strong>en from a very early age (Shore, 2009). The brain develops faster between<br />
conception and age five than any other point in a person’s lifetime, making it<br />
the most important time to lay a strong educational foundation (Shore, 2009).<br />
Ensuring a well educated and economically productive society hinges on<br />
providing quality early childhood education for all chil<strong>dr</strong>en.<br />
Clues for closing the gap in achievement among chil<strong>dr</strong>en <strong>of</strong> various<br />
backgrounds also lie in the stages <strong>of</strong> brain development. Varying levels <strong>of</strong><br />
achievement, be it high school graduation rates, test scores, literacy rates or<br />
any other measure <strong>of</strong> educational success exist among chil<strong>dr</strong>en <strong>of</strong> different races<br />
and socioeconomic statuses. Birth through age five is a crucial time to begin<br />
formal education due to the large amount <strong>of</strong> brain development taking place<br />
during this period. Access to quality education is especially important for<br />
chil<strong>dr</strong>en who are not exposed to a stimulating environment at home (Shore,<br />
2009). In order for all chil<strong>dr</strong>en to achieve their potential, they must have access<br />
to early childhood education that provides a strong cognitive foundation for<br />
additional learning to be built upon.<br />
ENHANCING EARLY<br />
CHILDHOOD<br />
EDUCATION FOR LOW-<br />
INCOME CHILDREN:<br />
EXPLORING<br />
POSSIBILITIES FOR<br />
INCORPORATING<br />
MONTESSORI<br />
METHODS WITHIN THE<br />
HEAD START<br />
PROGRAM<br />
Kesha Berg ’13<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Mentor<br />
Ruthanne Kurth-Schai, Ph.D.<br />
Pr<strong>of</strong>essor <strong>of</strong> Educational <strong>St</strong>udies<br />
Macalester College<br />
19
UST McNair Scholars Program Research Journal<br />
Attention must be devoted to each child’s emotional,<br />
physical, and social development in addition to concern for<br />
his or her cognitive development. Educators must concern<br />
themselves with the development <strong>of</strong> the whole child<br />
beginning at the preschool level. Chil<strong>dr</strong>en who are raised<br />
in poverty <strong>of</strong>ten have had less attention devoted to their<br />
emotional, physical, and social development than those<br />
from more affluent families (Follari, 2007). Adopting an<br />
educational method that supports dimensions <strong>of</strong> develop -<br />
ment beyond cognitive growth is essential for healthy<br />
chil<strong>dr</strong>en and a productive society.<br />
In an effort to provide early childhood educational<br />
opportunities for low-income chil<strong>dr</strong>en, the Head <strong>St</strong>art<br />
program was enacted under President Lyndon Johnson’s<br />
War on Poverty (Mills, 1998). Head <strong>St</strong>art, as described on<br />
its website, is a “program that promotes school readiness<br />
by enhancing the social and cognitive development <strong>of</strong><br />
chil<strong>dr</strong>en through the provision <strong>of</strong> educational, health,<br />
nutritional, social, and other services to enrolled chil<strong>dr</strong>en<br />
and families” (2011). The Head <strong>St</strong>art program provides<br />
grants to local “agencies to provide comprehensive child<br />
development service to economically disadvantaged<br />
chil<strong>dr</strong>en” (Office <strong>of</strong> Head <strong>St</strong>art, 2011). Head <strong>St</strong>art grants<br />
an opportunity for low-income chil<strong>dr</strong>en to begin building<br />
an educational foundation during the most crucial years <strong>of</strong><br />
their lives for learning. Additionally, the program concerns<br />
itself with chil<strong>dr</strong>en’s well-being outside their education,<br />
providing services such as dental and eye examinations for<br />
chil<strong>dr</strong>en who would otherwise go without (Mills, 1998).<br />
The Head <strong>St</strong>art program has provided critical<br />
educational and well-being opportunities for low-income<br />
chil<strong>dr</strong>en since its enactment. However, every education<br />
system requires continued revision to ensure it is providing<br />
the best possible education for its students. Enhancing<br />
Head <strong>St</strong>art could deepen support for low-income chil<strong>dr</strong>en<br />
by expanding their access to the quality <strong>of</strong> education<br />
necessary in providing a strong base on which to build<br />
upon throughout their educational career.<br />
While low-income chil<strong>dr</strong>en are predominantly educated<br />
through Head <strong>St</strong>art, many other effective forms <strong>of</strong><br />
preschool education produce successful students. The<br />
Montessori approach is acknowledged worldwide as a<br />
leader in effective preschool education concerned with<br />
educating the whole child. The method aims to “nurture<br />
the child’s natural desire to learn and grow” (Montessori<br />
20<br />
Training Center <strong>of</strong> Minnesota [MTCM], 2011). Chil<strong>dr</strong>en<br />
<strong>of</strong> Montessori schools learn to work independently to<br />
develop both life skills and curriculum knowledge through<br />
a prepared environment (MTCM, 2011).<br />
This research explores possibilities for enhancing early<br />
childhood education for low-income chil<strong>dr</strong>en by<br />
incorporating key principles from the Montessori education<br />
within Head <strong>St</strong>art. Maria Montessori’s theory <strong>of</strong> develop -<br />
ment, educational philosophy, and educational methods are<br />
summarized, as well as the history and common practices<br />
<strong>of</strong> the Head <strong>St</strong>art program. Research <strong>of</strong> the effectiveness <strong>of</strong><br />
each method is discussed. Recom mendations are made for<br />
the incorporation <strong>of</strong> Montessori principles within Head<br />
<strong>St</strong>art classrooms based on careful review <strong>of</strong> the two<br />
approaches, as well as consultation with the director <strong>of</strong> a<br />
Montessori training center and school and an educational<br />
coordinator <strong>of</strong> a Head <strong>St</strong>art program.<br />
AN INNOVATION IN EDUCATION: THE MONTESSORI<br />
METHOD<br />
THE STORY OF AN EDUCATIONAL PIONEER: MARIA<br />
MONTESSORI’S LIFE EXPERIENCES<br />
Maria Montessori was born in Chiaravalle, Italy, in 1870<br />
to a wealthy and educated family (Hainstock, 1997).<br />
Academics were not Montessori’s strength as a child, but<br />
her determination and sense <strong>of</strong> self allowed her to excel in<br />
school (Hainstock, 1997). At age twelve, she enrolled in<br />
an all-male technical school seeking to become an engineer<br />
(Hainstock, 1997). At a time when women had limited<br />
career options, Montessori was determined to study science,<br />
typically a subject reserved for men (Hainstock, 1997).<br />
Encouragement from her mother to break traditional<br />
gender roles gave Montessori the support she needed to<br />
pursue her interests despite her father’s resistance (Povell,<br />
2007). After receiving a degree in natural sciences in 1892,<br />
she enrolled at the medical school at the <strong>University</strong> <strong>of</strong><br />
Rome (Povell, 2007). Montessori graduated at the top <strong>of</strong><br />
her class, becoming the first Italian female medical doctor<br />
(Hainstock, 1997). She gained recognition for<br />
accomplishing this feat as a “champion <strong>of</strong> women’s rights”<br />
and spent considerable time advocating equality (Follari,
Kesha Berg<br />
Public Policy Enhancing Early Childhood Education<br />
2007; Povell, 2007). Montessori soon became known as a<br />
leader in the European women’s movement (Gutek, 2011).<br />
Following graduation, Montessori began working and<br />
volunteering for the <strong>University</strong> <strong>of</strong> Rome’s psychiatric<br />
clinic, where her job included “visiting insane asylums to<br />
select patients for treatment at the clinic” (Hainstock,<br />
1997, p. 11). Montessori’s interaction with chil<strong>dr</strong>en in this<br />
setting sparked her interest in their development<br />
(Hainstock, 1997). Physicians and psychologists Jean-<br />
Marc-Gaspard Itard and Edouard Sequin quickly became<br />
sources <strong>of</strong> study for Montessori, and would later have a<br />
grand impact on the theories she developed (Hainstock,<br />
1997). Itard and Sequin’s work included assessing the<br />
development <strong>of</strong> chil<strong>dr</strong>en with learning disabilities<br />
(Cossentino & Whitcomb, 2007). Montessori shared Itard<br />
and Sequin’s belief that “mental deficiencies were more<br />
problems <strong>of</strong> the way in which defective chil<strong>dr</strong>en were being<br />
taught, and less a medical problem” (Follari, 2007, p. 221).<br />
Theories <strong>of</strong> Rousseau, Pestalozzi, and Froebel also<br />
influenced Montessori’s work (Follari, 2007).<br />
When Montessori assumed the directorship <strong>of</strong> a school<br />
established by the National League for Retarded Chil<strong>dr</strong>en<br />
in 1900, she used Itard and Seguin’s theories and materials<br />
as a guide (Hainstock, 1997). Montessori modified their<br />
observational methods and incorporated her own ideas to<br />
best educate her students after intense observation <strong>of</strong> their<br />
needs in a specially prepared environment (Cossentino &<br />
Whitcomb, 2007; Hainstock, 1997). Montessori gained<br />
recognition as the developmentally delayed chil<strong>dr</strong>en in her<br />
classroom began to function and achieve the same as<br />
“normal” chil<strong>dr</strong>en (Nutbrown, 2006). At this time<br />
Montessori was also operating a private medical practice<br />
(Cossentino & Whitcomb, 2007). Interaction with chil<strong>dr</strong>en<br />
in this setting, especially chil<strong>dr</strong>en labeled as learning<br />
disabled, lead her to believe the chil<strong>dr</strong>en were actually<br />
quite capable <strong>of</strong> high levels <strong>of</strong> achievement (Cossentino &<br />
Whitcomb, 2007). After a two-year study <strong>of</strong> the chil<strong>dr</strong>en,<br />
Montessori concluded they were simply “starved for<br />
stimulation and were not biologically defective” (Follari,<br />
2007, p. 221).<br />
As Montessori continued to explore educational<br />
philosophy and pedagogy, her interest in working with<br />
“normal” chil<strong>dr</strong>en grew (Cossentino & Whitcomb, 2007;<br />
Hainstock, 1997). In 1907, Montessori opened her first<br />
school, Casa dei Bambini (Chil<strong>dr</strong>en’s Home), in Rome’s<br />
poverty stricken San Lorenzo district (Gutek, 2011). The<br />
practices that emerged from the first Casa dei Bambini<br />
have become Montessori’s well-known educational method.<br />
This marked the turning point in Montessori’s career; she<br />
had left the field <strong>of</strong> medicine and would spend the rest <strong>of</strong><br />
her life developing her educational methods (Cossentino &<br />
Whitcomb, 2007).<br />
The Montessori method quickly became known<br />
worldwide (Martin, 1996). Intrigued educators traveled to<br />
Rome to witness her lectures and visit her classrooms<br />
(Gutek, 2011). As Montessori’s method spread, gaining<br />
both international praise and criticism, she became<br />
concerned with the degree to which new programs<br />
modeled her original Casa dei Bambini (Follari, 2007). She<br />
preferred a very strict adherence to her method and<br />
philosophical beliefs, controlling all aspects <strong>of</strong> material<br />
production and teacher training (Follari, 2007; Gutek,<br />
2011). In 1929 Montessori established the Association<br />
Montessori Internationale (AMI) to oversee the sale <strong>of</strong><br />
materials, publication <strong>of</strong> her writings, and Montessori<br />
teacher training (Gutek, 2011). Montessori traveled the<br />
world beginning in 1909, including two trips to the<br />
United <strong>St</strong>ates, to promote her educational philosophies by<br />
delivering speeches (Cossentino & Whitcomb, 2007;<br />
Gutek, 2011). Soon after, Montessori began documenting<br />
her educational ideas and speeches in books (Gutek, 2011).<br />
Cossentino and Whitcomb describe the spread <strong>of</strong> the<br />
Montessori movement as “swift and international in scope”<br />
(2007, p. 113). Mussolini promoted Montessori’s methods<br />
throughout Italy after coming to power in 1922, despite<br />
their philosophical differences (Gutek, 2011). After<br />
Montessori turned down a position from Mussolini in<br />
1934, he closed Montessori schools and banned her from<br />
the country (Gutek, 2011). Montessori quickly established<br />
residency in multiple other countries including India and<br />
the Netherlands, confident her methods would gain broad<br />
and lasting support elsewhere (Cossentino and Whitcomb,<br />
2007; Gutek, 2011). As Montessori aged, she delegated<br />
many tasks to her only son, Mario, who took full<br />
responsibly after his mother’s death (Gutek, 2011).<br />
However, Montessori continued writing, training teachers,<br />
and attending conferences until her death in 1952 (Martin,<br />
1996).<br />
Following the initial recognition and fame <strong>of</strong> her ideas,<br />
Montessori’s influence faded (Martin, 1996). Her methods<br />
21
UST McNair Scholars Program Research Journal<br />
did not gain prominence again until the 1950s and 1960s<br />
when a greater emphasis was placed on academically<br />
focused early childhood education (Follari, 2007; Gutek,<br />
2011). This growing popularity sparked the establishment<br />
<strong>of</strong> the American Montessori Society in 1960, which<br />
provides an Americanized version <strong>of</strong> some <strong>of</strong> Montessori’s<br />
methods (Gutek, 2011). In America, a rise in interest<br />
regarding Montessori’s work was seen again in the 1980s,<br />
and curiosity is peaking today (Follari, 2007; Murray &<br />
Peyton, 2008). The American Montessori Society reports<br />
there are roughly 4000 Montessori schools currently in<br />
America, though their adherence to Montessori’s original<br />
methods vary (2011; Follari, 2007). Substantial portions<br />
<strong>of</strong> these schools are private, allowing access to the<br />
Montessori education for a limited group only (Gutek,<br />
2011). However, a growing public interest has resulted in<br />
a greater number <strong>of</strong> public Montessori schools in the recent<br />
past (Gutek, 2011).<br />
THE BLOSSOMING CHILD: MARIA MONTESSORI’S THEORY OF<br />
DEVELOPMENT<br />
The theories <strong>of</strong> development that form Maria<br />
Montessori’s educational approach were built on close<br />
observation <strong>of</strong> the developing child (Cossentino &<br />
Whitcomb, 2007). Montessori’s developmental theory<br />
gives validity to her emphasis <strong>of</strong> early childhood education<br />
(Gutek, 2011).<br />
Montessori’s theory consists <strong>of</strong> four different planes, or<br />
stages, <strong>of</strong> development. The planes track growth from the<br />
most basic reflexive motor skills through concrete and<br />
abstract thinking (Cossentino & Whitcomb, 2007). Each<br />
plane is accompanied by specific concepts <strong>of</strong> the child’s<br />
development during the identified period and learning<br />
which must take place during that time (Cossentino &<br />
Whitcomb, 2007; Gutek, 2004). The planes run in 6 year<br />
cycles beginning at birth: birth through age 6, age 6<br />
through 12, age 12 through 18, and age 18 through 24,<br />
each running smoothly into the next (Cossentino &<br />
Whitcomb, 2007; Gutek, 2004). Additionally, some<br />
planes are divided into two sub-planes to further specify<br />
developmental progress and needs at the appropriate times<br />
(Cossentino & Whitcomb, 2007).<br />
Within each plane Montessori designated “sensitive<br />
periods” (Gutek, 2011). A sensitive period is a stage at<br />
which a child is ready to learn or master a certain skill or<br />
22<br />
concept that will prepare the child for further learning<br />
(Follari, 2007; Gutek, 2004). During sensitive periods<br />
chil<strong>dr</strong>en experience intellectual, social, and moral<br />
awakenings, making sensitive periods especially important<br />
during the first plane (Cossentino & Whitcomb, 2007).<br />
The role <strong>of</strong> the adult is to provide the proper stimulation<br />
needed during each sensitive period to produce optimal<br />
awakening (Cossentino & Whitcomb, 2007). Montessori<br />
emphasized the importance <strong>of</strong> the adult adjusting to the<br />
child’s needs in order to maximize development and<br />
learning (Follari, 2007).<br />
Montessori dubbed the first stage, between birth and<br />
age 6, as that <strong>of</strong> the “absorbent mind” (Gutek, 2011).<br />
During this period, chil<strong>dr</strong>en absorb information from the<br />
environment through their senses (Gutek, 2011). Chil<strong>dr</strong>en<br />
absorb information and gain knowledge by exploring,<br />
constructing concepts <strong>of</strong> reality, beginning to use language<br />
and take on their culture (Cossentino & Whitcomb, 2007).<br />
This time period is essential in developing their sensory<br />
and motor skills (Cossentino & Whitcomb, 2007). The<br />
latter three years <strong>of</strong> the first plane are critical in developing<br />
cognitive skills and beginning the processes <strong>of</strong> socialization<br />
and acculturation (Gutek, 2011). Montessori’s theory <strong>of</strong><br />
the absorbent mind is a foundational piece <strong>of</strong> her<br />
educational theory; ages 3 through 6 are vital in creating a<br />
strong foundation for further growth (Follari, 2007).<br />
During the second plane, ages 6 through 12, chil<strong>dr</strong>en<br />
expand upon the knowledge they gained during their first<br />
six years (Cossentino & Whitcomb, 2007). The second<br />
plane comes with a greater sense <strong>of</strong> understanding<br />
relationships between a part and the whole (Cossentino and<br />
Whitcomb, 2007). This period allows time for chil<strong>dr</strong>en to<br />
reinforce and master the skills and concepts introduced and<br />
absorbed during the first plane (Cossentino & Whitcomb,<br />
2007). A greater emphasis is placed on organization <strong>of</strong><br />
tasks and deliberate work during the second plane <strong>of</strong><br />
development (Cossentino & Whitcomb, 2007). Plane three<br />
involves reaching maturity (Cossentino & Whitcomb,<br />
2007). During this plane, less sensory learning takes place,<br />
as chil<strong>dr</strong>en in plane three develop a broader understanding<br />
<strong>of</strong> social and economic roles and determine their place in<br />
society (Cossentino & Whitcomb, 2007).
Kesha Berg<br />
Public Policy Enhancing Early Childhood Education<br />
FOUNDATIONS OF THE APPROACH: MONTESSORI<br />
EDUCATIONAL PHILOSOPHY AND METHODS<br />
“The Montessori Method is a comprehensive, highly<br />
elaborated, and fully integrated system <strong>of</strong> intellectual,<br />
social, and moral development” (Cossentino & Whitcomb,<br />
2007, p. 111). Maria Montessori’s educational method is<br />
known for its holistic approach, especially when applied to<br />
early childhood education (Cossentino & Whitcomb,<br />
2007). However, Montessori developed a philosophy <strong>of</strong><br />
education across all ages based on her scientific observation<br />
<strong>of</strong> chil<strong>dr</strong>en and their development, research in<br />
anthropology, psychology, and pedagogy, and spiritual<br />
insights (Gutek, 2011). Montessori employed her medical<br />
background to build a model for education from science<br />
(Gutek, 2004). The scientific foundation <strong>of</strong> her methods<br />
continues to validate them today (Follari, 2007). The<br />
educational philosophy and methods developed by<br />
Montessori are built on natural human tendencies she<br />
became familiar with during close clinical observation <strong>of</strong><br />
her students (Gutek, 2004; Nutbrown, 2006). She believed<br />
education is a careful combination <strong>of</strong> the child’s natural<br />
development within nature (Gutek, 2004). The broader<br />
educational philosophy Montessori developed is aimed at<br />
“remaking the world,” which she saw as the work <strong>of</strong><br />
humanity (Gutek, 2011). Montessori advocated peace;<br />
peace became a central premise for Montessori education,<br />
as both a goal and context for it (Cossentino & Whitcomb,<br />
2007).<br />
Montessori described her broad educational theory as a<br />
cosmic education, meaning her educational theory has a<br />
focus <strong>of</strong> bringing together universals and particulars, both<br />
in the structure <strong>of</strong> its curriculum and the environment<br />
where learning takes place (Cossentino & Whitcomb,<br />
2007). The cosmological education emphasizes the<br />
connectedness <strong>of</strong> all things, linking cognitive, moral, and<br />
social development (Cossentino & Whitcomb, 2007). At<br />
the heart <strong>of</strong> the cosmic education is a child’s discovery <strong>of</strong><br />
his or her cosmic task (Cossentino & Whitcomb, 2007). In<br />
other words, the aim <strong>of</strong> education as Montessori saw it was<br />
to help each child discover his or her role in greater society.<br />
Montessori referred to each child in search <strong>of</strong> his or her task<br />
as a “cosmic being” (Cossentino & Whitcomb, 2007).<br />
Finding each child’s place in society is linked directly with<br />
his or her development, giving explanation to the heavy<br />
focus on chil<strong>dr</strong>en’s development in Montessori’s<br />
educational philosophy and methods (Cossentino &<br />
Whitcomb, 2007). Montessori’s cosmic education is<br />
comprised <strong>of</strong> three key components and attention to four<br />
skill sets.<br />
Fundamental concepts.<br />
The key to proper development, Montessori believed,<br />
revolves around preparing a particular environment for a<br />
child’s needs during each plane (Cossentino & Whitcomb,<br />
2007). Montessori based her theories on the idea that<br />
infants are born into a world they find chaotic, <strong>of</strong> which<br />
they naturally try to make sense (Follari, 2007). The<br />
environment surrounding a child is crucial for this reason<br />
(Gutek, 2011). Montessori asserted chil<strong>dr</strong>en are able to<br />
make order <strong>of</strong> the chaos <strong>of</strong> the world because <strong>of</strong> a natural<br />
sense <strong>of</strong> spirituality, inquisitiveness, capability, purpose,<br />
creative energy, and compassion with which all humans are<br />
born (Cossentino & Whitcomb, 2007; Follari, 2007).<br />
Montessori named this impulse to create order and peace<br />
the “spiritual embryo” (Cossentino & Whitcomb, 2007).<br />
Proper development fulfills a person’s innate capacities if<br />
the spiritual embryo is nurtured correctly within the<br />
proper environment (Cossentino & Whitcomb, 2007;<br />
Gutek, 2011). The spiritual embryo is replaced in later<br />
planes by moral and abstract thinking (Cossentino &<br />
Whitcomb, 2007). While most adults believe chil<strong>dr</strong>en to<br />
be rowdy, Montessori observed otherwise. Montessori noted<br />
the “secret <strong>of</strong> childhood” as chil<strong>dr</strong>en’s natural desire to<br />
become orderly and productive and engage in activities to<br />
further these goals (Follari, 2007). Montessori saw chil<strong>dr</strong>en<br />
as eager to become more independent, naturally motivating<br />
themselves to explore and develop on their own (Gutek,<br />
2011). This concept composes one <strong>of</strong> the fundamental<br />
principles <strong>of</strong> her philosophy (Gutek, 2004). Montessori<br />
went so far as to identify adults as generally<br />
misinterpreting chil<strong>dr</strong>en’s needs and hindering their<br />
development (Follari, 2007). She believed each child’s<br />
development to be self-regulated (Follari, 2007). Proper<br />
development is achieved through what Montessori termed<br />
“freedom within limits” (Cossentino & Whitcomb, 2007).<br />
Successful development requires chil<strong>dr</strong>en to be free to<br />
explore what they please within an environment prepared<br />
specifically for them (Cossentino & Whitcomb, 2007).<br />
Montessori cited the structured environment as something<br />
that enhances chil<strong>dr</strong>en’s freedom (Gutek, 2004). This<br />
23
UST McNair Scholars Program Research Journal<br />
means that chil<strong>dr</strong>en also must be free from dependence on<br />
adults (Gutek, 2011). Interacting with an environment<br />
brings about full development as a human being, including<br />
moral growth, greater willpower, self-discipline, and selfesteem<br />
(Gutek, 2011).<br />
Based on her theory <strong>of</strong> development, Montessori<br />
believed a specially prepared environment must be in place<br />
for chil<strong>dr</strong>en to flourish at each stage <strong>of</strong> their development<br />
(Gutek, 2011). Montessori’s emphasis on chil<strong>dr</strong>en’s<br />
independence influenced her theories <strong>of</strong> the prepared<br />
environment (Cossentino & Whitcomb, 2007). A primary<br />
objective <strong>of</strong> the prepared environment was to ensure that<br />
chil<strong>dr</strong>en were free from dependence on adults (Cossentino<br />
& Whitcomb, 2007). Montessori outlined strict guidelines<br />
for the preparation <strong>of</strong> the environment in which chil<strong>dr</strong>en<br />
would live because <strong>of</strong> the intimate connection she felt it<br />
had with their development. Different planes <strong>of</strong><br />
development require different needs, thus different<br />
environments must be prepared for different planes<br />
(Cossentino & Whitcomb, 2007). It is the task <strong>of</strong> the<br />
teacher, or guide, to prepare the environment according to<br />
the chil<strong>dr</strong>en’s needs and Montessori’s guidelines (Follari,<br />
2007). Environments are prepared to accommodate groups<br />
<strong>of</strong> chil<strong>dr</strong>en <strong>of</strong> various ages, typically in three year cycles<br />
(Cossentino and Whitcomb, 2007). Thus, a primary<br />
Montessori classroom serves chil<strong>dr</strong>en ages 3 through 6<br />
(Cossentino and Whitcomb, 2007). The environment<br />
surrounding a child determines the possibilities for that<br />
child; therefore, it is important the environment presents<br />
the maximum number <strong>of</strong> opportunities for learning<br />
(Gutek, 2011). The preparation <strong>of</strong> a Montessori classroom<br />
must be oriented around the chil<strong>dr</strong>en’s needs so they have<br />
freedom to pursue questions and construct understandings<br />
(Cossentino and Whitcomb, 2007). Montessori also<br />
believed the physical environment dictated the energy <strong>of</strong><br />
the space, providing another reason for the environment to<br />
be crafted with care (Follari, 2007). Cossentino and<br />
Whitcomb outline six features <strong>of</strong> the Montessori prepared<br />
environment: order, aesthetic beauty, broad access to<br />
materials, permeable boundaries, community respon -<br />
sibility, and flexible movement (2007). The prepared<br />
environment, as Montessori referred to it, must be orderly<br />
(Cossentino & Whitcomb, 2007). It must have clean, white<br />
spaces with an appropriate amount <strong>of</strong> artwork so the<br />
environment is not over stimulating or distracting for<br />
24<br />
chil<strong>dr</strong>en (Follari, 2007). Emphasis is placed on the<br />
aesthetic beauty <strong>of</strong> the environment because Montessori<br />
affirmed that a pleasing environment would instill respect<br />
(Cossentino & Whitcomb, 2007). Now commonplace, the<br />
child-sized furniture and materials that Montessori used<br />
were innovative at her time (Gutek, 2011). Materials are<br />
to be neatly arranged by discipline on child-sized shelves<br />
for easy access by all chil<strong>dr</strong>en (Cossentino & Whitcomb,<br />
2007). Montessori’s emphasis <strong>of</strong> child-empowered learning<br />
means the environment has few textbooks and a wealth <strong>of</strong><br />
hands-on materials instead (Cossentino & Whitcomb,<br />
2007). The child needs to have freedom to move about the<br />
classroom and access different materials at different times<br />
(Cossentino & Whitcomb, 2007). For this reason, the<br />
Montessori classroom does not have rows <strong>of</strong> desks facing<br />
forward, but rather tables and chairs with unassigned<br />
seating so chil<strong>dr</strong>en can move about and work where they<br />
need to (Cossentino & Whitcomb, 2007). Montessori<br />
aimed to organize the classroom in a way that caused<br />
purposeful movement for work (Cossentino & Whitcomb,<br />
2007).<br />
The idea <strong>of</strong> “work” is another staple <strong>of</strong> the Montessori<br />
education. Montessori referred to a student’s learning and<br />
exploration as his or her “work” (Gutek, 2011). Unlike<br />
most early childhood education programs, the Montessori<br />
education does not include time for free play (Follari,<br />
2007). Montessori believed play interrupts the child’s<br />
desire to be productive (Follari, 2007). However, some<br />
outdoor time is generally allotted around midday,<br />
providing an outlet for play (Cossentino, 2006). Indoors,<br />
however, chil<strong>dr</strong>en guide their own work. Montessori<br />
dubbed this concept the “auto education,” again<br />
emphasizing the child’s desire and ability to be<br />
independent (Follari, 2007). Montessori identified the<br />
“divine urge” to be the force propelling chil<strong>dr</strong>en into selfactivity<br />
(Gutek, 2004). Montessori believed chil<strong>dr</strong>en are<br />
excited about learning new skills and becoming<br />
independent (Gutek, 2011). According to Montessori, the<br />
self-directed education naturally maximizes development<br />
(Follari, 2007). In a traditional Montessori classroom,<br />
students begin their days with three hours <strong>of</strong><br />
uninterrupted, self-directed work time (Cossentino &<br />
Whitcomb, 2007). The multi-age groups <strong>of</strong> the chil<strong>dr</strong>en<br />
in each environment allows for chil<strong>dr</strong>en to work at various<br />
levels and help each other (Rambusch McCormick, 2010).
Kesha Berg<br />
Public Policy Enhancing Early Childhood Education<br />
During work time, chil<strong>dr</strong>en are free to use any <strong>of</strong> the<br />
materials they have been shown how to use. Often times,<br />
chil<strong>dr</strong>en work on small mats, a staple <strong>of</strong> the Montessori<br />
classroom (Cossentino, 2006). The rectangular cotton rugs<br />
or mats provide a space for chil<strong>dr</strong>en to set out their<br />
materials (Cossentino, 2006). The chil<strong>dr</strong>en are taught at<br />
an early age how to roll, unroll, and carry a mat properly,<br />
as it is a symbol <strong>of</strong> work in the Montessori environment<br />
(Cossentino, 2006).<br />
During this period <strong>of</strong> work the teacher, referred to by<br />
Montessori as a directress or guide, invites chil<strong>dr</strong>en for<br />
lessons (Cossentino & Whitcomb, 2007). The guide<br />
generally engages with chil<strong>dr</strong>en individually or in small<br />
groups to direct them in the use <strong>of</strong> a new material or lesson<br />
(L. Drevlow, personal communication, July 6, 2011). This<br />
allows for personalized attention for each child’s<br />
developmental needs and interests by the guide so each<br />
child can explore his or her interests when appropriate<br />
(Cossentino and Whitcomb, 2007). The job <strong>of</strong> the guide<br />
is to be familiar with each student’s level <strong>of</strong> development<br />
and to present lessons accordingly (Follari, 2007). The<br />
guide assists the child in directing his or her own work and<br />
education without interrupting the child’s own discovery<br />
(Follari, 2007; Nutbrown, 2006).<br />
Montessori created a specific set <strong>of</strong> materials to be used<br />
within the environment (Gutek, 2011). Her background<br />
in science is seen in the precision <strong>of</strong> each material and<br />
demonstration <strong>of</strong> its use (L. Drevlow, personal<br />
communication, July 6, 2011). Montessori’s advocacy <strong>of</strong> a<br />
strict adherence to her method is seen in the details for<br />
presenting a lesson (L. Drevlow, personal communication,<br />
July 6, 2011). In a conversation, Lisa Drevlow, <strong>of</strong> the<br />
Montessori Training Center <strong>of</strong> Minnesota, explained the<br />
process <strong>of</strong> presenting a lesson to a child. The guide has<br />
step-by-step instructions he or she must follow in<br />
presenting a lesson to a child. A lesson includes<br />
demonstrating how to use a new material and observation<br />
<strong>of</strong> the child mimicking the guide’s work. Lessons are aimed<br />
at a simple objective, such as folding a napkin. In the lesson<br />
<strong>of</strong> folding a napkin, the guide would invite the student to<br />
engage in the lesson and demonstrate how to fold in a very<br />
specific manner. Next, the student would be encouraged<br />
to repeat the action. The student would then practice<br />
folding until the skill was mastered without the aid <strong>of</strong> the<br />
guide (L. Drevlow, personal communication, July 6, 2011).<br />
If need be, the guide can present the material a second<br />
time, but it is the job <strong>of</strong> the guide to know when a student<br />
will be ready for each material (Gutek, 2011). The central<br />
role <strong>of</strong> the guide is to observe the chil<strong>dr</strong>en and document<br />
their development, noting when each child is ready for<br />
different materials (Follari, 2007). Although most learning<br />
takes place through student exploration, the guide does<br />
prompt learning through guidance within the environment<br />
and other specific means. The guide is responsible for<br />
presenting material to students, which the students then<br />
further investigate independently (Cossentino &<br />
Whitcomb, 2007).<br />
Montessori believed chil<strong>dr</strong>en need to see a whole before<br />
being able to thoroughly understand each <strong>of</strong> its parts<br />
(Cossentino & Whitcomb, 2007). Information is presented<br />
on a large scale first for this reason (Cossentino &<br />
Whitcomb, 2007). For example, Montessori crafted five<br />
stories entitled “The Great Lessons” for guides to relay to<br />
their students (Cossentino & Whitcomb, 2007). The<br />
lessons, which provide a substantial portion <strong>of</strong> the<br />
curriculum, convey the story <strong>of</strong> the universe including the<br />
creation <strong>of</strong> the earth, beginning <strong>of</strong> life and humans, and<br />
the development <strong>of</strong> society through language, numbers,<br />
and so forth (Cossentino & Whitcomb, 2007). The Great<br />
Lessons do not include much detail, as to keep chil<strong>dr</strong>en<br />
curious (Murray, 2011). Montessori believed the stories<br />
would intrigue the chil<strong>dr</strong>en, causing them to desire more<br />
knowledge and understanding (Murray, 2011). The entire<br />
history <strong>of</strong> the universe is presented to chil<strong>dr</strong>en to prompt<br />
discovery <strong>of</strong> individual portions <strong>of</strong> it. Similarly, an entire<br />
animal is presented before its parts are examined and the<br />
whole structure <strong>of</strong> the English language is presented at an<br />
early age (Cossentino & Whitcomb, 2007). This tactic sets<br />
Montessori’s philosophy apart from others, which generally<br />
present pieces <strong>of</strong> the whole first (Cossentino & Whitcomb,<br />
2007).<br />
Critical skill sets.<br />
Montessori’s central focus on development produced<br />
emphasis on four skill sets in her educational method:<br />
practical life, sensory education, language and<br />
mathematics, and physical, social, and cultural<br />
development (Gutek, 2011). Practical skills are still<br />
emphasized to give chil<strong>dr</strong>en a greater sense <strong>of</strong><br />
independence and self-confidence (Gutek, 2011). Teaching<br />
25
UST McNair Scholars Program Research Journal<br />
a child how to do things such as <strong>dr</strong>ess him- or herself, wash,<br />
brush teeth, prepare food, set the table, and so on allows<br />
the child to be free <strong>of</strong> dependence on an adult (Gutek,<br />
2011). This skill set and independence is emphasized<br />
heavily in Montessori’s methods because <strong>of</strong> her belief that<br />
chil<strong>dr</strong>en learn successfully only when their motivation is<br />
intrinsic; chil<strong>dr</strong>en need to have the ability to pursue their<br />
environment (Follari, 2007). A fundamental principle <strong>of</strong><br />
Montessori’s method is the need for chil<strong>dr</strong>en to have<br />
freedom to bring about their own growth and development<br />
(Gutek, 2011). Montessori emphasized practical skills in<br />
promoting physical, social, and cultural growth (Gutek,<br />
2011). Practical skills also aid in development <strong>of</strong> muscular<br />
coordination (Gutek, 2004). Montessori classrooms are<br />
home to plants and pets, which require care (Gutek, 2011).<br />
Responsibilities to take care <strong>of</strong> this aspect <strong>of</strong> the<br />
environment promote the acquisition <strong>of</strong> additional<br />
practical skills (Gutek, 2011). Montessori created frames<br />
for lacing, tying, buttoning, and snapping to provide<br />
chil<strong>dr</strong>en additional practice <strong>of</strong> these skills (Gutek, 2004).<br />
Practical skills are ordinary in a Montessori classroom<br />
because <strong>of</strong> the nature <strong>of</strong> the environment Montessori<br />
sought to create. Montessori’s first school opened in Rome<br />
to both educate and watch over chil<strong>dr</strong>en whose parents<br />
worked during the day (Cossentino & Whitcomb, 2007).<br />
This situation encouraged Montessori to develop the<br />
classroom as a sort <strong>of</strong> “school-home” for her students<br />
(Cossentino & Whitcomb, 2007). Therefore, practical skills<br />
such as sweeping and cleaning have a natural place within<br />
the setting. The school-home environment is central to<br />
Montessori’s education philosophy. The context in which<br />
Montessori’s first Casa dei Bambini was created explains in<br />
part why Montessori emphasized the classroom as a second<br />
home (Martin, 1996). In fact, Montessori criticized the<br />
common translation <strong>of</strong> Casa dei Bambini to “Chil<strong>dr</strong>en’s<br />
House,” preferring “Chil<strong>dr</strong>en’s Home” (Marin, 1996).<br />
Montessori intended her environment to be a home for<br />
chil<strong>dr</strong>en, a place for them to develop cognitively, socially,<br />
and morally while feeling safe, secure, and loved (Martin,<br />
1996).<br />
Montessori emphasized the importance <strong>of</strong> the ability <strong>of</strong><br />
chil<strong>dr</strong>en to understand the world through their senses.<br />
Developing sensorial skills impacts chil<strong>dr</strong>en’s awareness <strong>of</strong><br />
dimension, texture, shape, color, pitch, volume, and so on,<br />
thus developing their awareness <strong>of</strong> natural beauty<br />
26<br />
surrounding them (M. O’Shaughnessy, personal<br />
communication, July 21, 2011). Additionally, sensorial<br />
development prepares chil<strong>dr</strong>en for future math and<br />
language learning (M. O’Shaughnessy, personal<br />
communication, July 21, 2011). Montessori crafted specific<br />
materials to aid chil<strong>dr</strong>en in developing each skill set. For<br />
example, chil<strong>dr</strong>en use materials that develop<br />
understanding <strong>of</strong> size and dimension by stacking specially<br />
designed blocks or cylinders (Follari, 2007). All <strong>of</strong> the<br />
materials are self-correcting to assist the child in mastering<br />
his or her work (Gutek, 2011). For instance, the pink block<br />
tower will topple over if not stacked properly and a glass<br />
bowl will break if not shown proper care (Rambusch<br />
McCormick, 2010). These materials guide chil<strong>dr</strong>en by<br />
their senses, teaching them to use things properly<br />
(Rambusch McCormick, 2010). Montessori observed that<br />
during their first plane <strong>of</strong> development, chil<strong>dr</strong>en desire to<br />
manipulate things to learn from their surroundings<br />
(Gutek, 2004). This provides both cognitive development<br />
as well as practice <strong>of</strong> motor skills (Gutek, 2004).<br />
The third skill set focuses on language and mathematics<br />
(Gutek, 2011). By age 6, Montessori chil<strong>dr</strong>en have the<br />
ability to understand letters and their sounds, write words,<br />
sentences, and stories, read fluently, and communicate with<br />
clarity (M. O’Shaughnessy, personal communication, July<br />
21, 2011). Montessori created three-dimensional materials<br />
to assist chil<strong>dr</strong>en in development <strong>of</strong> language abilities (M.<br />
O’Shaughnessy, personal communication, July 21, 2011).<br />
Vocabulary is developed by learning names and categories<br />
<strong>of</strong> different items (Gutek, 2011). This aspect <strong>of</strong> learning<br />
can be tailored to the interests <strong>of</strong> the child. If a child is<br />
interested in animals, cards <strong>of</strong> different animals and their<br />
appropriate categories can be used to develop vocabulary<br />
and practice categorization. Development <strong>of</strong> vocabulary is<br />
closely related to learning the alphabet and letter sounds,<br />
and the vocabulary cards are used again for this purpose<br />
(Gutek, 2011). Montessori believed chil<strong>dr</strong>en learn<br />
language in three steps: first through syllables, then whole<br />
words, and finally syntax and grammar (Gutek, 2004). Her<br />
guidelines for chil<strong>dr</strong>en’s exploration <strong>of</strong> words are outlined<br />
similarly. Eventually, chil<strong>dr</strong>en trace sandpaper letters to<br />
familiarize themselves with each letter, its shape, and its<br />
sound (Gutek, 2011). The movable alphabet is used when<br />
chil<strong>dr</strong>en begin creating words from the sounds they have
Kesha Berg<br />
Public Policy Enhancing Early Childhood Education<br />
learned (Follari, 2007). This eventually gives way to<br />
writing (Gutek, 2004).<br />
Another aspect <strong>of</strong> the third skill set is mathematics<br />
(Gutek, 2011). The primary Montessori education aims to<br />
instill sufficiency in ability to understand meanings <strong>of</strong><br />
quantities, concepts <strong>of</strong> even and odd numbers, categories<br />
<strong>of</strong> unit, tens, hun<strong>dr</strong>eds, thousands, addition, subtraction,<br />
multiplication, division, and memorization <strong>of</strong> basic math<br />
facts (M. O’Shaughnessy, personal communication, July 21,<br />
2011). Math is learned through the use <strong>of</strong> geometric<br />
objects, counting rods, golden beads, and sandpaper<br />
numbers (L. Drevlow, personal communication, July 6,<br />
2011). Each material prepares students for the next and<br />
builds on previously acquired knowledge and skills (Gutek,<br />
2011). Sandpaper numbers are traced to learn numbers in<br />
learning mathematics (Gutek, 2011). These cards are used<br />
in conjunction with various counting rods, beads, bean<br />
counting, memory games, and fraction exercises to help<br />
chil<strong>dr</strong>en take their first steps in mathematics before<br />
elementary school (Follari, 2007; Gutek, 2011). These<br />
processes give way to more completed functions such as<br />
subtraction, multiplication, and division (Follari, 2007).<br />
Eventually, chil<strong>dr</strong>en expand on basic operations to more<br />
advanced mathematics (Follari, 2007). Examples <strong>of</strong> other<br />
didactic materials include solid cylin<strong>dr</strong>ical insets, red rods<br />
<strong>of</strong> various lengths, geometric solids, cards with geometric<br />
shapes, and musical tone bells (Gutek, 2011).<br />
The fourth skill set is focused on chil<strong>dr</strong>en’s physical,<br />
social, and cultural development (Gutek, 2011). In<br />
addition to creating materials for cognitive learning,<br />
Montessori developed materials for social and cultural<br />
development. The Montessori curriculum is formatted<br />
around what Montessori called the “cultural subjects,”<br />
which include history, geography, geometry, arts, and the<br />
sciences (Cossentino & Whitcomb, 2007). <strong>St</strong>udy <strong>of</strong> the<br />
subjects takes place via three questions: (1) What am I? (2)<br />
Where do I come from? (3) What is my role in the<br />
universe? (Cossentino & Whitcomb, 2007). Montessori felt<br />
it important for chil<strong>dr</strong>en to learn through cultural<br />
exploration and relationships between individuals and the<br />
larger society (Follari, 2007).<br />
Unlike many traditional classrooms today, Montessori<br />
encouraged an affectionate relationship between the guide<br />
and students, as well as among the students (Gutek, 2004).<br />
The environment was intended to be a community <strong>of</strong><br />
members who cared for each other (Cossentino &<br />
Whitcomb, 2007). Montessori envisioned members <strong>of</strong> the<br />
Casa dei Bambini to be a family, each member operating<br />
independently while still contributing to the larger group<br />
(Gutek, 2004). Chil<strong>dr</strong>en’s assistance among each other is a<br />
crucial component <strong>of</strong> the Montessori environment<br />
(Nutbrown, 2006). As a proponent <strong>of</strong> equality among the<br />
sexes, Montessori expected equality within the classroom<br />
as well (Follari, 2007). Some criticized the intimacy within<br />
the classroom for mixing too closely the separate worlds <strong>of</strong><br />
home and school, private and public (Gutek, 2004). Social<br />
skills are learned through absorbing the culture (Gutek,<br />
2004). To further chil<strong>dr</strong>en’s social skills, the guide <strong>of</strong>fers<br />
lessons in grace and courtesy to teach chil<strong>dr</strong>en proper social<br />
etiquette (L. Drevlow, personal communication, July 6,<br />
2011). One such lesson focuses on requesting attention<br />
without interrupting (L. Drevlow, personal communi -<br />
cation, July 6, 2011). Chil<strong>dr</strong>en are taught to demonstrate<br />
to their teacher their need for attention without speaking<br />
(Cossentino, 2006). Often, chil<strong>dr</strong>en request their guide’s<br />
assistance by gently placing their hand on their guide’s<br />
shoulder (Cossentino, 2006). Others look their guides in<br />
the eye (L. Drevlow, personal communication, July 6,<br />
2011). The properly prepared environment with the correct<br />
social balance provides room for chil<strong>dr</strong>en to develop moral<br />
character (Gutek, 2004). Montessori believed in a set <strong>of</strong><br />
universal principles that chil<strong>dr</strong>en developed awareness <strong>of</strong><br />
through interaction with their environment (Gutek, 2004).<br />
Keeping peace as a central theme to her methods,<br />
Montessori created the Peace Rose Ceremony to help<br />
chil<strong>dr</strong>en develop socially (Cossentino & Whitcomb, 2007).<br />
Cossentino and Whitcomb describe the Peace Rose<br />
Ceremony as a means to settle disputes among chil<strong>dr</strong>en. A<br />
space is designated within each prepared environment for<br />
peace and this ceremony, which <strong>of</strong>ten consists <strong>of</strong> a table<br />
with a vase and single peace rose and other calming objects,<br />
such as beads and prints. Chil<strong>dr</strong>en take turns holding the<br />
rose while discussing the issue at hand until peace is<br />
declared. The guide <strong>of</strong>ten aids this process until chil<strong>dr</strong>en<br />
are old enough to conduct the ceremony on their own.<br />
Chil<strong>dr</strong>en are able to visit the calm area to regroup whenever<br />
necessary (Cossentino and Whitcomb, 2007).<br />
Montessori’s belief that learning needs to take place by<br />
exploring beyond the prepared environment constitutes a<br />
critical part <strong>of</strong> her philosophy <strong>of</strong> the cosmic education<br />
27
UST McNair Scholars Program Research Journal<br />
(Cossentino & Whitcomb, 2007). Montessori recognized<br />
exploration <strong>of</strong> greater society as critical because it allows a<br />
child to discover his or her place in it (Cossentino &<br />
Whitcomb, 2007). Cossentino and Whitcomb describe<br />
what Montessori referred to as “going out” as investigating<br />
outside <strong>of</strong> the classroom. When a student’s inquiry cannot<br />
be answered within the classroom, he or she is encouraged<br />
to go out. Going out can range from collecting items in<br />
the schoolyard to becoming more involved within the<br />
community. As is the norm within the prepared environ -<br />
ment, work outside the classroom is student directed.<br />
Chil<strong>dr</strong>en go out both individually and in small groups.<br />
Older students coordinate community visits on their own<br />
(Cossentino & Whitcomb, 2007).<br />
Theory in practice: A day in a Chil<strong>dr</strong>en’s House.<br />
To supplement my review <strong>of</strong> the Montessori method, I<br />
conducted two consulting visits to the Montessori Training<br />
Center <strong>of</strong> Minnesota (MTCM). My first visit included a<br />
conversation with Lisa Drevlow, the primary course<br />
assistant, discussing further explanation <strong>of</strong> Montessori<br />
materials and methods, a presentation <strong>of</strong> various<br />
Montessori materials, and a look at Montessori teacher<br />
training materials. My second visit to the MTCM consisted<br />
<strong>of</strong> observation <strong>of</strong> a primary classroom for three hours. My<br />
conversation with Lisa Drevlow and my classroom<br />
observation reinforced my understanding <strong>of</strong> the Montessori<br />
methods and materials as seen in practice.<br />
Upon entering the Chil<strong>dr</strong>en’s House, the careful<br />
preparation <strong>of</strong> the environment was evident. Walls <strong>of</strong> the<br />
room displayed a modest amount <strong>of</strong> artwork on neutraltone<br />
walls. A door opened to the patio to provide natural<br />
light and the opportunity for chil<strong>dr</strong>en to work inside or<br />
outside depending on their preferences and materials. All<br />
<strong>of</strong> the child-sized shelves were lined with trays containing<br />
materials necessary for different work. Tables and chairs<br />
proved lightweight as chil<strong>dr</strong>en moved them around the<br />
room as they pleased. All materials were accessible by<br />
chil<strong>dr</strong>en so they could successfully work independently <strong>of</strong><br />
anyone else, including the guide.<br />
The effectiveness <strong>of</strong> the prepared environment in<br />
facilitating the auto-education was reinforced when the<br />
chil<strong>dr</strong>en entered the classroom and began working on their<br />
own. One child walked around the classroom to survey the<br />
materials she could work with before selecting a tray from<br />
28<br />
a shelf and carefully carrying it to a table. Once there,<br />
another child assisted her in putting on her apron. Soon<br />
she was scrubbing her shoes with soap and water. Before<br />
moving on to another piece <strong>of</strong> work, the child cleaned up<br />
her workstation and replaced the tray with the materials<br />
on the shelf.<br />
Evidence <strong>of</strong> the importance <strong>of</strong> independence in<br />
chil<strong>dr</strong>en’s development was also provided through the<br />
snack area. A table with two chairs provided a place for two<br />
chil<strong>dr</strong>en to eat snack at a time, whenever they felt hungry.<br />
Some students enjoyed one or two snacks, while others<br />
focused on their work without a snack. Chil<strong>dr</strong>en who<br />
desired a snack filled a bowl with apples, sat down, and ate<br />
while conversing with the other child at the snack table.<br />
When finished, the chil<strong>dr</strong>en dipped their bowl in a soapy<br />
bucket and then rinsed it clean before leaving it in a rack<br />
to <strong>dr</strong>y and returned to their work.<br />
Throughout the three-hour work period, the guide never<br />
interrupted a working child. Instead, she aided chil<strong>dr</strong>en<br />
when they requested her attention. Older students<br />
approached her for math problems to solve with various<br />
materials and others asked the guide to write sentences for<br />
them to read. When a child was having trouble finding<br />
work to select, the guide would pull him or her onto her<br />
lap for a hug while speaking to the child about what he or<br />
she might like to work with. Montessori’s idea <strong>of</strong> a family<br />
within the Chil<strong>dr</strong>en’s House was reinforced.<br />
The central role <strong>of</strong> peace was also seen within the<br />
classroom. The environment itself was very peaceful. The<br />
chil<strong>dr</strong>en were reminded <strong>of</strong> peace as a goal. When two<br />
chil<strong>dr</strong>en made gun shapes with their hands the guide made<br />
very clear that any type <strong>of</strong> violence or reference to violence<br />
was absolutely not tolerated.<br />
Respect for chil<strong>dr</strong>en was also present within the<br />
environment. Chil<strong>dr</strong>en were expected to help prepare the<br />
room for lunch. Some chil<strong>dr</strong>en moved tables and chairs<br />
together to form longer tables. Other chil<strong>dr</strong>en placed<br />
plates, silverware, and cups in line with each chair. The<br />
capabilities <strong>of</strong> chil<strong>dr</strong>en were also respected during a<br />
meeting before lunch. Chil<strong>dr</strong>en engaged in an open<br />
discussion with their guide in which they were free to<br />
present thoughts and questions respectfully.
Kesha Berg<br />
Public Policy Enhancing Early Childhood Education<br />
REVIEW OF RESEARCH: EFFECTIVENESS OF THE MONTESSORI<br />
EDUCATION<br />
Research concerning the Montessori education dates<br />
back over a century covering diverse topics (Dohrmann et<br />
al., 2007). Two leading contemporary studies regarding the<br />
Montessori education provide evidence it has positive longterm<br />
effects on students and their achievement (Dohrmann<br />
et al., 2007). Various studies have also shown Montessori<br />
students perform at or above national standards and<br />
averages (Lillard & Else-Quest, 2006). I examined two<br />
major studies that reported on the effectiveness <strong>of</strong><br />
Montessori methods in public schools. Lillard and Else-<br />
Quest examined the social and cognitive abilities <strong>of</strong><br />
Montessori students in comparison to those <strong>of</strong> non-<br />
Montessori students in a study assessing students at ages<br />
five and twelve (2006). The study was carried out within<br />
an Association Montessori Internationale accredited school,<br />
meaning it strictly adheres to Montessori’s methods, which<br />
served urban minority students. The school accepts<br />
students via a random lottery system, which was used by<br />
Lillard and Else-Quest to create the control and<br />
experimental groups. Chil<strong>dr</strong>en who sought enrollment and<br />
were accepted to the school made up the experimental<br />
group, while those who were not enrolled became the<br />
control group. This negated criticism that parents who<br />
enroll their chil<strong>dr</strong>en in Montessori programs are different<br />
from those who do not; therefore, Montessori students<br />
cannot be compared with students who did not seek<br />
Montessori education. A total <strong>of</strong> 59 Montessori students<br />
who had attended a Montessori school for at least three<br />
years were compared with 53 students who attended public<br />
inner city, suburban public, and private, voucher or charter<br />
schools. <strong>St</strong>udents from the control group had similar<br />
parental income levels as those in the experimental group<br />
(Lillard & Else-Quest, 2006).<br />
The outcome <strong>of</strong> Lillard and Else-Quest’s study<br />
illustrated the abilities <strong>of</strong> Montessori students to be<br />
superior to those <strong>of</strong> their non-Montessori counterparts<br />
(2006). At age five, Montessori students performed better<br />
on letter and word identification, decoding speech sounds,<br />
and applied math. They also outperformed non-Montessori<br />
students in a test <strong>of</strong> executive function. Additionally,<br />
Montessori students used higher-level reasoning, including<br />
references to justice and fairness, when presented with a<br />
story involving a social problem. This finding was<br />
reinforced by the conclusion that Montessori chil<strong>dr</strong>en<br />
engaged in more positive peer interaction and less rough<br />
play than other chil<strong>dr</strong>en. However, Lillard and Else-Quest<br />
reported no difference was seen between Montessori and<br />
non-Montessori students in vocabulary, spatial reasoning,<br />
or concept formation. In general, by the end <strong>of</strong><br />
kindergarten, Montessori students performed better on<br />
standardized tests <strong>of</strong> reading and math and had higher<br />
levels <strong>of</strong> social cognition and executive control. The twelveyear-old<br />
Montessori students outperformed their non-<br />
Montessori counterparts in creative writing and sentence<br />
structure. A greater amount <strong>of</strong> positive peer interaction was<br />
seen among this group as well (Lillard & Else-Quest,<br />
2006).<br />
The long-term effects <strong>of</strong> the Montessori education<br />
showed similar outcomes (Dohrmann et al., 2007). In a<br />
study comparing public high school students from<br />
Montessori and non-Montessori backgrounds, Dohrmann<br />
et al. found chil<strong>dr</strong>en who attended Montessori elementary<br />
programs to be performing as well as or better than non-<br />
Montessori students (2007). One hun<strong>dr</strong>ed and forty-four<br />
students who attended Montessori schools from preschool<br />
through fifth grade were compared with a demographically<br />
identical group <strong>of</strong> students who graduated from the same<br />
high school as the Montessori students. Particular<br />
differences were seen in the higher scores <strong>of</strong> Montessori<br />
students in math and science. Furthermore, students with<br />
a Montessori background had higher GPAs (Dohrmann et<br />
al., 2007).<br />
Further evidence the Montessori education is effective is<br />
found in school districts around the country. Demand for<br />
the Montessori education has caused huge waiting lists in<br />
a high performing district <strong>of</strong> 32,000 students speaking 80<br />
languages and dialects in Indiana (Robinson, 2006). In<br />
response, the culturally and racially diverse district has<br />
converted more <strong>of</strong> their traditional classrooms to<br />
Montessori-based environments (Robinson, 2006).<br />
Research in various other areas confirms the effectiveness<br />
<strong>of</strong> practices derived by Montessori. Montessori’s emphasis<br />
on self-motivation is backed by current research, which<br />
supports that autonomy is key to fostering intrinsic<br />
motivation (Murray, 2011). Murray reports self-directed<br />
learning to increase intrinsic motivation (2011). These<br />
findings help explain why Montessori students transition<br />
29
UST McNair Scholars Program Research Journal<br />
from Montessori to non-Montessori classrooms successfully<br />
(Dohrmann et al., 2007).<br />
Although existing research provides helpful insights<br />
about the Montessori education, limitations do exist. Often<br />
methodological limitations, such as small sample sizes and<br />
lack <strong>of</strong> random assignment, impact the data (Dohrmann et<br />
al., 2007). The Montessori name is not trademarked;<br />
therefore, various degrees <strong>of</strong> adherence to Montessori’s<br />
method are seen throughout the world. Accounting for this<br />
variation must also be taken into consideration when<br />
evaluating Montessori schools. The Montessori method<br />
requires chil<strong>dr</strong>en to be part <strong>of</strong> the environment for three<br />
years. Variations in the amount <strong>of</strong> time chil<strong>dr</strong>en have been<br />
educated in a Montessori setting also influence research<br />
(Dohrmann et al., 2007).<br />
HELP FOR AMERICA’S LOW-INCOME CHILDREN:<br />
PROJECT HEAD START<br />
LEGACY OF THE WAR ON POVERTY: THE CREATION OF HEAD<br />
START<br />
The Head <strong>St</strong>art program provides services to prepare<br />
chil<strong>dr</strong>en for kindergarten and “to improve the conditions<br />
necessary for their success in later school and life” (Butler,<br />
Gish, & Shaul, 2004, p. 2). Head <strong>St</strong>art is a product <strong>of</strong><br />
President Lyndon Johnson’s War on Poverty (Follari,<br />
2007). President Johnson’s federally funded efforts to<br />
employ poor adults through the War on Poverty did not<br />
receive thorough support (Abdill, 2009). Sargent Shriver,<br />
an appointee <strong>of</strong> Johnson and influential player in the War<br />
on Poverty, suggested a program to support poor chil<strong>dr</strong>en,<br />
rather than their parents, because it would be more widely<br />
accepted (Abdill, 2009). In the 1960s chil<strong>dr</strong>en accounted<br />
for half <strong>of</strong> America’s impoverished (Zigler, Gordic, &<br />
<strong>St</strong>yfco, 2007). Thus, policy makers designed Head <strong>St</strong>art to<br />
specifically ad<strong>dr</strong>ess communities <strong>of</strong> disadvantaged chil<strong>dr</strong>en<br />
despite the implementation <strong>of</strong> other early intervention<br />
preschool programs at this time (Follari, 2007).<br />
Project Head <strong>St</strong>art continues to be the “nation’s leading<br />
investment in early childhood care and education”<br />
(National Head <strong>St</strong>art Association [NHSA], 2011) and is<br />
“recognized as one <strong>of</strong> the most successful and lasting<br />
antipoverty programs in the United <strong>St</strong>ates” (Abdill, 2009).<br />
30<br />
Head <strong>St</strong>art serves a diverse population <strong>of</strong> over 900,000<br />
chil<strong>dr</strong>en, more than 65 percent <strong>of</strong> whom are minorities<br />
(Abill, 2009; Haskins & Barnett, 2010). The U.S.<br />
Department <strong>of</strong> Health and Human Services oversees the<br />
Office <strong>of</strong> Head <strong>St</strong>art under a $7.2 billion budget (Haskins<br />
& Barnett, 2010; Office <strong>of</strong> Head <strong>St</strong>art, 2011). Head <strong>St</strong>art<br />
is structured in a way to give most control to local<br />
organizations, as they better assess how each Head <strong>St</strong>art<br />
can be most effective in their area (NHSA, 2011). Federal<br />
funding for Head <strong>St</strong>art is awarded to local grantees, which<br />
organize local Head <strong>St</strong>art programs (NHSA, 2011). The<br />
federal government provides up to 80% <strong>of</strong> yearly costs for<br />
each program while the remaining 20% must be collected<br />
through contributions or donations (NHSA, 2011).<br />
Chil<strong>dr</strong>en must meet the federal requirements and any local<br />
criteria to be eligible to enroll (Love, Banks Tarullo, Raikes,<br />
& Chazan-Cohen, 2005). The federal government requires<br />
at least ninety percent <strong>of</strong> the population <strong>of</strong> each Head <strong>St</strong>art<br />
be at or below the federal poverty line (Love et al., 2005).<br />
However, Head <strong>St</strong>art is not an entitlement for<br />
impoverished families, as many more are eligible than are<br />
enrolled (Love et al., 2005).<br />
SUPPORT FOR EARLY CHILDHOOD EDUCATION: THE<br />
EMERGENCE OF DEVELOPMENTAL RESEARCH<br />
A new awareness <strong>of</strong> the importance <strong>of</strong> a “strong start<br />
early in life” among policy makers, civil rights activists,<br />
psychologists, and sociologists in the early 1960s also<br />
sparked interest in expanding early childhood education as<br />
a means <strong>of</strong> eradicating other social problems (Follari, 2007,<br />
p. 131). Fostering a strong early start in life was especially<br />
important within low-income and high-poverty<br />
communities because <strong>of</strong> the developmental delay chil<strong>dr</strong>en<br />
in those communities <strong>of</strong>ten face (Follari, 2007). In 1964,<br />
Benjamin Bloom cited critical periods when the child<br />
develops most early in life (Zigler, Gordic, & <strong>St</strong>yfco, 2007).<br />
In the 1950s, new evidence in brain development research<br />
began to expose the connection between development and<br />
environmental stimuli (Follari, 2007). In 1961, Joseph<br />
McVickor Hunt declared the environment <strong>of</strong> great<br />
importance in a growing child’s cognitive development<br />
(Zigler, Gordic, & <strong>St</strong>yfco, 2007). Adequate stimuli are<br />
required for appropriate and healthy development (Follari,<br />
2007). Situations <strong>of</strong> poverty <strong>of</strong>ten leave chil<strong>dr</strong>en without<br />
environments for healthy development, which creates a
Kesha Berg<br />
Public Policy Enhancing Early Childhood Education<br />
difference between low-income chil<strong>dr</strong>en and their<br />
classmates from more affluent backgrounds (Follari, 2007).<br />
Project Head <strong>St</strong>art was created with the intent <strong>of</strong><br />
ad<strong>dr</strong>essing the gap between chil<strong>dr</strong>en’s levels <strong>of</strong><br />
achievement (Follari, 2007).<br />
A HOLISTIC FOCUS: HEAD START’S COMPREHENSIVE<br />
APPROACH<br />
Head <strong>St</strong>art was created to ad<strong>dr</strong>ess more than chil<strong>dr</strong>en’s<br />
academic success. Project Head <strong>St</strong>art “provides<br />
comprehensive early childhood development, educational,<br />
health, nutritional, social, and other services” for enrolled<br />
chil<strong>dr</strong>en and their families (Butler et al., 2004, p. 2). Many<br />
programs today provide medical care, dental care, and<br />
mental health services to the families they serve (Abdill,<br />
2009). In 1965, the first pilot Head <strong>St</strong>art program opened<br />
to alleviate risks <strong>of</strong> living in poverty for both enrolled<br />
chil<strong>dr</strong>en and their families (Follari, 2007). Zigler, Gordic,<br />
and <strong>St</strong>yfco discuss how the focus <strong>of</strong> Head <strong>St</strong>art has shifted<br />
over time (2007). Head <strong>St</strong>art emphasized the importance<br />
<strong>of</strong> raising IQ scores after its inception. However, raising IQ<br />
scores had not been an intended goal <strong>of</strong> the creators. The<br />
deviance from original goals became a problem, as focus on<br />
IQ disregarded many <strong>of</strong> the other intentions <strong>of</strong> Head <strong>St</strong>art.<br />
The focus <strong>of</strong> Head <strong>St</strong>art turned to chil<strong>dr</strong>en’s social<br />
competence, which proved difficult to evaluate. By the<br />
early 1990s, the program had switched focus again, this<br />
time defining its goal as school readiness. Focus on<br />
preparation for further schooling provided goals closer to<br />
those the program was intended to ad<strong>dr</strong>ess. These goals<br />
included more specific guidelines, including improvements<br />
in chil<strong>dr</strong>en’s physical well-being and motor development,<br />
social and emotional development, language development,<br />
and cognitive and general knowledge. Despite these<br />
guidelines, school readiness has been complicated to assess,<br />
as measurement is difficult. However, this emphasis has<br />
proven a turning point toward focus on preparation for<br />
standardized testing (Zigler, Gordic, & <strong>St</strong>yfco, 2007).<br />
COMMON PRACTICES OF HEAD START PROGRAMS<br />
The way in which Head <strong>St</strong>art is organized allows for<br />
variation in practices between each Head <strong>St</strong>art classroom.<br />
However, the federal government does outline some<br />
general goals and specific procedures for local programs<br />
(Office <strong>of</strong> Head <strong>St</strong>art, 2011). The aim <strong>of</strong> the Head <strong>St</strong>art<br />
educational approach is holistic, as is the intent <strong>of</strong> the<br />
whole program (Follari, 2007). Physical and mental<br />
examinations are provided regularly (Follari, 2007). An<br />
emphasis on the strength <strong>of</strong> the educational aspect <strong>of</strong> the<br />
Head <strong>St</strong>art program is a goal maintained across the nation<br />
(Follari, 2007). The performance standards <strong>of</strong> the program<br />
<strong>of</strong>fer suggestions for a successful practice including<br />
providing a variety <strong>of</strong> materials, <strong>of</strong>fering challenging<br />
individual and group activities, concentration on building<br />
relationships, and engaging in active learning experiences<br />
(Follari, 2007). Recently, the program has seen a greater<br />
emphasis placed on development <strong>of</strong> language arts skills and<br />
less focus dedicated to social development, as had been seen<br />
in the past (Follari, 2007). Prominence is also placed on<br />
numerical skills in preparation for standardized testing<br />
(Follari, 2007).<br />
Parent involvement is critical to the Head <strong>St</strong>art program<br />
(PICA, 2011). One aim <strong>of</strong> Head <strong>St</strong>art is to establish a<br />
system in which parents are encouraged to participate<br />
(Follari, 2007). In addition to helping in the classroom,<br />
parents serve as a governing board, making decisions for<br />
local programs (Follari, 2007). Head <strong>St</strong>art programs are<br />
generally located within communities with low<br />
socioeconomic statuses (Follari, 2007). To improve quality<br />
<strong>of</strong> life, Head <strong>St</strong>art programs <strong>of</strong>ten give preference to parents<br />
<strong>of</strong> enrollees when paid jobs become available within the<br />
program (Follari, 2007).<br />
A majority <strong>of</strong> Head <strong>St</strong>art classrooms operate using either<br />
the High/Scope curriculum or The Creative Curriculum<br />
for Preschool (Bierman et al., 2008). Both methods are<br />
based on child centered learning with support from the<br />
teacher (Bierman et al., 2008).<br />
The High/Scope Curriculum.<br />
The High/Scope method was developed in the 1960s<br />
and is aimed at educating low-income chil<strong>dr</strong>en based on<br />
the developmental research <strong>of</strong> Jean Piaget (Follari, 2007).<br />
High/Scope utilizes both small and large group activities<br />
to build social and group problem solving skills while still<br />
focusing on each child’s individual learning and<br />
development through individualized planning (Bierman et<br />
al., 2008). Follari explains that ten critical learning areas<br />
are outlined through 58 key experiences, or learning goals<br />
(2007). Specific skills are associated with each key<br />
experience within each <strong>of</strong> the learning areas. Teachers guide<br />
31
UST McNair Scholars Program Research Journal<br />
their student’s progress through the planning element <strong>of</strong><br />
the plan-do-review routine. Planning allows the child to<br />
select his or her activity while thinking through the actions<br />
he or she will take with the help <strong>of</strong> the teacher. After<br />
planning, chil<strong>dr</strong>en are given nearly two hours to carry out<br />
their activities individually, with small groups, and<br />
sometimes with the teacher. A group dialogue between the<br />
chil<strong>dr</strong>en and their teacher following work time provides<br />
space to reflect and review the previous two hours <strong>of</strong><br />
activity. Chil<strong>dr</strong>en also reflect through other means such as<br />
<strong>dr</strong>awing or writing. Throughout this process, the teacher<br />
interacts in a way that causes chil<strong>dr</strong>en to engage deeper<br />
within their learning. This interaction allows the teacher<br />
time to observe each student and encourage the child based<br />
on the teacher’s assessment <strong>of</strong> the child’s development. The<br />
High/Scope method emphasizes the individual through<br />
providing attention to each child’s level <strong>of</strong> development,<br />
culture, and so on. The method focuses on allowing the<br />
child to take an active role in his or her education by<br />
pursuing his or her interests (Follari, 2007). Research has<br />
proven the High/Scope model effective in long-term<br />
scenarios such as increasing graduation rates, influencing<br />
lower crime rates, and contributing to better employment<br />
outcomes (Bierman et al., 2008).<br />
The Creative Curriculum for Preschool.<br />
The Creative Curriculum for Preschool takes a holistic<br />
approach to working with the preschool age child with an<br />
educational focus on literacy, math, science, social studies,<br />
the arts, and technology (US Department <strong>of</strong> Education,<br />
2009). Teaching <strong>St</strong>rategies, Inc., the founding organization<br />
<strong>of</strong> the Creative Curriculum, emphasizes the role <strong>of</strong> research<br />
in creating the curriculum (Teaching <strong>St</strong>rategies, Inc.,<br />
2011). The child may explore any <strong>of</strong> the eleven areas <strong>of</strong><br />
interest within the classroom: blocks, <strong>dr</strong>amatic play, toys<br />
and games, art, library, discovery, sand and water, music<br />
and movement, cooking, computers, and the outdoors<br />
(U.S. Department <strong>of</strong> Education, 2009). Each area <strong>of</strong><br />
interest is associated with specific outcomes <strong>of</strong> learning and<br />
corresponding interactions between the teacher and child<br />
(U.S. Department <strong>of</strong> Education, 2009). “<strong>St</strong>udies” supple -<br />
ment exploration <strong>of</strong> the areas <strong>of</strong> interest (U.S. Department<br />
<strong>of</strong> Education, 2009). A study refers to a project that<br />
examines an aspect <strong>of</strong> science or social studies, providing<br />
an outlet for chil<strong>dr</strong>en to practice math, literacy, and other<br />
32<br />
skills (U.S. Department <strong>of</strong> Education, 2009). The teacher<br />
observes chil<strong>dr</strong>en to guide their play and development,<br />
though emphasis is given to child assessment (U.S.<br />
Department <strong>of</strong> Education, 2009). The Creative Curriculum<br />
provides a method from which teachers can expand upon<br />
and modify to their classroom needs (Teaching <strong>St</strong>rategies,<br />
Inc., 2011). A 2009 report by the What Works<br />
Clearinghouse found that the Creative Curriculum had no<br />
discernable effects on oral language, print knowledge,<br />
phonological reasoning, or math skills, although Teaching<br />
<strong>St</strong>rategies, Inc. cites improved classroom quality and<br />
stronger academic and social-emotional skills when The<br />
Creative Curriculum is used (U.S. Department <strong>of</strong><br />
Education, 2009).<br />
REVIEW OF RESEARCH: EFFECTIVENESS OF HEAD START<br />
Head <strong>St</strong>art requires frequent evaluation due to its status<br />
as a federal aid program (Follari, 2007). From its inception,<br />
Head <strong>St</strong>art has claimed commitment to research and<br />
evaluation, though the Head <strong>St</strong>art program was not<br />
thoroughly evaluated until 1998 when assessment was<br />
mandated for reauthorization (Love et al., 2005). Research<br />
prior to the 1998 study proved flawed and inconsistent<br />
(Love et al., 2005). The Nixon administration even<br />
considered phasing out the Head <strong>St</strong>art program after<br />
various studies illustrated Head <strong>St</strong>art was having a small<br />
effect (Zigler, Gordic, & <strong>St</strong>yfco, 2007). <strong>St</strong>ill today, each<br />
reauthorization revives discussion around whether or not<br />
Head <strong>St</strong>art is meeting its intended goals and is effective in<br />
providing successful early childhood education and services<br />
to bridge the gap between chil<strong>dr</strong>en <strong>of</strong> various backgrounds<br />
(Follari, 2007). However, the lack <strong>of</strong> clearly defined goals<br />
by which Head <strong>St</strong>art operates has made assessment difficult<br />
(Zigler, Gordic, & <strong>St</strong>yfco, 2007). Assessing whether or not<br />
Head <strong>St</strong>art is successful in its vague goals has caused debate<br />
and confusion throughout its history (Zigler, Gordic, &<br />
<strong>St</strong>yfco, 2007). Little research was available to guide Head<br />
<strong>St</strong>art’s creators in formatting goals for educating lowincome<br />
chil<strong>dr</strong>en (Zigler, Gordic, & <strong>St</strong>yfco, 2007). This lack<br />
<strong>of</strong> solid foundation causes variability and inconsistency <strong>of</strong><br />
quality in Head <strong>St</strong>art programs today (Zigler, Gordic, &<br />
<strong>St</strong>yfco, 2007).<br />
In the early 1990s, the Administration for Chil<strong>dr</strong>en and<br />
Families (ACF), which oversees Head <strong>St</strong>art, increased the<br />
emphasis placed on research within Head <strong>St</strong>art’s program
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planning (Love et al., 2005). Action by the ACF to expand<br />
research coincided with mandates made by Congress to<br />
carry out several studies regarding Head <strong>St</strong>art chil<strong>dr</strong>en’s<br />
performance and progress during and after enrollment<br />
(Love et al., 2005). The Family and Child Experiences<br />
Survey (FACES) study began in 1997 and will continue<br />
through 2013 to better determine Head <strong>St</strong>art’s strengths<br />
and effectiveness, as well as areas where the program is<br />
unsuccessful or lacking (Follari, 2007). The study follows<br />
a representative group <strong>of</strong> chil<strong>dr</strong>en and their families<br />
through Head <strong>St</strong>art and beyond (Love et al., 2005). The<br />
completed study will consist <strong>of</strong> five cohorts <strong>of</strong> Head <strong>St</strong>art<br />
enrollees from all fifty states and the District <strong>of</strong> Colombia<br />
(Office <strong>of</strong> Head <strong>St</strong>art, 2011). Each child is assessed three<br />
to four times one-on-one for language, literacy, and math<br />
skills to determine his or her school readiness (Office <strong>of</strong><br />
Head <strong>St</strong>art, 2011). FACES has already revealed Head <strong>St</strong>art<br />
does narrow the gap between Head <strong>St</strong>art preschoolers and<br />
preschoolers who attended an alternative early childhood<br />
education program both academically and socially (Follari,<br />
2007). Particularly, students whose development was<br />
significantly behind norms when they entered preschool<br />
saw the greatest improvements (Love et al., 2005). Head<br />
<strong>St</strong>art chil<strong>dr</strong>en made the most significant gains in cognitive<br />
development in the areas <strong>of</strong> vocabulary and early writing<br />
(Follari, 2007). However, Head <strong>St</strong>art students, on average,<br />
still remain below the national averages for abilities at their<br />
age, scoring lower on standardized tests (Follari, 2007).<br />
Additionally, the FACES study has shown the<br />
improvements made during a child’s Head <strong>St</strong>art years <strong>of</strong>ten<br />
fade after two years (Follari, 2007). This finding illustrates<br />
Head <strong>St</strong>art’s inability to produce sustained benefits, an area<br />
<strong>of</strong> great importance (Follari, 2007). Head <strong>St</strong>art is <strong>of</strong>fered<br />
in both full-day and half-day settings across the country<br />
(Love et al., 2005). This is cited as one reason why lasting<br />
effects are not seen; three to four hours <strong>of</strong> classroom time<br />
per day does not allow much time to correct the child’s<br />
development and make gains (Zigler, Gordic, & <strong>St</strong>yfco,<br />
2007). However, the National Head <strong>St</strong>art Association<br />
claims Head <strong>St</strong>art is actually providing long-term benefits<br />
such as decreases in the amount <strong>of</strong> grade repetition, special<br />
education placements, and <strong>dr</strong>opouts (NHSA, 2011).<br />
Similar findings have been reported from the Head <strong>St</strong>art<br />
Impact <strong>St</strong>udy (HSIS). HSIS was carried out by an<br />
independent research panel and aimed at assessing the<br />
impact <strong>of</strong> Head <strong>St</strong>art on participants and identifying the<br />
source <strong>of</strong> the impacts (Love et al., 2005). The study was<br />
begun in 2002 to answer two questions: (1) What<br />
differences does Head <strong>St</strong>art make to the key outcomes <strong>of</strong><br />
development and learning <strong>of</strong> the nation’s low-income<br />
chil<strong>dr</strong>en? and (2) Under what circumstances does Head<br />
<strong>St</strong>art work best and for which chil<strong>dr</strong>en (Love et al., 2005,<br />
p. 7)? The HSIS compared 3 and 4 year old Head <strong>St</strong>art<br />
chil<strong>dr</strong>en with 3 and 4 year old Head <strong>St</strong>art eligible chil<strong>dr</strong>en<br />
who were enrolled in an alternative program or were cared<br />
for by their parents through the spring <strong>of</strong> their first grade<br />
year (Love et al., 2005). With data collection running from<br />
2002 to 2006, the HSIS involved roughly 5000 3 and 4<br />
year olds from 84 Head <strong>St</strong>art programs across the nation<br />
(Office <strong>of</strong> Head <strong>St</strong>art, 2011). Head <strong>St</strong>art programs were<br />
used in areas where Head <strong>St</strong>ate applicants outnumbered<br />
enrollees (Office <strong>of</strong> Head <strong>St</strong>art, 2011). Child assessments,<br />
interviews, parent and teacher ratings, and observations <strong>of</strong><br />
Head <strong>St</strong>art and alternative settings were used to assess the<br />
impact <strong>of</strong> Head <strong>St</strong>art (Love et al., 2005). Of the 4 year olds<br />
assessed, Head <strong>St</strong>art preschoolers outperformed non-Head<br />
<strong>St</strong>art preschoolers in multiple areas <strong>of</strong> development (Love<br />
et al., 2005). In 2005, results illustrated that cognitively<br />
the Head <strong>St</strong>art preschoolers were better able to identify<br />
words, name letters, and spell (Love et al., 2005). The Head<br />
<strong>St</strong>art three year olds assessed showed even greater results<br />
than their non-Head <strong>St</strong>art counterparts (Love et al., 2005).<br />
They, too, were better able to identify words and letters,<br />
<strong>dr</strong>aw a design, use varied vocabularies, name colors, and<br />
respond to oral communication (Love et al., 2005; Puma<br />
et al., 2010). The Head <strong>St</strong>art 3 year olds also showed<br />
reductions in behavior problems and hyperactivity (Love<br />
et al., 2005). Overall, the Head <strong>St</strong>art chil<strong>dr</strong>en showed signs<br />
<strong>of</strong> better health and parent relationships (Love et al., 2005;<br />
Puma et al., 2010). Black students and students with<br />
special needs were identified as making the most<br />
substantial gains (Puma et al., 2010). Deviance from the<br />
success seen in HSIS came primarily from non-English<br />
speaking homes, families with young mothers, and<br />
mothers with high levels <strong>of</strong> depression symptoms (Love et<br />
al., 2005; Puma et al., 2010). However, when data from<br />
the HSIS was produced again in 2010, there were no<br />
impacts found on chil<strong>dr</strong>en’s cognitive, social, or emotional<br />
development (Haskins & Barnett, 2010). Researchers<br />
concluded, based on Head <strong>St</strong>art’s poor effectiveness, reform<br />
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was needed after the 2010 evaluation (Haskins & Barnett,<br />
2010). Thus, a need for strengthening the educational<br />
aspects has been identified to ensure all Head <strong>St</strong>art<br />
graduates are well prepared for future schooling (Bierman<br />
et al., 2008).<br />
In an assessment <strong>of</strong> school readiness, Bierman et al.<br />
found Head <strong>St</strong>art graduates to be adequately prepared in<br />
areas <strong>of</strong> oral comprehension skills and speech sounds<br />
(2008). Additionally, findings indicated high levels <strong>of</strong><br />
aggressive behavior and lacking social skills among Head<br />
<strong>St</strong>art graduates (Bierman et al., 2008). The Civil Rights<br />
Education Fund described Head <strong>St</strong>art’s impact as modest,<br />
due in part to the small amount <strong>of</strong> statistical difference in<br />
both cognitive and social skills between Head <strong>St</strong>art and<br />
non-Head <strong>St</strong>art students (Besharov, 2005). Other programs<br />
continue to outperform Head <strong>St</strong>art due to its lack <strong>of</strong><br />
organizational support and lack <strong>of</strong> properly trained<br />
educators (Bierman et al., 2008; Haskins & Barnett, 2010).<br />
However, the National Head <strong>St</strong>art Association reports the<br />
Head <strong>St</strong>art graduates are achieving national norms in early<br />
reading and writing and are close to national norms in early<br />
math and vocabulary by the spring <strong>of</strong> their kindergarten<br />
year (NHSA, 2011).<br />
While Head <strong>St</strong>art has been recognized for providing a<br />
well-working system for reaching low-income chil<strong>dr</strong>en,<br />
there is a need to reach a broader community (Love et al.,<br />
2005). Currently, debate revolves around whether or not<br />
Head <strong>St</strong>art provides equal access to non-English speaking<br />
families and various cultures within the classroom<br />
(Jacobson, 2007; Love et al., 2005). Additionally, findings<br />
on achievement have differed among various races within<br />
the program (Love et al., 2005). Head <strong>St</strong>art is working to<br />
ad<strong>dr</strong>ess how to expand positive results to all chil<strong>dr</strong>en by<br />
determining what works well for different groups (Love et<br />
al., 2005).<br />
TWO COMPLIMENTARY APPROACHES: THE<br />
MONTESSORI EDUCATION AND HEAD START<br />
AREAS OF COMPATIBILITY<br />
Although Head <strong>St</strong>art and Montessori approaches to early<br />
childhood education have independent backgrounds, their<br />
goals are similar and their methods are compatible (Hixon,<br />
34<br />
2002). Both programs were created in response to the need<br />
to enhance educational opportunities for low-income<br />
students. Both embrace a holistic approach to child<br />
development. These similarities are reflected in<br />
philosophical and pedagogical compatibilities. Similarity<br />
also arises from each method’s dependence on research.<br />
Maria Montessori developed her method based on scientific<br />
observations <strong>of</strong> child development. Since the creation <strong>of</strong><br />
Montessori’s methods, additional research has supported<br />
Montessori’s developmental theory. Similarly, research<br />
provided a basis for creating Head <strong>St</strong>art and it continues<br />
to play an instrumental role within the program.<br />
Head <strong>St</strong>art is structured to allow different programs to<br />
adopt various methods. Some Head <strong>St</strong>art classrooms fully<br />
incorporate Montessori methods. Most, however, use either<br />
the High/Scope or Creative Curriculum for Preschool.<br />
While both approaches recognize some key Montessori<br />
principles—for example child-centered learning and<br />
leaning through doing—expanding emphasis on<br />
Montessori methods and materials could be beneficial.<br />
EVIDENCE OF SUCCESS<br />
The rise <strong>of</strong> Montessori methods within the United <strong>St</strong>ates<br />
during the time in which Head <strong>St</strong>art was established<br />
resulted in some early Head <strong>St</strong>art programs employing the<br />
Montessori method (Gutek, 2011). However, there is<br />
extremely limited literature regarding the use <strong>of</strong> the<br />
Montessori method within Head <strong>St</strong>art programs. An article<br />
from Montessori Life conveys that a Head <strong>St</strong>art classroom in<br />
Ignacio, Colorado, that began using the Montessori method<br />
saw success (Hixon, 2002). In fact, the director stated, “We<br />
found that the two philosophies were not only compatible,<br />
but very complimentary” (Hixon, 2002, p. 38). The<br />
director elaborated on the success <strong>of</strong> the program saying,<br />
“Parents are reporting chil<strong>dr</strong>en who are more self confident,<br />
more respectful, and better prepared academically” (Hixon,<br />
2002, p. 38). Positive results were also reported from a<br />
Nokomis, Florida Head <strong>St</strong>art program that began using<br />
Montessori methods (Allen-Jones, 2006). The program<br />
emerged from collaboration between Chil<strong>dr</strong>en First, a local<br />
non-pr<strong>of</strong>it, Sarasota County’s Head <strong>St</strong>art, and the Island<br />
Village Montessori Early Childhood Program (Allen-Jones,<br />
2006). Parents <strong>of</strong> enrolled students, as well as school<br />
<strong>of</strong>ficials, attested to the success <strong>of</strong> the collaboration (Allen-<br />
Jones, 2006). The program’s chil<strong>dr</strong>en surpass the national
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standards and mandates (Allen-Jones, 2006). Further<br />
evidence for the achievement <strong>of</strong> the collaboration came<br />
with the National Head <strong>St</strong>art Association’s recognition <strong>of</strong><br />
the program as a “program <strong>of</strong> excellence” (Allen-Jones,<br />
2006).<br />
The limited available documentation <strong>of</strong> Montessori<br />
methods within Head <strong>St</strong>art signals the room for growth<br />
and development in the field. The brief amount <strong>of</strong><br />
literature available does confirm the success <strong>of</strong> adherence<br />
to Montessori methods within Head <strong>St</strong>art in the past.<br />
INSIGHT FROM EXPERTS<br />
I conducted two interviews to further develop my<br />
understanding <strong>of</strong> the guiding philosophies, theories, and<br />
practices <strong>of</strong> the Montessori education and Head <strong>St</strong>art<br />
program. Information gathered during each <strong>of</strong> these<br />
interviews has provided guidance in developing a sense <strong>of</strong><br />
the main opportunities for improving early childhood<br />
education. Furthermore, this information has served as a<br />
guide in making practice recommendations for the<br />
incorporation <strong>of</strong> Montessori principles within Head <strong>St</strong>art<br />
classrooms. My first interview was with Molly<br />
O’Shaughnessy, the director <strong>of</strong> the Montessori Training<br />
Center <strong>of</strong> Minnesota. My second interview was with Jeanne<br />
Dickhausen, the education coordinator <strong>of</strong> the Community<br />
Action Partnership <strong>of</strong> Ramsey and Washington Counties,<br />
the <strong>St</strong>. Paul grantee for Head <strong>St</strong>art.<br />
Question 1: What is the overall philosophy, principles, and<br />
child development theory that guides the Montessori/Head <strong>St</strong>art<br />
education?<br />
Molly O’Shaughnessy identified freedom for the child<br />
as one <strong>of</strong> the guiding principles <strong>of</strong> the Montessori<br />
education. Allowing the child to be actively involved in<br />
his or her own learning and to have responsibility is critical<br />
for the child’s growth. Additionally, it helps foster<br />
independence. O’Shaughnessy discussed the ability to be<br />
functionally independent as a primary objective <strong>of</strong> the<br />
Montessori education. Developing this independence<br />
requires purposeful activity within the classroom,<br />
concentrating on the repetition <strong>of</strong> skills until they are<br />
mastered. Chil<strong>dr</strong>en’s independence is achieved through the<br />
prepared environment. Another guiding philosophy <strong>of</strong> the<br />
Montessori education cited by O’Shaughnessy is the<br />
inclusion <strong>of</strong> multiple ages within one classroom. This<br />
allows older students to reinforce skills and knowledge by<br />
helping younger chil<strong>dr</strong>en learn. Montessori stressed giving<br />
the best <strong>of</strong> culture to her students and providing them with<br />
the nicest, real materials with which to work. Peace is<br />
emphasized within the Montessori classroom, as<br />
Montessori saw it as a goal <strong>of</strong> humanity. O’Shaughnessy<br />
also discussed Montessori’s identification <strong>of</strong> “normali -<br />
zation” as the most important outcome <strong>of</strong> her work,<br />
meaning a successful education will lead all chil<strong>dr</strong>en to be<br />
contributing members <strong>of</strong> society.<br />
Jeanne Dickhausen referenced the mission and<br />
philosophy <strong>of</strong> the Community Action Head <strong>St</strong>art program<br />
as guiding statements. The mission states, “Head<br />
<strong>St</strong>art/Early Head <strong>St</strong>art’s mission is to help chil<strong>dr</strong>en and<br />
parents achieve their full potential through high-quality<br />
child development and family support services<br />
(Community Action Head <strong>St</strong>art Family Handbook/<br />
Calendar, 2010). Elements <strong>of</strong> the guiding philosophy,<br />
which was developed by the Community Action<br />
Partnership staff, Head <strong>St</strong>art parents, and community<br />
members, emphasize the importance <strong>of</strong> individualized<br />
attention to chil<strong>dr</strong>en’s interest, learning through<br />
engagement in various activities and play, and the<br />
importance <strong>of</strong> respect for healthy families and their<br />
cultures. Dickhausen discussed the high worth <strong>of</strong> parent<br />
involvement within the Community Action Head <strong>St</strong>art<br />
program. Head <strong>St</strong>art teachers must get to know each family<br />
and child individually to best help the child learn.<br />
Dickhausen emphasized the importance <strong>of</strong> ad<strong>dr</strong>essing each<br />
child’s developmental needs and interests in ensuring he<br />
or she is really learning. Additionally, Dickhausen<br />
emphasized the importance <strong>of</strong> the use <strong>of</strong> research-based<br />
approaches within the Community Action Head <strong>St</strong>art<br />
program. Assessment <strong>of</strong> chil<strong>dr</strong>en’s development is also<br />
crucial. The Community Action Partnership uses an<br />
ongoing assessment system to track each child’s<br />
development and progress. Parents and Head <strong>St</strong>art teachers<br />
set goals for each child, and assessment provides a way to<br />
determine progress.<br />
Question 2: What are the key early childhood education<br />
practices used by the Montessori/Head <strong>St</strong>art program?<br />
Molly O’Shaughnessy identified the Montessori<br />
education’s focus on the observation <strong>of</strong> chil<strong>dr</strong>en. Guides<br />
observe the chil<strong>dr</strong>en at work, interrupting them only when<br />
a child’s behavior is destructive. A Montessori classroom<br />
consists <strong>of</strong> one guide, an assistant, and thirty chil<strong>dr</strong>en <strong>of</strong><br />
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mixed ages. Including various ages in one classroom<br />
provides the opportunity for chil<strong>dr</strong>en to grow socially and<br />
reinforce their learning through helping other students.<br />
The guiding principles <strong>of</strong> Head <strong>St</strong>art classroom vary<br />
because not all classrooms use the same approach. Jeanne<br />
Dickhausen explained the Community Action Head <strong>St</strong>art<br />
classroom utilizes the Creative Curriculum. A focus <strong>of</strong> the<br />
Creative Curriculum classroom is placed on a welcoming<br />
and inviting environment. Eleven areas <strong>of</strong> interest are<br />
provided for students to explore and engage with.<br />
Relationship building is emphasized both between student<br />
and teacher and among the students. The teacher must<br />
ensure chil<strong>dr</strong>en develop a broad range <strong>of</strong> skills, even if the<br />
chil<strong>dr</strong>en’s interests seem to be narrow.<br />
Question 3: What are some recent trends in early childhood<br />
education?<br />
Molly O’Shaughnessy identified the increasing number<br />
<strong>of</strong> early childhood education providers that have begun<br />
<strong>of</strong>fering full-day programs to accommodate working<br />
parents. Also, a rise in bilingual chil<strong>dr</strong>en has increased the<br />
necessity for more than one language to be spoken within<br />
the classroom and in interactions with parents.<br />
O’Shaughnessy also discussed that policy reform has gained<br />
strength within recent years, including objectives such as<br />
diversifying the teaching pool and providing broader access<br />
to quality early childhood education.<br />
Jeanne Dickhausen noted the increase in research-based<br />
curriculum and assessment that is now being used in early<br />
childhood education. Another recent focus in early<br />
childhood education referenced by Dickhausen was the<br />
growing role <strong>of</strong> teacher education. A greater focus has been<br />
placed on the education for early childhood teachers as well<br />
as their pr<strong>of</strong>essional development. The Community Action<br />
Head <strong>St</strong>art program requires their teachers and staff to be<br />
members <strong>of</strong> a pr<strong>of</strong>essional registry. Also, the higher<br />
education provided for early childhood education teachers<br />
has recently increased continuity among programs. The<br />
importance <strong>of</strong> each early childhood education teacher<br />
learning and teaching the same material across the country<br />
is growing.<br />
Question 4: What are some problems with early childhood<br />
education today?<br />
The excessive use <strong>of</strong> technology by young chil<strong>dr</strong>en was<br />
identified as a problem for education today. Family<br />
influences are also having an impact on early childhood<br />
36<br />
education. Various and extreme parenting styles present<br />
problems within the classroom. In a Montessori setting,<br />
chil<strong>dr</strong>en are encouraged to become independent, but with<br />
“helicopter parenting,” independence is <strong>of</strong>ten stifled at<br />
home. External family factors such as poverty also affect<br />
learning in the classroom. With high poverty rates today,<br />
stress and violence at home translates into problems within<br />
the classroom. Increased immigration and the introduction<br />
<strong>of</strong> new cultures add more challenges to early childhood<br />
education. With chil<strong>dr</strong>en moving in and out <strong>of</strong> classrooms<br />
<strong>of</strong>ten, it is difficult to ensure quality education.<br />
Accommodating multiple cultures within a classroom<br />
provides another challenge.<br />
Jeanne Dickhausen identified regulated expectations and<br />
assessments required <strong>of</strong> chil<strong>dr</strong>en at an earlier age as a<br />
problem within early childhood education. She explained<br />
that what used to be expected <strong>of</strong> a first grade child is now<br />
expected <strong>of</strong> a preschool child. The effects <strong>of</strong> this added<br />
expectation and assessment can be developmentally<br />
unhealthy for young chil<strong>dr</strong>en. As a federal grantee, Head<br />
<strong>St</strong>art programs are continually worried about their financial<br />
stability, which provides an ongoing problem. Due to the<br />
continuing concern <strong>of</strong> funding, Dickhausen said<br />
Community Action Head <strong>St</strong>art is continually looking for<br />
ways to demonstrate the effectiveness <strong>of</strong> its program on<br />
chil<strong>dr</strong>en’s education and development. Part <strong>of</strong> ensuring<br />
effectiveness includes involving parents. Dickhausen cited<br />
the continued struggle to keep parents highly involved<br />
with their chil<strong>dr</strong>en’s lives, educations, and the Head <strong>St</strong>art<br />
program. Specifically, Dickhausen explained the difficulty<br />
<strong>of</strong> engaging parents from low-income areas that are <strong>of</strong>ten<br />
spending a lot <strong>of</strong> time working.<br />
Question 5: What are the most important steps that could be<br />
taken to improve early childhood education for low-income<br />
chil<strong>dr</strong>en?<br />
Molly O’Shaughnessy discussed the importance <strong>of</strong><br />
focusing on developing the child’s independence through<br />
practical life activities in enhancing early education. She<br />
cited any activity that aided in developing the child’s<br />
independence as important to incorporate in an early<br />
childhood education program.<br />
Jeanne Dickhausen identified broader access as a crucial<br />
component <strong>of</strong> enhancing educational opportunities for lowincome<br />
chil<strong>dr</strong>en. She also mentioned the importance <strong>of</strong><br />
well trained and prepared teachers in ensuring quality
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Public Policy Enhancing Early Childhood Education<br />
education. To improve this aspect, Dickhausen encourages<br />
the higher education community to continue to collaborate<br />
so various programs are on the same page. Another way to<br />
improve education for low-income students discussed by<br />
Dickhausen involved providing the best opportunities for<br />
chil<strong>dr</strong>en to learn based on their life experiences and<br />
situations. Dickhausen identified the ability <strong>of</strong> staff to<br />
provide research-sound support for their students while<br />
maintaining personal relationships to be crucial.<br />
A reflection on the interviews.<br />
Throughout the interviews, common themes between<br />
the two approaches emerged which provided guidance in<br />
creating recommendations. First, both O’Shaughnessy and<br />
Dickhausen ad<strong>dr</strong>essed elements <strong>of</strong> the guiding principles<br />
<strong>of</strong> their respective approaches that overlapped. Both<br />
approaches are aimed at ad<strong>dr</strong>essing the needs <strong>of</strong> chil<strong>dr</strong>en<br />
individually. The establishment <strong>of</strong> the Montessori<br />
environment as a place to foster independence and promote<br />
freedom <strong>of</strong> the child gives attention to each child as an<br />
individual, just as the Community Action Head <strong>St</strong>art<br />
program emphasizes attention to each child’s interests and<br />
development. The Head <strong>St</strong>art program also prides itself on<br />
getting to know chil<strong>dr</strong>en and families individually. Both<br />
O’Shaughnessy and Dickhausen discussed how their<br />
approaches are concerned with child development beyond<br />
education. Both methods are aimed at aiding the child in<br />
all aspects <strong>of</strong> his or her life, Montessori’s through providing<br />
practical life skills and fostering independence and Head<br />
<strong>St</strong>art’s through providing additional services. Both<br />
O’Shaughnessy and Dickhausen identified devoting<br />
attention to chil<strong>dr</strong>en’s individual needs as a means <strong>of</strong><br />
improving early childhood education. O’Shaughnessy<br />
discussed allowing chil<strong>dr</strong>en to have freedom to choose their<br />
work based on their own interests. Similarly, Dickhausen<br />
emphasized the importance <strong>of</strong> engaging each child in his<br />
or her learning through relating learning to his or her life<br />
experience and interests.<br />
In discussing recent struggles within the field <strong>of</strong> early<br />
childhood education, both O’Shaughnessy and Dickhausen<br />
mentioned the increase in effects seen due to growing levels<br />
<strong>of</strong> poverty. The high levels <strong>of</strong> stress put on chil<strong>dr</strong>en living<br />
in poverty <strong>of</strong>ten present themselves through behavior<br />
problems. Additionally, poverty affects chil<strong>dr</strong>en’s leaning<br />
in other ways. For example, learning is impacted when<br />
nutritional needs are not being met. Providing resources<br />
for chil<strong>dr</strong>en and ad<strong>dr</strong>essing problems that arise from<br />
situations <strong>of</strong> poverty is something that requires attention<br />
in all classrooms.<br />
RECOMMENDATIONS FOR THE INCORPORATION OF<br />
MONTESSORI PRINCIPLES WITHIN HEAD START<br />
While access to quality early childhood education is<br />
important for all chil<strong>dr</strong>en, it is absolutely critical for<br />
chil<strong>dr</strong>en from low-income backgrounds. Early childhood<br />
education provides opportunities for every child’s growth<br />
into a successful member <strong>of</strong> society. Access to quality,<br />
holistic early childhood education is necessary to prepare<br />
all chil<strong>dr</strong>en for life as a self-fulfilled, educated,<br />
economically productive, and civically engaged adult.<br />
Integrating Montessori methods within Head <strong>St</strong>art<br />
provides a philosophically consistent, pedagogically sound,<br />
and financially feasible approach to enhancing educational<br />
opportunities and experiences for low-income chil<strong>dr</strong>en.<br />
The following four recommendations are directed<br />
toward enhancing the quality <strong>of</strong> early childhood education<br />
for low-income chil<strong>dr</strong>en. All recommendations are aimed<br />
at assisting chil<strong>dr</strong>en from low-income families to develop<br />
self-reliance, self-confidence, personal responsibility, and<br />
the ability to care for others.<br />
Recommendation 1: Self-directed work.<br />
Allowing chil<strong>dr</strong>en to make choices about what they<br />
would like to do is critical in fostering intrinsic motivation<br />
and independence. I recommend Head <strong>St</strong>art programs<br />
incorporate the concept <strong>of</strong> self-directed work within their<br />
curriculum. Providing chil<strong>dr</strong>en with choices about which<br />
activities or materials they engage with allows them to<br />
pursue their own interests. A child learns best when<br />
exploring his or her interests. Montessori stressed the<br />
importance <strong>of</strong> allowing chil<strong>dr</strong>en to work independently for<br />
three hours each day. At least a portion <strong>of</strong> each school day<br />
should be devoted to uninterrupted, self-directed work.<br />
This provides time for chil<strong>dr</strong>en to fully engage in and<br />
complete each activity they begin.<br />
Recommendation 2: The prepared environment.<br />
The environment <strong>of</strong> a classroom has a significant impact<br />
on the possibilities for learning. For that reason, devoting<br />
specific attention to the careful preparation <strong>of</strong> each learning<br />
37
UST McNair Scholars Program Research Journal<br />
environment is key. I recommend Head <strong>St</strong>art programs<br />
devote attention to preparing each learning environment<br />
in a way that provides accessible materials for chil<strong>dr</strong>en and<br />
allows space for chil<strong>dr</strong>en’s movement and work. Maria<br />
Montessori outlined several factors that would enhance any<br />
environment for learning. In addition to the environment<br />
being welcoming to chil<strong>dr</strong>en, it should be orderly.<br />
Materials within the classroom should be easily accessible<br />
by chil<strong>dr</strong>en, so they are able to retrieve any materials they<br />
may need for their work. An orderly environment helps to<br />
facilitate material accessibility. If the environment is<br />
orderly, chil<strong>dr</strong>en know where things can be found and<br />
should be returned to for future use. This also promotes<br />
respect for the environment and materials. Another critical<br />
aspect <strong>of</strong> the prepared environment includes space for<br />
chil<strong>dr</strong>en to work and move throughout the room. Using<br />
various materials may require more space, and it is<br />
important for chil<strong>dr</strong>en to have space to work as needed.<br />
Recommendations 3: Incorporation <strong>of</strong> materials.<br />
The Montessori education emphasizes the use <strong>of</strong> handson<br />
materials and the use <strong>of</strong> physical objects to promote<br />
learning. I recommend Head <strong>St</strong>art programs utilize some<br />
<strong>of</strong> the Montessori materials within the classroom, especially<br />
in the areas <strong>of</strong> language, mathematics, and practice life<br />
skills. The use <strong>of</strong> hands-on objects can be applied to all<br />
subject areas to help chil<strong>dr</strong>en learn. For example, the<br />
moveable alphabet is used to help chil<strong>dr</strong>en formulate<br />
reading and writing skills. Various three-dimensional<br />
objects can also be used in learning mathematics, such as<br />
sandpaper numbers and different counting devises. In<br />
addition, utilizing hands-on materials for the acquisition<br />
<strong>of</strong> practical life skills is useful in developing independence.<br />
Providing materials for chil<strong>dr</strong>en to build practical skills<br />
such as buttoning, tying, pouring, washing, and so on can<br />
be achieved through the incorporation <strong>of</strong> additional<br />
Montessori materials within the classroom.<br />
Recommendation 4: The teacher as a guide.<br />
Incorporating self-directed work and Montessori<br />
materials within a traditional classroom will, in most cases,<br />
require the teacher to take on a slightly different role. Head<br />
<strong>St</strong>art classrooms that incorporate self-directed work must<br />
also incorporate the concept <strong>of</strong> the teacher as a guide to<br />
chil<strong>dr</strong>en’s independent exploration and learning. In<br />
38<br />
allowing chil<strong>dr</strong>en to work independently, it is important<br />
that the teacher allows the student to choose his or her task,<br />
rather than assigning a task for all chil<strong>dr</strong>en to complete.<br />
Once chil<strong>dr</strong>en have engaged with their work, the teacher<br />
should not unnecessarily interrupt the child’s work. The<br />
child may request the help <strong>of</strong> the teacher or work in<br />
collaboration with other students within the classroom.<br />
Throughout the self-directed work period, the teacher<br />
should <strong>of</strong>fer guidance in helping individual chil<strong>dr</strong>en<br />
discover what the child would like to work with and<br />
demonstrate how to successfully complete each activity.<br />
Overcoming barriers to implementation.<br />
Three primary barriers exist in integrating methods <strong>of</strong><br />
the Montessori education within the Head <strong>St</strong>art program.<br />
To ad<strong>dr</strong>ess these barriers, I suggest the following:<br />
First, Montessori methods must be implemented in a<br />
manner responsive to the needs <strong>of</strong> each unique Head <strong>St</strong>art<br />
setting. Implementing the above recommendations will be<br />
different within each different classroom community. For<br />
this reason, the recommendations are defined broadly, so<br />
they can be adapted to work within various educational<br />
approaches and environments. Flexibility is key to ensuring<br />
successful integration <strong>of</strong> methods.<br />
Second, successful incorporation <strong>of</strong> Montessori methods<br />
requires advanced teacher education. Teachers must be<br />
carefully prepared to take on the role <strong>of</strong> a guide to facilitate<br />
self-directed work, prepare the environment, and properly<br />
use Montessori materials. Training needs could be<br />
ad<strong>dr</strong>essed by engaging Head <strong>St</strong>art and Montessori<br />
educators in developing cost and time efficient in-service<br />
opportunities for participating Head <strong>St</strong>art teachers.<br />
Third, incorporating Montessori methods within Head<br />
<strong>St</strong>art will require funding. This could be ad<strong>dr</strong>essed by<br />
redirecting existing funds within the Head <strong>St</strong>art budget to<br />
support recommended changes. For example, funding for<br />
currently used materials may be redirected for Montessori<br />
materials. Additionally, funding could be sought for pilot<br />
programs through grant writing. Successful pilot programs<br />
could then be used to advocate for further funding.<br />
Although more research is required, overall, my project<br />
suggests efforts to incorporate key elements <strong>of</strong> the<br />
Montessori education within Head <strong>St</strong>art programs would<br />
enhance early childhood education for low-income<br />
chil<strong>dr</strong>en.
Kesha Berg<br />
Public Policy Enhancing Early Childhood Education<br />
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Jacobson, L. (2007). For head start, a marathon run. Education<br />
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Lillard, A., & Else-Quest, N. (2006, September 26). The early<br />
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(2005). Head <strong>St</strong>art: what do we know about its effectiveness?<br />
what do we need to know? Blackwell handbook <strong>of</strong> early<br />
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people <strong>of</strong> head start. New York: Dutton.<br />
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UST McNair Scholars Program Research Journal<br />
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& Westat, I. (2010). Head start impact study. final report.<br />
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Rambusch McCormick, N. (2010). Freedom, order, and the<br />
child: self-control and mastery <strong>of</strong> the world mark the<br />
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226&site=ehost-live; www.amshq.org/mLife/10_01/toc.htm<br />
Robinson, W. Y. (2006). Culture, race, diversity: How<br />
Montessori spells success in public schools. Montessori Life: A<br />
Publication <strong>of</strong> the American Montessori Society, 18(4), 9.<br />
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www.amshq.org/publications.htm#<br />
Shore, R. A. (2009). Reframing the first day <strong>of</strong> school. School<br />
Administrator, 66(10), 22-25. Retrieved from<br />
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e=ehost-live; www.aasa.org/SchoolAdministratorArticle.<br />
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e&db=eric&AN=ED506156&site=ehost-live<br />
Zigler, E., Gordic, B., & <strong>St</strong>yfco, S. J. (2007). What is the goal <strong>of</strong><br />
head start? four decades <strong>of</strong> confusion and debate. NHSA<br />
40<br />
Dialog, 10(2), 83-97. Retrieved from http://ezproxy.<br />
stthomas.edu/login?url=http://search.ebscohost.com/login.as<br />
px?direct=true&db=eric&AN=EJ828008&site=ehost-live;<br />
www.informaworld.com/openurl?genre=article&id=<br />
doi:10.1080/15240750701491233
ABSTRACT<br />
Human immunodeficiency virus, HIV, is the causative agent <strong>of</strong> AIDS, a pandemic<br />
affecting over 30 million people worldwide. Understanding how <strong>dr</strong>ug resistance develops<br />
in HIV is essential for improving antiretroviral therapy and is an important research<br />
area in the fight against HIV/AIDS. While much is known about HIV-1, the virus<br />
that accounts for majority <strong>of</strong> global infections and the mutations it acquires during <strong>dr</strong>ug<br />
resistance, information on HIV-2’s <strong>dr</strong>ug resistance is limited to a handful <strong>of</strong> studies.<br />
HIV-2 is prevalent in West Africa and the limited spread <strong>of</strong> the infection contributes to<br />
the lack <strong>of</strong> available research on this virus type. The present study will investigate HIV-<br />
2 <strong>dr</strong>ug resistance to nucleoside reverse transcriptase inhibitors, a <strong>dr</strong>ug class that inhibits<br />
activity <strong>of</strong> the reverse transcriptase enzyme, a major generator <strong>of</strong> mutations in HIV. We<br />
will create HIV-2 mutants containing HIV-1 resistant conferring mutations and observe<br />
how the mutants influence <strong>dr</strong>ug susceptibility and mutation frequency, two factors that<br />
stimulate <strong>dr</strong>ug resistance. NRTI-resistant reverse transcriptase increases mutation<br />
frequency in HIV-1, which results in a higher selection for <strong>dr</strong>ug resistant mutations<br />
and further diminishes NRTI potency. Because HIV-1 and HIV-2 have similar reverse<br />
transcriptase enzymes, we hypothesized that HIV-2 resistant RT would also increase<br />
mutation frequency and HIV-1 mutations will confer resistance in HIV-2. Current<br />
results from two, single round replication assays and flow cytometry show that HIV-2<br />
has an average mutant frequency <strong>of</strong> 0.239 ± 0.041 (first replicate) and 0.273 ±<br />
0.033 (second replicate). HIV-2 mutants will be generated by site-directed mutagenesis,<br />
and we can observe how these mutations influence mutant frequency and <strong>dr</strong>ug<br />
susceptibility. The ultimate goal is to develop a better understanding <strong>of</strong> HIV-2 <strong>dr</strong>ug<br />
resistance that could be used to create potential treatment options for the HIV-2 infection.<br />
INTRODUCTION<br />
A retrovirus is a RNA virus that encodes for the reverse transcriptase (RT)<br />
enzyme; RT converts viral RNA into DNA that can be integrated in a host<br />
cell’s nucleus. HIV is a retrovirus that attacks and replicates inside <strong>of</strong> T cells,<br />
a group <strong>of</strong> white blood cells that play a role in immune defense. The HIV life<br />
cycle begins when a virus particle binds and fuses into the host cell and releases<br />
its genetic material as RNA. The reverse transcriptase enzyme converts viral<br />
RNA into DNA, which is then transported into the host’s nucleus and spliced<br />
into human genetic material by the integrase enzyme. Proviral DNA is<br />
transcribed, using human enzymes, into mRNA and complete copies <strong>of</strong> HIV<br />
genetic material. The mRNA is used as a blueprint to create long chains <strong>of</strong><br />
HIV protein. Protease cuts these chains into individual proteins, which join<br />
with HIV genetic copies to form a new virus particle. As the newly assembled<br />
virus particle is released from the host cell, it takes part <strong>of</strong> the cell’s membrane<br />
containing proteins necessary to bind to and infect new cells (Tavassoli, 2011).<br />
HIV is the causative agent <strong>of</strong> acquired immunodeficiency syn<strong>dr</strong>ome, AIDS,<br />
a pandemic affecting over 30 million people worldwide. There are two types<br />
<strong>of</strong> HIV; HIV-1 is the common virus accounting for the majority <strong>of</strong> infections<br />
globally, and HIV-2 is centralized to West Africa. HIV-1 and HIV-2 are<br />
genetically similar; their virion (virus particle) structures are alike and they<br />
EXPLORING THE<br />
INFLUENCE OF HIV-1<br />
RESISTANT<br />
CONFERRING<br />
MUTATIONS ON<br />
ANTIRETROVIRAL<br />
DRUG RESISTANCE IN<br />
HIV-2<br />
Mon<strong>dr</strong>aya Howard ’13<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Mentor<br />
Louis Mansky, Ph.D.<br />
Pr<strong>of</strong>essor <strong>of</strong> Microbiology and<br />
Diagnostic and Biological<br />
Sciences<br />
<strong>University</strong> <strong>of</strong> Minnesota<br />
41
UST McNair Scholars Program Research Journal<br />
share a 60% homology in the amino acid sequence <strong>of</strong><br />
reverse transcriptase. However, HIV-2 has a lower<br />
transmissibility than HIV-1, which explains the low<br />
prevalence <strong>of</strong> HIV-2 infections outside <strong>of</strong> West Africa<br />
(Schim van der Loeff and Aaby, 1999). Since the discovery<br />
<strong>of</strong> AZT as an antiretroviral <strong>dr</strong>ug against HIV-1, several<br />
<strong>dr</strong>ugs have been developed for use in HIV-1 treatment<br />
(Menendez-Arias, 2002). No treatment has been developed<br />
for HIV-2; management <strong>of</strong> HIV-2 is based on HIV-1<br />
treatment guidelines. Both virus types develop resistance<br />
to <strong>dr</strong>ug therapies, but available data on HIV-2 <strong>dr</strong>ug<br />
resistance is lacking. The present research project will<br />
study factors that influence HIV-1 <strong>dr</strong>ug resistance and<br />
investigate if these factors present the same influence in<br />
HIV-2. Research on HIV-2 <strong>dr</strong>ug resistance is essential to<br />
the development <strong>of</strong> potential treatment options for the<br />
HIV-2 infection.<br />
Drugs currently used to treat HIV inhibit the activity<br />
<strong>of</strong> enzymes that are essential to viral replication.<br />
Monotherapy with antiretroviral <strong>dr</strong>ugs has given way to<br />
combination therapy because acquisition <strong>of</strong> resistance<br />
occurs in HIV (Menendez-Arias, 2002). Highly active<br />
antiretroviral therapy, HAART, combines three or more<br />
<strong>dr</strong>ug classes, usually two reverse transcriptase inhibitors<br />
and a protease inhibitor, to suppress viral replication. The<br />
accumulation <strong>of</strong> mutations that lead to <strong>dr</strong>ug resistance<br />
exacerbates antiretroviral therapy. HIV has a high mutation<br />
rate, 3 x 10 -5 mutations/base pair/cycle for HIV-1, which<br />
introduces one mutation every three genomes produced<br />
(Mansky, 1996; Mansky, 2002). The reverse transcriptase<br />
enzyme is a major generator <strong>of</strong> mutations because it has no<br />
pro<strong>of</strong>reading ability. In normal DNA synthesis, DNA<br />
polymerase pro<strong>of</strong>reads and removes incorrect base pairs or<br />
nucleosides from the growing DNA strand. RT synthesizes<br />
DNA from viral RNA and its polymerase activity is largely<br />
error prone (G<strong>of</strong>f, 1990). This research investigates<br />
mutations that lead to resistance to nucleoside reverse<br />
transcriptase inhibitors (NRTIs), a <strong>dr</strong>ug class that inhibits<br />
RT activity. NRTIs are nucleoside analogs; they are similar<br />
to normal nucleosides and can be incorporated into<br />
growing DNA. However, they act as DNA chain<br />
terminators and inhibit the attachment <strong>of</strong> additional<br />
nucleosides because they lack a 3’OH group in the ribose<br />
ring (Isel, Ehresmann, Walter, Ehresmann & Marquet,<br />
2001; Menendez, 2002). Resistance to NRTIs occurs when<br />
42<br />
RT selects for mutations that prevent the incorporation <strong>of</strong><br />
nucleoside analogs. Antiretroviral <strong>dr</strong>ugs can stimulate <strong>dr</strong>ug<br />
resistance in HIV. <strong>St</strong>udies show that antiretroviral <strong>dr</strong>ugs<br />
influence the mutation frequency <strong>of</strong> HIV-1 (mutation<br />
frequency is correlated to mutation rate and they are <strong>of</strong>ten<br />
used interchangeably). Mansky and Bernard (2002)<br />
investigated the influence <strong>of</strong> the antiretroviral <strong>dr</strong>ugs AZT<br />
and 3TC and AZT- or 3TC-resistant RT on the rate <strong>of</strong><br />
HIV-1 mutation. Results from this study found replication<br />
in the presence <strong>of</strong> either AZT or 3TC increased the HIV-1<br />
mutation rate. AZT resistant variants also increased the<br />
mutation rate. The selection <strong>of</strong> mutations that confer<br />
resistance increases in the presence <strong>of</strong> antiretroviral <strong>dr</strong>ugs,<br />
which allows resistance to occur at a rapid rate.<br />
HIV-1 develops <strong>dr</strong>ug resistance through two mechanism<br />
pathways. In the first pathway, mutations that inhibit RT<br />
from incorporating nucleoside analogs arise. A study by<br />
Sarafianos, Das, Hughes and Arnold (2004) identified<br />
residues, such as K65 and Q151 that play a role in<br />
positioning the incoming nucleoside; mutations at these<br />
residues lead to resistance to NRTIs. In the second<br />
pathway, mutations occur that promote adenosine<br />
triphosphate, ATP, to remove nucleoside analogs from the<br />
blocked DNA (Menendez, 2008). Previous studies have<br />
found that resistance by ATP excision is common in<br />
antiretroviral therapies that include thymidine analog<br />
NRTIs. A study conducted by Isel, Ehresmann, Walter,<br />
Ehresmann and Marquet (2001) found resistance to the<br />
<strong>dr</strong>ug zidovudine (AZT), associated with mutations such as<br />
M41L, D67N, K70R, T215F/Y and K219E/Q, is caused<br />
by selective excision <strong>of</strong> the <strong>dr</strong>ug. In another study, Lin et<br />
al. (1994) found the same set <strong>of</strong> mutations in viral isolates<br />
from patients under stavudine (d4T) therapy. AZT and d4T<br />
are both thymidine analogs, justifying their acquired<br />
mutations as thymidine analog mutations (TAMs). HIV-1<br />
uses one pathway more frequently than the other in the<br />
presence <strong>of</strong> certain NRTIs (Boyer et al., 2006)<br />
HIV-2 appears to acquire resistance by the first pathway<br />
only. Previous studies identified genetic changes<br />
responsible for HIV-2 <strong>dr</strong>ug resistance. These studies, which<br />
sequenced isolates from HIV-2 infected patients under<br />
NRTI therapy, found patients acquired HIV-1 resistance<br />
conferring mutations that correspond to the first resistance<br />
pathway. One trend found observed such studies were the<br />
frequent emergence <strong>of</strong> the K65R and Q151M mutations
Mon<strong>dr</strong>aya Howard<br />
Pharmacy HIV-1 Resistant Conferring Mutations<br />
in HIV-2. A study by Boyer, Sarafianos, Clark, Arnold and<br />
Hughes (2006) found the Q151M to be the primary<br />
mutation associated with AZT therapy. The Q151M<br />
mutation has also been shown to induce resistance to<br />
almost all NRTIs in HIV-1(Rhodes et al., 2000; van der<br />
Ende et al., 2000). Another study conducted by Descamps<br />
et al. (2004) found frequent emergence <strong>of</strong> the K65R<br />
mutation in patients under 3TC therapy. In their study,<br />
Smith et al. (2009) determined that the K65R and Q151M<br />
mutations, together, promote class wide NRTI resistance.<br />
The residues that these mutations take place play a role in<br />
positioning the incoming nucleoside during DNA<br />
synthesis. Resistance with these mutations follows the first<br />
mechanism pathway <strong>of</strong> HIV-1. There was a low prevalence<br />
<strong>of</strong> TAMs in HIV-2 resistance indicating that HIV-2 does<br />
not employ the excision pathway to confer <strong>dr</strong>ug resistance<br />
(Smith et al., 2009; Boyer et al., 2006).<br />
The primary goal <strong>of</strong> this project is to create HIV-2<br />
resistant RT by incorporating HIV-1 resistance conferring<br />
mutations into HIV-2 RT. Drug susceptibility decreases<br />
and mutation frequency increases in the presence <strong>of</strong> HIV-<br />
1 resistant RT. Since HIV-1 and HIV-2 have genetically<br />
and structurally similar RT, I hypothesize that HIV-2<br />
resistant RT will confer resistance to NRTIs and increase<br />
the mutation frequency <strong>of</strong> HIV-2. Mutation frequency <strong>of</strong><br />
HIV-2 was determined by producing the virus in a HIV-<br />
2env- vector containing two marker genes, HSA and GFP,<br />
and using flow cytometer to calculate the percentage <strong>of</strong><br />
cells expressing the marker genes (mutant frequency).<br />
Using site-directed mutagenesis, the Q151M and K65R<br />
mutations will be introduced into HIV-2 RT. Mutant HIV-<br />
2 can be produced and replicated the HIV-2env- vector and<br />
flow cytometry will examine the mutation frequency. Drug<br />
susceptibility will be observed by replicating HIV-2<br />
resistant RT in presence <strong>of</strong> NRTIs. Research on the HIV-<br />
2 infection is limited to a handful <strong>of</strong> studies because <strong>of</strong> the<br />
restricted spread <strong>of</strong> the virus. This research provides a<br />
better understanding <strong>of</strong> HIV-2 <strong>dr</strong>ug resistance and can<br />
contribute to development <strong>of</strong> potential treatment options<br />
for HIV-2.<br />
MATERIALS AND METHODS<br />
CELL LINES AND PLASMIDS.<br />
HIV-2ROD viral DNA was obtained from the Mansky<br />
Lab, Institute <strong>of</strong> Molecular Virology (<strong>University</strong> <strong>of</strong><br />
Minnesota). The 293T cell line was obtained from the<br />
American Type Culture Collection. Antibody to mouse<br />
heat-stable antigen protein (HSA) was purchased from BD<br />
Pharmingen (San Diego, CA). The Purelink Quick Plasmid<br />
miniprep kit was obtained from Invitrogen (Grand Island,<br />
NY). HIV-2env- vector was obtained from Hu Wei-Shau.<br />
pIRES2-EGFP was obtained from Clontech (Mountain<br />
View, CA). Restriction enzymes were purchased from New<br />
England Biolabs (Ipswich, MA). The pCR-18S plasmid<br />
was a gift from Mauro Magnani (Universita’ Degli <strong>St</strong>udi<br />
Di Urbino).<br />
CONSTRUCTION OF THE HIV-2 VECTOR FOR MUTATION<br />
DETECTION.<br />
HIV-2 vector (obtained from Wei Shau) was modified<br />
by restoring the gfp and HIV-2 vpr genes via site-directed<br />
mutagenesis. The vector contains the gene for HSA as well<br />
as a frame-shift mutation at the 5’end <strong>of</strong> env, which limits<br />
the virus to one round <strong>of</strong> replication. The internal ribosome<br />
entry site (IRES)-green fluorescent protein (GFP) fragment<br />
was PCR amplified from pIRES2-EGFP and subcloned<br />
into pCR2.1. This plasmid, as well as HIV-2env- was<br />
restriction digested with XhoI. Following purification,<br />
HIV-2env- and the IRES-enhanced GFP (EGFP) fragments<br />
were ligated and then transformed using DH5α cells.<br />
Restriction digestion and DNA sequencing analysis was<br />
used to verify the clones.<br />
TRANSFECTION OF 293T CELLS<br />
293T cells were maintained in Dulbecco’s modified<br />
Eagle’s medium (DMEM) containing 10% fetal clone 3<br />
(FC3) serum (HyClone, Logan, UT) and penicillin/<br />
streptomycin at 37°C in 5% CO2. 293T cells were plated<br />
on poly-L-lysine- coated 10-cm culture dishes 24 h before<br />
transfection. The cells were then transfected by calcium<br />
phosphate coprecipitation with 10m g <strong>of</strong> the HIV-2 vector<br />
(HIG) and 1m g <strong>of</strong> a plasmid encoding the HIV envelope,<br />
VSVG. The medium was replaced with 6 ml <strong>of</strong> DMEM<br />
containing 10% FC3 serum and penicillin/streptomycin<br />
43
UST McNair Scholars Program Research Journal<br />
24 h after transfection. Virus was harvested 24 h later by<br />
filtration <strong>of</strong> the cell supernatant through a 0.2-mm filter.<br />
INFECTION OF TARGET CELLS AND FLOW CYTOMETRY<br />
U373-MAGI-CXCR4C E M cells, maintained at 37°C<br />
in 5% CO2 in selection medium composed <strong>of</strong> DMEM with<br />
10% FC3 serum, 1 mg/ml puromycin, 0.1 mg/ml<br />
hygromycin, and 0.2 mg/ml neomycin, were plated in a<br />
12-well culture dish 24 h prior to infection. After<br />
pretreatment, the viral stock (500 ml) was added to each<br />
well. Cells were harvested for analysis 48 h after infection.<br />
Cells were then analyzed for fluorescence at 488 nm and<br />
568 nm. Qua<strong>dr</strong>ants were <strong>dr</strong>awn using non-infected cells<br />
to determine background levels <strong>of</strong> fluorescence. Cells<br />
expressing both HSA and GFP were used to determine the<br />
percentage <strong>of</strong> infected cells.<br />
Replication assay protocol was adapted from Mansky,<br />
Pearl and Gajary (2006).<br />
FIG. 1 (Adapted from Clouser, Patterson and Mansky, 2010)<br />
Single round replication assay use to assess mutation frequency.<br />
HIV-2 virus is produce in 293T cells by transfection <strong>of</strong> two<br />
plasmid constructs: the HIV-2 envelope-deficient vector contains<br />
two marker genes that are used to measure mutation frequency.<br />
The second plasmid encodes for HIV envelope. After<br />
transfection, the supernatant containing virus is collected and<br />
added to target cells. Cells are harvested after infection and flow<br />
cytometry is used to examine expression <strong>of</strong> marker genes.<br />
RESULTS<br />
Resistance conferring mutations have been shown to<br />
increase mutation rate <strong>of</strong> HIV-1. Since HIV-1 and HIV-2<br />
have similar reverse transcriptase, we asked if HIV-2<br />
resistant RT would influence the mutation rate <strong>of</strong> HIV-2.<br />
Mutation rate determines how many mutations are<br />
occurring per replication cycle and contributes to the<br />
emergence <strong>of</strong> <strong>dr</strong>ug resistance in HIV. To examine mutation<br />
44<br />
frequency, we used an assay that detects HIV-infection<br />
through the expression <strong>of</strong> two marker genes, HAS and<br />
GFP. The assay, Fig 1, uses a HIV-2 vector construct with<br />
a mutated Env gene, which limits the virus on replication<br />
cycle. 93T cells are used to produce the virus, which is used<br />
to infect target cells, U373-MAGI-CXCR4C E M cells.<br />
The expression <strong>of</strong> target genes is assessed by flow cytometry<br />
to determine mutation frequency.<br />
The two target genes, HSA and GFP, were used to<br />
simultaneously detect HIV infectivity and mutation<br />
frequency. To determine mutation frequency, the flow data<br />
were divided into four qua<strong>dr</strong>ants based on the expression<br />
<strong>of</strong> GFP and/or HAS (Fig 2). Cells infected with the wildtype<br />
HIV-2 construct were expected to express both GFP<br />
and HSA, whereas cells infected with a mutant HIV-2<br />
construct express either one or no marker gene. Cells that<br />
express only one marker gene have been infected with<br />
mutant HIV-2 that inhibits the expression <strong>of</strong> the other<br />
marker gene. Therefore, cells infected with mutant HIV<br />
were detected as cells expressing either HSA or GFP, but<br />
not both. The relative mutation frequency was then<br />
calculated as a fraction by dividing the percentage <strong>of</strong> cells<br />
infected with mutant virus by the total percentage <strong>of</strong> cells<br />
infected. Results shown in Table 1 demonstrate that HIV-<br />
2 had an average mutant frequency <strong>of</strong> 0.239 ± 0.041 in<br />
the first replication assay. Table 2 shows that HIV-2<br />
produced an average mutant frequency <strong>of</strong> 0.273 ± 0.033<br />
in a second replication assay. Once HIV-2Q151M mutants<br />
are generated, we can produce a HIV-2 resistant virus and<br />
repeat replication assay protocol to observe if resistanceconferring<br />
mutations influence HIV-2 mutation frequency.<br />
a)
Mon<strong>dr</strong>aya Howard<br />
Pharmacy HIV-1 Resistant Conferring Mutations<br />
b)<br />
FIG. 2. Flow data <strong>of</strong> single round replication assay use to assess<br />
the mutation frequency. (a) Flow data from 1 st replicate. (b) Flow<br />
data from 2 nd replicate Flow data were divided into 4 qua<strong>dr</strong>ants<br />
based on expression <strong>of</strong> HSA and GFP genes. Mutation frequency<br />
was calculated by dividing the number <strong>of</strong> cells infected with<br />
mutant virus (Q4) by the total number <strong>of</strong> infected cells (Q1-<br />
Q13). Values from this calculation expressed the mutation<br />
frequency in each replicate (Table 1, 2).<br />
HIV-<br />
2Replicate<br />
1 st<br />
replicate<br />
2 nd<br />
replicate<br />
Table 1. Summary <strong>of</strong> infection percentage and mutant frequency<br />
from flow cytometry data<br />
DISCUSSION<br />
Average %<br />
infection<br />
(n=3) ± sd<br />
Average mutant<br />
frequency<br />
(n=3)± sd<br />
χ 2<br />
(df = 1) p-value<br />
19.6 ±4.1 0.239 ±0.041 12.52 0.0004<br />
12.0 ± 2.9 0.273 ±0.033 65.02
UST McNair Scholars Program Research Journal<br />
Mansky, L., Pearl, D., and Gajary, L., (2002). Combination <strong>of</strong><br />
Drugs and Drug-Resistant Reverse Transcriptase Results in<br />
a Multiplicative Increase <strong>of</strong> Human Immunodeficiency Virus<br />
Type 1 Mutant Frequency. The Journal <strong>of</strong> Virology, 76(18),<br />
9253-59.<br />
Menendez-Arias, L. (2002). Targeting HIV: antiretroviral<br />
therapy and development <strong>of</strong> <strong>dr</strong>ug resistance. TRENDS in<br />
Pharmacological Sciences. 23 (8), 381-387.<br />
Menendez- Arias, L. (2008). Mechanisms <strong>of</strong> resistance to<br />
nucleoside analogue inhibitors <strong>of</strong> HIV-1 reverse transcriptase.<br />
Virus Research, 134, 124-146.<br />
Rhodes, B., Holguin, A., Soriano, V., Dourana, M., Mansinho,<br />
K., Antunes, F., and Gonazalez, J. (2000). Emergence <strong>of</strong><br />
Drug Resistance Mutations in Human Immunodeficiency<br />
Virus Type 2- Infected Subjects Undergoing Antiretroviral<br />
Therapy. Journal <strong>of</strong> Clinical Microbiology, 38: 1370-74.<br />
Sarafianos, S., Das, K., Hughes, S., and Arnold, E. (2004).<br />
Taking Aim at a Moving Target: Designing Drugs to Inhibit<br />
Drug- Resistant HIV-1 Reverse Transcriptases. Current<br />
Opinion in <strong>St</strong>ructural Biology, 14: 716-30.<br />
Smith, R., Gottlieb, G., Anderson, D., Pyrak, C., and Preston,<br />
B. (2008). Human Immunodeficiency Virus Types 1 and 2<br />
Comparable Sensitivities to Zidovudine and Other<br />
Nucleoside Analog Inhibitors In Vitro. Antimicrobial<br />
Agents and Chemotherapy, 52: 329-32<br />
Smith, R., Anderson, D., Pyrak, C., Preston, B., and Gottlieb,<br />
G. (2009). Antiretroviral Drug Resistance in HIV-2: Three<br />
Amino Acid Changes Are Sufficient for Classwide Nucleoside<br />
Analogue Resistance. The Journal <strong>of</strong> Infectious Diseases. 199,<br />
1323-1326.<br />
Tavassoli, A. (2011). Targeting the protein- protein interactions<br />
<strong>of</strong> the HIV Lifecycle. Chemical Society Reviews, 40, 1337-1346<br />
Van der Ende, M., Guillon, C., Boers, P., Ly, T., Gruters, R.,<br />
Osterhaus, A., and Schutten, M. (2000). Antiviral Resistance<br />
<strong>of</strong> Biologic HIV-2 Clones obtained from Individuals on<br />
Nucleoside Reverse Transcriptase Inhibitor Therapy. Journal<br />
<strong>of</strong> Acquired Immune Deficiency Syn<strong>dr</strong>omes (JAIDS). 25. 11-18.<br />
46
ABSTRACT<br />
Food waste in the United <strong>St</strong>ates is contributing to serious environmental, economic, and<br />
social distress. Individual consumers have the potential to combat food waste through a<br />
variety <strong>of</strong> simple mitigation practices. An important unanswered question is what would<br />
motivate Americans to waste less food. The current research adapted methods used by<br />
Nolan et al. to explore stated motivations for conserving energy. As in the Nolan et al.<br />
study, we presented 239 participants with either an information-only message or one <strong>of</strong><br />
four messages describing a reason to reduce food waste: environmental, financial self<br />
interest, social responsibility, and descriptive social norm. In addition, we tested whether<br />
the addition <strong>of</strong> a striking image <strong>of</strong> food waste made the message more motivating.<br />
Different from the case <strong>of</strong> energy conservation, our participants reported that the financial<br />
self-interest message was most motivating. However, the result <strong>of</strong> this study demonstrated<br />
that participants expressed similar motivations to reduce food waste as they did to conserve<br />
energy. Future research will examine whether a further pattern found in energy<br />
conservation also holds true for reducing food waste: that though people do not express<br />
explicit motivation from a social norm message, it has the highest influence on actual<br />
behavior.<br />
America is a nation that throws away almost half <strong>of</strong> its food (<strong>St</strong>uart, 2009).<br />
This enormous amount <strong>of</strong> food waste endangers the environment, the economy,<br />
and society. One <strong>of</strong> the most severe environmental problems with food waste<br />
is the fact that food waste in landfills is one <strong>of</strong> the leading sources <strong>of</strong> methane,<br />
a harmful greenhouse gas contributing to global warming. From an economic<br />
standpoint, many Americans cannot financially afford to waste money during<br />
a recession, yet spend money on food that ultimately gets thrown into the<br />
garbage. Finally, food waste is a social problem: How is it that in a country<br />
concerned with nationwide obesity, millions go without being able to eat each<br />
day? The United <strong>St</strong>ates’ food waste habits are contradictory to its goals <strong>of</strong><br />
protecting the environment, gaining financial stability, and being a responsible<br />
society.<br />
BLOOM’S THREE: WHY FOOD WASTE MATTERS<br />
Food waste is pervasive in America, and occurs at all stages <strong>of</strong> American<br />
food production and consumption. In his book American Wasteland, Jonathan<br />
Bloom (2010) explains how food is wasted throughout the agricultural process,<br />
beginning at the farm and ending with consumers. First, harvesters must pick<br />
through their crops and select only the best produce to sell to markets. The<br />
remaining crops are <strong>of</strong>ten hauled <strong>of</strong>f to landfills where the potentially edible<br />
food is dumped and left to rot. The long travel period <strong>of</strong> most produce leads<br />
to more food waste. By the time the produce reaches the market, grocers must<br />
perform another pick through and discard produce that does not meet their<br />
premium standards. Finally, consumers purchase fruits and vegetables, use a<br />
portion <strong>of</strong> what is purchased, and throw away what goes bad, what is not<br />
wanted, or both. Considering only what is thrown away at home, an average<br />
American wastes an annual total <strong>of</strong> 197 pounds <strong>of</strong> food, about the weight <strong>of</strong><br />
WASTE(LESS): A<br />
PSYCHOLOGICAL<br />
APPROACH TOWARD<br />
REDUCING FOOD<br />
WASTE<br />
Bridgette Kelly ’12<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Mentor<br />
Christie Manning, Ph.D.<br />
Visiting Assistant Pr<strong>of</strong>essor <strong>of</strong><br />
Environmental Psychology<br />
Macalester College<br />
47
UST McNair Scholars Program Research Journal<br />
an average American man (Center for Disease Control and<br />
Prevention, as cited in Bloom).<br />
Bloom highlights three compelling reasons why<br />
Americans should care about food waste:<br />
Environmental Impact The majority <strong>of</strong> food being thrown<br />
away is not recycled or recovered, meaning the majority <strong>of</strong><br />
food waste ends up in landfills (Environmental Protection<br />
Agency [EPA], 2011). When food decomposes in landfills<br />
it creates methane, a harmful greenhouse gas. Methane<br />
traps heat more effectively than carbon dioxide, meaning<br />
methane emissions may contribute to global warming even<br />
decades from now (Bloom, 2010). Multiple EPA reports<br />
detail alarming facts about the consequences related to<br />
these landfills. In 2007, the EPA reported food scraps to<br />
account for 19 percent <strong>of</strong> the waste Americans dumped<br />
into landfills, making it the second most disposed item in<br />
landfills behind paper waste (as cited by Bloom). The most<br />
current information identifies landfills as a leading source<br />
<strong>of</strong> human related methane emissions in the United <strong>St</strong>ates<br />
(EPA, 2011). There are also concerns regarding the<br />
potential for landfill toxins to leach into surrounding<br />
bodies <strong>of</strong> water, which would pollute the <strong>dr</strong>inking supply<br />
<strong>of</strong> nearby inhabitants (Bloom). Reducing food wasted in<br />
America is one way to combat global warming and<br />
environmental degradation.<br />
Economic Significance Wasting food translates to wasting<br />
money. With a family <strong>of</strong> four discarding an estimated 15-<br />
25 percent <strong>of</strong> the food purchased each year, financial losses<br />
are estimated to be between $1,350 and $2,200 (Bloom,<br />
2010). American consumers are also paying an increased<br />
price for food wasted throughout the food chain, as it is<br />
built into the price <strong>of</strong> our groceries. Farmers produce the<br />
amount <strong>of</strong> crops necessary to supply the amount <strong>of</strong> food<br />
demanded by consumers. The more food wasted by<br />
consumers, the higher the demand for more food to be<br />
supplied. Our current agricultural system is mostly<br />
dependent upon expensive technology, such as pesticides,<br />
which is predicted to <strong>dr</strong>ive up the price <strong>of</strong> all produce<br />
(USDA, 2010). Cutting down on the amount <strong>of</strong> food our<br />
country grows each year would lead to reducing the<br />
amount <strong>of</strong> money needed to produce it. One calculation<br />
estimated a rough total annual cost in the United <strong>St</strong>ates to<br />
be $160 billion in squandered food costs (Bloom, 2010).<br />
This cost for Americans should encourage waste avoidance.<br />
The amount <strong>of</strong> money being lost due to squandered food<br />
48<br />
is shocking, but it is also preventable if consumers change<br />
their wasteful habits.<br />
Societal Dilemma In a country where virtually half <strong>of</strong> the<br />
food being produced is wasted, there are still 35 million<br />
Americans living in households without sufficient food<br />
access (<strong>St</strong>uart, 2009). In 2008, 15 percent <strong>of</strong> Americans<br />
did not have enough to eat at some point in the year and<br />
22 percent <strong>of</strong> chil<strong>dr</strong>en in America lived in homes lacking<br />
food security (Bloom, 2010). Both food waste and food<br />
insecurity exist within the United <strong>St</strong>ates, one <strong>of</strong> the<br />
wealthiest countries in the world. Part <strong>of</strong> the problem is<br />
the unequal distribution <strong>of</strong> resources. Recovering a portion<br />
<strong>of</strong> the food wasted in this country could potentially feed<br />
millions <strong>of</strong> Americans (EPA, 2011).<br />
These three reasons alone should provide strong<br />
motivation for Americans to change their food wasting<br />
ways. <strong>St</strong>rong efforts to mitigate food waste in the United<br />
<strong>St</strong>ates must occur now. Consumers have the ability to<br />
reduce food wasted in their households even though food<br />
wasted during agricultural production, transport, and<br />
processing is outside <strong>of</strong> their control. Currently, though<br />
most American households throw away a substantial<br />
amount <strong>of</strong> food that could have been eaten, most do not<br />
recognize it as a major problem or feel the need to ad<strong>dr</strong>ess<br />
it. How can the issue <strong>of</strong> food waste be brought to American<br />
households’ attention and create a national effort toward<br />
reducing food waste? How can the problem be<br />
communicated in a way that will provoke Americans to<br />
take action?<br />
Successful efforts to reduce food waste have been made<br />
in other countries. For example, the Japanese government<br />
passed the Food Waste Recycling Law in 2001 which<br />
demanded food businesses to recycle 48 percent <strong>of</strong> their<br />
food waste by 2006, which resulted in 59 percent<br />
commercial and industrial food waste recycling (<strong>St</strong>uart,<br />
2009). This law has since been revised with a goal for<br />
businesses to reach a recycling rate <strong>of</strong> 66 percent by 2012<br />
(<strong>St</strong>uart). Japan provides an example <strong>of</strong> how the government<br />
is able to take an effective role in reducing national food<br />
waste.<br />
The UK has become another example <strong>of</strong> a country<br />
dedicated to reducing its national food waste. Campaigns<br />
such as Love Food, Hate Waste (LFHW) have<br />
demonstrated success in aiding individuals to reduce their<br />
food waste (www.lovefoodhatewaste.com/). The LFHW
Bridgette Kelly<br />
Environmental Sciences Reducing food waste<br />
campaign was created to raise awareness about the issue <strong>of</strong><br />
food waste and reduce the amount <strong>of</strong> household food waste.<br />
The Charter Institute <strong>of</strong> Waste Management (CIWM)<br />
reported the two year LFHW campaign resulted in a<br />
significant increase in the number <strong>of</strong> Manchester residents<br />
taking action to reduce their food waste by 48.5 percent as<br />
well as a 509 percent increase in traffic to the LFHW<br />
website (CIWM, 2011). The website contains helpful<br />
information regarding how to store food so it lasts longer,<br />
ways to creatively use last night’s leftovers, and tips for<br />
saving money on food bills. The amount <strong>of</strong> food wasted in<br />
America would decrease if more <strong>of</strong> its citizens adopted<br />
these simple behaviors. What would motivate Americans<br />
to take this sort <strong>of</strong> action?<br />
MOTIVATION<br />
Almost every model for green behavior, those which<br />
benefit the environment, includes an element <strong>of</strong><br />
motivation. <strong>St</strong>ern (2000) developed the Value-Belief-Norm<br />
theory <strong>of</strong> environmentalism (VBN) in order to explain how<br />
one’s motivations affect environmentally significant<br />
behaviors. Environmentally significant behaviors can be<br />
defined as actions with the intention <strong>of</strong> benefitting the<br />
environment. VBN suggests that values and beliefs are<br />
important in determining behavior. For example, if a<br />
person values the environment, and believes food waste<br />
harms the environment, then the individual will be more<br />
motivated to change his behavior around food waste.<br />
Furthermore, VBN suggests one’s personal and social<br />
norms have a significant effect on motivation. Similarly,<br />
the theory <strong>of</strong> planned behavior identifies intention as the<br />
central element used to predict behavior (Azjen, 1985).<br />
Motivational factors <strong>dr</strong>ive intention and determine the<br />
extent to which someone is willing to act. Clayton and<br />
Brook (2005) have proposed a model for conservation<br />
psychology that suggests personal motives are an important<br />
element in ad<strong>dr</strong>essing environmental problems. Since<br />
personal motives are one <strong>of</strong> the <strong>dr</strong>ivers <strong>of</strong> behavior,<br />
environmental issues are framed to reflect relevance to an<br />
individual’s personal motives in hopes <strong>of</strong> increasing proenvironmental<br />
behaviors. Understanding which<br />
motivations are the most influential on behaviors allows<br />
policy makers, government organizations, and individuals<br />
to promote pro-environmental information to the public<br />
in a way that will elicit increased compliance.<br />
What would motivate the American public to reduce<br />
food waste? According to Bloom (2010), there are three<br />
important reasons why food waste should be decreased:<br />
environment, economy, and social justice. However, do<br />
these reasons motivate people to reduce the amount <strong>of</strong> food<br />
they waste? Past research examining motivation to conserve<br />
energy confirms people do consider these three reasons<br />
(environment, economy, and social justice) to be<br />
motivating. Nolan, Schultz, Cialdini, Goldstein, and<br />
Griskevicius (2008) asked participants to rate how<br />
important it was that using less energy protected the<br />
environment, saved money, benefited society, and mirrored<br />
many other people trying to conserve on a scale from 1 (not<br />
at all important) to 4 (extremely important). Participants<br />
rated environmental protection highest among the four<br />
reasons to conserve energy followed by benefitting society<br />
and saving money. Interestingly these highest three rated<br />
reasons for energy conservation align with the reasons for<br />
why people should care about food waste. The findings<br />
from this study demonstrate an experimental framework<br />
that can be used to ad<strong>dr</strong>ess the issue <strong>of</strong> food waste.<br />
While the environment, finances, and social<br />
responsibility may be motivating for some, research in<br />
social psychology has identified a more powerful motivator<br />
for green behaviors: the social norm. Social norms are the<br />
stated or implied rules society has for acceptable behaviors<br />
(Aronson, Wilson, Akert, 2010). If green behaviors are seen<br />
as acceptable or encouraged by society, then people are<br />
more likely to perform the behavior.<br />
Assessing one’s own behaviors based on the behaviors <strong>of</strong><br />
others is a form <strong>of</strong> social pro<strong>of</strong>ing. The Principle <strong>of</strong> Social<br />
Pro<strong>of</strong> states people look at what others around them believe<br />
and do in order to decide what they should believe or do<br />
and has been noted as a main factor for influencing<br />
behaviors among individuals (Cialdini, 2009).<br />
In fact, in the Nolan et al. study (2008), while<br />
participants rated “a lot <strong>of</strong> other people conserving” (p.915)<br />
as the least influential motive out <strong>of</strong> the four, a follow-up<br />
analysis determined individuals’ conservation behaviors<br />
showed the strongest correlation with their beliefs<br />
regarding their neighbors’ conservation efforts. These<br />
findings suggest that beliefs about the standards performed<br />
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and held by others, social norms, are especially motivating<br />
to our own behaviors.<br />
People are more likely to engage in a behavior if they<br />
perceive many others in the same situation behave a certain<br />
way (Cialdini, 2009). In a second study conducted by<br />
Nolan and colleagues (2008), an experimental design was<br />
used to determine which forms <strong>of</strong> motivational messages<br />
were most effective to actually reducing participants’ home<br />
energy use. The households received either a self-serving<br />
(financial), environmental, social responsibility (ethical),<br />
information only (control), or descriptive normative<br />
message. The descriptive normative messages informed<br />
households that the majority <strong>of</strong> neighborhood residents<br />
were making an effort to conserve energy in some way.<br />
Meter readings were used to measure the energy used by<br />
the households. Over the next month, the households that<br />
received the descriptive norm messages used less energy<br />
than all <strong>of</strong> the households in other conditions combined.<br />
These findings provide strong evidence for the effectiveness<br />
<strong>of</strong> normative messages on changing people’s behaviors.<br />
Other research has also found social norms and<br />
normative pressure to be effective in promoting proenvironmental<br />
behavior change. Griskevicius, Tybur, &<br />
Van (2010) found consumers purchased “green” products<br />
more <strong>of</strong>ten when in public than when in private,<br />
suggesting that for many people green consumption is<br />
done more for public acceptance than as an altruistic act<br />
on the behalf <strong>of</strong> the environment. In another study,<br />
conducted by Schultz (1999), descriptive normative<br />
information, how we believe most people behave in a<br />
situation, was the most powerful influence on people’s<br />
behavior. The study found that when information was<br />
given to households regarding the amount recycled by a<br />
neighborhood family, the amount and frequency <strong>of</strong><br />
curbside recycling behaviors <strong>of</strong> other neighbors increased.<br />
Finally, a study by Goldstein, Cialdini, and Griskevicius<br />
(2008) found that hotel guests reused their towels 23<br />
percent more when normative messages were displayed in<br />
the bathroom promoting towel reuse compared to when no<br />
message was present. These results demonstrate that people<br />
are motivated to change their behaviors when they are<br />
influenced by normative information.<br />
It appears that social norms and normative messages can<br />
influence a range <strong>of</strong> “green” behaviors, however, no study<br />
to date has ad<strong>dr</strong>essed whether normative information<br />
50<br />
might motivate people to reduce their food waste. There<br />
are strong social, environmental, and economic reasons why<br />
people should be motivated to waste less food. Are these<br />
reasons strong enough? In the Nolan et al. study (2008),<br />
the social, environmental, and economic reasons for<br />
conserving energy were <strong>of</strong>ten cited, but in fact a normative<br />
message about energy conservation was the most influential<br />
when it came to actual behavior. Is it possible that the same<br />
is true for the issue <strong>of</strong> food waste? The current study is a<br />
partial replication <strong>of</strong> the second Nolan et al. study to<br />
examine motivations for reducing food waste. We<br />
hypothesized, following Nolan et al.’s results, normative<br />
messages regarding food waste would be rated as the least<br />
motivational and the environmental and social<br />
responsibility messages would be rated as the most<br />
motivational.<br />
PSYCHOLOGICAL DISTANCE<br />
The current study is based on prior research by Nolan<br />
and colleagues’ (2008) investigation into motivations to<br />
conserve energy. Nolan et al. used a single item dependent<br />
variable asking people how motivated they were by the<br />
particular energy conservation message they had received.<br />
The current study includes this item but also includes two<br />
additional measures: salience and abstraction.<br />
A 19-item scale that assesses personal engage -<br />
ment/salience regarding food waste and institutional<br />
affiliation was included in the survey. Food waste is an issue<br />
that may not seem relevant to the American public. Food<br />
waste does not present a direct threat like war, weather, or<br />
a faltering economy. Thus, it is not an issue people think<br />
much about. By measuring personal salience, we can see<br />
whether messages about food waste make the issue more<br />
relevant and psychologically present.<br />
People do not see polluting landfills, starving people,<br />
or wasted money as a result when they throw away food.<br />
Thus, the idea <strong>of</strong> wasted food being a problem remains<br />
abstract. An abstract problem is not as emotionally<br />
engaging and is less likely to result in action (Marx, Weber,<br />
Orlove, Leiserowitz, Krantz, Roncoli & Phillips, 2007) A<br />
scene becomes less abstract when individuals are presented<br />
with a visual representation <strong>of</strong> the scene (Henderson,<br />
2005). Therefore, a second variable tested in this study was
Bridgette Kelly<br />
Environmental Sciences Reducing food waste<br />
the effect <strong>of</strong> an image <strong>of</strong> food waste. We hypothesized<br />
presenting participants with a picture <strong>of</strong> wasted food would<br />
make the issue less abstract, more concrete, and more<br />
personally engaging and salient than if they did not have<br />
a visual representation <strong>of</strong> food waste. Thus, participants<br />
presented with a message including a scene <strong>of</strong> food waste<br />
should report being more motivated to reduce their food<br />
waste than those presented with messages not including<br />
the picture.<br />
MITIGATING COLLEGE CAMPUS FOOD WASTE<br />
Relatively little research has been done on food waste in<br />
the U.S., but the issue is gaining the attention <strong>of</strong> certain<br />
thoughtful, young activists throughout the nation. The<br />
current study was conducted on a college campus. Though<br />
food waste is not an issue that has gained much attention<br />
in households in the U.S., there has been a growing<br />
movement to reduce food waste on college campuses (G.J.,<br />
2005; Hattam, 2007; Sullivan, 2010). Efforts include<br />
promotional campaigns geared at reducing food waste,<br />
removing trays in the cafeterias to lessen the amount <strong>of</strong><br />
food taken by students, and displaying a day’s worth <strong>of</strong><br />
cafeteria food waste to show students how much they are<br />
wasting.<br />
College is a time in life when young adults have new<br />
experiences in ambiguous situations. People most <strong>of</strong>ten<br />
look at others around them when deciding how to behave<br />
in ambiguous situations, especially when they feel those<br />
people share similarities with them (Cialdini, 2007). The<br />
college atmosphere fosters both <strong>of</strong> these elements, thus<br />
looking to others to provide information on how to<br />
properly behave will <strong>of</strong>ten be employed during college.<br />
<strong>St</strong>udents form lifestyle habits that will predict their future<br />
behaviors (Neal, Wood, & Quinn, 2006), making it<br />
important to mitigate their food waste habits as early as<br />
possible. Furthermore, younger generations have been<br />
reported to be less involved in pro-environmental behaviors<br />
(i.e. energy conservation) than older generations (Nolan,<br />
Schultz, Cialdini, Goldstein, and Griskevicius; 2008),<br />
making it even more important to investigate college<br />
students’ motivations to reduce food waste.<br />
The proactive role taken by college students about the<br />
issue <strong>of</strong> food waste suggests there is already an infra -<br />
structure in place. This provides an opportunity to increase<br />
involvement in reducing food waste through under -<br />
standing attitudes, current behaviors, and motivations to<br />
reduce food waste stated by students. These young adults<br />
may eventually become the leaders, decision makers, and<br />
work force in the U.S. Knowing how to captivate this<br />
audience to reduce the amount <strong>of</strong> food they waste would<br />
be a pivotal step toward a waste(less) society in the future.<br />
This project endeavored to find effective ways <strong>of</strong><br />
communicating the food waste issue to the public. This<br />
project sought to do three things: 1) Identify which<br />
messages college students rate as the most motivating to<br />
reduce their food waste, 2) Determine whether a picture <strong>of</strong><br />
food waste affects reported motivations to reduce food<br />
waste, and 3) Determine whether personal relevance <strong>of</strong> a<br />
message is correlated with participants’ rated motivation.<br />
METHOD<br />
INFORMAL STUDENT POLL<br />
The researcher first conducted an informal poll <strong>of</strong> 20<br />
undergraduate students from the <strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
and Macalester College. The participants were contacted<br />
via a facebook message. The message informed students<br />
that participation in the poll was voluntary, answers would<br />
remain anonymous, and the purpose <strong>of</strong> the poll was to<br />
provide the researcher with information regarding<br />
students’ current efforts to reduce food waste. Participants<br />
were then directed to a Qualtrics survey link that asked<br />
“Do you try not to leave uneaten food on your tray when<br />
you bring it to the dish room in order to reduce the amount<br />
<strong>of</strong> food you waste?” The participants answered either “yes”<br />
or “no.” The percentage <strong>of</strong> students that answered “yes”<br />
served as a statistic utilized in the descriptive norm<br />
intervention during the study.<br />
INTERVENTION AND PSYCHOLOGICAL DISTANCE SURVEY<br />
Participants Undergraduate students at the <strong>University</strong> <strong>of</strong><br />
<strong>St</strong>. <strong>Thomas</strong>, Minnesota volunteered to participate in this<br />
study. No particular age, gender, or ethnicity was targeted<br />
for this study. <strong>St</strong>udents were recruited through a variety <strong>of</strong><br />
methods. A posting in the campus’s daily online bulletin<br />
advertised the study, listed the researcher’s contact<br />
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information, and provided a link to the online survey.<br />
Posting the study in the daily online bulletin allowed the<br />
researcher to contact students not on campus during the<br />
summer session. Paper posters were placed near campus<br />
dining halls, student centers, and residence halls. Finally,<br />
the researcher created a facebook invitation to recruit<br />
volunteers for the anonymous online survey. Each <strong>of</strong> the<br />
recruitment methods informed students <strong>of</strong> a <strong>dr</strong>awing for<br />
two $25 gift cards to the campus bookstore upon<br />
completion <strong>of</strong> the survey.<br />
MATERIALS AND PROCEDURE<br />
The study methods were adapted from procedures used<br />
by Nolan and colleagues (2008) in their experiment (<strong>St</strong>udy<br />
2) examining California residents’ motivations to conserve<br />
energy. Qualtrics Survey S<strong>of</strong>tware hosted the online survey.<br />
Participants logged on and were presented with a consent<br />
form that included the purpose <strong>of</strong> the study, contact<br />
information <strong>of</strong> the researcher, and the option to with<strong>dr</strong>aw<br />
from the study at any point. After indicating their consent<br />
to participate, students were randomly assigned to an<br />
experimental condition in which they were presented with<br />
a scenario and then asked to answer a set <strong>of</strong> questions. The<br />
study used a 2x5 factorial design. The first independent<br />
variable, with two levels, was the presence or absence <strong>of</strong> an<br />
image accompanying the text scenario. The second<br />
independent variable was the type <strong>of</strong> message. There were<br />
five message conditions, each presenting a different reason<br />
for reducing wasted food: descriptive norm, self interest<br />
(economic), environment, social responsibility, or<br />
informational control. All message conditions except the<br />
information only conditions contained motivational<br />
information as to why the student should reduce the<br />
amount <strong>of</strong> food they waste. In addition to varying the<br />
message, half <strong>of</strong> the participants were shown a picture <strong>of</strong><br />
food waste in a cafeteria setting, while the other half<br />
received no picture along with the message (see Figure 1).<br />
Each participant was then asked “How much did the<br />
information provided motivate you to reduce the amount<br />
<strong>of</strong> food you waste?” They then responded to a series <strong>of</strong><br />
statements to assess their perceived psychological distance<br />
to the issue <strong>of</strong> food waste. The set <strong>of</strong> 19 statements<br />
described their personal reactions to the idea <strong>of</strong> food wasted<br />
on campus and students indicated their level <strong>of</strong> agreement<br />
with each one. As part <strong>of</strong> the personal reactions measure,<br />
52<br />
participants then were asked to write-in three words that<br />
came to mind when they thought <strong>of</strong> food waste. Finally,<br />
the survey concluded with a demographic section to give a<br />
general picture <strong>of</strong> who took the survey. When participants<br />
reached the end <strong>of</strong> the survey, they read a message thanking<br />
them for their participation and were shown a debriefing<br />
page.<br />
RESULTS<br />
These preliminary results are based on 239 responses.<br />
Participants were asked “How much did the information<br />
in this message motivate you to reduce food waste on<br />
campus?” with responses ranging from 1 (not at all) to 4<br />
(extremely). Participants rated the environmental message<br />
(M = 2.35, SD = .80) as the most motivational for<br />
conditions with no picture present, followed by the<br />
financial self interest message (M = 2.29, SD = .64) and<br />
the social responsibility message (M = 2.25, SD = .55).<br />
The descriptive social norm message (M = 2.05, SD = .80),<br />
and the informational control message (M = 1.95, SD =<br />
.70) were rated as the least motivational by participants for<br />
conditions with no picture present.<br />
Participants rated the financial message (M = 2.62, SD<br />
= .88) as the most motivational for conditions with a<br />
picture present, followed by the social responsibility<br />
message (M = 2.56, SD = .77) and the environmental<br />
message (M = 2.25, SD = .99). Once again, the descriptive<br />
social norm message (M = 2.16, SD = .69) and the<br />
informational control message (M = 1.96, SD = .82) were<br />
rated as the least motivational by participants for<br />
conditions with a picture present.<br />
Overall, participants rated the financial messages (M =<br />
2.47, SD = .79) as being the most motivational, followed<br />
by the social responsibility messages (M = 2.42, SD = .69)<br />
and the environmental messages (M = 2.31, SD = .88).<br />
Participants rated the descriptive social norm messages (M<br />
= 2.12, SD = .73) and the informational only messages (M<br />
= 1.95, SD = .76) as being the least motivational overall<br />
(refer to Table 1).<br />
Pairwise comparisons showed that the scores for the<br />
information control conditions were significantly lower<br />
than those in the financial self interest conditions (t = -<br />
.503, p = .003), the environmental conditions (t = -.350,
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Environmental Sciences Reducing food waste<br />
p = .030), and the social responsibility conditions (t = -<br />
.453, p = .007) but not significantly different from the<br />
descriptive social norm conditions. These comparisons also<br />
showed that the scores for the descriptive social norm<br />
conditions were significantly lower than those in the<br />
financial self interest conditions (t = -.351, p = .029) but<br />
not significantly different from the environmental<br />
conditions, the social responsibility conditions, and the<br />
informational control conditions (see Table 2).<br />
An ANOVA showed that, overall, the presence <strong>of</strong> a<br />
picture <strong>of</strong> food waste did not have significant effect on<br />
rated motivations (F (1, 229) = 1.72, p = .19), as there was<br />
not a significant difference between picture present<br />
conditions (M = 2.31, SE =.07) and no picture present<br />
conditions (M = 2.18, SE = .08) (refer to Table 3).<br />
However, the ANOVA did show that message type had a<br />
significant effect on motivation ratings (F (4,161) = 2.81<br />
= p < .05) (refer to Table 4).<br />
These results did not ad<strong>dr</strong>ess the set <strong>of</strong> 19 statements<br />
describing participants’ personal reactions to the idea <strong>of</strong><br />
food wasted on campus, nor did they ad<strong>dr</strong>ess the three<br />
words participants wrote in as ones that came to mind<br />
when they thought <strong>of</strong> food waste.<br />
DISCUSSION<br />
The results show that message type has a significant<br />
affect on participants’ rated motivation to reduce food<br />
waste on campus. These results cannot confirm that the<br />
presence <strong>of</strong> an image displaying food waste has a significant<br />
affect on participants’ rated motivations to reduce food<br />
waste on campus. With a larger number <strong>of</strong> participants the<br />
influence <strong>of</strong> image on motivation may have become clearer.<br />
While no definitive statements can be made regarding the<br />
image presence conditions, there are speculations as to<br />
which messages may be most affected by presenting a<br />
picture <strong>of</strong> food waste.<br />
The financial self-interest and social responsibility<br />
messages demonstrated the greatest differences between<br />
the no picture present and picture present conditions (see<br />
Figure 2). One explanation for this may be that participants<br />
found the financial and social responsibility messages with<br />
a picture to have provided them with the most experiential<br />
learning (Marx et al, 2007). As a result <strong>of</strong> the experiential<br />
learning, participants may be able to conceptualize<br />
financial loss and nationwide hunger easier than they could<br />
conceptualize environmental degradation, social<br />
comparison, and straightforward information. Further<br />
exploration is necessary to affirm any <strong>of</strong> these assumptions.<br />
Collapsing the data across variables to focus on the<br />
significant variable, message type, shows that the financial<br />
self interest, social responsibility, and environmental<br />
messages were rated as the most motivational by<br />
participants, and the descriptive social norm and the<br />
informational only messages were rated as being the least<br />
motivational (see Figure 3). These findings partially<br />
supported my first hypothesis that the social responsibility<br />
message would be rated as one <strong>of</strong> the most motivating<br />
messages. However, the environmental message was rated<br />
as the third most motivating message and the financial selfinterest<br />
message reported higher motivational ratings<br />
among participants than the social responsibility message.<br />
This may be because college students are slightly more<br />
concerned with financial hardship than hunger in America<br />
at this point in their lives. These students may also not be<br />
as familiar with hunger in America as they are with<br />
financial stresses.<br />
The results did not support my hypothesis that the<br />
descriptive social norm message would be rated as the least<br />
motivational. This may be due to the fact that wasting food<br />
is not a topic which is discussed as frequently as energy<br />
conservation. Energy conservation has become a behavior<br />
which is considered to be positive due to the popularization<br />
<strong>of</strong> “going green” campaigns. However, food waste has not<br />
been as heavily focused upon in these conservation efforts;<br />
therefore, participants may not have automatically<br />
considered the action itself to be motivating. Though, it<br />
is noteworthy that these messages were still rated as being<br />
less motivating than the environmental, financial, and<br />
social responsibility messages, following a similar pattern<br />
to the results <strong>of</strong> the Nolan et al. (2008) study.<br />
Limitations included a lack <strong>of</strong> participants due to the<br />
time constraints. The researcher would have liked to collect<br />
300 participant responses total to conduct a final analysis<br />
<strong>of</strong> the data. Also, students may not wish to take the time<br />
for the survey. The researcher also found difficulty in<br />
recruiting <strong>St</strong>. <strong>Thomas</strong> students during the summer months<br />
since not as many students were on campus.<br />
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A next step to this research will be to implement the<br />
motivational messages at dining locations and determine<br />
which <strong>of</strong> the messages will actually elicit the most<br />
reduction in food wasted by students. A further interest is<br />
whether the stated motivations will be the same as the<br />
actual behaviors demonstrated in the dining halls.<br />
Future analysis will also focus on the psychological<br />
distance questions proposed during the study. The<br />
researcher is interested to see whether rated personal<br />
relevance to a message increased the rated motivation <strong>of</strong><br />
the message. Food waste is psychologically distant.<br />
According to Construal Level Theory (CLT; Trope,<br />
Liberman, & Wakslak, 2007) things that we do experience<br />
as not personally relevant and not happening in the here<br />
and now are subjectively felt as “distant.” Psychologically<br />
distant events or issues are represented in the brain<br />
differently than events or issues subjectively perceived as<br />
near (psychologically near). Psychologically near events or<br />
issues are represented in concrete, sensory detailed features<br />
called low-level construals, whereas psychologically distant<br />
events or issues are represented in abstract features called<br />
high-level construals (Trope, Liberman & Wakslak). An<br />
exploratory hypothesis is the more psychologically near the<br />
issue <strong>of</strong> food waste feels to people, the more likely they will<br />
be motivated to reduce their food waste.<br />
CONCLUSION<br />
The amount <strong>of</strong> food wasted in the United <strong>St</strong>ates has<br />
reached an excessive volume. Combating this issue will<br />
benefit our environment, the economy, and society. Thus<br />
far, the United <strong>St</strong>ates has not demonstrated practices which<br />
would nationally reduce food waste. Food waste mitigation<br />
policies must be implemented in order to gain success in<br />
this consumer battle. Becoming a waste(less) society will<br />
take the efforts <strong>of</strong> the people purchasing and consuming<br />
products.<br />
This research is a first step toward providing a<br />
framework for ad<strong>dr</strong>essing the national food waste issue.<br />
The stated motivations to reduce food waste demonstrate<br />
similar patterns as stated motivations to conserve energy.<br />
Thus, the method used to determine how to elicit energy<br />
conservation behavior (Nolan et al., 2008) can be used to<br />
further explore how to reduce food waste.<br />
54<br />
In conclusion, it is necessary to continue explicit research<br />
which ad<strong>dr</strong>esses the issue <strong>of</strong> food waste in order to provide<br />
more accurate results and propose which steps to take in<br />
the future. Implementing these motivational messages in<br />
a real world context is a direction which will assist in<br />
deepening the body <strong>of</strong> knowledge surrounding food waste<br />
mitigation.<br />
REFERENCES<br />
Ajzen, I. (1985). From intentions to actions: A theory <strong>of</strong> planned<br />
behavior. In J. Kuhi & J. Beckmann (Eds.), Action.control:<br />
From cognition to behavior (pp. 11.39). Heidelberg: Springer.<br />
Aronson, E, Wilson, T. D., Akert, R. M. (2010). Social Psychology.<br />
Upper Saddle River, NJ: Prentice Hall.<br />
Bloom, J. (2010). American wasteland. Cambridge, MA: Da<br />
Capo Press.<br />
Charter Institute <strong>of</strong> Waste Management. (2011, June 6). Love<br />
Food Hate Waste Campaign Success. Retrieved from<br />
http://www.ciwm.co.uk/CIWM/Publications/LatestNews/Lo<br />
veFoodHateWasteCampaignSuccess.aspx<br />
Cialdini, R. B. (2007). Influence: The psychology <strong>of</strong> persuasion. New<br />
York: Collins.<br />
Clayton, S., & Brook, A. (2005). Can psychology help save the<br />
world? A model for conservation psychology. Analyses <strong>of</strong> Social<br />
Issues and Public Policy (ASAP), 5(1), 87-102. doi:10.1111/<br />
j.1530-2415.2005.00057.x<br />
Environmental Protection Agency. (2011, July 26). Food Waste.<br />
Retrieved from www.epa.gov/wastes/conserve/materials/<br />
organics/food/<br />
G., J. (2005). Making the right connections to food loss Retrieved<br />
from ezproxy.stthomas.edu/login?url=http://search.ebscohost<br />
.com/login.aspx?direct=true&db=8gh&AN=19003608&site<br />
=ehost-live<br />
Goldstein, N. J., Cialdini, R. B., & Griskevicius, V. (2008). A<br />
room with a viewpoint: Using social norms to motivate<br />
environmental conservation in hotels. Journal <strong>of</strong> Consumer<br />
Research, 35(3), 472-482. doi:10.1086/586910<br />
Griskevicius, V., Tybur, J. M., & Van, d. B. (2010). Going green<br />
to be seen: <strong>St</strong>atus, reputation, and conspicuous conservation.<br />
Journal <strong>of</strong> Personality and Social Psychology, 98(3), 392-404.<br />
doi:10.1037/a0017346<br />
Hattam, J. (2007). Go big green. Sierra, 92(6), 32-33. Retrieved<br />
from http://ezproxy.stthomas.edu/login?url=http://search.<br />
ebscohost.com/login.aspx?direct=true&db=8gh&AN=2725<br />
4301&site=ehost-live<br />
Henderson, J. M. (2005). Introduction to real-world scene<br />
perception. Visual Cognition, 12(6), 849-851. doi:10.1080/<br />
13506280444000544
Bridgette Kelly<br />
Environmental Sciences Reducing food waste<br />
Hodges, B. (2009). Ecological pragmatics: Values, dialogical<br />
arrays, complexity, and caring. Pragmatics & Cognition, 17(3),<br />
628-652<br />
Marx, S., Weber, E., Orlove, B., Leiserowitz, A., Krantz, D.,<br />
Roncoli, C., & Phillips, J. (2007). Communication and<br />
mental processes: Experiential and analytic processing <strong>of</strong><br />
uncertain climate information. Global Environmental Change,<br />
17(1), 47-58.<br />
Neal, D. T., Wood, W., & Quinn, J. M. (2006). Habits—A<br />
repeat performance. Current Directions in Psychological Science,<br />
15(4), 198-202. doi:10.1111/j.1467-8721.2003.00435.x<br />
Nolan, J. M., Schultz, P. W., Cialdini, R. B., Goldstein, N. J., &<br />
Griskevicius, V. (2008). Normative social influence is<br />
underdetected. Personality and Social Psychology Bulletin, 34(7),<br />
913-923. doi:10.1177/0146167208316691<br />
Schultz, P. W. (1999). Changing behavior with normative<br />
feedback interventions: A field experiment on curbside<br />
recycling. Basic and Applied Social Psychology, 21(1), 25-36.<br />
doi:10.1207/15324839951036533<br />
<strong>St</strong>ern, P. C. (2000). Toward a coherent theory <strong>of</strong> environmentally<br />
significant behavior. Journal <strong>of</strong> Social Issues, 56(3), 407-424.<br />
doi:10.1111/0022-4537.00175<br />
<strong>St</strong>uart, T. (2009). Waste: uncovering the global food scandal.<br />
New York, NY: W. W. Norton & Company, Inc.<br />
Sullivan, D. (2010). College students initiate food waste<br />
diversion. BioCycle, 51(9), Retrieved from www.jgpress.com/<br />
archives/_free/002159.html<br />
Trope, Y., Liberman, N., & Wakslak, C. (2007). Construal levels<br />
and psychological distance: Effects on representation,<br />
prediction, evaluation, and behavior. Journal <strong>of</strong> Consumer<br />
Psychology (Lawrence Erlbaum Associates), 17(2), 83-95.<br />
doi:10.1080/10577400701242227<br />
United <strong>St</strong>ates Department <strong>of</strong> Agriculture. (2010, March 18).<br />
Agricultural Research and Productivity: Background.<br />
Retrieved from www.ers.usda.gov/Briefing/AgResearch/<br />
background.htm<br />
Waste Resources and Action Programme (2011, June) Love Food<br />
Hate Waste. Retrieved from www.lovefoodhatewaste.com/<br />
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UST McNair Scholars Program Research Journal<br />
Table 1. Mean Ratings (1-4) for Image Presence and Message Types: How much did the information in this message motivate you to<br />
reduce food waste on campus?<br />
56<br />
Image present or not<br />
present Message Type Mean<br />
No picture present Social norm message<br />
Financial message<br />
Environmental message<br />
Social responsibility<br />
Information only message<br />
Total<br />
Picture present Social norm message<br />
Financial message<br />
Environmental message<br />
Social responsibility<br />
Information only message<br />
Total<br />
Total Social norm message<br />
Financial message<br />
Environmental message<br />
Social responsibility<br />
Information only message<br />
Total<br />
2.07<br />
2.33<br />
2.38<br />
2.27<br />
1.89<br />
2.23<br />
2.08<br />
2.73<br />
2.38<br />
2.61<br />
2.00<br />
2.36<br />
2.08<br />
2.52<br />
2.38<br />
2.45<br />
1.95<br />
2.30<br />
<strong>St</strong>d.<br />
Deviation N<br />
.884<br />
.686<br />
.824<br />
.594<br />
.782<br />
.763<br />
.717<br />
.884<br />
.973<br />
.778<br />
.739<br />
.852<br />
.774<br />
.795<br />
.886<br />
.711<br />
.740<br />
.811<br />
15<br />
18<br />
24<br />
15<br />
9<br />
81<br />
24<br />
15<br />
21<br />
18<br />
12<br />
90<br />
39<br />
33<br />
45<br />
33<br />
21<br />
171
Bridgette Kelly<br />
Environmental Sciences Reducing food waste<br />
Table 2. Pairwise Comparisons <strong>of</strong> Means between Message Types<br />
(I) Message Type (J) Message Type<br />
Social norm message Financial message<br />
Environmental message<br />
Social responsibility<br />
Information only message<br />
Financial message Social norm message<br />
Environmental message<br />
Social responsibility<br />
Information only message<br />
Environmental message Social norm message<br />
Financial message<br />
Social responsibility<br />
Information only message<br />
Social responsibility Social norm message<br />
Financial message<br />
Environmental message<br />
Information only message<br />
Information only message Social norm message<br />
Financial message<br />
Environmental message<br />
Social responsibility<br />
* indicates significance at p < .05<br />
Mean<br />
Difference<br />
(I-J) <strong>St</strong>d. Error Sig. a<br />
-.458<br />
-.303<br />
-.364<br />
.131<br />
.458*<br />
.155<br />
.094<br />
.589*<br />
.303<br />
-.155<br />
-.061<br />
.434*<br />
.364<br />
-.094<br />
.061<br />
.494*<br />
-.131<br />
-.589*<br />
-.434*<br />
-.494*<br />
.191<br />
.177<br />
.191<br />
.219<br />
.191<br />
.183<br />
.197<br />
.224<br />
.177<br />
.183<br />
.183<br />
.212<br />
.191<br />
.197<br />
.183<br />
.224<br />
.219<br />
.224<br />
.212<br />
.224<br />
.018<br />
.089<br />
.059<br />
.553<br />
.018<br />
.398<br />
.633<br />
.010<br />
.089<br />
.398<br />
.740<br />
.043<br />
.059<br />
.633<br />
.740<br />
.029<br />
.553<br />
.010<br />
.043<br />
.029<br />
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UST McNair Scholars Program Research Journal<br />
Table 3. Effectiveness <strong>of</strong> Message Type on Motivation Ratings<br />
+ indicates significance at p
Bridgette Kelly<br />
Environmental Sciences Reducing food waste<br />
Figure 2. Estimated Marginal Means <strong>of</strong> “How much did this information motivate you to reduce food waste on campus?” for message<br />
type and image status<br />
Figure 3. Estimated Marginal Means <strong>of</strong> “How much did this information motivate you to reduce food waste on campus?” for only<br />
message type.<br />
Descriptive social norm<br />
message<br />
Financial self interest<br />
message<br />
Environmental message<br />
Social responsibility<br />
Message<br />
Information control<br />
message<br />
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UST McNair Scholars Program Research Journal<br />
APPENDIX<br />
INTERVENTION MESSAGES<br />
Descriptive Social Norm: Join other <strong>St</strong>. <strong>Thomas</strong> students<br />
in reducing food waste on campus. A new school year will<br />
begin soon and college students all over the U.S. are<br />
making an effort to reduce their food waste. How are<br />
students reducing their food waste? By not leaving uneaten<br />
food on their trays when they bring them to the dish room.<br />
Why? According to a recent poll, 8 out <strong>of</strong> 10 <strong>of</strong> students<br />
reported that they try not to leave uneaten food on their<br />
trays in order to reduce the amount <strong>of</strong> food they waste.<br />
Taking only what will be eaten-the popular student choice.<br />
Financial Self-Interest: Save money by reducing food waste<br />
on campus. A new school year will begin soon and the time<br />
is right for saving money on your student bill. How can<br />
you save money? By not leaving uneaten food on your tray<br />
when you bring it to the dish room. Why? According to<br />
recent research, universities have saved up to $100,000 for<br />
the school year by reducing costs relating to food waste.<br />
Savings like this can prevent your meal costs from<br />
increasing each school year, giving you extra cash to keep<br />
in your pocket.<br />
Environmental: Protect the environment by reducing food<br />
waste on campus. A new school year will begin soon and<br />
the time is right for reducing greenhouse gases. How can<br />
you protect the environment this school year? By not<br />
leaving uneaten food on your tray when you bring it to the<br />
dish room. Why? According to recent research, food waste<br />
had the highest rate <strong>of</strong> methane yield in landfills, which<br />
accounted for 23% <strong>of</strong> all methane emissions. Taking only<br />
what will be eaten-the environmental choice.<br />
Social Responsibility: Do your part to reduce food waste<br />
for those suffering from hunger in our country. A new<br />
school year will begin soon and we need to work together<br />
to reduce food waste on campus. How can you reduce food<br />
waste on campus and aid those suffering from hunger? By<br />
not leaving uneaten food on your tray when you bring it<br />
to the dish room. Why? According to recent research, if a<br />
quarter <strong>of</strong> the food currently wasted was redistributed, it<br />
could provide three meals per day for 43 million<br />
Americans. Taking only what will be eaten-the socially<br />
responsible choice.<br />
60<br />
Informational Control: Food waste reduction on campus.<br />
A new school year will begin soon and the time is right to<br />
reduce food waste on campus. How can you reduce food<br />
waste on campus this school year? By not leaving uneaten<br />
food on your tray when you bring it to the dish room.
ABSTRACT<br />
This research discusses healthcare accessibility issues among the Hmong ethnic group in<br />
the Twin Cities metropolitan area located in Minnesota. Research was based on the<br />
geographical access to healthcare in the Hmong community. Through the Geographical<br />
Information System (GIS), I predict that the Twin Cities’ Hmong community lacks<br />
access to healthcare. The Hmong community, when mapped, was concentrated in two<br />
particular locations in Minneapolis and Saint Paul. The use <strong>of</strong> GIS helped to project<br />
statistical analysis <strong>of</strong> different aspects concerning healthcare such as healthcare facilities,<br />
healthy and affordable food, and public transportation. These were analyzed by mapping<br />
their distances from the Hmong community. <strong>St</strong>atistical analysis was examined by scatter<br />
plots where the correlation between the Hmong community and where healthcare, food<br />
sources, and public transportation was located were weak. <strong>St</strong>atistical analysis showed<br />
that the Hmong community <strong>of</strong> the Twin Cities metropolitan area is centrally located.<br />
Given the study area at the scaled researched (1km), the Hmong were not especially<br />
isolated from healthcare, food, and public transportation. This showed that this<br />
community is isolated but isolation is not a major factor shaping healthcare outcomes.<br />
Other factors may contribute to the limitations in this community, such as cultural and<br />
language barriers and health literacy.<br />
INTRODUCTION<br />
The Hmong, an ethnic group from Asia, sought refuge in many nations,<br />
including the United <strong>St</strong>ates <strong>of</strong> America, beginning in the late 1970s. Although<br />
their origin is debatable because <strong>of</strong> their nomadic culture, history <strong>of</strong> wars,<br />
persecution, and acculturation, they are thought to come from China. From<br />
China, the Hmong settled in Southeast Asian counties such as Laos, Thailand,<br />
Vietnam, and Burma. The U.S. arrived in Laos to defend the Laotian people<br />
from Vietnamese Communists, and the U.S. Central Intelligence Agency<br />
recruited the Hmong in Laos to fight alongside them. This was known as the<br />
Secret War <strong>of</strong> Laos. The U.S. fled Asia in 1975 resulting in Hmong persecution<br />
by the Laotian government. Many Hmong fled to Thailand by crossing the<br />
Mekong River, settling among many refugee camps. From these refugee camps,<br />
the Hmong people moved to many parts <strong>of</strong> the world, including the United<br />
<strong>St</strong>ates. Today, the largest population <strong>of</strong> the Hmong outside <strong>of</strong> Asia is in<br />
California, Wisconsin, and Minnesota.<br />
The Hmong people are a unique community due to their different culture,<br />
religion, and healthcare practices. One ongoing challenge <strong>of</strong> the Hmong<br />
community is providing culturally acceptable healthcare while trying to reach<br />
the goal <strong>of</strong> respecting the Hmong culture and also providing quality<br />
healthcare. 1 Many Hmong in America still resort to herbal medicine and<br />
religious healing (shamanism), especially the elderly. Other Hmong individuals<br />
are still uncertain <strong>of</strong> Western health practices and the effects <strong>of</strong> living and<br />
eating Western food. In addition to healthcare concerns, the aspect <strong>of</strong> food in<br />
Hmong culture is very different. A study done by Franzen and Smith in<br />
Minnesota showed that Hmong individuals who are American-born and/or<br />
were raised in the U.S. have higher dietary acculturation than those born in<br />
HEALTHCARE<br />
ACCESSIBILITY IN<br />
THE TWIN CITIES<br />
METROPOLITAN AREA<br />
HMONG COMMUNITY<br />
Chia Lee ’13<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Mentor<br />
Paul Lorah, Ph.D.<br />
Associate Pr<strong>of</strong>essor <strong>of</strong><br />
Geography<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
61
UST McNair Scholars Program Research Journal<br />
Thailand or Laos. This study concluded that acculturation<br />
<strong>of</strong> foods, store types, conveniences, and English fluency<br />
were just some <strong>of</strong> the factors that contributed to the<br />
surveyed Hmong individuals and their food access and<br />
shopping behavior. 2 Improvements in the Hmong<br />
community with health and food are problems that need<br />
to be tackled.<br />
While the Hmong are still struggling to become<br />
accustomed to Western medicine and food, the need for<br />
healthy living is a concern for all. This is directly associated<br />
with improving access to healthcare. According to the<br />
American Public Health Association, “while the United<br />
<strong>St</strong>ates spends more on health care than any other nation in<br />
the world, it lags behind so many developed nations in<br />
important health measures.” 3 This particular statement<br />
shows how health and wellness is such an important role<br />
in our lives. Although money is spent for health purposes,<br />
the health <strong>of</strong> the country is still poor. Healthy practices are<br />
obtained with the availability <strong>of</strong> good, quality healthcare.<br />
According to Lora Todovora, MPH, “people’s health is<br />
closely related to access to health care.” 4 As health and<br />
wellness become a larger issue in today’s society, there is a<br />
concern about equal access to quality health and promotion<br />
to wellness.<br />
In this particular study, the large Hmong community<br />
in the Twin Cities metropolitan area <strong>of</strong> Minnesota was<br />
studied to determine their access to opportunities <strong>of</strong><br />
healthy living. This access to health and wellness was<br />
determined by locating and mapping four major aspects <strong>of</strong><br />
the promotion <strong>of</strong> health: healthcare facilities, food sources,<br />
and public transportation. First, the Hmong community<br />
was mapped to identify their location in relation to the<br />
area. Access to healthcare was determined by locating and<br />
mapping hospitals, clinics, dentists, and other healthcare<br />
facilities in the Twin Cities. As being healthy includes<br />
having the choice <strong>of</strong> nutritional, affordable, and quality<br />
food, grocery stores were mapped. Public transportation,<br />
such as buses, light rail, and bikeways were also mapped<br />
to provide affordable transportation to healthcare facilities<br />
and food sources. All these features provide an<br />
understanding <strong>of</strong> whether the Hmong community is<br />
geographically limited to healthcare access in the Twin<br />
Cities.<br />
This research is based on the geographical access <strong>of</strong><br />
healthcare in the community. Using the Geographical<br />
62<br />
Information System (GIS) in the <strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Geography Department, I propose that the Hmong<br />
community in the Twin Cities metropolitan area lacks<br />
geographical access to the promotion <strong>of</strong> a healthy lifestyle<br />
due to the poor access <strong>of</strong> healthcare, food sources, and<br />
public transportation.<br />
LITERATURE REVIEW<br />
In this section, I discuss the many different background<br />
studies surrounding my research. Knowledge <strong>of</strong> who the<br />
Hmong people are is significant, but there is also an<br />
understanding <strong>of</strong> how complimentary geography and heath<br />
are. This can be seen throughout various researches being<br />
done on the Hmong community, the fields <strong>of</strong> geography<br />
and public health, and the use <strong>of</strong> applications in GIS.<br />
THE HMONG PEOPLE<br />
The Hmong have traveled across the world as refugees<br />
<strong>of</strong> war and oppression. The history <strong>of</strong> the Hmong people,<br />
whether direct immigrants or descendents <strong>of</strong> immigrants,<br />
is ingrained in their culture. Ancestry <strong>of</strong> the Hmong is<br />
uncertain because <strong>of</strong> their oral and nomadic traditions.<br />
From research, they are thought to come from China,<br />
although those who have migrated to the United <strong>St</strong>ates<br />
have come from Laos, Vietnam, and Thailand. 5 Many<br />
American people were (and still are) unaware <strong>of</strong> the Secret<br />
War <strong>of</strong> Laos that occurred at the same time as the Vietnam<br />
War in the mid-1900s. As American men were fighting<br />
against the Vietnamese, Hmong men and boys were<br />
recruited by the U.S. Central Intelligence Agency (CIA) in<br />
the 1960s to battle the emergence <strong>of</strong> communism in Laos,<br />
the Pathet Lao. The U.S. with<strong>dr</strong>ew from Laos in 1975,<br />
abandoning the Hmong as communism took power. This<br />
created terror as “the Hmong became targets <strong>of</strong> retaliation<br />
and persecution.” 6 Re-education <strong>of</strong> the Hmong was ordered<br />
by the Pathet Lao through camps, and the Laos raged<br />
chemical warfare against the Hmong. Many Hmong fled<br />
to Thailand by crossing the Mekong River into the safety<br />
<strong>of</strong> refugee camps. Although out <strong>of</strong> the hands <strong>of</strong> the Pathet<br />
Lao, many did not leave until years after entering the<br />
refugee camps. Resettlement <strong>of</strong> the Hmong resulted in<br />
many moving to different parts <strong>of</strong> the world, such as France<br />
and the U.S., in the 1980s and years later. Many Hmong
Chia Lee<br />
Public Health Health care Accessibility in Hmong Community<br />
have returned to Laos due to the closure <strong>of</strong> refugee camps<br />
in Thailand, resulting in torture and abuse. 7 Today, large<br />
concentrations <strong>of</strong> the Hmong population outside <strong>of</strong> Asia<br />
reside in California, Wisconsin, and Minnesota. 8<br />
Upon their arrival in America, the Hmong had a<br />
different culture, spoke a different language, and followed<br />
a different religious belief resulting in a struggle <strong>of</strong><br />
acculturation. In the Hmong culture, the liver <strong>of</strong> a person<br />
regulates emotion and is the center <strong>of</strong> human emotion<br />
compared to the heart in Western beliefs. The liver plays<br />
an important role in the health and mental well-being <strong>of</strong> a<br />
person as well as their overall personality. The Hmong<br />
culture is dependent on spiritualism and herbal healing. A<br />
shaman is one who is able to travel between reality and the<br />
spiritual world to communicate with spirits for health<br />
purposes. 9 Ua neeb khu is the ceremonial healing practice<br />
used by shamans to treat health concerns involving<br />
spirits. 10 Along with shamans, herbalists are those who are<br />
knowledgeable <strong>of</strong> herbal medicine and their use for health<br />
conditions. As shamans and herbalists are important figures<br />
in the Hmong community, so are clan leaders. The social<br />
structure <strong>of</strong> the Hmong consists <strong>of</strong> a clan system (Xeem) <strong>of</strong><br />
originally 12 clans but now ranging from fifteen to twentyone.<br />
11 Clans are established through last names (paternal<br />
ancestry) and clan members are considered family. Birth,<br />
marriage, or adoption are the only ways <strong>of</strong> entering a clan. 12<br />
Clan leaders, usually the elderly men <strong>of</strong> a clan, are held in<br />
high regard to leadership. 13 In specific rituals, the head <strong>of</strong><br />
the clan is able to communicate with the deceased ancestors<br />
<strong>of</strong> clan members. 14 These clans are the different subgroups<br />
<strong>of</strong> the Hmong community.<br />
Rising numbers <strong>of</strong> health problems in the Hmong<br />
community include cancer, diabetes, hypertension, gout,<br />
and smoking today, which are only a few <strong>of</strong> Hmong health<br />
problems. 15 These various health concerns are due to the<br />
acculturation <strong>of</strong> Hmong and American culture. Healthcare<br />
is a concern to the Hmong community and health care<br />
pr<strong>of</strong>essionals. The lack <strong>of</strong> medical physiology and anatomy<br />
terms in Hmong language has created a barrier between<br />
translating medical terms and diagnosis. Different beliefs<br />
between the Hmong and American culture also create<br />
misunderstandings and unreliability between the two<br />
sides. 16 For quality care in the Hmong community, there<br />
must be relationships built on trust and mutual respect <strong>of</strong><br />
both cultures along with cultural awareness. 17 Sharon K.<br />
Johnson, Ph.D., suggests that negative health care<br />
experiences have caused many Hmong to mistrust and fear<br />
Western medical practice. 18 A study done by Dr. Hee Yun<br />
Lee and Suzanne Vang proposes that high mortality rate in<br />
the Hmong community in Minnesota is due to high<br />
prevalence <strong>of</strong> late stage cancer diagnosis. This study,<br />
through extensive literature review, concluded late stage<br />
diagnosis is because <strong>of</strong> barriers in the Hmong community.<br />
These barriers include healthcare accessibility, culture, and<br />
lack <strong>of</strong> cancer literacy. 19<br />
HEALTHCARE ACCESSIBILITY<br />
Proper access to healthcare has become one <strong>of</strong> the biggest<br />
current public health problems today. 20 Health has become<br />
a big issue in lives today resulting in the trends <strong>of</strong> dieting<br />
and fitness, as well as eating disorders and obesity. There<br />
is a growing concern for health care access as populations<br />
continue to grow and health problems still exist.<br />
Improvements in health have allowed healthcare to evolve,<br />
but there is still a lack <strong>of</strong> healthcare access to one billion<br />
people in the world. 21 The life expectancy rates for<br />
Americans are not the highest in the world and according<br />
to Lawrence Jacobs <strong>of</strong> the <strong>University</strong> <strong>of</strong> Minnesota and<br />
James Monrone <strong>of</strong> Brown <strong>University</strong> the partial answer to<br />
longevity is unequal access to health care. Universal health<br />
care, health insurance guaranteed to citizens from the<br />
government, is present in many <strong>of</strong> the countries that have<br />
surpassed the U.S.’s life expectancy. Citizens in those<br />
countries are given access to vaccinations, annual checkups,<br />
and a range <strong>of</strong> medical screenings, improving their nation’s<br />
health and well-being. 22<br />
Health disparities have become a large concern and some<br />
factors <strong>of</strong> this disparity could be linked to education,<br />
household income, health insurance coverage, and cost<br />
barriers. A study by the Centers for Disease Control helped<br />
raise awareness <strong>of</strong> health disparities in racial and minority<br />
populations in the United <strong>St</strong>ates. It suggests a need for<br />
community-based policies, systems, and environmental<br />
and individual-level changes while establishing prevention<br />
strategies accustomed to different communities. 23 This will<br />
allow healthcare access to expand to different populations.<br />
In Minnesota, some recent studies on healthcare access<br />
have ad<strong>dr</strong>essed racial disparities as well as socioeconomic<br />
status. One particular study conducted in Hennepin<br />
County, MN examined perceived discrimination and<br />
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UST McNair Scholars Program Research Journal<br />
underutilization in association with perspective to<br />
healthcare. The surveys conducted concluded an association<br />
between perceived discrimination and underutilizing<br />
medical care among Whites, U.S.-born Blacks, and<br />
American Indians while there was an association <strong>of</strong><br />
perceived discrimination and underutilizing mental<br />
healthcare among Whites, U.S.-born Blacks, Southeast<br />
Asians, and American Indians. 24 Another study was done<br />
about homeless families in Minnesota and their lifestyle<br />
choices due to shelter limitations and surrounding<br />
community. The environments <strong>of</strong> homeless families in<br />
shelters affected decisions such as food, work, and day care.<br />
Modifications <strong>of</strong> communities giving shelter to homeless<br />
families must involve access to affordable food, government<br />
assistance programs, and the increase <strong>of</strong> access to affordable<br />
day care. 25 These are only two <strong>of</strong> the many researches done<br />
in Minnesota showing disparities among health and wellbeing.<br />
GEOGRAPHY<br />
Geography is defined as ‘to write (graphien) the earth<br />
(geo)’ and encompasses the fields <strong>of</strong> physical and human<br />
geography. Human geography is broken down to humannature<br />
relations and society-space relations. 26 Society-space<br />
relations reflect social divisions. 27 This is seen in<br />
communities with housing values. Higher income<br />
individuals are able to live and maintain a living in houses<br />
<strong>of</strong> higher value and more pleasant environments while<br />
lower income individuals are limited to lower valued<br />
houses. These, then, become clustered, building a barrier<br />
between high and low income. Time is also a very<br />
important aspect with society-space relations. Socio -<br />
economic systems impact humans as locations and travel<br />
to such places are limited by time. This space-time path is<br />
seen with human activity and their limitations such as<br />
capability, coupling, and authority. Capability limitations<br />
refer to physical or biological factors limiting movement<br />
such as being in two places at one time. Interactions with<br />
others and a certain time restraint is coupling limitation,<br />
for example a family structure <strong>of</strong> work, school, and basic<br />
needs <strong>of</strong> life. Authority is the limitations <strong>of</strong> locations<br />
controlled by people or institutions such as government<br />
areas and private places. 28<br />
64<br />
HEALTH GEOGRAPHY<br />
The advancement <strong>of</strong> technology has improved, but has<br />
also held back lives today. A study done by Jane E. Brody<br />
suggests cases <strong>of</strong> “outdoor deprivation disorder” are circling<br />
the United <strong>St</strong>ates. Chil<strong>dr</strong>en are spending more time<br />
indoors rather than with outdoor activities due to<br />
electronic media. This lack <strong>of</strong> physical activity and<br />
disconnectedness to nature is contributing to the growing<br />
concern <strong>of</strong> obesity and obesity-related diseases in chil<strong>dr</strong>en<br />
and adults. Many <strong>of</strong> the health concerns are named<br />
“diseases <strong>of</strong> indoor living” by Dr. Daphne Miller, a<br />
<strong>University</strong> <strong>of</strong> California, San Francisco affiliated family<br />
physician. These health concerns include Type 2 diabetes,<br />
high blood pressure, heart disease, asthma, nonalcoholic<br />
fatty liver disease, vitamin D deficiency, osteoporosis,<br />
stress, depression, attention deficit disorder, and myopia.<br />
Engaging in green spaces and nature was seen to help<br />
improve healthy living. 29<br />
According to a study done by Erin Largo-Wight, there<br />
is a correlation between health and contact with nature.<br />
Largo-Wight developed twelve suggestions for public<br />
health: “(1) cultivate grounds for viewing, (2) maintain<br />
healing gardens, (3) incorporate wooded parks and green<br />
space in communities, (4) advocate for preservation <strong>of</strong><br />
pristine wilderness, (5) welcome animals indoors, (6)<br />
provide a plethora <strong>of</strong> indoor potted plants within view, (7)<br />
light rooms with bright natural light, (8) provide clear<br />
view <strong>of</strong> nature outside, (9) allow outside air and sounds in,<br />
(10) display nature photography and realistic nature art,<br />
(11) watch nature on TV or videos, and (12) listen to<br />
recorded sounds <strong>of</strong> nature.” 30 There are also suggestions<br />
that environmental sensory has a therapeutic impact on<br />
health, mood, and safety. 31<br />
Another issue <strong>of</strong> concern is “food deserts.” These are<br />
defined as low income neighborhoods lacking affordable<br />
and healthy food. 32 A typical food desert does not have a<br />
supermarket within easy access limiting the access to<br />
healthy, affordable food. 33 This is significant because there<br />
is a link between health disparities and health, particularity<br />
due to food deserts. A study completed in New York City<br />
researched low-income neighborhoods, predominantly<br />
African-American/Black residents suffering from high rates<br />
<strong>of</strong> obesity and diabetes. This study helped to give an<br />
understanding <strong>of</strong> the direct correlation between the<br />
environment and food. It had concluded that there is a
Chia Lee<br />
Public Health Health care Accessibility in Hmong Community<br />
relationship between demographic features pertaining to<br />
food deserts. An association between higher median<br />
household income and being healthier was seen throughout<br />
the neighborhoods studied. 34<br />
GEOGRAPHICAL INFORMATION SYSTEM<br />
Geographical Information System, GIS, is a<br />
technological advancement in the field <strong>of</strong> geography,<br />
particularly cartography, the study <strong>of</strong> mapmaking. GIS can<br />
be defined as a computer system which can store data,<br />
make relations between data sets, provide statistical<br />
analysis <strong>of</strong> data, data modeling, and display data as maps<br />
along with spatial analysis. 35 The main purpose <strong>of</strong> GIS is<br />
mapmaking. This can be done by linking data sets to<br />
project a map showing different relations. 36<br />
The new evolving field <strong>of</strong> GIS in Public health has<br />
brought breakthroughs into the health field. The use <strong>of</strong><br />
GIS will assist in the management and analysis <strong>of</strong> health<br />
and health care data. 37 A study done by Kerry Joyce shows<br />
one perception <strong>of</strong> GIS use in public health, and the study<br />
suggests that GIS is not a solution in public health. One<br />
main concern was that GIS could be misused,<br />
misinterpreted, and/or used wrongly. 38 Although this may<br />
be true, maps can help interpret data as a different<br />
technique to examining data. One particular study done<br />
by Jeanette Eckert and Sujata Shetty in Toledo, Ohio,<br />
helped to examine quantitative and measureable food access<br />
to help urban planners provide opportunities for healthy<br />
food choices. 39 GIS is also being used in other nations<br />
where health care is a concern, such as Africa. In this<br />
particular study, 23,000 homesteads were interviewed,<br />
mapped, and given an estimated travel time to a clinic with<br />
the consideration <strong>of</strong> public transportation and walking.<br />
The median travel time was measured at 81 minutes to the<br />
nearest clinic. There was also a decline <strong>of</strong> clinic visit<br />
compared to the longer distance and travel time. 40<br />
Physical walking can be a barrier in one country while<br />
in another promoted for physical well-being. A study was<br />
done in Sweden to examine “neighborhood walkability and<br />
walking for active transportation or leisure, and moderateto-vigorous<br />
physical activity” and their association with<br />
demographic features such as age, gender, income, marital<br />
status, and neighborhood-level socioeconomic status.<br />
Neighborhood walkability and physical activity was seen<br />
as a positive association in this Swedish study. Their<br />
concerns were providing policies that promoted physical<br />
activity with the collaborations <strong>of</strong> health pr<strong>of</strong>essionals and<br />
city planners. 41 These studies show the useful applications<br />
<strong>of</strong> GIS in public health concerns ranging from food access,<br />
health care access, and physical activity in different<br />
communities.<br />
METHODS<br />
To determine if there is a lack <strong>of</strong> geographical access to<br />
health care in the Hmong community in the Twin Cities<br />
metropolitan area, I first determined where this particular<br />
population is located. Using the ArcGIS program in the<br />
Geography lab located in JRC 426, I mapped where the<br />
Hmong community is located relative to the Twin Cities.<br />
In order to map certain projections, data must be obtained<br />
from reliable resources such as Esri, ReferenceUSA, and<br />
from the Geography department network. Data needed<br />
included Census population, health care facilities, food<br />
sources and public transportation. Health care facilities<br />
comprised <strong>of</strong> hospitals, clinics and dentist <strong>of</strong>fices. Grocery<br />
stores reflected food sources while public transportation<br />
consisted <strong>of</strong> bus stops, light rail stations, and bike paths.<br />
Using the data that was found, GIS was utilized to make<br />
maps and combine map layers for better understanding and<br />
analysis <strong>of</strong> the study area and data. <strong>St</strong>atistical analysis was<br />
also measured for significance. Tools from GIS helped to<br />
store and organize data.<br />
Mapping the Hmong community was a difficult task<br />
where the U.S. Census did not have quality data <strong>of</strong> ethnic<br />
groups, but rather races. In order to map where the Hmong<br />
community was located, I used ReferenceUSA, a large<br />
business database, with searches that contained key words<br />
such as “Hmong” and prominent Hmong last names like<br />
“Vang,” “Yang,” “Vue,” “Thao,” and “Xiong” seen in the<br />
model in figure 1. Each <strong>of</strong> the other features looked at were<br />
also mapped to consider where they were located in relation<br />
to the Hmong community appearing in figures 2, 3, and<br />
4. From these maps, 1km fishnets (squares) were projected<br />
to obtain statistical data from each section. Scatter plots<br />
were created along with the geographical weighted<br />
regressions tool to statistically analyze the data obtained.<br />
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Figure 1. Hmong Density = Hmong Community Model<br />
Figure 2. Health Care Facilities Model<br />
Figure 3. Food Sources Model<br />
Figure 4. Transportation Model<br />
R l<br />
66<br />
RESULTS<br />
Geographical access to health care in the Hmong<br />
community through the use <strong>of</strong> GIS was not seen as a<br />
limitation to health care facilities, food sources, and public<br />
transportation, rejecting my hypothesis. The Hmong<br />
community <strong>of</strong> the Twin Cities metropolitan area <strong>of</strong><br />
Minnesota was seen as centrally located in Minneapolis and<br />
<strong>St</strong>. Paul. <strong>St</strong>atistical analysis was also measured showing a<br />
weak correlation between the Hmong community with<br />
health care facilities, food sources, or public transportation<br />
from the scatter plots. The scatter plots did show positive<br />
correlation between health care facilities, food sources, and<br />
public transportation, however, they were not correlated<br />
with the Hmong community. The Twin Cities’ Hmong<br />
community in this particular study area at the 1 km scale<br />
by the use <strong>of</strong> the geographical weighted regression tool was<br />
shown that they are not especially isolated from health care,<br />
food, and public transportation. These results suggest that<br />
factors other than geographical access may be contributing<br />
to the lack <strong>of</strong> access to health care in the Twin Cities’<br />
Hmong community.<br />
Figure 5. Scatter plots <strong>of</strong> health care facilities, food sources,<br />
transportation, and Hmong community.<br />
CONCLUSION<br />
From my results, isolation was not a major factor in<br />
shaping health care outcomes in the Hmong community.<br />
It became questionable whether the limitations <strong>of</strong> health<br />
care in the Hmong community are due to geographical<br />
access or cultural barriers. The results <strong>of</strong> acculturation in<br />
this community have shown a gap in those who has
Chia Lee<br />
Public Health Health care Accessibility in Hmong Community<br />
blended into the American culture such as the younger<br />
generation compared to those who are still holding on to<br />
many Hmong beliefs, such as shamanism and herbal<br />
healing in the older generation. This gap has created<br />
barriers within the community to incorporate both Hmong<br />
and American culture. Along with cultural barriers,<br />
language and health literacy, according to this research’s<br />
literature review, are other factors in the limitations <strong>of</strong><br />
health care. Some suggested recommendations would be to<br />
battle two particular barriers: cultural and language.<br />
Programs targeted towards the Hmong to learn proper<br />
health practices such as regular check-ups and screenings<br />
while still respecting their cultural beliefs would be<br />
beneficial. Along with these programs, health care<br />
providers in largely populated Hmong areas should be<br />
provided with background on Hmong culture to better<br />
adapt medical procedures for Hmong individuals. Quality<br />
Hmong translators accessible in hospitals and clinics would<br />
be beneficial in properly providing the information for<br />
Hmong patients. To continue looking at health care<br />
accessibility in the Hmong would be valuable with some<br />
future research in this field.<br />
FUTURE RESEARCH<br />
One particular research idea expanding from the idea <strong>of</strong><br />
the Hmong community and geographical access to health<br />
care would be to restructure the research. A change in the<br />
study area would remove rural areas and areas where the<br />
Hmong community is not located such as only examining<br />
Hennepin and Ramsey counties. Comparison <strong>of</strong> the<br />
Hmong population would also be beneficial at studying<br />
the community within itself, for instance, examining<br />
economic status, gender, and age. This could result in<br />
significance in the data and that the Hmong community’s<br />
geographical access to health care is a Minneapolis-Saint<br />
Paul area concern only. Some other future research ideas<br />
would be to survey individuals in the community to<br />
examine health disparities and barriers to accessibility as<br />
well as incorporating health insurance coverage and other<br />
factors contributing to health care access. Other<br />
communities could also be researched to compare and<br />
contrast with the Hmong community expanding the<br />
awareness <strong>of</strong> health disparities.<br />
APPENDIX<br />
Map 1. Hmong Community Map<br />
Map 2. Health Care Facilities Map<br />
Map 3. Health Care Facilities Distances<br />
67
UST McNair Scholars Program Research Journal<br />
Map 4. Food Sources Map<br />
Map 5. Food Sources Distances<br />
Map 6. Transportation Map<br />
68<br />
Map 7. Transportation Distances<br />
Map 8. Hmong-owned Businesses<br />
ENDNOTES<br />
1 Torry Cobb, “<strong>St</strong>rategies for providing cultural competent<br />
health care for Hmong Americans” [Abstract], Journal <strong>of</strong> Cultural<br />
Diversity 17 no. 3 (2010): 79-83.<br />
2 Lisa Franzen & Smith, Chery, “Food System access, shopping<br />
behavior, and influences on purchasing groceries in adult Hmong<br />
living in Minnesota” [Abstract], American Journal <strong>of</strong> Health<br />
Promotion: AJHP 24 no. 6 (2010): 396-409.<br />
3 American Public Health Association, “Healthiest Nation in<br />
One Generation,” (2011).<br />
4 Lora Todorova, “Limits and access to health care” [Abstract],<br />
American Journal <strong>of</strong> Public Health 93 no. 11 (2003): 1794-1795.<br />
5 Joanne P. Ikeda, Hmong American food practices, customs, and<br />
holidays, American Diabetes Association, Inc, 1999: 1.<br />
6 “Hmong History,” Hmong International Human Rights<br />
Watch, 2007.<br />
7 “History <strong>of</strong> the Hmong—A Timeline,” Lao Family<br />
Community <strong>of</strong> Minnesota, Inc., 1997.
Chia Lee<br />
Public Health Health care Accessibility in Hmong Community<br />
8 Ikeda, Hmong American food practices, customs, and holidays,<br />
(1999) 1.<br />
9 Ikeda, Hmong American food practices, customs, and holidays, 2.<br />
10 Lisa L. Capps, “Ua neeb khu: a Hmong American Healing<br />
Ceremony” [Abstract], Journal <strong>of</strong> Holistic Nursing” Official Journal<br />
<strong>of</strong> the American Holistic Nurses’ Association 29 no. 2 (2011): 98-<br />
106.<br />
11 Dia Cha, Hmong American Concepts <strong>of</strong> Health, Healing, and<br />
Conventional Medicine (New York: Taylor & Francis Books, Inc,<br />
2003), 6.<br />
12 “Hmong Families,” Lao Family Community <strong>of</strong> Minnesota, Inc.<br />
(1997), http://www.la<strong>of</strong>amily.org/pdfs/Hmong_Families.pdf.<br />
13 Ikeda, Hmong American food practices, customs, and holidays, 4.<br />
14 “Hmong Families,” Lao Family Community <strong>of</strong> Minnesota, Inc.<br />
(1997).<br />
15 Ibid, 302; Ikeda, Hmong American food practices, customs, and<br />
holidays; S. Wahedduddin et al., “Gout in the Hmong in the<br />
United <strong>St</strong>ates” [Abstract], Journal <strong>of</strong> Clinical Rheumatology:<br />
Practical Reports on Rheumatic & Musculoskeletal Diseases 16 no. 6<br />
(2010): 262-266.<br />
16 Sharon K. Johnson, “Hmong Health Beliefs and<br />
Experiences in Western Health Care System” [Abstract], Journal<br />
<strong>of</strong> Transcultural Nursing 13 no. 2 (2002): 126-132.<br />
17 Torry G. Cobb, “<strong>St</strong>rategies for Providing Cultural<br />
Competent Health Care for Hmong Americans” [Abstract],<br />
Journal <strong>of</strong> Cultural Diversity 17 no. 3 (2010): 79-83.<br />
18 Sharon K. Johnson, “Hmong Health Beliefs and<br />
Experiences in Western Health Care System” [Abstract], Journal<br />
<strong>of</strong> Transcultural Nursing 13 no. 2 (2002): 126-132.<br />
19 Hee Yun Lee and Suzanne Vang, “Barriers to Cancer<br />
Screening in Hmong Americans: The Influence <strong>of</strong> Health Care<br />
Accessibility, Culture, and Cancer Literacy,” Journal <strong>of</strong> Community<br />
Health 35 no. 3 (2010): 301-314.<br />
20 Lora Todorova, “Limits and Access to Health Care,”<br />
American Journal <strong>of</strong> Public Health 93 no. 11 (2033): 1794-1795.<br />
21 Anup Shah, “Global Health Overview,” Global Issues,<br />
(2010), Last Accessed 28 June 2011.<br />
22 “U.S. Life Span Falls Behind,” Current Science 90 no. 11<br />
(2005): 15.<br />
23 Youlian Liao et al., “Surveillance <strong>of</strong> Health <strong>St</strong>atus in<br />
Minority Communities — Racial and Ethnic Approaches to<br />
Community Health Across the U.S. (REACH U.S.) Risk Factor<br />
Survey, United <strong>St</strong>ates, 2009,” Center for Disease Control, 2011.<br />
24 Diana J. Burgess et al., “The Association between Perceived<br />
Discrimination and Underutilization <strong>of</strong> Needed Medical and<br />
Mental Health Care in a Multi-Ethnic Community Sample”<br />
[Abstract], Journal <strong>of</strong> Community Care for the Poor and Underserved<br />
19 no. 3 (2008): 894-911.<br />
25 Rickelle Richards and Smith, Chery, “Shelter Environment<br />
and Placement in Community Affects Lifestyle Factors among<br />
Homeless Families in Minnesota” [Abstract], American Journal <strong>of</strong><br />
Health Promotion 21 no. 1 (2006): 36-44.<br />
26 Philip Cloke, Crang, Philip, and Goodwin, Mark, ed.,<br />
Introducing Human Geographies (New York: Arnold Publishers,<br />
1999), x.<br />
27 Susan J. Smith, “Chapter 2: Society—space,” Introducing<br />
Human Geographies (New York: Arnold Publishers, 1999), 12.<br />
28 John Corbett, “Tornsten Hägerstrand: Time Geography,”<br />
Center for Spatially Integrated Social Sciences Classics, Accessed July<br />
6, 2011, www.csiss.org/classics/ content/29<br />
29 Jane E. Brody, “Head Out for a Daily Dose <strong>of</strong> Green Space,”<br />
New York Times, November 29, 2010, p.7.<br />
30 Erin Largo-Wight, “Cultivating Healthy Places and<br />
Communities: Evidence-Based Nature Contact Recommen -<br />
dations” [Abstract], International Journal <strong>of</strong> Environmental Health<br />
Research 21 no. 1 (2011): 41-61.<br />
31 Todd Fergson, “Creating Healing Environments with<br />
Evidence-Based Design” [Abstract], Occupational Health & Safety<br />
79 no. 10 (2010): 14-16.<br />
32 Cynthia Gordon et al., “Measuring Food Deserts in New<br />
York City’s Low-Income Neighborhoods,” Health & Place 17 no.<br />
2 (2011): 696-700.<br />
33 R.E. Walker, Keane, C.R., and Burke, J.G., “Disparities<br />
and Access to Healthy Food in the United <strong>St</strong>ates: A Review <strong>of</strong><br />
Food Deserts Literature” [Abstract], Health & Place 16 no. 5<br />
(2010): 876-884.<br />
34 Cynthia Gordon et al., “Measuring Food Deserts in New<br />
York City’s Low-Income Neighborhoods,” Health & Place 17 no.<br />
2 (2011): 696-700.<br />
35 Alan L. Melnick, Introduction to Geographic Information Systems<br />
in Public Health, (Gaithersburg: Aspen Publication, 2002), 9.<br />
36 Ibid, 45.<br />
37 L. Twigg, “Health based geographical information systems:<br />
their potential examined in the light <strong>of</strong> existing data sources”<br />
[Abstract], Social Science and Medicine 30 no. 1990 (1990): 143-<br />
155.<br />
38 Kerry Joyce, “’To me it’s just another tool to help<br />
understand the evident’: Public health decision-makers’<br />
perceptions <strong>of</strong> the value <strong>of</strong> geographical information systems<br />
(GIS)” [Abstract], Health and Place 15 no. 3 (2009): 831-840.<br />
39 Jeanette Eckert and Shetty, Sujata, “Food systems, planning<br />
and quantifying access: Using GIS to plan for food retail”<br />
[Abstract], Applied Geography 31 no. 4 (2011): 1216-1223.<br />
40 Frank Tanser, Gijsbertsen, Brice, and Herbst, Kobus,<br />
“Modeling and understanding primary health care accessibility<br />
and utilization in rural South Africa: An exploration using a<br />
geographical information system” [Abstract], Social Science and<br />
Medicine 63 no. 3 (2006): 691-705.<br />
41 Kristina Sundquist et al., “Neighborhood walkability,<br />
physical activity, and walking behavior: The Swedish<br />
Neighborhood and Physical Activity (SNAP) study,” Social Science<br />
and Medicine 72 no. 8 (2011): 1266-1273.<br />
69
UST McNair Scholars Program Research Journal<br />
BIBLIOGRAPHY<br />
American Public Health Association. “Healthiest Nation in One<br />
Generation.” www.apha.org/advocacy/healthiestnation/ (Last<br />
Accessed 27 June 2011).<br />
Brody, Jane E. “Head Out for a Daily Dose <strong>of</strong> Green Space.” New<br />
York Times, November 29, 2010, p.7.<br />
Burgess, Diana J., Yingmei Ding, Margaret Hargreaves, Michelle<br />
van Ryn, and Sean Phelan. “The Association between<br />
Perceived Discrimination and Underutilization <strong>of</strong> Needed<br />
Medical and Mental Health Care in a Multi-Ethnic<br />
Community Sample” [Abstract]. Journal <strong>of</strong> Community Care<br />
for the Poor and Underserved 19 no. 3 (2008): 894-911.<br />
Capps, Lisa L. “Ua neeb khu: a Hmong American Healing<br />
Ceremony” [Abstract]. Journal <strong>of</strong> Holistic Nursing” Official<br />
Journal <strong>of</strong> the American Holistic Nurses’ Association 29 no. 2<br />
(2011): 98-106.<br />
Cha, Dia. Hmong American Concepts <strong>of</strong> Health, Healing, and<br />
Conventional Medicine. New York: Taylor & Francis Books,<br />
Inc, 2003.<br />
Cloke, Philip, Philip Crang, and Mark Goodwin, ed. Introducing<br />
Human Geographies. (New York: Arnold Publishers, 1999), x.<br />
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Gordon, Cynthia, Marnie Purciel-Hill, Nuripa R. Ghai, Leslie<br />
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——. “History <strong>of</strong> the Hmong—A Timeline.” Lao Family<br />
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Hmong_History.pdf, 1997. (Last Accessed 27 June 2011).<br />
——. “Hmong Families.” Lao Family Community <strong>of</strong> Minnesota,<br />
Inc. 1997.<br />
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——. “Hmong History.” Hmong International Human Rights<br />
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Ikeda, Joanne P. Hmong American food practices, customs, and<br />
holidays. American Diabetes Association, Inc, 1999.<br />
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72<br />
A QUALITATIVE<br />
ANALYSIS OF<br />
TEACHERS’<br />
PERCEPTION<br />
TOWARDS HMONG<br />
AMERICAN<br />
STUDENTS’<br />
ACADEMIC<br />
ACHIEVEMENT IN<br />
MINNESOTA<br />
Mai-Eng Lee ’12<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
Mentor<br />
Ken<strong>dr</strong>a Garrett, Ph.D.<br />
Pr<strong>of</strong>essor <strong>of</strong> Social Work<br />
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong><br />
ABSTRACT<br />
Minnesota has a growing population <strong>of</strong> Hmong American students who are <strong>dr</strong>opping<br />
out <strong>of</strong> public high schools and graduating at lower rates than their counterparts at<br />
significantly higher rates, especially in the Twin Cities area. Through qualitative<br />
research, this study explores the perceptions <strong>of</strong> six teachers who have taught Hmong<br />
students throughout their teaching career in regards to the necessary parental and<br />
academic support that will empower Hmong students to excel in their academic success.<br />
The results show Hmong students have literacy challenges with reading, writing, and<br />
verbal communication in English. It is also evident from the current study Hmong<br />
students are in need <strong>of</strong> a culturally sensitive school environment to help them identify<br />
and learn about their own culture and language. In addition, Hmong students need a<br />
supportive home environment that provides a quiet study space and some hands-on<br />
learning activities to actively engage them in their learning. Moreover, regardless <strong>of</strong> the<br />
lack <strong>of</strong> Hmong parents’ academic involvement within and intimidation by their<br />
chil<strong>dr</strong>en’s school, they value education and want to understand the Western education<br />
system to better provide a supportive home environment for their chil<strong>dr</strong>en. Therefore, it<br />
is essential for teachers and other school pr<strong>of</strong>essionals to collaborate and communicate<br />
with Hmong parents in assisting Hmong students with the academic learning activities<br />
to help them succeed in school. Further research is needed with Hmong parents and<br />
students in order to understand how they perceive the Western education system.<br />
The Hmong are an ethnic minority group <strong>of</strong> people. Though there are no<br />
accurate records or evidence to prove where Hmong originated, scholars<br />
suggested Hmong people came from the mountains <strong>of</strong> Southern China and<br />
migrated over centuries to Vietnam, Thailand, Laos, and Burma. After the<br />
Secret War <strong>of</strong> Laos in 1975, some <strong>of</strong> the Hmong people immigrated to the<br />
United <strong>St</strong>ates. According to the U.S. Census 2000, Minneapolis and Saint Paul<br />
are home to 97.3 percent <strong>of</strong> the Minnesota Hmong population at 44,205.<br />
However, the American Community Survey (2007) estimated that the Hmong<br />
American population in Minnesota is probably between 60,000 and 70,000<br />
because Hmong have a young population and it is a fast growing community<br />
(Lee & Pfeiffer, 2010).<br />
Thirty-six years after Hmong arrived in the United <strong>St</strong>ates, education has<br />
continuously been one <strong>of</strong> the most challenging issues facing Hmong American<br />
chil<strong>dr</strong>en. Problems such as low educational attainment, high <strong>dr</strong>op-out rates,<br />
low test scores, and other education-related issues have preoccupied the Hmong<br />
American community (Yang, 2003). According to Yang and Pfeiffer (2003),<br />
Hmong refugees were pre-literate before they entered the United <strong>St</strong>ates in<br />
1975. This was not unexpected because most <strong>of</strong> the Hmong <strong>of</strong> Laos did not<br />
have their first village school until circa 1939, and only a few Hmong families<br />
could afford to send their sons to school at that time (Yang & Pfeiffer, 2003).<br />
This historical background and the cultural assimilation in America meant<br />
Hmong had to start their educational development and new way <strong>of</strong> life at the<br />
very base <strong>of</strong> society. After over thirty years in the United <strong>St</strong>ates, Hmong<br />
Americans have observed successes, though they continue to face challenges<br />
in academic achievement (Yang & Pfeiffer, 2003).
Mai-Eng Lee<br />
Social Work Teachers’ Perception towards Hmong <strong>St</strong>udents<br />
Research on Hmong populations started emerging in<br />
the late 1980’s. Many studies have been done on family<br />
dynamics, cultural transitions related to student<br />
achievement, and lifestyle challenges (Lor, 2008). From<br />
these studies, Vang (2003) and Thao (2003) have found<br />
students from culturally diverse backgrounds need a lot <strong>of</strong><br />
support from parents and teachers to perform better in<br />
school. However, little research has been conducted<br />
specifically on the types <strong>of</strong> collaboration and<br />
communication parents, teachers, and other school<br />
pr<strong>of</strong>essionals need to engage in to assist Hmong chil<strong>dr</strong>en<br />
to achieve their full academic potential. In order to do so,<br />
this current study explores the perceptions <strong>of</strong> teachers in<br />
regards to the necessary parental and academic support that<br />
empowers Hmong students to excel in their academic<br />
success. The study seeks to answer the following questions:<br />
(1) What kind <strong>of</strong> school and home environment would be<br />
supportive <strong>of</strong> Hmong students’ academic success? (2) What<br />
kinds <strong>of</strong> communication and collaboration do parents,<br />
teachers, and other school pr<strong>of</strong>essionals need to engage in<br />
to assist Hmong chil<strong>dr</strong>en to achieve their full academic<br />
potential in school? (3) What type <strong>of</strong> school and home<br />
activities are most useful in helping Hmong students<br />
succeed in school? By looking at literature on acculturation<br />
<strong>of</strong> Hmong American families, parent and teacher<br />
communication, and home-school factors that help and<br />
hinder Hmong chil<strong>dr</strong>en’s academic learning, it is hoped<br />
that there can be a better understanding <strong>of</strong> the needed<br />
parent and teacher collaboration to support students’<br />
success.<br />
A REVIEW OF THE LITERATURE<br />
LIFE IN THE UNITED STATES<br />
<strong>St</strong>udies have speculated that Hmong were unprepared<br />
linguistically, culturally, educationally, and economically<br />
to adapt to their new life in the United <strong>St</strong>ates (Yang &<br />
Pfeiffer, 2003). Hmong parents struggled with assimilation<br />
to Western culture while holding on to customs, spiritual<br />
beliefs, values, and roles <strong>of</strong> the Hmong culture; whereas<br />
chil<strong>dr</strong>en were placed in American schools where they<br />
quickly learned English and adjusted to their new<br />
surroundings (Thao, 2010). Suinn (2010) and McBrien<br />
(2005) have shown mixed findings on how acculturation,<br />
the process <strong>of</strong> changing beliefs and behaviors as a result <strong>of</strong><br />
contact between cultures, impacts refugee students’ school<br />
performance. According to Suinn, (2010) the process<br />
linking acculturation and school work involves the attitude<br />
<strong>of</strong> parents. Asian American chil<strong>dr</strong>en are performing better<br />
academically than chil<strong>dr</strong>en <strong>of</strong> other ethnic groups because<br />
their parents aspired for them to earn better grades and<br />
progress toward higher education (Suinn, 2010). On the<br />
contrary, researchers have found that acculturation can<br />
contribute to anxiety among refugees in the way they cope<br />
with and succeed in their new surroundings (McBrien,<br />
2005). This means anxiety and economic struggles endured<br />
by adults have direct influences on refugee chil<strong>dr</strong>en in<br />
terms <strong>of</strong> emotional challenges and school performance.<br />
McBrien (2005) also provides insights into the ways in<br />
which educational success is essential for refugee chil<strong>dr</strong>en’s<br />
acculturation. She found refugee students who can learn<br />
the language <strong>of</strong> their new country and be accepted by their<br />
teachers and peers are more likely to do better in school<br />
(McBrien, 2005). These perspectives on acculturation will<br />
be beneficial in ad<strong>dr</strong>essing the very real factors that help<br />
and hinder Hmong chil<strong>dr</strong>en to attain an education in the<br />
United <strong>St</strong>ates.<br />
WESTERN EDUCATIONAL SYSTEM<br />
Today, refugee and immigrant students come to the<br />
United <strong>St</strong>ates from every part <strong>of</strong> the world. According to<br />
Vang (2005) language-minority students are one <strong>of</strong> the<br />
fastest-growing segments <strong>of</strong> the total student population<br />
in America. The Minnesota Minority Education<br />
Partnership, Inc. (2009) found students in Minnesota<br />
public schools speak 97 different languages, and the most<br />
predominant primary home languages spoken by students<br />
were Spanish (32,239 students), Hmong (22,665 students),<br />
and Somali (9,583 students). Moreover, <strong>St</strong>. Paul Public<br />
Schools are home to the largest Hmong student body in<br />
the <strong>St</strong>ate <strong>of</strong> Minnesota, with approximately 10,590<br />
students enrolled each year (Xiong, 2008).<br />
According to gathered data by the Minnesota Minority<br />
Education Partnership (2009), students <strong>of</strong> color and<br />
American Indian students are <strong>dr</strong>opping out <strong>of</strong> public high<br />
schools and graduating at lower rates than their White<br />
peers at significantly higher rates. The Minnesota<br />
Department <strong>of</strong> Education shows students <strong>of</strong> color and<br />
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UST McNair Scholars Program Research Journal<br />
American Indian <strong>St</strong>udents were 2 to 5 times as likely to<br />
<strong>dr</strong>op out <strong>of</strong> school as their White peers over the last five<br />
years. The result also shows White students exceeding the<br />
overall national average <strong>of</strong> graduation rates by nearly 6<br />
points; in contrast, Minnesota students <strong>of</strong> color and<br />
American Indian students average 10 to 17 points below<br />
the national average for graduation rates (Minnesota<br />
Minority Education Partnership, 2009).<br />
This is further evidence <strong>of</strong> what previous studies have<br />
stated about Asian American students fitting into the<br />
model minority ideal. Too <strong>of</strong>ten, Asian-American students<br />
have been stereotyped as the “model minority” in which<br />
they performed academically better than other ethnic<br />
groups (Lee, 1994; Um, 2000). This stereotype claims<br />
Asian Americans are not educationally disadvantaged and<br />
do not need any academic assistance (Ngo & Lee, 2007).<br />
Hmong, as a refugee population, presents an important<br />
view on the problems and challenges facing many groups<br />
within this conception <strong>of</strong> Asian as the model minority<br />
(Xiong, 2008). Hmong is one <strong>of</strong> the newest Southeast<br />
Asian groups <strong>of</strong> people within this conception, considering<br />
they have only been in the United <strong>St</strong>ates for approximately<br />
thirty-six years. Therefore, it is imperative to understand<br />
all Asians do not have similar values and cultural<br />
background, nor do they share the same educational and<br />
economic opportunity in the United <strong>St</strong>ates (Hamilton-<br />
Merritt, 1993).<br />
PARENTS’ AND TEACHERS’ COMMUNICATION<br />
Historically, researchers have found that there has been<br />
a lack <strong>of</strong> communication between school teachers and<br />
South East Asian parents (Blakely, 1983). These parents<br />
received notices <strong>of</strong> their chil<strong>dr</strong>en’s grades, opportunities for<br />
students to join sports, and invitations to open houses, but<br />
the majority were illiterate and did not understand these<br />
school communications (Blakely, 1983). The study showed<br />
how refugees in Cascade, Oregon exhibited similar<br />
characteristics <strong>of</strong> other minorities immigrating to this<br />
country. These refugees’ families were willing to start a new<br />
life and saw formal education as a critical component to<br />
surviving in the United <strong>St</strong>ates (Blakely, 1983).<br />
Much research has been conducted on the importance <strong>of</strong><br />
teachers, parents, and other school pr<strong>of</strong>essionals’ ways <strong>of</strong><br />
collaboration and communication to better assist Hmong<br />
students in school. Thao (2003) found both parents and<br />
74<br />
teachers wanted a well-balanced relationship to better<br />
engage their students at home and school. Parents and<br />
teachers expressed how they want to be able to understand<br />
one another and communicate about the academic needs <strong>of</strong><br />
Hmong students. Both Hmong parents and teachers want<br />
to maintain trust, exchange resources, as well as share ideas<br />
(Thao, 2003). Furthermore, Thao (2003) found that<br />
providing a level <strong>of</strong> parent- teacher conferences would give<br />
parents encouragement, role models, and technical tools to<br />
support Hmong students both at school and home. The<br />
study also suggested for parents, teachers, and adminis -<br />
trators to get together to talk about their different<br />
expectations, home and school, and talk about resources<br />
that exist in the student’s home (Thao, 2003).<br />
HOME AND SCHOOL FACTORS<br />
Many studies have been done on the types <strong>of</strong> school and<br />
home environments needed to better assist Hmong<br />
students to achieve academic success. Thao (2003) found<br />
the school environment needs to be a comfortable place and<br />
not isolate the Hmong students and their culture. The<br />
school environment must allow Hmong students to explore<br />
the American culture without placing academic pressure<br />
on the students (Thao, 2003). However, the home<br />
environment must consist <strong>of</strong> loving and supportive parents<br />
in order to motivate Hmong students to succeed in school.<br />
Berger (1995) found students who come from different<br />
cultures bring unique languages, ideas, feelings, strengths,<br />
and weaknesses <strong>of</strong> their homes into their school life. It is<br />
important that educators provide a supportive and nonthreatening<br />
environment to lesson academic anxiety for<br />
Hmong students (Thao, 2003). Moreover, Thao (2003)<br />
revealed in her study that teaching <strong>of</strong> the Hmong culture<br />
and history within the school would be beneficial to<br />
Hmong students so they can identify with their culture<br />
and understand its values. Hmong chil<strong>dr</strong>en need to be in<br />
classrooms where they have the opportunity to learn how<br />
to balance cultural differences among their home, school,<br />
and community (Shade et al., 1997). In addition, it is<br />
important Hmong students have a study space along with<br />
parents’ expectations in their home environment (Thao,<br />
2003).<br />
At present, Xiong (2008) found Hmong chil<strong>dr</strong>en are<br />
growing up in economically and educationally disad -<br />
vantaged families. Hmong students are among the poorest
Mai-Eng Lee<br />
Social Work Teachers’ Perception towards Hmong <strong>St</strong>udents<br />
citizens living in Minnesota and many <strong>of</strong> them are<br />
concentrated in poor neighborhoods without adequate<br />
resources to provide a strong education basis for these<br />
young chil<strong>dr</strong>en (Xiong, 2008). The study identifies several<br />
factors, most <strong>of</strong> which have to do with the low educational<br />
histories and employment status that can be attributed to<br />
the poverty <strong>of</strong> the Hmong population. As a consequence,<br />
Hmong chil<strong>dr</strong>en grow up in low-income households, in<br />
homes with lower market values and with parents and<br />
adults who are either unemployed or in low-paying, lowskilled<br />
occupations (Xiong, 2008). Furthermore, the<br />
linguistic isolation <strong>of</strong> Hmong parents may also explain<br />
some <strong>of</strong> the reasons why Hmong chil<strong>dr</strong>en have lower test<br />
scores in school. This study showed Hmong students<br />
scored the lowest, followed by Hispanic and African<br />
Immigrant students, after taking the Peabody Vocabulary<br />
Test (Xiong, 2008). More specifically, 82 percent <strong>of</strong> the<br />
Hmong students scored below the national average<br />
compared to only 17 percent <strong>of</strong> Caucasian students (Xiong,<br />
2008). This means Hmong families are still struggling<br />
with language and poverty after more than thirty years <strong>of</strong><br />
living in the United <strong>St</strong>ates, and this has a direct affect on<br />
their chil<strong>dr</strong>en.<br />
SUMMARY OF LITERATURE REVIEW<br />
It is evident that Hmong high school students are a<br />
growing population in the <strong>St</strong>ate <strong>of</strong> Minnesota. Educators<br />
must understand the history and culture <strong>of</strong> the people in<br />
order to better understand the needs <strong>of</strong> Hmong students.<br />
Acculturation also plays a role in how well Hmong<br />
students can academically succeed in school. As a result <strong>of</strong><br />
these studies, it is critical that school pr<strong>of</strong>essionals are<br />
aware <strong>of</strong> students’ languages spoken at home and their<br />
culture so they can begin to bridge this academic barrier<br />
and better communicate with culturally diverse parents.<br />
Many studies have found different factors that influenced<br />
students to achieve academic success; however, these<br />
studies did not provide in-depth perspectives about the<br />
kinds <strong>of</strong> communication between parents and teachers and<br />
the way these interactions have empowered Hmong<br />
students to gain confidence in their academic skills, both<br />
at home and school.<br />
Therefore, it is crucial to explore parent and teacher<br />
communication strategies in order to assist and empower<br />
Hmong students to achieve their academic potential both<br />
at home and school. The current study provides an indepth<br />
understanding <strong>of</strong> teachers’ perspectives about the<br />
needed academic support to empower Hmong to excel in<br />
school. This study seeks to answer these following<br />
questions: (1) What kind <strong>of</strong> school and home environment<br />
would support Hmong students to achieve academic<br />
success? (2) What kinds <strong>of</strong> communications do parents,<br />
teachers, and other school pr<strong>of</strong>essionals need to engage in<br />
to assist Hmong chil<strong>dr</strong>en to achieve their full academic<br />
potential in school? (3) What type <strong>of</strong> school and home<br />
activities are most useful in helping Hmong students<br />
succeed in school?<br />
METHODOLOGY<br />
Through qualitative research, the primary researcher<br />
looked in-depth at teachers’ perspectives <strong>of</strong> what activities,<br />
school-home learning environment, and type <strong>of</strong> parentteacher<br />
communication is needed to help Hmong students<br />
achieve academic success. According to Grinnell and Unrau<br />
(2011), the qualitative research approach involves looking<br />
at meaning, experience, emotions, richness, and depth to<br />
better understand the interpretative perspective. This<br />
research study was approved from the <strong>University</strong> <strong>of</strong> Saint<br />
<strong>Thomas</strong> Institutional Review Board.<br />
RECRUITMENT<br />
The study focuses on teachers’ perspectives <strong>of</strong> Hmong<br />
students’ academic achievements. The targeted population<br />
was teachers who had experience educating Hmong<br />
students throughout their teaching career in Minnesota.<br />
These teachers were targeted with a snow ball sampling<br />
approach (Grinnell & Unrau, 2011, p. 237), where the<br />
primary researcher contacted teachers throughout the Twin<br />
Cities area as potential participants and afterwards asked<br />
them to identify teachers. The researcher followed-up with<br />
the names provided and invited these individuals to<br />
participate in the study. This target population has a<br />
greater sense <strong>of</strong> understanding the language and cultural<br />
barriers within the Hmong community. These teachers<br />
engaged with the researcher to talk about Hmong students’<br />
behavior and academic learning due to direct experience<br />
with them in the classroom.<br />
75
UST McNair Scholars Program Research Journal<br />
Initial contact with potential participants was made<br />
through the use <strong>of</strong> e-mail and telephone invitations (e-mail<br />
and telephone recruitment letter can be found in Appendix<br />
A). E-mail and telephone invitations were used as a simple<br />
and quick way to invite potential participants to be a part<br />
<strong>of</strong> the study. In order to provide compensation for the<br />
participants in the study, they were given the opportunity<br />
to enter a <strong>dr</strong>awing for one <strong>of</strong> two $10 gift cards to a local<br />
store.<br />
PARTICIPANTS<br />
Upon request for more information or acceptance <strong>of</strong><br />
participation, the researcher did a follow-up through<br />
telephone or email to set up a time, date, and location to<br />
conduct interviews, including a discussion <strong>of</strong> the minimal<br />
risks <strong>of</strong> participating in the study. The teachers included<br />
two females and four males. All six teachers have taught<br />
ninth through twelfth grade students in local high schools<br />
throughout the Twin Cities area. The female teachers<br />
taught English and English Language Learning for<br />
approximately five to six years. In contrast, the four male<br />
teachers have taught between three to ten years in the areas<br />
<strong>of</strong> math, social studies, and physical education. One <strong>of</strong> the<br />
male teachers has been an advisor to their high school Asian<br />
student organization for six years.<br />
Each interview lasted for about 30-45 minutes<br />
(interview questions can be found in Appendix B). All<br />
interviews were audio recorded to ensure the clarity <strong>of</strong> all<br />
words and thoughts <strong>of</strong> each participant for transcription<br />
on a later date.<br />
76<br />
Teachers Literacy<br />
Challenge<br />
Concept Tally<br />
Culturally<br />
Sensi tive School<br />
Environment<br />
Concept Tally<br />
Supportive<br />
Home<br />
Environment<br />
Concept Tally<br />
FINDINGS AND DATA ANALYSIS<br />
The primary researcher used content analysis as a way to<br />
define and code the transcription. According to Grinnell<br />
and Unrau (2011), content analysis is the recording <strong>of</strong><br />
frequency in which certain symbols or themes appear in a<br />
communication. The researcher looked for recurrent<br />
themes or units <strong>of</strong> analysis that were noticeable from the<br />
individual interviews. Notable themes were the association<br />
between teacher and parent collaboration, home and school<br />
environment that may help or hinder learning, and<br />
academic resources needed to help students succeed in<br />
school. The results represented the perceptions, opinions,<br />
and feelings <strong>of</strong> six teachers at local high schools throughout<br />
the Twin Cities area.<br />
To analyze the results, a recording sheet was developed<br />
to tally the frequency <strong>of</strong> teachers’ comments from the<br />
transcriptions. Table one shows six subcategories that arise<br />
from the overall themes. The subcategories were 1) Literacy<br />
Challenge, 2) Culturally Sensitive School Environment, 3)<br />
Supportive Home Environment, 4) Parent’s Intimidation<br />
Factors, 5) Academic Learning Activities, and 6) Gender.<br />
The results are shown in the table below.<br />
LITERACY CHALLENGES<br />
Results from the six teachers were consistent in terms <strong>of</strong><br />
the literacy challenges experienced by Hmong students.<br />
These teachers understood that Hmong students and their<br />
parents have literacy challenges with reading, writing, and<br />
verbal communication in English. All <strong>of</strong> them discussed<br />
that acculturation to the Western education system may<br />
Parents Intimi -<br />
dation Factors<br />
Concept Tally<br />
Academic<br />
Learn ing<br />
Activities<br />
Concept Tally<br />
One 5 8 5 3 3 ✓<br />
Two 6 6 3 8 4 ✓<br />
Gender <strong>of</strong><br />
Teacher<br />
Male Female<br />
Three 4 4 3 0 5 ✓<br />
Four 5 9 4 4 4 ✓<br />
Five 7 5 5 3 5 ✓<br />
Six 4 6 3 1 3 ✓
Mai-Eng Lee<br />
Social Work Teachers’ Perception towards Hmong <strong>St</strong>udents<br />
also have contributed to how well Hmong students are able<br />
to perform on their tests and homework. All six teachers<br />
suggested for Hmong students to improve on their<br />
reading, writing, and verbal communication skills by<br />
asking for more teacher assistance or seeking after-school<br />
tutorial. The results illustrated that Hmong students need<br />
more engaging learning activities to help them improve<br />
on their reading, writing, and communication skills.<br />
CULTURALLY SENSITIVE SCHOOL ENVIRONMENT<br />
In order for Hmong students to excel academically, all<br />
six teachers from the interviews suggested parent-teacher<br />
communication was crucial. From the interactions between<br />
teachers and Hmong parents, the majority <strong>of</strong> the parentteacher<br />
communications have been made through the use<br />
<strong>of</strong> a Hmong interpreter, and the teachers agreed that a<br />
translator was helpful. All teachers perceived a need for<br />
improved staff representation among the Hmong<br />
community along with expanding translation services<br />
available for Hmong families. As seen in one <strong>of</strong> the<br />
interviews, respondent six, a female teacher, mentions:<br />
It is definitely effective to have someone, an adult that<br />
is established in the Hmong community to work at<br />
your school. I think the students see that as another<br />
bridge or piece <strong>of</strong> communication that the family can<br />
rely on. I just wish that we have better representations<br />
<strong>of</strong> Hmong staff along with translators who are readily<br />
available in our school. We never had a person here<br />
specifically to do the translating for Hmong families,<br />
but we did have a math teacher who is now retired<br />
and you can always rely on him. Now it is a challenge<br />
because if I need to get a document translated then it<br />
might take longer than I anticipated so I have to plan<br />
ahead.<br />
Four teachers felt that the schools should provide a<br />
Hmong language and cultural class geared toward Hmong<br />
students. The course would be beneficial for Hmong<br />
students and parents to maintain their culture and<br />
language at school. Such a course would connect students<br />
to their own culture and language within the school<br />
community and this would allow educators to better<br />
collaborate with Hmong parents. According to respondent<br />
two, a male teacher:<br />
Our school is very family-like. I think it works well<br />
with the Hmong culture <strong>of</strong> having the support from<br />
your family. We do have a Hmong language class. I<br />
think it’s nice for Hmong kids that struggled in<br />
regular class because they <strong>of</strong>ten do well in the Hmong<br />
class and it is good for them to have that success. The<br />
class is also helpful for the growing number <strong>of</strong> kids<br />
who do not speak Hmong or do not speak Hmong<br />
well because they are getting disconnected from their<br />
culture as time goes on. I think it’s definitely good to<br />
have that component to help these students succeed.<br />
SUPPORTIVE HOME ENVIRONMENT<br />
The current study established an agreement among the<br />
teachers about the need for an improved home environment<br />
in the Hmong community. All six teachers mentioned the<br />
lack <strong>of</strong> structure, a quiet space, and opportunities at home<br />
to help Hmong students fully engage with their education.<br />
The teachers seemed to understand that a lot <strong>of</strong> Hmong<br />
parents are in a situation where they cannot provide their<br />
chil<strong>dr</strong>en with adequate financial and academic support;<br />
however, they urged parents to continue to motivate<br />
students academically. Therefore, teachers have suggested<br />
for Hmong parents to continue to interact with their<br />
chil<strong>dr</strong>en either in their native language or simply check for<br />
completion on students’ assignments. Teachers perceived<br />
this as a useful way for Hmong parents to connect with<br />
their students and assist them to seek additional academic<br />
assistance if needed. As mentioned by respondent one, a<br />
male teacher, stated:<br />
The ideal best home environment is a place that provides<br />
quiet time, structure, and a quiet space where these<br />
students can do some work. I think having some resources<br />
where they can go and ask for help would also be beneficial.<br />
If the parents are really kind <strong>of</strong> out <strong>of</strong> touch with their<br />
chil<strong>dr</strong>en’s learning or if this is the first child that is going<br />
through it then I can see why this is really a difficult<br />
situation. When there is no quiet space in doing their work<br />
and no expectations on the part <strong>of</strong> the parents to get the<br />
work done then this can become a struggle. In my class, I<br />
see that it’s a challenge because some Hmong students tend<br />
to do their homework in school and so if they don’t find<br />
time to do it at home it’s not going to get done.<br />
PARENTS’ INTIMIDATION FACTORS<br />
Hmong parents may not necessarily understand the<br />
Western academic system, but it is clear to the teachers<br />
they understand the value <strong>of</strong> education. Four <strong>of</strong> the teachers<br />
77
UST McNair Scholars Program Research Journal<br />
stated they have had limited, but fairly positive, interaction<br />
experiences with Hmong parents. This study found<br />
Hmong parents are responsive to their students’ learning,<br />
but only a few parents are active within the school. Four <strong>of</strong><br />
the teachers agreed Hmong parents have limited English<br />
speaking skills and this may have contributed to how <strong>of</strong>ten<br />
they volunteered at school events. The results do show<br />
opinions on extreme levels where respondent two, highly<br />
perceived Hmong parents as intimidated to enter the<br />
school building due to language barriers and accessibility.<br />
Respondent two said,<br />
The most challenging thing working with Hmong<br />
parents is getting any sort <strong>of</strong> communication with<br />
them. We have mandatory calls with them all the<br />
time. Even when we try calling home, so <strong>of</strong>ten their<br />
phones are disconnected, their voicemail are full, they<br />
will hang up when they see it’s our school that is<br />
calling. It is a real challenge. We had in the past, do<br />
home visits for all <strong>of</strong> our students. Even then, we have<br />
parents who sit down and start to leave. I do not know<br />
what it is, intimidation? There’s needed to be<br />
something so parents are not intimidated <strong>of</strong> coming<br />
into the building. It could be as simple as making the<br />
front entrance more inviting and not having the metal<br />
detector sitting right there or having so many locked<br />
doors everywhere so they can at least come in and not<br />
sit outside.<br />
ACADEMIC LEARNING ACTIVITIES<br />
Five teachers suggested Hmong students struggled to<br />
learn English, but Hmong students are visual learners.<br />
Hmong students need reading, writing, and hands-on<br />
learning activities within their home and school<br />
environment to help them succeed. Teachers suggested<br />
Hmong students should have conversations with their<br />
parents, have access to books at home, and go to the public<br />
library. Hmong students may not have the opportunities<br />
to go to camp and classes during the summer but having<br />
additional resources could be helpful for Hmong students<br />
to gain the academic and social skills they need in school.<br />
Two teachers included in their comments that Hmong<br />
students should interact more with students who are<br />
different from them because it will help improve their<br />
communication skills. The teachers also agreed Hmong<br />
students are very open to learn about others’ cultures and<br />
may not be comfortable at first, but other students enjoyed<br />
78<br />
interacting with them. In addition, teachers believe having<br />
a mix <strong>of</strong> quiet times and interactive activities within the<br />
classroom will allow Hmong students to fully engage in<br />
their learning. As mentioned by respondent four, a male<br />
teacher:<br />
Many Hmong students are into the arts, such as,<br />
singing, dancing, and poetry writing. I think<br />
incorporating some things like that will definitely be<br />
helpful to their learning. They are really hands on too<br />
and like movement, and so any kind <strong>of</strong> hands-on<br />
activity where they can get up and move around are<br />
some <strong>of</strong> the things that we can definitely do to help<br />
them achieve.<br />
DISCUSSION<br />
The findings from this current study correspond with<br />
the results <strong>of</strong> previous studies that Hmong students need<br />
additional support and academic resources within their<br />
home and school environment in order to excel in school.<br />
In Thao (2003), Hmong students were empowered when<br />
their school valued their culture and utilized their parents<br />
as resources. In this way, Hmong parents can collaborate<br />
with school pr<strong>of</strong>essionals to support their chil<strong>dr</strong>en’s<br />
education and provide the necessary tools to guide the<br />
students. It is also evident from Thao (2003) that the home<br />
and school environment has a critical role in the academic<br />
success <strong>of</strong> Hmong students. Hmong students should<br />
receive relevant Hmong history and culture courses in the<br />
school to help Hmong chil<strong>dr</strong>en identify with their culture<br />
and understand its values (Thao, 2003). This perspective<br />
was perceived to be imperative by four teachers in the<br />
current study. Moreover, in correspondence to Xiong<br />
(2008), Hmong chil<strong>dr</strong>en are growing up in disadvantaged<br />
families, where Hmong parents lacked an educational<br />
background, and as a result, may have hindered their<br />
chil<strong>dr</strong>en from having a supportive home environment. This<br />
finding was reinforced by the results <strong>of</strong> the current study<br />
where five teachers felt Hmong parents are struggling with<br />
language barrier and acculturation. These two factors were<br />
perceived as the greatest hin<strong>dr</strong>ance to Hmong parents in<br />
order for them to support their chil<strong>dr</strong>en academically.
Mai-Eng Lee<br />
Social Work Teachers’ Perception towards Hmong <strong>St</strong>udents<br />
IMPLICATIONS FOR SCHOOL POLICY MAKERS<br />
It has become evident that Minnesota has a growing<br />
population <strong>of</strong> Hmong students in the Twin Cities area. The<br />
essential implications for school policy makers that were<br />
developed from the results are the following: 1) ensure<br />
schools have formal translation services available for<br />
teachers so they can better communicate effectively with<br />
parents who do not speak English or have limited English<br />
speaking skills, 2) provide additional funding to allow<br />
Hmong students to have access to a Hmong language and<br />
cultural classes, and 3) support school-based programs to<br />
provide extra help for students who speak more than one<br />
language. Moreover, there is a need for better<br />
representations <strong>of</strong> Hmong staff because it allows Hmong<br />
parents to feel less intimidated and instead more welcome<br />
within the school building.<br />
LIMITATIONS<br />
It is important to note there are limitations in this<br />
research study. Snow ball design calls for a cautious<br />
generalization from the sample so it only reflects the<br />
participants in this study. Due to the small sample size,<br />
this study provided little insight about teachers’<br />
perceptions <strong>of</strong> Hmong American students. Future research<br />
relating to this topic should include a larger population<br />
base to be more favorable. There are implications for future<br />
study where the researcher could explore the educational<br />
perspectives from teachers and both Hmong parents and<br />
students. This will allow the researcher to study more indepth<br />
and understand the perspectives <strong>of</strong> Hmong parents<br />
and students.<br />
CONCLUSION<br />
Through this research, the primary researcher conducted<br />
interviews with six teachers who have taught Hmong<br />
students throughout their teaching career in the Twin<br />
Cities area. It is evident from the study that Minnesota has<br />
a growing population <strong>of</strong> Hmong students who have<br />
literacy challenges with reading, writing, and verbal<br />
communication in English. The current study identifies<br />
Hmong students are in need <strong>of</strong> more reading, writing, and<br />
grammar activities. Hmong students are encouraged to<br />
talk to other students and be in a mixed group <strong>of</strong> kids in<br />
order to improve their communication skills.<br />
Acculturation to the Western education system also may<br />
have contributed to how well Hmong students are able to<br />
perform in school. The results show Hmong students are<br />
in need <strong>of</strong> a culturally sensitive school environment to help<br />
them actively engage in their learning, where Hmong<br />
students can learn about their own culture and language.<br />
In addition, Hmong students need a supportive home<br />
environment that provides a quiet study space and some<br />
hands-on learning activities to enhance their academic<br />
learning abilities. Despite the lack <strong>of</strong> Hmong parents’<br />
academic involvement and their intimidation within their<br />
chil<strong>dr</strong>en’s school, they highly value education and want to<br />
understand the Western education system to better provide<br />
a supportive home environment for their chil<strong>dr</strong>en.<br />
Therefore, it is imperative for teachers and other school<br />
pr<strong>of</strong>essionals to collaborate with Hmong parents in<br />
assisting Hmong students to achieve academic success.<br />
79
<strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong> McNair Scholars Program Research Journal<br />
APPENDIX A<br />
Recruitment email/telephone invitation:<br />
Hello,<br />
My name is Mai-Eng Lee and I am a current undergraduate<br />
at the (institution’s name) and Ronald E. McNair scholar.<br />
I am conducting a research project exploring the<br />
perceptions <strong>of</strong> teachers in regards to the necessary academic<br />
and parental support that will empower Hmong students<br />
to excel in school. I am looking for teachers who have<br />
experience teaching Hmong students in their classroom to<br />
be part <strong>of</strong> a 30-45 minute interview. Your decision to<br />
participate in this study is entirely voluntary. Please know<br />
that if you do choose to participate in this study, all<br />
information will be kept confidential.<br />
For your participation in the study, you have the<br />
opportunity to be entered into a <strong>dr</strong>awing for 1 <strong>of</strong> 2 $10<br />
gift cards to Target. If you are interested in participating<br />
in this research or would like more information, please<br />
contact Mai-Eng Lee at (email ad<strong>dr</strong>ess).<br />
Thank you for your consideration <strong>of</strong> this research.<br />
Sincerely,<br />
Mai-Eng Lee<br />
80<br />
Telephone script:<br />
Hello (potential participant’s name),<br />
My name is Mai-Eng Lee and I am a current undergraduate<br />
at the <strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong> and Ronald E. McNair<br />
scholar. I am contacting you because your name was<br />
recommended by other teachers who thought you would<br />
be interested my study. The reason I’m calling is that I am<br />
conducting a study on exploring teachers’ perceptions in<br />
regards to the necessary academic and parental support that<br />
will empower Hmong students to excel in school. I am<br />
currently seeking teachers who have experience teaching<br />
Hmong students in their classroom as participants in this<br />
study and I wondered if you would be interested in hearing<br />
more about it?<br />
[IF NO] Thank you for your time. Good-bye.<br />
[IF YES] Continue<br />
Participation in this study involves meeting with me for<br />
an interview, which will take approximately 30-45<br />
minutes. I will ask you some questions in regards to your<br />
teaching experiences working with Hmong students and<br />
families. In appreciation <strong>of</strong> your time commitment, you<br />
will have the opportunity to be entered into a <strong>dr</strong>awing for<br />
1 <strong>of</strong> 2 free $10 gift cards to Target. I would like to assure<br />
you that this study has been reviewed and received approval<br />
from the <strong>University</strong> <strong>of</strong> <strong>St</strong>. <strong>Thomas</strong> Institutional Review<br />
Board.<br />
However, your decision to participate in this study is<br />
entirely voluntary.<br />
Would you be interested in participating?<br />
[If NO] Thank you for your time. Good-bye.<br />
[IF YES] Thank you; I appreciate your interest in my<br />
research!<br />
(Schedule a mutually agreeable time to meet for an<br />
interview.)<br />
I look forward to meeting you on (day and time <strong>of</strong><br />
appointment). Thank you very much for helping me with<br />
my research!
APPENDIX B<br />
INTERVIEW QUESTIONS<br />
Background Questions:<br />
1. What grade levels have you taught in the past?<br />
2. Have you used an interpreter? If yes, what was this<br />
like?<br />
3. What challenges have you experienced working with<br />
Hmong students?<br />
4. What challenges have you experienced working with<br />
Hmong parents?<br />
5. Can you describe what in particular was rewarding<br />
when you work with Hmong students and their<br />
parents? Explain why?<br />
Main Questions:<br />
6. What would be the best school environment to<br />
support Hmong students to achieve academic<br />
success?<br />
7. What would be the best home environment to<br />
support Hmong students to achieve academic<br />
success?<br />
8. What kinds <strong>of</strong> efforts have you or your school done<br />
to facilitate Hmong parent’s involvement in their<br />
chil<strong>dr</strong>en’s schooling?<br />
a. Please explain<br />
b. Describe what your school can improve on to better<br />
support and welcome Hmong families.<br />
9. What specific learning activities do you think would<br />
help Hmong students to be more successful at<br />
school?<br />
10. What specific learning activities do you think would<br />
help Hmong students to be more successful at home?<br />
Ending Question:<br />
11.Do you have anything else to say? Any final<br />
thoughts?<br />
REFERENCES<br />
Berger, E. H. (1995). Parents as parents in education. Englewood<br />
Cliff, NJ: Prentice-Hall.<br />
Blakely, M. M. (1983) Southeast Asian refugee parents: An<br />
inquiry into home-school communication and<br />
understanding. Anthropology & Education Quarterly, 14, (1),<br />
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Grinnell, M. R., & Unrau, A. Y. (2011). Social work research and<br />
evaluation: foundations <strong>of</strong> evidence-based practice. New York, NY:<br />
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Hamilton-Merritt, J. (1993). Tragic mountains: The Hmong, the<br />
Americans, and the Secret Wars for Laos. Indianapolis, Indiana:<br />
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Lee, S. (1994). Behind the model-minority stereotype: Voices <strong>of</strong><br />
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Lee, T. P, & Pfeiffer, M.E (2010). Building bridges: Teaching about<br />
the Hmong in our communities. [PowerPoint slides]. Retrieved<br />
from www.hmongcc.org<br />
Lor, P. (2008). Key life experiences contributing to Hmong<br />
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47.<br />
McBrien, J. Lynn. (2005). Educational needs and barriers for<br />
refugee students in the United <strong>St</strong>ates: A review <strong>of</strong> the<br />
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The Minnesota Minority Education Partnership, Inc. (2009).<br />
<strong>St</strong>ate <strong>of</strong> students <strong>of</strong> color & American Indian students. Retrieved<br />
from http://www.mmep.org/sites/b432e9a3-0140-43f3-<br />
81b5-0b0f33e11a37/uploads/MMEP-09-ExecSummary-<br />
FINAL_2.pdf<br />
Ngo, B., & Lee, S. J. (2007). Complicating the image <strong>of</strong> model<br />
minority success: A review <strong>of</strong> Southeast Asian American<br />
education. Review <strong>of</strong> Educational Research, 77(4), 415-453.<br />
Shade, B. J., Kelly, C., and Oberg, M. (1997). Creating culturally<br />
responsive classrooms. Washington, DC: American<br />
Psychological Association.<br />
Suinn, R.M. (2010). Reviewing acculturation and Asian<br />
Americans: How acculturation affects health, adjustment,<br />
school achievement, and counseling. Asian American Journal<br />
<strong>of</strong> Psychology, 1(1), 5-17.<br />
Thao, M. (2010). Ntxhais Hmoob: ‘Hmong daughters’<br />
supporting the well-being <strong>of</strong> young Hmong women.<br />
Retrieved from www.wilder.org/download.0.html?<br />
report=2316<br />
Thao, Y.J. (2003). Empowering Mong students: Home and<br />
school factors. The Urban Review, 35, (1), 25-42.<br />
Um, K. (2000). A <strong>dr</strong>eam denied: Educational experiences <strong>of</strong> Southeast<br />
Asian American youth issues and recommendations. Washington,<br />
DC: Southeast Asian Resource Action Center.<br />
Vang, Christopher T. (2003). Learning more about Hmong<br />
students. Multicultural Education, 11(2), 10-14.<br />
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Vang, Christopher T. (2005). Hmong-American students still<br />
face multiple challenges in public schools. Multicultural<br />
Education, 13(1), 27.<br />
Vang, Christopher T. (2005). Minority students are far from<br />
academic success and still at risk in public school.<br />
Multicultural Education, 12(4), 9.<br />
Yang, K. (2003). Hmong Americans: Felt needs, problems and<br />
community development. Hmong <strong>St</strong>udies Journal, 4, 1-23.<br />
Yang, K., & Pfeiffer, M.E. (2003). Pr<strong>of</strong>ile <strong>of</strong> Hmong educational<br />
attainment. Hmong 2000 Census Publication: Data and<br />
Analysis. Hmong National Development and Hmong<br />
Cultural and Resource Center. Retrieved from http://<br />
hmongstudies.com/2000HmongCensusPublication.pdf<br />
Xiong, Z.B., Yang, K.K., & Lee, J.K. (2008). What helps and<br />
hinders Hmong pre-kindergartener’s school readiness: Learning from<br />
and about the Hmong in <strong>St</strong>. Paul, Minnesota. Saint Paul, MN:<br />
Ready 4 K.<br />
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