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The consistency of the United States population has changed dramatically over the last
few decades. Whereas in the early 20th century mostly people from Europe immigrated to
America, mainly people from Latin America, Southeast Asia and Eastern Europe emigrated from
their countries in the second half of the last century to move to the U.S. While many early
immigrants had to assimilate to life in the United States, the latter newcomers mostly retained
their culture and in addition acculturated to the American culture. This abundance of cultures,
with many different customs and beliefs in all aspects of life, makes it necessary for health care
professionals to become not only aware of but also intimately familiar with said cultural
differences to deliver culturally respectful and competent health care.
This research paper examines the unique cultural characteristics of Italian-Americans. It
investigates their eating habits, life expectancy, prominent and hereditary illnesses, and risk
factors of diseases that can be decreased through changes in lifestyle. Furthermore, it compares
and contrasts the answers of an interview with an Italian-American with the general ideas
presented about this group.
Italy is a southern European country and includes the peninsula of Italy, the islands of
Sardinia and Sicily and several smaller ones and is located on the Mediterranean Sea. Whereas
the north is on the European mainland and is bordered by the Alps and has ample vegetation and
four seasons (continental climate), the south of Italy is jutting into the Mediterranean Sea and is
hot and dry in the summer with poor vegetation (Mediterranean climate). The temperature
differences from north to south are most evident in the winter months (Answers, 2007). The
population of the north can have fairer skin and hair and blue eyes, whereas the people of the
south have predominantly darker, often curly hair and darker eyes and skin (Purnell & Paulanka,
2005). According to Purnell and Paulanka (2005), 14.7 million Italians live in the United States,
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predominantly in the northeastern states of Massachusetts, New Jersey, New York and
Pennsylvania, and in California. However, there are Italian enclaves in many major cities in
other parts of America. The average life expectancy of Italians in general is 79.68 years, with
men living on average 76.75 years and women living longer with 82.81 years, according to the
World Fact Book 2005, prepared by the Central Intelligence Agency.
The eating habits of Italian-Americans vary with the region were they originated from.
Italians from the north use mostly cream and cheese based sauces and a lot of butter, which could
lead to an increased intake of fat, whereas people from the south prepare tomato based pasta
sauces, with spices, extra salt and use plenty of olive oil. In general, the Italian diet consists of
vegetables, pasta, fruit, fish and cheese (Purnell & Paulanka, 2005). Italians drink wine with
almost every meal and even allow their children to drink red wine mixed with water during
meals to maintain healthy blood, as stated by Purnell and Paulanka (2005). Health care practices
involving food include “eating a clove of garlic every night before going to bed to prevent upper
respiratory infections” (Purnell & Paulanka, 2005). Garlic is also worn around the neck in times
of flu epidemics to prevent infection. Consuming a fresh raw egg every morning keeps one
strong and eating fresh dandelions in salads or soups helps a person regain his or her strength
(Purnell & Paulanka, 2005).
Moreover, Italians enjoy talking loudly and with passion, conveying their emotions to
their conversation partner. This does not necessarily mean that they are angry at each other.
During conversations, Italians frequently use non-verbal communication, e.g. touching each
other, to show their affection and kiss each other on the cheek upon greeting. They furthermore
use grand gestures while talking to make a point (Purnell & Paulanka, 2005).
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According to Purnell and Paulanka (2005), Italian women make decisions regarding the
economical situation of the family and the running of the household, since their husbands turn
over their paycheck to them. The mothers are also primarily responsible for the upbringing of
their children. From the children is expected to be well behaved and to respect their elders. Also,
they should contribute to chores in the household and “support the family as soon as they are old
enough to work” (Purnell and Paulanka, 2005). Purnell and Paulanka (2005) found that the
different generations of Italian families like to stay close to each other and frequently visit their
parents or grandparents for big family meals.
Spirituality is very important to Italians and in time of illness, prayers from family
members to cure the ill are common, as well as having faith and praying helps the ill to get
through the illness. Although, most Italians are roman-catholic and are obligated to fast during
lent and are not allowed to eat meat on Fridays, the ill do not have to follow these obligations
(Purnell & Paulanka, 2005).
Regarding health care practices of Italians, Purnell and Paulanka (2005) write that
Italians consider a disease or illness as god’s will and that it will run its course. Therefore, it is
often ignored until the health problem become too serious. Italians like to protect themselves
from negative influences, e.g. the evil eye and the eye of death, by wearing amulets and
practicing witchcraft. Because of the high cost of health care, many Italians are reluctant to seek
medical care and have little faith in medical professionals. If the physician is Italian, they are
more inclined to follow his or her recommendations (Purnell & Paulanka, 2005).
Due to a high carbohydrate and fat diet, Italian-Americans suffer from prominent illnesses
like diabetes and cardiovascular disease related to smoking and type A behavior. High-risk
behaviors include smoking and alcoholism (Purnell & Paulanka, 2005). A study published in the
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Annals of Internal Medicine by Beulens, Rimm, Ascherio, Spiegelman, Hendriks, and Mukamal
(2007) found that alcohol consumption among men with hypertension is a risk factor for
coronary artery disease.
A number of hereditary illnesses are common among Italian-Americans. One of them is
Familial Mediterranean Fever, also called familial paroxysmal polyserositis, which “is
characterized by short attacks of fever,” (Purnell & Paulanka, 2005) inflammation of the serous
membrane lining the cavity of the abdomen and covering the abdominal organs, pleurisy and
arthritis. If not treated, death may be caused by amyloidosis, a disorder marked by deposition of
a starch like protein in the liver, kidney, spleen or other tissues (Purnell & Paulanka, 2005).
Purnell and Paulanka (2005) found that there “is no specific diagnostic test available” and that
“treatment is symptomatic.”
Furthermore, another genetically passed on illness of people of Italian descent is
Mediterranean type glucose-6-phosphate dehydrogenase (G6PD) deficiency. According to
Purnell and Paulanka (2005) it is a disorder linked to the X-chromosome and mostly found in
men with two identical dominant genes coding for the disease, although it is also present in
heterozygous women in a carrier state. G6PD deficiency can lead to red blood cell damage
during extended treatment with medications like sulfonamides, i.e. synthetic drugs that are able
to prevent the multiplication of some pathogenic bacteria, antimalarial agents, salicylates, e.g.
Aspirin, and naphthaquinolones. Similarly, hemolysis can also arise in the company of
abnormally low concentration of oxygen in the blood or acidosis as well as after eating fava
beans (Purnell & Paulanka, 2005). To revert the effects of erythrocyte damage, Purnell and
Paulanka (2005) assert to simply remove the etiologic agent, give blood transfusions and iron
orally, which should lead to voluntary recovery.
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Moreover, Beta-Thalassemia is an additional inherited disease among Italian-Americans
that “is caused by a genetic defect in the synthesis of the hemoglobin A or B chain” (Purnell &
Paulanka, 2005). In Beta-Thalassemia minor, B chain synthesis is somewhat impaired leading to
mild or moderate anemia, abnormal enlargement of the spleen, the skin turning to a bronze color,
“and hyperplasia of the bone marrow,” (Purnell & Paulanka, 2005) whereas B chain production
in Beta-Thalassemia major, or Cooley’s anemia, is seriously reduced, causing severe anemia and
death in early childhood by heart failure if not treated. Although there is no cure, relieving the
pain is possible by frequently transfusing packed red blood cells (Purnell & Paulanka, 2005). Just
as G6PD deficiency, Beta-Thalassemia has a serious effect on drug metabolism and
administering above-mentioned medications is strongly advised against (Purnell & Paulanka,
2005). Further prominent hereditary illnesses include high blood pressure.
Some of the prevalent diseases and illnesses of Italian-Americans have risk factors that
can be decreased through lifestyle changes. Cardiovascular disease related to a sedentary
lifestyle can be prevented through regular exercise. According to Potter and Perry (2005) the
positive effects of exercise are “increased cardiac output, improved myocardial contraction,
thereby strengthening cardiac muscle, decreased resting heart rate and improved venous return.”
The risk factors of excessive alcohol consumption and smoking leading to cardiovascular and
pulmonary disease should be eliminated. Changing the diet can reduce the risk of developing
cardiovascular disease. Decreasing the amount of kilocalories, sodium, fat, soft-textured foods,
and cholesterol according to the American Heart Association guidelines will help prevent
coronary artery disease. The intake of magnesium, folic acid, and vitamin B6 seem to help with
preventing the primary development of cardiovascular disease (Potter & Perry, 2005).
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Moreover, exercise is also very important to reduce high systolic and diastolic blood
pressure. Potter and Perry (2005) note that “low- to moderate-intensity aerobic exercise (brisk
walking, bicycling) appears to be the most effective in lowering blood pressure.” Dietary
changes to help reduce the risk for hypertension consist of reducing the amount of kilocalories to
promote weight loss and lowering the amount of sodium and fat consumption (Potter & Perry,
2005) Furthermore, stress management, e.g. stress reducing techniques, quitting cigarette
smoking and discontinuing heavy alcohol consumption help lower blood pressure.
Diabetes is another disease that can be controlled with exercise, in addition to diet,
glucose monitoring and medications. According to Potter and Perry (2005), “individuals with
type 1 diabetes are encouraged to exercise because it leads to improved cardiovascular fitness
and psychological well-being.” People with type 1 diabetes should make sure to check their
blood glucose level before and after a low- to moderate-level workout. Furthermore, they should
not inject insulin into the muscle that is being exercised, make sure to bring a source of
carbohydrates and wear a medical alert bracelet. Similarly, persons with type 2 diabetes should
include a warm up and cool down period in their low-level workout and exercise 3 days a week
for 20-45 minutes (Potter & Perry, 2005).
Whereas type 1 diabetes has to be controlled by insulin and dietary restrictions, type 2
diabetes may be controlled at first exclusively by exercise and dietary changes. Later on oral
medications may need to be added and if exercise and diet changes are not effective, insulin
injections are required (Potter & Perry, 2005). Dietary changes, as noted by Potter and Perry
(2005), include: “Fats are moderately controlled (30% or less), and complex carbohydrates make
up the majority (50% to 60%) of the diet, rather than simple carbohydrates. Protein comprises
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10% to 20% of daily intake. Foods that contain soluble fiber are recommended, with a daily
intake of 40 g of fiber.”
For the purposes of this paper, I conducted an interview with my friend E. R., a
third-generation Italian-American, who is currently living in Miami Beach, Florida, but lived for
many years in the New York City area. Contrary to Purnell and Paulanka (2005), who state that
“many second-generation Italian-Americans do not speak Italian well or at all,” E. R. and his
parents speak Italian fluently. My interviewee also stated that he is usually on time for
appointments and for social engagements, confirming Purnell and Paulanka’s (2005) statement
about punctuality of second and third-generation Italians. Furthermore, Purnell and Paulanka
(2005) claim that in most Italian-American families the man is the head of the household and no
major purchase or decision is made without his consent, whereas in E. R.’s family the entire
family makes those decisions together. E. R. is gay and his family is accepting his sexual
orientation, which is in agreement with what Purnell and Paulanka (2005) write about
Italian-Americans. Regarding questions about biocultural ecology, E. R. provided answers
indicating no allergic reactions or problems associated with over-the-counter medications and no
major illnesses and/or genetic diseases in his family. Only when taking prescription medications,
E. R. is experiencing heartburn. My interviewee does not engage in any high-risk health
behaviors, e.g. smoking and recreational drug use, and uses condoms during sex and does not
have sex with drug users. Confirming Purnell and Paulanka’s claim that Italians drink wine with
every meal, E. R. stated that he drinks one glass of red wine with dinner on average per day.
Since E. R. is not satisfied with his weight, and he consumes a lot of carbohydrates, like bread
and pasta, every day, he tries to balance his diet with fish, fruit and vegetables. To maintain his
health E. R. is eating fruits and steamed vegetables and avoids foods like sugar and animal fat.
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He only eats twice a day, but snacks in between meals on pastries, something that gives him
heartburn. No other food allergies were mentioned.
Although E. R. does not practice a form of organized religion, he considers himself
deeply religious and spiritual, prays two times a day and considers faith as a source of strength
and to give meaning to his life. In correlation with Purnell and Paulanka’s (2005) views on how
Italians deal with health-care issues, E. R. is very responsible in his health-care practices. He
walks every day and gets regular check-ups by a doctor. Acupuncture is another health-care
practice E. R. uses. His family has access to primary care and practices health promotion
“through personal hygiene, good nutrition, clean living environments, regular exercise, rest, and
the adoption of positive health attitudes” (Potter & Perry, 2005). Furthermore, E. R.’s family has
access to and utilizes secondary and tertiary care, i.e. acute care, like emergency treatment or
critical care, and special care, as evidenced by the death of E. R.’s brother from long-term
cancer. My interviewee’s family places a great deal of importance on Western medicine,
regularly visiting health care professionals for screenings and only uses herbal teas for the
common cold as alternative and complimentary medicine.
When studying the family tree, I can identify certain trends regarding illnesses and
diseases in E. R.’s family. His family does not suffer from any of the hereditary illnesses and
diseases, i.e. Familial Mediterranean Fever, Mediterranean type G6PD deficiency, and/or
Beta-Thalassemia, with the exception of hypertension. High blood pressure is common in both
sides of his family. Furthermore, the death of E. R.’s brother from long-term cancer does not fit
any trend in his family, since there is no previous history of cancer in the family and no other
family member has cancer as of the time of this interview. However, there is a history of diabetes
on his mother’s side and his sister is also suffering from diabetes.
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Culture has an enormous impact on health and illness. When considering the example of
Italian-Americans, their health and illness are influenced by a number of factors. Because Italy is
located on the Mediterranean Sea, Italian-Americans can suffer from genetically passed on
diseases and illnesses, like Familial Mediterranean Fever, Mediterranean type G6PD deficiency,
and Beta-Thalassemia, diseases only affecting people from countries around the Mediterranean
Sea. Although Italians consume a lot of healthy foods, like fresh olive oil, spices and vegetables,
they also eat many empty calories in carbohydrates, like pasta and bread, and in fatty foods, like
cream sauces and cheese, leading to weight problems, cardiovascular disease, hypertension and
diabetes. Many Italian-American immigrants still smoke, adding to their health problems
pulmonary disease and lung cancer. Smoking is also considered a risk factor for cardiovascular
disease and diabetes. Although a glass of red wine a day can have positive effects on health,
drinking alcohol excessively can lead to alcoholism which is considered a risk factor among men
with hypertension for coronary artery disease.
Moreover, Italian-Americans’ health-care practices can have a huge impact on their
health. Since Italians believe in fatalism, they accept that a disease is a punishment from god and
let it run its course until it is possibly too late to cure the ill. The fact that Italians are mistrusting
of health care workers that are not Italian or do not make an effort to understand their culture,
can lead to ignoring their instructions regarding taking medications or discontinuing practices
that are harmful to their health.
However, most Italian-Americans are very religious and spiritual and they pray for
themselves when they are sick and for others who are ill. This positive attitude can lead to
improvement in times of illness. Furthermore, Italians like to use religious amulets to protect
them from negative influences, which can give them a great deal of comfort.
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Family Tree
P. R.
Male
86
Married
Deceased
Hypertension
G. F.
Female
84
Married
Deceased
Hypertension
P. R.
Male
66
Married
Alive
Hypertension
E. R.
Male
45
Divorced
Alive
Hypertension
E. R.
Female
44
Single
Alive
Diabetes
A. P.
Male
84
Married
Alive
Hypertension
T. A.
Female
83
Married
Deceased
Diabetes
E. R.
Male
40
Married
Deceased
Cancer
E. R.
Male
30
Married
Alive
Hyperte
I. P.
Female
63
Married
Alive
Hypertension
Diabetes
E. R.
Male
43
Single
Alive
Heartburn
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