Martha A. From
Key terms to become familiar with in this chapter are:
Overview, Inhabited Localities, and Topography
Over 9.4 million people in the United States (Information Please: Almanac, 1995) and 273,000 people in Canada (Statistics Canada: Ethnic Origin, 1993) identify their ancestry as Polish. Poland, whose capital city is Warsaw, is located in north central Europe. Poland, with almost 121,000 square miles, is approximately the size of New Mexico, has a population of 38.6 million, and a literacy rate of 98 percent (Information Please: Almanac, 1995). The countries surrounding Poland consist of Russia, the Ukraine, Bialorus, and Lithuania to the east; the Czech Slovak Republics to the south, and Germany to the west. Most of the country is a plain with no natural boundaries except the Carpathian Mountains in the south and the Oder and Neisse rivers in the west (Espenshade, 1992).
Between the years 1795 and 1919, Poland was divided among the countries of Prussia, Russia, and Austria and ceased to exist as a country (Davies, 1982). Through tenacity, determination, and the Catholic Church, the Poles maintained their language, culture, and heritage. Between 1920 and 1939, Poland again became a separate self-governing country following World War I.
After World War II, Poland was once again reconfigured. The discussion of what to do with Poland was undertaken by Stalin, Churchill, and Roosevelt at the Malta and Potsdam Conferences. This discussion was known as the Polish Question. In the reconfiguration, Poland lost 10,000 square miles to the east and 50,000 square miles to the west; a move that was "considered the most disruptive in postwar Europe" (Szulc, 1988, p. 85).
Polish immigrants and their descendants who have been in America for generations maintain their ethnic heritage by promoting and attending Polish parades, dancing the polka, eating ethnic foods, and actively maintaining the Polish language. For newer immigrant Poles, it means learning English while maintaining Polish language skills and keeping Polish customs and rituals (Schneider, 1992). Newer immigrants wanting to stay in America quickly learn American speech patterns and customs.
Heritage and Residence
The first substantive Polish settlement in America, Panna Maria, Texas, was led by Father Leopold Moczygemba in 1864. Even though most Poles preferred living in agrarian communities, they gravitated to cities where work for laborers was plentiful. Between the years of 1820 and 1940, over 400,000 Polish immigrants came to America. Between 1940 and 1960, 17,500 arrived; between 1960 and 1970, 53,500 came; between 1970 and 1980, 37,000 came; between 1980 and 1990, over 97,000 came, and in 1993 alone, 27,800 immigrated to the United States; thus, the Polish immigration to America continues. Today, more than 9.4 million people of Polish descent live in America (Information Please: Almanac, 1995).
The predominant residence for Polish immigrants in America is north of Ohio and east of the Mississippi River. At the peak of Polish migration, Chicago was considered the most well -developed Polish community in America. The city of Chicago and its suburbs has more Polish immigrants and their extended families than any other city outside Poland (Lopata, 1994). Almost 2 million native and foreign-born Polish people live in New York State (Lopata, 1994). Currently, Polish communities with retirees and new immigrants are growing in Florida, Texas, and California.
Polonia was the name of Polish communities found in northeastern and midwestern cities. Members of these Polish communities helped keep Polish nationalism alive by speaking the Polish language, preserving Polish customs, and by attending the local Polish Catholic church run by Polish clergy and the Felician Order of Sisters. Because early Polish neighborhoods were so well organized with religious and voluntary organizations dedicated to the support of schools, organized trade, banks, and political activities, Poles as an immigrant group were slow to assimilate into multicultural America. Many of these Polish organizations are active today.
Despite their slow assimilation, Polish-Americans are not a homogeneous group. Much of the variation within this ethnic group is owing to age, generation, socioeconomic status, and length of time living in America. Monuments, statues, and historical sites dedicated to Polish-Americans and Polish Nationals can be found in towns and cities settled by Polish immigrants (Galazka & Juszczak , 1992).
"Over 30,000 Polish Americans were killed in World War II defending America. Yet, when they returned home, many were passed over for jobs because their last names were unpronounceable" (Bukowczyk, 1987, p. 106). As a result, name changes became common for upwardly mobile Polish-Americans who hoped to decrease discrimination and attain higher-level jobs. A difficult experience for many Polish-Americans is discrimination and ridicule through ethnic Polish jokes, which are similar in scope to those about Irish- and Italian-Americans. However, the Solidarity movement in the 1970s and 1980s and the election of a Polish Pope have decreased the incidence of Polish jokes.
Reasons for Migration and Associated Economic Factors
Polish immigration to the United States occurred in three major waves. The first wave of immigrants, arriving in the mid-1800s through 1914, were considered a chlebam, or "bread," emigrants (Corrsin, 1983; Greene, 1980) because they came to America for economic and religious reasons. Of these immigrants, 35 percent were illiterate unskilled laborers in their own country (Lieberson, 1980). These immigrants took low-paying jobs and lived in crowded dwellings just to make a meager living.
The second wave of immigration occurred after World War II. During the war, Poland lost proportionally more people than any other country. Over 6 million of its 35 million people were killed (Brogan, 1990). "The devastation upon Poland wrought by the war staggers the human imagination" (Frydman, 1983, p. 617). Living conditions in Poland after World War II were very restrictive (Shin, 1992). Individuals in this second wave were primarily political prisoners, dissidents, and intellectuals from refugee camps all over Europe. Many in this group, who were educated and committed to assimilating into American culture, separated from Polonia and aligned themselves with other middle-class and professional groups in America. The upwardly mobile and middle-class aspirations of this group differed from the working-class orientation of the first- and second-generation descendants of the first wave (Aroian, 1992).
The current third wave of immigrants started arriving in 1980. These immigrants reflect the ideologies from the first two waves of immigrants; that is, they come for work and the full expression of ideas. Many in this wave come to America to work with no initial interest in permanently relocating; they enter on a visitor's visa and leave their families in Poland. These immigrants frequently live in low-income housing, share rooms with other immigrants, and work hard to send money to their families in Poland. They quickly take any job available, particularly as laborers, domestics, and unskilled farm laborers. These newer immigrants tend to save money on food by eating nutritionally inadequate diets and not seeking health care until a problem becomes severe. Networking with other Poles is their primary source of job contacts. Because many of these new arrivals have been used by inscrutable Poles and others, many are terrified of strangers and bureaucrats who may have them deported if they are found working ("No Jokes, Less Solidarity," 1991).
The remaining Polish immigrants of the third wave have chosen America for political and economic reasons. This group typically consists of well-educated professionals and small-business owners. They bring their families because they have consciously decided to leave Poland forever. This group epitomizes the Polish characteristics of hard work and determination, and actively seeks to learn English and assimilate into their new country. Many in this group are under employed, recognizing that this may be a necessary first step in assimilation.
Many Polish-Americans from the second and third wave avoid Polonia communities because the ethnic Polonias of America are different from the Polish communities left behind. The concerns and issues of political representation and discrimination of third- and fourth-generation first-wave immigrants living in America do not seem relevant to second- and third-wave immigrant Poles. Many Polonia communities are located in changing neighborhoods where other minorities have moved. Upwardly mobile Polish-Americans are leaving cities for the suburbs (Lopata, 1994).
Educational Status and Occupations
Educational differences and assimilation into American culture vary widely among Polish immigrants. The range of socioeconomic levels and cultural philosophies often depends on when families emigrated from Poland. Until the 1950s and 1960s, many Polish families were slow to recognize the value of education for their children. Before World War II, most Polish children went to Polish Catholic schools where they learned Polish culture, language, and Catholicism. In some communities, sending children to public schools with their strong patriotism and Americanization was considered to be a sin (Olson, 1987). After World War II, parents felt an acute responsibility to have their children learn English. After this time, the Polish language was taught only in a few schools, and the Polish language was no longer freely spoken even at home.
For first- and second-generation first-wave immigrants, work was considered more important than education. Hard work and the need for material goods were things that Poles could understand (Olson, 1987). Illiterate first-wave Poles initially had difficulty with unionized labor; however, once they understood what was at stake, they became staunch union supporters. As a consequence, until the late 1950s many children followed in their fathers' footsteps by working in union jobs. They entered Chicago packing houses, steel mills in Indiana, assembly lines in Detroit, and coal mines in Pennsylvania (Lopata, 1994). Because young Poles continued to follow in their parents occupational footsteps more frequently than other immigrant children, upward mobility was slower for Poles than some other ethnic minorities (Lopata, 1994).
The second wave of Polish emigrants placed a high value on education and culture. Educated, cultured Poles were expected to read widely and speak several languages (Wedel, 1986). Cultured Poles have great pride and respect for Poland's most famous people such as Chopin, Marie Curie, Joseph Conrad, Copernicus, and Cardinal Karol Wojtyllo, better known as Pope John II (Davies, 1982). Poles are known for epic works in prose and poetry. Major themes in Polish literature are nationality, freedom, exile, and oppression (Gillon & Krzyzanowski, 1964).
In the 1950s, the Polish community in America had a renewed interest in scholarly and cultured endeavors. The Polish Institute of Arts and Sciences began publishing The Polish Review, a scholarly journal devoted to the works of Polish scholars, and the Kosciuszko Foundation encourages cultural exchanges between Poland and America and provides scholarships to Polish-American students. Once the Polish community recognized the value of education for their children, Poles became one of the highest represented ethnic groups in institutions of higher learning. "The proportion of young people who finished college was more than double that of older Polish-Americans, and the proportion of young people who attended college was at least triple" (Lopata, 1994, p. 149).
After World War II, many Polish Catholics were blue-collar workers who valued hard work as honorable. Many feared that education and mobility were a threat to their religious and community life (Abramson, 1973). For females, education was seen as even less necessary because a high value was placed on women staying at home and rearing the children. "It was the television that changed the character of ethnic communities forever" (Bukowczyk. 1987, p. 109), because television brought the outside world into the community and into the home. This generation of first-wave descendants went to college, valued obedience, self-control, and respected authority and determination (Bukowczyk, 1987).
The following are the current employment percentages (rounded) of the 3.5 million native and immigrant Poles in the workforce. For males: 29 percent, in managerial roles; 15 percent, in professional and specialty occupations; 32 percent, in technical sales; 16 percent, in administrative support occupations including clerical; and 11 percent, operators, fabricators, or laborers. The remaining males work in a variety of semiskilled and unskilled settings. For women: 13 percent, in managerial and professional specialty occupations; 33 percent, in technical, sales, and administrative support roles; 8 percent, in professional specialty groups; and the remaining females work in semiskilled and unskilled jobs (U. S. Census, 1990).
Dominant Language and Dialects
The dominant language of people living in Poland is Polish with some regional dialects and differences. Generally, most Polish-speaking people can communicate with each other. Recently, there has been a resurgence of interest in learning to speak the Polish language among Polish-Americans. Both adults and children are learning Polish in Polish churches, cultural centers, and colleges. Polish radio stations help keep an ongoing interest in the Polish language, music, and culture.
The Polish language was influenced by the countries surrounding Poland and by the Latin of eleventh and twelfth century kings. Depending on the regional and cultural background of the speaker, Polish may sound German, Russian, or French. The Polish language has a lyrical quality that is pleasant to the ear, even if one cannot understand the words. Poles are an animated group and facial expressions generally denote the tone of the conversation.
Cultural Communication Patterns
Poles as a group tend to share thoughts and ideas freely, particularly as a sense of hospitality. A guest in a Polish home is warmly welcomed and may be overwhelmed by the outpouring of generosity (Ronowicz, 1995). Americans talk of baseball while Poles speak of their personal life, their jobs, families, spouse, and misfortunes. "To a person like the Pole who has experienced great suffering, sharing personal trials is considered normal and natural" (Chrobot, 1976, p. 31).
For Poles, alcohol can serve an important function because it allows people to express their anxieties without being labeled weak or dependent. A person can use alcohol to disclaim responsibility for his or her behavior (McGoldrick, Pearce, & Giordano, 1982).
Mostwin (1979) states that to Poles, love is expressed through covert actions and love is displayed easily in the form of tenderness to children. However, loving phrases are not common among adult Polish-Americans. Poles praise each other's deeds and good work, but they may be reluctant to acknowledge how they feel about each other. This behavior may or may not have persevered through generations of assimilated Poles, and thus is difficult to describe to parents and extended family when teaching about the Polish culture.
Acknowledging the hostess is important when Poles visit each others homes. Flowers or candy are always in good taste. Normally, guests are not expected to assist the hostess in the kitchen or with cleanup after meals (Chrobot, 1976). Poles value thank you letters and greeting cards.
Poles use touch as a form of personal expression of caring. Touch is common among family members and friends, but Poles may be quite formal with strangers and health-care providers. Handshaking is considered polite. In fact, not shaking hands with everyone present may be considered rude. Most Poles feel comfortable with close personal space, but personal space and distancing increases from friends to strangers.
First-generation Poles and other people from eastern European countries commonly kiss "Polish style," that is, once on each cheek and then once again (Rempusheski, 1988). For Poles, kissing the hand is considered appropriate if the woman extends it. Two women may walk together arm in arm, or two men may greet each other with an embrace, hug, and a kiss on both cheeks (Rempusheski, 1988).
When interacting with others, Poles consider age, gender, and title. For example, when a group is walking through a door, an unspoken hierarchy requires the person of lower standing to hold the door for a woman or for those of a higher title. To many Americans, this behavior may seem excessive, but for Poles, it shows respect and courtesy. Polish-Americans also use direct eye contact when interacting with others. Many Americans may feel uncomfortable with this sustained eye contact and may feel it is quite close to staring, but to Poles it is considered ordinary (Chrobot, 1976).
Most Poles enjoy a robust conversation and have a keen sense of humor. Polish humor sometimes has an openness and bawdiness that may be unnerving to those unaccustomed to it. Cultural nuances may make it difficult to understand the underlying meaning of some transactions. Because Poles in Poland have been censored for centuries, Poles have raised satire and political savvy to an art form.
Polish-Americans are both past and future oriented. The past is very much a part of Polish culture with the memory of World War II haunting most Poles in some way. A strong work ethic encourages Poles to plan for the future. Polish parents very much want their children to have a better life than the one they have experienced.
Punctuality is important to Polish-Americans. To be late is a sign of bad manners. Depending on the status of the person for whom they are waiting, Poles may be intolerant of lateness in others. Even in social situations, people are expected to arrive on time and stay late.
Format for Names
Many Polish-Americans consider the use of second-person familiarity rude. Often Poles speak in the third person. For example, they might ask, "would Sue like some coffee?" rather than "would you like some coffee?" Although the first expression might sound awkward, the latter expression may be considered impolite and too informal; especially if the person is older (Swick, 1991). A health-care provider is Pani Doktor, literally translated as "Lady Doctor" not plain Doctor (Chrobot, 1976). Many Polish names are difficult to pronounce. Even though a name may be mispronounced, a high value is placed on the attempt to pronounce it correctly.
Family Roles and Organization
Head of Household and Gender Roles
In most families, the father is perceived as the head of the household. Depending on the degree of assimilation, the father may rule with absolute authority in first-, second-, and even third-generation Polish-American families. Depending on circumstances, only the church may have greater authority than the father (Olson, 1987). For example, if a child wants to leave home to go away to college, the priest may help in convincing the family that it is an appropriate thing to do. However, among some third- and fourth-generation Polish-Americans, more egalitarian gender roles are becoming the norm.
Prescriptive, Restrictive, and Taboo Behaviors for Children and Adolescents
The most valued behavior among Polish-American children is obedience (McGoldrick, Pearce, & Giordano, 1982). Taboo child behaviors include anything that undermines parental authority. Parents are quite demonstrative with young children, but they may not show much affection toward them once they are older than toddler age. This is the parents' way of teaching children to be strong and resilient. Many parents praise children for self-control and completing chores. Little sympathy is wasted on failure, but doing well is openly praised (McGoldrick, Pearce, & Giordano, 1982). Children are disciplined to not feel helpless, fragile, or dependent.
Boyd et al. (1994) conducted a study of the internalization of personality characteristics and "not-just" behaviors between Polish and Polish-American mother-daughter dyads. The Polish mother-daughter dyads had a greater degree of congruence when compared with Polish-American mother-daughter dyads. These results suggest that cultural and ethnic differences exist. In America, the emphasis on individualism and living independently of one's parents may contribute to these differences.
Family Roles and Priorities
Traditional family values and loyalty are strong in most Polish households. Children are very valued in the Polish-American family. For many, marriage is an institution of respect and economic solidarity, and does not necessarily include romance. In the past, husbands owed their wives loyalty, fidelity, and financial support; wives owed their husbands fidelity and obedience. Children owed their parents emotional and financial support before and after marriage (Olson, 1987). An important family priority for many is to maintain the honor of the family to the larger society, have a good job, and be a good Catholic.
The elderly are highly respected in most Polish families. They attend church regularly and carry on Polish traditions. The Polish ethic of contributing to the family and enhancing family status extends to the aged as well. The elderly play an active role in helping grandchildren learn Polish customs and in helping adult children in their daily routine with families. For some families, one of the worst disgraces as seen through the eyes of the Polish community is to put an aged family member in a nursing home. Third- and fourth-generation Polish-Americans may consider an extended-care facility because of work schedules and demands of care, but first-generation immigrants rarely see this as an option.
Cohler and Lieberman's (1979) study of 386 first- and second-generation 40- to 80-year-old men and women of Polish, Irish, and Italian background living in Chicago reported differences in personality as one ages. Their study suggests that older Polish men become more introverted and less interested in learning new skills, whereas Polish women from middle to old age show an interest in learning new skills and assertiveness. Kahana, Kahana, Sterin, Fedirko, & Taylor (1993) studied the acceptance of a nursing homes by eastern European elderly Jews and Poles living in the greater Detroit area. According to their study, Polish-Americans have the most difficulty assimilating into institutional life. The Polish-Americans in this sample had lived their lives in Polonia, were uneducated, and their main wish was to leave the institution. They felt abandoned by their children, and they were not able to find confidants in their setting. Even though these Poles were institutionalized in predominantly Catholic nursing homes, the setting did not emphasize Polish culture or backgrounds. If Polish people are to assimilate into a nursing home, the Polish language and rituals may be crucial; thus, the health-care provider should assist clients in organizing these types of events for their family member or should help them select nursing homes that have these offerings.
Extended family, consisting of aunts, uncles, and godparents, are very important to Poles. Longtime friends become aunt or uncle to Polish children. Numerous family rituals around holidays and such family gatherings as births, marriages, and name dates (calendar date of the patron saint for whom one is named) quickly become times to socialize and cement relationships.
The goals of the family are to work, make economic contributions, and strive toward enhancing the "status position of the family in the community" (Knab, 1986, p. 31). The family unit bands together to help deter behaviors that might cause them shame or lower prestige in the eyes of the community. As Poles assimilate into the American culture, the American value of success may prevail. Most Poles expect their children to have an education, a well-paying job, and provide for them in their old age.
Alternative lifestyles are seen as part of assimilation into the blended American culture. Same-sex couples are frowned upon and may even be ostracized, depending on the level of assimilation. Older second- and third-generation Poles have one of the lowest divorce rates of white ethnic groups (Lopata, 1994), but patterns are changing with succeeding generations as they assimilate into the American lifestyle. This is not to say that marital problems do not exist, but rather that the Polish value for family solidarity is strong, and divorce is truly seen as a last resort. When divorce does result, single heads of households are accepted in the Polish-American community.
Culture in the Workplace
Most Polish-Americans are more segregated then other ethnic groups even in second-generation groups. In the past, many Poles never rose above the level of foreman (Wilensky & Ladinsky, 1967). Polish-American immigrants of the 1800s maintained group solidarity and could always be counted on to help their families (Greeley & Rossi, 1968). Because men were semiliterate with low-level skills, they gravitated to cities like Chicago where they could work long hours as laborers and earn overtime pay. "They worked in steel mills, stockyards, mines, tanneries, and other heavy industries" (Greeley & Rossi, 1968, p. 135). Because Poles were active in trade unions and maintained a sense of loyalty to the group, they were stronger union supporters than many other American-born workers of the 1930s and 1940s (Lieberson, 1980).
Polish-Americans have an extensive social network, and their strong work ethic enables them to gain employment and assimilate into the workforce easily. It is still possible to spend one's entire life inside the boundaries of Polonia. While this may have helped immigrants in the past, it now acts as a deterrent to assimilation. Many newer immigrants move beyond the Polonia neighborhoods, and some even avoid them to obtain employment that will help them obtain future work goals.
Even though nursing in Poland is considered a profession, newer immigrants may be unprepared for the level of sophistication and autonomy of American nurses (Lenartowicz, 1992). However, with additional education, they quickly adapt to the American health-care environment.
Issues Related to Autonomy
Some second- and third-wave Poles entering America are under employed and may have difficulty working with authority figures that are not as well educated as they are. Poles quietly comment that they are not respected for their educational background and that the endurance of decreased status is necessary to stay in America (Bukowczyk, 1987; Lopata, 1994). Poles are usually quick learners and work hard to do a job well. The Polish characteristic of praising people for their work makes Poles strong managers, but some lack sensitivity in their quest to complete tasks and please their own authority figure.
Because Poles learn deference to authority at home, in the church, and in parochial schools, some may be less well suited for the rigors of a highly individualistic competitive market (Bukowczyk, 1987). Poles are conscientious employees and adhere to the rules of authority figures (Miller, Slomczynski, & Kohn, 1985). The strong Polish work ethic exhibited as volunteering for overtime, being punctual, and rarely taking sick days is valued by employers.
Native-born Polish-Americans do not have difficulty with the English language. Foreign-born frequently have some difficulty understanding the subtle nuances of humor. Less educated Poles tend to seek jobs as domestics or choose to perform manual labor because they do not have to rely as heavily on their language and communication skills in these occupations.
Skin Color and Biologic Variations
Most Poles are medium height with a medium-to-large bone structure. As a result of foreign invasions over the centuries, Polish people may be dark and Mongol looking or fair and delicate with blue eyes and blond hair. Those with fair complexions are predisposed to skin cancer and illnesses related to exposure to environmental elements. Health-care providers must be aware of these conditions when assessing Polish clients and providing health teaching.
Diseases and Health Conditions
Risk factors for newer Polish immigrants are connected with their employment in industries and the climate of Poland, which is similar to that of the northeastern region of the United States, with short summers and long harsh winters. This similarity encouraged Poles to settle in these areas of the United States. Additionally, employment opportunities in these regions are similar to employment opportunities in Poland where mining, agriculture, and heavy industry are the main occupations (Shin, 1992), which have increased risk for adverse health.
Common health problems are obesity, smoking, and low leisure-time physical activity, all of which contributed to an increased incidence of heart disease (Zahorska-Markiewicz, 1991). In Poland, many of the steel plants constructed after World War II were built without filtering systems and were located near major cities thereby contributing to excessive pollution. As a result, Poland has an increased incidence of respiratory disease and cancer. Miners and workers in heavy industry are at risk for the development of pulmonary diseases. More recently, the Chernobyl incident in Russia has created a new concern, that of radiation filtration into the land and water systems of Eastern Poland. Time will tell the impact of this disaster on the incidence of cancer in Poland. Health-care providers should carefully screen Polish individuals for cardiac diseases, alcoholism, respiratory conditions, thyroid disorders, and cancer, particularly leukemia. Culturally congruent health teaching strategies associated with these risk factors must be implemented when working with this population.
Endemic diseases of native Poland are similar to endemic diseases found in the United States. The common health problems of newer immigrants are heart disease, respiratory diseases, smoking, and obesity, particularly in women. During the 1970s (Report from Poland, 1983), the major Polish health problems were tuberculosis, infant mortality, psychoneurosis, cardiovascular disease, musculoskeletal disorders, and alcoholism. These diseases spread from poor sanitary conditions, outdated hospitals, lack of money for preventive services, lack of access to medicines and drugs, and limited number of health-care providers including physicians, psychiatrists, physical therapists, nurses, and social workers. Risk factors are associated with their high-fat diet, limited exercise, smoking, and alcohol abuse. Poles have an increased susceptibility to cardiovascular and respiratory diseases, diabetes, and obesity related to these factors.
In a longitudinal study between the United States and Poland over a 10-year period, Rywik et al. (1989) compared cardiovascular diseases in male and female native Poles and Polish-Americans living in rural and urban settings. The study reports that native Poles have a greater concern with cardiovascular disease than Polish-Americans. A report by the World Health Organization showed that of the 27 countries studied between 1968 and 1977, Poland had one of the highest increases in mortality from ischemic heart disease and cardiovascular accidents, while the United States had one of the lowest rates (Uemura & Pisa, 1985).
Variations in Drug Metabolism
Documentation on the pharmacodynamics of drug metabolism in Polish individuals is limited. The medical literature does not report any pharmacological studies specific to people of Polish descent.
Polish-Americans have some significant health risk behaviors that are common to other ethnic groups in the United States. Alcohol abuse (Rywik, et al., 1989; Uemura & Pisa, 1985) with its subsequent physiological and sociological effects continues to be an ongoing concern among Polish-Americans. In Poland, there is a high rate of alcoholic psychosis, cirrhosis of the liver, and acute alcohol poisoning. Other related illnesses include cancer of the gastrointestinal tract, peptic ulcer, accidents, and suicide. Alcohol abuse is an important part of the history of Poland. For many people of the first wave, alcohol was a way of relieving boredom and the severe hardships of peasant life. For many second- and third-wave immigrants, alcohol was a way of mitigating the pain of World War II and reducing depression and the symptoms of posttraumatic stress syndrome. For many second- and third-generation Poles, alcohol may still influence family patterns of behavior.
Because Poles place a high value on hospitality in both Poland and America, drinking among Poles is an accepted part of the culture. Part of being a good hostess is to have enough alcohol for every guest. For newer immigrants and older Polish-Americans, vodka or other spirits is the alcohol of choice. Upper socioeconomic groups drink wine, and beer is consumed by all socioeconomic levels.
In a study on drinking patterns of American and Polish college students, Polish students drank more than their American counterparts (Eng, Slawinska, & Hanson, 1991). Wine was the preferred drink of Polish students and beer the preferred drink of American students.
Osterberg (1986) compared rates of alcohol consumption from a cross-national perspective. Poland had a much lower per capita consumption of alcohol than Switzerland, California, Ontario, and the Netherlands. Cultural differences related to alcohol consumption imply that Californians are concerned about drunk driving while Poles are concerned about family disruption. Public drunkenness is less common in Poland than in California. Illicit drug use is not part of the culture of Poland, but with the changing society this behavior might change.
Polish-Americans have a higher rate of smoking than other Euro-Americans, but this trend may be decreasing with younger generations. Research suggests that Polish descendants start experimenting with cigarettes at the age of 14 or 15 (Wijatkowski, Forgays, Wrzesnewski, & Gorski, 1990).
Since alcohol use and cigarette smoking are prevalent among many Poles, it is essential for the health-care provider to assess individual clients for abuse and provide counseling and referral for those who express an interest.
In Poland, the urban intellectual group is very interested in preventive health behaviors and exercise, with hiking and mountain climbing being important physical activities. In the working class, there is a strong commitment to obeying laws, and seatbelt and traffic regulations are generally followed. Many Poles continue these healthy activities on arriving in America. The health-care provider needs to encourage these positive health-seeking behaviors among newer immigrants.
For newer immigrants, tooth decay may be a problem because of lack of dentists in Poland. Thyroid deficiency also may be present because Poland stopped using iodized salt through the 1980s. Thus, health-care providers need to carefully screen newer immigrants for thyroid and dental disorders.
Meaning of Food
Food is a very important symbol of sustenance and hospitality. Most Poles extend the sharing of food and drink to people entering their homes; guests are expected to eat. Three important considerations influence Poles regarding food. First, Poland is primarily a land-based country with short summers and very cold winters. Thus, root vegetables and cabbage survive the best in this climate. Fish is limited, and game meat and pork are meat staples, depending on economics and availability. Second, the cold weather encourages consumption of stews, soups, and foods that have high satiety. Third, the strong Catholic influence is evidenced in many festivals and rituals; each requiring a special fast or feast (Jones, 1990). Many Poles continue these dietary practices after immigrating to the United States. Health-care providers need to assess Polish clients dietary habits and provide nutritional information that is congruent with personal dietary choices.
Common Foods and Food Rituals
Polish foods and cooking are similar to German, Russian, and Jewish practices. Staples of the diet are millet, barley, potatoes, onions, radishes, turnips, beets, beans, cabbage, cucumbers, tomatoes, apples, and wild mushrooms. Common meats are chicken, beef, and pork, including pigs knuckles and organ meats such as liver, tripe, and tongue. Kapusta (sauerkraut), golabki (stuffed cabbage), babka (coffee cake), pierogi (dumplings), and chrusciki (bowtie pastries) are common ethnic foods. Hot soups and stews are favored during bitter cold winters, and cold soups are preferred during the summer.
The meal plan for many first-wave and rural Polish (Kolasa, 1978) consists of a hearty breakfast of coffee, bread, cheese, sausage, and eggs. A mid-morning snack consists of a sandwich and tea or coffee. The main meal in mid-afternoon includes soup, meat, potatoes, a hot vegetable, and dessert. In the evening, cold cuts, eggs, sour cream, bread, and grains are common. This diet is modified depending on economics and availability. Dill and paprika are the most commonly used herbs. Food is rarely eaten raw and may be pickled, which increases the sodium content.
Dietary Practices for Health Promotion
The Polish-American diet is frequently high in saturated fat from frying food in butter or bacon fat. The basic diet includes sour cream, butter, and fatty processed meats such as kielbasa and Polish ham. Clients with increased cholesterol levels, cardiovascular disease, and diabetes will require dietary counseling.
Nutritional Deficiencies and Food Limitations
There are no major enzyme deficiencies among Polish-Americans. Native food practices may not change much when arriving in the United States where there is a general availability of their major food groups and most ingredients are easily accessible. Often the Polish diet is deficient in fruits and vegetables. Meats and vegetables are cooked for a very long time resulting in the destruction of B vitamins and other vitamin deficiencies. Because newer immigrants may live in crowded conditions and may try to save money from food purchases, they may benefit from additional education that addresses how to purchase less expensive foods and still maintain a healthy diet.
Table 1: Polish Foods
Served plain or with sour cream
Stew with game, sausage, sauerkraut
Fried egg dough
Cooked cabbage stuffed with chopped meat and rice in tomato sauce
Sour cream cucumbers
Dumplings filled with potatoes, cheese, or sauerkraut
Pregnancy and Childbearing Practices
Fertility Practices and Views toward Pregnancy
Because family is very important, most Poles want children. In an agrarian society, and for early immigrants, children were considered important because they brought status to the family and were an economic necessity. However, in difficult economic times and during the years of poverty and the war, abortion and child spacing were considered a necessity. In Poland, the church strongly opposes abortion, which is the prevailing attitude of many second- and third-wave Polish in America. In Poland, fully paid maternity leave is for 90 days, and longer with paritial payment, but many women do not take the entire leave because of trying economic circumstances. Fertility practices are balanced between the needs of the family and the laws of the church.
Prescriptive, Restrictive, and Taboo Practices in the Childbearing Family
Pregnant Polish-American women are expected to seek preventive health care, eat well, and get adequate rest to ensure a healthy pregnancy and baby. For those immigrants who remember the war and famine when infant mortality rates were high, attention is paid to prenatal care. The emphasis on food and "eating for two" is a common philosophy. The health-care provider must pay special attention to ensure that the pregnant Polish-American woman does not gain excess weight during pregnancy.
Because the process of childbirth was poorly understood by the early peasant society, there continues to be magicoreligious and taboo beliefs surrounding childbirth depending on the age of the Polish-American. Many consider it bad luck to have a "baby shower" and even now in America, many Polish grandmothers may be reluctant to give gifts until after the baby is born. Birthing is typically done in the hospital. Midwives may be used if there is a community feeling that they are "just as good as the doctor."
Pregnant women usually follow the physician's orders carefully. In America, Polish women seek out a prenatal clinic when they cannot afford private fees. The birthing process is considered the domain of women. Newer Poles immigrating to America may not feel comfortable with men in the birthing area or with family-centered care.
Women are expected to rest for the first few weeks after delivery. To many immigrants and women who are descendants from second- and third-wave Polish-Americans, breast-feeding is important. Health-care providers may need to provide active counseling and education about breast-feeding to Polish-American women. They may also need to teach the proper techniques to the women who choose to breast-feed and to help them to balance rest with exercise after delivery.
Death Rituals and Expectations
Most Poles have a stoic acceptance of death as part of the life process, and a strong sense of loyalty and respect for their loved ones. Family and friends stay with the dying person so that the dying do not feel abandoned. The Polish ethic of showing care by doing means bringing food to share, caring for children, and assisting with household chores for close family members. Most Polish women are quick to help with the physical needs of the dying. Hospice care at home is acceptable to most Poles. The health-care provider may encounter difficulty in convincing the family that the dying member may choose not to eat as a result of the illness rather than because of stubbornness or a slur against the caretaker's cooking. Polish women may tend to hover, so the health-care provider also needs to help the family understand that it is important for the dying person to conserve energy.
Responses to Death and Grief
In early Poland, because of the absence of embalming practices, individuals were buried within 24 hours of their deaths. Poles of the early twentieth century continued this practice by burying the deceased from the home and having home burial ceremonies, which included a wake or vigil in which family members prayed and repeated the rosary over the dying. Late twentieth century Polish-American family members follow a funeral custom of having a wake for 1 to 3 days followed by a Mass and religious burial. Most Poles honor their dead by attending Mass and making special offerings to the church on All Souls Day, November 1. Families may continue tending the gravesite for years by pulling weeds, planting flowers, and leaving wreaths for their loved ones.
Religious Practices and Use of Prayer
The Catholic Church, with its required attendance on Sundays and holy days, is an integral part in the lives of most Polish. There are holidays for every month of the year plus the rituals of baptism, confirmation, marriage, last rites, and burial.
Christmas and Easter are the two biggest feasts requiring special foods and rituals. On Christmas Eve, depending on the affluence of the family, there are up to 13 meatless dishes served with the oplatek (wafer) that everyone at the table shares. On Christmas Day, the main meal consists of goose or turkey. The Easter holiday may begin with women bringing food to the church Easter Saturday to be blessed by the priest. On Easter Sunday, lamb or kielbasa and boiled eggs are served, and as a table ornament, a lamb made of salt or butter is displayed. Like many Americans of various ethnic backgrounds, Polish-Americans have had a renewed interest in their ethnic roots. For example, since the 1970s, the attendance of Polish-Americans at Catholic churches in Polish neighborhoods has been on the rise.
Poles are very much concerned that churches continue to act as a vehicle of Polish culture. A group of Polish Catholics created the Polish National Church in 1895 (Buczek, 1976) because they believed that the American Catholic Church was not meeting the needs of Polish Catholic Americans. This church is still in existence today in some areas of Polonia.
Between 1800 and 1918, speaking the Polish language was forbidden in Poland. After World War II, schools were required to teach Russian. As a result, Polish-American immigrants were concerned that their language be preserved; thus, the Polish Catholic Church became a center of Polish language and culture. At one point, Poles considered it a mortal sin to send their children to public schools, and even some third- and fourth-generation individuals have continued to send their children to Catholic schools (Greeley & Rossi, 1968). In fact, Poles imported their own priests and nuns, the Felician Sisters, to teach in American Polish Catholic schools.
Birthdays and name days are important events for Poles. One very popular song is Sto Lat, which means that the celebrant should live 100 years (Ziemba, 1972).
Religious ceremonies are a very important part of maintaining Polish culture. The Polish wedding is legendary as a time when family and friends get together and two families unite. One folk practice is to bring bread and salt as a symbol "that there always be plenty of food in the home" (Ziemba, 1972, p. 16). There is always plenty of food and drink for the guests and music for singing and dancing. Virtually everywhere in eastern Europe "the peasant weddings (wesele or wedding sequence) lasted 2 to 7 days and were replete with some of the oldest rituals, songs, dances, and instrumental music among rural populations" (Noll, 1989, p. 3). The Polish peasant wedding has been described as "something on the scale of grand opera, each person had a part" (Bystron, 1960, p. 80). In America, Polish weddings may only last 1 day, but plenty of food and drink consisting of hors d'oeuvres, dinner, and a late evening cold-cut buffet are considered essential to the joyous occasion.
Primary spiritual sources are God and Jesus Christ, with first- and second-generation Polish immigrants praying to the Virgin Mary, saints, and angels to ward off evil and danger. Honor and special attention is paid to the Black Madonna or Our Lady of Czestachowa. (Swick, 1991). In Czestachowa , a town in central Poland, there is a picture of the Virgin Mary with a darkened face and two scratch marks on her face. Every year, may Poles join a pilgrimage on foot to see the Madonna. In the United States, there are several settings with the Black Madonna. At times of illness and family concerns, one might hear a Pole praying or saying Matka Boska, which literally means "mother of God, Poland's patroness to help in times of need (Bukowczyk, 1987).
Most of the older Polish believe in the special properties of prayer books, rosary beads, medals, and consecrated objects. Early immigrants and first-generation Polish-Americans commonly exhibit devotions to God such as crucifixes and pictures of the Virgin Mary, the Black Madonna, and the Polish Pope John II in their homes (Galazka & Juszczak, 1992).
Meaning of Life and Individual Sources of Strength
Most Polish-Americans have a strong work ethic and pride themselves on being fastidious and punctual. They are loyal to friends and family and have a strong sense of Catholic ideals (Kantowicz, 1992). "He [the Pole] is hardheaded, self disciplined, much concerned about honor, and modest to a fault with a reserve that can be mistaken for arrogance" (Ziemba, 1972). Most Poles enjoy music and dancing, including the jovial Polish polka, the waltz or polonaise, and the works of Chopin and other classical composers. Liturgical music may be important to older and more religious Poles.
After years of being under Communist censorship, newer immigrants value freedom, independence, being respected for their work, and having status in the community (Marody, 1988). Most Polish-Americans find meaning in family loyalty and show great generosity to friends and extended family. They want to be respected for their contribution to the world around them.
Spiritual Beliefs and Health-care Practices
Among the early peasants, religion had a folk tradition and formal Catholic element. Most peasants believed in mythological beings, water spirits, and house ghosts. Killing and useless slaughter of animals did not exist. All life had meaning, and if an experience could not be explained, superstition and religion filled in the gaps (Olson, 1987). This view of life is not commonly found in educated urban Poles, particularly young adults, but some immigrants from rural areas still hold to their early beliefs (Tobacyk & Tobacyk, 1992).
Health-seeking Beliefs and Behaviors
Most Poles put a high value on stoicism and doing what needs to be done. Many only go to health-care providers when symptoms interfere with function, and then they may consider their advice carefully before complying (Kolarska-Bobinska, 1989). Describing anxiety and expecting nurturance is not a characteristic of most Polish adults and children. Many Poles do not discuss their treatment options and concerns with physicians and just accept the plan as outlined. Many have a strong fear of becoming dependent. It is very important that they "carry their own weight" (McGoldrick, Pearce & Giordano, 1982, p. 403). This may also include paying medical bills. If Poles believe they cannot pay the medical bill, they may veto treatment unless the condition is life threatening. Older Poles and newer immigrants may have difficulty with the concept of Medicare and Medicaid. Anything that lowers their status in their community is generally not acceptable. The health-care provider must describe these financial programs carefully or the Pole may interpret them as charity and not follow through on prescriptions and advice.
Poles usually look for a physical basis of disease before considering a mental disorder. If mental health problems exist, home visits are preferred to clinic visits, and talk therapy without suitable psychosocial strategies is not maintained unless interventions are action oriented (McGoldrick, Pearce, & Giordano, 1982). In addition, Poles look to other family members and the community to assess the appropriateness of treatments. Polish-Americans often will seek self-help groups such as Alcoholics Anonymous before seeing a health-care provider. A family physician is preferred over a specialist (Fandetti & Gelfand, 1977). Assimilated Poles follow American patterns of entry into the health-care system and tend to seek specialists when necessary.
In Poland, health care is subsidized by the state so cost is not an issue. The problem is that access to health care is difficult, and many people in Poland who can afford to pay private and higher fees to see a private physician do not have access to one. Some third-wave Poles return to Poland to have medical or surgical procedures performed because it is more affordable in their homeland.
Responsibility for Health Care
Given the continuation of limited access to care in Poland and the strong work ethic of this cultural group, health promotion practices are often not valued by older Polish-Americans and newer immigrants. In fact, older Polish-Americans and newer immigrants commonly smoke and drink, get limited physical exercise outside of work, and have poor dental care (Lenartowicz, 1992). Partial and complete dentures are common in older Poles as one might expect in older Americans. A number of secondary teeth are often found missing in Polish-American immigrant children. This often surprises school nurses who may be unaware of the limited number of dentists in Poland.
Attention to health promotion practices among women may be complicated by the Polish-American female's sense of modesty and religious background. Breast self-exam and Pap tests are poorly understood by many older women, and practices vary depending on the woman's assimilation into American culture.
The Polish ethic of stoicism does not encourage the use of over-the-counter medications unless a symptom persists. Most Poles do not take time from work to see a health-care provider until self-help measures are no longer effective. Few Poles use vitamins unless suggested by a physician or a trusted family member; even then, their extrinsic value is considered over the cost.
When an older Pole is asked to undress for a physical examination, the health-care provider should pay special attention to any medals pinned to the patient's undergarments. Most of these medals have special religious significance to the wearer and should not be removed. Older Polish-Americans and newer immigrants may use certain remedies to cure an illness such as tea with honey and spirits to "sweat out" a cold. Herbs and rubbing compounds also may be used for problems associated with aches, pains, and inflammation from overworked joints and muscles. Depending on the level of assimilation, most Polish-Americans follow American practices of health care. Because of individual differences, every client must be assessed personally and asked specifically about use of home remedies and over-the-counter medications.
Cultural Responses to Health and Illness
Because of their strong sense of stoicism and fear of being dependent on others, many Polish-Americans use inadequate pain medication and choose distraction as a means of coping with pain. When asked, many Poles either deny or diminish their pain. Poles with chronic illnesses may have similar attitudes; thus persevering with pain is a common behavior among Poles. The health-care provider should use a visual analog scale to assess pain, assist clients with distraction techniques, and help Poles to accept pain medication as needed.
Even though Poles of the second- and third-wave talk of suffering and their experiences during World War II, few turn to psychiatrists or mental health providers for help; those who do seek help, do so as a last resort. "When the war ended, while the number of distraught, physically and mentally exhausted survivors were staggering, there were only 100 psychiatrists alive and 5000 psychiatric beds" (Frydman, 1983, p. 617). Most individuals choose their priest or a voluntary Polish agency over a health professional for psychiatric help (Knab, 1993).
Studies of first-time admissions to a psychiatric hospital in England (Hitch & Rack, 1980) and Australia (Krupinski, 1967) reported that eastern European refugees have a higher rate of admissions than those who are native-born, and female admissions greatly outnumber male admissions. The primary diagnoses are schizophrenia and paranoia. These studies imply that people are able to overcome the initial shock of moving to a foreign country, but they do not have adequate coping skills to get through the stressors of middle age. Some of the reasons given are that people stay in Polonia where basic services such as grocery shopping and banking are provided. Children become the go-betweens of their parents and the larger community. As children leave their parents to start their own families, the leave their parents behind. Thus, their lack of assimilation, even 25 years later, creates stressors leading to poor coping behaviors. Similar results were found in the Malzberg and Lee study (1956) of first admissions to hospitals for mental disease in New York between 1939 and 1941.
Aroian (1992) describes three types of social support needed by Polish immigrants. During the first 3 years, immigrants need help finding housing and jobs, and information about getting through the system, that is, learning English, buying groceries, and learning American customs. During the next 3 to 10 years, help is required to secure credit, obtain loans, and assimilate into American life. Finally, those immigrants in America for more than 10 years need support in honoring their Polish heritages through Polish networks and maintaining an American support system.
After immigrants are comfortable with resettlement, feelings of grief and loss begin to be acknowledged. "The psychological adaptation to migration and resettlement requires the dual task of mastering resettlement demands and grieving, and removing the losses left in the homeland" (Aroian, 1990, p.8).
Suicide rates in Poland and the United States are similar, 11.7 per 100,000 inhabitants (Kolankiewicz & Lewis, 1988). For Poland, this statistic shows improvement over previous rates, which were much higher. Currently, there is an increased incidence of white-collar worker suicides in Poland; in the past, the highest incidence of suicide was among laborers and blue-collar workers.
Handicapped members of Polish families are usually cared for at home. The Polish characteristics of loyalty to family and the historical lack of health-care facilities in Poland make this a family duty. This same belief necessitates caring for elderly family members at home rather than placing them in a nursing home or residential care facility.
Many Poles do not assume the sick role easily and underplay their symptoms to continue functioning. If a client has an acute episode of an illness, such as the flu, the community helps to informally decide when it is time for the person to return to work. As in many other cultures, women are expected to continue their roles as wife and homemaker. When a woman is sick, other women usually help the family; men do not usually assume these roles. This practice may be different for third- and fourth-generations as Poles assimilate into the American culture.
Barriers to Health Care
Being unable to speak and understand English is the greatest barrier to health care for newer Polish immigrants. In addition to overcoming the language barrier, Polish clients need health-care providers who understand Polish family values. Health-care providers also must consider that Poles often filter information through the extended family and neighborhood before accepting appropriate health-care action. Health-care providers may need to employ primary care or case management and help obtain a cultural broker from the Polish-American community to help decrease the number of barriers to health care for newer immigrants.
Poles who have learned English as a second language may have some difficulty with the nuances of health-care jargon and terminology in America. The health-care provider should ask clients to restate what has been said in a discussion. If an interpreter is needed, the Polish community can usually help provide someone through an informal network. Poles are polite to authority figures and would not want to offend a health-care worker by not being agreeable; thus, they may not ask for clarification on questionable issues. Additionally, many Poles are concerned more with how a disease affects daily functioning rather than its survival rates.
Blood Transfusion and Organ Donation
Given the ethic of being useful, independent, and a good Catholic, using extraordinary means to keep people alive is not commonly practiced. The individual or family determines what means are considered extraordinary. Third- and fourth-generation assimilated Polish-Americans may view this issue differently. There is no taboo about receiving an organ transplantation, but it is important for a family to know the extent to which a patient can function following surgery. Cost is an important consideration. Most Poles do not want to be a burden on their families' physical or financial resources. On the other hand, Poles consider it their duty to care for a sick member at home.
Traditional Versus Biomedical Practitioners
Assimilated Poles share many of the same values as other Americans, but it is the earlier immigrants who need to be especially respected within their cultural milieu. Immigrant patients often assess physicians by the warmth of their manner and the bitterness of their medicine (Kraut, 1990). Newer Polish-American immigrants may seek health advice from chiropractors and local pharmacists as well as neighbors and extended family. Generally, they seek biomedical advice when a symptom persists and interferes with function.
Status of Health-care Providers
Physicians are held in high regard in Polish communities. Poles typically follow medical orders carefully. Titkow's (1983) study of Polish views of physicians reveals that Poles may switch physicians if they believe they are not getting better or if a second opinion is needed. In Poland, Poles with more education are more willing than are Poles with less education to follow medical orders and continue with prescribed treatment. Less educated Poles tend to change physicians if the disease does not subside fast enough. Another study (Ostrowska, 1983) shows that the more medical knowledge Poles have, the less confidence they exhibit in their physician. Poles respect physicians, but they want to understand the purpose of the medical treatment.
In Rempusheski's (1988) study of elderly Poles, the caring nurse was described as the nurse who knew what the patient was feeling without being told by the patient, had a quiet gentle approach, was efficient with treatments, administered medication on time, looked neat and clean, and enjoyed the work of nursing.
Thomas Wyzinski came to America as a young boy in the 1930s and has lived in the same Polish neighborhood his entire life. He married his neighborhood girlfriend, Zosia, and has two children. He is proud of his ethnic heritage and the fact that his wife is a "healthy looking woman and a good Polish cook." He openly boasts about how proud he is of his wife and children, but he does not like the idea that his children moved to the suburbs 15 years ago. He states, "They act so stuck up sometimes."
Mr. Wyzinski has always prided himself on working hard and earning his seniority at the electronics factory. When Thomas was younger, he was a heavy drinker, and he smoked one pack of cigarettes daily for 30 years. He gave up smoking 10 years ago and drinking about 5 years ago. He stopped smoking because he felt "winded" and stopped drinking because "I just couldn't hold it like I used to. I guess I'm just getting old."
Mr. Wyzinski has been feeling sick for the past month. Finally, his wife told him he had to go to the doctor because he was drinking so much water and was going to the bathroom all of the time. Mr. Wyzinski was concerned that he could not hold his urine getting to the bathroom.
At the physicians office, his blood glucose level was 450 mg/%. Thomas was told he had to go to the hospital. Protesting loudly, he called his wife and went to the hospital.
A complete physical examination revealed that his legs were swollen and that he was having trouble breathing. Thomas was prescribed furosemide (Lasix) 20 mg daily and Novolin 70/30 insulin 25 units in the morning and 10 units in the evening. He was a model patient and discharged 3 days later.
The visiting nurse came every day for a week to teach Mr. Wyzinski diabetic care and assist him with giving himself insulin. Mr. Wyzinski was a quick learner, but he did not like the food restrictions and thought the cost of needles and insulin was too expensive. The nurse said she would call in 1 week to see how he was doing.
Mr. Wyzinski took sick days from his job for the first time in 10 years. He still felt tired but insisted on returning to work.
Mrs. Wyzinski is a full-time secretary. When the nurse called a week later, Mrs. Wyzinski told the nurse that when her husband picks her up from work she has noticed chocolate on his shirt. He denies having any desserts. She is also concerned that he may have started drinking again, and he reuses needles three times as he feels it's a waste of money to use them once and throw them out.
After 3 weeks, the swelling in his legs is still present, and Mr. Wyzinski tells his wife there is nothing to worry about. Mr. Wyzinski gets angry when his wife tells him he should call the nurse.
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